What do Trump and Yale Medical School have in common? Both were duped about hydroxychloroquine

Hydroxychloroquine, promoted just a few short weeks ago as a cure for COVID-19, is useless.

Actually, it's worse than that. Hydroxychloroquine causes heart arrythmias, which can be fatal. Data from early trials of hydroxychloroquine show that it is killing people, not saving them.

Why, then, are so many people talking about hydroxychloroquine? The answer is a tale of scientific hubris and incompetence bordering on fraud. It's also a tale of how Yale Medical School and the Trump administration both fell for it.

Part 1: the hubris of a French "science star."
Last week, the New York Times ran a lengthy profile of Didier Raoult, a French microbiologist who the Times lauded as a "science star." Raoult vaulted into the public eye in March, when he published a very small study claiming that a combination of hydroxychloroquine, an anti-malarial drug, and the antibiotic azithromycin could cure COVID-19. Claimed Raoult:

"We know how to cure the disease" (Didier Raoult, quoted in the NY Times)

Actually, Raoult's proclamations began earlier, on February 25, when he posted a video on YouTube called "Coronavirus, game over." Not surprisingly, the world took notice. (Note that as the evidence for his so-called treatment evaporated, he re-titled the video "Coronavirus, towards a way out of the crisis.")

Raoult's study was deeply flawed, and it has been taken apart by multiple scientists, so I won't repeat all their points here. A good summary of many of the flaws was written by Elisabeth Bik, first on Twitter and then in a blog article, back in late March. Among other flaws, the study dropped 6 of the 26 patients who were given hydroxychloroquine without explaining why. One of those patients died. “My results always look amazing if I leave out the patients who died,” Bik commented.

Raoult is not happy with Dr. Bik. He recently called her a "witch hunter" on Twitter. This apparently is not unusual for Raoult; the NY Times compares his psychology to that of Napoleon. I wonder what he'll call me after this article appears.

In addition to its serious flaws, the paper was published in a journal whose editor-in-chief, Jean-Marc Rolain, was also a co-author on the paper. Even worse is the fact that, as the journal itself notes, the paper was accepted just one day after being submitted. Clearly, this paper did not undergo careful peer review, and it reeks of extremely sloppy science.

Since then, several larger, better-run studies have either found no benefit for hydroxychloroquine, or found actual harm. To be specific, a study of 368 patients in US Veterans Administration hospitals found that the mortality rate in patients given hydroxychloroquine was 27.8%. Patients who received both hydroxychloroquine and the antibiotic azythromycin had a mortality rate of 22.1%. But patients who did received neither one had a mortality rate of 11.4%.

In other words, giving patients hydroxychloroquine doubled their risk of dying.

One final note about Didier Raoult: he has a truly unbelievable number of scientific publications, over 2,800 according to PubMed. From 2012-2019, he averaged 176 papers per year, or about one paper every two days. Speaking as a scientist, it simply isn't possible that he made any real contribution to the vast majority of these papers. The NY Times explained that Raoult puts his name on every paper published by his institute, which employs hundreds of scientists. Again, speaking as a scientist, this is grossly unethical. No scientist should put his/her name on a paper unless they made a genuine scientific contribution to it. At many universities, Raoult's behavior would be grounds for dismissal.

Part 2: Trump and Yale Medical School fall for it.
As the NY Times reported, and as most of the U.S. knows, Trump began touting the benefits of hydroxychloroquine at a news conference on March 19:

“I think it’s going to be very exciting. I think it could be a game changer and maybe not. And maybe not," Trump said.

Right. Soon after that, the FDA, "under what appears to have been strong pressure from the Trump administration," issued an emergency use authorization for hydroxychloroquine.

Medical experts, including NIAID director Anthony Fauci, quickly injected a note of caution, pointing out that the evidence was very preliminary, and that we needed better studies. Nonetheless, Trump and his political allies ran with the news that a "cure" was available. They were wrong.

Perhaps most disturbing, though, was the behavior of some highly regarded doctors, who also fell for Didier Raoult's hype. One might excuse politicians for being fooled–they don't have the training–but the same excuse doesn't work for a medical expert.

And yet on March 26, Yale Medical School boldly tweeted out its "Treatment algorithm for COVID19," promoted with two megaphone icons:

Attached to the tweet was a graphic of a flowchart, showing that the first steps in their treatment algorithm were hydroxychloroquine and atazanavir. At the time, I replied to their tweet and warned them that there was no good evidence for their recommendations. Their response:

"While there are no FDA approved treatments for COVID19, this protocol is based on available knowledge, personal observations & communications from other institutions. In the absence of firm evidence for best treatments, this is intended as a working document & subject to change."

Well, at least they responded. But in their response, they admit that their protocol is based on anecdotal evidence and little else. This is seriously disappointing, coming as it does from one of the nation's top medical schools. It also displays hubris not that dissimilar from Didier Raoult's.

Now that more evidence has emerged, and we know that hydroxychloroquine doesn't help and probably harms COVID19 patients, has Yale updated its treatment protocol? Well yes: they tweeted out a new algorithm on May 15. Now it says:

"Consider hydroxychloroquine x 5 days with close cardiac monitoring."

This is truly appalling. The only evidence of efficacy was the small, badly-run study promoted by Didier Raoult, which has now been contradicted by much larger, better run studies. We now know that hydroxychloroquine is harmful. Others on Twitter quickly questioned the new Yale recommendation, but it's still there as of this writing.

So there you have it. As of this writing, many so-called experts are still pushing the use of an ineffective, dangerous drug that doesn't help, and may harm, people infected with the SARS-CoV-2 coronavirus. A bogus claim promoted by a self-important, egotistical scientist who published a sloppy study in a journal run by one of his co-authors turned into millions of doses of medication wrongfully prescribed.

