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Why Is President Trump Taking Hydroxychloroquine?

cwick (Chadwick Matlin, deputy editor): Clare, Kaleigh and Maggie, thanks for joining me to talk about the president’s medicine cabinet. Yesterday, President Trump revealed that he’s taking hydroxychloroquine, an anti-malarial medication, to help prevent him from contracting COVID-19. Trump’s comments were the culmination of his interest in the drug, which he has hyped for months as a way to help fight the pandemic. Let’s talk about what the science says about hydroxychloroquine, what Trump has said about it, and what it says about Trump that he’s taking it.

Trump says he’s taking hydroxychloroquine

So, let’s start with the science, which is about the only thing that can ground us in this frenzied moment. Can hydroxychloroquine prevent someone from getting COVID-19?

clare.malone (Clare Malone, senior political writer): (Readers can, on their own time, imagine what else is in the president’s gold-plated medicine cabinet.)

maggie (Maggie Koerth, senior science writer): What we’re basically looking at here is a massive lack of evidence for anything, Chad.

kaleigh (Kaleigh Rogers, science and politics reporter): The results from the few studies that have been done are mixed, at best. Some have found hydroxychloroquine reduced the duration of COVID-19, others have found no difference between using the drug and not, and at least one found there was actually a worse outcome for patients who were on hydroxychloroquine versus those who were not.

maggie: There are ongoing studies of better quality happening — I’m particularly interested in one that’s looking at COVID-19 incidence and outcomes in lupus patients who were already taking hydroxychloroquine for their chronic illness — but we just don’t have evidence to say it does anything.

kaleigh: We do know from past trials of hydroxychloroquine that it can cause abnormal heart rhythms, so the president’s claim that there’s no harm in trying it is not based on evidence. This isn’t like taking vitamin C.

cwick: And are these all studies that test for whether hydroxychloroquine prevents COVID-19? Or are they testing whether it improves treatment of the disease?

kaleigh: Most trials I’ve seen are to treat COVID-19, not to prevent it. (Though there is at least one trial currently testing it out for preventive use.)

cwick: So Trump’s decision to take it preventively complicates things further. We’re in the dearth-iest corner of the dearth of evidence.

maggie: You have the science side of things, which is mostly proceeding as it ought to, and you have the political side, which is full of hype and boom-or-bust demand.

cwick: With that said, Clare, why is Trump doing this? Or maybe the better question: Why is Trump telling us he’s doing it?

clare.malone: On a personal level, Trump is likely taking it because of the recent infections of White House staff and because, well, as we all know, he’s a germaphobe!

But I think it’s a piece of his public response to the outbreak. He attempted, in a quite pitched way at first, to convince the public that things were not as bad as they were made out to be. He promised a non-entity of a disease at first and compared it to the flu. The idea of taking this drug plays into all that, in a more tamped-down way, because he’s offering the public a sort of “cure” or hope. I don’t think it’s a slip of the tongue, but it is a key part of his own thinking about the virus and a key part of how he wants to talk about it in public.

cwick: That’s interesting, Clare. One of the defining characteristics of this disease has been its uncertainty. That’s in part because we haven’t known how to treat those who are sick (let alone make the rest of us immune). Trump seems to be saying: If a medication is good enough to make the president feel safer, it’s good enough to make you feel safer.

maggie: I’m interested, Clare, in whether we’ve seen presidents get so specific in their hope-peddling before. It seems normal for a president to say, “Oh there’s all this research being done and we will have options, let’s fund them.” But it feels to me like Trump has uniquely used the bully pulpit to tout specific products — hydroxychloroquine, that Abbott Laboratories test — when there was more than one option out there. And it’s come back to bite him multiple times. Because when science is moving fast, most of the “good ideas” are going to fail at first. Pinning hope on specific brands and products seems like a real risk he’s taken on.

clare.malone: Right, Chad. The president has gotten A TON of flak for his refusal to wear a mask, but that’s also part of his messaging! It’s certainly odd that he’s taking this drug and not wearing a mask, but he’s a big believer in the sort of traditional displays of “masculine” strength that American politicians have thought the public likes to see. His no-mask thing is the pandemic equivalent of presidential candidates not wearing winter coats while campaigning in Iowa in January.

cwick: This isn’t about promoting promising research, or the latest trial results. He is, in effect, becoming part of the trial himself.

kaleigh: Except it’s not controlled, randomized or blind, so his “trial” is scientifically meaningless. I drink coffee every day and haven’t gotten COVID-19 yet — maybe that’s a prophylactic, too! This is the logic of anecdotal evidence.

