The Lancet casts doubt over hydroxychloroquine study

In a statement, the medical journal acknowledged “important” questions over the research. (File/AFP)
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Updated 03 June 2020

The Lancet casts doubt over hydroxychloroquine study

  • Its publication last month triggered the WHO to announce it was pausing clinical trials of the drugs
  • France was among the countries to also halt COVID-19 treatment with hydroxychloroquine

PARIS: The Lancet has issued an “expression of concern” over a large-scale study of hydroxychloroquine and chloroquine it published that led to the World Health Organization suspending clinical trials of the anti-viral drugs as a potential treatment for COVID-19.
In a statement, the medical journal acknowledged “important” questions over the research, after dozens of scientists issued an open letter last week raising concerns about its methodology and transparency around the data, which was provided by the firm Surgisphere.
“Although an independent audit of the provenance and validity of the data has been commissioned by the authors not affiliated with Surgisphere and is ongoing, with results expected very shortly, we are issuing an Expression of Concern to alert readers to the fact that serious scientific questions have been brought to our attention,” The Lancet said Tuesday.
While an expression of concern is not as severe as a journal withdrawing a published study, it signifies that the research is potentially problematic.
The observational study looked at records for 96,000 patients and concluded that treatment with hydroxychloroquine, which is normally used to treat arthritis, and chloroquine, an anti-malarial, showed no benefit and even increased the likelihood of patients dying in hospital.
Its publication last month triggered the WHO to announce it was pausing clinical trials of the drugs.
France was among the countries to also halt COVID-19 treatment with hydroxychloroquine.
It has whipped up fresh controversy over hydroxychloroquine, which has been endorsed by public figures including US President Donald Trump despite concerns over its side effects and a lack of evidence that it is effective.
The study’s authors, led by Mandeep Mehra of the Brigham and Women’s Hospital in the US, looked at data from hundreds of hospitals between December and April and compared those who received treatment with a control group.
It followed numerous smaller studies that suggested hydroxychloroquine is ineffective in treating COVID-19 and might even be more dangerous than doing nothing.
But in an open letter last week, a group of scientists raised “both methodological and data integrity concerns” about it.
These included a lack of information about the countries and hospitals that contributed to the data provided by Chicago-based health care data analytics firm Surgisphere.
While The Lancet corrected a discrepancy in data from Australia, the authors said they stood by their findings and announced an independent review.
But concerns over the underlying data continued, and this week the New England Journal of Medicine also issued an expression of concern over another study using the Surgisphere database that looked at cardiovascular drugs and COVID-19.
Among the most outspoken critics of The Lancet study has been Marseille-based professor Didier Raoult, whose own work has been at the forefront of promoting hydroxychloroquine and has also been subject to criticisms over methodology.
But other critics, like Francois Balloux of University College London, raised concerns over the way the study was conducted, even though they are skeptical the drugs themselves would work as a treatment for COVID-19.
Peter Horby, professor of emerging infectious diseases and global health at Oxford University said the controversy should spark “serious reflection” over the quality of the peer review process.
“Scientific publication must above all be rigorous and honest. In an emergency, these values are needed more than ever,” he said.
He added, however, that decisions to halt trials on the basis of an observational study were “completely unjustified.”
A spokesman for the WHO last week said a comprehensive review of the drugs was expected to reach a conclusion in mid-June.


John Hume, who worked to end N. Ireland violence, dies at 83

Updated 03 August 2020

John Hume, who worked to end N. Ireland violence, dies at 83

  • Although he advocated for a united Ireland, Hume believed change could not come to Northern Ireland without the consent of its Protestant majority
  • John Hume: I want to see Ireland as an example to men and women everywhere of what can be achieved by living for ideals, rather than fighting for them

