The COVID-19 Publishing Paradox

Hundreds and thousands of scientific papers are published each day, communicating progress in medicine and up-to-date results to both scientists and the eager public eye. We turn to these articles and journals for reliable information on the latest advancements, with the assurance that the author is an expert in their field and that each work undergoes a rigorous editorial process often spanning months. Indeed, most of the publications we read are the result of months and years of work and a rigorous peer-review process. However, in recent years, light has been shed on the existence of a minority of flawed or even fraudulent publications that lack careful editing and review by publishers.

The discussion of the issue of publication ethics at this time is crucial, as the quantity and speed of publications have skyrocketed during the months of the COVID-19 pandemic. Researchers have suddenly found themselves faced with an overwhelming demand for medical research to be carried out and disseminated rapidly to the concerned public. As a result of these demand pressures, turnover rates of papers related to COVID-19 have increased extraordinarily. For example, journals available on PubMed are now averaging publication only 6 days after the time of submission, with an average of over 350 COVID-19 article publications per week including retractions of select publications.

Rapid publication provides us with new, much-needed evidence and knowledge during this fast-evolving pandemic, but how heavily should the pressure for speed be weighed against the need for extensive peer review and quality control? This paradox must be reconciled. The speed of this research has the ability to save lives, but we must ensure that the credibility of these publications is not put on the line for the sake of urgency alone. We must ensure that the sheer quantity and expedited nature of COVID-19 publishing does not plant doubts about scientific integrity or dilute the pool of evidence that is critical for experts and directly translates to public policy discourse and decisions. Ethical concerns of misinformation are being raised by scholars and they cannot be overlooked—trust is fragile, and at this time, to lose it is a dangerous thing.

What can be done to protect and reinforce the ethics of publication amid the surge in scientific literature? Measures such as the transparent labelling of non-peer-reviewed publications as preprints may help prevent news outlets and the general public from misusing these works or being misled. Given the volume of articles, we must also question the general public’s ability to identify the substance of these articles and their limitations. Requiring a simple summary for a nonprofessional audience on findings, applications, and their limits may help prevent public confusion. Select journals have begun to raise the conventional bar for publications to ensure the vigor of the review process and to refine the growing sea of articles that the general audience is drowning in.

The ethics of publication is central to integrity in research, and now more than ever it must be safeguarded.

References

Q. Chen, A. Allot, et al. “Publishing Volumes in Major Databases Related to Covid-19.” Scientometrics, Springer International Publishing, 28 August 2020, link.springer.com/article/10.1007/s11192-020-03675-3.

Palayew, Adam, et al. “Pandemic Publishing Poses a New COVID-19 Challenge.” Nature News, Nature Publishing Group, 23 June 2020, www.nature.com/articles/s41562-020-0911-0.

The Promise to Do Better: A Reflection on the Fight for Intersex Rights in Medicine

As children, we learn, albeit on a smaller scale, many of the fundamental skills we need to navigate the world. We are taught how to share, to treat others with kindness and respect, and crucially, we are taught how to apologize. Choruses of “I’m sorry. I won’t do it again” fill the soundtrack of our days, and we undoubtedly sound like broken records. Yes, we make a lot of mistakes, but we do our best not to make the same ones twice. As adults, we continue to call on much of what was taught to us at a young age, often times without conscious effort. Unfortunately, this is not always true when it comes to making meaningful apologies.

This idea has weighed on my mind with the recent passing of Intersex Awareness Day and the focus on several notable apologies from the medical field addressing past wrongdoings that have harmed the intersex community. Intersex Awareness Day is recognized on the 26th of October and marks the anniversary of the first public demonstration by intersex individuals in the US (1996). They protested the accepted practice of performing unnecessary genital surgeries on infants and children in order to better match them into binary sex categories. The prevailing argument is that these children could not and cannot provide meaningful consent, and the only procedures that should be performed in this case are those that are medically necessary.[1] In the decades since this demonstration, many individuals and several larger bodies have spoken out against the harm inflicted upon the intersex community by the healthcare system. However, it wasn’t until this year (nearly a quarter of a century after the first public demonstration) that Lurie Children’s Hospital and Boston Children’s Hospital announced actual changes to their policies on performing genital surgeries on intersex children.[2]

These decisions could be a catalyst in the fight for intersex rights, prompting other hospitals and policymakers to follow suit. That said, it is important for us to realize that advocates aren’t just protesting for an admission of guilt. An apology isn’t simply a statement of regret or a request for forgiveness. A true apology is a promise to do better, and the only way to do better is to know better. Knowing better means taking responsibility for past actions and learning from them. Although we are slowly making progress in the realm of recognizing past mistakes, we are nowhere close to where we need to be when it comes to learning from these mistakes and taking action to rectify them, evidenced by the fact that the first study on intersex adults in the United States wasn’t published until October of 2020.[3]

At this very moment, we are on the cusp of truly meaningful change for the intersex community. This is a pivotal moment in which the decisions of the medical community have the potential to propel us down a path of righting past wrongs and ensuring that they do not happen again. While these monumental announcements are reason to celebrate, they are not the end of the road. In terms of forgiving and forgetting, we may see a day when the medical community has enacted significant change that warrants forgiveness, but we ought never to forget these, or any other, injustices committed. A forgotten history is a soon repeated one.

