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Opinion Publications

Murder by Misinformation – Dr Janet Menage, BMJ

This is a BMJ Rapid Response letter by Dr Janet Menage, Wales, UK, in response to Covid-19: Social murder, they wrote-elected, unaccountable, and unrepentant, by Kamran Abbasi. You can find the full response in the link below.

From a medical perspective, it was clear early on in the crisis that disregarding clinical acumen in favour of blind obedience to abnormal ventilation measures, reliance on an unsuitable laboratory test for diagnosis and management, and abandoning the duty of care to elderly hospitalised patients and those awaiting diagnosis and treatment of serious diseases, would create severe problems down the line.
Doctors who had empirically found effective pharmaceutical remedies and preventative treatments were ignored, or worse, denigrated or silenced. Information regarding helpful dietary supplements was suppressed.

https://www.bmj.com/content/372/bmj.n314/rr-8

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Publications

Conflicts of interest among the UK government’s covid-19 advisers – BMJ

Little is known about the interests of the doctors, scientists, and academics on whose advice the UK government relies to manage the pandemic. Attempts to discover more are frequently thwarted, finds Paul D Thacker.

https://web.archive.org/web/20201210214506/https://www.bmj.com/content/371/bmj.m4716

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Publications

Pandemrix vaccine: why was the public not told of early warning signs? – BMJ (2018)

“We fully support the swine flu vaccination programme … The vaccine has been thoroughly tested,” they declared in a joint statement.

Except, it hadn’t. Anticipating a severe influenza pandemic, governments around the world had made various logistical and legal arrangements to shorten the time between recognition of a pandemic virus and the production of a vaccine and administration of that vaccine in the population. In Europe, one element of those plans was an agreement to grant licences to pandemic vaccines based on data from pre-pandemic “mock-up” vaccines produced using a different virus (H5N1 influenza). Another element, adopted by countries such as Canada, the US, UK, France, and Germany, was to provide vaccine manufacturers indemnity from liability for wrongdoing, thereby reducing the risk of a lawsuit stemming from vaccine related injury.

https://web.archive.org/web/20200408051329/https://www.bmj.com/content/362/bmj.k3948

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Publications

Covid-19: The lost lessons of Tamiflu – BMJ

While the truth about Tamiflu emerged only after years of exhaustive work by the Cochrane review group and investigative journalists, the machinations behind remdesivir’s rapid climb were evident at an early stage. On 29 April, the same day as a trial was published showing no significant effect of remdesivir among patients in hospital, remdesivir’s manufacturer rushed out interim findings of a more favourable trial by press release and with full White House honours. The much vaunted but minimal benefits shown in severely ill people were used to justify FDA approvals and worldwide purchase. Now a much larger trial has found little or no benefit in hospital patients, and a BMJ Rapid Recommendation, produced in collaboration with the World Health Organization and Magic App, has come down against use of remdesivir in patients with covid-19 of any severity.

…Science by press release, on the basis of interim or ad hoc analyses, and without access to the data, also afflicts our knowledge about the covid-19 candidate vaccines. Patients and the public deserve better than this. So do health professionals. Pandemic or no pandemic, decisions must be based on scrutiny of the full data from trials that are independent of drug and vaccine manufacturers.

https://web.archive.org/web/20201205164516/https://www.bmj.com/content/371/bmj.m4701

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Publications

COVID-19 in children: analysis of the first pandemic peak in England – BMJ

Children represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%–34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%–45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children.

Children accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2.

https://web.archive.org/web/20201124224223if_/https://adc.bmj.com/content/105/12/1180

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Publications

Covid-19 vaccine candidate is unimpressive: NNTV is around 256 – BMJ

Pfizer’s vaccine “may be more than 90% effective.” (Mahase, BMJ 2020;371:m4347, November 9) Specific data are not given but it is easy enough to approximate the numbers involved, based on the 94 cases in a trial that has enrolled about 40,000 subjects: 8 cases in a vaccine group of 20,000 and 86 cases in a placebo group of 20,000. This yields a Covid-19 attack rate of 0.0004 in the vaccine group and 0.0043 in the placebo group. Relative risk (RR) for vaccination = 0.093, which translates into a “vaccine effectiveness” of 90.7% [100(1-0.093)]. This sounds impressive, but the absolute risk reduction for an individual is only about 0.4% (0.0043-0.0004=0.0039). The Number Needed To Vaccinate (NNTV) = 256 (1/0.0039), which means that to prevent just 1 Covid-19 case 256 individuals must get the vaccine; the other 255 individuals derive no benefit, but are subject to vaccine adverse effects, whatever they may be and whenever we learn about them……We’ve already heard that an early effect of the vaccine is “like a hangover or the flu.” Will vaccinees who are later exposed to coronaviruses have more severe illness as a result of antibody-dependent enhancement of infection (ADEI), a known hazard of coronavirus vaccines? Is there squalene in the Pfizer vaccine? If so, will vaccinees be subject to autoimmune diseases, like Gulf War Syndrome and narcolepsy that have been associated with the adjuvant?

https://www.bmj.com/content/371/bmj.m4347/rr-4

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Opinion Publications

Covid-19: politicisation, “corruption,” and suppression of science – BMJ

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

Politicians and governments are suppressing science. They do so in the public interest, they say, to accelerate availability of diagnostics and treatments. They do so to support innovation, to bring products to market at unprecedented speed. Both of these reasons are partly plausible; the greatest deceptions are founded in a grain of truth. But the underlying behaviour is troubling.

