Didier Raoult

[English translation of video-dialogue below the video.] In this very interesting video, Frederic Taddei of Interdit d'interdire (Forbidden to censure) states, at the beginning, that he has no intention of evaluating the value of hydroxycloroquine and azithromycine, because he lacks the medical knowledge to do so. He states his intention in inviting his guests (Olivier Berruyer, economist and statistician, and Raphaël Liogier, sociologist and philosopher) is to find out why there is so much controversy over Professor Didier Raoult and his promotion of COVID-19 treatment using hydroxychloroquine. [Note that this unpolished translation took hours out of several days. Both debaters spoke emotionally and with multiple redundancies, also different versions of the word hydroxychloroquine.] Among other things, the participants' discussion of the politics seemed to boil down to the ambiguity of testing drugs in a pandemic situation where big-pharma, other commercial competition, and fraud, loom. I thought that the main argument could be summarized as: (Olivier Berruyer) 'The effectiveness claimed by Didier Raoult for hydroxychloroquine could only be proven through randomised double-blind trials, but these have never been successfully completed due to a series of mishaps', and 'There is no way anyone could scientifically reproduce Raoult's method because he keeps changing it', versus (Raphael Liogier) 'Pending a perfect cure for COVID-19, Didier Raoult is doing the best he can as he treats people in a personalised manner, monitoring their responses, with drugs he believes to be effective'. I would add that, as the translator, and as an evolutionary sociologist, my own feeling about the reasons for such controversy is that it is related to the way apes behave over a tasty food supply or some other big event (good or bad) that concerns them. It is natural for everyone in the community to get involved in something important - in this case a pandemic. We seize whatever handle, whatever fact or factoid we can get hold of, and we run with it, to the best of our ability and enthusiasm. Apes with alpha-pretensions get up in trees and shout loudly about what they've got, competing for audiences and power. So, I invite the reader to keep in mind ape-ethology when he/she reads the translated dialogue below. {See also the notes at the end, on hyrdoxychloroquine trials and prescription of this drug and the law in France.)

FREDERIC TADDEI (Host of Interdit d'Interdire): But the controversy around Professor Raoult goes beyond all that. For four months the lines have been drawn between those who believe in Raoult and those who don't believe in him. It has become a real war of religion. So, although we cannot debate the existence of god, or faith, or miracles - you either believe in them or you don't - we can debate the sacred literature. That's what we are going to do, with a pro- and an anti-Raoult, since France has been divided into pro- and anti-Raoult. My two guests are not medical doctors, but they have looked into what Didier Raoult says. The first guest is Raphael Liogier. He is a philosopher and sociologist, professor at the institute of political studies in Aix en Provence.

FREDERIC TADDEI [Addressing Liogier]: You are the author of Sacred medicine, history and future of a sanctuary of thinking, with Jean Bauberot, and of the Horror of emptiness, a critique of industrialist thinking, which will come out at the beginning of the school year, [...] and which will talk about, notably, the politics surrounding Didier Raoult. I will add that you are a member of the ethics committee at Didier Raoult's Marseille IHU [IHU = Instituts Hospitalo-Universitaires], and that you took part in the editing of the report at the request of Professor Raoult, on how to articulate research and care, in a time of pandemic. This report is expected to be available soon, and everyone will rush to read it. So, for you, who defend the work of Professor Raoult, what is the meaning of all this controversy, in two words, RapHael Liogier?

Interdit d'interdire - L'affaire Didier Raoult

RAPHAEL LIOGIER: Over and above, the polemics, it's much deeper. We are looking at a loss of credibility in science and a transformation of the major scientific paradigms. Whilst we are talking about things like randomised double blind trials, we are talking about a method that is supposed to be able to find a pure and absolute drug. Then, on the other side, we have Didier Raoult's methodology which is, in fact, a methodology more of feeling one's way; it's more relativist: one seeks, one looks at what works and what does not work. There isn't that background, paradoxically, that is almost religious, in fact, where the religious are not on the side you would expect. They are more given over to positivism and rationalism. The philosopher, Hegel, said that everything real is rational. My feeling is that the anti-Raoults are like Hegeliens who defend a kind of industrialist ideal of controls, research, truth, perfect drug, etc. This whilst, in a way, society has largely gone past that. And that's the quarrel, the meaning of the quarrel, in the most profound meaning of the term. I think that's it. We are looking at two different conceptual approaches, two different scientific paradigms, clashing.

Now we go to Olivier Berruyer, founder of the Les-Crises site which specialises in deconstructing propaganda; Olivier Berruyer, who wrote a study that was very critical of Didier Raoult's work, based on Raoult's publications and his assertions. For you, Olivier, what underlies this controversy?

OLIVIER BERRUYER: I would not put myself in an anti-Raoult camp. Raoult was one of the only ones to do a very interesting piece of work on sequelae, scanning infected people [...], so I'm not anti-Raoult, in fact. I am pro-the fundamental principles of science; that's true. I would say that underlying this controversy is that we are becoming a conflict-oriented society. Everyone tries to get a position against something, much more than they do to be for something. This is really quite interesting. The major media push for this, in order to create some buzz, clicks, to sell more paper, but, in the end, one notices that this pushes people to not use their critical faculties to try to find the truth, or at least to come together to create situations where they can discuss it together, but can cause a fairly large number of people to become fanatical, using their critical faculties to confirm their biases, rather than doubting - and science is made up of doubting, and Russell said, "Never be certain of anything." In any case, have reasonable doubts, don't over-doubt, because that will also prevent you from reaching the truth. For me, it's really that: this story of strange passions, when instead one could discuss the subject peacefully. I do hope we will enter reality and leave this sort of Orwellian truth potion, where each person invents their own reality. When we live in different realities, we can no longer communicate.

FREDERIC TADDEI: Let's start then by what you don't like, Olivier, in Professor Raoult's work, since you have said that you are not an 'anti-Raoul', and that you admire him for a certain number of things. But, nonetheless, you have been very very severe about his publications and his assertions concerning COVID-19.

