IT’S SIMPLY ABOUT RESPECTING THE DOCTOR/PATIENT RELATIONSHIP.
By Craig Kelly
Congratulations to SBS for publishing this balanced article.
That’s all I ask, for the debate to be on the facts and the evidence, to determine if doctors’ freedoms from prescribing drugs they think will help their patients (in consultation with their patient) should be removed.
The drug hydroxychloroquine is used to treat malaria and some autoimmune conditions such as rheumatoid arthritis and lupus, according to the Australian Medical Association (AMA).
Promoted by US President Donald Trump, the drug has attracted substantial controversy when it comes to its effectiveness in treating and preventing COVID-19.
The World Health Organisation dropped clinical trials on the drug in July after finding it produced “little or no reduction in the mortality of hospitalised COVID-19 patients.”
An AMA spokesperson told The Feed “the existing high-quality evidence” shows the drug “should not be used on a wider scale”.
“The AMA is once again urging Australians not to seek out or use hydroxychloroquine to ‘cure’ or ‘prevent’ the COVID-19 virus,” the spokesperson said.
Australia’s National COVID-19 Clinical Evidence Taskforce and Therapeutic Goods Association have also stated that the drug should not be used as a treatment for anyone with COVID-19.
But federal MP for Hughes, Craig Kelly told The Feed he believes the choice to prescribe the drug should be in the hands of the doctors themselves.
“I’m not saying take the drug. I’m not saying the drug works, but I’m saying the doctor should be free to sit down with their patient and make a decision,” Mr Kelly told The Feed.
“Other countries around the world are using this drug and it has shown very, very successful results…You’ve got countries like India, Qatar, Costa Rica, Morocco and Kazakhstan, the United Arab Emirates, the list goes on and on of countries whose medical boards have recommended this drug,” he said.
In recent months, Mr Kelly has shared a number of articles and videos discussing the benefits of the drug to his almost 50,000 Facebook followers, claiming there is a “political war on hydroxychloroquine”.
“There is a special place in hell awaiting those that have been part of the war on Hydroxychloroquine for poltical [sic] reasons. They have the blood of tens of thousands on their hands,” Mr Kelly wrote on Facebook.
“The weight of medical studies indicate that EARLY use of Hydroxychloroquine saves lives,” the backbencher wrote in another post.
Mr Kelly’s online comments have drawn heavy backlash from the opposition with Labor’s Shadow Health Minister, Chris Bowen, labelling his posts a “Trumpian rant”.
Labor Opposition Leader Anthony Albanese also weighed in commenting: “I was shocked by them, that any member of Parliament would be so irresponsible at a time where Victorians are doing it tough.”
But Prime Minister Scott Morrison has stayed silent on the issue, refusing to comment in a press conference earlier this month.
“I’m not going to get onto what people talk about on Facebook on a day like this,” he said.
While Acting Chief Medical Officer Paul Kelly said: “in terms of its use for COVID – 19 the jury is pretty much out, it doesn’t work.”
The Feed has reached out to the Prime Minister’s office for comment but did not receive a response.
It’s not the first time Craig Kelly has broached controversy; he’s previously challenged links between climate change and drought in parliament and appeared in a fiery segment with Good Morning Britain where he said record fuel loads and drought were the key reason behind the summer’s bushfire crisis.
“I know I’m sticking my neck out saying these things”
Mr Kelly said he became passionate about hydroxychloroquine after someone sent him a video of a US doctor pleading President Trump to look into the drug as it was “highly successful”.
“I put that up because I thought this was the time that people needed some good news… I first checked to make sure it was a legitimate doctor and legitimate video and I posted that to my Facebook page,” Mr Kelly said.
“The next day, Facebook deleted it and had censored that doctor’s video. A social media expert at Facebook, to me, should have no right to censor the medical opinion of a highly respected doctor. And when someone wants to censor something, and stop me from reading it, I think it makes me want to look at it more,” he added.
Facebook has been taking down videos they consider to contain COVID-19 misinformation.
The Liberal MP told The Feed, “I know what I’m saying seems all a bit far-fetched. I know I’m sticking my neck out saying these things. But yeah, I’ve looked at this very carefully. And, you know, I’ve read everything I can.”
Mr Kelly said he believes there are many reasons why people are “desperate to see that [hydroxychloroquine] doesn’t work”.
“One is because President Trump said the drug works. So there’s definitely been a blowback on that,” he said.
“I think there’s a factor that hydroxychloroquine treatments, the tablets and the treatment that the doctors are prescribing… You’re talking 10 tablets. You book your treatment that costs less than $10. As with the other medical treatments are costing thousands,” he added.
Amid the broader global debate over the use of hydroxychloroquine, the Australian Border Force has detected an increase in the importation of the drug, and have issued multiple warnings about its illegal importation.
“ABF officers have seized more than 26,000 tablets of hydroxychloroquine and chloroquine between January 1 2020 and June 21 2020,” the ABF said.
ABF Assistant Commissioner, Erin Dale warned Australians not to take drugs for COVID-19 that have not been prescribed “by a medical health professional”.
“It is illegal to bring these substances into Australia without the proper permits and I strongly urge Australians against importing these items,” Dale said.
When asked if his social media posts may encourage Australians to seek out the drug without a prescription, Mr Kelly told The Feed: “no, because they should obviously always listen to their doctor. The black markets come around by the ban, not by commentary from me.”
Professor Andrew McLachlan is the Head of School and Dean of Pharmacy at the University of Sydney. He told The Feed that “passionate belief doesn’t make up for rigorous evidence.”
“We look at the weight of evidence. One study shows it’s favourable, one might not. Some studies have appeared in the media without appropriate peer-review,” Professor McLachlan said.
