Hydroxychloroquine: Listen to doctors, not the Clorox guy
It’s no secret that patients greatly influence their doctor’s decisions about drug prescriptions. Think a medical provider never writes a prescription for a drug simply because a patient pleads for it? Happens all the time. As a 1997 survey of patients and doctors found, nearly one-in-four prescriptions aren’t “strictly indicated on purely medical grounds.” That’s why pharmaceutical companies spend billions of dollars on TV ads with the tag line, “ask your doctor about” whatever the new drug. They know what happens, particularly if the drug in question is already widely prescribed, and therefore judged “safe.” Now, imagine the patient asking for that drug is one of the most powerful people on the planet and your medical career is literally in his hands.
That’s why President Donald Trump’s announcement Monday that he is taking the anti-malaria drug hydroxychloroquine shouldn’t have come as any surprise to anyone who has heard him wax poetic about the medication’s potential to treat COVID-19 for months now. A noted hypochondriac, he was obviously alarmed that at least two White House staffers were diagnosed with the virus two weeks ago. And while the drug is neither a proven treatment nor prophylaxis for the coronavirus, it’s potential efficacy is at least being studied with front-line health care workers. One can imagine the conversation between the president and the White House physician described obliquely by Dr. Sean P. Conley in a letter as “numerous discussions he and I had regarding the evidence for and against.” Let’s just say we’re going to count Dr. Conley among the one-quarter of doctors who get bullied by their patients.
But here’s the rub. There’s nothing especially remarkable about that. Had President Trump made no public comment about his choice we’d chalk it up to a personal, albeit ill-advised, choice. But it didn’t end there. He felt an obligation, unprompted, to advertise his decision to the public. Worse, he doubled down on it Tuesday attacking a study showing that veterans who took hydroxychloroquine suffering higher death rates than those who did not as an “enemy statement,” as if medical research was based on supporting or attacking him personally. In this, he does a disservice not just to science but to the veterans under his administration’s care, including those who participated in the study that the president cruelly described as “very old … almost dead.”
The danger here is not that President Trump has made a poor choice for himself. The real risk is that his fellow Americans will take their cues from his behavior and believe that, as president, he is privy to information about the drug that they are not. They will assume a president is getting the best possible medical advice, and, so, many are bound to do exactly what he did and browbeat their family doctors into prescribing hydroxychloroquine for them as well. And likely about 25% or so of those physicians will capitulate.
And what happens then? Perhaps a lot of unfortunate things. First, it should be noted that the U.S. Food and Drug Administration currently recommends against prescribing the drug outside a hospital or research setting. Why? Because it comes with some serious side effects, not the least of which is irregular heart beat, cardiac arrest and seizures. As House
Speaker Nancy Pelosi so indelicately noted on Tuesday, that’s a bad idea for Mr. Trump’s “weight group.” And while fat-shaming was unnecessary, the point was well taken — it’s one thing for people who have the virus to try an unproven drug, it’s another to take it when there are significant health risks involved, obesity included.
Are Americans wary of medical advice given by someone who not long ago speculated that ingesting disinfectant might be a good way to address the virus too? Surely, most have recognized the president’s weakness for quackery, self-promotion and, well, pretty much anything that distracts from the pandemic. He especially does not like being reminded about how, under his stewardship, the United States leads the world in total COVID-19 cases and deaths. By far. Still, it’s not unreasonable to expect him to at least stop making matters worse — to not interfere with the work of research scientists, to not substitute his judgment for that of the Centers for Disease Control and Prevention, to not muzzle medical experts or cheer on protesters who want to put an end to social distancing restrictions. If there’s a drug that accomplishes all that, Dr. Conley needs to prescribe it. Stat.