Patterico's Pontifications

4/5/2020

President Trump Advises Americans To Try Hydroxychloroquine, If They’d Like

Filed under: General — Dana @ 1:05 pm



[guest post by Dana]

During his Coronavirus Task Force briefing yesterday, President Trump didn’t just promote hydroxychloroquine, he encouraged people to take it to treat coronavirus. This after Dr. Hahn (FDA Commissioner) cautioned about its use:

DR. HAHN:

I’m going to speak about hydroxychloroquine and the efforts around that…Last week as the president said, we issued an emergency use authorization to allow the donated hydroxychloroquine to come into the country and enter the general circulation. We are prioritizing this drug to come in for clinical trials, also to general use for physicians because, as you know, physicians, based upon their interaction with the patients, their assessment of the risks and benefits, can write a prescription for hydroxychloroquine if they think it’s appropriate for that patient. Being a physician, we do this all the time, and that assessment needs to be done between a patient and a doctor. And then the third portion is we wanted to make sure that these drugs were in the supply chain so that people who have them or need them for the other indications, lupus, rheumatoid arthritis, had them available. So that was the purpose of the emergency use authorization.

PRESIDENT TRUMP (later in the briefing):

One of the reasons that I keep talking about hydroxychloroquine is that the question that nobody ever asks, and the question that I most hate the answer to is what happens if you do have a ventilator? What are your chances? I just hope that hydroxychloroquine wins. Coupled with perhaps the Z pack, as we call it, dependent totally on your doctors, and the doctors there.

Because you know the answer to that question. If you do have the ventilator, you know the answer to that question. I hate giving the answer, so I don’t want to get them there. I don’t want to get them there. There’s a possibility, a possibility, and I say it. What do you have to lose? I’ll say it again. What do you have to lose? Take it. I really think they should take it, but it’s their choice, and it’s their doctor’s choice or the doctors in the hospital. But hydroxychloroquine. Try it, if you’d like.

But I’ve seen some results now. It’s early, I guess. It’s early, and they should look at the lupus thing. I don’t know what it says, but there’s a rumor out there that, because it takes care of lupus very effectively as I understand it. It’s a drug that’s used for lupus.

So there’s a study out there that says people that have lupus haven’t been catching this virus. No. Maybe it’s true. Maybe it’s not. Why don’t you investigate that?

And there’s also other studies with the malaria that the malaria countries have very little people that take this drug for malaria, which is very effective for malaria, that those countries have very little of this virus. I don’t know. You’re going to check it out. But I think people should … If it were me, in fact, I might do it anyway. I may take it. Okay. I may take it, and I’ll have to ask my doctors about that, but I may take it.

And there was more from Dr. Trump:

During the briefing, as Dr. Fauci and other advisers looked on, the president talked about the potential of other medicines, too. He mentioned azithromycin, often referred to as a Z-Pak, which has been given to some patients along with hydroxychloroquine.

“The other thing, if you have a heart condition, I understand, probably you stay away from the Z-Pak. But that’s an antibiotic. It can clean out the lung. The lungs are a point of attack for this horrible virus.”

The President of the United States is putting any number of Americans at potential risk, not only by touting the drug, but by casually advising them to try it, like it was a Tic-Tac. It is apparent that the President has become increasingly reckless about what he says. More so than he was in March, when he said of the drug: “It’s been around for a long time, so we know that if things don’t go as planned it’s not going to kill anybody.” And it doesn’t lessen the potential damage by throwing in the caveat, “it’s their doctor’s choice or the doctors in the hospital.” I’ve said it a million times: Trump holds the most powerful position in the world, and his words carry that much more weight because of it. He plays fast and loose with the facts, contradicts the medical experts standing next to him, and has the temerity to disagree with these same experts after they clean up his verbal messes. This is reckless behavior, and because of his directive, people might fall ill, or even die. And if they do, because they stupidly followed his advice, then Trump would bear some level of moral responsibility. These are dangerous times, and when the chief executive cavalierly tells Americans to take a drug and has no idea how it might affect them, he potentially endangers them. And while I don’t believe that the vast majority of Americans would take medical advice from Trump, there is a loyal base of true believers who hang on his every word. So much so, in fact, that they put him into office.

