Dr. Ioannidis
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I was asked (not by Dr. Ioannidis but another Dr.) to read this article and bio. “Current citation rates suggest that I am among the 10 scientists worldwide who are currently the most commonly cited, perhaps also the currently most-cited physician” to which most readers seem to stop at impressed. I got curious. This is not an ad hominem attack: why is he cited so much?
“To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent.” Ioannidis
All publicity is not good publicity. Technically accurate but cusp comments, sound bites, manipulating the mainstream and media can be effective like how Trump got into office or vanity metrics for professorship. In short: job security. This isn’t an author problem; it is a systemic problem. If Stanford valued validity over popularity then Stanford would be open with COVID19 instead of closed.
From a journalist “Ioannidis…forced a confrontation when he published his studies in 2005”. and later “Ioannidis’s shockingly high estimate of the degree to which medical knowledge is flawed” fodder to publish into a tizzy. This circle jerking — incorporating each other’s material into your own — sustains most: Dave Asprey, Tim Ferriss, the list continues with authors, social media influencers, Podcasters — readers are more familiar with than Ioannidis.
2017 January Ioannidis was considered for Trump’s cabinet.
March 1 Trump caught flack for his COVID19 plan and Ioannidis was quick to defend.
March 14 most research labs stopped — including Ioannidis.
Ioannidis “I take all the researchers who visit me here, and almost every single one of them asks…the same question,” Ioannidis tells me…“‘Will my research grant be approved?’” He chuckles, but Ioannidis (pronounced yo-NEE-dees) tends to laugh not so much in mirth as to soften the sting of his attack. And sure enough, he goes on to suggest that an obsession with winning funding has gone a long way toward weakening the reliability of medical research.”
March 16 San Francisco, Ioannidis’ location, issues a stay at home order.
March 17 Ioannidis publishes his article, and given the above context, that appears retaliatory to work closing and ordered to stay home.
Stat news, the site that published both that March 14 research labs’ news and March 17 Ioannidis’ article, enjoyed a 78% improvement in website statistics.
By the end of that week Trump tweeted “we can’t let the cure be worse than the problem”.
Applying Ioannidis cynical approach to his own work:
Ioannidis writes 68 deaths in USA but by that date there was 112 deaths in USA.
Ioannidis cites the Diamond Princess cruise ship, which is about as close to a lab as a research epidemiologist can hope for, fatality COVID19 ratio at 1% but it is 2.3% and over age 70 increases to 18%. We do not live on a cruise ship locked in our cabins, surroundings cleaned, nonstop medical care, meals provided and very few children doing the things that children do as Ioannidis writes in his article: “children socialize anyhow, if school closure leads children to spend more time with susceptible elderly family members, if children at home disrupt their parents ability to work, and more. School closures may also diminish the chances of developing herd immunity in an age group that is spared serious disease” hence Israeli Defense Minister Naftali Benett saying, “The most important thing — more than social distancing, more than testing, testing, testing, more than anything else — is to separate old people from younger people.” Young is under 20 and especially old are those over 70. TLDR? Our risk is higher than Ioannidis’ article.
Also Ioannidis doesn’t mention infection. 17% from one person in 3 weeks in a lab like environment. Again our risk is higher.
Google “draconian” and Nazi comes up. What did Ioannidis see in the United States’ response to COVID19 as draconian? Remember his article is published March 17 before any American stay at home suggestion. Also today’s technology capable world with grocery delivery, remote work and online schools, endless entertainment and communication, staying at home is not what it was a century ago. Most people do stay at home: streaming, esports…replacing cinemas, athletics.
Speaking of too long ago, “matching the 1918 influenza pandemic” why is Ioannidis’ benchmark of success from over 100 years ago? Ioannidis’ cited work argues for a higher standard.
Curious Ioannidis didn’t mention Italy. Sometimes what someone does NOT say is of more intrigue. Ioannidis does mention UK. Data was available more than a week before his article:
Another concern is no mention of the health impacts for survivors. Some impact are visual like the chicken pox scars on my face or a person with polio. With COVID19 the impact is hidden, a 20–30% reduced lung capacity. That becomes a greater societal issue and healthcare burden. My scars are cosmetic. Lung issues are serious.
