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Applying Porter's Five Forces to Fix US Politics – Harvard Business Review



CURT NICKISCH:  Welcome to the HBR IdeaCast from Harvard Business Review.  I’m Curt Nickisch.

It’s a widespread opinion that the U.S. political system is dysfunctional.  Just look at the government response to the Covid-19 crisis, you’ll hear people say, or the protests against police brutality.  There is a tremendous disconnect between what people want and what politicians are doing to serve those wishes.

But our guests on the show today say the political system is working exactly how it is designed to work.  They’re from the business world and have applied competitive strategy frameworks and market analyses to the political sphere.  They argue it is not optimized to work for ordinary citizens, but instead to keep two political parties in power, and that’s what it does very well.  Think of the Republican and Democrat parties more like Coke and Pepsi, they say, two organizations that have sold a lot of cola over the decades and have been immensely successful at dominating the market.

Katherine Gehl is the former CEO of Gehl Foods and the founder of the Institute for Political Innovation.  And Michael Porter is a professor at Harvard Business School.  Together they wrote the book, The Politics Industry, How Political Innovation Can Break Partisan Gridlock and Save Our Democracy, as well as the HBR article, “Fixing U.S. Politics: What Business Can and Must Do to Revitalize Democracy.”  Katherine, thanks for coming on the show.

KATHERINE GEHL:  Thrilled to be here, Curt.  Thanks for having us.

CURT NICKISCH:  And Michael, welcome.

MICHAEL PORTER:  My pleasure, Curt.  Thank you.

CURT NICKISCH:  Now, Katherine, you came to the political arena through a business career, which is not unusual.  What makes your experience different?  How do you see politics different than many other business leaders who’ve gone on to political careers?

KATHERINE GEHL:  Yes, so I came to this way of thinking while I was working on my corporate strategy project using Michael Porter’s Five Forces.  And fortunately for us at our company, Michael Porter was the consultant on our corporate strategy project.  And so while we were working on corporate strategy, since I was deeply engaged in the political world and the policy world, I, in the back of my head, started running the Five Forces analysis on what I began to call the politics industry, and I found it to be fascinating

CURT NICKISCH:  W hat did you see?  Or what was your first conclusion?

KATHERINE GEHL:  The most striking thought that I had – actually, there are two, one is, the barriers to entry for new competition in the politics market are so high.  And then a second thing that really came out when we looked at the Five Forces is that, oh, well, the customer, which is to say the public interest, has no power in this industry.

CURT NICKISCH:  Is there, and Michael, maybe this a question for you, but is there a limitation to using this framework, which was designed for the business world – is there a limitation to applying this to political science?

MICHAEL PORTER:  Well, I would tell you, I didn’t know anything about applying it to anything besides business. What I find is, the framework proves to be incredibly powerful.  It makes it clear what’s actually going on here.

This what we call a duopoly.  This is an industry where there’s two dominant competitors.

CURT NICKISCH:  Yeah, the idea of a duopoly struck a chord with me.  I remember going to the European Union once, and a German lawmaker there told me, ah, yes, the U.S. two-party system, the minimum number of parties you need for a democracy…

MICHAEL PORTER: And there’s only been two dominant competitors for the last 100 plus years. These barriers to entry have largely been created in a collaborative way between the parties.  It’s interesting that they are bitter rivals, but they cooperate in setting the rules and structuring the game of competition in their particular industry.  Companies love to do that in for profit industry, too, but they usually can’t do it.

CURT NICKISCH: We do know that in competitive markets, two dominant players can work, like Coke and Pepsi can be very intensely competitive with each other, but generally you have higher profitability.  You have stronger producer surpluses.  You don’t have the most efficient market, and maybe not the one that’s the most innovative when it comes to choices and value and solutions for its customers.

KATHERINE GEHL:  Look, when there’s only two, neither party needs to deliver results in order to keep winning, because no matter how disappointed you, the voter, are, you still likely prefer what your side says they’re for, than what the other side says they’re for.  And so, you know, instead of results in the public interest, we get this gridlock and increasing polarization, because there’s no incentive for the two sides to come together to solve our problems in a sustainable, scalable way.

