The Trajectory of Discovery

Description:

Medical research works in trajectories. Scientists and researchers must choose to pursue certain scientific pathways and omit others, limited by resources, attention, and time. The trajectory of medical progress is therefore characterized by two crucial characteristics: rate and direction. These two components form the foundation for this book – what are the forces that determine the rate and direction of progress in medicine? This book brings together the worlds of scientific policy, economics, sociology, philosophy, and innovation to describe why the world of medical research looks the way it does. The book also addresses fundamental contemporary issues in medicine, how they influence progress, and how we might improve medical research going forward. The contemporary issues discussed include: flawed incentive structures, a concentration of power and resources among few actors and disease groups, the potential distortionary effects of lobbying by different scientific actors, and missing novelty in drug development.

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Acknowledgments

I am indebted to myriad friends and colleagues who have inspired the contents of this book, which is based on great conversations and discussions over the years. There are too many to name individually, but a few deserve a special mention. Thanks to Johan Bundgaard and Daniel Raaschou-Pedersen for being perennial academic sparring partners and collaborators. Thanks to David Thein, Barry Thrasher, and Kyle Myers for providing feedback on earlier drafts and vastly improving the quality and clarity of the writing. From the world of academia, I also owe a huge thanks to those who have been great mentors during my career, including Jens Lundgren, Isabelle Lodding, Amanda Mocroft, Gwen Knight, Swapnil Mishra, Elizaveta Semenova, David Duchêne, and Samir Bhatt.
From the team at Cambridge University Press, special thanks to everyone involved in the writing and editing process of the book, including Anna Whiting, Camille Lee-Own, Beth Sexton, and Kathryn Myers. Thanks for believing in the project from the very beginning and helping this book become a reality.
On a more personal note, I would also like to thank close friends who have provided encouragement from the very beginning of the project: Emil, Ana, Giaan, Rasmus, Hadi, Sarah, Marie, Mathilde, and Stephanie – your support has been invaluable. Finally, I would like to thank my exceptionally supportive and patient family. I am particularly indebted to my mother and Maya for providing feedback on initial drafts and being an unwavering source of encouragement through tough times. This book would never have been written without you.

Introduction

On January 30, 2020, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) in light of the COVID-19 outbreak. In a short space of time, countries mobilized to attempt to contain the virus through travel restrictions, national lockdowns, and an unprecedented collective effort to develop treatments and vaccines.

All around the world, any sense of normalcy soon vanished. In India, for example, millions of workers were suddenly left unemployed and unable to return home due to the closing of factories and businesses. European countries were forced into national lockdowns, rendering many unemployed. For those that weren’t, working from home became the new normal for some, while essential workers continued to keep countries afloat. In South Korea, highly sophisticated track-and-trace programs were initiated at an unprecedented pace to contain outbreaks.1 Meanwhile, certain political leaders, despite an abundance of evidence to the contrary, continued to pursue a dismissive line, claiming that the effects of the virus were vastly exaggerated – all while millions were being infected and perishing from the effects of the virus. The world had changed in the blink of an eye.

The emergence of a new public health threat also had an immense effect on science. Scrambling to understand the virus, scientists and clinicians reoriented their focus toward its effects on mankind. They put their primary areas of research on hold to pursue COVID- 19 research, working on projects spanning from SARS-CoV-2 diagnostics to investigating the effect of the virus on rates of cardiac arrest, to how lockdowns were affecting mental health in adolescents.2 Clinical trials testing possible treatments were initiated and run at lightning speed, an impressive feat of international collaboration between countries and institutions previously unseen at such a ferocious pace.

However, these changes in the direction and rate of research, while largely necessary, also resulted in several potentially negative consequences. Firstly, the literature surrounding the pandemic exploded in quantity. One estimate suggests that by June 2020, not even six months after the PHEIC was declared by the WHO, a staggering 20,000 unique manuscripts about COVID-19 had already been published, increasing by approximately 2,000 a week at the time.3 The rate of publishing led to what some dubbed an “infodemic,” where the volume of new information was overloading our ability to process and make sense of it. The need for scientific speed unintentionally ended up hurting us. Ironically, in an attempt to understand the consequences of the virus more clearly, we had exposed ourselves to information-induced disorientation.

The quality of research suffered too; a large proportion of the manuscripts posted online were preprints, meaning that they were posted without formal peer review to ensure rapid

dissemination, making them more error-prone and often less comprehensive. Anecdotal evidence suggests “that preprints [were] being used to share more work-in-progress data than a complete story,” which is supported by the fact that COVID-19 preprints, on average, were 2,711 words shorter than non-COVID-19 preprints.3

Others were concerned by the drastic change in scientific direction. Efforts pivoted en masse toward COVID-related research – an effect dubbed “Covidization” – seemingly neglecting other pressing health issues such as malaria, cancer, and HIV. Madhukar Pai, in a piece in the journal Nature Medicine, highlighted that “we need to acknowledge that all health research cannot be about a pandemic or infectious threats, and all infectious-disease research cannot be about COVID-19.”4 The trajectory of medical discovery had well and truly changed.