The US doctors taking Trump’s lead on hydroxychloroquine – despite mixed results
There is an alternate universe of Covid-19 misinformation masquerading as science, which with the encouragement of Donald Trump, is proliferating among his supporters.
Among the most ardent proponents of these claims is the American Association of Physicians and Surgeons (AAPS), a fringe group of less than 5,000 doctors. The group was recently cited by Trump’s campaign manager, Brad Parscale, to explain the president’s stunning announcement that he is taking the drug hydroxychloroquine in an attempt to protect himself against Covid-19 despite a lack of evidence of its effectiveness.
When asked what evidence guided the president’s decision-making, Trumpsaid: “Are you ready? Here’s my evidence: I get a lot of positive calls about it.”
Since hydroxychloroquine was approved on an emergency basis by the Food and Drug Administration (FDA), studies have shown mixed results, and the dangers of potentially life-threatening side-effects for patients.
Yet Dr Jane Orient, executive director of AAPS, told the Guardian she believed the drug “should be prescribed more often”, and in a statement based on a flawed database claimed the drug offered “about 90% chance of helping Covid-19 patients”.
“I’ve talk to a lot of doctors who are prescribing it [in the US], they are not reporting any problems, their patients have done very well,” she said. She did not say how many doctors she knew were prescribing it, and declined to answer whether she herself was prescribing it.
“I don’t want to have a target put on my back … which could result in somebody wanting to scrutinize my entire practice,” Orient said.
At first glance, the AAPS has the imprimatur of science. Its members rank among America’s most trusted professionals, and yet it has a track record unlike any other professional medical association.
“They seem frequently to offer advice and opinions about medical practice that are not consistent with evidence-based medicine,” said Dr Michael Carome, an expert on drug and medical device safety at Public Citizen, a public advocacy group.
“They’re aligned with the Trump administration, that doesn’t believe in science, doesn’t believe in fact. They’re completely compatible with the Trump White House.”
The group has questioned whether HIV causes Aids (it does), argued abortion causes breast cancer (it does not), linked vaccines to autism (repeatedly debunked), and even alleged former president Barack Obama used hypnosis techniques to trick voters, especially Jewish people, into supporting him (no).
“The name does not determine the quality of the group,” said John Ayers, a professor of infectious disease and global public health who studies misinformation at the University of California San Diego. “This group is lobbying on behalf of what they believe to be right, but invariably experts would disagree on their stance on hydroxychloroquine and other topics and issues,” said Ayers.
As far as the president’s pronouncements, Ayers said: “We don’t know if he’s actually even taking it.”
Even as Trump said he was taking the drug, some of America’s most respected institutions have begun to move away from it. Yale New Haven medical center, one of the most respected hospitals in the world, removed the drug from its Covid-19 protocol after three weeks of de-emphasizing it in clinical practice.
Massachusetts general hospital, another world-renowned academic medical center, is giving priority to remdesivir, a drug developed by Gilead, although hydroxychloroquine is provided on a case-by-case basis.
The FDA has issued stringent warnings about the drug’s potentially life-threatening side-effects and recommended patients on hydroxychloroquine be participants in a clinical trial, or undergo rigorous monitoring, possibly including “baseline [electrocardiogram], electrolytes, renal function and hepatic tests”.
The AAPS’s statements on hydroxychloroquine are not its only dubious views on the Covid-19 crisis.
The US Centers for Disease Control and Prevention (CDC) has recommended wearing masks in public places to prevent asymptomatic people spreading the disease. In other words, it is mostly a selfless act which protects others.
But Orient argued that masks “are not free of side-effects” and that they “retard oxygen” to the brain. She later added: “I think one jogger even dropped dead.” One man in China reportedly suffered a collapsed lung while wearing a mask, though a doctor in the report said there was “no clear evidence” the mask caused the injury.
While prolonged use of some masks, such as N95 respirators, might cause lightheadedness and discomfort, loose-fitting cloth or surgical masks most commonly used by the public are highlyunlikely to cause such severe side-effects.
Orient also voiced her support for lifting stay-at-home orders. “They are destroying the economy, they are destroying people’s lives, there is really no evidence they work,” she said. The economic and social impacts of the lockdowns have been devastating.
But, there is widespread evidence that stay-at-home orders work, and could have saved thousands more lives had they been imposed earlier. A recent Italian study found the stay-at-home order there prevented about 200,000 hospitalizations. Data from Columbia University found if lockdowns had been imposed in the US two weeks earlier, on 1 March, as many as 54,000 lives could have been saved.
AAPS was formed in 1943, in opposition to a proposal to provide Americans the sort of universal, governmentrun healthcare established just a few years later in the UK. The NHS would become one of the country’s proudest achievements.
Orient’s group is small, especially when compared with the mainstreamAmerican Medical Association (AMA) which has 240,000 members. But it is influential.
Trump’s first health and human services secretary, Tom Price, was a member of AAPS. In a 2011 video unearthed by the Washington Post, Price called Orient a “kindred” spirit. He said: “It’s always wonderful to be in the same room with Jane Orient. Jane has been a hero of mine.” Price later resigned after spending $1m in taxpayer funds on private jets.
AAPS has diligently worked against proposals which would constrain doctors. For example, it sued the Texas medical board to force it to stop relying on anonymous complaints of misconduct against doctors (the group lost).
“Most recently, like Trump, they encourage the use of hydroxychloroquine for treatment of Covid-19, and they think that any oversight – be it a physician group or state medical board or mainstream medicine – that makes recommendations against use of that drug or tries to restrict use of that drug is just an affront,” Carome said.
The view of AAPS, he added, is “that doctors should be basically free to do whatever they want to do, regardless of the level of evidence, and that’s a dangerous perspective for medical practitioners to have in the 21st century”.
Samantha Bastow, a licensed pharmacist and clinical pharmacy adviser at Lumere, said it was uncommon and challenging for the government to be involved so directly in prescribing.
“The use for Covid-19 has not significantly been substantiated,” Barstow said. “The efficacy data is just not there yet.” In the meantime, drug shortages could cause patients with approved uses, such as rheumatoid arthritis and lupus, to suffer without medication.
Only six drugs have ever been approved on an emergency basis, like hydroxychloroquine, and most recently Gilead’s remdesivir. Some researchers believe past drugs approved this way offer a lesson.
In 2009, during the H1N1 influenza pandemic, a drug called peramivir showed promise. It was studied in three clinical trials, but despite compelling and transparent scientific evidence, it failed. By contrast, hydroxychloroquine was backed only by limited lab tests and case reports.
Nevertheless, Orient argues hydroxychloroquine should be available over the counter. Concerns from scientists have “nothing to do with concerns about safety and concerns about science”, she argued. Her view that lockdowns are “despotic, tyrannical and completely unwarranted”, and will probably also cause consternation in many circles.
But on some subjects, all can agree: “Our pandemic preparedness on the whole has been lousy.”
This group is lobbying on behalf of what they believe to be right, but invariably experts would disagree on their stance on hydroxychloroquine
John Ayers