Category: Corona Virus

Scientific Petitions and Open Letters in the Covid-19 Era

John P.A. Ioannidis
October 2, 2020

Scientific truth should not be decided by the bulk of signatories, argues John Ioannidis

Petitions and open letters signed by large numbers of scientists are not new, but they have proliferated in the covid-19 era. [1,2] They have a clear role when it comes to questions of ethics, social problems, and injustices. With monumental consequences from both the pandemic and the response to the pandemic, debating ethical and social issues is the right of every citizen, including scientists. A collateral damage, however, is when these documents are aimed to prove or disprove scientific positions.

Scientists may take pride that their advocacy can save lives, mobilize resources for worthy enterprises, or teach leaders and fellow citizens. Petitions often convey a sense of urgency, conviction, and resolution. Different petitions may fervently support opposing positions: e.g. be in favour or against measures such as lockdowns or school closures/openings. They may press on issues of transmission (e.g. whether airborne, aerosol transmission is common) or risk (e.g. whether children are at risk). Sometimes, they acquire a component of personal attack, lambasting (or supporting) government officials for recommendations and actions. Various media and social media further reverberate these documents. Participation of the general public in these debates is welcome, but bounds of civility are sadly often crossed and many scientists, signatories or opponents, get unjustifiably smeared. However, most importantly, petitions cannot and should not be used as a means to prove that the positions of the signatories are scientifically correct. As it has been previously observed, this is a fallacy, an argumentum ad populum, implying that the larger the number of scientists who sign, the more valid their scientific positions are. [3,4] Vote counting is a faulty method of scientific inference. Science is replete of situations where vehement majorities have held wrong beliefs.

Signatory credentials carry little weight for further validating the veracity of petitioned materials. Invoking authority is yet another fallacy. Expert opinions are at the bottom of the evidence hierarchy. Angry, scared, opinionated experts have even less trustworthiness. Petitions over-confident of their alleged know-how can even be embarrassing, when the recruited experts actually do not even cover key dimensions of necessary expertise. E.g. microbiologists and infectious disease experts may not know enough about diseases of despair, economics, and social meltdown dynamics; and economists may lack knowledge about virology, immunology, or intensive care.

There are many other drawbacks in using petitions to prove scientific points. First, absolute knowledge that can be summarized with a few paragraphs or bullet points (an unavoidable feature of letter-writing) is almost non-existent across science. Good science is nuanced. Forced consensus or over-simplification are detrimental.

Second, signatories may not fully agree or may even partly disagree with what they co-sign. A previous survey examining the positions of signatories on a hot topic (denouncing “statistical significance”) showed that several of them had not read the petition, or read it after it was published; many of them held opposite views to several points made by the signed petition; and most had adopted research practices in their recent work that contradicted what they were espousing in the letter. [3]

Third, petitions create covert coercion, stifling academic freedom. When academic leaders encourage their faculty to sign, coercion exists, even if the language of the invitation is relaxed. Younger or more junior faculty members depend on their senior leaders for their academic prospects. Not signing a document espoused by their supervisor may be an embarrassment. Many may compromise to avoid appearing defiant.

Fourth, petitions create a false sense of certainty for a new pandemic where uncertainty may unavoidably exist on important questions. [5] This hinders scientific inquisitiveness. Many scientists may feel threatened by the mass mentality expressed by these letters and by the accompanying media and social media smearing and they may self-censor their high-risk or unpopular ideas. Challenging orthodoxy is never easy, but it becomes almost impossible when proponents of whatever orthodoxy speak out vehemently about how incontestable “their truth” is smearing their opponents.

Fifth, exaggerated certainty can backfire and damage science at large, if some vehemently held positions are refuted downstream by accumulating evidence. The anti-vaccine movement and climate emergency deniers are already drawing ammunition from the reversals of opinion and policy during the covid-19 pandemic. Clearly the strategy of deniers is inappropriate, since the knowledge we have about covid-19 and how to handle it is still evolving, while we have solid evidence about the efficacy and safety of MMR or the dangers of climate emergency. However, science deniers capitalize on the exaggerations that accompany covid-19-related statements.

