When old ways of doing things prove insufficient, humans try something new. That’s true especially during emergencies like the coronavirus crisis, as doctors and engineers jury-rig lifesaving equipment and government officials scramble to find different ways to procure and disseminate critical supplies.
But how do you make sure the innovation itself is not a problem?
That tension underlies President Donald Trump’s fixation on hydroxychloroquine as a treatment for COVID-19, against the advice of his top medical advisers. Helping victims recover is an admirable goal, but Trump’s advocacy ignores numerous rules of scientific research. When actual human lives are at stake, that’s a slippery slope.
Hydroxychloroquine is an anti-malarial drug used to treat lupus and rheumatoid arthritis. Evidence that it works against COVID-19 is mostly anecdotal. No randomized controlled trial, the industry standard for testing, has been done. Scientific studies have been small, not controlled, and inconclusive; the most recent, published earlier this week from a trial in France, shows the drug did not help at all. But Gov. Andrew M. Cuomo said New York’s ongoing testing of hydroxychloroquine shows “positive” results. And the usually sclerotic Food and Drug Administration has given emergency approval to Trump’s plan to distribute millions of doses around the country on the theory that the potential benefits outweigh the potential risks.
And there are side effects — multiple cardiac issues and psychiatric problems among them. Without testing, doctors don’t know the appropriate dose for COVID-19 patients. And public interest created by Trump’s loud support has led to shortages of the drug with some state medical and pharmacy boards threatening physicians who write prescriptions for themselves, their families and healthy people. Patients who need hydroxychloroquine for its prescribed purposes are finding it harder to get.
There is much that’s wrong about Trump’s approach to hydroxychloroquine. He is taking advice from staffers and cronies who are neither doctors nor scientists. He is relying on gut instinct rather than science, and mistaking anecdote for proof. Not allowing Dr. Anthony Fauci, the nation’s top infectious disease expert and a hydroxychloroquine skeptic, to answer a question about the drug at a White House news briefing was an error that smacked of stifling information with which Trump disagrees. We hope there are no other motivations for Trump’s advocacy. But what about the doctor with a COVID-19 patient who’s failing? What is he or she supposed to do? Scientists worldwide are working on more than 140 experimental medicines and vaccines, and more than 250 clinical trials including those for drugs approved for other diseases. But the doctor in the intensive care unit doesn’t have the time to let scientific rigor evolve.
Trump is right to push the process, but wrong to present the drug as a panacea. By eschewing the nuance his role demands, he risks raising false hopes. Balancing the need to proceed responsibly with the desire to relieve suffering now is difficult. Until the science catches up, those decisions are best left to real doctors with real patients who need real help.
— The editorial board