By Meryl Nass, M.D.
It is remarkable that a series of events taking place over the past 3 months produced a unified message about hydroxychloroquine, and produced similar policies about the drug in the US, Canada, Australia, NZ and western Europe. The message is that generic, inexpensive hydroxychloroquine is dangerous and should not be used to treat a potentially fatal disease, Covid-19, for which there are no (other) reliable treatments.
Hydroxychloroquine has been used safely for 65 years in many millions of patients. And so the message was crafted that the drug is safe for its other uses, but dangerous when used for Covid-19. It doesn’t make sense, but it seems to have worked.
In the US, “Never Trump” morphed into “Never Hydroxychloroquine,” and the result for the pandemic is “Never Over.” But while anti-Trump spin is what characterized suppression strategies in the US, the frauds perpetrated about hydroxychloroquine and the pandemic include most western countries.
Were these acts carefully orchestrated? You decide.
Might these events have been planned to keep the pandemic going? To sell expensive drugs and vaccines to a captive population? Could these acts result in prolonged economic and social hardship, eventually transferring wealth from the middle class to the very rich? Are these events evidence of a conspiracy?
Here is a list of what happened, in no special order. Please help add to this list if you know of other actions I should include. This will be a living document, added to as new information becomes available.
I have penned this as if it is the “To Do” list of items to be accomplished by those who pull the strings. The items on the list have already been carried out. One wonders what else might be on their list, yet to be carried out, for this pandemic.
- You stop doctors from using the drug in ways it is most likely to be effective (in outpatients at onset of illness). You prohibit use outside of situations you can control.
Situations that were controlled to show no benefit included 3 large, randomized, multi-center clinical trials (Recovery, Solidarity and REMAP-Covid), the kind of trials that are generally believed to yield the most reliable evidence. However, each of them used excessive hydroxychloroquine doses that were known to be toxic and may have been fatal in some cases; see my previous articles here and here.
- You prevent or limit use in outpatients by controlling the supply of the drug, using different methods in different countries andstates. In NY state, by order of the governor, hydroxychloroquine could only be prescribed for hospitalized patients. France has issued a series of different regulations to limit prescribers from using it. France also changed the drugs’ status from over-the-counter to a drug requiring a prescription.
- You play up the danger of the drug, emphasizing side effects that are very rare when the drug is used correctly. You make sure everyone has heard about theman who died after consuming hydroxychloroquine in the form of fish tank cleaner. Yet its toxicity at approved doses is minimal. Chloroquine was added to table salt in some regions in the 1950s as a malaria preventive, according to Professor Nicholas White in his study for the Recovery trial.
- You limit clinical trials to hospitalized patients, instead of testing the drug in outpatients, early in the illness,when it is predicted to be most effective.
Finally, but not until May, you have Fauci’s NIAID conduct a trial in outpatients, using hydroxychloroquine plus azithromycin, but you only enroll 20 patients, after earlier planning for 2,000. Only half get the drugs. You reduce the duration of followup from 24 weeks to 13 days post treatment. This ridiculously small number of subjects assures meaningless results. Who pulled the plug on this trial?
- You design clinical trials to givemuch too high a dose, ensuring the drug will cause harm in some subjects, sufficient to mask any possible beneficial effect. You make sure that trials in 400 hospitals in 35 countries (Solidarity) plus most hospitals in the UK (Recovery) use these dangerous doses, as well as additional sites in 13 countries (REMAP-Covid trial).
- You design clinical trials tocollect almost no safety data, so any cause of death due to drug toxicity will be attributed to the disease instead of the drug.
- You issue rules for use of the drug based on theresults of the UK Recovery study, which overdosed patients. Of course the Recovery results showed more deaths in the hydroxychloroquine arm, since they gave patients 2.4 g in the first 24 hrs, 800 mg/day thereafter. Furthermore, the UK has the 2nd highest death rate in the world for Covid-19 (Belgium is 1st), so simply conducting the trial in the UK may have contributed to the poor results.
