John Ioannidis vs. the “science Kardashian” and critics of the Great Barrington Declaration

The other day, I wrote about a breathtakingly awful “study” by John Ioannidis, prepandemic science superstar turned booster of the Great Barrington Declaration (GBD) and unrelenting foe of anything resembling “lockdowns.” Given that my post was long even by Orac standards, I will try not to rehash (much) of it, other than to mention that my key criticism of Ioannidis’ “study” (such as it was) was that it suffered from a fatal flaw: Its author apparently didn’t realize that the “Kardashian index” that he used to portray signatories of the John Snow Memorandum (JSM), an answer to the GBD criticizing its premises and recommendations, as “science Kardashians” had always been intended as a satirical means of mocking certain scientists’ obsession with scientific publication citation metrics. Even worse, even the peer reviewers (whose reviews were published, albeit belatedly, per BMJ Open Access policy) apparently also never recognized that very same fatal flaw in the Kardashian index, thus leading me to wonder whether Ioannidis’ paper was satire like the Kardashian index, only some sort of satire too subtle for me or the peer reviewers to have recognized as satire. That’s one reason why I rather sarcastically suggested that perhaps there’s no better example of the accuracy of the satire intended by the Kardashian index than Ioannidis’ paper.

Given how many times I’ve discussed the GBD, I won’t belabor the point, but it is important to understand that the GBD, published months before safe and effective vaccines against COVID-19 were widely available, recommended a “let ‘er rip” strategy for the disease among the “low risk” and “young,” while advocating “focused protection” for the elderly and those with medical conditions that made them high risk for severe disease and death from COVID-19. Basically, it was the product of a weekend public relations meeting arranged by a right wing “free market” think tank (American Institute for Economic Research) featuring three scientists, Martin Kulldorff (Harvard), Sunetra Gupta (Oxford), and Ioannidis fellow Stanford professor, friend, and collaborator, Jay Bhattacharya. The JSM simply countered that message with standard epidemiological and public health science about the dangers of such an approach and the impossibility of “focused protection” for the vulnerable when a highly transmissible respiratory virus was spreading unchecked.

One of the interesting features of BMJ Open Access and other BMJ publications is their feature known as the “Rapid Review.” In brief, unlike traditional letters to the editor in peer-reviewed journals, which often take months to be published and usually have ridiculously strict format and word count requirements for the era of online—as opposed to dead tree print—publication, Rapid Reviews (usually) live up to their name in that they are published very quickly with only minor editorial gatekeeping; indeed, The BMJ describes the Rapid Response as a “moderated but not peer reviewed online response,” although my experience with them has sometimes involved long delays in publication due to libel concerns of The BMJ. This is somewhat understandable given the UK’s notoriously plaintiff-friendly libel laws. Indeed, the discussion in the Rapid Responses has led me to conclude that the reason for Ioannidis’ support for the GBD and obtuseness in the face of criticism boils down to a combination of ideology, obliviousness to COVID-19 conspiracy theories, and a belief in his own superiority that leads him to dismiss reasonable criticism and expressions of genuine anguish from his former admirers over the turn he has taken and characterizing descriptions of how his previous words have amplified COVID-19 and antivax conspiracy theories as a result of these descriptions somehow “facilitating” the “weaponization” of conspiracy theories against him, all while donning the mantle of victimhood, even though he is perhaps the most published scientist alive right now.

As an aside, I realize that antivaxxers and other cranks have a long history of having frequently weaponized Rapid Reviews by taking advantage of the features that make them useful, their immediacy and open nature, to publish responses to article on vaccines and then represent them as “BMJ publications,” even though The BMJ‘s policies explicitly point out that, unlike the letters to most peer-reviewed journals, Rapid Responses are not indexed in PubMed and do not get DOI numbers. That doesn’t mean, however, that Rapid Responses can’t be incredibly useful. Indeed, in the specific case of Ioannidis’ infamous “science Kardashian” article, Rapid Responses, all of them other than Ioannidis’ responses incredibly negative, have been. For example, excellent Rapid Responses to him have pointed out even more gross methodological problems than I have, as well as other serious problems, such as lack of important information that makes the paper basically uninterpretable, lack of disclosures of Ioannidis’ conflicts of interest, ethical concerns over lack of institutional review board (IRB) approval for a study that named scientists, and Ioannidis’ fallacy in equating citation data with scientific quality and impact.