LONDON: John Hume, the visionary politician who won a Nobel Peace Prize for fashioning the agreement that ended violence in his native Northern Ireland, has died at 83, his family said Monday.
The Catholic leader of the moderate Social Democratic and Labour Party, Hume was seen as the principal architect of Northern Ireland’s 1998 peace agreement. He shared the prize later that year with the Protestant leader of the Ulster Unionist Party, David Trimble, for their efforts to end the sectarian violence that plagued the region for three decades and left more than 3,500 people dead.
“I want to see Ireland as an example to men and women everywhere of what can be achieved by living for ideals, rather than fighting for them, and by viewing each and every person as worthy of respect and honor,” he said in 1998. “I want to see an Ireland of partnership, where we wage war on want and poverty, where we reach out to the marginalized and dispossessed, where we build together a future that can be as great as our dreams allow.”
Hume died Monday morning after suffering from ill health for several years, his family said.
Born on Jan. 18, 1937, in Northern Ireland’s second city — Londonderry to British Unionists, Derry to Irish nationalists — Hume trained for the priesthood before becoming a fixture on Northern Ireland’s political landscape. An advocate of nonviolence, he fought for equal rights in what was then a Protestant-ruled state, but he condemned the Irish Republican Army because of his certainty that no injustice was worth a human life.
Although he advocated for a united Ireland, Hume believed change could not come to Northern Ireland without the consent of its Protestant majority. He also realized that better relations needed to be forged between Northern Ireland and the Republic of Ireland and between London and Dublin.
He championed the notion of extending self-government to Northern Ireland with power divided among the groups forming it.
“Ireland is not a romantic dream; it is not a flag; it is 4.5 million people divided into two powerful traditions,″ he said. “The solution will be found not on the basis of victory for either, but on the basis of agreement and a partnership between both. The real division of Ireland is not a line drawn on the map, but in the minds and hearts of its people.”
While both Hume and Trimble credited the people of Northern Ireland and the Irish Republic for approving a referendum that led to power sharing, it was Hume’s diplomacy that offered the impetus to the peace process that led to the 1998 Good Friday accord.
Hume won the breakthrough in Belfast’s political landscape in 1993 by courting Gerry Adams, the head of Sinn Fein, the political wing of the Irish Republican Army, in hopes of securing an IRA cease-fire. That dialogue burnished Adams’ international credibility and led to two IRA cease-fires in 1994 and 1997.
Like most Protestant politicians at the time, Trimble had opposed efforts to share power with Catholics as something that would jeopardize Northern Ireland’s union with Britain. He at first refused to speak directly with Adams, insisting that IRA commanders needed to prove they were willing to abandon violence.
He ultimately relented and became pivotal in peacemaking efforts.
Hume had envisioned a broad agenda for the discussions, arguing they must be driven by close cooperation between the British and Irish governments. The process was overseen by neutral figures like US mediator George Mitchell, with the decisions overwhelmingly ratified by public referendums in both parts of Ireland.
“Without John Hume, there would not have been a peace process,” Mitchell said at the time the prize was announced. ”Without David Trimble, there would not have been a peace agreement.”
Hume and Trimble were said to have had a frosty relationship. But Trimble on Monday described a thawing after the Nobel ceremony in Oslo, recalling that the hotel at which they were staying had suggested the two men chose to relax away from each other.
“We didn’t do that. We relaxed and in some sense celebrated the occasion jointly, and that for me spelt out the principle for how we were going to proceed in the years after that,” he told the BBC.
Tributes poured in after’s Hume’s death was announced, including praise from Adams, who called him a “giant in Irish politics.” Former Prime Minister Tony Blair, who was in office at the time the accord was signed, lauded Hume’s “epic” contribution to the peace process.
Former US President Bill Clinton and former Secretary of State Hillary Clinton issued a statement describing their sadness.
“Through his faith in principled compromise, and his ability to see his adversaries as human beings, John helped forge the peace that has held to this day,” they said.
UK Prime Minister Boris Johnson said the Northern Ireland of today is Hume’s legacy.
“He stood proudly in the tradition that was totally opposed to violence and committed to pursuing his objectives by exclusively peaceful and democratic means,” Johnson said on Twitter. “His vision paved the way for the stability, positivity and dynamism of the Northern Ireland of today and his passing is a powerful reminder of how far Northern Ireland has come.”
Hume’s family said his funeral would be in keeping with strict guidelines on attendees because of the COVID-19 pandemic. A memorial will be arranged later.
“We are grateful for your condolences and support, and we appreciate that you will respect the family’s right to privacy at this time of great loss,” the family said in a statement. “It seems particularly apt for these strange and fearful days to remember the phrase that gave hope to John and so many of us through dark times: ‘We shall overcome.’”