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28 Mar, 37 tweets, 10 min read
Recently, Professor John Ioannidis, most famous for his meta-science and more recently COVID-19 work, published this article in the European Journal of Clinical Investigation

It included, among other things, a lengthy personal attack on me

Some thoughts 1/n
2/n The article itself is here, and honestly it’s a bit of an odd piece. If I were to commission a review on the small number of SR/MAs on the COVID-19 IFR, I’d probably want it to be written by someone who hadn’t authored one of the 6…
3/n Moreover, I personally find the entire focus of the piece strange. I do not think it is reasonably possible to accurately estimate the GLOBAL IFR (infection fatality rate/ratio) of COVID-19
4/n The problem with trying to work out a global IFR – i.e. the total number of people dead/infected for COVID-19 across the world – is that both the death AND infection data is scant in most places in the world
5/n For example, this recent systematic review of seroprevalence studies found that even after including more than 400 pieces of research total there was insufficient evidence to infer a truly global estimate…
6/n On the other side of the coin, there’s evidence that in some countries that the death figures from COVID-19 may underestimate the true toll by an order of magnitude (or more!)…
7/n So I don't know if the primary purpose of this paper makes sense

But what is it exactly?

Well, it’s mostly a review of systematic reviews
8/n The author looks at each review and discusses his view on their limitations and successes, then concludes that the best estimate is his own
9/n He spends quite a bit of time on my and @LeaMerone's paper, arguing that we “cherry-picked” evidence to suit our conclusions and that our analysis methods are “overtly implausible”
10/n Now, one thing to note is that these are judgement calls rather than actual scientific critiques. We laid out our methodology quite transparently – saying that this is “implausible” is an opinion, not a fact
11/n That being said, I disagree with many of these statements. For example, this passage argues that we excluded studies in “overtly biased ways” with these three pieces of research
12/n I’m not sure how it is possible to say that something is “overtly biased” when it is transparent and open, but nevertheless there are quite obvious explanations for all of these things (that we give in the paper)
13/n For example, this tabulated estimate includes studies that we reference elsewhere in the review, with 5 of these estimates ~included in our meta-analysis~

It would actually be BAD scientific practice to include these figures twice!
14/n The paper which he co-authored is, I suppose, a matter for discussion – perhaps @LeaMerone and I were presumptuous in reading “selection bias is likely...” as an explicit warning against extrapolating to the entire population of LA County
15/n There are also parts of this paper that are bizarre. It is, for example, not a strength of meta-research to include MORE studies. Indeed, the phrase “garbage in garbage out” is commonly used to describe analyses that do not attempt to exclude poorly-done studies
16/n I would argue that one of the biggest STRENGTHS of our meta-analysis was the time we spent EXCLUDING biased research, because as has now become fairly obvious these studies often overestimate seroprevalence in a population
17/n But overall, I think that Prof Ioannidis' review really shows the issues with having people who have staked their reputation on an issue author perspective pieces on the issue. We all tend to think that our own research is the best
18/n Now, to the personal attacks

I must admit, I was quite shocked to read this published in a scientific paper

I’m not going to go over them, but please do have a read in the paper itself (appendix 1)
19/n For my followers who don’t publish academic research, it’s worth noting that these attacks not only were written by the author, but approved by at least one editor and (usually) 2-3 peers as well
20/n I make no secret of my junior status (it’s there in my twitter bio and every paper I publish), but to say that my research is flawed because of it is a remarkable piece of gatekeeping and I think really quite harmful
21/n It is also worth noting that while I am still doing my PhD, I have been working in public health for more than half a decade, because often the more sought-after qualification is an MPH not PhD
22/n I appreciate the many wonderful people who have come to my defense against these attacks, but in all honesty it’s not me that I’m worried about.

For better or worse, I have a large platform, and I’m not in any huge danger from a professor being publicly mean to me
23/n But imagine, for a second, that I had not been in the news a bit and grown a social media platform. Imagine I was one of 1,000s of faceless PhD students watching a tenured professor at Stanford publicly defame one of their comrades

It’s quite chilling
24/n I may have the wherewithal to defend myself, and I’ll be writing to the journal, but the implication that PhD students have no place in scientific discourse, that their papers are worthless scientifically will, I think, have far greater ramifications
25/n Imagine reading this as a PhD student at Stanford. This is a senior faculty member telling these students that no matter what work they do, their opinions will always come second to professors

