Rudy Giuliani, a familiar voice in Donald Trump’s ear, promotes experimental coronavirus treatments

WASHINGTON — Rudy Giuliani, who was in the center of the impeachment storm earlier this year as an unpaid private attorney for President Donald Trump, has cast himself in a new role: as personal science adviser to a president eager to find ways to short circuit the coronavirus epidemic.

In one-on-one phone calls with Trump, Giuliani said, he has been touting the use of an anti-malarial drug cocktail that has shown some early promise in treating covid-19, but whose effectiveness has not yet been proved. He said he now spends his days on the phone with doctors, coronavirus patients and hospital executives promoting the treatment, which Trump has also publicly lauded.

"I discussed it with the president after he talked about it," Giuliani said in an interview. "I told him what I had on the drugs."

Giuliani's advice to Trump echoes comments the former New York mayor has made on his popular Twitter feed and a podcast that he records in a makeshift radio studio installed at his New York City apartment, where he has repeatedly pushed the drug combination, as well as a stem cell therapy that involves the extraction of what Giuliani termed "placenta 'killer cells.' "

The former New York mayor is part of a chorus of prominent pro-Trump voices who at first downplayed the severity of the virus and then embraced possible cures — worrying health experts who fear such comments undermine efforts to slow the virus's spread and downplay the risks of the unproven treatments.

Giuliani's controversial comments have helped him regain a bit of the prominence he had during impeachment — last week, he was back in the spotlight when Twitter briefly locked his account for promoting misinformation about covid-19, the disease caused by the novel coronavirus.

"​He's been out of the news and out of the limelight since the end of the impeachment drama," said Andrew Kirtzman, a Giuliani biographer who is writing his second book about the former New York mayor. "What you're seeing is an effort to regain relevance."

The White House did not respond to a request for comment about the president's conversations with Giuliani.

Giuliani's name has not come up during meetings of the administration's coronavirus task force, according to two members of the group, who spoke on the condition of anonymity to describe internal dynamics.

However, Giuliani said he has spoken directly to Trump “three or four times” about the potential coronavirus treatment, describing to him the results of an initial small-scale study in France that suggested the anti-malarial drug hydroxychloroquine may help treat covid-19. Giuliani said he has not spoken to other White House officials about his views.

"There are obviously other people around him who agree with me," Giuliani said.

The drug cocktail has been touted on Fox News and One America News Network, a cable news favorite of the president, and New York Gov. Andrew Cuomo, a Democrat, has said there is a "good basis" to believe the treatment could work and directed that it be distributed to New York hospitals.

At his daily briefings, Trump has praised the drug combo, saying it could be one of "the biggest game changers in the history of medicine."

Last week, the FDA issued emergency authorization for the use of the anti-malarial drug for some covid-19 patients.

FDA spokesman Michael Felberbaum said decision was made by expert career staffers, after extensive discussions with officials at other government agencies and based on the scientific evidence available.

"The known and potential benefits to treat this serious or life-threatening virus outweigh the known and potential risks when used under the conditions described in [the order]," he said.

On Saturday, Trump said the drug had passed the "safety test" and that he had seen results that were positive.

"I hope they use it, because I'll tell you what, what do you have to lose?" the president said, adding: "I may take it. I'll have to ask my doctors about that."

In his newly fashioned role, Giuliani — who was widely praised for steering New York City with a steady hand through the 2001 terrorist attacks — has solicited medical tips from a controversial Long Island family doctor with a following in the conservative media, as well as a former pharmacist who once pleaded guilty to conspiring to extort the actor Steven Seagal.

"Got lots of positive reports on hydroxy and Zithromax," Giuliani tweeted on March 26.

It was one of at least 14 messages Giuliani posted during the past three weeks referring to the combination of the anti-malarial drug and the antibiotic azithromycin.

"The Hydroxy treatment, first introduced by POTUS, appears to be working so far!" he tweeted two days later. Another message blasted the "demented left" that he claimed wished to ban the therapy.

Giuliani said that while he is hoping to turn his podcast into a moneymaking venture, he is not working for any of the companies involved with the treatments he has promoted. He said he last worked for medical companies a decade ago, when he represented Pfizer and Purdue.

"I'm not trying to get a dime out of this," he said.

Some doctors say the anti-malarial treatment has appeared anecdotally to help some covid-19 patients, but it has not yet been proved effective in valid clinical trials.

Anthony Fauci, the White House task force's infectious-disease expert, has repeatedly counseled caution until more research is completed. Fauci warned in an interview on "Fox and Friends" on Friday that there is not yet any "strong" evidence that it is effective in treating covid-19, and he has been aggressive in making that argument internally, officials said.

Giuliani said that he has not discussed the treatment with Fauci, but that Trump agrees with him. "I'm sure he thinks I am an ignoramus," he said of Fauci.

