Sickle Cell Trait: As with Statins, When Leading Editors Disagree Please Give Principles Same Weight As Details

Sickle Cell Trait: As with Statins, When Leading Editors Disagree Please Give Principles Same Weight As Details

Dr Fiona Godlee’s Editorial [1] is the basis of a Front Page Headline in the Daily Telegraph “‘End statins controversy’ with government review” [2]. Its Science Editor states “The Lancet argued that thousands of people had been misled into stopping their medication after two articles appeared in the BMJ questioning their use and warning of side effects”. [September 16]. Our editorial giants (BMJ & Lancet) clearly disagree on matters of detail relating to Statins so I am not going to wade into the “who found what?” questions when principles that have not been explored stare us in the face.

PRINCIPLES VERSUS DETAIL
Dr Fiona Godlee was right to highlight the principle about the need to continue asking questions in a scientific debate when she said “who should decide when such questions are too dangerous to ask? Certainly not those who have a vested interest in the debate being shut down.” [1] Which leads me to something else that worries me, namely the general reluctance to call a spade a spade in scientific debate. In his otherwise impressive invited Editorial Professor Harlan M Krumholz of Yale School of Medicine makes the following statement: “Some people fear that data sharing could produce poor science that spreads misinformation. But science should be self-correcting when there is open access to the data” [3]. Now, come on, why do we give the impression that something called “poor science” is responsible for spreading misinformation? And when did “science” become “self-correcting”? Are we afraid to say it is scientists, not science, who need blaming for defects? And scientists, not science that have to do the “self-correcting”? Have we forgotten the BMJ article entitled “Journal agrees to retract paper after university found study was never done”? [4]. Was it Mr Poor Science that caused the problem or a human being? Probity involves human beings, not something called “Science”, which leads me to another principle.

APPLY SAME PRINCIPLE TO OTHER SITUATIONS
To Lisa Blakemore the “debate on childhood vaccine adverse reactions” that some people want to curtail requires the same principle of “Fiona’s current thinking” [5]. But I go further. Just as Lisa Blakemore felt very strongly about childhood vaccines so do I about Sickle Cell Trait misinformation in a reputable journal like The Lancet which refused to publish my protest letter that demanded retraction of a dangerously flawed paper [6] exactly as I presented it [7]. If Lancet is not happy about BMJ’s viewpoint on Statins and there have been calls “for retraction of two BMJ articles that disputed the use of statins in low risk people” [1] why was my call for a retraction of a Sickle Cell Trait article [6] that had no laboratory results but only the word of the patient as evidence of Sickle Cell Trait not heeded? Was it because I implied that the reviewer of the article knew little about sickle cell trait? [7]

I SUGGEST ONE NOVEL PRINCIPLE FOR ADOPTION BY EDITORS
I was previously involved in making both BMJ and Lancet withdraw published reports. The then BMJ Editor Dr Martin Ware withdrew a false report [References available]. I was also first to publish that a Lancet article “left a lot to be desired” [8] whereupon Editors Robin Fox, David Sharp, and Imogen Evans pursued the authors who later confessed to “Erroneous data” [9] and the paper was withdrawn. As Former Editor of the Ghana Medical Journal I am now inclined to think from recent developments (Statins imbroglio not excluded) that any expert in future asked to referee a scientific paper must henceforth declare “Conflict of Interest” in the same way as authors are asked to do. I cannot advise Dame Sally Davies how to approach Dr Fiona Godlee’s request but one novel principle that could not be out of place would be to request a “Lack of Conflict of Interest Declaration” from referees of scientific papers especially from those that recommended for publication “Statins are OK”.

THIS SICKLE CELL TRAIT MISINFORMATION HAS HAPPENED BEFORE
The leading author of the BMJ article on Sickle Cell Trait causing intestinal infarction in a lady after just 45 minutes’ flight from Kumasi to Accra leading to their recommendation that “all negro travellers need testing for sickle cells before flight” happened to be an employer of an international airline. BMJ pursued him to produce records on the patient with haemoglobin electrophoresis results confirming sickle cell trait. There was nothing. So BMJ’s Dr Martin Ware had the Case History withdrawn. And now Lancet publishes “acute rhabdomyolysis in a Sickle Cell Trait patient” after flying [6]. “Who passed this article for publication?” was my first of 4 questions sent to the Lancet [7]. Like the case that BMJ withdrew, the paper had no record of Haemoglobin electrophoresis. Nor was there G6PD quantification, no full blood count, nothing. Not even a sickle cell test result.

