Donald Trump is obsessed with hydroxychloroquine.
The anti-malarial drug has not been tested for treatment of coronavirus but that hasn’t stopped the US president aggressively promoting it as a potential “game changer”.
“What do you have to lose?” he said on Saturday. “Take it”.
Because of a lack of conclusive scientific studies, the US government’s top infectious disease specialist, Dr Anthony Fauci, is urging caution. But Trump appears to be taking the advice of Fox News hosts who are persistently pushing the drug.
While acknowledging that he is not a doctor, Trump insists his “common sense” qualifies him to make such bold claims.
So what do coronavirus patients actually have to lose if they take hydroxychloroquine?
Dr Daniel Sterman is the critical care director at New York University (NYU) Langone Health. He believes almost every doctor in the United States, especially in New York City, has been approached by a family member, friend, or patient about this drug.
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Doctors at his hospital are using it despite the lack of research on whether patients are actually benefiting.
“There are no proven therapies for COVID-19 unfortunately – so we are doing the best we can with applying the best supportive care that we can. But there’s a lot we don’t know about this disease.
“And this disease is unlike many other diseases that we’ve seen before. It has unique clinical characteristics. So we just don’t know whether any drug therapies are effective.”
He disagrees with Trump’s claim that if it’s good for malaria – it’s good for this virus.
“Malaria is a very different organism than the SARS CoV-2,” says Dr Sterman.
“I think that you could make an argument that it’s been proven safe to be used in malaria in large numbers of patients. And for that reason, the drug may be safe.
“But you can’t say that because it works in malaria that it’s effective in treating COVID-19.”
While there is no comprehensive or conclusive data on hydroxychloroquine’s coronavirus efficacy, there have been some early studies that have offered a fraction of hope – a specific one from France.
“The early French study, which prompted all the interest in this drug, was in 20 patients, a very small subset and no controls and only a very small subset had the combination of azithromycin and hydroxychloroquine,” says Dr Sterman.
“And there appeared to be some synergy between the two drugs in a very small number of patients who received both. This small study was what generated all the interest, in part because I think that we were so frustrated by the fact that we had no therapies to offer.”
The World Health Organisation is conducting trials to test the drug’s efficacy. NYU’s Langone Medical Centre has also designed a trial in its patients.
“My hope is that these randomised trials will give us definitive information as to whether or not hydroxychloroquine or is effective in COVID-19 patients,” says Dr Sterman.
It’s not just President Trump who wants a cure. Medical professionals battling on the front lines of this viscous disease are urgently seeking an answer.
“‘I think we struggle, all the doctors who are caring for these patients around the world are struggling with two things,” says Dr Sterman. “One is our desperate desire to find a drug that works and a willingness to try anything to try to save our patients.”
President Trump has insisted “you’re not going to die” from this drug and has dismissed its potential side effects.
Dr Sterman says the drug is not without risk: “We’ve heard a few stories. We’ve not seen any side effects in the patients who’ve been administered hydroxychloroquine at our medical centre. There certainly are risks. The major risk that we worry about is cardiac, heart side effects.”
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There are also potential risks with patients’ eyes.
Medical experts are concerned that Trump’s daily push of the drug could prompt dangerous home use and mixing with other medications. Dr Sterman says no one should take it without their doctor’s supervision.
Trump says the US has stockpiled 29 million doses – but he wants more.
India is the world’s largest producer of the drug and after pressure from Trump – he threatened retaliation if they did not lift their export ban – it has approved some exports to the US.
The scramble to get hold of it has meant shortages for people with conditions like lupus and rheumatoid arthritis.
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“That’s a big concern,” says Dr Sterman. “If there are shortages of the drug because people are prescribing it for themselves or hoarding it, for non FDA approved reasons, it may deprive patients who really rely on this drug for treatment of their chronic disease in a proven fashion from having that proven beneficial drug.”
Dr Sterman says he won’t comment on the criticisms levelled at Trump for his persistent promotion of the drug.
“I think that the bottom line is that this is a very scary time for everyone.
“This is affecting everyone in the world in a way that I’ve never seen. So I can understand an emotional reaction to the possibility of having a drug that can help you.
“That being said, as a physician and as a physician investigator, my goal is to get answers as to whether what our emotions tell us are absolutely true.”
The New York Times has reported that there may be more to Trump’s new obsession.
If this drug is accepted for coronavirus treatment, certain pharmaceutical companies will profit. It is reporting that Trump has a link to one of those companies and therefore could benefit financially.
Whatever his motives, Trump is adamant that this drug should immediately be approved to treat COVID-19.
The experts want a solution that is effective and safe. We just don’t know yet if hydroxychloroquine fits that crucial bill.