The danger in Trump's decision to self-medicate
Posted May 19, 2020 12:00 a.m. EDT
Updated May 19, 2020 7:44 a.m. EDT
CNN — The fragile foundation of evidence-based reality shoring up Donald Trump's life and presidency just got even more tenuous.
Trump's admission that he was dosing up on hydroxychloroquine, an unproven and possibly harmful therapy to ward off the coronavirus, appears to conflict with the codes of medical science and is a stunning development given his position.
"Here's my evidence: I get a lot of positive calls about it," Trump told shocked reporters when he made the disclosure about a malaria drug he has all but dispensed from the bully pulpit.
Trump's medical choices and the risks he chooses to take are his personal business. But he is not an ordinary citizen, and his use of the therapy sends a conflicting message to Americans told by the US Food and Drug Administration that it is not proven to work against Covid-19 and could be counterproductive.
The President's preventative pitch even prompted the anchor on duty at the friendly confines of Fox News to warn that some viewers could die if they followed his example.
It was not the only moment on Monday when Trump's personal and political priorities brought him into a collision with evidence. He grouched that Attorney General William Barr said he's not inclined to pursue criminal charges in a false conspiracy theory against former President Barack Obama and Trump's 2020 foe, Joe Biden.
"I think if it was me they would do it," Trump said.
Earlier, the President responded with optimism that strained credulity when a desperate restaurant CEO pleaded for an extension of loans designed to keep their industry afloat.
"Well, my news negates what you just said, because you would be back into business like you had it," Trump said, appearing to base his sunny talk on one hopeful but rudimentary early test for a vaccine that may still be many months away and may come far too late to save the catering sector.
Each of these events might have ranked as the strangest moment in a conventional presidency. That they unfolded within minutes of one another stressed the surreal nature of the times but more than anything underscored how traditional standards of truth and scientific proof mean less to Trump than any of his immediate predecessors.
His new collision with fact was more incongruous since it unfolded against the backdrop of yet another tragic day in the worst health crisis in a century. The United States recorded its 90,000 Covid-19 death Monday and passed 1.5 million cases in a pandemic that the President predicted a few months ago -- again based on no evidence -- would just be swept away in a "miracle."
Trump treatment goes against FDA advice
After Trump's repeated touting of hydroxychloroquine as a "game changer" cure for the virus, the FDA issued an advisory warning that the drug has not been "shown to be safe and effective for treating or preventing Covid-19."
It also warned that Covid-19 patients with heart disease may be at risk of abnormal heart rhythms and a dangerously rapid heartbeat if they take it. Trump, 73, has a common form of heart disease, based on the results of his physical, and appears to be overweight -- all risk factors for complications and an increased morbidity rate.
Given his influence on the GOP base, it would be no surprise if some of Trump's most devoted supporters rejected the recommendations of scientists and started to use hydroxychloroquine themselves, with uncertain consequences for their health and implications for lupus patients, who are facing treatment shortages.
Similarly, when Trump asked an aide in a news conference last month whether disinfectant could be a treatment for Covid-19, makers of cleaning products felt obliged to warn against ingesting them.
This time, the public service announcement fell to Fox News anchor Neil Cavuto, who had a warning for viewers after playing the tape of Trump's remarks on Monday.
"If you are in a risky population here, and you are taking this as a preventative treatment to ward off the virus or in a worst-case scenario, you are dealing with the virus, and you are in this vulnerable population, it will kill you," Cavuto said. "I cannot stress that enough. This will kill you."
Former Surgeon General Vivek Murthy told CNN that Trump had a responsibility, given his visibility, to send clear messages to the public.
"As leaders it's essential that we lead by example. It's true for public officials in particular when the spotlight is on them," Murthy said. "This risks sending the wrong message to people, and that could come at a serious cost to their health."
National security implications
The health of the commander in chief is not simply a personal issue. It's a question of national security, and Trump's revelation will set off intense debate about the White House's medical arrangements -- usually among the world's best.
The President didn't help matters with his offhand remarks about his conversation with his doctor about taking hydroxychloroquine despite FDA warnings.
"I asked him, 'What do you think?' He said, 'Well, if you'd like it,' " the President told reporters, adding that front-line health workers exposed to a heavy load of virus had also taken it.
After several hours of speculation that again underlined the irregular manner in which this White House makes disclosures about the President's health, White House physician Sean Conley issued a statement.
"After numerous discussions (Trump) and I had regarding the evidence for and against the use of hydroxychloroquine, we concluded the potential benefit from treatment outweighed the relative risk," Conley said, adding that the President was showing no signs of symptoms and that all his tests for Covid-19 had come back negative.
The timing of Trump's announcement and treatment is also intriguing.
The President said he had been taking hydroxycholoroquine for about a week-and-a-half -- roughly the time since it emerged that the virus had penetrated the West Wing and infected a presidential valet and an aide to Vice President Mike Pence.
This raises the possibility that the drug was prescribed to the President just in case clinical trials eventually show that there is some prophylactic benefit to its use.
Dr. Jonathan Reiner, who treated former Vice President Dick Cheney for his heart disease, spoke bluntly about the drug's cost and benefits. He said Trump had a significant risk of dying from the virus if he were infected and that the comprehensive care that was available to him meant he could be constantly monitored for any side effects from the dosage.
"Is the risk of him dying from this drug higher than the risk of him dying from the virus?" Reiner said to CNN's Erin Burnett, in what was an extraordinary conversation given that it was about the health and mortality of the President of the United States.
"It's a very complicated question, and I feel for Dr. Conley. I don't know how I would come down on it," Reiner said, though he reiterated that other Americans should not take the drug.
Still, the fact that the President was prescribed an unproven drug is a comment on the precarious nature of his exposure, and it contrasts sharply with the bravado he shows by refusing to be seen in public wearing a mask and reflects his casual compliance with scientific norms.
Trump's medical mystery
The reality of a self-medicating President raises even more concerns because Trump has hardly been forthcoming on his medical history since taking office. Mystery still surrounds an unannounced trip to a hospital last year that aides put down to a desire for Trump to get a jump on his annual physical.
Now Trump appears to be basing his medical choices on a drug touted incessantly by conservative media but that has not been proved effective by clinical peer-reviewed trials. He is assuming that since it is prescribed for malaria and lupus it can't do any harm.
"I'm not going to get hurt by it. It's been around for 40 years for malaria," the President said Monday.
His decision put Republican senators in a tough spot.
"He, obviously, is a believer in it. And there have been some previous indications that it could be helpful, but I would wait for the clinical trials," said Sen. John Cornyn of Texas.
There is nothing new in Trump choosing to inhabit a world shaped by his alternative facts and inviting his followers to share it. From the moment he sent his first press secretary, Sean Spicer, out to make inflationary claims about his inaugural crowds, it has been one of the few constants of his mandate.
Trump has created alternative propagandistic worlds to outrun special counsel Robert Mueller, Democratic impeachment managers and the media as it struggles to catalog all his lies. He's rejected the analysis of US intelligence agencies that Russia interfered in the 2016 election, and gotten half the country to believe him. He's claimed without evidence that millions of stolen ballots cost him a popular-vote victory in 2016.
And Trump is insisting that the US has already "prevailed" over the virus, even though the true situation mixes signs of hope with alarming rises in infections in some states. But his faith in hydroxychloroquine certainly marks his most personal departure from evidence-based decision-making yet.