CURT NICKISCH:  And you give lots of examples of this, like immigration reform, any number of issues where you think a solution would be preferred by a majority of the population, but it’s just not in the interest of either party to compromise, because if it doesn’t happen, they can still complain about a problem and go back to their donors and raise money for candidates, and you know, wage an election campaign again.

MICHAEL PORTER:  The core competition in this industry is really captured by the word polarization.  That’s because the parties have divided up the voters into voters that are more left or voters that are more right, that are better limed up with their ideology.  And those kind of voters tend to vote in the partisan primaries.  So the partisan primaries become a critical part of this industry, as I’m sure we’ll talk about later.

Frankly, as a business strategy professor, I will tell you, this is very clever from their point of view.  This is very clever.  They are very good at optimizing the system for them, collectively.  And they are able to get away with not optimizing almost anything about it for the public.  And we have lots of issues in America.  Our business environment, lots of things to fix.  You said immigration reform, we have no infrastructure.  We haven’t had any improvements in that in decades.  We have education problems.  We have all kinds of issues in our healthcare system.

People had not been served with things that have enabled them to live a good life and to feel that they have opportunity and have a decent standard of living.  So the parties have been able to not perform on the things that are most important for citizens and not be held accountable.

And in most for profit industries that we look at, you know, you can’t sustain this.  If you’re doing a really bad job, then somebody comes in, and how do you think Uber got into the taxi industry?

CURT NICKISCH:  Yeah.  How would you fix the party primary system, then?  Let’s start with that.

KATHERINE GEHL:  So let’s illuminate the real problem with the party primary.  So they really are the reason why so many people show up at the general election and think, I don’t really like the choices that I have.  Most elections are really decided in the primary, especially in gerrymandered districts, and voters who turn out for the party primaries tend to be more ideological than the electorate as a whole.  So therefore, to make it through the primary, the candidates have to go further to the left or to the right than the voters as a whole really want.

But here’s the much bigger problem that we don’t always think about, which is that the influence of the party primary extends beyond the election to the legislative process, to decision making while governing.  So I want each of your listeners to imagine yourself as a politician.  You, as a politician, have an opportunity to vote yes on bipartisan landmark legislation, perhaps addressing one of our biggest problems in the country.  What are the questions that you ask yourself?  Maybe, is this a good idea?  Maybe, is this the right policy for the country?  Or perhaps, is this what the majority of my constituents want?

But the fact is, it’s none of those questions.  You have to ask, will I make it back through my next party primary if I vote for this?  And if the answer to that question is, no, and on all the big issues, it virtually always is for both sides, then the other important questions are virtually wholly irrelevant because the rational incentive to get reelected dictates that you vote, no.

MICHAEL PORTER: If you’re some hapless member of the House, and you voted against something that the party leaders in your party were for, they’re going to, they’re not going to forget.  They’re going to look at you, and they’re going to put a target on your forehead.  This person, we’re going to run somebody against that person in the next primary.  And so there’s the control of the party leadership is combined with the importance of the partisan primary, and it just reinforces these kinds of outcomes.  And the only time we pass anything lately is when the party – one party – can actually pass it by itself.

CURT NICKISCH:  Right, like corporate tax reform.

MICHAEL PORTER:  Corporate tax reform.  Zero Democrat votes.  All Republican votes.  And the tax reform that we got is very partisan. The corporate tax was lowered dramatically.  And if it had been lowered half as much, it would have been fine.  Every business would be happy.  But it got lowered even more, because it was a highly partisan tax bill, and so our budget right now is on very bad track.  I mean, it just really knocked up the deficit that we’re tracking right now.  So it’s, that’s what we’re talking about here.

CURT NICKISCH: What are some of the specific innovations you’re advocating for?

KATHERINE GEHL:  So there’s one major thing we need to do, and that is change how we vote.  Because how we vote is what drives the incentives.  First, we have to get rid of the broken party primary system.  And we replace that with a single, nonpartisan, top five primary.  So everybody will be on the same ballot in the primary.  You don’t vote in the Democratic primary or the Republican primary.  You vote in the nonpartisan primary.  And the top five finishers advance to the general election.

