We don’t expect mercenary scientists. Science is supposed to be constant, apolitical, and above the fray.
Michaels, 2020, p. 23
In the international competition for the best anti-epidemic strategies, Luxembourg is supposed to be a model to follow. With 42.9% of infections prevented, large-scale testing is supposed to have enabled the small country to avoid a major health and economic disaster. At least that is what the politicians and their scientists unambiguously proclaim. According to the current military language, the government’s scientific “Task Force” would have taken advantage of “the tremendous opportunity” to “gradually test the entire population against the new coronavirus in a relatively short period of time”. A scientific study by the Task Force’s specialists, published in May 2021, supposedly proved that the number of cases detected could not only be reduced by almost half, but that, in the case of compulsory testing, 82.7% of cases of infection could have been prevented. Clearly, democracy is a serious health hazard. What then of the science that informs health policy? A critical re-reading of the scientific study and its context reveals a somewhat more dubious situation than the advocates of ‘evidence-based’ policy would have us believe.
In the midst of the 2020 crisis state, the Luxembourg government issued a press release announcing the official strategy for exiting containment without further debate or discussion. Behind the closed doors of government consultations, policymakers had opted for a large-scale testing strategy to contain the momentum of the epidemic. The project of a first testing phase, budgeted at 32 million euros, was to “take advantage of the enormous opportunity” to “progressively test the entire population against the new coronavirus in a relatively short period of time”.
The first phase of this testing was carried out on 25 May, at the height of the seasonal decline of the epidemic, and lasted until 15 September, the end of the summer holidays. The large-scale testing also benefited from a very broad collaboration involving the Luxembourg Ministries of Education and Health, while a “COVID-19 Task Force” comprised representatives of the Ministries, the University of Luxembourg, the Luxembourg Institute of Health, the Luxembourg Institute of Science and Technology, the Laboratoire National de Santé, the Centre Hospitalier du Luxembourg, the Fonds National de Recherche, Luxinnovation (economic development was not forgotten) and the Luxembourg Institute for Socio-Economic Research. The enormous opportunity of the pandemic should also be the opportunity of Luxembourg science.
Like other European countries, Luxembourg wanted a few hand-picked ministry officials and scientists to benefit from the situation to contribute to general epidemiological knowledge.
Science and conflicts of interest
Obviously, since Galileo, the truth of science, which many still consider the direct inheritance of the truths of the Gospel, has become more problematic. For the new heroes of science do not always seem to defend their truth against the state or against commercialism. From the communist science of a Lyssenko to the crisis of reproducibility (cf. Ioannidis, 2005), via the science of tobacco and agribusiness, the coronavirus pandemic broke out in the midst of the scientific “credibility revolution” (cf. Vazire, 2018).
Thus, during the pandemic crisis, irregularities and conflicts of interest in science have multiplied exponentially. Kamran Abbasi, the editor of the British Medical Journal, already warned in his editorial of 13 November 2020 about the politicization, corruption and suppression of science in the context of the pandemic. Covid-19, Abbasi wrote (Abbasi, 2020), has unleashed “state corruption on a massive scale” that harms the very health it purports to protect.
Corruption does not stop at the political and economic use of scientific research. It penetrates the pores of scientific publications and spills over into the practices and reasoning of science itself to create true “epistemic corruption” (see e.g. Sismondo, 2021). Epistemic corruption occurs when a “knowledge system loses its integrity […] and ceases to provide the kind of reliable knowledge that is expected of it.” (op. cit.)
The recent Lancetgate scandal is a remarkable example of this kind of corruption and its disastrous political consequences. On 22 May 2020, The Lancet published an article by Sapan Desai et al. estimating the mortality of hydroxychloroquine Covid-19 treatment at 11.1% (Mehra et al., 2020).
The article provoked an immediate major policy response: the World Health Organisation, the UK Medicines and Healthcare products Regulatory Agency and the US Food and Drug Administration, to name the most important, immediately recommended a complete halt to all hydroxychloroquine treatments and research related to the Covid-19 pandemic. As a result of the Lancet article, a near-global halt was imposed on hydroxychloroquine use and research.
