India’s missing research papers

If you’re looking for a quantification (although you shouldn’t) of the extent to which science is being conducted by press releases in India at the moment, consider the following list of studies. The papers for none of them have been published – as preprints or ‘post-prints’ – even as the people behind them, including many government officials and corporate honchos, have issued press releases about the respective findings, which some sections of the media have publicised without question and which have quite likely gone on to inform government decisions about suitable control and mitigation strategies. The collective danger of this failure is only amplified by a deafening silence from many quarters, especially from the wider community of doctors and medical researchers – almost as if it’s normal to conduct studies and publish press releases in a hurry and take an inordinate amount of time upload a preprint manuscript or conduct peer review, instead of the other way around. By the way, did you know India has three science academies?

  1. ICMR’s first seroprevalence survey (99% sure it isn’t out yet, but if I’m wrong, please let me know and link me to the paper?)
  2. Mumbai’s TIFR-NITI seroprevalence survey (100% sure. I asked TIFR when they plan to upload the paper, they said: “We are bound by BMC rules with respect to sharing data and hence we cannot give the raw data to anyone at least [until] we publish the paper. We will upload the preprint version soon.”)
  3. Biocon’s phase II Itolizumab trial (100% sure. More about irregularities here.)
  4. Delhi’s first seroprevalence survey (95% sure. Vinod Paul of NITI Aayog discussed the results but no paper has pinged my radar.)
  5. Delhi’s second seroprevalence survey (100% sure. Indian Express reported on August 8 that it has just wrapped up and the results will be available in 10 days. It didn’t mention a paper, however.)
  6. Bharat Biotech’s COVAXIN preclinical trials (90% sure)
  7. Papers of well-designed, well-powered studies establishing that HCQ, remdesivir, favipiravir and tocilizumab are efficacious against COVID-19 🙂

Aside from this, there have been many disease-transmission models whose results have been played up without discussing the specifics as well as numerous claims about transmission dynamics that have been largely inseparable from the steady stream of pseudoscience, obfuscation and carelessness. In one particularly egregious case, the Indian Council of Medical Research announced in a press release in May that Ahmedabad-based Zydus Cadila had manufactured an ELISA test kit for COVID-19 for ICMR’s use that was 100% specific and 98% sensitive. However, the paper describing the kit’s validation, published later, said it was 97.9% specific and 92.37% sensitive. If you know what these numbers mean, you’ll also know what a big difference this is, between the press release and the paper. After an investigation by Priyanka Pulla followed by multiple questions to different government officials, ICMR admitted it had made a booboo in the press release. I think this is a fair representation of how much the methods of science – which bridge first principles with the results – matter in India during the pandemic.

The matter of a journal’s reputation

Apparently (and surprisingly) The Telegraph didn’t allow Dinesh Thakur to respond to an article by Biocon employee Sundar Ramanan, in which Ramanan deems Thakur’s article about the claims to efficacy of the Biocon drug Itolizumab not being backed by enough data to have received the DCGI’s approval to be inaccurate. Even notwithstanding The Telegraph‘s policy on how rebuttals are handled (I have no idea what it is), Ramanan – as a proxy for his employer – has everything to gain by defending Itolizumab’s approval and Thakur, nothing. This fact alone means Thakur should have been allowed to respond. As it stands, the issue has been reduced to a he-said-she-said event and I doubt that in reality it is. Thakur has since published his response at Newslaundry.

I’m no expert but there are many signs of whataboutery in Ramanan’s article. As Thakur writes, there’s also the matter of the DCGI waiving phase III clinical trials for Itolizumab, which can only be done if phase II trials were great – and this they’re unlikely to have been because of the ludicrous cohort size of 30 people. Kiran Mazumdar-Shaw and Seema Ahuja, the former the MD of and the latter a PR person affiliated with Biocon, have also resorted to ad hominem arguments on Twitter against Itolizumab’s critics, on more than one occasion have construed complaints about the drug approval process as expressions of anti-India sentiments, and have more recently begun to advance company-sponsored ‘expert opinions’ as “peer-reviewed” evidence of Itolizumab’s efficacy.

