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How Medicine™ Incentivized Bad Covid Science
It is usually in retrospect that we speak about the financial incentives that underlie decades of bad 'science' and medical opinion, such as with smoking or cholesterol. But, what about covid?
Brief History of Bad Medicine™
For over a century, the Western public has struggled with obtaining reliable and accurate medical opinion from the doctors in whose hands they have placed their well-being.
This, in my opinion, is a natural consequence of the lucrative nature of healthcare. Where there is a lot of money, there are ample opportunities for corruption.
Some of the most famous examples of these practices having widespread impact on the population have been with pro-smoking campaigns, dietary recommendations, and lead in combustible fuel or indoor paint. More recently, we have come to learn about all of the shady and corrupting practices that pharmaceutical companies have undertaken to push the widespread use of opioids as painkillers.
We are currently in the midst of propaganda campaigns that continue to be perpetrated on the population, for example in the form of “cholesterol is bad, now take this Statin.”
But the clock on this scam is coming to an end, and I get the sense that by the end of this decade we will look at it like another pro-smoking campaign.
But, what about covid? Covid the disease? The covid vaccine?
What’s the story behind this campaign?
As someone who published several peer-reviewed articles in 2020, I am starting to see parallels between what happened this decade and in the prior century.
The Rise of Fiat Medicine
Before we understand exactly what happened with covid, we first need to review the rise of Medicine™ and the currency of academic physicians.
For those interested in the whole spiel, I wrote about it here:
Briefly, I assert that peer-reviewed publication is the currency that lubricates the gears of academic medicine (and even private medicine, to some extent).
Peer-review is an invention of the mid-20th-century, and is not a critical component of scientific endeavor. As Eric Weinstein effectively put it:
Real peer-review happens after the article is published.
However, this reality does not stop academic medicine from treating peer-reviewed publications with the utmost importance.
From the above article:
Peer-review is for people who are playing the role of a scientist.
Within academic medicine, “peer-reviewed publications” is an important marker that is conveyed on the curriculum vitae, or resume. The standard academic CV has a section specifically for peer-reviewed literature.
“Peer-review” is the currency of academia. Similar to fiat currency, it is the denomination by which students are chosen for education, graduates are chosen for training, trainees chosen for faculty positions, and all of the above chosen for grant funding.
For those that don’t appreciate the importance of this, let me paint you a picture:
You are a medical student, or doctor-in-training, or junior faculty, or even senior faculty
Your success within academic medicine will be determined in large part by what can be found on your resume
There is a section in your resume that lists all of your ‘peer-reviewed publications’
Your citation record, h-score, and mainstream exposure are all valuable for your career prospects
Thus, while you struggle to balance time between your life and taking care of patients, you must also figure out a way to get as much published as you can.
Not all publications are viewed equally, however.
For instance, a randomized control-trial or systematic review is a much larger task than a simple case report.
Another element to consider is the specific journal within which your work gets published.
For example, a case report in Radiology Case Reports is viewed differently compared to a case report that is published in a journal from the American Heart Association. Not only is it more difficult to publish a case report in an AHA journal, but more costly.
If you want to publish a case report in the former journal, you will pay a nominal cost of a couple of hundred dollars to essentially guarantee that your case report will get published, regardless of the quality of the manuscript.
In an AHA journal, however, this same article may cost thousands of dollars to publish (and be perceived by the editors as uniquely informative).
Then, why would anyone want to pay thousands of dollars instead of hundreds of dollars to publish the same case report?
An AHA journal has an impact factor that is often an order of magnitude higher than some no-name case report journal that nobody is going to read.
Before we dive into what happened in 2020, let us take stock of what we discussed.
You desire to advance your career as an academic doctor
There is a novel pathogen ravaging the population
This pathogen is all that the industry, and world, can talk about
What’s your next move?
You want to make statements about that which is popular in the news and always discussed. It just so happens that all your patients are being admitted with positive covid tests. When life gives you lemons, as the saying goes.
But, you don’t know anything about covid because it is presented as this novel disease that can cause anything and everything. All you know is that sick people are being admitted to the hospital (as they always have been) and they are testing positive on an unreliable test.
One day, a patient comes in with knee pain and tests positive for covid!
For the unassuming and misinformed budding physician, this is enough information for them to think: wow, this could be covid!
So they decide to put together a couple of cases, or do an observational study within their hospital with the help of their colleagues. They think to themselves, ‘this can help us understand covid!’
