Why is Trump promoting hydroxychloroquine as a treatment for COVID-19?

Question

As of this writing (2020-05-18) Trump has publicly recommended the use of hydroxychloroquine as a preventive measure for COVID-19. In addition, he has publicly announced that he is taking it himself as a preventative measure for COVID-19. (Politico CNBC)

There is no evidence suggesting that hydroxychloroquine helps prevent a COVID-19 infection and some evidence there are deleterious side effects in a small number of cases (ASHP, Intercept)

My question is:

Why is Trump promoting the use of hydroxychloroquine as a treatment, preventative or otherwise, for COVID-19?

There have been suggestions that Trump is engaging in profiteering by promoting a drug so that companies he has a financial interest in will be bolstered (EB, Daily Beast), but from various sources this looks to have been debunked (snopes, Washington Examiner).

Some have suggested that Trump is promoting an unproven drug as a kind of long shot gamble, with little negative political repercussions and potential large political repercussions if it does pan out (Washington Post).

Trump doesn't need to gain a direct financial benefit from pandemic profiteering and could be using it as political capital in some way but hydroxychloroquine is a generic drug and there doesn't seem to be any real connection to Trump and anyone directly profiting from it. The Washing Post article above talks about Trump's promoting hydroxychloroquine as a kind of low risk political gamble but, while this may be true, it strikes me as odd that Trump would pick this particular drug to promote.

Is there any evidence, one way or the other, of what Trump could gain financially or politically from promoting hydroxychloroquine? Is there any precedent or other literature about using this tactic?

In particular:

• Is there any evidence of Trump profiteering or helping someone else profiteer in hopes of remuneration?
• Is Trump promoting hydroxychloroquine to give the illusion of control over the situation? Is there any evidence of other political figures using the same tactic?
• Why is Trump promoting hydroxychloroquine and not some other drug?

Answer 1

What is HCQ?

Let's back up and consider the history of hydroxychloroquine(HCQ). It's primarily a drug used in treating Malaria. The best description I've heard of how it works is this

Chloroquine and hydroxychloroquine actually slow down parts of a patient’s immune system by “interfere with lysosomal activity and autophagy, interact with membrane stability and alter signalling pathways and transcriptional activity, which can result in inhibition of cytokine production and modulation of certain co-stimulatory molecules” — which is a jargon-heavy way of saying it makes your immune system’s cells not work as well together.

and

The coronavirus identified as SARS-CoV-2 can generate a “cytokine storm” — when the body’s immune system kicks into overdrive and starts attacking healthy cells in important organs. Dr. Randy Cron, an expert on cytokine storms at the University of Alabama at Birmingham, told the New York Times last month that in about 15 percent of coronavirus patients, the body’s defense mechanism of cytokines fight off the invading virus, but then attack multiple organs including the lungs and liver, and may eventually lead to death. As the patient’s body fights its own lungs, fluid gets into the lungs, and the patient dies of acute respiratory distress syndrome.

In other words, there was some reason to be hopeful about HCQ helping some patients in certain medical states caused by COVID-19.

Trump often gloms onto one bit of information and runs with it

Trump's comments on HCQ are all over the map. In March Trump said

When reporters asked Tony Fauci, the director of the National Institute of Allergy and Infectious Diseases, whether the drug hydroxychloroquine was effective at preventing coronavirus, he said simply: “The answer is no.”

But when Trump came back to the microphone, he told reporters that “we ought to give it a try.”

“I think we disagree a little bit,” Trump added. “I feel good about it. That’s all it is, just a feeling, you know, smart guy. I feel good about it.”

In April Trump said

We bought a tremendous amount of … hydroxychloroquine, which I think is, you know, it’s a great malaria drug. It’s worked unbelievably, it’s a powerful drug on malaria. And there are signs that it works on [coronavirus], some very strong signs. And in the meantime, it’s been around a long time, and also works very powerfully on lupus. So there are some very strong, powerful signs, and we’ll have to see. Because again, it’s being tested now, this is a new thing that just happened to us, the invisible enemy, we call it.

Most importantly, he said

I want them to try it, and it may work, and it may not work. What if it doesn’t work? It’s nothing lost by doing nothing. Because we know, long-term, what I want. I want to save lives. And I don’t want to be in a lab for the next year and a half as people are dying all over the place

Trump often focuses on one part of any new information. That's an opinion sometimes shared by his advisors. Here's Dr. Birx after Trump's "UV lights and injecting cleaning agents" comments

When he gets new information, he likes to talk that through out loud and really have that dialogue — and so that’s what dialogue he was having. I think he just saw the information at the time immediately before the press conference and he was still digesting that information

Likely Trump hasn't moved on because he's become so politically invested in this.

Nobody seems to be profiting from HCQ at present

Generally you don't give away product you expect to sell. From the previous April quote link

[T]he [HCQ] units were donated by drug companies, not purchased by the federal government, and he’s actually underselling the number: It’s 31 million doses, not 29 million. Sandoz, the generic subsidiary of Novartis, donated 30 million doses of hydroxychloroquine sulfate to the Strategic National Stockpile last month, and Bayer donated another 1 million doses of hydroxychloroquine phosphate.

