the antiviral that paralyzes global medical research

The media madness around chloroquine, this anti-malaria drug touted by French experts since the beginning of March, has not finished causing damage around the world. In addition to all that we already knew, we now see that this cacophony is amputating global clinical research.

Chloroquine and COVID19: what to think about it? Chloroquine has aroused enthusiasm among the population after the careless communications of a Marseillaise research team. However, care must be taken. The entire scientific community criticizes and calls for restraint in the interpretation of the results of this study.

Who hasn't heard of the chloroquine ? Who does not have an opinion on its supposed effectiveness? If this is not already the case, our article Chloroquine and Covid-19: what to think about it? can help you see more clearly. The problem with what can now be fearlessly called "the chloroquine affair" is the media hype that has taken place about it. This cacophony worthy of a bad reality TV has considerably cut medical research in France. We already knew that. What we didn't know was that this story had impacted medical research around the world. An article published in the prestigious review Nature helps us to see more clearly.

When a media and political craze cut medical research

An announcement from China, a "boastful" virologist from Marseille on the results of his lax study, a freewheeling American president. It didn't take more to shoot a bullet, or even a burst of bullets, in both feet of medical research. " There is a huge favoritism ”, explains Valdés-Ferrer, researcher in medical sciences, at the National Institute of Medical Sciences and Nutrition, in Mexico, who studies the effects of a drug against dementia on the Covid-19. " Studies of all other potential drugs, for all ages and degrees of gravity, are in big trouble. "

Everywhere, clinical tests are having problems. Already in France, the fiery controversy, doctors had found it difficult to include patients in the protocol of the Discovery study. Results were expected to be available in early April. They should be published very soon. One month, during a pandemic, it's long. Very long. As if that weren't enough, the difficulties are now global : in Mexico, Iran, Spain, the United States and France, of course.

"When you have desperate people and, let's say, desperate doctors, you want to believe that you have something that workssays Daniel Kaul, an infectious disease specialist at the University of Michigan medical school. But at the end of the day, it does not help anyone if it is not effective, and if it prevents people from participating in other studies. "

A majority of patients want to participate in trials that include the possibility of receiving chloroquine. Sometimes they don't even want to participate. They want hydroxychloroquine, period. Including them in essays then becomes a real ordeal. Some have even taken it prevention or are under "treatment". At this point, it becomes impossible to include them anywhere. In fact, taking another drug constitutes an unsurpassable bias in interpreting the data from another clinical trial. " Patients have already started taking two or even three medications ”, give up Alireza Ghaffarieh, pathologist at the University of Medical Sciences in Kermanshah, Iran. He gave up his intention to exclude chloroquine treatment from his chelating drug trial iron in people with Covid-19.

Media noise over statistical noise

Also, this uproar does not seem proportional to the effectiveness of the molecule. In fact, little by little, we see that chloroquine looks more and more like the skin of the bear that we were sold before we killed it against Covid-19. We must, of course, remain cautious. " Small tests can oscillate on both sides – from "yes, that hasair Great" at "no, it's harmful" – and that's what we see ", recalls says Richard Whitlock, surgeon and critical care physician at the Institute for Population Health (PHRI) in Hamilton, Canada. This is called measurement noise. Some observational studies pre-published and pharmacokinetic analyzes urge even more caution and expectation of randomized controlled trials.

In addition, ongoing clinical trials were not stopped early. Now, there is procedures to stop them when you see dramatic benefits or colossal risks. We can already, it seems, mourn its presupposed benefits. The craze has taken on such a proportion that drug agencies different countries are also starting to get involved. They call for the use of this drug only in clinical trials within the framework of Covid-19. Note that this is what the World Health Organization recommends (WHO) from the beginning. " Doctors try just because they want to give something to their patients, deplores Lauren Sauer, a researcher in emergency medicine at Johns Hopkins University, in Baltimore, in the state of Maryland (United States). The anecdotes now serve as proof, it seems. " Let's not forget that the group placebo is not always the least "lucky" group.

If all that wasn’t enough to be really careful, other data concerning seventeen people suffering from lupus, an autoimmune disease requiring treatment with hydroxychloroquine, are even more restrained. When infected with the SARS-CoV-2, they would have more side effects than normal. Of course, their health, dosage or long-term treatment duration are all confounding factors that may play a role. The small sample obviously does not allow us to know if the effect is real. Nevertheless, that must call, you guessed it, because we harp on it from the beginning, with the greatest caution.

Finally, the collective hysteria surrounding chloroquine seems above all to have delayed clinical research in its potential discovery effective treatments. " Researchers could have resolved some of these issues weeks ago if there had been a rapid international effort to develop real, rigorous chloroquine clinical trials, explains Ole Søgaard, a doctor specializing in infectious diseases at the Aarhus University Hospital in Denmark. Today, more than 100 clinical trials aim to Review chloroquine or hydroxychloroquine against Covid-19. "

However, in the scenario where chloroquine would have a therapeutic interest, even a modest one, within the framework of Covid-19, time will also have been lost to find an alternative molecule to heart patients. Indeed, this molecule is contraindicated in this type of patient because of the side effects it can cause. In this same scenario, one should not be the victim of a result bias.

Learn the right lessons

What lessons can be learned from this cacophony around chloroquine? Several things are important:

The argument of authority is not an argument. Even if experts in the field say something, it is important to watch how the scientific community, which knows how to analyze the results presented, reacts to the announcements of the experts concerned. We also saw this recently with the "fanciful fantasies" of Luc Montagnier on the origin of SARS-CoV-2.

We have to take a step back and always ask ourselves how ignorant we are on a subject. It's supposed to be the normal attitude of the scientist. Given what has been observed during these media events, it is better to apply this rule also to yourself.

Let us not be blinded by our hopes and beware of our communication. Hope can make anything believe while poor communication that arouses or is the result of that hope can lead to dangerous behavior.

To detail all these points and more, ABSMARTHEALTH organizes a LIVE on his Facebook page this friday 1er may : " Science in the era of the sensational: how not to be manipulated? " We will try to address the issue of expertise, the functioning of science and initiation to critical thinking. We hope to see you there in large numbers.

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