Only by listening to and debating honest opposing views, can we hope to overcome the fear and anger that surrounds us, say these authors
Covid-19 has generated multiple and multifarious fears, encompassing death, suffering, loss of loved ones, and disruption of plans, futures, education, employment, and careers. For frontline healthcare professionals there may also be the fear of failing patients in the face of a horrible disease, while feeling exhausted and vulnerable. It is therefore easy to understand why some individuals deeply committed to working to limit the already horrific death toll from covid-19, might worry that bad public policy, facilitated by misinformation, could lead to even more harm.
Within such a climate of fear, a difference of opinion, based on different interpretations of available evidence, can be interpreted as something entirely different—a marker that one does not even share a commitment to protecting public health.
Given the novel nature of this pandemic, it is not surprising that there isn’t strong evidence upon which to define, with any certainty, all aspects of what we might hope is the optimal public health response. A tightly restrictive societal policy would be likely to save at least some lives, by decreasing the spread of the virus. But it could also produce non-trivial harm, because of the attendant economic (and psychological) consequences. It is important to acknowledge that such harm would not be “merely” economic, but could also lead to increased mortality—due both to suicide and homicide caused by despair, and to the downstream effects of severe economic deprivation. The effect of a strict “lockdown” policy has been described as a transfer of risk both from the rich to the poor—not only because the poor are less able to tolerate further economic loss, but also because they are more likely to be forced by economic necessity to continue working in circumstances that expose them to the virus—and from the old to the young, who are far more vulnerable to the harms associated with decreased socialization and restricted educational activities.
Attempts to characterize a scientific debate about how best to respond to this pandemic, as one where only one side values life above money, is obviously inaccurate and inappropriate. We don’t understand how this issue can be framed as a choice between “two sides,” only one of which is correct; surely there is an entire gradient of possible behaviours between a strict lockdown and a laissez-faire approach. But, while choosing the optimal response is a critically important public health question, we believe it is one that no one can yet answer with precision or certainty. It is crucial that we engage in honest and open debate—based on what we currently know, and on the best models we can generate—while also undertaking further study regarding things such as the prevalence, infectivity, lethality, and long-term consequences (both medical and societal) of the virus. That is, we need to approach this as an urgent scientific matter that only dispassionate scientific inquiry, and scientific debate, can best resolve.
It is perhaps not surprising that over the past year the immediate past US President, who seemed to boast of his disdain for science, and even for the notion that facts matter, rejected this approach, right from the outset, and framed our response to covid-19 as essentially a political question—anyone who disagreed with his many pronouncements, and for example recommended that we each wear a mask and practice physical distancing while in a public space, was tarred as an opponent of individual liberty.
Nor is it terribly surprising that Trump was able to claim the support of a few physicians whom he placed into prominent positions and gave a large microphone despite their having no expertise in either public health or infectious disease, and who then proceeded routinely to make outsized claims without even the pretence that they are supported by evidence. But surely such pseudoscience is different than the reasoned opinion of actual experts—even if or when that opinion ultimately proves to be faulty. We were therefore greatly disappointed to see critics of the US federal government’s obvious overall mismanagement, including some leaders in the healthcare community, respond in ways that are equally political, although reaching diametrically opposite conclusions, by suggesting that anyone who questions the utility of any proposed “public health” measure, or insists that we need to think about the harms as well as the benefits of every given approach, deserves to be insulted, ostracized, and even censored.
John Ioannidis is a Stanford professor who has been widely recognized as one of the most important medical scientists of our time; many of his studies and analyses are among the very most cited in medicine and public health. But he has also in the past year become the target of intense, and often ad hominem, attacks because of his writings, interviews, and research about covid-19. [1,2] While there are clearly valid criticisms of a study about the prevalence of covid-19, for which he was a secondary named author, many of the attacks directed at Ioannidis distorted his overall position, and also claimed, in the absence of any evidence, that his position is based on either pro-Trumpian politics and/or a personal financial conflict of interest.
Jeanne Lenzer and Shannon Brownlee described the attacks on Ioannidis in an opinion piece (and a sidebar) in Scientific American where they also reported that an independent review at Stanford failed to find any evidence that these attacks were justified. [1,2] In addition, they made a reasoned plea for our healthcare community to reject framing opinions about covid-19 in political terms, and not only argued that it is critically important to address this pandemic as scientists, but also celebrated a recent meeting at Johns Hopkins where groups who started with very different viewpoints recognised the important ways in which they actually agreed, thus pointing a promising way forward. It basically asked us to tackle our differences as colleagues, rather than as righteous inquisitors, in order that we can work together to try to find the best way to protect the public health.
