[bertil]

That researcher is likely, at best, controversial:

- he starts by arguing against quarantine; his point is that it didn’t work for Cholera in 1832;

- he dismisses two thirds of the efforts against HIV/AIDS: understanding transmission effort and promoting condoms, focusing on treatment lowering viral load;

- he then moves on to framing response to the pandemic in a conspiracy-sounding “shift of power towards the Far East”;

- he then says “most countries” have chosen to test extensively early — I don’t think that’s really true: South Korea, has but I don’t think many other did;

- he’s surprisingly unmoved by mortality on the cruise boat ashore Japan; I know epidemiologists can seem comfortable with terrifying stats, but he’s more than that.

He’s not terrible over all and fairly eloquent to make his case but I’d take his presentation with a grain of salt.

Key points:

- children don’t seem to be contagious (they are asymptomatic but vectors for the flu);

- viral loads are more predictive than anything;

- people appear contagious for 20 days; key point isn’t a fix duration but measuring viral load and isolating anyone with a high level;

- the hospital has 143 samples, they are looking forward to comparing genes with symptoms.

He’s happy that people are attacking him for advertising chloroquinine because the controversy drives traffic… Not sure most doctors would be confortable with that media strategy. He’s unhappy that television features people without qualification, though.

He compares his findings with similar findings in China and Korea with slightly different treatment (600 mg vs 2x500 hydroxi-chloroquinine, which he claims to have been the first to propose for other infections).

He uses patients from nearby town who didn’t receive the treatment in a quasi-experiment on the impact on viral-load duration. He’s also recommending a combination with an anti-biotic because complications are often microbial.

His final point is to not recommend to go home but be tested and treated.

I think that he’s onto something scientifically and he could be talking about it on TV but before that, he _needs_ to get some media training to focus on the positive.

[psadac1]

That researcher is probably one of the best experts on communicable diseases with decades of experience : http://www.expertscape.com/ex/communicable+diseases

He has published at least 71 articles : http://www.expertscape.com/ar/communicable+diseases/a/Raoult...

His most recent article seems to be "Chloroquine and hydroxychloroquine as available weapons to fight COVID-19" https://www.ncbi.nlm.nih.gov/pubmed/32145363

Have you already published something in this domain ? Is it your field of expertise ?

[bertil]

I have not but she has: https://twitter.com/MicrobiomDigest/status/12414295448478638...

[cm2187]

Is that what you base him being "controversial" on? My understanding is that he regularly publishes in the Lancet [1] and New England Journal of Medecine [2] (if I am using pubmed correctly).

[1] https://www.ncbi.nlm.nih.gov/pubmed?term=(Raoult%2C%20Didier...

[2] https://www.ncbi.nlm.nih.gov/pubmed?term=(Raoult%2C%20Didier...

[bertil]

His tone is controversial: he’s happy to say things that will make some people unhappy.

You are quoting a highly respected peer-review journal. Those were set-up to avoid appeals to individual authority and replace them with (anonymous) peer review. His presentation is certainly promising but it hasn’t gone through such a review yet.

[j88439h84]

I don't think 'controversial' is the right word for "he’s happy to say things that will make some people unhappy."

[stubish]

How does his tone compare to other French researchers? The work is the important bit, not the accent or even individual personality.

[Nettle2]

He wrote letters to the editor of the Lancet in response to somebody else's papers!

[heyoni]

I don't see how any of what he's saying can be interpreted as controversial and I think you're nitpicking. I watched his presentation and to me he is clearly suggesting we move to a treatment based approach _after_ finding something that works, while suggesting that we can do better than we did with cholera and aids - medical professionals didn't even want to test their patients.

And obviously nothing coming out now is going to be clinical trial grade research! At least you admit that he's onto something, so it's strange to see you up and down this thread criticizing his work and presentation.

[bertil]

He’s not asking for reviews, or using the usual precautionary tone: he’s claiming that his solution work, explicitly seeking limelight. I’m afraid of two things:

1. Without professionals pandemic specialist to deliver the message, people who care about rumours, organisation and industrial capacity, there will be runs on pharmacies and hospitals won’t be able to treat severe patients in time. Or that people start taking large amount of a fairly toxic compound. Or that people leave quarantine because they have taken an (unproven) treatment. The 200,000 people who have seen this video, how many know how to measure a viral load? How many will decide to order Chloroquine vs. have the lab experience to measure that? Chloroquine is available OTC in many countries because most people take it as a prophylactic. Can you guarantee that the same people won’t double the dose, to an amount that even Pr. Raoult sees as hard to manage? There’s already been some problematic situations with masks.

