In mid-March, a cryptocurrency investor, a law school graduate and a self-described philosopher found each other on Twitter. They discussed their hopes that a little-known drug called hydroxychloroquine could help contain the accelerating coronavirus outbreak.
Two days later, two of them published a paper about the drug’s potential on Google Docs, falsely claiming the imprimatur of two major universities and the National Academy of Sciences.
Three weeks later, the president of the United States said he himself may take the drug and encouraged others to do the same.
“What do you have to lose?” Trump asked on Saturday. “I’ll say it again: What do you have to lose? Take it.”
The events appear to be part of a remarkable domino effect that could happen only in this moment, with this administration.
There has been no scientific consensus that hydroxychloroquine is effective against the coronavirus.
What started as a Twitter discussion on March 11 among strangers led to a thinly sourced Google Doc published on March 13 that grabbed the attention of Silicon Valley elite and conservative media. Within days, the paper scored one of its authors a spot on on both Laura Ingraham’s and Tucker Carlson’s Fox News shows. The day after Carlson’s show, Trump made his first mention of hydroxychloroquine from the White House podium. After that, presidential allies like personal attorney Rudy Giuliani started trying to dig up any information they could find.
Now, Trump is vowing to distribute millions of doses of the drug to people through the country’s strategic national stockpile, even though there’s no conclusive research that the drug works for coronavirus.
All in three weeks.
To some of the drug’s most ardent proselytizers, the chain reaction is a positive sign that people can come together to accelerate the timeline for potential coronavirus treatments. The methods “weren’t ideal,” conceded Adrian Bye, the philosopher who was part of the initial discussions but not listed as a coauthor on the paper. But the document “got this treatment into the public eye significantly earlier than would have happened otherwise.” As a result, he added, “I think a massive number of lives may have been saved, not just in the U.S., but worldwide as most countries follow the lead of the U.S.”
Yet there has been no scientific consensus that hydroxychloroquine is effective against the coronavirus — far from it. The Food and Drug Administration has not approved the drug for that purpose, and initial small studies from China and France had defects that make it impossible to draw firm conclusions. Meanwhile, Trump’s promotional monologues have led to shortages for people who rely on hydroxychloroquine for other conditions, including rheumatoid arthritis and lupus.
“What’s crucial is that there are several other promising drugs undergoing trials, but the focus on chloroquine creates more strain on the medical system to prescribe this drug not only in hospitals to Covid-19 patients, but also to the worried well,” said Joan Donovan, who directs a project on media manipulation at the Harvard Kennedy School of Government’s Shorenstein Center, referring to the disease that results from the novel coronavirus.
Additionally, medical experts note, some of those other drugs may prove to work better against the virus that hydroxychloroquine or the related drug, chloroquine.
“In a crisis,” Donovan added, “rumors will play a strong role in people’s behavior.”
The day the group came together on Twitter was the same day the World Health Organization declared the coronavirus a pandemic. Over 100 countries had confirmed coronavirus cases, more than 128,000 people had become infected and health experts were warning that the situation would grow more dire.
On Twitter, James Todaro, a medical school graduate-turned cryptocurrency investor, and Greg Rigano, a law school graduate and fellow crypto investor, started publicly inquiring about the drug, which was starting to get some attention because of some initial anecdotal evidence and early, limited studies.
“Any data of chloroquine’s effectiveness?” Rigano asked Todaro and Bye, who had been summarizing the preliminary trials being conducted in South Korea and China.
As of now, there is no conclusive scientific evidence that hydroxychloroquine is effective in treating coronavirus patients | Gerard Julien/AFP via Getty Images
“There are a few preliminary studies that aren’t hard to find. I’m not at a computer now,” Todaro replied.
Slightly over a day after asking that question, Rigano said he had written the first draft of the paper, telling Bye that he and an “eminent scientist” were about to publish a “peer reviewed” paper with evidence that chloroquine was both a cure and a “preventative” for Covid-19.
“thank u james and adrian. next level humans,” he tweeted.
Bye, who has no medical or scientific background, expressed hesitation. He said he had simply been following the research that had been coming out of China, and was happy to share it in a casual setting.
“I’ve worked very hard researching the virus since January, looking for a potential solution,” Bye said later in an interview, noting he had previously lived in the region where the disease originated. “I used a decade of philosophy research, including 18 months living by a famous sacred mountain in Hubei province, China, to do this work in a very delicate area where lives are at stake.”
Most scientists who study these issues warn that while the drug may have shown some early promise, the data has been thin.
But he was worried that overhyping and overprescribing the drug so early might create a chloroquine-resistant coronavirus strain later — even though scientists have seen no evidence the novel coronavirus is mutating to become more dangerous. And he suggested on Twitter that the WHO and the Centers for Disease Control and Prevention should first review the drug.
In response to Bye’s concern, Rigano said a crisis trumped the necessity for scientific review. “world is burning,” he wrote on Twitter. “need all options on deck.”
“There are multiple reports published on pubmed at this point from chinese government,” Rigano also tweeted, referencing the government-run search engine that indexes medical papers around the world. “we are witnessing mass inefficiency by the ‘pros’.”
The paper was published on Google Docs the next day, with Todaro now listed as a coauthor, and including claims that Stanford University, the University of Alabama and the National Academy of Sciences were affiliated with the study.
