‘What do you have to lose?’: Inside Trump’s embrace of a risky drug against coronavirus

In fact, Fox host Laura Ingraham and two doctors who are regular on-air guests in what she dubs her “medical cabinet” visited the White House last Friday for a private meeting with Trump to talk up the drug, according to two White House officials and another person familiar with the meeting.

Never mind that hydroxychloroquine is an unproven treatment for covid-19 and is still in the testing stages, or that it has dangerous side effects, or that medical professionals are divided on its capability. The infectious disease expert on Trump’s own coronavirus task force, Anthony S. Fauci, has privately pleaded with the president to be more cautious.

But Trump — who famously has said he trusts his gut more than anything an expert could counsel him — is again letting his impulses guide what he tells a locked-down nation eager to return to normal.

The past several days he has been advocating thatpeople infected with the 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.”

As the president has said repeatedly, “What do you have to lose?”

Trump’s swift embrace of hydroxychloroquine — as well as azithromycin, which he has hyped as “one of the biggest game changers in the history of medicine” — illustrates the degree to which the president prioritizes anecdote and feeling over science and fact. It also has provoked an ugly divide within a White House already besieged as it struggles to make up for lost time in slowing the spread of the coronavirus.

The president has frequently clashed with or undercut scientists leading the effort against the virus, from equivocating on whether to wear masks in public to repeatedly pressing to reopen businesses sooner than advised by public health experts.

Hydroxychloroquine is still being studied for its effectiveness in treating covid-19, but the Food and Drug Administration already has approved it for malaria, lupus and rheumatoid arthritis. That means doctors can prescribe the drug for covid-19 or other ailments on an off-label basis. The agency also has authorized the emergency use of the drug from the Strategic National Stockpile for certain hospitalized patients.

Many doctors are reportedly taking the medication themselves as a potential preventive measure and are giving it to their patients, especially in New York, which has by far the largest number of coronavirus cases in the country.

Kenneth E. Raske, chief executive of the Greater New York Hospital Association, which represents all of New York City’s hospitals, said clinicians have reported that “the jury is still out” on the drug. Still, he said he did not believe the side effects were so deleterious that it should be avoided.

“We’re using those drugs extensively,” Raske said. “It’s not as if this is a distant conversation. The drug has been around for a long time. I think everybody is going into this eyes wide open.”

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.

“In peacetime, the conservative approach would be correct,” Peter Navarro, a trade adviser who recently was named the administration’s Defense Production Act policy coordinator, said in an interview. “In wartime, with the potential of mass casualties, you may have to be more forward-leaning and accept additional risk.”

The action came after Trump met with Ingraham, who has been enthusiastically promoting hydroxychloroquine on her 10 p.m. Fox News 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, according to two White House officials and a person familiar with the meeting.

Trump listened intently, they said, and emerged from that meeting seemingly determined to advocate for hydroxychloroquine to be more widely used.

Smith, who has known Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, for decades and has treated more than 100 covid-19 patients, said in an interview Monday that he walked Trump through a spreadsheet and other documents about how hydroxchloroquine works and its uses during hospitalization.

“I’m a guy who looks at data,” Smith said. “I came as a scientist and physician. I trained under Dr. Fauci and respect him a lot.” He described Hahn as “supportive.”

The FDA declined to comment on the meeting. A senior administration official said that the session appeared to be an effort to press Trump to ratchet up his public support for the drug. The official, who spoke on the condition of anonymity because he was not authorized to speak on the matter, said Hahn has been flexible in handling the drug but wasn’t comfortable endorsing it before trials are completed. Efforts to reach Oskoui by email and phone were not successful.

During Saturday’s task force meeting, Navarro pushed hard for the drug. He showed up with a folder of statistics and papers to forcefully argue the case for using the drug and got into a fight with Fauci over its efficacy, as first reported by Axios.

Navarro said the disagreement “isn’t a real debate. It’s Kabuki theater for political junkies.” A couple hours earlier, however, Navarro sounded provocative during an appearance on “Fox & Friends,” a morning show Trump often watches.

“I think history will judge who’s right on this debate, but I’d bet on President Trump’s intuition on this one,” he said.

