The word ‘judgment’ appears in the first sentence of the classical Hippocratic Oath. Evidence-based honest judgement has been a cornerstone of the art and practice of medicine for thousands of years. Our clinical decisions are guided by evidence disseminated in the medical literature and whether this is distilled down via Twitter infographics or scrutinised in a journal club there is a chain of events that will have guided the scientific conclusions.
That chain involves patient selection, accurate data collection, accurate data aggregation, statistical analysis, interpretation, synthesis of findings into a paper and then acceptance of the conclusions by the scientific community. Errors along the chain are magnified by the time these conclusions are drawn. Fundamental flaws in study design and interpretation not only ruin careers but more importantly destroy lives and erode the trust that is placed in us by the public. Furthermore, it can provide ammunition for all manner of anti-vaxxer type loons and shady stakeholders.
The unfolding Surgisphere scandal is a spectacular case in point. The WHO pulled the plug on worldwide clinical trials involving hydroxychloroquine in the treatment of COVID-19 based on the results of a now retracted international study published in The Lancet, a byword for reputable medical information. The Lancet study used patient data collated by a largely unknown multinational ‘global research network’ by the name of Surgisphere to demonstrate a supposed increase in mortality risk from using hydroxychloroquine to treat COVID-19. Surgisphere claimed to have obtained data from more than a thousand hospitals worldwide yet the veracity of this data is now under close scrutiny. The bottom line is the medical community made an assumption of trustworthiness based on the fact that this data was published in the Lancet. Having said that, this wouldn’t be the first case of bad science making it into this particular journal as anyone who has had to have the “MMR doesn’t cause autism” conversation with parents will attest to.
In the midst of an unprecedented global pandemic with every nation battling to reignite their stagnant economies and people longing for a return to normality there will inevitably be a rush to publish data, especially data that gives hope. And where there is haste there will be corners cut and mistakes made. It’s becoming something of a Wild West out there with the Commander-in-Chief shooting misinformation from the hip, mixed public health messaging and inaccurate COVID test products flooding the market. In May the House Subcommittee on Economic and Consumer Policy reported that in April alone over 150 such tests had gone to market without any FDA review.
The big question is should events like the Surgisphere debacle spark a change in how we use data to make decisions? Do we need to be more questioning of research from supposedly reputable sources and less snobbish about research from lesser known outlets? What are the alternatives to evidence-based medicine? Surgeons in particular are renowned for indulging in daily idiosyncratic practices that have little evidence base.
Perhaps in a world of big data that moves at breakneck speed and where attention spans are shorter than ever, we just have to accept that bad science will creep in at times and hope to minimise its impact when it does.
Obi Nnajiuba is a British surgical resident with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.
