Good morning. My name is Saul Flores. I'm a cardiac intensivist at Texas Children's Hospital and an associate professor in the Department of Pediatrics at Baylor College of Medicine. I'm also the treasurer in the in-training section steering committee of the Society of Critical Care Medicine, and it's a pleasure for me to introduce the following physicians, members of the Society of Critical Care. First, I have Dr. Jamie Sturgill. She's currently an assistant professor in the Department of Microbiology, Immunology, and Molecular Genetics, as well as Pulmonary Critical Care and Sleep Medicine at the University of Kentucky College of Medicine in Lexington, Kentucky. She's also the director of the Kentucky Research Alliance for Lung Disease Pulmonary Critical Care Biobank. Currently, she co-chairs the SCCM Research Section SAC Committee on Basic and Translational Research. Her own research focuses on inflammatory lipids as the driver of lung dysfunction in critical ill patients. Thank you for joining us, Dr. Sturgill. And I also have Dr. Ken Remy. He's an associate professor with tenure track and an NIH-funded physician in the Department of Internal Medicine, Pediatrics, Pathology, and Biochemistry in the divisions of Pulmonary Critical Care Medicine and Pediatric Critical Care Medicine at Case Western Reserve University in Cleveland, Ohio. He serves as the director of the division of Pulmonary Critical Care Medicine, Basic Science, and Translational Critical Care Research and co-director for Clinical, Basic Science, and Translational Critical Care Research in the division of Pediatric Critical Care Medicine. Previously, Dr. Remy was an associate professor at Washington University in St. Louis in the Department of Pediatrics and Internal Medicine. At Washington University, Dr. Remy successfully completed the Academic Medical Leadership Program for Physicians and Scientists in the School of Medicine, the All-in-Business School, and BJC Healthcare. He is the incoming chair of the Research Section at SCCM and member-at-large of the Internal Medicine Section. Dr. Remy, thank you for joining us. Thank you for having me. What an interesting year. A couple of years we've had since the pandemic happened back in March 2019. Sorry, March 2020. And I think SCCM had a very important impact in what critical care physicians in the U.S. and across the world had to use for them to be able to carry out their activities during this pandemic. So now what we're going to be talking about is going to be the explosion of COVID-19 data regarding the pandemic, specifically for critical care providers in the pediatric world. So let me ask you a few questions based on your guys' expertise on this topic. So question number one, and I'd like to hear Dr. Sturgill's comments on this explosion of reporting data regarding COVID-19 in critical care. Dr. Sturgill, what do you think of this? Yeah, there's absolutely been an explosion of data. I remember when the pandemic started many eons ago, it feels like papers were just coming out left and right. There were initially opinion pieces and hypothesis papers and case studies of this patient, that patient, and then they became case series. And then every time a new piece of the puzzle was found, I remember some very first papers were just saying, this is how the patients behaved on ventilators. This is what we're seeing in pediatrics. This is what we're seeing in adults. This is what we're seeing in elderly. And so there has absolutely been an explosion of data and it may not always be good reports coming out. And so that's been really interesting to follow the rigor and the reproducibility of data as it's emerged over time. That's an excellent point. Dr. Ramey, what are your thoughts about the explosion of data? No, I absolutely agree with my colleague. We wrote a paper, myself and Robert Tasker and Tex Kassoon, about the pandemic really spawning an infodemic, if you will. And it's interesting because undeniably in this pandemic, there's been rapid dissemination of knowledge and sharing of research and information, not just locally and nationally, but globally. And that includes in things like vaccines. And these vaccines have been produced and deployed in record time, therapies being evaluated much faster with these innovative trials and designs and platforms. But it's been challenging, I think, to separate what's important from what's trivial. And that poses, I think, a dilemma for not only journals and their editorial staff, but also the lay press. And so it's been said that the existence of a pandemic does not lower the bar for standards of evidence, but rather it should raise the bar to protect the safety of those that we endeavor to heal. And so I think that those points are poignant because it provides us an opportunity in this pandemic to learn about how we evaluate data, how we disseminate information. And really, once we disseminate that information, if we find that something perhaps is less clear than it was when it was originally disseminated, how we can do so in a fashion that certainly does not lose both the trust of the medical and scientific community, but also our partnership with the lay and public. And I think that that's certainly a lesson that we need to learn from this pandemic. Those are really interesting points, right? The fact that data was being utilized at such a fast pace and being able to keep up with the common knowledge, with the community's knowledge, with the administration's guidelines, and just being able to sort that out while trying to maintain the trust of the community is one of the biggest challenges and hurdles that we've witnessed happening as we went through this very interesting period. And, you know, kind of like to couple that, I'd like