Ending for hydroxychloroquine? It took international studies, a lot of procrastination and an inaudible media hubbub for the Ministry of Health, by a decree published Wednesday May 27 in the Official Journal, to finally ban hydroxychloroquine as a treatment against Covid-19.
→ READ. Hydroxychloroquine: its use should be reviewed in France
The reality, however, is more complex. The public health code, in its article 8, indicates that “The doctor is free from his prescriptions which will be those which he considers the most appropriate in the circumstances. “
The marketing authorization remains
Thus, as long as the prescribed molecules benefit from a marketing authorization (MA) for a precise indication, a doctor can prescribe them, including outside this indication, “As long as there is no expressed reservation, of the type reserved for the hospital”, “reserved for geriatricians” “ specifies Bernard Bégaud, professor of pharmacology at the University of Bordeaux.
Reserved in hospital when it was authorized against Covid-19, hydroxychloroquine normally benefits from an unqualified marketing authorization, in particular for the treatment of rheumatic diseases, and is marketed under the name of Plaquénil. “It would therefore be inconceivable to withdraw it from the market, since tens of thousands of patients are taking it for treatment, for example against arthritis, Bernard Bégaud analysis. As long as it is available, I can prescribe it to my neighbor with Covid-19. If, and only if, I believe it is justified “.
Doctors’ responsibility
It is up to doctors to understand the situation and above all, to take responsibility, at the risk of being prosecuted criminally in the event of complications. “Today, the code of ethics does allow a doctor to prescribe a drug without indication from the Marketing Authorization, he must however inform the patient of the risks, include it in his file, and rely on data solid. So we come back to the main question: is Professor Raoult’s data sufficiently solid? “, wonders Jean-François Bergmann, professor of therapeutics at Paris Diderot University.
“I believe so, and this decree does not change my position an iota!” “ exclaims the liberal doctor Thierry Lardenois. “I work in Moselle, on the border with Luxembourg. In my department, there are 700 dead, in Luxembourg, 100. Why? Because there we treat with hydroxychloroquine. “ Him, “Out of pragmatism”, would like to prescribe it, despite the prohibition of the Ministry of Health, but regrets that it is deprived of it, “By recovering all stocks, including pharmacists. “
Accountability of the State
If it is not binding, what is the use of this decision of the Ministry of Health? Unanimously, the professionals consider that it acts in a way of “Take away the responsibility of the state” : “The patient can now attack only his doctor”, analyzes Jean-François Bergmann. “Everyone is in the perspective of a commission of inquiry, even a trial, and the ministry prefers to protect themselves from it”, advances Bernard Bégaud.
It must be said that initially, and despite the uncertainties, it was the ministry, already, which had chosen, by decree again, to temporarily authorize the use of hydroxycloroquine on severely ill Covid-19 patients, and to the hospital exclusively. “It was already a desire to respond to public opinion, and especially to the pro-hydroxychloroquine wave, on which the President himself surfed, on his way to Marseille, with Professor Raoult”, recalls Jean-François Bergmann.
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