Bad MATH+? Covid treatment paper by Pierre Kory retracted for flawed results

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Pierre Kory

A Wisconsin physician who has been pushing unproven treatments for Covid-19 has lost a paper on a hospital protocol his group says radically reduced deaths from the infection after one of the facilities cited in the study said the data were incorrect.  

Pierre Kory, whose titles have included medical director of the Trauma and Life Support Center Critical Care Service and chief associate professor of medicine at the University of Wisconsin School of Medicine and Public Health, in Madison, has become a key figure in the controversy over the use of ivermectin — the deworming agent that proponents insist can treat Covid-19 despite a lack of evidence that it does.

In late December 2020, Kory — who rails on Twitter about unfair and incompetent journals — and another ivermectin advocate, Paul Marik, of Eastern Virginia Medical School in Norfolk, and several other authors published a paper in the Journal of Intensive Care Medicine on a group they’d created called the Front-Line COVID-19 Critical Care Alliance. Per the article

The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+).

Kory’s group reported that patients treated with the MATH+ protocol — about which he testified to the U.S. Senate in May 2020 — were roughly 75% less likely to die of their infection than those who received other forms of care. (Medscape reported that Kory said the regimen was amended to include ivermectin after the researchers submitted their paper to the JICM.)

Those conclusions met with skepticism, as Medscape reported, less about the potential for effectiveness than the aggressiveness of the authors’ claims. Those doubts now appear to have been well founded. The new MATH+, it seems, doesn’t add up. 

According to the retraction notice:

At the request of the Journal Editor and the Publisher, the following article has been retracted.

Kory P, Meduri GU, Iglesias J, Varon J, & Marik PE. Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19. J Intensive Care Med. 2021:36;135-156. 10.1177/0885066620973585

The article has been retracted after the journal received notice from Sentara Norfolk General Hospital in Norfolk, Virginia (“Sentara”) raising concerns about the accuracy of COVID-19 hospital mortality data reported in the article pertaining to Sentara. Sentara’s notice included the following statements:

‘The data from Sentara Norfolk General Hospital were presented in Table 2, which lists in-hospital or 28-day mortality rates at the 2 MATH+ centers as compared to 10 published single-center and multicenter reports. The mortality rate among 191 patients at Sentara Norfolk General Hospital as of July 20, 2020 was reported as 6.1%, as compared to mortality rates reported in the literature ranging from 15.6% to 32%. The authors state that these data “provide supportive clinical evidence for the physiologic rationale and efficacy of the MATH+ treatment protocol.”‘

‘The data from Sentara Norfolk General Hospital that [are] reported in this paper are inaccurate. The paper briefly states the methods as: “Available hospital outcome data for COVID-19 patients treated at these 2 hospitals as of July 20,2020 are provided in Table 2 including comparison to the published hospital mortality rates from multiple COVID-19 publications across the United States and the world.”‘

‘We have conducted a careful review of our data for patients with COVID-19 from March 22, 2020 to July 20, 2020, which shows that among the 191 patients referenced in Table 2 that the mortality rate was 10.5%, rather than 6.1%. In addition, of those 191 patients, only 73 patients (38.2%) received at least 1 of the 4 MATH+ therapies, and their mortality rate was 24.7%. Only 25 of 191 patients (13.1%) received all 4 MATH+ therapies, and their mortality rate was 28%.’

‘Apparently […] census and mortality counts from hospital reports [were used] to calculate a mortality rate, but in so doing counted some patients in the denominator but not in the numerator because they died after July 20, 2020, the reported end date of the study. This would be an incorrect calculation of a hospital mortality rate, but might explain the incorrect number of 6.1% in Table 2. Using this incorrect mortality rate to compare with the published reports and claim a “75% absolute risk reduction” is thus an incorrect conclusion regardless of which mortality rate is used.’

Given the above concerns that are material to the article’s findings, the article has been retracted.

Kory, who had a paper on ivermectin removed from Frontiers in Pharmacology earlier this year, did not immediately respond to a request for comment.

The newly retracted article is the 190th retraction of a COVID-19 paper, according to our count.

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