- You publish, in the world’s most-read medical journal, the Lancet, an observationalstudy from a huge worldwide database (96,000 Covid cases) that says use of chloroquine drugs caused significantly increased mortality. You make sure that all major media report on this result. This was said to be the nail in the coffin for hydroxychloroquine. Then you have 3 European countries announce they will not allow doctors to prescribe the drug.
- You do your best to ride out any controversy, never admitting culpability. Even after hundreds of people renounced the Lancet’s observational study due to easily identified fabrications–the database used in the study did not exist, and the claimed numbers did not agree with known numbers of cases–the Lancet held firm for two weeks, serving to muddy the waters about the trial, until finally 3 of its 4 coauthors (but not the journal)retracted the study. But neither the authors nor the journal admitted responsibility. You make sure very few media report that the data were fabricated and the “study” was fraudulent. Even though the story was full of scandalous details, it went largely unnoticed. You make sure people believe the original story: that hydroxychloroquine routinely kills.
- You ensure federal agencies like FDA and CDC hew to your desired policies. For example,FDA advised use only in hospitalized patients (too late) or in clinical trials (which are limited, are difficult to enroll in, or may use excessive doses). As of mid June, FDA advises patients and doctors to only give the drug to patients if they are in a clinical trial where, presumably, the results can be controlled.
Another example: you have FDA make unsubstantiated and false claims, such as: “Hospitalized patients were likely to have greater prospect of benefit (compared to ambulatory patients with mild illness)“ and claim the chloroquine drugs have a slow onset of action. If that were really true, they would not be used for acute attacks of malaria or in critically ill patients with Covid. (Disclosure: I once dosed myself with chloroquine for an acute attack of P. vivax malaria, and it worked very fast.). Providing no other treatment advice, even though providing such information is a large part of its mission, CDC instead refers clinicians to the NIH guidelines, discussed below.
Despite the fact that Belgium’s COVID treatment guidelines repeatedly mention that the doses of HCQ in the Recovery and Solidarity trials were 4 times the cumulative dose used in Belgium, you make sure the Belgian guidelines, paradoxically, only recommend use of HCQ within clinical trials.
- You make sure to avoid funding/encouraging clinical trials that test drug combinations like hydroxychloroquine with zinc, with azithromycin, or with both, although there is ample clinical evidence that such combinations provide a cumulative benefit to patients. For example, oneof very few studies to look at this combination had no funding.
- You have federal and UN agencies make false, illogical claims based on models (or invention) rather than human data. For example, you have the FDA state on June 15 that the doserequired to treat Covid is so high it is toxic, after the Recovery and Solidarity trials have been exposed for toxic dosing. This scientific double-speak gives some legal cover to the clinical trials that overdosed their patients. According to Denise Hinton, RN, the FDA’s Chief Scientist (yes, a registered nurse without scientific qualifications is the Chief Scientist at FDA), or some clumsy FDA wordsmith:
“Under the assumption that in vivo cellular accumulation is similar to that from the in vitro cell-based assays, the calculated free lung concentrations that would result from the EUA suggested dosing regimens are well below the in vitro EC50/EC90 values, making the antiviral effect against SARS-CoV-2 not likely achievable with the dosing regimens recommended in the EUA. The substantial increase in dosing that would be needed to increase the likelihood of an antiviral effect would not be acceptable due to toxicity concerns.”
You have a WHO report claim toxic doses are needed. This is nonsense since:
- CDC researchers showed strong effects against SARS-1 at safely achievable concentrations,
- the drug at normal doses is being tested in over 30 different medical conditions (see clinicaltrials.gov), and
- reports from many different countries say that the drug is effective for Covid-19 at normal doses, while
- a high dose chloroquine treatment trial was halted in Brazil and a preprint of the study was posted April 11, or perhaps April 7, after finding that drug effects were causing ventricular arrhythmias and deaths.