Then the second thing we need to do in the general election, we need to get rid of the plurality voting, and we need to move to ranked choice voting, where we can rank our choices, and in that way, we can allow for new competition.  When we do these two things together, we will now connect solving problems to the American people with a likelihood that they’ll get reelected, and we will create a pathway for new competitors, which is what drives accountability in any industry.

CURT NICKISCH: I want to ask briefly about ranked choice voting, which to many people who are listening in European countries will be familiar with.  It’s in some U.S. states.  But this is something that you advocate for in the general election, because it tends to arrive at somebody who’s elected who is supported by the broadest coalition of voters.  Is that a fair explanation?

KATHERINE GEHL:  Yes.  So the second important thing we need to change in how we vote is, we have to change how we determine the winner, which is that we need majority winners.  We need people that win with over 50% of the vote.  And an obvious reason is because it’s good to have majority support.  But the most important reason is because allowing winners to win with the most votes, but not necessarily a true majority, is the single greatest reason we never see any new competitors.

Now, that’s hard to understand, so I need to just spell it out.  Let’s look at an example.  In the spring of 2019, the widely respected, admired former CEO of Starbucks, Howard Schultz, said that he was considering running for the presidency as an independent.  But the Democrats believed that Schultz would spoil the race for the eventual Democratic nominee, because they thought he would take just enough vote away from the eventual Democratic nominee to essentially spoil the race for the Democrat and throw the race, therefore, to Trump.

And so they were viciously opposed to his run.  The Republicans, I promise you, would be equally viciously opposed to some well-known, well-respected candidate running who was considered likely to draw too many votes away from Trump, and accidentally, in a sense, make the Democrat win.

And neither party is wrong about that.  The way you get rid of the spoiler problem is by instituting ranked choice voting.  And what ranked choice voting is, you go into the booth on general election day.  You see your five choices that came out of the top five primary.  And you rank them.  It’s quite natural.  We do this with everything in our life.  This is my favorite flavor of ice cream.  My second flavor.  All the way down to, I hate that.  I would never eat that flavor.

And so you do that with the candidates.  You can rank as many or as few as you would like.  And when the polls close, you count the first place votes.  And if one candidate has over 50%, that’s fine.  The election’s over.  That candidate wins.  But if none of the five candidates have gotten support from the majority of voters, then the candidates who came in last place is automatically eliminated from the race, and voters who had selected that candidate, who’s now out, had their second choice counted instead.

We run the vote totals again for the four candidates remaining, and look for a winner to get over 50%.  We keep doing that until we get the true majority winner.  Think of it as a series of runoff elections, but you cast all your votes at once, instead of having to keep coming back to the polling place.

CURT NICKISCH:  So those are the innovations.  Then there’s a matter of getting the innovations to the market.  How does that happen?  What’s the strategy for that?

KATHERINE GEHL:  Well, the interesting thing is each of the states can change these rules at any time.  And so the strategy is to have leaders in the states, grassroots leaders, come together to create a campaign in their state to change these rules.  In half of the states, they can actually use direct democracy.  They can put final five voting as an issue on the ballot, and if they get a majority, we change to final five voting.

In the other half of the states, the legislature needs to pass a bill, and the governor needs to sign it, and so there, the citizens and the leaders in that state need to put pressure on their legislature and their governor to change these rules for how we elect people to Congress.  And that’s how we get it done.

And what’s really important is that we don’t need to get it done in all 50 states for it to begin to make a difference in Washington, DC, to begin to change the competition away from a competition of division and towards a competition to solve problems.  The benefits of competition are not about changing who wins.  They are much more about changing what the winners do.

So in any industry, you can have a new competitor that doesn’t end up winning in the marketplace, but they brought something innovative to the table, and then the existing behemoths maybe take that new innovation and add it into their products.  The customer ends up winning with healthy competition, regardless of which players actually win the election.  So we’re not against Democrats.  We’re not against Republicans.  We want whoever wins to have the freedom and incentive to solve problems for Americans.

