Trump, Public Demand for Unproven COVID-19 Therapies

As the search continues for COVID-19 treatment and the FDA has yet to approve treatments, people may end up searching for unproven therapies. Therefore, when President Donald Trump and CEO of SpaceX, Elon Musk, endorsed the use of chloroquine and hydroxychloroquine to treat COVID-19, it brought the issue of misinformation to the public; leading to negative consequences. 

According to a new study published in JAMA Internal Medicine, a team of researchers at Oxford, Harvard, UC San Diego and Johns Hopkins used Americans' Google searches to track how the public began shopping for these unproven drugs soon after these high-prole endorsements.

"We know that high-profile endorsements matter in advertising, so it stands to reason that these endorsements could spur people to seek out these medications" says Michael Liu, a graduate student at Oxford and the study's first author.

Estimating the Effect of Misinformation

The study used Google Trends, a public archive of Google searches, to track searches originating from the U.S. between February 1 and March 29, 2020 related to chloroquine and hydroxychloroquine. This time period included the first endorsement by Musk on March 16, President Trump's first endorsement on March 19, and the first reported chloroquine poisoning in the U.S.

"We specifically wanted to know if people were looking to buy these drugs, instead of just looking to learn more about them," says John Ayers, study co-author, co-founder of the Center for Data Driven Health at the Qualcomm Institute, and Vice Chief of Innovation in the Division of Infectious Disease & Global Public Health, both at UC San Diego.

Related: Trial of High-Dose Chloroquine for COVID-19 Halted After Deaths 

According to the report, the study tracked all Google searches mentioning the drugs "chloroquine" or "hydroxychloroquine" in combination with "buy", "order", "Walmart", "eBay", or "Amazon." The team then compared the phrases' search frequency over that time frame with a hypothetical scenario in which there were no high-profile endorsements, based on historical search trends for the same terms.

Searches for purchasing chloroquine were 442% higher and searches for hydroxychloroquine were 1,389% higher following their public endorsements. In addition, the first and largest spikes in searches coincided with Musk's Twitter endorsement and Trump's first endorsement.

Even after widespread reports of a fatal chloroquine poisoning in Arizona on March 23, queries for purchasing either chloroquine or hydroxychloroquine remained elevated. Searches for chloroquine and hydroxychloroquine were 212% and 1,167% greater than expected following the first reported poisoning through the end of observation March 29.

"In absolute terms, we estimate there were more than 200,000 total Google searches for buying these two drugs in only 14 days following high-profile endorsements. This could be evidence that thousands of Americans were interested in purchasing these drugs," says Mark Dredze, study co-author and Associate Professor at Johns Hopkins University.

Lui claims that Musk's and Trump's endorsements are especially troublesome for three reasons:

• These treatments have inconclusive clinical efficacy.

• The drugs have potentially fatal side effects.

• Chloroquine-containing products such as aquarium cleaner are commercially available to the public without a medical prescription.

"As someone who has been studying health misinformation for years, we usually think misinformation spreads from unreliable health sources, online trolls, and bots. It's rare to have health misinformation coming from such high-profile figures," says Dredze.

Liu adds that even during these unprecedented circumstances, we must still practice evidence-based medicine.

"This means allowing the usual FDA approval process to run its course so the public is protected from unnecessary harms," he says.

After much backlash, many health leaders and companies have done a fantastic job to help protect against the dangers of misinformation, the team notes, but more remains to be done.

"Google responded to COVID-19 by integrating an educational OneBox into search results related to the pandemic that linked millions of searchers seeking information on coronavirus to evidenced-based resources. This should be expanded to include warnings after searching for potential COVID-19 therapies so people can be directed to reliable information," says Liu. "Similarly retailers selling unapproved products that might be linked to use for COVID-19 - and marketplaces like Amazon that coordinate these sales - should provide appropriate warnings."

Theodore Caputi, a study co-author and research fellow with the Center for Data Driven Health at the Qualcomm Institute, says it's also critical that regulatory agencies pivot to address COVID-19 misinformation.

"The FDA should directly communicate with the public about the potential harms of unapproved therapies and create resources where the public can learn accurate information about the ecacy of chloroquine or hydroxychloroquine, and other unproven medications or products the public might be turning to."

The FDA has recently released a report regarding the issue cautioning the use of these drugs.

The FDA recommends no one should use hydroxychloroquine or chloroquine for COVID-19 outside of the hospital setting or a clinical trial due to risk of heart rhythm problems.

According to the report, Hydroxychloroquine and chloroquine can cause abnormal heart rhythms such as QT interval prolongation and a dangerously rapid heart rate called ventricular tachycardia. These risks may increase when these medicines are combined with other medicines known to prolong the QT interval, including the antibiotic azithromycin, which is also being used in some COVID-19 patients without FDA approval for this condition. Patients who also have other health issues such as heart and kidney disease are likely to be at increased risk of these heart problems when receiving these medicines. 

These drugs are not approved by the FDA to treat anything other than malaria and autoimmune conditions. Those patients should only continue taking their medicine as prescribed if they are diagnosed with the two conditions.