
Three authors retract study on hydroxychloroquine and chloroquine - marvin
https://www.thelancet.com/lancet/article/s0140673620313246
======
pen2l
A lot of the controversy surrounding this Lancet paper was about the data
being used, which was provided by a firm named Surgisphere [1]. One of the co-
authors of the Lancet paper is Sapan Desai, he is incidentally also the chief
executive of this firm.

The lone one who chose not to retract the paper was him.

I recommend this twitter thread that explains the thrust of the issue:
[https://twitter.com/reverendofdoubt/status/12669029690454630...](https://twitter.com/reverendofdoubt/status/1266902969045463041)

Essentially, doubt began swirling around when this company claimed to acquire
in a very short time massive amounts of EHR (Electronic Health Record,
basically large datasets showing how patients are doing, how they're
responding to medication, etc.). When Sapan Desai was pressed on by the other
three authors of this very paper, he refused to cooperate, invoking a somewhat
shoddy defense of not being at liberty to reveal sensitive information.
Surgisphere refuses to say which hospitals chose to give it the EHR.

The thing is, this EHR data is a big deal. Pharma companies give _big_ money
to hospitals for this data. One of the key questions has been how this
newcomer company managed to acquire these EHR deals with such a large number
of hospitals. Since the scrutiny, NEJM has also chosen to retract a
Covid-19-related paper which sourced data from this company:
[https://www.nejm.org/doi/full/10.1056/NEJMoa2007621](https://www.nejm.org/doi/full/10.1056/NEJMoa2007621)

[1]: The company is choosing to stand behind the data:
[https://surgisphere.com/2020/05/29/response-to-widespread-
re...](https://surgisphere.com/2020/05/29/response-to-widespread-reaction-to-
recent-lancet-article-on-hydroxychloroquine/)

~~~
taurath
It feels like a large part of the value of a journal like the Lancet is that
they DON'T do stuff like this. That one of the authors is ceo of the company
that owns the data behind the study should be a glaring red flag. What value
does the Lancet still have?

Note - I edited this post because it was much more crass and reactionary, and
realized its not at all my domain, so I rephrased.

~~~
knzhou
The value is that even given this, they're much more reliable than preprints,
and _much much_ more reliable than sensational Twitter threads or public
forums. They manage to filter out a tremendous amount of crap, but a
sufficiently crafty and dishonest author can still sometimes slip past -- as
is possible in any system.

~~~
sbierwagen
Sure, but lots of high profile papers in top end journals like Nature fail to
replicate: [https://www.vox.com/science-and-
health/2018/8/27/17761466/ps...](https://www.vox.com/science-and-
health/2018/8/27/17761466/psychology-replication-crisis-nature-social-science)

If we are to learn anything from the last 10 years of the replication crisis,
it has to be that a single paper is a data point, not a conclusion.

~~~
Fishysoup
Scientists, especially in biology (possibly psychology too but i don't know),
do look at papers as data points and not conclusions. The "conclusion-minded"
treatment of papers is a sad artefact of the publish-or-perish system (have to
add a ton of spin to your results to make them publishable) and of pop science
journalism.

------
walterbell
How about thanking or crediting the many independent doctors and scientists
([https://zenodo.org/record/3873178](https://zenodo.org/record/3873178)) who
identified the issues in Lancet's publication? Even Apple credits/pays
independent researchers for finding weaknesses in Apple code.

Will countries now revert national health policy changes that were based on
this questionable study? What about the families of patients who were denied
_early_ HCQ treatment based on this study? Who is liable for their denial of
treatment?

