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The Claim

Scott Adams recently made the claim that the majority of doctors in the USA support the use of hydroxychloroquine. Normally a cartoonist's podcast would not be a notable source for a claim, so it is worth reviewing the background.

Context and background

There is clearly a great deal of controversy over the use of hydroxychloroquine (HCQ) for treating COVID-19. And mainstream media seem to side with the view that its effectiveness has not be demonstrated and therefore promoting it is unsafe. Hence they tend to push back when Trump or his supporters promote it. Some claim this is a political conspiracy designed purely to hurt Trump.

In a recent CNN interview with Peter Navarro (Trump's trade advisor) this scenario played out in a fairly typical way (reported by The Hill here):

In the combative Wednesday interview, Navarro continued to push the drug as a coronavirus treatment, dismissing contradictory comments made by the nation’s top public health expert and White House coronavirus task force member Anthony Fauci.

“Tony is a great guy. There's just disagreements on things like, for example, hydroxychloroquine. He has a strong point of view. There's as many doctors on the other side,” Navarro said on CNN’s “OutFront,” referring to Fauci.

“But there aren’t,” Burnett responded.

“Peter, first of all, on a basic level, you're an economist, not a scientist,” she added.

...

Navarro responded by referencing a video posted by Scott Adams, the cartoonist behind Dilbert, that attacks CNN over its coverage of the anti-malaria drug as a coronavirus treatment.

“He did a beautiful video on Twitter, and the thesis of the video is that CNN might be killing thousands because of the way they’ve treated that. I’ll let Scott Adams be my defense on this,” Navarro said.

Since the video has been referenced in a major news outlet by a very senior government official as a key plank in his support for the use of HCQ, it is worth questioning the key claim in the video.

The audio of the Scott Adams podcast is here.

The Adams Argument

Scott Adams' argument in the podcast claims the mainstream media are conspiring to suppress evidence to hurt Trump. His argument is that many if not most doctors agree with Trump's position.

He claims around 1:30 in the podcast that many doctors worldwide support its use (all quotes my manual transcription):

I would guess that maybe fifty thousand doctors around the world are using it on themselves or prescribing it.

He builds on this argument the idea that Trump's views on HCQ are entirely consistent with the views of the majority of doctors:

It is completely true that Trump's opinion on HCQ matches exactly most doctors' in the USA.

More specifically at around 4:25 he claims that "perhaps 90%" either use it or support its use:

I don't know if it is 100% and I won't make that claim, but it's probably 90%.

He clarifies by excluding academic medical experts (like epidemiologists) from his claim as he seems to think they are institutionally biased. So his claim appears to be about "front-line" doctors only.

His entire argument is founded on this claim. Including the idea that media suppression of evidence that HCQ works could be costing tens of thousands of lives.

I don't think Skeptics.SE is a good place to assess whether there is a conspiracy theory by the mainstream media to hurt Trump, but a simple factual claim like the foundation of Adams' analysis is a good fit here.

Do the majority of US doctors support the use of HCQ for treating covid-19?

Clarification notes on dates

The Navarro interview took place on August 5 and quoted the Adams podcast which was done on July 30. We should presume that their claims are intended to reflect the situation on those dates.

I would presume that, early in the pandemic, most doctors would support testing any drug where there might be a reasonable hypothesis of benefit. So results reporting medical opinion in answers need to take into account when the opinion was surveyed.

Also note that the issue of whether we know HCQ works is addressed in other questions here, notably Is hydroxychloroquine + zinc + antibiotics an effective treatment for COVID-19? and Is hydroxychloroquine proven to reduce the need for hospitalization for Covid-19?.

matt_black
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    **Mod notice**: Before this comments thread possibly gets out of hand, please consider that [we don't care about your political opinion](https://skeptics.meta.stackexchange.com/questions/3858/sorry-but-we-dont-care-about-your-political-opinions). We welcome anyone [in chat](https://chat.stackexchange.com/rooms/311/hub-of-reason) if you'd like to talk about your political opinion. –  Aug 14 '20 at 19:41
  • There are two ways to use hydroxychloroquine against COVID-19. You can use it preventively and you can use it to treat people diagnosed with COVID-19. The question should likely focus on one of those. – Christian Aug 16 '20 at 09:59
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    The claims as quotd are alrady *inconsistent* and *self-contradictory*. - Google says that there are over 500,000 physicians in the US, so 90% of these (who "use or support") would already outnumber the "guessed" 50,000 worldwide (who "use or prescribe") by an order of magnitude. – Hagen von Eitzen Aug 18 '20 at 06:46

2 Answers2

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The only way to settle this is to find and cite a study or survey that supports or refutes the claim that "the majority of doctors in the USA support the use of hydroxychloroquine against COVID 19."