The UK’s pandemic response provides at least four examples of suppression of science or scientists. First, the membership, research, and deliberations of the Scientific Advisory Group for Emergencies (SAGE) were initially secret until a press leak forced transparency.2 The leak revealed inappropriate involvement of government advisers in SAGE, while exposing under-representation from public health, clinical care, women, and ethnic minorities. Indeed, the government was also recently ordered to release a 2016 report on deficiencies in pandemic preparedness, Operation Cygnus, following a verdict from the Information Commissioner’s Office.

https://www.bmj.com/content/371/bmj.m4425

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Opinion Publications

When good science is suppressed by the medical-political complex, people die – BMJ

The UK’s pandemic response relies too heavily on scientists and other government appointees with worrying competing interests, including shareholdings in companies that manufacture covid-19 diagnostic tests, treatments, and vaccines. Government appointees are able to ignore or cherry pick science—another form of misuse—and indulge in anti-competitive practices that favour their own products and those of friends and associates.

https://www.bmj.com/content/371/bmj.m4425

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Publications

Covid-19: GPs to get £12.58 per dose to deliver vaccine from December – BMJ

Practices will be paid £12.58 (€14.15; $16.69) per vaccination. This is 25% more than the current £10.06 practices receive for an influenza vaccination, in recognition of the need for extra training, post-vaccine observation, and other associated costs. Practices will need to provide most of the required staff from their own workforce.

https://www.bmj.com/content/371/bmj.m4354

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News

Lockdown cancer warning: Four week delay in treatment will see chance of dying soar – The Express

A four week delay in cancer treatment increases the chance of dying by as much as 13 percent new “staggering and sobering” research reveals.

The research published last week online in the BMJ, was put together in the light of treatment delays resulting from the pandemic and have led to calls for more attention to be given to other deadly health conditions whose treatment is being put at risk by national measures to contain the virus.

https://www.express.co.uk/news/uk/1357434/Lockdown-latest-cancer-warning-treatment-coronavirus-news

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Publications

Harms of public health interventions against covid-19 must not be ignored – BMJ

The harmful consequences of public health choices should be explicitly considered and transparently reported to limit their damage, say Itai Bavli and colleagues

The SARS-CoV-2 pandemic has posed an unprecedented challenge for governments. Questions regarding the most effective interventions to reduce the spread of the virus—for example, more testing, requirements to wear face masks, and stricter and longer lockdowns—become widely discussed in the popular and scientific press, informed largely by models that aimed to predict the health benefits of proposed interventions. Central to all these studies is recognition that inaction, or delayed action, will put millions of people unnecessarily at risk of serious illness or death.

However, interventions to limit the spread of the coronavirus also carry negative health effects, which have yet to be considered systematically. Despite increasing evidence on the unintended, adverse effects of public health interventions such as social distancing and lockdown measures, there are few signs that policy decisions are being informed by a serious assessment and weighing of their harms on health. Instead, much of the discussion has become politicised, especially in the US, where President Trump’s provocative statements sparked debates along party lines about the necessity for policies to control covid-19. This politicisation, often fuelled by misinformation, has distracted from a much needed dispassionate discussion on the harms and benefits of potential public health measures against covid-19.

https://www.bmj.com/content/371/bmj.m4074

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Publications

Will covid-19 vaccines save lives? Current trials aren’t designed to tell us – BMJ

The world has bet the farm on vaccines as the solution to the pandemic, but the trials are not focused on answering the questions many might assume they are.

…But the truth is that the science remains far from clear cut, even for influenza vaccines that have been used for decades. Although randomised trials have shown an effect in reducing the risk of symptomatic influenza, such trials have never been conducted in elderly people living in the community to see whether they save lives.

