
A mysterious company’s Covid-19 papers in top medical journals may be unraveling - onemoresoop
https://www.sciencemag.org/news/2020/06/mysterious-company-s-coronavirus-papers-top-medical-journals-may-be-unraveling
======
tuna-piano
Ugh. I'm so disappointed in this whole situation. Feels like Theranos.

I want to cover my eyes and ears for the media and political shit show that's
going to come from this. It's true that a certain politician shouldn't be
trumpeting unproven treatments, but the media seemed to celebrate when that
politician was "proven" wrong. Did we forget that we should all be rooting for
treatments to work?

I hoped during this pandemic science would move fast and sacrifice some
accuracy for speed. But I didn't expect (a seemingly) complete fabrication
could go so far with so many eyes. Now I worry the overreaction toward
accuracy-over-speed will cause significant slowdowns in published data.

We shouldn't over-punish honest mistakes when we value speed over accuracy...
but this just feels awful. Would think prison is likely to come.

A good read: [http://freerangestats.info/blog/2020/05/30/implausible-
healt...](http://freerangestats.info/blog/2020/05/30/implausible-health-data-
firm)

~~~
gfodor
Even I hadn't let my cynicism about our national discourse sink so low as to
think medical treatments would be politicized. Ultimately, it was a new low
point. Once it started it was clear where this was going. Many may have died
from it if the worse case scenario turns out to be true: this treatment does
in fact work, and was stalled or prevented due to politics.

Similarly, the complete disregard by the medical community of playing their
role in reminding others organizing protests to take steps to prevent
participants from spreading the virus has been equally disturbing. I've heard
literally nothing from the medical community about tips, methods, or
instructions for ensuring protestors do not cause a new outbreak. There does
not seem to be any innovation happening in helping people organize and protest
while keeping social distancing in mind. I don't know what that would look
like, but it's a moral failure that the problem hasn't been worked whatsoever.
I haven't even heard stories of people just handing out masks. Things are
quite dire.

~~~
Nursie
>it if the worse case scenario turns out to be true: this treatment does in
fact work, and was stalled or prevented due to politics.

There are two worst case scenarios here - Firstly, politicians pushing
unproven drugs on the general population, causing unnecessary deaths.
Secondly, treatments which may have some efficacy being abandoned because of a
reaction against those politicians, potentially causing a failure to bring an
effective treatment to bear.

Both of these can be true at the same time.

~~~
DataWorker
But did we actually have “politicians pushing drugs”? “Push” sounds to me like
“suggest people take.” I’m certain that the president didn’t tell anybody to
take anything. He said almost verbatim what dr fauci was saying elsewhere at
that same point in time. (See dr fauci on the jama podcast earlier that same
week.) I won’t argue that the president has not oversold optimism at every
juncture, but to say he “pushed” people to take plaquinil (illegally?) is
either delusional or dishonest.

~~~
Nursie
It's beyond optimism to latch on to an a specific treatment that has no real
evidence attached, and say things like "what have you got to lose?" from your
podium, speaking as president. It's deeply inappropriate.

Where you personally draw the line between "authority figure spouting off
about something in official capacity" and "pushing" is up to you, but it's
hardly delusional. It's also a hypothetical worst case scenario, if you read
what I actually wrote.

------
fabian2k
Hydroxychloroquine is a really frustrating topic as there's so much bad
science involved. The early studies were terrible and didn't give any useful
information. And now we have more studies in prestigious journals that appear
to be at least problematic, if not based on outright faked data. And on top of
that are the politics, endorsing and promoting it before any substantial data
could be collected.

We still have no idea whether hydroxychloroquine works or not for COVID19. And
the hype is rather harmful and misleading as even if it did work, it is
exceedingly unlikely to be a game changer but a small incremental improvement.

This is also certainly a failure of peer review. Though that has always been
rather weak for cases of outright fraud and scientific misconduct, it still
relies on the researchers to be honest about the data they represent.

~~~
dboreham
>We still have no idea whether hydroxychloroquine works or not for COVID19

Don't we know to a first approximation that it doesn't work? This because it
has been widely tried and there wasn't an "Awakenings" experience where the
patients obviously got better. So if it works at all, it only does so at the
margin. So hard to tell that it's necessary to gather a large statistical
sample to know one way or the other.

~~~
fabian2k
I personally think it is unlikely to work, and at best might have a marginal
effect. That is mostly because most of these early results don't pan out, so
that is a reasonably safe bet in any case. And as you said, a very strong
effect would likely have been shown by now, with all the attention and the
large number of people getting the drug.

I was trying to keep objective when writing that, there simply wasn't any
really well-designed trial yet. Though from what I read just an hour ago or so
there is a new trial that is said to be randomized and well-designed that
hasn't found an effect, but I haven't looked beyond the headlines there yet.

~~~
SomeoneFromCA
One of the potential reasons that ex-USSR has quite low death rate (even if we
consider that numbers are forged, and actualy 5x (!) bigger than in reality is
that all of these countries actively use antimalarial drugs.

~~~
zoomablemind
Where does this claim come from? Ex-USSR sounds too broad. Any sources on the
'active use'?

~~~
SomeoneFromCA
Russia does according to various circumstantial pieces of evidence - keep in
mind, being Russia, lot of this info is not public. All of ex-USSR shared
similar medical system previously, and many (except for Baltic countries
probably) tend to follow the advice of Russian doctors. I cannot give you some
"hard evidence", only probably for Russia, yet the death rate and speed of
infection spread is clearly lower in these countries.

~~~
zoomablemind
Russia is currently third in the world with the highest number of confirmed
cases (over 400k), after USA and Brazil. Deaths data reported from Russia are
even more questionable, given their disposition, early in epidemic, to fudge
it on comorbidities.

As for the malaria drugs, these were not in routine use, at least not prior to
the current epidemic. Moreover, recently Russia seems to place its bets on a
Japanese broad-spectrum antiviral drug Favipiravir [1].

