The Fall of Dr. Raoult

Nothing stimulates the emergence of a guru like a crisis, especially one to which the correct response is far from clear. People want simple, reassuring answers. They eagerly suspend their critical faculties; their wishes are father to their beliefs. A good guru can transform the proudest skeptic into a believer.

The case of France’s Didier Raoult is illustrative. Raoult, a professor of microbiology in ­Marseille, has a distinguished record of ­scientific work. He has discovered species of bacteria and viruses; he has developed effective treatments for Q fever and Whipple’s disease, which are still in standard use. By means of modern genetic science, he and his team proved that the plague epidemic in Marseille in 1720 really was the plague and not some other disease. He was part of a team that found evidence that Caravaggio died of staphylococcal septicemia. He was largely responsible for ending an epidemic of typhus in ­Burundi. His bottomless energy and incessant lobbying ­resulted in the creation in Marseille of the most important and up-to-date hospital for infectious diseases in France, one of the best in the world.

These achievements were more than sufficient to earn Raoult an honorable mention in the history of medicine. But though he had written several books for laymen and many articles for the general press, he was not a household name, nor had he been elevated to the status of guru—until the advent of the COVID-19 pandemic.

It was Raoult’s advocacy of the use of hydroxychloroquine, with or without the antibiotic azithromycin, as both prophylactic and cure for COVID-19, that shot him to celebrity. Here was a man who knew beyond peradventure what to do in these frightening times, when those all around him were contradicting themselves. But his knowledge alone of what to do would not have turned him into the most recognizable, talked-about, admired, and feted man in France. Raoult had all the qualities to turn himself into the leader of a cult.

He had esoteric knowledge that far exceeded his followers’ understanding. He cultivated an appearance unusual among persons in his position. In his late sixties, he let his hair grow lank and grew a straggly beard. Large and blond, he looked as if he had strayed from the ­pages of Asterix, or was an aging rock musician reluctant to let go of his youth. Some called him “the Druid.” No one should judge a book by its cover, but many of us will judge a guru by his hair. A homeless tramp with a long beard is more likely to have otherworldliness or spirituality ascribed to him than is a beardless one. He is a homeless tramp not because he is mad or drunken, but because of his rejection of the vanities of this world.

Whether ­consciously or not, Raoult played perfectly on two strings: that of rebel and that of authority. In his public statements, he exuded a ­hieratic certainty, even as he poured scorn on the medical establishment, especially the Parisian medical establishment, whose achievements he compared unfavorably with his own. They were pygmies; he was a giant. He therefore appealed to authority and anti-authority at the same time. He was a refreshing figure in a country that seemed increasingly to be ruled by a technocracy without competence, a fact the epidemic had cruelly exposed. And just as some people believe that their enemy’s enemy is their friend, so they believe that the enemy of the incompetent must be competent.

Raoult represented a provincial France, resentful as ever of ­Paris’s predominance in running the country. He was the gilet jaune of medical science. If the solution to the epidemic emerged not from Paris but from Marseille, the former would be suitably chastised and humiliated. One always feels much the better for humbling the arrogant, irrespective of whether it does one any good.

The professor also appealed to conspiracy theorists. His regimes of prophylaxis and treatment were very cheap, using drugs that were long out of patent; if adopted, they would deny the pharmaceutical industry the vast profits it would accrue by developing expensive new drugs. That, rather than considerations of medical value, satisfactorily explained why his proposals were not immediately adopted. In essence, the medical establishment worldwide had been bought by the international pharmaceutical ­industry. The professor was not shy about alluding to the economic connections of his opponents to various multinational companies, which were indeed sometimes ­extensive.

Conspiracy theories require an element of plausibility to spread beyond the ranks of the ­clinically paranoid, and there was some plausibility to Raoult’s allegations. For example, a paper in the New England Journal of Medicine implied that the patented drug remdesivir might be of use in severe COVID-19 infections. Billions of doses were sold. Yet the paper was so methodologically flawed that it smacked of sales literature and stock manipulation rather than science—the study having been paid for, designed, and written by the manufacturer. The publication of this paper was a disgrace to the journal, and Raoult was right to say that the drug was of little use except to shareholders.

Again, The Lancet published a paper supposedly demonstrating not merely the inefficacy of hydroxychloroquine, but its positive dangerousness. The paper, however, was patently fraudulent. The editor should have noticed, and his failure to do so was grist for Raoult’s mill. Surely the failure was deliberate, part of a campaign led by the pharmaceutical industry to denigrate hydroxychloroquine, which so threatened their profits.

