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The Politics of Hydroxychloroquine – The Wall Street Journal

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Joe Biden and Donald Trump.



Photo:

jim bourg/Reuters; Patrick Semansky/Associated Press

Hubert Humphrey began his career as a pharmacist before going into politics. Today’s politicians sometimes seem to have the opposite aspiration. President Trump “pushes dangerous, disproven drugs,” Joe Biden declares in his “Plan to Beat Covid-19.” “Our country is now stuck with a massive stockpile of hydroxychloroquine, a drug Trump repeatedly hailed.”

Neither man has any expertise in pharmacology, and Mr. Trump did get out over his skis in promoting the malaria treatment, also known as HCQ, for the novel coronavirus. But since every Trump action prompts a reaction, his political and media opponents launched a campaign to discredit the drug. This politicized environment has produced dubious science and erratic policy.

The Food and Drug Administration issued an emergency use authorization on March 28, allowing hospitals to treat Covid-19 patients outside clinical trials using HCQ donated by manufacturers to the national stockpile. But on June 15 the agency rescinded the authorization. “In light of ongoing serious cardiac adverse events and other potential serious side effects,” the FDA announced, “the known and potential benefits of . . . hydroxychloroquine no longer outweigh the known and potential risks for the authorized use.”

But the scientific basis for the revocation now appears faulty. Most studies didn’t adjust results for confounding variables such as disease severity, drug dosage or when patients started treatment. Two new peer-reviewed studies find that HCQ can significantly reduce mortality in hospitalized patients. With hospital beds filling up across the American South and West and a limited supply of

Gilead Sciences

’ antiviral remdesivir, the FDA should reinstate its emergency-use authorization for HCQ.

HCQ has been safely used for decades to treat patients with lupus and rheumatoid arthritis, both inflammatory autoimmune conditions. The drug has also been found to interfere with the novel coronavirus’s replication in vitro, and studies this spring from France, Brazil and China showed the drug might help moderately ill patients.

HCQ also has side effects. It can cause cardiac arrhythmias, a particular risk for severely ill Covid-19 patients because the virus can damage heart tissue. But the FDA emergency authorization warned about this and required doctors to monitor patients closely and report adverse side effects to the agency.

In late May, the Lancet published a large-scale international study that claimed hospitalized Covid-19 patients treated with HCQ were 30% more likely to die. But the medical journal retracted the study on June 4 after more than 120 scientists pointed out significant flaws in the data and methodology. The source of the raw data refused to share it with independent reviewers.

Nonetheless, the anti-Trump media claimed vindication later that day when the New England Journal of Medicine published a randomized trial that concluded HCQ didn’t prevent illness in people who had been exposed to the virus. The study’s raw data showed that people who took HCQ within two days of exposure were 38% less likely to develop symptoms. But a third of subjects in the trial took the drug four days after exposure, which obscured its benefits. Since the average viral incubation period is five days, starting the drug four days after exposure is unlikely to do much good.

On June 5, University of Oxford researchers reported that a midpoint review of their HCQ trial had found no clinical benefit. “This result should change medical practice worldwide,” Oxford epidemiologist Martin Landray declared in a press release. It usually pays to be skeptical of such sweeping claims based on a single study.

The Oxford team didn’t release its raw data, so it’s impossible to know whether the drug may have helped a subset of patients, such as those treated at an earlier stage of the disease or with elevated biomarkers of inflammation. The trial’s protocol also called for dosages two to three times as high as those recommended by the FDA’s emergency use authorization.

In revoking the authorization 10 days later, the FDA cited the New England Journal and Oxford work as well as a British Medical Journal study from China that purportedly found no benefit from the drug. Yet an April draft of the last study concluded that HCQ accelerated “the alleviation of clinical symptoms, possibly through anti-inflammatory properties” and “might prevent disease progression, particularly in patients at higher risk.”