I found an article "USA Today" from 18 June, 2020 which quotes a survey that (among other things) asked doctors around the world which treatment they thought was most effective against COVID 19.

USA Today says that 51 percent of US doctors chose "nothing" (meaning "no treatment" rather than "didn't choose anything") out of the list of possible treatments in the survey question. That was the highest percentage for any of the treatments on the list. Hydroxychloroquine was on the list, and scored 37 percent for doctors all over the world - USA Today didn't give the hydroxychloroquine results for just the US.

That knocks hydroxychloroquine out of the majority position in the US. 51 percent is just barely definable as "majority," and hydroxychloroquine didn't get it.

This survey from Sermo seems to be the basis of the USA Today article.

From page 4:

enter image description here

Quoted as text:

Treatments & Efficacy:

  • 3 most commonly prescribed treatments amongst COVID-19 treaters are 56% analgesics, 41% Azithromycin, and 33% Hydroxychloroquine.
  • Hydroxychloroquine usage amongst COVID-19 treaters is 72% in Spain, 49% in Italy, 41% in Brazil, 39% in Mexico, 28% in France, 23% in US, 17% in Germany, 16% in Canada, 13% in UK and 7% in Japan.
  • Hydroxychloroquine was overall chosen as the most effective therapy from a list of 15 options (37% of COVID-19 treaters).
    • 75% in Spain, 53% Italy, 44% in China, 43% in Brazil, 29% in France, 23% in US and 13% in UK.
  • The two most common treatment regimens for Hydroxychloroquine were:
    • (38%) 400mg twice daily on day one; 400 mg daily for 5 days.
    • (26%) 400mg twice daily on day one; 200mg twice daily for 4 days.
  • Outside the US, Hydroxychloroquine was equally used for diagnosed patients with mild to severe symptoms whereas in the US it was most commonly used for high risk diagnosed patients.
  • Globally, 19% of physicians prescribed or have seen Hydroxychloroquine prophylactically used for high risk patients, and 8% for low risk patients.

That says that only 23 percent of US doctors picked hydroxychloroquine as the most effective treatment, and that 23 percent of the US doctors use hydroxychloroquine to treat COVID 19.

That's a far cry from "majority."

To finish it off, Sermo reports that the use of hydroxychloroquine is dropping. The rate of use was higher before 11 June, and was still dropping.

That pretty well disposes of "majority of US doctors recommend the use of hydroxychloroquine for COVID 19."

Given how quickly things change in respect to COVID 19, the situation might have changed since Sermo conducted the survey.

If anyone knows of a newer or better survey, I'm all ears.

