Covid-19: politicisation, “corruption,” and suppression of science
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4425 (Published 13 November 2020) Cite this as: BMJ 2020;371:m4425Read our latest coverage of the coronavirus outbreak
Rapid Response:
Re: Covid-19: politicisation, “corruption,” and suppression of science
Dear Editor,
First a word of appreciation; it takes true courage in these woke days
to speak the truth on undeclared interests among ‘experts’ such as
share ownership (ex. Companies being procured for rapid testing kit
design and delivery1), expectations of future grant extensions (ex.
through the Gates Foundation2) and, anonymous membership in
organisations fostering cronyism (ex. Freemasonry3) all rife in 'expert'
academia, partially exposed during this pandemic response. I await the
day when membership in Freemasonry has to be part of formal declarations
of interest in the NHS. Knowing the truth does indeed set one free, and
significantly downregulates uncertainty and fear, which is a pandemic
of its own, with real consequences as in lockdown morbidity and
mortality.4
There has been a lot of interest in the leadership field on the value of
good followership5. However, as a leadership sceptic (as bad as being a
global warming sceptic which I am not), I wonder if senior professional
followers in public service are more dangerous than their political
(and transient) leaders tempted to ‘follow the science’. Certainly in
Britain (mainly in England) these public servants have made a series of
unfortunate decisions due to poor situational awareness, perfunctory
(not actuarial) risk assessments, with attempts to obfuscate details of
the decision makers subsequent to the consequences being revealed to the
public. They have failed to realise that their primary duty is to
ordinary people who actually pay for their salaries and will be paying
for their pensions for the foreseeable future.
I refer of course to the ‘processing’ of the 24,000 elderly hospitalised
patients, who were summarily discharged to any available care home
places in April 2020, when testing for SARSCov2 was not readily
available at general hospitals 6. This led to 50% of the English care
homes to be infected (~15,000 deaths), when a more considered choice of
setting up potential Covid floors in some care homes with dedicated
staff would have been possible, even considering the need to urgently
clear hospital beds.
Then there was the recommendation for GPs to ‘optimise’ DNAR orders, if
necessary using a blanket approach for care home residents; which the
CQC is currently investigating7. Both of these policies were in breach
of article 2 of the European Convention of Human Rights (ECHR): the
right to life.8 Furthermore the risk of breaching article 8 of the ECHR
(the right to family life) continues, with capacitious older people
willing to accept the risk of contracting Covid, being obstructed from
hugging their grandchildren after 6 months of enforced.
On drug trials of prophylaxis treatments for pre hospitalised patients
with Covid19, the WHO ‘solidarity’ and Oxford’s ‘recovery’ studies both
used 4 times the BNF maximum recommended doses of Hydroxychloroquine9.
How these researchers managed to get their study protocols through
‘expert’ ethics committees and (perhaps more to the point) what was
actually told to patients volunteering in these trials remains a
mystery. I understand that the dose of HCL was determined by computer
modellers to determine the dose likely to be effective against SARSCov2.
I will not repeat the discussion on the now infamous retractions in
Lancet and New England Journal of Medicine linked with the Surgisphere
data mining company, apart from emphasising the ever present risk of
data fabrication and the related inadequacy of our peer review system;
worsened by authors refusing to submit raw data for independent post-hoc
analysis. Based on my clinical outcome experience, I suspect that at
least 30% of publications (NICE approved) on which I base my clinical
practice potentially involve data fabrication or at least selective data
presentation10. Statistical methods to pick up data fabrications are
being attempted11 as whistleblowing is even more hazardous for one’s
career prospects compared to clinical postings.
Finally, as my medical career proceeds to its autumnal stage (36 years
as a doctor in the NHS) I have serious reservations about our
consultation practices, especially on achieving ‘good enough’ consent
from vulnsarable (often elderly) patients, for example having to make
decisions on admissions and on accepting potentially toxic treatments.
This issue continues despite the events leading to the Montgomery
judgement of 201512. Thankfully (albeit late in the day) the GMC has
produced good practice guidance on this issue, hopefully which will
improve our consultation and consent practices13.
I think we should be unbiased and spell out in simple (non-jargon)
english about numbers need to treat and to harm, and what the
consequences (or lack of them) if treatment was delayed or not
undertaken entirely; yes we do have the facts most of the time.
‘Treatment trials of 1’ should only be undertaken after jointly deciding
on the trial duration, success criteria and a guarantee that the same
doctor reviews outcomes at the end of the trial, firstly to avoid
retrospective bias, but also to avoid unnecessary polypharmacy, as
another doctor (especially a junior) conducting follow up would be
typically loath to discontinue a drug if there are no side effects.
It is a genuinely interesting time to be in medicine, as I remind my son
(age 18) who is applying for medical schools, but interestingly,
considering starting with a biomedical year, in order to get a grounding
in critical appraisal and to better understand the rapidly evolving
basic sciences of immunology, cell biology and gut microbiota. Maybe he
will be speared of all these malfeasance (at least I hope so).
References
1. Harcombe, Z. SAGE conflicts of interest. Pub. 9.1.20. https://www.zoeharcombe.com/2020/11/sage-conflicts-of-interest
2. Howley, P. gates Foundation funded both Imperial College and IHME; failed model makers. Pub. 16.5.20. https://nationalfile.com/gates-foundation-funded-both-imperial-college-
3. Pal, R. Freemasonry and Medicine. Pub 19.10.11 https://www.huffingtonpost.co.uk/rita-pal/freemasonry-and-medicine_b...
4. Office for National Statistics. Analysis of death registrations not
involving coronavirus (Covid19), England and Wales: 28/12/19 to 1/5/20. www.ons.gov.uk › deaths › articles › technicalannex
5. Gibbons, A., Bryant, D. Followership; the forgotten part of leadership. Last updated on 18.5.20
https://www.medicalprotection.org/uk/articles/followership-the-forgotten......
6. National Audit Office. Readying the NHS and adult social care in England for Covid-19. 2020; ISBN 9781786043191
7. CQC to review use of DNACPR during pandemic. September 2020. www.cqc.org.uk › news › stories › cqc-review-use-dna...
8. Bates, E.S. Covid-19 symposium: Article 2 ECHR’s positive
obligations. How can human rights law inform the protection of health
care personnel and vulnsarable patients in the Covid-19 pandemic?
opiniojuris.org/2020/04/01/covid-19-symposium-article-2-echrs-positive...
9. Wise, J., Coombes, R. Covid-19: The inside story of the Recovery trial. BMJ 2020;370:m2670 https://www.bmj.com/content/370/bmj.m2670
10. Fanelli, D. How many scientists fabricate and falsify research? A
systematic review and meta-analysis of survey data. PLOS ONE. Pub
29.5.2009 https://doi.org/10.1371/journal.pone.0005738
11. Hartgerink C, Wicherts J, van Assen M The value of statistical tools
to detect data fabrication. Research Ideas and Outcomes. 2016; Vol
2e8860. doi: 10.3897/rio.2.e8860
12. Talukdar, S. Ensuring Risk Awareness of Vulnerable Patients in the
Post-Montgomery Era: Treading a Fine Line. Health Care Analysis. 2020
https://doi.org/10.1007/s10728-020-00396-9
13. Sokol, D. New guidance from the GMC: what constitutes meaningful
dialogue? BMJ 2020;371:m3933
doi: https://doi.org/10.1136/bmj.m3933
14. Carvour, M. Teaching critical appraisal of medical evidence. AMA Journal of Ethics. 2013; Vol 15 (1): 23 - 27.
Competing interests: No competing interests
Nessun commento:
Posta un commento