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America’s Diseased Politics – The New Republic

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Hydroxy hysteria: When saving lives collides with politics and bureaucracy | TheHill – The Hill

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Field reports from physicians around the world suggest that hydroxychloroquine, a relatively inexpensive drug used to treat malaria for more than 60 years, may be useful in fighting COVID-19. Based on this emerging data, President TrumpDonald John TrumpSanders says he wouldn’t ‘drop dead’ if Trump decided on universal healthcare Overnight Health Care: Trump officials lay groundwork for May reopening | Democrats ramp up talks with Mnuchin on next relief deal | Fauci says death toll could be around 60,000 Hillicon Valley: State officials push for more election funds | Coronavirus surveillance concerns ramp up pressure for privacy bill | Senators warned not to use Zoom | Agencies ask FCC to revoke China Telecom’s license MORE has suggested that doctors consider the “off-label” use of hydroxychloroquine in this global emergency.

So why is President Trump being ridiculed or condemned for at least spreading a ray of hope against a disease so new it would be impossible for the Food and Drug Administration (FDA) to have its own officially approved treatment yet? Is the president promoting quackery, or worse?

Nothing of the sort.

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To start, hydroxychloroquine is not being used without any safeguards. The standard clinical trials proving its value against this disease have not been conducted — but hydroxychloroquine was tested and approved six decades ago, and it has an established record of efficacy and side effects that physicians can review. More importantly, no doctor is (or should be) prescribing it without following standard protocols observed for any drug or any patient.

While hydroxychloroquine may not be the best or ultimate cure against COVID-19, and while its use may be more experimental than proven at this stage, the fact is that this is not a normal situation. We face a new, dangerously infectious virus, and abnormal times can require abnormal measures. Hydroxychloroquine has shown promise in treating symptomatic cases of COVID-19, which is why many doctors are using it. And a recent survey of some 1,200 U.S. doctors found that 65 percent said they would prescribe it to treat or prevent COVID-19 in a family member.

Indeed, medical authorities have explained for years that off-label drug use — prescribing a medication for a health condition other than its normal, approved purpose — can be an innovative way to broaden therapeutic tools in challenging medical situations. Here is what the FDA itself tells us:

Once the FDA approves a drug, health care providers generally may prescribe the drug for an unapproved use when they judge that it is medically appropriate for their patient. You may be asking yourself why your health care provider would want to prescribe a drug to treat a disease or medical condition that the drug is not approved for. One reason is that there might not be an approved drug to treat your disease or medical condition. Another is that you may have tried all approved treatments without seeing any benefits. In situations like these, you and your health care provider may talk about using an approved drug for an unapproved use to treat your disease or medical condition.

And here is what the National Library of Medicine said — well before COVID-19 appeared on the scene — about using hydroxychloraquine against diseases for which the drug had never been officially approved: “It is also used to treat discoid or systemic lupus erythematosus and rheumatoid arthritis in patients whose symptoms have not improved with other treatments. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.”

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What, then, is really going on with this debate? Sad to say, it appears that at least some of the president’s critics are being influenced by what might otherwise be rational disagreements with him on other issues, a legitimate rivalry between political parties, or even a purely personal dislike for Trump. This, despite the potential for needless deaths of thousands of Americans who contract COVID-19, long before the FDA can finish the typical multi-year process of approving a drug for any one disease.

If any example shows us that partisan politics generally has gotten out of hand, it would be this. But it is more than this, too. In truth, President Trump has a different view of “expertise” than most liberals, progressives, academics or Washington insiders. He has shown a willingness to listen to the results of scientific research, but he does not automatically “defer to the experts” on the policy implications of that research. As his record of regulatory reform has demonstrated, he is willing to cut bureaucratic red tape in order to get results.

