Contribute Try STAT+ Today

When major decisions must be made amid high scientific uncertainty, as is the case with Covid-19, we can’t afford to silence or demonize professional colleagues with heterodox views. Even worse, we can’t allow questions of science, medicine, and public health to become captives of tribalized politics. Today, more than ever, we need vigorous academic debate.

To be clear, Americans have no obligation to take every scientist’s idea seriously. Misinformation about Covid-19 is abundant. From snake-oil cures to conspiracy theories about the origin of SARS-CoV-2, the virus that causes the disease, the internet is awash with baseless, often harmful ideas. We denounce these: Some ideas and people can and should be dismissed.

At the same time, we are concerned by a chilling attitude among some scholars and academics, who are wrongly ascribing legitimate disagreements about Covid-19 to ignorance or to questionable political or other motivations.

advertisement

A case in point involves the response to John Ioannidis, a professor of medicine at Stanford University, who was thrust into the spotlight after writing a provocative article in STAT on Covid-19. He argued in mid-March that we didn’t have enough information on the prevalence of Covid-19 and the consequences of the infection on a population basis to justify the most extreme lockdown measures which, he hypothesized, could have dangerous consequences of their own.

We have followed the dialogue about his article from fellow academics on social media, and been concerned with personal attacks and general disparaging comments. While neither of us shares all of Ioannidis’ views on Covid-19, we both believe his voice — and those of other legitimate scientists — is important to consider, even when we ultimately disagree with some of his specific analyses or predictions.

advertisement

We are two academic physicians with different career interests who sometimes disagree on substantive issues. But we share the view that vigorous debate is fundamental to the existence of universities, where individuals with different ideas who have a commitment to reason compete to persuade others based on evidence, data, and reason. Now is the time to foster —not stifle — open dialogue among academic physicians and scientists about the current pandemic and the best tactical responses to it, each of which involve enormous trade-offs and unanticipated consequences.

Since Covid-19 first emerged at the end of 2019, thousands of superb scientists have been working to answer fundamental, vital, and unprecedented questions. How fast does the virus spread if left unabated? How lethal is it? How many people have already had it? If so, are they now immune? What drugs can fight it? What can societies do to slow it? What happens when we selectively evolve and relax our public health interventions? Can we develop a vaccine to stop it? Should governments mandate universal cloth masks?

For each of these questions, there are emerging answers and we tend to share the consensus views: Without social distancing, Covid-19 would be a cataclysmic problem and millions would die. The best current estimate of infection fatality rates may be between 0.4% and 1.5%, varying substantially among age groups and populations. Some fraction of the population has already been infected by SARS-CoV-2 and cleared the virus. For reasons that aren’t yet totally clear, rates of infection have been much higher in Lombardy, Italy, and New York City than in Alaska and San Francisco. To date no drug has shown to be beneficial in randomized trials — the gold standard of medicine. And scientists agree that it will likely take 18 months or longer to develop a vaccine, if one ever succeeds. As for cloth masks, we see arguments on both sides.

At the same time, academics must be able to express a broad range of interpretations and opinions. Some argue the fatality rate will be closer to 0.2% or 0.3% when we look back on this at a distance; others believe it will approach or eclipse 1%. Some believe that nations like Sweden, which instituted social distancing but with fewer lockdown restrictions, are pursuing the wisest course — at least for that country — while others favor the strictest lockdown measures possible. We think it is important to hear, consider, and debate these views without ad hominem attacks or animus.

Covid-19 has toppled a branching chain of dominoes that will affect health and survival in myriad ways. Health care is facing unprecedented disruption. Some consequences, like missed heart attack treatment, have more immediate effects while others, like poorer health through economic damage, are no less certain but their magnitude won’t immediately become evident. It will take years, and the work of many scientists, to make sense of the full effects of Covid-19 and our responses to it.

When the dust settles, few if any scientists — no matter where they work and whatever their academic titles — will have been 100% correct about the effects of Covid-19 and our responses to it. Acknowledging this fact does not require policy paralysis by local and national governments, which must take decisive action despite uncertainty. But admitting this truth requires willingness to listen to and consider ideas, even many that most initially consider totally wrong.

A plausible objection to the argument we are making that opposing ideas need to be heard is that, by giving false equivalence to incorrect ideas, lives may be lost. Scientists who are incorrect or misguided, or who misinterpret data, might wrongly persuade others, causing more to die when salutatory actions are rejected or delayed. While we are sympathetic to this view, there are many uncertainties as to the best course of action. More lives may be lost by suppressing or ignoring alternate perspectives, some of which may at least in part ultimately prove correct.

That’s why we believe that the bar to stifling or ignoring academics who are willing to debate their alternative positions in public and in good faith must be very high. Since different states and nations are already making distinct choices, there exist many natural experiments to identify what helped, what hurt, and what in the end didn’t matter.

