Epidemiologist, biostatistician, specialist in AIDS and infectious diseases, Dominique Costagliola received the Inserm grand prize in 2020 for its action during the health crisis. During her career, she has developed expertise that is crucial to understanding HIV. Its work has notably made it possible to improve strategies to combat mother-to-child transmission. At the height of the Covid epidemic, Dominique Costagliola helped coordinate research efforts against the virus. But she stood out above all for her “cash” speech and her scientific rigor in the media and on social networks. A frankness which proved to be very valuable.
L’Express: Why is the defense of rationality and scientific truth an important fight for you?
Dominique Costagliola: Your question is baroque! [Sourire.] We do science because we seek the truth and we want to defend it, obviously. To do this, we must base ourselves on facts, ask ourselves questions, try to build study protocols to validate a hypothesis and, in the end, let the data decide. And, of course, being able to admit that you might have been wrong.
Not all scientists were as engaged as you, in the media or on social networks, during the pandemic. What motivated you?
I rarely intervene on subjects where I am not competent. On the other hand, I have often been involved in committees which decided on the funding of medical research, so it is a subject on which I have legitimacy. It therefore seemed logical to me, during the crisis, to correct those who were saying anything and everything – and there were many of them – and to say things based on facts.
For example, there was this so-called meta-analysis that said masks didn’t work. This work mixed studies which mainly concerned the flu – only two concerned Covid – and did not distinguish between the two effects of masks: do they protect against contamination if I am not infected, and do they prevent the transmission if I am? Suffice to say that they didn’t answer any interesting questions. I wasn’t going to let it be said that the mask was useless because of an irrelevant study!
Wasn’t the price to pay too heavy?
I started to be attacked on social networks when I won the Inserm grand prize in 2020. Some took it as a kind of response from the Institute to Didier Raoult’s attitude and started to defame me. This was accentuated after an article in which I wrote that there was no data showing the effectiveness of ivermectin against Covid. France-Soir then claimed that I had forced a British researcher to change the conclusion of his meta-analysis – financed by the international organization Unitaid – on this molecule! Their “proof” was a photo where I can be seen handing a file to Marisol Touraine, who has been the director of Unitaid since 2019, while this photo was taken in… 2013, when she was Minister of Health.
Shortly after, the National Financial Prosecutor’s Office initiated an investigation against me for influence peddling, based on a complaint based on this article! I had the joy of being raided at 6 a.m. on December 2, 2021. At first, they were going to seize my computer, but ultimately decided to transfer documents containing keywords like Marisol Touraine, Unitaid or Inserm. Knowing that I worked for Inserm for forty years, you can imagine the number of documents involved! Plus, they didn’t know anything about Macintoshes, I had to explain to them how to do it! [Sourire.] The downloads were still in progress around 1:30 p.m., the gendarmes left for lunch, leaving me all their equipment. Fortunately, I recently learned that this case was closed without further action and without even being questioned.
You have also been harassed on social networks…
I received numerous emails and letters, with death threats and promises of a Nuremberg 2.0. Seeing people you don’t know sending messages like that is hard. But if I had to do it again I would do it. Because fighting for your beliefs is always useful.
Do you feel like your fight for rationality and the scientific method has paid off? Are we giving more importance to these questions today?
I am not convinced that we have made much progress, particularly because behavior that should have been punished was not. It is astonishing that an investigation could be launched against me without any basis, while researchers who did not respect the laws relating to studies on human beings suffered no consequences of any type.
What would you have expected?
Let those who were punishable be punished! When people do not respect the law, it is logical that they are incriminated. But nothing happened. I’m talking about scientists, some of whom are still on the job. It’s incomprehensible.
Shouldn’t scientific institutions have reacted more quickly and more strongly?
They have a role to play in the hunt for fake news. Inserm publishes videos to help sort out fact from fiction on certain themes. However, each time a Laurent Mucchielli [NDLR : sociologue, figure du complotisme français] utters an untruth, the CNRS must issue a press release to remind us that its comments do not take into account scientific knowledge and that its statements are solely its own? I’m not sure it’s very useful, because who would it convince?
What to do then?
The regulations already exist: they must be applied. Take the very first article from Didier Raoult’s team on hydroxychloroquine. It was clear that the rules governing clinical trials had not been respected. However, the National Medicines Safety Agency did nothing. For what ? Was there negligence? Pressure to prevent him from acting? I wrote a report on this study at the request of the scientific council on March 19, 2020. My analysis was clear. However, Emmanuel Macron went to Marseille to meet Didier Raoult in April of the same year…
But, beyond what happened around the Mediterranean Infection University Hospital Institute, there were other concerns in the management of Covid, including the scuttling of the mask. I also think of the “return to life before”, which mainly consisted of not learning the lessons of the crisis, such as the importance of aerosol transmission and therefore of controlling air quality. However, these measures would make it possible to reduce respiratory syncytial virus (RSV) and influenza infections – in addition to Covid -, which would do a lot of good for the health of people as well as that of the healthcare system and in particular hospitals. Instead, during the 2022 elections, we sold a narrative that not wearing a mask represented a “great liberation”, as if wearing it was as serious as being confined or having to cover it. -fire ! We’ve been wearing the mask for many, many years.
More recently, you warned about the downward trend, in certain health agencies, in the level of proof required for treatments. Why ?
This is a major current issue. I participated, with biostatisticians who regularly work for the High Authority of Health, in the writing of a scientific article aimed at determining whether there are alternative methods to randomized trials – the ultimate in proof – when it is not possible to achieve it. Take the case of cancers. Today, we no longer really choose treatments based on where the tumor is located, but rather based on the markers it expresses. Certain immunotherapies can be used for many cancers. As a result, it is very complicated for researchers to conduct randomized trials, in particular because of the lack of potential candidates.
Could we then include patients who suffer from different cancers that do not have the same progression at all? These are complex questions, but very important for patient safety. We must find methodologically relevant solutions and not simply ask for early access based on almost nothing by promoting treatments that do not improve people’s health.
An article from the special health section published in L’Express on March 28.