COVID-19 Guest post

The Chloroquine Elephant in the Room, by Christian Lehmann

"How I would have loved it if a brilliant genius, in the style of Jeff Goldblum, had discovered, on a corner of a grubby lab bench, THE miracle treatment for SARS-cov-2! But we're not in a Hollywood style blockbuster."

The following guest post by the French clinician Christian Lehmann is about chloroquine or hydroxychloroquine therapies against coronavirus, and of course about Didier Raoult, director of the now world famous (or infamous) IHU Méditerranée Infection research hospital in Marseille, France. I previously published two articles in this regard, here and here.

Lehmann has been a general practitioner for 36 years. In 2018, he belonged to a team of doctors who achieved the termination of public health funding for homeopathy in France. When Raoult began his bizarre chloroquine campaign to cure COVID-19, Lehmann and his colleagues went to social networks and national newspapers like Liberation to voice their concerns. They were immediately attacked by Raoult’s disciples, his IHU, and the chloroquine guru himself.

But now, before Lehmann’s guest post I would like to quote another newspaper article by the way of introduction.

Journalists followed up on how IHU and Raoult’s own research unit there, URMITE, were investigated in 2017 by the international panel of the High Council for the Evaluation of Research and Higher Education (HCERES), which ended with the withdrawal of both national research networks CNRS and INSERM as the institute’s sponsors. No reason to worry: pharma industry, big and small, continues their generous cash injections for IHU, secret money flows which purpose and directions are none of anyone’s business.

The ESSF article by Pascale Pascariello narrates, referencing an earlier Mediapart story by same author:

the evaluators regret that priority is given to “volume publications rather than their quality ”. If Professor Raoult’s unit was the source of more than 2,000 publications between 2011 and 2016, “only 4% of them were in journals of high international impact”, they specify.

Furthermore, the “lack of expertise in key areas”, in particular “in epidemiology”, leads to poorly conducted clinical trials and approximate biostatistical studies. […]

They also consider that the creation of the journal New Microbes and New Infections, “which is used to publish articles refused by other journals, is somewhat hopeless”. They note that this journal is judge and jury, since several researchers from the laboratory are part of the editorial committee headed by Professor Michel Drancourt, himself head of the Mephi research unit and Didier Raoult’s right-hand man.

This Michel Drancourt is of course one of Raoult’s co-authors on a chloroquine/COVID-19 Gautret et al 2020 paper about an apparently illegal clinical with 80 patients (including children), accepted the next day it was submitted at a journal where Philippe Gautret is associate editor.

The HCERES report found widespread bulling and even sexual harassment happening at IHU under Raoult’s watch. And also research fraud:

Out of seven written testimonies received, two reveal and regret the deliberately biased results of their studies. One engineer thus reports “a falsification of experimental results at the request of a researcher” and another “questions scientific rigour of how certain results are obtained“.”

Journalists then spoke to a former PhD student of Raoult’s:

The problem, according to him, is that “he [Raoult, -LS] does not allow any discussion”: “We work in reverse. He has an idea and we are manipulating to prove that he is right. With fear of contradicting him, this can lead to biased results.

That PhD student was eventually forced to produce an artefactual result which Raoult decided to publish anyway. After all proper journals rejected it as scientificality worthless, the paper appeared in, where else, one of Raoult-controlled journals: Microbial Pathogenesis. Another scientist, who refused to put his name on fabricated papers and left URMITE, recalled:

Raoult often said: “When I say something, it is true.””

A former INSERM unit director and whistleblower is quoted:

What struck me,[…] is Didier Raoult’s obsession with his publications. A few minutes before the evaluation of his unit began, it was the first thing he showed me on his computer, his H factor.”

When evaluating Raoult’s IHU on behalf of CNRS and INSERM, the whistleblower noticed:

His laboratory hosts many foreign students. On the one hand, we could see the pressures exerted against them, being more precarious than the rest of the researchers, she explains. Some had also alerted us to studies whose results were arranged.

Now guess who until September 2019 used to be the Head of IHU’s scientific council in charge of evaluating Raoult and his kingdom? Laurence Zitvogel, who, as the article mentions, has a heavy financial conflict of interests. What the journalists missed is that this cancer researcher from Villejuif is life partner of Guido Kroemer, together they published a long list of papers with falsified research figures (read here and here). What a perfect supervision for Raoult, whose papers also suffer from data fakery.

Now to the bombshell in that article. Raoult namely declares in all of his publications and in all official documents to have no financial conflicts of interest whatsoever, he personally allegedly does not receive a cent from pharma industry. Well:

Professor Raoult, who prides himself on being independent, forgets to specify that his foundation received, according to data from the Ministry of Health, 909,077 euros from pharmaceutical laboratories since 2012. In addition to 50,000 euros paid by Sanofi in 2015, Institut Mérieux, founding member of the foundation and member of its board of directors, contributed more than 700,000 euros to the laboratory.

