WEBVTT - The Truth About Hydroxychloroquine 0:00:02.759 --> 0:00:07.600 Welcome to Prognosis. I'm Laura Carlson. It's day eighty nine 0:00:07.800 --> 0:00:12.360 since coronavirus was declared a global pandemic. Our main story 0:00:13.039 --> 0:00:18.160 the ongoing drama over hydroxy chloroquine. Studies have shown conflicting 0:00:18.239 --> 0:00:21.840 information about the value of using hydroxy chloroquine to fight 0:00:21.920 --> 0:00:27.000 the coronavirus. The flip flopping raises questions about not just 0:00:27.120 --> 0:00:31.120 the drugs efficacy and safety, but also on the reliability 0:00:31.240 --> 0:00:36.680 and accuracy of the scientific review process itself. But first, 0:00:37.640 --> 0:00:47.960 here's what happened today. Transmission of the coronavirus by people 0:00:48.080 --> 0:00:53.040 who aren't showing symptoms is quote very rare. The World 0:00:53.120 --> 0:00:57.960 Health Organization said Monday that contradicts earlier speculation by public 0:00:57.960 --> 0:01:01.440 health officials and researchers that disease was being spread by 0:01:01.480 --> 0:01:06.360 people who weren't shown signs of illness. New York City 0:01:06.400 --> 0:01:09.800 on Monday opened up non essential retail stores for the 0:01:09.880 --> 0:01:14.080 first time in months. Governor Andrew Cuomo says a little 0:01:14.080 --> 0:01:17.160 more than one percent of New Yorkers tested Sunday were 0:01:17.200 --> 0:01:21.120 infected with the new coronavirus, the lowest rate since the 0:01:21.160 --> 0:01:25.880 pandemic began. The UK death toll rose by fewer than 0:01:25.959 --> 0:01:30.000 one hundred for the second straight day, and London reported 0:01:30.200 --> 0:01:34.319 no new fatalities for the first time since its lockdown began. 0:01:36.760 --> 0:01:42.319 But worldwide infections from the coronavirus surpassed seven million. That's 0:01:42.400 --> 0:01:45.200 up by one million cases in just a little more 0:01:45.240 --> 0:01:49.240 than a week. The surge is driven by hotspots including 0:01:49.280 --> 0:01:54.600 Brazil and India. That worrisome trend adds weight to the 0:01:54.680 --> 0:01:59.280 value of social distancing. A report showed that lockdowns and 0:01:59.400 --> 0:02:02.760 other public health measures may have prevented about half a 0:02:02.880 --> 0:02:08.040 billion infections in six countries, including China and the US, 0:02:15.240 --> 0:02:21.560 And now our main story. Hydroxychloroquine is back in the news. 0:02:22.480 --> 0:02:25.880 In the early days of the pandemic, the antimalarial drug 0:02:26.000 --> 0:02:29.440 was touted by President Trump and some doctors as an 0:02:29.440 --> 0:02:34.440 effective treatment for COVID nineteen, but the drug has largely 0:02:34.480 --> 0:02:39.280 been discredited for use against the virus. Now the studies 0:02:39.480 --> 0:02:43.639 dismissing the drug have also been thrown into doubt. So 0:02:43.760 --> 0:02:47.520 what's the truth about this controversial drug? I spoke to 0:02:47.560 --> 0:02:51.440 Bloomberg Health and Science reporters Michelle Cortes and Robert Langrath 0:02:51.760 --> 0:03:01.800 for some answers. Thank you both for joining us UM 0:03:01.840 --> 0:03:03.840 you know in the news. We have heard a lot 0:03:04.120 --> 0:03:07.880 about this drug, hydroxy chloroquin in terms of whether or 0:03:07.919 --> 0:03:12.880 not it can treat COVID nineteen, but we've also heard 0:03:12.880 --> 0:03:16.560 that it's an actually antimalarial drug. Can you maybe walk 0:03:16.680 --> 0:03:20.640 us through the narrative here about how this drug began 0:03:20.800 --> 0:03:25.680 being touted as a potential treatment for COVID