 Thank you. Hello. I'm Shannon Brownlee. I'm senior vice president of the Lawn Institute, and I'm the author of Overtreated Why Too Much Medicine is Making Us Sicker and Poor. And I want to welcome all of you to another social distancing social from Future Tense, which is a partnership of Slate, New America, and Arizona State University. And today, we're going to talk about issues with viral medical misinformation, which is appropriate to the COVID-19 virus. And I'm joined by my longtime colleague and friend, Jeannie Lenzer, who's a medical investigative journalist and author of The Danger Within Us, America's Untested, Unregulated Medical Device Industry, and One Man's Battle to Survive It. Welcome, Jeannie. Welcome, everyone, who's out there in the virtual audience. And today, we're going to start talking with an article that Jeannie and I just published in Issues in Science and Technology. And I don't even remember the topic of our own article, but it is Pandemic Science Out of Control. And what we were talking about was the kind of crazy hysteria that has kind of developed around a number of putative remedies for COVID-19 and the poor science that's being bandied about as if it were proof for efficacy for these various remedies. You'll know the names of a couple of the drugs that we're going to talk about, Hydroxychloroquine and Remdesivir. We're going to talk a little bit about a couple of studies, and we should just get started from that. So, Jeannie, why don't you talk a little bit about how we got interested in this issue and why we thought we needed to write about it? Well, I had originally written an article in the BMJ, formerly the British Medical Journal, about the Hydroxychloroquine because I was just dumbfounded that this study managed to trigger this avalanche of support, including from Trump and a number of doctors and scientists. And when I looked at the study, I was just astounded. So this was a French study conducted by Didier Raoul and I think it was 36 patients and I think about 12 of those were given usual care and the rest were treated with Hydroxychloroquine. And this was announced as a success. You know, this was a great treatment and Trump announced it as 100% successful. In truth, there were a number of problems on that study. One person died three people were transferred to ICU and two people withdrew. And these were people who were given the drug, Hydroxychloroquine. Yeah. That's what I was going to say is that, yeah, oh, we are old buddies, is that, you know, all of those bad outcomes occurred in the arm of people who got the Hydroxychloroquine. So how does this researcher get to say that it was successful when every bad outcome was in the people who got Hydroxychloroquine and none of those bad outcomes, no deaths, no ICU transfers, and no withdrawals in the people who got usual care? Well, the way he did it was by excluding those six people from analysis. And how did he get to do that? He got to do that because he only included people who made it through today six of the protocol. That sort of can sound reasonable. Let's not look at people who only made it through 12 hours of treatment she was, you know, that's not a real treatment. But when every bad outcome is in that group and they, it's kind of interesting, how do you not make it to six days? Well, you die or you get transferred to ICU. And that's exactly what happened. Those six people were excluded because they didn't make it today six. So he announces the benefit based on a surrogate marker. And a surrogate marker is something that's like a lab outcome or a blood pressure, something that is not relevant to the clinical outcome. So say, which is what we hear about like, does the person get better? Does the person live? Exactly. So a surrogate marker say seems obvious, say you're treating blood pressure, but the real problem you want to treat is the outcome of heart attacks, strokes and deaths. So if you only tell people what the surrogate marker is, the blood pressure, you're not, I mean, you can lower people's blood pressure and kill their livers or kill their kidneys. And that doesn't tell us about the real outcome you want to know. Did they live? And that's exactly what happened with hydroxychloroquine. We use this surrogate marker of how many people had the virus in their nose. Well, yeah, you can wipe out the virus in their nose by swaddling bleaches, Trump suggested, you might be dead too. That reminds me of the old joke about the surgeon who comes out to the family in the waiting room and he says, I have good news and bad news. The good news is the surgery was a complete success. The bad news is the patient died. So on the basis of this really questionable study and questionable interpretation of the results, all of a sudden the world explodes thinking hydroxychloroquine is going to save everybody. And I think that's the part that we found kind of astonishing was that there were other studies out there looking at this drug and all of them were inconclusive or didn't find that the drug was effective or were badly done studies. And yet doctors around the country and around the world were suddenly not only prescribing this drug, they were taking it themselves. 40% of doctors said that they had prescribed hydroxychloroquine for COVID and it gets even worse because a common problem now and I'm fascinated by this problem because I'm reading the microbe hunters now and we see a distinct difference between what happened years ago and what's happening now. But the problem is is that once they did a Raul got a single study that said it was beneficial, he said, oh, it's unethical to use placebo or usual care as a control arm anymore because I've proved that it's beneficial. So the subsequent larger studies that he published were simply testing one dose of hydroxychloroquine against another dose. Well, one of them is going to win. So you've got to win either way, but you still don't know if the drug is killing more people than it's helping or if it's useless. And this is a real problem today is that we're leaving medical discovery to corporations with billions of dollars riding on these drugs. And in the past in the microbe hunters, what fascinates me is that these guys would do experiment after experiment after I mean they would