President Trump lost patience on Sunday when a reporter asked Anthony Fauci about the effectiveness of anti-malarial drugs chloroquine and hydroxychloroquine. Interjecting to prevent the director of the National Institute of Allergy and Infectious Diseases from answering, Trump scolded the reporter, saying, “He’s answered the question 15 times.”
The exchange brought to the surface growing tensions that have been reported within the administration between those pushing the promise of the drug and those urging caution.
But there really shouldn’t be much need for this to become a heated debate. The simple solution is that Trump and other public officials should not get ahead of their skis in promoting any drugs as a miracle cure for the coronavirus until there is sufficient scientific evidence. At the same time, doctors should be allowed to discuss with their patients whether they want to give the drugs a shot.
Trump has said, “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.” And, at press briefings, he has consistently promoted the treatment, repeatedly asking over the weekend, “What do you have to lose?”
Right now, the evidence in favor of hydroxychloroquine and azithromycin is quite thin. There have been some studies in France and China with a small number of mildly symptomatic COVID-19 patients that suggested that the drug combination could help. There have also been some anecdotal reports from doctors and nurses using the treatment. However, there have also been small studies finding the drug combination does not help.
Ultimately, this debate won’t be resolved until there are results from a randomized controlled trial in which COVID-19 patients with similar characteristics are split into groups, given either drugs or a placebo, and then the results are compared. This will not take forever. There are currently such trials underway that should provide a more definitive answer by sometime in May.
So, what to do in the intervening time? Trump shouldn’t be arguing that there’s nothing to lose — for instance, hydroxychloroquine could contribute to heart arrhythmia that can lead to cardiac arrest. And the hoarding of these drugs could render them unavailable to treat the illnesses for which we already know they’re effective. But as the number of cases rapidly rises in the United States and the death toll increases, it certainly makes sense to encourage doctors to do whatever they believe has a chance of improving outcomes for their patients, within reasonable guidelines.
In this case, these drugs have been around for decades, and their general safety has been tested, even though there are potential side effects. Given that this is a prescription drug rather than one that can be purchased over the counter, doctors should be trusted to weigh these risks with their patients. In an emergency, our healthcare system should allow for a certain degree of trial and error.