[1]: [https://www.trialsitenews.com/russia-ministry-of-health-
appr...](https://www.trialsitenews.com/russia-ministry-of-health-approves-
avifavir-favipiravir-for-covid-19-patients-cuts-duration-of-illness-by-
over-50/)

~~~
SomeoneFromCA
1\. They have lots of cases, because they do lots of testing. Even then it is
on 33rd place on the cases per capita scale. 2\. As I said, even if the actual
death rate is more than 500% (unrealistic number) of claimed the number is
still low, much lower than of the most of Europe. 3\. Of course they did not
use malaria drugs prior to epidemic - why would they? They used quinine
derivative long before May, cannot find a link right now, but here is a link
for Uzbekistan ([https://podrobno.uz/cat/obchestvo/stalo-izvestno-chem-
lechat...](https://podrobno.uz/cat/obchestvo/stalo-izvestno-chem-lechat-
koronavirus-v-uzbekistane-/)) which uses chloroquine. The death rate is
abysmal in Uzbekistan, and everywhere else in Central Asia, the other
countries use similar methods. You may argue that Uzbekistan is not a reliable
source of information, but there is clearly no outbreaks in that particular
country.

------
RcouF1uZ4gsC
> Desai, through the spokesperson, also said of the company’s work with
> patient data: “We use a great deal of artificial intelligence and machine
> learning to automate this process as much as possible, which is the only way
> a task like this is even possible.”

I wonder if we are heading for an AI winter soon. AI has been heavily hyped,
but is having a lot of real world failures and is becoming associated with a
bunch of fraud. At this time, I am less inclined and I believe a company if
they invoke “AI” or “machine learning”.

Sure, businesses will still use machine learning for problems where it makes
sense, but the hype of AI will die down and funding will dry up.

~~~
battery423
I think AI/Machine learning fits much better at the big big companies like
google.

You only need one or 2-3 competiting Neuronal Networks for cancer detection
and if you look how expensive it is to train that stuff, not many can actually
do it anyway.

But what tripples down are pre learned networks you can easily reuse for your
small use cases which are specific and have plenty of data and only need to
outperform the existing solution.

~~~
tw000001
>You only need one or 2-3 competiting Neuronal Networks for cancer detection
and if you look how expensive it is to train that stuff, not many can actually
do it anyway.

This is just wrong. You can train a cancer discriminator on a low end gpu on
your desktop. The hard part is getting quality [often annotated] data - and
thats why data brokers like Google are positioned to dominate.

~~~
battery423
So why are those papers with good results are not running on 'low end gpus'?

I don't mean running them, i mean training them.

~~~
tw000001
Which papers? There are thousands of papers being published.

There are a couple potential reasons. Powerful GPUs accelerate research and
iteration. Some state of the art problems have hit the limits of current
theory and make up the deficit by building massive nets - but even there we
already have multiple automatic pruning/optimization algorithms to shrink
those nets so that they work with smaller resources.

Make no mistake, the field is advancing exponentially. The state of the art
googlenet/inception that arguably kicked off the whole craze with image
recognition are laughably obsolete now and easily outperformed by simpler
nets.

MNIST was the gold standard for recognition problems just a couple years ago,
and now it's considered a solved toy problem.

~~~
battery423
If i google for it specificly, the paper in nature states:

"This study had some limitations. Mammograms were downsized to fit the
available GPU (8 GB). As more GPU memory becomes available, future studies
will be able to train models using larger image sizes, or retain the original
image resolution without the need for downsizing. Retaining the full
resolution of modern digital mammography images will provide finer details of
the ROIs and likely improve performance."
[https://www.nature.com/articles/s41598-019-48995-4](https://www.nature.com/articles/s41598-019-48995-4)

Here they use a Nvidia V100
[https://www.researchgate.net/publication/336339974_Deep_Neur...](https://www.researchgate.net/publication/336339974_Deep_Neural_Networks_Improve_Radiologists'_Performance_in_Breast_Cancer_Screening)

Which yeah okay is more reasonable than i thought. But the advantage will
still be at who ever has the hardware and thats just cheap for google.

You wouldn't need a market for models, you would just use whatever research
delivers from whoever has the most accurate data & hardware.

------
Gatsky
I gave up reading The Lancet some time ago. They have a poor record frankly
with this kind of thing, Andrew Wakefield et al chief among them. They should
have been cancelled over that one.

Anyway, the larger point is that these established journals have failed us.
Their added value, already low, has dropped below zero in this pandemic. They
are slow, opaque, rent seeking parasitic entities seemingly run by individuals
who don’t grasp basic statistics. The combination of preprint servers +
twitter has proven far more effective in looking after humanity’s best
interests.

~~~
PiggySpeed
No, you don't understand this.

The Lancet is one of the most impactful journals in medicine, and has played
an important role in shaping how medicine is practiced. It is rigorous in its
process, but it's not foolproof. So yes, there are some bad studies that come
through, but that is why healthcare professionals are TRAINED to interpret
studies--we separate all the bullshit from the legitimately useful stuff.

You should see some of the crap that comes through in some of the lower-impact
journals.

> The combination of preprint servers + twitter has proven far more effective
> in looking after humanity’s best interests.

This view is incredibly false and dangerous for so many reasons.

~~~
Gatsky
I am a healthcare professional, and I've published in one of the Lancet
Journals. I understand perfectly fine.

Here's the thing - The Lancet is not impactful. Researchers choose to publish
their impactful research in The Lancet. Other researchers donate their time to
peer review this research. It is the researchers that have shaped how medicine
is practiced, not The Lancet. It is the researchers and the peer reviewers
that are rigorous. The Lancet itself is none of these things, it is a business
run by people who don't do research. Without the people who actually do the
work, or the patients that volunteer for the research, it is nothing. The
Lancet, like all top tier journals, has long forgotten this distinction.

The problem isn't healthcare professionals lacking training. Take the
Wakefield study. Did any doctor decide to stop offering vaccines because of
that study? No. But it had a large impact on a the anti-vax narrative. These
top journals have influence far beyond the professional sphere. This is why
your suggestion we should give them a free pass is dangerous.

