Starting with just the second self-praise session / coronavirus rally replacement he staged on national television, Donald Trump has touted the drug chloroquine as wonder cure for COVID-19. Over and over, despite being aware that his claims were unproven, despite being aware that people had died from taking the drug, despite being warned that his hucksterism was resulting in a shortage for people who needed the drug to treat rheumatoid arthritis, lupus, and, oh yeah, malaria, Trump has insisted he has a “hunch” that chloroquine and the closely related hydroxychloroquine are a “game changer” in the fight against COVID-19.
Trump’s pushing the drug has generated not just a nationwide, but a worldwide shortage, that means people are genuinely suffering over his hunch — a hunch in which Trump has a personal financial interest. But it’s also putting doctors in an difficult situation where they can be faced by patients asking for an untested, possibly harmful treatment in a time of extreme fear.
Then there’s Texas. Where nursing home patients are being turned into experimental subjects in a quest to prove Trump right.
As NPR reports, a doctor working at a nursing home in Texas has been doing what too many others have—giving hydroxychloroquine to patients, even though this represents an off-label use of the product which, despite Trump’s many blessings, has still not been cleared by the FDA. Dr. Robin Armstrong, the medical director of an extended care facility called “The Resort” at Texas City, Texas, has made the drug a routine part of his care for patients. And he has a lot of patients. 87 people at The Resort have tested positive, making it one of the largest outbreaks in the state.
Armstrong’s actions, along with his statements, show that doctors can feel both desperate to find something, anything, that will help patients in extremis. Unfortunately, they also show how doctors can also be as subject to misinformation and magical thinking as anyone else.
For example, Armstrong states that hydroxychloroquine has “virtually no side effects” which is definitively, absolutely not true. Both hydroxychloroquine and chloroquine can both worsen existing heart conditions and cause new heart conditions — the kind of problem exactly likely to worsen the outcome of COVID-19. In fact, these drugs have a long list of side effects from digestive issues to retinal damage. Researchers looking into the use of these drugs against COVID-19 have actually found more serious side effects than expected.
Those side effects are being imposed on patients even though there continues to be no real evidence that chloroquine is effective in helping against COVID-19. But how it gained that reputation is exactly evident in the statements made by Armstrong. Armstrong told NPR that after just a handful of days, “some” of the 39 patients on the medication are showing signs of improvement. How many? That’s not clear. How many were getting better because of the medication? Even less clear, because Armstrong made no effort to do a random trial. He just gave the drug out on a basis that he has so far not defined. What about the patients not in that “some” that are getting better? Armstrong can’t explain it … except to say that they probably haven’t had enough of the drugs.
So, Armstrong is:
- Underplaying the risk of the drugs despite an 80-year history of side effects and counter-indications from the FDA, as well as warnings from trials underway around the world.
- Providing these drugs indiscriminately without concern for underlying conditions, and in some cases giving an experimental drug to patients in extreme distress without the consent of a family member.
- Presenting the outcome in the rosiest possible way, without bothering to provide any data whatsoever to show that this represents a genuine treatment providing positive results.
Why would he do this?
Well, it so happens that Armstrong is also a prominent player in Texas Republican politics. He’s served in a series of roles, including as the Vice Chairman of the Republican Party of Texas. In fact, his pipeline to getting an ample supply of hydroxychloroquine in the midst of a shortage was by placing a call to Republican Lt. Gov. Dan Patrick. That would be the very same Lt. Gov. Dan Patrick who sad that patriotic grandparents would gladly sacrifice themselves to save America’s economy.
So Republican Vice-Chairman Armstrong, called Republican Lt. Governor Patrick, and obtained a supply of Donald Trump’s wonder drug. And he’s even giving that drug to patients with dementia who are unable to consent to being part of this experiment.
Chloroquine may ultimately prove to have some net positive effect in the treatment of COVID-19. However, that effect is likely to be limited, because despite several studies currently underway, there is still no better evidence than early experiments conducted with no more rigor than what Armstrong has done. Had any of the randomized tests underway around the world shown unequivocal positive outcome in this situation, it’s very likely they would have suspended normal protocol to announce that result and issue preliminary findings. That has not happened.
Armstrong says that he intends to write “some kind of report” on the outcome of his experiment. Though since he’s not been taking a single step required to ensure any type of scientific or medical value in his results, it’s not clear what that report will be — except for one thing. It will be a report that’s pleasing to Trump.