Not what I would hope the scientific discourse to be
26/n This issue is not a new one by a long shot. @hertzpodcast covered the issues that PhD students face several times in great detail – I recommend you listen
27/n I could point out that our paper was reviewed by several very senior epis before we submitted it (including one of the most senior epis in Australia), but that they did not feel they contributed enough to add their names – perhaps this would’ve saved me a tongue-lashing
28/n But the point is that we should not have to have Big Fancy Professors on our paper for it to be considered on its own merits. I’m sure we could have twisted our colleagues’ arms, but we did not think that a professor would stoop to our PhDs as a means of attack
29/n I will be writing to the European Journal of Clinical Investigation. Given that the immediate past Editor In Chief was one professor John Ioannidis, I’m not sure it will do much good, but at least I will have my say
30/n But for anyone reading this who is mentoring PhD students, particularly people at Stanford, I would suggest strongly that you check in and assure them that you do indeed find their opinions and perspectives useful
31/n As to the paper itself? There are obviously more issues – covered here in depth by @AtomsksSanakan – but oddly enough there are also places where Prof Ioannidis and I agree about our paper
32/n Perhaps that is because many of the issues he raises about our meta-analysis are pointed out by ourselves in our discussion. Regardless, it would perhaps have been interesting to discuss these in the Journal if not for the unfortunate attacks
33/n Oddly enough, I think that the personal nature of the attack has effectively “silenced” criticism, at least in the EJCI. I do not think I would ever trust the editors of a journal that published attacks such as this and I’m not going to submit an official letter in response
34/n That being said, it’s worth noting that I’m not the only person being targeted here. @LeaMerone, my co-author and a spectacular public health physician, is also being derided for still working on her (I believe) 4th postgraduate degree
35/n More broadly, I think that this sort of punching down is truly unacceptable in academic debate. It is unprofessional, unscientific, and quite depressing to see
36/n Thanks again for every person who has reached out. I cannot express how much it means to me to have the support of such wonderful people as all of you ❤️
37/ One other thing - I do not think it is reasonable to infer from Prof Ioannidis' behaviour to anyone else. I know some of his former colleagues and students and they are all lovely people and excellent researchers

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More from @GidMK

26 Mar
I've been thinking a bit about why I'm so unimpressed by the arguments about how terrible "academic silencing" is, and I've got some thoughts 1/n
2/n You know the arguments I mean. They usually go something like "[x famous academic] is being horribly silenced/faced the modern inquisition!"

And they usually come off as, well, nonsense
3/n Now, part of this is because the academic being defended usually has not by any description been silenced. Nobel laureates and tenured professors at Stanford don't really need defending they can do it themselves
Read 17 tweets
23 Mar
People often make the claim that, during the COVID-19 pandemic, we have "failed to protect the elderly"

While initially this was definitely true (April/March 2020), I'm not sure the claim is accurate past that 1/n
2/n I'm basing my opinion here on seroprevalence data. This is basically data looking at who has antibodies to COVID-19, and therefore who was previously infected

We reviewed 100s of studies for our IFR paper. What did they show?…
3/n Well, not all of them looked at the age-stratified rates of infection

But of those that DID, an interesting pattern emerges
Read 17 tweets
22 Mar
The somewhat depressing fact is that making COVID-19 predictions is essentially cost-free

No one will hold you accountable for predicting wrong, if they even remember in a few months time
The reality is that most people who have predicted the future of COVID with any certainty have made a lot of mistakes, but no one ever checks back to audit those in any meaningful way
There are people who get massive media attention once a month when they confidently predict that COVID-19 will be over in 4-6 weeks time, even though they've been doing it for over a year now
Read 5 tweets
21 Mar
It's not like this is something most infectious diseases epidemiologists have been saying since March last year

Oh wait
Herd immunity through natural infection was always an absurd idea that made no sense whatsoever

Herd immunity through population vaccination is more complex
This is something covered in the John Snow Memorandum quite well, actually. There's no guarantee that immunity (even vaccine-induced) will last sufficiently long to ensure herd immunity
Read 7 tweets
18 Mar
Very interesting study out of Denmark looking at SARS-CoV-2 reinfections:

- 0.65% symptomatic reinfections after 7 months
- in sensitivity analysis this doubled to 1.2%
- estimated ~80% short-term protection against reinfection Image
Studies like this make me very jealous of my Nordic colleagues. The authors had access to linked data for *the entire country of Denmark*, which is a pretty enormous strength of the research Image
Basically, they looked at every PCR test done in the first wave, and followed up every person to see if they had tested positive in the first, second, or both waves

Of those in the sample, 0.65% were infected twice
Read 7 tweets
17 Mar
Something I think about a lot is that studies don't get retracted because they're bad, they get retracted because they are famous
Don't get me wrong, they are ALSO bad. It takes a truly awful study to get a scientific journal to wrest itself free of apathy and inertia to take some action

But there are 1,000s of woeful papers
Thing is, no one is paid to catch bad research. It is a thankless, time-consuming task that at best earns you the mistrust of most of your peers

And so, no one does it methodically
Read 9 tweets

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