There is no other, more gentle way to say it: The Journal of Attention Disorders (JAD)–the prestigious academic home for research on ADHD–withholds critical information from its readers. Devout readers of Mad in America probably recall that, back in 2020, the JAD published an article by Merzon and colleagues with multiple omissions and distortions that created a false impression as if ADHD increases the risk for COVID-19 infections, and as if ADHD medications can mitigate this risk. But back then, the depth of the scientific misconduct was unknown to us.
We also assumed that the JAD, as a distinguished representor of objective and unbiased science, would not take an active part in the misrepresentation of the evidence. How naïve we were; we are only now starting to understand. Our goal in the current short article is therefore to share the worrisome lessons we have learned from our two-year-long saga–lessons that should trouble every honest scientist and every mental health patient.
Lesson #1: Scientists avoiding their data-availability declarations may have something to hide.
On August 5, 2020, shortly after Merzon and colleagues published their 2020 study on ADHD and COVID-19 infections, we sent them several requests to receive access to their data. It was our (naïve) position that the best strategy to examine the validity of their conclusions would be by inspecting the original data file, replicating the reported analyses, and completing additional (missing) analyses. Unfortunately, we were not granted this access, so we had to investigate the written, and essentially limited, information that was available to us at that time (through three publications by the same authors, which relied on similar data, and which were published at the same time).
We submitted this critique to the JAD, but the editor-in-chief refused to consider it for publication. In the decision letter we received he wrote: “It has come to my attention that you have also submitted this paper to another publication and released a version prior to any peer review. Therefore I am rejecting your submission.”
Our efforts to convince the editor of the JAD that the contemporary and highly common practice of uploading preprint versions to designated servers (especially since the outbreak of the COVID-19) only contributes to scientific transparency (along with our friendly reminder that we were the ones who “brought this matter to his attention” in our initial submission) didn’t work, so we eventually ended up publishing it in the peer-reviewed journal of Ethical Human Psychology and Psychiatry (along with a shorter and easier-to-follow version in Mad in America).
Our detailed critique revealed severe methodological and representational biases that undermine the conclusions made by Merzon and colleagues in 2020, but the authors, to our knowledge, never responded to our critique. Instead, they published a second study on this topic, in the JAD. In this new study from 2021, they made an even more far-reaching claim: that the behavioral condition (ADHD) is associated with severe outcomes of the respiratory virus (COVID-19).
To settle this ongoing scientific debate, which has tremendous implications for the public health, we have sent Merzon and colleagues another set of data-availability requests. Considering our past experience, we decided this time to include the editor-in-chief of the JAD in the email correspondence. The JAD, which provided the Kosher Stamp for these studies, we assumed, has the most interest to ensure the quality of its publications. After all, Merzon and colleagues specifically declared in their JAD publications that the data used for their studies will be available upon request. Imagine then, how shocked we were to receive the following, three-word response from the corresponding author of these studies: “Beware, Scientology Related.”
Apparently, Prof. Iris Manor, the corresponding author of the two studies by Merzon and colleagues (2020, 2021) felt the need to warn the editor-in-chief of the JAD from our plain and respectful data request. As fate would have it, this ad hominem, blatant lie was sent to our email address, probably by mistake, in addition to the email address of the editor of the JAD. Needless to say, we do not belong to the scientology movement, but this false accusation triggered a fascinating email correspondence with multiple addressees that exposed the highly problematic happenings that usually take place behind the (unfortunately) closed academic curtains.
In the article you are reading now, we made a conscious decision not to release the actual letters we received from Prof. Manor and Dr. Merzon (although we are allowed to share them from a purely legal point of view). Nevertheless, it is crucial we discuss the content of these letters as they seem to include a variety of stalling tactics that ranged from shifting responsibility to the health care service holding the data, an absence of a data scientist in-charge, COVID-related delays, participants’ privacy considerations, and various technical restrictions. Dr. Merzon also informed us that the access to the data will require payment and be limited to selective portions of the data only.
But guess what? Even this selective access was not granted to us (or to anyone else, to our knowledge) to this very day, September 8, 2022–almost a year after our second round of data requests and more than two years after our first requests. We therefore cannot help but wonder: What are the authors afraid of? Is there something in the data that should be kept secret? A clue that might unravel this secret can be found in Lessons #3 and #4.
Lesson #2: Scientific gatekeepers (e.g., journal editors) may play a role in the concealment.
Once the editor-in-chief of the JAD realized that we are not given access to the data, and once we had sent him our detailed critique of Merzon et al.’s 2020 study on COVID-19 infections (the one he refused to consider for publication), he invited us to write up our concerns and submit a new critical article to the JAD. Complementing his proposal, we deepened our original evaluation, exposed additional troubling distortions and contradictions that appeared in the authors’ new study from 2021, and raised concerns that crucial information about outcomes of stimulant use during the COVID-19 was not disclosed to the scientific community.
This time, the editor was kind enough to send our new critique to further peer review, but eventually decided that JAD is “not the best placement” for its publication, despite his own original proposal to us, and despite his own judgement that our new critique is indeed “worthy of publication” (see Lesson #3 for more information).
Lesson #3: Scientific misconducts are hidden in the details (and it’s our role to expose them).
Following the decision letter from the JAD, we turned back to Ethical Human Psychology and Psychiatry–one of the few righteous journals in the conflict-of-interest city of Sodom–and published our new critique there. This new critique delves into the meat and bones of the studies by Merzon and colleagues and reveals seven severe discrepancies that do not allow us to trust their conclusions.