Turned out, the IHU Foundation is exempt from transparency and is not accountable to anyone. Read more details in this article.

Raoult coucou

The Chloroquine Elephant in the Room

By Christian Lehmann

Everything begins on 25 February 2020, when Didier Raoult, white-haired with age, venerable in appearance, microbiology professor from Marseille, posts his famous video “Coronavirus, game over”, since more modestly rebaptised “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. 

Later that afternoon,  I watched that “Game Over” video again. 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 as “well known, and devoid of any toxicity”. If chloroquine or Nivaquine, to give it its commercial name, is celebrated for the prevention of paludism (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. 

Some of us, practitioners  and first responders, knew well the toxicity of chloroquine, that it was to be handled with care. 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 alarmed. Our first warnings are vehement and rational, reaffirming the toxicity of chloroquine in cardiology, 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. 

Full statement by French Academy of Medicine here.

A census of untruths about chloroquine  

It’s  the end of February. We see the first death, in the Oise department, near Paris, of a French citizen who has not recently travelled abroad. For doctors concerned about what is happening in China, this is the red alert, the coronavirus has made it onto French soil. Nobody knows at that point how it will spread. Almost nobody, apart from those responsible for it, yet knows that France has completely run down its stocks of masks. Doctors themselves do know that the health service has only held out for as long as it has on the backs of its care personnel. 

The announcement by Didier Raoult about the spectacular effectiveness of a synthetic antimalarial, chloroquine, has brought enormous relief, followed immediately for many of us health professionals by growing doubts about an accumulation of errors: Raoult denies any toxicity, urges people to “fall upon” a medication requiring sensitive handling. When we locate the Gao et al 2020 article from China on which Didier Raoult is basing his crisis communication, we are stupefied. No need for specialised knowledge in statistical methodology to understand that there is something far wrong. No numerical data. Nobody knows what dosage has been given, to what type of patient, nor how many have been treated. The article has not been “peer reviewed”, it has the effect of a simple announcement. So of course at this chaotic time we tell ourselves that given a revelation of such importance, the Chinese wanted to act as quickly as possible, to inform the whole world. And Didier Raoult, who routinely advises, as he explains with delicious modesty, the Chinese, « the world’s best virologists », has probably been entitled to the first fruits of this revelation.

On Youtube, on 28 February, he posts a weird interview, “Why would the Chinese be mistaken?”, in which he repeatedly takes up his interviewer with obvious irritation. “No, that’s not the question that you should be asking me. You should be asking me….” An informal group of doctors and others pass around the link on Twitter. We are rubbing our eyes in disbelief. What Didier Raoult is passing off as an interview is nothing more than a lecture arranged by one of his media aides. We advise him, sarcastically, to make a professional cut of the video before broadcasting it. An hour later the video disappears and returns in a more professional form which could create the illusion of a genuine interview. And rapidly, in the press which is beginning to turn its microphones towards  the Professor from Marseille, he modifies his stance.

Chloroquine, spectacular and miraculous only yesterday, disappears as if by magic, replaced from one day to the next by hydroxychloroquine (HCQ, Plaquenil), a different medicine, less common. Though its chemical structure is close to that of the antimalarial medication, hydroxychloroquine is used primarily in rheumatic conditions such as rheumatoid polyarthritis, or immune conditions such as lupus. So at least it isn’t lying around in large quantities in medicine cabinets. And its cardiac toxicity, very real, is slightly lower than that of chloroquine. Didier Raoult puts forward HCQ as an immense discovery, continuing in his usual manner to ridicule his detractors. 

The doctors who criticise me are neither in my field nor up to my weight”. 

He fumes at the inaction of embittered petty health officials, only fit to  follow the diktats of the authorities, who, bogged down in their catastrophic crisis management, dare not intervene. And his posturing as a refractory Gaul, a loudmouth taking on the system, gains sympathy, from those to whom he gives hope, from those who believe that the State does not tell them everything, and from those looking for a hero to fit their stereotypes: a man on his own against the establishment, a White Knight taking on Big Pharma, a Hippocratic colossus besieged by hordes of soulless ants.

Among those who hold out their microphones to him, not one asks him the question which we are all asking, GPS, cardiologists, pharmaceutical specialists, emergency specialists, resuscitation specialists – by what sleight of hand has Didier Raoult exchanged his miracle medicine, in 48 hours, in broad daylight? And how is it that no one has noticed the sleight-of-hand? 

For Didier Raoult, a minimum of intellectual integrity would demand that he admits having changed horses in midstream. That the concerns of his despised detractors was well-founded, about chloroquine to which many have access without knowing its dangers (Nivaquine is very often used in suicides). Instead, every supporter of the Wise Man of Marseille piles in with a testimony. Their brother, sister, uncle, the father-in-law of their hairdresser has been taking the Professor’s medicine (Which one, chloroquine or hydroxychloroquine?) for eight years in Africa and has never had a problem, which proves that the Professor’s detractors are just jealous, or, even worse, backed by “the lobbies”.