repeat their experiments a million times before they were convinced of what they were finding. But now we have these companies who they're not going to let multi millions of dollars on a drug go down the drain. They're going to make sure that it's a win. And once they get that win, they say it's unethical to conduct further studies. Let's back up a minute. Let's back up a minute. Raul wasn't wasn't representing a drug company. He was just a guy at a Institute in France doing these studies. So it's not like a company was supporting this research and hydroxychloroquine has been out for a zillion years. So it's not like anybody's making brand name money on it. Are they? They are. Yes. And even generic, I mean, generic drug makers make generic drugs for a reason. They're getting profits. So it's sort of like McDonald's. It's volume. So they may not have as high a price, but their volume lets them win. And that's why they get in the business. No, you're right. So it's sort of like lung cancer. Not every smoker gets lung cancer, but that's more likely to give you lung cancer. So the problem with remdesivir and many of the other drugs, and I'll talk briefly about the vaccine, is that industry funding is really interfering with what we're going to learn because we know and in fact, the recent withdrawal of this study, Lancet just hours ago withdrew that study you and I were talking about that found that remdesivir was harmful and not beneficial. Well, how did that happen? That was a company that is there to make profit. Well, let's talk about that one in a minute and kind of finish up with hydroxychloroquine. One of the things that I found really interesting in kind of looking historically at what happened in the 1918 pandemic flu pandemic was in addition to really crazy stuff like, you know, boiling hot, hot peppers in your house and, you know, putting onions around and giving people laxatives and stuff like that breathing. Oh, you know, one of the remedies was breathing fumes from factories. So in England, they brought children near a tin factory to breathe the fumes because there had been this sort of observation that people who live near factories were less likely to die of the flu than other people. So, you know, there was there was a lot of crazy stuff, but two of the things that were used in 1918 were based on some reasonable kind of medical knowledge. And one of them was quinine, which is used, was used back then for malaria. It brought down fever from malaria. And then the other one was digitalis, which is a heart drug. I don't know what the reasoning around the digitalis was, but the reasoning around the the reasoning around the quinine was that it brings down the fever and it was thought that the fever was actually part of what was hard on your body and what killed you. Well, so it turned out that in fact, quinine and digitalis were bad and actually harmed people who had flu and that was eventually discovered. But 100 years later, we come along and what drug do we have against COVID-19, another virus hydroxychloroquine, which happens to be related to quinine. Yeah. So, you know, what goes around comes around or, you know, plusage, whatever term you want to use, but we kind of keep making the same kinds of logical leaps and then not actually testing them before we give them to patients. Now, one of the things I think that that really needs people need to kind of understand about hydroxychloroquine, which they may not, is that it may not be like drinking bleach, but it's not a risk-free drug. So, can you talk a little bit about what some of the side effects are? So, the worst one of great concern is something called torsade, torsade du point, which is an abnormal heartbeat that can be deadly. And it doesn't occur often, but if you're, you know, the truth is, is that 99% of people who get coronavirus or COVID-19 survive, 99% of them. So, if that's the case, and you've got a drug that may be, cause a rare harm, but nonetheless a harm, and you give this to everyone, you may actually kill more people than you help. And so, it's not clear yet whether that's the case or whether it's just ineffective, but it's, it's a serious problem and something to look at. Yep. So, let's, let's talk now, talk about this latest study of hydroxychloroquine. So, about, oh gosh, how long ago? Is it three weeks ago? The, yeah, the Lancet, a prominent medical journal, international medical journal published a paper that said that it had looked at tens of thousands of patients at 671 hospitals around the world and found that hydroxychloroquine caused more harm than benefit and therefore should not be used. And a number of governments then reacted to that. The French government said, no more giving hydroxychloroquine. The United States started to be much more cautious about it. I don't know what kind of directive the FDA gave, but this was a very important kind of finding. And the study was actually believed, the results were believed to the point where people said, okay, we, we might not have to do other studies looking at hydroxychloroquine. And we know that this drug causes more harm than good. Well, today, about an hour ago, the Lancet just withdrew that, withdrew that paper. And the reason is that it looks like the paper was fraudulent. So, tell us what we know about that paper at this point, Jeannie. Well, I don't really know much other than that the company, you know, had, it just seemed like a fraudulent company. The, the guy who headed it, I think his name is Desai, had come under scrutiny a number of times in the past for various forms of medical either, I don't know that the word would be misconduct, but some kind of fraud or problems with his work. And apparently their researchers were not qualified to be doing the kind of work, nor did they have enough, I think they had like five people listed as employees. And for those kind of data, you need many, many, many people to handle the data. I think what's interesting is, is that this turning on a single study is a problem in either direction. So they turn, you know, the fact that they are now saying, well, you know, it may not cause harm, that it changes behavior is just as bad as their earlier behavior where everybody was adopting it. I mean, it became part of protocols at