Commentary: Fake medical research is rampant, take findings with a pinch of salt 

In fight against COVID19 (Corona virus induced disease) two drugs are in news. Hydroxychloroquine (an anti-inflammatory drug) and Remdesivir (an anti viral drug). Hydroxychloroquine is a cheap generic drug and has been there ever since, albeit for use in Rheumatology. Much to the discomfiture of the scientific community, the first public proponent for its use in COVID-19 was Donald Trump. Doctors of the world divided themselves as either supporters or opponents of its benefit. Scores of trials were started across the world to validate its use.

Then came Remdesivir with a fanfare of hope that baffled sceptics and the credulous alike. It got a near universal acceptance based on a rather flimsy evidence published in NEJM(New England Journal of Medicine- a journal that commands credibility). This is a prohibitively expensive patented new drug with enormous potentials of profit for Gilead Life Sciences.

Even before the froth of excitement had settled, on 22 May WHO issued an advisory to stop all clinical trials of the rival drug Hydroxychloroquine, citing concerns of adverse side effect. Even for an Anosmic or someone suffering from ‘smell blindness’, it smelt like a rat.

The concern for adverse effects emanated from a preprint report in Lancet based on dataprovided by a dubious Illinois firm called Surgisphere, that had neither the expertise nor the experience in the field of medicine. Exposure on the credentials of the firm left many including WHO and The Lancet red-faced.

In less than a fortnight, on 03 June WHO had to hurriedly rescind its earlier order. You don’t need the genius of Sherlock Holmes to deduce the role of business forces working behind the scene.

I am not holding any brief for either drug. In fact, neither of them passes muster of a rigorous scientific scrutiny. To put it the other way, in an illness that cures itself naturally in over 90% of the instances, any treatment protocol can be proven to be effective with just a bit of statistical jugglery.

In Rajkot there is an ongoing trial to prove the effectiveness of a mixture of five cow products (panchgavya) in COVID cases. I can say with confidence that it will be proven effective while I know for sure the truth to be otherwise.

But that is not the point. As a doctor I am here to highlight the predicament of a physician that stems from the helplessness of a deliberate denial of my right to know the truth. Doctor being a fiduciary is bound ethically to act in the other's (read patient’s) best interests. Where there is an entire ecosystem at work for obfuscation of truth, how can one work in the best interest of the patient?

In the foregoing paragraphs, two journals have been named- The Lancet and NEJM. Both have a formidable standing in the medical world with a high impact factor. The Editor of NEJM, Mercia Angell has been on record saying, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of The New England Journal of Medicine”.

Richard Horton, editor of The Lancet has also similarly voiced his frustration by saying, “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, Science has taken a turn towards darkness.” He goes on to add, “The bad news is that nobody is ready to take the first step to clean up the system.”

This has been taken note of, deliberated and analysed threadbare. There are several factors at play, the foremost being conflicts of interest- intellectual and financial. The scientific conclusions are drawn beforehand and the facade of a research is created for the gullible.

So often, the papers are ghost written by the industry and reputed names are put as authors to give credibility. Authors have been on record to admit ignorance of the findings of their own research. Journals need money to stay afloat and so do the researchers. Jerome Kassirer, ex editor of NEJM has been candid in saying, “when revenues fall there is enormous pressure on the editor to publish more pharmaceutical studies to sell more reprints.” The journals have devolved to launder the information on behest of the vested interests.

The most recognised book in all of medicine, ‘Harrison’s Principles of Internal Medicine’ is also a case study in hidden conflicts of interest. It has come to fore that contributors in Harrison’s received millions of dollars from makers of drugs and medical devices. So pervasive has been the malady that the authors ‘without conflict of interest’ have become endangered species on the verge of extinction.

It is not only the journals and the textbooks, the watchdog USFDA is also said to be on the payroll of the industry. It has received close to a billion dollars last year from the industry. Irrefutable science is based on reproducibility and data sharing. In modern medicine conflicting results are commonplace with raw data that is inaccessible behind layers of legal opacity.

Nobel laureate Ronald Coase has famously said, “If you torture the data long enough, it will confess to anything". Medical research today is all about torturing the data with a motive. The patient may just be a collateral and unintended beneficiary- or collateral damage.

A WhatsApp post is doing the rounds among doctors, which says, ‘A recent study showed that all recent studies are false’.

I am not amused.