"The speed of communications is wondrous to behold. It is also true that speed can multiply the distribution of information that we know to be untrue," declared Edward R Burrow, the legendary American radio journalist and war correspondent.
Burrow's marvel at speed and his scepticism about false information, especially in a war-like situation, is a dilemma that the world continues to struggle with. We may not be in a war, but we continue to fight with the virus that has led to more fatalities than World War-II.
The idea of diligence and accuracy in healthcare continues to monopolise all discussions, and rightly so, given the impact on the society. Due to this emphasis, speed has often taken a backseat till COVID-19 hit us, when pretty much everything else took a backseat while the hope of a vaccine arrested the collective imagination of the world.
At the beginning of 2020, when the world was waking up to the looming threat of COVID-19, many hospitals were beginning to flood with critically ill patients and had little information on how to fight the novel coronavirus. The help to fight this virus came in the form of preprints in early February 2020 from China.
Guan et al published their clinical experience gained from 1099 patients with COVID-19 in a preprint server a month before its formal publication in a medical journal (The New England Journal of Medicine). This was well before American clinicians had gained any direct experience with the virus.
Preprints are clearly faster, accessible and in this case, help save lives. But first, let us understand what are preprints. A preprint is a full draft of a research paper that is shared publicly before it has been peer reviewed.
As medical writers, we regularly read a lot of preprint articles but the non–peer-reviewed nature of these sources constantly make us question the authenticity of the information. Thus, we set out to investigate the trends of acceptance of preprints in the pharma industry and its implications for the larger public. During the study, we found enhanced importance given to preprints owing to COVID-19, with COVID-19 preprints being accessed 15 times more than other preprints, which made this study even more crucial.
We analysed industry-authored preprints from different preprint servers and used their citations and altimetric as a surrogate marker for scientific and social media impact and found interesting insights, mentioned below.
1. The largest pharma companies contributed up to 68% for scientific and social media impact, with Roche AG emerging as a winner (26%).
Post COVID-19, clinical studies are increasingly getting published in preprint servers, which is in stark contrast to the pre-coronavirus era, wherein we observed that only 11% of the studies were clinical studies, while the others were mainly basic science research. Our analysis reveals that there could be a major shift taking place, with more and more clinical research being published as preprints in the post–COVID-19 environment.
2. The ultimate credibility test for the preprints is their final publishing in peer-reviewed journals.
About 41% of preprints were yet to be published in peer-reviewed journals, although, COVID-19–specific preprints had a higher success rate of being subsequently published in journals.
This can lead to possible polarisation of the preprint landscape in the short term with scientific community paying increased attention to COVID-19 preprints due to their credibility.
Currently, all preprint articles have a watermark informing the non–peer-reviewed nature of these articles. Despite this, there is a chance that social media users may not understand the implications of using such information from the preprint servers which could lead to an exaggeration of research findings, although, it could also play a positive role in welcoming comments for the preprints.
The role of media is more complex than social media. On the one hand, they could take the scientific information from such preprints to the general population, while on the other hand, they could also unintentionally broadcast misinformation. Even if the media mentions the non–peer-reviewed nature of these preprints in their coverage, the general population may not fully understand the potential implication. In such a scenario, this information could act as ‘WhatsApp forward,’ which could set a dangerous precedent.
The pharma industry has not quite embraced preprints yet, but there is a clear upward trend in their adoption, and we believe preprints can be used to publish negative results and early phase studies, which may not see the light of the day otherwise. All this while, the scientific community has shown low citation for preprints. However, we also observed preprint versions of highly cited peer-reviewed publications to have a good number of citations. Using this information, we are happy to infer that credible science is getting noticed regardless of whether it is from a preprint server or a peer-reviewed journal.
Preprints thus have the possibility of opening doors to a more open-access model of peer-reviewed publications due to faster dissemination of scientific content at a lesser cost and with increased access for all.
We live in unprecedented times where speed of execution is as important as the accuracy of the information in healthcare preprints are merely signs of our times and are here to stay.