Lenzer and Brownlee were in turn personally criticised after their essay was published, not merely on social media, but more importantly in communications to organizations to which they belong and publications for which they had previously written, asking that they be prevented from publishing in the future. This led to Brownlee being removed from the advisory board of the magazine Undark, as well as the publication of critical amendments to the original articles in both Undark and Scientific American, each of which suggested that the two had their own undeclared COI, and depicted them as having misled the magazines. [1,2] These claims were based on the fact that Ioannidis had been the coauthor on a small number of review articles written by one or the other of them. Lenzer and Brownlee dispute the overall contention, and many of the individual “corrections;” they say that their response has not been properly addressed by either of the publications. 
The obvious irony of this is both striking and demoralizing—Lenzer and Brownlee are attacked for writing an article that asks us to avoid attacking someone because he or she has taken an unpopular position.
We understand why there is concern when a scientist of Ioannidis’ stature makes a statement that can be seen as consistent with one aspect of a government policy that is in its entirety clearly disastrous. But surely it is possible to distinguish between him making an argument about possible harm related to a strict lockdown, from an endorsement of many other aspects of that policy, one which in general clearly ignores both science and concern for health.
We acknowledge that we wish to defend the good name of Lenzer and Brownlee, whom we greatly admire for the work they both have done as journalists, and as passionate and committed healthcare advocates, and important contributors to the fields of public health and health policy. Still, this article is not about them (or Ioannidis). Nor are we interested in suggesting a “right” answer as to how best to try to limit the harm from covid-19, or either to refute or support any of the arguments Ioannidis has made. We are writing because we believe that failure to oppose the public demonization to which they have been subjected is dangerous—not as dangerous as covid-19—but with the potential to cause far more harm to the scientific community than it could do even to them as individuals.
We believe it is critical to reaffirm the values at the core of the essay by Lenzer and Brownlee—first, that we as a community reject the bizarre notion that scientific questions should be resolved by a popularity vote or by political affiliation, and second, that we must view this public health crisis (and any others that arise) through a scientific lens—which must include attempting to estimate the societal consequences of whatever response we choose—rather than as a litmus test of fealty to any particular political group or philosophy. Only by listening to and debating honest opposing views (even those that ultimately prove to be inaccurate) can we hope to overcome the fear and anger that surrounds us, and find the best way forward.
Jerome R Hoffman is Professor of Medicine Emeritus, UCLA School of Medicine
Iona Heath is a retired general practitioner, and Past President, UK Royal College of General Practitioners
Luca De Fiore is publisher, Il Pensiero Scientifico, and Past President, Associazione Liberati, an affiliate of Cochrane Italy
Acknowledgement: One of authors of this article co-authored a single paper with Dr. Ioannidis, and has also chatted with him briefly on a number of occasions. Another of us invited Dr. Ioannidis to attend a congress in Italy, and has had a few email discussions with him. The third authors has no personal or professional relationship with him.
Competing interests: One of the authors of this essay also has personal and professional ties to Lenzer and Brownlee – substantially more than with Dr Ioannidis, having known and occasionally collaborated with each of them over many years, and considers each of them a friend. Another of us has a slight professional link, having met them briefly at a small number of professional meetings. All three of us have also been included on the Lown Institute’s List of Industry Independent Experts that was created by Ms Lenzer and Ms Brownlee for the journalism community.
- Lenzer, J Brownlee S. The COVID science wars. Scientific American 2020 https://www.scientificamerican.com/article/the-covid-science-wars1/.
- Lenzer, J Brownlee S. The Ioannidis affair: A tale of major scientific overreaction. Scientific American 2020. https://www.scientificamerican.com/article/the-ioannidis-affair-a-tale-of-major-scientific-overreaction/.
- Lenzer J.. The Scientific American dustup. https://jeannelenzer.com/scientific-american-scandal.
- Lenzer J, Brownlee S. Naming names: is there an (unbiased) doctor in the house? BMJ. 2008;337:a930. http://www.bmj.com/cgi/content/full/337/jul23_3/a930.