to know your level of exposure to COVID-19 data. Were you part of the explosion? I mean, it always fascinates me to see COVID-19 published papers on PubMed over the last three years, and it's record-breaking. Were you guys, were exposed to this explosion of data? Dr. Remy, you want to start? Sure. You know, I've been fortunate that during COVID, our laboratory and in our collaborations, we've published a little over 20 papers just in COVID alone. And we've got a number of manuscripts coming out because my laboratory is an immunologic based laboratory, and my collaborations are among a group of folks that either do immunologic-based research or have worked in global health or in the public health sphere. And so the work that I've done in COVID certainly has spanned both adults and children and has implications certainly in taking care of children. But what I will tell you is that we publish in peer-reviewed journals specifically, and I do a lot of reviewing in a number of different high-impact journals specifically in COVID work. And I think that that level of rigor is what provides you at least it provides what a product at the end that at least has been scrutinized by others in the field. And I think that's really important because it's very easy to put things out in a pre-print server, if you will. However, the difficulty is now things like MSNBCs and CNNs and Fox News and different news outlets are taking pre-print reviews and using them out into the public as if it's basically gospel. And the challenge with that is that as we all know, a lot of times that first draft that you get out in that pre-print looks very different when it comes out actually after peer review. And that I think is ripe for an opportunity to perhaps produce mistrust among the community. And just one more point to that. So in the volume of research that's out there in a pandemic where we certainly want to get information out there as soon as possible, because we do want to try to find ways to impact the outcomes of people. We also have to be very vigilant of why do these pre-print servers exist? Well, in part they exist because from the time of submission of a paper or much like a grant, many, many, many, many months elapse before that information actually gets out to the public. And so I think that there's certainly an opportunity for us to improve the quality of what's put forth even in pre-print. But I think it's a good step back for those of us that are actually at the site of being editors of journals to really to take a look and say, well, perhaps the manner in which we are reviewing it could be perhaps altered at this point in a fashion that allows information to be reviewed by peers, but also come out and be disseminated in a timely fashion so that we can put what's best out there rather than just what's first out there. That's a wonderful point. And then I do want to hear Dr. Strobel's comments on that particular point and kind of circle back on some of your comments. Yeah, I mean, I think anyone who's in critical care has been exposed to the data as one who has published as well, whose lab also works on the immune response in critical illness. You know, our research never stopped publishing papers, but also I was asked to sit on a task force for the Society of Leukocyte Biology and the number of papers that we were just getting. And so, you know, you actually have levels of scrutiny for papers like coming in to pre-print, like to basically like you screen this first before we even send it to reviewers and then finding reviewers. And so I set up PubMed alerts. So every Monday I get, you know, papers published on ARDS. I've had it set up, you know, for years and I actually went through and saw the tracking of, you know, sometimes some weeks you'd get 20, 30 papers. During the peak of the pandemic, I think one week I got 220 papers published in a week using the MeSH term of ARDS. And so, I mean, you could graphically visually see this explosion of data just by setting up MeSH alerts in PubMed and getting papers directly in your inbox, let alone somebody going to PubMed themselves. And I completely agree with Ken about pre-print servers. I sometimes get friends and family members who will send me an article they saw on social media or the news. And I say, I'm going to stop right there. It's from a pre-print server, like the news article. And that has to go back with trust and communication. I think scientists need to do better at communicating. And I think our news outlets and media need to do a better job at understanding what we're trying to say. So I think it goes both ways. And so we've all kind of been subjected to this data implosion, so to speak. Dr. Flores, to Dr. Sturgill's point, I think that there's something poignant in what she said. So one of the most interesting things is that it has become very easy to push out manuscripts. And the quality is varied across the board. But one thing I am noticing is that it's sometimes hard to find what the hypothesis that led towards the study is. And rather than just reporting data as, you know, these are the cases of MISC and what the outcomes are, or these are the cases of these patients. I mean, I can't tell you how often, even, you know, two and a half years into this, we get, you know, certainly requests to review these articles that are basically descriptive, epi, but they're nothing novel, or they don't necessarily add anything, but they do take up certainly, you know, print and pages and people's time to look through them. And, you know, and I have to applaud those people that are enthusiastic to write them. But I think there's an opportunity for us in the scientific and the medical community to take a step back and say, hey, listen, if you're going to publish