Preprint server founded by Yale now leading source for COVID-19 discoveries

medRxiv, a new website for sharing preliminary medical research, has become a leading source of scientific discovery related to the COVID-19 pandemic.
Joseph Ross and Harlan Krumholz

Co-founders Dr. Joseph Ross and Dr. Harlan Krumholz

A site co-founded by two Yale researchers for sharing preliminary medical research called medRxiv (pronounced “med archive”) has become a leading source of scientific discovery related to the COVID-19 pandemic. 

Known as a preprint server — an online archive of scholarly papers that have not yet been peer-reviewed — medRxiv allows scientists to rapidly share new discoveries and research findings in the clinical and health sciences to accelerate possible treatments. On May 12, the site received a $2 million award from the Chan Zuckerberg Initiative to support its operations. 

Increasing openness and transparency in scientific research has long been a goal for Drs. Joseph Ross and Harlan Krumholz, the researchers who launched medRxiv in June 2019 in partnership with research institute Cold Spring Harbor Laboratory and BMJ, a global medical journal. 

During a pandemic, sharing scientific data is especially critical, said Ross, professor of medicine and public health. 

With COVID-19, all the rules have changed,” Ross said. “Thousands of scientists are working on the same problem at the same time. It would be such a lost opportunity if scientists were not immediately aware of one another’s work and able to improve, validate, and learn more quickly.” 

When scientists submit a research paper to a traditional journal for publication, it goes through rounds of peer review and revision prior to publication. The process can take months, and sometimes years. Studies related to a global health crisis often don’t appear until after the epidemic has ended. That happened during the Ebola and Zika outbreaks, a study found, when just 5% of published research papers related to the crises were shared as preprints. 

In order to share new discoveries prior to publication, medical researchers have instead had to wait for opportunities to present them in person at scientific meetings. Of course, findings presented at meetings could not later be accessed, and there was no easy way to solicit feedback from fellow researchers prior to official journal submission, said Krumholz, the Harold H. Hines Jr. professor of medicine and public health, and director of the Center for Outcomes Research and Evaluation. 

Though preprint servers are common in the social sciences (economics, geography, psychology, for example) and the basic sciences (biology, astronomy, physics), there has been resistance from medical journals to support preprints, Krumholz said. “Some thought it was threatening their business models,” he said.

But COVID-19 made it clear that medical scientists need a way to share information quickly. “Suddenly,” Krumholz said, “everyone who was resistant thought maybe we do need a rapid way to communicate clinical research.”

Ross agreed: “COVID-19 has put a foot on the gas and accelerated interest in preprints.”

As of June 16, there were over 4,300 studies on medRxiv devoted to COVID-19 research from around the globe. These included studies on the impact of “superspreaders” on disseminating COVID-19; the estimation of the true infection rate of COVID-19 in each country; and a novel antimicrobial coating that has been found to be effective against the virus for hours after application.

In-house staff and volunteer health professionals screen all manuscripts upon submission. Although these papers are not peer reviewed, Krumholz said, the site will not post any paper that seems likely to lead to public harm, i.e., one claiming cigarettes are safe. All scientists who post research must be registered with the site, attest that they have followed ethical guidelines, and disclose competing interests and funding sources. To avoid spurring self-medication or runs on certain drugs, medRxiv does not post papers identifying potential drug treatments that do not come from clinical trials. It also requires that all studies involving clinical trials be registered with an internationally recognized trial registry. 

MedRxiv has an active following ready to weigh in — the site receives over 10 million monthly page views. Within minutes after a study goes live, scientists begin providing feedback, posing questions, and evaluating methods and findings. This commentary plays a vital role in calling attention to suspect research, say Krumholz and Ross. When one virology paper suggested that there were similarities between the coronavirus and HIV and that the former might be man-made, it led to widespread criticism from scientists and a retraction within 48 hours. 

When an engaged community is looking at papers, there’s an opportunity for rapid feedback,” Ross said. “It’s a great example of how the process can work.” 

Preprints are not meant to detract from the role of traditional journals, Ross emphasized, adding that both have an important role to play. “Journals play the role of validator,” he said. “They stamp and approve finalized knowledge. With preprints, the point is to learn from one another.” 

The grant from the Chan Zuckerberg Initiative will help medRxiv scale up its screening efforts for incoming papers, support machine-readable content to make papers easier to find, and improve education and advocacy related to preprints more generally. 

Yale has long been a leading advocate for making science open and shareable. In 2013, Krumholz, Ross and others were behind the launch of the Yale Open Data Access (YODA) project. It has made clinical trial data generated by Johnson & Johnson, Medtronic, and other data partners from over 400 trials and counting available to researchers for independent projects.  

A preprint server for clinical research was the next logical step, said Krumholz.

This has changed people’s view of preprints,” he said of medRxiv. “It is one of the things I am most proud of.” 

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Part of the In Focus Collection: Yale responds to COVID-19

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