Tuesday, April 7, 2020

The battle over hydroxychloroquine - what and why

The NY Times reports on Trump’s push for an untested drug - the what and why. Trump’s Aggressive Advocacy of Malaria Drug for Treating Coronavirus Divides Medical Community. While Dr. Anthony Fauci has urged caution in using hydroxychloroquine, some doctors are prescribing it to patients who have the virus despite the fact it has never been tested for it.

In what follows make sure to distinguish between the real Dr. Fauci, a respected medical scientist, and Dr. Fauxi - the persona I created and adopted by Donald Trump when he prescribes an untested drug.

What drives the fight between the real Dr. Fauci and the fake Dr. Fauxi?

[The real] Dr. Fauci made his concern clear last week. “I think we’ve got to be careful that we don’t make that majestic leap to assume that this is a knockout drug,” he said on Friday on Fox News. “We still need to do the kinds of studies that definitively prove whether any intervention, not just this one, any intervention is truly safe and effective.”

The same day, Laura Ingraham, a Fox host, visited [Dr. Fauxi] at the White House with two doctors who had been on her program promoting hydroxychloroquine, one of whom made a presentation on its virtues, according to an official, confirming a Washington Post report.

The next day, Peter Navarro, the president’s trade adviser, who has been assigned to expedite production of medical equipment and become an advocate of the drug, upbraided Dr. Fauci at a White House task force meeting, according to people informed about the discussion.

Mr. Navarro arrived at the meeting armed with a thick sheaf of papers recounting research. When the issue was raised, according to a person informed about the meeting, confirming a report by Axios, Mr. Navarro picked it up off a chair, dropped it on the table and started handing out copies.

Mr. Navarro, who earned a doctorate in economics from Harvard, defended his position on Monday despite his lack of medical credentials. “Doctors disagree about things all the time. My qualifications in terms of looking at the science is that I’m a social scientist,” he said on CNN. “I have a Ph.D. And I understand how to read statistical studies, whether it’s in medicine, the law, economics or whatever.”

Well, Bub, I also have a Ph. D. (Psychology from U. Cal. Berkeley)“And I understand how to read statistical studies, whether it’s in medicine, the law, economics …”

[Fake Dr. Fauxi] made clear on Sunday whose side he took in Mr. Navarro’s confrontation with [the real] Dr. Fauci. At his briefing after the meeting, he said it was wrong to wait for the kind of study Dr. Fauci wanted. “We don’t have time,” [Dr. Fauxi] said. “We don’t have two hours because there are people dying right now.”

Does it work? What the doctors say.

These are quotes from the Times’ report.

  • data about its effectiveness remained “weak and unsubstantiated” pending the study. “We do not know whether our patients are benefiting from hydroxychloroquine treatment at the present time,”
  • “We explain the pros and cons and explain that we don’t know if it works or not”
  • “We’ve been throwing the kitchen sink at these patients,” he said. “I can’t tell whether someone got better on their own or because of the medication.”

The professional organization that published a positive French study cited by Mr. Trump’s allies changed its mind in recent days. The International Society of Antimicrobial Chemotherapy said, “The article does not meet the society’s expected standard.” Some hospitals in Sweden stopped providing hydroxychloroquine to treat the coronavirus after reports of adverse side effects, according to Swedish news media.

In addition, I recommend reading the research review I posted in this blog yesterday, President Trump says he is not a doctor and yet prescribes drugs that are not effective in treating coronavirus. He is Dr. Fauxi.

Given that, what are the motives for aggressively touting the drug?

Election politics, certainly. Another possible, simple answer is “Follow the money.” Here’s more from the Times’ report.

If hydroxychloroquine becomes an accepted treatment, several pharmaceutical companies stand to profit, including shareholders and senior executives with connections to the president. Mr. Trump himself has a small personal financial interest in Sanofi, the French drugmaker that makes Plaquenil, the brand-name version of hydroxychloroquine.

Some associates of Mr. Trump’s have financial interests in the issue. Sanofi’s largest shareholders include Fisher Asset Management, the investment company run by Ken Fisher, a major donor to Republicans, including Mr. Trump. A spokesman for Mr. Fisher declined to comment.

Another investor in both Sanofi and Mylan, another pharmaceutical firm, is Invesco, the fund previously run by Wilbur Ross, the commerce secretary. Mr. Ross said in a statement Monday that he “was not aware that Invesco has any investments in companies producing” the drug, “nor do I have any involvement in the decision to explore this as a treatment.”

As of last year, Mr. Trump reported that his three family trusts each had investments in a Dodge & Cox mutual fund, whose largest holding was in Sanofi.

Ashleigh Koss, a Sanofi spokeswoman, said the company no longer sells or distributes Plaquenil in the United States, although it does sell it internationally.

Several generic drugmakers are gearing up to produce hydroxychloroquine pills, including Amneal Pharmaceuticals, whose co-founder Chirag Patel is a member of Trump National Golf Course Bedminster in New Jersey and has golfed with Mr. Trump at least twice since he became president, according to a person who saw them.

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