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When we think about how science is distorted, we usually think about concepts that have ample currency in public discourse, such as pseudoscience and junk science. Practices like astrology and homeopathy come wrapped in scientific concepts and jargon that can’t meet the methodological requirements of actual sciences. During the COVID-19 pandemic, pseudoscience has had a field day. Bleach, anyone? Bear bile? Yet the pandemic has brought a newer, more subtle form of distortion to light. To the philosophy of science, we humbly submit a new concept: “zombie science.”
We think of zombie science as mindless science. It goes through the motions of scientific research without a real research question to answer, it follows all the correct methodology, but it doesn’t aspire to contribute to advance knowledge in the field. Practically all the information about hydroxychloroquine during the pandemic falls into that category, including not just the living dead found in preprint repositories, but also papers published in journals that ought to have been caught by a more discerning eye. Journals, after all, invest their reputation in every piece they choose to publish. And every investment in useless science is a net loss.
Zombie science bestows an aura of credibility on results not answering real scientific questions.
From a social and historical stance, it seems almost inevitable that the penchant for productivism in the academic and scientific world would end up encouraging zombie science. If those who do not publish perish, then publishing—even nonsense or irrelevancies—is a matter of life or death. The peer-review process and the criteria for editorial importance are filters, for sure, but they are limited. Not only do they get clogged and overwhelmed due to excess submissions, they have to deal with the weaknesses of the human condition, including feelings of personal loyalty, prejudice, and vanity. Additionally, these filters fail, as the proliferation of predatory journals shows us all too well.
As scientists and science communicators, we see the harm that a system preoccupied with productivity and quantity of publications is doing to science and to the way science is perceived by the public. Such a system tends to reward zombie science, and research groups are going into it as a response to a perceived need for self-preservation. Zombie science, whether well intentioned or an attempt to game the system, consumes funding and bestows an aura of scientific credibility on results that are not answering real scientific questions.
Some scientists have come forward to denounce zombie science. Piotr Rzymski, a researcher in the Department of Environmental Medicine at the Poznan University of Medical Sciences, complained about the amount of useless peer review he was forced to do during the pandemic. “Some were ridiculous,” he told Science Business.1 “My favorite example is a suggestion to blow very hot air into a patient’s lung to eliminate the virus.” In the same article, Hans Ochs, professor of pediatrics at the Seattle Children’s Research Institute, said that some submissions he reviewed “are material for Saturday Night Live.”
Derek Lowe, renowned chemist, and Science contributor, has also called attention to zombie science. In his blog In the Pipeline, he lamented the proliferation of papers during the pandemic that don’t advance scientific knowledge but fit the sole purpose of enhancing someone’s résumé. As a “designated Pain the Rear,” he wrote, addressing his own field of drug discovery, “I have to ask if we needed over ninety different papers screening what in many cases is more or less the same set of compounds, over and over and over.” Many papers, he wrote, may as well have been titled “Stuff We’ve Already Done, Now With a Coronavirus Angle Glued Onto It So It Can Be Published Again.”
This trend of worthless science has been exacerbated by the media spotlight, political pressure and, presumably, the strong human impulse in the face of an emergency to do something, anything, even if it is sheer lunacy. This way, zombie scientists get not only peer-review recognition but also the public’s impression that they are doing important work.
