Spray and pray – the COVID-19 version

Kiran Mazumdar-Shaw is the head of Biocon, a company headquartered in Bengaluru and which has repurposed a drug called itolizumab – already approved to help manage severe chronic psoriasis in different markets – to manage cytokine release syndrome (CRS) in COVID-19 patients. Setting aside CRS’s relevance in the COVID-19 pathology (considering it is currently in dispute), Mazumdar-Shaw and a specific coterie of Biocon employees have been aggressively marketing itolizumab despite the fact that its phase II clinical trial seems by all accounts to have been a joke. (I recommend this account.)

Funnily enough, The Print published an article by Mazumdar-Shaw on September 1, in which she describes her experience of the infection (she’s one of The Print‘s funders). Two portions of the article are striking. One is the following paragraph about her treatment, which tacitly implicates a host of drugs and devices in her recovery without providing any additional information of their respective usefulness:

Dr Murli Mohan from Narayana Health, Bengaluru and Dr Shashank Joshi from Lilavati hospital, Mumbai, were my key medical supervisors. I was put on a course of Favipiravir, azithromycin and paracetamol. Apart from this, I continued with my daily dose of Vitamin C, Vitamin D, Zinc, baby aspirin and chyavanprash. Not to mention my twice a week 200mg dose of HCQ. Day two and three were uneventful. I was measuring my oxygen saturation levels six times a day, which were all between 96-98 per cent even after a brisk six-minute walk. My temperature was normal but late evening on Day three, I felt fluish and it extended to Day four and five. No measurable temperature but frequent bouts of sweating, which suggested that my body was fighting the virus. I was also tracking my Cytokine levels.

Reading this brought to mind a terrible period in early 2010, when I had malaria and jaundice together with an unusually strong spate of migraines. I can’t remember the exact drugs and diet that got me feeling better. But after reading what Mazumdar-Shaw went through, I’m inclined to attribute my recovery also to the mug of Bournvita I had every night before bed.

The other striking portion is a list of suggestions that subtly make the case to pay more attention to CRS and treat it with the drugs available in the market for it: “Doctors should not just treat clinical symptoms but rather the cause of the symptoms. If SpO2 (oxygen saturation) reduces, just increasing oxygen flow is not the answer. Treating inflammation caused by cytokines is the answer.” Wonder why researchers don’t yet have consensus… But the Drug Controller General of India has approved two drugs to treat CRS due to COVID-19 in India (through a highly criticised approval process) – and Kiran Mazudar-Shaw’s Biocon’s itolizumab is one of them.

The list is also prefaced by the following statement, among others: “… avoid TV and social media as negative news is bad for fighting Covid-19.” I wonder if this refers to criticism against hydroxychloroquine (HCQ), favipiravir, azithromycin and purported Ayurvedic remedies as well.

A trumpet for Ramdev

The Print published an article entitled ‘Ramdev’s Patanjali does a ‘first’, its Sanskrit paper makes it to international journal’ on February 5, 2020. Excerpt:

In a first, international science journal MDPI has published a research paper in the Sanskrit language. Yoga guru Baba Ramdev’s FMCG firm Patanjali Ayurveda had submitted the paper. Switzerland’s Basel-based MDPI … published a paper in Sanskrit for the first time. Biomolecules, one of the peer-reviewed journals under MDPI, has carried video abstracts of the paper on a medicinal herb, but with English subtitles. … The Patanjali research paper, published on 25 January in a special issue of the journal titled ‘Pharmacology of Medicinal Plants’, is on medicinal herb ‘Withania somnifera’, commonly known as ‘ashwagandha’.

This article is painfully flawed.

1. MDPI is a publisher, not a journal. It featured on Beall’s list (with the customary caveats) and has published some obviously problematic papers. I’ve heard good things about some of its titles and bad things about others. The journalist needed to have delineated this aspect instead of taking the simpler fact of publication in a journal at face value. Even then, qualifying a journal as “peer-reviewed” doesn’t cut it anymore. In a time when peer-review can be hacked (thanks to its relative opacity) and the whole publishing process subverted for profit, all journalists writing on matters of science – as opposed to just science journalists – need to perform their own checks to certify the genealogy of a published paper, especially if the name of the journal(s) and its exercise of peer-review are being employed in the narrative as markers of authority.

2. People want to publish research in English so others can discover and build on it. A paper written in Sanskrit is a gimmick. The journalist should have clarified this point instead of letting Ramdev’s minions (among the authors of the paper) claim brownie points for their feat. It’s a waste of effort, time and resources. More importantly The Print has conjured a virtue out of thin air and broadcast asinine claims like “This is the first step towards the acceptance of ‘Sanskrit language’ in the field of research among the international community.”

3. The article has zero critique of the paper’s findings, no independent comments and no information about the study’s experimental design. This is the sort of nonsense that an unquestioning commitment to objectivity in news allows: reporters can’t just write someone said something if what they said is wrong, misleading, harmful or all three. Magnifying potentially indefensible claims relating to scientific knowledge – or knowledge that desires the authority of science’s approval – without contextualising them and fact-checking them if necessary may be objective but it is also a public bad. It pays to work with the assumption (even when it doesn’t apply) that at least 50% of your readers don’t know better. That way, even if 1% (an extremely conservative estimate for audiences in India) doesn’t know better, which can easily run into the thousands, you avoid misinforming them by not communicating enough.

4. A worryingly tendentious statement appears in the middle of the piece: “The study proves that WS seeds help reduce psoriasis,” the journalist writes, without presenting any evidence that she checked. It seems possible that the journalist believes she is simply reporting the occurrence of a localised event – in the form of the context-limited proof published in a paper – without acknowledging that the act of proving a hypothesis is a process, not an event, in that it is ongoing. This character is somewhat agnostic of the certainty of the experiment’s conclusions as well: even if one scientist has established with 100% confidence that the experiment they designed has sustained their hypothesis and published their results in a legitimate preprint repository and/or a journal, other scientists will need to replicate the test and even others are likely to have questions they’ll need answered.

5. The experiment was conducted in mice, not humans. Cf. @justsaysinmice

6. “‘We will definitely monetise the findings. We will be using the findings to launch our own products under the cosmetics and medicine category,’ Acharya [the lead author] told ThePrint.” It’s worrying to discover that the authors of the paper, and Baba Ramdev, who funded them, plan to market a product based on just one study, in mice, in a possibly questionable paper, without any independent comments about the findings’ robustness or tenability, to many humans who may not know better. But the journalist hasn’t pressed Acharya or any of the other authors on questions about the experiment or their attempt to grab eyeballs by writing and speaking in Sanskrit, or on how they plan to convince the FSSAI to certify a product for humans based on a study in mice.