Inadequate support The claim that AMA’s refusal to support the use of hydroxychloroquine as a treatment for COVID-19 may have caused many deaths is unsupported. Scientific evidence from clinical trials does not show a clear effect of HCQ on COVID-19 mortality.
RECLAMACION: The AMA “reversed course”, now “giving the green light to doctors prescribing HCQ to their COVID patients.”
REVIEW
Articles published on several websites including American Thinker and Rush Limbaugh claimed that the American Medical Association (AMA) switched its official position on hydroxychloroquine (HCQ), changing from a stance “adamantly against HCQ as a therapeutic for COVID-19” to “giving the green light to doctors prescribing HCQ to their COVID patients”. These articles suggested that the AMA’s delay to approve HCQ may have caused “countless” unnecessary deaths. However such claims are based on a misinterpretation of AMA’s documents and baseless allegations of the efficacy of HCQ to prevent deaths from COVID-19.
First, the articles allege that the AMA previously held a position against using HCQ as a therapy for COVID-19 patients. However, this is inaccurate. In an official statement from April 2020, at the peak of the first COVID-19 epidemic wave in the U.S., the AMA acknowledged the right of health administrations to issue guidelines about drug off label drug prescription, while strongly favoring evidence-based medicine. The statement also clearly supports the ability of physicians to use their informed judgement to prescribe off-label drugs. Off-label refers to drugs that are used in a manner not explicitly specified in their FDA approvals. As described in the AMA statement, “Novel off-label use of FDA-approved medications is a matter for the physician’s or other prescriber’s professional judgment.”
In the statement, the AMA solely opposed drug hoarding, as it may disrupt supply for other patients requiring a particular drug. In the case of HCQ, which is a proven and FDA-approved treatment for lupus, hoarding HCQ for off-label use could prevent lupus patients from receiving the treatments they need.
Second, the articles claim that AMA reversed its position in October 2020 from opposing the use of HCQ as a treatment for COVID-19 patients to supporting it. However, this claim is based on an inaccurate interpretation of a proposal written by the AMA Delegation of Georgia on 23 October 2020. The proposal was discussed during a Special Meeting of the AMA House of Delegates in November 2020. This proposal requested that the AMA rescind its previous statement from April 2020. However, it was rejected by the AMA committee reviewing it. The article in American Thinker, which repeated these claims, acknowledged that it misconstrued this proposal as an official statement, but did not withdraw or modify its article or headline to reflect the correct information.
The AMA also denied that it changed its position regarding the use of HCQ to treat COVID-19 patients on its Twitter account. Therefore, the former statement from April 2020 still holds: The AMA recognizes the freedom of practitioners to exercise their medical judgement, including the prescription of off-label drugs, while emphasizing the importance of basing such judgement on published clinical evidence.
In March, AMA urged caution about prescribing hydroxychloroquine off-label to treat #COVID19. Our position remains unchanged. Evidence-based #science & practice must guide these determinations. Thank you @Poynter for the #FactCheck to set record straight https://t.co/hz1j1Xz2St pic.twitter.com/2qfUdFqdRk
— AMA (@AmerMedicalAssn) December 16, 2020
Using the rhetorical technique of “just asking questions”, the articles suggest that HCQ can prevent COVID-19 related deaths and that the failure of the AMA to publicly support the use of HCQ as a treatment for COVID-19 may have caused many unnecessary deaths. The efficacy of HCQ to treat COVID-19 patients has been difficult to establish due to large discrepancies in the results of the various clinical studies that have been undertaken. An international, controlled clinical trial conducted by the World Health Organization (WHO) that enrolled 11,266 patients in 500 hospitals across 30 different countries found that HCQ had no effect on COVID-19 mortality[1].
The WHO also conducted a meta-analysis to assess the efficacy of HCQ as a treatment for COVID-19 by evaluating results from comparable trials. The meta-analysis found that HCQ did not reduce mortality from COVID-19, even in patients with mild cases. Furthermore, using HCQ to treat COVID-19 patients resulted in 10 more deaths per 1000 patients compared to COVID-19 patients not given HCQ (the control group), based on data from 10,859 patients involved in 29 studies. Therefore, the WHO issued a “strong recommendation” against the use of HCQ to treat COVID-19 patients with “any disease severity and any duration of symptoms.” In addition, the WHO points out that several clinical trials enrolled patients who were in the very early stages of COVID-19, receiving HCQ doses one to three days after symptoms were detected. Altogether, these findings indicate that a beneficial effect of HCQ on COVID-19 mortality remains unproven at best. Therefore, any claim suggesting that the refusal to endorse HCQ as a treatment for COVID-19 may have resulted in countless deaths is currently unsupported by scientific evidence.
REFERENCES
- 1 – WHO Solidarity trial consortium et al., Repurposed antiviral drugs for COVID-19 –interim WHO SOLIDARITY trial results. medRXiv (pre-publication).
