COVID-19 | science, damage limitation, NO POLITICS

[Robert Roaldi]

Come on Bob.  You know that it's the media that takes the ball and runs with it. The public listens to the media. They're the ones who advise the public.  Frankly, I doubt if the media reads it.  They all just repeat everything someone else says anyway.  So wrong or misinterpreted "science" gets repeated.  The public suffer. Policy makers are ignorant as well.  We all just muddle along.

Utter nonsense. You are surrounded by physicians and public health authorities whose job it is to keep abreast of this info and they tell the public about it every day. The problem arises when people go look for conspiracy nonsense on the web and think that's research. Don't take medical advice from National Enquirer or youtube. (Is there still a National Enquirer, I don't actually know.)

[Robert Roaldi]

Something smells fishy.

No it doesn't, calm down. Conspiracy novels are fun but don't take them seriously.

Anyway, if this was a conspiracy, it was a third-rate one without much consequence. I mean, if I were going to go to the trouble to submit an article to a prestigious science journal, find data, some co-authors, write and submit, I'd try to come up with something that would at least net me some cash or something. Otherwise, what's the point.

[BernardLanguillier]

No it doesn't, calm down. Conspiracy novels are fun but don't take them seriously.

Anyway, if this was a conspiracy, it was a third-rate one without much consequence. I mean, if I were going to go to the trouble to submit an article to a prestigious science journal, find data, some co-authors, write and submit, I'd try to come up with something that would at least net me some cash or something. Otherwise, what's the point.

I don’t have an opinion about the authors.

But I still cannot understand how and why:
- the Lancet decided to publish such an article without peer reviews
- how they could themselves overlook the obvious huge issues with the article before publishing it, knowing full well how controversial it was going to be. It took less than one hour for professional researchers to report about the very visible issues with this study

I am sorry, but this level of screw up doesn’t happen.

This is akin to Real Madrid loosing 10:0 against a team of blind monkeys.

Cheers,
Bernard

[Alan Klein]

The heart issues associated with HCQ are well known and totally unrelated to whether one has COVID-19 or not.  There have been other reputable studies published showing increased mortality from heart problems when on HCQ, including a large study from the group that I am associated with.

Alan, you didn't answer my question.  As I recall the report that was pulled indicated heart issues.  Those were reported with a lot of fanfare in the news.  You indicated that this new report closed the case anyway.  That isn't true because the new report said nothing about heart issues.  You should have indicated that the original pulled report was wrong about their severe conclusions of heart issues.  After all, that point was a big issue at the time the report was originally published.  Everything that report said was pulled including their conclusions about heart problems.  Your keeping silent on that is inappropriate.

[Alan Klein]

I don’t have an opinion about the authors.

But I still cannot understand how and why:
- the Lancet decided to publish such an article without peer reviews
- how they could themselves overlook the obvious huge issues with the article before publishing it, knowing full well how controversial it was going to be. It took less than one hour for professional researchers to report about the very visible issues with this study

I am sorry, but this level of screw up doesn’t happen.

This is akin to Real Madrid loosing 10:0 against a team of blind monkeys.

Cheers,
Bernard

For a change we seem to be in total agreement.  How did the authors discover this issue within one week after publishing it?  Suddenly they do their due diligence afterwards, not before. How come they didn't ask for the data before the report was published yet days afterwards they pull it? 

It seems they had to know the original data would not be released to them long before they published.  But they published anyway.  Why?

[Alan Klein]

No it doesn't, calm down. Conspiracy novels are fun but don't take them seriously.

Anyway, if this was a conspiracy, it was a third-rate one without much consequence. I mean, if I were going to go to the trouble to submit an article to a prestigious science journal, find data, some co-authors, write and submit, I'd try to come up with something that would at least net me some cash or something. Otherwise, what's the point.

It was done for political reasons.  But we can't discuss that in this thread.  So we'll all have to walk around acting like dummies.  Which is why this thread is a waste of everyone's time.

[BernardLanguillier]

Yes, this pretty much ends the conjecture.  This was a very large trial and the Data Safety Monitoring Board found it necessary to communicate preliminary results because of clinical importance.  The full press statement is here: https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf and it's pretty darn clear.  Of course this won't satisfy all of the hydroxycholorquine fans who may argue that the right level of zinc or azithromycin wasn't used.