One shortcoming that I alluded to in my post, but didn’t go into in any depth was this:

A key limitation not noted in this study is that the author has chosen to use a metric designed for one of the smallest social media platforms in the world. While precise figures may be opaquely calculated due to commercial interests, Twitter reported 192 million monetizable active users in 2020 (1), and according to the data aggregation website Statista has a total of 436 million ‘active’ users as of October 2021 (2). This is in stark contrast to other social media sites such as Facebook (2.9 billion users) Youtube (2.3 billion users) and even newer platforms such as Telegram (550 million users) Snapchat (538 million users) and Tiktok (1 billion users) (2).

On examining other social media sites, the inadequacy of using only metrics derived from Twitter becomes immediately apparent. Facebook shares can be analyzed freely through several websites linked to the API (3,4), and these show that the URL for the Great Barrington Declaration (https://gbdeclaration.org/) has been shared more than 700,000 times on the platform. The John Snow Memorandum (https://www.johnsnowmemo.com/), meanwhile, has seen just 10,000 shares, or roughly one seven-hundredth the number. This may be in part due to the large following of the American Institute for Economic Research (AIER) on Facebook (340k followers) the organisation that hosted the GBD in 2020.

As I said, Twitter is not the be-all and end-all of social media and social media influence, and Twitter follower counts are far less important than how many times content is actually shared and thereby amplified. Yet, no matter how many times this is pointed out to Ioannidis, in his responses he simply seems completely unable to “get it.” Similarly, when it is pointed out how his narratives and words have been embraced by antivaxxers and even echoed common antivax and QAnon conspiracy theories, he has viewed that not as an opportunity to learn but as an attack that encourages conspiracy theories to use his words. When he criticizes his detractors for being harsh and, worst of all, “divisive,” ignores even worse rhetoric from his friends and those supporting the GBD.

For example, one must cite the example of the Brownstone Institute. Described by its founder Jeffrey Tucker, former AIER editorial director (who has bragged about helping edit the GBD), as the “spiritual child of the GBD“, Brownstone actually boasts of having all three GBD authors affiliated with it. Indeed, three months ago Martin Kuldorff himself left his tenured faculty position at Harvard University to become its Scientific Director, and Jay Bhattarcharya is a Senior Scholar there, with Sunetra Gupta having co-authored a number of articles. One would think that, if GBD supporters truly wanted “nuanced” and “civil” debate, as Ioannidis seems to think they do, there could be no better platform for them to demonstrate their commitment to that and lead by example than at the Brownstone Institute. Yet instead, he accuses his critics (me included) of actually hindering vaccine uptake with our criticism!

Unfortunately, as has been noted many times here, Brownstone is hardly “nuanced” in its messaging about public health interventions against COVID-19 or its response to GBD critics. For example, articles on the its website have likened treatment of the unvaccinated to “othering” that led to the Holocaust, the gulag, and the Rwandan genocide, vaccine mandates to prohibition, public health efforts to Nazi manipulation of crowds, and Dr. Robert Malone, who has promoted many antivaccine conspiracy theories, to a hero. Other articles have likened vaccine mandates to atrocities such as the Chinese Cultural Revolution, all while falsely claiming that masks harm children (20) and cause “brain fog,” while and likening mask wearers to “tribes” and masks instruments of slavery and control rather than public health. Worse, recent news report describes how the BI has spread antivaccine misinformation in Uganda. Let me suggest to Prof. Ioannidis that the messaging portraying vaccine and masking mandates as “tyranny” and ineffective is likely to be more harmful to widespread vaccine uptake than anything Dr. Yamey or I could ever do, our Kardashian indices notwithstanding.