JRE
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    The reported survey was conducted in late March, before multiple double blind studies showed that some people experienced significant downsides from hydroxychloroquine, and that a placebo had just about the same upsides as did hydroxychloroquine. – David Hammen Aug 14 '20 at 12:21
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    @DavidHammen: Yup. HCQ seems to be a poor choice in light of the studies done. The question was whether the majority of US doctors recommends it, and that's all I answered. – JRE Aug 14 '20 at 12:24
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    That seems more evidence-based than Adam's whiteboard extrapolation from a guestimate. – jeffronicus Aug 14 '20 at 15:55
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    @JRE: I think you're misunderstanding David Hammen's comment. Doctors pay attention to studies. So your answer about what doctors supported *before* that research does not really answer the OP's question about what doctors supported *at the time of Scott Adams' podcast*. – ruakh Aug 14 '20 at 23:30
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    @ruakh: The survey I quoted says that a majority of American doctors did **not** support HCQ before the studies were finished. Even so, support for it was falling, and has continued falling since the survey in June. So, it supports the idea that doctors **now** do not support HCQ. **Unless** someone can find a survey that shows American doctors have done an about face and jumped back on the sinking HCQ ship. – JRE Aug 14 '20 at 23:35
  • @JRE: I was just clarifying David Hammen's comment for you, since your reply shows that you'd misunderstood it. To be clear, I'm not sure that his comment is actually *correct*; after all, your Sermo link says that "In the U.S., hydroxychloroquine usage for COVID-19 decreased significantly from **56%** to 23% over a seven week period" (namely "**April 14** to May 26"; emphases mine), which implies that Scott Adams' claim could have been (roughly) correct if only he had made it three or four months earlier . . . – ruakh Aug 14 '20 at 23:53
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    @ruakh It is a fair assumption that doctors would support the treatment less after studies showed it was not very effective than before said studies. – Captain Man Aug 14 '20 at 23:54
  • @CaptainMan: Yes, thanks for agreeing with me. :-) – ruakh Aug 14 '20 at 23:54
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    @ruakh: I don't think I've misunderstood anything at all. David Hammen posted a reminder that the apparent popularity of HCQ at the time of the survey would be due to a lack of sufficient studies **at the time.** I agree with that. – JRE Aug 14 '20 at 23:57
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    In other words, the survey says that even without the studies we now have that show HCQ to be ineffective, the American doctors weren't supporting its use in a majority. – JRE Aug 14 '20 at 23:59
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    @JRE: I know you agree with that, but your answer doesn't mention it. (Remember that the main purpose of comments is to help improve answers, not just to mention random facts . . .) – ruakh Aug 14 '20 at 23:59
  • @JRE: The *survey* says that (according to David Hammond's comment), but the *answer* does not. (As it happens, I think David Hammond's comment was mistaken. But that's what it was saying.) – ruakh Aug 15 '20 at 00:00
  • @ruakh: There's not much point in mentioning the studies. The question is about what American doctors advocate **doing.** The results of the survey address that. If I drag in the studies that busted HCQ, then I'm speculating on what effect those studies had on the doctors. The question can't be answered by my speculation. It can only be answered by asking the doctors. The survey I quoted is the newest I could find that **asked** doctors what they think. – JRE Aug 15 '20 at 00:06
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    @JRE: I think you can't avoid *some* degree of speculation. Right now, your answer speculates that a survey conducted earlier in the year is a useful measure of how doctors feel today. That's a very reasonable assumption, but an important aspect of skepticism is calling out potential limitations. (You don't need to write, like, a whole big paragraph about it. But if an event since then is likely to have changed the situation significantly, then it's 100% reasonable to briefly call that out.) – ruakh Aug 15 '20 at 00:17
  • Do you have the exact wording of the survey questions? – Acccumulation Aug 15 '20 at 00:40
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    Completely skeptics-annoying anecdote. My wife had minor surgery this week (in the Dallas, TX area). In preparation for the surgery she had both a COVID test and a COVID antibodies test. In part because of that, and in part because I was asking about their COVID experiences in the hospital, I asked three doctors what they think about COVID treatment. One mentioned Remdesivir, one mentioned Dexamethasone and one mentioned both. No one talked about HCQ. – Flydog57 Aug 15 '20 at 00:51
  • @DavidHammen Can you please post links to the studies you mention in your first comment? If I missed them posted somewhere you posted them already, I apologize. – RockPaperLz- Mask it or Casket Aug 15 '20 at 02:02
  • @RockPaperLz-MaskitorCasket - It's the same Sermo survey that is linked in this answer. – David Hammen Aug 15 '20 at 02:45
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    @ruakh - That was the point of my comment. If that Sermo survey is the survey to which Scott Adams was referencing (that survey remains a favorite amongst Trump supporters), it was rather disingenuous of Adams to use the present tense when the survey was conducted four and a half months ago, fairly early on in the pandemic. It was also rather disingenuous of him to use the word majority when plurality would have been a better word. – David Hammen Aug 15 '20 at 02:51
  • @DavidHammen Indeed. Spain is the country which has used HCQ most extensively because of timing: pandemic hit in March, just while first studies about HCQ efficiency emerged and it was controlled by lockdown measures just as those initial studies were being disproved. Now its use is discouraged except in most severe causes (when the situation is pretty dire and you can try anything). https://www.elindependiente.com/vida-sana/salud/2020/08/02/de-la-hidroxicloroquina-al-remdesivir-como-ha-cambiado-la-forma-de-tratar-a-los-pacientes-de-covid-19/ (source in Spanish) – Rekesoft Aug 17 '20 at 08:21
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    @Rekesoft - Indeed, again. The rationale for looking into HCQ against COVID was that HCQ was somewhat effective against SARS, and that the viruses that cause SARS and COVID are closely related. While related, SARS is much more deadly than is COVID but is much less contagious than is COVID. Slightly different viruses can result in different diseases. It made massive amounts of sense at the start of the pandemic to use HCQ. It now appears that HCQ it doesn't work all that well against COVID. There is an ongoing trial that will end late this year. There are well known bad side effects from HCQ. – David Hammen Aug 17 '20 at 08:50
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    I deleted a couple of comments which were unrelated to this specific answer. Please keep comments focused on trying to improve this answer. If you have a different answer, feel free to post it as an answer instead of a comment. – tim Aug 17 '20 at 14:56
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Do the majority of doctors in the USA support hydroxychloroquine use for covid-19?

