The specious arguments of Didier Raoult to defend his study on hydroxychloroquine

This was to be the flagship article that would prove the effectiveness of hydroxychloroquine against Covid-19: at the beginning of April, Didier Raoult and his teams posted an ambitious study online involving more than 30,000 patients, conducted by the University Hospital Institute (IHU) of Marseille. On June 2, the professor, now retired, ended up announcing on Twitter its withdrawal, “out of solidarity with Professor Lagier, threatened by management”.

The National Agency for the Safety of Medicines and Health Products (ANSM) announced its intention to take legal action concerning this study, which has been strongly criticized since May 28. Several medical organizations have published a column in The world accusing Didier Raoult of having led the “largest known wild therapeutic trial”. They accuse him of having continued to administer hydroxychloroquine as part of a scientific experiment without any authorization.

A “Fool’s Stand”, swept the interested party, questioned on BFM-TV. In recent days, Didier Raoult has long defended his method, his style and his results in a media tour which led him to express himself on the news channel continuously but also on media which supported him, such as Sud Radio, the covidosceptic site France-Evening, the program “Touche pas à mon poste” (“TPMP”, on C8) or the WebTV of the Republican People’s Union (UPR), the sovereignist party of François Asselineau. He presented the facts to his advantage, even if it meant coming to terms with reality.

The Forgotten Blame of December 2021

Faced with those who accuse him of having conducted an unauthorized trial by continuing to prescribe hydroxychloroquine despite the many disavowals, the researcher opposes that he has “Perfectly entitled to prescribe off-label”the marketing authorization, which also provides the framework within which a drug is supposed to be prescribed, in accordance with the available scientific data.

Freedom of prescription is indeed forbidden by the public health code, and many drugs are prescribed off-label, especially in pediatrics. On France-Evening, Mr. Raoult even explains that the council of the order of doctors, before which he appeared in December 2021, confirmed that he was entitled to prescribe hydroxychloroquine. He had however been sanctioned with a reprimand, for having precisely promoted the drug without sufficient scientific proof, causing his patients to take reckless risks. The council of the order then appealed, not to cancel the sanction but to increase it.

A biased method

Another ambiguity, the methodology of its latest study involving 30,423 patients treated at the IHU in Marseille. “To be able to see differences, you need sufficient numbers”, says Didier Raoult on Sud Radio. Contradictory remarks with those he made in June 2020: in “very good methodologist”he declared that “Any trial that involves more than 1,000 people is a trial that seeks to demonstrate something that does not exist.”

Didier Raoult’s detractors, who criticized him for studies on too small numbers, must recognize him this time with a more satisfactory statistical power. This study nevertheless suffers from the same selection bias: patients with a contraindication, in particular cardiac, to hydroxychloroquine were placed in the control group (those who do not receive the treatment), whereas by definition they are more likely to contracting serious forms of Covid-19, distorting the comparison.

Many other biases make his self-congratulations fragile. “Do you know what the mortality rate for Covid patients at the IHU is? It’s 10%. All the studies that have been published elsewhere have mortality rates of 20%”, he said on the set of “TPMP”. But as highlights it on Twitter epidemiologist Mahmoud Zureik, the comparison does not hold, because the IHU does not does not have an intensive care unit : the most serious cases have therefore been transferred to other Marseille hospitals, which reduces the mortality rate.

Dubious sources or read backwards

In his media interventions, Mr. Raoult also cited dubious sources, such as the aggregator c19early.org, explaining that on the “2,600 studies analyzed” re “500,000 patients”including 393 studies focused on hydroxychloroquine, “they find an efficiency that is the same as ours”.

Except that c19early.org is not a scientific journal. This anonymous website automatically references all the studies published on the subject, like before it c19hcq.org and hcqtrial.com, or its cousins ​​c19zinc.com and c19vitamind.com. This opaque and unscrupulous network puts studies of very disparate quality on the same footing, and regularly twists their conclusions in favor of hydroxychloroquine. A network considered unreliable by the US disinformation watchdog NewsGuard.

The microbiologist also cites more serious sources, such as an observational study by AP-HP published in May 2020 in the British Medical Journal. “If you look at this study of [l’immunologue français Matthieu] Mahevas, he explains on BFM-TV, there are a few people he has treated with hydroxychloroquine and azithromycin, for whom there is a significant difference in preventing resuscitation and preventing death. » But the study says the opposite twice, protests its author. On the one hand, the association between hydroxychloroquine and azithromycin is not evaluated there, in particular because of too marginal numbers – an interpretation that has still contested Didier Raoult ; on the other hand, at the global level, it proves the infectiologist wrong. “The conclusion is that hydroxychloroquine, at the dose recommended by Didier Raoult, did not modify the number of intensive care visits or survival. So there is no effect., summarizes Mr. Mahévas to the World.

Conspiratorial exaggerations

To explain the lawsuit against his treatment, the professor emeritus repeatedly denounces a pharmaceutical industry that has become too powerful, with too high financial stakes. “Of course there are considerable risks of corruption”he explains on the UPR website, citing the heavy fines, very realpaid by Pfizer for fraud, or data manipulation for the drug Vioxx, in the early 2000s.

But the conspiratorial fantasy is never far away, as when it declares, to explain the critical articles of which it is the object, that “subsidies of the French press by the pharmaceutical industry are considerable” – it seems at best to confuse state subsidies to the press, at worst to invent it completely.

Likewise, he repeats that the decision of the World Health Organization (WHO) to stop the trials concerning hydroxychloroquine was taken after the publication of a fraudulent study, “a gross fake”In The Lancetin May 2020. This study has indeed been called into question, but Didier Raoult forgets to specify that many publications had already highlighted, in the previous weeks, the potential toxicity of chloroquine and hydroxychloroquine, in the USA as In Franceand that their ineffectiveness had already been pointed out, including by researchers attached to the Marseille IHU.