Even without presuming to know who’s ultimately right here, Mazumdar-Shaw and Ahuja don’t sound like the good guys, especially since their fiercest critics I’ve spotted thus far on Twitter are a bunch of highly qualified public health experts and medical researchers. Accusing them of ‘besmirching India’ inspires anything but confidence in Itolizumab’s phase II trial results.

It’s in this context that I want to draw attention to one particular word in Ramanan’s article in The Telegraph that I believe signals the ‘you scratch my back, I scratch yours’ relationship between many scientific journals and the accumulation of knowledge as a means to power – and in my view is a further sign that something’s rotten in the state of Denmark. Ramanan writes (underline added):

Itolizumab was first approved by the Drugs Controller General of India for the treatment of patients with active moderate to severe chronic plaque Psoriasis in 2013 based on “double-blind, randomized, placebo-controlled, Phase III study”. The safety and efficacy of the drug was published in globally reputed, peer-reviewed journals and in proceedings (Journal of the American Academy of Dermatology, and the 6th annual European Antibody Congress, respectively).

What does a journal’s reputation have to do with anything? The reason I keep repeating this point is not because you don’t get it – I’m sure you do; I do it to remind myself, and everyone else who may need to be reminded, of the different contexts in which the same issue repeatedly manifests. Invoking reputation, in this instance, smells of an argument grounded in authority instead of in evidence. Then again, this is a tautological statement considering Biocon issued a press release before the published results – preprint or post-print – were available (they still aren’t), but let’s bear on in an attempt to make sense of reputation itself.

The matter of a journal’s reputation, whether local or global, is grating because the journals for whom this attribute is germane have acquired it by publishing certain kinds of papers over others – papers that tend to describe positive results, sensational results, and by virtue of their reader-pays business model, results that are of greater interest to those likely to want to pay to access them. These details are important because it’s important to ask what ‘reputation’ means, and based on that we can then understand some of the choices of people for whom this ‘reputation’ matters.

Reputation is the outcome of gatekeeping, of deeming some papers as being worthy of publication according to metrics that have less to do with the contents of the paper* and more with the journal’s desirability and profitability. As Björn Brembs wrote in 2010:

It doesn’t matter where something is published – what matters is what is being published. Given the obscene subscription rates some of these journals charge, if anything, they should be held to a higher standard and their ‘reputation’ (i.e., their justification for charging these outrageous subscription fees!) being constantly questioned, rather than this unquestioning dogma that anything published there must be relevant, because it was published there.

However, by breaking into an élite club by publishing a paper in a particular journal, the reputation starts to matter to the scientist as well, and becomes synonymous with the scientist’s own aspirations of quality, rigour and academic power (look out for proclamations like “I have published 25 papers in journal X, which has an impact factor of 43″). This way, over time, the scientific literature becomes increasingly skewed in favour of some kinds of papers over others – especially of the positive, sensational variety – and leads to a vicious cycle.

The pressure in academia to ‘publish or perish’ also forces scientists to shoehorn themselves tighter into the journals’ definition of what a ‘good’ paper is, more so if publishing in some journals has seemingly become associated with increasing one’s likelihood of winning ‘reputed’ awards. As such, reputation is neither accidental nor innocent. From the point of view of the science that fills scientific journals, reputation is an arbitrary gatekeeper designed to disqualify an observer from calling the journal’s contents into question – which I’m sure you’ll understand is essentially antiscientific.

Ramanan’s appeal to the reputation of the journal that published the results of the tests of Itolizumab’s efficacy against cytokine release syndrome (CRS) in psoriasis patients is, in similar vein, an appeal to an entity that has nothing to do either with the study itself or the matter at hand. As Dr Jammi Nagaraj Rao wrote for The Wire Science, there’s no reason for us to believe knowing how Itolizumab works against CRS will help us understand how it will work against CRS in COVID-19 patients considering we’re not entirely sure how CRS plays out in COVID-19 patients – or if Itolizumab’s molecular mechanism of action can be directly translated to a statement of efficacy against a new disease.

