Health Care/Joan Retsinas

The Clorox Candidate: A Eulogy for His Right-to-Try Act

All those PhDs plugging away in laboratories. All those tests that take forever. Common sense should reign. Let people try whatever they want to try. Freedom to drug yourself whenever, with whatever you wish. You can take your inspiration from the web, from friends, from infomercials on late-night television. Thus spake Donald Trump, a.k.a. the Clorox President, who advised Clorox as a prophylactic for COVID. (Most Americans had enough common sense to reject Clorox, but his enthusiasm for other elixirs boosted their sales, though not anybody’s health.)

So now we have the eulogy for the Clorox President’s much ballyhooed 2018 “Right to Try” legislation. He pushed it, to the cheers of desperate patients and politicians swooning to woo those patients. His supporters pushed it through Congress, to the backdrop of dreary scientist-nay-sayers. Thanks to the energetic Goldwater Institute, six states — Arizona, Louisiana, Maryland, Mississippi, Nevada, and North Carolina — passed their own Right-to-Try clones. Pitting the FDA against the common sense of patients, the head of the Goldwater Institute says of Mississippi’s law: it “signals to the rest of the country that states don’t have to wait on the FDA to put patients first.”

The naysayers argued for science. Those time-consuming trials aim to discern not only whether a drug is harmful, but whether it helps. The tests look for the diagnoses that would render the drug either more harmful, or less helpful. “It works” is not a simple Eureka moment. The age and the gender of patients, their co-morbidities, their other medications all matter. So do the incidence, and the severity, of side effects. Even after the FDA approves a drug, the FDA collects the reports of side-effects. Sometimes the FDA reconsiders its judgment, retracts its approval. Time is a factor: a drug that works for six months might not work the same after a patient takes it for five years.

The terminally ill patient who reaches for a non-FDA approved treatment risks not just injury, but foregoes the possibility of a more effective treatment. A desperate patient faces a choice: a treatment with a statistically low chance of success, or a touted “new option.” Plenty of entrepreneurs will offer that “new option,” one that bypassed the FDA screens. Of course, in reaching for the possible sure-thing, the patient bypasses the drug that just might help.

Finally, the politicians’ rhetoric about an intransigent FDA is false: the FDA has long allowed for exceptional instances where terminally ill patients who had tried the standard regimen could try experimental treatments. Thousands of patients have received the dispensation of “exceptional circumstances.” And, in those instances, the FDA collects data on efficacy and side effects.

In short, the Right to Try Legislation was not just potentially harmful, but unnecessary.

But as the Clorox Candidate steps into the ring once again, he is touting his “Right to Try” law. In his standard hyperbole at the Republican National Convention, he praised the law as a “big deal” that “is saving thousands and thousands of lives.” He added that nobody else had passed “such a big deal.” He promised to expand it to other non-FDA options.

Like other Trumpian boasts (the best economy, the best peacetime, the best …), this boast is false. ( Right to Try Annual Reporting Summary 06/06/2024.) In 2023, the Act supported access to four products; from 2018 through 2022, 12 products. The data, moreover, show only that people underwent experimental treatments, not their efficacy. (The Right-to-Try law does not mandate that kind of reporting.)

The government can help patients. It can bump money into basic research. It can expand the number of clinical trials. It can bolster the efforts of the FDA to put more regimens into the clinical pipeline. Of course, those strategies cost money. Instead, the Clorox Candidate promises hyperbolic nonsense, along with the mega tax cut that would negate any possibility of truly helping patients.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.

From The Progressive Populist, September 15, 2024

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