"They've thrown cold water on it because they are academics," he said of scientists such as Fauci. " 'You can't blind test it.' I know you can't blind test it. But we've got thousands of people dying, sweetheart. And by the time you blind test it, we'll have 100,000 people who are dead. Why don't we get in the real world of being a doctor instead of being an academic?"

"We've got to take a little risk … if we want to save lives," he added. "We are looking at a slaughter."

Giuliani said he knew the medicine had side effects, but he said that even if it is "marginally" helpful, it should be used.

Joel Farley, a professor at the University of Minnesota College of Pharmacy, said it concerned him to hear prominent political figures publicly advocate for FDA action on any specific covid-19 treatment.

"It worries me that political pressure could be applied and potentially distract from other possible treatments," Farley said.

The avid promotion of the unproven treatment by nonmedical experts has worried scientists, who are concerned they downplay some known side effects of the medications and could lead to hoarding of drugs used to treat other ailments, such as lupus and rheumatoid arthritis.

"You should be listening to credible scientists, ideally physicians and researchers who approach this issue with a respect for the scientific method. Rudolph W. Giuliani is the opposite of that kind of person," said David Juurlink, an internist and head of the division of clinical pharmacology at the University of Toronto. Juurlink said that some of Giuliani's "statements are dangerous and are not to be believed."

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On March 27, Twitter locked Giuliani's account until he deleted one of his messages that indicated the treatment had been "100 percent effective" in treating covid-19, part of an effort to crack down on misinformation about the virus being spread on the platform, a company spokeswoman said.

Giuliani said he "didn't think" he knew of the action by Twitter. He says he has been consulting widely with medical professionals on the treatment and that at least 20 have told him that they are enthusiastic about its promise.

While some doctors in China and France have said they have used hydroxychloroquine on patients with covid-19 and seen improvements, Juurlink said the studies have been small and contradictory.

And the medicine does in rare cases have serious side effects, including lethal cardiac complications. Its interactions when used in combination with azithromycin, as Giuliani has promoted, are not well-understood, he said.

"The issue is that these are powerful medications that may or may not work for the desired efficacy but nevertheless have a side-effect package," said Michael Ackerman, a genetic cardiologist at the Mayo Clinic who published an article last week in the Mayo Clinic Proceedings warning health-care providers about hydroxycholoroquine's cardiac side effects.

Still, he said, it may not hurt for figures such as Giuliani and Trump to share their enthusiasm over the early reports that the medicine has helped some people.

"Hope is a powerful medicine," he said, cautioning against drawing political battle lines over treatments that could work.

Many of Trump's allies had hoped Giuliani's influence over Trump might end with the impeachment crisis — a drama he helped spark with his efforts to find damaging information about Democratic presidential candidate Joe Biden in Ukraine.

Two Giuliani associates who assisted in the project were arrested and charged with campaign finance violations. Late last year, federal prosecutors in New York sought information that indicated that they were scrutinizing Giuliani's consulting and legal work on behalf of foreign clients. He has not been charged, and Giuliani has denied wrongdoing.

In early February, when Trump was acquitted by the Senate of charges that he had abused his office, Giuliani declared vindication. ("Acquitted for life!" he tweeted just after the vote). He then spent weeks continuing to press his case against Biden in his podcast "Common Sense," which debuted in January.

By March, as the virus spread across the globe, Giuliani changed his focus to the growing crisis — at times calling for unity and comparing the moment to how the U.S. pulled together after the Sept. 11 attacks, and at other times issuing biting attacks against Trump's perceived enemies.

In early March, he posted a sobering interview about the virus with Joe Lhota, a former mayoral aide who now serves as a top executive at New York University's Langone Health center. Lhota explained that researchers increasingly believed that people with no symptoms could be spreading the deadly virus.

"They may not even know they have it?" Giuliani responded, exclaiming, "Oh my goodness!"

But days later, like other Trump supporters who at the time believed the virus was being exaggerated by Democrats to hurt the president's poll numbers, Giuliani appeared to play down the threat.

On March 10, he tweeted statistics from the Centers for Disease Control and Prevention showing how many people die of various ailments in the U.S. each year. "Heart Disease: 635,260; Cancer: 598,038," the list began, followed by four other common causes of death, including the flu. "Likely at the very bottom, Coronavirus: 27," he wrote.

On March 26, he tweeted a quote from prominent Trump supporter Candace Owens: "Approximately 7500 people die every day in the United States. That's approximately 645,000 people so far this year. Coronavirus has killed about 1,000 Americans this year. Just a little perspective."

Giuliani said his tweets were referring to the fact that a small percentage of people who contract coronavirus will die. "I was right," he said. He did not address projections that more than 100,000 people in the United States could die from the virus.

