JAMA Pediatrics rejected our letter criticizing a study that pulled school children into the school yard and made a dog sniff them to see if they had COVID19

First researchers dehumanize children, and then the journal refuses to publish criticism

A few months ago, a sensational letter came out in JAMA Pediatrics. The authors took California school children out of the classroom, and had them line up in the school yard. Then a dog sniffed them to see if they had COVID19. Students were told not to look backwards at the dog, but inevitably some students must have snuck a peak. The dog sat down next to suspected COVID19 kids, indicating they might have COVID19 (towards their peers). Kids were then taken away and tested.

In my opinion, the study was unethical. It should not have been run in children— it should have been run in a nursing home. Kids are a vulnerable population— subject to teasing and bullying— and frankly the dogs were not that good at sniffing COVID19. Lots of false positives and negatives. We wrote this letter and submitted it to the journal, documenting that the trial violated ethical codes. Yet the journal refuses to print it.

To the editor: Subpart D of 45 Code of Federal Regulations Section §46.404 states that research involving children should not entail greater than minimal risk, meaning that harm or discomfort should be no greater than those encountered in everyday life. Given the low risks to children from COVID‐19 and a potential for stigmatization, we questioned whether there was minimal risk to children participating in a recent study published in JAMA Pediatrics.

Specifically, unaccompanied children, who may or may not have provided assent, were made to line up outside, face away from an unfamiliar canine animal, and be subjected to a dog sniffing them and their personal space, which would immediately sit down if the child might have COVID‐19, publicly signaling the health status of the child. This was all done in front of kids who were instructed to not look, although inevitably some would because they are children who are naturally curious (and maybe scared).

The potential for emotional and mental harm for children in this study was clear, and these were circumstances that would not be imposed on adult and other less‐vulnerable populations in ethically sound situations.

Further, the study was conducted during a time of low COVID‐19 prevalence, in a population with the lowest risk of adverse COVID‐19 outcomes, suggesting that there was little to no benefit from their participation in this study. This study was conducted under the auspices of public health surveillance. By definition, this should include activities that “reduce morbidity and mortality and to improve health.”

Yet, from the outset of the study, the research activities were unlikely to accomplish any of the surveillance objectives because of the low risk of adverse COVID‐19 outcomes in children and the low risk of COVID‐19 in general.

While it is reasonable to study canines, the study by Glaser et al., infringed upon gray areas of unethical conduct in the pursuit of this novelty. Ultimately the core ethical question is, why did the authors consider this acceptable to conduct this research in children? Why did they not run this experiment in adults, or nursing home patients, or health care providers, or some other population that had more to gain?

Research must be continually mindful of unintended but preventable harms to children, who may be especially vulnerable to coercion and undue influence during research activities.

Alyson Haslam, PhD

Vinay Prasad, MD, MPH

The authors would have been obligated to respond to our letter, if the journal had accepted it. At a minimum, they owe it to the scientific community to make their thought process transparent and tell us what ethical standards were discussed.

This is a common theme. Journals reject letters that offer strong criticism.

What do you think? Shouldn’t journals be obligated to accept and print criticism of their articles? Should they be allowed to accept unethical research on children and then block letters to the editor?

If you are a reader of Sensible Medicine, and concerned with the treatment of children during the pandemic, and are interested in doing research— particularly if you are a medical student, resident or fellow— please send a note to Alyson Haslam (alyson.haslam@ucsf.edu). We have a number of projects that aim to shed light on this and other concerning practices during the pandemic.