When Dr Elisabeth Bik raised serious concerns about the methodology of a paper that claimed hydroxychloroquine was effective in treating Covid-19, the online trolling was relentless.
The trolls, mostly supporters of the controversial French professor Didier Raoult, who co-wrote the paper, “bombarded me on Twitter with all kinds of threats and false accusations”, says Bik, a microbiologist who grew up in the Netherlands and now lives in the United States.
Bik’s home address was posted on Twitter, and other users tweeted photos of women behind bars at her, tagging the FBI.
After Bik examined and critiqued further studies from Raoult’s laboratory, “Raoult and his lawyer even filed a legal complaint against me, which was very intimidating,” Bik says.
Raoult’s colleague, Prof Eric Chabriere, revealed on Twitter that he and Raoult filed a complaint against Bik and Boris Barbour, which alleges harassment over Bik raising concerns on the website PubPeer, and alleges extortion because Bik once wryly suggested to Raoult on Twitter that she would investigate all his work in exchange for a donation to her Patreon account.
“In the past year, I had to spend quite some time and effort in getting legal advice, archiving and taking screenshots of nasty tweets, and defending myself,” Bik says. “I lost some sleep too. I also had to be much more careful in tweeting about my personal life or my current location.”
What struck her about the attacks was that none addressed the detailed concerns she had raised about the credibility of the research into the antimalarial drug. Raoult himself has never responded publicly to the substance of her critique.
“I was determined to not be intimidated and to keep on asking critical questions,” she says.
An uncanny ability
Bik discovered her skill for scientific detective work in 2013, when she was working at Stanford University in California. By pasting some lines from one of her research papers into the Google Scholar search engine, she found that her work had been used without giving her credit.
Bik began to wonder how widespread such plagiarism was. As her curiosity led her to poring over scientific papers with a more sceptical eye, it became clear Bik also had an uncanny ability. She could identify duplicated images and photo manipulation, the paper found, which would normally be undetectable to the human eye, or at least very difficult to identify without computer assistance.
— Elisabeth Bik (@MicrobiomDigest) July 20, 2021
Microscopic tissue and cell images featuring tiny circles, squiggles and lines would jump out at Bik. If a scientist were to take an image of tissue, rotate it, and use it again in the same paper – to make it seem as though it was a separate sample – Bik would detect it, even if the image was first used pages earlier.
“I have always seen repetitive patterns in laminate floors or bathroom tiles,” she says. “Part of it is talent, like some people can sing and others not. But the other part is experience. I know what to look for, and where to look for it.”
In 2016, Bik and fellow microbiologists Ferric Fang and Arturo Casadevall published a study that attempted to determine the percentage of published papers containing inappropriate image duplication. Bik analysed images from a staggering 20,621 papers in 40 scientific journals from 1995 to 2014 using nothing but her eyesight, memory and knack for detecting duplication. Fang and Casadevall cross-checked her findings using computer tools to analyse the images she flagged.
“Overall, 3.8% of published papers contained problematic figures, with at least half exhibiting features suggestive of deliberate manipulation,” the paper found. “The prevalence of papers with problematic images has risen markedly during the past decade.”
— Elisabeth Bik (@MicrobiomDigest) July 24, 2021
As public, open websites began to emerge, such as PubPeer, which allows scientists to comment on and critique scientific papers and show their working, Bik began to submit more of her findings. Soon she was being contacted by research institutes, journals and scientists for help when they had suspicions or concerns about a paper. In 2019 she quit her job at a biotech firm to focus on her detective work full time. She launched a blog called Science Integrity Digest, and fields requests daily from around the world.
Her work has led to 519 retractions, 74 expressions of concern and 452 corrections.
‘You don’t really make friends doing it’
The Australian doctor and researcher Kyle Sheldrick, who revealed errors in a paper in April that claimed another drug, ivermectin, was useful in treating Covid-19, calls Bik a hero.
“It’s not just that she does it without any great personal benefit,” he says. “It’s that she has kept doing it for years, and continues to do it in the face of what can only really be described as incredible levels of abuse.
“I use the word ‘hero’ to describe her because what she is doing is not something that’s really good for her career, telling people their research is wrong, or bad. You don’t really make friends doing it, but you can make enemies. And she just does it because she thinks science is important and should be as good as possible.”
Bik has made many high-profile discoveries of error, but it was not until the Covid-19 pandemic that the errors she identified led to such a coordinated and vitriolic level of pushback.
With no effective treatment available at the beginning of the pandemic, some people latched on to hydroxychloroquine, hyping its benefits even before strong clinical trials had been conducted.
Former US president Donnald Trump and the Brazilian president, Jair Bolsonaro, were among those who promoted the drug, particularly after the March 2020 paper co-written by Raoult that purportedly found hydroxychloroquine was effective in treating Covid infections, especially when given in combination with an antibiotic.
But Bik claimed it was riddled with problems, the sample size was small and the methodology was questionable.
Six patients enrolled in the treatment group at the beginning of the study were not included in the key data set on which results from the study were based. As the paper itself noted, they had become very sick or, in one case, died and dropped out of the study. Including them could have skewed the results to make hydroxychloroquine seem less effective or even harmful.
An anonymous reader contacted me about unexpected repetitive values in the source data of this paper: https://t.co/wikDpqPU0r
I just posted our concerns on @PubPeer here: https://t.co/2U2iQhOjDT
Here is a plot showing repeats in the lipid measurements from the 433 subjects 😮 pic.twitter.com/rbnPp6t05m
— Elisabeth Bik (@MicrobiomDigest) July 24, 2021
Instead of being lauded for identifying concerns with a paper that would influence treatment during a global crisis, Bik was attacked.
“There is praise as well, but the unkind responses – which can be extremely nasty – often seem to have a bigger impact than the positive responses,” Bik says.
“Unfortunately, some of these attacks go beyond unpleasant words. Some scientists have received real and personal threats and had to go into hiding or live with extra security measures. It is very tough for scientists who are often not used to being in the spotlight and who are just doing their job and report on the facts.
“Before Covid I got an occasional unpleasant tweet once a week or so, but the attacks in the past year have been coordinated and massive, hundreds a week sometimes. Women are perceived as more vulnerable and less important. Women researchers and medical professionals receive more negative comments, are less influential on social media and receive more rape threats on social media.
“In my personal experience, several people wrote about my work without giving me credit, and in each of these cases those people were men. It had not reached the point yet where I wanted to give up, but I did feel a bit alone in my fight at times.”
Sheldrick says: “If her name was Eric instead of Elisabeth, there is no way the type and level of attacks would have been the same.”
Bik says she has pondered why people are so angered when drugs such as ivermectin or hydroxychloroquine are proved not to be the panacea against Covid-19 they hoped for. Isn’t this the scientific process working as it should – self-correcting?
“A good scientist should be willing to reject an attractive hypothesis if there is overwhelming evidence that it is not true,” Bik says. “But in this case, some scientists might have hoped their discovery or invention would result in saving a lot of lives and earning them a lot of praise and awards.”
But it does not explain why the supporters of those scientists, or politicians promising to secure supply of unproven drugs and roll them out to citizens, also go on the attack.
“Science might be self correcting, but it doesn’t mean scientists are,” Sheldrick says.
“There are really fixed hierarchical structures in science, in which established institutions dominated by men are very, very unused to being seriously challenged.”