OLIVIER BERRUYEY: [...] I disapprove of his having ceased to do science and medicine in order to do politics. He has politicised a subject that should have remained scientific. In order to prove that he was right, he abandoned the fundamental principles of medicine at a time when we needed them the most. He transformed the IHU Marseille institute into a lobbying centre for chloroquine. [Berruyey disagrees that Raoult's had a method of 'feeling one's way', describing it as] simply Raoult dedicated to proving that he was right, bit by bit. Systematically deconstructing any study that contradicted his assertions. Staying silent about a number of studies that showed certain dangers of the treatment, but carrying on about some extremely pedestrian studies, such as Professor Peron's, which was then withdrawn a few days later, and no-one talked about it anymore; and hiding the truth from people so as to make believe that chloroquin works. So, I demonstrated this in referring to scientific publications. I can do it here - it would take a bit of time - but people can look [for themselves]. I can cite a couple of little examples, which started off this chloroquin story. At the beginning of February, Raoul said, 'We have to listen to the Chinese. They are really the kings of virology. The Chinese use Chloroquin'. Terrific. So we must use chloroquin. After a month he said, 'We have to use hydroxychloroquine'. Hydroxychloroquine is close, but it isn't the same thing. The Chinese do not use hydroxychloroquine. Then he says, 'We're going to add an antibiotic, because that works better'. The Chinese guidelines say, 'If you use hydroxychloroquine, above all, don't use antibiotics because it is dangerous. And so, after a while, we find that Raoult says we should listen to the Chinese, but does the opposite. And, I will cite a second example which, to me, epitomises the problem: There was a study that showed that chloroquin seemed a little dangerous. Raoult said, no, it wasn't, and produced a small paper in response, drawing the reader's attention to a third study, which said chloroquine was not dangerous. Very good. However, after a comma following that statement, it said that, if you added an antibiotic - Raoult's protocol - it was very dangerous. It raised mortality. It's really pretty odd to have under your nose a study that says your protocol is dangerous, in order to convince people that your protocol is not dangerous. That's Raoult's method, in fact. It is perfectly understandable, because it's no longer science. There isn't any debate because 90% of scientists can see very well that it doesn't work, that there is a big methodological problem. But, obviously, there is a media problem as well, which tries to give the impression that if they look into it, that will be divisive. Scientists are not very divided. Someone with a doctorate in virologie, in biochemistry, who knows science, can see very well that there is a big problem. That's true overseas too. All the fake-science hunters have demolished this work.

RAPHAEL LIOGIER: I would really like to... The first thing is that to really look at it. In a way, my interlocuteur has validated what I said at the beginning. I said that Raoult works by feeling his way. Initially he said we have to follow the Chinese, then he changed his dosages, he changed the very nature of the product, going from chloroquine to hydrochlorothiazide. [sic] So, exactly - Raoul works pragmatically. And science has always been pragmatic; medical science especially. Medicine isn't physics theory. I have myself studied a little of the epistemology of medicine, and it isn't physics theory, it is, in fact, an almost artisan practice, where one goes from caring for patients to research, and from research to caring for patients. And Raoul functions within that paradigm. It is for that reason that he favours what he calls "observational studies" on the one hand, and going back and forth between them and caring for patients, on the other. It is in this way that he has progressively developed his treatment, which proves, in fact, that he is not maintaining a monological posture, only talking to himself and not with his team. No, he has progressively developed in his work whilst caring for patients - and I would remind you that the largest number of people tested in France proportionate to inhabitants is Marseille. He therefore had an enormous living lab for his practical studies, and he developed, little by little, coming to a point where he had the most efficient treatment possible. But I want to say a second thing, a second thing which is that what Didier Raoult was proposing cannot be limited to hydrochloroquine [sic], and I think that here, we are trying - it's a bit like the tree that hides the forest - we are trying to hide a certain number of errors. I think these are political errors. It's not a question of conspiracy theory, but of political errors by politicians. That's what took Didier Raoult well beyond the question of hydrochloroquine. [sic] Systematically testing everyone - and that's what was done in Marseille. You can reproach him what you will, but I assure you, it was what he could do in Marseille, as much as he could do with the means that he possessed - systematically everyone, and then to put to one side, that is, to put into quarantine, individuals who tested positive - and only them, only them. Then, after that, look after them, no matter the degree of their illness, and this with every precaution - meaning even when they were asymptomatic, and with every precaution - the precautions that are possible whilst using the drug hydrochloroquine mixed with azithromycine - but, as you said, my interlocuteur, doing scans, doing everything necessary, including systematically doing electrocardiograms. I went there, so I had an electrocardiogram. Everyone had an electrocardiogram. I was asymptomatic. So, taking every precaution. So, it was a methodology with everything together, of crisis management, second point. And the third point with which I would be in agreement, I think, and not completely with my interlocuteur, the third point, is that where there has been politicisation - but I am not sure that it came from Raoult. I think that there was politicisation from outside. Because, the only thing that Raoult did, if you listened, apart from his cheeky humour, his mind, his character [which was] a little direct. He might allow himself to say that it was a little bit of flu, etc. I'm not talking about that. Because, from a scientific point of view, he was a very serious person. I want to say that he was politicised precisely because what he was proposing was not just hydrochloroquine, it was a comprehensive strategy, opposed, in fact, to systematic quarantine. We don't know today if general quarantine was good. We don't even know if it saved lives or if, to the contrary, it caused lives to be sacrificed, when we look at societies like the Korean society, which did not practice systematic confinement, but which practised, as was proposed as a general method by Didier Raoult, systematic testing and quarantining of those who tested, and the act of caring for them, but which effectively reduced the circulation of the virus. Therefore, I believe, something quite rational and very pragmatic. But without that conceptual approach of seeking the perfect drug, because, whilst looking for the perfect drug, one finishes up sacrificing lives, on the pretext of claiming a kind of pure vision of what would have happened by the [indecipherable]. Medicine has only very rarely worked that way in the field of viruses and bacteriology. It didn't function that way with AIDS, which was frightening, and much more frightening in terms of numbers of deaths, of lethality, than the coronavirus. Why have we become obsessed with this today? Why has it entered into debate? I don't believe it's Didier Raoult who should be questioned. The question should be, why has Didier Raoult been the pretext of this, of these politicisations?

