September 30, 2014

The Greek Doctor Who Exposes Bad Science

John Ioannidis

John Ioannidis

Source: The National Herald

Don’t tell Professor John Ioannidis – formerly of the University of Ioannina in Greece and now at Stanford in California – that he’s a hero to science deniers because he exposes faulty research among his peers and in his field: which still haven’t kept him from earning the praise of his colleagues and renowned as one of the greatest scientists in the world. “I definitely want nothing to do with science deniers … I don’t think science would be harmed by its ability or desire to check facts or improve on these facts,” he said in a radio interview. “Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”

Nonetheless, his debunking of bad scientists and discrediting their alleged work in his 2005 paper Why Most Published Research Findings Are False is the most-downloaded article in the history of Public Library of Science and elevated him to the position of cult hero – which he said he despises – to those who have little regard for science. He says they missed the point of his paper, but the humble scientist, who was born in New York City in 1965 and grew up in Athens, where he was first in his 1984 graduating class, can’t escape the fame that has come with his remarkable work, especially after a recent lengthy article in the prestigious Boston-based magazine The Atlantic, which lauded him for a career challenging his peers by exposing their bad science, noting that much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong – and even worse – the results are still being used despite being false.

The Atlantic article, Lies, Damned Lies, and Medical Science, noted that Ioannidis analyzed 49 of the most highly regarded research findings in medicine over the previous 13 years, and found 34 had to be retested while 14 were wrong or significantly exaggerated, a remarkable standard of failure in a field which uses trial-and-error trying to reach conclusive results. He certainly has the standard to raise questions. Besides his teaching in Greece and now at Stanford, where he is director of the Prevention Research Center, he got his medical degree at Harvard and then did a fellowship in infectious disease at the highly-regarded Tufts Medical School in Boston, won the National Award of the Greek Mathematical Society and held appointments at the National Institute of Health and Johns Hopkins University School of Medicine. Just as Houdini exposed frauds posing as fortunetellers, Ioannidis reveals bad scientists.

The Atlantic article, by David H. Freedman, opened with a chilling anecdote about empirical evidence and the work of medicine and science. “In 2001, rumors were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school’s teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she’d like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor’s and other colleagues’ help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names. “It was hard to find a journal willing to publish it, but we did,” recalls Tatsioni. “I also discovered that I really liked research.” Good thing, because the study had actually been a sort of audition. The professor, it turned out, had been putting together a team of exceptionally brash and curious young clinicians and Ph.D.s to join him in tackling an unusual and controversial agenda.” And Ioannidis was off and running.

During one meeting at the Greek medical school’s campus, there was a lively discussion about a study considering whether drug companies were manipulating published research to make their drugs look more effective. After a lot of back-and-forth and give-and-take that seemed to be missing the point, Freedman – who attended the meeting – wrote that, “Ioannidis, who had mostly been listening, delivered what felt like a coup de grace: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?”

That’s what Ioannidis work has been questioning as well and that question, as the article noted, has been central to his career as what’s known as a meta-researcher who has become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90% of the published medical information that doctors rely on is flawed.

His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

Ioannidis’ Greek roots remain deep. In Ioannina, in northern Greece, there is a sanctuary built at the site of the Dodona oracle. The oracle was said to have issued pronouncements to priests through the rustling of a sacred oak tree. Today, a different oak tree at the site provides visitors with a chance to try their own hands at extracting a prophecy. “I take all the researchers who visit me here, and almost every single one of them asks the tree the same question,” Ioannidis tells me, as we contemplate the tree the day after the team’s meeting. “‘Will my research grant be approved?’” He chuckles, not maliciously or in glee, but to soften the sting of what he said. Nonetheless, his work has stung enough to change how medical and scientific research is being done.

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    Geo Michalopulos says:

    Bravo to Dr Ioannides! Let his experience serve as an example to those devotees of “science” (Robin, are you listening) who think that there are no hidden agendas or sloppy research happening. Or dogmatism, heresy-hunting, and career-destruction for that matter.

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