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Table of Contents
MUSINGS
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 434-436

Bad science in the time of COVID-19


1 Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
2 University of Kentucky Markey Cancer Center, Lexington, Kentucky, USA; Department of Hematology-Oncology, MOSC Medical College, Kochi, Kerala, India

Date of Submission09-Aug-2020
Date of Decision14-Aug-2020
Date of Acceptance16-Aug-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Aju Mathew
MOSC Medical College, Medical College Road P O Kolenchery, Kochi - 682 311, Kerala

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_272_20

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How to cite this article:
Roy AM, Mathew A. Bad science in the time of COVID-19. Cancer Res Stat Treat 2020;3:434-6

How to cite this URL:
Roy AM, Mathew A. Bad science in the time of COVID-19. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Oct 29];3:434-6. Available from: https://www.crstonline.com/text.asp?2020/3/3/434/295515



The coronavirus disease 2019 (COVID-19) pandemic has led to a cloudburst of scientific claims and discoveries. We have seen science progress at breakneck speed. However, it has come at a cost. Bad science has cracked through the fissures and created chaos among the people. There are examples galore.

The Bacillus Calmette–Guérin (BCG) vaccine suddenly staked a claim for being the key reason why the Global South did not see much of COVID-19. All of a sudden, there were graphs showing countries with high rates of BCG vaccination and remarkably low rates of COVID-19. It was not surprising to see even doctors mistake correlation for causation. Ecological studies can help formulate hypotheses, but the fact remains that these are just hypotheses and not evidence for a direct link.[1],[2]

Even the brief correspondences appearing in medical journals turned into viral social media phenomena. In a letter published in The Lancet Respiratory Medicine, it was hypothesized that patients with hypertension and diabetes who were treated with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and ibuprofen had a high risk of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[3] This was based on the fact that the SARS-CoV-2 binds to its target cells through the ACE2 receptor, which is expressed on the surface of cells in the lungs, heart, kidneys, blood vessels, and intestine.[4] Chronic exposure to ACE inhibitors, ARBs, and ibuprofen has been shown to upregulate the expression of ACE2 in animal models. News and social media broadcast the message causing confusion and worry among patients and physicians. Finally, after a couple of months of raging debate, rigorous studies have now effectively debunked this hypothesis.[5],[6]

What could have been done to avert the pandemonium? Let's go back to the basics of scientific rigor. Good science is built on sound principles of investigation – most importantly, those of avoiding biases, using preclinical and clinical data judiciously, and the ethical tenet of scientific integrity. Good science withstands the test of replication. Good science strictly adheres to scientific methods of investigation.

Of course, one can say that in the current situation of a pandemic, time is of paramount importance. But that thought presupposes the idea that the speed of scientific progress is proportionate to the number of lives saved. Let's not forget that bad science has hurt people since the beginning of modern scientific investigation. The best example is that of the now-debunked vaccine-autism hypothesis published in The Lancet.[7] The research study has been found to be faulty, and the author's lack of integrity has been highlighted in countless articles. However, the damage was already done when the first prints of the journal carrying the faulty research hit the newsstands.

Good clinical research should be properly designed, conducted, and thoroughly reviewed before an eventual dissemination through peer-reviewed journal publication. The gold standard of clinical investigation, the randomized clinical trial, involves adequate randomization (to minimize the risk of selection bias which means the preferential selection of people into one arm to skew the results favorably), appropriate selection of the control group, and masking the interpretation from the people who can influence the conclusions (patients and investigators).[8]

The recent controversy about the use of the antimalarial drug hydroxychloroquine for treating COVID-19 is a ripe example of bad science. A non-randomized, single-arm clinical trial conducted by a French scientist showed that hydroxychloroquine was associated with significant reduction in the viral load in the patients infected with SARS-CoV-2.[9] Even though the study was very poorly designed and conducted, it was welcomed by many powerful individuals across the world and subsequently received greater acceptance from the general public. Credible scientific voices were shouted down. People overlooked the several limitations of this study, including the very small sample size, lack of an effective control arm, absence of blinding, unsupported conclusions, and numerous errors of omission,[10] and campaigned for wider use of this drug. If those in power had stayed in their lane and not swayed into scientific analysis and interpretation, proper clinical investigation could have been conducted to assess whether the drug had any benefit in treating or preventing COVID-19.

Good science withstands the test of effective and efficient peer review. Peer review is the scientific equivalent of the system of checks and balances seen in politics. It deconstructs the scientific validity, clinical impact, worthiness of the conclusions and their applications, and the contribution of the research to the existing body of science.[11] COVID-19 science desperately missed the peer review system. Preprint servers meant to improve the pace and rigor of science were soon used as a source for all information. It is therefore not surprising that one of the most widely shared manuscripts from a preprint server provided fodder for conspiracy theorists regarding the origin of the virus. Very few people who have read the fake news probably know that the manuscript was discredited and removed from the server after a few days. The lay public had no understanding of peer review and its importance to ascertain the scientific validity. As cliched as it sounds, the truth is that the damage was already done when news reports of the spurious research first went online.

However, peer review should not be considered infallible. The reliability of the articles that are published even after thorough peer review is currently being questioned. The journals that are considered as the epitome of scientific research such as The Lancet and The New England Journal of Medicine have recently retracted their articles about the use of hydroxychloroquine,[12],[13] ACE inhibitors, and ARBs in COVID-19[14] because of the skeptical research data.

Good science should be the backbone of the strategy to tackle the pandemic. Speed should not be at the expense of replicability of scientific discoveries. Quality should be the buzzword in times of pandemic research rather than quantity. Scientists, clinicians, health-care officials, media, and politicians should coalesce their best efforts during this exceptional time in the history of humankind to conduct and promote proper scientific research. In that, there should be no conflicts of interest.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Loney T, Nagelkerke NJ. The individualistic fallacy, ecological studies and instrumental variables: A causal interpretation. Emerg Themes Epidemiol 2014;11:18.  Back to cited text no. 1
    
2.
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Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020;8:e21.  Back to cited text no. 3
    
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Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB, et al. Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19. N Engl J Med 2020;382:2441-8.  Back to cited text no. 6
    
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Eggertson L. Lancet retracts 12-year-old article linking autism to MMR vaccines. CMAJ 2010;182:E199-200.  Back to cited text no. 7
    
8.
Kabisch M, Ruckes C, Seibert-Grafe M, Blettner M. Randomized controlled trials: Part 17 of a series on evaluation of scientific publications. Dtsch Arztebl Int 2011;108:663-8.  Back to cited text no. 8
    
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Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020;56:105949.  Back to cited text no. 9
    
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Batra U, Sharma M, Redhu P. Chloroquine and hydroxychloroquine: Clutching at straws in the time of COVID-19? Cancer Res Stat Treat 2020;3 Suppl S1:3-6.  Back to cited text no. 10
    
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Campion EW, Curfman GD, Drazen JM. Tracking the peer-review process. N Engl J Med 2000;343:1485-6.  Back to cited text no. 11
    
12.
Mehra MR, Desai SS, Ruschitzka F, Patel AN. Retracted: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: A multinational registry analysis. Lancet 2020;395:P1820.  Back to cited text no. 12
    
13.
Qayyumi B, Sharin F, Singh A, Tuljapurkar V, Chaturvedi P. Management of COVID-19: A brief overview of the various treatment strategies. Cancer Res Stat Treat 2020;3:233-43.  Back to cited text no. 13
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14.
Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Retraction: Cardiovascular disease, drug therapy, and mortality in COVID-19. N Engl J Med 2020;382:2582.  Back to cited text no. 14
    




 

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