Last week in Acts II and III we learned that our hero known as Hydroxychloroquine (HCQ), along with its sidekick azithromycin, had proven to be very effective in early pandemic clinical trials. As the curtain opens on Act IV this week, we learn how HCQ became the villain.
The American Veteran’s Administration study was not an RCT and it was not peer reviewed. It was a retrospective analysis of patients who did and did not get HCQ, in all U.S. Veterans medical centers up to April. They reported that 158 patients got the standard care (neither HCQ or azithromycin), 97 patients received HCQ, and 113 patients received the cocktail (HCQ + azithromycin). Of those with just standard care, 11% died, of those who just got HCQ, 28% died, and of those who got the cocktail, 22% died. Not very reassuring. However, the study cited, “The HCQ patients were sicker and were more likely to get the drug as a last resort”—just what Raoult had warned against. There were other problems with the study, particularly the use of chloroquine as interchangeable with HCQ---two very different drugs.
CNN grabbed the lukewarm results and ran with it. Anderson Cooper stated, “The President had been out there, touting hydroxychloroquine saying, ‘What do you have to lose?’” But the headline at the bottom of the screen answered that question as it said, “No Benefits, Higher Death Rate.” Raoult was furious and tried to explain the problems with the VA study, mainly giving HCQ to much sicker individuals, but his arguments fell on deaf ears.
Soon there was a mass movement of cherry-picking studies that met the talking point that the cocktail (HCZ) would kill people. There were now many studies showing HCQ didn’t work, and none that showed it did. Raoult continued to rail stating, “It is bizarre, but it is part of something, you know, that people are completely turned mad about one of the most prescribed medications in the history of humanity.”
Meanwhile, there was another drug, newly developed for Ebola called remdesivir that started gaining traction. Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases and on the Trump COVID-19 task force was very enthusiastic about remdesivir. He was not complementary of HCQ. The early remdesivir studies showed modest early results, but Fauci claimed, “The data show that remdesivir has a clear-cut significant positive effect in diminishing the time of recovery. This is really quite important.” That study showed a mortality rate of 8.0% vs 11.6% mortality in the placebo group---statistically significant, but not a cure all. Additionally, the WHO had leaked a report by accident that showed remdesivir had no benefits and that it caused serious side effects to some. However, the data was enough for the media and they were now cheering for the new kid in town as our hero’s reputation was smeared in the mud.
By May 1, the National Institute of Health (NIH) COVID-19 Treatment Guidelines allowed for the emergency use of remdesivir and started limiting HCQ saying it could only be used in the hospital---exactly where it wouldn’t be as effective. At the same time investigative journalist Sharyl Attkisson looked into the financial links of members of the group that was all of a sudden restricting HCQ and pushing, instead, remdesivir. She and her team found the ties of those on the committee were connected to Gilead, the company that makes remdesivir, which costs $3,500 for a treatment series. It was not just a few who had ties, no, actually, Attkisson found 11 members reporting links to Gilead, and two were on Gilead’s advisory board. Others from the NIH committee were paid consultants or had received research money. Nobody reported ties to hydroxychloroquine, which is now manufactured generically and is extremely cheap. Attkisson’s team also found that one of the authors of the VA study that indicated HCQ caused increased deaths had received research funding from Gilead, “including a $247,000 grant in 2018.”
Another argument used by those who opposed the use of HCQ gave as their reason for opposition because “we can’t have people using HCQ for COVID-19 because we need to keep supplies for people with rheumatoid arthritis and lupus, who are dependent on it.” Harvard Medical School cardiologist Haider Warraich in the New York Times stated, “The bottom line is that even as we are in the midst of the pandemic with a climbing death toll, hydroxychloroquine has potentially added to the body count because of its serious possible side effects—like liver and kidney damage, heart failure and cardiac arrest—and by creating a shortage of the drug for patients with lupus, whose disease flares when they don’t take hydroxychloroquine.”
Actually, Warraich was correct about the shortage of HCQ in America. Part of the reason was because other countries like Switzerland, India, Brazil and Israel, among others, were using it because their public health officials considered it safe and promising enough that physicians all over the world were using it prophylactically for themselves.
By May two more publications showed that HCQ and chloroquine (not the same thing) increased the death rate in COVID patients by 30% and caused heart problems. The first study was published in the Lancet and was supposedly based on data taken from 96,000 patients. That same data set was in part used in the second study published in the New England Journal of Medicine. It, too, claimed basically the same outcome and although it wasn’t an RCT the big numbers served to impress the health care world. When the New York Times declared, “Malaria Drug Taken by Trump Is Tied to Increased Heart Problems and Death in Study”, the reaction around the world couldn’t have been more swift. The WHO immediately suspended its own clinical trial on HCQ, the United Kingdom suspended all their studies, and even France reversed its policy that had allowed HCQ to be used. On June 15, the FDA revoked the emergency status use of HCQ. All of a sudden, research groups could no longer access HCQ for their studies, and all of them were abandoned right in the middle of a pandemic.
Next week will see the end of this melodrama. Stay tuned to see what happens to our hero and sidekick. Stay tuned.