It also seems that patents for HCQ expired

2012-09-15 - Anticipated expiration

TL;DR

Trump seems to genuinely believe in HCQ, to the point that he's now banking on it not just politically, but personally

Answer 2

To understand this, and certain other curious behaviors Trump has committed himself to, we need to start from the observation that — consciously or unconsciously — Trump has adopted a nationalist worldview and style of leadership. That much is self-evident from his pronounced 'America First' rhetoric and his consistent division of the political world into loyalists and enemies, based in good part on personal allegiance. Generally I follow Orwell's understanding of nationalism, where he holds that a nationalist is "one who thinks solely, or mainly, in terms of competitive prestige", but where personal prestige has become inextricably linked with identity-group prestige. Among nationalists, advancing the prestige of the group is synonymous with advancing one's own prestige, and this paradoxically frees nationalists to act in ways that others might consider ridiculous, shameful, or degraded. A nationalist is willing to take risks with his own reputation on the understanding that if he succeeds (thereby raising the reputation of his identity-group) any untoward act he commits will not merely be forgiven or forgotten, but lionized by his group as virtue or heroism.

Nationalism in Orwell's view is "inseparable from the desire for power," because power both brings and secures prestige. That point cannot be overstated.

With this in mind, Trump is politically constrained, as the symbolic face of a nationalist movement, to avoid showing anything that might be construed as weakness. Signs of weakness would offend his base, because they would see his weakness as their weakness: that intertwining of personal and group prestige that marks nationalist movements. This includes obvious signs of weakness, like fear and shame, obviously. But it also precludes more subtle perceptions of weakness: indecision, deference to others, compassion or forbearance, gentleness, or anything that has traditionally been considered a 'feminine' quality.

This brings us to hydroxychloroquine (HCQ). As we all remember, Trump's early attitude towards covid-19 was blithe dismissal. It was just another flu; it was not something we needed to worry about in the US; it would blow over as the weather got warmer. From his view, we all needed to settle down and tough it out, and that was all there was to it. The idea that we needed to make preparations out of some vague fear of a pandemic grated against the nationalist worldview in which only the weak suffer. He maintained this attitude through mid-march, when cases and deaths from the pandemic started to mount and blithe dismissal became untenable; it was clear that he would have to act or he would look weak and incompetent. At that time HCQ was beginning to be touted on social media and FOX Opinion shows — both major sources of information in Trump's world — and Trump seized on it as a 'silver bullet' solution: something that could project his decisiveness, competence, and authority, to show that he was strong and in control of the situation. Having committed himself to this (perhaps purely symbolic) choice, however, he was caught in a political bind. Every avenue of retreat from HCQ gave the appearance of weakness: deference to medical authorities, admission of an error, compassion for those who might need the drug for other diseases or might suffer or die from HCQ itself... Had some other (effective) treatment arisen Trump could have shifted focus and pretended as though he'd never mentioned HCQ — a tactic he has used in other contexts — but no other treatment arrived. He was stuck defending HCQ primarily because he had staked his political prestige on it.

As to Trump's announcement that he has been taking HCQ... I have significant doubts about whether that is true. First, no conscientious doctor would prescribe HCQ to someone with Trump's physical characteristics and dietary habits, not without dire cause; the risk of heart failure would be too significant. Second, Trump sees precautions as weakness. This is why, I think, he refuses to wear face-masks in public or obey social distancing rules. If he had been taking the drug he would hide the fact so as not to look fearful. Claiming that he has been taking it strikes me as a tactic to recover the prestige he has lost by various bungles (e.g., the debacle about injecting sunlight or disinfectant). This claim (whether true or not) allows him to appear to lead by example and to offer himself up as anecdotal support to his original claims about HCQ. At any rate, until someone finds some more effective approach to treating covid-19, Trump cannot jump ship and is stuck defending HCQ as a matter of prestige.

Answer 3

All people are prone to error. For example the error of promoting hydroxychloroquine as a primary treatment for COVID-19. In such cases either the errant person knows that they're in the wrong, or they do not know. It's not obvious whether Trump really knows if he's mistaken here or not. Trump was never much of a scholar.

Many people feel that admitting an error makes them look weaker than not admitting an error. Some advocates for strong authorities believe that a contradictory skepticism is more harmful than error, so that it would be better for a soldier to loyally follow even a futile and virtually suicidal order and lose their life, or lose a battle, than it would be to protest that order and worse consequently risk toppling their comrades' fragile morale which if shattered could, they believe, lead to losing wars.

Some people that avoid admitting errors therefore prefer to "double down" as a daring morale-building strategy, which Trump has up to now had very much more success with than most who attempt it.

