Readers discuss whether hydroxychloroquine should be used despite lack of proper clinical trials.

To the Editor:

Re “Trump Again Pushes Drug, Never Mind Expert Opinion” (news article, April 6):

Despite a lack of clear evidence of their efficacy, President Trump and others continue to strongly recommend unproven treatments for Covid-19. While azithromycin and hydroxychloroquine may eventually prove of benefit for this disease after proper scientific study, to date this has not occurred.

Individuals treated with both of these medications may have serious side effects, including cardiac toxicity, especially when used in combination. Demands for these medications may lead to their shortages so that they are unavailable to patients who need them for such diseases as rheumatoid arthritis and lupus for which their benefits have been proven.

Perhaps most important, patients’ demands for unproven medications may lead to their reluctance to enroll in properly conducted placebo-controlled clinical studies that may provide effective proven treatments for Covid-19.

David Siegel
Davis, Calif.
The writer is emeritus professor of medicine at the University of California Davis School of Medicine.

To the Editor:

The decision whether to give hydroxychloroquine to coronavirus patients should not be influenced by frustration with President Trump’s inappropriate promotion of this drug.

Hydroxychloroquine is an old drug, originally an anti-malarial, later used for rheumatoid arthritis and lupus patients, sometimes chosen because it was the most benign option. It has a potential adverse effect of a serious cardiac arrhythmia, a relatively uncommon complication, but unstudied in the current critically ill population.

Several factors argue in favor of its use. Hydroxychloroquine and azithromycin are known, established drugs. Small studies, as well as recent anecdotal reports, suggest possible benefit. Coronavirus patients requiring I.C.U. admission and intubation have a poor prognosis, thus shifting the risk-benefit curve.

Whether to try a medication regimen that does not have supporting clinical trials is complicated and should be made by a team of medical experts, including physicians on the front lines, specialists and epidemiologists — a clinical decision, not a political one.

Melinda Hansen
San Diego
The writer is a retired nurse practitioner.

To the Editor:

“What do we have to lose?” President Trump asked this past weekend, referring to giving people hydroxychloroquine to treat Covid-19. My daughter has lupus and cannot get her medication, like so many others with lupus and rheumatoid arthritis. Hydroxychloroquine keeps the symptoms of both diseases in check.

The federal government, with no established epidemiology as to the drug’s efficacy in reducing the effects of Covid-19, just purchased 29 million pills. As a result, many pharmacies have, essentially, no medication available for patients that rely on this drug. What do we have to lose? Access to the one medication that keeps the symptoms of millions of Americans with autoimmune disease in check.

Lewis Saul
New York

To the Editor:

It is painful to see an adult president behave like a petulant child — especially with his promotion of a dangerous drug to cure Covid-19. At Sunday’s briefing, President Trump did not allow Dr. Anthony Fauci to express his feelings about the efficacy of hydroxychloroquine and whether it should be used. Instead, he unfairly attacked the questioner.

I feel that Mr. Trump believes he has much to gain and little to lose by this puerile behavior. If the drug works — of course a gamble, but Mr. Trump was an owner of casinos — then he can present himself as a medical genius. He can show that he knows more than the medical experts.

If the drug does not work, he will simply resort to his usual strategy of avoiding any censure for his mistakes. He will simply say: “I never said that we should use this drug. I said I was not a doctor. Don’t blame me for what others do.”

Simon Raskin
New York