法國總統是否正在對未經證實的冠狀病毒治療進行大肆宣傳？
關於使用氯喹和羥氯喹這兩種抗瘧藥來治療COVID-19的高度政治化辯論在法國達到了極端，在法國進行了兩項小型試驗，旨在證明其潛在的益處。儘管很少有證據表明，羥氯喹有效，但法國醫生承受著絕望患者開處方的巨大壓力，已有460,000人簽署了請願書，以使其更廣泛可用。微生物學家迪迪埃·拉烏爾特（Didier Raoult）領導著這一倡導活動，是一位有爭議且在政治上關係密切的人物。
今天，隨著法國總統伊曼紐爾·馬克龍（Emmanuel Macron）前往馬賽會見領導這兩項試驗的醫院主任和研究員拉烏爾特（Raoult），他的形象進一步提高。馬克龍在會後沒有發表評論，但馬克龍發起的會面是拉烏特新政治影響力的明顯標誌。法國醫生聯合會主席讓·保羅·哈蒙（Jean-Paul Hamon）稱其為“演藝圈政治”，是批評會議的眾多科學家和醫生之一。
法國民意測驗研究所IFOP在4月6日發布的一項調查顯示，法國人口中有59％的人認為氯喹對新的冠狀病毒有效。在最右邊和最左邊對毒品的信心更高，在“黃色背心”運動的同情者中達到了80％，該運動在2018年和2019年對馬克龍的經濟政策進行了大規模抗議。支持率也很高，達到74％，在馬賽地區。
巴黎圣安托萬醫院傳染病負責人卡琳·拉科姆（Karine Lacombe）在法國電視台上表示，她和她的團隊因拒絕開氯喹而屢屢受到“身體威脅”。她說她還看到過許多偽造該藥的處方。其他醫生也報告了類似的經歷。壓力是由防護設備，診斷測試和醫務人員短缺引起的壓力之上的。
人們對羥氯喹的普遍看法與數據的薄弱形成了鮮明對比。幾項有關其抗COVID-19功效的研究得出了模棱兩可或陰性的結論，並且它可能具有重大的副作用，包括心律不齊。 Raoult的積極研究因其局限性和方法論問題而受到廣泛批評。第一個只包括42名患者，Raoult選擇了接受藥物或安慰劑的人，這在臨床研究中是不行的。國際抗微生物化學療法協會與該論文在國際抗微生物劑國際期刊上發表的論文相距甚遠。第二項研究以預印本的形式發布，沒有經過同行評審，根本沒有對照組。
拉烏爾（Raoult）消除了批評，並抱怨“方法學家的專政”，他們堅持在臨床試驗中採用隨機分組和對照組。在他的醫院中，每位被診斷出COVID-19的患者都會接受羥氯喹與抗生素阿奇黴素的聯合治療。 Raoult聲稱這導致了非常低的死亡率，他說他將很快在出版物中記錄。
他的倡導使他成為一名醫學先知，他的工作在新聞媒體和社交媒體上不斷地被討論。他的政治關係擴大了他的影響力。前保守黨工業部長兼拉烏爾特人的親朋好友尼斯市長克里斯蒂安·埃斯特羅西（Christian Estrosi）在從COVID-19中康復後，最近在電視上露面，並告訴觀眾他“說服”了羥氯喹和阿奇黴素的結合治癒了他。
Raoult在醫學界也找到了一些高級支持。支持羥氯喹的在線請願書由心髒病專家，前衛生部長Philippe Douste-Blazy（法國於2017年領導世界衛生組織的候選人）和著名的RaymondPoincaré大學醫院傳染病負責人Christian Perronne發起，巴黎附近。來自醫療界的其他十位知名人士，包括兩名醫學科學院的成員，共同簽署了請願書，該書要求對醫院環境中的輕度病例授權使用羥氯喹。 （Raoult忽略了當前法規，僅允許該藥物僅用於COVID-19的嚴重病例。）
在保守的《費加羅報》上，三位著名的退休腫瘤學家認為，“所有被測試為COVID-19陽性且未包括在臨床試驗中的患者”都應接受羥氯喹-阿奇黴素組合。
Perronne告訴ScienceInsider，法國衛生部一直“僵硬”，並“分解”了羥氯喹。他說，有相當大的證據（儘管“不完善且常常未公開”）證明該藥有益處，並且他認為該藥的副作用很少且易於避免。 Perronne說，他拒絕讓患者參加羥氯喹的隨機試驗，因為安慰劑組對致命疾病是“不道德的”。相反，他最近決定將除最輕度病例外的所有患者服用該藥。
但是法國的許多科學家對此感到憤怒，認為這種潛在有害的藥物可以被廣泛使用，而對其功效的證據卻很少。這種強烈的熱情也使得以嚴格的方式測試藥物變得更加困難。
巴黎圣路易斯醫院傳染病前負責人讓·弗朗索瓦·伯格曼說，發現號是在至少七個歐洲國家發起的一項隨機試驗，旨在研究羥氯喹和其他幾種治療方法的有效性，目前正努力在法國招募參與者。 。 （Macron也與Discovery的領導人會晤。）“在五家醫院中，五分之四的患者拒絕參加，拒絕接受除羥氯喹以外的任何治療。” Bergmann說，並補充說法國正在目睹一種形式的“醫療民粹主義” 是“減慢真理的出現”。
The highly politicized debate about the use of chloroquine and hydroxychloroquine, two antimalarial drugs, to treat COVID-19 has reached an extreme in France, where two small trials purporting to show potential benefit were done. French physicians have come under enormous pressure from desperate patients to prescribe hydroxychloroquine, despite scant evidence that it works, and 460,000 people have already signed a petition to make it more widely available. Leading the advocacy is a controversial and politically well-connected figure, microbiologist Didier Raoult.
