As I used to be deciding what to write down this week, I couldn’t assist however come throughout references on social media to a current paper by John Ioannidis and over 40 different coauthors that mainly bemoans how “they” apparently “stacked the deck” when doing consensus statements relating to scientifically beneficial approaches to the COVID-19 pandemic:
I used to be intrigued and had to have a look. First, nevertheless, let’s have a look at a little bit of background on how I went from an admirer of John Ioannidis to one in all his harshest critics. His accusation of “stacking” consensus panels with horrible (to him) public well being scientists who advocate for lowering COVID-19 transmission along with utilizing vaccination to attenuate illness and dying is unquestionably of a chunk with what he’s printed and advocated because the pandemic that ended up in my profound disillusionment with him.
From admiration to disillusionment: John Ioannidis
Longtime readers will know that, as soon as upon a time in a special, extra harmless period a few years in the past, I thought of science meta-researcher and critic John Ioannidis to be one in all my medical and scientific idols. In step with that, I wrote (principally) glowingly—albeit not and not using a few quibbles—about a few of his most well-known and influential papers, my posts having titles like:
For the reason that pandemic, nevertheless, my opinion—and that of quite a lot of Ioannidis’ former admirers—turned, as early within the pandemic he embraced “pure herd immunity” approaches to COVID-19 that later grew to become the idea of the Nice Barrington Declaration (GBD), which known as for a “let ‘er rip” strategy to the pandemic to realize “pure herd immunity” in six months by letting the younger and well being simply get COVID and utilizing “centered safety” to maintain these at excessive threat of dying and problems from COVID secure. It’s a tactic that by no means would have labored—and didn’t work—and was profoundly eugenicist at its coronary heart. Though he was not an creator and refused to signal it not based mostly on disagreeing with its premise however due to his opposition to “signing petitions” as a method of settling “questions of scientific reality,” his name early within the pandemic for “centered safety” was everywhere in the GBD, and he was a co-author, together with GBD co-author Jay Bhattacharya of the notorious Santa Clara seroprevalence research that misleadingly claimed that over 80 occasions extra folks had been uncovered to COVID-19 than beforehand thought (and subsequently the an infection fatality fee, or IFR, was means decrease than was being claimed, which means COVID was not practically as harmful as claimed and subsequently all these public well being interventions had been pointless). Earlier than that, he had printed what’s now in hindsight a ludicrous estimate in STAT that COVID-19 would probably kill 10,000 Individuals. (He was off solely by an element of 100 or so.) Then there was the time that Ioannidis made the evidence-free accusation that ICU docs of killing COVID sufferers by intubating them once they actually didn’t want it. And don’t even get me began on Ioannidis’ notorious “Kardashian index” paper, through which he smeared scientific critics and opponents of the GBD as “science Kardashians” utilizing risibly unhealthy methodology based mostly on what was initially printed as a satirical index to remark on scientists with extra social media affect than affect within the scientific literature.
The primary indication of the course that Ioannidis might go—no less than the primary indication to me—was what I perceived as his comparatively poorly supported argument that the NIH is so conservative that solely the very “most secure” tasks are funded and that the “courageous maverick scientists” who see “bolts out of the blue” to make nice leaps in science have a tendency to not be NIH funded. Such a view tends to be widespread amongst “courageous maverick” docs and scientists who view the sluggish accretion of proof that makes up most scientific discovery as too timid and “secure.” One other indication was when he bemoaned the “hijacking” of evidence-based drugs (EBM) by trade. Mainly, he took a typical criticism of EBM after which added methodolatry (the worship of the randomized managed trial as the one legitimate technique of medical investigation) to exaggerate the issue. On the time, I didn’t suppose a lot of those papers by way of something really worrisome about Ioannidis’ takes, as they had been principally throughout the mainstream, simply susceptible to a little bit of EBM methodolatry and an overestimation of the final significance of “daring” courageous maverick concepts in science.
If these had been the one areas the place I disagreed with John Ioannidis, I’d most likely nonetheless be an admirer. Sadly, by April 2020, Ioannidis was already relishing his standing as a courageous maverick with respect to COVID-19 public well being interventions. Issues haven’t gotten any higher, as he nonetheless hasn’t apologized or admitted how unsuitable he was relating to the “science Kardashian” paper. rident attacking “lockdowns,” social distancing, and even vaccines as instruments to manage COVID-19.
