The Good, the Bad, and the Ugly: Academic Medicine in the Spotlight

These are complex times for the world of academic medicine. The coronavirus disease 2019 (COVID-19) pandemic has raised the public profile of experts in infectious disease, epidemiology, and public health. Laboratory-based scientists and their clinical counterparts in universities and industry are in a widely publicized, crucial race to develop one or more safe and effective viral vaccines.

Public health experts at the national, state, and regional levels who usually conduct their routine but important work far from the media spotlight have been called upon to help develop and subsequently explain policies that are often unsettling, difficult to understand, and challenging for individuals and large groups to accept. Particularly disturbing have been the strong recommendations from public health experts to close parts of the economy temporarily but extensively with the evident goal of interfering with the transmission of this deadly virus.

The medical and epidemiological justifications for these policies are clear: to prevent serious morbidity and mortality and permit local hospital systems to cope with an influx of very ill, infected individuals while researchers work frantically to find treatments for active infection and vaccine strategies to immunize against the worse effects of the virus. However, the impact of these actions on the livelihood of individuals and families may be severe, even devastating.

This public health challenge has been compounded by often competing, highly conflicting messages, as well as frequent major changes in policy and recommendations on the local, state, and national levels since the pandemic was discovered in the United States in early March (eg, “Do we or do we not need to wear a mask?”).

Some of these disturbing developments result from economic or political considerations. However, a substantial part of the problem is a direct result of our profound lack of basic understanding of this novel virus, its mode of transmission, and strategies to treat and prevent infection. And today, the uncertainty surrounding all aspects of the illness and medical care are played out in the era of Facebook, Twitter, and conspiracy theory websites where the expertise of highly recognized scientists in the relevant areas of infectious disease, epidemiology, or public health may be viewed, shockingly, as nothing more than an opinion equivalent to that of any political pundit who wishes to loudly weigh in on the topic.

Unfortunately, the public’s doubts about “expert medicine” may be exacerbated by advice that appears to be influenced by nonmedical objectives and priorities, such as conflicting statements that have been made about the dangers of mass gatherings and protests.¹ As valid as the issues that are prompting these gatherings may be, it is not difficult to appreciate why many members of society may legitimately question the objectivity of health experts’ reactions about the dangers these events pose, especially when their recommendations have such potentially negative implications and personal consequences for so many people.

Journal Retractions Take Toll

An additional concern that likely raises questions in the minds of many people about the quality and basic integrity of the scientific enterprise surrounding COVID-19 has been the high-profile retractions from major medical journals of scientific papers related to the infection, its clinical consequences, and the effect on potential treatments.^2,3 Not surprisingly, these events have been prominently highlighted in the lay press and employed by political pundits to challenge the overall objectivity and legitimacy of expert medical opinion expressed to the public relating to the pandemic.^4,5

Although the rush to research and subsequently publish clinically relevant material that may critically inform prevention, therapy, and public health policy is certainly understandable, it must be appreciated that inadequate peer review or the absence of meaningful peer review may be highly problematic for the future of the public’s trust in clinical science.⁶

In fact, a report in Science noted that from January through May 2020 there had been 31,000 papers related to COVID-19 in the literature and that this number was projected to reach at least 52,000 by the middle of June.⁷ In addition, the COVID-19 pandemic has seen a surge in the availability of so-called “preprints”—investigators posting their research online prior to the performance of peer review. Two such platforms, medRxiv and bioRxiv, apparently had more than 5300 papers related to COVID-19 available for review as of mid-June 2020.⁸

The intent of such a process, in concept, is that other members of a relevant research community will comment on the new work, potentially improving its quality before formal peer review is undertaken. Unfortunately, there is nothing in this process that prevents members of the media, or other parties, from widely reporting these observations to the general public, including those who are vested in debunking valid scientific evidence regarding COVID-19, despite the fact that at the time there has been little or even no reliable review of the claims.

With this toxic brew, it is possible that the valid expert medical opinion so critical to worldwide efforts to control and subsequently impede the COVID-19 pandemic will be marginalized, discounted, or effectively disputed by individuals or groups whose overall agenda has nothing to do with optimizing public health or safety. As the leadership of the scientific and clinical evidence-based establishment in the United States and the world confronts an increasingly complex future that most likely will include COVID-19 for many years, it is hoped these concerns will be carefully considered and confronted.

These issues hold important implications in the oncology domain, where expert opinion driving societal discussions and policy regarding prevention, screening, treatment, survivorship, and the cost of cancer care will be increasingly relevant in the coming years.

References

1. Powell M. Experts feel torn on dangers of different protests. New York Times. July 11, 2020:A4.

2. Piller C, Travis J. Authors, elite journals under fire after major retractions. Science. 2020;368(6496):1167-1168. doi:10.1126/science.368.6496.1167

3. Ledford H, Van Noorden R. High-profile coronavirus retractions raise concerns about data oversight. Nature. 2020;582(7811):160. doi:10.1038/d41586-020-01695-w

4. Ravin RC. Two retractions hurt credibility of peer review. New York Times. June 15, 2020: A1.

5. The Lancet, HCL and Trump. Wall Street Journal. June 4, 2020:A14.

6. Mandavilli A. Scientists urge retraction of another Covid-19 study. New York Times. June 21, 2020:A10.

7. Brainard J. New tools aim to tame pandemic paper tsunami. Science. 2020;368(6494):924-925. doi:10.1126/science.368.6494.924

8. Chan Zuckerberg Initiative funds medRxiv. bioRxiv. June 18, 2020. Accessed July 21, 2020. http://connect.biorxiv.org/news/2020/06/18/czi_funds_medrxiv