By now, millions of people were partisans of the professor; his pronouncements and denunciations were as tablets of stone brought down from Sinai. He was a local hero in Marseille, and his face began to appear on T-shirts and mugs. President Trump espoused hydroxychloroquine. There were long queues outside his hospital for testing for COVID-19, and for his treatment for those who tested positive. The rich and famous lined up with the hoi polloi: Here, at last, was the equality and fraternity promised by the Revolution.

So popular was the professor that President Macron felt constrained to visit him in Marseille: If the ­mountain wouldn’t go to ­Muhammad, Muhammad would have to go to the mountain. The president was aware of his unpopularity in provincial France, and there were elections looming (as, nowadays, there always are). He could not afford to disdain provincial France’s great hero. He made Raoult one of the advisers on his twelve-man committee on the pandemic.

The professor was not very clubbable, however. The one time he attended a meeting of the committee, in the presence of Macron, he called an eminent epidemiologist an astrologer. He swiftly resigned from the committee.

Raoult’s ego had never been small, but it now swelled to gigantic proportions. Asked by a journalist how his three thousand scientific publications—more than one per week for forty years—could all be of high quality, he invoked the precedent of Mozart. He revealed to the authors of a book about him that, when he was aged fourteen and behaving badly, an educational psychologist had told his father not to worry, because he had an IQ of 180.

Pride goeth before destruction, and a haughty spirit before a fall. Doubts about Raoult’s famed prophylaxis and treatment accumulated. The favorable papers were scientifically worthless, in essence merely anecdotal. When it was pointed out that Raoult’s studies of the treatment-­regime lacked controls, he replied belligerently that controlled trials were not the be-all and end-all of medical research, that most medical advances had taken place without them, and that, as a doctor, he had an ethical duty to employ a treatment that he knew worked.

Again, there was an element of plausibility in his self-defense. It is true that double-blind trials are not the only form medical research can take, and that real medical science existed before such trials were widely utilized. Indeed, most of the discoveries that transformed medicine were not subjected to such trials. No one needed a double-blind trial to notice the difference between surgery with and without anesthesia.

But these arguments are irrelevant to Raoult’s case. His published efforts to demonstrate the value of hydroxychloroquine in the prophylaxis and treatment of COVID-19 were virtually worthless as a guide to practice. The choice of hydroxychloroquine as a substance to treat the condition was not without basis: It had shown antiviral activity in vitro and clinical value in the treatment of other intracellular organisms. But there is no more dangerous argument in medicine than that something stands to reason, and the route from demonstrating that something works in vitro to demonstrating that it works in vivo is long and arduous. Nor did Raoult seem to grasp the elementary point that, in contrast to conditions with high case-fatality rates, a condition with a low case-fatality rate, such as COVID-19, requires large, randomized trials to establish the efficacy of a treatment. Clinical experience is not enough.

To his millions of followers, it hardly mattered that many of Raoult’s pronouncements turned out to be mistaken. At the beginning of the pandemic, he was dismissive of its seriousness and claimed that more people had died of accidents on pedestrian scooters than from COVID-19. Later he announced that, with his method of prophylaxis and treatment, it was “game over” for COVID-19, and there would be no second wave. He said it was unlikely that vaccines would be discovered quickly or play much part in the control of the disease. He insisted that he never prophesied—he left prophecy to “astrologers,” such as epidemiologists—but in fact he did behave like a prophet, and one who was almost invariably proved wrong.

Faith can survive a great deal of disconfirmation, but not an infinite amount. The fact that efforts around the world failed to vindicate Raoult’s methods eventually filtered into popular consciousness, and like a fickle crowd in Shakespeare’s plays, the public turned on him, mocking him where it did not ignore him—whereas only a few months before he had appeared daily on television and in newspapers almost as a ­Daniel come to judgment. Journalists who had excoriated resistance to his ideas, attributing it to vested interests, now maintained a delicate silence. No doubt they were grateful that the public’s memory is short. A few people still believe in him with an almost religious ardor (I know one or two), but not many.

The rise and fall of Didier Raoult is a case study in what happens when a large and indefinitely expansible ego meets a desire for a secular saviour. Yet the story has a tragic aspect. A man who, whatever his faults, had deserved well of his fellow creatures, who contributed more than most to the reduction of the concrete suffering of mankind, will now be remembered not for the good he did nor for the enlightenment he brought, but for a kind of charlatanry, without his ever truly having been a charlatan. He is a man destroyed by the dialectical relationship of ego to mankind’s willingness to invest gurus with all but ­supernatural powers.

Theodore Dalrymple is the author, most recently, of Around the World in the Cinemas of Paris.