I think it is clearly true that rapid publication and out in the open
discussion and peer review is very healthy. I don't see how you could argue
otherwise? Why wouldn't I want to be able to read the opinion of someone I
respect intellectually eg Andrew Gelman, on a study they have decided to
comment on? How is that 'dangerous' if I am a healthcare professional who
should be able to critically review a published paper as you suggest? Why do I
need to rely on the reviewers the journal has chosen? The Journals want to
keep things as they are to maintain their importance and their bottom line. We
suffer as a result.

~~~
DiogenesKynikos
How can you criticize The Lancet for a small number of faked studies that have
gotten through, but then praise pre-print servers, which are rife with
complete nonsense?

Pre-print servers are great for getting results out quickly, but the level of
quality control is extremely low. Journals are slower, but have a higher level
of quality control.

There is a trade-off between speed and quality control, and both pre-print
servers and journals sit at useful points in that trade-off.

Given the pressure to get information that might help fight CoVID-19 out
quickly, journals have probably shifted towards the "quick/low-quality" end of
the spectrum in the past few months. They'll move back when things calm down.

~~~
Gatsky
Specifically I am praising pre-print servers in the current crisis, not in
general. I don't propose they can replace journals wholesale in the near
future.

The harm done by bad research in the Lancet is colossal because the results
are widely read and disseminated, that is obvious isn't it? Pre-print servers
are still quite obscure. Anyway, arxiv has been running for a long time with
much success in certain fields, and hasn't been overwhelmed with nonsense, so
your characterisation of pre-print servers is poorly calibrated and
hyperbolic.

Also the Lancet charges money for its products, and can therefore expect to be
held to greater account.

~~~
DiogenesKynikos
So the pre-print servers are better because not a lot of people read pre-
prints?

> arxiv has been running for a long time with much success in certain fields,
> and hasn't been overwhelmed with nonsense, your characterisation of pre-
> print servers is poorly calibrated and hyperbolic

I just said that the level of quality control on pre-print servers is
extremely low - which it is. They check for very little beyond blatant
plagiarism and obvious junk (determined within minutes).

I didn't say that pre-print servers are useless. They're very useful, but it's
undeniable that prestigious journals apply an additional filter, which is much
more exacting.

If you were to pick a random study from a pre-print server, and a random study
from the Lancet, which do you think is more likely to be reliable? Which do
you think has undergone more thorough peer-review?

~~~
Gatsky
You don't seem to be reading my comments. I agree with you that pre-print
servers are not useless, and that prestigious journals are also not useless.
Pre-print servers obviously have a lot of questionable content, this is
immediately obvious. As I said, they are not a replacement for peer-reviewed
journals (except maybe in the early stages of a pandemic, which was my long
departed original point). It is also true that good research gets published in
prestigious journals. Lots of good research also doesn't get published in
prestigious journals because the editor of the Lancet decides it isn't
interesting enough, or they chose clueless or callous reviewers who kill the
paper in peer-review, or they just accepted a paper with the opposite result
last week or for many other arbitrary reasons unrelated to the quality of the
research or utility to humanity.

------
mensetmanusman
The best quote is at the end:

“Here we are in the middle of a pandemic with hundreds of thousands of deaths,
and the two most prestigious medical journals have failed us.”

There should be prison time if an investigation determines that this was done
to increase certain drug sales.

~~~
eric_b
I strongly believe there were people at the Lancet who _wanted_ to believe the
HCQ study, regardless of how well it was run.

See, if you can skewer HCQ, that means you get to take a shot at a certain
politician too.

There were a number of researchers who criticized the study's structure and
numbers from day 1. Over 100 researchers wrote an open letter about how
skeptical they were.

I understand journals make mistakes, but this was egregious and smells like
agenda to me.

~~~
newacct583
> See, if you can skewer HCQ, that means you get to take a shot at a certain
> politician too.

For clarity, and I'm sure you agree: Trump's boosting of this drug as a
"miracle" and "greatest breakthrough" was absolutely irresponsible _even if_
the drug actually works, for the simple reason that we didn't know if it did
(frankly we still don't), and that it is known to have significant risks (it
still does, even usingly only baseline data and ignoring this study).

This was a bad study. It's possible that the editors at the Lancet hate Trump.
But... you're simply reading too much here. Bad science gets published all the
time. In particular, bad science gets published in circumstances like we have
now where there is desperate need for "fast science".

Not everything has to be an "agenda" by global elites to damage your favorite
politician.

But even granting your framing: why are you so concerned about the Lancet
boosting bad data as an "agenda" but not with Trump doing _exactly the same
thing_ , with even less evidence? Why is it an "agenda" only when your enemies
do it?

~~~
eric_b
Where did I defend Trump's tweets? Where did I say it was OK for him to give
false and misleading medical advice? Obviously he should NOT. HAVE. DONE.
THOSE. THINGS. I think you're wearing your bias on your sleeve a bit too much.
I get it, you hate him too. That's fine. But it's blinding you just like it
did whoever let this garbage pass muster.

Just because Trump does a thing that is despicable doesn't mean we give
everyone else a pass too.

~~~
newacct583
Where did I defend the Lancet? Where did I say it was OK for them to publish
that paper? Obviously they should NOT. HAVE. DONE. THAT.

I could go on, but I think you get the idea -- literally everything you wrote
can be flipped right around, which is why you need to consider whether or not
your own sleeve is maybe a little decorated.