nineteen. When 0:03:25.840 --> 0:03:29.000 coronavirus first started circulating around the world, we had nothing 0:03:29.360 --> 0:03:32.079 for it at all. It was a brand new virus 0:03:32.120 --> 0:03:35.520 and the entire world was a vulnerable So drug companies 0:03:35.600 --> 0:03:39.160 and academic researchers started combing through all the evidence that 0:03:39.200 --> 0:03:41.760 they had, looking at every type of drug. They looked 0:03:41.760 --> 0:03:45.080 at antibiotics, they looked at other anti virals, they looked 0:03:45.080 --> 0:03:48.360 at anti fungals, they looked at at immune system drugs, 0:03:48.400 --> 0:03:51.680 they looked at everything. And in laboratory tests, it looks 0:03:51.760 --> 0:03:54.880 like this drug actually makes it more difficult for the 0:03:54.960 --> 0:03:57.880 virus to penetrate a healthy cell. And that's where it 0:03:57.880 --> 0:04:02.080 all started. When we saw something that effectiveness, it was approved. 0:04:02.400 --> 0:04:06.240 They believed that there was an acceptable amount of side 0:04:06.240 --> 0:04:10.400 effect risk. They moved forward with it, and as hydroxy 0:04:10.440 --> 0:04:14.480 chloroquine has been this new potential in terms of a 0:04:14.520 --> 0:04:18.760 treatment for COVID nineteen. Obviously, we've seen many new reports 0:04:18.800 --> 0:04:22.760 being issued, a lot of discussion about its efficacy, and 0:04:22.880 --> 0:04:25.239 I was wondering if you might be able to explain 0:04:25.240 --> 0:04:28.680 a little bit about some of these reports and some 0:04:28.800 --> 0:04:31.599 of the conflicting evidence that we seem to be getting 0:04:31.600 --> 0:04:35.520 from the reports about whether it is indeed defective. Very 0:04:35.560 --> 0:04:39.960 early on, some researchers in France tested them the medicine 0:04:39.960 --> 0:04:42.479 and patients, and they found that it dramatically lowered the 0:04:42.480 --> 0:04:46.080 amount of virus in patients who are affected with coronavirus, 0:04:46.160 --> 0:04:49.359 and so they believed that that would translate to a benefit. 0:04:49.400 --> 0:04:51.680 If you have less virus in your body, you're likely 0:04:51.720 --> 0:04:54.719 to have fewer symptoms and less likely to get deadly ill. 0:04:55.400 --> 0:04:58.080 Then there were other smaller studies that were coming out. 0:04:58.440 --> 0:05:01.840 There were anecdotal reports. A doctor said that they gave 0:05:01.839 --> 0:05:04.840 the medicine to patients and within hours and days they 0:05:04.839 --> 0:05:08.880 were getting miraculously better. The thing is, in these cases 0:05:09.320 --> 0:05:13.720 they didn't have comparison patients, and most patients with coronavirus 0:05:13.760 --> 0:05:16.360 do get better, so it wasn't clear whether or not 0:05:16.440 --> 0:05:19.160 they were getting better because of this medicine or just 0:05:19.240 --> 0:05:21.640 because of time and their bodies taking care of the virus. 0:05:22.520 --> 0:05:25.000 And then what happened there was there's this giant study 0:05:25.000 --> 0:05:28.360 he suddenly published a couple of weeks ago in the LANDSTUH, 0:05:28.680 --> 0:05:31.839 a well known medical journal, and it was led lead 0:05:31.880 --> 0:05:36.560 author was a you know, big name Harvard professor UH. 0:05:36.600 --> 0:05:38.599 And it purported to do kind of the mother of 0:05:38.640 --> 0:05:42.400 all data gatherings from around the world and UH. And 0:05:42.440 --> 0:05:47.359 they purported to gather data from nine patients from around 0:05:47.400 --> 0:05:50.599 the world on all continents, hundreds and hundreds of hospitals, 0:05:51.040 --> 0:05:55.400 from all sorts of