The group had all the trappings of medical authority.
Wearing white coats as they stood with serious faces in front of the US Supreme Court earlier this week, they called themselves “America’s Frontline Doctors”.
In the video of their press conference, which was livestreamed on Facebook, the group promoted a familiar but controversial narrative: that the drug hydroxychloroquine could help treat COVID-19.
They made their claims despite large scientific studies showing the drug doesn’t benefit people hospitalised with the disease.
The original clip was removed from Facebook but it lived on, with a retweet from US President Donald Trump and a boost on Instagram from celebrities like Madonna. After that, right-wing and conspiratorial online communities — including those in Australia — made a point of keeping the video available online.
Even a transcript of the press conference, on the website of transcription service Rev, has received more than 800,000 interactions on Facebook, according to data from social media monitoring firm Crowdtangle. It has been posted more than 500 times.
The video controversy is only the latest instalment in the saga of hydroxychloroquine’s transformation, from relatively obscure anti-malarial drug to political football.
It first arrived in the spotlight thanks to widespread press coverage and now, in private Facebook groups and in YouTube comment feeds, hydroxychloroquine is no longer just an unlikely medicine for COVID-19.
To believe in its efficacy is often a way to indicate support for President Trump or an ideological scepticism of the medical establishment, entirely disconnected from the science.
“It’s a tenet of faith,” said Tom Sear, a fellow with UNSW Canberra Cyber at the Australian Defence Force Academy. “All the scientific evidence is doubtful — and there’s Trump with certainty.”
Where did the hype come from?
As coronavirus spread in early 2020, the world scrambled for a silver bullet and the antimalarial drug hydroxychloroquine — or HCQ — emerged as an early candidate.
Also used to treat lupus and rheumatoid arthritis, it had shown some promise when used against two previous coronaviruses, SARS and MERS.
“The hope was it might be somewhat useful,” said Derek Lowe, a long-time drug discovery researcher and author of In the Pipeline, a long-running science blog on the Science Translational Medicine website.
On Facebook, some of the first mentions of the drug as a potential COVID-19 treatment came in mid-February from Chinese media like Xinhua and China Daily but attracted relatively little engagement.
Outside the research community, however, the real attention came after the intervention of a media-savvy French microbiologist named Didier Raoult.
His study, published in the Journal of Antimicrobial Agents in March, tested a combination of hydroxychloroquine and the antibiotic azithromycin on patients with COVID-19 and found that it helped.
But in the eyes of other scientists, the study was decidedly lacklustre. It was small and uncontrolled, which meant there was no group that did not receive the treatment to compare the results against.
But those caveats, and underwhelming results from other trials, ceased to hold much weight in the greater public consciousness after US President Donald Trump weighed in.
On March 19, Trump said the drug could be a “game changer” at a White House news conference with his coronavirus task force. A few days later, he tweeted a link to Dr Raoult’s study. It was retweeted more than 300,000 times.
Since March 1, public posts containing the word “hydroxychloroquine” have received at least 55 million “interactions” on Facebook — a measure that includes reactions, shares or comments.
Other cable news characters emerged as willing soldiers in a burgeoning culture war, such as Dr Vladimir Zelenko, a doctor in upstate New York who claimed to have treated patients with a combination of hydroxychloroquine and other drugs.
And in the months since, President Trump and members of his administration have repeatedly returned to the hydroxychloroquine narrative despite the protests of White House medical advisor Dr Anthony Fauci, who has repeatedly stated that all “valid” scientific data suggests hydroxychloroquine is not effective against COVID-19.
The drug has attracted the attention of populist politicians outside the United States as well.
It’s been heavily promoted by Brazilian President Jair Bolsonaro, and the drug even became a political instrument in Australia, when erstwhile MP Clive Palmer bought Facebook ads in March, as well as full-page newspaper ads, promoting his proposal to buy “1 million doses” of the drug to support the fight against COVID-19.
Hydroxychloroquine was seized upon because it offered an appealing narrative, Mr Lowe suggested: a cheap, immediate cure. And if there were naysayers, those were just evil forces at work.
“There was an element of sticking it to the ‘big evil’ drug companies — ‘we’re going to use this cheap generic medicine that’s been around forever’.”
It is a political drug now
Of course, the attraction of a miracle cure is nothing new. But the media and social media platforms can amplify and convert this desire into an article of faith, often tied to politics and identity.
If it were effective, hydroxychloroquine might offer an immediate and individualistic solution that could appeal to those on the right, Mr Sear said, in opposition to more left-leaning values around social responsibility.
“[Hydroxychloroquine is] characterised as a quick fix, a magic cure for the ‘problem’ of the virus,” he said of how the drug is often characterised online.
Throughout the pandemic, the spruiking of so-called coronavirus “treatments” has been widespread — grifters adapting to the current panic by offering unproven solutions such as colloidal silver.
But hydroxychloroquine is different, according to Elise Thomas, a misinformation researcher at the Australian Strategic Policy Institute.
“The reality is, most of these people have no knowledge of what hydroxychloroquine is,” she said.
“From that angle, it does become more of an article of faith, or more wrapped up into an ideological or political narrative as opposed to being an actual industry that ordinary people can participate in.”
George Buchanan, a researcher at the University of Melbourne, has been observing online discussions about COVID-19 on platforms like YouTube and Twitter.
Like Ms Thomas, Dr Buchanan has seen hydroxychloroquine picked up by right-wing and pro-Trump circles on social media. He said it remains one of the most discussed potential treatments online.
“HCQ has been the dominant narrative up to this point.”
The failure of hydroxychloroquine to emerge as a usable COVID-19 treatment so far can be seen as many things by such groups. It might be “evidence” of the pharmaceutical industry’s backing of alternative drugs, for example, or an excuse by the “deep state” to eventually vaccinate everyone.
Ms Thomas described what she calls “conspiracy collapse”, where social media platforms bring together many different kinds of sometimes contradictory conspiracies.
“You look at it at the end, and you can’t figure out what started where.”
What the HCQ misinformation means for a vaccine
The online obsession with hydroxychloroquine seems unabated — not helped by the media’s difficulty in reporting the uncertainty inherent in medical science and drug trials.
Just in the past seven days, Crowdtangle data shows Facebook posts on pages and in public groups mentioning the drug have received more than 12 million interactions. And posts from right-wing figures such as Dan Bongino and Rush Limbaugh about censorship of the treatment have been shared tens of thousands of times.
Thanks in part to social media networks and other online coverage, misinformation and conspiracy theories have periodically flowed from the US and Europe into Australia — at times an “information colony”, as Mr Sear put it — and hydroxychloroquine is no exception.
Similar statements of belief in the drug and accusations of cover-ups have been shared widely here in recent days thanks to posts from Australian politicians, wellness influencers and anti-vaccination pages.
Whether or not hydroxychloroquine ever becomes a viable coronavirus drug, the evolution of its online narrative has created a template for how to muddy the narrative around potential treatments, and especially around any potential vaccine.
Mr Lowe predicted there is going to be “a lot of craziness” as the vaccine clinical data starts to emerge.
Ultimately, however, what frustrates him most about the hydroxychloroquine hype is the vast gulf between the appealing narrative it offers and the usual way that medical science advances.
Most of the drugs that scientists develop, Mr Lowe said, for everything from cancer to coronaviruses, simply do not work. They fail.
“There aren’t very many miracle drugs.”