A truth and reconciliation in evidence based medicine

Have you heard that stem cells can develop into any type of cell in the body? It’s a claim that’s been “very rigorously disproven,” says Charles Murry from the University of Washington in Seattle (doi:10.1136/bmj.q1581).1 Undaunted, private companies are asking parents to pay anything from £550 to £3000 to bank cord tissue. The promise is that, when needed later, these “pure and plastic” cells can become any body tissue and can even be “used to regrow entire organs.” Harvesting umbilical cord blood seems to be much more of a commercial opportunity than a beneficial one for health.

Private companies profiting from health was a prominent theme of the pandemic response, and the UK’s Labour government plans to recoup billions of pounds of public funds by appointing a corruption tsar (doi:10.1136/bmj.q1657).2 The matter will also soon attract greater attention from the UK’s covid inquiry. The first report—which focused on resilience and preparedness—delivered a damning verdict and recommended the creation of an independent statutory body to develop strategies for pandemic preparedness and response (doi:10.1136/bmj.q1602).3 The previous government’s decision to dismantle much of the pandemic response infrastructure looks increasingly reckless. The impact of a recent surge in covid-19 cases was therefore hard to evaluate (doi:10.1136/bmj.q1496),4 and evidence of the wider clinical impact of covid-19 continues to mount (doi:10.1136/bmj.q1557).5

The UK, explains Christina Pagel, had a pre-pandemic flu plan that expected more than 800 000 deaths. And the plan, remarkably, considered how to cope with those deaths rather than how to prevent them (doi:10.1136/bmj.q1633).6 A plan for a lower number of deaths from a different pathogen, which might be prevented by interventions, didn’t exist. We didn’t need to wait four years for this verdict. An editorial in The BMJ had noted in May 2020 that the response was already “too little, too late, too flawed” (doi:10.1136/bmj.m1932).7

The inquiry, led by Heather Hallett, also criticised “groupthink.” This conclusion was based on the failures of the test and trace system, insufficient diversity of scientific advice received by ministers, and a lack of autonomy for advisers to express differing opinions. Again, these were all issues prominent throughout the pandemic (doi:10.1136/bmj.o2066).8 Hallett’s inquiry isn’t merely benefiting from hindsight; it’s focusing on areas that were identified as major concerns as the pandemic unfolded.

The findings of the inquiry resonate with clinical experience (doi:10.1136/bmj-2023-075613).9 Representatives of the bereaved families, however, believe that the inquiry’s recommendations should be stronger on what needs to be done now. And that’s the central issue: as the inquiry moves from module to module and the verdicts are no more generous to policy makers, how will the government react? Another pandemic is a matter of when, not if.

The danger, however, is that this serious examination of pandemic performance revives the bitter divisions that marked scientific and policy discourse during the pandemic. These are wounds that haven’t healed. They reopen each time new evidence emerges, such as a randomised trial finding that wearing a surgical mask in public reduces respiratory symptoms (doi:10.1136/bmj-2023-078918).10 Ironically, people from all sides except the last government will feel vindicated by Hallett’s denouncement of “groupthink.”

Is the scientific community ready and willing to embark on a truth and reconciliation in evidence based medicine? The polarised pandemic debate was damaging. A whole generation now thinks that this is how science works, through unaccountable and untested position statements on social media, podcasts, and YouTube—with only a rare person willing to give an inch. It’s a phenomenon that has become its own pandemic of toxic debate (doi:10.1136/bmj.q1661).11 We need to rediscover the art of debate and re-establish scientific journals as its home, where the discourse is captured in one place and conducted with civility and without tribalism.

Unless scientists, specialists, and policy makers return to a constructive dialogue, the recommendations of the UK’s thorough and serious covid inquiry will be squandered. The polarisation of politicians should not be matched by a polarisation of scientists.