MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

These are exceptional times and they need exceptional measures. Therefore, I am yet again deviating from my policy of focussing exclusively on SCAM and welcome my French colleague Dr Lehmann posting a series of articles on the hydroxychloroquine story.

Guest post by Christian Lehmann

 

THE ELEPHANT IN THE ROOM

This pandemic diary was begun just before lock down, already four weeks ago, and yet I have scarcely touched on the elephant in the room. Our personal elephant is called Didier Raoult. White-haired with age, venerable in appearance, he has been number one in the press, constantly in capitals in online news headlines, waking hopes, feeding passions. And arousing the interest of a plethora of epidemiologists of renown, from Valerie Boyer to Donald Trump, by way of Alain Soral and Alexandre Benalla.

Everything begins on 25 February 2020, when the microbiology professor from Marseille posts his famous video “Coronavirus, game over”, since more modestly re-baptised “Coronavirus, towards a way out of the crisis?”.

Standing in front of a student audience out of camera, Didier Raoult reveals “a last-minute scoop, a very important piece of news”: the Chinese, whom he regularly advises, rather than seeking a vaccine or new products have been “repositioning”, trying old molecules, “known, old, without toxicity,” among them chloroquine, which has shown itself to be effective in a daily dose of 500 mg per day “with a spectacular improvement and it is recommended for all clinically positive cases of coronavirus. This is excellent news, it is probably the easiest respiratory infection of all to treat” Here, the whole roomful laughs, with pleasure, with relief, and I remember sharing these sentiments, briefly, but completely. Because this was 26th of February, because like others I felt confusedly that the reassurances with which Agnes Buzyn ( then the French Health Minister) was inundating us were built on sand, and that the virus would only laugh at little notices in airports.

I knew Didier Raoult only by name, as a columnist in Point, I had read some of his articles and I had felt simultaneously soothed by his smooth eloquence, attracted by some of his iconoclastic stances, but also sometimes rather irritated by his Mandarin-style fake cool posturing. At the end of February, I immediately reposted the video in the medical forums, on the walls of worried friends, explaining that, if the suggestions of Didier Raoult were confirmed, we would have escaped with a scare which would soon be dispelled by this “magic bullet”, this “game changer”.

Then between two consultations in my GP’s office, later that afternoon, I watched that video “Game Over” again. How could such an important piece of news have reached me by means of a Youtube video? Where were the overseas publications, the much vaunted Chinese study, the releases from AgenceFrancePresse, Reuters, the first articles from the New York Times and the Guardian, proclaiming from the rooftops that the pandemic we had so much feared was in fact only a technical hitch, easily controllable by a widely available drug. It was at that second viewing that I balked. As a GP who had worked in cardiac resuscitation some years ago, I was brought up short by hearing Didier Raoult talking up a medicine “well known, and devoid of any toxicity”. If chloroquine or Nivaquine, to give it its commercial name, is celebrated for the prevention of malaria, it is also a medicine known for its frightening toxicity as soon as the dose is exceeded, with the risk of irreversible visual damage and extremely serious problems with cardiac rhythm which can prove fatal. To say that chloroquine is without toxicity problems is in fact an error, all the more so because the dose suggested by “the Chinese”, without an iota of proof at this stage, is five times larger than the customary dose, 500 mg instead of 100 mg.

Deeply uneasy, I’m in discussion with doctor friends on Twitter when the video makes its appearance there. We know nothing at this point about Didier Raoult’s past, or about his Marseille Institute. Neither the enmity felt towards him by the Parisian intelligentsia represented by Agnes Buzyn and her husband, nor the fact that his institute has just lost its INSERM and CNRS accreditations, nor the stance adopted by him a month earlier explaining that coronavirus would never escape from China and that it was ridiculous to get worked up about it because “the world has gone mad, something or other happens and three Chinese die and that brings about a world-scale alert”.