Seriously: I agree with you. I'm pointing out, however, that you're jumping in
to claim "bias" by the "media" in a context where the "other side" very
clearly already had blood on its hands over the same issue. And treating one
side and not the other is helping no one.

~~~
eric_b
"Where did I defend the Lancet"

Umm.... right here...

"It's possible that the editors at the Lancet hate Trump. But... you're simply
reading too much here. Bad science gets published all the time. In particular,
bad science gets published in circumstances like we have now where there is
desperate need for 'fast science'"

------
lenkite
ICMR in India does _not_ trust the Lancet study and have formally objected to
it.

[https://www.thehindu.com/sci-tech/health/coronavirus-csir-
ch...](https://www.thehindu.com/sci-tech/health/coronavirus-csir-chief-flays-
hcq-trial-suspension/article31712065.ece)

[https://www.news18.com/news/india/icmr-says-hcq-reducing-
ris...](https://www.news18.com/news/india/icmr-says-hcq-reducing-risk-among-
healthcare-workers-even-as-lancet-study-questions-drug-benefits-2647007.html)

[https://theprint.in/talk-point/lancet-hcq-study-row-did-
who-...](https://theprint.in/talk-point/lancet-hcq-study-row-did-who-experts-
rush-to-damn-the-drug-due-to-trump-modi-politics/434908/)

------
eric_b
Chloroquine and its derivatives were given to thousands, if not millions, of
people for years. We know and understand the safety profile of this drug well.
To think that all of a sudden it became more dangerous was silly and
unreasonable.

This study always smelled bad. The media was _so_ quick to champion it
everywhere though. Why might that be I wonder? Where are the retractions now?
The whole thing is disgusting.

The media in the US is doing everyone a disservice. Because of this less
people are going to believe "science" and more people are going to just
retreat to their echo chambers and believe whatever they want. I know I'm not
going to trust the Lancet or the NEJM ever again. It's all political now.

What a mess.

~~~
nathan_compton
"I know I'm not going to trust the Lancet or the NEJM ever again. It's all
political now."

This is an absurd reaction and I suspect you know it. There isn't a single
scientific journal in the world not subject to some bias, trend, or failure of
one form or another. To dismiss an entire platform because of an imperfect
record amounts to an abdication of your own responsibility to form your own
opinions about scientific matters. This is a responsibility for which journal
reviewers can only ever take partial responsibility for both practical and
intrinsic reasons.

Peer review is not a rubber stamp which blesses anything which passes through
it as "TRUTH." It is a minimal standard and subject, at any rate, to all the
uncertainties and biases implicit in any human endeavor. It is entirely
possible this paper represents a political bias. Almost everything does. It
still falls to us to make reasonable judgments about science. What doesn't
make sense is to reject the entire process because it fails to meet some
unreachable expectation of perfection.

~~~
eric_b
> This is a responsibility for which journal reviewers can only ever take
> partial responsibility for both practical and intrinsic reasons.

So what you're saying is we should never fully trust these journals? We should
always be skeptical?

That's what I'm saying too...

~~~
PiggySpeed
If you're healthcare, you're taught not to trust results because it was
published under a brand-name journal.

YES, you should be skeptical, but mostly not at the journal-level. You need to
be skeptical at the article-level. That is why it's so important to be
actually TRAINED to interpret the studies.

The abstract of a trial is like an "advertisement" for the study. You quickly
scan it to see if the study is worth reading. If it is, you make multiple
passes of the article, identifying biases, understanding the study context,
calculating ratios and numbers, reading through the lens of your own practice,
and a bunch of other things.

~~~
panabee
i am in the process of compiling a list of ways to quickly spot flawed
studies. do you mind sharing your best tips?

~~~
raphlinus
There is a course on this (taught Autumn 2019 at U Wash) that will also soon
be published as a book:

[https://callingbullshit.org/](https://callingbullshit.org/)

------
raverbashing
It's amazing how big of a mess this is:

\- NEJM and the Lancet published (and "peer reviewed") this article, or
apparently just rubber stamped it.

\- The company doesn't have any semblance of having the capability of doing
the work it purports to do.

\- The article has severe inconsistencies, for example, do you really have
data on 98k hospitalized patients?
[http://freerangestats.info/blog/2020/05/30/implausible-
healt...](http://freerangestats.info/blog/2020/05/30/implausible-health-data-
firm)

\- The company apparently was founded in 2008 but no data from them was used
in any peer-reviewed journal until this year.
[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)

And governments and the WHO bought this, hook line and sinker?

~~~
javagram
Look at how easily the original flawed pro-HCQ paper was bought into (edit:
removed my false statement it was retracted - I think it was criticized by the
publishing society of the journal, but not retracted.). Many people were
treated with HCQ across the world and so far there is no evidence it did
anything to help them.

An important lesson here about the limits of peer review and science. A lot
depends on the original authors not being frauds or simply making mistakes as
we’ve seen time and again with scandals.

~~~
lenkite
There is a truckload of evidence unless you have closed your eyes to it.
Anyways many national medical boards of south-asia have adopted HCQ formally.

[https://www.newindianexpress.com/nation/2020/may/29/icmr-
wri...](https://www.newindianexpress.com/nation/2020/may/29/icmr-writes-to-
who-disagreeing-with-hcq-assessment-officials-say-international-trial-dosage-
four-ti-2149702.html)

[https://timesofindia.indiatimes.com/india/hcq-and-ppe-
used-t...](https://timesofindia.indiatimes.com/india/hcq-and-ppe-used-
together-cut-covid-risk-by-80-icmr/articleshow/76146220.cms)

~~~
javagram
Looked at both your links

1\. Seems to be saying there isn’t currently a health risk posed by the
continuing of their trial.

2\. Says they tried using HCQ and PPE together and found health providers were
catching the virus less. Nothing in the article attempts to break out whether
HCQ or PPE was responsible for it - obviously it’s common sense that using PPE
would reduce the risk of catching the virus.

This is hardly a truckload of evidence at all. Also the original study from
France was about using HCQ for patients who had already caught the virus, not
prophylactic use. HCQ proponents shift around between possible uses of the
drug as it becomes clearer that there is a lack of evidence for one way to use
it.

Could evidence be found in the future that the drug has some small beneficial
effect? It’s possible - but what’s clear is that claims that it was a miracle
cure are completely unfounded.

~~~
lenkite
Yes, I guess I should have posted the other links apart from the French study.
Apologies. There is also a massive ongoing study in India which is expected to
post findings by July end.

