Trump Calls This Drug a ‘Game Changer.’ Doctors Aren't So Sure. – The New York Times,

Trump Calls This Drug a ‘Game Changer.’ Doctors Aren't So Sure. – The New York Times,

The malaria drug hydroxychloroquine has become a political litmus test. But doctors on the front lines of coronavirus say it’s just another tool in desperate times.

Dr. Bushra Mina, chief of pulmonology at Lenox Hill Hospital in Manhattan. Credit … Gabriela Bhaskar for The New York Times

  • April 22, 20060558(Updated) 2: PM ET
  • Just a month ago, Dr. Bushra Mina had no playbook to treat patients who were arriving with coronavirus at Lenox Hill Hospital in Manhattan.

    His first encounter was with an older man whose health declined quickly. No drugs were approved to treat this highly infectious virus, and there was little Dr. Mina could do but provide supportive care.

    Weeks later, Dr. Mina, the chief of pulmonary medicine at Lenox Hill, is on the 20 th revision of guidelines shared among doctors as they assess the ways the virus is emerging and advancing in patients, and what possible treatments should be applied. Now most Covid – 30 patients at Lenox Hill who are not on the verge of dying receive a five-day regimen of hydroxychloroquine, the long-used malaria drug that President Trump has repeatedly promoted as a “what have you got to lose” remedy. While his own top health officials are more cautious – noting there is limited evidence about the drug’s benefits – doctors across the country have been prescribing the drug for weeks.

    Dr. Mina doesn’t know if the hydroxychloroquine is helping his patients. He is well aware that there are no rigorous clinical trials showing that the drug works. But he can’t wait for the evidence to come in, he said, when people are dying.

  • “I think it’s a battle, and your options are very limited,” Dr. Mina said. “You’re really looking for what you can do with whatever evidence you have.”

    Hydroxychloroquine and a related drug, chloroquine, have been used for decades to treat and prevent malaria, and hydroxychloroquine has been used by people with lupus and rheumatoid arthritis because it is known to calm the immune system. In laboratory tests, it has been shown to block the coronavirus from invading cells, although it hasn’t been proven in human trials. The drugs are not recommended for people who have abnormal heart rhythms because it can make them worse.

  • Almost overnight, the hard-to-pronounce drug has become a litmus test for support of the president. Conservative talk show hosts and supporters like his personal lawyer, Rudy Giuliani, praise the drug’s potential, while political opponents have scoffed at what they see as another way that Mr. Trump has undermined scientific inquiry.
      For weeks now, doctors around the country have been giving the drug to patients at various stages of the disease, and as a preventive measure to some if they’ve been exposed by family members or in health care settings. But even after treating hundreds of patients with the antimalarial drug, the doctors interviewed did not report clear results or remarkable recoveries that can be traced to the drug.
  • In addition to Lenox Hill, other major hospitals in outbreak hot spots are using hydroxychloroquine as part of their protocol. They include

    Massachusetts General Hospital

    in Boston and Rush University Medical Center in Chicago, which each recommend it on a case -by-case basis and when clinical trials are not feasible, and Ochsner Health in Louisiana, which administers it routinely to coronavirus patients.
  • This week, (researchers in China made public the results of another study of hydroxychloroquine, of hospitalized patients. The study, which has not been peer-reviewed, found that patients who were given the drug did not fare significantly better than those who did not receive it, nor did they experience more serious side effects. Some medical societies have recently recommended against its regular use. The Infectious Diseases Society of America (recently advised that use of hydroxychloroquine be limited to clinical trials, as did the American Thoracic Society
    At the Henry Ford Health System in Detroit, (researchers are beginning a 3, (0-person) clinical trial that will test whether hydroxychloroquine can prevent infection in health care employees and other front-line workers. But they have also given it to sick patients, outside of a trial, when there is little other hope.

      “In many ways we feel driven to help patients who are in front of us – today – in the hour of their greatest need,” said Dr. Steven Kalkanis, the chief academic officer of Henry Ford Health System. “And there is a clamoring to use whatever we have at our disposal.”

        But outside of a clinical trial, it can be hard to assess the drug’s value, especially when it is being given to a variety of patients, of different ages and medical conditions, and at different points in their disease. Based on the hospital’s experience, Dr. Kalkanis said, the drug’s benefits do not appear to be a slam dunk.

  • “For every anecdotal success story, we hear one where a patient unfortunately died, ”he said. “It’s not coalescing around, ‘Oh my gosh, this is the answer.’”