Toxicity was noted after only 3 days of treatment, during which 3.6 grams of chloroquine were administered. But the Solidarity (3.2 grams of hydroxychloroquine in 3 days), Recovery (3.6 grams of hydroxychloroquine in 3 days) and REMAP-Covid trials (3.6 grams of hydroxychloroquine in 3 days) continued overdosing patients until June, despite Brazil’s evidence of deaths by overdose.
Tellingly, JAMA editor Gordon Rubenfeld wrote in April, after the Brazilian study came out in JAMA, “if you are prescribing HCQ after these JAMA results, do yourself and your defense lawyer a favor. Document in your medical record that you informed the patient of the potential risks of HCQ including sudden death and its benefits (???).”
- You create an NIH Guidelines committee for Covid treatment recommendations, in which16 members have or had financial entanglements with Gilead, maker of Remdesivir. The members were appointed by the Co-Chairs. Two of the three Co-Chairs are themselves financially entangled with Gilead. Are you surprised that their guidelines recommend specifically against the use of hydroxychloroquine and in favor of Remdesivir, and that they deem this the new “standard of care”?
- You frighten doctors so they don’t prescribe hydroxychloroquine, if prescribing it is even allowed in their jurisdiction, because prescribing outside the newNIH “standard of care” leaves them open to malpractice lawsuits. You further tell them (through the FDA) they need to monitor a variety of lab parameters and patient EKGs when using the drug, although this was never advised before, which makes it very difficult to use the drug in outpatients. You have the European Medicines Agency issue similar warnings.
- You manage to control the conduct of most trials around the world by specially designing the WHO-managedSolidarity trials, currently conducted in 35 countries. WHO halted hydroxychloroquine clinical trials around the world, twice. The first time, May 25, WHO claimed it was in response to the (fraudulent) Lancet study. The second time, June 17, WHO claimed the stop was in response to the Recovery trial results. Recovery used highly toxic doses of hydroxychloroquine in over 1500 patients, of whom 396 died. You stop the trial before the data safety monitoring board has looked at your data, a move that is unlikely to be consistent with trial protocol. WHO’s trial in over 400 hospitals overdosed patients with 2.0 g hydroxychloroquine in the first 24 hours. The trial was halted 3 days after the toxic doses were exposed (by me). The trial involved doctors around the world typing minimal patient information into an online WHO platform, which assigned the patient a treatment.
The only “safety” information collected during the trial was whether patients required oxygen, required a ventilator, or died. This effectively masked the adverse effects of the drugs tested.
I should mention that WHO’s initial plan for its Solidarity trial entirely omitted the chloroquine drugs, but they were added at the urging of participating nations. WHO’s fallback position appears to have been to use toxic doses.
- You have theWHO pressure governments to stop doctors prescribing hydroxychloroquine.
- You have theWHO pressure professional societies to stop doctors prescribing hydroxychloroquine.
- You make sure that the most-consulted US medical encyclopedia, UptoDate,advises physicians to restrict hydroxychloroquine to only clinical trials, citing the FDA.
- You have the head of the Coronavirus Task Force, Dr. Tony Fauci,insist the drug cannot be used in the absence of strong evidence…while he insisted exactly the opposite in the case of the MERS coronavirus outbreak several years ago, when he recommended an untested drug combination for use…which had been developed for that purpose by his agency. And while he was bemoaning the lack of evidence, he was refusing to pay for trials to study hydroxychloroquine. And he was changing the goalposts on the Remdesivir trial, not once but twice, to make Remdesivir show a tiny bit of benefit, but no mortality benefit. And don’t forget, Fauci was thrilled to sponsor a trial of a Covid vaccine in humans before there were any data from animal trials. So much for requiring high quality evidence before risking use of drugs and vaccines in humans.
- You convince the population that the crisis will be long-lasting. You have the 2nd richest man in the world, and biggest funder of the WHO, Bill Gates, keep repeating to the media megaphone that we cannot go back to normal until everyone has been vaccinated or there is a perfect drug. (The Gates Foundation helped design the WHO clinical trials, helped fund the Recovery trial, and Gates is heavily invested in Covid pharmaceuticals and vaccines.)
