Ottawa senior scientist urges using ‘living evidence’ to fast-track information for decision-makers

About 250,000 scientific papers have been written about COVID-19 in the past two years.

It’s a lot of information for doctors, policy-makers and ordinary people to process. But the pandemic has also presented scientists with an opportunity to learn how to fast-track information in near real-time, says Dr. Jeremy Grimshaw, a senior scientist at The Ottawa Hospital and a professor of medicine at the University of Ottawa.

Grimshaw is co-author of a commentary that appeared last week in the prestigious science journal Nature, published under a cartoon showing white-coated scientists and administrators in black jackets frantically grabbing at whirlwinds of paper.

In the commentary, Grimshaw and his fellow researchers urged the global science community to adopt a new scientific approach summarizing scientific research quickly and accurately. They call it “living evidence” or “living reviews.”

Since the 1980s, national policies and guidelines have drawn on formal summaries of research known as systematic reviews to get a clear understanding of the scientific knowledge available at the time.

In systematic reviews, scientists take evidence from a number of studies, combine the information and analyze the data to come to a conclusion about whether an approach — such as a drug or a policy — is beneficial.

But reviews are often of poor quality, duplicative and out of date, especially when there’s a flood of new research, the researchers said.

That’s been obvious during the pandemic. The antiviral drug Remdesivir was one example.

Originally developed to treat hepatitis, Remdesivir was approved or authorized for emergency use to treat COVID-19 in about 50 countries as researchers thought at the beginning of the pandemic that it had treatment potential.

The data was weak, but promising in 2020, and 30 systematic reviews were produced to assess whether the drug was effective.

But many of the studies were outdated before they were published because they omitted recently published primary studies, the researchers noted in the Nature commentary. (On Nov. 20, the World Health Organization conditionally recommended that Remdesivir not be used in patients with COVID-19, regardless of the severity of the disease.)

“Before COVID, a lot of people were starting to argue that we needed living evidence. In COVID, we have seen extreme interest from citizens and decision-makers,” Grimshaw said.

Using the model, researchers continuously identify new studies by monitoring databases of the latest journal publications and other digital collections. Artificial intelligence and other technologies can help.

Each “living review” has a team that handles the interpretative side.

For example, a team led by Dr. Lori-Ann Linkins of McMaster University produces reviews of studies from around the world that look at the effectiveness of vaccines on COVID variants of concern, Grimshaw said. The living reviews are forwarded to bodies including the Public Health Agency of Canada and the National Advisory Committee on Immunization.

Living evidence has benefits for ordinary people who want up-to-date information to make decisions. “Citizens Google. And it’s the Wild West. When you do a search, you will find certain things,” he said.

The method is only about five years old, but it is gaining traction around the world.

Australia’s National COVID-19 Clinical Evidence Taskforce produces guidelines using the method. Over 70 versions have been published since March 2020.

The United Kingdom’s National Institute for Health and Clinical Excellence and the World Health Organization have both endorsed the approach and are using it for their COVID guidelines.

The Australian Stroke Foundation uses living evidence to expedite changes to its stroke guidelines. What used to take five to seven years now takes only a few months.

There is growing interest in using the method in other sectors, from climate change to education, as well.

“That’s one of the most exciting areas — how to support teachers and families,” Grimshaw said.

“As we go forward, we should make it the new normal. If we have living reviews, whenever anyone wants the best knowledge at any point in time, they would have confidence. I think society should have ways to have trusted information for citizens, provided in plain language.”

How fast is fast with the Omicron variant in the headlines? When it comes to Omicron, it will likely be another month or so before reliable studies in print and pre-printed versions are available to be part of a review, Grimshaw said.

“There are a lot of preliminary findings and noise out there. We’re trying.”

Are you interested in staying up to date with COVID-19 news?

Sign up for our daily newsletters here