Statement from American Journal of Epidemiology,
[https://academic.oup.com/aje/advance-
article/doi/10.1093/aje...](https://academic.oup.com/aje/advance-
article/doi/10.1093/aje/kwaa093/5847586)

Statement from Yale [https://medicine.yale.edu/yigh/news-
article/25085/](https://medicine.yale.edu/yigh/news-article/25085/)

HCQ Studies
[https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v...](https://www.medrxiv.org/content/10.1101/2020.03.22.20040758v3)
[https://www.medrxiv.org/content/10.1101/2020.04.27.20073379v...](https://www.medrxiv.org/content/10.1101/2020.04.27.20073379v1)

The older study on SARS
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1232869/)

~~~
javagram
Ongoing studies should continue and we can see if there is an provable effect,
now that the claim of health danger has been discredited.

My guess right now is that at best it will be as effective as remdesivir, but
really until an actual RCT is conducted there is no proof either way.

The only thing I’m sure of it isn’t a “100%” cure as was touted by some
politicians since if so, that would be obvious by now as the drug has been
tried since January/February and yet patients treated with it are still dying.

~~~
lbeltrame
> My guess right now is that at best it will be as effective as remdesivir,
> but really until an actual RCT is conducted there is no proof either way.

By now, it also matters _when_ you give it. Lopinavir/ritonavir were called
ineffective in NEJM, but a recent publication (in Lancet, ironically) says
that perhaps (no placebo, blech) that given within 7 days of symptom onset
they may be beneficial.

Remedisivir looks best in patients with moderate (requiring oxygen) but not
critical disease.

And as for RCTs on HCQ, one of those (for post-exposure prophylaxis) from UMN
should be apparently be published soon (no idea when or how: their PI is
being, IMO rightly so, tight-lipped), and another is under review. A third one
is ongoing.

------
gator-io
The corruption of science should be aggressively confronted.

If you dig into Surgisphere, you will see they have significant consulting
engagements with Johnson and Johnson. Not saying that's necessarily bad, but
so much bad science about Covid and HCQ seems geared towards promoting high-
priced treatments like Remdesivir, and not low-cost preventative measures like
making sure you're not D deficient. All these studies need to be evaluated
based on who's funding them or the political agenda behind them.

HCQ seems like it's been targeted for destruction. Every study I've read on it
shows you shouldn't use it in late stages of disease. Fair enough, but the
theory of its effectiveness (as a Zinc ionophore) hasn't been fully studied,
although there is a good amount of anecdotal and country-level evidence it
works well if taken early (with Zinc).

These garbage studies are dangerous and should be called out loudly.

~~~
jbritton
I have been wondering why so many HCQ studies do not include Zinc. A couple
months ago I watched a video that detailed how Zinc once inside a cell could
block replication of coronaviruses. And that HCQ being a Zinc ionophore gets
the Zinc into the cell. The relevant study was published approximately 10
years ago.

~~~
javagram
Zinc has been pushed as a cure/treatment for common cold for decades.

The actual track record of whether the OTC zinc tablets you can buy in a store
work is quite uncertain though. Lots of studies coming down one way or
another, and uncertain levels of statistical rigor.
[https://www.mayoclinic.org/diseases-conditions/common-
cold/e...](https://www.mayoclinic.org/diseases-conditions/common-cold/expert-
answers/zinc-for-colds/faq-20057769)

It is easy enough to make a video with what seems convincing but many of these
neat explanations don’t actually work once you get into the human body.

------
walterbell
Media & select journals helped justify trillions of societal costs when many
could be saved from death by _early_ treatment with zinc + zinc ionophore
(HCQ/quercetin) therapeutic that costs less than one dollar. Some poorly
designed HCQ studies have used late treatment or omitted zinc, which is known
not to work. Specific cohorts are also excluded, including cardiac patients
with long QT interval and some malaria-prone populations with G6PD gene.

Some US states have blocked pharmacies from filling doctor prescriptions for
HCQ, instead of advocating for increased manufacturing capacity within US
factories that make HCQ/ingredients. Meanwhile, we boosted ventilator
production, where hospitals received $30K for each late-stage patient placed
on ventilation, with only 20% chance of survival. We blocked early treatment
that worked and we funded expensive late-stage equipment that did not work.

All this with more global information sharing than ever before in the history
of humanity. Since we were collectively unable to filter/parse data generated
by wildly different economic incentives, where the consequences were DEATH,
how can we design new systemic incentives to avoid repeating such mistakes?

[https://www.telegraph.co.uk/news/2020/06/02/prof-lockdown-
ne...](https://www.telegraph.co.uk/news/2020/06/02/prof-lockdown-neil-
ferguson-admits-sweden-used-science-uk-has/)

 _> Neil Ferguson, who became known as “professor lockdown” after convincing
Boris Johnson to radically curtail everyday freedoms, acknowledged that,
despite relying on “quite similar science”, the Swedish authorities had “got a
long way to the same effect” without a full lockdown._

~~~
chasd00
I never understood the hate for what Sweden did during the pandemic both here
and in media. It's like there was a whole misinformation campaign to frame
Sweden's approach as irresponsible and deadly. Article after article in the
news, all the comments here back in April, the list goes on. Yet the data
shows Sweden pretty much as stable as any other country.

[http://91-divoc.com/pages/covid-
visualization/](http://91-divoc.com/pages/covid-visualization/)

~~~
ceejayoz
[https://www.theguardian.com/world/2020/jun/03/architect-
of-s...](https://www.theguardian.com/world/2020/jun/03/architect-of-sweden-
coronavirus-strategy-admits-too-many-died-anders-tegnell)

> Sweden’s chief epidemiologist and the architect of its light-touch approach
> to the coronavirus has acknowledged that the country has had too many deaths
> from Covid-19 and should have done more to curb the spread of the virus.

> Sweden’s death rate per capita was the highest in the world over the seven
> days to 2 June, figures suggest. This week the government bowed to mounting
> opposition pressure and promised to set up a commission to look into its
> Covid-19 strategy.

> Sweden’s 4,468 fatalities from Covid-19 represent a death toll of 449 per
> million inhabitants, compared with 45 in Norway, 100 in Denmark and 58 in
> Finland. Its per-million tally remains lower than the corresponding figures
> of 555, 581 and 593 in Italy, Spain and the UK respectively.

~~~
drtillberg
That's a _seven_ _day_ death rate.

The specific shortcoming its government is looking into, according to the
article, was inability to "protect care homes where half of all Sweden’s
Covid-19 deaths have occurred."

Sorry, don't need a society-wide lockdown to protect nursing and group homes,
which are highly regulated and often government-operated.

Lies, bad lies, and statistics.