James Todaro, May 29th, [https://www.medicineuncensored.com/a-study-out-of-
thin-air](https://www.medicineuncensored.com/a-study-out-of-thin-air)

 _> Misinformation is bad. Misinformation in medicine is worse. Misinformation
from a prestigious medical journal is the worst. Herein is a detailed look at
the controversial Lancet study that resulted in the World Health Organization
ending worldwide clinical trials on hydroxychloroquine in order to focus on
patented therapeutics._

Guardian, June 3rd,
[https://www.theguardian.com/world/2020/jun/03/covid-19-surgi...](https://www.theguardian.com/world/2020/jun/03/covid-19-surgisphere-
who-world-health-organization-hydroxychloroquine)

 _> The very serious concerns being raised about the validity of the papers by
Mehra et al need to be recognised and actioned urgently, and ought to bring
about serious reflection on whether the quality of editorial and peer review
during the pandemic has been adequate. Scientific publication must above all
be rigorous and honest. In an emergency, these values are needed more than
ever._

James Todaro helped to bring this questionable study to light—his website
([https://www.medicineuncensored.com/](https://www.medicineuncensored.com/))
and compilation of HCQ studies ([https://docs.google.com/document/d/1O6Cls-
Oz2ZAgJuyDbnICEGjM...](https://docs.google.com/document/d/1O6Cls-
Oz2ZAgJuyDbnICEGjMvQPEyM-aaXARUomR9Ww/)) may be of interest.

~~~
sjg007
The university of Minnesota has a clinical trial out showing no early benefit
of HCQ treatment.

~~~
adventured
> The university of Minnesota has a clinical trial out showing no early
> benefit of HCQ treatment.

They have yet to publish the results on whether it benefits patients during
the early onset of symptoms. [1]

Is hydroxychloroquine paired with zinc in the two studies? That has been the
central claim of people supporting hydroxychloroquine this entire time and so
far I've yet to see them used together in an early treatment / preventative
study in the US (perhaps they've done so in Europe or China?).

[1] "A separate U trial is examining whether it benefits patients after early
onset of symptoms, but results haven’t been published."

[https://www.startribune.com/anti-malaria-drug-in-u-of-m-
tria...](https://www.startribune.com/anti-malaria-drug-in-u-of-m-trial-does-
little-to-stop-covid-19/570989342/)

------
staycoolboy
Here is a great example of why I keep pointing out how difficult it is to be a
critical thinker. There isn't a single source to go to that gives the current
status of HCQ + COVID, and there are dozens of links to journals in this
thread that are making my head spin. So when people ask my opinion on HCQ, my
answer is now: "I don't know, we don't have enough data that has been studied
and approved by multiple peer-reviewed journals, because one isn't enough."

This doesn't shake my attitude toward science in the slightest, but it does
leave me feeling very uninformed. But maybe, just maybe, that is the correct
phase-state to be in given the data? Or have I been zone-flooded?

~~~
deelowe
My answer is "we don't know but there seems to be little harm in trying it."
This is what's happening right now. Sure, it's a bit of a shotgun approach,
but again, if Drs want to used an already fda approved drug and try various
approaches to see if it helps, I see no issue. Honestly, I don't get all the
politics around this.

~~~
gus_massa
> ... _there seems to be little harm in trying it [...] if Drs want to used an
> already fda approved drug_ ...

All drugs have side effects, for example
[https://www.webmd.com/drugs/2/drug-5482/hydroxychloroquine-o...](https://www.webmd.com/drugs/2/drug-5482/hydroxychloroquine-
oral/details) So each drug is a (small) risk for the patient. The idea of
testing the drugs in RCT before using in the patients in the wild is that you
can be quite sure that the benefits are greater than the risks.

------
mhandley
Well done to the three authors who launched an independent peer review of the
dataset, and when those reviewers couldn't verify it, asked for the paper to
be withdrawn. I'm sure they will always regret they didn't ask more questions
earlier, but once discrepancies emerged, they seem to have acted with
integrity.

~~~
mindfulhack
However, it reminds me how many believe in scientific studies - i.e.
_individual_ scientific studies - almost like a religion - holding up one
study and result like it's the bible. Instead, we need to attach our primal
emotions to the _scientific process_. Work should be done in the media and
popular science to educate the public to make them learn to latch on to the
process...and much less abuse of science may take place.

Would anyone else agree?

