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. As a result, Ferrer faced numerous questions about the issue during her weekly press briefing Thursday and her response was incredible, as in, not 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. The other authors were employees of the Los Angeles County Department of Public Health:

• Sherry Yin, 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:

I am not an author on that study. I had nothing to do with that study. I didn’t review that study. I actually didn’t see that study until recently.

Nobody said she was an author of the study. But how can the director of the department that employs four of the five authors say she had nothing to do with the study? More on her contention that she didn’t review or see the study until recently in a bit.

The people who complete conflict of interest forms are people who worked on the study who completed those conflict of interest forms. I have no family relatives that work at 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. However, the third sentence (bolded) is 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. One item 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:

Conflicts of interest comprise those which may not be fully apparent and which may influence the judgment of author, reviewers, and editors. They have been described as those which, when revealed later, would make a reasonable reader feel misled or deceived. They may be personal, commercial, political, academic or financial.

“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). Perceptions of conflict of interest are as important as actual conflicts of interest.

It further states:

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 may erode trust in science as much as actual conflicts of interest. Ultimately, readers must be able to make their own judgments 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.

The group further requires:

When authors submit a manuscript of any type or format they are responsible for disclosing all relationships and activities that might bias or be seen to bias their work.

ICMJE also provides a form for authors to complete, and that form gives an additional description of the conflict of interest issue:

The author’s relationships/activities/interests should be defined broadly.  For example, if your manuscript pertains to the epidemiology of hypertension, you should declare all relationships with manufacturers of antihypertensive medication, even if that medication is not mentioned in the manuscript.

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. During the period in which the study was being conducted, very few schools in California had in-person learning, and those that did were only meeting a few hours a day, and not for all grade levels. (For example, my youngest son was a high school senior in an adjoining county during that academic year, and even he did not return to campus until the spring of 2021.) Should Barnes have disclosed that the study findings would directly impact her employer?

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. I did not review this study before it was published. We have a chief science officer who is in charge of reviewing studies here. That’s not my role. I didn’t see this study. And I recently looked at it in relationship to the concerns that were being raised. 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.

Now, Ferrer is playing games. 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. I think I answered the question. Unless it’s a different question — you don’t disclose conflicts if you’re not an author on an article, okay. So, for folks who are new to the research world, everybody who is participating in authoring an article discloses. 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. She then tries to educate us on what a conflict of interest is.

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 did not participate in this project. So I did not disclose anything because I wasn’t part of this research study at all. I had nothing to do with it.

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?