~~~
ceejayoz
10x the total per-capita deaths of Norway (third paragraph I quoted is not
seven-day; seven-day rate has held consistently higher than their neighbors;
it's not a short-term aberration, and it remains that high _after_ locking
down care homes etc.) is an issue you can't just handwave away.

~~~
jeltz
But much lower per capita rate than Belgium which had full lockdown. So
obviously a lockdown is not a magic fix. we do not even know how effective
they are since there are many more differences than lockdown/no lockdown
between Norway and Sweden.

~~~
ceejayoz
[https://www.npr.org/sections/coronavirus-live-
updates/2020/0...](https://www.npr.org/sections/coronavirus-live-
updates/2020/04/22/841005901/why-belgiums-death-rate-is-so-high-it-counts-
lots-of-suspected-covid-19-cases)

> Belgium has surged to the top of the grim leaderboard because authorities
> decided to be radically transparent, if perhaps a bit speculative, about the
> toll from the novel coronavirus. They include not only deaths that are
> confirmed to be virus-related, but even those suspected of being linked,
> whether the victim was tested or not.

> As of Wednesday, Belgium, with a population of over 11.4 million, has
> counted a total 6,262 deaths from COVID-19 — roughly 540 per million
> citizens — and more than half of those deaths were in nursing homes. Of
> those 52%, just 4.5% were confirmed as having been infected, yet all are
> counted in the national tally.

------
valarauko
To the comments suggesting preprint servers as the solution, it's worth
remembering that they are subject to much higher levels of noise, especially
at high volume times like now.

In early April, my co-authors and I were planning to submit a computational
COVID manuscript (I was the first author). The journals were overrun with
COVID submissions, and _required_ preprint submission. This was a sticking
point for my co-authors, who felt they had a much bigger paper on their hands
given more time, and were opposed to a preprint submission. Personally, I was
in favour of the preprint, since I felt we had hit the upper limit of what
could be achieved with our collective resources. The other authors disagreed,
and outvoted me to bring in a big name author who could steam roll his way
into a reputable journal. The only way they could tempt a big name scientist
would be to offer up the first author credit, so I bowed out.

At the time, there were 4,500 preprints dealing with COVID, which just seems
bonkers. Honestly, even most of the published work around COVID is of poor
quality.

~~~
SiempreViernes
What, they forced you out of a paper you did most of the work on?

~~~
valarauko
Honestly, it's not that straight forward, which is why I didn't mind leaving
the manuscript in the end. I did much of the work bringing it to a workable
manuscript, but I didn't originate the project.

I was approached by the corresponding author, who had originated and done most
of the initial work. This was just a data dump, and he felt he didn't have the
time or the ability to polish it into a manuscript. My contribution was to
analyse the data, and write most of the manuscript. However, it became clear
that the two other authors were pushing a narrative which I felt wasn't well
supported by the data we had. We discussed two possible options: bring in an
immunologist to determine if our results make sense, which I voted for, or
stick to our guns. The second option would have also required submitting to a
preprint, which they were against. The corresponding author felt the claims
were justified, and decided that a more forceful (and prestigeous) first
author was what was needed instead, and I agreed. Since my contribution wasn't
all that much (about a week of my time?), and I wasn't convinced by the
findings, I didn't mind losing the authorship. This sort of negotiating
happens all the time in academia, so it's unsurprising.

------
knzhou
Whenever this kind of thing happens, you get a lot of people advocating for
the abolition of peer review and its replacement with Twitter or something. I
simply don't understand that.

Normal peer review means "we showed our work to about 2 people who know what
they're talking about and they thought it was okay."

Preprints mean "nobody who knows what they're talking about has looked at this
carefully yet, but we think it's okay."

Viral Twitter threads mean "here's my opinion, which hasn't been shown to
anybody who actually knows what they're talking about, but which has been
selected for maximum public response."

Of course, in all cases, real credibility only comes once a paper has been
looked over by _hundreds_ of people who know what they're talking about. Yes,
showing something to only 2 experts (who themselves are very busy, and are
powerless to directly verify many of the paper's claims) is not a perfect
initial quality cut -- but no cut at all is worse.

If you really believe in the power of Twitter, take a long, hard look at the
sensational, outrageous tweets you've liked. Go look at a sample of 100 old
threads and see how many actually held up. The accuracy rate will not even be
comparable to the Lancet's.

~~~
stephc_int13
The credibility problem has been partially solved with a PageRank type
algorithm. (Sergei and Larry were actually inspired by the weighting system of
research papers)

Highly regarded scientific journals like the Lancet are used to accelerate
this weighting process.

The problem is that nowadays they seem kind of outdated, opaque and corrupt on
many levels.

Nobody wants to suppress peer-review, simply replace the journals mafia with
something less corrupt.

~~~
knzhou
But this isn't a case of a journal acting like a "mafia". This is a case where
something bad slipped past peer review, because of the inherent limitations of
peer review. The reason is that expert time and attention is intrinsically
scarce (if you double the number of experts, you double the number of papers
produced, and hence double the amount of time that must be spent on peer
review), and really properly vetting a paper takes a massive amount of time.
This wouldn't be changed by system reform.

In my opinion, the best option for everybody who's serious about this is to
read a lot of papers, until you become "well-calibrated", i.e. when you have a
good handle on the overall chances a preprint is true, vs. a Twitter thread,
vs. a paper in a top-tier journal. This has to be learned from experience.
Reform doesn't change the fact that you need to do this -- it just adds yet
another venue, either more or less reliable than the previous ones, that you
also need to become calibrated on.

~~~
fragmede
> read a lot of papers

In order to do this, those that are serious need to be able to access papers,
but paying hundreds or thousands of dollars for Elsevier can put them out of
reach.

~~~
knzhou
Indeed, but that _is_ the problem that preprints can solve. (As in, they don't
solve the problem of telling what is correct, because that's just inherently
hard, but they solve the problem of giving access so people can learn to
tell.)

