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Episode #862: There's Some Dangers
First Broadcast: 5/25/20
It was surprising, to say the least, when President Donald Trump announced on May 18 that he was taking hydroxychloroquine in response to the COVID-19 pandemic. As he put it:

And a lot of good things have come out about the hydroxy. A lot of good things have come out. And you'd be surprised at how many people are taking it, especially the front line workers, before you catch it. The front line workers, many many are taking it. I happen to be taking it. I happen to be taking it. I'm taking it. Hydroxychloroquine. Right now, yeah. Couple of weeks ago. Started taking it. 'Cause I think it's good. I've heard a lot of good stories. And if it's not good, I'll tell you right, I'm not gonna get hurt by it. It's been around for 40 years for malaria, for lupus, for other things, I take it. Front line workers take it. Doctors take it. 'Scuse me. A lot of doctors take it. I take it. Yeah, I hope not to be able to take it soon, because, you know, I hope they come up with some answer, but I think people should be allowed to.

Despite Trump's promotion of hydroxychloroquine for the better part of two months, this revelation was still unexpected in the wake of the FDA's public statement discouraging the use of that medication to prevent or treat COVID-19 on April 24, which contained this warning:

Hydroxychloroquine and chloroquine can cause abnormal heart rhythms such as QT interval prolongation and a dangerously rapid heart rate called ventricular tachycardia. These risks may increase when these medicines are combined with other medicines known to prolong the QT interval, including the antibiotic azithromycin, which is also being used in some COVID-19 patients without FDA approval for this condition. Patients who also have other health issues such as heart and kidney disease are likely to be at increased risk of these heart problems when receiving these medicines.

In 2019, the White House physician disclosed that Trump was taking rosuvastatin, a drug that lowers cholesterol, so we can assume that Trump might have some form of heart disease. With that in mind, why would a doctor prescribe hydroxycholoquine to a patient with a heart condition, when one of the potential side effects of that drug is "changes to your heart rhythm"? Why would a doctor prescribe a drug that could cause someone to become "agitated, irritable, or display other abnormal behaviors ... have suicidal thoughts and tendencies, or to become more depressed" to the person who controls the nuclear arsenal of the United States? Why would a doctor prescribe a drug that "can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection" during a pandemic? This led to speculation that perhaps Trump wasn't really taking hydroxycholoquine at all, speculation that wasn't dispelled by a public letter from the White House physician which, among other things, did not confirm that Trump was even taking hyrdroxycholoquine in the first place.

And yet, none of this dissuaded Trump fans from supporting his decision to take this drug, and in turn take it themselves. A typical example:

The irony is hydroxychloroquine has been safely prescribed to hundreds of millions for 65+ years.
CDC literally says it can be "safely taken by pregnant women and children".
WHO calls it an essential medicine.
While the media has people all of a sudden thinking its dangerous?
This brings up a good question. How can the same drug simultaneously be considered safe enough to taken by pregnant women, but dangerous enough to potentially cause heart attacks? Perhaps the answer lies in the dosage required for hydroxychloroquine's respective functions. For prophylaxis for malaria, "The weekly dosage for adults is 310mg". The prophylaxis for COVID-19, on the other hand, has been tested at this level:
Our aim was to identify possible hydroxychloroquine dosing regimens through simulation in those at high risk of infections by optimizing exposures above the in vitro generated half maximal effective concentration (EC50 ) and to help guide researchers in dose-selection for COVID-19 prophylactic studies. To maintain weekly troughs above EC50 in >50% of subjects at steady state in a pre-exposure prophylaxis setting, an 800 mg loading dose followed by 400 mg twice or three times weekly is required. In an exposure driven post-exposure prophylaxis setting, 800 mg loading dose followed in 6 hours by 600 mg, then 600 mg daily for 4 more days achieved daily troughs above EC50 in >50% subjects. These doses are higher than recommended for malaria chemoprophylaxis, and clinical trials are needed to establish safety and efficacy.
To recap: Only 310 mg of hydroxychloroquine per week is recommended to prevent malaria, but between 2400 and 3800 mg per week was being tested to prevent COVID-19--a 1000% increase over the malaria prevention dosage. So, if the 310 mg/week dosage is enough to cause the above side effects, wouldn't a dosage ten times as great increase the chance of the above side effects? Could that be a reason why doctors aren't recommending hydroxychloroquine to people who either haven't been diagnosed with COVID-19 or who might be dying from it? That, and a recent study involving around 96,000 people that showed no evidence that hydroxychloroquine could help COVID-19 patients, and it could very well increase their chances of dying? Does it even matter, now that Trump says he "finished" taking hydroxychloroquine altogether? Perhaps the moral of all this is that you should just stick to wearing a mask to keep yourself and others safe, instead of relying on unproven treatments? It's the least you could do.

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