“Pure herd immunity” advocates versus the Delphi consensus assertion
Let’s check out his newest output. I can’t assist however preface a dialogue of the “consensus panel stacking” paper with a sarcastic Twitter remark:
Additionally:
And:
I didn’t know who Irene Petersen is, but it surely didn’t take me lengthy to seek out out that she was an advocate of “dashing up the pandemic” to succeed in “pure herd immunity. Sure, it’s arduous to not be aware a good quantity of projection on this paper. The authors all look like individuals who have been fairly strident advocating for GBD-like approaches to the pandemic. Additionally, did they really want 66 authors on this factor? That moderately strikes me as “stacking the deck” in a lot the identical means that they accuse Delphi of doing.
Authors apart, let’s check out the paper itself. Ioannidis’ paper mainly boils all the way down to dissatisfaction with a Delphi consensus assertion printed in Nature in 2022 that made numerous suggestions for the optimum strategy to the pandemic. Now, don’t get me unsuitable. I’ve been essential of Delphi consensus statements myself. Certainly, I as soon as wrote a moderately scathing tackle simply such a consensus assertion written to help the quackery that’s “naturopathic oncology” that basically did stack the panel on condition that its specialists had been all naturopathic oncologists, main me to consult with the entire effort as “making use of the Delphi Technique to nonsense.” Let’s simply say that that’s not what occurred with the Delphi consensus assertion being attacked by John Ioannidis and cronies, though they appeared to dislike the outcomes of the COVID-19 Delphi consensus assertion nearly as a lot as I detested the outcomes of the naturopathic oncology Delphi consensus assertion.
As is commonly the case earlier than such papers go off the rails, the introduction begins with pretty cheap statements as background, issues that nobody can actually discover too objectionable:
Consensus statements might be very influential in drugs and public well being. A few of these statements use systematic proof synthesis however others fail on this entrance. Many consensus statements use panels of specialists to infer perceived consensus by means of Delphi processes. We argue that stacking of panel members in the direction of one specific place or narrative is a serious menace, particularly in absence of systematic proof overview. Stacking might contain monetary conflicts of curiosity, however non-financial conflicts of robust advocacy may trigger main bias.
In equity, I’ve lengthy argued that advocacy conflicts of curiosity (COIs) are simply as vital—probably much more so—in comparison with monetary COIs, as a result of they will undoubtedly produce bias. So I regarded on the COI statements of all of the authors, nearly none of whom offered a press release of their involvement with advocacy teams. For instance, Ioannidis’ assertion solely says:
John P.A. Ioannidis has printed within the scientific literature each earlier than (https://onlinelibrary.wiley.com/doi/10.1111/eci.13162) and in the course of the pandemic (https://www.bmj.com/content material/371/bmj.m4048) articles which can be skeptical in regards to the worth of vote counting and signature collections for deciding scientific points.
Discover the very tight definition of an advocacy COI right here, through which the one factor that Ioannidis deems related is his having argued in opposition to the “worth of vote counting and signature collections for deciding scientific points,” not all of the occasions that he’s argued for GBD-like “pure herd immunity” approaches to the pandemic and his quite a few media appearances making such arguments. Equally, among the authors of this paper are very biased in opposition to public well being approaches used to attempt to mitigate the pandemic; for instance, Francois Balloux has during the last 4 years said that PPE was prolonging the pandemic, SARS-CoV-2 was “no threat” to youngsters, lengthy COVID incapacity “doesn’t matter,” and the virus got here from a lab. A deep dive on the opposite authors (Petersen, once more!) would probably discover related statements very a lot exterior the scientific consensus, however with 66 authors I believe I’ll transfer on now. I’m solely shocked that Ioannidis didn’t recruit Vinay Prasad for this paper.