2. Other doctors in this pandemic or the next, admire his success, stumble on a treatment that has similar numbers but isn’t a solution (because of confounding factors, lack of random control trial) publish it through the same channels.

I’m not a clinician, but I teach people how to use proper scientific method and avoid listening to the loudest voice in the room, even when that voice is right, because science was built on giving time to the less appealing criticism.

I’m not criticising his work: he’s onto something. I am criticising his presentation because he’s explicitly ignoring good practices.

[heyoni]

I think he just wants to get this out there and in use by people. It's a fairly harmless drug that can even be taken long term (so long as you don't start hallucinating -- I have) and there are long term effects on respiratory capacity from this infection in some people who might otherwise be healthy.

But I completely agree though that once we're through this, we need proper clinical trials. And people are going to be stupid and overdose or break quarantine and all that stuff...but there's not much you can do about that: https://www.youtube.com/watch?v=ZZamrmTMs6w

Better to have that stuff out there than not, though honestly I think we're going to end up having to have a forced quarantine like China, because whatever we're doing now may not end up working.

[bertil]

I'd love to have your reaction to this: https://twitter.com/MicrobiomDigest/status/12414295448478638...

[heyoni]

Fox news, bitcoin..the communities surrounding these two entities are cesspools of misinformation and do pose a risk that I don't believe should be abated by throwing away the idea of abridged trials during times like these.

Look, my brother is infected, and he's positive and under 40 without any underlying disease and weeks of respiratory symptoms. Doctors now think he might suffer permanent lung damage in the form of reduced lung capacity, so on a personal/emotional level, the risk of doing nothing is far greater than any side effects such a dose could bring.

On the other hand, we have people still going out for spring break and crowding the parks in Florida and NYC respectively...and a drug with this effect might close the gap between a proper lockdown and whatever it is we have going on now. With those two risk factors in mind, I think it's fair to let this half-assed study out into the wild. It's not like chloroquine is available without a prescription, and people will be vomiting their guts out from the sugar long before they get a clinical dose of it from tonic water.

But come to think of it...did the author of the original paper go on Tucker Carlson and say that it's 100% effective or was that the random eye doctor? If it's the former, then yea I'm furious, but I can't seem to find the clip. Otherwise, stuff like this is never going to stop from happening. It sounds to me like the real culprits here are the news agencies responsible for diluting down the information responsibly.

[bertil]

> did the author of the original paper go on Tucker Carlson and say that it's 100% effective

He did so, in French but he absolutely offered to go on the French talk shows, with a clear snide to Cauhet, the French equivalent of Tucker Carlson, because people who were not him where scaring people into quarantine while he “has a treatment that cheap, reliable and safe”. So yes, he absolutely did that.

There was no reason to make his presentation public beyond specialists — hell, he quotes studies on the same molecule who have shared temporary results without the same publicity.

[heyoni]

This is some good research...reading it now.

[heyoni]

Found the clip. That doctor is insane.

[bertil]

I don’t know what he wanted, but he walked into creating this aware, awake and knowing:

https://twitter.com/BostonJoan/status/1240626380020289539

[dillondoyle]

One one point, HIV treatments is so effective now (viral load undetectable) that many don't use condoms with informed partners. On the other end of the spectrum PrEP has been wildly successful in virtually eliminating transmission. And we know humans are not great at using condoms despite the risks.

[bertil]

The focus on the viral load has helped, that’s for sure but as doctor and a researcher, I wouldn‘t throw most of the initial effort under the bus, or explain that quarantine doesn‘t work by quoting a pre-Pasteur example.

[agumonkey]

question about viral load[0]: do masks reduce it ?

[0] IIUC viral load means amount of viruses getting in your system

[bertil]

I believe that viral load ("charge virale") is the number of virus in your system, so mainly viruses that are coming out of your own cells. Masks prevent contamination before it starts but if one is measuring load, I’d say it’s too late.

[agumonkey]

ok, I thought it was the initial intake

[tunesmith]

does higher viral load mean worse symptoms?

[bertil]

He seems to assume it but doesn’t really detail. I’m not sure there’s a scale for measure symptoms in details.