The hydroxychloroquine story started with James M. Todaro, an ophthalmologist and Bitcoin aficionado who has worked at Beaumont Hospital, Dearborn, Michigan for about two years.[4] On March 11, Todaro tweeted a link to a document published by the American Society of Health-System Pharmacists showing that there was a shortage of chloroquine phosphate tablets on the market.[5] Within a few hours, a self-professed philosopher, Adrian Bye, and Gregory Rigano, a crypto-investor and lawyer who has no medical background, had gotten into a conversation about hydroxychloroquine.

Later that day, Bye posted a link to a 15-year-old article from Virology Journal, that showed the tentative success of chloroquine in combating SARS-CoV (not SARS-CoV-2) in a small laboratory test. Rigano then posted a MedCram video by pulmonologist Roger Seheult explaining a paper in Korea Biomedical Review. In the video, Seheult reviews a February recommendation that older patients or those with underlying conditions might be treated with Kaletra, an anti-retroviral drug used to treat HIV/AIDS. (Scientists have since completed a trial with the drug and found it didn’t do much.[6]) The video also mentions chloroquine and hydroxychloroquine but warns that if combined with Kaletra (lopinavir/ritonavir), it could cause fatal heart arrythmias.[7] Then, the next day, Rigano told Bye that he was going to publish “a report tomorrow w/ eminent scientist, peer-reviewed.” Bye cautioned him against it, even asking Todaro to step in and intervene with Rigano. Nevertheless, the next day, Rigano, who has no medical training, had worked up a Google document.[8] Nothing about it was peer-reviewed. Todaro listed himself as the first author, since he had an MD after his name, though it appears Rigano did most of the writing. On March 13, Todaro tweeted an announcement about their “paper.”[9]

As far as I can tell, little about this tweet was rooted in established fact. On LinkedIn, Rigano lists a law degree from Hofstra and is “on leave” from working on a Masters Degree in Bioinformatics at Johns Hopkins (he has been on leave since 2016, for a 2-year Masters Degree). Thomas Broker is not listed on the article as an author at all. He is only mentioned in the acknowledgments. He is not a professor at Stanford; in fact, he works at The University of Alabama at Birmingham. Evidently Rigano and Todaro called him on the phone, and then Todaro used Broker’s name in this tweet without his permission.[10] The whole thing appears to be a lie. Of course, Todaro took the time to post the piece to Investorshub.[11]

Three days later, on March 16, Elon Musk of Tesla Motors tweeted “Maybe worth considering chloroquine for C19.”[12] Then, a few minutes later, he wrote, “Hydroxychloroquine probably better,” followed by an impressive-looking graph taken from the “Medcram” YouTube video.[13] From that point on, people started noticing the story. Those two tweets from Musk were retweeted 73,700 times during this episode.

Minutes before 9pm (ET) on March 18^th, Tucker Carlson’s Fox News talk show cut to a “Dr. Gregory Rigano, Stanford Univ. Med. School Advisor.” Rigano, reading from a piece of paper and struggling with the language (because, again, he has nothing to do with Stanford Medical School and does not have any medical expertise), called on the president to “authorize the use of hydroxychloroquine against coronavirus immediately.”[14] The only connection with Stanford is UAB’s Thomas Broker, who graduated from Stanford Medical School back in 1973, and is now retired. Broker’s involvement was simply that he took a phone call from Rigano. That’s it. Broker never sanctioned this story and seemed mortified to have been included.[15] Fox News allowed Rigano to portray himself fraudulently as a medical expert. And, because this is 2020, this scam went, as we used to say so flippantly, viral.

What is even more upsetting is that the President of the United States, who has the best intelligence available to him, ate it up and acted on it apparently unimpeded. The next day, words from that Google doc—hastily written by two Bitcoin investors who had spent about three nights working on it—spewed forth from the mouth of the President of the United States.[16] Predictably, the morning show “Fox & Friends,” took it from there. On March 20^th, they claimed a “French study” demonstrated that after taking some miraculous pharmaceuticals for “six days” that the patients had “none of the virus remaining.” This was the paper Rigano and Todaro dug up in their research.[17] Not long after, the president began one of his tweet storms on the subject of the drugs.

Now back to the chart of prescriptions in March. Why the bump in all these prescriptions? The FDA issuing an Emergency Use Authorization (EUA) on March 28 could not have been the cause, since that came after the bump in prescriptions. My hypothesis is that media influenced a White House that reinforced the largely fabricated story. Trump’s followers then started asking their doctors en masse for hydroxychloroquine prescriptions. An older, whiter population that normally skips the trips to the physician went in to get a hydroxychloroquine prescription after watching Fox News. Once examined, their physicians decided to go ahead and give them the anti-malarial that they demanded. In the meantime, they directed their older patient to get their other health conditions under control. So, the patients walked out with prescriptions for losartan or lisinopril—hypertension medications—along with their Fox News-prescribed, and much demanded, hydroxychloroquine.