There is not an FDA-approved treatment for COVID-19 yet — it is simply too early. But that does not mean it is an “insult against science” to conclude that governmental action should be taken in the midst of an emergency based on the best facts available. Indeed, even outside of an emergency, it is no disrespect to science to say some medical treatments that some physicians deem prudent for their patients should be allowed — and, yes, promoted — even if those have not been the subject of someone’s peer-reviewed Ph.D. thesis or years of regulatory process. Even when the experts have the time to spend years studying a problem, they often can be wrong. Doctors in the field who are treating patients have valuable information to contribute in this crisis, too.

Even when the experts are correct, there often are many assumptions and policy biases hidden in the way they articulate their conclusions and recommendations. And organizations like the FDA have their own inherent institutional biases. The more involved and sophisticated the FDA can make the process of investigating drug “efficacy,” the more the process tends to help the biggest drug companies and deter smaller competitors. If you are part of that process — a lobbyist, a drug company executive, or even an FDA scientist committed to applying the most rigorous possible standards — you may see an emergency order moving an experimental drug or process to the top of the list as a challenge to the established way of doing business.

In this crisis, the president rightly has become deeply involved in the details of public policy and is working closely with members of his White House coronavirus task force. You may disagree with his views or his style, but the establishment needs to be shaken up: The normal order of business will not be enough to defeat COVID-19. And even if you think we were unprepared for COVID-19, it was not simply the fault of one man. It is part of the problem with our national approach to solving challenges: too much regulation, too much cronyism, too much corruption.

This crisis is a wake-up call. We need to set aside the old ways of doing things in Washington, innovate together, put on our masks, and get our country back to work. 

Ramin Oskoui, MD, is CEO of Foxhall Cardiology in Washington and has met with President Trump and White House advisers on the coronavirus pandemic.

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Politics This Morning: Parliament to sit over Easter weekend to pass feds' wage subsidy bill – The Hill Times

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Good Friday morning,

Parliament is set to sit over the long weekend to pass the feds’ $73-billion wage subsidy, with the House is slated to convene Saturday at around noon. In a tweet yesterday afternoon, Government House Leader Pablo Rodriguez said he put in a request to the Speaker so that the government can “bring in new emergency economic measures” to support businesses and workers amid the coronavirus pandemic.

Finance Minister Bill Morneau expressed frustration the other day over the pace of negotiations, suggesting that other parties had been delaying the recall of Parliament. But outgoing Conservative Leader Andrew Scheer pushed back, tweeting a letter addressed to the prime minister that “while we can all agree that there is a need to move quickly in this current crisis, when there is no debate, no discussion, no opportunity for regular questions from Opposition, it makes it that much harder to perfect legislation.”

Parliamentary Budget Officer Yves Giroux released a series of reports, including one that projected the federal deficit could soar to $184.2-billion for the 2020-21 fiscal year. The last time Canada was that deep in the red was in 1984-85. That analysis does not yet account for the multibillion-dollar wage subsidy program.

In jobless numbers for March, StatsCan reported that more than a million people have been laid off, leading to a jump in the unemployment rate from 5.6 per cent to  7.8 per cent. That does account for those who have seen their hours cut or income slowly dry up due to the pandemic. Women, particularly those between 25 and 54, were disproportionately affected, losing their jobs twice as men in that cohort.

After facing daily pressure to release national projections forecasting the extent of the pandemic’s toll, Prime Minister Justin Trudeau and public health officials offered a preview of what Canadians could expect. With the current measures in place, Canada could see up to 44,000 deaths related to COVID-19 in the coming months. In the short term, the public health agency said there could be between 500 and 700 deaths by next week. While federal officials said the social-distancing measures could last between 12 and 18 months, given that a vaccine is still a long way off, the Quebec government is eyeing a gradual return to some sense of normalcy, as the number of cases have started to stabilize, according to The Canadian Press. It was still unclear which parts of the economy would be reawakened.

Chief public health officer Dr. Theresa Tam said Canadians can expect a “very cautious approach” to relaxing physical-distancing measures, with different parts of the country’s experiences expected to vary, depending on the severity of the outbreak.

