There is not, as of writing, any medication that has been shown in controlled trials to significantly hasten recovery from covid-19, the disease caused by the coronavirus that’s become a global pandemic. Last week, there were nonetheless some new developments on that front. One drug seems to show signs of promise. Another has seen red flags raised.
The one that’s raised hopes isn’t the one that President Trump has been hyping.
Again: It is not the case that we have new, incontrovertible proof of a drug’s efficacy. But news of a trial demonstrating some benefit for covid-19 patients from the anti-viral drug remdesivir helped push the stock market higher on Friday. A report from the National Institutes of Health further suggested the drug had halted the progression of covid-19 — at least in monkeys.
For the anti-malarial drug hydroxychloroquine, the news was less positive. There’s still no demonstrated evidence that improvements after taking the drug are causal. A number of controlled studies in fact failed to demonstrate evidence that hydroxychloroquine or a related drug, chloroquine, had an effect on the disease. A New York family blames the drug for causing their mother’s heart attack — an unproven claim but one in line with concerns about use of the drug. The CIA even warned its employees about using the drug due to the possibility of “sudden cardiac death.”
You’ve probably heard of hydroxychloroquine. Over the past month, Trump has mentioned it at least 45 times, according to public comments catalogued by Factba.se. His promotion of the medication has been folded into the partisan/cultural fight over the coronavirus pandemic, with his allies and his campaign actively trying to bolster the case for the drug, clearly because it’s something Trump has emphasized as important.
For Trump, the fight is low-risk. By touting the drug, the worst thing that happens is he has to rely on anecdotal data for evidence of his case. Should hydroxychloroquine suddenly prove to be a miracle cure — something former FDA administrator Scott Gottlieb has noted is unlikely, given its already broad use — Trump gets to tout his having been right. His gut, triumphing yet again over the experts. There are other downsides, of course, including limited availability of the drug for patients who require it for other treatments and including negative side effects. But it’s easy to see why Trump might feel he can escape much damage.
The thing that’s interesting is Trump could have bet on remdesivir. At the March 19 briefing by the White House coronavirus task force, Trump talked up a number of medications.
“Nothing will stand in our way as we pursue any avenue to find what best works against this horrible virus,” Trump said. He began by touting chloroquine and hydroxychloroquine.
“It’s shown very encouraging — very, very encouraging early results,” Trump said. “And we’re going to be able to make that drug available almost immediately. … I think that’s a tremendous — there’s tremendous promise, based on the results and other tests.”
“I think it’s going to be great,” he added a bit later.
Then, he continued on to other possible treatments.
“There are promising therapies produced by Gilead, and that’s remdesivir,” he said. “Remdesivir. And that’s a drug used for other purposes that’s been out and has had very good results for other purposes, but it seems to have a very good result, having to do with this virus.”
And that was that.
The precise genesis of Trump’s fixation with hydroxychloroquine in particular isn’t clear. By the time of that March 19 briefing, the drug had already been mentioned on Fox News and Fox Business repeatedly. Over the next few weeks, though, hydroxychloroquine in particular was mentioned repeatedly on the Fox channels, day after day. Host Laura Ingraham talked about it the most — and brought doctors to the White House to sell Trump on the medication.
In one tweet on March 21, Trump coupled the drug with another one called azithromycin, saying the combination “have a real chance to be one of the biggest game changers in the history of medicine.” But azithromycin never really caught on as a focus for Trump or for Fox News.
There was another way all this could have unfolded for Trump. Instead of banking on hydroxychloroquine, scooping up millions of doses of the medication for a sort of national uncontrolled experiment in its use, he could have reserved judgment, allowing trials to move forward while nonetheless making the medications available for use. He could have let the science lead and his own rhetoric follow. But that is not how Trump operates as president.
We’ve spent a month hearing about a drug that remains unproven. Trump’s touted the government’s efforts to make it available, all while couching his obvious hype in we’ll-see-what-happens language. Why? There’s no other obvious reason than the simple fact that Trump was hyping the medication. He wanted it to work mostly, it seems, because he said it might work.
If he’d chosen another path on March 19, who knows? Had he let the doctors conduct their research, he could have been an early advocate of whichever medication proves most useful. Instead, there will always be those lingering questions: Why promote that drug, and why so energetically?