When crunching numbers consider 1.53 billion people (of which 58.8 million die) have pre existing conditions that increase their probability of fatality with COVID19. With shortage of testing and stretched healthcare I haven’t seen reports that rule out cause of death from COVID19 since the first case was discovered in November. If COVID19 is addressed like HIV it may be decades before any location does such reporting. We only know what is killing people if we test the dead. We are not testing the dead. We barely test the living.
Then I mused “well, this article is from TEN DAYS ago. Maybe he thinks differently now?” He did a podcast yesterday. Nope. His opponent, Dr. Vermund (love that this page has a pop up with a telephone number to call about COVID19), said we can’t compare 1918 to 2020: the world was different, medicine was different, population was different, so fatality rate were higher. Also why is that bygone era a barometer of success again?
What else came up again? UK? Nope. Oddly instead Iceland made this podcast. Have you been to Iceland? Naming is done to help prevent inbreeding — not a stereotypical country. Iceland’s COVID19 policy was aggressive and proactive:
January 24 travel advisories
February 27 daily press
February 28 state of distress at first case
March 6 state of emergency, highest alert
March 13 social distancing AND community spread
March 14 free testing
March 19 quarantine
United States is contrastingly casual and reactive. I don’t understand why Ioannidis chose such different countries!
Iceland is a Nordic countries like taciturn Finns. “Social distancing” is business as usual whereas for romance cultures like Italy that is counter culture. How are Americans? Too chatty. Are we nearer Italians or Icelanders? Americans are culturally warm with 1/5th hispanic — a romance culture like Italy.
At least Italy made a mention this time. Ioannidis exaggerated that in Italy “one third of the population was kissing and hugging each other” whereas Americans are “freezing in place”. As warm as Italian culture is I doubt there was a one third orgy happening in the Catholic capital during Lent. It was China “freezing in place” sealed people in their homes and delivered food for 2 months — not USA!
Speaking of warmth, weather is a factor. In February Iceland was -3C/26F whereas Italy was 12C/54F. Even if culture and genetic diversity are the same — they are not — in those temperatures Icelanders (fully dressed, wearing gloves) were probably not out, about and canoodling as much as Italians (showing skin). Guess what weather virus prefer? Humid. Guess which country is more humid? Italy.
Dr. Vermund spoke of some of these country differences. Namely the USA didn’t and can’t follow China’s social isolation policy nor Korea’s testing. Political response requires understanding both the behaviour of the virus and the behaviour of the governed. I could get into the numbers but at what point do we trust CDC and/or The World Health Organization to know more about COVID19 and what to do than me? or you? The podcaster asked Ioannidis about returning to preCOVID19 by Easter and he skirted answering. Between his article and his podcast his message “I need data” “more testing please” is lost and misconstrued into “abandon plan, resume life as usual, we’ll all be fine”. If the latter were true perhaps Ioannidis would champion the only first world country doing so: Sweden.
COVID19 became an evidence of absence problem. There isn’t enough data. That argument works for Ioannidis — for now. It also shortchanges the good work being done because we can’t measure effectiveness. If we succeed in reducing premature deaths then people will be upset they took precautions.
If we don’t do this now then when will we? If no global pandemic plan what happens with the next bigger, badder bug? Which might be 6 months away, or maybe already exists, killing and isn’t news. If no return to public health now, then when and shudder why?
TB kills 4,000 people daily. One third of humans have it. Ioannidis mentions TB but doesn’t suggest a population with a weakened immune system and damaged lungs from COVID19 is now predisposed to TB. Tuberculosis is our number one killing virus. I am not vaccinated. Even if you are vaccinated that vaccine was invented over 100 years ago, helped 20% of the time, and last year 500,000 TB cases didn’t respond to treatment. To quash any suggestions that there is little to no risk: I was quarantined twice in USA for tuberculosis in the 2000s.
