Pandemic Poses a Crucial Moment for Science and the Public Trust

Maurie Markman, MD, editor in chief, is president of Medicine and Science at Cancer Treatment Centers of America and clinical professor of medicine, Drexel University College of Medicine

Maurie Markman, MD

The uncertainty and anxiety that the coronavirus disease 2019 (COVID-19) pandemic has brought throughout the world is simply unprecedented. This is not to suggest that the flu pandemic of 1918 or 2 world wars were not catastrophic. However, the extensive interconnectivity of nations; the rapid spread of infection; and the remarkably unfocused, uncoordinated, and often ill-conceived nature of communication has exacerbated conditions for which past experiences provide limited assistance in effectively guiding both near-term and longer-term policies.

To this complex mix we must add the rather sudden and strikingly relevant role for scientific expertise, both laboratory based and in clinical practice, in governmental efforts to control, treat, and ultimately prevent this infection. At the same time, the scientific community is being called on to help develop rational strategies that will protect the safety of the public and simultaneously balance the impact of these measures on increasingly fragile regional and national economies.

Over the past several months, it has become almost routine in the United States to see federal and state public health officials share the podium with elected leaders at press conferences designed at least in part to help explain why certain policies are being recommended, based on the best scientific evidence available. Further, clinicians and experts in more basic aspects of laboratory science have been regularly called on to address large television and internet audiences and explain, in lay terms, current events related to COVID-19 and discuss what might transpire in the near- and longer-term future.

The message delivered today is appropriately somber but also hopeful, based on the efforts of so many working within clinical and investigative medicine and in laboratory science. Clinical trials examining numerous possible treatment strategies and potential vaccine candidates serve as a counterbalance to the distressing daily reports about the number of confirmed infections and deaths from COVID-19.

The heroism of all those on the front line providing care to those seriously ill from the virus are constant reminders to the public of not only the magnificence of these individuals and clinical teams but also the shocking fragility of our health care system in its ability to adequately confront such an infectious disease.

Censorship, Overpromising Can Undermine Confidence

Unfortunately, the efforts of a clinician in China to sound the alarm regarding this virus, which were not only ignored by that authoritarian government but also led to a demand that he recant his observations, highlight the often complex relationship between critically relevant science and political reality.¹ This concern is further underscored by troubling suggestions that efforts by academics in China to report accurately on their experiences with COVID-19 are being “reviewed” (translation: censored) by governmental officials prior to submission to a peer-reviewed publication.²

There is also a worry that pronouncements from individuals who “wear the badge” of doctor might be misinterpreted as objective, valid, completely devoid of partisan politics, and accepted by the mainstream scientific community. Unfortunately, this crisis has produced bewildering examples indicating that this is a legitimate concern, including public proclamations by some doctors of unsubstantiated claims for clinical benefit associated with specific approaches to COVID-19 treatment.³

Finally, in this brief discussion of the evolving relationship between science and public policy, we must emphasize the risk of establishing unrealistic expectations and making scientifically inappropriate promises, despite the understandable desire of this community to help safely navigate these dangerous and uncharted waters.4 The concern here relates to setting realistic timelines, based on extensive past experience in similar though certainly not identical situations, for developing effective treatments and vaccines, as well as sensitive and specific COVID-19 antibody testing platforms. What will happen to the public’s faith in the scientific enterprise if unrealistic promises are not kept?

This may be a critical moment that could define for decades the relationship between clinically relevant science and the public. The future relationship will be heavily influenced by the short- and longer-term success of efforts highlighted above that, hopefully, will favorably affect individual clinical outcomes and lead to effective public health policy.

Before the introduction of COVID-19 into our lexicon, other issues challenged the long-standing support of the American public for the scientific enterprise; these matters had and will continue to have the potential to negatively influence public attitudes. Despite our focus on this viral pandemic, it is critical that these concerns be directly addressed and resolved by the scientific community. These include recent revelations of questionable and apparently secret relationships between established senior scientists in the United States and China (including members of the cancer research community)5 and the failure to publicly report the outcomes of a large percentage of completed clinical trials in a timely manner, as required by federal law.

At this moment, we should consider what it will take for the scientific community as a collective entity to self-regulate far more forcefully so that the actions of a limited number of its members do not squander the well-deserved awakening of public trust in the entire scientific enterprise.

References

1. News at a glance. Science. 2020;367(6478):606-608. doi:10.1126/science.367.6478.606
2. Thorp HH. The costs of secrecy. Science. 2020;367(6481):959. doi:10.1126/science.abb4420
3. Burton TM, Hopkins JS. FDA warns of danger from virus treatment. Wall Street Journal. April 25, 2020.
4. Thorp HH. Underpromise, overdeliver. Science. 2020;367(6485):1405. doI:10.1126/science. abb8492
5. Viswanatha A, O’Keeffe. China’s funding of U.S. scientists raises concern. Wall Street Journal. January 31, 2020.