Hydroxychloroquine Back In The News

 

Hydroxychloroquine is back in the news, and has again caused much controversy and division within the physician community, as well as confusion for patients.   As recently as Monday 8/3/2020, President Trump told CNN reporter Jim Acosta that he had taken HCQ after exposure to a COVID+ contact.

 

This article is NOT about President Trump and whether or not he should be publicly talking about what medications he took or didn’t take, or whether or not it is safe for him to take this medicine. 

 

I was inspired to write this article when I read a Facebook post written by practicing Family Physician and Sports Medicine specialist Dr. Amy Zellers where she “broke it down” for those who had been asking her about hydroxychloroquine. I always find her posts refreshing because she provides sound advice and medical interpretation for the lay public in an easy-to-read, unbiased format.

 

In her post, Dr. Zellers wrote

“Since I’ve gotten tons of messages asking about hydroxychloroquine in the past few days, I will explain to you why this is not simply cut and dry. Again, my point remains that science is unfolding in front of our eyes and government restrictions on medication hinder our response as physicians to develop and test hypotheses and offer the best we can to our well-informed patients. This is why even physicians can’t agree on best practices at this time. Mid-pandemic when we want answers yesterday, is difficult timing to carry out good double-blinded, placebo controlled randomized studies, but even harder when the medication that anecdotally may work is illegal to prescribe. I’m NOT here to debate the credentials or experiences of the frontline doctors or promote medication. Just answering some questions that I’ve been asked. Feel free to scroll on if not interested.

Everyone that is anti-HCQ with their google medical degree is currently citing the below article to support their case. You are clearly doing this based on the headline. You are actually proving that more research could be justified. And of course, the decision to try, as with any treatment, should be left up to the doctor and patient! Really, this is the sword I choose to die by these days. Substitute medical marijuana, experimental chemo or pediatric treatments that are based on anecdotal reports and not well designed studies in place of HCQ. The choice to try any of these relies on informed consent and patient choice.”

 

A similar message to Dr. Zellers’ was produced by The Texas Medical Board in a press release issued on 7/31/2020.  “…Both patients and physicians have a right to decide what treatment may be used for COVID-19...any treatment decision must be made with full, proper and accurate disclosure by a physician…” 

 

This statement was apparently issued by the Texas Medical Board as a “warning shot” intended for Dr. Stella Immanuel, who on July 27, 2020 very publicly claimed that “…COVID-19 has a cure, and it is hydroxychloroquine, zinc and azithromycin…” The video of her stating this went viral and was re-tweeted by President Trump and his son before it was taken down.  Dr. Immanuel’s videos had over 17 million shares before they were censored and removed from social media.

 

This article is NOT about Dr. Stella Immanuel (who wrote this article in April 2020 for www.physicianoutlook.com ) and her controversial dual-role as a physician and Christian minister. It is not about “demon semen” or her opinions about what causes infertility, ovarian cysts and endometriosis. She firmly believes that she “… is a warrior, a sniper in the kingdom of God...”

 

This article is NOT about whether hydroxychloroquine works or doesn’t work for COVID-19.  The reality is that when YOU get sick, even “people who know better” such as Dr. Daniel Sterman a COVID-19 survivor may decide they want to take SOMETHING, rather than waiting to see if the condition deteriorates enough to require hospitalization. Dr. Sterman admitted to taking HCQ publicly on the radio, for all to hear.  He happens to be my former medical school classmate and someone I trust emphatically, without a doubt.  He proved himself over 3 decades ago to be a good person, with a good soul and character, and honest intentions, and it appears that he has not changed.  When I heard him on the radio publicly admit to taking the controversial drug when he himself was diagnosed with COVID-19 in March it was refreshing to hear his honesty.  He readily admits that he felt that taking the medication may have helped him. It may have had a placebo effect, but he was scared for his life, as he had seen the death and destruction the virus had caused in his own unit (he is the Critical Care Director at NYU Langone). 

 

This article is NOT about whether it should be used as prophylaxis, or as treatment in early disease.  We have plenty of studies that conclude that the use of hydroxychloroquine in hospitalized COVID-19 is not effective, and actually probably causes harm.  There are a few studies and clinical trials that have focused on OUTPATIENT treatment, but the majority have been fraught with poor design, toxic doses of medication, inadequate numbers of participants, poor statistical correlations, and/or most importantly (according to pro-HCQ physicians), the majority did not include the use of zinc, which (at least in vitro) is what is thought to stop the intracellular replication of viruses.  There are currently only two outpatient clinical trials that are using both HCQ and Zinc, one at Saint Francis Hospital in Roslyn NY, and the second at Progenabiome in Ventura, California. Both are still recruiting patients at the time of this publication.  It is clear that more COVID19 studies need to be done, both for the inpatient and outpatient population, at least until the virus extinguishes itself, herd immunity develops or we have a safe, viable, widely accepted vaccine.

 

This is how TRUE science is supposed to work, science that is non-conflicted, non-biased, non-politically and non-financially incentivized.  We will get back there, post-pandemic, I hope.

 

However, until science can catch up with this aggressive pandemic, we need to continue to do what we can to lower the morbidity and mortality caused by this evil spiked protein novel coronavirus. Those at highest risk of complications need to continue to socially isolate as much as possible, and EVERYONE’s health should be optimized through improved nutrition, weight loss, increased exercise, smoking cessation and stress reduction.

 

Until science can catch up, in my opinion, we need to encourage the use of masks when in public spaces and social distancing is not possible.

 

This article is NOT about whether or not masks work.  If wearing masks is what will keep our economy going, and get schools open, then WEAR. THE. DAMN. MASK.

 

If a physician wants to try prayer, high dose nebulized budesonide, ivermectin, anti-depressants, high-flow home oxygen, marijuana, quercetin, essential oils, snake oil and….yes….even hydroxychloroquine to try to keep a COVID-19 positive at-risk patient from being hospitalized, there should be NO interference by government officials, politicians, or the media. 

 

The physician needs to clearly explain in the patient’s medical record the reasoning involved in making such a therapeutic decision, and the patient needs to clearly express that they understand that they are agreeing to purely anecdotal treatment.

 

 

This article IS ABOUT ONE issue, and ONE ISSUE ONLY, and it is one that should be at the forefront of EVERYONE’s minds, whether you are a physician or a patient (and remember, we will ALL become patients at some point in our lives).

 

The issue IS THIS: the relationship between doctor and patient is SACRED, and should not be interfered with. The decision to treat belongs between the PATIENT and their PHYSICIAN.