Google searches for hydroxychloroquine surged following endorsement

When presidents and other leaders or experts speak, people listen. Worse, they sometimes act as in the case of a man in Arizona who drank fish tank cleaner that contained chloroquine after President Donald Trump called the combination of hydroxychloroquine and azithromycin “one of the biggest game changers in the history of medicine” for the treatment of Covid-19.

But certainly, Trump did not tell anyone to go out and get fish tank cleaner to self-medicate, did he?

Of course not.

Pandemics breed fear, especially when no proven treatments exist. Thus, it’s not surprising that scared people look to their leaders or scientists for hope and direction.

“[W]hen several high-profile figures, including entrepreneur Elon Musk and President Donald Trump, endorsed the use of chloroquine, a malarial prophylaxis drug, and hydroxychloroquine (with the antibiotic azithromycin), a lupus and rheumatoid arthritis treatment, to treat COVID-19, it drew massive public attention that could shape individual decision-making,” John W. Ayers, PhD, MA, Division of Infectious diseases and Global Health, Department of Medicine, University of California, San Diego, and colleagues wrote in a research letter appearing in JAMA Internal Medicine.

And, where do people turn for help with their healthcare decision-making? Google.

Ayers and colleagues found a spike in Google searches for purchasing chloroquine and hydroxychloroquine correlating with when Elon Musk tweeted about the drugs on March 16 and when Trump endorsed the drugs during a televised briefing on March 19. There were 216,000 total searches to buy these drugs over two weeks. Moreover, even after the news of the Arizona man’s death from ingesting the chloroquine-containing tank cleaner, the searches for purchasing chloroquine or hydroxychloroquine were 212% higher than expected levels (95% CI, 66%-1,098%) and 1,167% (95% CI, 628%-1,741%) higher, respectively.

“The potential harms [of using these drugs] are substantial,” Colette DeJong, MD, and Robert M. Wachter, MD — both from the Department of Medicine, University of California, San Francisco — wrote in an accompanying editorial. “Hydroxychloroquine is QT prolonging, which poses a risk of sudden cardiac death in certain populations. People with autoimmune conditions, disproportionately women and people of color, could face disease flares owing to medication shortages. The burden may fall hardest on the most vulnerable; low-income patients worldwide could be the first to lose access to hydroxychloroquine therapy.”

Ayers and colleagues noted that when Musk and Trump touted the use of the two drugs, their efficacy was not known — or at best inconclusive — for treating Covid-19.

In their study, Ayers and colleagues examined daily Google searches from Feb. 1 to March 29, 2020, using the keywords “buy”, “order”, “Amazon”, “eBay”, or “Walmart” in combination with chloroquine or hydroxychloroquine, “using the date Musk endorsed the drugs on March 16 as the cut point for when knowledge of using chloroquine and hydroxychloroquine became widespread to compare observed search volumes with expected search volumes.”

They looked at two post-periods of interest: “(1) all days after March 16 (the entire period, including when President Trump first endorsed these drugs on March 19) and (2) all days after March 22 (when news reports on chloroquine-related poisonings were published).”

They looked at the query fraction (QF) of google searches per million for those looking to buy chloroquine on Feb. 1, March 16, March 22, and March 29 and found they were “4.78 (equivalent to 542 estimated searches), 26.90 (3,052 estimated searches), 66.16 (7,506 estimated searches), and 19.19 (2,177 estimated searches), respectively.”

They did the same for QFs for buying hydroxychloroquine and found “7.68 (871 estimated searches), 79.37 (9,006 estimated searches), and 31.95 (3,625 estimated searches), respectively.”

The searches spiked after high profile claims about the drugs and especially after Musk’s tweet and Trump’s televised endorsement of the drugs.

“In times of public health crises, therapies not supported by adequate evidence — such as would lead to U.S. Food and Drug Administration approval — should not be touted by public figures,” Ayers and colleagues wrote. “Endorsements can lead to unsupervised use of the products with dangerous consequences to the people who take them and hoarding of these medications can result in shortages for those who require them for legitimate health reasons. These negative consequences are magnified in this circumstance because chloroquine-containing products are commercially available to the public through such sites as Amazon.”

The study authors noted that Google included a Covid-19 educational section on its website but suggested that could be expanded to include searches for unapproved therapies. In addition, retailers “must establish warnings or withhold products that might be linked to use for Covid-19 treatment, as was exemplified by eBay’s removing chloroquine sales from its site,” they wrote.

DeJong and Wachter agreed and said that, while the urge to “do something is enormous and understandable,” it cannot lead “clinicians to jettison the tenets of evidence-based medicine and the admonition to do no harm.”

  1. After Elon Musk and President Donald Trump touted chloroquine and hydroxychloroquine, Google searches spiked as people were looking for places to buy the products.

  2. Even after news broke of an Arizona man dying from ingesting fish tank cleaner containing chloroquine, Google searches for buying the drugs continued to spike.

Candace Hoffmann, Managing Editor, BreakingMED™

Ayers reports receiving grants from the Burroughs Wellcome Fund and the University of California Office of the President, as well as nonfinancial support from the Division of Infectious Diseases and Global Health of the University of California, San Diego; he also owns equity in Directing Medicine, Health Watcher, and Good Analytics, which are companies that advise on the use of digital data for public health surveillance.

Cat ID: 190

Topic ID: 79,190,254,287,290,791,932,570,190,926,192,927,151,928,925,934