CURT NICKISCH:  Michael, briefly, you’ve seen, you’ve advised businesses on how to sort of see the industry structure and figure out a way to create value for customers and compete. What do you think when you look at this, these Five Forces?

MICHAEL PORTER:  Well, it’s too bad that you couldn’t persuade one of the parties to their strategy.  That’s what you normally do in an industry.  You know?  You look in XYZ industry.  You say, this isn’t working.  You’re not delivering good service to the customer.  You’re losing share.  You need to start rethinking, you know, what’s your value proposition and how are you positioned?  What market segments can you serve?  And smart businesspeople who want to maximize value to the customer, that’s what makes them profitable, and makes them grow, they’ll do it.

And that’s the wonderful thing about business competition, is it’s rational in the sense that it’s tied directly to value to the customer.  Whereas in politics, it’s not.  dAnd we’ve got to around the parties.  You know, we can’t persuade one of them to change.  It would be great if we could have a new party.  But we tried that for a long, long time, and it doesn’t work, because there’s just too many barriers to entry.

So I think these things that Katherine described are the most, the two most powerful leverage points that would actually change the structure here in a way that would have a demonstrable impact on what happens.  And I think the big concern that we sometimes here is, oh, we’ll never get this done.  It’s too hard.  How could we get all these states?  How can we get a state legislature to do things?  How can we change the ballot initiative?

And the answer is, you know, answer number one is, well, actually, Americans, we did this once.  We had to do it.  A long time ago, in the 1880s, in the Gilded Age, we had a mess.  The mess was worse, even, than the mess we have today, and our citizens just, you know, decided they were, it was unacceptable, so they set out to do a lot of things. And our system made a dramatic structural change.

I think we also need, citizens, hopefully, if we educate them more and more, they’re going to understand that sticking to their parties’ ideology is a really bad idea.  If you want to be a citizen, and you want to advance your country, then thinking through everything through the lens of, you know, heavy conservatism or heavy liberalism, it’s not right, because those are not the right solutions to many of the things we need to change.

We need to synthesize the good ideas that exist in some of these ideologies to get the right solution.  So hopefully, citizens will not only do this innovation work, but they’ll also start to think differently about how they’re thinking, how they’re talking, how they’re voting.  You know, right now we have, citizens in this country have, don’t have a shared reality.  We don’t have a shared reality of what’s good for us.  Because we’ve been taught that these people think this is good for us.  You know, low taxes, and on and on and on.  And then this set of people thinks this is good for us.  And the parties have taught us that if they’re not on your side, they’re actually bad.  They’re the enemy.  They’re not just another citizen with another point of view.

So hopefully these other things, as I just described, if these can start to take root as well, I think that will make the actual reforms in the rules more feasible and more doable and hopefully will happen faster.  So it’s, that’s our hope.  That’s our dream.  And we’re getting a lot of people that are so anxious that our country gets in a better place that I think they’re going to join.  They’re going to be a part of this.

CURT NICKISCH:  Well, Michael and Katherine, you’ve given us a lot to think about.  But maybe more importantly, a new way to think about it.  Thanks so much for coming on the show to talk about this.

KATHERINE GEHL:  Thank you, Curt.  A pleasure.

MICHAEL PORTER:  Thanks for having us.

CURT NICKISCH:  That’s Katherine Gehl, founder of the Institute for Political Innovation, and Michael Porter, professor at Harvard Business School.  They wrote the new book, The Politics Industry, and the HBR article, “Fixing US Politics, What Business Can and Must Do to Revitalize Democracy.”

This episode was produced by Mary Dooe.  We get technical help from Rob Eckhardt.  Adam Buchholz is our audio product manager.  Thanks for listening to the HBR IdeaCast.  I’m Curt Nickisch.

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Economics and politics will slow down COVID-19 vaccine distribution –



With international news reports detailing promising COVID-19 vaccine candidates moving into advanced human trials, along with renewed claims that a game-changing drug could be ready by the year’s end, Niagara’s acting medical officer of health says it may be helpful to tamp down expectations.

Dr. Mustafa Hirji isn’t talking about how effective a vaccine may be, but how long it will take before anyone in Niagara gets an immunizing shot even after a vaccine is approved for use.

