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Wednesday, June 03, 2020 - 17:35 SGT
Posted By: Gilbert

Of Logic, Looting, Twitter & Disinformation (Part I)

"There are decades where nothing happens;
and there are weeks where decades happen.

- Vladimir Ilyich Lenin

That there's been a lot going on these days, has to be a bit of an understatement, and it's nearly a full-time job just attempting to keep on top of events. But first, some updates on the local situation, and the developing #Lancetgate scandal. First up, in local news, the gahment has committed to building new and better dorms for migrant workers, which should probably have been done earlier, but late better than never. Alongside this, our Second Lady has come out with one of her more lucid Facebook posts, on how mask adherence and mask efficacy factors combine to reduce effective coronavirus R0. Hopefully somebody forwards this research to the WHO, who are by some reports "on the verge of doing a U-turn on its mask advisory", or perhaps on the brink of the verge thereof.

As noted in the previous post, the WHO certainly wasted no time at all in shuttering their HCQ trials based on a hot-off-the-press Lancet publication, and let's just say that it's not looking very good for either The Lancet's or the WHO's reputation, as Nature has picked up on. As the number of signatories to the open letter demanding clarification and transparency grows, a number of statisticians and clinicians have been moved to speak out on the incongruity of it all, with one particularly-pointed accusation of outright data fabrication gaining traction.

The main thesis of this statistician is fairly direct: how would a single, by all accounts quite-new and not-very-large company, have access to privileged patient health data from nearly 700 hospitals from all around the globe?! He points out that an entity capable of such a feat would require a veritable army of managers, liaisons, trainers, researchers, in-house lawyers, software developers, database engineers etc, merely to get off the ground. By all accounts, they should be easily a billion-dollar unicorn, if not close to that; instead, one estimate of its revenue has it at barely US$50,000 - which as the statistician notes, is not enough for "the discovery stage of an EHR integration project at a single hospital, never mind deploying anything" (on this, you might be surprised at just how varied and incompatible the EHR systems at different Singapore healthcare clusters alone can get, from my own experience)

These guys would have to be the greatest EHR integration specialists I have ever seen in my career
(Source: twitter.com)

It is then noted that the QuartzClinical software involved is heavy on platitudes and misattributed awards, and a parallel investigation by an M.D. from Columbia University turned out many more tasty tidbits about the firm - basically, there's no evidence of any research chops, and of the anywhere from five to eleven employees, only the founder (and second author) seems to have any medical credentials. Other than that, only a General Manager, a VP of Sales, a Science Editor and a "Scoence Editor" [sic] are listed on LinkedIn, which might not bode well for attention to detail. Apparently, QuartzClinical's Director of Sales Marketing might also be an event hostess and model, but if true this is one of the few details that would actually add to Surgisphere/QuartzClinical's credibility, IMHO.

Now, even if one were to discount entirely the company's shrouded history, possible links to Gilead (which is pushing the HCQ competitor, Remdesivir), and that their founder has seemingly been named in three medical malpractice lawsuits just last year, their purported data alone remains quite unbelievable, according to not a few practitioners. On the African data alone (since they've divided it by continent, for some reason), a professor from the London School of Hygiene & Tropical Medicine reckons it essentially impossible for some 40% of their coronavirus deaths to have been captured in hospitals with cardiac monitoring & comprehensive EHRs, from his group's extensive experience in southern Africa; reported smoking rates seem weirdly homogeneous across continents, and bear little resemblance to known rates; the American data appears infeasibly complete. Now, it's one thing if a paper has a discrepancy or oddity or two, I've seen plenty in my time, but the sheer amount of questionables here defies comprehension.

To top it off, it has moreover been noted that it could even be worse if all this data were in fact real and non-fabricated, since this would suggest that the hundreds of hospitals involved had somehow surrendered their precious confidential health records to a no-name startup - including cases where particular demographic data is outright illegal to maintain, as with ethnicity in France. In the first case, only the authors get canned for dishonesty; in the second, one gathers that there would possibly be a lot of interested lawyers circling about.

The public response was as expected
(Source: twitter.com)

In the face of this flood of justified doubt and sniff-test-failing, the company has put out a response, starting by asserting that their findings were consistent with previous retrospective studies in the other Big Four journals (which, note, say next to nothing about prophylactic potential), that their research was completely unfunded (another red flag), and concluded with what amounted to a repeated flaunting of their ISO certifications. On the actual substance of the criticisms raised in the open letter from the scientists, the authors first admitted to the mistake of wrongly labelling an Asian hospital in an official correction, with no acknowledgement of the many other salient points raised in the open letter, or promise of any further clarifications, while insisting that their findings stand.

Unfortunately, these ain't the bad old days of medical research, and I highly doubt that the 201 and counting scientists who put their names behind the challenge would be mollified by such a non-response - and nor should they. Fortuitously, the authors of the Lancet HCQ paper turned out to have published on the less-controversial topic of cardiovascular disease on a subset of the same dodgy data in NEJM, earlier this month. The signatories would send out a similar open letter to the NEJM on June 2nd. Credit to the NEJM, they appeared to have taken a second, closer look at the supplementary data (which could somehow be stratified by country, this time round), gulped, realised there was no way out, and put out an official Expression of Concern by the next day. Their hand now forced, The Lancet had little option but to belatedly follow with a similar statement of their own, and that they would... have the authors independently audit themselves. I suppose that settles it, then.