~~~
mhandley
I would definitely agree; even when we're trying our absolute best to get to
the bottom of a phenomenon (and from some people's publication counts, it's
clear not everyone does that), it's still possible to delude ourselves and
often then also the reviewers. Over time consensus is achieved, but it's rare
any scientist trusts a single study or paper. A problem then arises when you
really need results fast, as with COVID-19, because good science isn't fast.

------
ardy42
Influential Lancet hydroxychloroquine study retracted by 3 authors
([https://www.cbc.ca/news/health/hydroxychloroquine-covid-
lanc...](https://www.cbc.ca/news/health/hydroxychloroquine-covid-
lancet-1.5598761))

> Three of the authors of an influential article that found hydroxychloroquine
> increased the risk of death in COVID-19 patients retracted the study on
> concerns about the quality of the data....

> Results of a [different] high-quality randomized, placebo-control trial also
> published yesterday in the New England Journal of Medicine from U.S. and
> Canadian researchers showed hydroxychloroquine was no better than placebo
> pills at preventing illness from the coronavirus.

------
hartator
> "can no longer vouch for the veracity of the primary data sources."

It's a little understatement when the accusations are they made up the data.

~~~
groby_b
You're conflating many "they" here.

The retraction is by the study authors. The data is from a company that's
entirely different, and that company claims their data is "proprietary" and
they can't share it.

There's strong suspicion that that proprietary data is in fact made up, but
the study authors cannot prove it. And you really don't want to retract a
study by making unproven allegations.

"We can't vouch for the veracity" is all they can truthfully say.

For the full statement: "“Our independent peer reviewers informed us that
Surgisphere would not transfer the full dataset, client contracts, and the
full ISO audit report to their servers for analysis as such transfer would
violate client agreements and confidentiality requirements. As such, our
reviewers were not able to conduct an independent and private peer review and
therefore notified us of their withdrawal from the peer-review process.”[1]

The authors tried for an independent audit. Surgisphere failed to cooperate.
Given the history of its principal, not a surprise.

[1]
[https://www.theguardian.com/world/2020/jun/04/covid-19-lance...](https://www.theguardian.com/world/2020/jun/04/covid-19-lancet-
retracts-paper-that-halted-hydroxychloroquine-trials)

~~~
himinlomax
The CEO of said company is one of the authors.

In any case, even if he wasn't, the other three dunces should never have
trusted such dubious data.

------
stephc_int13
In the best scenario, this whole story is an illustration of incompetence, in
the worst case, this is a sign of corruption. In both, more scrutiny is
needed.

------
jussij
Back in 1998 Andrew Wakefield duped Lancet with a concocted MMR autism study
and the consequence of that study still haunt us to this day.

Now it appears this has happened again.

~~~
knzhou
The MMR study took 12 years from publication to retraction. This one took 12
days.

~~~
marvin
That's certainly an improvement, but even if health authorities and
researchers quickly adapt their knowledge to reflect the retraction of this
paper, the wide media circulation of "HCQ will kill you" has permanently
poisoned the well of test patients for future research.

Even though the retraction was quick, the damage to future research is
permanent. If this was in fact a propaganda operation rather than just
incompetence, pride and an unethical career gambit, it was an incredibly
successful one.

When someone fakes data to this degree, in a case that has this level of
immediate real-world impact, one has to question the motivation behind it.
Hope this gets illuminated during the investigation, but I'm not holding my
breath.