research, please make sure that there's an objective and a hypothesis. And that that hypothesis occurred at the beginning, before you started writing the manuscript, rather after than when the data came, and you decided to figure out what variables could have some statistical significance. Because mining data to try to find something that's statistically significant usually doesn't work out quite well. It could be hypothesis generating, but it's got to be at least described in that fashion. And I think that's been one of the challenges, is that we're inundated with just all of these publications that are very similar in some fashion, but may lack that sort of refinement of a hypothesis and a subsequent development with methods that reflect that. I think that that brings up very important points about the scientific principle, right? Like one of the, we're not, one of the number one rules is the importance of the hypothesis and being able to test that hypothesis with different populations. And I think, you know, at the pace that some authors and investigators in the community wanted to get their data out there, some of those principles were probably left aside, you know, in that little bit of a race. So, you know, the other thing that is interesting is that prior to this, I'm going to be honest with you, and I've been doing this a bit too, I wasn't aware of preprint platforms. And, you know, in a way, kind of like changes the notion of that peer-to-peer review necessity, right? Which we, I know it's going to, it's coming. I think the availability of open access journals had expedited and facilitated the publication to production to printing of some studies. But whether we're going to be losing the importance of being able to have peer-to-peer review to enhance and strengthen studies is going to be something that I still, I'm trying to wrap my head around that. But certainly your points are going to be very well taken by the community that we practice with. Let me continue on with some questions. So another thing that we were thinking that it's very related to this explosion of data is the roles that professional societies, the society that we belong to, SCCM, but there's so many other societies trying to keep up with guideline placement, recommendations, being challenged to their core to try to provide the most reliable, effective, and clear, transparent information out there. What do you think should be the role of those professional societies in a situation like the pandemic, now COVID-19 environment regarding the explosion of data? Why don't we start with Dr. Sturgill this time? Okay. So I think one of the best examples of this is when it comes to kids. The pediatric vaccines were behind the adult. We're still in the process of developing vaccines for kids under five. We politicized masking. And so when the American Academy of Pediatrics came out and said, we need to protect children. Children are not, while they don't maybe necessarily get COVID-19 as often as adults, they can still get critically ill. I mean, you guys are both pediatric intensivists. I don't need to convince you that children are as affected. And so I think that is, to me, that is a prime example of how a professional society has taken the lead on communicating to the public effectively and doing it in a good manner to address public health. So I do believe that when you have a societal backing like AAP, you know, like SCCM or, you know, American Thoracic Society or something like this, it carries weight and it says, look, we as researchers and providers stand behind this data that supports these guidelines. Dr. Raymond, what are your thoughts on that? Well, I think that in a time of a pandemic, when you've got multiple NGOs and government organizations certainly doing their best to provide guidance, whether that's the CDC or WHO or even the NIH or IDSA, you've got different organizations undeniably trying to do their best. I think the role of other societies is multifactorial. I think, one, I think it's important for, say, a society to convene multiple groups of people and different facets of, say, the pandemic, whether it's diagnostic, the effect on social determinants of health, on how to conduct research and how to develop clinical-based guidelines and best practices, even with the limited data. I think that there's an opportunity for a society to put together those sort of task forces to help develop and lead the field publicly, not just internally within the society. And I think that who else is uniquely positioned to give out that information in the critically ill, right? I think that the SCCM and certainly in conjunction with Chaston and American Thoracic Society and the Shock Society and other like-minded groups of individuals, I think that partnership will certainly and can and has demonstrated and will pay dividends to improvements in how we take care of patients and how we understand the science. But I think there's also an opportunity for societies to publicly work with their members to be able to interact with their local media and their national media, because we know that many individuals within our society are best positioned to be able to talk about things that would be preventative or things that would be helpful and beneficial, and quite honestly, be able to tell the public, these are areas we just don't know. We don't know the answers to these things. And so, although you as a public person, governmental official are likely inundated with everything that's out there in the news, that we as a society will help guide you to what's the best level of evidence and what we think is the best science. And when it changes, we will be out up in front to say, listen, we as a group in March and April used