The need for rigor: Retractions can damage public trust
A spate of retractions of scientific papers relating to COVID-19 has the potential to damage public trust in medicine, public health experts warn.
As of early July, more than 22 scientific papers on COVID-19 have been retracted, according to Retraction Watch – a non-profit that operates a database of retracted studies in healthcare. Two recent retractions drawing significant attention came from respected medical journals, the Lancet and the New England Journal of Medicine (NEJM).
The Lancet paper raised alarms about the safety of chloroquine and hydroxychloroquine for COVID-19. The NEJM paper investigated the use of blood pressure medications. Study authors requested the retractions after concerns were made about the source of the data for both studies. The NEJM paper influenced the World Health Organization (WHO) to halt studies using the drugs in a large international trial.
Overall, there are about 1,500 retractions each year but there may be many more that should be retracted, says Ivan Oransky, a medical journalist and co-founder of Retraction Watch. That’s out of an estimated two to three million papers published each year, he says. On average, it takes about three years for a retraction to happen (in one case, a Lancet paper took 12 years to retract). The database currently lists more than 22,000 retractions over the past decade.
“Peer review isn’t perfect,” says Timothy Caulfield, professor of law and public health at the University of Alberta. He researches issues around public trust in medicine and misinformation, and has been involved in peer review himself.
It can be difficult for peer reviewers to catch errors since they often don’t have access to full datasets, as occurred in the Lancet and NEJM studies, he says.
COVID-19 has brought a sense of urgency to publish findings. A letter in Bioethics from researchers from Taiwan pointed out that to meet high demand, some journals have adopted a fast-track process for COVID-19 papers, speeding up their review compared to other submissions.
The retracted COVID-19 papers are a drop in the bucket, says Oransky. A PubMed search on “COVID-19” listed more than 27,000 studies.
While retractions may contribute to distrust in science, Oransky argues they shouldn’t. Retractions “are a sign someone is paying attention,” he says. “It’s when you deny that problems happen that you lose trust.”
Retractions occur for a variety of reasons, ranging from misconduct to honest errors or even plagiarism. “It’s a regular part of the scientific publishing process … that’s the reality,” says Oransky. “What I don’t understand is why an agency like the WHO would change their course based on a single paper.”
With the normal scientific process, opinions change as knowledge is gained. But that in itself can give people the impression scientists are wishy-washy or don’t know the answers, says Caulfield. A flawed study adds another level to that wariness of science.
“What these controversies remind us of is the need for rigor. And the need to emphasize good science and that the science is communicated well to the public and to the policy-makers,” he says.
Retractions are only one of the reasons public trust in medicine has eroded. Others include occasional scandals associated with the medical profession, big pharma controversies, personal frustrations with the medical system and science illiteracy.
“The perception that public health authorities are changing their minds – masks weren’t beneficial, now masks are beneficial. People see those kinds of changes in policy and they think it shows that they were wrong earlier,” says Caulfield. Yet recommendations follow the trail of evidence as it changes.
A survey by Carleton University researchers conducted in May found that public health officials, physicians/nurses and academics/scientists received the highest scores on relative measures of trust compared to other professions.
But when it comes to science, things are murky. 3M’s 2019 State of Science Index found that globally there is an increase in science sceptics. In 2019, 35 per cent of respondents questioned the validity of science, a three percentage-point increase from 2018. A total of 14,025 people were surveyed in 14 developed and emerging countries. Out of 1,000 Canadians surveyed, 32 per cent either somewhat or completely agreed with the statement “I am sceptical of science.” It also found 24 per cent of Canadian respondents were either indifferent to, or intimidated by, science.
Similarly, a 2019 Leger poll for the Ontario Science Centre found 29 per cent of respondents said that because scientific theories are fluid, they can’t be trusted.
What’s more important than the erosion in trust, says Caulfield, “is a polarization where people are gravitating toward conspiracy theories or messaging (including misinformation) that is trying to increase distrust because those messages either appeal to their ideological leanings or preconceived notions.
“My fear is if people don’t trust the good science, don’t trust science from these respected journals, it’s going to be increasingly difficult to fight misinformation because people aren’t going to trust the correction.”
Still, Caulfield has a positive take. “I’m an optimist and like to believe that science ultimately wins.”