The tension between Trump’s faith in an unproven drug and the reticence of public health experts to endorse it was evident at Sunday’s White House news conference, when CNN correspondent Jeremy Diamond asked Fauci for his opinion on hydroxychloroquine. Trump interrupted and said Fauci did not have to answer the question, and he scolded Diamond for asking. Fauci was silent.

White House spokesman Hogan Gidley insisted “there is no daylight” between Trump and Fauci regarding the drug and accused the media of trying to create “soap opera-like drama.”

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 patient. In addition, covid-19 is causing a heart infection, myocarditis, in some of the most seriously ill patients.

“The heart may already be involved in this virus,” Gladwin said. “And now we’re adding a drug that prolongs the QT [interval]. We have no idea what that will do in the setting of patient with covid-19.”

Scott Gottlieb, who served as FDA commissioner earlier in the Trump administration, said the data on hydroxychloroquine is “very preliminary” and the drug has been used widely in the United States and Europe without “any obvious benefit.” Clinical trial data is needed, he said. Meanwhile, he added, “We should focus on the drugs that are most likely to be transformative,” such as antibody drugs that are under study.

FDA spokesman Michael Felberbaum said, “The FDA’s role is to make independent, science-based decisions to bring new therapies to sick patients as quickly as possible, while at the same time supporting research to further evaluate whether these medical countermeasures are safe and effective for treating patients infected with this novel virus.”

Hydroxychloroquine had rarely come up in official task force meetings before Saturday’s explosive Navarro-Fauci discussion, which ended only after Vice President Pence and senior adviser Jared Kushner stepped in, according to a person with direct knowledge of the discussions.

Trump’s obsession with 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 who, like some other officials interviewed for this story, spoke on the condition of anonymity to offer a candid assessment. This official described the president’s “overwhelming desire for a silver bullet to make it all go away.”

Trump’s aides are giving him reason to believe. White House officials compiled upbeat news articles about people who said they were helped by the experimental drug to give to the president. And on Monday, an email blast went out to administration aides with the subject: “CORONAVIRUS FLAG: LA doctor seeing success with hydroxychloroquine to treat COVID-19,” linking to a story from KABC in Los Angeles.

“The president is talking to so many people in New York — friends, Wall Street guys, real estate guys,” one White House official said. “He’s hearing about this drug and he’s seeing his own optimism repeated back to him on Fox News. It’s all self-reinforcing. An echo chamber.”

Trump has pressured Hahn to make more favorable statements about hydroxychloroquine and has regularly raised it with him, according to two White House officials with knowledge of the discussions.

At times, Trump has grown frustrated because some of the doctors in his administration — including Hahn and Fauci — have conceded privately that there is some anecdotal evidence the drug may work, but will not state so publicly at the president’s news conferences, these officials said.

Another regular on Fox News, New York-based oncologist William Grace, has suddenly emerged as an influential voice in Trump’s orbit despite having no formal links to the government. Grace has appeared regularly on Ingraham’s show touting hydroxychloroquine.

Grace said in an interview that as he has tracked the pandemic as a self-described “interested physician,” he has become convinced that the “drugs are working, that fewer people are having to go to the respirators at places like Lenox Hill hospital.” 

Grace is not a spokesman for the hospital or approved to speak about its use of hydroxychloroquine on patients. When Ingraham posted a tweet on March 20 about Grace’s comments regarding the hospital, Twitter deleted it for violating the platform’s policies, and the hospital said in a statement that “his views are his own and do not represent the hospital.” 

Grace has continued to speak out, and has been communicating with Navarro.

“I don’t know of a single institution anywhere that’s not treating inpatients with hydroxychloroquine,” Grace said. “It’s being implemented very quickly all over. You’ve never seen such speed.” 

Peter Lurie, a top FDA official in the Obama administration who is now president of Center for Science in the Public Interest, said he was concerned that Trump’s campaign for hydroxychloroquine undercuts the FDA’s fundamental philosophy on approving drugs.

“When the president says, ‘What have you got to lose?’ that is profoundly different than what the science-based agencies have been trying to communicate to the public for decades,” Lurie said.

Lenny Bernstein contributed to this report.

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