I am sure that the reactions to this new article isn’t going to be limited to the question of the doses.
 
I can anticipate at least two other significant challenges:
- in both populations the level of mortality is around 25%, which indicates that patients were probably at an advanced stage of the disease and/or could not be treated the right way, possibly due to the high load of hospitals in UK at the time. Either way, this rate is much higher than what was reported elsewhere. Raoult reports 0.5% for instance
- the hydrochloriquine was not used in combination with the azithromycin if my understanding is correct.

So the protocole whose inefficiency is convincingly demonstrated appears to differ significantly from that said by Raoult to work, even if they both utilize the hydrochloriquine.

I am not a fan of any particular treatment, just trying to point out some questions.

Finally, I sense that momentum is building due to the accumulation of apparent data points against the hydrochloriquine, something akin to “there is no smoke without fire”, but I would just like to stress that both recently withdrawn article should be 100% removed from the picture since they demonstrated nothing at all.

Cheers,
Bernard

[faberryman]

It was done for political reasons.  But we can't discuss that in this thread.  So we'll all have to walk around acting like dummies.  Which is why this thread is a waste of everyone's time.

What part of No Politics don't you understand? You'd think being banned for seven days would be enough of a wake up call. Apparently not.

[BernardLanguillier]

For a change we seem to be in total agreement.  How did the authors discover this issue within one week after publishing it?  Suddenly they do their due diligence afterwards, not before. How come they didn't ask for the data before the report was published yet days afterwards they pull it? 

It seems they had to know the original data would not be released to them long before they published.  But they published anyway.  Why?

Not quite Alan.

You are focusing on the authors and on their possible motivations, I am focusing on The Lancet, which is an order of magnitude more serious.

Authors can be genuinely convinced, no issue. It could be a combination of honnest mistakes and an inability to take sufficient distance with one’s own work.

But a scientific journal as prestigious as the Lancet is supposed to act as a gatekeeper. And they have failed miserably here.

Note that I am not focusing on the why but on the what which is relevant because it touches on the credibility or lack thereof of the very mechanism through which scientific knowledge is being shared.

Cheers,
Bernard

[Robert Roaldi]

I don’t have an opinion about the authors.

But I still cannot understand how and why:
- the Lancet decided to publish such an article without peer reviews
- how they could themselves overlook the obvious huge issues with the article before publishing it, knowing full well how controversial it was going to be. It took less than one hour for professional researchers to report about the very visible issues with this study

I am sorry, but this level of screw up doesn’t happen.

This is akin to Real Madrid loosing 10:0 against a team of blind monkeys.

Cheers,
Bernard

It's not anything of the kind. I think your outrage is exaggerated. This is not the end of science. It's not even a particularly nasty case. I don't understand your statement that these kinds of screw-ups don't happen. They do. And this one self-corrected and pretty quickly at that.

Why do you say it was published without peer review? I never saw that mentioned anywhere and I find that doubtful. There is no guarantee that the peer review would have discovered the underlying issues. My understanding is that the authors relied on a data base not of their creation. If the researchers who did the peer review also accepted the data source, if they had no reason not to, then the problems with the underlying data would not have been discovered by them. It's quite possible that none of the reviewers had any reason to doubt the source of the data. Peer reviewers do not repeat all your work from the ground up.

[Chris Kern]

It was done for political reasons.  But we can't discuss that in this thread.  So we'll all have to walk around acting like dummies.  Which is why this thread is a waste of everyone's time.

You have sat too long here for any good you are doing.  Depart, I say, and let us have done with you.

(1) Apologies to the monarchists in the audience.
(2) That is a request for a voluntary departure, not a proposal to have anyone banned from posting.

[Alan Goldhammer]

Alan, you didn't answer my question.  As I recall the report that was pulled indicated heart issues.  Those were reported with a lot of fanfare in the news.  You indicated that this new report closed the case anyway.  That isn't true because the new report said nothing about heart issues.  You should have indicated that the original pulled report was wrong about their severe conclusions of heart issues.  After all, that point was a big issue at the time the report was originally published.  Everything that report said was pulled including their conclusions about heart problems.  Your keeping silent on that is inappropriate.