many hospitals in the US and the UK, and around the world. China was using it based on what evidence. And a lot of it is just observational evidence or incredibly poor quality evidence like the Raul studies. So now, so for people who don't really understand what a randomized control trial is and why it's more, you can believe it a little bit more than a, than an observational study, what a randomized control study does is it, it basically takes a group of people and it randomly assigns half of them to get a new treatment or the treatment that you want to find out whether or not it works. And the other half get something called a placebo, which is a sugar pill or usual care. But somehow they are there, the two groups are given different treatments, but they don't necessarily know which treatment they're getting. The patients don't know. And it's also important that the researchers, the doctors who are delivering the treatment don't know which one their patients are getting because scientists are not, they're people, they're not infallible. Physicians are people, they're not infallible. And everybody comes into a study with a sort of set of, of prior beliefs. And so what you want a study to do is try to get rid of those assumptions and those prior beliefs as much as you possibly can. So randomized control trials are set up this way so that when you get to the end of the study and you look at who, which group did better, you can say with some confidence that you had gotten rid of as many biases as possible and you might be able to believe the results. Now, once again, believing the results of one randomized trial is not a good idea, especially when it's a teeny trial like the Raul trial and he does tricky things like takes out six of the patients and doesn't analyze them in the end. So, so your point about not believing one trial is really critical. Yet here we are, this is a terrible time. People need to do something. Don't doctors have to do something? Why shouldn't they say, okay, this looks like it might work. I'm going to try it better to be safe than sorry. That's the boogeyman that occurred. We see it when we look back at the 1918 flu pandemic. We look at any pandemic and we look at what's happening now. That's sort of almost a natural reaction. We've got to do something. Isn't something better than nothing? But there's a wonderful saying of doctors who've been through this game and seen how that kind of attitude results in harm. And that is, don't just do something, stand there. But stand there and observe. Do the studies. The feeling that if we don't treat the individual right now with unknown treatments, that that's, and I saw one doctor say that's compassion. Well, it's not compassion because A, if we don't know whether that treatment works or not, we also don't know if it causes excess harm. And so you're not only potentially harming the patient in front of you, but you're depriving all future patients of the knowledge we need to understand whether something works. So going back to yellow fever, which we had originally started our article with, and we remember they were doing bloodletting then. The big problem was is the doctor observed his own patients and said, I got them all better. If they went through seven bloodlettings, they survived. That's sort of a self fulfilling prophecy there. If they live long enough to get through seven bloodlettings, they were going to get through anything. Right. So, you know, and this was Benjamin Rush. This was probably the most, the most prominent and famous physician of his time. This was in 1790s. It was a, it was the yellow fever epidemic in, in Philadelphia, and his support of bloodletting during this yellow fever epidemic led to blood letting persisting long beyond the time when it should have just died. For more than 50 years, based on his observations. And I also happened to be a PA, a physician assistant. And, you know, one doctor said, you know, if this many people were dying from treatment X, we'd know it. We'd see these people dropping like flies. Well, I've got one response to that. And, and that has a lot to do with why I wrote my book. I was fascinated by these medical illusions. And one of those illusions is exemplified by the painkiller by ox. So there was this mild painkiller by ox that was taken off the market years ago. But it was ultimately found to have killed an excess number of about 60,000 people from heart attacks and strokes. And my question, when I understood that, because I prescribed it, was how in God's name did we not see it? Why didn't we see those people dropping like flies? 60,000 people in just about four years? We should have known. But it turns out when you look at anybody's individual practice of about, you know, two to 4,000 patients, and how many patients are over 60 or 70 who take it, and they die of a heart attack? I mean, weren't they going to die of a heart attack anyway? How would we connect that with this drug? We can't. And that's why we need studies. That's why we need well designed, well controlled studies. Observations have turned out to be wrong over and over again. Over and over and over again. In fact, you know, I, I wrote my book over treated. In part, I was a medical reporter for a long time. And, and you know this, Jeannie, but, and we, we found each other in many ways because of our shared interest in the fact that when you start looking at the history of discarded treatments and the kind of enthusiasm that existed for them, and then realize that it took really dogged research to find out whether it actually worked or not, it made it very clear that there was lots of stuff out there now that is in standard clinical practice that not only doesn't work but actually causes harm because we haven't subjected it to the kind of scrutiny that we need to. So, so let's move to the next drug, Remdesivir, which is a drug by a biotech company based in California, I believe, Gilead. And, and we have what a few more minutes left just yacking away with each other. Before questions, which I think is really fun. So, Remdesivir is a drug that before COVID had never been found to be effective for anything. It was developed for many things. Right. It's been tried on a lot of things, most recently on Ebola virus. There were trials