Truly, hydroxychloroquine is the Black Knight of drugs to treat COVID-19. Monty Python fans will immediately know what I’m talking about, but for those who aren’t familiar with the hilarious scene to which I refer, the Black Knight is a fictional character from Monty Python and the Holy Grail. In the film, King Arthur encounters him guarding a rather pathetic bridge and asks him to join his quest to seek the Holy Grail. The Black Knight refuses and then blocks Arthur’s passage with a menacing, “None shall pass.” The battle is joined, and Arthur, one by one, chops off all of the Black Knight’s limbs in a truly warped comedy sequence. After losing each limb, the Black Knight says things like, “‘Tis but a scratch” and “I’ve had worse.” Before his last leg is chopped off, the Black Knight proclaims (while hopping around), “I’m invincible,” to which Arthur retorts, “You’re a loony.” After losing his last limb, the Black Knight finally concedes, “All right, we’ll call it a draw.” Then, as Arthur crosses the bridge and rides off, the Black Knight yells, “Oh. Oh, I see. Running away, eh? You yellow bastards! Come back here and take what’s coming to ya! I’ll bite your legs off!”
The reason the sketch is so funny and has become such a classic since the movie was released during 1970s, to the point that almost everyone recognizes it just by reference to the Black Knight, is, of course, due to the extreme disconnect between the Black Knight’s overconfidence and his rapidly declining limb count. (The bleeding from each limb stump is also so obviously fake and absurd that it contributes to the ridiculousness of the entire scene.) If you apply the sketch to the situation with respect to hydroxychloroquine as a treatment for COVID-19, you can quickly see where I’m going with this. Initially (on the surface at least), like the Black Knight versus Arthur, hydroxychloroquine looked fairly formidable as a potential treatment for COVID-19 based on anecdotal evidence. It wasn’t long, however, before the drip-drip-drip of negative studies soon rendered hydroxychloroquine a stump of a treatment, one limb at a time. Examples included the publication of a randomized controlled clinical trial of the drug as post-exposure prophylaxis that was entirely negative. This was followed by two more, first, a Spanish post-exposure prophylaxis trial that was also negative. Then there was the Recovery Trial from the UK. Most recently, last week the New England Journal of Medicine published a clinical trial of 667 patients with mild-to-moderate COVID-19 randomized to receive placebo or hydroxychloroquine (with and without azithromycin, yet!), with the primary outcome being clinical status at 15 days. It was completely negative. Two weeks ago yet another randomized controlled trial of hydroxychloroquine was published in Clinical Infectious Diseases. It was a Spanish trial of 293 non-hospitalized patients with mild COVID-19. Guess what? It was negative. No benefit was observed with hydroxychloroquine beyond the usual care. None of this stopped a Yale epidemiologist named Harvey Risch from publishing a risibly, embarrassingly inept defense of the evidence base for hydroxychloroquine, which I interpreted as the Black Knight losing his last leg.
So last week, the Black Knight was reduced to a stump. This week, we hit the part of the scene in which, as Arthur pretend-gallops off using coconuts to simulate the sound of horses’ hooves, the Black Knight is yelling, “Oh. Oh, I see. Running away, eh? You yellow bastards! Come back here and take what’s coming to ya! I’ll bite your legs off!” Yes, the frenzied promotion of hydroxychloroquine for COVID-19 has gotten just that ridiculous, with the release on Monday of a video produced by the right wing conspiracy outlet Breitbart featuring a group of doctors portentously calling themselves “America’s Frontline Doctors” that was viewed 17 million times on Facebook in just eight hours, retweeted by President Trump and his allies. It rapidly went viral:
A dangerous video spreading misinformation about a cure and treatment for COVID-19 circulated on Facebook, Twitter, and YouTube yesterday.
Created by the media outlet Breitbart, the video depicts a group of experts who claim to be “America’s Frontline Doctors” at a press conference outside the U.S. Supreme Court in Washington. They say that Americans are captured by fear of the novel coronavirus— but there’s no need to be scared because hydroxychloroquine treats and prevents COVID-19. The video was seen by millions of people before it was pulled by all three channels for violating their misinformation policies, BBC reports.