The study is based on a database with information from about 96,000 patients in 671 hospitals on six continents, which could not be verified in any peer review process. One week after the article was published, on 23 May 2020, serious doubts began to emerge about the study’s findings. On 28 May, some 146 researchers sent an open letter to the Lancet expressing surprise at Desai’s study (see Mahase, 2020). Among other things, the authors of the letter expressed concern about inadequate control of variables, confusing data, non-validation of data, lack of information about the source of the data and the non-transparency of the peer review process, which is considered one of the undisputed standards of scientific research.
The bottom line is that the study in question was not only riddled with methodological problems and miscalculations. In fact, Richard Horton, the editor-in-chief of the Lancet, eventually called the work of Desai and his collaborators a “monumental fraud” (“Richard Horton, Lancet chief”, 2020). For while the authors were claiming to prove the scientific harmfulness of hydroxychloroquine, based on data never verified by Desai’s private company, Desai was publishing about the equally problematic efficacy of ivermectin treatments. Thus, monumentally fraudulent publications had managed to pass through all scientific publication control bodies of the most reputable scientific journal like clockwork.
Scientific pragmatism in Luxembourg
At the end of February, Paul Wilmes et al, members of the same Luxembourg Task Force, presented a study on large-scale testing in The Lancet Regional Health – Europe (one of the new Lancet sub-journals, currently without any “impact factor” (Wilmes et al., 2021)).
The purpose of the publication was to scientifically prove the success of the large-scale testing strategy. And the result of this strategy, if the designers are to be believed, was an extraordinary success. As a result of widespread screening and through mathematical modelling of the assumed detection of asymptomatic infections, considered to be the main drivers of the epidemic, “the total number of expected cases would have been 42.9%” (Wilmes et al., 2021, p. 1, fig. 6 p.7, p. 8).
According to the same model, “mandatory participation would have led to an additional difference of 39.7%”. In short, if the entire population could have been obliged to participate in large-scale testing, the authors of the study found, 82.7% of cases in Luxembourg could have been avoided. Obviously, as Axel Kahn, President of the French League Against Cancer, stated: “In the context of a pandemic, democracy is a disadvantage” (cf. Stiegler, 2021, p. 14).
However, this study, covering a first testing phase and with a budget of 32 million euros, quickly triggered a touch of déjà-vu among some independent experts. As the famous Luxembourgian “shortcuts policy” had become a widespread mindset in Luxembourg, it seemed perfectly normal that a scientific analysis of a health strategy would be carried out by the same actors who had designed the programme and were also responsible for its implementation.
But what is the bread and butter of public-private partnerships for the so-called “pragmatism” of business seems far less trivial in the research context. Opaque data collection, omissions, subtle suggestions, problematic interpretations and major conflicts of interest may characterise the “politics of shortcuts”, but they pose a major problem for the ethics of scientific research.
As infectious disease specialist Dr Gérard Schockmel (“De Kloertext“, 2021) has pointed out, the technical problems in carrying out the testing, the scientific and methodological problems, the interpretation of the results, the lack of information, the flimsy cost-benefit ratio and the conflicts of interest of the study carried out by the Luxembourg task force appear so overwhelming that they are more reminiscent of a highly elaborate version of political marketing than a scientific research study worthy of the name.
For, as with the work of Desai et al, the inconsistencies of the Luxembourg study begin at the level of data collection, which is supposed to inform a speculative mathematical model that in turn is supposed to certify the actual scientific success of the political strategy.
Small arrangements with the truth
Let us briefly summarize the most striking scientific inconsistencies. First, although the final version of the paper retains the uncertainty of the data collected, the authors of the study “failed” to clearly state the inaccuracies resulting from the extraction of nucleic acids from oropharyngeal swabs. The reasons why oropharyngeal swabs were preferred over nasopharyngeal swabs, which provide much more reliable detection, were not disclosed (see Wang et al., 2020).