These discrepancies include inconsistencies in definitions and rates of ADHD; inadequate definition for treated individuals; omissions of crucial information; unsuitable analyses; and unmet declarations regarding conflicts of interests and data-availability. To avoid repetition, and to make a long story short, we highlight here two gaps only, which we believe would be of great interest to readers of Mad in America, but we urge readers to inspect our complete, and somewhat more technical article published in Ethical Human Psychology and Psychiatry because scientific biases are typically hidden in the methodological and representational details.
Moreover, aside from the specific critique of the topic at hand (i.e., the proclaimed relationships between ADHD and COVID-19), our detailed critical article also includes a fascinating appendix that provides a glimpse into the peer review process of the JAD. Using this appendix, readers can evaluate, for themselves, the quality and the appropriateness of the editor’s decision (for the second time) not to give voice to scholars who criticize studies published in his journal.
The first gap we wish to point out here concerns the authors’ declarations of interests. The very fact that conflicts of interests exist in a given study doesn’t necessarily mean that its findings were distorted. However, in the case of the ADHD and COVID-19 studies, something very strange happened. In both studies, the authors specifically declared that they have “no potential conflicts of interest.”
However, only a year before the publication of the 2020 study, its corresponding author declared that she served on the counseling and advisory boards of leading pharma companies, such as Janssen-Cilag, Teva, and Novartis. Moreover, the 2021 study on COVID-19 outcomes included an “author note” in which both the first author and the corresponding author reported of personal fees or reimbursements for travel and accommodation expenses from pharmaceutical companies. We are not sure why this information was not disclosed in the 2020 study and how it is possible that the authors can still declare “no potential conflicts of interest” in their 2021 study, despite this “author note.” However, we are sure that readers of the JAD must receive a complete and honest picture regarding the potential interests that might have been involved in the research, even if the authors believe that these interests did not impair their scientific work. This gap, by itself, can serve as grounds for retraction of an academic article, especially when these undeclared conflicts of interests are accompanied with questionable methodological and representational choices as described in the following gap.
The second gap we wish to highlight here concerns a sophisticated method to conceal unwanted information. Towards the end of the 2020 article on infections, the authors noted that “data regarding the presenting symptoms and severity of COVID-19 infection, as well as adverse clinical outcomes (hospitalization and mechanical ventilation) were not assessed.” This choice of words (“not assessed”) is misleading because the authors did have access to this critical information as they explicitly stated in the method section of this study.
“Well,” readers may rationalize, “perhaps the 2021 study compensates for this missing information?” This could have been the case if the results from the 2021 study were not misrepresented as well. The 2021 study that did assess severe outcomes of COVID-19, did not include any information about medications. Now this negligence is really disturbing because it is in complete contrast to the 2020 study, which aimed to show the protective role of the medications through a designated stratification of ADHD cases, to medically treated and untreated cases.
In fact, the corresponding author insisted in a recorded TV interview (in Hebrew), that the main headline from her 2020 study is that ADHD medications mitigate the risk for COVID-19 infections among ADHD individuals (a saved copy of this TV interview, in which she repeated this headline several times, is available upon request). Where did these life-saving medications disappear?
Lesson #4: Scientific misconducts might have real-life dangerous implications.
The nuanced, yet critical choice not to stratify the cases to treated and untreated ADHD cases in the 2021 study is also disturbing in light of what we know about stimulant medications (which are the treatment-of-choice for ADHD). Research on neurotoxins, such as methamphetamines, teaches us that psychostimulants can alter the blood-brain barrier permeability, thus perhaps increasing the risk for invasion of dangerous viruses into the brain. Prohibited stimulant drugs, as well as medically prescribed stimulant medications, may also have a negative impact on our natural immune system.
Finally, and probably most importantly, numerous studies have warned of cardiovascular outcomes of prescribed stimulant medications. In fact, all stimulants have FDA warnings on their consumer leaflets regarding potential cardiovascular implications, and even proponents of the medications do not dismiss this risk (for an elaborated description of the strong signal for cardiovascular reactions to stimulant medications, see the newly released book by the first author of the current article, ADHD Is Not an Illness and Ritalin Is Not a Cure: A Comprehensive Rebuttal of the (Alleged) Scientific Consensus.
We mention this known cardiovascular risk in this context, because a large body of research now links cardiovascular problems to severe COVID-19 outcomes, including mortalities. These links require us to ask: Is it really such a good idea to prescribe stimulant medications during an active pandemic? Together, the fact that the 2020 study reporting of medications does not report of severe COVID-19 outcomes, and the fact that the 2021 study reporting of severe COVID-19 outcomes does not report of medications, do not allow us to rule out the possibility that stimulant medications constitute an artifact that might explain the observed link between ADHD and severity of COVID-19 outcomes.
Of course, without transparent and open access to the data, we cannot examine the empirical support for this concern. Nevertheless, we cannot run away from contemplating the frighting option that stimulant use limits the person’s ability to cope with infectious viruses. We would be happy to see this concern proven wrong by receiving access to the data. But until full transparency is achieved, and until our scientific criticism stops being silenced by leaders of the field, we remain with the lessons brought in this article. The seemingly aesthetic, not to say “holy” scientific process is sometimes tainted by biases and foreign interests, and it is our ethical duty to inform the public of the ongoing debate and warn them from misinterpreting the distorted studies on ADHD and COVID-19.
Dear readers of Mad in America, beware!
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
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