The process, he said, won’t be quick.

“We are preparing an 11- to 12-week blitz,” Hirji said. “That will be to get the early adopters and then we have to continue to get everyone else. But that is after a vaccine is approved, manufactured and distributed.”

And those last three hurdles could slow down the time frame from successful vaccine approval to public distribution by several months.

“This could be particularly true if the vaccine is made in the United States,” said Hirji. “They might actual hog the vaccine for a time. There could be a lot of tricky politics involved.”

This week, international headlines pointed to two vaccine trials — one by Moderna Inc in the United States in conjunction with Cambridge University and one in the United Kingdom at Oxford — that have passed through the first round of human testing with promising results.

There is still some distance in travel before final approval for either drug. Large scale human tests are needed to determine efficacy and safety.

Hirji said if either, or both, prove successful, economics and politics will be the next challenging hurdle.

The home nation of the successful developer will likely want to use the vaccine on their own populations first. Hirji expects this will be particularly true if an American drug is greenlit first, requiring other governments, including Ottawa, to negotiate with Washington.

Manufacturing billions of doses to launch a global immunization program is also going take time. Some of those arrangements are already in place, but it will take months to produce and distribute around the world.

Even after the vaccine arrives, it will take months to immunize the community to a sufficient level to significantly tamp down the threat of the novel coronavirus. Emergency services, health care workers and those most vulnerable to the virus may be prioritized to get the vaccine first. That time frame could be extended if more than one injection is required. The Moderna vaccine, for instance, would require two shots a month apart.

Hirji says this all means that the current infection control measures — physical distancing, masks and hand hygiene — will be necessary to prevent the spread of the virus even after a vaccine is approved.

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Just how much a COVID-19 vaccine will allow those measures to be put aside remains an open question. Hirji has said the most successful vaccine ever developed, the vaccine for measles, is around 98 per cent effective in preventing disease. Other vaccines, like the annual flu shot, have a significant impact on disease spread but is not nearly as effective as the measles shot.

Hirji said public acceptance of a vaccine will also impact how much it curtails the spread of the disease. He said influenza remains a serious public health threat, in part, because not enough people get the flu vaccine every year. The greater the number of people immunized, the more effective a vaccine program will be.

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A ‘celebration of young leaders’ becomes a scandal for old political families – TVO



The first two ethics breaches under Prime Minister Justin Trudeau’s government caused concern, but, with the pandemic and global crisis in full swing, we as a nation seemed to have moved on. There were more pressing challenges to deal with. Then, last week, the WE scandal broke.

I stumbled upon treasured Canadian R&B singer Jully Black’s frustrated Instagram video montage, in which she asked, in earnest, whether she’d been had by the celebrated WE Charity. Black has regularly hosted and performed at their big event, WE Day, for free: Justin Trudeau’s mother, Margaret, and his brother Alexandre received a combined honorarium of almost $300,000 for speaking at the events between 2016 and 2020.

A few years ago, I was downtown, heading to a meeting near the Air Canada Centre (now Scotiabank Arena). On that sunny spring day, the square was packed with energetic, fresh-faced schoolchildren. The air was warm and the day as bright as the looks on their faces as they laughed, joked, and headed to the gates. Many of these young students were wearing T-shirts that said “WE Day” across the front in bold blue letters. I had no idea what WE Day was, and I was curious about the event that had inspired thousands of kids to fill a hockey arena, their enthusiasm and innocence palpable.

Then Canadian politics got involved.

 “A celebration of young leaders,” as per the tagline on its website, WE Day is organized by the WE Charity and grew from a 7,500-student event at Ricoh Coliseum in Toronto in 2007 to a multi-city, stadium-filling tour, pulling in notable social activists and celebrities who perform, MC, and give motivational speeches to young people. From my introduction to WE Day up until now, there was always a bit of mystery and surrounding it. In 1995, at 12 and 18 years old, the WE Charity founders Craig and Marc Kielburger had already co-founded their first charity, Free the Children, which would later be renamed WE Charity. Tickets to WE Day are free, as long as schools meet certain volunteering criteria and promote social activism, volunteerism, and leadership. The WE Charity is a multimillion-dollar international charity that earned the Kielburger brothers each the prestigious Order of Canada and a host of other perks, such as board seats and honorary doctorates. For over a decade, it seemed that WE Charity’s upward trajectory was limitless — but, then, in 2019, cracks began to show, culminating in the dissolution of a plum $912 million government program contract it was set to receive.

