Whether Hydroxycholoroquine Works Is Not About Trump

President Donald Trump addresses the daily coronavirus task force briefing at the White House in Washington, D.C., April 6, 2020. (Kevin Lamarque/Reuters)
The data are not in, but we should be hoping it’s effective in treating COVID-19.

NRPLUS MEMBER ARTICLE W hat’s your opinion on the use of hydroxycholoroquine to treat coronavirus infection? What’s your opinion of Donald Trump? Far too many people are letting their answer to the second question decide the first.

The blogger Ace of Spades had a brilliant insight back in 2013 about “The MacGuffinization of American Politics”:

In a movie or book, “The MacGuffin” is the thing the hero wants. . . . Alfred Hitchcock noted — counterintuitively, when you first hear this — that . . . the audience doesn’t care at all about the MacGuffin. The hero in the movie itself cares, but the audience doesn’t. . . . No audience member really cared if the Nazis wound up with the Ark of the Covenant. . . . But we cared about Indy.

And that, of course, explains all you need to know about the abnormal political situation we find ourselves in, and the Cult of Barack Obama. . . . This is a movie. And Barack Obama is the Hero. And the Republicans are the Villains. And policy questions — and Obama’s myriad failures as an executive — are simply incidental. They are MacGuffins only, of no importance whatsoever, except to the extent they provide opportunities for Drama as the Hero fights in favor of them.

Watching Chris Matthews interview Obama, I was struck by just how uninterested in policy questions Matthews (and his panel) were, and how almost every question seemed to be, at heart, about Obama’s emotional response to difficulties — not about policy itself, but about Obama’s Hero’s Journey in navigating the plot of President Barack Obama: The Movie. As with a MacGuffin in the movie, only the Hero’s emotional response to the MacGuffin matters. . . . American politics is now merely a MacGuffin, an important-sounding but ultimately inconsequential and disposable plot device for holding interest in the Hero’s Journey.

Once you thought in these terms, you quickly realized how much of the behavior of Obama’s supporters and sympathetic media it explained. Enormous attention, for example, was lavished on whether or not Obama was given adequate “respect” by Republicans. All opposition to Obama was assumed to be a reaction to him personally, rather than to his agenda or his actions in office.

Ace’s blog, has, sadly, gone to darker places since then, in part a victim of the very syndrome he diagnosed in 2013. Large swaths of the Right have, too. Donald Trump seems to MacGuffinize everything, driving people into such deep obsessions with his Heroic or Villainous nature (depending on where you sit) that even physical reality itself is believable only if it agrees with your view of Trump.

Which brings us to hydroxycholoroquine and other chloroquine-based remedies for the coronavirus. Nearly nobody had an opinion about these drugs two months ago. Trump has latched on to the notion that these could be highly effective treatments, even miracle drugs. Probing Trump’s thinking is typically a hazardous exercise, but the simplest explanation of at least one of his major motivations is that he is visibly eager for any piece of good news he can use to make the whole pandemic-and-lockdown situation go away. He’s hardly alone on that score. It is even possible that the president wants fewer Americans to die.

Typical of Trump in full salesman mode, he has frequently exaggerated what we know about the treatment. Hydroxycholoroquine has been around for quite a while, but COVID-19 has not, and so the data we have on its effectiveness in treating the virus is limited. Under normal circumstances, the use of even an established drug for a new purpose requires extensive clinical testing, which would normally take years. It’s a rigorous process. We don’t have time for that now; much as happened during the peak of the AIDS crisis, the urgency of the situation has persuaded regulators to let doctors and willing patients experiment with more speculative treatments.

Will it work? I have no idea, neither does Trump, and neither do most of the people reading and writing about hydroxycholoroquine. We should be hoping it works to stem if not stop a dread disease. We should be cautious in our optimism, waiting to see what works and what does not work, and what can actually be proven to work.

Instead, there’s been a stampede among Trump supporters and advocates to embrace hydroxycholoroquine: The Hero must always be right! And there has been a reflexive reaction among the president’s critics: The Villain must always be wrong! People dig in their heels on the notion that a legitimate and longstanding drug, never tested for a particular use, must be either a miracle elixir or a totally fraudulent snake-oil remedy. In some cases, they seem rather palpably to be rooting for its failure, because defeating the Villain is the only thing that is real; the pandemic all around us is just another MacGuffin.

On one side, you have presidential advisers and confidants such as Rudy Giuliani, Peter Navarro, Sean Hannity, and Dr. Oz publicly pushing hard for the drug’s potential. Twitter has responded by forcing Giuliani, Laura Ingraham, and Charlie Kirk to delete Tweets touting the treatment.