hydroxychloroquine and azithromycin for everyone. Let's be clear, we as a profession did this, right? We intubated many patients after they were on six liters of oxygen, because we thought it would reduce transmission. We did these things because that was what we thought at the time. But we know, you know, months later that that likely was not necessarily the best practice. And so we have to also come to terms with when decisions are made that perhaps were not based off of the, you know, maybe the best decisions at that moment. And so, you know, that I think is a good way to temper some of the relationships that occurs between societies and the public, and then the lay press. And then quite frankly, we should be publishing these sorts of things out there. And we should not, we might have to maybe disband some of the rules about writing white papers and the delay for which it takes many, many, many, many months to get to that point, so that we could actually write them rigorously in a more quickly fashion and get it out there. Because I think we are uniquely poised to be able to be that group out front. And so people will listen to perhaps some of the things that we would provide. Just to follow up on that, I affectionately joke that we did ourselves no favor by calling this Operation Warp Speed. And while it was, I understand the initiative behind it and why it was named that way, but I think it didn't communicate well. And so when you've got government saying this and Operation Warp Speed, I think, you know, healthcare providers are still, are the most trusted people in society. And so when you have leaders from such a prestigious organization like SCCM come forth and say, you know, this is what's going on, this is what we're seeing, this is what we're doing. I think in some regards, it may even be held higher esteem than, you know, other, you know, people on the press or media or things like that. So. I'm going to be completely honest with you guys. I think that was my favorite, most challenging questions. I really enjoy your guys' response. And I really think that that may have been the most important point that I wanted to cover with you all regarding the role of professional societies in the dissemination validation of data out there. I do agree with you all that we carry, it's the burden of the strong. I mean, we carry these very, very big weight on our shoulders where transparency, clarity of communication are fundamental. We can be wrong. It's okay to be wrong. It's not okay to stay wrong. So if principles have to be applied out of necessity at the beginning of a situation such as the pandemic, it's okay. But as data rises and points out that maybe those results were not really good at looking at it at a different timeframe, different lens, being able to be nimble and fluid and being able to change that such that we can benefit ultimately the patient, we have to be able to do that. And I couldn't agree more with you all where you say that societies are poised in such a powerful role to be able to say, it wasn't like that. Let's move on. This is what the data is telling us here. Excellent, excellent points. So let me, let me ask you a few additional questions about key elements of the data that we've utilized to make a lot of the big decisions that we have to do to practice during this time. So for instance, what are some of the key elements regarding data governance and specifically data acquisition analysis research utilized during the pandemic in this period that you think should have been reinforced for disaster preparedness? In other ways, is there something that we can rescue from this environment? Are there a lot of items that we should be able to discard moving forward? And why don't we start with Dr. Sturgill this time? I think some of the key things to come out of this are data integrity, data quality, rigor and reproducibility of research. Those tenants have always been in science, but I think they have just highlighted a huge importance in the pandemic. You know, being able when people are reporting, you know, case studies or case series or this thing in their lab versus this hospital for that, it's really hard to actually see, you know, to provide evidence-based practice if the evidence is not of quality. And so I think that's why you needed solid placebo control, randomized, double-blinded clinical trials to determine hydroxychloroquine was not an idle drug. That's why, you know, after the recovery trial, dexamethasone, you know, kind of changed the way that we practiced. And so I think these elements of data integrity and rigor and reproducibility have always been important, but I think they've been even more important, I don't mean more important, but have just highlighted the need to have a common database. And so I know SCCM has really pushed for, you know, these common variables, but these have been around before with other networks. You know, Dr. Perrin-Cobb has kind of led these trials before trying to look at common elements in terms of viral respiratory pathogens and things like that. So I think it's critical. Dr. Remy, what are your thoughts on that? Oh, you know, when we don't know something, we go search for answers. We search questions first, and then we try to search answers. And then after we think we find some answers, then we research it, right? That's what research is, right? We actually go back and we look at those questions and we try to rigorously study those things. I think that I actually, I like what Jamie said. And, you know, it's interesting too, because we are in a unique time in medicine, right? Where precision medicine is really going to start taking over in a lot of ways, the ways that we manage. And in large scale versus usual care trials, there are