His messages echoed arguments made at the time by Trump, who repeatedly compared the coronavirus to the flu and played down its severity as he resisted efforts to shut down the economy.

Among those with whom Giuliani has consulted about the virus are Vladimir "Zev" Zelenko, a family doctor from Monroe, New York, who has repeatedly been featured in conservative media after reporting that he successfully treated hundreds of suspected covid-19 patients with what he called a cocktail of hydroxychloroquine, azithromycin and zinc sulfate. Experts say his results are anecdotal and need to be validated through controlled scientific studies.

"We text," Zelenko said in an interview when asked about his communication with Giuliani.

Zelenko has also been in touch with White House officials, including Trump's new chief of staff, Mark Meadows, as The Washington Post previously reported.

Giuliani said he met the New York doctor through a rabbi and now speaks with him several times a day to compare notes. Appearing on Giuliani's podcast last week, Zelenko said that no one under 60 should be given the medications, because they would overcome infections from the coronavirus without them.

"Your immune system is strong enough. Statistically, it's been proven. You will recover," Zelenko said.

While younger people are less at risk, Juurlink said it is "just not true" that people under 60 all recover.

On March 27, Giuliani hosted Robert Hariri, a doctor and chief executive of a New Jersey biotech firm Celularity that has been experimenting with using stem cells harvested from placentas to treat various forms of cancer.

Hariri said he believes the treatment could be effective with covid-19. Giuliani pressed to know when Hariri's company would receive approval to begin administering the experimental treatment to covid-19 patients.

"The general reputation of the FDA — and I don't mean to be critical at a time like this — but that it's very slow," Giuliani said. "I've represented pharmaceutical companies in very, very difficult situations, and it was my observation that they just took forever."

Hariri told Giuliani that he expected to hear from the FDA on a request to conduct an early clinical trial within days; five days later, the company announced that the FDA had approved a study using the therapy in up to 86 covid-19 patients.

Felberbaum, the FDA spokesman, said the agency cannot by law comment on pending applications, but he said they are subject to "internal scientific review" to determine whether it is "reasonably safe to move forward with testing the drug in humans."

Through a spokeswoman, Hariri declined to comment.

He told The New York Times last week that he has known Giuliani for years. He described the podcast appearance as "a friendly chat between people who know each other and who share a common interest in this particular response to this disease." He said Giuliani had no financial relationship with him or his company.

Another recent podcast guest, Julius Nasso, who runs a company that supplies medical equipment to the shipping and cruise industries, used his March 25 appearance to pitch U.S. and state authorities on his idea for them to lease empty cruise ships to care for covid-19 patients.

"You can't have any higher than the president's personal attorney," Nasso said in an interview. "He's the one that basically gets it to the right channels."

Nasso said he had been in touch with federal officials about his idea.

He also credited himself with prompting Trump's March 26 suggestion that cruise companies repatriate their holdings from tax havens to receive state aid. "That was all a result of my interview with Rudolph W. Giuliani," Nasso said. He declined to provide additional details.

Giuliani denied connecting Nasso with the White House. But, he said, "I did put him on my podcast, and I know people there listen."

The White House did not respond to a request for comment.

On the broadcast, Giuliani praised Nasso's cruise ship idea.

"Frankly, a lot of these people are not that sick. It'd be kind of a nice environment for them, too," Giuliani said, adding: "Could they use the pool?"

The former mayor described Nasso as a Brooklyn-raised pharmacist and shipping industry figure who was "another one of those great American success stories."

In August 2003, Nasso pleaded guilty to conspiring to extort Seagal, the actor, and was sentenced to a year in prison. In 2008, he received a payment from Seagal in a civil legal settlement to resolve a business dispute.

The year before he was indicted, Nasso launched a film-production company whose board members included Paul Manafort, the political strategist who would go on to chair Trump's presidential campaign. Manafort is now serving a 7 1/2-year federal prison sentence for financial crimes.

In a telephone interview, Nasso said that he had known Giuliani for 35 years but that they had no business relationship. Nasso declined to comment on his criminal conviction.

Before the pandemic, Giuliani would spend long hours with friends at exclusive cigar bars and traveled the world tending to foreign clients.

These days, Giuliani said, he "keeps up with the six-foot thing," but spends time with his usual "six or seven people around him," including Denny Young, his former chief counsel at City Hall, who is now living with him.

The former mayor says he goes on drives every other day to inspect New York. When he records his podcast in his apartment, ambulance sounds often intrude.

“I don’t think the Grand Havana Room is open,” he said of one of his favorite cigar haunts in New York City. “If it was open, nobody would be there. I can dream of it coming back. That’s what I did after 9/11. I dreamed of all the things coming back.”