Only two placebo controlled trials in this population have ever been conducted, and neither was designed to detect any difference in hospital admissions or deaths. Moreover, dramatic increases in use of influenza vaccines has not been associated with a decline in mortality 

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Publications

Covid-19’s known unknowns – BMJ

When deciding whom to listen to in the covid-19 era, we should respect those who respect uncertainty, and listen in particular to those who acknowledge conflicting evidence on even their most strongly held views. Commentators who are utterly consistent, and see whatever new data or situation emerge through the lens of their pre-existing views—be it “Let it rip” or “Zero covid now”—would fail this test.

https://www.bmj.com/content/371/bmj.m3979

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Publications

Use of “normal” risk to improve understanding of dangers of covid-19 – BMJ

Accumulating data on deaths from covid-19 show an association with age that closely matches the “normal” risk we all face. Explaining risk in this way could help people understand and manage their response, says David Spiegelhalter

As covid-19 turns from a societal threat into a matter of risk management, it is vital that the associated risks are understood and clearly communicated.1 But these risks vary hugely between people, and so finding appropriate analogues is a challenge. Although covid-19 is a complex multisystem disease that can cause prolonged illness, here I focus solely on the risks of dying from covid-19 and explore the use of “normal” risk—the risk of death from all causes each year—as an aid to transparent communication.

  • General population: the risk of catching and then dying from covid-19 during 16 weeks of the pandemic was equivalent to experiencing around 5 weeks extra “normal” risk for those over 55, decreasing steadily with age, to just 2 extra days for schoolchildren
  • Over 55 who are infected with covid-19: additional risk of dying is slightly more than the “normal” risk of death from all other causes over one year, and less for under 55s.

https://www.bmj.com/content/370/bmj.m3259

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Publications

Covid-19: the problems with case counting – BMJ

While the testing data are so opaque, using them to direct local lockdowns is unhelpful, argues Heneghan. “The testing is there to drive the test and trace strategy,” he says. “But what seems to be happening is that, as soon as we see an outbreak, there tends to be panic and over-reacting. This is a huge problem because politicians are operating in a non-evidence-based way when it comes to non-drug interventions.”

https://web.archive.org/web/20200904104824/https://www.bmj.com/content/370/bmj.m3374.full

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Publications

The role of chest radiography in confirming covid-19 pneumonia – The BMJ

A normal chest radiograph does not exclude covid-19 pneumonia

No single feature of covid-19 pneumonia on a chest radiograph is specific or diagnostic, but a combination of multifocal peripheral lung changes of ground glass opacity and/or consolidation, which are most commonly bilateral, may be present

Diagnosis might be complicated as covid-19 pneumonia may or may not be visible on chest radiograph; consider other causes for patients’ respiratory symptoms

https://www.bmj.com/content/370/bmj.m2426

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Publications

Preventing a covid-19 pandemic – BMJ

A randomized placebo-controlled trial in children showed that flu shots increased fivefold the risk of acute respiratory infections caused by a group of noninfluenza viruses, including coronaviruses. (Cowling et al, Clin Infect Dis 2012;54:1778) From Table 3, vaccine recipients had 20 noninfluenza virus-positive ARIs and 19 virus-negative ARIs; non-recipients had 3 noninfluenza virus-positive ARIs and 14 virus-negative ARIs. These figures yield an odds ratio of 4.91 (CI 1.04 to8.14).

Such an observation may seem counterintuitive, but it is possible that influenza vaccines alter our immune systems non-specifically to increase susceptibility to other infections; this has been observed with DTP and other vaccines. (Benn et al, Trends in Immunology, May 2013) There are other immune mechanisms that might also explain the observation.

https://www.bmj.com/content/368/bmj.m810/rr-0

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Opinion

Evidence-based medicine and COVID-19: what to believe and when to change – BMJ

The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.

https://emj.bmj.com/content/early/2020/07/09/emermed-2020-210098

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Interpreting a covid-19 test result – BMJ

No test gives a 100% accurate result; tests need to be evaluated to determine their sensitivity and specificity, ideally by comparison with a “gold standard.” The lack of such a clear-cut “gold-standard” for covid-19 testing makes evaluation of test accuracy challenging.

A systematic review of the accuracy of covid-19 tests reported false negative rates of between 2% and 29% (equating to sensitivity of 71-98%), based on negative RT-PCR tests which were positive on repeat testing. The use of repeat RT-PCR testing as gold standard is likely to underestimate the true rate of false negatives, as not all patients in the included studies received repeat testing and those with clinically diagnosed covid-19 were not considered as actually having covid-19.

Further evidence and independent validation of covid-19 tests are needed. As current studies show marked variation and are likely to overestimate sensitivity, we will use the lower end of current estimates from systematic reviews, with the approximate numbers of 70% for sensitivity and 95% for specificity for illustrative purposes.

https://www.bmj.com/content/369/bmj.m1808

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Covid-19: Doctors sound alarm over hospital transmissions – BMJ

Doctors have told The BMJ they are deeply concerned at the number of patients becoming infected with covid-19 in NHS hospitals in England and have called for more stringent infection control measures to combat its spread.

https://www.bmj.com/content/369/bmj.m2013