Taking a starring role in this rogue’s gallery of quacks was a Houston doctor and religious minister named Dr. Stella Immanuel:
A Houston doctor who praises hydroxychloroquine and says that face masks aren’t necessary to stop transmission of the highly contagious coronavirus has become a star on the right-wing internet, garnering tens of millions of views on Facebook on Monday alone. Donald Trump Jr. declared the video of Stella Immanuel a “must watch,” while Donald Trump himself retweeted the video.
Before Trump and his supporters embrace Immanuel’s medical expertise, though, they should consider other medical claims Immanuel has made—including those about alien DNA and the physical effects of having sex with witches and demons in your dreams.
Immanuel, a pediatrician and a religious minister, has a history of making bizarre claims about medical topics and other issues. She has often claimed that gynecological problems like cysts and endometriosis are in fact caused by people having sex in their dreams with demons and witches.
She alleges alien DNA is currently used in medical treatments, and that scientists are cooking up a vaccine to prevent people from being religious. And, despite appearing in Washington, D.C. to lobby Congress on Monday, she has said that the government is run in part not by humans but by “reptilians” and other aliens.
See what I mean? Truly, the Black Knight Hydroxychloroquine is raging against King Arthur (science). Don’t believe me? Just take a look at Dr. Immanuel’s Twitter feed. First up, last week:
Here’s a hint: 250 patients are not a lot of patients to study for a disease whose overall infection fatality rate is likely less than 1%, particularly if there is no control group to compare the treated patients to. Seriously, this is such basic stuff that I learned it in my first year of medical school. How is it that Dr. Immanuel either did not or forgot?
Here she is, describing hydroxychloroquine as the “cure”:>
Next up, she’s complaining about being ridiculed:
Here’s a hint: Dr. Immanuel is being ridiculed and discredited because she and her fellow “Frontline Doctors” are ridiculous.
My favorite, though, is Dr. Immanuel challenging people to do urine tests to “prove” that they’re not taking hydroxychloroquine:
Because those of us who have concluded, based on existing evidence and the accumulation of negative randomized controlled trials, that hydroxychloroquine almost certainly doesn’t work against COVID-19 are secretly taking the drug to prevent disease.
Curious, I wandered over to the America’s Frontline Doctor’s website, only to discover that it has been taken down, with the hosting service presenting a message of “Website Expired.” I kicked myself, because I had checked out the website earlier yesterday, with the intent of writing about it. The almighty Wayback Machine has some of it still available, but the formatting, for some reason, is screwed up. The video, called “White Coat Summit,” can still be found at the Tea Party Patriots website. It’s 43 minutes long (if you can stand it), and it’s chock full of misinformation, pseudoscience, and disinformation about hydroxychloroquine of the sort I’ve been writing about since March. I debated whether to slog through the whole thing and do a blow-by-blow, but, given that there’s really nothing much new here, I decided to hit the “high points” (if you can call them that). But, first, who are “America’s Frontline Doctors”?
We’ve already met Dr. Stella Immanuel and learned of her belief in the reptilian conspiracy theory, that gynecological problems like cysts and endometriosis are in fact caused by people having sex in their dreams with demons and witches. You might have seen the hashtag #DemonSperm trending on Twitter. She’s the reason.
Next up is Dr. James Todaro, an ophthalmologist. Interestingly, we’ve met him before on this blog in the context of the SurgiSphere debacle. The interesting thing about Dr. Todaro is that, while he was correct about how bad the SurgiSphere study was, he’s wrong about just about everything else having to do with hydroxychloroquine, as he is a hydroxychloroquine cultist. Let’s just put it this way. He’s buddies with Didier Raoult, the “brave maverick doctor” ande bully who initially published a truly awful, incompetently done (and perhaps even downright fraudulent) study claiming that hydroxychloroquine and azithromycin clear coronavirus in 100% of cases. (The numbers were single digit.) Dr. Todaro also found his way onto my radar for publishing a credulous, pro-hydroxychloroquine article entitled An Effective Treatment for Coronavirus. He’s also a managing partner in a cryptocurrency company, which is always a red flag for grift, in my book.
It turns out that it was probably Dr. Todaro who was responsible for sparking President Trump’s obsession with hydroxychloroquine in the first place, something I didn’t know:
On March 13, cryptocurrency investor James Todaro and New York City lawyer Gregory Rigano tweeted out a link to a paper they’d put on the file-sharing service. In it, the men described a drug they’d been following, chloroquine, that in early trials in China and France appeared to show promise as a COVID-19 treatment. Long used as a treatment for malaria, the drug is cheap and plentiful and available to combat the pandemic immediately. Not only has it been deemed “effective in treating COVID-19,” they wrote, but it “also has strong potential as a prophylactic (preventative) measure against coronavirus.” The pandemic, they suggested, could be snuffed out in one stroke—if the authorities would just take action. The paper ended with a call for readers to disseminate it and translate it into other languages.
