Physician Outlook

Healthcare and Insurance: Who is "The Jerk"?

The real "jerks" are the middlemen who are interrupting the supply chain of medications to outpatients, and those who seem hell-bent on discrediting the possibility that hydroxychloroquine MAY work to prevent serious COVID19 if given PRIOR to hospitalization.


You may choose to disagree, but I am not a "jerk."

Neither is Dr. Stella Immanuel, a physician who is desperately trying to save the lives of COVID-19 infected patients at her outpatient clinic in Houston, Texas. Many of her patients are undocumented immigrants who fear deportation if they step foot in a hospital.  Not only is Dr. Imanuel keeping her patients out of the hospital, but she is also making them better, often within 24 hours of presentation to her.



 I met Dr. Immanuel via social media when I posted that I might be helping to recruit for a Phase 2 FDA/IRB-approved COVID-19 preventive clinical trial (a trial which incidentally has been indefinitely put on hold after a Twitter attack that criticized the trial for lack of a placebo arm).



Dr. Imanuel wasn’t worried about herself, she wanted to know if I knew where she could get hydroxychloroquine for her patients. She is from Cameroon and has been using this medication for years for malaria prophylaxis for herself, and for her patients who travel, without any issues. 



I do not have rheumatoid arthritis, nor do I have lupus. I do not have malaria. But, yes, I have been taking hydroxychloroquine (HCQ), suspecting that I had been exposed to coronavirus.  I had taken care of a patient in late January and early February with fever and cough who had just returned from China.  The CDC had refused to test the patient because of lack of travel to the Hubei province. 



My dear friend, Dr. Marion Mass, was concerned when I confessed that I had gotten myself a prescription and had already popped two pills into my mouth.  She and I are involved in grass-roots healthcare reform advocacy groups, and had learned early in the epidemic about HCQ and it’s potential benefits when taken prophylactically or early on-set.  At that time she was not convinced about its merits, and she thought I was being hasty for starting it. “We need studies, Marlene.  We need data. We need to follow what is going on in other countries.”  She thought it was prudent to have the medication on hand, but only take it at the first sign of illness. If I’m honest with myself, the truth is that our mutual HCQ-passionate friend scared me, saying that other countries were reporting late-onset disease weeks after exposure, and that “time was running out.” That's what made me take my first dose on March 9, 2020.



Fast-forward a week. 



My daughter also didn’t have an FDA-approved indication for HCQ when I woke her up out of a deep sleep to pop a pill in her mouth.  But when she returned from an overseas trip with a fever and cough, I started her “off-label” on the medication hours before her COVID19 test result came back positive. When my only child’s oxygen level dipped into the high 80’s I panicked. I thought she was going to die.  She had the “happy hypoxemia” that I had been reading about from colleagues on the front lines that were treating inpatients with COVID19, and many patients were ending up on assisted ventilation. Only 20% of patients put on ventilators made it out of the hospital alive. 



I credit that 10 pill course of hydroxychloroquine with keeping her from requiring hospitalization, and dramatically improving her cough. My husband also started HCQ prophylactically.   Call it statistically insignificant, but in our “N of 3”, all of us are alive and well.  None of us have suffered from life-threatening arrhythmias (nor have the hundreds of thousands of patients before us who take the medication for their underlying conditions). Despite close household interaction with our daughter, neither my husband nor I have developed protective antibodies, meaning we have not been infected. 



On April 9, 2020, both my husband and I tested negative for IgG and IgM on a COVID19 antibody test. Our daughter tested strongly IgG positive.  On April 20,  the three of us had blood drawn and I sent our serum to Dr. Ryan Cole, who is an anatomic/clinical and dermatopathologist who owns and operates an independent laboratory in Idaho. On this more sensitive test, our daughter was found to be IgG positive and trace IgM positive. Surprisingly, results continue to indicate that my husband and I are IgG and IgM negative for COVID19.  



Are we negative BECAUSE we took HCQ (and/or Zinc, Vitamin C and D)? We don’t know right now, and we won’t know until more research is done. But I’m sure glad I got my HCQ when I did - if my daughter got sick today I am not sure she could have successfully been treated at home. The increasing intrusion and the scare tactics being used by the government and the media are interfering with the patient-physician relationship.  This interference could have resulted in more loss than I could begin to imagine.  



We are living in unprecedented times, where many of our freedoms have been compromised by our global circumstances.



I am confident these times will pass.  



Our freedoms will return.  



Will one of them be our freedom to practice medicine?



P.S....I ask for any patient with Rheumatoid Arthritis or lupus who is having difficulty getting their medication to please contact me at I will do my best to help you get your medication. I don't know for sure if there are millions of doses being stockpiled and held up at warehouses, including the big chain pharmacies, but I suspect there are. Where are the millions of doses that have been donated?  Insurance companies are requiring prior authorization from PCPs and rheumatologists for refills.  It is not physicians and their families hoarding the medication that has caused a "shortage."  


Anyone who needs the medication should have access to it without a hassle or increased cost.  Anyone who wants to try it to prevent COVID19 (after a discussion with their physician about the possible risks, which include a heart rhythm abnormality and vision issues with long-term use and large doses).  Clinical trials should be permitted to proceed without delay.  If the FDA ultimately requires a placebo arm, let it be a vitamin regimen only.  It is unethical in my opinion to require that patients be sick enough to be hospitalized to be started on hydroxychloroquine. 


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