OLIVIER BERRUYEY: There is a lot to say. Amusing... We know that the people of Marseille were not put into quarantine at all, contrary to your [Raphael's] statement. Obviously, to stop an epidemic in the way that Korea did, is a very good example. You have to test to the maximum, from the beginning. We [the French] did not test to the maximum from the start, no more at Marseille than anywhere else because, at the time that we should have started testing, Raoult was saying everywhere that there would be fewer deaths [than from] scooters, and that all that was nothing particularly serious, that it was funny, really, and there was nothing to do, that [only three Chinese had died? - (indistinct)]. And so it was: when we needed to do something, we didn't do it. In effect, it's more problematic, when you finish up with millions of people infected, to do it. You can't dream of treating them. But, with respect to what Raphael Liogier said, would it be possible for us to agree on the fact that, today, we lack sufficient proof to say that there is clinical effectiveness and sufficient safety of use of hydroxychloroquine, not hydrochloroquine as you term it, with regard to managing COVID? Can we say today, at least, we don't know if it works?

FREDERIC TADDEI (INTERVIEWER): Raphael, Olivier has put a question to you.

RAPHAEL LIOGIER: So, I have three things to say about that. The first is that there was no quarantine in Marseille, but there were systematic tests, for the good reason that Didier Raoult does not have the police force at his service and does not have the powers of a state, in order to declare a quarantine and impose a quarantine on people. He is only able to look after them according to his ability, which is only a medical ability. So, that's a first thing. Evidently a quarantine required a political decision. That's precisely what I am criticising - on people who had tested positive, of course. On the dangers of the product. There is a difference between danger and effectiveness. I think that the proof of effectiveness, of absolute effectiveness of the product are not yet there. It's true that the only way to have formal proof of the effectiveness of the product would be to have randomised double-blind studies, etc etc. On the other hand, the proof we have today, with the backing away from this drug, which had been in free circulation for years, is that it is not dangerous if one takes a certain number of precautions - precautions which were taken. That's the first point. The second point is that, once again, the practical studies and the studies that were undertaken at the IHU institute on thousands of patients, show that there is a reduction in the viral load. I know that after it was said, "Yes, but there is other stuff." There is perhaps other stuff, but, whilst waiting for it, we have a death-rate that does not exist. And, not certainty, but an approximation of a treatment that reduces the viral load and which allows, at least at the start of the illness, avoiding passing on to the next stage. It seems to me that the statistics - although I know that you won't agree - since today this is the subject of controversy - but the statistics today in terms of mortality of infected people, seem less than in Marseille, at least in the people who have been treated at Didier Raoult's service - the 3 or 4 thousand people who went there, [compared] with the rest of France. [...] Therefore, for the moment, these statistics are effectively subject to caution, but I think that Didier Raoult was right to take that risk, for the good reason that he knew that by taking precautions, at least he was not causing the people he was caring for medically to run a risk. And thus, that the only possible risk, the only measurable one, might be to his advantage, according to what he knew. I believe that the matter is proven enough from that perspective.

OLIVIER BERRUYEY: What's proven is that Pharmacovigilance pointed to seven deaths and two hundred very grave side effects with chloroquine. In any case, it is not because you say so ... there is strictly not the slightest proof that the medication saves lives, nor that it reduces the viral load. The phrase that I cited before, saying that there is no demonstrated clinical effectiveness, was a phrase from Sanofi [Multinational Pharmaceutical Company and manufacturer of hydroxychlorquine] which was broadcast about 15 days ago, to every Belgian doctor. I repeat: To this day there sufficient clinical proof does not exist from which to be able to draw any conclusion about the effectiveness or safety of use of hydroxychloroquine in the management of COVID - that the manufacturer of hydroxychloroquine is telling you that it doesn't know if it works and if it causes damage. I find it amazing that we have succeeded in creating in France a world center for chloroquine lobbying, which manages to be far more extreme than its own manufacturer's. Furthermore, using techniques that even the worst laboratories would not use to promote their drugs. That's the problem. And, with reference to what you say, [...] The people of Marseilles are not macaque monkeys, nor things, on which, hey, let's look at this powder and see if it works, sniff this, gee, it's killing them. Lets test it a while to see and if there aren't too many deaths, maybe we can test it on animals. I mean, there were tests done on monkeys three weeks ago. Chloroquine with antibiotics, without antibiotics, at the beginning, before, after, the disease. It is ineffective for monkeys to date. It's all that. There's no 'feeling one's way'. Raoult's only subtlety is that chloroquine has to be given at 8am, or at midday. Should you give 600mg or 550mg? He's not asking, does [unclear] work or does plasma work or does interferon work? It's not respecting fundamental principles. It's taking a health risk, because it's not at all a [unclear] medicine. Hydroxychloroquine attacks the heart, somewhat, and so does COVID. When you add azithromycine, that also attacks the heart. A lot. That's why there are people who die of that treatment. As noted by Pharmacovigilance. These aren't things made to cause trouble or administrative regulations designed to prevent people being cared for. You said it very well yourself, Mr Liogier, the best thing is to have randomised double blind trials. To do a clinical trial you need a month. It's not something that takes eight and a half years. And, in fact, actually, the English did it; they didn't see any effectiveness, they just stopped testing hydroxycholoroquine, to go and concentrate on something else, other drugs. Because, when you say there aren't negative effects - if the greatest precautions are taken and one does echocardiograms every day, there probably aren't too many serious effects, I agree, but, in the whole story, over and above having attacked fundamental medical principles - and, I repeat, there is more need - listen, we lose time this way! Because, in the end, we have a raft of evidence - and I hope we will find the solution soon - I don't care - I hope it will work - chloroquine. I don't care, I am neither for nor against, but today there is a whole raft which demonstrates that it probably doesn't work because pharmacokinetics tells us that the dosage does not reach a sufficient level in the body to work. It has been tested on monkeys; it doesn't work. It has even been tested on the English; it doesn't work. And the tests on the people of Marseille, in terms of methodology, are ridiculous; there was never a control group, so one could not know if it works or does not work. We are losing time. If there is a second wave in autumn, we will attack it just as we did the first. There is no treatment. We have not tested interferon, we haven't tested lopinavir. Look, there are 50 molecules tested by [? unclear]; we have only talked about one. We have put all our eggs in the same basket. We must have had half the clinical tests in the world on that particular molecule. It's pretty staggering! There's no security for patients and it's not gone to the heart of the matter. I don't want -

FREDERIC TADDEI: Raphael Liogier has the floor. We have four minutes before the break.