Meanwhile, the President might want to read this:

[A] study just published in a French medical journal provides new evidence that hydroxychloroquine does not appear to help the immune system clear the coronavirus from the body. The study comes on the heels of two others – one in France and one in China – that reported some benefits in the combination of hydroxychloroquine and azithromycin for COVID-19 patients who didn’t have severe symptoms of the virus.

I am a medicinal chemist who has specialized in discovery and development of antiviral drugs for the past 30 years, and I have been actively working on coronaviruses for the past seven. I am among a number of researchers who are concerned that this drug has been given too much of a high priority before there is enough evidence to show it is indeed effective.

There are already other clinical studies that showed it is not effective against COVID-19 as well as several other viruses. And, more importantly, it can have dangerous side effects, as well as giving people false hope. The latter has led to widespread shortages of hydroxychloroquine for patients who need it to treat malaria, lupus and rheumatoid arthritis, the indications for which it was originally approved…Thus, despite the recent approval of this drug for use against COVID-19, questions remain as to the efficacy of this treatment. As Molina and colleagues note: “Ongoing randomized clinical trials with hydroxychloroquine should provide a definitive answer regarding the alleged efficacy of this combination and will assess its safety.”

You can watch the press conference from yesterday here.

–Dana

5/18/2020

POTUS Announces He Is Taking Hydroxychloroquine As A Preventative Measure

Filed under: General — Dana @ 10:54 pm



[guest post by Dana]

In spite of warnings by Dr. Fauci, and in spite of *FDA safety warnings issued in April, President Trump announced today that he has been taking hydroxychloroquine as a preventative medicine against the coronavirus. Apparently, the potential side effects on a 73-year old, overweight man with high blood pressure, and lack of actual evidence that it is effective as a preventative medicine did not matter in the end:

President Trump said Monday that he has been taking hydroxychloroquine, an antimalarial drug whose effectiveness against the coronavirus is unproven, for about a week and a half as a preventive measure, saying he had no symptoms of Covid-19.

“All I can tell you is, so far I seem to be OK,” he said, explaining that he takes a daily pill.

The president also said that, along with the daily dose of hydroxychloroquine, he has been taking a a daily dose of zinc and an initial dose of the antibiotic azithromycin. Studies have linked the combination of these drugs to an increase of cardiac arrests.

Dr. David Boulware of the University of Minnesota, who is overseeing a national trial to determine whether hydroxychloroquine can prevent infections, cautioned:

There are no data that pre-exposure prophylaxis is effective to prevent coronavirus. It may be. It may not be. We do not know. The only way I would recommend taking hydroxychloroquine is within a clinical trial.

Other doctors also cautioned against taking it:

“I think it’s a very bad idea to be taking hydroxychloroquine as a preventive medication,” said Dr. Eric Topol, a cardiologist and the director of the Scripps Research Translational Institute in La Jolla, Calif. “There are no data to support that, there’s no evidence, and in fact there is no compelling evidence to support its use at all at this point.”

Dr. David Maron, a cardiologist and the chief of the Stanford Prevention Research Center, said in an interview that in his opinion “the risk-benefit ratio doesn’t make sense.”

Further:

Dr. Steven E. Nissen, the chief academic officer of the The Miller Family Heart, Vascular & Thoracic Institute at the Cleveland Clinic, said hydroxychloroquine was “not an innocent therapy,” adding that he had treated a number of patients who developed a life-threatening arrhythmia, which the drug can cause.

“This disorder can be lethal,” Dr. Nissen said. “My concern would be that the public not hear comments about the use of hydroxychloroquine and believe that taking this drug to prevent Covid-19 infection is without hazards. In fact, there are serious hazards.”

