Trump and public demand for unproven COVID-19 therapies

Since there are no FDA-approved treatments for COVID-19, people may end up searching for unproven therapies. Therefore, when several high-profile figures – including President Donald Trump and Elon Musk – endorsed the use of chloroquine and hydroxychloroquine to treat COVID-19, it brought the issue of misinformation to the forefront of public discourse. How did these endorsements of an unproven treatment impact the public?

A new study published in JAMA Internal Medicine from 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-profile 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" said 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 aggregate Google searches, to track searches originating from the United States between February 1 and March 29, 2020 related to chloroquine and hydroxychloroquine. This time period included the first endorsement by a high-profile individual (Elon Musk on March 16), President Trump's first endorsement on March 19, and the first reported chloroquine poisoning in the US.

"We specifically wanted to know if people were looking to buy these drugs, instead of just looking to learn more about them," said Dr. 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. 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 these 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. Moreover, the first and largest spikes in searches coincided with Musk's Twitter endorsement and Trump's first endorsement.

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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 on 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," said Dr. Mark Dredze, study co-author and Associate Professor at Johns Hopkins University.

The Dangerous Consequences of Misinformation

"Musk's and Trump's endorsements are especially troublesome for three reasons," said Mr. Liu. "First, these treatments have inconclusive clinical efficacy. Second, these drugs have potentially fatal side effects. Third, 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," said Dr. Dredze.

"Even during these unprecedented circumstances, we must still practice evidence-based medicine," added Mr. Liu. "This means allowing the usual FDA approval process to run its course so the public is protected from unnecessary harms."

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Combating the Consequences of Misinformation

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," said Mr. 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."

"It is also critical that regulatory agencies pivot to address COVID-19 misinformation", added Theodore Caputi, a study co-author and research fellow with the Center for Data Driven Health at the Qualcomm Institute. "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 efficacy of chloroquine or hydroxychloroquine, and other unproven medications or products the public might be turning to."

"Our leaders and news makers need to be more mindful of the potential collateral effects of their speech," concluded Dr. Ayers. "You can't quickly put humpty dumpty back together again once you've broken him."