- You have CDC (with help from FDA)prevent the purchase of coronavirus test kits from Germany, China, WHO, etc, and fail to produce a valid test kit themselves. The result was that during January and February, US cases could not be tested, and for several months thereafter insufficient and unreliable test kits made it impossible to track the epidemic and stop the spread.
- You have trusted medical spokesmen lie to the public about the pandemic’s severity, so precautions weren’t taken when they might have been more effective and less long-lasting. Congress was repeatedly briefed about the pandemic in January and February, which scared several Congress members enough that they sold off large amounts of stock, risking insider trading charges. Senator Burr is one of them, currentlyunder investigation for major stock sales on February 13.
Yet Dr. Fauci told USA Today on February 17 that Americans should worry more about the flu than about coronavirus, the danger of which was “just miniscule.” Then on February 28, Drs. Fauci and Robert Redfield (CDC Director) wrote in the New England Journal:
“…the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.”
- You destroy the reputation of respected physicians who stand in your way. Professor Didier Raoult and his team in Marseille have used hydroxychloroquine on over 4,000 patients, reporting a mortality rate of about 0.8%. (The mortality rate of patients given hydroxychloroquine in the Recovery trial was 25.7%.) Raoult is very famous for discovering over 100 different microorganisms, and finding the long-sought cause of Whipple’s Disease. With this reputation, Raoult apparently thought he could treat patients as he saw fit, which he has done, under great duress. Raoult was featured in a New York Times Magazine article, with his face on the magazine cover, on May 12, 2020. After describing his accomplishments, the Times very unfavorably discussed his personality, implied he conducted unethical trials without approval, and using anonymous sourcing produced a detailed hit piece. Raoult is now considered an unreliable crank in the US.
Physician and state senator Scott Jensen of Minnesota is being investigated by his state medical board due to anonymous complaints about ‘spreading misinformation’ and giving ‘reckless advice’ about COVID in interviews. Jensen was previously selected as “Family Physician of the Year” in his state. Now his medical license is at risk, not because of how he treated a patient, but for what he said outside of the office. Unprecedented.
UPDATE: Jensen was exonerated.
- You have social media platforms ban content that does not agree with the desired narrative. As YouTube CEO and ex-wife of Google founder Sergey Brin, Susan Wojcickisaid,
“YouTube will ban any content containing medical advice that contradicts World Health Organisation (WHO) coronavirus recommendations. Anything that would go against World Health Organisation recommendations would be a violation of our policy.”
- When your clinical trials are criticized for overdosing patients, you have Oxford-affiliated, Wellcome Trust-supported scientists at Mahidol University publish papers (aliterature review with modeling and a modeling study) purporting to show that the doses used were not toxic. You develop a new method to measure hydroxychloroquine in a handful of Recovery patients who were not poisoned. However, there are 2 problems you forgot with this approach:
- The Brazilian data, including 16 deaths, extensive clinical information and documented ventricular arrhythmias, are much more persuasive than a theoretical model of hydroxychloroquine pharmacokinetics.
- Either the drug is too toxic to use, even at normal doses, for a life-threatening disease, or even extremely high doses are safe. You can’t have it both ways.
Oxford is the institution running the Recovery trial, and invented a Covid vaccine that already has 400 million doses on order. The Wellcome Trust funded the Recovery trial.
- You change your trial’s primary outcome measures after the trials have started, in order to prevent detection of drug-induced deaths (Recovery) or to make your drug appear to have efficacy (NIAID Remdesivir trial).
- You stop manufacturers from supplying the drug. Shortly after the fraudulent Lancetpaper came out, Sanofi announced it would no longer supply the drug for use with Covid, and would halt its two hydroxychloroquine clinical trials. One of the cancelled Sanofi trials was expected to test 210 outpatients early in the course of disease. The trial remains suspended at the time of writing, while the Lancet paper was retracted 13 days after publication. You surely don’t want a trial of hydroxychloroquine treatment early in the disease, since it might show an excellent effect.
