Manufactured Fear During Hydroxychloroquine's Trump Moment

The Chloroquine Wars Part XII

“If Hitler invaded hell I would make at least a favourable reference to the devil in the House of Commons.” –Winston Churchill

Most people do not suffer from Narcissistic Personality Disorder (NPD), but a great many people will twist and contort themselves, tell lies small and large, to avoid playing the fool under the spotlight. We all feel that pressure, not knowing how much of that is in our nature and how much is taught to us through repeated demonstrations of humiliation. Only the very strong learn to stand up to that pressure, and for the most part, they learn wisely to do so backed with solid support. But in a nation of such fractured and disjointed communities, fearing cancel-culture and anxiety over the inability to make a decent living, many succumb to the pressure. To avoid suffering, they either learn to hide in silence, or simply join the jeering crowds---going along to get along.

At a White House press conference addressing the pandemic, held on March 19, 2020, President Trump spoke optimistically about a pair of drugs for which the Food and Drug Administration (FDA) gave emergency approval:

So you have remdesivir and you have hydroxychloroquine. So those are two that are out now, essentially approved for prescribed use. And I think it’s going to be very exciting. I think it could be a game changer, and maybe not and maybe not, but I think it could be, based on what I see, it could be a game changer. Very powerful. They’re very powerful.

Trump also made the very reasonable observation that HCQ has “been around for a long time, so we know that if things don’t go as planned it’s not going to kill anybody. When you go with a brand new drug, you don’t know that that’s going to happen.” While it is always possible that a drug could conceivably interact poorly with a novel virus, the odds were extremely high that this would not be the case, and large bodies of evidence seemed then and seem now to confirm Trump’s statement.

What happened next was baffling, even in this era of politics. The American media which had been eerily and suspiciously silent about CQ and HCQ (while other nations were taking it up as standard treatment and reporting success), suddenly went into overdrive denigrating the suggestion that the drugs might work in treating the novel coronavirus and COVID-19. Their method seemed to revolve primarily around associating the drugs with Trump, while using National Institute of Allergy and Infectious Diseases (NIAID) director Anthony Fauci as Trump’s perfect nemesis. It all seemed as if the media never wanted to find out much about the drug and the evidence developing around the world.

To their credit, a handful of mainstream media organizations ran basic, apolitical articles about hydroxychloroquine in the twenty-four hours after Trump introduced it as “could be a game changer, and maybe not”. Sai Balasubramanian’s article in Forbes stands out as one such apolitical example. He gave a brief explanation of the drug and acknowledged that the evidence was new and developing. That same day, Aristos Georgiou wrote about HCQ in Newsweek, describing the then-present state of Dr. Didier Raoult’s research in a neutral tone. However, these articles seemed to be the exception more than the norm.

In a Vox article published the day after Trump’s first mention of HCQ, the medicine was referred to as “Trump’s new favorite treatment,” establishing the association in people’s minds. Such association might (ahem) lead those who dislike or distrust Trump to reject the idea of the HCQ Hypothesis before hardly learning what it entailed, or what further evidence might unfold. The article quoted Fauci as saying, “The evidence was thin and anecdotal,” with no further explanation of what that evidence entailed. Here Fauci became elevated to the position of “anti-Trump”, a new association for many readers, and one repeated in many articles and news reports to come. The Vox article goes on to describe inaccurately the evidence of HCQ efficacy to date, with key exclusions including its then-recent usage in Costa Rica, Spain, Indonesia, Italy, and other nations.

On March 21, USA Today really set the tone declaring that “Trump peddles snake oil”, implying that “the science is settled” already. Such a hard to walk back statement suggests a commitment to a shared journey of cognitive dissonance and the rejection of future evidence---the very antithesis of the scientific method. This and other articles began using the word “contradict” to describe mundane statements made by health authorities, such as an FDA official saying that they had not yet approved any drug for COVID-19 treatment.

In the Washington Post, in an opinion piece derisively titled, “Trump’s not a doctor. He’s only playing one on TV,” chief architect of the Affordable Care Act, Zeke Emanuel, called Trump’s promotion of HCQ “irresponsible”, “sloppy science”, and “dangerous policy”. While he talks of “unpredictable harms”, he never conveys the long safety record HCQ enjoys, compares it with other ordinary medicines, or weighs the benefits of its potential success. While he writes about experiments, he never once mentions the many nations already using HCQ at that time, nearly all of which had lower fatality rates and deaths per million than does the United States (and still do a year later). The primary effect of the article was likely to further ingrain a partisan association with the subject matter, along with the subtext, “Whatever good SCIENCE exists, it can only be on our side [so you won’t need to think any more about it].”

Meanwhile, as dozens of news stories further ingrained the association of HCQ and Trump, scary reports of shortages of HCQ began to surface in the media, starting within a day of Trump’s first public mention of the drug. Those who take HCQ for lupus, rheumatoid arthritis, or the many other auto-immune conditions for which it treats, often do so daily. These chronic HCQ users require a steady and healthy supply of the drug and a handful of them found it unavailable at their local pharmacy. A letter documenting brief supply shortages in the U.S. was eventually published in the BMJ, but there were no claims in late March that anyone at all was unable to obtain HCQ.