RAPHAEL LIOGIER: Olivier, you know that today, most trials are not focused on chloroquine. They are focused on the others - It [chloroquine] is taking nothing from them. It's taking nothing from [trials] done elsewhere. I don't see why controlled use of Chloroquine in certain contexts would cost time. Why? I don't see the logic in what you are saying to me.

OLIVIER BERRUYEY: [Much crosstalking.] I will answer you, Mr Liogier. [...] All the media has said, for weeks, chloroquine is wonderful! Well, allow discovery to people. Come on, let us test Remdesevir on you. People said, 'No, I don't want any! I want chloroquine, and I don't want a placebo'. You have prevented recruitments [to other drug trials]. Stacks of media articles have described the problem very well.

RAPHAEL LIOGIER: I think it's a lot more complicated than that, what happened with the Discovery trials.[1] You are simplifying what happened with the Discovery trials. Furthermore, there was a series of trials undertaken using doses that were more than double those that were used at the Marseilles IHU. Responding to what you said about Sanofi - because you said a lot of things I need to respond to. On Sanofi - the fact that it wasn't conclusive, yes, I agree with Sanofi, as I said at the start. However, with regard to what you said about safety, you said there were seven deaths, until proof to the contrary, there is no certainty at all that death was due to any direct effect of chloroquine! And, moreover, the only effects that were able to be observed were relatively weak, and they can be controlled, they can be controlled, actually, by dosage, and they can be controlled, in fact, by - in certain extreme cases - by not using chloroquine - obviously. It's a medication which has effects, strong effects, and since those effects are strong, a certain number of precautions need to be taken - precautions that were taken. So, I say to you, you say, what was done in Marseille, it's vague, it's not serious, etc. All the same, thousands of people have passed through the IHU; hundreds have been cared for at the IHU, of which we have access to, whatever you say, we have access, I mean, through observation, to the progress of those patients- one can compare them statistically with what happened in other hospitals. We don't have - it's not yet conclusive, but it seems to me that it goes in the direction of the protocol that was used in Marseille. So, afterwards, one can say what one wants, regarding what Sanofi has said. You know very well that it doesn't constitute a proof. A laboratory can say whatever it likes; they are not scientific, even if they pay scientists. Besides, other interests could be involved, since Sanofi makes other medications, and it wouldn't be so profitable for Sanofi to sell hydrochloroquine, [sic] which is a drug that costs 30, 40, 50, 60 times less than all the others that are [unclear] proposed. So, I don't want to enter into conspiracy theories, but I don't think that your argument on 'the laboratory that says that... etc.' is a good argument.

[PROGRAM BREAK]

FREDERIC TADDEI: [summarises and asks Olivier Berruyey a question]: Olivier you said, in effect, that Didier Raoult failed to conduct a 'serious' trial in this area, randomised, double-blind etc. etc. He could have done it, you say. It takes a month. But, at the same time, we can see that no-one else did it either. In France no-one conducted that trial. Each time that we were told, 'Yes, someone is conducting a trial', either we never heard the results, or we discovered that it didn't have exactly the same protocol as Didier Raoult's. All that helped to strengthen the idea that there was a conspiracy against Raoult, against his treatment. Then some saw the reason that Rhaphael Liogier evoked, that it was a low cost treatment, and therefore undesirable, in the face of a preference for a very very costly hypothetical treatment that would present one day. But, for you, why hasn't anyone done serious clinical trials in France on this treatment?

OLIVIER BERRUYEY: Very quickly, very quickly, in effect, Didier Raoult did not conduct serious clinical trials, and I believe that he did not even conduct a legal trial, because there were problems with the legality of what he did, related to the primitive nature of those clinical trials, which are criminally punishable and [unclear] is dealing with this at the moment. We can see that the authorities have been completely lax on this issue. Why he didn't do it is very simple, because, when you do a trial, you have proof as to whether something works or does not work. In fact, what Raoult did, was to reject the method which would have subjected his assertions to a test of proof ... he knows very well ... but it's been a century that chloroquine, or quinine, from which it derives. People [?advocated] it as a treatment for flu; it wasn't. Every new era refers again to this resource. So, Didier Raoult, I understand very well, because he isn't doing science, he's doing politics. So, he wasn't going to do something that potentially would show him to be wrong. Why wasn't it done elsewhere? Yes. It is being done. The Discovery Trial in Europe, but its going very badly, because it is having difficulty recruiting, for the reasons I mentioned before. Look at the media coverage. There are many articles that explain that people wanted chloroquine and nothing else. The intention was to work out once and for all what was happening in France, but others said, let's involve other European countries. Let's do a European thing, with the Germans, with the Italians, with Spain. It will be wonderful! -- Finally only Luxembourg joined the study. I think they only had 10 patients, what's more. So, the thing was completely ridiculous. Macron promised us the results for the 13th of May, so, ride the tiger, it won't be long. On the other hand, however, maybe due to Brexit, the English did manage to test it. Their test showed that a double dose of chloroquine was ineffective. It is therefore very strange that Liogier again took up that argument. 'Look, people tested it at double the dose. That's the reason it didn't work'. It's beyond ridiculous.

FREDERIC TADDEI: There was a review planned by the Angers CHU [Centre Hospitalier Universitaire], wasn't there?[2] I said to myself, we can tell people about it during this program. We will know the answer then. It won't be necessary after to have friction between believers and unbelievers; between for and against Raoulters. We'll just [unclear - refer to?] the Anger results. What happened to it?