Recently, the president quipped in front of cameras that he was taking hydroxychloroquine, too. The truth-status of this claim is unknown. What we do know is that last week The Lancet published a study of almost 15,000 patients diagnosed with COVID-19 from December 20, 2019 to April 14, 2020 who were assigned chloroquine or hydroxychloroquine and a macrolidic antibiotic, like erythromycin. The authors then compared those four groups of thousands of individuals each with over 81,000 patients in a control group. Their results were disappointing for those hoping hydroxychloroquine was the magic bean that was going to help us climb out of this crisis: “We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.”[18] Fatal arrhythmias were also cited in the original “MedCram” video that Rigano and Bye located in March. And it came up again last month in an FDA review.[19]

So, not only is hydroxychloroquine ineffective against this second coming of SARS, but it’s also possibly dangerous for heart patients. The kind of heart patients who see a guy reading a Google doc just to the left of Tucker Carlson’s head on the TV screen and then go to their physician to demand a pill.

Notes

[1] Muthiah Vaduganathan et al., “Prescription Fill Patterns for Commonly Used Drugs During the COVID-19 Pandemic in the United States,” JAMA, May 28, 2020, https://doi.org/10.1001/jama.2020.9184.

[2] David J Sullivan, “Theories on Malarial Pigment Formation and Quinoline Action,” International Journal for Parasitology, Malaria Progress, Problems and Plans in the Genomic Era., 32, no. 13 (December 4, 2002): 1645–53, https://doi.org/10.1016/S0020-7519(02)00193-5.

[3] U.S. National Library of Medicine, “COZAAR- Losartan Potassium Tablet, Film Coated,” DailyMed, November 14, 2019, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5ac32c20-169d-475a-fc8a-934f758d6ab0.

[4] U.S. News Health, “Dr. James M. Todaro, Ophthalmologist in Dearborn, MI,” US News Doctors, n/a, https://health.usnews.com/doctors/james-todaro-913781.

[5] @JamesTodaroMD, “Two medications currently used…,” Twitter, 03/11/2020.

[6] Bin Cao et al., “A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19,” New England Journal of Medicine 382, no. 19 (May 7, 2020): 1787–99, https://doi.org/10.1056/NEJMoa2001282.

[7] Coronavirus Epidemic Update 34: US Cases Surge, Chloroquine & Zinc Treatment Combo, Italy Lockdown, MedCram – Medical Lectures Explained CLEARLY, 2020, https://www.youtube.com/watch?v=U7F1cnWup9M&feature=youtu.be&t=630.

[8]James M. Todaro, MD (Columbia MD, jtodaro2@gmail.com) and Gregory J. Rigano, Esq. (grigano1@jhu.edu, “An Effective Treatment for Coronavirus (COVID-19,” Google Doc, https://docs.google.com/document/d/e/2PACX-1vTi-g18ftNZUMRAj2SwRPodtscFio7bJ7GdNgbJAGbdfF67WuRJB3ZsidgpidB2eocFHAVjIL-7deJ7/pub

[9] @JamesTodaroMD, “There is growing evidence…,” Twitter, 03/13/2020. https://twitter.com/JamesTodaroMD/status/1238553266369318914

[10] Gary Spradley, “Broker, Tom, Ph.D. – School of Medicine – Biochemistry and Molecular Genetics | UAB,” n/a, https://www.uab.edu/medicine/biochem/faculty/broker.

[11] NYBob, “Cancer Post # 2060,” Investors Hub, March 15, 2020, https://investorshub.advfn.com/boards/read_msg.aspx?message_id=154352923.

[12] @elonmusk, “Maybe worth considering,” Twitter, 03/16/2020, https://twitter.com/elonmusk/status/1239776019856461824?s=20

[13] https://www.youtube.com/watch?feature=youtu.be&v=vE4_LsftNKM&app=desktop

[14] Fox News video, Tucker Carlson Discusses Chloroquine with Dr Greg Rigano (Fox News, 2020), https://www.youtube.com/watch?v=tcHeVqoLVWI.

[15] Adam Rogers, “Chloroquine May Fight Covid-19—and Silicon Valley’s Into It,” Wired, March 19, 2020, https://www.wired.com/story/an-old-malaria-drug-may-fight-covid-19-and-silicon-valleys-into-it/.

[16] Nick Robins-Early, “The Strange Origins Of Trump’s Hydroxychloroquine Obsession,” HuffPost, May 18, 2020, https://www.huffpost.com/entry/trump-hydroxychloroquine-coronavirus-fox-news_n_5ebaffdbc5b65b5fd63dac80.

[17] Audrey Conklin, “Existing Medication Sought in Coronavirus Treatment,” FOXBusiness (March 20, 2020), https://www.foxbusiness.com/lifestyle/existing-medication-coronavirus-treatment.

[18] Mandeep R. Mehra et al., “Hydroxychloroquine or Chloroquine with or without a Macrolide for Treatment of COVID-19: A Multinational Registry Analysis,” The Lancet (Preprint; May 22, 2020), https://doi.org/10.1016/S0140-6736(20)31180-6.

[19] Center for Drug Evaluation and Research, “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,” FDA, April 24, 2020, https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or.