certain therapies that may or may not bore out as being beneficial. It doesn't negate the fact that perhaps when precisely being delivered and evaluated and then therapeutically given, that they could have benefit in some patients. And so, you know, we're in a situation where certainly the, you know, remap or recovery trials are certainly demonstrate benefits across the board, but not every patient. And, you know, and I don't want to be so, I don't want to believe and bloviate that I believe that there couldn't be a benefit to some patients that received hydroxychloroquine to some degree. I don't know that answer. The study wasn't derived that way, but in mass it certainly wasn't beneficial, right? And so I think where we're at is we're at a crossroads, I think, as a society and in the scientific community and how this pandemic is teaching this to us, I think in some ways, is how are we going to transition to conduct better trials, more adaptive trials? Because in a pandemic for two years, you can't have a five-year study. You've got to have the ability to have an adaptive trial design. How do you precisely evaluate certain people and subjects in research and decipher whether or not perhaps that they would benefit from different combinations of different therapies rather than just single therapies or perhaps conventional therapy combinations? I think these questions all are at the forefront of where we go next in our scientific endeavors. But back to the original point of today's talk, because I could probably talk about this for days, as far as the infodemic and dissemination of information, just because hydroxychloroquine works in an in vitro dish, somehow something went wrong or awry when that got translated to, this is the greatest therapy that should be used for everyone, right? That's not the rigor by which we usually adopt therapies. We have to question what happened and why we did that. And undeniably, it's because 37,000 people were infected in New York City at a time, which rose to 80,000 people, which then subsequently rose to 150,000 people. And bodies were sadly piling up and we were at a position in Seattle and in New York and in other locations where sadly we were overrun and we wanted to just grab what we thought could help because there was no great data at that point to help drive this. And so I think we have to then take a step back going forward and say, if presented with this situation in the future, are there ways that we could rapidly, I use the word rapidly, rapidly assess potential therapies? And if we can do that, how can we demonstrate their efficacy in a fashion that would be a bit different than what we did previously? Because what we did was our best, but it wasn't our best. It was what we needed to do when we were becoming overrun. And so there's an opportunity, I think, certainly for us to try to shape the future of this with probably more precision. And I think that most people are probably engaging in wanting to do that and realize that perhaps some of the things that we talked about back then may have not been exactly right. I think that's another very important point that both of you guys bring up. And I think for our listeners and audience, I think the key points here are the ability to deploy adaptive trials out of the necessity of having to come up with validated data at a rapid pace. And number two is going to be what Dr. Remy just said at the end, which is being able to utilize what we've done wrong, even though it was our best effort at the time, but now we have the opportunity to look back and say it really wasn't our best effort and lay the foundation for a potential better future in a terrible situation like the one we just experienced. On that note, let me ask you both a question about the data, a new term for me, and I know it's becoming very popular now during this time is the infodemic. How do you think this can affect the public trust? Why don't I start with Dr. Remy on this one? Well, I think that we're certainly with public trust in the infodemic. We are at, we have times of an all-time great high when we got the vaccine out in a rapid fashion. And then, you know, obviously the mask debate, you know, I tell people this, you know, this is a crosstalk so I can get to talk calmly like we're having coffee or drinks together. You know, I have taken care of my share of donkeys and elephants who don't wear masks and are unvaccinated in the ICU. And the people that sadly have died under my hands have been from all walks of life. But one thing is invariably true. There is different messaging going on in the lay press and lots of it is not accurate across the board. And so how do we fight that? How do we fight living off of preprints or of anecdotal information? How do we do that in a fashion that, and then in the same vein, be able to tell the public we don't know the answers to these things because you do need to do that. Otherwise you will lose trust when you're wrong because you hazard an inappropriate guess. And then how do you do such a thing and gain trust in a fashion where there are other individuals even cloaked in the white coat who are saying things that are just, you know, salaciously incorrect or just, you know, driving the myth. And I think you do that by publishing high quality papers and having society leaders and the membership alike out in public giving and saying, no, this isn't correct. You know, whether you have an N or a B or an F or X at the end of your news station, we've got to hold our news stations accountable for reporting the actual news. And I think that's an actual opportunity where we should avail ourselves to make ourselves more out there to be able to disseminate this information in the public. And what is the one area