Marco Papageorgiou

Scientific research and the blockchain Publish or perish. That is the common paradigm most – of not all – [insert field] scientists must adhere in the world of academic publication. And who can really question this set of scientific research principles? It is, after all, survival of the published; keeping scientists in jobs, and keeping science up-to-date. On top of this, there are over 25,000 medical journals currently circulating [1]. This means, essentially, that science has become a highly evolved network, stretching, creating multi- and inter-disciplinary research fields, helping to solve some of the world’s most pressing medical issues, such as dementia, Alzheimer’s Disease, various forms of cancer – the list does indeed, sadly, go on. Peer-reviewed articles allow scientists to communicate their results, methodologies, and conclusions/inferences within their respective research area(s). The process is scrutinised and placed under immense strain to publish ‘papers’ that can add significantly to a problem. The peer-reviewed process has led to many great biomedical discoveries and products: in December 2017 Genentech announced the FDA approval of an adjuvant treatment for HER2-positive early breast cancer. This is one example; CSL currently boasts 11 products that are in the registration and post-launch stage. Thought…What if the blockchain – and appropriately created decentralised applications – within the scientific research space could allow patients who suffer from chronic inflammatory demyelinating polyneuropathy to upload their medical data – symptoms, past blood tests - to assist scientists in achieving a much wider range of medical outcomes for their clinical studies? There really isn’t an answer to this yet, however one answer seems promising. Could the blockchain assist in peer-reviewed articles and clinical studies? The goal of blockchain technology is to create a decentralised environment without the need for a ‘third party’ in control of transactions and data. As these transactions add up, they are grouped into an encrypted block. A series of ‘blocks’ ensures that every transaction is recorded; thus, providing an immutable form of data integrity – through a network of nodes. These nodes each contain a copy of the blockchain: if one copy of the blockchain is copied, altered or modified in any way, this modification is quickly discovered and rejected. This is the power of secure, immutable data. Think of the blockchain as a large global community in which members can join – based on permissioned or permission-less access. Trust through verification is built from the wider group – collective – not the individual. This immediately provides people with a sense of responsibility – trust is siphoned away from central groups of authority, such as a company or an organisation. There is no doubt that the scientific method has greatly advanced human medicine and its outcomes in clinical trials. However, as is in most industries, there is embedded the problem of centralised human bias coupled with occasional conflict of interest. This bias may morph into a lack of reproducibility [2], something that is dangerous in the world of clinical studies. ‘Bugs’ have been reported to occur in medical scientific publications. These bugs relate to un-reproducibility from errors such as fraud, misconduct and plain old academic misconduct. A recent article suggests that advances in medicine can be made through the immutability of the blockchain. The same article posits that a ‘company culture that is open to innovation and new types of collaboration’ will lead to the development of scientific-based decentralised applications [3]. Another related article communicates that the blockchain could have a ‘global impact on [clinical] research’, wherein an improved methodology can be achieved, along with trust [2]. ICOs and decentralised applications (dapps) This is why initial coin offerings (ICOs) remain a salient feature that could provide investor confidence in a changing medical and healthcare landscape. To ensure this confidence in an ICO, it is important that this new approach to scientific rigour is developed on a strong decentralised application that can foster partnerships within the blockchain and of course throughout the scientific and layman community. This timely article succinctly describes the four criteria that decentralised applications must meet to achieve a ‘decentralised status.’ It is also imperative that the shift to a blockchain approach to clinical trials and/or even the peer-reviewed process can be supported by what Ethereum founder Vitalik Buterin lists as the three separate axes of decentralisation – Architectural, Political and Logical. I believe that those dapps which can enhance the healthcare, biomedical peer-reviewed and clinical trialling process is definitely well-deserved. However, with a strong focus on the patient (patient-centric). Conclusion We may be at the edge of a precipice peering across to a new scientific revolution in how we approach scientific research where publicly available, immutable patient medical data and scientific research outcomes – linked through the blockchain - can be accessed by scientists. These changes might indeed lead to better precision in clinical studies and optimised drug design and delivery never seen before. The ‘precision’ in this case is the large, anonymised raw data that can be readily analysed and applied, through statistics, to strengthen the aforementioned reproducibility in science. This really does change everything; new avenues of vital patient data suddenly become accessible, and scientists across many fields can enjoy many advancements in their respective scientific quests. Maybe, just maybe, the blockchain might eliminate – cut - the fear of perishing from publishing. References [1] Anthony L. Zietman, 2017. The Ethics of Scientific Publishing: Black, White, and Fifty Shades of Gray”. International Journal of Radiation Oncology, Vol. 99, No. 2, pp. 275e279. [2] Mehdi Benchoufi, and Philippe Ravaud, 2017. Blockchain technology for improving clinical research quality. Trials, 18:335. DOI: 10.1186/s--z. [2] Thomas F. Heston, 2017. The Blockchain-based Scientific Study. Digital Medicine, DOI: 10.4103/digm.digm_17_17. How to Find Clinical Trials for Crohn's