How masks reduce risk, major coronavirus research retracted and battling mutating cancer cells

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Health Report 34 min 2 speakers 8 chapters transcribed 3 days ago

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What is the main topic discussed in this episode?

Unknown 0:01

This is an ABC podcast.

Dr. Norman Swan 0:06

Hello and welcome to this week's health report with me, Norman Swan.

How effective are masks and physical distancing at reducing COVID‑19 risk?

Dr. Norman Swan 0:09

Today, in the aftermath of Black Lives Matter protests over the weekend, we look at a new review of the evidence on social distancing and masks. A new study into how some cancers develop resistance to chemotherapy and the exciting possibility of ways around it. and the extraordinary story of two COVID-19 papers which were retracted last week and have crystallised concerns about the quality of COVID-19 research, questioning what you can trust. Both studies were in prestigious medical journals and were based on analysing the experience of hospitalised patients sick with COVID-19. One was in the New England Journal of Medicine and claimed that two blood pressure medications, which had been thought to make COVID-19 worse, were in fact safe.

Dr. Norman Swan 0:52

The other paper was in The Lancet and showed that hydroxychloroquine in people with COVID-19 increased the chances of dying. That paper prompted the World Health Organization to put a halt to hydroxychloroquine trials around the world. The hospital data in both papers was provided by a tiny US company called Surgisphere, with no track record in the field and a tiny handful of employees of dubious background. An independent audit of the data had to be halted because they couldn't access information they'd requested, and eventually last week, the authors of both papers asked for the studies to be retracted. The saga which led to that point started days beforehand and was triggered by Dr. James Watson and his colleagues at the Mahidol Oxford Tropical Medicine Research Institute in Thailand.

What was the Surgisphere scandal and why were two high‑profile COVID‑19 papers retracted?

Dr. Norman Swan 1:39

I spoke to James just after both retractions.

James Watson 1:43

Hi Norman.

Dr. Norman Swan 1:44

How did you get onto this?

James Watson 1:46

So I work for a research unit in Thailand and we're running a very large prophylaxis trial of hydroxychloroquine or chloroquine versus placebo drugs.

Dr. Norman Swan 1:57

And by prophylaxis, you mean you take it to see whether it prevents infection?

James Watson 2:01

Exactly. There'll be, you know, health workers from hospitals all around the world, 40,000 in total. They'll be taking it for three months and then we'll be following them up and seeing whether they fall ill or not. The UK regulator had given approval 10 days before and then this Lancet paper came out and, you know, a few hours after it was published, the investigators got an email saying you have to suspend immediately.

Dr. Norman Swan 2:24

And this was before the Guardian story on the matter?

How did researchers uncover data problems in the Lancet and NEJM COVID‑19 studies?

James Watson 2:27

Yeah, this was long before the Guardian story. This was, you know, a good week before, I'd say.

Dr. Norman Swan 2:31

And when you went to look at the paper, what did you conclude?

James Watson 2:35

We immediately saw that the statistical analysis wasn't very carefully done. And the big problem with these kind of observational data is that the patients who get the drug and the patients who don't get the drug, it's not a randomized allocation. Doctors in hospitals are giving drugs like hydroxychloroquine under this compassionate use. So that means patients who are very sick is kind of given as a sort of last resort. And so when you compare the patients who got the drug versus those who didn't get the drug, it's not exactly apples, you know, it's kind of apples versus pears. So you have to make these adjustments. And the most important adjustment to make is for disease severity. And this hadn't been done very well in the analysis.

James Watson 3:18

So that was our first concern.

Dr. Norman Swan 3:20

And then when you look further?

James Watson 3:22

Well, we were surprised that there were only four authors on the paper. We're very surprised that there were no acknowledgments to anybody else in the world. I mean, this is a global study, you know, hundreds of hospitals around the world. We're also surprised that there wasn't really even a mention of which countries they were working in. It was just which continents. And then I sent an email to Andrew Gelman, who's a quite well-known statistician in Columbia University in America. And, you know, I sent him an email with some of my concerns, mostly statistical concerns. And then in the comments, someone wrote, well, actually, it's interesting because there are more deaths in their data set in Australia than were observed in hospital in Australia in that time.