that's probably the biggest spreader of misinformation? It's social media. And so I think that this is going to be a great challenge. And then the real question is, is how do we in the scientific and medical community, how can we better disseminate information that's more accurate in the social media platform? How do we become influencers? I mean, that's a term that I never thought I would say, but how do we become influencers so that we can influence people that our only goal is to potentially keep you alive? Our only goal is to try to find who's going to be at the highest risk for a certain bad disease and try to find ways for you to make good decisions to mitigate that disease. And for some reason, if you come to the hospital, take care of you and provide the best level of information to take care of you with the best drugs that we have known. So, you know, maybe that's the 2022, 2023 SCCM mantra. We are going to be public health myth busters and we are going to become influencers of good scientific level of evidence and practices. I love that. Dr. Sturgill, your thoughts. Yeah, I often joke that the only thing more virally infectious than SARS-CoV-2 itself is misinformation on Facebook because, you know, maybe I spend too much time on social media, but it's very, you know, it's interesting to see what people believe, what biases that come out, regardless of, you know, different affiliations, it's on both sides. There's biases that people have and then they spread. And when your cousin's uncle's hairdresser said that this worked, and then next thing you know, it's been shared 20, 30, 40, 50,000 times on a social media platform, you know, and then how do we combat that? How do we, in an appropriate and culturally competent way say, look, you know, I know that you may believe this or you may have heard this, but, you know, scientifically, this is not what happens. There is no one, you know, we are scientists and clinicians. Our goal is to improve the human condition. You know, their ventilators do not kill people. That is just mind boggling that, you know, anyone who's ever worked with a mechanical vent, you know, and so, and then it comes back, I think, to education, you know, improving science education across the board, improving science communication across the board. And I sit, I sometimes, you know, people will send me messages on Facebook and they'll say, I saw this paper, or I saw this, I don't understand it, but is it true? And I'll say, no, and, you know, we have to do a really good job of explaining to where people understand there's, you know, barriers of education, language, science, understanding, medical competence, and so our job, you know, in addition to the 4,000 things that we do already, I think we really need to do a really good job of communicating that we tried this drug, it did not work, this is why, and that is why you don't need to go to Farmer's Supply and get ivermectin, it's not going to work. But, you know, this is what we are doing, this is what we are learning, and so I completely agree that the infodemic is out there, it's coming from all sides, it's not one side versus the other, and I think I completely agree with Ken. I never thought in a million years I would download TikTok, but I did, just to see what was on there, and it's mind boggling, and so how do we become influencers, for lack of a better term, to improve healthcare across the spectrum? We do need to also rotate our, we have to rotate those influencers, too. You know, one of the other problems with this pandemic is wonderful scientists that sit at the NIH, or perhaps at the CDC, appropriately, their messages were accurate, but they became like Charlie Brown's teachers, right? No one wanted to hear them anymore, because it was the same wah, wah, wah, wah, wah, not to me, because I've got great respect for these individuals, and what they've done in their careers, and what they're, but a lot of individuals saw them like that, and so we've got to also be creative, that the public, you gotta hear things from different people, because sometimes people say things a little bit differently, and maybe that second or third time hearing it a different way, just might say, huh, that does click. Yeah, you're right. It's not that you can't get COVID by wearing a mask, it's that it decreases the level of inoculum for spreading it in such a fashion. You know, oh, I never thought about it that way. And maybe we do need to, perhaps, minimize Charlie Brown's teachers to a point that we get just voices that can be heard with clarity. That's a really, really good point, and I think, you know, we kind of take it in a negative way, the fact that critical care providers may have to become influencers, but we really are. We're performing up on the stage, and like you said, we are trusted members of the community, where most of our neighbors, coworkers, and friends are looking up to, and everything that we do is in a positive, sometimes negative way, looked at in a lot of detail, and we've got to make sure that we are transparent. You know, that just reminds me that I got to make sure to look for you guys on Twitter and find your Twitter handle to follow you. So I want to ask you one final question. We've covered a lot of material on this almost an hour, but I want to leave our audience with the role of critical care providers and scientists regarding the assurance that the highest caliber research and data is presented for research, whether that be peer review versus preprint. What are your thoughts on that? And I'm going to start with you, Dr. Remy. Uh-oh. So, well, let me just say that this pandemic has been harrowing for all of us, and as the greatest lows in a lot of our profession have occurred in some ways in the last