A review
In a previous essay I wrote the following about Dr. John Ioannidis:
On a podcast (at 1:37:25), Dr. Ioannidis said, “There is an effect of what we did, mostly wrong, in the first wave”. To be clear, Dr. Ioannidis is not referring to himself when he said, “what we did, mostly wrong,” but rather to doctors who treated patients with a completely new virus early in the pandemic. Had he been referring to himself, I suspect he would not have laughed when he said this. He then said that “a lot of lives” were lost at that time 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”.
In a subsequent essay I reported on a similar accusation made by Dr. Ioannidis, this time in one of his publications.
Dr. Ioannidis said that the “future infection fatality rate may decrease with better protection of vulnerable children, more effective treatments, and avoidance of harmful treatments (e.g. improper mechanical ventilation strategies.)” In other words, Dr. Ioannidis expects that fewer kids will die from rushed intubations moving forward. No reference is given for this claim, as conspiracy theory sites that push this idea can’t be referenced.
Dr. Ioannidis was wrong about all this. As I explained,
Not only is there no evidence that doctors were “just going crazy” intubating patients, leading to their demise, in fact, a meta-analysis of 12 studies found “The synthesized evidence of almost 9,000 patients suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19”. This suggests that early intubation of critically ill COVID-19 patients may not be necessary, but it doesn’t kill them. This meta-analysis was published after Dr. Ioannidis made his accusation, but all 12 studies it reviewed were published beforehand.
I further reported on another study that even found improved survival rates in COVID-19 patients who were intubated early and noted that this is not a trivial academic debate.
There are real-world consequences when people believe false information. Dr. Alison Pittard, an intensivist from the UK, said patients were refusing ventilators because,
“They think if they do not go on a ventilator, they have got a better chance of surviving, because once they go on a ventilator they are going to die irrespective. And of course that is not correct because if you are faced with a patient who needs to go on a ventilator … if they don’t go on a ventilator then the chances are that they will die. So, that is almost saying there is a 100% chance of dying. Whereas if they go on a ventilator then they will have a 40% chance of dying.”
An update
Dr. Ioannidis encountered my criticisms in an essay by Dr. David Gorski and responded to him thusly in a discussion in The BMJ:
Later, I do mention that probably we had more deaths because of not knowing how to use mechanical ventilation. This statement is also correct. The paper cited by Gorski is examining early versus late intubations and actually concludes that “these results might justify a wait-and-see approach, which may lead to fewer intubations”.
So who is right here? After all, we are all referencing the same paper to support our conclusions.
Here are the complete conclusions of the meta-analysis, which I accurately reported in my essay:
The synthesized evidence of almost 9000 patients suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.
So let’s be clear what happened here. As Dr. Gorski explained, Dr. Ioannidis doubled down on his claim that “probably we had more deaths because of not knowing how to use mechanical ventilation”. To bolster this extremely serious accusation against overwhelmed frontline doctors at the start of the pandemic, Dr. Ioannidis selectively quoted a sentence from a paper whose key finding was “The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19”.
A famous economist once said, “When the facts change, I change my mind”. Unfortunately, other people try to change the facts to preserve their beliefs.
Read their work with this in mind.