that were done in Africa on Ebola virus and it turned out that it was not effective. But, you know, try, try, try, and try, and try again is the motto here. And there was reason to think that it might actually be effective against COVID. So, so it was, it had promised, but it had not had the real scrutiny that it needed. So the National Institutes of Health created a big clinical trial, a randomized controlled clinical trial to see if Remdesivir actually works or not. And, oh, this is now at least a month ago, the trial was stopped because the drug was found to reduce the time to recovery. Now, I don't know what the right answer is, but it strikes me as a little strange that we are now about to spend massive amounts of money on a drug that reduces time to recovery a little, but we don't actually know whether or not it reduces mortality. It looks like it might, but since the study was stopped, it's going to be very difficult to find out the answer to that question because now people are going to say it would be unethical to not give the drug because it's been shown to reduce time to recovery. Well, and in fact, the fact that they changed to make time to recovery their endpoint, so they changed the goalpost during the study, which- Well, that's a little, you're talking inside baseball, make this really understandable. All right, so- I know what you're saying, but- Say you have a shotgun and a tree and you say, I'm going to hit tree B and there's seven trees out there, but you're going to hit tree B and then you go ahead and you fire your shotgun, but the pellets don't hit tree B, they hit tree F. So you go and report, I killed the tree I wanted to kill. I'm a great aim. You've drawn a circle around the target that you wanted, not that actually occurred, and that's the problem. So if you can't, you know, you're supposed to have a hypothesis and test that hypothesis, I can hit tree B. If you then just go and say, well, scatter, I can do anything, and I'm going to eat, you have to reproduce that. Okay, well, I'm going to ask you a backup. So what they did, so what they did on that study is the researchers said, here are a bunch of things that we want to know about this drug. One of them is whether or not people are less likely to die if they take this drug from COVID, if they take the drug versus if they don't. Another one, what? That was an original end point. That was an original end point. So I'm saying at the outset of the study, they said, we're going to give this drug to half of the people in this randomized control trial and the other people are going to get a placebo, and we're going to see who lives, who dies, we're going to see who recovers. Well, I don't think recovery was actually even one of the original end points, but they had a whole bunch of it. In a sense, time to decide. But the really important one was, are people going to survive? Are they more likely to survive? And partway through the study, they say, oopsie, doesn't look like people are surviving. So we're going to look at a different end point, which is time to recovery, which is a weaker end point. It's a softer end point. It's not only softer, but if you're dying before your discharge, you could actually have more mortality. So in other words, we could have shorter time to recovery among the people who don't die from the drug. Exactly. It's possible. So it is possible. So we just need better studies. We need studies where money isn't at the center, at the heart of this. And right now, we have a government that is a corporatocracy. I hope we have a second to go to vaccine, because that is conflicted money out the wazoo, not to mention what Gilead has invested in Remdesivir. We also know that stopping a study early, there are studies that show this, and it's well documented, stopping studies early tends to bias towards a mistaken belief that there's benefit. So if they've done several things that are really troubling, they changed the goalpost, they stopped it early. And what was the other one? There was a third thing that was pretty significant. Well, yeah, but this wasn't, this wasn't Gilead that did this. This is the federal government. This was our premier research agency. No, no, no, no, that's the problem. So we have this, we have this game where I'm the, you know, I'm the, I'm the the Patsy. She's the pest to make me get it right. And she does it on purpose because she knows all this. But the thing is, is that NIH studies are almost all quote unquote, partnered with industry. There is no way that the Gilead designed this study. NIH is standing by. And what I know, and I've published this in the New Republic folks should look it up, is that there is no transparency with so-called NIH studies. There's a data in Sunshine Act. And if you read it carefully, it actually reads, thou shalt never release data from NIH funded studies, despite the, and I actually have been writing from the NIH an email in which they told me after I went through a Freedom of Information Act request for NIH data on clinical trials. And they said, despite numerous requests, we have never released data under the Sunshine and Data Act. So we've got money problems we've got transparency problems. Do we have time for vaccine for a second or we're still on one? I think we do. We have two minutes. You have two minutes. Okay. So now the thing that everybody is saying is what we really need is a vaccine. And that's true. I mean, you know, vaccine that actually works would be pretty darn nice because I don't want to wear a mask for the rest of my life. Thank you very much. I'm with you on that. And I also would like to be able to visit my mother in her assisted living home, which is not possible at the moment. Yeah. So who did Trump appoint as the COVID czar for vaccine and treatment development? Development. Well, his name is Monsef Slaoui. And he's a former pharmaceutical executive who resigned as the director of Moderna. Well, what does Moderna do? It just happens to be testing a vaccine for COVID. What a coincidence. And it turns out that Slaoui holds continues to hold $10 million in stock in Moderna. On top of that, the federal government in a nice I'll scratch your back if you scratch my back way a $483 million to Moderna. So once they develop their vaccine, if it