Zombie science not only pollutes science and generates noise; it also contributes to the hype of miracle cures and false hopes that end up in the press. A paper published by a Brazilian group of scientists on the use of saline solution as COVID-19 prevention accomplished just that. The paper tested the use of saline solution in vitro and concluded that it inhibits viral replication. The authors carried out all kinds of experiments and statistical analyses and presented the results in what looks like rigorous methodology. The conclusion, typical for zombie science, is that more studies are needed to evaluate whether saline solution would be a good alternative to treat and/or prevent COVID-19.2
Because the paper was signed by scientists from the University of São Paulo, and funded by one of Brazil’s largest funding agencies, it received a lot of publicity. The funding agency’s magazine, Revista Fapesp, published an article on how Brazilian scientists had proposed the use of nasal sprays with saline to prevent COVID-19, stressing just how important this discovery could be to help control the pandemic. Another Brazilian magazine also picked up the bait and highlighted the good news, being careful to stress that this was not a cure for COVID-19.3
The same was observed with the publication of the clinical trial for the use of nitazoxanide in Brazil, published in the European Respiratory Journal.4 The paper doesn’t dare state the vermifuge, a medicine to kill intestinal worms, cures COVID-19 but, of course, concludes that more studies are needed. The authors don’t say so in the paper, but they participated in hyping the paper with the federal government. One of the authors of the paper is the current secretary to Marcos Pontes, Brazil’s Minister of Science, Technology, and Innovations, responsible for approving funding for the project. Pontes cried when the paper’s results were broadcast in a press conference, thanking the Brazilian scientists for their tireless work.4
During the pandemic, zombie science has not been restricted to Brazil. Many clinical trials have been small, lacked proper randomization, and have been low in methodological quality.5 Such poorly designed clinical trials have contributed to hype and misinformation. Brazil, though, has shown us that zombie science is not just insidious, arising out of suspect relations between the academic and political systems, but can be evil. In fact, maybe “evil science” deserves a category of its own. It would be identified by its intent to use science to achieve a political or ideological goal, without excluding, of course, financial gain. It doesn’t shirk from fraud and has complete disregard for medical ethics and human rights. The cases of hydroxychloroquine, ivermectin, and other miracle drugs provide sad examples.
Hydroxychloroquine was first promoted in Brazil in March 2020, following the hype in France when physician and microbiologist Didier Raoult went on YouTube to brag about his results, presented in his now infamous Marseille paper.6 The paper was highly criticized by the international scientific community for its grave methodological flaws.7
During the COVID-19 pandemic, pseudoscience has had a field day. Bleach, anyone?
Shortly after Raoult’s publication, the chloroquine hype exploded in the United States and Brazil, with both President Trump and President Bolsonaro promoting the malaria medication as a miracle cure for COVID-19. A private healthcare operator in Brazil, Prevent Senior, produced a makeshift paper, “the game-changer,” which was circulated as a PDF but never appeared in a peer-reviewed journal.
The results of the study showed no deaths in its treatment group. The work, as presented, had shabby methodology and the rosy conclusions were obviously unwarranted, Later, a group of medical doctors fired by the study sponsor came forward and declared the study was rife with fraud, ethical misconduct, and withheld information.8 It turned out that there had been deaths in the treatment group, but they were removed from the record.
The doctors also accused Prevent Senior of pressuring them to prescribe unproven medication, not just hydroxychloroquine but also other drugs that came to compose what became known in Brazil as the “COVID early treatment kit.” The kit contained a huge amount of other unproven drugs such as ivermectin, nitazoxanide, flutamide, vitamin D, zinc, and azithromycin.
Messages from the hospital directors and program coordinators were released to the press and to Brazil’s Parliamentary Inquiry Committee (CPI, in the Portuguese Acronym). The messages showed that directors pushed the doctors to prescribe the COVID kit, treating the number of prescriptions as if they were sales goals in a retail marketing campaign. Those who refused were reprimanded. There were also instructions not to inform the patients or their families about the prescriptions.
Prevent Senior’s medical director, Pedro Batista, was summoned by the CPI and calmly confirmed that the ICD (International Classification of Disease) of all COVID-19 patients was altered after 14 days. This meant that patients would come in with COVID-19, get treatment, preferably with the COVID kit, and, after 14 days, if they made it out of intensive care, either dead or discharged, the ICD would be altered. Death certificates would state that those patients died from sepsis, pneumonia, or any other COVID-related complications, but the fact that the patients presented with COVID-19 would be omitted.9
The conclusion, typical for zombie science, is that more studies are needed.
Prevent Senior is also under the suspicion of having close ties with Bolsonaro and the federal government. The President and his sons were the first to promote the “game-changer” PDF, and there are leaked videos of scientists and medical doctors working together with Prevent Senior and President Bolsonaro to promote the COVID kit, in an attempt to convey to the populace the notion that the pandemic was under control and there was no need for mitigation and preventive measures that would “hurt the economy.”10
Another case in Brazil is the use of proxalutamide, a male hormone blocker, as a COVID-19 treatment. This involved another private healthcare operator, the Samel group. Proxalutamide is a drug still under study for prostate cancer, and its use is not authorized by Brazil’s regulatory agency Anvisa. Nonetheless, it was used in clinical trials, which in turn, have also not been authorized by the Brazilian Board of Ethics in Research (CONEP). A group of Brazilian researchers conducted clinical trials with the drug, with suspicious results that did not go unnoticed by the international scientific community. “Too good to be true” was the ironic remark in Science.11 Besides having no ethical clearance to run the trials, the group failed to inform CONEP of the elevated number of deaths during the trial, which would have been reason to halt it. The study protocol also differed from the one deposited at the website Clinical Trials.12O Globo, one of Brazil’s largest newspapers, published a series of reports and articles on proxalutamide, but a judge deemed them prejudicial and censored them.13
UNESCO declares that the proxalutamide case in Brazil, if the details known so far are to be confirmed, is one of the most serious violations of human rights of patients in the history of Latin America.13 Patients were not informed that they were part of a trial, and neither were families.