This is precisely what an April survey of 1,271 US doctors showed:

Sixty-five percent of physicians across the United States said they would prescribe the anti-malaria drugs chloroquine or hydroxychloroquine to treat or prevent COVID-19 in a family member, according to a new survey released today by Jackson & Coker, one of the country's largest physician staffing firms.

Only 11 percent said they would not use the drug at all.

The use of HCQ dropped off later, due to the FDA withdrawing its emergency use authorization (Doctors can still prescribe it off-label in some states, as far as I know, but it's risky from their point of view, due to liability and other concerns). Less use due to the FDA ban doesn't imply that the doctors believe in its effectiveness less though.

In any case, the survey took place in early April, while Trump admitted using HCQ in mid-May. The (in)famous anti-HCQ Lancet study everyone and their dog heard about on the news was published days later. It was exposed as using fake data and withdrawn in June.

So, it's safe to say that Trump's use of HCQ was not considered heretical by doctors at the time he spoke.

Adams's argument is that the media's frenzied attack on Trump over this issue shows their bias.

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    I would suggest you linking to the actual survey, that is an opinion article in a political site – bradbury9 Aug 17 '20 at 06:57
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    The Jackson Coker link doesn't work for me - I get a connection timeout. I found the linked page on [The Wayback machine.](https://web.archive.org/web/20200522134731/https://jacksoncoker.com/about/in-the-news/physician-poll-on-covid-19-chloroquine-and-hydroxychloroquine/) – JRE Aug 17 '20 at 08:00
  • Seems Jackson Coker is getting knocked off line by all the requests. – JRE Aug 17 '20 at 08:01
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    Just an FYI, but any statement or paragraph you start off with "Presumably,..." almost certainly isn't a good fit for skeptics.se. – Shadur Aug 17 '20 at 08:37
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    Early in the pandemic there were notable circumstantial hints that drugs such as HCQ could work. I would hope that most doctors would support testing it then. So timing matters. There have now been many trials many of which had reported before the Adams claim. The answer ignores this but would be an adequate answer here if it was explicit about the timing and reported the same opinions over time. – matt_black Aug 17 '20 at 08:50
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    @FredStark: Does the link work for you? I consistently get a time out (hence the Wayback machine link in my comment above.) – JRE Aug 17 '20 at 09:05
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    "Less use due to the FDA ban doesn't imply that the doctors believe in its effectiveness less though" -- It also doesn't imply that they still believe in it either. – Shadur Aug 17 '20 at 14:37
  • @LangLаngС: The [Jackson Coker poll results can be seen on the Wayback machine.](https://web.archive.org/web/20200522134731/https://jacksoncoker.com/about/in-the-news/physician-poll-on-covid-19-chloroquine-and-hydroxychloroquine/) There seems to be some kind of problem with the Jackson Coker site. Some people can access it, others (like you and I) get a time out. – JRE Aug 17 '20 at 14:40
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    [Sermo](https://app.sermo.com/covid19-barometer) seem to have regular surveys of global medical opinion up to june. They cover treatment used, opinions of their effectiveness and different clinical environments of use. Why not quote their results? – matt_black Aug 17 '20 at 21:22