Sixth, petition letters can easily fall prey to political ideology. In a polarized, charged environment, as is typical of the USA and many other countries around the world, petitions may often reflect the political preferences of the leaders who composed them. This becomes most obvious in attacks against government officials and task force figures. Brilliant scientists like Tony Fauci have been ferociously smeared and need bodyguards. [6] Even when letter writers have absolutely no intention of taking political sides, their petitions may be misused to promote political agendas. Mixing science with politics can become highly damaging.

Seventh, many signatories may have conflicts of interest, but these are hardly ever disclosed in the petition format. Conversely, they would have had to disclose these conflicts, if they submitted their views to a scientific journal.

Dealing with the major threat of covid-19 requires the best science, and the best environment that fosters it: unperturbed academic freedom, without partisanship, with healthy skepticism rather than screams, and with full transparency about potential conflicts. Petitions are a superb advocacy tool. Both scientists and non-scientists may use them for ethical purposes, to advocate on what matters to them. However, petitions should not be masqueraded as weapons of scientific argumentation. Scientific truth is not an issue of zealotry and is not decided by the bulk of signatories.

John P.A. Ioannidis, professor, departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA

Competing interests: I have no conflicts of interest and I have received no funding for my COVID-19 work. I have signed in the past open letters and petitions on ethical issues, but have declined to sign open letters and petitions that claim to settle scientific matters.

References:

  1. McCook A. Thousands boycott new Nature journal about machine learning. Retraction Watch. https://retractionwatch.com/2018/05/01/thousands-boycott-new-nature-journal-about-machine-learning/, last accessed September 15, 2020.
  2. Open letter in support of funder open publishing mandates. http://michaeleisen.org/petition/, last accessed September 15, 2020.
  3. Hardwicke TE, Ioannidis JPA. Petitions in scientific argumentation: Dissecting the request to retire statistical significance. Eur J Clin Invest. 2019 Oct;49(10):e13162. doi: 10.1111/eci.13162.
  4. Walton DN. Why is the ‘ad Populum’ a fallacy? Philos Rhetoric. 1980; 13: 264‐ 278.
  5. Ioannidis JPA. Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest. 2020 Apr;50(4):e13222. doi: 10.1111/eci.13222.
  6. Holpuch A. Fauci tells of death threats as Birx pinpoints fresh areas of Covid concern. The Guardian, https://www.theguardian.com/world/2020/aug/06/anthony-fauci-death-threats-coronavirus, last accessed September 15, 2020.

Remdesivir Gets FDA Approval, but WHO Says Drug Ineffective for COVID

OCTOBER 23, 2020

By

Jeremy Loffredo

On Oct. 15, WHO reported that remdesivir not only failed to produce any measurable benefit in terms of mortality reduction, but that it also didn’t reduce the need for ventilators, or the length of hospital stays.
[…]
“It is unclear if any conclusive findings can be drawn from the study results.”
[…]
U.S. taxpayers covered some of the research and development costs for Veklury, to the tune of $70.5 million.
[…]
Medicare does not reimburse directly for remdesivir, and one five-day treatment course costs more than $3,000 for U.S. patients with private insurance and more than $2,000 for government purchasers like the Department of Veterans Affairs.

This high price stands in stark contrast to that of another antiviral, hydroxychloroquine, which costs 30 cents a pill. Hydroxychloroquine, FDA-approved since 1955, is far safer than most popular over-the-counter drugs like Tylenol and aspirin. Physicians can prescribe it for any off-label use and the Centers for Disease Control and Prevention deems the drug safe for pregnant women, breastfeeding women, children, elderly patients, immunocompromised patients and healthy persons of all ages.

Since the beginning of the COVID pandemic, dozens of new studies have demonstrated the effectiveness of hydroxychloroquine and its first cousin, chloroquine, against COVID. These studies occurred in China, France, Saudi Arabia, Italy, India, New York and Michigan. However, such proof of hydroxychloroquine’s benefit to patients with COVID has posed an existential threat to Gilead sales throughout the COVID outbreak.

Under federal law, new treatments do not qualify for emergency use authorization if an FDA-approved treatment exists for the same disease. If hydroxychloroquine had been shown to be effective in COVID patients, Gilead, along with other companies making therapeutics and vaccines for COVID, could not have been granted EUA [emergency use authorization]. The companies would have had to complete standard safety testing and await FDA approval — meaning less profits, longer runways to market, and an end to the lucrative COVID vaccine gold rush.

As Dr. James Todaro wrote in OmniJournal, “Perhaps no other company has more to gain in the immediate future from hydroxychloroquine’s failure than Gilead.”