The scope of wrongdoing in our healthcare system is vast, and I would be naïve to believe that the collection is finite. There will always be growth to be had and progress to be made. In that journey, we will make mistakes, but it is our responsibility to acknowledge those mistakes and learn from them. We must know better, and we must promise to do better.

[1] Intersex Awareness Day History. (2020, October 24). Retrieved October 25, 2020, from https://interactadvocates.org/intersex-awareness-day/ [2] Luthra, S. (2020, October 22). Boston Children's Hospital will no longer perform two types of intersex surgery on children. Retrieved October 25, 2020, from https://www.usatoday.com/story/news/health/2020/10/22/intersex-surgery-boston-childrens-hospitals-decision-watershed-moment-rights/3721096001/ [3] Rosenwohl-Mack, A., Tamar-Mattis, S., Baratz, A. B., Dalke, K. B., Ittelson, A., Zieselman, K., & Flatt, J. D. (2020, October 9). A national study on the physical and mental health of intersex adults in the U.S. Retrieved October 25, 2020, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0240088

The Pink Collar in Medicine

As a student pursuing the field of medicine, I have one of the classic pre-medical student narratives: I have been wanting to be a physician ever since I was a young girl, and I could not imagine considering another career. In recent years, as more and more women have joined the medical field, and the presence of women has expanded across all aspects of medical practice, women like me to continue to be inspired to seek this career path. In 2014 alone, women already dominated some medical professions, accounting for more than 70% of physician assistant students, 62% of practicing PAs, and 57% of faculty in PA programs (Essary, 2014). Half of all US medical students, 30% of actively practicing physicians, and 37% of faculty at academic medical centers are female, and the number of women in the profession has only been increasing (Essary, 2014).

Growing up, I never had a doubt in my mind that I belonged in the medical field, and even as a woman in STEM, I never once stopped to reconcile the idea that my gender could prevent me from realizing my aspirations in medicine. However, even as more women are participating in the medical profession, inequalities in pay, leadership, and respect still run rampant in the practice, causing many women to reconsider their places as physicians. The representation of women in the field of medical practice is rapidly increasing, but society needs to change the allotment of resources, social attitudes, and bureaucratic control in order for women to truly have an equal influence in medicine. By neglecting female healthcare workers and denying them equality, the healthcare system also neglects to recognize the importance women have in the representation of patient populations, hindering the care that patients can receive.

On average, women earn about $30,000 less per year as a physician than men in the same position (Essary, 2014). This wage gap is something women experience in countless professions, and in medicine, it indicates how more competitive, higher-paying specializations are occupied disproportionately by men, especially as women are thought to drop out of those positions once they have children. Not only is this a strong misconception as women are actually more likely to return to their full-time practice and increase their hours after having children, but it is fundamentally rooted in the patriarchal idea that women must be the primary actor in raising a family (Ross, 2003). Even if the woman has no interest in raising a family, they are still automatically assumed to want one in the future and thus thought to be unfit for high-paying physician jobs. The lack of equal pay opportunities female physicians encounter is only one of the many inequalities they face and something that requires a great deal of change.

Women in medicine are also often criticized for not taking their share in leadership roles, but when female physicians do demand equal pay and leadership positions in healthcare, they are thought to hit a so-called “glass ceiling”— a very real, invisible barrier that prevents women from achieving the leadership status that men achieve. Female healthcare workers with the same credentials and abilities as male healthcare workers are found to have harsher resident milestone evaluations and less access to leadership opportunities, limiting them in the paths they can take in medicine.

In addition, the increase of female physicians in the field has led to the belief that the medical profession is being “feminized” and that it has become a “pink collar career,” losing the respect and monetary compensation the career usually carries (Ross, 2003). Why must a profession become less distinguished when women hold positions in it? The idea that women entering medicine decrease its prestige is a clear reflection of the view people have on women themselves, seeing the jobs they occupy as less revered because women themselves are less respected. The decrease of monetary compensation in the field is also directly related to the lack of leadership roles and high-paying opportunities female health workers have access to, perpetuating the inequities women experience in medicine.

The increase in women in medicine should not represent the decrease of prestige or respect in the profession, rather an increase of diversity and representation in the field. More women in healthcare means that more female patients are being listened to and receiving the representation and attention that male physicians often fail to provide them, and female healthcare workers inspire younger generations of girls to pursue the medical profession. There needs to be a change in the social beliefs and attitudes surrounding women, and only then will they receive the compensation, opportunities, and respect they deserve. Medicine is a profession that aims to serve the public, and until there is equality in medicine, the medical field will not be serving its patients in the best way possible.

1. Essary, Alison C, and Coplan, Bettie. “Ethics, equity, and economics: a primer on women in medicine.” JAAPA : official journal of the American Academy of Physician Assistantsvol. 27,5 (2014): 35-8. doi:10.1097/01.JAA.0000446231.08425.6d

2. Ross, Shelby. "The Feminization Of Medicine". Vol 5, no. 9, 2003. American Medical Association (AMA), doi:10.1001/virtualmentor.2003.5.9.msoc1-0309.