OLIVIER BERRUYEY: It was a lamentable government mistake. We agree. There was no pilot. That business was in the image of -
[Both talking over each other so Unclear.]

FREDERIC TADDEI: Why, in that case, would [French President] Macron go and visit Raoult? Was it because he doesn't want to cut himself off from all the French who believe in Raoult? Is this demagogy?

OLIVIER BERRUYEY: I don't know. Because Macron is anti-system, as he says. And there will be anti-system people there. And, with all these anti-system people, they will argue between themselves. [Laughs.] It's lamentable. Truly lamentable.

RAPHAEL LIOGIER: Well, to begin with, I don't know why it would be a ridiculous argument to say that one doubled the dose. You must know what the medical word, 'pharmacon' means? In Greek, it means what? It means something that both poisons and treats. So, that means that dosage, in medicine, until otherwise proven, is a fundamental variable. Therefore, an absolutely fundamental variable. It's not a detail. It's not at all funny. To have given a double dose - that could be totally counter-productive. Therefore -

OLIVIER BERRUYER: [Shouts and makes exaggerated feeling with hands out motions:] He's feeling his way! Feeling his way! He's feeling his way. He's looking.

RAPHAEL LIOGIER: Don't get excited. Calm down.

FREDERIC TADDEI: [Laughing silently at the spectacle.]

RAPHAEL LIOGIER: You know perfectly well, that if you take aspirin, even aspirin, you can kill someone by increasing the dosage. Even more so with [? azithromycine]. You know very well that dosage is actually important. Especially a double dose. You yourself have argued as if it's a medication that should be handled delicately. To double the dose, I believe, is a major [unclear]. Secondly, I find the argument interesting, what you are trying to do here: That Didier Raoult is politicking. I don't see in what way Didier Raoult is doing politics. I think this is a way of attributing a kind of conspiracy theory. If Didier Raoult has not done double-blind randomized etc studies, this would not be because we are in a crisis, and an emergency, would it? You look after people before you do controlled experiments, don't you? It wouldn't be for that reason, as I believe it is? There's crisis, a time of crisis, and there's a time for research, at another rhythm. And I am in agreement that the two may work without excluding one from the other. But, instead of thinking this way, people project onto Raoult some kind of malign intention, since you say, 'He wouldn't have, because that would have proven that ...' So, why has he become so attached to hydroxychloroquine? Why, when it doesn't work? Because he is absolutely bent on proving that it does, so he had a malign intention? He makes the people he looks after take a risk - and his patients' opinion, I mean patients he has taken care of, whose opinion is important, until proven otherwise - after all, no legal suite has been launched against him to date, and I don't think that every doctor in France and Navarre could say as much. There is no legal matter against Didier Raoult in Marseille today. It's not because the people of Marseille are more stupid than others; it's because they feel looked after; those who were touched have felt it in the first degree. As for me, I cannot understand what can be Didier's interest - what is the conspiracy theory that supposes that Raoult's obstinacy is politically motivated? That is, hydroxychloroquine as a political weapon for Didier Raoult. Why? In order to become mayor of Marseilles? To be elected President of the Republic? To get the Nobel Prize? But he won't get the Nobel Prize, of course. You say that you are sure that ultra-serious trials will prove that it doesn't work. Then he is sure, at that moment, to hit the wall and not win the Nobel Prize. So, what he is, you are saying is - conspiracy theory - intentionality, and, furthermore, he is stupid, because, as it will be revealed, he will fall on his face. Which one is it? Either he's an extremely intelligent bloke, in a conspiracy theory, or he's completely stupid. You want both at once. It's contradictory. You can't have both at once. So, I don't understand your relentless desire to politicise Raoult's discourse, when he is just behaving like a doctor in a time of crisis, in an emergency situation. And, until there is proof to the contrary, the patients he takes care of, who are massive in number, well, I believe they are quite satisfied. That's not bad. He hasn't killed anyone.

OLIVIER BERRUYER: At the IHU there are 75 places. Is that right? There are 75 beds?

RAPHAEL LIOGIER: [Nods.]

OLIVIER BERRUYER: You aren't contradicting me? There were 36 deaths.

RAPHAEL LIOGIER: Yes. Exactly, 75 beds. - No, no! [in response to the 36 deaths statement]

OLIVIER BERRUYER: Raoult finished up saying it at the [?United Nations/United States]. That's all I'm saying. There were 36 deaths and 85 beds. Already it seems to me that they weren't very happy. There, you see. Second point:

RAPHAEL LIOGIER: No! No! 75 beds, I agree, but -

FREDERIC TADDEI: Let Raphael Liogier speak. He is a member of the Ethics Committee, after all ...

RAPHAEL LIOGIER: 75 beds reserved for urgent cases who must enter those beds according to very specific conditions, you know, because they are very expensive - there are very particular hygiene conditions, in order to manage a patient in a bed at IHU. Therefore, the patients stay a very short time, then move on - the next kind of care occurs in the main part of the AP-HM [Hôpitaux Universitaires de Marseille], in the [?], sometimes even in other hospitals, or sometimes people go back home. The 75 beds are a place of transit, in fact, thousands of people have been through them, since the beginning of the crisis. 75 beds, it's just a place of transit and for - how can I say it - extreme cases, exactly.

OLIVIER BERRUYER: Okay. It's not a place of transit. Most people who are treated - there are more than 3000 - have not been hospitalised. Those people were ambulatory, they were not - at any rate, there was nothing wrong with them when they were examined for symptoms. And even asymptomatic. There were 36 deaths. So, then, give us the number of hospitalisations that occurred before there were 36 deaths. That interests us. Do the ratio. You like ratios; you are a statistician. So, little statistical manipulations; [? one can't do too many of them.]

