Hurry, Don’t Rush

I want to tell you a story about cancer. I promise you it’s relevant.

Introduction

High-dose chemotherapy is brutal.

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.9.1515
https://www.amazon.com/Emperor-All-Maladies-Biography-Cancer-ebook/dp/B003UYUP58
https://www.amazon.com/Emperor-All-Maladies-Biography-Cancer-ebook/dp/B003UYUP58
  • a strong, bold, risky treatment presented by a mercurial saviour
  • the rush to use, and the overconfidence born from initial work
  • the morphing of the issue into something larger and a lot messier when it hits the public domain
  • the difficulties in performing testing because demand and access completely outstripped the ability to provide a controlled testing platform
  • and the eventual disappointment, because of the unreliability of the early work

Hurry Don’t Rush

The following is a heavily shortened summary of the scientific evidence for HCQ as a frontline treatment for COVID right now. The situation is ridiculously fluid, and has been changing day to day as I wrote and edited this, so I hope it’s accurate at time of publication.

  • The paper was published at predatory publisher speed (ie. almost instantly) at a journal where the authors have existing affiliations and/or editorial control. Peer review was cursory at best. Elsevier just released a statement which assures us that “the journal’s standard peer review process was followed in the publication of this paper”. Of course, the standard review process does not guarantee that a paper can get reviewed and accepted in 24 hours, so that seems… wrong.
  • The results were then heavily promoted by a, uh, lawyer. He claimed a series of academic affiliations and authority which seems questionable at best. If he’s not a grifter, he certainly is wearing grifter’s clothing.
  • The author/institute have produced a worrying series of previous papers containing duplicate and overlapping figures. I don’t know their reputation specific to their scientific field, but in any field that I do know, this makes me trust you a lot less.
  • The International Society for Microbial Chemotherapy released a statement released a statement saying the first study did not meet the society’s expected standard. This is an extremely unusual step, for a society to censure a paper published in an affiliated journal, without the explicit input of the journal itself.
  • The second HCQ study didn’t have a control group. What else needs to be added to that? If patients are treated for an illness and recover… they recover relative to what? By this standard, rubbing a penguin on your earlobes cures the common flu in 99% of cases, because people usually get better. With this kind of evidence, it makes as much sense to rush to the wet bit of the zoo if you have a sniffle.
  • HCQ has some substantial side-effects. As it’s already being handed out indiscriminately, often to people with pre-existing conditions, this is a Serious Problem.

Heroes who hurry, weasels who rush

There are two reasons to try to rush scientific work through to publication in a crisis, and the one that all researchers would tell you is that we need the information right away, to help solve the problem. So, research is being produced, reviewed, and disseminated faster. We need to act now, we are told, and science is answering the call. There are people out there putting heroic hours into project that will seriously, actually, really help.

Conclusion

Make no mistake: we need science right now. There’s a global problem whose solution lies squarely in the domain of building empirical knowledge about the natural world. This comes with something of a gold rush, both for money and for profile.

The dire need for information should not mean rush to produce unreliable information quickly, and attempt to shoehorn your research in particular to the center of the problem. Hurry, don’t rush.

I write about science. We can probably be friends.