In desperate times, people grasp for answers. But those answers are not always helpful or accurate. In the past few weeks, we have heard about a number of anecdotal solutions to the Coronavirus that have turned out to be either downright false or misleading. A single story or even a series of cases– anecdotes — should not be sufficient to persuade us. But they too often do. When the President touts a drug like hydroxychloroquine, which is still without solid evidence of effectiveness against this virus, people will blindly go out and try it. And some will die because of it. Too often someone will cite a solution from a source like “people tell me” or “some doctor suggests it” or even “my cousin’s father in law knows a doctor who said….” It is more important than ever to distinguish anecdotes from solid evidence.
What type of evidence is solid enough to provide a real solution? I suspect that many people find the scientists’ answers less than satisfying, because the gold standard of evidence, the randomized clinical trial, takes time to complete and sounds very complicated. When you are desperate for answers, it’s hard to imagine you would have to wait months to know the results and find answers.
Dr. Fauci, who has become our nation’s key scientific voice about the CoronaVirus, talks a lot about the need for randomized control trials to find a vaccine or treatment for the virus. Why does he emphasize this so much? The main reason is that if you do find that a treatment works for “some” patients, how do you know it will work for you and others like you? How do you know if will harm you? If the trial has been biased toward men, or a certain age group, or certain ethnicity, giving it to you could be dangerous, or at least ineffective.
“The best way to compare a new treatment to the standard treatment is in a randomized controlled trial. In such a study, participants are randomly allocated to either the new or standard (control) treatments using the computer equivalent of tossing a coin. This process is known as randomization and is the only commonly accepted method of ensuring an unbiased estimate of the treatment effect.”
In a randomized control trial (RCT), the drug or device is administered to an experimental group and a placebo or no intervention is given to a control group. The purpose of a control group in a randomized controlled trial is to help reduce the likelihood that any benefits or risks that the researchers identify during the trial occur due to factors outside of the experimental treatment. The ideal trial is also “blinded” or “masked” so that neither the physicians administering the drug or device nor the patient knows if they are receiving the real treatment or just as placebo. That keeps the bias out of the experiment. If a doctor knows she is giving a patient a powerful new drug, she could inadvertently telegraph to the patient that they are receiving the “real thing.” And if the patient knows they are receiving the actual treatment, the placebo effect can convince them that the treatment is working when it may only be a sugar pill.
Randomized trials take a while to administer and draw a conclusion about whether or not the drug or device is effective. There are phases that test whether the drug is safe and then once identified as safe, the providers move on to whether the drug actually works — is effective.– and for whom. When all phases of a trial are concluded, it can then be safely given to a broader population. The urgency of our current situation with COVID-19 is that we all want a solution right away.
The rumors about CoronaVirus are rampant. Here is a great website for understanding some of the myths and rumors about the CoronaVirus.
https://www.digitaltrends.com/news/coronavirus-conspiracy-theories-and-myths/
I understand the passion of frontline doctors to try almost anything to stop the course of this awful disease. In some desperate cases, a so-called “unproven” treatment might be the only way to try to save a life. But we must keep pushing for the kind of studies that will tell all of us what really works — not just for us, but for everyone.
Meanwhile… stay home, stay safe and eat a healthy diet. If you can avoid this first wave of illness, perhaps some of the more promising treatments will have been successfully tested and proven by the time you need them.
Linda. Yes but …… in desperate cases I would want doctors to use their best professional judgement and take on some risk to try to save someone I love. Always assuming that I am pretty confident that is what the patient wants.
Yes, I agree with you, Jan. That is why I added the point about why doctors take risks in desperate situations. Many doctors apparently are using arithromycin and hydroxycholoquine fairly regularly, but with very mixed results. Some patients seem to get better. Others do not. For the ones who improve, it is impossible to tell if feeling better would have happened anyway. But when there is no real proven treatment, doctors may choose to take these risks, particularly if they feel fairly confident the potential benefits outweigh the harms. Since Hydroxycholoroquine has potential for harm to the heart, it is not risk free by any means.
Many thanks Linda for this Post – it makes a lot of sense, as I heard on the news in the middle of the night that our President wants Dr. Fauci to be fired, as alledgedly he put out wrong information – that would be one of our biggest mistakes, so thanks for your detailed explanation. We all need to use common sense, and what you say, stay home, stay healthy and eat well makes a lot more sense than firing this intelligent scientist. Please keep Blogging. Ursula K.
Thanks Ursula! Hope you are doing well and staying safe!