The draft also noted that after adjusting for the confounding effects of other antivirals used to treat patients, “the efficacy of HCQ on the alleviation of symptoms was more evident.” This analysis of HCQ’s benefits was scrubbed from the published version because some editors and reviewers quibbled that it wasn’t called for in the trial protocol.

The first of the new studies showing benefits from HCQ appeared in the Journal of General Internal Medicine on June 30. It found patients treated with the drug at New York’s Mount Sinai Health System hospitals were 47% less likely to die after adjusting for confounding variables such as underlying health conditions and disease severity. Notably, Mount Sinai’s treatment protocol called for lower dosages than in the Oxford trial, and patients on average were treated within one day of hospitalization.

The second, published July 1 in the International Journal of Infectious Diseases, found that patients treated with HCQ at Henry Ford Health System hospitals in Detroit were 50% to 66% less likely to die after adjusting for confounding variables including other treatments. Nearly all patients began treatment within two days of admission, received dosages that hewed closely to FDA guidelines, and were continuously monitored for cardiac arrhythmias.

“Our patient population received aggressive early medical intervention, and were less prone to development of myocarditis, and cardiac inflammation commonly seen in later stages of COVID-19 disease,” the Henry Ford doctors noted.

This shouldn’t be surprising. An FDA safety review published July 1 reported only five adverse side effects from HCQ through the emergency use authorization among tens of millions of doses that were distributed to hospitals. This suggests that the drug isn’t harmful to the vast majority of patients who are treated according to FDA guidelines.

With hundreds of Covid-infected Americans still dying each day, the agency should let physicians decide whether to treat patients with HCQ based on their experience and scientific evidence. Leave politics out of it.

Ms. Finley is a member of the Journal’s editorial board.

Copyright ©2020 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

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Football and politics: when Algeria won the 2019 Africa Cup of Nations – The Conversation Africa

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With African football on hold and the Africa Cup of Nations (Afcon) rescheduled because of the COVID-19 pandemic, there’s plenty of nostalgia to go around. But memories of the Algeria’s biggest football wins can offer more than just nostalgia. The 2019 Afcon win in Egypt also offers insights into how governments co-opt the game.

Algeria’s victory against West Germany in the 1982 FIFA World Cup, still in Algeria’s post-independence, was an iconic moment. As was their first Afcon win in 1990 in Algiers.

A decade later the country entered one of its darkest times since independence. Under Abdelaziz Bouteflika – who would serve as president for 20 years from 1999. Political violence caused the deaths of thousands and deeply affected Algerian society.

The 2019 Afcon trophy would be lifted 29 years after the first. This game, in Egypt, is especially worth recalling because of the political circumstances surrounding it. All the elements of a Greek tragedy were in place that day.




Read more:
Bouteflika steps aside as Algerians push to reclaim and own their history


On the streets

On Friday 22 February 2019, after a campaign on social media following the announcement by the ruling National Liberation Front that an ailing Bouteflika would stand for a fifth term, hundred of thousands of demonstrators took to the street to express their discontent. The prospect of enduring another five years of Bouteflikism was too dire.

Since then, every Tuesday for students, and every Friday after the prayer, Algerians of all ages and regions have returned to the streets. The peaceful protesters want real change, including the end of the army-backed establishment that has ruled since independence in 1962. On March 8, Women’s Day, the number of demonstrators, men and women of different age and class in the hirak (the Arabic word for “movement”), reached an unprecedented level.

The army, led by General Major Gaïd Salah, Minister of Defense, pushed for Bouteflika’s resignation and the postponement of the election. This led to the disintegration of Bouteflika’s high profile entourage, called the essaba (gang), who accumulated colossal fortunes in exchange for financially backing political manoeuvres to maintain Bouteflika’s regime.

Demonstrators in Algiers in October 2019.
Mustafa Hassona/Anadolu Agency/Getty Images

In the stadia

This money was also used to co-opt sport, football in particular. Each election, photos of Bouteflika would adorn football stadia and be displayed at the opening of matches. It was not unusual for club bosses and former players to be seen at political rallies for Bouteflika, who famously claimed during a 2009 speech that Algeria “has the means to organise two football World Cups”.

