randombio.com | commentary
Thursday, April 23, 2020. Updated April 25 2020

Bad science and bad reporting about COVID-19

The dismal quality of science reporting by the news media now threatens our very lives

D uring the Reagan administration the press once picked up a story about some low level bureau­crat classifying ketchup as a vegetable. For weeks they tried to blame President Reagan for it, as if he had personally demanded that ketchup was a vegetable. This idiocy went on for weeks.

News media coverage has gotten much worse since then. It is now so bad that unless I know from personal experience that something the media say is true, I assume it's a lie.

There's no better example than their misreporting of that retrospective Veterans Administration study on the preprint server MedRxiv purporting to show that hydroxychloroquine (HCQ) increases the death rate in Covid-19 patients. The study was so badly done I almost didn't bother blogging it.

Here's what I wrote on Tuesday (Apr 21 2020):

There is a strong suggestion that HCQ might have been preferentially given to sicker patients. This is shown by the clinical chemistry results in the authors' Table 2, which showed significant baseline differences among the three groups for pulse oximetry, ALT, AST, serum albumin, bilirubin, RBCs, hematocrit, C-reactive protein, Troponin I, leukocytes, lymphocytes, and platelet count.

The percentage of patients who were hypoxic was 40% higher in the HCQ group and 60% higher in the HCQ+AZ group compared to the controls, indicating that the patients who were treated started with more severe illness.

No conclusion about HCQ can be derived from the data presented. If I were peer-reviewing this one, I'd recommend rejection.

HCQ headline from UK Daily Mail
Fake news headline about HCQ from UK Daily Mail

I remain agnostic as to whether HCQ works, but even a layman with minimal medical knowledge would know that this particular study was useless. I suspect even the authors knew it, but submitted it for publication anyway, perhaps hoping it would be useful. This was undoubtedly why they included a detailed table describing how their subject population was unbalanced. Since their scientific reputation has taken such a beating in the past few days, in part from a blistering rebuttal from Raoult himself (the senior author on the original French study), they probably wish they'd been more forthright about it.

Imagine my surprise when the mainstream press gleefully reported this bad study as if it was final proof that HCQ was useless, and that it was all Trump's fault. Here's how CNN reported it:

New study shows hydroxychloroquine didn't work against Covid-19

A new, unpublished study found that hydroxychloroquine, a drug President Trump has cited as key in fighting coronavirus, has a higher death rate among coronavirus patients compared to those not on the drug.

The UK Daily Mail said much the same thing, only with more CapsLock (see screengrab). The reporters could not have either read or understood the paper, nor could they have contacted any scientist or physician, as used to be traditional for any science story. Any scientist would have taken one look at it and told them it was fatally flawed.

The news media's misleading coverage of the statement from the National Institutes of Health is similar. Here are the main points of the statement:

There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19 (AIII). If chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for adverse effects, especially prolonged QTc interval (AIII).

There are insufficient clinical data to recommend either for or against using the investigational antiviral drug remdesivir for the treatment of COVID-19 (AIII).

Except in the context of a clinical trial, the COVID-19 Treatment Guidelines Panel (the Panel) recommends against the use of the following drugs for the treatment of COVID-19:

The combination of hydroxychloroquine plus azithromycin (AIII) because of the potential for toxicities.

Lopinavir/ritonavir (AI) or other HIV protease inhibitors (AIII) because of unfavorable pharmacodynamics and negative clinical trial data.

This is an intelligent, balanced, and thoughtful statement, and I'm not just saying that because I have a grant being reviewed there. Yet the news media misreported it as if NIH was condemning HCQ and that it is another rebuke to Trump. Here's how Forbes reported it, using it as a springboard to attack Trump:

A panel of medical experts from the National Institutes of Health on Tuesday recommended against using the combination of hydroxychloroquine and azithromycin to treat the coronavirus outside clinical trials, undercutting President Donald Trump's early claims that the drugs were a promising treatment for the disease.

Any doctor would recommend against using a combination of drugs that hasn't been shown to be safe and effective. Drug interactions can be nasty indeed.

As my summary shows, much of the research so far has been unimaginably shoddy: some studies were done without a placebo control, meaning it is in principle impossible to tell whether the treatment did anything. Other studies had treated groups in one hospital and controls in another. One used as a control group patients where the treatment was delayed for 48h, even though they knew the date that the infection started was impossible to determine.

The misreporting of science by the press has crossed a line where it threatens our very survival. It's no longer as amusing as it once was. This pandemic is almost over and we still don't have a clear answer from any of the trials. The press, normally viciously hostile to Big Pharma, took uncritically Gilead's PR statement on remdesivir, which was contradicted by their own paper in NEJM just a week earlier.

I could rant for hours about the poor quality of the science on this topic, and maybe some readers think that's what I'm doing now. And maybe they're right.

But these examples of bad science and worse reporting undermine the reputation of scientists everywhere. Scientists must fight back when the press jumps on a bad study and demand that the press cover it accurately. Otherwise the public will increasingly see science as a political tool.

Our society might be able to survive without a viable English literature or without a credible university sociology or climate studies department, but it cannot survive without an accurate understanding of how to differentiate good science from bad. People make life and death decisions based on what they believe to be true. If no one can be relied on to speak the truth, then those decisions will be wrong.

As for ketchup, tomatoes are technically fruit, as are eggplants from which ketchup was originally made (according to my dictionary). Does that make ketchup a fruit? I suspect no one really cares.

Update, apr 24 2020 A new study from Brazil was released today showing that doses of chloroquine (not hydroxychloroquine) when given at high doses with two antibiotics (ceftrixone (i.v.) and azithromycin) and an antiviral (oseltamivir) increased death rates. The headlines are predictable: celebrate it as a defeat for Trump. A summary of the results is here.

apr 23 2020, 6:44 am. updated apr 25 2020, 5:58 am

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