RAPHAEL LIOGIER: I am not a statistician! I don't know the exact numbers. But I know that up until then, and until proof contrary, there have been no complaints, individuals who were displeased with the treatment, and the deaths to this point which have been accounted for - I'm not a doctor, but we will see - [?unclear] were not deaths, until proof to the contrary, due to treatment there, but due to what is called co-morbidity - a whole series of things. What counts - since you are a statistician - what counts - and, in the end, it's that which we will look at - is the number of persons treated, not just hospitalised, in the IHU - because, to be precise, they pass through the emergency part, intensive, because they are in crisis, and, after that, their place becomes available for someone else. What is important to know is, on the total of people treated, who may or may not have been hospitalised - if the illness did not require hospitalisation - to know what the statistical ratios are in terms of mortality, aggravations, or people who left. It's that alone that will give us the data, and we will have it. We will have it, necessarily. I believe that the [ratios] are to the advantage of the IHU, for the moment.

FREDERIC TADDEI: It was believed that we had that data when the Lancet, the prestigious scientific review, published a study that tended to agree with your critical work, Olivier Berruyer, since it was said that, looking retrospectively, several tens of thousands of patients, who had been treated just about everywhere in the world, once could conclude - and that is what this study concluded - published in the Lancet - conclude, not only that this treatment was ineffective, but moreover, it was dangerous; it added to the mortality. And, it was, besides, following that publication, that the WHO [World Health Organisation] said that it would be better not to use hydroxychloroquine anymore, and, in France, its use was forbidden, therefore, as treatment. And then, boom boom, the next day, or the day after that, the Lancet itself backpedaled and warned against what it had published the day before. And we noticed, and we were told, that data had been falsified, etc etc. How do you explain that, Olivier Berruyer, because you must have read it, this study, you must have thought it backed you up and then, the day after, that it didn't.

OLIVIER BERRUYER: No, no. Not at all. At no moment did I take a position on chloroquine. I don't know if it works. There is only one way to find out if a medication works - you need to do a double blind randomised trial. And then you will know if it works or not. I have never said on my site whether it works or does not work. There are studies that say it works, when it's not true. So, that's the Raoult problem. I don't say that hydroxychloroquine doesn't work. I say that, when Raoult says it works - and he said it from February, in February, he said, it's good, we've found the remedy and COVID will be the easiest respiratory infection to treat. I repeat his words, and 400,000 people are dead. Perhaps we will not have a remedy and that's something that people are not about to accept. There may never be a medical treatment, because generally viral illnesses don't have treatments. There's no treatment against measles, against rubella, against flu. It doesn't exist, so, there's no obvious treatment. Simply, when I saw the Lancet - to go back to the subject, the conclusions went in the same direction of five or six preceding studies; it wasn't a revelation. In effect, its statistical power was interesting, for having a beginning of an answer. [The study] in the Lancetconcluded by saying, 'Now, it's not sure, we need to do a randomised double-blind trial'. It was not categorical on this point. Anyway, globally, that the Lancetgot caught up in all these politics was quite astonishing. It's proof that there is fraud in science, of course. That's the reason we have [? unclear] ethical; that's why we have fraud-hunters. I'm not against Raoult. I'm against bad science. It's just as disgusting what Mehra [presumably Dr Mandeep R.Mehra, the leader of said study that was withdrawn] did, as what the Lancet did. Them and Raoult's bad science. So, we really have to organise ourselves, we surely need to do major reforms, on pharmaceutical laboratories so that there will be less lobbying at that level, on public research, and on the publication of data, umm... I'm not going to elaborate further here, but there are lots of things to do.

FREDERIC TADDEI: After the final rebound on the study in the Lancet, against which the Lancet itself has warned us, what conclusion have you drawn, a part from the fact that we are always in the shadow of belief, aren't we? Whether we are for or against, Didier Raoult. It's passion and it's blind.

RAPHAEL LIOGIER: There, yes. We are testing, but we are blind, in fact. We have blind conclusions. [Laughs.] Even if, in effect, the Lancet article, as the New England Journal of Medicine, which are two big medical journals that published the same information, are not entirely conclusive. For me, what I find fascinating - and I agree with my interlocuteur - is the politicization that has taken place, a politicization - and I imagine that you would agree with me saying, how is it that reaction to the only article in a serious publication (putting aside the standard of the article itself) has been an almost immediate reaction by the WHO and the French government? This is irresponsible on the part of Raoult's critics, who call him inopportune, but I think that what they did was inopportune, in the real sense of the word, meaning, 'ill-timed'. I mean that it was extremely rapid, as if an immediate reaction was needed. That's the first point, because there, the politicization is very real. And, the second point: These scandals make it seem - because it's over and above the question of chloroquine, over and above the political question of Raoult, for or against, and all those things - make it seem as if, today, research in medicine particularly - there are problems today in medical research - how should I say it? In the financial links of laboratories - because we know that it is partly linked to that - the [unclear]. I mean financed in order to go faster, in order to impress - since we are talking about statistics - impressing by having extremely wide statistical samples, using artificial intelligence to process them, via a start-up - we don't really know that start-up is serious, if it exists, if it even exists, for as long as it has done what it has done, how it did it. We discovered, little by little, that even Australian hospitals had not given the figures that they were presented [in the study] as having been received. There were even errors where an Asian hospital was counted among Australian ones. To sum up, it was - Imagine, imagine the other way round, just for a second, what would have happened - we saw what happened there - Imagine what would have happened if such a mistake - I mean such a scandal - had occurred in the setting of the emergency management choices that Didier Raoult might have made in his IHU. He would have been literally crucified! Because truly, the article - I mean it's almost never happened - [...] I had never seen, at any case, in the Lancet [...] even the head director of the Lancet had already criticised his publication editorially in certain articles - but, to such an extent? It had never happened. A questioning of the actual credibility of the most prestigious scientific medical journal in the world, the one that is supposed to represent the greatest guaranties, I tell you, followed by the New England Journal of Medicine. It is truly extraordinary! Truly extraordinary!