In other non-COVID news, Canada is planning to go ahead with its sale of armoured vehicles to Saudi Arabia, after it reached a new deal, worth $14-billion, which would give the feds the ability to be more open about the terms, according to CBC.

The Hill Times

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The Atlantic Politics Daily: Two Key Swing States During a Pandemic – The Atlantic

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It’s Thursday, April 9. In today’s newsletter: There’s something about Michigan and Florida. Plus: How the legacy of Bernie Sanders might live on.

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« TODAY IN POLITICS »

(KAMIL KRZACZYNSKI / AFP / GETTY)

Two COVID-19 Swing-State Case Studies

President Trump’s complicated relationships with the governors of two swing states could ultimately cost him reelection, my colleague Ron Brownstein writes.

First, Michigan: The president said at a White House press briefing in March he told Vice President Mike Pence not to “call the woman in Michigan”—Governor Gretchen Whitmer—if she didn’t “treat [him] right.” While he won Michigan in 2016 by a slim 0.23 percent margin, that sort of hostility could hurt his chances of doing so again.

The president can hardly afford any erosion in the populous Detroit metropolitan area …. “It is politically stupid of the president to pick a fight with a governor who is trying to manage a crisis in a state that he has to win,” one political strategist told Ron.

Governor Gretchen Whitmer is hardly the only Democrat to face the president’s ire. The president has expressed displeasure toward Democratic leadership across the country for what he regards as insufficient gratitude to the administration’s response efforts, my colleague Peter Nicholas has reported. But what happens when the COVID-19 outbreak peaks in red states?

On the opposite end of the spectrum: The Trump administration’s fingerprints are all over Florida Governor Ron DeSantis’s playbook. DeSantis initially dragged his feet over shutting down Florida (all the while, Trump described him as a “great governor” who “knows exactly what he’s doing”).

In Florida, conditions have not yet reached such a crisis point, though its caseload is growing steadily. But because DeSantis waited so long to act, he and Trump could be punished if the outbreak ultimately imposes a heavy cost on the state.

Read Ron’s full analysis.

—Kaila Philo

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« ARGUMENT OF THE DAY »

(CHANG W. LEE / THE NEW YORK TIME​S / REDUX)

The departure of Bernie Sanders from the 2020 presidential primary leaves Joe Biden the presumptive nominee. The greatest accomplishment of the Sanders campaign has less to do with moving good ideas out of the “radical” category and into the mainstream, the writer John Nichols argues—and more to do with inspiring the people who will carry those ideas forward. In a way, Bernie Sanders has won.

+ The left’s theory of politics fell apart in this cycle’s Democratic primary, but its policy critique of the Barack Obama era has real merit, Adam Serwer argued in March, and the centrist wing of the party should not dismiss it.

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« THE CORONAVIRUS READER »

(JAN BUCHCZIK)

+ Launching a column on happiness during a pandemic seems awkward, but that’s what we’re doing today: Here’s the first installment of our new weekly column on how to live a life that feels whole and meaningful, from Arthur C. Brooks.

+ America’s obsession with keeping aid from the undeserving is making a bad economic crisis worse, Mehrsa Baradaran argues. It should just send checks—yet won’t.

+ If there is a way to stop COVID-19, it will be by blocking its proteins from hijacking, suppressing, and evading humans’ cellular machinery. These are the best hopes for a coronavirus drug, our science writer Sarah Zhang reports.

You can keep up with The Atlantic’s most crucial coronavirus coverage here.


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Today’s newsletter was written by Kaila Philo, a Politics fellow. It was edited by Shan Wang, who oversees newsletters.

You can reply directly to this newsletter with questions or comments, or send a note to politicsdaily@theatlantic.com.

Your support makes our journalism possible. Subscribe here.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.

Kaila Philo is an editorial fellow at The Atlantic.

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