seems to be useful, they will have private benefit on the public dime and no transparency. This kills me. Yep. Yep. And, you know, let's just hope it's the best vaccine if that's the one that gets awarded. Yeah. So we're we're we're anything else on vaccines, you want to say? Well, just if we really want to help people, I mean, what we see is how money does interfere with these financial conflicts of interest interfere with honest development of drugs and devices and vaccines. And if we really want to know that something works, I think we have to go back to the idea of independent research. And that means getting these partnerships out of NIH research means treating medicine and healthcare as a common good rather than as a private commodity. Yep. And I know there are groups out there that are working on the cost piece of it. But I think what we also need is and there are some groups that are that are clamoring for more open more transparency around clinical trials, there are groups that are clamoring around better evidence for medical treatments and for the vaccine. And they all have to go hand in hand because a vaccine that doesn't work very well at any price is probably not worth it. A vaccine that works really well has to be priced so that everybody has access to it, including people around the world. So I think I better look at my email now because I think the questions are supposed to come. Look at my phone. Well, I don't see anything at this point. Good, then we get to yak some more. Here they are. Sorry. You have to answer questions for a minute. Okay, so as someone who is looking at this issue from outside the US, it seems to me that the willingness by people to believe the gross misinformation is much greater in the US than in other countries. Do you think that's true? And if it is, what's the explanation? And this is from our good friend, Joel Lexchin. I think that's for you, Shannon. Oh, boy. I don't know if it's true, actually. I think that I think the media as the conduit to the people is so important. And I have to say that I don't think that the media in other countries are that much better than the US around issues of science and technology. And that's really sad because as a former member of card-caring member of the media, it's hard to say how badly we've really done in terms of informing people about a lot of issues in science and technology and the need for evidence. And so I see stories all the time that, you know, that sort of blindly support some terrible study as proof that this or that treatment is absolutely effective. When in fact it's a really terrible study and you don't have to be a statistician or a researcher or a PhD to recognize how bad it really is. So I don't know that it's really true that there's more or less misinformation. What we do have right now is an administration that has fueled an awful lot of misinformation. And I don't know that Canada, for example, has that, which is where Joel lives. Well, I think, you know, coming at it from a different angle. I mean, I think you're right about the media and I've attended some international media conferences and it does appear in part because we are so contaminated with private interests that we've become accustomed to being critical and searching out financial conflicts, some of us. But I think there's a different aspect that Joel was asking about, Dr. Lexchen, and that has to do with are people more willing to believe crazy stuff. And I think in the US that actually has been shown so that, for example, belief in evolution is extremely low in the United States compared to other OECD nations. And I think there was a thing about ghosts that, you know, enormous number of people in the US believe in ghosts that these kinds of superstitions and beliefs that are much more common, I think, in the US than other places. And I do think... There are people who don't think the earth revolves around the sun. I mean, that's kind of scary. We now have people who honestly believe the earth is flat. I mean, they're really are literally flat. We used to say that as a joke. They are literally promote. So, you know, this disconnect from facts and science is huge in this country and it's a serious problem. It is. It absolutely is. And I think it speaks partly to science education. But again, I think it also speaks to the media, which is so important in how much people know and don't know about everything, about medicine, about science, about physics, about all kinds of things. But right now it's so important that people have good information about medicine having to do with this virus. Yeah. So the second question, what can and should be done to stop the spreading of false information when it comes to medication, especially with the proliferation of social media and tons of enablers of lies that proliferate on these medias? And this is from Wolfgang Bearman, who I don't know. But thank you, Dr. Bearman or Mr. Bearman for that question. And thanks to Joel for his question. What can be done? Oh boy. So we have a friend and a colleague, Gary Schweitzer, who had, who ran a website for many years called Health News Review that did an incredibly important service. It's still running. It's still running. It's just, he's doing it on his own dime. On his own dime. And what the website does is it has a series of reviewers, these are people who look at media journal, media articles, and look at them in a very systematic way for how accurate they are and whether or not they mention really key points about any new treatment, about any new study, et cetera. So one of the criteria, for example, is does the article talk about cost for a new product? Does the article actually have anybody quoted who is, who has a different point of view than everybody who's saying this is the greatest thing since slight spread? Conflict of interest needs to be reported. And Health News Review really started to have an impact on how science and medical journalists viewed what they needed to do. Every outlet in the country knew about Health News Review and were a little bit upset when they got bad grades on their articles or their broadcasts. And that's one of the ways to actually start improving the kind of misinformation. But social media is a mess. And I have no idea how you control