As we know from the horror movies, the only way to kill a zombie is to destroy its brain—before it devours ours. The same is true for zombie science. As scientists, science communicators, and citizens, we need to recognize this distortion of science and take aim at its methods before it has another chance to distort, harm, and kill.
Natalia Pasternak is a microbiologist, science writer, and a visiting adjunct scholar at the Center for Science and Society, Columbia University. She is the author of two science popularization books: Science in Our Daily Lives, winner of Brazil’s National Literature prize for best science book in 2021, and Against Reality: Science Denialism, Its Causes and Consequences.
Carlos Orsi is a science journalist and writer, editor-in-chief of Revista Questão de Ciência. He is the author of several science-fiction and science popularization books, including The Book of Miracles; The Book of Astrology; Pure Quackery; Science in Our Daily Lives, winner of Brazil’s National Literature prize for best science book in 2021; and Against Reality: Science Denialism, Its Causes and Consequences.
Aaron F. Mertz is a biophysicist, educator, and director of the Aspen Institute Science & Society Program, which seeks to democratize science as a guiding force for public good. He executive-produced the PBS documentary series INFODEMIC: Global Conversations on Science and Misinformation, co-chaired the Aspen Global Congress on Scientific Thinking & Action, and launched the national youth initiative “Our Future Is Science.”
Stuart Firestein is a professor of neuroscience and former chair at the Department of Biological Sciences, Columbia University. He is the author of two books about science for the public, Ignorance: How It Drives Science, and Failure: Why Science Is So Successful.
References
1. Kelly, E. COVID-19 pandemic leads to flood of “useless” science. Science Business (2020).
2. Machado, R.R.G., et al. (2021). Inhibition of Severe Acute Respiratory Syndrome Coronavirus 2 Replication by Hypertonic Saline Solution in Lung and Kidney Epithelial Cells. ACS Pharmacology and Translational Science 4, 1514-1527 (2021).
3. Ziegler, M.F. Solução salina pode inibir replicação da covid, indica estudo da USP. Revista Exame (2021).
4. Rocco, P.R.M., et al. Early use of nitazoxanide in mild COVID-19 disease: Randomised, placebo-controlled trial. European Respiratory Journal 58, 2003725 (2021).
5. Janiaud, P., et al. The worldwide clinical trial research response to the COVID-19 pandemic—the first 100 days. F1000Research (2020).
6. Gautret, P., et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents 56, 105949 (2020).
7. Bik, E. Thoughts on the Gautret et al. paper about Hydroxychloroquine and Azithromycin treatment of COVID-19 infections. Science Integrity Digest (2020).
8. Sakamoto, L. Prevent Senio e Bolsonaro usaram brasileiros como cobaias de cloroquina. UOL (2021).
9. Mattos, M. & Resende, S. Diretor confirma que Prevent mudava código de diagnóstico da Covid; senadores falam em crime. G1 (2021).
10. Pancher, S. Exclusivo: “gabinete paralelo” levava dados da Prevent Senior para o governo federal. Metrópoles (2021).
11. Service, R.F. “Too good to be true”: Doubts swirl around trial that saw 77% reduction in COVID-19 mortality. Science (2021).
12. Neto, J.G., Peçanha, A.C., & Tessler, L. Integridade em pesquisa clínica: o caso da proxalutamida. Revista Questão de Ciência (2021).
13. FolhaJus. Justiça do Amazonas amplia censura contra O Globo sobre suspeitas em teste com proxalutamida. Folha de São Paulo (2021).
Lead art: Photobank.kiev.ua / Shutterstock
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