Trump, hydroxychloroquine, ripple effects and credulity

Speaking to reporters during an event on Monday, President Donald Trump made a surprising pivot away from attacking a whistleblower who had criticized his administration’s handling of the coronavirus epidemic.

The whistleblower, Rick Bright, said he was fired by the White House for criticizing Trump’s endorsement of the anti-malarial drug hydroxychloroquine as a treatment for COVID-19, the disease caused by the virus. But Trump noted that it was Bright himself who — in his official capacity — signed a request to the Food and Drug Administration to provide emergency authorization for the drug’s use to treat the disease.

“Now, if he doesn’t believe in it, why would he sign it? And a lot of good things have come out about the hydroxy. A lot of good things have come out,” Trump said. “You’d be surprised at how many people are taking it, especially the front-line workers, before you catch it. The front-line workers, many, many are taking it.”

“I happen to be taking it. I happen to be taking it,” Trump then added.

A murmur in the room. He was taking hydroxychloroquine?

“Right now,” Trump claimed. “Couple of weeks ago I started taking it because I think it’s good. I’ve heard a lot of good stories.”

The White House doctor approved his use of the medication, Trump said, noting that it has “been around for 40 years” to treat other illnesses. Asked what evidence he had that the medicine was effective as a preventive, Trump offered a curt response.

“Here we go. You ready? Here’s my evidence,” Trump said. “I get a lot of positive calls about it.”

At another point, he said he had received a letter from a doctor in New York who had treated patients with the medication and who asked that he “keep pressing” the drug.

“The only negative I’ve heard was the study where they gave it — was it the VA? People that aren’t big Trump fans,” Trump said. He was referring to a report released by the Department of Veterans Affairs that indicated that the drug didn’t help in treating COVID-19 and, in fact, correlated to higher death rates. This report, he said, was a “very unscientific report” — conflicting with the “tremendously positive news” he gets personally on the drug.

“You know the expression I’ve used …? What do you have to lose,” Trump said. “OK? What do you have to lose?”

All of this, every word, is remarkable in its own way.

The first is that Trump’s focus on hydroxychloroquine has always been anecdotal, spurred by reports from Fox News anchors and their guests or other individuals who claim positive effects from the drug. As the Washington Post has reported, those unscientific assessments conflict with observed effects from the use of the drug in clinical trials, where the effectiveness of it in treating COVID-19 has been limited and outweighed by the risk of death the drug poses. (This, of course, is what patients have to lose: their lives.)

The FDA, after granting the emergency-use authorization, formally warned against using the medication to treat COVID-19. One former FDA official who spoke to the Post expressed surprise that the agency had not yet revoked that authorization.

It’s also remarkable that Trump claims to have taken the medicine and that there’s no reason to accept his claim at face value. It seems hard to believe that a practicing physician would give a patient a pass on trying a potent, unproven medication solely on the basis of seeking to prevent a disease. Particularly when that patient is already the focus of a robust protective regimen, including frequent testing of those with whom he associates. And particularly given that the risk posed by hydroxychloroquine centers on its effects on the heart. Trump’s past health reports have shown that he takes medications aimed at heart health, including Crestor — likely aimed at reducing his cholesterol — and aspirin.

It’s worth noting, too, that the FDA does not allow for a use such as the one Trump claims. The emergency-use authorization specifies that the drug can be used “to treat adults and teens hospitalized with COVID-19 who weigh more than 50 kg (110 pounds).”

Of course, Trump’s predilection for making false assertions is well-documented. This announcement follows a predictable pattern for Trump of escalating a rhetorical point. Trump wants to disparage Bright, so he claims that hydroxychloroquine is safe and effective. To bolster that point, Trump points to unnamed doctors who he asserts have been prescribing the medication. Then, he escalates the point again: In fact, he himself is taking it, and he’s doing just fine. How can you argue with that? Trump is healthy and COVID-free, so how can anyone suggest that the drug is dangerous or ineffective? Sure, the argument is of the anti-tiger-rock variety, but you work with what you’ve got.

In the moment, it’s an expedient example to cite and, who knows, perhaps an honest one. But one effect of the claim is almost certain: Trump supporters will view the drug as a harmless way to potentially prevent a dangerous illness. Many, presumably, might then seek it out and take it — hopefully without negative side effects. The case of the couple in Arizona who took a fish-tank cleaning substance that was tangentially related to hydroxychloroquine may have been a complicated murder plot. But if the president insists that he’s taking a potentially lifesaving medication without any problems, why wouldn’t others try to do the same?

More broadly, this reinforces a central gap in Trump’s approach to the pandemic. While formally embracing the suggestions of medical experts, he has consistently undermined their advice, from pushing for a rapid scaleback of efforts to contain the virus to ignoring the need to wear a mask in public. This is another example of Trump knowing better than the “experts,” a message that resonated with many of his supporters in 2016 but which is far riskier in the present conditions.

In other words, the best-case scenario to Trump’s admission on Monday is that he is taking a risky medication with his doctor’s consent for which he’s not seeing repercussions and which his supporters will not see as a green light for seeking it out themselves. The worst case? Trump claimed to be taking the medication to make a point, inadvertently triggering a new embrace of the medication among those who take his words at face value — putting lives at risk.

Not only the lives of those taking it, mind you. Trump’s past advocacy of the drug led to a shortage among patients who rely on it to treat other illnesses. What’s more, a legion of Americans taking the drug who believe erroneously that it protects them from contracting COVID-19 can be relied upon to take risks in their behavior that increase the possibility that the virus might spread to others.

If it is the case that Trump is taking the medication, he could have released that information in a controlled, carefully articulated way, making sure to highlight either the uniqueness of his position and the risks it poses to others. But that’s not what he did. Instead, he quintupled down on past advocacy of the medication using similarly hollow evidence, apparently for little more immediate reason than being more right than his critics.