We believe that the bar to stifling or ignoring academics who are willing to debate their alternative positions in public and in good faith must be very high.

Society faces a risk even more toxic and deadly than Covid-19: that the conduct of science becomes indistinguishable from politics. The tensions between the two policy poles of rapidly and systematically reopening society versus maximizing sheltering in place and social isolation must not be reduced to Republican and Democratic talking points, even as many media outlets promote such simplistic narratives.

These critical decisions should be influenced by scientific insights independent of political philosophies and party affiliations. They must be freely debated in the academic world without insult or malice to those with differing views. As always, it is essential to examine and disclose conflicts of interest and salient biases, but if none are apparent or clearly demonstrated, the temptation to speculate about malignant motivations must be resisted.

At this moment of massive uncertainty, with data and analyses shifting daily, honest disagreements among academic experts with different training, scientific backgrounds, and perspectives are both unavoidable and desirable. It’s the job of policymakers, academics, and interested members of the public to consider differing point of views and decide, at each moment, the best courses of action. A minority view, even if it is ultimately mistaken, may beneficially temper excessive enthusiasm or insert needed caveats. This process, which reflects the scientific method and the culture that supports it, must be repeated tomorrow and the next day and the next.

Scientific consensus is important, but it isn’t uncommon when some of the most important voices turn out to be those of independent thinkers, like John Ioannidis, whose views were initially doubted. That’s not an argument for prematurely accepting his contestable views, but it is a sound argument for keeping him, and others like him, at the table.

Vinay Prasad is a hematologist-oncologist and associate professor of medicine at the Oregon Health and Science University and author of “Malignant: How Bad Policy and Bad Evidence Harm People with Cancer” (Johns Hopkins University Press, April 2020). Jeffrey Flier is an endocrinologist, professor of medicine, and former dean of Harvard Medical School.

  • “…others, like poorer health through economic damage, are no less certain…”

    To you, good, sirs, I say: google.com/search?q=life+expectancy+during+great+depression

  • Bravo! Truth is never afraid of criticism, that’s how “real science works” and produces meaningful results. Any scientist who has ever tried to publish anything knows this very well. Unfortunately science has become politics and politics has become science. We care witnessing before our eyes how a pet theory proposed by some has turned us into sheep running to fall of the cliff.

  • Ioannidis has always been a gadfly. It’s a valuable thing to be in certain cases.

    While there’s always a need for a countervailing voice in scientific discussion, there are plenty of those–even in the current disaster. Few are finding it difficult to express themselves in as voluble a fashion as they desire.

    What we don’t need in the public sphere are voices who merely raise objections to be obstreperous.

    Iaonnidis knows that when he calls our societal response to COVID-19 “a once in a century evidence fiasco”, he’s naturally going to be embraced by the kooks and the cranks who have no interest in scientific discussion, but merely want to live without the burden of societal rules for the common good.

    Furthermore, we are all erring on the side of caution. To do otherwise is to risk a calamitous loss of life.

    • I have a slight objection to your use of the word ‘gadfly’.

      Possibly you consider it pretty neutral, but it is very commonly used quite dismissively. It can be a way of allowing that someone may occasionally have a point but that they more often just make a pest of themselves. Kook and crank are practically synonyms, in my view.

      In such cases it’s a little better to just call them pests and then back it up with reasoned statements.

      He never did, as you assert, “[call] our societal response to COVID-19 “a once in a century evidence fiasco” ” He said it “may” be one.

      And it’s mere question beggaring to imply (as I strongly sense you do) that lockdown measures are “societal rules for the common good” when an open debate is what would determine if that’s true or not. For all we know—as we may begin to wonder when looking at the per capita death rates in Europe, where the locked-down countries of the UK, France, Spain, and Italy are doing worse than Sweden and the Netherlands, which have not had full lockdowns—it may be in fact the locked-down countries that are the death traps. A glance at the very low deaths per capita in non-locked-down Japan, South Korea, and Taiwan may make one wonder a great deal more.

      It needs to be talked about, and trying to end a conversation with ‘what I favour equates to erring on the side of caution, and not risking a calamitous loss of life’ is the sort of questionable thing this article was penned to fight against. The Swedes, Dutch, Japanese, etc. as peoples are not famed for their anti-scientific irrationality and neuroses. Americans sort of are, though.

  • You don’t have to be a scientist to have an opinion on whether a certain distancing policy or lockdown is appropriate – it’s a matter of ethics and politics. The scientist, while sciencing, can only inform that decision by providing the most accurate information possible.

  • Science is based on data. The quality of data is a critical part of understanding what is being observed. Opinion is not data. The heart of Ioannidis’ analysis is data, not opinion. And his findings appear to be consistent with findings of other researchers. Why are his data wrong? What is incorrect in his analysis? Let’s not forget that Semmelweis died from an infected finger in an insane asylum, bring committed for his unconventional views of infection.

