In a few words, for those who are feeling pressed for time:
Following the publication of a study by The Lancet concluding there are risks associated with the use of hydroxychloroquine or chloroquine in the treatment of covid-19, the World Health Organization (WHO) has suspended the international research it was conducting on the use of chloroquine.
A few days later, more than 180 researchers and scientists signed a letter questioning the validity of the study, mainly from a methodological standpoint. To my mind, this shows two things:
- the influence of the pharmaceutical industry, for whom the use of chloroquine can be seen as an obstacle to huge profits;
- the challenges faced by developing countries aspiring for greater autonomy and the need for an appropriate response.
For those who have suddenly found some free time, let's push on.
1. What exactly is this study about?
The study sought to examine the effect of hydroxychloroquine and chloroquine, used with or without a macrolide antibiotic, in the treatment of Covid-19.
To do this, researchers analyzed data from more than 96,000 patients with confirmed cases of coronavirus, who had been hospitalized between December 2019 and April 2020 in 671 facilities across six continents.
2. What are the results of the study?
The study suggests that the use of chloroquine and hydroxychloroquine, used alone or with antibiotics, does not improve the condition of patients and may in fact aggravate it, by increasing cardiac risks.
3. Who conducted the study?
- Professor Mandeep R. Mehra, Executive Director of the Brigham and Women's Hospital Center for Advanced Heart Disease in Boston, was the study's lead author;
- Professor Frank Ruschitzka, MD, director of the Heart Center, University Hospital, Zürich;
- Dr. Sapan S. Desai, President and CEO of Surgical Outcomes Collaborative (Surgisphere);
- Dr. Amit N. Patel MD, BS, MS, cardiac surgeon, former researcher and professor of cardiothoracic surgery at the University of Utah.
4. How did the World Health Organization respond?
Following publication of the study, the WHO announced its decision on May 25 to temporarily suspend the study of hydroxychloroquine, as part of the Solidarity clinical trial it was directing.
5. How did the scientific community respond?
The first response was a letter signed by more than 180 researchers who cast doubt on the methodological validity of the study. (1) (2)
6. What should we think of the study?
Firstly, it should be noted it is an observational study, which means researchers compared risk factors and their relationship to the evolution of the disease in patients. They did notice a correlation but there was no evidence of a causal relationship. This would require further research.
Secondly, at a time when information is ubiquitous, it seems surprising that a handful of researchers had access to a database of this importance without anyone knowing about it.
Thirdly, the study is based on data concerning over 90,000 patients from 671 hospitals located in six continents. When one learns that a global institution such as the WHO is conducting a study seeking to collect data on 17,000 patients, the disproportion is surprising to say the least!
Fourthly, the study was published on May 22 and the WHO's reaction followed on May 25, just three days later! Given the typically sluggish decision-making process of global organizations, this celerity comes as another surprise. (It would be greatly appreciated if the UN would show the same diligence, for example, in restoring the right of the Palestinian people to their own country, a right that has been denied them for over 70 years!)
Fifthly, it is not known how the sample used in the study was obtained. Is it truly representative? Countries and hospitals are not listed. Gray areas surround certain data sets.
In the end, I cannot help think that big pharma is behind these maneuvers - especially when considering that the use of chloroquine, which is inexpensive and has a 70-year history, is an obstacle to enormous profits. Powerful pharmaceutical lobby groups are known to use increasingly sophisticated means to achieve their ends, even at the cost of lives and human suffering.
7. What is Africa's place in all of this?
Three Americans and one European produced the study. Of the over 180 signatories to the letter expressing doubts about the study, 17 are from institutions located in Africa.
In practice, we know that several African countries had decided to launch clinical trials or authorize the use of chloroquine, including Morocco, Algeria, Tunisia, Nigeria, South Africa, Senegal, Chad, Burkina Faso, Ivory Coast, Cameroon, Gabon, Togo, Madagascar, the DRC and Sierra Leone.
Following publication of the study, while the United Kingdom and France decided to suspend clinical trials, African countries which use chloroquine - such as Morocco, Algeria, Nigeria, Senegal and Chad –announced they would continue its use.
Without a doubt, these events raise crucial questions in these times of Covid-19. Given their precarious health systems, the African countries have placed great hope in chloroquine. The real problem is the capacity of decision-makers when faced with enormous challenges affecting the lives of millions of people. State authorities are aware of the need to address this challenge, but do they have the means to do so?
It seems to me there is a two-stage path forward:
- in the immediate future, products deemed essential must be made available. This is the case with chloroquine, which is one of the best-known medicines in Africa, even though it is largely imported like many essential products. Needless to say, the situation varies from country to country;
- in the medium and long term, in order for African countries to have the capacity to make vital decisions on all kinds of questions, robust industrial economies need to be built, with priority given to scientific research, which is the only way to guarantee true autonomy - which is true independence.
Benyounès
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(1) The Scientist "Disputed Hydroxychloroquine Study Brings Scrutiny to Surgisphere"
https://www.google.com/amp/s/www.the-scientist.com/news-opinion/disputed-hydroxychloroquine-study-brings-scrutiny-to-surgisphere-67595/amp.
(2) The guardian "Covid-19 study on hydroxychloroquine use questioned by 120 researchers and medical professionals"
https://www.theguardian.com/world/2020/may/29/covid-19-surgisphere-hydroxychloroquine-study-lancet-coronavirus-who-questioned-by-researchers-medical-professionals
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