COMMENTARY

Is COVID-19 Fueling the Fire of Opinion-Based Medicine?

Harpreet S. Bajaj, MD, MPH

Disclosures

June 04, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Is it just me, or have you noticed that the sounds of pseudoscience are getting louder lately?

"I heard that vitamin C and zinc boost the immune system against COVID-19, so I take both supplements every day."

"I believe vitamin D has important immune-modulatory properties, so I supplement my sun exposure with 20,000 IU vitamin D daily."

"I read online that this natural therapy has COVID-19–killing properties."

"I'm satisfied with the preliminary hydroxychloroquine and azithromycin data."

"I've been doing it this way for years."

The problem in each of the statements above is the "I." The "I" that believes that "I" analyze scientific studies better than the regulatory agencies or the World Health Organization, or that "I" am smarter than the top physician or public health professional who appears on TV everyday. The "I" wants to be proven correct, and the "I" makes a lot of noise to try to make people notice them and garner followers/hits/likes online or on social media.

Often, the "I" forgets that it's the science that needs to be proven right or wrong, not a personal opinion. And verifying science does not depend on noise bias. The problem with noise bias is that only those who survive and do well (and who were probabilistically going to do well anyway) make or substantiate unproven claims. No one hears—or wants to hear—about those who suffered illness or death, even though they followed the same voodoo sciences.

It reminds me of Albert Einstein's quote: "Not everything that counts can be counted, and not everything that can be counted counts."

In this case, those who fall while following the pseudoscientific theories go uncounted—unlike in a well-done scientific study.

The Power to Influence Others

What is most problematic is that the "I" often has the power to influence others. An example is the tennis star Novak Djokovic's stance against vaccination in general and against a future COVID-19 vaccine, even if such vaccination becomes compulsory for tennis players to return to the world tours. Another example is US President Donald Trump starting prophylactic hydroxychloroquine and azithromycin after a potential COVID-positive contact in the White House.

But the "I" doesn't need to be the top tennis player or the US President to influence others. All that the "I" needs is some social media savvy and know-how to create a viral post, or to be a parent anti-vaxxer who wouldn't let the "dirty vaccine industry" profit from vaccinating their kids.

What's frightening is that some of these "I's" are doctors, healthcare providers, homeopaths, and naturopaths—people with a reputation to know health data. Some of these "I's" are vehemently convinced that their recommendation is absolute biblical truth. Such convictions and biases may have been etched in their memory by experiencing or reading about outliers (eg, the one in a million patients on a statin who ended up needing a liver transplant or the similarly low probability for Guillain-Barré syndrome caused by influenza vaccination). But they forget to count the million (minus one) who are saved an important health outcome, with a number needed to treat of less than 50.

If that "I" happens to be a cardiologist or a diabetologist, they're even more dangerous, because they'll withhold that lifesaving statin or COVID-19 vaccine from the groups at highest risk.

The Potential to Harm Others

Some of the "I's" will get harmed—yes, even from "natural" therapies.

If millions of people start taking megadoses of vitamins, some will get vitamin D toxicity. And almost everyone who drinks disinfectant to try to kill COVID-19 may end up in the hospital poison control unit.

The "I" can also harm others by creating supply shortages that jack up prices of these vital medicines for treating lupus or malaria.

Harm can also result when personal pseudoscience convictions make the "I" feel superhuman, and they then deny the need to follow public health rules such as physical distancing. Someone might think, I am on hydroxychloroquine, so I can go back to my normal life and not have to hide my face behind a mask.

Waiting for the Science

Donald Trump is using hydroxychloroquine prophylactically, which was justified by his physician because the "potential benefit...outweighed the relative risks." But what is that medical assessment based on? Multiple studies suggest no benefit of hydroxychloroquine in the treatment of COVID-19; they actually caution against potential harm. There is not a single published (or pre-published) study yet on COVID-19 prophylaxis with malaria drugs, though at least two trials have just begun. [Editor's note: One of these trials has since been published, and suggests no prophylaxis benefits from hydroxychloroquine.]

The crux of the matter is that rigorous scientific processes take time, while voodoo figments of imagination don't. And during this catastrophic, once-in-a-century pandemic facing humanity, there are a lot of superhero "I's" who, in their desperate efforts to save the world, can't waste any time waiting for science to be proven.

All in all, the "I" of opinion-based medicine is making a resurgence, bolstered by the shock and enormity of COVID-19.

Taking Action

So, what can the scientific community do to douse this raging fire of pseudoscience? To start, let's not remain mute spectators. It's about time we joined forces to counter misinformation with information. Let's help educate the public about the importance of rigorous scientific processes, trials, and regulation so that they in turn start demanding proof for health claims that they read or hear about.

On a broader level, class-action lawsuits should be considered against the source (organization or website) if multiple people are harmed by a blatantly false health claim and then highlighted in the media to generate public awareness. Media and social media may need regulations to apply fact-checks and not allow unsubstantiated, potentially harmful health content on their platforms.

Finally, on a regulatory level, agencies like the US Food and Drug Administration need to tighten their noose around fake health claims made by supplements and "health foods."

At the end of the day, when everything is done and dusted, this pandemic will surely be remembered as a watershed moment in the world's history for multiple reasons. I hope that one of them will be how the medical and scientific communities united to uphold the principles of evidence-based medicine to prevail over the pseudosciences.

Harpreet S. Bajaj, MD, MPH, is a community endocrinologist in Brampton, Ontario, Canada, and vice chair of the Diabetes Canada Guidelines. His clinical and research interests are the prevention and management of diabetes and its related complications. He is the founder of STOP Diabetes Foundation and volunteers with numerous community public health organizations to raise awareness of diabetes prevention and treatment.

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