They weren’t.
At the White House, Trump announced the FDA had approved the “promising” drug for immediate use| Chip Somodevilla/Getty Images
All three institutions, as well as Thomas Broker, a third researcher listed as a coauthor, subsequently said they were not involved in the paper and had no knowledge of its existence before it was published. Stanford also knocked down Rigano’s claim that he was an “adviser” to their medical school.
Still, the early association of these institutions gave the paper the prestige it needed to go mainstream, landing Rigano and Todaro on entrepreneur Elon Musk’s Twitter feed, then on Fox News.
In just a few days, hydroxychloroquine had morphed from one of several options that could be studied for preventing or treating Covid-19 into a potential superstar drug that some hoped could end the pandemic quickly. Todaro gained 10,000 Twitter followers; Rigano accumulated over 20,000 new followers. On Carlson’s show, Rigano called the drug “the second cure to a virus of all time.”
At the White House the next day, Trump announced the FDA had approved the “promising” drug for immediate use — a pronouncement that Dr. Anthony Fauci, the government’s top infectious disease expert, had to walk back, clarifying that it had been approved only for clinical trials.
As of now, there is no conclusive scientific evidence that hydroxychloroquine is effective in treating coronavirus patients.
An upstate New York doctor in a Hasidic Jewish community claimed he cured hundreds of coronavirus patients withhydroxychloroquine.
Most scientists who study these issues warn that while the drug may have shown some early promise, the data has been thin — and that results are mixed. A small early study out of France suggested benefits, but experts have since questioned that research, saying the lead researcher has a dubious history with manipulating data and noting that the researcher chose who would get the drug, skewing the results. On Monday, the scientific society that published the French paper formally said it now believes the research did not meet “the expected standard” about why or how patients were selected.
More recently, a Chinese study suggested no effect from the pills.
But that hasn’t stopped a segment of Trump’s supporters from loudly trumpeting the drug’s potential. Some have started calling the combination of hydroxychloroquine and azithromycin, another commonly available drug, “Trump Pills.” Twitter has deleted tweets from Trump allies like Giuliani, Ingraham and conservative campus organizer Charlie Kirk for touting the drug as a “promising cure,” citing the lack of scientific evidence backing it.
The initial paper was even deleted, after Google decided it had violated its terms of service.
Still, subsequent anecdotal reports have bolstered some people’s belief in the drug. An upstate New York doctor in a Hasidic Jewish community claimed he cured hundreds of coronavirus patients with the drug. “Hawaii Five-0” and “Lost” star Daniel Dae Kim claimed hydroxychloroquine was his “secret weapon” in his fight against the coronavirus.
Medical researchers have encouraged these further studies of hydroxychloroquine but cautioned that scientific standards must be maintained.
The sudden, intense interest in the drug has had downsides. A man died after ingesting a drug normally given to fish in the belief that one of its ingredients, chloroquine phosphate, was the drug that Trump had touted. It’s also led to a shortage of the drug for lupus and arthritis patients who take the medicine regularly. Separately, researchers fret that the hyperfocus on one drug will hamper the development of other potential treatments.
“There’s only so much we can do at one time, right? The bandwidth for scientific research is not infinite,” Harvard’s Donovan said.
“The downstream effects of this is it causes major disruptions in our medical system,” she added. “Families that have to call in and advocate for their family members who are hospitalized, because they heard the name of this drug, are going to advocate to try to get this drug to their family member when it might not be the best option at that time.”
Through official channels, the FDA and New York state have dramatically ramped up trials for hydroxychloroquine, ordering millions of doses of the drug and conducting wide-scale clinical trials. The FDA also authorized emergency use of the drug for coronavirus patients — a move that makes it easier to use the drug but is not an endorsement of the drug’s effectiveness in fighting the illness.
Medical researchers have encouraged these further studies of hydroxychloroquine but cautioned that scientific standards must be maintained.
Bodies are moved to a refrigeration truck serving as a temporary morgue n Brooklyn | Bryan R. Smith/AFP via Getty Images
“This desire to quickly find safe and effective treatments may … lead to relaxed standards of data generation and interpretation, which may have undesirable downstream effects,” a group of researchers recently wrote in the Annals of Internal Medicine, a medical journal.
That hasn’t stopped some of Trump’s supporters pushing to fast-track the drug even further.
Michael Coudrey, a Twitter commentator popular in pro-Trump circles, has been one of the movement’s most vocal hydroxychloroquine boosters, frequently celebrating various advances in the drug’s usage. A former far-right journalist who describes himself as a “biopharmaceutical analyst,” Coudrey said in an interview that he believes clinical trials were not necessary — anecdotal evidence was enough.
“Due to the time-sensitivity of patients in critical care, we do not have the ability to wait for clinical testing and official FDA approval of hydroxychloroquine for specific use to treat Covid-19 patients,” he said.
Jack Posobiec, a host for the Trump-friendly One America News Network and voluble pro-Trump pundit on Twitter, said some conservatives were understandably glomming on to a possible solution to a desperate situation.
“People were looking for a magic bullet that would take out this bug quickly,” he said in an interview. “But I don’t think there’s anything more serious than telling people which medicine to take to cure themselves in the middle of a global pandemic.”
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