Then Sanofi started collecting information on all off-label use of hydroxychloroquine in New Zealand and Australia. Why is Sanofi, a drug manufacturing company, becoming a surveillance/enforcement mechanism intended to frighten medical providers from using the drug for Covid, which use is by definition “off label.” Sanofi alternatively suggests one may report (anonymously or not) others’ off-label use to New Zealand’s Pharmacovigilance Center or the Australian equivalent.
And see this: Novartis will supply HCQ only under certain conditions, and halted its HCQ trial due to lack of enrollments, although enrollment was not an issue for its other COVID trials.
- You attempt to retract published papersthat provide evidence to support use of hydroxychloroquine for COVID.
- You have your ‘bought’ scientists conceal their financial conflicts of interest in their HCQ clinical trials and publicationsas well as in the guidelines they produce.
- You can get your experimental, unlicensed drugs tested, much more expeditiously and cheaply than under ordinary circumstances, on Covid patients in large clinical trials, but only as long as no drug is designated effective for the condition. This opportunity only lasts while the “standard of care” is nothing more than supportive measures.
- You have a research organization with big Pharma members (A.O.K.I.) pressure the Russian Ministry of Healthto remove hydroxychloroquine from its treatment guidelines.
- You stopped use of hydroxychloroquine, allegedly in response to the fabricated Lancet study, in France, Italy and Belgium (countries with very high COVID mortality rates) then Portugal then Switzerland. But Switzerland restarted using HCQ 15 days later. This created a natural experiment in Switzerland. About 2 weeks after hydroxychloroquine use was halted, death rates approximately tripled, for about 15 days. Then, after its use was allowed again, two weeks later death rates from Covid fell back to their baseline. (Thanks to FranceSoir:
- You reverse an old trick of clinical trials, to mask benefit of hydroxychloroquine. The trick was to replace the saline placebo with a substance that is being used by many cliniciansand in many trials against Covid, thus by comparison likely to reduce the positive effect of your tested medication. This was done in trials both at NYU and at University of Washington, using vitamin C or vitamin C and folate respectively as placebos.
- You have the chief medical officers of Wales, England, Scotland and Northern Ireland, and the director of the UK’s National Health Service, write to UK doctors, a) urging them to enroll their Covid patients in one of 3 national clinical trials, two of which greatly overdosed patients with hydroxychloroquine, and b) stopping their use of “off license treatments” outside of a trial. Yet again, we encounter a veiled threat against clinicians actually attempting to treat the primary SARS-Cov-2 infection. The chief doctors wrote:
While it is for every individual clinician to make prescribing decisions, we strongly discourage the use of off-licence treatments outside of a trial, where participation in a trial is possible… Any treatment given for coronavirus other than general supportive care, treatment for underlying conditions, and antibiotics for secondary bacterial complications, should currently be as part of a trial, where that is possible.”
- You have a state Pharmacy Board refuse to dispense hydroxychloroquine outside of clinical trialson June 15, citing the FDA recommendation for use only in trials. You issue this new regulation on the same day that FDA publishes its recommendation, indicating prior coordination. But when your regulation is exposed on July 14, you immediately rescind it.
- You have the IMF offer rapid financing to Belarus, but only if it follows the recommended model of Covid responseand imposes quarantines, isolation and curfews.
- A group of doctors went to Washington DC July 27-28. They called themselves “America’s Frontline Doctors” and gave a press conference and livestream talks about the Covid-19 pandemic as well as about the need for physicians to be able to prescribe HCQ freely. While the media sparsely attended the press conference, the livestream got millions of views. And within hours, their livestream was bannedby Google, YouTube, Facebook and Twitter. Twitter was said to additionally ban comments about its ban. Then Squarespace took down the Frontline Doctors’ website.
- After the HCQ issue got so much attention on social media, you impose another ban on July 29 on the prescribing of HCQ for Covid, starting July 30 in Ohio, using its Pharmacy Board to dictate to physicians what they may not prescribe. (A repeat of #35 in a different state.)
