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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.

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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.

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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.

  • Seems to me that genuine productive scientists, a small number, do not participate in these kinds of debates at all so the field is left to folks who make representations about good and bad science without really understanding it. Good science including the Chinese style continues on but understanding it requires a very high level of skill and effort. Politicalized science is an unfortunate hangover from the “climate wars” with its bogus attempts to claim consensus among second rate rent seekers with their nefarious and cynical invention of “denial” as a label for non-conforming views. Unfortunately this performance science appeals to the legions of young people who have bought at excess cost into the the low quality product of contemporary education starting right at the supposed top, Stanford, Harvard, and the rest including even the better Chinese universities. Fortunately these institutions still maintain a core of real scholarship and students who ignore the politics and the best we can hope for is a good housecleaning of the unproductive elements of education from top to bottom.

    • Adding to this, I look forward to a reduction of current education by at least 50 percent with the remainder supported on very strict productivity criteria including elimination of tenure, with this being carried down all the way to high school level, substituting trade and agricultural schools and local religious institutions (these latter being particularly helpful to older people who can appreciate monastical solitude even as they separate themselves from epidemic infections). All aimed at dispersed and community-focussed living much as I see in my own village here in Thailand. Such a system provides a good life without the dysfunctional demand for medical intervention that ultimately directs so many westerners into the horrors of excess old age.

  • Thank you for publishing your opinion. As a lifelong democrat I’ve been bewildered by how poorly the media outlets that I’ve long trusted have been covering this story. We need the airing of debates and the presentation of different points of view. Science should be about questioning. Where I live, it is considered an act of selfishness to question what we are being told as fact. You are right in saying “science becomes indistinguishable from politics” – and in both cases – it might be enlightening to follow the money.

  • The guy who blocks anyone and everyone on Twitter now talks about the “chilling attitude among some scholars and academics” because “more than ever, we need vigorous academic debate.”

    What a joke of a person.

  • I’m glad you had the courage to publish this over a month after Ionnidis’s original article…which has proven overwhelmingly accurate.

    Why the world (including the medical world) roundly ignored our most reliable data sets (diamond princess cruise) is beyond me. Everywhere we get ubiquitous testing, we are seeing .3 to .5% CFR. I just don’t understand how that justifies the draconian measures we have been implementing.

    • New York has a population of 8.4 million (roughly), has (as of today) 160,000 confirmed cases, and has 12,287 covid19 deaths. If everyone in New York has already been infected, the CFR would be .15%. That seems unlikely. But if ten times the number of confirmed cases, 1.6 million, have been infected, the CFR would be 0.76%, higher than your value.

      In either case, if your lower value of 0.3% is applied to the entire population of the United States of 330 million (about), then Covid-19 would kill about a million people. If you believe the deaths of 1 million people is less important than a temporary slowdown in our economy, that is your prerogative.

    • No disease infects 100% of the population.

      The IFR might be higher than 0.3%, but an 0.3% IFR is definitely not compatible with 1 million deaths in the US.

      And there is not one “true” IFR either (except in the sense of a global average); different places have different age distributions of population and different rates of pre-existing conditions.

    • You’re giving Ioannidis entirely too much credit. He went with a 0.3% mortality estimate. The Imperial College London study used 0.83% for the US in an unmitigated epidemic, presumably somewhat lower under suppression where we selectively protect (a little bit) the most vulnerable.

      New York State reported an estimate of 14.9% of the population infected yesterday, and has had about 0.11% of the population die so far. That gives a fatality rate of 0.74% in NY.

      Tell me, which estimate was better? The one from Imperial College London that shook everyone up with an estimate of 2.2m deaths in an unmitigated epidemic and used 0.83%? Or Ioannidis’s back-of-the-envelop 0.3%?

      Further, Ioannidis went completely off the deep end with his estimate of number of deaths. Once he had his 0.3%, he used an absurdly low estimate that only 1% of the US population would catch it, to come up with his estimate of 10,000 deaths — lost among the noise.

      He has not been proven out, he’s been proven wrong. And he absolutely deserved to catch hell at the time of publication, as that 1% prevalence example was just nuts. Further, if we had taken his advice and just done wait-and-see, then right now we’d be a good chunk of the way toward 60% or 80% infected with all the attendant deaths and overwhelmed ICUs that would’ve come with it.

