PRESIDENT Trump’s unexpected retweet of TCW’s investigative article on the potential benefits of the anti-malaria drug hydroxychloroquine (HCQ) for tackling Covid-19 has done a good turn. It helped to bring attention at a vital time to our balanced consideration of the evidence for and against this treatment.
As one US reader commenting on the article said: ‘The information seems to be unbiased, reasonable and logical. It seems zinc is the key that allows chloroquine (sic) in to clean up this virus. If this does not receive some mention in my news media, the American press, l can only assume they are at war with President Trump and we are collateral damage.’
And serious questions have been brought to the fore about a study which led the World Health Organisation (WHO) to pull the drug from global treatment trials.
About time too.
The president’s retweet unsurprisingly resulted in renewed support for this study, one published in the British medical journal the Lancet, and conducted by the Brigham and Women’s Hospital Centre for Advanced Heart Disease in Boston, warning (negatively) about the use of HCQ to treat Covid-19. A number of the gullible had swallowed its reporting, unwilling to consider that it might have flaws – and which are my subject matter today.
‘Were they not aware of the huge controversy surrounding this study?’ James Delingpole tweeted.
Clearly they were not. When the Lancet findings were released, the media embraced them uncritically, seemingly delighted to find a stick they could beat President Trump with – for having the temerity to give his public support to considering the potential benefits of a drug which a number of doctors are taking themselves and also prescribing.
Indeed, a survey of doctors by a leading American physician staffing firm in April found that 65 per cent would give HCQ to their own family as a prevention or treatment.
A few days earlier, Trump had revealed that he was a recipient of HCQ, alongside zinc, as a precautionary measure. The president was once again on the receiving end of the standard attacks by the usual suspects.
The combination of the Lancet study, the WHO’s action and the negative media response seems to have been enough to make France’s health ministry cancel a decree which had been in place for nearly two months that had allowed hospital doctors to dispense HCQ in specific situations for Covid-19.
A UK study into HCQ’s effectiveness in up to 40,000 health care workers (which was partly funded by the Bill and Melinda Gates Foundation) was also reported to have been suspended.
Yet there are a number of significant problems with the study that was published by the Lancet, concerning the findings’ validity and reliability, as Delingpole flagged up. They concern:
1. The reported effect of HCQ on deaths in the study, which is significantly larger than the effect found in other studies of the drug’s impact.
2. The fact that the study’s authors do not appear to have found a relationship between the dose given and the death rate.
3. Major anomalies in the study’s data. For example, more than 100 scientists and clinicians asked questions regarding authenticity of a massive hospital database that was the basis for the study. Their letter cited concerns regarding statistical analysis and data integrity.
Australian researchers have also identified data-related issues pertaining to that country. ‘If they got this wrong, what else could be wrong?’ asked Dr Allen Chang, a Melbourne epidemiologist and infectious disease doctor.
The study was also reported elsewhere to include more patients from Africa than is said to be plausible, given the numbers released by Africa’s equivalent of America’s Centers for Disease Control.
Finally, as the American news website Vox said: ‘The gold standard for a study of disease treatment is a Randomised Control Trial (RCT), where patients are assigned at random to get a treatment or a placebo… however, the study published by the Lancet was not an RCT’.
It added: ‘It doesn’t help that the Lancet, in particular, has erred badly in the past (for example, by publishing a fraudulent paper claiming that vaccines cause autism and taking more than 10 years to retract it).’
In a recent podcast, persuasion expert Scott Adams said the study was now being ‘debunked’. Pointing to the data-sourcing issues, he commented: ‘If you think the Steele dossier was a bunch of bullshit … you should read about how the study was put together.’
[The Steele dossier was the allegation of Russian interference in the 2016 presidential election in favour of Donald Trump.]
The range of doubts and discrepancies leads one to ask why the findings were so widely (and so uncritically) reported by the global mainstream media at the time of release.
However, it’s been reported that one UK study into HCQ as a Covid-19 treatment will continue despite the WHO suspending global trials. HCQ is one of the drugs in Oxford’s Randomised Evaluation of Covid-19 therapy trial study. A number of countries have also said they will continue to treat Covid-19 patients with HCQ.
The Spanish health watchdog said the Lancet’s paper was not conclusive enough to stop testing it at Spanish hospitals. A Turkish government official said his country will also continue to use HCQ. Russia has announced it will not ban the drug.
Meanwhile, other countries are still widely using HCQ, including Morocco, Bahrain, Tunisia and Costa Rica. Indeed, Costa Rica deployed the drug and is now reported to have one of the lowest hospitalisation rates in the world, according to local health official Roman Macaya, who added: ‘We cannot say that the low rate of hospitalisation in Costa Rica is because of this medicine, but we cannot rule it out either.’
President Trump severed the United States’ relationship with the World Health Organisation last week. Did this topic play a role in his decision?
A top American specialist, Dr Harvey Risch of Yale University, finds there’s new reason to be hopeful about the use of HCQ in outpatient treatment. Writing in the American Journal of Epidemiology he says: ‘Five studies, including two controlled clinical trials, have demonstrated significant major outpatient efficacy (for HCQ) … these medications need to be widely available and promoted immediately for physicians to prescribe.’
A number of American doctors continue to support more analysis, or outright use, of HCQ (while anecdotal reports suggest many physicians are using it as a preventive measure). Some have treated people with it with apparent success; others simply note that potential benefits outweigh the risks, especially if used early or as a prophylactic. Other reports suggest HCQ should be used with zinc.
Those specialists who have expressed guarded or outright optimism include:
Dr Stephen Smith, an infectious disease specialist based in New Jersey.
Dr Ramin Oskoui, CEO of Foxhall Cardiology in Washington DC.
Dr Harvey Risch, Professor of Epidemiology at the Yale School of Public Health and Yale School of Medicine.
Dr Anthony Cardillo, CEO of Mend Urgent Care of Los Angeles.
Dr Drew Pinsky, the globally-recognised California internist.
Dr Joseph Raminian, an infectious disease specialist at NYU Langone Health, New York.
Dr Vladimir Zelenko, a medical doctor based in New York.
Dr Pier Luigi Bartoletti, of the Italian Federation of General Practitioners.
Professor Didier Raoult, of l’Institut Hospitalo-Universitaire Méditerranée Infection in Marseille.
Dr William W O’Neill, medical director of the Center for Structural Heart Disease at Henry Ford Hospital in Detroit.
They are joined by President Trump’s personal physician, Dr Sean Conley (a former commander in the US Navy) who wrote on May 18: ‘After numerous discussions [the President] and I had regarding the evidence for and against the use of HCQ, we concluded the potential benefit from the treatment outweighed the risks.’
And in the TCW article that Trump shared with his more than 80million Twitter followers, my focus was on the missing link, zinc, which is believed by several specialists to be useful for improving efficacy of the treatment.
The purpose of this piece is to highlight specific aspects of a topic of major concern for readers in the hope that it might be more effectively addressed, in the interest of public information, by the UK authorities and by the media. It does not seek to offer expert opinion about medical treatment, nor is the author qualified to do so. Medical advice, and advice about treatment, should be sought only from a qualified professional.