Clearly, all medical practitioners are not on the same page with regard to using hydroxychloroquine as a preventative medication for the coronavirus:

Asked if the White House doctor recommended he begin taking hydroxychloroquine, Trump demurred.

“I asked him what do you think, he said, ‘Well if you’d like it,’ ” the President told reporters.

The President’s physician, Navy Cmdr. Sean Conley, alluded in a memo released Monday night to Trump’s personal valet testing positive two weeks ago for coronavirus. While Conley didn’t say directly that Trump started taking hydroxychloroquine in response to the valet testing positive, the timing mentioned by Trump and the positive test match up.

“After numerous discussions, he and I had regarding the evidence for and against the use of hydroxychloroquine, we concluded the potential benefit from treatment outweighed the relative risks,” Conley wrote, adding that Trump has taken multiple tests for coronavirus — all negative — and remains symptom free.

“I’m not going to get hurt by it,” Mr. Trump said, claiming he was making the revelation in order to be transparent with Americans. “It has been around for 40 years for malaria, for lupus, for other things. I take it. Front-line workers take it. A lot of doctors take it. I take it.”

And although the released memo reveals that the doctor did discuss the use of hydroxychloroquine by the president, it did not confirm that he was indeed taking it. However, there is this tweet from the NYT:

The president’s decision to take the drug comes as no surprise, given his zealous promotion of it back in early April. He takes a drug that doctors warn against taking as a preventative medicine. He refuses to wear a mask in public, as recommended by medical experts. But I do wonder about the level of pressure Trump put on Conley to prescribe him the drug. Given the lack of evidence supporting its effectiveness as a preventative medication against the coronavirus, as well as the potential side effects on an older person who is not in the best physical shape, and in this case, just happens to be the President of the United States, I would have guessed that the White House physician would have not simply said no to any such request, but would have emphatically said Absolutely Not!.

Anyway, here are some brief clips of Trump explaining why he decided to take the drug:

As The Post notes, today was a “triple whammy” of good news, so why would Trump want to detract from that by making a controversial announcement? I don’t really know why, but I do know that know one steps on his own good press more effectively than Trump himself.

*The FDA did authorize emergency use of hydroxychloroquine against the coronavirus in March, even though there was little evidence that it could work.

–Dana

4/22/2020

Paging Dr. Trump: NIH Panel Recommends Against Drug Combo President Touted For COVID-19

Filed under: General — Dana @ 6:58 am



[guest post by Dana]

In spite of Trump’s repeated promotion for the use of hydroxychloroquine and azithromycin to combat coronavirus, members of the COVID-19 Treatment Panel have recommended against use of the combination of drugs:

A panel of experts convened by the National Institute of Allergy and Infectious Diseases recommends against doctors using a combination of hydroxychloroquine and azithromycin for the treatment of COVID-19 patients because of potential toxicities.

“The combination of hydroxychloroquine and azithromycin was associated with QTc prolongation in patients with COVID-19,” the panel said.

QTc prolongation increases the risk of sudden cardiac death.

The panel also addressed usage of the two drugs by themselves:

As for using the use of hydroxychloroquine or chloroquine alone, the panel said there was “insufficient clinical data to recommend either for or against.” It reached the same conclusion about the drug remdesivir.

The panel of medical experts, with clinical experience and expertise in patient management, clinical science, and/or development of treatment guidelines, will not make recommendations about a drug’s use if strong scientific evidence is lacking to make a firm conclusion one way or the other:

“It’s all based on the data,” said panel member Dr. Susan Swindells, a professor in the department of internal medicine at the University of Nebraska College of Medine. “We just plowed through everything that was, and apart from supportive care, there wasn’t anything that was working terribly well.”

The panel also concluded that there was insufficient evidence to recommend any kind of treatment either to prevent infection with the coronavirus or to prevent the progression of symptoms in those who are already infectious. That recommendation could change based on clinical trials presently underway.

–Dana

UPDATE BY PATTERICO:


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