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• 1 2020-04-29T20:21:50+00:00 Covid - 19: Real Debates and Fake News 44 plain 2020-05-12T22:46:44+00:00 In the Covid-19 pandemic we've seen attempts to sell (sometimes dubious) cures to the public. These attempts are often motivated by greed, and prey on the fear people are experiencing. There are also many debates about the science involved in the disease, including how it is spread, how prevalent it is, and how deadly. Some of what is published could be fake news, while other information is well-intentioned and perhaps true. But the difficulty of gathering accurate data and analyzing it correctly during a fast-moving international health crisis means "truth" can be a moving target. The result is confusion for the public, for whom discerning what is true can literally mean life or death. 
  
  Themes seen in our fake news stories echo in this crisis. In the pandemic we've seen appeals to emotion as a way to deceive and make money, celebrity endorsements of treatments, and confusing scientific debates. 

  Appeals to Emotion to Sell Products

  In the Covid-19 pandemic, fear is a strong driver of how people behave, and many are eager to prey on that fear to make money. Social media such as Twitter and Facebook help to spread disinformation published by those who seek to exploit the anxiety that is rampant during a pandemic. 
  
  
  
  
  
  
  
  
  
  
  
  In the current highly polarized political environment, news about potential true cures will often be filtered through a political lens, and this has been on display in the Covid-19 pandemic. In one example Michigan state representative Karen Whitsett credited hydroxychloroquine, a drug used to treat lupus, with curing her Covid-19 infection.
  
  
  

  Her case was immediately seized on by political supporters of President Trump, a proponent of the drug as a treatment for Covid-19, and then roundly denounced by those opposed to the President and some Democrats. Lost in the angry debate was a reasonable way to evaluate what this single result means for the usefulness of hydroxychloroquine as a Covid-19 treatment. 
  
  As people are desperate for a cure, interest in hydroxychloroquine spikes. It is now one of Google's most popular searches, and a topic of much published research.  A Google Scholar search revealed 1320 articles written just about Covid-19 and hydroxychloroquine in the first four months of 2020 alone. No individual could realistically read and carefully evaluate every article.

  Fake News with Political Motives

  Some motives for spreading fake news are less clear. Some do seem to have underlying political agendas, such as spreading information to incite anger at China.
  
  

  Celebrity Endorsements

  Both President Trump and Elon Musk have touted hydroxychloroquine as a potential treatment for Covid-19. Their endorsements were picked up worldwide, and have led to more interest in this drug as a potential cure, as shown by increases in Google searches. In addition, some began to hoard the drug, causing shortages and risks for lupus patients, who are often treated with hydroxychloroquine. Hydroxychloroquine is being studied as a Covid-19 treatment, but with only preliminary and mixed results. As yet there is no definitive proof that it is an effective and safe treatment for the virus. It is easier for a famous person to have their opinion spread and listened to than it is for scientists who speak in more complex and nuanced ways about how to treat Covid-19.
  
  
  
  
  
  
  

  Understanding Scientific Debate

  When scientists begin to research the underlying cause of a disease, there is lack of clarity and consensus. The debate among them is real and can be heated. Initially, many small studies and case reports come out of clinical settings, and often yield conflicting results.The popular press will seize on early results, especially those that seem positive, like a drug that may be a "miracle cure."  More conclusive studies must include more people and take years to run. Good science takes time and during that time genuine debate among researchers is a healthy and necessary thing. For the public, this debate can make it difficult to evaluate all the information they see and hear about Covid-19. 
  
  During the time of necessary scientific debate, polarization among the public can make understanding the motives of scientists difficult and lead to angry assessments of research. 
  
  
  One researcher, John Ioannides has famously revealed some of the biases in how research is reported. He has noted that many published studies are small and perhaps make claims that cannot be supported, and often are either not reproducible by other experimenters or are later contradicted by larger, higher quality research. Working at Stanford, he recently wrote one of two reports out of California indicating that exposure and infection with Covid-19 was far higher than was previously believed.  If that is true, then the mortality rate from Covid-19 may be much lower than is currently thought. Even before this study, Ioannidis had staked out a position of doubting the severity of the virus, arguing in an editorial that the lockdowns in the United States were not yet supportable by available data and would do more harm than is necessary. Others vehemently disagreed, and pointed out that a very small number of cases (68 in the United States at the time) would rapidly explode,and that social distancing was a reasonable response to take. After Ioannidis published data that infections were more widespread, controversy ensued. Some people angry with mandatory shutdowns seized on the studies as proof that government had overreacted to the disease. The study used Facebook to recruit 3330 people, which is not a random group and is potentially skewed. These respondents were administered a Covid-19 test, and 50 tested positive. They extrapolated from this group that true infection rates in the entire population were 50 to 85 times higher than known, meaning mortality rate was much lower. Many have raised reasonable objections about his methodology, saying that recruiting on Facebook does not yield a random sample of people, that those who responded may have already suspected they were ill and were thus more interested in the test, the testing itself may have been flawed and resulted in a high rate of false positives. To be fair, the preprint of the released study noted these limitations. Some ascribed dubious motives to Ioannidis, claiming that he is overly dedicated to his role as the skeptic who points out the limitations of scientific studies. 
  