And for now, Yale Medical School still hasn't admitted any error. I'm waiting.

[Note: I am an alumnus of Yale University, and I have long been one of its biggest fans. I did not attend medical school there, but their unscientific behavior is nonetheless especially disappointing to me as an alum.]

The WHO's endorsement of TCM may have helped cause the coronavirus pandemic

About a year and a half ago, I wrote an article titled "WHO endorses Traditional Chinese Medicine. Expect deaths to rise." It went somewhat viral, with over 100,000 views, and then went quiet until last week, when it was revived on Twitter, which has driven thousands of new views to it. Multiple people asked me to re-visit it, in light of the coronavirus and its possible origin in a live animal market in China.

The deaths I was referring to in that title were the deaths of animals (as I'll explain below), not people. What I didn't write about–and what Twitter is buzzing about now–is the possibility that live animal markets in China, such as the one where the Covid-19 virus may have first infected humans, include bats sold for their use in traditional Chinese medicine, or TCM. We now know that the coronavirus almost certainly originated in bats. It's entirely possible–indeed, it seems very likely–that TCM is responsible for the emergence of the Covid-19 coronavirus.

The title of my article might have been more prescient than I guessed at the time.

Indeed, a just-published scientific paper pins the blame for Covid-19 squarely on TCM. The paper argues that

"a live or recently deceased infected bat species was handled by traders because of its value in TCM, and that such an infected individual, or the still infective bat or bat products, may have been the route by which the virus entered the exotic meat market in Wuhan."

Let's back up a bit and review the World Health Organization's involvement in this debacle. Just one year ago, the WHO added a chapter on TCM to its official International Classification of Diseases (ICD-11) for the first time. It apparently took this action after strong lobbying pressure from China: as a 2018 story in Nature pointed out:

"Over the past few years, [China] has been aggressively promoting TCM on the international stage both for expanding its global influence and for a share of the estimated US$50-billion global market."

This action by the WHO was the result of a long effort by its previous director (she left in 2017), Margaret Chan, who "worked closely with China" to get the WHO to endorse TCM.

Many scientists decried this action. The editors of Scientific American called it a "bad idea." Nature warned that it could "backfire," writing that it

"risks legitimizing an unfounded underlying philosophy and some unscientific practice.... Whatever its aims, the WHO’s chapter [on TCM] is unlikely to do anything other than fuel the expanding sales of largely unproven treatments."

TCM is not medicine. It's little more than a set of traditional beliefs (or a philosophy, as Nature called it) about various concoctions and their effect on one's health. Most of these beliefs have no evidence whatsoever that they provide any health benefits. Many of them derive from a pre-scientific view (which is not at all unique to China) that eating an animal gives one some of the properties of that animal. This is utter nonsense, of course.

Unfortunately, TCM is far from harmless, as I pointed out in my 2018 article. TCM has led to the horrific slaughter of the last remaining rhinoceroses in Africa in order to hack off their horns, which are sold to become part of elixirs that some people mistakenly think confer strength, virility, or other health benefits. Two years ago, National Geographic ran a heart-wrenching photo essay showing some of the awful results of rhinoceros poaching in Africa; take a look at these photos here (warning: these are very graphic).

TCM is behind the slaughter of the last remaining wild tigers, which are virtually extinct now in Asia, so that men can foolishly eat their bones, claws, and genitals in the mistaken belief that tiger parts will make them virile. Here too, National Geographic has details and photographs of cruel "tiger farms" that are almost too painful to look at.

TCM has also nearly wiped out pangolins, a completely harmless, gentle animal that has been killed in vast numbers because TCM practioners believe, wrongly, that its scale have some medicinal value. (They don't.) For more about this harmful practice, see this article I wrote in 2017.

And donkeys too: the Independent reported last November that "half the global population of donkeys could be wiped out in just five years, due to a surge in demand for their hides, which are used in traditional Chinese medicine." The world's donkey population is now in a state of crisis, according to the article, because of soaring demand in China for donkey hides, which are used to make eijao (donkey hide glue), a popular TCM product with no evidence that it has any medical benefits. Literally millions of donkeys are being slaughtered for nothing.

Before people accuse me of cultural insensitivity, let me add that there's no legitimate reason to use terms such as "Chinese" medicine, or American, Italian, Spanish, Indian, or [insert your favorite nationality] medicine. There's just medicine–if a treatment works, then it's medicine. If something doesn't work, then it's not medicine and we shouldn't sell it to people with false claims.

TCM has been a scam for decades: it was revived and heavily promoted in China by former dictator Mao Zedong, who didn't believe in it himself, but pushed it as a cheap alternative to real medicine. I won't go over that again here, but see these stories from Alan Levinovitz in Slate and David Gorski at Science-based Medicine.

The WHO is under new leadership now, but I see no sign that it's revising its endorsement of TCM, which is still lauded on the WHO website. Now we see that, in addition to the pointless slaughter of thousands of animals, some of which are likely to go extinct as a result, TCM might also create conditions that lead to new human pandemic diseases.

The new scientific paper that I mentioned above–the one that explains why trading in bat species for TCM may have caused the current pandemic, concludes that "a change in these practices is highly recommended."

That would be the understatement of the year.

It's sadly ironic that the WHO, which has in many ways been leading the fight against the Covid-19 virus, may have contributed to the conditions (live animal markets trading in wild animals) that allowed the virus to jump into the human population. It's too late to prevent that, but it's not too late for the WHO to take steps to prevent the next pandemic: they can and should remove TCM from their official guidelines.

As for China, they should recognize that the profits they make from the sales of animal parts for TCM are vastly outweighed by the harm these practices cause. China should stop promoting TCM, and it should ban the killing of wild animals for spurious medical reasons.