FREDERIC TADDEI: We need to be clear that there have been previous retractions by great journals like the Lancet. And, as Olivier Berruyer said before, more and more falsification. I remember two books on that problem, which increases every year because researchers are obliged to publish in order to justify the money they ask for, therefore publishing takes place at greater and greater speeds, and sometimes the data is a bit manipulated to make it fit one's case. All the same, a retraction -

[two people talking at once]

RAPHAEL LIOGIER: In science it impacts even more, because it isn't only publishing in order to publish, like us in political science, it's because it is necessary to publish immediately, because [the research] was financed by a laboratory that wants immediate results, so as to be able to proceed more quickly towards commercialisation of its drug. I think that's it, really. It's undeniable; I'm not slinging stones at anyone. There are direct links between finance, pharmaceutical laboratories, and what is called 'basic research'. It's undeniable.

FREDERIC TADDEI: Olivier Berruyer, given that this has been a recurring accusation during the entire Raoult business, this accusation against big pharma, the pharmaceutical industry, and its links with a number of doctors who would then be anti-Raoult ...

OLIVIER BERRUYER: I feel that it's a rather sad business. Obviously there's a basic problem, and I'm not pro-big pharma. I think that we should nationalise Sanofi because it isn't right that we lack a public laboratory for the production of medications. I think that we should forbid remuneration of doctors by laboratories. I think we absolutely need a public organisation for publications. Okay, that's all true, but there are also problems with the public system. For instance at the IHU of Marseille, where Raoult started signing 150-200 studies a year, when a quality researcher only publishes about 100 in his lifetime, normally. This makes Americans laugh, knowing that each time colleagues who have organised themselves at Marseille, publish in a review, it means that 600 euros go to the AP-HM, to the detriment of other hospitals in France, for which there is also a big problem with public finance and that method of finance, which has been very strongly criticised by the Court of Accounts [French supreme auditing institution]. I dare to hope that the government will act on this point. Yes, there is a problem, and it needs to be treated. Now I find it regrettable that side of things that consists of saying, 'Yes, but any doctor in a situation of conflict of interest is an untrustworthy creep, a low-life, whom you should not listen to.' I repeat, I don't like this system, but you should not conclude that just because there is a financial conflict, that shows that you should look more closely at the case against that person, just because they have a conflict of interest. It doesn't mean that what they say is false. And conflicts of interest are not only financial. There is also the Marseille IHU conflict of interest. It's obvious. Mr Raphael Liogier is trying to tell me that there would be no problem if Raoult were to say, 'Hey, I made a mistake. I've just treated 3000 Marseille people for nothing. Chloroquine doesn't work at all.' It's true that it is going to be very interesting in a few months, alas, if scientific truth concludes this. [...] To conclude, as Mr Liogier does, that when Sanofi says that chloroquine doesn't work, it's possibly -

RAPHAEL LIOGIER: [Interjects]

OLIVIER BERRUYER: [Laughing and waving finger] Yes, yes, I think you did say that. You said that, even when the laboratory says its own drug doesn't work, to try to get out of it - when normal logic would [conclude that the drug] doesn't work - [by saying], 'But no, perhaps they are hiding another drug, which they can sell for a higher price.' Meaning that those involved prefer that we die without treatment. That's it. This is dirty reasoning. And that a philosopher could think that, could introduce that idea to the population - and we know that the population will easily react to such a shocking kind of thing

RAPHAEL LIOGIER: [Softly] No, no, no, no.

OLIVIER BERRUYER: I find it very shocking. We can go over that bit in the recording. I'm not fussed. That's exactly what you said.

RAPHAEL LIOGIER: Fine, we'll go over that bit in the recording. I'm not fussed either.

OLIVIER BERRUYER: But it's the little refrain that

[Liogier and Burruyer talk over each other.]

OLIVIER BERRUYER: Yes. Okay, I'll take that on. It's of little importance.

RAPHAEL LIOGIER: Don't say it's of little importance.

OLIVIER BERRUYER: But what importance does it have?

RAPHAEL LIOGIER: Don't say it's unimportant. It is important. I think what you said is important.

OLIVIER BERRUYER: You have to find the sweet spot. Of course, you have to doubt, of course there are conflicts of interest, of course you have to be careful, but afterwards you find yourself in a world where you imagine that everyone is surrounded by untrustworthy creeps who aren't telling the truth and who... Hey, when I think of the number of doctors who have bust their guts throughout France [and] there's an attempt to make us believe that Raoult is fighting a war for medicine ... but all doctors have tried it - Even the Salpetriere [major teaching hospital in Paris] used it from the outset, since the Chinese used it. I've talked to doctors at the Salpetriere, and it's not the only thing, Raoult is not the only one doing it - all the doctors are busting their guts; you have 15-20% of the medical corps who have caught COVID. That's too many. To try to make them all out to be low-lifes and sell-outs, all of them - it's too many - to cultivate that sort of - I don't like the word, 'populism', that sort of [?bitter opinion] to conduct polls-

RAPHAEL LIOGIER: [Interjects] I didn't say that -

OLIVIER BERRUYER: But many have said it. You didn't say it, but many have in that fringe-thinking. I find that - I don't see how we can construct a decent world if one thinks that way and, if, furthermore, one has different realities. One can no longer agree on basic facts, when Science normally allows us to do that.

FREDERIC TADDEI: Raphael.

RAPHAEL LIOGIER: Okay. Firstly, on Sanofi, I absolutely did not say that they were low-lifes, that they wanted to sacrifice peoples' lives to profit etc. I'm only saying that, when you give as an argument [that] chloroquine doesn't work - the proof you say is that Sanofi says so - is not at all an argument, a laboratory that says something works or does not work, even if the same laboratory manufactures that particular medicine. That's what I wanted to say. Because I am not at all into conspiracy theory and I'm not at all inclined to the idea that the world is full of low-lifes. I believe there are interests, but multiple and variable interests: we have an interest is being cared for, an interest in being happy, an interest sometimes in earning money, and all that is very complex and multiple. I don't believe in an intentional malignity. So, it wasn't a perverse argument. It was just to say that there is no proof for [the argument] you have advanced -

OLIVIER BERRUYER: Yes, yes.

RAPHAEL LIOGIER: - that it's because of what Sanofi said.

OLIVIER BERRUYER: Of course. There is only blind clinical testing, that's the only proof.