different electrotronic medical records UH providers 0:05:55.920 --> 0:05:58.760 UH and combine them to one joint report of how 0:05:58.880 --> 0:06:01.520 patients who got I draw c clorkin did. And it 0:06:01.640 --> 0:06:04.240 said that not only was it not working, UH, it 0:06:04.360 --> 0:06:07.240 was causing all sorts of harms, including increasing the risk 0:06:07.360 --> 0:06:09.599 of heart disease and death. So what beyond that it 0:06:09.640 --> 0:06:12.800 didn't work and said it was dangerous? And what was 0:06:12.839 --> 0:06:16.400 the upshot of this study? This caused a great concern 0:06:16.520 --> 0:06:19.120 and caused the Double World Health Organization to pause a 0:06:19.200 --> 0:06:24.040 trial clinical trial hydroxychloricin UH that was going on. So 0:06:24.080 --> 0:06:27.359 there's a very very big impact to this study. But 0:06:27.400 --> 0:06:31.320 A problem with this study is that as data researchers 0:06:31.360 --> 0:06:36.360 and kind of online sluice doctors and places around the 0:06:36.400 --> 0:06:39.560 world and the internet started, Internet started looking more carefully 0:06:39.600 --> 0:06:42.080 at the data behind this study. They found a large 0:06:42.120 --> 0:06:45.520 number of inconsistenccies and red flags and things that just 0:06:45.760 --> 0:06:48.440 didn't add up. And one of the most basic ones was, 0:06:48.480 --> 0:06:53.000 how could uh this Uh, this small group of researchers 0:06:53.800 --> 0:06:56.320 gather all this data on from so many hospitals and 0:06:56.360 --> 0:06:59.120 around the world, with so many different privacy research privacy 0:06:59.240 --> 0:07:01.400 laws and rules, and put it all together in such 0:07:01.400 --> 0:07:03.919 a short period of time. Uh. And then it turned 0:07:03.920 --> 0:07:06.640 out that the data all came from one tiny company 0:07:06.640 --> 0:07:08.719 that nobody had ever heard of, called service Fare, that 0:07:08.800 --> 0:07:12.920 was led by a vascular surgeon in Illinois with a 0:07:13.000 --> 0:07:16.280 very few employees and very little up presence. Uh. It 0:07:16.440 --> 0:07:20.360 just seemed highly implausible to outside researchers that this tiny 0:07:20.360 --> 0:07:22.440 little company could have gathered all this that nobody had 0:07:22.480 --> 0:07:24.320 ever heard of, could have just gathered all this data 0:07:24.360 --> 0:07:26.640 in the midst of the pandemic and done such a 0:07:26.680 --> 0:07:29.440 giant study so fast. But what else do we know 0:07:29.640 --> 0:07:33.040 about this small company that otherwise we would never have 0:07:33.120 --> 0:07:37.080 heard about? Yeah, we know very little about it. It's 0:07:37.160 --> 0:07:40.800 very mysterious. It's very few employees are the main person associated, 0:07:40.800 --> 0:07:47.840 which appears to be this vascular surgeon, Zapandasi, who Illinois 0:07:47.840 --> 0:07:51.480 based vascular surgeon. Uh, but you know, we know very 0:07:51.480 --> 0:07:54.080 little about the company. It's very mysterious. And so as 0:07:54.160 --> 0:07:57.800 people started asking questions about this data, uh, the Harvard 0:07:57.800 --> 0:08:00.880 researchers on the top researchers on the paper that his 0:08:00.960 --> 0:08:03.760 collaborators went back and said, we need an independent audit 0:08:03.840 --> 0:08:05.960 to verify that this data is real and where it 0:08:06.000 --> 0:08:08.480 came from, there's not problems with it and what and 0:08:09.400 --> 0:08:12.680 uh he uh. Dr Desi said at first that he 0:08:12.880 --> 0:08:16.640 would cooperate with the audit, but then apparently he wouldn't 0:08:16.640 --> 0:08:19.280 provide the