Wait. No I gained’t. Ioannidis is a person who appeared within the media seemingly innumerable occasions in 2020 to advertise the concepts that COVID-19 isn’t as harmful as portrayed and {that a} GBD-like “pure herd immunity” strategy to the pandemic, with “centered safety” of the susceptible, was the optimum path out of the pandemic. Certainly, on reflection, I don’t suppose it’s unsuitable to say that Ioannidis was the mental father of the GBD, on condition that he was criticizing “lockdowns” and voicing related concepts to the GBD as early as March 2020 and continued to take action all through the primary 12 months of the pandemic. (Yeah, that was the identical essay when he estimated that COVID-19 would possibly kill as many as 10,000 within the US.) It’s not simply that, although. Ioannidis had in depth contact with excessive rating Trump administration officers, together with his coronavirus czar Scott Atlas, throughout that horrific first summer time of the pandemic to advocate in opposition to lockdowns and for a really GBD-like strategy:
It’s not simply Ioannidis, although. One other creator, Michael Levitt, suggested PANDATA, a company devoted to selling an agenda just like the GBD, though in equity he did say in his disclosure that he had signed the GBD. And don’t get me began on Francois Balloux or Stefan Baral, neither of whom reacted nicely to being precisely quoted in Jonathan Howard’s ebook We Need Them Contaminated. Political advocacy, nearly none of it reported on this paper as a COI, is what quite a lot of the authors of this paper, particularly John Ioannidis, have been about. Apparently, it’s transparency by way of disclosure of COIs for thee, however not for me. If that weren’t the case, he would have talked about his longstanding advocacy for approaches that battle with “lockdowns,” particularly his advocacy of “pure herd immunity” approaches. Ditto many of the different authors. That’s creator stacking, if not consensus stacking.
However wait, a critic (of me) would possibly say, aren’t you simply lobbing an advert hominem assault in opposition to the authors of the paper? Kind of, however I do it with what I view as a objective and powerful justification. Your entire premise of the paper is that the Delphi consensus assertion panel was “stacked” with advocates of scientific positions that Ioannidis and cronies don’t like. Honest’s truthful in mentioning that he’s mainly accomplished the identical factor in his criticism, stacking his creator checklist with individuals who agree with him and have lengthy expressed criticism and opposition to traditional public well being approaches to the pandemic. Certainly, in that context, his criticism that 35% of the panel members for the Delphi consensus assertion may need been “zero COVID” advocates is moderately ironic, given the—shall we embrace?—lack of range with regard to scientific opinions relating to COVID-19 in Ioannidis’ creator checklist.
So far as the precise paper, one essential advice of the Delphi panel that appeared to impress this assault disguised as an goal evaluation was, as Pandemic Accountability Index sarcastically famous:
It’s mainly the identical motivation that led Ioannidis to assault as “science Kardashians” the signatories of the John Snow Memorandum, which criticized the GBD and advocated for extra standard approaches to the pandemic whereas mentioning, based mostly on identified science, why a “pure herd immunity” strategy wouldn’t work and would result in tens of millions of probably preventable deaths.
After all, the conclusions of any paper like this will probably be very a lot influenced by the assumptions behind it and the methodology, which led me to look very a lot askance at this assertion:
We current descriptive statistics and keep away from statistical testing of hypotheses given the exploratory nature of the analysis.
Nicely, then, I suppose I’ll deal with the findings with all of the seriousness that they deserve, given the dearth of statistical testing.
The opposite assumption that one has to contemplate is: What constitutes a “zero COVID” strategy or advocacy group? Let’s have a look:
We discovered that panel choice favoured the inclusion of advocates of SARS-CoV-2 elimination (“Zero-COVID”) views. Zero-COVID was a minority place in 2021 even within the gentle model of being possible in “some” areas (e.g., New Zealand),16 however the teams recognized right here advocated in Europe and North America, the place the coverage was much less possible. Zero-COVID was extensively deserted by 202217 and ultimately broadly recognised as unattainable.18
At the least 14 of 40 (35%) core members of the Nature consensus and no less than one other 59 panelists are explicitly named in influential and extremely seen Zero-COVID advocacy/activism efforts in North America and Europe (Field 1: References R1-R11, Determine 1, Supplementary Desk 1). Thus, no less than 20% of named panelists (73/367; 19 panelists didn’t want their names revealed) engaged in such robust advocacy/activism.
The 367 named panelists embody 9/25 (36%) signatories of a extremely publicised Zero-COVID open letter,[R1] 3/8 (38%) signatories of a Lancet letter supporting elimination,[R2] 36/132 signatories (26%) of the World Well being Community (WHN),[R3] 41/108 (38%) signatories of the Vaccines Plus advocacy letter,[R4] 7/19 (37%) full members of Impartial Scientific Advisory Group for Emergencies 451 (indieSAGE),[R5] 14/47 (30%) WHN members or experts-advisors,[R6] 5/79 (6%) OzSAGE members,[R7] 3/14 (21%) NOCOVID members,[R8] 5/8 (63%) Finish Coronavirus advisors[R9], 9/13 (69%) authors of one other elimination viewpoint[R10] and three/17 (18%) ZeroCOVID-US members[R11]. Massive overlap emerged in membership throughout these efforts, typical of advocacy actions.