Furthermore, at no point does the Luxembourg study address the question of well or poorly mastered sampling techniques for rRT-PCR tests (an interesting little detail that will be crucial later), nor possible errors in the interpretation of the results. The authors of the study only consider the perfect laboratory validity (100%) of the test kits as guaranteed by their manufacturer. Furthermore, there is no mention of how infectious the detected positive cases are.
But that’s not all: the laboratory, which was exclusively contracted by the Luxembourg Health Institute, has hired a test manufacturer that it owned until 2017. Still in the logic of Luxembourgish business pragmatism, the laboratory in question will itself have certified the tests of its ex-company, with the knowledge and approval of the Ministerial Directorate of Health. “Short paths and shortcuts…” (Ducat, 2014)
While these entanglements of financial interests were not mentioned in the Wilmes et al. article, neither was the provision in the purchase agreement, common in this type of transaction, for earn out opportunities, which provide for the possibility of additional compensation if certain targets are met.
In short, the scientific study of large-scale testing does not consider the problems of the correct performance of the samples, nor the issues of certification of the tests used, nor the possible conflicts of interest due to the exclusive contract given to a private laboratory, which in turn contracts a private company with which it is linked under conditions protected by commercial confidentiality.
Beyond the data, the screening methodology has benefited from the same happy opacity.
The division of samples into three risk groups, which required the participation of 50% of the resident population and 22% of the border workers, allowed on average only one test every 4 weeks for the resident population and every 8 weeks for the border workers in the high-risk group. In the numerically much larger medium-risk group, residents were tested on average every 10 weeks, while border workers were tested every 20 weeks.
So, according to a simple arithmetic calculation (see Dr Gérard Schockmel’s calculations on Luxembourg State Radio, 2021), the probability of detection was 1/30 for the group of residents at highest risk, 1/60 for those tested at 8-week intervals, 1/70 for those tested at 10-week intervals, and 1/140 for those tested at 20-week intervals. It’s like hunting mosquitoes with big fishing nets.
To the credit of the political decision-makers and their scientific representatives, however, it should be noted that they themselves do not seem to have believed in the great scientific success of the screening. The closures and curfews that were put back in place as early as December 2020, after the second phase of the testing billed at some €60 million of taxpayers’ money, will have shown that large-scale testing will clearly not have made a perceptible difference to the epidemic dynamics.
Conflicts and agreements: buddies first
The ethics of scientific research, unlike those of political and business partnerships, consider the falsification or manipulation of data and results to be fraud. In the world of science, conflicts of interest that can distort research results usually lead to the withdrawal of studies and the disqualification of researchers rather than to good business relationships and academic careers.
Covert economic interests in scientific research are obviously not new and did not start with to the pandemic. In fact, an international charter for the declaration of conflicts of interest was proposed in 2009 by the New England Journal of Medicine (Drazen et al., 2009, p. 1896) for all international bodies of medical journal editors. According to this charter, “non-financial affiliations that may be relevant to the submitted manuscript”, affiliations “with commercial entities that have supported the work presented in the submitted manuscript”, and “affiliations with commercial entities that may be deemed to have an interest in the general area of the submitted manuscript” must be declared (36 months before submission).
While the Wilmes et al. paper correctly disclosed the scientific and economic entanglement of the sponsoring state, it failed to mention the various commercial companies that provided support and incidentally benefited from a multi-million dollar business case; some 150 million to date for the first three phases of large-scale detection. It is also not disclosed why the private laboratory was chosen over the national health laboratory.
It can be stated that it was only under the pressure of urgency that the government task force contracted a single private laboratory and military services company based in Dubai to organize and evaluate the tests, without any further public tender. The fact of this commercial outsourcing was obviously not among the declarations of conflicts of interest considered by the authors of the study.
A shrewd guess, however, is that the tests were actually conducted by the scientific task force itself. The fact that the military logistics company in Germany was taken over because of various problems with favouritism, IT management and lack of staff training (Corona tests, 2020) was also not reported anywhere. The validity of the test pattern is no longer reassuring.