Today his profile rose even higher, as French President Emmanuel Macron traveled to Marseille to meet Raoult, a hospital director and researcher who led the two trials. Macron did not comment after the meeting, but the rendezvous, initiated by Macron, was a clear sign of Raoult’s newfound political clout. Jean-Paul Hamon, president of the Federation of Doctors of France, one of many scientists and doctors critical of the meeting, called it “showbiz politics.”
A survey released by French polling institute IFOP on 6 April revealed that 59% of the French population believes chloroquine is effective against the new coronavirus. Confidence in the drugs is higher on the far right and far left, and reached 80% among sympathizers of the “yellow vest” movement that staged massive protests against Macron’s economic policy in 2018 and 2019. Support is also very high, at 74%, in the Marseille region.
Karine Lacombe, head of infectious diseases at the Saint Antoine Hospital in Paris, has said on French TV that she and her team have received repeated “physical threats” for refusing to prescribe chloroquine; she said she has also seen many falsified prescriptions for the drug. Other doctors have reported similar experiences. The pressure comes on top of the stress caused by shortages of protective equipment, diagnostic tests, and medical staff.
The popular faith in hydroxychloroquine stands in stark contrast to the weakness of the data. Several studies of its efficacy against COVID-19 have delivered an equivocal or negative verdict, and it can have significant side effects, including heart arrhythmias. Raoult’s positive studies have been widely criticized for their limitations and methodological issues. The first included only 42 patients, and Raoult chose who received the drug or a placebo, a no-no in clinical research; the International Society of Antimicrobial Chemotherapy has distanced itself from the paper, published in the society’s International Journal of Antimicrobial Agents. The second study, published as a preprint without peer review, didn’t have a control group at all.
Raoult has dismissed the criticism and complained about the “dictatorship of the methodologists” who insist on randomization and control groups in clinical trials. In his hospital, every patient diagnosed with COVID-19 receives hydroxychloroquine combined with azithromycin, an antibiotic. Raoult claims this has resulted in a very low death rate, which he says he will document soon in a publication.
His advocacy has made him a kind of medical prophet whose work is discussed incessantly in news outlets and on social media. His political connections have amplified his influence. Former conservative industry minister and Nice Mayor Christian Estrosi, a personal friend of Raoult’s, recently appeared on TV after recovering from COVID-19 and told viewers he was “convinced” the combination of hydroxychloroquine and azithromycin cured him.
Raoult has also found some high-level support in the medical world. The online petition in support of hydroxychloroquine was started by cardiologist and former Minister of Health Philippe Douste-Blazy—France’s candidate to lead the World Health Organization in 2017—and Christian Perronne, head of infectious diseases at the renowned Raymond Poincaré University Hospital in Garches, near Paris. Ten other prominent figures from the medical community, including two members of the Academy of Medicine, co-signed the petition, which demands hydroxychloroquine be authorized for mild cases in hospital settings. (Current regulations, which Raoult ignores, allow the drug to be used only for severe cases of COVID-19.)
In the conservative newspaper Le Figaro, three prominent retired oncologists argued that “all patients tested positive for COVID-19 and not included in a clinical trial” should receive the hydroxychloroquine-azithromycin combo.
The French Ministry of Health has been “incredibly rigid” and has “diabolized” hydroxychloroquine, Perronne tells ScienceInsider. He says there is considerable—though “imperfect and often unpublished”—evidence that the drug has benefits, and he believes its side effects are rare and easy to avoid. Perronne says he has refused to enroll patients in a randomized trial of hydroxychloroquine because a placebo group would be “unethical” for a fatal disease. Instead, he recently decided to give the drug to all patients except the mildest cases.
But many scientists in France are outraged that a potentially harmful drug can be widely used with so little evidence for its efficacy. The fervor also makes it harder to test the drug in a rigorous fashion.
Discovery, a randomized trial launched in at least seven European countries to study the efficacy of hydroxychloroquine and several other treatments, is struggling to recruit participants in France, says Jean-François Bergmann, a former head of infectious disease at the Saint Louis Hospital in Paris. (Macron has met with Discovery’s leaders as well.) “In some hospitals, four out of five patients are declining to take part and refuse any treatment but hydroxychloroquine,” Bergmann says, adding that France is witnessing a form of “medical populism” that is “slowing the emergence of the truth.”
原文出處 Science