One example of this interplay between football, business and politics is a long-time backer of Bouteflika, construction magnate Ali Haddad, who purchased the football club USM Alger in 2010 and became its president. Interestingly, the club’s fans continued with their chanting attacks on the symbols of Bouteflika’s privileged class or “les nouveaux riches” who controlled the networks of politics, media and business in Algeria.

Football fans have been active in the hirak from the beginning, and their politicised football chants have been embraced as an expression of popular resentment with political systems and socio-economic conditions.

Following on the heels of Bouteflika’s resignation amid massive protests and the nomination of a caretaker president, the 2019 Africa Cup of Nations came in the right time. It was for the new decision makers, led by General Salah, an opportunity to reconcile with the population and rebrand the new ruling elite as guarantors of stability and the fight against corruption.

For the Algerian national football team, after years of instability and management changes, it was another opportunity to reconcile with supporters at home and among the large Algerian diaspora in Europe and in North America.

On the Afcon field

In 2014, Algeria experienced its first time in a knockout round at the FIFA World Cup. But when Djamel Belmadi was appointed as new coach in August 2018, the team had plunged into a crisis of confidence. Results were absent and critics were present and acerbic. So when Belmadi announced that Algeria would go to Egypt to lift the cup, few took him seriously.

The tournament was being played in Egypt, one of the favourites for the title. For Algeria, Egypt was a rather hostile sporting environment. The two countries had been football foes for decades – and at political loggerheads over the Libyan conflict – and the animosity was tangible. The hostility continued especially after Egypt failed to reach the second qualifying round. Yet opposition to Algeria’s opponents in the final, Senegal, was also great.

With the logistic support of the army, the new Algerian leadership organised the airlifting of Algerian supporters from different regions of the country into Egypt, even offering them free tickets once in Cairo.

In the stadium Algerian fans cheered a team that was “reborn alongside the hirak”.

Back on the streets

And so the celebrations of Algeria’s second Afcon cup happened in a unique context. They extended to the Algerian community around the world, in Europe, Canada and the US, and in France in particular.

Algeria’s supporters in France celebrate after Algeria beat Senegal 1-0 in the final.
Estelle Ruiz/NurPhoto/Getty Images

And, as always, raising the Algerian flag in French cities fuelled the debate on French identity and the question of alliance with Algeria’s former colonisers.

Algeria’s captain Ryad Mahrez, after scoring a winning free kick against Nigeria to qualify for the final, had tweeted “the free kick was for you, we are together” with Algerian and French flag emojis. There were a number of French-Algerian dual nationals on the team.

The tweet was in response to a far-right tweet “to avoid the tide of Algerian flags, to preserve our national holiday … Trust the 11 Nigerian players.”

You could also read how around 2,500 police officers had been mobilised in Paris to “prevent street clashes”. The situation led French-Algerian coach Belmadi to urge Algerian supporters in France to celebrate in an “orderly” way – a reference to the peaceful and orderly hirak protests.

A number of supporters were nonetheless arrested after clashes with police.




Read more:
Why, after one year, protests continue to rock Algeria


Looking back, the 2019 Afcon win underscores how the Algerian regime has long understood how to mobilise the national football team victories for its own agenda. But the regime is also now very aware of the liberty football can bring.

For years young Algerians have understood that stadiums are the ideal venue to freely voice their socio-political and economic discontent. These football chants and slogans reached their zenith when they were eventually repeated by thousands every Friday during hirak marches.

Abdelkader Abderrahmane contributed to this article. He is a geopolitical researcher and international consultant on African peace and security issues.

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Meet The 19th*, a new gender and politics news organization by women and for women – Poynter

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Meet The 19th*, a new gender and politics news organization by women and for women – Poynter


Meet The 19th*, a new gender and politics news organization by women and for women – Poynter









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John Hume: Reaction to the death of a 'political titan' – BBC News

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Former SDLP leader and Nobel Peace Prize laureate John Hume has died at the age of 83.