This ban got so much attention that the Ohio Governor (who must have initially supported it) rescinded it the next morning. July 30, saying he agrees with FDA Commissioner Stephen Hahn, who said in a July 30 interview that the prescribing of HCQ is between a doctor and patient.
- After having Google take down physician James Todaro’s article on hydroxychloroquinefor 4 months, you allow it to resurface right before Google’s (and Facebook’s and Amazon’s and Apple’s) CEOs testify before Congress on July 29 on censorship and abuse of power. You have Twitter warn that Todaro’s article is at an unsafe link.
- After massive attention to the banning of the videos posted by the physician group ‘America’s Frontline Physicians’ and its website, you make intense efforts to discredit the physicians involved.
MedPageToday claimed it “could find no evidence that any of the speakers worked in hospitals with significant numbers of COVID-19 patients.” But the doctors claimed they used the drug early and prevented hospitalizations and deaths. With over 4.4 million Americans diagnosed with Covid, what doctor hasn’t seen a Covid patient?
USAT headlined: ‘America’s Frontline Doctors’ may be real doctors, but experts say they don’t know what they’re talking about.
You have USA Today review and publish detailed information on the licenses, practice locations and malpractice histories of the doctors who spoke out. USAT reporters claim these doctors are not experts and lack knowledge about the use of HCQ in Covid-19, despite the fact that most work in primary care, urgent care or emergency medicine and report using the drug for Covid. Yet no one asks how many years ago ‘expert’ Fauci last treated a patient? Expert Birx’ medical license expired in 2014, so she hasn’t treated a Covid patient either.
- Hydroxychloroquine use is truly the wedge issue for understanding and turning around the pandemic. If hydroxychloroquine works reasonably well as a prophylactic and treatment for Covid-19, it could potentially end the seriousness of the pandemic and return us to life as we knew it. You must make use of the levers of government, mainstream media and social media to stop that from happening.
So, just in case doctors thought the Frontline Doctors’ video, or a new study from Spain showing the drug’s usefulness meant they should use hydroxychloroquine to treat Covid, you must act fast. You use Representatives at a Congressional health subcommittee hearing on July 29 to threaten doctors about the use of the drug last April in veterans who were nursing home patients. Per the Washington Post:
“doctors at the 238-bed nursing home dosed  patients with what came to be called a “covid cocktail” for more than two weeks in April, often over the objections of nurses and without the full knowledge of residents’ families. At least 11 residents received the drug even though they had not been tested for covid-19, The Post found.”
I have treated patients in nursing homes, and one rarely discusses medication changes with family, unless the patient is seriously ill. When nursing home residents were dying like flies last April, when tests were hard to come by and confirmed diagnoses few and far between, doctors used this medicine to try to prevent nursing home deaths during a pandemic. And now they are being scapegoated for doing so.
The WaPo article does not even tell us whether the patients survived, thrived or were harmed. The article hardly makes sense. Its only purpose is to blacken the drug and the physicians who use it.
- You use state Medical Licensing Boards tothreaten doctors who claim there is a cure for Covid-19.
- You have Dr. Faucidiscredit published observational studies that show benefit during a Congressional hearing, demanding randomized controlled trials. Fauci never tells the Committee he has cancelled the one randomized controlled trial of HCQ that his agency, NIAID, was supposed to conduct on HCQ. NIAID claimed that it could not enroll enough subjects, and was cancelled after only 20 were enrolled. However, Fauci told the Committee that 250,000 Americans have shown interest in participating in trials of a Covid vaccine. It is difficult to believe there was extreme lack of interest in a treatment trial, and such massive interest in a vaccine trial.
Doctors who wrote studies showing benefit (50% mortality reduction) defended their work from Fauci’s criticism.
- Youerode the doctor’s primary responsibility to the patient, replacing it with the need to perform clinical research. This is the first time I have ever heard such a thing: research physicians are pressuring frontline doctors not to veer from protocol-determined treatment, even when patients enrolled in treatment trials are at risk of death.
- You mention the “stellar” Recovery trial in the August 5NY Times, but avoid any hint that its hydroxychloroquine arm gave patients a toxic dose.
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