“So far the evidence is that there is no consensus that hydroxychloroquine is effective at treating and preventing COVID-19 and the evidence shows it potentially harmful.”
On Facebook, Mr Kelly also referenced a Melbourne study about Ivermectin — an antiparasitic drug used to treat head lice and worms — quoting an interview with gastroenterologist Professor Thomas Borody where he said the drug could be a “real killer of coronavirus”.
But Professor McLachlan said while the “treatment was able to disrupt the virus that causes COVID-19… the concentration in the test tube was well over 100x what you can put in the human body.”
“Scientists, the media and the community are desperate for a treatment and so stuff like this gets traction,” he added.
“We know now that physical distance, isolation and detection is really the key to dampening the spread. New Zealand’s success came from rapid testing, isolation, washing hands and wearing masks.”
While discussing Professor MacLachlan’s views with Craig Kelly, The Feed asked Mr Kelly what questions he would like put to Professor McLachlan about the drug.
Craig Kelly supplied the questions, and we then put these questions to Professor McLachlan on his behalf. His responses are below:
Craig Kelly’s question: “Of the trials that didn’t work, did those trials include zinc, and did they use hydroxychloroquine and zinc in the early or late stages of the illness?”
Professor McLachlan’s answer:
“These are important questions to consider; when treatment is commenced, characteristics of the person and the stage of infection, dose of drug administered and combinations. There remains some unanswered questions including the role of hydroxychloroquine for post-exposure prophylaxis. Trials are ongoing and evidence is being reviewed by the National Taskforce.
Zinc has been tested alone and in combination with other medicines (including hydroxychloroquine) for coronaviruses (as well as COVID-19). The studies I am aware of have been inconclusive in COVID-19 and have not yet been published in a peer-review journal to validate the findings.
The main study that investigated the combination of hydroxychloroquine and zinc has a weak study design that could not control for bias, it simply treated people and followed them over time (retrospective comparative observational study). This has lead most people to remain sceptical about the findings of improved outcomes for people with COVID-19.”
Craig Kelly often quotes Professor Harvey Risch, a Professor of Epidemiology at Yale. The professor studied hydroxychloroquine (used in conjunction with two other drugs) and concluded the approach should be “widely available”.
Craig Kelly’s question: “Why would Professor Harvey Risch [be] wrong?”
Professor McLachlan’s answer:
“Professor Risch is from Yale and clearly has much experience and has been one of many commentators. His commentaries on hydroxychloroquine have been much debated as lacking in balance.
Some argue that he has conflated correlations (simple random association) with causality (ie the treatment works). This critique is the best and point by point addresses the issues he raises.
Claims need to be supported by the weight of evidence that has been critically analysed and agreed as a matter of consensus. That is how decisions are best made when providing care that has the potential to harm people.”
Craig Kelly’s question: “Dr Zelenko has come up with a protocol in the US using hydroxychloroquine that reports all this success.. was he wrong?”
Professor McLachlan’s answer:
“Dr Zelenko’s protocol has not been tested in a rigorous clinical trial to provide a balanced assessment of whether it is safe and effective. In an interview, even Dr Jelenko acknowledges that trials are needed and his protocol provides a “hopeful possibility”.
In short, clinicians may have a strong belief in a treatment and even implement this in practice, but this does not mean a treatment is safe for all to use.”
Craig Kelly’s question: Why should a doctor be prohibited from giving the drug to COVID-19 patients?
Professor McLachlan’s answer:
The appropriate use of medicines in Australia is regulated by the Therapeutic Goods Administration. The TGA made a clear statement that hydroxychloroquine should not be used for COVID-19 unless it is part of a clinical trial.
Craig Kelly’s question: “The Recovery Trial in the UK gave [patients] 2400 mg rather than 500mg of the drug [the maximum dose]. Do you think it’s strange they’d give them such a massive dose of the drug that’d give them adverse side effects?” Mr Kelly asked why this trial is being referenced to say hydroxychloroquine is ineffective when it is, in his view, flawed.
Professor McLachlan’s answer:
“The Recovery Trial has a robust design – agreed by consensus experts internationally. It is regarded as the best designed and most rigorous study.
The dose of hydroxychloroquine used was well justified and approved by the human research ethics committee. The hydroxychloroquine dose was higher than usually given for other chronic health conditions (lupus and rheumatoid arthritis) but was for a short period of time for hospitalised people who were carefully monitored.
The higher dose was shown to be tolerated but the benefits in treating people were not realised. Importantly, giving a high dose under carefully controlled conditions with appropriate monitoring and support would also provide the very best chance to confirm whether hydroxychloroquine could be an effective treatment for COVID-19. Even at this high dose, it was not effective.”
Craig Kelly would like the government to “consider all the evidence”
When asked what he’d like the government to do in relation to hydroxychloroquine, Mr Kelly said he’d request the National Taskforce to “consider all the evidence”. He claimed it has only studied nine medical papers of 70 that have been written.
“They should look again at the so-called Recovery Trial out of the UK and they should reject that… The studies they should be looking at are those studies [in which] hydroxychloroquine and zinc were given early in the infection,” he said.
“I believe, if you look at all the evidence, the evidence is not there to take that freedom away, and it should be handed back to the effective doctor and patient relationship.”
Professor McLachlan said Australia’s medicines regulator, the TGA, carefully reviews evidence about drugs.
“This process has stood the test of time and should not be thrown out,” he told The Feed.
“The changing times we face has also seen an important role for experts who formed the National COVID-19 Clinical Evidence Taskforce National to rapidly review high-quality evidence to guide the care of people with COVID-19,” he added.
“Not all studies are equal when it comes to guiding treatment selection – only high-quality studies will guide treatment decisions.