Since RedState published an exclusive story Tuesday regarding a CDC-published study regarding COVID protocols in Los Angeles County schools that was relied upon by the CDC and Los Angeles County Public Health to require masking in schools, and which was co-authored by LA County Public Health Director Barbara Ferrer’s daughter, who didn’t disclose that relationship, there’s been an intense local media focus on the story. Ferrer was confronted with many questions regarding the topic during Thursday’s weekly press conference. Her response was amazing, and she said that it wasn’t credible.
Let’s go through those responses, but first, for background, the study, COVID-19 Case Rates in Transitional Kindergarten Through Grade 12 Schools and in the Community — Los Angeles County, California, September 2020–March 2021, was published as a pre-print on the CDC’s MMWR page on August 27, 2021.
Ferrer’s daughter, Kaitlin Barnes, MBA, was the second author listed in the abstract and the only employee from the Los Angeles County Office of Education. Other authors were employed by the Los Angeles County Department of Public Health.
- Sherry Yang, MPH
- Rebecca Fisher, MPH, Chief Epidemiologist
- Dawn Terashita MD
- Andrea Kim, Ph.D.
The first question directed to Ferrer was from Fox LA’s Marla Tellez, who interviewed me Tuesday night about the story. She asked about the potential conflict of interest, why Ferrer “chose not to disclose the conflict of interest,” and whether she was concerned about further eroding public trust.
Ferrer replied:
This study was not written by me. This study did not involve me. I didn’t review that study. I actually didn’t see that study until recently.
She was not the author of this study, but nobody said so. The director of the university department where four of five of the authors are employed cannot claim that she did not have anything to do with it. More on her contention that she didn’t review or see the study until recently in a bit.
Only people working on the study can complete conflicts of interest forms. There are no relatives who work for the Department of Public Health. I don’t supervise any family relatives who do any work that relates to work at the Department of Public Health. I have no interest or ability to control any of my family members’ work since they don’t work for me or at this department at all. So there’s no conflict of interest here at all. I think — I’m not really sure what you’re referring to, since I had nothing to do with the study.
Ferrer is correct that she would not have completed a conflict of interest form for that study since she wasn’t an author, and that she doesn’t have relatives who work for DPH. But, I find the bolded third sentence curious. Her daughter’s work on that study clearly relates to work at the Department of Public Health, but why would she take pains to state that she doesn’t supervise her daughter? In an org chart sense, of course, she doesn’t. And while she might not “control” any of her family members’ work, it’s not unreasonable for one to believe that a mother might have some influence over her daughter’s work, when that work can either reflect positively or negatively on the mother’s own work.
However, RedState’s story didn’t state that Ferrer should have completed a conflict of interest form; it stated that study authors are required to disclose conflicts of interest, but that the abstract stated that “no conflicts of interest were disclosed.” Meaning, that neither Barnes nor any of her co-authors — including Ferrer’s employees — disclosed any conflicts of interest.
The CDC’s Morbidity and Mortality Weekly Report (MMWR) provides “Instruction for Authors” submitting a piece to MMWR in addition to a checklist. A single item is on the checklist.
Corresponding author has ensured that all authors have identified and addressed ethical considerations….
In general, MMWR follows guidance from the Committee on Publication Ethics (COPE), Guidelines on Good Publication Practice and ICMJE’s Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.
So, in addition to each author having the duty to complete any conflict of interest forms and be familiar with those guidelines, the corresponding author (in this case Sherry Yin, MPH) must ensure that the authors — including Kaitlin Barnes — have done so.
In COPE’s “Guidelines on Good Publication Practice,” conflict of interest is defined as:
These conflicts of interest include those that may not be obvious and could influence the judgement of authors, reviewers and editors. These are the ones who, when they’re not busy, can be described as “those which do everything.” If the truth was revealed, it would lead to a normal reader feeling deceived or misled.. These can be financial, personal, or political.
“Financial” interests may include employment, research funding, stock or share ownership, payment for lectures or travel, consultancies and company support for staff.
So, conflicts of interest don’t just have to do with employee reporting relationships or someone “controlling” what an author writes. Given that Barnes’ address on public records is the same as her mother’s, it could be argued that there’s a financial interest there. There’s definitely an interest in Ferrer keeping her job.
In addition, an argument could be made that the DPH employees should have disclosed that they were working with their boss’s daughter on the study.
ICMJE’s section on conflict of interest is substantial so I won’t quote all of it here, and instead will focus on certain portions (emphasis mine):
The potential for conflict of interest and bias exists when professional judgment concerning a primary interest (such as patients’ welfare or the validity of research) may be influenced by a secondary interest (such as financial gain). As important as the actual conflict of interests are, perceptions of conflicts of interest can be as significant as they actually are.
