Health Dept. Doctor Says Doubts on Hydroxychloroquine Led to His Ouster

Health Dept. Doctor Says Doubts on Hydroxychloroquine Led to His Ouster

WASHINGTON — The doctor who led the federal agency involved in developing a coronavirus vaccine said on Wednesday that he was removed from his post after he pressed for rigorous vetting of hydroxychloroquine, an anti-malaria drug embraced by President Trump as a coronavirus treatment, and that the administration has put “politics and cronyism ahead of science.”

Dr. Rick Bright was abruptly dismissed this week as the director of the Department of Health and Human Services’ Biomedical Advanced Research and Development Authority, or BARDA, and removed as the deputy assistant secretary for preparedness and response. He was given a narrower job at the National Institutes of Health.

In a scorching statement, Dr. Bright assailed the leadership at the health department, saying he was pressured to direct money toward hydroxychloroquine, one of several “potentially dangerous drugs promoted by those with political connections” and repeatedly described by the president as a potential “game changer” in the fight against the virus.

“I believe this transfer was in response to my insistence that the government invest the billions of dollars allocated by Congress to address the Covid-19 pandemic into safe and scientifically vetted solutions, and not in drugs, vaccines and other technologies that lack scientific merit,” he said in his statement. “I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way.”

Doubts about the use of hydroxychloroquine as a treatment for the coronavirus and the lack of evidence about the drug’s effectiveness — including some small studies that indicated patients could be harmed — appear to have dampened Mr. Trump’s p enthusiasm for it.

As the seriousness of the pandemic became clearer in mid-March, the president seized on anecdotal reports about victims of the coronavirus who recovered quickly after using the drug. Desperate for good news as he watched the death toll climb and the stock market plummet, Mr. Trump could hardly contain his excitement.

In a post on Twitter on March 21, the president urged federal officials to quickly approve the use of hydroxychloroquine with an antibiotic called azithromycin — a combination that he believed could work on the coronavirus.

“Hopefully they will BOTH (H works better with A, International Journal of Antimicrobial Agents) be put in use IMMEDIATELY,” he tweeted. “PEOPLE ARE DYING, MOVE FAST, and GOD BLESS EVERYONE!”

By then, Mr. Trump’s favorite Fox News hosts were echoing his optimism that hydroxychloroquine could be a magic bullet against the virus. A day after meeting in the Oval Office with Laura Ingraham and two doctors promoting the drug as a cure-all, Mr. Trump became First Salesman, promoting it from the White House briefing room.

“I’ll say it again: What do you have to lose?” Mr. Trump said on April 4, carefully pronouncing the drug, hydroxychloroquine. His presidential prescription: “Take it.”




‘What Do You Have to Lose?’ How Trump Has Promoted Malaria Drug

President Trump has pushed a malaria drug, hydroxychloroquine, as a treatment for coronavirus patients. A recent study found that patients taking it had higher death rates compared with those who did not.

It is known as a malaria drug, and it’s been around for a long time. And it’s very powerful, but the nice part is it’s been around for a long time, so we know that if things don’t go as planned, it’s not going to kill anybody. And it’s shown very encouraging very, very encouraging early results. There’s a possibility — a possibility — and I say it: What do you have to lose? I’ll say it again, what do you have to lose? Take it. I really think they should take it. But it’s their choice, and it’s their doctor’s choice or the doctor’s and the hospital. But hydroxychloroquine, try it if you’d like. It will be, not a game changer because that’s not a nice enough term — it will be wonderful. It’ll be so beautiful. It’ll be a gift from heaven. If it works that would be great. If it doesn’t work, we know for many years — malaria, it’s incredible what it’s done for malaria. It’s incredible what it’s done for lupus. But it doesn’t kill people. But if it was somebody else other than President Trump that put it forward, if some other person put it forward that said, “Oh, let’s go with it, you know, what do you have to lose?”

President Trump has pushed a malaria drug, hydroxychloroquine, as a treatment for coronavirus patients. A recent study found that patients taking it had higher death rates compared with those who did not.CreditCredit…Craig Lassig/Reuters

In briefing after briefing with reporters at the White House, Mr. Trump defied the voices of medical experts and some of his own top advisers — including Dr. Anthony S. Fauci, the nation’s top infectious disease specialist and an adviser to the coronavirus task force — who cautioned that hydroxychloroquine, which is used to treat autoimmune diseases like rheumatoid arthritis and lupus as well as malaria, needed to undergo the same kind of rigorous evaluation that other drugs do.

In mid-April, a small trial in Brazil was halted after some patients developed irregular heart rates. Then a study this week of 368 Veterans Affairs patients, which has not been peer-reviewed, found that it did not help patients avoid the need for ventilators, and that the use of the drug alone was associated with an increased risk of death. And this week, a panel of the government’s own experts at the National Institute of Allergy and Infectious Diseases said there was “insufficient data” to recommend taking it to treat symptoms from the virus.