It is not difficult to see in these networks of connivance, in these complex arrangements and state machinations protected by commercial secrecy (see Schmit & Reuter, 2021), the very model of Luxembourg’s political economy based on political and legislative know-how, whose scandals regularly fill the headlines of foreign newspapers. And it seems to be fashionable in this small world to admit that where there is interest, there is no conflict. Because where there is interest, there are arrangements, regardless of the world of scientific research.
Very private public-private partnerships
The pandemic crisis has shown that the Ministry of Health is no exception to this strategy of the veil of ignorance. Private law contacts make it possible to shield the most obscure public-private partnerships from public scrutiny and critical analysis (cf. Schmit, 2021). Obviously government science, for its part, benefits from the same commercial secrecy.
In his editorial on the political and financial corruption of science, Kamran Abbasi noted that the only way to combat scientific fraud is through “full disclosure of the competing interests of government, politicians, scientific advisors and commissioners, such as those responsible for testing and tracking, purchasing diagnostic tests and providing vaccines” and “full transparency of decision-making systems, processes and knowledge of who is responsible for what” (Abbasi, 2020).
Contrary to the recommendations of the International Committee of Medical Journal Editors, the success of Luxembourg’s politicized epidemiological science will again bear all the hallmarks of a certain type of business that has become notorious.
Far from contributing to the credibility of science that could address the real problems of the pandemic, government science in Luxembourg will have fed the epistemic corruption that fuels conspiracist theories and undermines the credibility of health policy, not without reason. Given the budget invested in the large-scale testing strategy and the reputation and professional standing of those involved in the study, those involved will obviously have had every reason to do their best to avoid failure.
However, the Luxembourg Task Force study will have revealed one of the saddest facts of the health crisis: When policymakers pretend to follow science, it is because they already know how to rely on the interests of their scientific mercenaries (cf. Conway & Oreskes, 2012).
Drazen, J. M., Weyden, M. B. V. D., Sahni, P., Rosenberg, J., Marusic, A., Laine, C., Kotzin, S., Horton, R., Hébert, P. C., Haug, C., Godlee, F., Frizelle, F. A., de Leeuw, P. W., & DeAngelis, C. D. (2009). Uniform Format for Disclosure of Competing Interests in ICMJE Journals. New England Journal of Medicine, 361(19), 1896–1897. https://doi.org/10.1056/NEJMe0909052
Mehra, M. R., Desai, S. S., Ruschitzka, F., & Patel, A. N. (2020). RETRACTED: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet, 0(0). https://doi.org/10.1016/S0140-6736(20)31180-6
Michaels, D. (2020). The Triumph of Doubt: Dark Money and the Science of Deception. Oxford University Press.
Stiegler, B. (2021). De la démocratie en Pandémie: Santé, recherche, éducation. Gallimard.
Vazire, S. (2018). Implications of the Credibility Revolution for Productivity, Creativity, and Progress. Perspectives on Psychological Science, 13(4), 411–417. https://doi.org/10.1177/1745691617751884
Wang, H., Liu, Q., Hu, J., Zhou, M., Yu, M., Li, K., Xu, D., Xiao, Y., Yang, J., Lu, Y., Wang, F., Yin, P., & Xu, S. (2020). Nasopharyngeal Swabs Are More Sensitive Than Oropharyngeal Swabs for COVID-19 Diagnosis and Monitoring the SARS-CoV-2 Load. Frontiers in Medicine, 7. https://doi.org/10.3389/fmed.2020.00334Wilmes, P., Zimmer, J., Schulz, J., Glod, F., Veiber, L., Mombaerts, L., Rodrigues, B., Aalto, A., Pastore, J., Snoeck, C. J., Ollert, M., Fagherazzi, G., Mossong, J., Goncalves, J., Skupin, A., & Nehrbass, U. (2021). SARS-CoV-2 transmission risk from asymptomatic carriers: Results from a mass screening programme in Luxembourg. The Lancet Regional Health – Europe, 4. https://doi.org/10.1016/j.lanepe.2021.100056
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Thierry Simonelli is a psychoanalyst, doctor in psychology and philosophy. He has taught psychology and philosophy at various universities – in Paris, Reims, Metz and Luxembourg. Since 2001, he has been in private practice as a psychoanalyst in Luxembourg.