Ioannidis even made a determine:
I be aware that, for many of the statements, the variety of panel members is kind of small. Two stand out, with a lot of Delphi panelists having signed. So I attempted to look a few of these references up. Sadly, they had been listed as references within the Supplementary Strategies and Information part, and I couldn’t discover a hyperlink to this part anyplace. WTF, Journal of Scientific Epidemiology? Or perhaps it’s my Wayne State entry. Regardless of the motive, no hyperlink to the Supplementary part(s) reveals up. So I searched The Lancet for something containing World Well being Community and COVID, which yielded two references, one on mass testing (which didn’t actually advocate something resembling zero COVID) and this reference, The World Well being Community: a world residents’ initiative. It doesn’t appear so unreasonable to me within the context of 2021, even when it in the end turned out, because of efforts of activists selling GBD-like approaches, zero COVID did turn into inconceivable:
Elimination means bringing circumstances all the way down to sufficiently low numbers in order that no group transmission happens for prolonged durations of time. Outbreaks would possibly happen however will probably be quickly detected and managed. Regardless of the manifest success of this strategy, many governments rejected it outright, and after repeated lockdowns and substantial losses to life and financial system, these governments now converse of studying to dwell with the virus. Many governments’ responses have been formed by false dichotomies, pitting public well being in opposition to the financial system and collective wellbeing in opposition to particular person liberty.1,2,3 Efficient responses have been hampered by vested pursuits,4 rampant and organised misinformation, short-term considering, and resistance to vital information, together with airborne transmission, the position of kids and faculties in transmission, and the worth of facemasks and air flow. Exceptionalism (ie, a perception that the consequence of comparable insurance policies will one way or the other be totally different in a given context), the refusal to be taught from experiences of different international locations, and the failure to undertake the precautionary precept (ie, taking motion within the face of uncertainty to forestall hurt, resembling the usage of masks to forestall the unfold of an airborne pathogen) led to the identical avoidable errors being repeated in several international locations. Even the arrival of efficient vaccines, that are historically the idea of elimination, has not modified the considering of many governments that ongoing group transmission with inevitable penalties of dying and incapacity for many individuals ought to be accepted. Moreover, the reliance on vaccination alone as the primary response technique to the pandemic with out controlling transmission dangers the emergence of harmful escape variants.5
No surprise Ioannidis et al don’t like the concept that governments ought to do one thing to attempt to management the unfold of COVID-19 and never attempt to depend on vaccination alone, particularly the rejection of the concept that we should always simply let the virus unfold, which was, in spite of everything, all the thought behind the GBD. No surprise they didn’t like criticism of the best way activists selling a GBD-like agenda had promoted false dichotomies “pitting public well being in opposition to the financial system” and “public nicely being in opposition to particular person liberty.” That’s the very core of GBD-like arguments, to prioritize “freedom” and the financial system over public well being, even to the purpose of portraying masks mandates in indoor public areas as some kind of existential menace to freedom and democracy.
As for the “vaccines-plus” letter, which I present in The BMJ printed in January 2022, I might argue that quite a lot of what was within the letter sounds fairly prescient now, for instance:
Some international locations view an infection as a internet hurt and pursue methods starting from suppression to elimination.2 They search to maintain low an infection charges by means of a mix of vaccination, public well being measures, and monetary help measures (vaccines-plus). Different international locations applied mitigation methods that intention to forestall well being programs from being overwhelmed by constructing inhabitants immunity by means of a mix of an infection and vaccination. These international locations depend on a vaccines-only strategy and appear keen to tolerate excessive ranges of an infection offered their healthcare programs can cope.
They even be aware:
Whereas vaccination enormously reduces dangers of great sickness and dying, lengthy covid stays a priority.12, 13 Disruption to training because of employees and scholar illness, and/or repeated lockdowns attributable to failure to manage the virus, are prone to have a long-lasting impression on the wellbeing and prospects of the following era.14
In order that they weren’t cheerleaders for “lockdowns.” Furthermore, their ideas had been something however radical, opposite to how Ioannidis portrays them. They included such “radical zero COVID” measures as:
- Unequivocally declare SARS-CoV-2 an airborne pathogen and stress the implications for stopping transmission.
- Promote the usage of high-quality face masks for indoor gatherings and different high-transmission settings.
- Advise on efficient air flow and filtration of air.