The document also states that:
Individuals may disagree on whether an author’s relationships or activities represent conflicts. Although the presence of a relationship or activity does not always indicate a problematic influence on a paper’s content, Perceptions of conflict could be as damaging to science trust as actual conflicts of interests.. Final word: Readers must have the ability to judge for themselves. regarding whether an author’s relationships and activities are pertinent to a paper’s content.
And truly, that’s the heart of the matter and the heart of the questions asked of Ferrer. Trust in public health authorities has eroded as “two weeks to flatten the curve” has turned into two-plus years of a State of Emergency in California and as we’ve witnessed officials openly flouting public health “orders” while the plebes are forced to pay the price.
Further requirements are required by the group:
Authors must disclose all connections and activities to their manuscripts.
ICMJE offers authors a form that allows them to describe the issue of conflict of interest.
The author’s relationships/activities/interests should be defined broadly. You should, for instance, declare any relationships that you may have with the manufacturers of antihypertensive medications if the manuscript concerns the epidemiology or treatment of hypertension.
In addition to the conflict of interest issue regarding her mother, Barnes’s department, the County Office of Education, was during that time negotiating with teachers’ unions regarding the conditions under which teachers would either go back to the classroom or remain in the classroom. The study found that very few California schools had in-person learning during the time it was conducted. Those who did have the opportunity to meet for a limited amount of hours each day and were not available at all grades. For example, my oldest son was a senior at a nearby high school during the academic year. He did not return to campus for his final semester until 2021. Would Barnes have been required to disclose that her study results would impact her employer’s business?
Now, Ferrer and Barnes might not believe that there should even be a question, but the reaction to this story proves that their relationship could be seen to bias her work – even without considering the teacher’s union angle.
Back to Ferrer’s press conference, and a follow-up question from Tellez, who asked how it was that she didn’t read the study until this question about a conflict of interest came up, given that her name is listed in the acknowledgments and that her department and CDC Director Walensky had referenced the study. Ferrer replied:
I mean, I don’t know where the reference is for me referring to the study, but, you know, happy to take a look at that. This study was not published before I reviewed it. This study is being reviewed by the chief science officer. That’s not my role. I didn’t see this study. This study was not in my view, and I recently compared it to other concerns. But I – you know, I mean, I’m glad the CDC Director uses studies. I’m proud of the staff here that worked on really pulling together our data.
Ferrer plays video games now. Her department relied on the study to keep various “layered protection” strategies in place in LA County Schools, including forced masking. And does she really want us to believe that when a study her department funded and published was given a specific mention by the CDC director (someone she’s known for years, since Walensky was at Mass General and Ferrer was the Public Health Director for the City of Boston), and discussed on the American Academy of Pediatrics website, that she didn’t go look it up and read it? It’s only a page and a half long — one if you consider that half a page is taken up by a graph — so it’s not like it would take her longer than a bathroom break to do so.
Ferrer stated that they have a chief science officer who is in charge of reviewing studies there, so it wasn’t her job to read this study before it was published. That’s irrelevant to the question asked. No one asked if it was her job to read it, though if she’s going to be competent, yes, it is her job to read it. She’s always expressed major concern for what goes on in schools regarding COVID-19 transmission. If she didn’t read a study seeking to determine if the protocols she put in place worked, well, she’s simply unfit to hold her job.
Sandra Mitchell with local television station KTLA, which also ran a story on the issue, prefaced her question by referencing the RedState piece, and Ferrer immediately defensively cut her off – and giggled.
Ferrer said:
I’m actually gonna not comment. I made a comment. The question was answered. Unless it’s a different question — you don’t disclose conflicts if you’re not an author on an article, okay. For those who are just starting out in the field of research, everyone who participates in an article’s authoring must disclose. The second thing I want to note is there are many, many – hundreds of instances where family members, in fact, collaborate on research projects. And you’re right, they will disclose a conflict of interest.
We get it, Director Ferrer, and see the subtle slight and that you’re throwing your daughter under the bus again. We are then educated by her about a conflict in interest.
But I want to note the conflict of interest is not that they’re a family member. A conflict of interest have to do with, does anybody influence what you’re writing? So unless there’s reporting authorities that need to get disclosed, husbands and wives, partners, you know, children and their parents are welcomed to participate on research studies together.
I was not part of this research project. So I did not disclose anything because I wasn’t part of this research study at all. This was all my fault.
Yes, it has to do with “does anybody influence what you’re writing.” Did anybody influence what Ferrer’s daughter was writing? The people of Los Angeles County deserve to at least know that Ferrer’s daughter was the only LA County Office of Education employee on this study — and, they deserve to know when and how she was hired.
No, Dr. Ferrer, the public doesn’t know everything that they need to know, and the smug insinuation that they do confirms our impression that you believe yourself above everyone else. Do you believe that you’re also above ethical codes and the law?
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