Politicians and others have been paying tribute to him and his long career, from the civil rights movement to the Good Friday Agreement.

Former Prime Minister Tony Blair

John Hume was a political titan; a visionary who refused to believe the future had to be the same as the past.

His contribution to peace in Northern Ireland was epic and he will rightly be remembered for it. He was insistent it was possible, tireless in pursuit of it and endlessly creative in seeking ways of making it happen.

Beyond that he was a remarkable combination of an open mind to the world and practical politics. In any place, in any party, anywhere, he would have stood tall.

It was good fortune that he was born on the island of Ireland.

First Minister of Northern Ireland Arlene Foster

Sincere condolences to Pat and the wider Hume family. A giant in Irish nationalism, John left his unique mark in the House of Commons, Brussels and Washington.

In our darkest days he recognised that violence was the wrong path and worked steadfastly to promote democratic politics.

Deputy First Minister of Northern Ireland Michelle O’Neill

John was a huge figure in Irish politics for many years and was known the world over for his peacemaking efforts.

He was a leader who worked tirelessly for the community and his beloved Derry.

His work alongside Gerry Adams in the Hume-Adams talks were instrumental in creating the space for developing and progressing the peace process which led to the Good Friday Agreement.

Irish President Michael D Higgins

John’s deep commitment to these values and his practical demonstration of tolerance and social justice, oftentimes in the face of strong opposition and tangible threats to his person and his family, asserted the fundamental principles of democracy.

He and those others who helped usher in a discourse that enabled a new era of civil rights and responsive government that few would have thought possible, have placed generations in their debt, have been a source of hope.

That his efforts were recognised through the awarding of the 1998 Nobel Peace Prize brought great joy not only to his people in Derry, his colleagues in politics, particularly in the SDLP, but to a wider global set of colleagues and fellow advocates for peace abroad who held him in the greatest esteem and admiration.

SDLP leader Colum Eastwood

Derry, and the whole island, is in mourning today following the passing of our friend, leader and greatest peacemaker.

We can never repay all that John did for us but we can live the values that meant so much to him. We shall overcome.

Former Ulster Unionist Party leader and First Minister Lord Trimble

There is absolutely no doubt he was a major figure in the [peace] process.

Right from the outset of the Troubles, John was urging people to stick to their objective peacefully and was constantly critical of those who did not realise the importance of peace.

He was a major contributor to politics in Northern Ireland particularly to the process that gave us an agreement that we are still working our way through.

That is hugely important. He will be remembered for that contribution for years to come.

Taoiseach (Irish PM) Micheál Martin

John Hume was a great hero and a true peacemaker.

Throughout his long life he exhibited not just courage, but also fortitude, creativity and an utter conviction that democracy and human rights must define any modern society.

For over four decades, he was a passionate advocate for a generous, outward-looking and all-encompassing concept of nationalism and republicanism. For him the purpose of politics was to bring people together, not split them apart.

During the darkest days of paramilitary terrorism and sectarian strife, he kept hope alive. And with patience, resilience and unswerving commitment, he triumphed and delivered a victory for peace.

While the 1998 Good Friday Agreement was the product of many people’s work, can anyone really claim that it would have happened without John Hume?

He didn’t just talk about peace, he worked unstintingly for peace, at times in the face of the most virulent criticism and risk to his life. He knew that to be a peacemaker on this island meant being a risk taker.

Ulster Unionist Party leader Steve Aiken

John Hume’s huge contribution to political life in Northern Ireland is unarguable, even by those who would have regarded themselves as political opponents.

On behalf of the Ulster Unionist Party I would like to extend my deepest condolences to his wife Pat, his family and to all his friends and colleagues.

Alliance Party leader Naomi Long

Very sad to hear of John Hume’s passing. A man who took risks for peace, his was a life well lived.

I often saw him in Greencastle with Pat in his latter years – such a devoted couple. My sincerest condolences to her and the family circle and to his SDLP colleagues and friends.

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