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Once things get to the point of testing loyalty, it no longer matters that much to the loyal whether the order, or cause, is good or bad, or true or false. Indeed, for really pathological regimes, the more absurd the edict, the better believing and obeying it proves and establishes the loyalist's superior faith. Loyalists then are like reckless youths playing "chicken", for whom a good war can justify even a bad cause.

Answer 4

Trump disregards the studies that found hydroxychloroquine ineffective, e.g.

Trump lambasted a study that had found no benefit from hydroxychloroquine in a group of veterans with the coronavirus who were given the drug. He called it a "phony study" and said it was done by "obviously not friends of the administration" who wanted to "make political points."

The President made similar comments earlier on Tuesday, speaking of an unspecified "bad survey" that was "a Trump enemy statement." On Monday, he claimed the study at the VA was done by "people that aren't big Trump fans."

And that study seems to be only negative news about the use of this drug that Trump said he has heard:

He said the "only negative" he had heard was from a "very unscientific report" conducted by "people that aren't big Trump fans".

Also he seems to misinterpret what the FDA said (previously) about hydroxychloroquine.

Trump was reminded by a reporter on Tuesday that the FDA has said hydroxychloroquine should not be used outside of a hospital setting or research studies.

Trump interjected: "No. That's not what I was told. No."

The reporter was right. The FDA issued a safety warning on April 24 that was headlined, "FDA cautions against use of hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems."

However, soon after that, the FDA leadership made this statement:

“The decision to take any drug is ultimately a decision between a patient and their doctor,” FDA Commissioner Dr. Stephen Hahn said in a statement to CNBC. “Hydroxychloroquine and chloroquine are already FDA-approved for treating malaria, lupus, and rheumatoid arthritis.”

That is talking about “off-label” prescriptions, basically.

Also, the FDA's Emergency Use Authorizations for hydroxychloroquine in Covid-19 cases has come under congressional scrutiny, with Democrats and some medical experts (including two former FDA chief scientists) alleging it was made under political pressure. The FDA's current leadership denied that was the case.

As for his personal use, it was approved by the WH physician, at Trump's request:

Despite these warnings, and the fact Trump has not tested positive for Covid-19, Conley wrote a memo stating that following discussions with the president they concluded that the “potential benefit from treatment outweighed the relative risks” of taking hydroxychloroquine.

Describing his consultation with Conley, Trump said on Monday: “I asked him ‘what do you think?’ He said ‘Well, if you’d like it.’ I said ‘Yeah, I’d like it. I’d like to take it.’”

“Here’s my evidence: I get a lot of positive calls about it,” the president added. “So far, I seem to be OK.”

All in all, Trump's view of this drug with respect to Covid-19 with is rosier than others'.

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Besides the particular issue of why Trump promotes this particular drug (rather than e.g. Remdesivir), in general it seems Trump would promote anything that materially or just in the public-relations realm helps him reopen the country quickly, e.g.

President Donald Trump's 2020 re-election campaign is rounding up "extremely pro-Trump" doctors to appear on television and elsewhere in the media, unpaid, in the coming months to promote the president's push to reopen the U.S. economy as quickly as possible, despite health officials' warnings that doing so could fuel another COVID-19 outbreak and cost lives.

The Associated Press first reported Tuesday that Republican political operatives raised the idea on a call with a senior member of the Trump campaign earlier this month, per a leaked recording of the conversation. The president's re-election campaign confirmed the report with PEOPLE.

The AP reports that on the leaked recording of the May 11 conference call between the Trump campaign and the conservative advocacy group CNP Action, Nancy Schulze, a Republican political activist, said, "There is a coalition of doctors who are extremely pro-Trump that have been preparing and coming together for the war ahead in the campaign on health care."

"And we have doctors that are … in the trenches, that are saying ‘It’s time to reopen.’ ”

So yeah, expect more "Obama doctors" vs "Trump doctors" (like with the judges) whether explicitly framed like that or not.

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Also, by now this drug has become part of the right-wing lore (at least) across the Americas. The AAPS--a non-mainstream (from a medical perspective) association of conservative US physicians--has promoted it. Bolsonaro has promoted it, and had a post on that taken down by Facebook etc. (Uunsurprisingly, a tweet of Rudy Giuliani on this topic was also taken down.) Likewise the drug was promoted by Fox News prime talents like Laura Ingraham and Sean Hannity (at least back in April). A quantitative analysis of the US media mentions of the drug during that time frame found that the right-wing media had mentioned the drug 11 times more often than their left-wing counterparts. In summary:

Brazilian President Jair Bolsonaro neatly sums up how thoroughly politics has hijacked the debate over using malaria drugs against the new coronavirus: "Right-wingers take chloroquine."

So it shouldn't be too surprising that Trump (says he) hears only good news about it.

(Meanwhile Trump's "enemies" keep at it publishing another "negative" observational study, the largest so far [96,000 patients, 15,000 on the H/CQ arm]. And Brazil's newly appointed health minister approves expanded use of the drug.)