[This article deals with a continuously developing situation. It was written by Norbert Gleicher, MD, on April 28, 2020 and published on April 29, 2020. For a list of all COVID-19 Bulletins, scroll to the bottom.]
One of the major problems why COVID-19 is being managed incorrectly almost all over the world, is the extraordinary exaggeration of risk by interested parties. It starts with the media who have an inherent bias toward sensationalism because the more grusome the news, the more clicks they attract on the Internet, the higher the viewership on television and the better will be newspaper sales. Add to this the political motivations, of course inherent to any political opposition, the almost obsessive opposition in the U.S. by most of the media to everything “Trumpian,” the self-interests of the “expert” class in dominating the decision-making process and, finally, consider the pressure government faces from lobbyists in a crisis like we are currentlt facing, and one really cannot envy the President in his position of being the ultimate decision-maker.
Who can one trust for advice in such a situation ?
We would argue that one such person is Stanford scientist John P. A. Ioannidis, MD. One cannot be interested in medical research without knowing of Ioannides and having read many of his papers. He is one of these few physician-scientists who are not only bright, hard working and original in their thinking but also have an uncanny ability to read between the lines of scientific writing and discourse. In a very unique way, he, better than most, has given the medical field the absolute necessary bitter medicine in laying bare how much of published research is either reaching incorrect conclusions and/or is basically clinically irrelevant. Wikepedia describes him as a Greek-American physician-scientist and writer (yes, he also writes poetry and novels) who has made (important) contributions to evidence-based medicine, epidemiology, and clinical research by studying research, itself, including so-called meta-research (i.e., large data sets) primarily in clinical medicine and the social sciences.
At Stanford University, he is the distinguished C. F. Rehnborg Professor in Disease Prevention in the School of Medicine, Professor of Medicine, of Health Research and Policy (Epidemiology) and by courtesy of Statistics and of Biomedical Data Science.
In other words, he is exactly the kind of person one should listen to in COVID-19 times, where the correct _analysis and understanding of still very limited data is of such great importance. Yet, he, to the best of our knowledge, is not part of the President’s COVID-19 Task Force. Indeed, we are unaware that he even counselled anybody in the White House at a time when _The Wall Street Journal on the front page (on April 29) reported that a group of billonairs and self-appointed science “experts” have gotten together to find solutions for the COVID-19 crisis and they, indeed, succeeded in gaining access to White House staff. How interesting even a guest appearance of Ioannidis at one of those daily Task Force TV updates would be, became quite apparent when he was interviewed by Allysia Finley for the editorial page of The Wall Street Journal on April 24, 2020. We, for example, would be willing to pay for seeing him debate Anthony Fauci, currently by many considered the “oracle” and/or “prophet” of COVID-19-truth.
In that interview Finley quotes California Governor Gavin Newsom as saying, “we are going to do the righ thing, not judge by politics, not judge by protest, but by science.” Similar phrasing, always stressing the “decision-making based on science,” could also be heard from many other governors, including New York’s Cuomo, New Jersey’s Murphy and Connecticut’s Lamont; and, of course, also from the President and his COVID-19 Task Force team, headed by V.P. Mike Pence. Yet while everybody is claiming to follow science, unfortunately hardly any one of these politicians knows to differeniate between good and bad science. Ioannidis knows to do that better than almost anyone else. This is why Trump should have him on his side (rather than Fauci or anybody else) when making important decisions about “reopening” the country. And this advice would not hurt Governor Cuomo or any of the other governors either, who appear so self-assured in their decision making but, of course, have been only too often rather dramatically off course.
A very good example for the originality of Ioannides’ thinking is how he made practical use of what in medicine is called a “model of nature.” When the cruise ship the Diamond Princess made headlines around the world in early February because Japan initially did not allow to evacuate the ship of its COVID-19-stricken patients and crew, Ioannides instinctively understood that this created a perfect environment for assessing infectivity and mortality caused by the COVID-19 virus.
The world at that point was obsessed by the fact that a whopping 700 passengers and crew got infected on the ship and 9 died. In these early days of the pandemic, those seemed to be enormous numbers and they were, indeed, described as such by all the media. Based on the demographics of who was on the ship, Ioannides, however, already then calculated correctly that this would suggest for the U.S. a fatality rate from the virus of as low as 0.25-0.625%, comparable to the mortality of the annual flu. These numbers only rececently were fully confirmed, as real disease rates on West and East Coasts were reported based on anti-viral antibodies detected in random populations (for details, please see our last COVID-19 Bulletin).
Considering that only a little later the so-called “experts” at the Royal College in London predicted that COVID-19 would cause over 2 million deaths in the U.S., Ioannides, thus, developed remarkably accurate insight into the the true risks of the virus at a very early stage of the epidemic and one really has to wonder whether the U.S. government (and many other contries) would have really shut down their econmomies to the degree they did, had they known the true mortality rate of the COVID-19 virus. The answere is, likely, a NO!
The tragedy , however, has been that the U.S. and most other governments have been following the alarmists, like the British Royal College and the Anthony Faucis of the world, who may be good theoreticians and may mean well but do not have the insights into and ability to accurately assess messages offered by complex, multifactorial mega-data. Ioannides, in contrast, recognizing that the Diamond Princess offered him an in vivo laboratory, a microcosm of the world, in assessing the COVID-19 virus, was basically able to assess the virulence of the virus instantly correctly on the backside of an envelope.
Unfortunately, many of our governors and the President, claiming to be directed ”by science,” still have not learned to differentiate between good and bad science. As many of us in medicine very well know, bad science is all around us and, unfortunately, frequently propagated by very esteemed colleagues. But nobody has taught us more about bad science than Professor John P.A. Ioannidis, MD, and, therefore, everybody who has not read his interview in The Wall Street Journal, should do so.
CHR's COVID-19 Bulletins
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
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