WEST AFRICANS’ NEXT MOVE
Our next move is quite clear. Northern Nigeria has 30 million sickle cell traits of whom quite a few are millionaires with private planes. If flying can make their muscles rot as the article in Lancet suggests [6] then they ought to know urgently. They will pay for an investigator to go to the national medical association of the doctor whose paper was published in Lancet and demand to see the patient’s records. We shall then
present the findings to the UK’s Committee on Publication Ethics (COPE) because this is a very serious matter. One in every three of the 90 million people in Northern Nigeria is Sickle Cell Trait, and Insurance Companies will be gloating as they quote Lancet in support of their high fees for Sickle Cell Traits. There is, sadly, no longer our friend Cambridge University’s Professor Hermann Lehmann, FRS to write as he did to The London Times whose Science Correspondent used the BMJ’s non-existent Case History to suggest grounding “All Black Air Crew”. Lehmann simply said “Look here. Black Sickle Trait athletes ran at the Olympic Games at Mexico City 7000 ft high and beat the entire world with Gold Medals” so why use a discredited Sickle Cell Trait Case Report in the BMJ to say all Black Air Crew should be grounded forthwith? [10] There are great financial implications in calling Sickle Cell Trait Sickle Cell Disease, that was why I was given 4 body-guards in Philadelphia for pointing out in my Keynote Address (“The Vital Difference Between Sickle Cell Trait and Sickle Cell Disease”) that Insurance Companies in New York were defrauding Sickle Cell Traits [11]. Indeed, just as I predicted [7], the flawed Sickle Cell Trait Rhabdomyolysis article [6] is being used frenetically on Facebook in such terms as “Sickle Cell Trait mixed with Rhabdomyolysis could equal sudden death during exercise” [12].

The Statins Debate may well involve reputable scientists who are economical with the truth, and we should not equate them with “poor science” that will “correct itself”.

Dr F I D Konotey-Ahulu MD(Lond FRCP(Lond) DTMH(L’pool) Former Editor of the Ghana Medical Journal. Kwegyir Aggrey Distinguished Professor of Human Genetics
University of Cape Coast, Ghana and Lately Consultant Physician Genetic Counsellor in Sickle Cell and Other Haemoglobinopathies, 9 Harley Street, London W1G 9AL.

1. Godlee Fiona. Statins: We need an independent review. BMJ 2016; 354: i4992 http://www.bmj.com/content/354/bmj.i4992
2. Knapton Sarah. “End statins controversy with government review. Daily Telegraph. Friday 16 September 2016, page 1.
3. Krumholz Harlan M. Statins evidence: when answers also raise questions. Sharing the data is more likely to settle the debate than another review. BMJ 2016; 354: i1463 (doi:10.1136/bmj.i4963)
4. Dyer Clare. Journal agrees to retract paper after university found study was never done. BMJ 2013; 347: 155 http://dx.doi.org/10.1136/bmj.f5500 Sept 5 2013.
5. Blakemore Sarah. Statins: We need an independent review. BMJ Rapid response www.bmj.com/content/354/bmj.i4992/rapid-responses.
6. Rhida A, Khan A, Al-Abayechi S, Puthenveetil V. Acute compartment syndrome secondary to rhabdomyolysis in a sickle cell trait patient. Lancet 2014; 384:2172
7. Konotey-Ahulu FID. Dangerously flawed diagnosis of sickle cell trait in compartment syndrome rhabdomyolysis http://bit.ly/2d4t9Zd
8. Konotey-Ahulu FID. Group specific component and HIV infection. Lancet 1987; i: 1267.
9. Eales L-J, Nye KE, Pinching AJ. Group specific component and AIDS: Erroneous Data. Lancet 1988; i: 936.
10. Lehmann Hermann. Sickle cell and flying. The Times, London January 4, 1972.
11. Konotey-Ahulu FID. Four bodyguards and the perils of unmasking scientific truths. BMJ 2007; 335: 210-211 www.bmj.com/cgi/reprint/335/7612/210.pdf
12. Whiskey Delta Charlie [Facebook September 5 at 5:35 pm] Sickle Cell Trait mixed with Rhabdomyolysis could equal sudden death during exercise or if low oxygen levels are present. Secondary complications can be present as well #sicklecelltrait #exercise #rhabdomyolysis #trackandfield #marathontraining #2milerun #crossfit #physicaltraining #preseason #military my story in the bio# sicklecellawarenessmonth #itsnotblackgene #global #bloodline #fighgtsmalaria #hispanic #mediterranean #europe #asian bloodtests