Medical Tribalism in the Era of Covid-19

John Ioannidis and Medical Tribalism in the Era of Covid-19BY JEANNE LENZER & SHANNON BROWNLEE – June 2020

I’ve posted about his contrarian views several times because I think it’s a good idea to see information and opinions from reliable scientific professional sources that are different from the panic-inducing click-bait spouted endlessly by the media.

It started on March 17, when Ioannidis published an opinion essay in STAT saying that the data on Covid-19 were not sufficient to know the disease’s true prevalence and fatality rate.

Ordinarily sober-minded researchers have attacked Ioannidis’ methods with hyperbolic and emotional arguments that suggest it’s not so much his science but his questions that they dislike. 

In politicizing Ioannidis’ work, both the left and the right have failed to understand or acknowledge the critical questions he is raising.

In doing so, they impede our ability as a nation to respond in a way that minimizes deaths, not just from the disease, but from our reaction to it. 

From the beginning of the pandemic, there has been uncertainty surrounding two crucial pieces of information about Covid-19:

  1. its prevalence, or the percentage of the population infected with the disease; and
  2. its infection fatality rate, the percentage of infected people who die.

Many early estimates placed that rate at around 1 percent, roughly 10 times deadlier than the seasonal flu.

In April, a couple of weeks after Ioannidis’ essay appeared in STAT, he and 16 other researchers conducted a study in Santa Clara County, California, to better define the infection fatality rate.

The researchers tested the blood of 3,330 participants and found that 50 had antibodies to Covid-19

This finding suggested that the prevalence of Covid-19 in Santa Clara County was far higher than official counts indicated, and that the infection fatality rate was therefore much lower than previously feared, only around 0.17 percent — many of them without even knowing it.

The most troublesome aspect of this virus is the incredibly wide range of human responses, from not even noticing it to requiring intensive hospital care and dying from it.

People who have it but don’t know it are the greatest danger because they unknowingly (to them and to us) spread the virus despite seeming healthy. Some are presymptomatic and will eventually get “sick” but others get through the viral infection and recover without symptoms.

Although the Stanford group’s estimation of the infection fatality rate falls at the low end of the range obtained in other antibody studies, it is not an outlier.

A meta-analysis by Ioannidis found that other groups have independently estimated similar fatality rates.

Even the Centers for Disease Control and Prevention has placed the case fatality rate at 0.4 percent, meaning the infection fatality rate is substantially lower. Yet the Santa Clara study was singled out for particularly pointed attacks.

The Santa Clara study caught on in the popular press, where opinion-makers and reporters quickly took sides.

  • The right-leaning press was quick to embrace the idea that the threat of the pandemic had been exaggerated.
  • On the left, The Nation published an article calling Ioannidis’ work a “black mark” on Stanford University.

Attacks on Ioannidis came early and often. Just days after the study published, Columbia University statistician Andrew Gelman wrote that Ioannidis and his co-authors “owe an apology not just to us, but to Stanford.”

And in May, YouTube pulled one of Ioannidis’ interviews, saying that it contained “medical misinformation.”

Despite numerous queries, neither YouTube nor its parent company, Google, has revealed which part of the interview could be construed as misinformation.

The politicization of medicine and science is nothing new.

But some people seem to think this tribalism is owned by the political right — that the rightwing leverages science as propaganda, while the left engages in “discussion and debate.” But in the case of Ioannidis, the nuance has been lost on both sides.

Ioannidis…has regularly pointed out how researchers often downplay or ignore the harms of medical interventions.

As he wrote to a private list of doctors and researchers, “Locking ourselves in our beautiful mansions and continuing with our videoconferences practically does nothing for nursing homes and chronically badly prepared hospitals . . . It also kills the poor, the disadvantaged . . .”

He has cautioned that protracted lockdown will cause starvation, violence, poverty, and deaths that could exceed the number of lives saved by avoiding Covid-19 infections.

He’s not alone in these concerns. The World Food Program estimates that 265 million people worldwide could face hunger and starvation due to lockdown-related disruptions in the food supply.

Ioannidis will almost certainly emerge from this imbroglio with his reputation as a rigorous researcher restored, but the level of vitriol being aimed at his work is causing others in the medical community to self-censor, as a number of doctors and researchers have acknowledged to us.

Ioannidis, right or wrong, has raised difficult questions, in the best tradition of science. Silencing him is an enormous risk to take.

Jeanne Lenzer
is a medical investigative journalist and author of “The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It.”
Shannon Brownlee, MSc, is senior vice president of the Lown Institute, a nonpartisan health care think tank based in Boston, and author of “Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer.” She is a member of the Undark advisory board.

I have previously posted about Dr. Ioannidis’ contrarian views:

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