  • Layperson here. Dr. Ioannidis’ choice to appear on FOX a biased voice for Trump brought the criticism on himself. Is there no responsibility to the public at large. It’s been a long hard road for the science supporters’ side of the aisle battling the science deniers. No, it’s not hats off to different opinions if the study has questionable methods. Where’s the respect to the public at large? Who the hell should we listen to? Autism-vaccine controversy and shifting hypothesis has hurt us enough.

    • You may be a layperson, but you are a partisan. Your comments make that really clear. You are as bad as the partisans on the other side. Partisan laypeople pick and choose sides in scientific debates consistent with their preferred political narratives. That’s fine. That’s what partisans do, even if they couldn’t define a confidence interval if their life depended on it. The problem is not the debate itself; bad science should always be called out. That’s what the peer review process is for. is the way the message is being delivered by scientists, acting like babies scrapping in the sand box, just like you. They should rise above the Twitter mob, not become part of it. And the argument about needing to defend “true science” because “lives are at stake” is the same trope used to silence scientists throughout history. Flawed science can be called out with more science, not the Spanish Inquisition.

    • I watched that fox interview on YouTube and Dr ioannidis was very professional. He didn’t let the interviewer control the conversation. You could clearly tell the interviewer had an agenda but he didn’t budge. My respect for him went through the roof after that interview. We need more of that on TV.

    • Yes, FOX News “is a biased voice for Trump.” But all the other outlets are biased against him, so your calling Dr. Ioannidis’ appearing there irresponsible and disrespectful of the public does little but proclaim your disapproval of Trump and hatred of FOX News.

      And it verges quite close to dangerous and objectionable guilt by association to mention anti-vaxxers in the same paragraph as the estimable Dr. Ioannidis, who is by contrast virtually a crusader for better scientific thinking and is of course without a science-denying molecule in his body.

      I myself think Trump is a pretty poor president and spend extremely little time watching FOX News, but I think you could have perhaps given them a bit of credit if they actually raised their game by having him on the air.

  • Social media and cable news has created an interesting dichotomy among scientists during the pandemic. Half of them appear to be working on a solution, the other half (Bergstrom being one of the biggest offenders) don’t seem to be doing anything at all but sending derogatory tweets about the folks who are actually doing something. A lot of this seems like flat out narcissism. Some of it almost reads like a football rivalry; snarky comments on an all-sports AM channel after Stanford plays Harvard in basketball. East versus West. It would just be entertaining but for the politics underlying many of the posts. Many epidemiologists and statisticians are arguing politics more than data. In fact, interpretations of data are now seemingly dictated by ones political affiliation. To laypeople reading these posts, trying to make sense of what is going on, this infighting and unprofessional conduct is undermining the public’s trust in science just when we need more of it. When scientists start to be seen as “CNN doctors” or “Fox doctors,” their opinions, right or wrong, no longer appear objective. They are then used as political fodder by extremists on both side or, more commonly ignored. The epi/stats community’s’ reputation in particular is already sullied by its seeming inability to define the present, much less predict the future. The very public twitter wars aren’t doing them any favors. They are fast becoming the used car salesmen of science.

    • Obviously, I’m partisan. I admit it. You missed my point which is who and what are we supposed to believe? None of us know who we should listen to.

  • Thank you so much for having the courage and integrity to write this!! I have shared it n FB and hope it doesn’t get deleted or censored.

    • Physical distancing not social distancing.

      Isn’t the gold standard double blind placebo tested randomized trials, not just random.

      Besides those mentioned, the other problem is when scientists use a public platform and don’t justify their points with methods, source data or references, without inviting further scientific scrutiny, or share cherry picked facts. It happens too frequently, especially if they have a following or media access.

  • Unfortunately, I think a lot of this has to do with the marriage of politics and science. Instead of science elevating public policy, in the end it will simply soil science. “What should we do?” is not a scientific question and I think that scientists or politicians that act like it is will do lasting damage to both the impartiality and reliability of science. Regardless of the scientific reality, what one should do– or what we should do as a society is always a question of values.
    As long scientists stick to science,and do not add “therefore we should do XYZ” a lot of these issues disappear. A scientist could quite simply indicate that without social distancing, XX models indicates that YY number of people will die. Just as easily, a second scientist can take issue with the parameters of XX model and suggest that ZZ people dying is more probable. Then it is really science instead of activism.

    • Yes. There should be a clearer distinction between data, data-informed models (both of which are part of science) and policy recommendations (informed by science but not themselves science).

      Elected officials should take into account input from science/public health voices, but also economics, infrastructure, etc., then make policy decisions. That’s *their* job.

Comments are closed.