In effect, the invitation to defer to a journal’s reputation is akin to an invitation to hide behind a cloak of superiority that would render scrutiny irrelevant. But that Ramanan used this word in this particular context is secondary**; the primary issue is that journals that pride such arbitrarily defined attributes as ‘reputation’ and ‘prestige’ also offer them as a defence against demands for transparency and access. Instead, why not let the contents of the paper speak up for themselves? Biocon should publish the paper pertaining to its controversial phase II trial of Itolizumab in COVID-19 patients and the DCGI should publicise the inner workings of its approval process asap. As they say: show us (the results), don’t tell us (the statement).

Beyond determining if the paper is legitimate, has sound science and is free of mistakes, malpractice or fraud.

** There are also other words Ramanan uses to subtly delegitimise Thakur’s article – calling it an “opinion article” and presuming to “correct” Thakur’s arguments that constitute a “disservice to the public”.

An Upanishadic lesson for modern science?

Do the Bhagavad Gita and the Upanishads lack the “baggage of biography” – to borrow Amit Chaudhuri’s words – because we don’t know who the authors, outside of the mythology, are or – as Chaudhuri writes in a new essay – do these texts carry more weight than their authors themselves because Eastern Philosophy privileged the work over its authorship? Selected excerpts:

One might recall that the New Critical turn against biography is related to a privileging, in the twentieth century, of the impersonality, rather than the emotional sincerity or conscious intention, of the creative act. This development is not unrelated … to the impact that certain Indian texts had on modernity after they were translated into European languages and put into circulation from the late eighteenth century onwards. …

By the time the Gita’s Krishna was first heard in Europe, all judgements were deemed, by the Enlightenment, to be either subjective or objective. What kind of judgement escapes this binary by being at once passionate and detached, made in earnest without mindfulness of outcome? Immanuel Kant addresses this in a shift in his own thinking, in his writings on aesthetics in 1790 … Five years separate the Gita’s appearance in English, and three years its translation into French, from Kant’s intervention in aesthetics. It’s unlikely he’d have been unaware of the work, or made his sui generis departure without it. The second time such “disinterestedness” appears as a concept, when Matthew Arnold redefines what criticism is, the link to the Gita is clear, and doesn’t require speculation. …

The Gita’s practice of “impersonality” points to T. S. Eliot’s attack, in “Tradition and the Individual Talent” in 1919, on the idea that poetry is an “expression of the personality” or of “emotion”. It’s no accident that the final line of The Waste Land is the Upanishadic refrain, “shantih shantih shantih”, the Sanskrit word for spiritual peace or even-mindedness …

It’s uncertain in what way these conceptual departures would have existed in modernity if these texts hadn’t been put into circulation when they were. Yet a great part of this history of ideas remains unwritten.

Chaudhuri also sets out the relative position of the Upanishads in modernity, particularly their being in opposition to one of the fundamental tenets of modern philosophy: causality. Per Chaudhuri, the Upanishads “dismantle” the causal relationship between the creator and the creation and “interrogate consciousness” through a series of arguments that attempt to locate the ‘Brahman’ in human and natural logic.

He concludes this portion of his text by speculating that the Upanishads might in fact have been penned by “anomalous Brahmins” because in the Bhagavad Gita, which is contemporaneous with some of the Upanishads and followed the rest after more than a century, Krishna asserts, “Neither Vedas, nor sacrifices, nor studies, nor benefactions, nor rituals, nor fearful austerities can give the vision of my Form Supreme” – whereas just these rituals, and their privation, concern the typical orthodox Brahmin today.

While the essay provides much to think about, the separation of creator and creation – in terms of the Upanishads being disinterested (in the specific sense of Chaudhuri’s definition, to mean an ‘evenness of the mind’ akin to unfixation rather than uninterestedness) with both a godlike figure or rituals and making room for biographical details in their verses – is incredibly interesting, especially in relation to modern science.

As Chaudhuri writes,

… “the field of knowledge called “the history of Western philosophy” could just as easily be called “the history of Western philosophers”, inasmuch as Western philosophers are the sum total of their lives and works, and we often defer to both biography and thought when we interact with the philosophy. Each body of work has a personality, but so does its author; in almost every case, we can, literally, put a “face” to the work, whether that’s a photograph of Bertrand Russell or a fourth-century BC bust of Plato.”