maggie: So this reminds me of the study I saw about how men were significantly less likely than women to take non-pharmaceutical preventive measures in a health crisis, like wearing masks, but were more likely than women to take pharmaceutical measures.

kaleigh: His announcement that he’s taking it certainly felt defiant, like he’s doubling down in spite of the evidence. He also spent some time yesterday criticizing a Veterans Affairs study, which found that patients on hydroxychloroquine actually had a higher risk of death.

cwick: Kaleigh, your point about the VA study is super interesting. We’ve seen how the president can dismiss news and findings that run counter to the narrative he wants to promote, and part of his political struggle during this crisis has been knowing when to embrace the science and when to reject it out of hand. By putting his chips in on one drug, the drug itself becomes a cause to rally behind, and news that disputes its power becomes easier for Trump to critique. Essentially, hydroxychloroquine has become part of the White House policy agenda.

clare.malone: Also, if you’ve eschewed a lot of the science in your initial stages of your response, you might as well bet big on a miracle cure, right? Maybe you’ll be right and people will credit with you being early to the party. Americans do love pharmaceutical solutions to their problems.

Shoutout here to former Sen. Bob Dole, the OG American politician-pharmaceuticals spokesman.

kaleigh: It is strange that he got so fixated on this one possible treatment, though. The antiviral drug Remdesivir, by contrast, actually has some promising early results. Why is Trump so interested in hydroxychloroquine? He has scoffed at questions about whether he, say, owns stock in a company that produces the drug, but he also hasn’t provided a lot of explanation about why he’s so fascinated with it.

cwick: Some would have you believe that it might be an issue of cronyism. Here’s the New York Times from April: “Some associates of Mr. Trump’s have financial interests in the issue. Sanofi’s largest shareholders include Fisher Asset Management, the investment company run by Ken Fisher, a major donor to Republicans, including Mr. Trump. A spokesman for Mr. Fisher declined to comment.”

clare.malone: It’s a good question. I’m a bit skeptical of the stock interests answer, since what Trump seems to own is quite negligible. But to Chad’s point, Trump’s personal phone line is always known to be open to friends outside the White House! In the initial stages of the crisis, there’s a sense that he was hesitant to trigger portions of the Defense Production Act because of feedback from the Chamber of Commerce and private industry.

maggie: And meanwhile, his political advocacy has pushed for millions to be spent on it … supplies acquired by the VA and the Strategic National Stockpile.

kaleigh: One thing is clear: When Trump touts a treatment, interest goes up. Not only do Google searches soar, but at least one online prescription service reported a nearly six-fold increase in demand for hydroxychloroquine prescriptions after Trump first mentioned the drug.

maggie: We know there were people from the anti-vaccine movement promoting the so-called ”miracle mineral solution” to him — a pseudoscience “treatment” that basically amounts to industrial bleach — before he spent that one press conference talking about treating yourself with disinfectant.

clare.malone: And we know Trump is susceptible to anti-vaxxers from earlier in his time in public life.

maggie: I can see why the open phone line thing would work in real estate — hot backdoor tips from buddies. But that doesn’t really work in science.

clare.malone: But isn’t it more politics masquerading as science? Which might be the whole problem.

cwick: Right, it seems like we’re all arriving at the same terminus: The president has long demonstrated a contrarian approach to science, so his taking hydroxychloroquine despite iffy science is as much about the political as it is about the personal.

kaleigh: What is the political motivation to fixate on one drug and also continue to tout it against all current evidence?

clare.malone: Momentum. You’ve already been saying it: Why stop saying it?! You’ll just look more fallible.

cwick: Politicians don’t like to be wrong.

maggie: This politician in particular really doesn’t like to be wrong — maybe even more so than others.

clare.malone: It’s the spin zone, y’all! Hop on in. It’s dark, but that’s what it is.

kaleigh: Right, changing your mind based on new and better information is bad in politics, for some reason.

clare.malone: Flip flopping.

cwick: It’s considered bad in broader society, too!

clare.malone: Is it?? That’s actually an interesting question.

cwick: I’d say that I’m reconsidering, but then you’d think I was weak…

Maggie Koerth was a senior reporter for FiveThirtyEight.

Clare Malone is a former senior political writer for FiveThirtyEight.

Chadwick Matlin was a deputy managing editor at FiveThirtyEight.

Kaleigh Rogers is FiveThirtyEight’s technology and politics reporter.