Fake News In The Days of COVID-19.
Posted by Edmund R. Folsom
April 15, 2020.
This isn’t a post about the law. It’s a post about an example of bad information, false information. And it’s an example that is all too typical. On this site, I will always try my best to get the facts straight. In this post, I will straighten out some facts that were presented as news today that are just plain false — are they fake? You decide.
Today’s Portland Press Herald contains a story about some Maine doctors reportedly prescribing chloroquine, hydroxychloroquine and azithromycin for COVID-19. It also contains significant false information (read on). The story reports that some Maine doctors are prescribing the drugs for themselves and others to guard against the disease, before any symptoms appear. The Maine Board of Pharmacy has issued guidance to address the practice. The Board of Osteopathic Licensure and Board of Licensure in Medicine are expected to follow suit. The Pharmacy Board has instructed pharmacists that: “To prevent drug shortages, pharmacists should contact prescribers to confirm the diagnoses of patients newly prescribed these medications, and pharmacists should refrain from inappropriately stockpiling these medications.”
Why would the Pharmacy Board be concerned about shortages of these drugs? Hydroxychloroquine is regularly prescribed to treat lupus and rheumatoid arthritis. Azithromycin is something nearly everyone is familiar with. Shortages of hydroxychloroquine and azithromycin might adversely affect lupus patients, rheumatoid arthritis patients and those in need of antibiotics for conditions other than COVID-19. Chloroquine shortages are probably not a realistic problem in Maine. The drug is usually only prescribed to those traveling to an area where Malaria is endemic. And, in fact, the focus in treating people for COVID-19 in the U.S. has not been by use of chloroquine, but by use of hydroxychloroquine often combined with azithromycin.
Now to focus on the deception in today’s PPH story and to set it straight with a few facts. The story ends with the following several paragraphs:
“In March, Trump said the pairing of hydroxychloroquine and azithromycin had ‘a real chance to be one of the biggest game changers in the history of medicine.’ He’s touted it at several briefings since, despite hesitation from his top infectious disease expert, Dr. Anthony Fauci, who warned against making claims until the drugs’ use against COVID-19 could be studied further.
Other medical experts have not been as bullish about the drugs, which have shown promise but have dangerous side effects. Some early studies have produced grim results.
The New York Times reported Monday that a study in Brazil was halted after 11 people died from heart arrhythmia they developed after being given the drugs.
Other countries, including France and Sweden, have discontinued the use of chloroquine and hydroxychloroquine after patients there developed heart problems.” (Italics added)
The above quoted passages from the PPH story are deceptive/flat out false, in the following ways:
1. Contrary to the quoted Portland Press Herald assertions immediately above, The New York Times story does not actually state that 11 people in the Brazilian study died from heart arrhythmias. And in fact, that is not what happened, according to the published study itself.
2. Contrary to the impression created by the quoted portion of the PPH story above, the Brazilian study did not involve the use of hydroxychloroquine. The drug that was administered was chloroquine. The study involved 2 groups of patients who were hospitalized with “severe” cases of COVID-19 who were divided into 2 groups. One group (41 of the participants) received a high dose (600 mg.) of chloroquine. The other group (40 of the participants) received a low dose (450 mg.). As the study points out: “one limitation for the conclusions of the study on lethality per arm is that high CQ dosage arm presented more patients prone to cardiac complications, with or without CQ.” In other words, the high dose group was more prone to cardiac complications from COVID-19 than the low dose group. For instance, all participants age 75 and older were assigned to the high dose group.
3. Although heart arrhythmias were observed in the high dose group, causing the high dose group to be shifted to a low dose after 6 days, neither the New York Times story nor the published report says 11 people in the study died from heart arrhythmia, let alone heart arrhythmia caused by chloroquine. Instead, both state that a total of 11 study participants died before the high dose part of the study was ended. In fact, in the 6 days before the high dose portion of the study was ended because of observed arrhythmias, 7 of the 40 participants in the low dose group died (problematic arrhythmias not observed), versus 4 of the 41 participants in the high dose group (in which problematic arrhythmias were observed) (see Table 3, study report). The 11 deaths among the 81 participants was not above the expected death rate for this group of severe COVID-19 sufferers. In other words, chloroquine did not kill 11 of the participants by arrhythmia. Evidently, COVID-19 killed them.
4. Neither the country of France nor the country of Sweden discontinued the use of chloroquine and hydroxychloroquine due to patients developing heart problems.
5. Instead, in Sweden, some hospitals in the Vastra Gotalan region were administering chloroquine, as distinct from hydroxychloroquine, to some COVID-19 patients (See a description of the differences and different side effects here). Several of those hospitals in that particular region stopped after some patients reported developing symptoms such as cramps and loss of peripheral vision.
6. In France, hydroxychloroquine is undergoing trials in numerous hospitals. In one of those hospitals, the University Hospital Center of Nice, as of last week four experimental treatments were undergoing trials, one of which involved hydroxychloroquine. The head of the cardiology department at The University Hospital of Nice reported last week that a trial involving hydroxychloroquine was stopped for one patient when ECG monitoring detected a heart rhythm anomaly. The use of hydroxychloroquine to treat COVID-19 patients continues in France.
To recap: It is not true that 11 people died in the Brazilian study from arrhythmias caused by the drugs they were administered. The participants in the Brazilian study did not receive hydroxychloroquine at all. Instead they received chloroquine in either a high or low dose. Although arrhythmias were noted in the high dose group, causing the high dose part of the study to be ended after 6 days, only 4 of the 11 deaths that occurred within that 6 days occurred in the high dose group. Seven of the deaths occurred in the low dose group in which arrhythmias did not cause their trial to be terminated. And the 11 deaths during those 6 days were within the expected range of deaths from this population of participants, all of whom suffered severe COVID-19 Infections. Neither France nor Sweden have discontinued the use of hydroxychloroquine to treat COVID-19 patients for any reason, let alone because patients developed heart problems. Instead, some Swedish hospitals in one particular region of the country have stopped using chloroquine because patients developed problems such as loss of peripheral vision and cramps. And one French hospital stopped the use of hydroxychloroquine for one patient (maybe more) after EEG monitoring revealed a heart arrhythmia. Hydroxychloroquine continues to be used to treat COVID-19 throughout France.
How does a news outlet that asks to be taken seriously as a reliable source of information pack so much misinformation into just a few small paragraphs? Not to pick on this particular news outlet, since what it did is now routine in the trade, but is fair to call what the PPH did here fake news? It sure isn’t real, and it sure was presented as news. Be careful what you run with.