I don't know which study you are talking about.  the big one that was pulled was whether HCQ worked or didn't.  The paper said it did not and the "owner" of the data base would not let it be audited.  That is all I know about that.  One of the major side effects of HCQ is heart arrhythmia and this is exacerbated when given in combination with azithromycin.  If you want a list of citations on this I probably can dig them up.  This is one of the reasons the VA, who published their own study a month ago, stopped giving it to patients and why the medical community at large are no longer using either HCQ or the combination as "standard of care" in hospitalized patients.  The drugs just don't work and this is what most of the papers say.

I don't know how better to answer your question.

[Alan Goldhammer]

But I still cannot understand how and why:
- the Lancet decided to publish such an article without peer reviews
- how they could themselves overlook the obvious huge issues with the article before publishing it, knowing full well how controversial it was going to be. It took less than one hour for professional researchers to report about the very visible issues with this study

I am sorry, but this level of screw up doesn’t happen.

This is akin to Real Madrid loosing 10:0 against a team of blind monkeys.

Cheers,
Bernard

Medical journals frequently publish communications on important clinical issues.  These are not peer reviewed but the editors may decide the issues are important enough that broader dissemination to the medical community is needed.  It is not just The Lancet but most other medical journals do the same thing.  Stuff happens and, as I said earlier, Dr. Mehra should have been more vigilant before submitting the paper for publication.  His reputation took a serious hit.

Real Madrid got trashed last year by my team, Ajax, at the Bernabeu in a Champions League game and were knocked out of the competition.  Stuff happens to them as well.

[Robert Roaldi]

Medical journals frequently publish communications on important clinical issues.  These are not peer reviewed but the editors may decide the issues are important enough that broader dissemination to the medical community is needed.  It is not just The Lancet but most other medical journals do the same thing.  Stuff happens and, as I said earlier, Dr. Mehra should have been more vigilant before submitting the paper for publication.  His reputation took a serious hit.

Real Madrid got trashed last year by my team, Ajax, at the Bernabeu in a Champions League game and were knocked out of the competition.  Stuff happens to them as well.

Ah, thank you. It was a Communication, not a full-blown article. My apologies for not knowing that, I managed to miss it. As you say, it looks bad for those authors, but Bernard's statements about the journal are misplaced. This is not much of anything in the end, a goof-up at a time when people are probably being a bit less careful because of the current pressure.

[armand]

All this drama happens because some people try to make science political, which shouldn't happen.
Honestly I didn't even read this study because it didn't really add anything, currently there is no good data that hydroxychloroquine is beneficial. Until such data exists, there is no purpose for it outside of prospective trials. As it is it shouldn't be given and that should be the default.


As to why Lancet published it, I don't know. Obviously there were failures to properly vetoed critical parts of it, maybe they were looking to become more relevant and jumped some steps. It makes no sense to be political, it didn't really add anything new. And Lancet also published the retracted study with the MMR causing autism, that probably did more damage (and still is) than all other retracted studies combined.

[armand]

Mortality in critically ill patients. Limited by location but supporting that when you have resources it's not that bad as some made it to be.
https://journals.lww.com/ccmjournal/Abstract/9000/ICU_and_Ventilator_Mortality_Among_Critically_Ill.95639.aspx

[BernardLanguillier]

Medical journals frequently publish communications on important clinical issues.  These are not peer reviewed but the editors may decide the issues are important enough that broader dissemination to the medical community is needed.  It is not just The Lancet but most other medical journals do the same thing.  Stuff happens and, as I said earlier, Dr. Mehra should have been more vigilant before submitting the paper for publication.  His reputation took a serious hit.

Real Madrid got trashed last year by my team, Ajax, at the Bernabeu in a Champions League game and were knocked out of the competition.  Stuff happens to them as well.

Alan,

You know much better than this.

The very importance of this issue should have triggered an in-depth review by the Lancet. And one was not even needed. Any person with reasonable knowledge of medical studies in general and of the covid19 situation in particular, could have easily detected the problems that have caused the article to be withdrawn.

Anyway, I'll stop here.

Cheers,
Bernard

[Ray]

Anyway, if this was a conspiracy, it was a third-rate one without much consequence. I mean, if I were going to go to the trouble to submit an article to a prestigious science journal, find data, some co-authors, write and submit, I'd try to come up with something that would at least net me some cash or something. Otherwise, what's the point.

