The American Journal of Medicine didn’t recommend hydroxychloroquine as a treatment for COVID-19; scientific evidence doesn’t show hydroxychloroquine is effective against COVID-19

Key takeaway

No scientific evidence demonstrates that hydroxychloroquine is useful for preventing or treating COVID-19, despite social media posts and articles claiming otherwise. Large, randomized, controlled clinical trials in several countries found that hydroxychloroquine doesn't produce any benefits in terms of mortality rate or clinical outcomes in COVID-19 patients. Due to the lack of benefits and risk of heart rhythm problems, public health authorities recommend against using hydroxychloroquine to treat COVID-19 patients outside of clinical trials.

Reviewed content

Verdict:

Inaccurate

Claim:

The “American Journal of Medicine admit their stand on [hydroxychloroquine] was wrong“; it “published evidence that hydroxychloroquine is effective for preventing COVID-19“

Verdict detail

Inaccurate: The American Journal of Medicine didn’t endorse hydroxychloroquine as a treatment for COVID-19 patients. Scientific journals publish findings, but don’t issue treatment recommendations. The study published in The American Journal of Medicine is a review of previous literature that doesn’t provide new data or an analysis to support the use of hydroxychloroquine for treating COVID-19 patients.

See our method of evaluation

Full Claim

“After 440,000 americans are dead, Facebook and American Journal of Medicine admit their stand on [hydroxychloroquine] was wrong”; "The American Journal of Medicine published evidence that hydroxychloroquine is effective for preventing COVID-19“; “Peer-reviewed journal reports hydroxychloroquine can reduce mortality rates in covid-19 patients”

In late January 2021, social media posts and articles claimed that hydroxychloroquine was effective for the early treatment of COVID-19 patients based on a scientific publication in The American Journal of Medicine. The claim went viral on social media platforms, mainly shared by groups opposing lockdowns and outlets such as Gateway Pundit, Mercola, and One America News Network (OAN), which previously published health misinformation about COVID-19 (examples here, here, and here). Such articles and posts received more than 110,000 interactions on Facebook, Instagram, and Twitter, according to the social media analytics tool CrowdTangle.

To support their claim, these posts cite the same article by McCullough et al.^[1], published in the January 2021 issue of The American Journal of Medicine. Some posts interpreted this to mean that the American Journal of Medicine “recommended” hydroxychloroquine as a treatment for COVID-19 (here). Others claimed that the journal “admit[s] their stand on hydroxychloroquine was wrong” (here).

However, those claims are inaccurate. Joseph S. Alpert, editor-in-chief of The American Journal of Medicine, explained to Newsweek that “this article does not mean the journal recommended this therapy”:

“We have also published articles from other authorities that said don’t use [hydroxychloroquine] … We are a scientific journal and do not push or recommend any specific thing. The authors do that”.

Rather than issuing recommendations, scientific journals publish articles where the authors might recommend for or against the use of a particular treatment. For example, The American Journal of Medicine previously published an editorial in which the authors recommend against the use of hydroxychloroquine for COVID-19 patients, which also doesn’t mean that it endorsed this recommendation.

Many articles and posts cite the article by McCullough et al. as a “study”, claiming “the study found that immediate use of hydroxychloroquine, while the patient was still at home, showed significant benefits”. This article focuses on early treatment strategies that can reduce the risk of hospitalization and death in ambulatory COVID-19 patients. Given the lack of clinical trials and specific guidelines for the early treatment of COVID-19 patients, the authors propose several strategies and recommendations.

However, the publication by McCullough et al. doesn’t provide new evidence on the effectiveness of hydroxychloroquine in COVID-19 patients, contrary to what many social media posts claim. “Studies” or “research articles” are publications that report newly collected research data and include specific sections describing the methods, results, and conclusions of the research. Instead, the article by McCullough et al. makes general recommendations for treating ambulatory COVID-19 patients based on previous evidence. In fact, the article’s summary highlights the lack of scientific evidence on the topic:

“In the absence of clinical trials and guidelines, with hospitalizations and mortality mounting, it is prudent to deploy treatment for COVID-19 based on pathophysiological principles”.

Therefore, the claim that the publication by McCullough et al. provides scientific evidence of the efficacy of hydroxychloroquine in COVID-19 patients is inaccurate.

As Health Feedback explained in this earlier review, large-scale clinical trials in several countries found no beneficial effect of hydroxychloroquine in terms of viral shedding, disease severity, or mortality among COVID-19 patients^[2,3]. Clinical trials also found that hydroxychloroquine was not beneficial for preventing the disease^[4,5]. In April 2020, the U.S. Food and Drug Administration cautioned against the unsupervised use of hydroxychloroquine due to potential cardiac toxicity. In June 2020, the agency revoked the Emergency Use Authorization for hydroxychloroquine in hospital settings. Public health authorities, including the U.S. National Institutes of Health, also recommend against using hydroxychloroquine to treat COVID-19 patients as it shows no benefit and may cause heart rhythm problems in a small proportion of patients.

Some articles claim that the number of COVID-19 deaths “could have been lowered significantly if hydroxychloroquine use would have been promoted in the U.S”. However, these claims are unsubstantiated. Given that hydroxychloroquine has shown no beneficial effect in COVID-19 patients, the scientific evidence doesn’t support the claim that widespread use of the drug could have saved lives.

In summary, The American Journal of Medicine didn’t endorse hydroxychloroquine treatment for COVID-19 patients. The journal simply published a review in which the authors recommended general early treatment strategies based on previous research. Large-scale clinical trials indicate that hydroxychloroquine doesn’t prevent or treat COVID-19. The absence of benefits, coupled with the fact that hydroxychloroquine may cause heart rhythm problems in some patients, led public health authorities to recommend against using hydroxychloroquine as a treatment for COVID-19 patients outside of clinical trials.

Additional notes

Peter McCullough, the first author of the review in The American Journal of Medicine, was one of the four expert witnesses testifying in a November 2020 Senate hearing held by the U.S. Homeland Security and Governmental Affairs Committee. There, McCullough advocated for the early treatment of COVID-19 patients with hydroxychloroquine. This hearing, and a second one held in December, were both criticized for promoting the use of unproven drugs and the spread of misinformation.

REFERENCES

• 1 – McCullough et al. (2020) Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection. The American Journal of Medicine.
• 2 – Ghazy et al. (2020) A systematic review and meta-analysis on chloroquine and hydroxychloroquine as monotherapy or combined with azithromycin in COVID-19 treatment. Scientific Reports.
• 3 – Skipper et al. (2020) Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19 : A Randomized Trial. Annals of Internal Medicine.
• 4 – Abella et al. (2021) Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers: A Randomized Clinical Trial. JAMA International Medicine.
• 5 – Rajasingham et al. (2020) Hydroxychloroquine as Pre-exposure Prophylaxis for Coronavirus Disease 2019 (COVID-19) in Healthcare Workers: A Randomized Trial. Clinical Infectious Diseases.