------
gnusty_gnurc
So much of the lockdown and gov't response around the world has been
political. It fundamentally rests on virtue, not science. It's clearer with
every passing day. There were legitimate concerns in the beginning, but by now
it's bizarre to see when people decide to ignore lockdown with the right
political justifications.

------
seesawtron
This guy [0] did some good analysis of the "mysterious company".

[0]
[https://news.ycombinator.com/item?id=23394357](https://news.ycombinator.com/item?id=23394357)

~~~
joncrane
Linking directly to the article here:
[https://www.medicineuncensored.com/a-study-out-of-thin-
air](https://www.medicineuncensored.com/a-study-out-of-thin-air)

It reads like a Muddy Waters (famous stock shorter) screed. Good stuff. Fair
to say the data is made up. The question is, who would be incentivized to do
such a thing? Things that make you go hmmm....

~~~
seesawtron
When such a large study is published in a big Journal, claiming that a drug
might have a negative impact on lives of people in the trials, the authorities
will be considered stupid not to pay attention to it at all and continue the
trials. That is exactly what they did: They paused their trials temporarily to
look at the evidence of this study, examined it and found that it was indeed
controversial and lacked solid data. Now they have resumed the trials again.
The media sells it as a clickbait story "All trials STOPPED because of a
flawed study" implying they were stopped PERMANENTLY to excite the general
audience. For them it is entirely something that brings them huge revenue from
ads when they write such "emotinally driven" stories, they do not care about
the effects it has on the public in the long term by reducing faith in world
health organizations.

------
ddrt
Can anyone explain why there’s a new trend I. Saying a negative, then saying
“but” and stating another negative. Like...

“He was a dishonest man. But, he cheated on his wife”

“He had a nut allergy. But, he had a dairy allergy.”

It’s like they’re saying: “he’s a good father. However, he had a dark side.”
But they’re really not.

Also, at the beginning they say “it may be unraveling” and begin to show how
it never had any legs to stand on. Just confusing communication for an
article.

~~~
dec0dedab0de
_Antimalarial drugs touted by the White House as possible COVID-19 treatments
looked to be not just ineffective, but downright deadly._

I think the quote above is what you're referring to. If so, the structure "Not
only {small_point}, but {large_point}" is extremely common and used both with
negatives and positives.

------
salimmadjd
OT - lets face it. Half of the country wants to see Trump fail and another
half want him to succeed. For covid we should hope 100% of country want to see
him succeed.

The problem is, part of that half is entire media enterprise (BTW, next
adminstration will face the wrath of the other half of that enterprise) who
have invested so much of their own credibility on Trump failing.

As a result I have little confidence (just knowing how the CYA-mindset works
inside any type of corporations) that we will ever hear a correction with (or
nearly with) the same magnitude that will inform the public of the updates.
It's unclear what data ultimately comes out of the Hydroxychloroquine
research, maybe no update is needed. But I just don't have the confidence
we'll get any mea culpa broadcasted across the airways. Nor will I expect
much, if any, of my social media contacts who posted some of the articles to
post the correction.

Trump is a polarizing figure, but I don't understand (outside of increase
ratings) why the media falls for his traps day after day.

It's possible Trump might accidentally be right once (or not completely
wrong), if the media can not remain objective, the entire nation will lose
faith in the institution of journalism as a whole. Opening the doors for all
types of conspiracies and people searching for alternative news sources. This
will eventually lead to a showdown between Facebook and these media entities
that Facebook should ban anything outside of the few established news outlets
to prevent the spread of disinformation. Which is another bad policy, because
people ultimately leave Facebook to other places to find these disinformation
or alternate sources.

Doing some basic fact checking on this company, before taking their research
at face value, especially given there was so much red flags, is what should
separate established media from someone writing a blog post in Romania. This
is really a massive failure, given the vitality of information around COIVD.

------
BrandonMarc
... and the W.H.O. based their decision making on this ...

What exactly _is_ surgisphere? Hackers that paid for illicit data feeds? A
total fabrication? Chinese misinformation? Nothing makes any sense.

------
ed25519FUUU
> _Antimalarial drugs touted by the White House as possible COVID-19
> treatments looked to be not just ineffective, but downright deadly._

Immediately when the long knives came out against HCQ I was cynical. A drug on
the market for 60 years (and over the counter in many countries) is “extremely
dangerous”?

Or, more likely because it’s out of patent there’s a lot of _money_ interested
in exploring other things as a treatment.

~~~
boomboomsubban
>A drug on the market for 60 years (and over the counter in many countries) is
“extremely dangerous

Tylenol has been on the market for a 60 years, often over the counter, but off
label recommendations involving a high dose could be deadly. Drugs should
always be considered "extremely dangerous."

~~~
emmelaich
Anything in high dose can be dangerous. So that's not helpful.

Anything. For instance, water.

~~~
boomboomsubban
Yep, taking ~8 extra strength Tylenol twice a day is comparable to drinking
however many gallons of water a day you would need to cause problems.

