Illustration picture shows a pharmacist holding a box of Plaquenil, Monday 06 April 2020. Belgium ... [+] goes into its fourth week of confinement in the ongoing corona virus crisis. There are lots of debate around the use of Chloroquine medecine te treat Covid-19.BELGA PHOTO BENOIT DOPPAGNE (Photo by BENOIT DOPPAGNE/BELGA MAG/AFP via Getty Images)
Hydroxychloroquine, promoted just a few short weeks ago as a cure for COVID-19,is useless.
Actually, it's worse than that. Hydroxychloroquinecauses heart arrythmias, which can be fatal. Data from early trials of hydroxychloroquine show that it is killing people, not saving them.
Why, then, are so many people talking about hydroxychloroquine? The answer is a tale of scientific hubris and incompetence bordering on fraud. It's also a tale of how Yale Medical School and the Trump administration both fell for it.
Part 1: the hubris of a French "science star."
Last week, theNew York Timesrana lengthy profile of Didier Raoult, a French microbiologist who the Times lauded as a "science star." Raoult vaulted into the public eye in March, whenhe published a very small studyclaiming that a combination of hydroxychloroquine, an anti-malarial drug, and the antibiotic azithromycin could cure COVID-19. Claimed Raoult:
"We know how to cure the disease" (Didier Raoult, quoted in theNY Times)
Actually, Raoult's proclamations began earlier, on February 25, when he posteda video on YouTubecalled "Coronavirus, game over." Not surprisingly, the world took notice. (Note that as the evidence for his so-called treatment evaporated, he re-titled the video "Coronavirus, towards a way out of the crisis.")
Raoult's study was deeply flawed, and it has been taken apart by multiple scientists, so I won't repeat all their points here. A good summary of many of the flaws was written by Elisabeth Bik,first on Twitterandthen in a blog article, back in late March. Among other flaws, the study dropped 6 of the 26 patients who were given hydroxychloroquine without explaining why. One of those patients died.
My results always look amazing if I leave out the patients who died, Bik commented.
Raoult is not happy with Dr. Bik. He recently called her a"witch hunter"on Twitter. This apparently is not unusual for Raoult; the NY Times compares his psychology to that of Napoleon. I wonder what he'll call me after this article appears.
In addition to its serious flaws, the paper was published in a journal whose editor-in-chief, Jean-Marc Rolain, was also a co-author on the paper. Even worse is the fact that,as the journal itself notes,the paper was accepted justone dayafter being submitted. Clearly, this paper did not undergo careful peer review, and it reeks of extremely sloppy science.
Since then, several larger, better-run studies have either found no benefit for hydroxychloroquine, or found actual harm. To be specific,a study of 368 patients in US Veterans Administration hospitalsfound that the mortality rate in patients given hydroxychloroquine was 27.8%. Patients who received both hydroxychloroquine and the antibiotic azythromycin had a mortality rate of 22.1%. But patients who did received neither one had a mortality rate of 11.4%.
In other words,giving patients hydroxychloroquine doubled their risk of dying.
One final note about Didier Raoult: he has a truly unbelievable number of scientific publications, over 2,800according to PubMed. From 2012-2019, he averaged 176 papers per year, or about one paper every two days. Speaking as a scientist, it simply isn't possible that he made any real contribution to the vast majority of these papers. TheNY Timesexplained that Raoult puts his name on every paper published by his institute, which employs hundreds of scientists. Again, speaking as a scientist, this is grossly unethical. No scientist should put his/her name on a paper unless they made a genuine scientific contribution to it. At many universities, Raoult's behavior would be grounds for dismissal.
Part 2: Trump and Yale Medical School fall for it.
As theNY Timesreported, and as most of the U.S. knows, Trump began touting the benefits of hydroxychloroquine at a news conference on March 19:
I think its going to be very exciting. I think it could be a game changer and maybe not. And maybe not," Trump said.
Right. Soon after that, the FDA, "under what appears to have been strong pressure from the Trump administration," issued an emergency use authorization for hydroxychloroquine.
Medical experts, including NIAID director Anthony Fauci, quickly injected a note of caution, pointing out that the evidence was very preliminary, and that we needed better studies. Nonetheless, Trump and his political allies ran with the news that a "cure" was available. They were wrong.
Perhaps most disturbing, though, was the behavior of some highly regarded doctors, who also fell for Didier Raoult's hype. One might excuse politicians for being fooledthey don't have the trainingbut the same excuse doesn't work for a medical expert.
And yet on March 26,Yale Medical School boldly tweeted outits "Treatment algorithm for COVID19," promoted with two megaphone icons:
Image taken from my own twitter feed
Attached to the tweet was a graphic of a flowchart, showing that the first steps in their treatment algorithm were hydroxychloroquine and atazanavir. At the time, I replied to their tweet and warned them that there was no good evidence for their recommendations.Their response:
"While there are no FDA approved treatments for COVID19, this protocol is based on available knowledge, personal observations & communications from other institutions. In the absence of firm evidence for best treatments, this is intended as a working document & subject to change."
Well, at least they responded. But in their response, they admit that their protocol is based on anecdotal evidence and little else. This is seriously disappointing, coming as it does from one of the nation's top medical schools. It also displays hubris not that dissimilar from Didier Raoult's.
Now that more evidence has emerged, and we know that hydroxychloroquine doesn't help and probably harms COVID19 patients, has Yale updated its treatment protocol? Well, yes:they tweeted out a new algorithm on May 15. Now it says:
"Consider hydroxychloroquine x 5 days with close cardiac monitoring."
This is truly appalling. The only evidence of efficacy was the small, badly-run study promoted by Didier Raoult, which has now been contradicted by much larger, better run studies. We now know that hydroxychloroquine is harmful. Others on Twitterquickly questioned the new Yale recommendation, but it's still there as of this writing.
So there you have it. Many so-called experts are still pushing the use of an ineffective, dangerous drug that doesn't help, and may harm, people infected with the SARS-CoV-2 coronavirus. A bogus claim promoted by a self-important, egotistical scientist who published a sloppy study in a journal run by one of his co-authors turned into millions of doses of medication wrongfully prescribed.
And for now, Yale Medical School still hasn't admitted any error. I'm waiting.
[Note: I am an alumnus of Yale University, and I have long been one of its biggest fans. I did not attend medical school there, but their unscientific behavior is nonetheless especially disappointing to me as an alum.]
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