the incredible level of true mendacity and the kinds of lies that are being spread on social media. Yeah, it's a completely separate animal from journalists reporting, which is troubling enough that Gary Schweitzer had to start that outlet, which I think is wonderful. And journalists should go there. And if anybody has a lot of money and wants to invest in something that's really important, give Gary your dough, because it's really important service. And he has a toolkit there with things that journalists can use to learn about good reporting. There's also the list of industry independent experts listed there. So those are great resources. But when it comes to social media, that is such a mess and such a difficult problem to address that short of turning that into a journalistic outlet for medicine, where it has to go through a third, you know, assessment, I just don't know what you could do. It's a disaster. Let's talk a little bit about the list of independent, independent experts. So this is something that Jeannie and I started about a decade ago. At least, at least, I think it was 2000. And it came out of a story that we wrote about an NPR show. I forgot that's an NPR show. I don't even remember the name of the show, but the show was about mental health and media matters. No, it wasn't. It was something about the mind. Anyway, it was an NPR show. Oh, that's right. That's right. That's right. And the host of the show was a fellow Dr. Fred Goodwin, who had been, he'd been, he'd lost his job at the National Institutes of Health, as the head of National Institutes of Mental Health. No, NIMH. Because of comments, racist comments that he had made. And he had, he was hosting this show pretty regularly. And he had on a series of guests who were talking about antidepressants. And this was an period where the information about the fact that antidepressants can cause suicidal thinking and acts was just really starting to emerge. And he had on three guests, and all of them had conflicts of interest with the very manufacturers of the drugs. And all of them expressed the view that any fears about suicidality being caused by these drugs were completely overblown. And we wrote a story about it and basically exposed the conflicts of interest, which were not disclosed on the show. And it caused a huge flap. NPR dropped the show. The New York Times picked up the story. It made, it caused a really big deal. It was a big deal at the time. And clearly that information has finally gotten out that these drugs, while they can be effective for some people, you have to watch for the potential for them triggering suicidal thoughts and feelings and behavior. So we started thinking about the fact, and we've known this for years, that many journalists don't bother to ask their sources whether or not they have conflicts of interest. Their outlets didn't require that they do that. They didn't make a habit of it. And so a lot of what was appearing in the press was statements by people who had an economic self-interest to say one thing or another. So we just looked in our Rolodexes. Of course, everybody under the age of 30 has no idea what a Rolodex is, but it's an antiquated way of keeping track of average addresses on a piece of a little card. And we just opened up our address books and we created a list of all the experts in medicine, epidemiology, healthcare policy, a whole variety of public health, people that we knew did not take industry money and yet were absolute experts in their fields. And we made that list available to anybody who was a journalist. If you freelance and could show that you were getting stories published in the media, if you were a staff member of a broadcast outlet or a print media outlet, we were happy to give you our list. Ten years later, that list now has grown considerably. It's starting to have a real impact. There is a case of a practice with women who are giving birth, who are pregnant, that has really been changed because the members of the list were recruited to write a letter to a journal that then made it available to for people to make a decision about changing that practice. And the list is now housed at the Lown Institute and I hope any journalists who are listening out there will avail themselves of the list of industry independent medical experts. It's a good resource. It's a really good resource and it was mostly Genie's brainchild, but I like to pretend like I do. No, we did it together and we published an article about it in the BMJ for the British Medical Journal. Sorry, we can't solve the social media problem. Another question, why do you suppose the bad studies made it through the peer review system into prestigious journals like, oops, lost that one. It jumped away. Oh, why did bad studies make it through the peer review system into journals like the Lancet and the New England Journal of Medicine? Are there too few qualified researchers, reviewers, and if so, what should be done about it? Well, you've opened a can of worms, Mr. or Mrs. Anonymous. It's a huge problem. Peer review is very problematic. It lets a lot of things through that really shouldn't get through. And it's kind of understandable because it's really pretty time-consuming to be a peer reviewer. And peer reviewers often don't do the kind of real digging that they need to do to know whether or not, say, the statistics are really correct. And a lot of reviewing, unfortunately, reviewers have their own biases. And when a paper comes in that violates their own biases or goes against their biases, they're very, very tempted to reject it out of hand. And that happens pretty regularly. Whereas if it confirms their biases, they think that it's probably a good paper and they don't necessarily look at it very carefully. But peer review is a problem. Now, I don't know about this hydroxychloroquine paper that made it into the Lancet. I think it got in pretty quickly, so I'm not sure what kind of peer review it actually got. But it is a little shocking that the sort of holes in that study and the gossamer of what this company appears to be didn't get caught. Jeannie, any thoughts about peer review I'd left away? I'd actually love to address the issue of preprints if we have a moment or you need to get on with it. No, no, we're good. So