Of course, Prof. Ioannidis probably has a hard time believing that GBD authors had anything to do with these sorts of “divisive” messages from Brownstone. That denial would be rather unconvincing to me given Kulldorff’s and Bhattacharya’s continuing to serve in high ranking positions there. After all, if they so opposed to such “divisive” messages, why do they continue to lend their reputations to the BI and its message? An answer suggests itself to me, at least. One only has to quote certain GBD signatories themselves to realize that, at the very best, they are not strongly opposed to BI’s “divisive” messages. For example, Kulldorff and Bhattacharya have written, “The idea that everyone must be vaccinated against COVID-19 is as misguided as the anti-vax idea that no one should. They have also likened Anthony Fauci and public health officials who do not accept the GBD to a “‘covidian’ high priesthood,” a message repeated by Kulldorff on Twitter. As before, I note from my long experience dealing with these issues that comparing scientists to priests or cult leaders is a common rhetorical technique by antivaccine activists and science deniers. Even the kindest description of such rhetoric would not include the words “nuanced” or “civil.”

While Ioannidis, having had his nose rubbed in it, had little choice but to accept that GBD advocates have not been particularly nuanced, civil, or interested in building bridges with the other side, he was quick to “bothsides” it, which is where, stung by his words being linked with COVID-19 conspiracy theories, he accused us of “facilitating” the “weaponization” of conspiracy theories to be linked with him, to which I respond: Conspiracy theorists do not need me in the least; they were doing an outstanding job of “weaponizing” Prof. Ioannidis’ own words without my input, thanks to Prof. Ioanndis himself! His irresponsible and inflammatory claim that “a lot of lives” were lost early in the pandemic in part because of doctors “not knowing how to use mechanical ventilation, just going crazy, and intubating people who did not have to be intubated,” whether Prof. Ioannidis realizes it or not, couldn’t have been better for conspiracy theorists if he had intended it to be!

Again, it is not facilitating “weaponization” to try to educate Prof. Ioannidis, who was—and apparently remains—blissfully unaware of the particular conspiracy theory to which I had referred, which is why I am more than happy to continue his education with one example from the Natural News website, an article by S.D. Wells entitled WHISTLEBLOWER: Medical device sales expert reveals ‘morbidly unsuccessful’ Covid VENTILATORS as ‘deadly therapy’ in this population reduction scamdemic. A brief taste:

Mr. Chambers of Los Angeles, a medical equipment expert and salesperson with 50 years experience, which includes selling ventilators to hospitals for Covid patients, is done staying quiet about this pandemic of deaths caused by the mechanical ventilators, so he’s blowing the whistle.

You don’t have to be famous, or a scientist or doctor to let the world know the awful truth about something dangerous that the medical industry claims is working. Western medicine, after all, is wrought with fraud through and through, but this whistleblower explains in great detail exactly why very few Covid patients survive the ultimate choke machine, and this information needs to go viral, soon.

I can list more examples, obviously, but this article on the most prolific conspiracy and antivaccine sites in the world, is but one of many examples why it is not a good idea for someone as respected as Ioannidis to echo, even partially and, apparently, inadvertently, the sorts of horrible conspiracy theories being promoted in the deepest, darkest conspiracy sites on the Internet. That’s not all, though.

Prof. Ioannidis took particular umbrage at Dr. Jonathan Howard, who observed that Ioannidis also “continues to promote a QAnon meme” about death certificates. Dr. Howard was, of course, correct. Again, assuming that Prof. Ioannidis was unaware of a viral conspiracy theory that arose during the summer of 2020 that did, in fact, turn into the very QAnon meme described by Dr. Howard, the idea that death certificates were being gamed by doctors for the nefarious purpose of inflating COVID-19 deaths and justifying extreme interventions (like lockdowns) arguably reached its apotheosis in what I originally dubbed the “6% gambit.” This misinformation and conspiracy theory claimed that only 6% of COVID-19 deaths reported were actually due to COVID-19, the rest being due to “comorbidities” listed on the death certificates that really killed the patients but were not correctly listed as the primary cause of death. Whether Prof. Ioannidis realized it or not, his narrative in 2020 that COVID-19 death counts were likely highly overreported based on death certificates fed that conspiracy theory that became a QAnon meme and continues to exist today as a conspiracy theory about COVID-19.

There’s no greater validation to a conspiracy theorist than to see a narrative similar to his repeated by a scientist as eminent as Prof. Ioannidis. That’s why, whether Prof. Ioannidis is willing to accept it or not, his promotion of the idea that COVID-19 deaths were being massively overcounted thanks to incorrectly filled out death certificates contributed considerably to this conspiracy theory.

