Hydroxychloroquine 'not likely to be a silver bullet' for coronavirus, former White House medical official says

This post has been updated with new information.

U.S. President Donald Trump has been pushing for the use of an anti-malarial drug hydroxychloroquine against the coronavirus, and one prominent doctor says that could be a problem given the lack of data available.

“It’s just not likely to be a silver bullet,” Dr. Ezekiel Emanuel, who served as special advisor for health policy to the director of the White House Office of Management and Budget during the Obama administration, told Yahoo Finance’s The Ticker. “We all want a silver bullet, but … rather than being overly optimistic and talk about the good feelings that we have, we need to rely on data. Because if we just go with our feelings, we’re likely to be severely disappointed. And that could be a problem.” 

The president has repeatedly touted hydroxychloroquine as an effective way to combat COVID-19, the disease caused by the new coronavirus, even as his top medical advisors disagreed with him.

U.S. President Donald Trump listens as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, addresses the daily coronavirus task force briefing at the White House in Washington, U.S., April 4, 2020. REUTERS/Joshua Roberts

“If it does work, it would be a shame we did not do it early,” Trump said on Sunday, asserting that there are “very strong, powerful signs” of its effectiveness and adding that the government had stockpiled 29 million pills of the drug. “We are sending them to various labs, our military, we’re sending them to the hospitals.”

[See also: The coronavirus scenario that has Dr. Zeke Emanuel ‘really worried’]

On the one hand, Trump asked: “What do you have to lose?” On the other hand, the president added: “But what do I know? I’m not a doctor. But I do have common sense.”

There is some anecdotal evidence of the drug being helpful for COVID-19 treatment. A Democratic representative in Michigan credited President Trump after taking hydroxychloroquine as she recovered from COVID-19, and some doctors in major U.S. health care systems are now routinely administering the drug as part of COVID-19 treatment without knowing if it will work.

“Anecdotally, it may have had limited effect in patients with milder disease,” Dr. Daniel McQuillen, an infectious disease specialist at Lahey Hospital & Medical Center in Massachusetts, told Reuters. However, the drug “has had no effect in limiting or slowing progression of our patients that have been at or near ICU level when they arrived.”

A pharmacy worker wears a protective mask shows a box of Plaquenil, also known as hydroxychloroquine, on March 25, 2020 in Paris, France. (Photo: Chesnot/Getty Images)

Doctors weigh in on hydroxychloroquine

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and a key advsior amid the coronavirus pandemic, has repeatedly downplayed hydroxychloroquine’s potential use to treat COVID-19.

“In terms of science, I don’t think we can definitively say it works,” he told CBS’s Face the Nation. “The data are really just at best suggestive. There have been cases that show there may be an effect, and there are others to show there’s no effect.”

Members of Trump’s inner circle, including personal attorney Rudy Giuliani, are encouraging the use of hydroxychloroquine despite no meaningful clinical trials being conducted. A small trial by Chinese researchers touted by some was found to have clear limitations. Another small-scale trial from France touted by others broke with standard clinical practices by specifically choosing patients (instead of the standard practice of randomly assigning patients to treatment or control groups) and failing to collect some data.

“We’ve got to take a little risk, goddamnit, if we want to save lives,” Giuliani, who cited the French study to President Trump during discussions of using hydroxychloroquine amid the pandemic, told The Washington Post. “We are looking at a slaughter.”

Coronavirus cases are still on the rise. (Graphic: David Foster/Yahoo Finance)

Another person close to Trump, White House Economic Adviser Peter Navarro, aggressively pushed back against Dr. Fauci’s skepticism: According to a report by Axios, Navarro argued in a meeting of the White House Coronavirus Task Force that there was indeed enough evidence to prove hydroxychloroquine’s effectiveness.

Amid some anecdotal reports, experts are largely siding with Dr. Fauci’s stance.

“First of all, there are no proven benefits [and] we have to be very clear about that,” said Dr. Emanuel, who is currently Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.

Emanuel added that “many of us in the health community are suspicious, because you use the drug with patients who are doing well. We call that patient selection, and that’s probably what we’re seeing in most of the positive reports. Those patients may have done well anyway without the drug.” 

Nurses adjust protective masks inside a testing tent at St. Barnabas hospital on March 20, 2020 in New York City. St. Barnabas hospital in the Bronx set-up tents to triage possible COVID-19 patients outside before they enter the main Emergency department area. (Photo: Misha Friedman/Getty Images)

Other prominent doctors argued, contradicting the president, that people may indeed have something to lose by taking the drug without proper medical oversight.

“There are side effects to hydroxychloroquine,” Dr. Megan L. Ranney, an emergency physician at Brown University in Rhode Island, told The New York Times. “It causes psychiatric symptoms, cardiac problems, and a host of other bad side effects.”

Ranney added that there “may be a role for it for some people. But to tell Americans ‘you don’t have anything to lose,’ that’s not true. People certainly have something to lose by taking it indiscriminately.”

Dr. Emanuel noted that “the idea that you’re going to take it as a prophylactic” — something to prevent a disease like COVID-19 — “when it’s totally unproven: bad idea.”

He explained that “if you have a serious illness like lupus, it’s worth taking” on risks related to the potential side effects. “But if you’re taking it because you want to prevent [COVID-19], that’s not a good idea.”

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