two years, hands down, some of the greatest successes have occurred as well. Some of the most important level of teamwork between practitioners and scientists alike and collaborations and among different organizations and even hospitals working together that ordinarily would be in competition has certainly occurred during this pandemic, and so we do need to be proud, I think, of that. In regards to where we go from here, I think that we just, to get to the best level of science and to the best level of practice of medicine, we have to make sure that we have an actual question to answer, and we want to understand the tenets and variables associated with that question. I teach trainees our elevator pitch. I think that if you start with an elevator pitch of exactly why you're studying, what you're studying for this reason, and this is what the impact is going to be, and this is what I hope to gain by using these methods, and at the end, I hope to have this deliverable, and from that deliverable, I'll be able to transfer this into perhaps some way to impact this diagnostic or this therapy or this manner in which we take care of patients. If you start with that sort of those who, what, what, where questions that you have for your elevator pitch that are part of your specific aims, then you're likely going to conduct a rigorous study that is hopefully going to be written in a fashion that's going to go through peer review with perhaps very little reviewers' comments that are going to delay dissemination of that information. If your information is being pushed out in a preprint because it's quicker and easier to do, and you still decide you're going to go to peer review and the peer review final version is very different than the preprint, then we really need to start questioning the processes by which that is true. Because inherently, I think for a scientist, the integrity is upon me to provide what I believe is data-driven after very rigorous methods, after understanding specific questions. And in one part, I would say one more thing. As becoming more seniors in this field, we have to mentor our young junior faculty to be able to write the currency, write the language, be able to write in a fashion that allows it to be the same level of rigor that we would expect. All of the giants on our field have taught us in many ways, and we've got to pass that on to our trainees and they to their trainees in the future. And so the only way that I think we get to being successful to minimizing the infodemic in a fashion that could be more positive is by mentoring our next generation of writers of manuscripts and in those that are conducting research. And I'll comment back on those. You bring up very, very important points on that question. Dr. Sturgill, what are your thoughts on that? Yeah, I completely agree that rigor needs to be upheld. The other thing that, so there's not much, I think one of the best thing that has come out of the pandemic is increased in team science. I'm a basic science trained immunologist, but now I'm working alongside leaders in critical care physicians like you and Ken and people here at Kentucky. And so bringing that interdisciplinary work together I think improves research as a whole. The second thing is reproducibility. When someone at University X publishes something and then someone at University Y publishes something different, we need to figure out what's the reason for that. Is it data fabrication? Is it truly methods? Because that needs to be transparent and it needs to be out in the field because people will cling to a certain paper that has been proven, it's been disproven or it should have been not, there was an error or something happened or data fabrication or things like that. I think the scientific community needs to come out and say, look, this paper was not being able to be reproduced. So therefore it should not be, those people should be held accountable. And for the longest time, journals wouldn't publish reproducibility journals or reproducibility articles. And so if you're trying to reproduce a study and you can't reproduce it and you get something different, you were almost penalized. And I think as a society, we need to encourage openness with rigor and reproducibility of science to ensure that the best and clearest message is being released to the public in order to develop platform adaptive trials to rapidly disseminate therapies that are gonna benefit patients in the clinic. Those are really, really, really good points. And I think it's a great way of finishing up our little time together. I think as Dr. Remy was mentioning, I think we can probably go over hours just covering this last couple of years. But I think we've been able to review your views on the explosion of data regarding COVID-19 in critical care. We certainly have covered your exposure, the pros and cons, how individually and the institutional we've benefited from this explosion of data. Another very key point that you guys have shared with us have been your insight on the roles of the professional societies on guideline placement and development. And I think your points on the key elements regarding data governance have been so important for our community that is gonna be watching this short video. And on that, I wanna thank you both for spending a little bit of time with me. And then on behalf of the in-training section and steering committee and the Society of Critical Care Medicine, I would like to thank you and hope you guys have a wonderful time and hope to see you in 2023 in person. Yes. Thank you. Thank you so much. Have a good one. Thanks.

COVID-19 data

critical care

professional societies

data integrity

precision medicine

misinformation

science communication

pediatric world