by Adrian Barnett
The COVID-19 crisis has put an already pressured system under even more strain, and the cracks are clearly visible.
Small studies have been used to justify massive changes in clinical practice, such as the early results on Hydroxychloroquine, which have looked less promising as more results are published. A paper in the Lancet examined patients in ICU but excluded those who were still there at the end of the study. This was 75 per cent, who are very likely to be very different from the 25 per cent who either died or recovered early. Despite this it has been cited 1000 times in just one month, meaning its potentially flawed findings are guiding clinical practice. I saw the same problem when reviewing submissions to the Pharmaceutical Benefits Scheme, with requests for millions of dollars of government subsidies based on single studies of fewer than 50 patients.
Badly designed studies are nothing new, with an estimate that around 40% of clinical trials use inadequate methods. And key methods and data not visible is another ongoing problem. Back in 2015 we tried to get the original data used by 157 research studies published in the BMJ, but we only received seven.
One potentially positive change in the present crisis is journals not putting COVID-19 papers behind paywalls, making research open to all. My view is that this concession just exposes the hypocrisy of keeping hidden the information on other killer diseases.
It is difficult for decision-makers to know what new COVID-19 research to apply. The World Health Organisation has talked about an over-abundance of COVID information in the public sphere. The same thing is happening in research, with a massive increase in the number of papers on COVID-19. Filtering out the gold in this flood of information is a mammoth task that would likely need years of careful work, not the few weeks we have. Again, we already face this problem, with good quality research not getting translated into practice for a myriad of reasons, including just bad luck.
There are lots of other problems I could rail about, such as the unnecessary delays to getting access to COVID-19 related health data, due to burdensome ethics process; the lack of research replication, to verify important findings; the fact that too much funding is going into drugs and vaccines; and the public fights between scientists that make disagreements personal rather than scientific.
All these problems hampered research before the crisis. Now they are amplified by the rush to provide answers to a terrible and novel disease.
Other researchers might have a more positive view, and the crisis might lead to genuine breakthroughs and new collaborations. But from my perspective, ongoing problems in research are not being swept aside by this pandemic, and they will continue to blight the research endeavour.
Adrian Barnett, Queensland University of Technology
Professor Barnett researches health and medical statistics. He is president of the Statistical Society of Australia