The president has not talked much since then about hydroxychloroquine.

In his statement, Dr. Bright did not directly name Mr. Trump. But the searing language he used left little doubt that he viewed the administration’s support for the drug as pressure to ignore scientific facts in favor of politics.

“My professional background has prepared me for a moment like this — to confront and defeat a deadly virus that threatens Americans and people around the globe,” Dr. Bright wrote. “To this point, I have led the government’s efforts to invest in the best science available to combat the Covid-19 pandemic.”

“Unfortunately, this resulted in clashes with H.H.S. political leadership, including criticism for my proactive efforts to invest early into vaccines and supplies critical to saving American lives. I also resisted efforts to fund potentially dangerous drugs promoted by those with political connections,” he said, adding that hydroxychloroquine was “promoted by the administration as a panacea, but which clearly lack scientific merit.”

Asked about Dr. Bright and his transfer on Wednesday at the daily White House briefing, Mr. Trump said he did not know who he was.

“I never heard of him,” the president told reporters. “You mention the name, I never heard of him. When did this happen? I never heard of him. The guy says he was pushed out of a job. Maybe he was. Maybe he wasn’t. I don’t know who he is.”

A career government official who has led BARDA since 2016, Dr. Bright pointed specifically to the initial efforts to make chloroquine and hydroxychloroquine widely available before it was scientifically tested for efficacy with the coronavirus.

“While I am prepared to look at all options and to think ‘outside the box’ for effective treatments, I rightly resisted efforts to provide an unproven drug on demand to the American public,” Dr. Bright said, describing what ultimately happened: “I insisted that these drugs be provided only to hospitalized patients with confirmed Covid-19 while under the supervision of a physician.”

A person familiar with Dr. Bright’s account said that he was pressured to rush access to the drug after the president and Larry Ellison, the chairman and chief technology officer of Oracle, had a conversation about chloroquines. Dr. Bright was then directed to put in place a nationwide expanded access program to make the drugs available on a broad basis without specific controls in place, according to the person familiar with his account.

Medical experts say that it is still not known whether hydroxychloroquine might yet emerge as an effective treatment for the most devastating symptoms of Covid-19, the disease caused by the coronavirus. The studies in Brazil and at the Department of Veterans Affairs were small and limited. Comprehensive, peer-reviewed studies have yet to be completed, and while hospitals are using the drug, many doctors acknowledge they are doing so only because they have few other tools to help dying patients.

And inside the White House, the drug still has its true believers, including Peter Navarro, a trade adviser who has been put in charge of procuring protective gear and other medical supplies to fight the virus. Mr. Navarro is relentless with anyone in the West Wing who will listen, encouraging the government to keep stockpiling the drug and dismissing the recent studies as “deeply flawed.”

The Brazil study gave doses of hydroxychloroquine in excess of the levels recommended by the Food and Drug Administration, he said in an interview. The Veterans Affairs study administered the medicine too late and focused narrowly on an older population with high incidences of cardiac failure, diabetes and lung disease, among other issues, he insisted.

“None of this was reported by a mainstream media which appears incapable of reading anything more than study headlines,” he said. “To date, almost 40 studies have reported apparent usefulness of hydroxychloroquine or chloroquine in shortening length of hospital stay, improving symptoms, and resolving lung lesions as seen on X-rays.”

And some doctors around the country are still hopeful that more complete tests of the drug might still yield some positive news.

Dr. William W. O’Neill, a cardiologist at the Henry Ford Health System in Detroit who is organizing a large randomized study using the drug as a preventive medication in health care workers and emergency medical workers, said he had “cautious optimism” but urged the public to avoid drawing premature conclusions.

“Everybody is desperate to find out all the answers,” Dr. O’Neill said. “But we have to be careful about jumping to conclusions either way.”

Dr. Bright said his superiors at the Department of Health and Human Services were doing exactly that.

He is represented by the lawyers who represented Christine Blasey Ford, who testified against the nomination of Judge Brett M. Kavanaugh to the Supreme Court, accusing him of sexual misconduct decades ago, a claim he denied.

In a statement, the lawyers called Dr. Bright’s change in position “retaliation, plain and simple” and said they planned to ask for an investigation.

A White House spokesman, Judd Deere, did not directly address the accusations on Wednesday.

“While some are rooting for the drug to fail, President Trump is simply offering a consistent message of hope, comfort and optimism while telling Americans to consult with their doctor,” Mr. Deere said.

A spokeswoman for Alex M. Azar II, the secretary of the Department of Health and Human Services, did not immediately respond to an email seeking comment.

The medical publication Stat reported on Tuesday that Dr. Bright had clashed with Dr. Robert Kadlec, the assistant health secretary for preparedness and response. A former administration official disputed that Dr. Bright expressed significant opposition to the drug and insisted that he was moved out of his position because of longstanding concerns about his job performance.

Michael D. Shear reported from Washington, and Maggie Haberman from New York. Katie Thomas contributed reporting from Chicago.

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