Hierarchies hinder science advancement in hospital settings

When prestige is valued more than evidence, outdated practices persist and innovative professionals leave

The image shows four wooden pawns arranged on a red background, forming a hierarchical structure: a larger pawn at the top, connected by wooden sticks to three smaller pawns at the bottom, representing an organizational chart.

In many hospital settings, science is not yet the primary basis for healthcare initiatives. Instead of evidence, decisions are often driven by prestige—a dynamic that has a real impact on public health costs.

Physician and researcher Beatriz Barreto-Duarte of the Clinical and Translational Research Laboratory at the Oswaldo Cruz Foundation (FIOCRUZ) in Bahia has observed this pattern throughout her career. In an interview with Science Arena, she contextualized the problem: “We still treat physician-scientists as exceptions, rather than an essential part of the healthcare system.”

When prestige supersedes evidence

According to Barreto-Duarte, medicine becomes guided by hierarchies when clinical or policy decisions are based on the reputation of the speaker, rather than the robustness of the scientific evidence. The result is that practices without scientific backing remain in place, anchored only in tradition.

“This culture allows outdated practices to persist simply because ‘that is how it has always been done,’ creating an environment where asking questions is seen as disrespectful,” she explains.

“True leadership in science and medicine should not be about who speaks the loudest, but about who seeks the best answers to provide better care”

The burden of tradition over innovation

Physician-scientists are uniquely positioned to translate research findings into improvements in patient care. But when the work environment prioritizes tradition, presenting new proposals, even when based on solid evidence, can be a frustrating exercise.

The burden is even greater for women, as Barreto-Duarte explained to Science Arena.

“I believe that authority and experience are extremely valuable, but they need to go hand in hand with continuous learning and a commitment to evidence,” she emphasizes.

Why this drives talent away from the system

For Barreto-Duarte, the hierarchical model has a serious side effect: it pushes the professionals most capable of contributing to innovation away from the public system. When they cannot find space for evidence-based proposals, physician-scientists seek more receptive environments—usually outside the public sector and often outside Brazil.

The problem, therefore, is not only cultural. It is also structural. A system that fails to recognize the value of evidence as a basis for decision-making loses human capital that took decades to train.

Click here to read Science Arena’s full interview with Beatriz Barreto-Duarte on the career challenges faced by physician-scientists in Brazil.

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