Who will guard the guards? Covid-19 research may be incomplete, but experts are vital during this pandemic

I share Armstrong’s concerns about research integrity and the peer review process.1 The inconsistencies surrounding hydroxychloroquine (HCQ) and its potential role in treating covid-19 is a case in point.

Many covid-19 HCQ studies are published as preprints without peer review on websites like medRxiv. Despite headings stating that preprints are “not certified by peer review,” many readers, including clinicians, do not place enough significance on these warnings.

Comments from world leaders and celebrities on social media don’t help in tempering the unfounded enthusiasm surrounding the possibilities of HCQ. They are often not properly referenced and don’t include caveats, leading to assumptions about the origins of the information, with mistaken authenticity, and approval by association.

Some medical authorities recommended HCQ as treatment for patients with covid-19 and as prophylaxis for healthcare workers; the Indian Council of Medical Research2 was accused of using “weak evidence to justify its recommendation.” Specific HCQ doses stated in its advisory confer unsubstantiated confidence in its recommendations. The same council, however, rejected a randomised trial on the efficacy of HCQ used according to its advisory.

Concerns have been raised about the peer review processes of some prestigious medical journals. The controversy involving the multinational registry analysis published in the Lancet provoked “methodological and data integrity concerns” from international researchers3 who asked the journal to “make openly available the peer review comments that led to this manuscript being accepted for publication.”4

The World Health Organization temporarily halted the HCQ arm of its Solidarity trial in order to review the data from the Lancet paper as well as its own randomised available data, to “adequately evaluate the potential benefits and harms,”5 suggesting there are inadequate trial resources to maintain confidence and safety supervision, and raising concerns about its ability to deal with new information.

There is a need for transparency, as suggested by Munafò, “to help ensure the process is seen as trustworthy”1 when these decisions are “informed by high quality evidence, even if it is imperfect or incomplete.” I am concerned that researchers, clinicians, and publishers—who should know better—are not coping with the process.