At a time when public anxiety about the pandemic was snowballing, the paper offered a rare ray of hope. As its authors had urged, the paper was quickly disseminated over the internet. On March 16, Elon Musk tweeted a link to the Google Doc, writing: “Maybe worth considering chloroquine for C19.” On March 18, right-wing websites Breitbart and The Blaze picked up the story. On March 19, Rigano went on Fox News and told Tucker Carlson that a chloroquine study had shown “a 100% cure rate against coronavirus.”
From there it was a short leap to the biggest bullhorn of all. That same day Donald Trump declared at a press conference that chloroquine was a possible “game changer” and that the FDA had approved it. “We’re going to be able to make that drug available almost immediately,” he promised.
If this is true, Dr. Todaro is responsible for the one of the two most harmful bits of propaganda and disinformation about COVID-19 spreading around the US (the other being that masks and social distancing don’t work to slow the spread of coronavirus).
As for the rest, Jenny Beth Martin is not a doctor, but she is co-founder of an anti-tax group called the Tea Party Patriots Foundation and claims:
Martin, among other things, dislikes Dr. Anthony Fauci’s skepticism of hydroxychloroquine and insists that he could change his opinion if he only met with this group of right-wing health workers.
“My message to Dr. Anthony Fauci is to have a meeting with these frontline doctors who are seeing real patients,” Martin said on Tuesday. “They’re touching human skin, they’re looking people in the eye, they’re diagnosing them, and they’re helping them beat the virus.”
No, Ms. Martin. Science will persuade Dr. Fauci (and those of us of a science-based bent), not a bunch of quacks touting their “anecdotal experience” coupled with conspiracy theories.
Next up, Dr. Simone Gold:
Dr. Simone Gold is a doctor and lawyer in Los Angeles who publicly takes credit as the founder of “America’s Frontline Doctors,” a group whose website was set up 12 days ago, and amusingly appears to be down right now.
Gold has been a regular on the right-wing media circuit during the pandemic, appearing on Fox News on May 21, arguing that patients are being harmed by the shutdowns taking place across the country.
She also revealed the reason why the group’s website is down:
She’s also pulling the favorite disinformation technique beloved of cranks and quacks everywhere, the “open debate” gambit:
She’s also arguing that hydroxychloroquine should be available over-the-counter, which, given its risk of serious arrhythmias is utterly bonkers:
Sadly, she has access to power:
Apparently, Dr. Simone is a lawyer and a board-certified emergency medicine physician. This leads me to ask: What is it with all these ER docs who, during the COVID-19 pandemic, suddenly think they are epidemiologists, infectious disease experts, and can science better than the true experts? Other examples have included Dr. Kelly Victory, who’s been claiming that masks don’t work, and Drs. Dan Erickson and Artin Massihi, owners of a chain of urgent care centers in Bakersfield, CA who made a splash in April promoting bad epidemiology designed to minimize the severity of the pandemic.
Speaking of Dr. Dan Erickson–surprise! surprise!—he’s one of “America’s Frontline Doctors” too. So is a doctor named Dr. Robert Hamilton, who appears to be the least bizarre of the group. He’s a pediatrician in Santa Monica and hasn’t shown up on right wing media much since 2015. He’s the founder of a Pacific Ocean Pediatrics.
The main themes of the video were simple. The first was very much an appeal to authority. Like the much larger Association of American Physicians and Surgeons, the far right wing John Birch-like group disguised as a medical society, “America’s Frontline Doctors” are playing on their authority as physicians to peddle a distinctly political agenda not based in science. (Unsurprisingly, AAPS also claims that masks don’t work.) Indeed, Dr. Gold starts out by laying it on really thick about how they are “experts” and “frontline doctors.” My response to that is that, while emergency medicine doctors and primary care doctors are certainly “frontline doctors,” that doesn’t give them any expertise in epidemiology, public health, or infectious disease. It doesn’t necessarily even give them any insight into how well specific treatments for a disease work (or don’t work), given that personal clinical experience can be misleading and, especially in the case of ER docs, many don’t even have longterm followup of their patients beyond an ER visit that might or might not lead to an admission. Basically, this group is playing on the average American’s lack of understanding of what their actual expertise really is.