- Set standards for imposing or stress-free measures to cut back covid-19 unfold based mostly on ranges of transmission in the neighborhood.
- Help pressing measures to realize international vaccine fairness, together with vaccine sharing, suspension of vaccine patents, removing of obstacles to expertise switch, and set up regional manufacturing centres to create a plentiful native provide of high-quality vaccines all over the place.
These horrible “zero COVID” fanatics! How dare they? How dare they even counsel that they had been worthy to be a part of a Delphi consensus panel on COVID-19!
Ioannidis additionally appears to have a bug up his butt about members of IndieSAGE; so I regarded up its web site. They look like a bunch of “radicals” too (no less than to Ioannidis. For instance, right here is their 7-point plan for COVID-19 mitigation printed in The BMJ in 2022:
- Clear and constant messaging regarding covid threat and threat mitigation, bolstered by public statements by these in positions of authority;
- Elevated efforts to advertise vaccine uptake, amongst all age teams, and with specific emphasis on teams amongst whom uptake has been low, particularly ethnic minority communities. This ought to be coupled with a transparent long run plan to deal with waning immunity and immune escape by new variants;
- Putting in and/or upgrading air flow/air filtration in all public buildings, with faculties an pressing precedence over the summer time holidays;
- Provision of free lateral move checks to allow everybody to observe current public well being guidelines8;
- Monetary and different help for all employees to self-isolate if contaminated;
- Systematic promotion of the usage of FFP2/FFP3 masks in indoor public areas and public transport when an infection charges are excessive;
- Elevated help for the equitable international provision of vaccines and anti-virals.
Humorous, however that appears similar to the “vaccines-plus” technique and under no circumstances radical. I’m getting the sensation that what Ioannidis and his fellow vacationers object to are something that smack of attempting to sluggish the unfold of the virus by means of conventional public well being interventions. Significantly, nowhere in these two statements do I see something that doesn’t observe longstanding identified public well being practices for an infectious viral illness that’s transmitted by means of the air.
The true downside
Once more, there’s actually nearly nothing objectionable from a public well being or medical science standpoint within the Delphi consensus assertion that Ioannidis assaults or within the letters to which he tries to yoke Delphi panel members to as proof of such excessive bias that they hopelessly tainted None of this stops Ioannidis from stating:
The issue with stacked consensus statements and proposals isn’t solely the elevated threat of being unsuitable. Even when they’re proper, the suggestions usually tend to be incomplete and partial, as they might prioritise narratives that preoccupy the advocates. This diminishes and even eliminates different vital views. Selections of language, phrasing, statements, and proposals turn into lopsided. Illustratively, within the COVID-19 consensus instance dissected above, the prolonged 41 statements and 57 suggestions12 by no means point out the phrases “randomised”, “lockdown”, “closures”, “isolation”, “loneliness”, “studying loss”, “poverty”, “despair”, “starvation”, “cost-benefit”, “tradeoff”, “censorship” or “mandate”. They point out the phrase “hurt” as soon as, in assertion STMT3.1, which doesn’t talk about harms to people, teams, or communities themselves, however highlights “threat of hurt to others” to endorse authorities necessary insurance policies.12 “Training” or “faculties” are by no means talked about and “instructional” and “education insurance policies” are solely talked about in advice REC4.6: “Prevention of SARS-CoV-2 transmission within the office, instructional establishments and facilities of commerce ought to stay a excessive precedence”… “distant work/education insurance policies”.12 “Psychological” (well being) is talked about just for youngsters and healthcare employees. “Proof-based” is talked about solely twice: STMT2.1 admits lack of evidence-based requirements and STMT6.8 is dismissive of the evidence-based drugs paradigm.12
Pot. Kettle. Black. Ioannidis simply doesn’t just like the consensus assertion, which you’ll learn for your self and see in the event you suppose it’s as unhealthy as he portrays. Let’s look, as an illustration, at what STMT6.8 truly says:
The incorporation of analysis paradigms from various disciplines has better potential to finish COVID-19 as a public well being menace than reliance on a single analysis paradigm (for instance, evidence-based drugs).
You realize what? No matter else the consensus assertion says, it’s completely right right here! Ioannidis is simply partaking in methodolatry once more, through which randomized managed medical trials are worshiped as the one legitimate methodology of medical investigation and any query for which RCTs won’t be the perfect software (or would possibly even be unethical) is perpetually dismissed as “low high quality” proof. This assertion solely acknowledges that, for public well being, RCTs are usually not sufficient.