Some of us, practitioners and first responders, knew well the toxicity of chloroquine, that it was to be handled with care, and that was about all we said on Twitter. It was already too much. The next day in a 20 minute interview Didier Raoult brushed away his detractors. “Malicious gossip, I don’t give a damn about it. When a medication has been shown to work on 100 people while all the world is busy having a nervous breakdown, and there’s some idiots who say there’s no certainty that it works, I’m not interested! It would honestly be medical misconduct not to use chloroquine to treat Chinese coronavirus”. And he drives the point home. “People who have lived in Africa like me took chloroquine every day. Everybody who went to hot countries took it throughout their time there, and for two months after they came home. Billions of people have taken this medication. And it costs nothing: ten centimes per pill. It is a medication which is extremely reliable and it’s the cheapest imaginable. So this is super amazing news. Everybody who learns about these benefits should fall upon it.” This is no longer a mistake, this is grave medical misconduct. Nobody who knows about therapeutics would use such words so lightly.

Cardiologists, resuscitation specialists, emergency doctors, GPs, public-health specialists, we are all alarmed. Our first warnings are vehement and rational, reaffirming the toxicity of chloroquine in cardiology, and the majority of us insisting on the senseless and significant risk which Didier Raoult is running. Because it is familiar, prescribed for long stays in Africa in packages of 100 tablets, chloroquine is lying around in many medicine cabinets. To declare as a fact that we should “fall upon it” in this agonising pandemic context is to encourage unrestrained self medication, and to endanger life. Incoherent, dangerous, this announcement disturbs us deeply. Incredulous, not for a moment do we imagine just what Didier Raoult will unleash, nor that the nightmare had already begun.

 

9 Responses to Didier Raoult and the hydroxychloroquine controversy ( part 1 )

  • I was attacked by some guy, a techie i think, on lLnkedIn when i pointed out some obvious flaws in the study and told him to go away and read Bad Science or your blog before spouting rubbish about so called miracle cures. He called me an idiot and left it at that.

    I’m a humble techie but I read your blog assiduously, have read two of your books and of course read Bad Science and shared it with several friends.

    I don’t say it enough but a) thanks so much for this invaluable and fascinating blog b) keep up the good work!

  • Christian:
    are you sure about the dose?
    in our trial – many years ago – we gave patients peri-operatively 600 mg to 1400 mg hydroxychloroquine sulphate in 48-hours
    https://pubmed.ncbi.nlm.nih.gov/6504946/?from_single_result=ernst+e%2C+hydroxychloroquine&expanded_search_query=ernst+e%2C+hydroxychloroquine

  • This is part of the controversy, as I will show in part II. Raoult started with chloroquine and NOT HCQ and would switch two days later without ever acknowledging he had changed horses. Dosage for everyday use of chloroquine is 100 mgs.

  • I feel that Dr Lehmann is being very diplomatic when he describes Didier Raoult as “White-haired with age, venerable in appearance”. In his videos, I was reminded more of an ageing hippy musician in a white lab coat.

    I had not realize that his institute had lost its INSERM and CNRS accreditations. Given the “quality” of that first paper, Hydroxychloroquine plus Azithromycin as a Treatment for Covid-19: Results of a Non-Randomized Open-Label Clinical Trial one can understand their actions if it reflects earlier “research”

  • What´s the deal with these long-haired, white-bearded COVID19-deniers with a superior sense of mission?!

    Our German representative of this strange, Gandalf-inspired guild is Dr. W. Wodarg, a guy who is completely blind to all scientific evidence that does not go along with his preconceived notion that SARS-CoV-2 is just another harmless common flu virus.

  • Be so kind as to provide a case (or cases) in which hidroxichloroquine to treat patients on d1-d2 (or maybee later) of symptoms have led to heart issues. By now it is being used in many countries, as it has been used before for other purposes. If you are not able to, please be so kind as to not bring forward unprecise commentaries.
    Be so kind also as to provide concrete suggestions as how to move forward on the treatment of the disease. Keep away from commenting vaccines please for these will take at least a few months to become available.
    Let us be practicle.

    • If you want to know about cardiac toxicity you have only to read the data sheet, which lists prolonged QT interval, torsades des pointes ventricular fibrillation and cardiomyopathy among the cardiac effects (oh yes, and death).

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