Underpromise, overdeliver
PHOTO: CAMERON DAVIDSON
The majority of crises that most of us have lived through have not looked to science for immediate answers. In many cases, much of the scientific analysis came after the fact—the effects of climate change on extreme weather events; the causes of nuclear accidents; and the virology of outbreaks that were contained such as severe acute respiratory syndrome (SARS) in 2002–2003 or Middle East respiratory syndrome (MERS) in 2012. Now, science is being asked to provide a rapid solution to a problem that is not completely described.
I am worried that science may end up overpromising on what can be delivered in response to coronavirus disease 2019 (COVID-19). This isn't because I think the scientific community has bad intentions or will purposefully overhype anything, but because of what science can report in real time. It is difficult to share progress with adequate caveats about how long things might take or whether they will work at all. The scientific method is a very deliberate process that has been honed over time: Basic research, which describes the problem, is followed by applied research that builds on that understanding. Now, scientists are trying to do both at the same time. This is not just fixing a plane while it's flying—it's fixing a plane that's flying while its blueprints are still being drawn.
On the testing side, polymerase chain reaction (PCR) technology is allowing folks to know quickly whether they are infected with SARS coronavirus 2 (SARS-CoV-2), the cause of COVID-19. However, a negative PCR test result may lead a person to erroneously conclude that they're in the clear, which is a danger to controlling the spread. We urgently need serology tests that show whether someone has had the infection and recovered. And we must be able to identify individuals who have some immunity to SARS-CoV-2 because understanding their biology may contribute to helping the world recover.
When it comes to drug trials, we've now seen the first negative result on the lopinavir-ritonavir combination, which performed no better than placebo. Efforts are underway to identify other possible drugs—remdesivir, novel antivirals, and numerous antibodies. These are exciting possibilities, but also extremely speculative. Political overhyping of such approaches is extremely dangerous—it risks creating false expectations and depleting drugs needed to treat diseases for which they are approved. And it sets science up to overpromise and underdeliver.
As for vaccines, we know so little about SARS-CoV-2. Developing a vaccine could take at least a year and a half—as many experts have suggested—or maybe won't happen at all. Fortunately, a clinical trial for a vaccine is already underway in the United States, but the public must be told that these early vaccines may not work or be safe—that this vaccine is only being tested for safety, not efficacy, at this point.
Scientists involved in COVID-19 research know these caveats. But the general public—who are agonizing over how long this pandemic will last, how it will affect the economy, and whether they and their loved ones will be safe—are looking for hope wherever they can find it. If science can deliver answers, public trust in science could increase substantially (the high point for trust in science in the United States was at the end of World War II). But if the scientific community contributes to building up hope in the fight against COVID-19, but then doesn't deliver, the consequences for science could be dire, especially if politicians continue to amplify the false hope irresponsibly.
When science addressed the HIV/AIDS crisis, it took years of careful virology, drug development, and epidemiology. The global scientific assault on COVID-19 is faster, and as I see the research that comes to Science and that appears on preprint servers, I am hopeful that science will deliver on this challenge, too. But I worry that engendering false hope will cause complacency that will deprive us of the time needed to find a lasting solution. And I worry about lasting damage if science overpromises.
Let's underpromise. Let's overdeliver.
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Science
Volume 367 | Issue 6485
27 March 2020
27 March 2020
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Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
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- COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?, Frontiers in Pharmacology, 11, (2020).https://doi.org/10.3389/fphar.2020.581840
- Pandemic publishing: Medical journals strongly speed up their publication process for COVID-19, Quantitative Science Studies, 1, 3, (1056-1067), (2020).https://doi.org/10.1162/qss_a_00076
- COVID-19 and “natural” experiments arising from physical distancing: a hypothetical case study from chronobiology, Chronobiology International, 37, 7, (1115-1117), (2020).https://doi.org/10.1080/07420528.2020.1779993
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Tackling Misinformation and Delivering Scientific Evidence
In crises, we need to seek for robust information and scientific evidence to make sure what we could promise and deliver. The outbreak of coronavirus has triggered a viral spread of biased and fake news. While blocking certain information on COVID-19 could have painful consequences, misinformation overload on the coronavirus pandemic could generate greater side effects.
Two kinds of misinformation are currently prevalent and detrimental, not only to people's health and wellbeing but also to the progress of battling the invisible enemy. The first kind is misinformation from self-media rapidly spread on social media platforms where individuals create their own "news". Dangerous infodemic without robust scientific evidence can potentially steer people away from professional medical advice and spread fear and anxiety, which is linked to the observed increase in the cases of suicide or crimes during this pandemic.
The second kind of misinformation could stem from major news agencies and even authorities, such as hiding information, stigmatizing certain ethnicity groups for being responsible for the spread of the virus, or reporting news about the situation in different countries with biases. This can cause misunderstanding and sometimes even hatred, which may lead to racial discrimination, harassing crimes, and prevent the communication and collaboration between nations and peoples. The misinformation communicated by mainstream news media could cause even more harm as people tend to trust them.
Unlike publishing academic papers usually requiring peer review, media, especially self-media, could easily publish and forward information, and the damage caused by misinformation could be more severe for people in difficulty and poverty, especially in developing countries. To crack down misinformation, mainstream news media should join hands with authorities to publish reliable and objective news and stop the rampant spread of fake news solely aiming at eye-catching headlines. At this critical moment, both self-media and public media should check the robustness and source of the information and rely on scientific evidence. Social media platforms should also take responsibilities to reduce the adverse impact of fake news. Tackling misinformation and delivering scientific evidence is critical for us in a crisis.