What happened in 2020 that incentivized bad covid medicine?
Let us count the ways.
In the hospital, everyone presenting to the emergency department got tested for covid. Even if they didn’t have anything related to an upper respiratory infection. For one thing, this would determine where to place the patient - with the lepers (covid+) or with the normal people (covid-). Secondly, if you needed any imaging or procedure done they would have to determine if you are ‘infectious’ with a covid test. This would guide cleaning and management of a high-usage room afterwards.
Ultimately, this has resulted in people with a known medical condition being classified as someone with ‘covid.’ Many have written on this extensively, so I won’t go into it.
In the academy, if you want to write up any research paper you must first go through the institutional review board (IRB). The IRB, like all departments in 2020, had limited office time and staff availability. They also prioritized reviewing and approving research concerning ‘covid.’
Why? Financial incentives, of course.
Practically, this fast-tracks the pipeline of ‘covid research’ performed within an institution and shifts everyones research endeavors towards that which has ready and abundant grant-funding and expedited IRB approval.
Finally, we consider the journals.
Remember how I said that the highest impact journals have publication fees in the thousands of dollars?
Well, you will be pleased to know that these fees were scrapped by most of the sought after journals. Completely scrapped. Zero dollar publication fee. Just get them the manuscript, and do it fast!
Yours truly published a case report in a high impact factor journal without having to pay their nearly $2000 publication fee. Don’t worry, the point of the article was that the patient suffered because of mismanagement brought on by covid policies, not covid itself.
This brings in a clinching element that we had not discussed. Competition.
In our hypothetical scenario, you are not the only one trying to publish a manuscript talking about how ‘covid’ has caused a person with 4 other disease to be admitted in critical condition.
The rat race was on.
The doctors and their institutions ate it up.
Journals started publishing any old garbage, regardless of the tenuous nature of the connection, as long as it was some new mysterious presentation of ‘covid.’
I remember reading one article suggesting that a person’s wrist inflammation (carpal tunnel syndrome) was due to covid because they had a positive test. Obviously, this idea didn’t last long. But, it still got published and got some media attention.
Journals would incentivize and prioritize publishing articles claiming any random connection with an upper respiratory virus. The news media ate this up, and started pushing headlines non-stop.
I used to read the New England Journal of Medicine with some regularity. I always tried to get useful information out of their publication. During the covid era, however, it became unbearable. Almost every article was some combination of covid fear-mongering or shilling for the experimental drug manufacturers. There was a stretch of time where that was pretty much all that they published, sprinkled in with some new chemotherapy.
The net impact of this was to scare the population into believing that covid was a monster, and no effort to understand and treat covid was too costly.
Unless of course, your approach to treat covid was using vitamins and generic drugs. These were not a high priority, nor as sexy to publish.
Even if your manuscript which minimized the impact of ‘covid’ or the effectiveness of conservative approaches to managing it got published…if it got too much media attention…it was swiftly removed from publication.
Such was the fate of several articles published by those who supported things like vitamins, hydroxychloroquine, ivermectin, or just sun exposure. Once the population got wind of it…it had to be censored.
Why Do This?
Whether you are a tobacco company, or in the business of fossil fuels, or…a pharmaceutical company…your goals as a corporate entity are similar.
You want to maximize revenue, minimize costs, and eliminate the possibility of legal repercussion.
On this basis, you begin campaigning:
Securing government contracts.
Lobbying for policies which loosen regulations and favor you legally.
Providing financial incentives to journals (which are almost entirely funded by corporate interest), hospitals, research labs and independent doctors.
If you think about it…it worked for a little while.
The good news is that the tide is turning. People are starting to realize the magnitude of what transpired recently, as well as what has happened historically.
In the future, we will speak about the covid campaign as one of the worst assaults on the public consciousness and the integrity of medicine.
A Silver Lining
There was an upside to all this drama, however.
One of the avenues of research publication that flourished during this time period were pre-print repositories, like bioRxiv.
Simply, these are servers which researchers upload their manuscripts before they are submitted for ‘peer-reviewed publication.’ Because of the collective sense of urgency, usage of these servers absolutely exploded.
The net effect of this change in publishing is that, for once, the public was not at the whim of a captured editorial board and a random selection of three careerist ‘peer-reviewers.’
We could read any and all research that someone would dare upload online. No publication bias.
Just you and the research.
Of course, it is up to you to appropriately appraise the quality and reliability of the work.
However, you already have to do that with the peer-reviewed literature as well.
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