there's been this idea that peer review somehow is rigorous. I think Shannon's pointing out that that's not always the case. Often, if you submit an article to a journal, they will ask you, who do you want to peer review your paper? So you're not likely to say someone who is going to trash it. You're going to pick from your tribe. And Shannon and I just completed an article that will be coming out soon on medical tribes and belief systems that she was referencing. But the issue of preprints is interesting because now hundreds of preprints are coming out every day. And it may even be in the thousands, I think, are coming out every single day because of the pandemic. And there's this idea that, you know, we shouldn't pay attention to preprints. It's true because they haven't gone through peer review. However, I want to talk about a little exception to that and really where the line should be drawn with journalists because, yes, these articles have not been accepted into a medical journal. They haven't been put through much scrutiny, if any, and many of the cases. But there was a paper recently that was very controversial about the prevalence of COVID-19. And that actually went through an extraordinarily rigorous process because these researchers put it on the preprint server and put it out to the world, including not just the people they would like to review it, but they threw it out to the lions. And in doing so, you really improve your work. And as a journalist, that's something I try to do. I will talk to people who I know totally disagree with me in order that I can pick up what kinds of problems I might not be seeing. What do I need to address? And so in a way, the preprint service can be fantastic. But it should be kept within the medical community. That should not be picked up by journalists in broadcast, I don't think. I think that's right. And the interesting thing about the preprints is that everybody's going after them in public in a very interesting way. But the problem for journalists is most journalists, actually most physicians, unfortunately, are in the same boat. But most journalists actually don't have the skills to be able to look at papers and be able to dissect them and know what's a reasonable paper and what's something they should pay attention to and what isn't. And so when I was a journalist at a news magazine, a national news magazine, we would get these faxes. Remember, faxes from the major journals every week when they would publish. Or you are dating yourself. I know. And we got emails too. And the journals would basically tell journalists what the important papers were. So what journalists ended up doing was basically trusting the journals, the editors of the journals, and the peer review process for what they then put into the newspapers and magazines across America. And a lot of the stuff that got printed was garbage. A lot of the stuff that got printed in the journals was garbage. At one point, the editor of the New England Journal of Medicine said to me, if we didn't publish the garbage, we wouldn't be able to fill our pages. So that's a problem for journalists. How do they know what they ought to talk about and what they ought to not write about? And relying on the journals was one way to sort of put the responsibility on the journal. And that seems kind of reasonable. But now with these preprints, it's even more problematic. Do you write about a preprint the minute it's out? Or do you need to wait a little while before the lions have a chance to tear it apart and decide whether or not it's really a legitimate piece of work or not? And I don't know the answer to that one. I don't know how journalists are supposed to deal with that one. Yeah, really and truly. Let's move on. Independent trials are important, but do you think independent follow-up, once a drug is approved, has an important role to play? How do we spot the next Vioxx? This is a really great question, anonymous once again. This is an incredibly good question. One of the things that we don't do in this country is track what happens to patients once a drug or a medical device is out on the market. And I was having this conversation with my husband last night because he's in the healthcare community as well. And I was saying what we really need is a registry. If Toyota has a bad brake system, every Toyota driver in the country knows about it and knows there's a recall, they need to take their car in and they need to get those brakes fixed. How come we don't have that with drugs and devices? Yeah, it's absolutely insane. The manufacturers have fought that tooth and nail. They have fought any required registries. So, for example, in Europe, they had and I think Australia had registries for artificial hips and they were able to pick up cobalt poisoning because they had a registry where every... So there was a hip that had coke that was made with cobalt and it was causing cobalt poison. But we didn't know about that and people died and were harmed in this country because we didn't pay attention to what was going on in other countries. Why didn't Australia tell us? I think they probably did. It was probably out there. It was certainly out there as public information. But there's a real tendency in the U.S. to say that no evidence coming from anywhere but us is valid. Of course, that's very hypocritical because the us includes all our contract research organizations which tend to contract out all this trials to impoverish nations where they can basically entrap patients into these studies, some of which are completely unethical and certainly not related to outcomes that we'll see here. Well, let's go back to COVID. This is another question. In a joint statement Sunday, the U.S. and Brazil said hydroxychloroquine will be used as a prophylactic to defend healthcare workers in Brazil against the virus as well as a treatment to help Brazilians who become infected. There was a study announced just today that they did to test prophylaxis and they mentioned Trump using it as prophylaxis and they found no benefit. It just came out today. Now, I don't know the nature of that study or what, but this is really, this is crazy time. It is crazy time. So Brazilians get to get to be subjected to an unproven treatment. And they won't