The ethics around academic discourse, scientific integrity, uncertainty, and disinformation in medicine

The COVID-19 pandemic brought many issues in health care to light, including the issues of scientific integrity; decision making in the face of scarce or conflicting data; and rapidly-changing guidance that raised and resulted in dis- and misinformation. These issues are discussed in a new ethics paper from the American College of Physicians (ACP) published in Annals of Internal Medicine.

The paper addresses four overarching themes, including the evolving science through the lens of COVID-19 and history; bias and beyond: tactics straying from virtues and reasoned debate; institutional virtues and vices and health care literacy, disinformation and misinformation as well as detailed supporting positions specific to each theme.

A number of complex topics related to ethics and academic discourse are discussed in the paper, including the tenet that if science is to function well, scientists and physicians must not stray from core values and practices. Additionally, promoting scientific integrity is about more than individual action; it requires attention to institutions and organizations.

The paper touches on the need for conflict-of-interest policies that reinforce the physician's first obligation to the individual patient. Mis- and disinformation, often for intellectual and/or financial gain and involving fraud, violate principles of ethics and can harm patients and the public.

Recognizing that scientific evidence is uncertain and changing, institutions should demonstrate humility and respect in the face of disagreement. The appropriate response is to create an institutional culture that supports openness, independence from social or political forces, objectivity, and organized skepticism—not to suppress ideas, but to promote more dialogue.

The position paper was developed on behalf of the ACP Ethics, Professionalism and Human Rights Committee (EPHRC) and makes clear that open discourse and debate based in principles of ethics, evidence, and scientific inquiry and integrity; and an understanding of evidence gaps, uncertainty and how to communicate about them are important values in the advancement of science and the practice of medicine.