On the other, former longtime D.C. journalist Ron Fournier sneered on Twitter that “Trump won’t wear a mask, but he’ll take a magic potion.” As if modern medicine is just hocus-pocus. Progressive blogger Oliver Willis tweeted, “The mainstream media frame is there is a ‘debate’ on hydroxychloroquine. the two ‘sides’ are the facts and every legitimate medical expert versus a bunch of political hacks who are wrong about everything and have a hand in killing thousands of people. both ‘sides.’” Tavia Galonski, a Democratic state representative from Akron, Ohio, tweeted, “I can’t take it anymore. I’ve been to The Hague. I’m making a referral for crimes against humanity tomorrow.” NBC legal analyst Glenn Kirschner responded to Galonski, “Trump’s conduct easily satisfies all 3 elements of involuntary manslaughter. In fact, his gross negligence is beginning to look more like conduct evincing a “conscious disregard of an extreme risk of death/serious bodily injury = the standard for depraved heart/2nd degree murder.” Jonathan Chait, in New York magazine, compared Trump’s embrace of hydroxychloroquine to Lysenkoism, the Stalinist adoption of quack biology as government orthodoxy. Elizabeth Warren joined the fray, arguing against the president even talking about the treatment: “Trump’s unproven claims about hydroxychloroquine have already led to stockpiling, creating shortages for the physicians and patients who rely on the medication. Medical misinformation is dangerous and Donald Trump has no business giving this advice.”

The assumption that the Villain could only ever be acting for venal motives led to some painfully stretched efforts to sniff out corrupt reasons for anyone to consider hydroxychloroquine as a treatment. The investigative site Sludge claimed: “It’s unclear why Trump has been such a proponent of hydroxychloroquine, but one answer may lie with the millions of dollars in political support he has received from the founder of a pharmaceutical industry-funded group that has been pushing him to make the drug available.” The New York Times rushed out a report:

Some associates of Mr. Trump’s have financial interests in the issue. Sanofi’s largest shareholders include Fisher Asset Management, the mutual fund company run by Ken Fisher, a major donor to Republicans, including Mr. Trump. . . . Another investor in both Sanofi and Mylan, another pharmaceutical firm, is Invesco, the fund previously run by Wilbur Ross, the commerce secretary. . . . As of last year, Mr. Trump reported that his three family trusts each had investments in a Dodge & Cox mutual fund, whose largest holding was in Sanofi.

One investor in Sanofi used to be run by Wilbur Ross? Trump has family trusts that own shares in a mutual fund that owns shares in Sanofi? Really? Sanofi is an enormous pharmaceutical company; it is not the sole producer, but the Times is here to warn you that one of the generic manufacturers has golfed with Trump!

Several generic drugmakers are gearing up to produce hydroxychloroquine pills, including Amneal Pharmaceuticals, whose co-founder Chirag Patel is a member of Trump National Golf Course Bedminster in New Jersey and has golfed with Mr. Trump at least twice since he became president, according to a person who saw them.

Fortunately, people closer to the situation recognize that the coronavirus pandemic and the pros and cons of hydroxychloroquine treatment have real-life consequences. Axios reports that “most members of the [White House coronavirus] task force support a cautious approach to discussing the drug until it’s proven.” Dr. Anthony Fauci, the administration’s lead pandemic expert, cautioned in a Face the Nation interview: “The data are really just, at best, suggestive. There have been cases that show there may be an effect, and there are others to show there’s no effect. . . . So I think in terms of science, I don’t think we could definitively say it works.” Michigan’s Democratic governor, Gretchen Whitmer, whose administration had initially issued an order banning new prescriptions of hydroxychloroquine, reversed course at a Thursday town hall and cautiously acknowledged the “great potential” in the treatment. A Detroit health system is now leading the nation’s first large-scale study and is recruiting more than 3,000 volunteers to take the drug. New York’s Democratic governor, Andrew Cuomo, in his daily briefing Monday, said that in New York hospitals, “there has been anecdotal evidence that it is promising; that’s why we’re going ahead.” But he cautioned: “The tests in the hospital, they’re too short a period of time to get a scientific report. . . . Anecdotally, you’ll get suggestions that it has been effective. But we don’t have any official data yet from a hospital or a quote-unquote study, which will take weeks if not months”

This is as it should be: The effectiveness or ineffectiveness of hydroxychloroquine is an empirical reality. It is not simply a plot device in President Donald Trump: The Movie. We cannot make it succeed or fail simply by how we feel about Trump.

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