  Ultimately the debate is healthy and necessary as pointed out by Viany Prasad and Jeffrey Flier in First Opinion

  ...vigorous debate is fundamental to the existence of universities, where individuals with different ideas who have a commitment to reason compete to persuade others based on evidence, data, and reason. Now is the time to foster —not stifle — open dialogue among academic physicians and scientists about the current pandemic and the best tactical responses to it, each of which involve enormous trade-offs and unanticipated consequences.

  Power of Social Media

  
  While themes repeat through history as we see stories of confusion and outright deception around medical issues, the speed and power of social media moves the problem to a whole new level. During the Covid-19 pandemic, a video posted to Youtube became hugely popular and was viewed eight million times in just days. In it, Dr. Judy Mikovits attacked CDC scientists, claiming they had suppressed her own research about vaccines and people's immune systems. Her original research had to be retracted when no other scientists could replicate her results.
  
  
  
  While almost all scientists reject her claims, both in her original research about vaccines and her current accusations, she is now followed by opponents of vaccination and of social distancing restrictions. The Youtube video is just part of a larger film "Plandemic." Dr. Mikovits has also published a book which reframes her original research as subsequent disgrace as an attempt by big science to squash opposing viewpoints. 
  
  
  In debates about the truth of medical claims, belief in personality or preconceived notions about the truth of a medical claim, seem to overpower meaningful and reasoned discussion.

  Who do I believe? Can I decide for myself what is true?

  There are answers to the Covid-19 questions. There is a true mortality rate, and there are treatments more effective than others. In the middle of the crisis it is just incredibly difficult or impossible to know what the real answers are. No one study, or even several studies early in any investigation will be conclusive. Occasional studies may be contradictory, but over time if a relationship is real, more studies will begin to point to the same findings. As with early research on cigarettes and cancer, over time, more research pointed to the same results, and it was only a few outlier scientists that continued to try to cast doubt on what the majority of research was finding.
  
  Early on in a medical crisis, it is wise to be suspicious of anyone who claims absolute knowledge and certainty about a disease. As time goes on and consensus builds, it may be better to be more skeptical of the skeptics: those few who will claim that the majority of scientists are wrong.  Still, how can the public judge for themselves the validity of any one piece of research?
  
  In reading research scientists also pay attention to levels of evidence. This has been characterized as a pyramid of evidence by those who promote evidence-based medicine, a movement aimed at helping clinicians to sift through and understand massive amounts of published research.
  
  At the bottom, the weakest evidence is the opinion of recognized experts, often conveyed through textbooks but also can be found in popular media, like any talk show on cable news who often features experts. Case reports are also common but not considered strong evidence. In these, practitioners may report on experiences with a small number of cases in great detail. An example would be during the pandemic clinicians would report on small numbers of patients who might show good or poor results when treated with an experimental drug. In these types of studies, outcomes may have been influenced by a range of factors that were not controlled. Patients who get better while on a drug may just have easily gotten better with no treatment at all. While some patients may have experienced no ill effects, other patients on the same drug may experience very negative side effects. Also, be aware that positive results tend to be published and also appeal to popular media outlets. In times of fear, a story with happy news will "sell." A higher level of evidence, the randomized controlled trial, attempts to remove some superfluous factors from affecting outcomes. A control group not receiving treatment will be compared to one getting the treatment. If other variables are constant, this type of comparison can better demonstrate efficacy. At the top of the evidence pyramid are studies that pull together results from many different studies in a meta-analysis. When many studies point to the same finding in a meta-analysis you can be more confident in research findings. 

  Summing It All Up

  1. Be very skeptical of reports of individuals making recovery from an experimental drug. Single results could be influenced by many factors. Anyone claiming a miracle drug may simply be trying to sell something.
  2. If one or two researchers seem to disagree with the majority of other scientists, think about their background. Is their degree in the area in question, or do they have a degree in an unrelated area?
  3. To publish in most reputable journals, researchers need to state any financing they have received. An organization giving out funding may sound altruistic, but sometimes they represent industry funding. Think carefully about the funding and motives behind some research. 
  4. What is not published is another difficult problem, and one less easy to decipher. Drug companies may fund research, and they may not allow negative results to be published. In addition, negative results are not so good for careers, and less likely to be published.

  Learn More About Evaluating the News and Medical Research

  
  Understanding Medical Research Medline Plus the National Library of Medicine
  Among All the Categories of Fake News, Health News is the Worst Atlantic Magazine June 25, 2017
  Three Ways to Spot a Bad Statistic TED Talk, Mona Chalabi
  Become Data Literate in Three Steps 
  Recognizing Fake News Cornell University Library
  Play the Fake News Game