For MedPage Today‘s “After the Pandemic” series, we asked our editorial board members to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.
Here, we interview Harlan Krumholz, MD, SM, cardiologist and researcher at Yale University in New Haven, Connecticut, and co-founder of the preprint server medRxiv.
Check out some of our other articles in the series here.
Can you share an anecdote about a patient you saw in your practice and how the pandemic influenced their situation? What was the outcome?
Krumholz: I will say globally that I have had the opportunity to talk with very many people suffering from long COVID, and the impact can be devastating and debilitating.
Someone who was previously healthy — and now suffering from long COVID — recently conveyed how the lingering symptoms have caused her to lose her job and wander from doctor to doctor in search of answers. She is disabled by intermittent symptoms that affect her thinking, her energy, her bowel function, and more. The costs of care are threatening her financial well-being — and she does not know where to turn.
The problem for doctors is that we have little evidence-based information to provide and we are chasing symptoms without understanding their cause — or what might resolve them. There is a feeling of great inadequacy — and a determination to work hard to find some solutions. At this point, we are so limited in what we know and how we can help. This has to be a top priority.
What was the role of medRxiv during the pandemic?
Krumholz: medRxiv has been a terrific help to the scientific community during the pandemic. It has sped the communication of science and fostered interactions among scientists around the world. It is an open and rapid way to share pre-peer reviewed studies. For the most part, people seemed to have quickly realized that this is science in progress, and not to take it as truth — but as work open for comment. It has embedded the preprint culture in a way that I hope will be sustained and spread.
I am not aware of any harm that has accrued and I am aware that many good interactions have resulted from the sharing of the information. And it is certainly better than science by press release alone. Also, importantly, our screening process is intended to protect the public’s interest — safeguarding privacy, promoting registration, requiring ethics approval, and ensuring that dangerous claims are avoided.
What will be medRxiv’s impact going forward? How can medRxiv and traditional journals coexist in the future?
Krumholz: They serve different functions. The traditional journals produce a peer-reviewed product of record — and the preprint server is enabling the rapid dissemination of science in progress.
The purpose of the preprint is to engender engagement and to stimulate constructive comments that enable the work to be put in perspective. The preprint server is for rapid communication of work that is yet to be peer-reviewed — we know peer review publication can take years — and could benefit others with an interest in the topic. I know I depend on preprints to learn what others are doing and finding — and it sparks collaborations.
Anyone interested in science — and eager to learn what others are doing — will benefit from greater adoption of preprints.
You might have depended on scientific meetings for that in the past. The preprint server is doing a scientific meeting in real time, with more content than a usual poster, and with an archived copy that can be cited and will always be available.
What changes to the scientific establishment are needed beyond preprints?
Krumholz: We need more open science and more collaboration and more engagement of people as participants and teammates in studies, and more use of digital data and technologies. And just the spirit that we need to work together, without regard for credit, to relieve suffering.
Source: MedicalNewsToday.com
