Not testing for the virus you are trying to associate with a disease is really dumb...

I quickly skimmed over two new papers last Friday (AEST) and was appalled.[1,2] 

In their current format, these papers really just should not have been published at all. 

Any respectable peer review would have sent them back for additional results, to be completely re-written as a letter or more simply - and what I would have recommended to the Editor - that they be rejected outright. 

I was asked if this was just a lost-in-translation error, but complete absence of laboratory data is not that. And that's what these lack - any testing for the virus they name - Zika virus. 

How can you publish something even hinting that a disease is caused by a virus infection, when you present no data to show that person was ever infected by that virus? How can you seriously have that conversation at all?

And using "presumable"and "clinically diagnosed" doesn't get you out of jail either. 

You need some evidence that the virus is or was in the tissue(s) in question (viral genetic material or infectious virus isolated in culture), or was present at some point in the past (antibodies or cells tat respond to the virus when challenged by it in the laboratory) in the person. Neither of the papers here do that. Which astounds me.

Sadly today, there seems to be a journal willing to take any manuscript so that even had the authors been rejected, they most likely would have had their paper appeared elsewhere. 

Or perhaps they had been rejected - and this is that "elsewhere".

I think this sort of publishing sets a hugely dangerous precedent. If the "scientific and medical" literature cannot be relied upon to present its results accurately and with necessary context, how do we expect the community to be able to accurately judge risk and respond reasonably, or our public health experts to find the extra time to sort the signal from the background noise, or the media to get the story straight? 

The Zika virus epidemic of 2015/16 has made much more background noise than signal to date. I hope that changes soon because its hugely disappointing to see so many responding to noise as if it were fact, and fact as if it was hiding conspiracy.

References...

1. Ophthalmological findings in infants with microcephaly and presumable intra-uterus Zika virus infection.
   Arquivos Brasileiros de Oftalmologia
   http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492016000100002&lng=en&nrm=iso
2. Zika virus-related hypertensive iridocyclitis
   Arquivos Brasileiros de Oftalmologia
   http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27492016000100020&lng=en&nrm=iso&tlng=en

Publishing on 'ebola' is a booming pastime...

One of my jobs since October last year has been to keep up on the literature for Ebola virus and Ebola virus disease. 

At this stage I have a lot of reading to catch up on.


There were 1,858 publications during the 37 years including 1977 to 2013. In 2014 and 2015 (so far), there have been 1,485 publications. 

Click on image to enlarge.

According to a basic search of PubMed using the term 'ebola' - there have been over 1,500 publications - and those are the ones captured by PubMed - to be found using that search term.

Case->outbreak->epidemic->publication->learn a lesson...repeat

The global cumulative curve of suspect+probable+confirmed
cases EVD cases (orange) , suspect+probable+confirmed
EVD deaths (red) and the confirmed cases (yellow dots)
Updated from last WHO data posted 10JAN2015 AEST.
Click on image to enlarge.

When looking at the PubMed database search results for 'ebola', one can have no doubt that something big must have happened lately to drive such a massive number of science doers and writers to their keyboards. 

And of course something did - the world's largest, most widespread, multinational and longest running epidemic of Ebola virus disease (EVD) which roared through Guinea, Sierra Leone and Liberia. At the end of 2014 there were 20,000 cases and 8,000 fatalities - and those were just the cases we have seen added to official lists and made public.

A tally downloaded from the PubMed search engine
based on numbers returned using the search term 'ebola'.
Click on graph to enlarge.

The adjacent image shows what the US National Library of Medicine's search engine generates when one searches for 'ebola'. The search engine, called PubMed because it makes the MEDLINE database public (MEDLINE being the Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), lists many of the world's life science and biomedical publications that meet the PubMed standards; currently >24,000,000 citations. In 2014, a lot was written about EVD.

While a lot of the 'ebola' publications in 2014 were commentaries and a lot of reviews that mostly presented the same information, these were necessary to feed many different groups of readers and specialities hungering for background on EVD and the ebolaviruses and how these related to them and their roles, patients and lives. 

I had cause to scan the literature on a daily basis for a few weeks and was particularly impressed with the New England Journal of Medicine's clinical papers and the BMJ's summaries and updates. Of course Science/Sciencexpress and Nature had some beautifully informative articles as well - delving into the humanity behind the numbers and seeking answers to questions we were all asking. I thought PLOS Current Outbreaks (although I'll never enjoy reading that layout), Lancet, Lancet Infectious Diseases and Morbidity and Mortality Weekly Report also stood out in 2014. 

Some of these articles came out very quickly and many were available without the need to breach a paywall. But some of the research...I can't help but wonder how many lives could have been saved if studies detailing and reinforcing the apparent benefits to survival from the aggressive use of intravenous fluids and electrolytes could have come out sooner-through whatever venue. What if we'd talked about, researched or actually published better personal protective gear designs earlier? Imagine if the world had registered that Ebola virus seemed to be in the region years ago, when research papers suggested it. Would any of this knowledge have saved more lives? Who knows? Would the focus on what needed to be delivered to West Africa have changed because of earlier dissemination of need? Would more point of care chemistry instruments have been prioritised? Would the urgency about the need for more healthcare workers have been stepped up if more specific examples of why they were needed were out there for our leaders to be briefed on? Probably unanswerable questions.

Why can't humans ever seem to learn enough to prevent the event sneaking up and whacking us senseless? Why is it always after the event that the light dawns and processes are created for 'next time'?

There will be many more publications to come in 2015, spinning out of this epidemic and the events yet to unravel. Hopefully they will create enough memory for the world to be better prepared for next time. Prepared for a little...uooh - goober fish...