In a recent address at Hillsdale College, National Institutes of Health Director Jay Bhattacharya spoke of a replication crisis in medicine. He means the absence of studies intended to reproduce the results of original research in order to confirm the validity of these results. The need for replication was implicit in a 2005 paper by John Ioannidis, a highly respected physician and researcher at Ioannina University, Greece, and now at Stanford University, titled “Why Most Published Research Findings Are False.” As of 2020, it was still the most accessed article in the history of the Public Library of Science.
Nothing the paper describes has changed since its publication. The Covid pandemic and the years following saw a surge in retractions of published scientific papers, including in highly respected journals such as The New England Journal of Medicine, The Lancet, and Nature Medicine.
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To produce results that truly advance science and medicine, studies must be designed with proper controls, carried out using rigorous methods, provide sufficient data points from which to draw conclusions, objectively interpreted using well established analytical tools, and reported without ideological or commercial bias. For the results of studies to be considered valid, they must be replicable by independent researchers utilizing those same criteria. Unless others can reproduce a scientific study’s results, its validity must be seen as questionable.
Bhattacharya’s Hillsdale address was a damning indictment of the state of science research, especially medical research. In particular, he focused on a lamentable shift in the field—from establishing truth in science through reliance on the reproducible results of objective research to acceding to whatever authority figures declared that truth to be. This is what gave us the unprecedented reaction of then NIH Director Francis Collins to the Great Barrington Declaration (which Bhattacharya coauthored with two other scientists), a statement that challenged the management of the Covid pandemic. In an email to Anthony Fauci, Collins called its three authors “fringe epidemiologists” in need of a “devastating published takedown,” though each had more credentials and experience in epidemiology than Fauci and Collins combined.
Research to obtain a predetermined conclusion is not research; it is a tool to advance an agenda, in other words propaganda, the antithesis of research. A perfect example of this is a 2020 study claiming that newborn black babies have better survival rates if treated by black doctors. The study was done to advance the concept of racial concordance, which claims that black patients fare better generally in the care of black physicians. Both the study and the concept itself have been definitively debunked.
Ideologically motivated studies are in part a result of a skewed incentive structure. Scientists are rewarded for doing original research and making new discoveries that advance science. Replicating past studies does not enhance an academician’s chances of obtaining NIH funding or achieving tenure on university faculties. Replication, the crucial work of ensuring that original study results stand up to scrutiny, does not enjoy professional distinction or robust funding. That needs to change if we want to stop seeing so many published studies with findings that turn out to be false.
One of Bhattacharya’s primary goals as NIH director has been to restore confidence in the results of scientific research and the trust of the general public in our public health agencies. He plans to allocate more funding for replication studies. He wants to spread NIH funds across a greater number of institutions, rather than sending the lion’s share to a few elite institutions. To the number of times a study has been viewed or cited, he wants to add how many times it has been replicated: the study on black babies, for example, has been viewed 160,422 times, cited 627 times—and replicated zero times. Bhattacharya is also pushing to get politics and DEI/gender ideology out of medical research.
Bhattacharya now directs the agency whose former head tried to discredit him. It is my hope that his tenure can help restore faith in science and scientists, which took a serious hit during the Covid pandemic and has yet to return to pre-pandemic levels.