I actually thought we were through with hydroxychloroquine.
That medication, which has legitimate uses for the treatment of malaria and certain autoimmune disorders like lupus, was dubiously touted by President Trump earlier this spring as a potential miracle treatment for COVID-19. At one point, he proclaimed that tens of millions of doses had been released to the nation’s doctors struggling with the pandemic illness that has now killed more than 90,000 Americans.
Unfortunately, at this time, there is no reliable evidence to support the use of hydroxychloroquine for treatment of the novel coronavirus. There is, however, ample evidence of the potential for very serious, potentially fatal side effects from the medication. It was because of these side effects that clinical trials using it to treat COVID-19 were halted in France and Brazil, and that an NIH-backed (not peer-reviewed) study of patients at the Veterans Administration concluded it was more strongly associated with killing than relieving ailing veterans. The Food and Drug Administration went so far as to issue a warning to the general public about use of the medication outside of hospital settings.
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For ailments where its benefits are well-established, these risks may be worth accepting. Without evidence of genuine benefit, touting it for widespread use is grossly irresponsible.
Which is to say, precisely the kind of thing that Trump is apt to do.
As physicians nationwide, myself included, rushed to discourage people from demanding hydroxychloroquine to prevent COVID-19—and news of halted trials began to mount—Trump had largely stopped talking about it. Fox News did the same thing.
Now Trump, at least, is back at it—and this time, he’s gone even further.
At a press briefing Monday, the president declared that he is taking the medication himself. Citing the kind of hearsay that informs most of his decisions, he said he’d asked the White House physician for it and was rewarded with a prescription.
I happened to be in my kitchen when this news started showing up in my Twitter feed. If heads could really explode from rage, my kitchen would be in need of an extremely thorough cleaning.
The decision to prescribe hydroxychloroquine, confirmed by a White House spokesperson, represents not just one more failure on the president’s part but one on the part of his physician as well. (An official letter attributed to the doctor is evasive, and Trump, of course, has only a glancing awareness of facts or truthfulness.)
Among the most important responsibilities of a medical provider is to provide only treatments or other interventions that are truly in a patient’s best interest, that have sufficient evidence in favor of ordering them. Many times I have had to explain to my own patients or their parents why a medication they want (an antibiotic for an illness that I suspect is viral, to cite a common example) is not appropriate for me to prescribe. Those conversations are not always easy, but having them anyway is an obligation I take very seriously.
If a doctor in the White House prescribed a medication to the president just because he asked for it, without sound evidence to support it and with risk of serious ill effects, that was a failure of his professional responsibilities.
When it comes to Trump himself, of course, expecting behavior that indicates a sense of obligation is absurd at this point. If there’s one thing his time in office has made clear, he is plainly incapable of meeting the most basic of presidential responsibilities. One may as well ask an emu to merengue.
But however plain his failings by any measure you could choose, he still has millions of people nationwide who take him seriously, and who listen to what he says. Which means that once again those followers could start seeking hydroxychloroquine treatments that may do them no good, could seriously harm them, and could deprive others who truly need them.
Compared to some of the other treatments Trump has publicly flirted with, including injecting household cleaners or somehow getting UV radiation into a person’s body, at least hydroxychloroquine is an actual medication. That doesn’t make taking it a good idea.
We all want an effective treatment for COVID-19. I can think of nothing that would fill me with more joy than to know there was one I could prescribe, one that could help reduce the horrible toll this pandemic is taking on our nation and the world. I understand well why people would look for anything that seemed like it could be the one we’re all hoping for.
The evidence for hydroxychloroquine just isn’t there. It may be good enough for Trump, but it’s not good enough for my patients.