track those people to really know, but even if they do, there's a real problem with that because then it's just an observational study. It's not a randomized controlled trial. That's what we have to have. Yep, we have to have that. Well, let's wrap up with, unless there are more questions, more questions coming in that I'm not seeing, I don't think so. I think that, let's finish up with this whole question of the completely different issue, which is lockdowns. And many people who are listening to this may know that there is a considerable controversy around the current approach to COVID and reducing deaths from COVID. And let me see if I can sort of articulate it correctly, Jeannie. The debate is around whether or not lockdowns, we know that lockdowns are probably damping down the rate at which COVID is being spread. There may be cases where it's not like in hospitals, it may actually be accelerating spread because you're basically cramming a whole lot of people into a small space where a lot of them are infected. But there's a reasonable reason to think that lockdowns do kind of slow down the rate of spread. And there's some evidence that's coming out to suggest that that's actually the case, that it's, quote, flattening the curve of the rate of infection. Absolutely. The controversy comes over the question of whether or not we are actually likely to be saving more lives by doing lockdowns, by preventing COVID infections, than people we may be harming with the lockdowns. And one of the consequences of lockdowns is very clearly that we are disrupting our economy, that many, many millions of people have been thrown out of work, and that may have health consequences for them. So that's the current controversy right now. And I don't know what the right answer is, but I know that we have to ask the question. And part of the problem is complexity. I mean, there is so much complexity in this. What components of lockdown work? Which components don't work? Are there some that are neutral? Are there some that we should be doing? Some that we shouldn't be doing? Some that cause harm? Like, should we all be wearing masks? Is that effective? There's now a new study that suggests that masks do reduce the risk of infection. Yeah. And yet which type of masks? Because another study showed that cloth masks actually did worse than people who didn't wear any masks. So there's all sorts of complexity in this. And, you know, when the pandemic first started in China, I remember thinking, oh, gee, you know, they're doing the right things. They're really locking down. That's preventing stuff. And then you see that Singapore and Indonesia and other countries were doing different aspects of lockdown. They were not doing all the same things. And yet they were also getting excellent results. So the complexity gets even worse when you look at the sort of temporal nature of infectious diseases that tend to come and go. So the flu, terrible flu pandemic of 1918 went. It just went. There was no cure. There was no treatment. There was no vaccine. And that's what happens with a lot of infectious diseases. And that raises, you know, a point that, you know, you and I were talking about yesterday that just fascinates me. The whole issue of the pump handle at Broad Street. I mean, this was the yeah, the father of epidemiology stopped cholera by removing the pump handle on a well in Broad Street. And in London. Yeah. And yet now a number of sources have printed what the actual rate of decline was before he took that pump handle off. And it turns out that there's a decline that goes like this. And about right here is where he took the pump handle off. And it just simply continued to go. Well, he actually had hold of some truth. He was right. Cholera was in the water. But we did the complexity of this kind of stuff observing what happens when and what makes a difference. We need to study those issues and not do what we always do with drugs and devices, which is a soon benefit. And that's what people say when Trump says, what do you have to lose? You have a lot to lose. You have your own life to lose. But we also have truth to lose. We won't know what will help people in the future if we don't do appropriate studies. And we need people asking the right questions, which includes not just what are the benefits? How much do we reduce COVID? But what are the harms of these interventions? Because we know that starvation increases as the food supply is disrupted. And it looks like we stand to have millions of people die from this disruption. That may be many, many more people than would die of COVID. And we also know that unemployment dramatically increases mortality for years to come. So we have to look at the the problems as well as the benefits. And this and what's so fascinating about this particular debate is it's not just in the scientific community. It's been highly politicized. And so there's this polarization of views on the left and the right or on the different spectrum of political views where now it seems to be sort of the standard liberal leaning view that lockdowns are good and the standard right leaning view that lockdowns are bad. And are simplistic. And both are simplistic, exactly. And it's a tragedy because it makes it much more difficult for us to figure out what really would work and what wouldn't. It does. So we're kind of getting to the end of our time. And I just don't know if I've missed questions or not. I don't think I have. So do we have anything, any other things we want to talk about anything else except for the fact that I can't wait for the next article we write together? I don't know what it's going to be. Yeah, who knows? We get in trouble, whatever we do. That's exactly. So I want to thank everybody for being on on the air with us and for participating in this for your questions, for your attention. Oh, hello, sweet pea. Just decided to come in for the ending and say and say so long. This has been this has been a social distancing social from future tense, which is a collaboration between Slate, New America and Arizona State University. I want to thank all three organizations for inviting us to participate in this event. And I hope to I hope we can be on it again in some time in the future. Okay, take care. Thanks, Shannon.