  • I believe the premis that without social distancing there would have been millions of death is incorrect. Whatever government plans were distancing did not take place in the UK for example until late in the disease outbreak. Supermarkets were packed with panic buyers for many weeks and at the end of March special hours were assigned to people over the age of 70. I went on 22 March. It was near impossible to shop with the congestion. All checkouts were open but each had lines of 10-12 people all next to each other. Packed supermarkets continued for weeks. It is clear that the peak deaths and daily cases followed on later, with incubation time, time for serious disease and time in ICU’s resulted in declining cases and deaths before social distancing was widely practiced.

  • Your comment decries bias yet drips with bias itself. Yes, FOX News is “a biased voice for Trump” but all the other channels are biased against him. So calling Dr. Ioanniddis irresponsible for appearing there does little besides indicate that you oppose Trump and hate FOX. What you mean is that to be responsible to the public he ought have appeared on, say, CNN or PBS.

    You then bring in “science deniers”, who are a plague, surely, whenever they deserve the label, but here again we have little more than biased question-beggary. Whoever appears on FOX, no matter what they say while there, disrespects the public and supports science denial, even the estimable Dr. Ioannidis. He or she should be responsible to the public and respect them by appearing elsewhere. Here there is no mention of FOX improving its game by having on a crusader for improved scientific thinking.

    I myself think Trump is a pretty poor president and spend extremely little time watching FOX News, but I really think your comment is along the lines of “four legs good, two legs bad.” Fine for you and people who already agree with you (up to a point I’m probably one of them) but I don’t think you’ve made much of a argument, more of just a slur against the professor not far short of lumping him in with anti-vaxxers. What he says, if true, is no less true even if he says it outside the bathroom at a bus station, and fair-minded people know that quite well. Let no one endorse or excuse guilt by association.

  • Terrible article.

    With not a single example of the “personal attacks and general disparaging comments” that they have witnessed, how can we evaluate their claims? How do we know that what they perceive as stifling isn’t simply full throated disagreement in the midst of vigorous debate?

    Frankly, Ioannidis’s arguments (not all of them, but each at some point) are absurd. In his initial piece in this publication, he used an example where only 1% of the population gets Covid in an unmitigated outbreak. That was absurdly low to the point of being dangerous, and needed to be called out.

    They can write that off to “disagree[ment] with some of his specific analyses or predictions”, but if Ioannidis really didn’t know any better than to illustrate with 1% prevalence, he really shouldn’t be in the discussion at all.

    • The point of the article was not to defend Ioannides’s position, and the authors make that clear. Critiquing Ioannides is beside the point.

      “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.”

  • Great article! However, I would have liked the authors to have disclosed their conflicts of interest. Vinay Prasad has a number of publications with the John Ioannidis and Jeffrey Flier was the dean of the school where John Ioannidis trained. This article can come across as biased. Nowhere in the article have they suggested their associations with John.

  • As I understand the purpose of this article is to deliberate all scientific point of views. But in this article only the name of one scientist “Dr. Ioannidis” was used multiple times, there are other point of views as well, Dr. Anthony Fauci, Dr. Michael Osterholm. Scientist are welcome to share their point of view, but after through consideration and understanding of the repercussions. We have lost more than 200,000 lives and it is not okay to loose more than 1 million lives in 2020, due to a pandemic caused by our oldest enemy. Being a scientist my first and foremost instinct is to save lives and as I understand this is not flu, when was the last time flu overwhelmed the US medical system? Like many mentioned here, science is not about conveniently cherry picking data.

    • The health system is not “overwhelmed” at all. Doctors around the nation are noting a sharp decrease in the number of people coming to the hospitals.
      Even emergencies like myocardial infarction and Strokes are decreased by about 50% not because MI and stroke are magically cured but because ordinary people are so scared from a disease with a fatality rate of 0.3% that they avoid seeking help for diseases with almost 100% fatality rate.
      https://www.latimes.com/california/story/2020-04-22/coronavirus-emergency-rooms-numbers-decline
      https://www.nytimes.com/2020/04/25/health/coronavirus-heart-stroke.html

      Each year 60 million die around the world, you cannot stop death. And probably this year we will have a higher number, not only because COVID-19 pandemic, but also for all these people who will die because they are too scared to go to the ER, people who will not be screened and diagnosed by cancer because of the COVID scare, people who will die due to homicide from increased poverty in the coming economic depression and unemployment.
      Is it okay to lose all these people due to irrational scare?

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