------
elihu
What did the retracted study say about hydroxychloroquine and chloroquine? Did
it claim they were efficacious versus COVID-19, or that they weren't? Or was
it something else?

~~~
tjenkinsqs
If you want real scientific studies, have a look here:

[https://academic.oup.com/aje/advance-
article/doi/10.1093/aje...](https://academic.oup.com/aje/advance-
article/doi/10.1093/aje/kwaa093/5847586?fbclid=IwAR1uM2zcTs_UpRT4hKcf2Vm4gHDHI8wWflHEArys-
Dax4vRPcTYoZCgLi9Q)

~~~
benmaraschino
One of these "studies" is a 2-page Google Doc with no real data. Another is
the discredited Raoult study, which is under investigation by the journal [1].
Another study cited is also by Raoult's team. The Brazil study (ref. 29)
doesn't seem to have passed peer review (yet?) and has severe methodological
flaws. Like the Raoult studies, the Brazil study was not randomized, but makes
no attempt to control for confounding by indication or self-selection, such as
with propensity score matching or similar methods commonly used in
observational studies. The last study cited isn't a study, but an article from
a local news station.

[1] [https://retractionwatch.com/2020/04/06/hydroxychlorine-
covid...](https://retractionwatch.com/2020/04/06/hydroxychlorine-
covid-19-study-did-not-meet-publishing-societys-expected-standard/)

------
wyck
The media really went to town on this one, the reports that you might die
using it lacked some real common sense, all of a sudden a drug that was
approved in 1955, considered extremely safe (listed as an essential medicine
by WHO) , and used on millions of people... is suddenly not safe.

~~~
mafuy
Isn't the problem that it was so far used in a quite different dosis? The
covid applications seems to increase the limit 14x. That's reason enough not
to carry over the established safety status.

------
mrosett
The medical profession needs to have a serious discussion about whether or not
the Lancet should still be treated as a top journal.

In addition to this retraction, 3 of the top 10 most cited retracted papers of
all time were published in the Lancet. [0] This includes the infamous
Wakefield "vaccines cause autism" paper which is probably the most damaging
scientific fraud of the last several decades.

On the editorial side, they've become quite outspoken on political matters
[1], publishing one piece calling for the ban of tobacco, a letter expressing
strong opinions on the Israel/Palestine conflict, and a piece just a couple
weeks ago calling for Americans to vote Trump out of office. The also
published a rather controversial study that provided very high estimates of
the civilian death toll of the Iraq War. I'm inclined to agree with their
position on some issues and disagree with it on others, but either way they
seem to court controversy.

All of this has been under the same editor, Richard Horton (who is himself
quite outspoken.) Put it all together, and the picture that emerges is a
publication that values making a splash (whether by publishing shocking
results or by taking a position on political issues) over getting things
correct. That's irritating behavior in a tabloid. In a prestigious journal,
it's horrifyingly irresponsible.

[0] [https://retractionwatch.com/the-retraction-watch-
leaderboard...](https://retractionwatch.com/the-retraction-watch-
leaderboard/top-10-most-highly-cited-retracted-papers/)

[1]
[https://en.wikipedia.org/wiki/The_Lancet#Controversies](https://en.wikipedia.org/wiki/The_Lancet#Controversies)

------
emtel
As I understand it, the WHO changed policy on HCQ because of this study. So,
if you had posted a YouTube video criticizing this study and the WHO decision,
Google may have taken that video down in accordance with their policy to
delete videos the are counter to WHO policy. That didn't actually happen, to
my knowledge. But it would have been Google policy if it did.

 _That_ is what is wrong with platforms like Google and Facebook adopting the
role of fact-checkers.

~~~
newacct583
> Google may have taken that video down in accordance with their policy to
> delete videos the are counter to WHO policy.

Good grief. Why are urban legends so hard to kill? There is no such policy.
There never was.

The source of that bit of ginned-up outrage was an informal interview (when I
looked this up earlier, there wasn't even video or a transcript available
anywhere!) where someone senior was asked about what Youtube's criteria were
for vetting advice in the face of the pandemic. And the answer was a hand-wavy
thing about how anything that was clearly wrong, or clearly dangerous, and one
of the examples given was about medical advice that clearly runs counter to
existing health care bodies like the WHO.

