Faced with a Global Pandemic, Now is the Time to Innovate

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Dr. Mariannette Miller-Meeks (photo from Iowa Legislature website)

Guest column submitted by Dr. Mariannette Miller-Meeks

Several years ago, a reporter asked me if I was “a politician who is primarily interested in medicine or a physician primarily interested in politics.”

I immediately replied that I was a physician interested in politics because politics and the government interfered with the ability to care for my patients. Never has that been proven more true than in the past week when two governors “prohibited” doctors from prescribing Chloroquine or hydroxychloroquine to COVID-19 patients. One governor, who had no medical background, threatened to remove doctors’ licenses.

These instances of overreach are precisely why I became interested in politics and ran for office! Understandably, we want to prevent shortages for those patients who are on these medications for a variety of medical conditions that can be serious and even life-threatening. So, it is not unreasonable for a governor to limit the amount of medication dispensed and prevent hoarding as we have seen with other products.

However, the ability of government, particular in a time of crisis when we need sound answers to save lives and slow the spread of COVID-19, to threaten a physician’s license is worse than overreach; it is irresponsible and short-sighted. As a physician, it is precisely my responsibility to utilize all available information, present it to a patient, discuss the risks and benefits and then the doctor and patient (or the patient’s family) can reach an informed decision on the best course of treatment.

Around the time the legislative session paused, I began researching Centers for Disease Control updates on the global coronavirus pandemic. I came across an article on Chloroquine and its effect on SARS, the severe acute respiratory syndrome that began in southeastern China in November 2002 and spread to 26 countries in 2003.

That article led to other research and recent publications from China and France on the beneficial effects of Hydroxchloroquine and Azithromycin in combination for the treatment of COVID-19, the disease that results from infection with this novel coronavirus. They, in turn, led to other articles published over 15 years in Science, Nature and Virology regarding the ability of these anti-malaria medications to inhibit replication of the virus which could be utilized both to reduce contagiousness and severity of disease.

The lack of a controlled, randomized placebo study approved by the Food and Drug Administration (FDA) is an important consideration but, as physicians, we have used medications off label before. I am most familiar with the use of Avastin as an intravitreal injection for wet macular degeneration because I appealed to Congress to require Medicare to cover the very low cost of reimbursement for its use prior to its ultimate FDA approval.

Given everything I have researched, should I contract COVID-19, I would discuss with my physician prescribing the combination of hydroxychloroquine/azithromycin. I come to this conclusion also because of my familiarity with these medications, the low risk of side effects, high safety profile and low cost.

To me, given the research I’ve done and knowledge I have, it would be unethical for me not to discuss this approach with patients or family members as a possible treatment. And for a state governor to threaten a physician’s license for prescribing the combination or informing patients, is far too great an incursion into the practice of medicine.

It was a fellow ophthalmologist in China who tried to warn of this impending crisis and was suppressed and silenced by his own government prior to succumbing to COVID-19. A hallmark of the United States has always been and a willingness to engage, innovate and challenge the status quo. This is one of those times.

State Sen. Mariannette Miller-Meeks, R-Ottumwa, is an ophthalmologist and former president of the Iowa Medical Society. She is also a candidate for the GOP nomination in the 2nd Congressional District.