One senses that some fairly highly-placed heads are going to have to roll over this, as the enormity of this absolute abortion of the scientific process and medical hierarchy unwinds; but first, to put the entire clusterf**k in proper perspective here:
  1. You had a virtually-unknown company, claiming access to unverifiable proprietary patient information supposedly from many hundreds of hospitals throughout the world (that established consortiums helmed by renowned physicians would sweat to obtain a fraction of), write up a couple of papers presenting aggregate data that was wholly improbable, at least to those in the know

  2. Two medical journals widely acclaimed as the two most prestigious anywhere, The Lancet and the NEJM, went on to publish these articles and enshrine them in the topmost shelf of medical literature, after peer-review

  3. The World Health Organization then swiftly latched onto the Lancet paper on HCQ as definitive evidence, to halt their HCQ trials, and signal HCQ's inefficacy

  4. This recommendation from the WHO - who had been regarded as the foremost authority on public health internationally - causes several European countries to follow suit in abandoning their own investigations on HCQ; this, together with other disruptions, clearly impacted millions of lives in the middle of a pandemic

Now, there was no way that this could have gone from Point 1 to Point 4 directly; had Surgisphere and partners published in a third-rate journal, there would have been no possibility that their "findings" on HCQ could have driven global scientific direction. Instead, they had to borrow The Lancet's prestige, that in turn bought them (what remains of) the WHO's heft, which was used to demonize research into what is, to the best of my knowledge, the most practical, accessible and at least mechanically-plausible prophylactic treatment that has been in widespread application for the coronavirus. I don't think The Lancet, the WHO or their many mainstream media supporters can pin this on racists or rightists or "the Russians", for once.

Luckily, a number of countries have begun to follow Taiwan's lead on not trusting the WHO in earnest, with Indian health leaders quickly figuring that the Lancet study was incredibly sloppy, and various African nations continuing with their use of HCQ all along, because can one expect them to wait for a US$1,000++ course of Remdesivir? Meanwhile, the White House - so often at the cutting edge of scientific research - has okayed the delivery of two million doses of HCQ to longtime friend Brazil, over the outdated advice of Dr. Fauci (who has disappointingly been talking Remdesivir up despite scarce better evidence, which is probably why he's beginning to get ignored) on CNN. Retrograde Democrats in the House Foreign Affairs Committee and various congressional campaigns have only escalated their attacks on HCQ, because it's not like these people keep up with breaking exposés from Science.

To me, there remain two major "whys" - first, why did The Lancet have to print an egregiously-substandard piece of work, to further discredit HCQ? The various other big journals have already done their part, with technically-valid-if-inherently-biased retrospective studies, which generally compared the outcomes of particularly-sick patients that had been given sometimes strangely-high doses of HCQ as a Hail Mary, against generally-healthier controls; certainly, mainstream newspapers wouldn't bother to explain such subtleties; look at the New York Times not bothering to mention HCQ anywhere in the headline of their "report" on #Lancetgate, while being happy enough to scream "HCQ!" on negative articles. It wouldn't have been difficult to manipulate the public into being wholly against HCQ, had the corrupt corporate media simply kept this tack up.

So, it has come down to this?
(Source: twitter.com)

Some have suggested that it was down to ego, perhaps some CCP influence, and a desire to validate left-wing views (including past controversies where they seemed to loosen standards where surveys/papers concerned the Iraq War, and U.S. gun control) and discredit TRUMP, at least in The Lancet's case. A prominent statistics professor from Columbia has ironically pinpointed the most damning criticism, which came from a certain British activist editor. Which brings us to the second why - why stack the deck to this extent, against an approach that might well help? Heck, I am hardly certain that HCQ plus whatever is a steel-plated prophylactic/cure, but isn't it the point of science to give it a fair go?

Look, it's one thing if politicos shitpost "stout man morbidly obese", "ugly woman sick" or "black people ain't black if they don't vote for me"; but this is supposed to be science, and not only that, public health. One really shouldn't politicize it, whatever moral high ground they think they occupy, because everyone deserves the same opportunity to medical care, however ludicrous and unfounded their political inclinations are. There was simply no call for The Lancet and other prominent medical journals to put their grubby thumbs on the scale. I'm watching if the various medical celebrities playing up the Lancet study do the right thing here (but a brief glance suggests not, given they're popularizing statistics without even normalizing for total population here), but one expects that, in a responsible world, The Lancet and the WHO are going to take a yuge hit.

Now, I could be entirely wrong here, of course, and Surgisphere etc. could indeed produce convincing evidence that the data from their 671 hospitals are real to the satisfaction of the open letter signatories, in which case I would gladly make a grovelling apology. However, if I were a betting man - and I can be one, under the right circumstances, such as this one - I'd bet not. Let's just hope The Lancet doesn't take twelve years for this retraction, then.

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Next: Of Logic, Looting, Twitter & Disinformation (Part II)

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Of Logic, Looting, Twitter & Disinformation (Part II)
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Of Logic, Looting, Twitter & Disinformation (Part 2.5)
Of Logic, Looting, Twitter & Disinformation (Part 2.75)

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