Exactly! We're all biased to some degree, and earning a living, maintaining the cash flow, and increasing one's prosperity, is a major cause of bias. However, I wouldn't describe that as 'without much consequence'.

Here's an informative article from the 'Journal of the Royal Society of Medicine' which addresses the problems of the Peer Review process.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420798/

"Peer review is at the heart of the processes of not just medical journals but of all of science. It is the method by which grants are allocated, papers published, academics promoted, and Nobel prizes won. Yet it is hard to define. It has until recently been unstudied. And its defects are easier to identify than its attributes. Yet it shows no sign of going away. Famously, it is compared with democracy: a system full of problems but the least worst we have.

That is why Robbie Fox, the great 20th century editor of the Lancet, who was no admirer of peer review, wondered whether anybody would notice if he were to swap the piles marked `publish' and `reject'. He also joked that the Lancet had a system of throwing a pile of papers down the stairs and publishing those that reached the bottom. When I was editor of the BMJ I was challenged by two of the cleverest researchers in Britain to publish an issue of the journal comprised only of papers that had failed peer review and see if anybody noticed. I wrote back `How do you know I haven't already done it?'   

I'll add a few more quotes from the article, for the benefit of those who can't be bothered to read it.

"But does peer review `work' at all? A systematic review of all the available evidence on peer review concluded that `the practice of peer review is based on faith in its effects, rather than on facts'. But the answer to the question on whether peer review works depends on the question `What is peer review for?'.
One answer is that it is a method to select the best grant applications for funding and the best papers to publish in a journal.

Stephen Lock when editor of the BMJ (British Medical Journal) conducted a study in which he alone decided which of a consecutive series of papers submitted to the journal he would publish. He then let the papers go through the usual process. There was little difference between the papers he chose and those selected after the full process of peer review.

Peer review might also be useful for detecting errors or fraud. At the BMJ we did several studies where we inserted major errors into papers that we then sent to many reviewers. Nobody ever spotted all of the errors. Some reviewers did not spot any, and most reviewers spotted only about a quarter.

So we have little evidence on the effectiveness of peer review, but we have considerable evidence on its defects. In addition to being poor at detecting gross defects and almost useless for detecting fraud, it is slow, expensive, profligate of academic time, highly subjective, something of a lottery, prone to bias, and easily abused.

People have a great many fantasies about peer review, and one of the most powerful is that it is a highly objective, reliable, and consistent process. I regularly received letters from authors who were upset that the BMJ rejected their paper and then published what they thought to be a much inferior paper on the same subject. Always they saw something underhand. They found it hard to accept that peer review is a subjective and, therefore, an inconsistent process."

[Jeremy Roussak]

It was done for political reasons.  But we can't discuss that in this thread.  So we'll all have to walk around acting like dummies.  Which is why this thread is a waste of everyone's time.

You have my permission not to read or contribute to it; I think we can survive being deprived of your insight into the motives of people of whom you know nothing. God forbid your time should be wasted.

The very importance of this issue should have triggered an in-depth review by the Lancet. And one was not even needed. Any person with reasonable knowledge of medical studies in general and of the covid19 situation in particular, could have easily detected the problems that have caused the article to be withdrawn.

As far as I've been able to gather, the paper was withdrawn because of perceived unreliability of the source data; that's not something peer review is designed, or indeed able, to detect.

Jeremy

[Alan Goldhammer]

I'll only add one final point to the ugly Surgisphere database retraction.  There are many good large data sets the either already exist or are being constructed as the SARS-CoV-2 virus infections have increased.  The UK National Health Service data records and the UK Biobank have both contributed to our understanding of the disease and offered some valuable clues as to how treatment of serious COVID-19 can be improved.  This is a huge advantage in countries that have national health systems and robust electronic medical records that can be easily examined.  One of the difficulties in the US is that each regional and local health system may have good data but it is cumbersome to aggregate and analyze.  this is one of the reasons there are a proliferation of preprints from US sites.  I think I've seen at least eight different groups within the greater New York/New Jersey area (there may be more as this is just a quick recollection) that have preprints on very similar clinical issues.