Jully Black’s Instagram video led me to another account, with the username @antiracistwe. It was there that I learned that one of WE Charity’s former employees, Amanda Maitland, said her speech about her experiences as a Black women dealing with racism had been significantly edited without her consent by her white colleagues. When Maitland brought up the issue, she says, she was “aggressively” shut down by Marc Kielburger while her colleagues looked on. Other past and present colleagues soon began to open up about their “horrifying” experiences at WE Charity. Interestingly enough, one statement, from former staffer Santai Kimakeke, was later retracted.

As if things weren’t interesting enough at WE Charity, on June 25, the Liberal government announced that it was awarding the charity a $19.5 million sole-source (as in, no other NGOs had an opportunity to bid on this project) contract to administer the $912 million Canada Student Service Grant program. Note that this is the same government whose leader’s close family members had been compensated by this very charity. This makes the waters around the awarding of this grant very murky. For starters, WE Charity initially denied having paid Margaret Trudeau for speaking. The situation got even murkier when Prime Minister Trudeau admitted that he had not recused himself from the cabinet discussions that had led to the decision to award the CSSG contract to WE Charity. Murkier still: it came out shortly after that Finance Minister Bill Morneau also has family connections with the charity.

While this is not a good look for the Liberals, it follows the centuries-old tradition of Canada’s old political and industrial families disproportionately benefiting from taxpayers’ and the public’s goodwill. Both Trudeau and Morneau are legacy kids from their own family dynasties, in politics and human resource services, respectively, while Morneau’s wife is from the McCain frozen-foods family. For those of us who are old enough, the Sponsorship Scandal certainly rings some bells, as does British Columbia’s BingoGate. Then there are the near-oligopolies that several Canadian family empires own across several industries. Many of us Canadians like to throw stones at our neighbour to the south about its own messy conflicts of interest involving politics and family, when we should be focusing more on our own glass house. Perhaps our clean-cut, polite, don’t-rock-the-boat Canadian tendencies have allowed us to turn a blind eye to our politicians’ and elites’ ethically ambiguous, financially advantageous power moves. But, in the era of COVID-19 and civil unrest, those days may be over.

As countries keep their economies float on billions of dollars of debt, topics that were once avoided are now being discussed freely and questionable practices regularly challenged. It’s more important than ever to hold our leaders accountable. The fate of our country moving forward depends on it.

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The Politics of Hydroxychloroquine – The Wall Street Journal



Joe Biden and Donald Trump.


jim bourg/Reuters; Patrick Semansky/Associated Press

Hubert Humphrey began his career as a pharmacist before going into politics. Today’s politicians sometimes seem to have the opposite aspiration. President Trump “pushes dangerous, disproven drugs,” Joe Biden declares in his “Plan to Beat Covid-19.” “Our country is now stuck with a massive stockpile of hydroxychloroquine, a drug Trump repeatedly hailed.”

Neither man has any expertise in pharmacology, and Mr. Trump did get out over his skis in promoting the malaria treatment, also known as HCQ, for the novel coronavirus. But since every Trump action prompts a reaction, his political and media opponents launched a campaign to discredit the drug. This politicized environment has produced dubious science and erratic policy.

The Food and Drug Administration issued an emergency use authorization on March 28, allowing hospitals to treat Covid-19 patients outside clinical trials using HCQ donated by manufacturers to the national stockpile. But on June 15 the agency rescinded the authorization. “In light of ongoing serious cardiac adverse events and other potential serious side effects,” the FDA announced, “the known and potential benefits of . . . hydroxychloroquine no longer outweigh the known and potential risks for the authorized use.”