RAPHAEL LIOGIER: That is true. I am even in agreement with you on that. But I believe, on the other hand, that practical international studies in crisis situations, in pandemic situations, over a long time - over a short time! - excuse me! - are not at all incompatible with tests in [unclear] and, contrary to what you say, do not slow down research. But, as far as the number of important articles by Didier Raoult is concerned, I'm letting you know that this also happens in America, but I am an invited researcher at Columbia University, which has a very, very, very big medical school - of medical research - and I assure you that the [?unclear] there, the really big researchers, well, they also put their names on many massively published articles. Then, money doesn't go to the AP-HM, it goes to the IHU Foundation - yes, it's not the AP-HM.

OLIVIER BERRUYER: It goes to the AP-HM, it goes to the AP-HM.

RAPHAEL LIOGIER: Nooo...

OLIVIER BERRUYER: No, no, not directly. Into the pockets of -

RAPHAEL LIOGIER: It doesn't go into Raoult's pockets...

[They continue to contradict eachother for a little while]

OLIVIER BERRUYER: At any rate you haven't published the accounts. You haven't published anything on your figures on your internet site, therefore ... It would be good, besides, if you would do that.

RAPHAEL LIOGIER: Wait! Wait, just a second! I am not a representative for the IHU! I don't know the IHU's [financial] curves, I am a university professor in political sciences, and I am a member of the Committee of ethical supervision, and my position stops there. And no more than that.

FREDERIC TADDEI: This show is about to end. I propose that you each conclude with a few words - if it's possible to conclude anything in this business, when there will certainly be comebacks. Olivier Berruyer, on this business of Didier Raoult:

OLIVIER BERRUYER: It's a rather special business because usually you can have doctors who try to fool other doctors and scientists. Here we have someone who has come out and who is more preoccupied with what other scientists think of his work, in order to get opinion to support his side. He has succeeded rather well in this. [unclear] Raoult's method; Raoult's refusal of the scientific method is nothing new. It has happened before. It is Moliere's vaccine. Hey, here comes COVID, blood-letting for everyone! Let's test, but, above all, don't separate the group into those that are bled and those that are not. In any case, we've been bleeding people for 200 years so, if it didn't work, we'd know it. It's exactly that, this method that rejects science. It's a method that rejects proof and it refuses respect for the patient, who is not a guinea-pig.

FREDERIC TADDEI: Raphael Liogier's response?

RAPHAEL LIOGIER: Well, it's funny, because I find that it's exactly, in a sense, symmetrically the opposite. It's symmetrically the opposite, meaning, to offer a patient a strategy that does not pretend to be unfalsifiable, is pragmatic. It's rational and pragmatic. Pragmatic because rational. And, if there were, in fact, problems, well then, it would stop. If there were [problems] then [the treatment] would stop. That would happen through observation of the patient by the doctor. When one is operating on a scale of thousands of patients, the problem is inverted. The problem of randomised trials is that theyseek a pure, an absolute, medication, which you have said yourself may never be found. Well, it's through waiting, as long as the perfect medication, the unfalsifiable medication, has not been found, in some way, then you are sacrificing the population. Sacrificing the population, in a way, by calling on a kind of positivist theology of ideas that it is absolutely necessary to find the corresponding medication, but without going as far as Moliere, because that's a false criticism, because, in that era, it was more or less magic. It is in fact - euh - medicine is not a science like the others. It is a science which supposes what is called the unique dialogue, which means a special relationship with the patient, which therefore evolves. This is, in effect what Didier Raoult practices, without this implying any opposition to basic science.

FREDERIC TADDEI: [Thanks the participants.]

NOTES

[1] See re the Discovery clinical trials.https://www.francetvinfo.fr/sante/maladie/coronavirus/discovery-ou-fiascovery-les-resultats-de-l-essai-clinique-pour-trouver-un-traitement-contre-le-coronavirus-se-font-attendre_3962331.html These trials were meant to enroll many more than they did. It seems that most who enrolled were French, and that people in other countries decided to opt for other trials. The numbers enrolled ultimately were too few to provide sound clinical conclusions, it would seem.

[2] It seems that the government stepped in after these trials involving multiple hospitals had commenced. L'hydroxychloroquine désormais interdite en France pour traiter le Covid-19 On 27 May 2020, the French Minister for health suddenly banned the use of hydroxychloroquin, with or without an antibiotic, in the treatment of COVID-19, on the advice of the High Counsel of Public Health, based on the results of the Mandreep R. Mehra Lancet article, which was then so rapidly discredited by the Lancet itself (also discussed in the interview above). Newspaper article recording the announcement of the [subsequently ill-fated] 'pilot' by Anger CHU.https://france3-regions.francetvinfo.fr/pays-de-la-loire/maine-et-loire/angers/coronavirus-chu-angers-pilote-etude-effets-hydroxychloroquine-covid-19-1809274.htmla>

This interdiction was modified in July 2020, so that Plaquenil (brand-name for hydroxychloroquine) could again be prescribed. However, the French national health scheme would not reimburse prescriptions for its use outside traditional indications, like malaria, lupus and arthritis. It could still be used and prescribed for other purposes, including COVID-19 treatment, as long as this was stated on the script, but in such cases, the government would not reimburse the script. See >Non, l'hydroxychloroquine n’a pas été "réautorisée en douce par le gouvernement Castex". See quotes below in English and French:

"However, it states that Plaquénil may be prescribed outside its marketing authorisation, as provided for in the Public Health Code, provided that "this is justified by scientific knowledge and that the patient is clearly informed". "In this case, it must be mentioned on the order and it will not be reimbursed", noted the DGS stressing that "in case of problem, the civil, criminal or ordinal liability of the doctor can be engaged." (Translation from: "Elle précise toutefois que le Plaquénil peut être prescrit hors de son autorisation de mise sur le marché, comme prévu par le code de la Santé publique, à condition que "cela soit justifié par les connaissances scientifiques et que le patient en soit clairement informé". "Dans ce cas, cela doit être mentionné sur l'ordonnance et elle ne sera pas remboursée", a relevé la DGS soulignant qu'"en cas de problème, la responsabilité civile, pénale ou ordinale du médecin peut être engagée."