And that's as far as it went. There never was a policy about the WHO. To my
knowledge no video was ever removed because of a conflict with the WHO.

The whole point wasn't to nitpick about exactly what the WHO said, it was to
reference the fact that Youtube would adhere to expert consensus where
possible.

> That is what is wrong with platforms like Google and Facebook adopting the
> role of fact-checkers.

The irony there is that, had Google or Facebook or _someone_ taken on that
role, you wouldn't have internalized this fake fact because whoever it was
that spun it to you wouldn't have had an audience. But they didn't. So you got
lied to.

Which is better?

~~~
nostromo
> There never was a policy about the WHO.

"Anything that would go against World Health Organization recommendations
would be a violation of our policy." \- YouTube CEO Susan Wojcicki

> To my knowledge no video was ever removed because of a conflict with the
> WHO.

"Sharyl Attkisson, host of the nationally syndicated news magazine TV show
"Full Measure" had her story about "politicizing COVID-19 medicine" pulled by
YouTube, because the video service deemed it 'dangerous.' The issue was that
one doctor said that hydroxychloroquine still needed to be studied."

[https://abc3340.com/news/nation-world/youtube-reinstates-
hyd...](https://abc3340.com/news/nation-world/youtube-reinstates-
hydroxychloroquine-story-after-deeming-it-dangerous)

~~~
newacct583
That's the quote from the interview I mentioned. Now find me the _policy_ you
claim exists. Hell, even find me a transcript of that interview. This is
literally one story written about one out of context quote with no external
verification by any of the parties involved. It's the very definition of
manufactured outrage.

As far as the video you linked: it was reinstated. That's right there in the
headline of the article you linked. They messed up, and put it back. Isn't
that saying that their actual policy is the _opposite_ of what you claim?

~~~
emtel
Here is the policy:
[https://support.google.com/youtube/answer/9891785?hl=en](https://support.google.com/youtube/answer/9891785?hl=en)

~~~
pnako
That policy is completely absurd on its face.

>YouTube doesn't allow content that spreads medical misinformation that
contradicts the World Health Organization (WHO) or local health authorities’
medical information about COVID-19

What if local health authorities contradict WHO medical information?

Google's mission used to be to organize the world's information. Now they seem
to be want to go way beyond that.

~~~
josephcsible
>>YouTube doesn't allow content that spreads medical misinformation that
contradicts the World Health Organization (WHO) or local health authorities’
medical information about COVID-19

>What if local health authorities contradict WHO medical information?

Simple: then you're not allowed to upload videos on those topics at all.

------
hkai
So then should we also retract the continuous media message that we've heard
for days, claiming that chloroquine kills people? It was on the front page of
every media outlet.

~~~
newacct583
No, we should cover the retraction. And we are, that's what the linked article
is. I genuinely don't understand the need on some people's part to impart an
"agenda" here.

The president of the united states _made_ this front page news by boosting the
drug in a context where there was minimal evidence that it helped. That's
newsworthy. It just is. The same principle that gets his statements on the
front page gets refutations there too. It's news if he's right. It's news if
he's wrong.

I mean... what would your preferred action be? Not cover newsworthy science?
Not cover the statements of the president? Or do you just not want them to
cover stuff you personally disagree with?

In reality: they covered the president, they covered the result, and they
covered the retraction. All with pretty solid reach, frankly. We're literally
yelling about it right now.

------
tartoran
Such a poop-show. This is going to hurt the public trust in science, let’s
hope this is short term because what is the alternative?