We however, untiringly repeat the fundamental facts:

  • Yes chloroquine has existed for years
  • Yes it is widely used
  • But for a different treatment, the prevention of malaria
  • And in dosages  5 to 10 times lower
  • And in large dosages it causes cardiac arrest
  • And it has never been effective in fighting a virus
  • Not this virus nor any other
  • And the same is true for hydroxychloroquine
  • In fact it’s rather the opposite

This is NOT a Hollywood disaster movie

How I would have loved it if a brilliant genius, in the style of Jeff Goldblum, had discovered, on a corner of a grubby lab bench, THE miracle treatment for SARS-cov-2! How I would have applauded if, working fast, very fast, too fast for the eyes of mere mortals, this magnificent hero had blazed brilliantly ahead and saved millions of lives, so proving the accuracy of his hypothesis before an awestruck world. But we’re not in a Hollywood style blockbuster.

When Didier Raoult launched his first study on chloroquine he was basing it on three things: a verifiable fact, an assertion, and an intuition.

The verifiable fact is that in a test-tube (in vitro), and not in tests in humans or other animals (in vivo), chloroquine is active against SARS-cov-2 , the virus of Covid-19. The fact that this in vitro action was observed for a number of other viruses, without ever having given good results in humans, even increasing mortality in the case of chikungunya virus, would suggest the need for some degree of caution.

A reservation swept aside by Raoult’s following assertion: a Chinese study has just emerged which demonstrates that chloroquine brings about spectacular improvement and is recommended for all clinically positive infections involving the Chinese corona virus. Unfortunately, nearly two months after this scoop the world still awaits the slightest corroboration in a properly controlled clinical trial.

Finally, intuition is what Didier Raoult is still defending today, stubbornly, in ever weirder videos. The idea that a researcher outside the select Parisian elite, who has been knocking around for a long time, a practical man, can see at once straight to the heart of the matter, while a horde of science bureaucrats bogged down in their standard procedures would take months to get going.

So Didier Raoult launches more studies, raising great hopes by his attitude of complete certainty, his media facility. Hopes so great that nobody, in the media or at the heart of politics, thinks of questioning him. But these studies are crazily rigged and pile up errors and approximations.

In the first study, out of 42 patients, among those treated by the Didier Raoult procedure, one dies, and three are hospitalised because of deterioration in their condition. And by a wave of a magic wand (which in France and elsewhere should be called a fraud)… all four were excluded from the results when they  should have been considered as failures of hydroxychloroquine. Somewhere along the way Didier Raoult will add Azithromycine to Hydroxychloroquine, and will conclude that the combination is more efficacious than HCQ alone, though the difference, on six patients only, is not significant.

The criterion established to judge the success of the trial was to be a check for the virus in the nasal passages around 14 days. The study will be halted on the sixth day, and the reduction in the intranasal viral load will be treated as a proof of efficacy/effectiveness (without any knowledge of whether this disappearance might simply indicate the migration of the virus to the pulmonary level). Children of 10 years old will be included in one of the extensions of the study, without their consent.

A second study will be launched as a follow-up, while the first will be published under doubtful conditions and immediately disowned by the International Society of Antibacterial Chemotherapy. This second study in which Didier Raoult and his team choose which patients to treat (thus intervening in their therapy of an illness which already offers 95% of spontaneous recoveries), is declared as a simple observational study (without intervention by doctors on the development of events), instead of an interventional study. This serves to avoid obtaining the obligatory agreement from the Agence Nationale de Securite du Medicament.

As this all takes place, nobody dares to object, as if paralysed by the obvious shambles of the government’s management of the epidemic. Bypassing any requirement to seek the agreement of the ethical committee, the Marseille Institute grants itself a blessing and at the end of March treats 80 patients with Hydroxychloroquine, because “that is what we are told to do by the Hippocratic oath which we have taken”. So Didier Raoult, on a hunch, will prescribe potentially cardiotoxic and untested medicines to asymptomatic patients, in violation of the fundamental rules of ethics concerning the prescription of medicines.

There would be, there will be much to be said on the inaction of agencies, of institutions, of politicians, faced with the forward flight of a man who trails behind him tens of thousands of frightened people, thousands of conspiracy theorists and hundreds of hate-filled trolls who have turned themselves into virologists after a couple of hours spent on YouTube gobbling down the videos of their Guru.