Why might Ioannidis be so inflexible and unwilling to accept these criticisms? Why would he, as he accused me of “weaponizing” conspiracy theories against him, actually “weaponize” science against GBD critics by using the Kardashian index to portray them as a bunch of unserious “science Kardashians“? (It was a method enthusiastically taken up by the AIER and AIER-linked GBD advocates and allies.) Why did he do the same thing in December by publishing a paper that denigrated COVID-19 science communicators by suggesting that, by citation bibliometrics, most of them aren’t at the top of their fields? One reason, clearly, is that Ioannidis very much supports a the GBD’s message about “lockdowns” and pandemic mitigations, calling them a “threat to democracy”:

Several governments responded to the lethal pandemic by undermining the very systems that were in place to ensure accountability and to protect public health and well-being. No single individual can be blamed for this—it was a systemic problem, as decisions taken by one government or government agency instantaneously affected the decisions of others. But the result was the restriction of basic freedoms and the normalization of scapegoating and exclusion, both historically a prelude to atrocities. While some extreme actions were justified as efforts to achieve otherwise laudable goals (like increasing rates of vaccination), the attempt to isolate vast numbers of people while whipping the general population into agreement on aggressive public health policies probably damaged even these goals.

Wow. I hadn’t noticed before, but there’s Ioannidis claiming that pandemic mitigation measures are a danger to democracy akin to incipient authoritarianism and, even worse, arguing that they are the sort of actions that are a “prelude to atrocities”! I will give him credit for restraining himself and not explicitly linking them to incipient fascism, as Dr. Vinay Prasad once did, or to the “othering” that led to the Holocaust, as the Brownstone Institute recently did. On the other hand, perhaps Ioannidis is far closer to these extreme viewpoints than I had realized, even if he did restrain himself from directly likening COVID-19 mitigations to the Holocaust and the governments undertaking them to Nazis, choosing an only slightly more subtle way of doing it.

In a similar vein:

Concern about the manipulation of power and influence has also been exacerbated by the performance of media and social media. It is critical in free, democratic societies that media never become a vessel for a single, state-sanctioned, official narrative at the expense of public debate and freedom of speech. The same appliesfor social media: Removing content considered “fake” or “false” in order to limit the ability of ordinary people to judge information for themselves only inflames polarization and distrust of the public sphere.

This of course reveals that Prof. Ioannidis’ lack of understanding of social media is even worse than I had thought reading his Kardashian index paper. He completely ignores the role of the algorithms that decide what social media users see in their feeds, as well as organized and concentrated disinformation campaigns designed to feed that algorithm, all while ignoring the role of conspiracy theories in those efforts. No wonder he can’t seem to accept criticisms in the Rapid Responses to his Kardashian index paper that he had inadvertently amplified conspiracy theories about intubations and COVID-19 death certificates! In retrospect, I now realize that I had forgotten how Ioannidis’ most famous study about how over half of scientific studies are “wrong” was also misrepresented by conspiracy theorists as meaning that evidence-based medicine is “no better than a coin flip.”

Ioannidis protests that he can’t control how cranks use his words and work, which is true but far from the whole story. Just because he can’t totally control how people use their words doesn’t mean that he has no control. If he doesn’t want his words misused by cranks and conspiracy theorists, it’s probably impossible for him to stop it entirely, but he sure as hell can make it a lot harder for them to do so if he were to put his mind to it. All he has to do is to be aware of the conspiracy theories out there, particularly how his words are used to support them, and try! He could, if he desires, make his message, even when it might somewhat echo conspiracy theories, much more difficult than it is now for cranks to cite and weaponize. He doesn’t and doesn’t even bother to try.

I can only sincerely hope that, stung by the criticism he’s now receiving, Prof. Ioannidis might take a moment to reflect and ask himself why so many of those who formerly admired him greatly (myself included) now view him as a cautionary example of how ideology can lead any scientist or skeptic down a dark path of using science not as a tool of enlightenment but rather as a tool of ideology. This is nothing new of course. It’s not as though the climate science denial that ran rampant among the libertarian-leaning side of the skeptics movement a decade ago or the “gender critical” attack on transgender people that is now echoed by some of the same self-identified skeptics don’t provide copious examples. I just never thought that, among scientists, Prof. Ioannidis would be another example. I consider this a lesson learned: No more heroes, at least not as big as Ioannidis was to me.