------
buboard
Another study that was using the same data was retracted from NE Journal of
Medicine:

[https://www.nejm.org/doi/full/10.1056/NEJMc2021225](https://www.nejm.org/doi/full/10.1056/NEJMc2021225)

------
tjenkinsqs
Regarding HCQ safety:

This is from the CDC web site: safe for young, old and pregnant:

[https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/hydroxyc...](https://www.cdc.gov/malaria/resources/pdf/fsp/drugs/hydroxychloroquine.pdf)

~~~
mafuy
Is this the same as what is applied for covid patients? Elsewhere it was
stated that for covid, the dosis is increased 14x.

------
asdff
The lancet is a good journal, but how did this study as well as that retracted
study on vaccines and autism end up in this journal and not JAMA or NEJM? At
this point, I'm a little suspicious of their peer review process if these
contrarian papers that turn out to be wrong in the end aren't being properly
scrutinized at the peer review level, and will spend much more time in methods
sections of striking lancet papers.

------
dang
See also
[https://news.ycombinator.com/item?id=23420774](https://news.ycombinator.com/item?id=23420774)

~~~
jakeogh
And the original:
[https://news.ycombinator.com/item?id=23272222](https://news.ycombinator.com/item?id=23272222)

------
stephc_int13
I hope this will lead to more public scrutiny about the practices of the
leading scientific journals.

------
MilnerRoute
_The study 's three authors retracted their study on June 4th, "because
independent peer reviewers could not access the data used for the analysis,"
reports The Hill. "The source of the data was Surgisphere Corporation, which
told peer reviewers it would not transfer the full dataset used for the study
because it would violate client agreements and confidentiality requirements."_

 _However, the same day the New England Journal of Medicine published results
from a new double-blind randomized, placebo-controlled trial which found
hydroxychloroquine didn 't help prevent people exposed to others with Covid-19
from developing the disease. One of the study's co-authors said that as a
preventative agent, "It doesn't seem to work."_

[https://science.slashdot.org/story/20/05/23/0140202/study-
of...](https://science.slashdot.org/story/20/05/23/0140202/study-
of-96000-covid-19-patients-finds-hydroxychloroquine-increased-their-risk-of-
dying)

~~~
mxcrossb
This should terrify any researcher working with a private company’s data. I
think top journals need to change their policy here ably data availability,
especially when private companies get involved.

~~~
WalterBright
> private companies

Government entities hardly exempt from self-serving bias and manipulation.

------
Alex3917
Headline is wrong. Lancet didn't retract the study, three of the four authors
did.

~~~
dang
Ok, we've put three authors in the HN title to reflect that.

------
bsaul
now will there be a next step ? This looks like fraud, and my hope now is that
there is a police investigation, because it may very well be guided by
economical interest.

No conspiracy theory here, there's nothing sure, but we can't rule it out
completely either.

~~~
tunesmith
What's the economic interest of claiming the medication _doesn 't_ work?

~~~
comicjk
The company that provided the data, Surgisphere, might have been trying to
raise their profile by getting a big publication. They're a bit shady.

[https://blogs.sciencemag.org/pipeline/archives/2020/06/02/su...](https://blogs.sciencemag.org/pipeline/archives/2020/06/02/surgisphere-
and-their-data)

------
tjenkinsqs
Five studies show effectiveness of Hydroxychloroquine for outpatients

[https://academic.oup.com/aje/advance-
article/doi/10.1093/aje...](https://academic.oup.com/aje/advance-
article/doi/10.1093/aje/kwaa093/5847586?fbclid=IwAR2x3eEIuV9EbOmtAN7U35eZsmMNsohWXrh-
RIwxTIei5KhHa5iKsk2YE2o)

~~~
abbracadabbra
Since this is being repeated multiple times, quoting benmaraschino:

One of these "studies" is a 2-page Google Doc with no real data. Another is
the discredited Raoult study, which is under investigation by the journal [1].
Another study cited is also by Raoult's team. The Brazil study (ref. 29)
doesn't seem to have passed peer review (yet?) and has severe methodological
flaws. Like the Raoult studies, the Brazil study was not randomized, but makes
no attempt to control for confounding by indication or self-selection, such as
with propensity score matching or similar methods commonly used in
observational studies. The last study cited isn't a study, but an article from
a local news station.

