The Next Phase of Ground Truths

Some reflections on this newsletter and future plans

Since starting Ground Truths in December 2021, I haven’t written about the newsletter —why I committed to it and where it’s headed. This post is about that.

What communication in medicine and science means to me

It took me a couple of decades to realize that our role in the medical community can and should be to communicate not just to our peers, a microcosm, but to the public. To do that, it’s vital to eliminate all the fancy jargon, which I try to do, but sometimes fail or don’t take the requisite time. It reminds me of a story with Alan Alda, who is a master communicator that I’ve had the chance to get to know. When I got a review back for a paper in Science, one of the reviewers wrote “it’s at the 6th grade level.” I sent that review on to Alan and he wrote back that it was the nicest compliment I’ve ever received. For my presentations, I give the same talk and show the same slides whether it’s a lay public audience or a science/medicine group of attendees. For many years, I have tried to inspire trainees and young faculty to broaden their reach, engage the public, and simplify their writings and presentations so they are understandable by all.

A recent national survey in Health Affairs of over 4,200 American adults looked into who people trusted for health information during 2022, summarized by the graphic below. The level of high trust (a great deal) wasn’t impressive for any group, but doctors were leading the list.

It was that sense I had back in early 2020 when I started posting about Covid on twitter—to aspire to be a trusted source of information. Without any background as an infectious disease specialist, or in epidemiology, virology, or immunology, I thought I could contribute as an “outsider” by keeping up with the abundant new findings, whether they were by publications or preprints, providing context as a veteran physician-scientist. I do my best to make interpretations based on the prevailing and cumulative data—I’m not afraid of “telling it like it is” taking on the CDC, FDA, the White House, and pharmaceutical companies. Many times I’ve made projections or declarations before they appear in the media, such as how Paxlovid is a big breakthrough, or the imminent threat of a new variant. I make mistakes and when they are clearcut (not differences in interpretation) I‘m happy to correct and learn from them. My colleagues and I at Scripps got actively engaged in key pandemic research that included genomic surveillance, asymptomatic carriers of Covid, digital tracking, Long Covid, rapid antigen and molecular Covid testing, Paxlovid rebound, and next- generation vaccines that include nasal and pan-coronavirus. Furthermore, as I previously wrote, I have no financial conflict-of-interests with any matters related to Covid (vaccine, drug, diagnostic companies) and if any are relevant to non-Covid posts I will certainly provide them.

This initiative of covering Covid led to posting virtually every day on twitter for now over 3 years and being asked to write many op-eds in the NY Times, Washington Post, LA Times, The Economist and The Guardian. Unfortunately, the toxicity of twitter has progressively gotten worse, while at the same time the ability to reach followers has become seriously impaired. On the other hand, the format here is more favorable for providing explanations, and less chance to be taken out of context.

A bit about me

Many of you are not familiar with my background, so let me briefly review that. I’m a practicing cardiologist since 1985 [which means I’m old :-(] and have been an active researcher and educator throughout my career. Here’s my Google Scholar page which tallies my citations (>320,000) and h-index (238). The latter is “a metric for evaluating the cumulative impact of an author's scholarly output and performance.”

Here is my short bio. I’ve had 3 jobs: at the University of Michigan, Cleveland Clinic, and Scripps Research. Along the way, I started a new medical school at Cleveland Clinic, serve as editor-in-chief at Medscape, and have published 3 books on the future of medicine. For the past 15 years, I’ve headed up a research institute (SRTI) within Scripps Research focused on biomedical innovation and individualized medicine using genomics, digital and AI.

I’m also a husband (our 44th anniversary is coming up soon), father, and grandfather. I spend much of my weekends with our grandkids.

Ground Truths so far

This began as an experiment for me, unfamiliar with the platform, and unsure whether it was worth the time I put in for the posts, which usually include a substantial number of links and citations. The response has been gratifying with about 55,000 subscribers from 172 countries and throughout the United States.

Since December 2021, I’ve now posted 58, which, on average, amounts to nearly one per week. While the majority have been related to Covid, one-fourth have delved in other biomedical topics such as genomics/genome editing, machine “eyes,” AI chatbots, and large language models, medical selfies, hospital-at-home, the new obesity drugs, T-cell engineering, and major advances in cancer. As the pandemic begins to enter an endemic phase, which does not represent the downgrade in potential for harm that many have come to believe, I plan to be writing more about exciting advances in medicine and healthcare, and the caveats that inevitably surround them.

The feedback from many subscribers has also helped me know the posts have been appreciated. Some below, more here. Ground Truths has been recommended by 113 other Substack authors including Dan Rather (Steady), Holden Thorpe (Editor-in-Chief, Science; Science is Forever) and 2 of my favorite epidemiologists (Katelyn Jetelina (Your Local Epidemiologist), and Caitlin Rivers (Force of Infection).

There was one major early setback. My very first Substack post (on Covid), I was viciously attacked in the comments section by an organized mob, with a multitude of ad hominem remarks—one of the worst I am told (by Substack’s founders) in the history of the platform. That led to having to abruptly close comments down and discontinue the interactivity which I had fully anticipated and would greatly prefer. Fortunately, since that experience there’s been considerable momentum, which lays the foundation for my intent to establish and foster direct engagement with readers.

Ground Truths going forward

With this background, I’ve decided to do more on Substack here. That is beyond writing posts, I’ll be setting up podcasts and will try to get interactivity established, along with Q & A sessions. I will be soliciting topics that you would like me to write about. I want to encourage healthy debate about issues, but they must be done with civility and collegiality. For example, I previously debated Martin Kulldorf, a proponent of the Great Barrington Declaration, and we both got our points across in a respectful and courteous fashion. I’m old enough to remember that was the norm before there was such profound political polarization and the rise of social media.

I will always keep the core content free—explaining groundbreaking science in accessible terms—and what’s coming next in medicine and technology that I think you should know about.

Today I’m opening the door to readers who want to financially support this publication. Importantly, I will be donating all proceeds to support the research at Scripps. That research is what’s known as translational, translating advances in biomedical science to improve the practice of medicine and the care of patients.

I am extremely grateful to have established a readership for this newsletter and hope in the months ahead to take it to the next level. Deep thanks for all your support and encouragement that has reinforced and inspired the work here.