But what most interests me is Didier Raoult’s rationale, that certainty that the Hippocratic oath (which at no point mentions the right to enter into freestyle experimentation on human beings), his medical degree, and personal intuition, constitute a sort of trump card. Let us remember: Didier Raoult is a microbiologist, a specialist in viruses and bacteria. He has no experience of therapeutic research, and the gross errors which he commits in the development of his studies and in the analysis of his results and his publication procedures are not linked, as he would like us to believe, to the emergence of a new paradigm, but to the rancid reemergence of something which we hoped had disappeared, the overweening power of  untouchable and tyrannical “mandarins” , medical overlords incapable of allowing any criticism.

Worldwide, the results of the first correctly executed clinical studies carried out on Hydroxychloroquine, are globally negative. The only line of defence which appears to be left to Didier Raoult is the excuse of having acted in an emergency. Comparing himself one day to Clemenceau, the next to Foch, he sees himself as a fantasy wartime leader. All that the media seem to have retained from his most recent video, entitled “The Lesson of Short Epidemics” is his assertion that Covid-19 is a seasonal illness, destined to disappear, and that “in a month there will be no more new cases”. 

The assertion of the mighty soothsayer who in January scoffed as he told us  “when three Chinese who die, that sparks off a world alert” does not work any longer. Eventually, Didier Raoult will not be able to escape a minutely detailed autopsy of his statements and his actions. And the result will be devastating.

Christian Lehmann, MD

General Practitioner (Poissy 78300, France)

Update 20.05.2020

Raoult was made to resign his job, he was cited go to China already this summer. Incidentally, by leaving France and Europe, he would escape any eventual criminal charges for illegal human experimentation.

The French newspaper Entreprendre cited his letter to Robert Lafont, the CEO of this publishing house. The online article was swiftly deleted, but here is a backup. Newspapers were quick to denounce the report as fake news and a prank, Lafort himself played stupid, but I personally am not so sure (although it is likely Raoult was never offered a job in Peking). This was Raoult’s letter, translated:

Since you have been one of the rare journalists to have exhibited exemplary behaviour during this period, I would like to take this opportunity to reserve for you the first news: my upcoming departure for China (by the end of the summer). I was indeed recruited as Professor by the Peking University (PUHSC), the most renowned medical school in the country, which happens to be very advanced in the field of virology. It became very complicated to undertake research projects in the health sector in France, the sector being plagued by partisan quarrels, sprawling bureaucracy and political correctness. “

42 comments on “The Chloroquine Elephant in the Room, by Christian Lehmann

  1. If I have learned on thing in the Covid-19 crisis is that you cannot believe medical scientific publications … at all. The situation is a desaster, because there is too much money and interest involved to warrant anything like scientific integrity. This is a saddening observation and it makes me doubt the whole scientific process (in which I participate, in a different field, though). Given the publication pressure higher than in any other medical research facility, I am certain that there is a temptation for forgery. And given the number of publications signed by Raoult, I wouldn’t be surprised that he would even be aware of more than the title page of many of « his » publications. So, mecanically, yes, I can believed that he has signed forged results as a co-author.

    However, concerning the current crisis, I think you completely misunderstood the motivation of D. Raoult’s actions.

    If he has anything to gain personnally, it is boosting his ego and maybe selling his book (but that also probably much more for his ego than for the money). But he could have gained much more if he had jumped on the bandwagon of some innovative medication rather than HCQ. HCQ is in the public domain and it is produced in many countries by different companies, it is easy to administer and it is really cheap and safe (risks and side effects are well documented). It was a pragmatic choice, it was worth the try, don’t you agree up to this point? What people don’t realise is that this choice did not come out of nowhere, but Raoult had anticipated it several years ago for the event of a viral pandemic: HCQ shows in vitro antiviral properties for several viruses. Of course, the actual efficacy cannot be determined without a serious ongoing epidemic.

    The actual motivation of Raoult is to spread hope as a counter measure against panic and hysteria … and that really is a good thing! HCQ might kill a handfull of patients worldwide when applied to millions of patients, but the hope that people obtain from it clearly saves thousands or helps them to get well faster. That might be beyond your understanding.

    Consider this: you thought doing right in acting against homeopathic « medication » and I personnally agree with you in that it is utter nonsense. However, that you and I think that way does not exclude that it is a vector of the placebo effect for millions. No longer refunding homeopathic « medication » will cost the french social security much more in the end than it will save: in search for their placebo need, medics will prescribe actual (more expensive) drugs with potential side effects.

    Now, HCQ was a believable candidate for an anti-viral treatment as it works in vitro, nobody questions that, and many continue to believe in HCQ. Treating Covid-19 patients in the early phase of the desease with HCQ, even if it were completely ineffective in a double blind study, would still most certainly boost the immune response of many patients at least by the placebo effect and it would reach much more people than, say, homeopathic medication.

    Since there is no alternative for treating the early phase of the desease that is significantly better … why take away hope?!

    Finally, nobody can deny that Raoult’s IHU did an excellent job in access to tests in Marseille.


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