The appetite for emerging medical news and discoveries has never been greater than in the last two years, as consumers went online to research COVID-19-related breakthroughs, treatments and remedies. The problem is that those responsible for that information — principally scientists, but also the journalists who cover their work — have been cutting corners by not distinguishing preliminary, unvetted research from fully reviewed discoveries published in reputable scientific journals.

Here are two quick examples:

Over the summer, poison control centers saw a more-than-threefold jump in reports of poisonings of people ingesting ivermectin, a medication meant to treat ringworm in farm animals, in the mistaken belief that it would prevent or treat COVID-19. While this drug is FDA approved to treat certain intestinal and skin conditions in humans, it has not been approved to treat COVID.

And last year, thousands of healthy people took a second-line treatment for rheumatoid arthritis called hydroxychloroquine, erroneously thinking it would keep them safe from COVID. The result, again, was more death, not less.

In both examples, scientists first shared their “discoveries” with the public and without expert review on internet platforms that were never intended to be viewed by the public or covered by journalists as news. These repositories, called preprint servers, are a sort of library of very preliminary, unvetted scientific work. Their stated goal is rapid dissemination of unreviewed work for the purpose of getting feedback from other scientists before submission, peer-review and possible publication in mainstream medical journals.

The problem is these preprint servers are being used for very different purposes now. Some scientists use them to promote their work (often making grandiose claims that will never pass peer review), and journalists generally have done a poor job of warning readers that the work is not just unpublished, but that it’s so raw that it’s unlikely ever to see the light of day in a responsible medical journal.

Health care consumers need to be skeptical about such claims because they put your health and well-being at risk.


Let me explain.

In the beforetimes, medical researchers generally didn’t share their work publicly or promote their findings in the media until they had been peer reviewed and published in professional journals. In fact, cutting that corner would have made it hard if not impossible for those researchers to get their work published, and the culture of science generally frowned upon it as well. Journalists, if not always pleased with embargoes on media coverage of new treatments or discoveries, usually respected those embargoes, since their own ethical standards kept them from serving undercooked science to a hungry public.

Now, cutting that corner is encouraged in medicine. Researchers post unvetted work on preprint servers, and newspapers cover their unreviewed claims — which may be self-serving, overstated, or incorrect — as though they are breakthrough discoveries in leading medical journals. They’re not.

Why is this happening? Incentives. Scientists want to be first to share a discovery; doing so may help them to get the next grant. They may also think that they’re improving health by getting their ideas out more quickly. Newspapers and cable-news channels want their journalists to break stories.

But what’s good for the media may be bad for you. You’ve got to do your own homework; if you’re going to read medical news, you need to hit the links that take you to the sources: If those are preprint servers, beware. What you’re reading generally has not been evaluated by experts in the field. By contrast, if the source is a journal like New England Journal of Medicine or the Journal of the American Medical Association, your odds of the content being trustworthy are much higher.

Journalists should not make you do this. They should avoid using preprints as sources in news articles.

There have been many examples of journalists covering preprints that were posted to boost a company’s stock, to promote a politically motivated conspiracy theory, or to undermine faith in prudent scientific and public health measures. The news articles themselves — disseminated still more widely by reporters’ use of social media — further amplify these unreviewed scientific claims, and when they prove to be inaccurate, further undermine the public’s trust.


I acknowledge that medical journals have not always gotten it right, and preprint servers sometimes have. It took 12 years for The Lancet to retract the article incorrectly linking vaccines to autism. But the fact that both journals and preprints may contain errors does not make them equivalent, nor even comparable. Preprints are freely available; leading journals, like the one I edit, have to convince the world that our content is worth paying for. We go to considerable lengths to make sure this is true.

I can see why researchers hunting for their next grants would want to disseminate their work quickly and with little oversight, and why they might not want to be forced to respond to peer experts who might insist they modify overstated messages, inject some nuance, correct errors or require disclosure of industry involvement in the work. It’s less clear to me why a journalist would cover this as news, or why we, as readers, should trust it.

It can be difficult for health-conscious readers to make sense out of the medical discoveries we read about or hear. Is red wine good for you or bad for you? What about dark chocolate? How bad is a little high cholesterol, really? The answers seem to change all the time, and it can be frustrating to keep up. For better or worse, that’s how science works. We need to be open to the possibility that what we thought was true may not be, or that it may be more nuanced.

If you think that health has improved over the last 75 or 100 years, as I do, the main reason for this is that we have used a process — peer review — that has helped us sort generally helpful medical suggestions from generally harmful ones. Short-circuiting this process with the rapid dissemination of poorly vetted science does not help.

Importantly, the main argument in support of preprint publication — that traditional journals can’t keep pace with fast-moving public-health crises like COVID-19 — is not supported by the facts. On Jan. 21, 2020, The Seattle Times reported, “Snohomish County man has the United States’ first known case of the new coronavirus.” Three days later, a peer-reviewed, scholarly article on that topic was published in the New England Journal of Medicine. The pace was similarly brisk 20 years ago, when the tried-and-true approach of peer review helped us to beat SARS and beat it quickly.

In my specialty, the editors of the four leading journals have agreed not to publish articles that have been posted to preprint servers because of the harms we associate with them. We had hoped journals in more medical specialties would follow our lead, which we believe will help keep patients safe. A few others are moving in that direction, or at least they’re raising questions. I think journal editors owe their readers, and the patients whom they serve, at least this bit of protection.

But the more important fact is that claims posted to preprint servers would not influence the public’s behavior at all, and would not result in needless harm and death, if journalists at newspapers did not cover them as news. Generally speaking, they shouldn’t. When they do, they should clearly convey that the “discovery” is preliminary and has not been peer reviewed. As importantly, they should start asking the hard questions about how we got here.