------
devit
So they suspect that Surgisphere has manufactured or falsified the data?

~~~
gator-io
Yup. More than suspicious.

------
rdtsc
> Chaccour says both NEJM and The Lancet should have scrutinized the
> provenance of Surgisphere’s data more closely before publishing the studies.
> “Here we are in the middle of a pandemic with hundreds of thousands of
> deaths, and the two most prestigious medical journals have failed us,” he
> says.

Well maybe that's one positive thing here and people will be more skeptical
about where this data is coming from

> “We use a great deal of artificial intelligence and machine learning to
> automate this process as much as possible, which is the only way a task like
> this is even possible.”

He meant it as a defense and to paint themselves as highly knowledgeable
professionals using advanced technology, but I read it as "we used machine
learning to generate this data".

------
ucha
For reference, this is the original study and HN comments:
[https://news.ycombinator.com/item?id=23273615](https://news.ycombinator.com/item?id=23273615)

------
InTheArena
The lancet has really fscked up a number of elements in Covid19. Not only
this, they also published a letter on March 11th saying that NSAIDS make COVID
worst.

This is a consistent problem with them recently. I'm more then willing to say
that it's more due to error in judgement then malice, but the political
ramifications are obvious.

------
aksss
I always think that you can tell when a 'narrative' is being pushed in the
news when there's an obvious lack of dialectic examination of the issue at
hand across multiple outlets (even better when the same keywords are used
across publishers). This was observable during the WMD, Russiagate, and yeah,
the HCQ stories, and many other issues. It's a pattern which, if you read many
sources of news every day (thanks RSS), you can spot pretty quickly.

The other thing is hyperbole, which may be a little harder to discern if you
don't have direct experience with the subject. I used to take HCQ regularly so
was pretty "read up" on the health impacts. The fear-mongering I was seeing in
the news about the risks was a bit much. A common refrain about Trump is that
if he publicly said cancer was bad, the media would advocate cancer for
everyone.

I don't know if it's better or worse that journalists wear their politics on
their sleeves these days, but the one person out there who still regards
journalists as competent objective reporters should probably read the mess
they make of science and legal reporting and then realize the same level of
competence is applied to domestic and foreign affairs reporting.

------
Ghostt8117
There are a lot of comments questioning the political motives of publishing
this research quickly. In medicine, if there is even a hint of increased risk
of death, then studies are stopped. It happens a lot. In two weeks the
journals published statements and corrections. Imagine if this same article
was posted that said the drug was killing patients for two weeks, and the
journals withheld the research because it was politically sensitive. This was
a mistake, and human error and bias may have come into play, but it was a
mistake that erred on the side of caution. Unfortunately, if the drug does
prevent deaths, then it could also be just as bad an error. Hindsight is
20/20\. I wish politics never entered this equation, and I blame the president
for pushing politics into medicine during a pandemic. It was dangerous and
these are the issues we are now facing.

------
jakeogh
More:
[https://news.ycombinator.com/item?id=23272222](https://news.ycombinator.com/item?id=23272222)

------
chrisbrandow
Despite the helpfulness of quick exchange of laboratory results via preprint,
peer review is clearly going to remain central to the scientific process.

~~~
rootusrootus
I completely agree. It seems great now, because the situation is dire, to get
preprints instantly as they become available. But people don't seem to realize
just how much crap gets into preprints and ultimately fails during peer
review. There's so much garbage out there now, and it can and will (and
probably already is) be used as just more political fodder.

I like reading preprints as much as the next geek, but I think we might
ultimately be better served if the papers weren't released until after peer
review.

~~~
James_Henry
Do you think that people will start to read preprints for what they really
are? If that's the case then I think they'll never go away. Open review by
peers before publication is incredibly useful compared to peer review. Imagine
if these 3 papers could have been scrutinized before getting that Lancet peer
review stamp that has led to bad policy decisions and research decisions by so
many. People would have started questioning Surgisphere's data sooner and
wouldn't have taken their results so seriously.

------
Threeve303
Perhaps this is the phenomenon behind fake news being applied to medical
research?

------
mrfusion
It feels like science is becoming more like religion every day.

------
gator-io
Fantastic analysis of the Lancet study's flaws:
[https://www.youtube.com/watch?v=IUD_wvkNhnk](https://www.youtube.com/watch?v=IUD_wvkNhnk)

~~~
gamegod
This is a garbage analysis that ends up with a plug for vitamins and t-shirts.
You don't write off a journal for making mistakes. Retraction is part of the
scientific process.

What this YouTuber failed to mention is that there were already a couple of
other studies before this one that reached the same conclusion - that there
was no evidence of it working for COVID-19, or that it potentially made things
worse in the most sick patients. The retraction of a single paper doesn't
invalidate the body of evidence (albeit small) provided by other papers prior
to it.

~~~
gator-io
Don't get hung up on the how the channel survives. The channel, whose host has
a Phd in pathology, has been focused on Covid issues for months, after being
demonitized by YouTube.

~~~
ufo
If a channel advertises snake oil supplements and products then that should be
a valid reason to criticize them.

~~~
gator-io
And just to be clear, the supplements are recommendations based on research,
not advertisements. No commissions.

Go back a few episodes and you'll see the rationale for them.

------
drocer88
A lot of people got hung up in the politics of this issue. A prominent
politician endorsed using hydroxycholoroquine.

Bill Maher recently made a good point: "Liberals are falling into lionizing
someone because because they are the anti-Trump. Even before the virus America
had a far too chronically sick population which is one reason we've lost so
many now. We need to demand something better than how the entrenched medical
establishment manages symptoms but cures and heals far too little".

I guess pushing "the narrative" was more important than the science.

~~~
alkonaut
The narrative was never that the drug was good or bad. What people were upset
about was that a politician stept in and started pushing for treatments. It
makes no difference what so ever if a politician turns out to be _correct_ ,
it's an absolutely unthinkable thing to do regardless.

Now, you could argue that people _wanted_ the politician to be right or wrong
(depending on views) and that this muddled the reporting, and that's probably
right.

But it doesn't change the fact that everyone should be upset when their
politician starts doing experts' jobs (poorly).

~~~
blhack
>The narrative was never that the drug was good or bad.

Multiple prominent journalists came out saying this like: "if you take HCQ,
you will die."

Thousands of headlines were written saying "Donald Trump pushing _dangerous_
drug" etc.

The narrative from the left was that the drug was bad. The narrative from the
right was that it is a miracle cure. NEITHER of them are correct yet.

~~~
belltaco
>Multiple prominent journalists came out saying this like: "if you take HCQ,
you will die."

Huh? Can you point to some of those claims?

~~~
blhack
Sure: [https://www.businessinsider.com/fox-news-neil-cavuto-
shocked...](https://www.businessinsider.com/fox-news-neil-cavuto-shocked-
trump-hyroxychloroquine-announcement-video-2020-5)

------
throwawy8429
How much of this coordinated FUDDing of HCQ was knee-jerk because Trump touted
it, and how much of it was because progressives (the rich ones, especially)
wanted a higher death toll, longer lockdowns, and more overall suffering to
blame on Trump?

If they willingly buried a viable, cheap, unpatented, easy to produce therapy,
then they have blood on their hands.