But the scientific basis for the revocation now appears faulty. Most studies didn’t adjust results for confounding variables such as disease severity, drug dosage or when patients started treatment. Two new peer-reviewed studies find that HCQ can significantly reduce mortality in hospitalized patients. With hospital beds filling up across the American South and West and a limited supply of

Gilead Sciences

’ antiviral remdesivir, the FDA should reinstate its emergency-use authorization for HCQ.

HCQ has been safely used for decades to treat patients with lupus and rheumatoid arthritis, both inflammatory autoimmune conditions. The drug has also been found to interfere with the novel coronavirus’s replication in vitro, and studies this spring from France, Brazil and China showed the drug might help moderately ill patients.

HCQ also has side effects. It can cause cardiac arrhythmias, a particular risk for severely ill Covid-19 patients because the virus can damage heart tissue. But the FDA emergency authorization warned about this and required doctors to monitor patients closely and report adverse side effects to the agency.

In late May, the Lancet published a large-scale international study that claimed hospitalized Covid-19 patients treated with HCQ were 30% more likely to die. But the medical journal retracted the study on June 4 after more than 120 scientists pointed out significant flaws in the data and methodology. The source of the raw data refused to share it with independent reviewers.

Nonetheless, the anti-Trump media claimed vindication later that day when the New England Journal of Medicine published a randomized trial that concluded HCQ didn’t prevent illness in people who had been exposed to the virus. The study’s raw data showed that people who took HCQ within two days of exposure were 38% less likely to develop symptoms. But a third of subjects in the trial took the drug four days after exposure, which obscured its benefits. Since the average viral incubation period is five days, starting the drug four days after exposure is unlikely to do much good.

On June 5, University of Oxford researchers reported that a midpoint review of their HCQ trial had found no clinical benefit. “This result should change medical practice worldwide,” Oxford epidemiologist Martin Landray declared in a press release. It usually pays to be skeptical of such sweeping claims based on a single study.

The Oxford team didn’t release its raw data, so it’s impossible to know whether the drug may have helped a subset of patients, such as those treated at an earlier stage of the disease or with elevated biomarkers of inflammation. The trial’s protocol also called for dosages two to three times as high as those recommended by the FDA’s emergency use authorization.

In revoking the authorization 10 days later, the FDA cited the New England Journal and Oxford work as well as a British Medical Journal study from China that purportedly found no benefit from the drug. Yet an April draft of the last study concluded that HCQ accelerated “the alleviation of clinical symptoms, possibly through anti-inflammatory properties” and “might prevent disease progression, particularly in patients at higher risk.”

The draft also noted that after adjusting for the confounding effects of other antivirals used to treat patients, “the efficacy of HCQ on the alleviation of symptoms was more evident.” This analysis of HCQ’s benefits was scrubbed from the published version because some editors and reviewers quibbled that it wasn’t called for in the trial protocol.

The first of the new studies showing benefits from HCQ appeared in the Journal of General Internal Medicine on June 30. It found patients treated with the drug at New York’s Mount Sinai Health System hospitals were 47% less likely to die after adjusting for confounding variables such as underlying health conditions and disease severity. Notably, Mount Sinai’s treatment protocol called for lower dosages than in the Oxford trial, and patients on average were treated within one day of hospitalization.

The second, published July 1 in the International Journal of Infectious Diseases, found that patients treated with HCQ at Henry Ford Health System hospitals in Detroit were 50% to 66% less likely to die after adjusting for confounding variables including other treatments. Nearly all patients began treatment within two days of admission, received dosages that hewed closely to FDA guidelines, and were continuously monitored for cardiac arrhythmias.

“Our patient population received aggressive early medical intervention, and were less prone to development of myocarditis, and cardiac inflammation commonly seen in later stages of COVID-19 disease,” the Henry Ford doctors noted.

This shouldn’t be surprising. An FDA safety review published July 1 reported only five adverse side effects from HCQ through the emergency use authorization among tens of millions of doses that were distributed to hospitals. This suggests that the drug isn’t harmful to the vast majority of patients who are treated according to FDA guidelines.

With hundreds of Covid-infected Americans still dying each day, the agency should let physicians decide whether to treat patients with HCQ based on their experience and scientific evidence. Leave politics out of it.

Ms. Finley is a member of the Journal’s editorial board.

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