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Like me, you’ve probably wondered how and why the president of the United States became the world’s number one hype man for an anti-malaria drug called hydroxychloroquine—and, knowing who the president is, what exactly is in it for him. There’s been some pretty good reporting on this over the last few days, so I want to walk you through two theories, which aren’t mutually exclusive.

But first, a quick guide to the president’s relationship with hydroxychloroquine

What he says: “In the past several days, [Trump] has been advocating that people infected with the novel coronavirus consider taking hydroxychloroquine in consultation with their doctors. He remarked Sunday that ‘a lot of people are saying’ patients should take the drug and called it ‘a very special thing.’”

What his friends tell him: “He hears about the controversial anti-malarial drug on the phone from friends in New York, including from his personal attorney Rudolph W. Giuliani. He hears about it in White House meetings from some advisers eager to please the boss, who share anecdotes of the drug working on covid-19 patients. And he hears about it on television, from physicians on Fox News Channel panels who tout its efficacy.”

What his other friends tell him: “Mr. Trump first expressed interest in hydroxychloroquine a few weeks ago, telling associates that [Larry] Ellison, a billionaire and a founder of Oracle, had discussed it with him. At the time, Dr. Mehmet Oz, the host of television’s The Doctor Oz Show, was in touch with Mr. Trump’s advisers about expediting approval to use the drug for the coronavirus. Mr. Giuliani has urged Mr. Trump to embrace the drug, based in part on the advice of Dr. Vladimir Zelenko, a self-described simple country doctor who has become a hit on conservative media after administering a cocktail of hydroxychloroquine, the antibiotic azithromycin, and zinc sulfate.”

How he reacts: “Over the weekend, Trump’s task force decided to rush-deliver hydroxychloroquine to hospitals and pharmacies in the New York area, Detroit, New Orleans, and other coronavirus hot zones, provided that the medicine be administered to patients only on the advice of their doctors. … The action came after Trump met with [Fox News host Laura] Ingraham, who has been enthusiastically promoting hydroxychloroquine on her 10 p.m. show. She brought along two guests of her program—Ramin Oskoui, a Washington-based cardiologist, and Stephen Smith, a New Jersey-based infectious disease specialist—and Trump asked that FDA Commissioner Stephen Hahn attend as well. Smith made a detailed presentation to Trump about his view on treatment, putting an emphasis on the benefits of hydroxychloroquine based on his own experiences and studies.”

→ THEORY 1—MIRACLE DRUG: In Monday’s newsletter, I mentioned the recent Associated Press and Washington Post stories detailing how the administration’s bungling cost the government both a chance to contain the coronavirus before it spread and then to meet the demand for medical equipment before the peak of the crisis hit. Trump wants to lay the blame somewhere else, but that gets harder to do when stories like this keep dropping: 

“A top White House adviser starkly warned Trump administration officials in late January that the coronavirus crisis could cost the United States trillions of dollars and put millions of Americans at risk of illness or death. … ‘The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,’ [Peter] Navarro’s memo said. “This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.’”

“Dated Jan. 29, it came during a period when Mr. Trump was playing down the risks to the United States, and he would later go on to say that no one could have predicted such a devastating outcome.”

The longer this drags on—the pandemic, the economic carnage—the worse the political fallout will be. Hydroxychloroquine offers a glimmer of hope. Per The Washington Post: “Trump’s focus on hydroxychloroquine stems from a place of desperation and an optimism that the drug will work, even if the science is not conclusive, allies said. As one person put it, ‘The president lives in a world of wishes and hope.’ ‘It’s the only thing anyone has held out as offering an immediate reprieve from what’s become his greatest challenge—and political threat,’ said a former senior administration official. This official described the president’s ‘overwhelming desire for a silver bullet to make it all go away.’”

→ THEORY 2—$$$$: As with any New York Times story to which Peter Baker affixes his byline, this piece on Trump’s love affair with hydroxychloroquine goes out of its way to both-sides the president’s fantasyland. But it does conjure up legitimate news—even if it buries it in the sixth paragraph.   

“If hydroxychloroquine becomes an accepted treatment, several pharmaceutical companies stand to profit, including shareholders and senior executives with connections to the president. Mr. Trump himself has a small personal financial interest in Sanofi, the French drugmaker that makes Plaquenil, the brand-name version of hydroxychloroquine.”

I want to learn more! Let’s go to, um, paragraph 23—who the hell edited this thing, anyway? “Some associates of Mr. Trump’s have financial interests in the issue. Sanofi’s largest shareholders include Fisher Asset Management, the investment company run by Ken Fisher, a major donor to Republicans, including Mr. Trump. … Another investor in both Sanofi and Mylan, another pharmaceutical firm, is Invesco, the fund previously run by Wilbur Ross, the commerce secretary.” 