Read more here:

https://childrenshealthdefense.org/defender/remdesivir-fda-approval-who-ineffective-covid/?utm_source=salsa&eType=EmailBlastContent&eId=8e37790c-2a57-480f-9d27-721c5ad35e61

Epidemiologists Stray From the Covid Herd

(Photo from WSJ by Barbara Kelley)

Interview concerning the Great Barrington Declaration authors:

“The politicization of Covid,” Mr. Kulldorff says, “is extremely unfortunate. People automatically assume what your political beliefs are based on your views on the pandemic. This is very strange, in my mind.” Dr. Bhattacharya adds that “the traditional markers for political identity have absolutely no meaning” in the context of Covid. Illustrating the point, Mr. Kulldorff says he has defended Sweden’s Social Democratic government, which “kept schools open against enormous international criticism,” criticized the British Conservative government for its lockdown, praised the Republican governor of South Dakota for her open-for-business policies, and criticized the pro-lockdown Republican governor of Massachusetts, where he lives. “I must be very split-minded,” he chuckles, “because in one place I’m a socialist, in another I’m a conservative.”

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Concerning lockdowns:

In contrast to privileged professionals, Mr. Kulldorff says, the blue-collar class is “out there working, including high-risk people in their 60s. So the working class is building up the population immunity that will eventually protect all of us.” Dr. Bhattacharya adds that one of the reasons “minority populations have had higher mortality in the U.S. from the epidemic is because they don’t often have the option—even if they’re older or have co-morbid conditions—to stay at home.”

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Mr. Kulldorff laments the closing of scientific minds. He cites “a very strange letter,” an open letter published on Sept. 9 by 98 faculty members of the Stanford Medical School criticizing Scott Atlas (a former member of the Stanford med-school faculty), who is on President Trump’s coronavirus task force. “They criticized him very harshly for being unscientific, for misrepresenting science,” but offered no evidence, Mr. Kulldorff says. The Swede wrote a letter to the Stanford Daily, a student newspaper, inviting Dr. Atlas’s critics to “a scientific discussion or discourse, but none of the 98 were willing to engage in that.” Mr. Kulldorff adds that, “from talking to Scott, who I’ve gotten to know somewhat through the epidemic, I learned that not a single one of them reached out to him prior to writing that letter, to verify that he actually believed the things they attributed to him.”

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We circle back to the idea of herd immunity, which Mr. Kulldorff calls “the most misunderstood term of 2020.” He jokes that use of the term can invite “accusations of mass murder, and Dr. Bhattacharya laments its frequent “mischaracterization.” The words, he says, are a “technical term that comes out of standard models of epidemic spread.” It is the “end state of any epidemic where some immunity actually happens after infection. It’s a biological fact. It’s not something nefarious or strange.” Many media outlets, he complains, have said that “we’re advocating a herd-immunity strategy. That’s a propaganda term. After all, the lockdown-until-a-vaccine strategy will also end with herd immunity.”

“As an epidemiologist,” says Mr. Kulldorff, “it’s weird and stunning to have this discussion about herd immunity—flockimmunitet in Swedish.” He likens it to gravity: “You wouldn’t have physicists talking about whether we believe in gravity or not. Or two airline pilots saying, ‘Should we use the gravity strategy to get the airplane down on the ground?’ Whatever way they fly that plane—or not fly it—gravity will ensure eventually that the plane is going to hit the ground.”

Dr. Bhattacharya does say that he would call the idea “population immunity” if he could rephrase it. The word “herd,” he says, “has connotations that it doesn’t deserve.” But he stresses that herd immunity is a basic scientific principle, from which flows the one important question epidemiologists and policy makers need to consider: “How do we get to that end state with the least amount of devastation, the least amount of human misery, the least amount of death?”

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Read interview HERE.

Science, Hypocrisy and Lies

CLICK HERE FOR VIDEO PRESENTATION

Published October 15, 2020

John P. A. Ioannidis is a Greek-American physician-scientist, writer and Stanford University professor who has made contributions to evidence-based medicine, epidemiology, and clinical research. Ioannidis studies scientific research itself, meta-research primarily in clinical medicine and the social sciences.

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

This video was recorded at the Institute of Art and Ideas’ annual philosophy and music festival HowTheLightGetsIn.