Let’s see what STMT3.1 says:
When the chance of hurt to others is sufficiently extreme, governments might decide that the precise of all people to good well being overrides the autonomy of anybody particular person to decide on to not be vaccinated.
OK, one can argue over necessary vaccination insurance policies, however humorous how Ioannidis doesn’t point out the assertion that instantly follows:
Particular person medical autonomy acknowledges that people who’ve decision-making capability have the precise to make selections relating to vaccination, even when their selections contradict their healthcare suppliers’ suggestions.
That is moderately troublesome to argue with, even for somebody like Ioannidis. What about REC4.6? It says:
Prevention of SARS-CoV-2 transmission within the office, instructional establishments and centres of commerce ought to stay a excessive precedence, mirrored in public well being steerage and supported by means of a number of social measures and structural interventions (for instance, distant work/education insurance policies, air flow, air filtration, facemask carrying).
I’m going to should say this once more:
I can’t assist however be aware this REC4.2, which is so radical that even Ioannidis can’t disagree:
Measures which can be now not scientifically legitimate for COVID-19 prevention ought to be instantly faraway from COVID-19 steerage and coverage.
These zealots! How dare they counsel…wait. Isn’t this what a consensus panel ought to be recommending, that outmoded science be discarded in favor of latest rigorous findings?
Ultimately, what Ioannidis objects to is that his view was not and continues to be not mainstream in public well being sciences, therefore the try to painting the Delphi consensus assertion as being so hopelessly biased with zero COVID advocates as to not be trusted. Certainly, he’s downright conspiratorial on this strategy, in essence utilizing some very doubtful arguments to counsel that the consensus panels that produced pandemic suggestions that didn’t jibe with GBD-like lack of interventions will need to have been “stacked” to be able to guarantee predetermined suggestions that “They” wished. In equity, it is rather true that it’s attainable to stack a consensus panel and that “stacked” panels are a nasty factor. The issue comes when, having misplaced the scientific debate truthful and sq., you determine to painting a panel that ended up supporting present scientific consensus as hopelessly within the pocket of both huge pharma or ideology, at the same time as you stack your creator checklist with people who find themselves far much less intellectually various with respect to the related scientific questions than the panel that you just’re criticizing as “stacked.” It’s undoubtedly a step down the street in the direction of conspiracy mongering, if not outright conspiracy mongering.
Furthermore, you’ll excuse me if I believe that there’s one other objective to this paper, given what I discovered on social media:
This sounds to me as if some or the entire authors complained to the editors of Nature—be aware how Preserve tagged the editor-in-chief in his submit, a under no circumstances refined transfer—in regards to the supposed perceived “undisclosed COIs” of the members of the Delphi consensus panel and are utilizing the paper to stress them. (“Good journal ya obtained there. Be a disgrace if somebody attacked it.”) This led me to suppose: You realize what? What’s good for the goose is nice for the gander! Honest’s truthful. Let’s do the identical factor to Kepp, Ioannidis, et al and write to the editors of the Journal of Scientific Epidemiology, Andrea C. Tricco, PhD, MSc and David I. Tovey, FRCGP (contact data web page right here), and request that they require some…modifications…to Ioannidis’ manuscript earlier than it’s finalized, particularly, an inventory of each advocacy group associated to COVID-19 that each creator has ever been related to and any political advocacy associated to COVID-19 through which they’ve engaged. As I stated, if that’s what they appear to need from The BMJ, truthful’s truthful. Certainly neither Kepp, Ioannidis, Levitt, and many others. might object to this, on condition that it’s what they’ve demanded of the panel members who put collectively the Delphi consensus assertion!
Lastly, there are many criticisms to be fabricated from the Delphi methodology to develop consensus statements, however Ioannidis doesn’t make any of them, no less than not in regards to the precise methodology. Quite, he focuses solely on the who, not the how, with an advert hominem assault looking for to painting the members of this Delphi consensus panel as hopelessly biased, based mostly on their advocacy of decidedly nonradical positions not exterior the mainstream, which he goes to determined lengths to painting as wildly exterior the mainstream at the same time as he tries to insinuate that GBD-like positions belong within the mainstream. (They don’t, no less than not anymore—in the event that they ever did.) The paper isn’t as unhealthy as Ioannidis’ “science Kardashians,” but it surely’s loads unhealthy and sure not the top of what I’m probably going to have to write down about sooner or later, both right here or elsewhere. The autumn of Ioannidis continues apace.