You don’t say? “As of last year, Mr. Trump reported that his three family trusts each had investments in a Dodge & Cox mutual fund, whose largest holding was in Sanofi. Ashleigh Koss, a Sanofi spokeswoman, said the company no longer sells or distributes Plaquenil in the United States, although it does sell it internationally.”

But wait, there’s more: “Several generic drugmakers are gearing up to produce hydroxychloroquine pills, including Amneal Pharmaceuticals, whose co-founder Chirag Patel is a member of Trump National Golf Course Bedminster in New Jersey and has golfed with Mr. Trump at least twice since he became president, according to a person who saw them.”

And what about this? “It just so happens that one of the largest manufacturers of the drug, Novartis, previously paid Trump’s now-incarcerated former personal attorney Michael Cohen more than $1 million for healthcare policy insight following Trump’s election in 2016.”

→ REALITY CHECK: On March 31, the Annals of Internal Medicine issued an advisory to doctors on the use of hydroxychloroquine during the pandemic. 

“The antimalarials hydroxychloroquine (HCQ) and chloroquine (CQ) have demonstrated antiviral activity against severe acute respiratory syndrome–coronavirus 2 (SARS–CoV-2) in vitro and in small, poorly controlled or uncontrolled clinical studies. Normally, such research would be deemed hypothesis-generating at best.”

“Data to support the use of HCQ and CQ for COVID-19 are limited and inconclusive. The drugs have some in vitro activity against several viruses, including coronaviruses and influenza, but previous randomized trials in patients with influenza have been negative. In COVID-19, one small nonrandomized study from France demonstrated benefit but had serious methodological flaws, and a follow-up study still lacked a control group. Yet, another very small, randomized study from China in patients with mild to moderate COVID-19 found no difference in recovery rates.”

“Sadly, reports of adverse events have increased, with several countries reporting poisonings and at least 1 death reported in a patient who drank fish tank cleaner because of its CQ content. Antimalarial drugs can cause ventricular arrhythmias, QT prolongation, and other cardiac toxicity, which may pose particular risk to critically ill persons. Given these serious potential adverse effects, the hasty and inappropriate interpretation of the literature by public leaders has potential to do serious harm.” 

→ WHAT IT MEANS: It’s possible that hydroxychloroquine helps to treat COVID-19. It’s also possible that it does absolutely nothing. That’s why drugs typically undergo controlled studies, so you can tell whether people are recovering because of the treatment or on their own. Without a control group, we don’t know what effect, if any, the drug is having if the people who are taking it improve. And while the drug itself is a known quantity—used by lupus and malaria patients, among others—it’s not without side effects. 

“Hydroxychloroquine has a number of serious side effects, chief among them its impact on the ‘QT interval’—the time it takes for the heart’s electrical system to reset between contractions, which push blood into the vascular system and around the body, according to Mark Gladwin, chairman of the Department of Medicine at the University of Pittsburgh School of Medicine. This raises the risk of heart arrhythmias—irregular heartbeats—that can be fatal, he said.”

“With many covid-19 patients arriving at hospitals as emergencies, it is not always possible for doctors to know what other drugs a patient is taking or conduct an electrocardiogram, making use of the drug dangerous, Gladwin said. Because hydroxychloroquine hasn’t been studied in valid large-scale research, doctors can’t know the appropriate dose for any covid-19 patient. Also, the disease is causing a heart infection, myocarditis, in some of the most seriously ill patients.”

In New York, doctors are using it because they don’t know what else to do, and they have no idea if it works: “Doctors at Northwell Health and Mount Sinai Health System are using it as well. At the Mount Sinai South Nassau County branch on Long Island, doctors have employed a regimen of hydroxychloroquine and azithromycin ‘pretty much since day one’ with mixed results, said Dr. Adhi Sharma, its chief medical officer. ‘We’ve been throwing the kitchen sink at these patients,’ he said. ‘I can’t tell whether someone got better on their own or because of the medication.’”


Here’s some non-coronavirus news. State elections guru Michael Bitzer dug through the March 3 primary voter files for a sense of what the electorate looked like. A few highlights: 

Turnout was 31%, down from 35% in the 2016 primary. 

62% of voters cast Democratic ballots; 37% cast Republican ones. 

33% of registered white voters showed up; 30% of African American voters did; 20% of “other races” did.

The Democrats were overwhelmingly female (57–39), while the Republicans were evenly split (49–49). 

Gen Zs and Millennials are overwhelmingly Democratic—if Democrats can keep them interested. 

If you’re wondering why Joe Biden blew out Bernie Sanders, here ya go: 

Click here to read the rest of today’s PRIMER.

The newsletter is sponsored this week by Village Hearth Cohousing, a 55-and-up Durham cohousing community for the LGBTQ community, allies, and friends that will open in mid-May. They’ve brought together wonderful people from all over the country, and they’ve only got four homes left. Would you like to join them? Learn more about Village Hearth and whether it could be right for you or someone you love.  

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