raw data, names of the hospitals, and that's 0:08:19.280 --> 0:08:23.440 when the paper was retracted. How did then this get published? Um? 0:08:23.480 --> 0:08:25.880 I mean, what were the circumstances that the Lancet was 0:08:25.920 --> 0:08:30.760 willing to accept clearly something that was very problematic in 0:08:30.840 --> 0:08:34.040 terms of its data sources. Well, yeah, I mean that 0:08:34.240 --> 0:08:37.080 is exactly the question. It is, you know, pretty unbelievable 0:08:37.080 --> 0:08:40.160 in retrospect that these studies got got published and there's 0:08:40.160 --> 0:08:42.520 not just one study by this group. There's a second 0:08:42.520 --> 0:08:44.760 study that had to end up being retracted in the 0:08:44.800 --> 0:08:47.840 New England Journal Medicine. So this group got multiple studies 0:08:48.320 --> 0:08:51.679 into multiple major journals. And one of the things that 0:08:51.679 --> 0:08:55.440 it may be happening is that in this rush to 0:08:55.600 --> 0:08:59.600 come out with new data and you know, healthful information 0:09:00.040 --> 0:09:02.600 COVID nineteen because it's new virus, and because we know 0:09:02.679 --> 0:09:05.360 so little and have so few treatments, you know, the 0:09:05.440 --> 0:09:08.680 journal also appearing the major medical journals also appeared to 0:09:08.720 --> 0:09:12.240 be pushing out you know, stuff quicker than ever before, 0:09:12.280 --> 0:09:15.040 and that appears to be leading to some mistakes, including 0:09:15.120 --> 0:09:18.520 some major mistakes here such as this. This leads me 0:09:18.600 --> 0:09:23.080 to kind of too related questions in terms of what 0:09:23.240 --> 0:09:26.440 is the fallout from this um Both from the sense of, 0:09:27.160 --> 0:09:30.800 you know, this report had seems to have had significant 0:09:30.800 --> 0:09:35.920 impact in halting other clinical trial programs, other um studies 0:09:35.960 --> 0:09:39.320 involving hydroxy chloroquine. What is going to be the impact 0:09:39.360 --> 0:09:43.719 of this one report being retracted and also, i mean 0:09:43.760 --> 0:09:47.680 one of the longer, perhaps more broader impacts in terms 0:09:47.720 --> 0:09:51.720 of well, certainly the reputation of the lancet. But again, 0:09:51.880 --> 0:09:55.280 this this rush to research and rush to publication as 0:09:55.360 --> 0:09:58.560 far as what we can find out about how to 0:09:58.679 --> 0:10:02.520 treat COVID nineteen. When it comes to hydroxy chloroquine, we 0:10:02.640 --> 0:10:06.680 can see that this imperfect and very fast science has 0:10:06.720 --> 0:10:09.400 really had an impact across the board. In the early 0:10:09.480 --> 0:10:13.040 days when we were grasping for anything and President Trump 0:10:13.080 --> 0:10:15.720 got on board with this, we saw use of hydrox 0:10:15.800 --> 0:10:19.160 chloroquine go through the roof. Then we started seeing some 0:10:19.280 --> 0:10:23.160 pulling back, and after the lance At trial, we actually 0:10:23.200 --> 0:10:26.079 saw the w h O and others halt their trials because, 0:10:26.120 --> 0:10:29.760 of course, the idea that patients were actually being harmed 0:10:29.800 --> 0:10:33.280 by this medicine is terrifying. You don't want to make 0:10:33.320 --> 0:10:37.520 people who are already critically ill even worse. The questions 0:10:37.520 --> 0:10:40.959 that are surrounding all of these drugs, though, are leaving 0:10:41.080 --> 0:10:44.720 us just with unanswered issues of what do we do 0:10:44.800 --> 0:10:47.920 going forward. The University of Minnesota did do a trial. 