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‘Science is flawed’: COVID-19, ivermectin, and beyond

29th December, 2021
Health

Gideon Meyerowitz-Katz is an epidemiologist and writer based in Sydney, Australia. His work covers chronic disease, the pandemic response, and more recently, error detection in science. In this op-ed, he discusses issues with research that has become increasingly apparent during the pandemic.

There are no two ways about it: Science is flawed. We’re not talking about the philosophical leanings of science or the origins of white coats and linoleum-floored laboratories, but about the nuts and bolts of the process by which we determine whether things are true or false.

In the decades before the pandemic, scientists spent endless hours wrestling with the painful fact that much of the knowledge base of science and medicine is reliant on research that is flawed, broken, or potentially never occurred at all.

Science has a gap between its mechanics and outputs. The mechanics of science are fine. The machines always get bigger and more efficient. New tools are always developed. Techniques become more sophisticated over time, and more knowledge is acquired.

The outputs of science are not. The culture of academia demands publication and warrants little retrospection about potential errors — this means that mistakes are rarely corrected, and even outright fraud is often left undetected in academic literature.

Enter the pandemic

And then along came a pandemic, and the gaps in science widened to an inescapable chasm. While biomedical research has had obvious and immediate success in COVID-19 mitigation, it has been accompanied by an enormous tidal wave of garbage, which instantly overwhelmed our garbage mitigation mechanisms.

From fraud to wasteful research to papers so error-filled that it is amazing that they’ve been published, the pandemic has produced a tidal wave of woeful scientific output that has, nevertheless, had staggering consequences for people’s lives.

Take ivermectin. It is an amazingly successful antiparasitic medication that has treated literally billions of people in the time since it was invented, and it has almost eliminated some parasitic diseases from the world.

It has also been globally promoted as a cure for COVID-19 by a group of passionate fans. It is likely that more ivermectin has been taken to prevent or treat COVID-19 than any other single medication, except perhaps dexamethasone.

And yet, we do not know if ivermectin is actually useful in the treatment of COVID-19 at all.

A recent review from the Cochrane collaboration — long considered the gold standard in medical research — concluded that ivermectin should not be used for the treatment or prevention of COVID-19 outside of well-conducted clinical trials, which is a stark contrast to the hundreds of millions of doses still being taken for those exact reasons.

How? 

In early 2020, people were desperate for any kind of treatment for COVID-19. A melange of partial evidence emerged.

This included: a laboratory study showing that the drug acted as a strong antiviral in a petri dish, a study in a French nursing home where the residents took ivermectin to treat a scabies outbreak and seemed to subsequently enjoy higher survival rates, and preprint reporting that ivermectin reduced the mortality from COVID-19 by 90%.

All three were weak evidence in different ways. Single in vitro studies are very poorly predictive of eventual clinical outcomes, and the nursing home paper was an accidental and uncontrolled observational study — what if the residents had never been exposed to SARS-CoV-2 in the first place?

The clinical study was entirely fabricated and later withdrawn from the preprint server, subsequent to the great scandal.

The ivermectin story somehow got even worse from there. In late 2020, studies started popping up showing what can only be described as simply incredible results for the medication — a 90% mortality benefit or a 100% reduction in cases when used as a prophylactic.

After nearly a year, I and other data sleuths demonstrated that many of these studies probably never happened, but the damage was well and truly done long before the first fake paper was retracted.

A meta-analysis of ivermectin, which is usually considered the gold standard of research practices, found a huge benefit for the drug. However, the paper has not been corrected, even though the studies underlying its results were found to be likely fraudulent.

In any other discipline — media, government, private enterprise — such an analysis would be taken down with apologies immediately. Instead, the paper is allowed to stand as a testament to the general disinterest of the scientific world in correcting errors.

This story could’ve been told very differently. Imagine a world where the initial laboratory paper came with a disclaimer, where the fraudulent preprint was looked on with skepticism immediately, and where the positive trials were assessed for fraud before they were even published.

Instead, at every stage, the process of highlighting concerns with data is ignored, with peer-review being the only flimsy barrier to publication for terrible research.

When we most needed effective fact-checking, our grand institutions of scientific research instead reviewed studies in a matter of days, if not hours, and posted fraudulent studies online to be shared across the world.

It’s tempting to say that research into ivermectin is uniquely flawed, but that’s clearly not true — realistically, it would be remarkable if a broken system produced only one failure.

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