In the wake of HCQ’s Trump moment, doctors around the U.S. wrote many prescriptions for the drug. Most were likely well-intended without too much thought or knowledge of the capacity of the drug supply chain. A few were likely dubious and with the intention of stockpiling for family or friends in case of extreme emergency. After all, the extent of harm of the pandemic was still unknown and many believed the death toll would be larger than what was seen during the first half of 2020. When timing could be of the essence, a box of medicine at least eased anxieties.

On March 19, the day of Trump’s press conference, the drug maker Mylan announced that it would ramp up HCQ production to provide 50 million additional tablets. The following day, not to be outdone, Novartis committed to donating 130 million pills including its entire stock of 50 million pills on hand. Other companies piled on commitments and immediate contributions to the pool of medicine. A strategic national stockpile of HCQ was quickly organized to ensure supply for chronic users. By April 5, that stockpile stood at 29 million doses and grew to 63 million doses ten weeks later.

That did not stop the Washington Post from running an article on March 20 entitled, “As Trump touts an unproven coronavirus treatment, supplies evaporate for patients who need those drugs,” (emphasis ours). The article begins by saying that the “U.S. has all but exhausted its supplies of two anti-malarial drugs,” despite the fact that there was not a single claim in the country of a patient waiting more than 24 hours to receive the drug. As the article in the BMJ notes, lupus symptoms “can flare up in as little as 2 weeks after HCQ cessation,” due to the drug’s long half life in the body. After setting up the scary story and associating it with Trump, the article points out that the real pressure in the supply chain came from large hospital purchases prior to Trump’s first mention of HCQ, then goes on to talk about the commitment of manufacturers to quickly alleviate that pressure. But how many people read past the headline, anyhow?

The supply shortage story continued for weeks in various news outlets, culminating in a JAMA article dramatically declaring, “First, Do No Harm,” published on April 29. While Trump gets mentioned in the first words of the article, the article describes potential harms of a shortage without ever discussing the national stockpile set up weeks before its publication. The article also brings up the story of the Arizona man who died after ingesting aquarium cleaner without mentioning either the extreme rarity of such events, historically, nor the suspicious nature of the story.

Regardless of the details, such articles further associated HCQ with Trump and a sense of danger and recklessness, not to mention an artificial partisanship over the process of finding out how best to use the drug. They also laid the foundation for misguided bans on the drug, as well as intimidating warnings to physicians. Under Governor Gretchen Whitmer, Michigan’s Department of Licensing and Regulatory Affairs published a letter on March 24, 2020, warning of professional consequences for doctors or pharmacists prescribing HCQ for COVID-19 patients. She even added a reminder that medical professionals are required to rat each other out. Nevada’s Governor Steve Sisolak outright banned both HCQ and CQ as prophylaxis for the novel coronavirus and treatment of COVID-19. Other Democratic governors pushed through restrictions on HCQ, though most or all were rescinded months later. Remember, this is all shortly after hospitals ramped up supplies, (at least) hundreds of researchers were committing to scores of experiments to test HCQ or CQ efficacy, and HCQ was most highly favored by the largest portion of the medical community.

So, is “Trump Derangement Syndrome” to blame for the media blitz to convince Americans, or at least the ones who hate or fear Trump, that HCQ is a crazy, dangerous, unproven shot-in-the dark with scary consequences? 

Look back to where Trump first talked about HCQ in that March 19 press conference. When he suggested that HCQ could be a “game changer”, he followed up with “maybe, maybe not”. He also promoted the possibility that Gilead’s drug, remdesivir, might also work. Why didn’t the media go after remdesivir in the same way? Is this really all about Trump, or is Trump simply the boogie man set up to create an association in people’s minds---to encourage Never Trumpers to shield themselves from facts with an already well developed cognitive bias, and to project that pressure onto doctors themselves, if not other social groups? Is the point to promote outrage in a way that affects public health policy, or justify excuses for prohibition?

Without going deep into the details, we take this moment to note that a starkly parallel story took place in Brazil, whose president, Jair Bolsonaro, is often described as Brazil’s right-wing analog of Trump. So too did those stories similarly infuse the medical discussion of HCQ with a harshly partisan tinge. It is noteworthy that Bolsonaro stopped pushing HCQ shortly after Trump stepped back from it.

One observation we take away from all this media frenzy is not that articles are still published daily derisively associating HCQ with Trump (or Bolsonaro or even Dr. Didier Raoult). More to the point is that prior to March 19, the entire Western media outside of immediate proximity to Raoult were completely silent about HCQ. But within 48 hours, a large proportion of that media seemed to know enough medical biology to conclude that HCQ is a terrible, dangerous drug, and to use Trump and Fauci as Hegelian puppets to repeat that story daily while narcissistic clowns perform their own versions of the debate on social media until a desired narrative could develop that would control the outcome.

Suppose you were an evil mastermind who wanted to convince or harass the world into not making use of an effective medication during a pandemic, perhaps in order to take authoritarian control over entire economies, but you want to limit the baggage that obviously comes with large conspiracies. Could you hire just three prominent men, a handful of researchers, and a few media gatekeepers to pull it off? 

Who could stop you?