sciencebasedmedicine | As much as I used to admire him, since the pandemic hit John Ioannidis has consistently disappointed me to an extreme degree. In the last year, my disappointment with Prof. Ioannidis has gotten to the point where it’s hard for me to avoid lumping him with the COVID-19 minimizers/deniers like those who published and continue to promote the Great Barrington Declaration, one of whom was his co-author on his infamous Santa Clara seroprevalence study. The Great Barrington Declaration, boiled down to its essence, asserted that COVID-19 is not dangerous to the vast majority of the population, leading to its writers and signatories to conclude that governments should, in essence, let SARS-CoV-2, the coronavirus that causes the disease, run rampant through the population in order to achieve “natural herd immunity”, while putting in place measures designed to protect only those viewed as “at risk”, such as the elderly and those with significant co-morbidities. (Note that, at the time the Declaration was published, there was as yet no safe and effective vaccine against COVID-19, while now there are at least four.) Of course, as many noted, it is not possible to protect the vulnerable if COVID-19 is rampaging unchecked throughout the rest of the population. Also, as I noted when I wrote about it, the Great Barrington Declaration was the product of the American Institute for Economic Research, a right-wing, climate science-denying think tank, which recruited three ideologically—shall we say?—amenable scientists to sign on as authors of the declaration, which was basically, as I put it, “eugenics-adjacent” and full of misinformation and half-truths.
Moreover, I’m not the only one who’s now soured on Prof. Ioannidis. For example, Scientific American columnist John Horgan, someone with whom both Steve Novella and I have had disagreements based on his downplaying of skepticism in medicine with respect to homeopathy:
Optimism has also distorted my view of the coronavirus. Last March, I took heart from warnings by Stanford epidemiologist John Ioannidis that we might be overestimating the deadliness of the virus and hence overreacting to it. He predicted that the U.S. death toll might reach only 10,000 people, lower than the average annual toll of seasonal flu. I wanted Ioannidis to be right, and his analysis seemed plausible to me, but his prediction turned out to be wrong by more than an order of magnitude.
Horgan didn’t go quite far enough in his criticisms for my taste, but such is life.
Then there’s Alex Rubinstein:
“What a weird turn to see John Ioannidis pushing one of sloppiest studies in the deluge of Covid-19 papers,” Alex Rubinsteyn, an assistant professor of computational medicine and genetics at the University of North Carolina School of Medicine, wrote on Twitter. “If he weren’t an author I would expect [the study] to show up in one of his talks as a particularly potent cocktail of bad research practices.”
Then, of course, there are all the scientists on Twitter criticizing Prof. Ioannidis. In fairness, one has to acknowledge that there are things Prof. Ioannidis has argued that have some merit. His estimates of IFR were closer to the mark than some of the very high estimates early in the pandemic, but they were still off considerably in the other direction. He was not wrong about the poor quality of so much of the data and research on COVID-19; it’s just, in an amazing feat of lacking self-awareness, he himself contributed to it as well.
This brings me back to that discussion of Ioannidis’ paper claiming that the NIH is too conservative and that only conservative, “safe” science is funded. It was more than that, though. He claimed that the scientists on NIH study sections were no better than scientists not on NIH study sections. Before I get to that, though, I note that Ioannidis’ cardinal sin since the pandemic started is not to have been wrong, even repeatedly so. It’s been his extreme arrogance:
Instead, Ioannidis sounded sure of himself. He was right; the others had it wrong. He called out other research teams by name—Johns Hopkins, Imperial College London—to berate their findings as “astronomically wrong,” and “constantly dialed back to match reality.” Here he was, about to come out with an exciting and important finding—if he were right, it could change almost everything about how we deal with this virus—and he seemed unworried by the possibility that something might be amiss with the project.
If anyone should understand how the pressure to contribute to the science of the crisis might lead to flawed work and exaggerated claims, it ought to be Ioannidis, arguably the world’s most famous epidemiologist. Who knows? Perhaps like so many of us, he’s just stressed out by the whole damned thing. Maybe he’s just off his game.
The article from which this quote came dates back to May 2020. Now, eleven months later with the benefit of hindsight, I don’t think you can say that Ioannidis was “off his game”. With his attack on a graduate student, he’s continued to double down and, in fact, has even gone further than Freedman had previously described. That is what brings me back to my previous discussion of his article about those “safe” scientists at the NIH, with a funding process that he’d characterized as “conformity” and “mediocrity”. I wrote this over eight years ago:
In the end, as much as I admire Ioannidis, I think he’s off-base here. It’s not that I don’t agree that the NIH should try to find ways to fund more innovative research. However, Ioannidis’ approach to quantifying the problem seems to suffer from flaws in its very conception. In light of that, I can’t resist revisiting the discussion in my last post on the question of riskiness versus safety in research, and that’s a simple question: What’s the evidence that funding more risky research will result in better research and more treatments? We have lots of anecdotes of scientists whose ideas were later found to be validated and potentially game-changing who couldn’t get NIH funding, but how often does this really happen? As I’ve pointed out before, the vast majority of “wild” ideas are considered “wild” precisely because they are new and there is little good support for them. Once evidence accumulates to support them, they are no longer considered quite so “wild.” We know today that the scientists whose anecdotes of woe describing the depredations of the NIH were indeed onto something. How many more proposed ideas that seemed innovative at the time but ultimately went nowhere?
And my conclusion:
However, the assumption underlying Ioannidis’s analysis seems to be that there must be “bolts out of the blue” discovered by brilliant brave maverick scientists. It’s all very Randian at its heart. However, science is a collaborative enterprise, in which each scientist builds incrementally on the work of his or her predecessors. Bolts out of the blue are a good thing, but we can’t count on them, nor has anyone demonstrated that they are more likely to occur if the NIH funds “riskier research.” It’s equally likely that the end result would be a lot more dud research.
Maybe the problem with Prof. Ioannidis was there all along, and I just didn’t see it until the pandemic amplified it for all to see. He seems, dating back at least to 2012, have had the belief that conventional science is too “safe” and “conformist,” perhaps with a bit of a self-image of himself as being the “brave maverick doctor” or iconoclast. Maybe that’s why, during the pandemic, he was so easily drawn to being a “rebel” or a “contrarian,” whose findings bucked the existing consensus, and maybe that’s why he can’t give that up. After all, it’s happened to greater scientists than he. Moreover, Prof. Ioannidis seems to be an excellent cautionary tale at how being a critic doesn’t necessarily mean that you can do what’s being criticized that well. He’s very good at finding the flaws in studies, but his studies during the pandemic demonstrate that, when designing studies of his own, he’s prone to every bias and flaw that he criticizes in others.
In any event, I should go back and read some of Prof. Ioannidis’ old work in light of what I know about him now, with the realization that the pandemic has done me a favor. I wonder what I might find.
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