0:10:48.120 --> 0:10:52.000 It was double blind, randomized. It was a trial to 0:10:52.000 --> 0:10:54.280 see if people who had been exposed to the virus 0:10:54.559 --> 0:10:59.200 could get protection from coming down with it from actually 0:10:59.760 --> 0:11:03.320 be coming infected if they take hydroxychloroquin and it did 0:11:03.360 --> 0:11:05.560 not find that. It found that it didn't help those 0:11:05.600 --> 0:11:10.439 patients avoid getting infected, but it also didn't cause significant 0:11:10.480 --> 0:11:13.800 side effects. So where that leaves us now is just 0:11:13.960 --> 0:11:16.000 in the same unknown space that we were in the 0:11:16.080 --> 0:11:19.000 very beginning. There are some people who really believe this 0:11:19.040 --> 0:11:21.320 is going to work, and there are other people who 0:11:21.360 --> 0:11:24.240 really believe that it doesn't work. If it does anything, 0:11:24.280 --> 0:11:26.920 it's not significant, it's not worth the time and effort, 0:11:27.240 --> 0:11:29.960 and patients should be moving on to other treatments that 0:11:30.080 --> 0:11:33.320 might give them more benefit. Yeah, so I think this 0:11:33.480 --> 0:11:36.200 is a major warning sign for some of the medical journals, 0:11:36.440 --> 0:11:38.960 including the lance of the England Journal of Medicine, which 0:11:39.000 --> 0:11:42.680 also had a retraction on a different uh subject matter 0:11:42.720 --> 0:11:45.600 but from the same tiny company. Um this is a 0:11:45.640 --> 0:11:48.040 warning sign that they need to perhaps move a little 0:11:48.040 --> 0:11:50.400 bit slower to make as to make sure that the 0:11:50.520 --> 0:11:54.800 data coming out about this virus is really true and 0:11:54.840 --> 0:11:57.640 correct data. It has really just been kind of a 0:11:57.679 --> 0:12:01.040 perfect storm when it comes to this early suggestions of 0:12:01.120 --> 0:12:05.720 possible benefit, this environment where we didn't have anything except 0:12:05.720 --> 0:12:10.120 for some fear data set that appeared at least initially 0:12:10.120 --> 0:12:13.440 to be good doctors who wanted to be helpful and 0:12:13.920 --> 0:12:17.640 get out information right away. But Bob's point is exactly 0:12:18.240 --> 0:12:21.640 exactly right. We actually need to make sure that our 0:12:21.760 --> 0:12:24.560 data is accurate and safe and that doctors are making 0:12:24.559 --> 0:12:27.920 decisions based on things that are scientifically true. And the 0:12:27.960 --> 0:12:30.200 other thing to keep in mind is this virus is 0:12:30.240 --> 0:12:32.600 not going away. This is going to be with us 0:12:32.640 --> 0:12:35.600 for months, perhaps years, and we need to know the 0:12:35.679 --> 0:12:43.319 right answers, not just the fast ones. That was Michelle 0:12:43.320 --> 0:12:47.240 Cortez and Robert Langrath, and that's our show today. For 0:12:47.360 --> 0:12:51.800 coverage of the outbreak from around the world, visit Bloomberg 0:12:51.880 --> 0:12:56.160 dot com slash coronavirus and if you like the show, 0:12:56.640 --> 0:12:59.520 please leave us a review and a rating on Apple 0:12:59.559 --> 0:13:02.960 podcast Us or Spotify. It's the best way to help 0:13:03.000 --> 0:13:07.880 more listeners find our global reporting. The Prognosis Daily edition 0:13:07.960 --> 0:13:13.080 is produced by Topher Foreheads, Jordan Gaspoure, Magnus Hendrikson, and 0:13:13.200 --> 0:13:17.920 me Laura Carlson. Today's main story was reported by Michelle 0:13:17.920 --> 0:13:23.400 Cortes and Robert Langrith. Original music by Leo Sedrin. Our 0:13:23.600 --> 0:13:28.280 editors are Francesco Levi and Rick Shine. Francesco Levi is 0:13:28.320 --> 0:13:31.840 Bloomberg's head of Podcasts. Thanks for listening.