Dr. Hamilton shows up next to tout the known information that children tend to be much less likely to get COVID-19 and to be less severely affected by the disease when they do get it. I do note, however, that it’s not as though coronavirus is completely safe for children. You and I have seen the reports of children dying from the disease and of the mysterious, Kawaski-like syndrome that, although rare, is not so rare that we haven’t seen it. Basically, Dr. Hamilton dismisses the reasonable concerns about whether opening schools again as baseless, all based on cherry picked science. You can also tell where he’s coming from, at least politically, because he includes a gratuitous swipe at teachers’ unions at the end of his segment for being (quite understandably, from my point of view) concerned that too many school districts are rushing to reopen without good plans to prevent outbreaks.
The most bonkers segment is up next, and, as you might guess, it’s Dr. Stella Immanuel. Her entire schtick is that she’s “personally treated 350 patients” with COVID-19 and that none of them have died. She’s also used zinc and azithromycin. As I said, this is all well and good, but that is actually a small number and, without a control group, is meaningless. She even goes on to claim:
This virus has a cure. It is called hydroxychloroquine, zinc, and Zithromax. I know you people want to talk about a mask. Hello? You don’t need a mask. There is a cure.
She even emphasizes that “nobody needs to get sick,” that “you don’t need masks” because there’s a cure, and that the schools should be opened because—you guessed it—there is a cure.
But what about all those negative studies that I’ve been discussing? Dr. Immanuel dismisses them as “fake science” by “fake pharma companies.” Her entire argument, boiled down to its essence, is that facemasks and social distancing are unnecessary because hydroxychloroquine prevents and cures COVID-19. Again, face masks work, and existing evidence is trending strongly in the direction of the conclusion that hydroxychloroquine doesn’t work against COVID-19. But to Dr. Immanuel, her single-physician anecdotal stories trump well-designed randomized clinical trials.
I think this bit from her says it all:
And let me tell you something. All you fake doctors out there that tell me, “Oh, yeah, I want a double-blinded studies.” I want to tell you, stop sounding like a computer, double-blinded, double blinded. I don’t know what are you, are your chips malfunctioning? But I’m a real doctor. We have radiologists. We have plastic surgeons. We have neurosurgeons like Sanjay Gupta saying, ‘Oh, yeah, it doesn’t work and it can harm in heart disease.’ Dr. Sanjay Gupta, hear me. Have you seen a COVID patient? Have you ever treated anyone with hydroxychloroquine who had heart disease? When you do, come and talk to me, because I sit down in my clinic every day and see these patients walk in every day scared to death. I see people driving two and three hours to my clinic because some ER doctor is scared of the Texas Board and won’t prescribe medication.
You hear that, all you pointy-headed docs who insist on—oh, you know—actual scientific evidence that a drug works, you’re mindless computers. Dr. Immanuel is the real doctor who knows what’s what! No, wait. It’s worse than that. Dr. Immanuel thinks you’re like the “good Germans, the good Nazis” who “watched Jews get killed” and didn’t speak up. Indeed, the martyr complex is strong in Dr. Immanuel. She rants about how she doesn’t care if “they” kill her because she’s “not going to let Americans die.” Indeed, the paranoia is strong in this one.
At this point, I really couldn’t take it much any more. I also learned of this video of another talk by Dr. Immanuel that really tells you how seriously you should take her:
I did skim through the rest of the “America’s Frontline Doctors” video, enough to know that it’s utter and complete nonsense. It makes me wonder. Dr. Immanuel was clearly the star of the show in this video. Given that the rest of the “America’s Frontline Doctors” apparently had no problem being part of the show should tell you all that you need to know about them. All of the key points promoted in this video are either false or misleading, but you’d think that the other doctors would be reluctant to put their reputations on the line by appearing alongside a doctor like Dr. Immanuel, who is so obviously a crank’s crank. You’d be wrong, apparently.
There are far too many quacks, cranks, and grifters in my profession. This video from “America’s Frontline Doctors” tells me that we’ve reached the point in the hydroxychloroquine story where the limbless Black Knight rails futilely against reality.