Trump’s ‘Hail Mary’ drug push rattles his health team

Source: Politico | April 6, 2020 | Dan Diamond and Nancy Cook

Some health officials see Trump’s promotion of hydroxychloroquine as an effort to make up time lost early in the coronavirus outbreak.

Top health officials are increasingly unsettled by President Donald Trump’s continued championing of an unproven drug in the fight against the coronavirus pandemic, even as some of the president’s political and policy advisers and outside allies cheer him on.

A growing number of senior Trump appointees have moved toward viewing hydroxychloroquine, a pill typically used to treat malaria and lupus, as a potential salve for the Covid-19 outbreak — adding it to the national stockpile, urging manufacturers to ramp up its production and sending huge shipments of the drug to hospitals and pharmacies in hot zones like New York City where doctors are free to prescribe it to patients.

Trump has become an avid promoter of the drug from the White House podium. “What really do we have to lose?” he told reporters over the weekend. “It is a very strong, powerful medicine. It does not kill people. We have some very good results and some very good tests,” he added, glossing over concerns from some of his own officials, who fear that the evidence of the drug’s efficacy is anecdotal at best.

The nation’s top infectious-disease expert, Anthony Fauci, has repeatedly warned in public and private that no definitive evidence exists about the drug. Behind the scenes, career health officials have raised even stronger warnings about the risk to some Americans’ heart health and other complications, but been warned not to publicly speak out and potentially contradict Trump, said two officials.

The divide highlights widening tensions in the Trump administration between protecting the American public against the spread of the coronavirus and reopening the economy as soon as possible. The president and many of his economic, policy and political advisers within the White House are trying to overrule scientific experts who increasingly worry that touting the drugs could harm Americans and cost valuable time to research other treatments. Interviews with more than a dozen officials for this story highlighted tensions within the administration that are occupying increasing amounts of time among health officials and drawing attention away from other critical issues.

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Trump’s focus on the drugs — driven by his faith in scant evidence that they work to speed recovery from Covid-19 — has increasingly warped his administration’s response. Health officials have been told to prioritize the anti-malaria drugs over other projects that scientists believe have more potential to fight the outbreak.

The rush to focus on unproven drugs also comes after months of lost opportunities to contain the spread of the outbreak. “There’d be less focus on [hydroxychloroquine] now if we had planned better then,” said one official, who added that the drug is seen by some career scientists as a “Hail Mary” effort to find a Covid-19 cure.

Trump is as enthusiastic about the drug in private as he is in public, said one senior administration official. He talks about the drug so often, another official added, because he views it as a potential therapy for the coronavirus when people have no other options.

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Officials generally describe three camps inside the administration on the hydroxychloroquine debate: One group of Trump devotees, like Navarro and other policy advisers and outside allies, who fully support the president’s belief that the drugs represent a viable path to rapidly controlling the outbreak.

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Meanwhile, officials in a second group, such as Surgeon General Jerome Adams and Food and Drug Administration Commissioner Stephen Hahn, are willing to entertain the possibility that the drugs work — given the lack of other existing treatments — but stress that the decision should be made between a doctor and a patient.

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Finally, a third group of officials — like Fauci — have repeatedly taken a tougher line against widespread use of the drugs, urging the president to wait on what clinical trials will reveal. Officials also have grown concerned about the president’s advocacy of combining hydroxychloroquine and zithromax, a treatment that some front-line providers have attempted but could significantly raise the risk of cardiac problems.

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Two officials said Fauci and another top health adviser, White House coronavirus coordinator Deborah Birx, have been boxed in as they work to keep the president’s ear on public health measures like social distancing.

They also have lacked robust allies: Centers for Disease Control and Prevention Director Robert Redfield, who’s been minimized in recent weeks, and other career scientists, have also struggled to effectively warn the president away from his focus on hydroxychloroquine, the officials said. White House officials, in particular, hold Redfield and the CDC responsible for the country’s lag in producing an adequate number of tests for the coronavirus.

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But the debate alone has caused significant frustration in the medical field, with doctors saying that Trump is amplifying shoddy science while ignoring the risks. “Public figures should refrain from promoting unproven therapies to the public,” physicians in the Annals of Internal Medicine argue. “The hasty and inappropriate interpretation of the literature by public leaders has potential to do serious harm.”

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