Prof Gita Chadha alluded to the same trait in the context of science pedagogy – in The Life of Science‘s promised postscript to their webinar on July 10 about ‘geniuses’ in science. In response to a question by Mrinal Shah, as to how teachers and educators could disprivilege the idea of a ‘scientific genius’ at the primary school level, Chadha said (excerpt):

There is an interesting problem here … In trying to make science interesting and accessible to children, we have to use relatable language. This relatable language organically comes from our social contexts but also comes with the burden of social meanings. So then, what do we do? It’s a tricky one! Also, in trying to make role models for children, we magnify the individual and replay what goes on in the world of science. We teach relativity as Einstein’s theory, we teach laws of motion as Newtonian laws of motion. The pedagogic need to lend a face to an idea becomes counterproductive.

‘Geniuses’ are necessarily individuals – there are no ‘genius communities’. A genius’s status as such denotes at once a centralisation of power and authority, and thus influence; a maturation of intellect (and intellect alone) presented as a role-model to others; and, in continuation, a pinnacle of achievement that those who profit from the extraction of scientific work, such as universities and research funders, valorise.

This said, I can’t tell if – though I suspect that – the modern history of ‘Western science’ is largely the modern history of ‘Western scientists’, especially of the ‘geniuses’ among them. The creator causes the creation, so by contemplating the science, you contemplate the scientist himself – or, as the ‘genius’ would have it, by contemplating the science you necessarily contemplate the creator and his specific choices. And since the modern scientific enterprise was largely harmonised to the West’s methods in the post-colonial period, this is our contemporary history as well.

Chadha had previously noted, in response to a question from yours truly, that she struggles to argue for the non-separation of science and scientist in the context of the #MeToo movement. That is, our liberty to separate important scientific work from the (extra-scientific) actions of an errant scientist may not be so easily achieved, at least if one intends to the extent possible to not participate in the accumulation of power. Instead, she said, we must consider them together, and call out “unethical or non-inclusive practices” – and by extension “you will also call out the culture to which they belong, which will help you to restore the balance of justice, if I may say so.”

This resolves to some extent my issue with Lawrence M. Krauss (although not fully because while Krauss’s culture has been dismantled at his previous university, however temporarily, he continues to maintain an innocence grounded in distasteful convictions). However, I’m still adrift vis-à-vis the late Richard Feynman and others. As a physics journalist first, I can’t help but encounter Feynman in one form or another – but how do you call out a dead man? Or does calling out the dead man’s culture, as perpetuated by the likes of Krauss today, suffice?

Chaudhuri has a similar question: “What do we do with a philosophy when there’s no philosopher in sight?” This matters because the philosopher’s “absence constitutes a problem in giving, and claiming, value. Meaning and significance in Western culture are not just features of the work, but pertain to, and arise from, the owner of the work – the author is the work’s first owner; the author’s nation or culture (“Greece” or “Germany”, say; or “the West”) its overarching one.”

So as with the Upanishads, would we be better served if we concerned ourselves less with deities and their habits and more with the “impersonal” instruction and interrogation of what is true? This seems like a straightforward way out of the problem Mrinal Shah poses, but it doesn’t address, as Chadha put it, the “pedagogic need to lend a face to an idea” – while “impersonal” interrogations of what is true will wrongly ignore the influence of sociological forces in science.

However, all said, I suspect that the answer is here somewhere. The ‘scientific genius’ is a construct and a shared one at that. When we contemplate a body of groundbreaking scientific work, we don’t contemplate the work alone or the scientist alone; we contemplate the work as arising from the scientist but even then only in a limited, constructive sense. But there is more at play; for example, as Chadha said, “We need to critically start engaging with how the social location of a scholar impacts the kind of work that they do”. If I write an article calling X a ‘genius’, X wouldn’t immediately occupy that position unless he is held there by social and capitalist forces as well.

The Upanishads in this context encourage us to erase the binary of ‘creator’ and ‘creation’ and with it the causal perspective’s temptation to think the scientist and the science are separable. In their stead, there is I think room to compose a communitarian story of science – where good arises not from the one but the whole, where power becomes, in keeping with the Upanishads, impersonal.