Thursday, March 26, 2020

"Cures" for COVID-19 - caveat emptor

Most of what I was taught about pharmacology in medical school many decades ago is long outmoded and useless, but one aphorism remains very relevant. “When the latest ‘miracle drug’ appears,” our professor said, “use it right away, because in a few months it will not work as well.” This sums up nicely the fallacy of using media accounts of “breakthroughs” as a guide to truth, or of listening to science-denying political figures as a source of medical advice.

I had an interesting experience many years ago when a long-time but infrequently seen patient was brought in by his wife because of failing memory. He was clearly in the beginning stage of Alzheimer’s disease. Aricept had just been brought to market as a treatment for this disease, so I prescribed it and saw him back a few weeks later and was astonished by his improvement. I was ready to pronounce this a “cure” for the disease. Unfortunately, this experience was never repeated in the dozens of subsequent patients to whom I gave the drug, and we now know that Aricept and similar medicines are not a cure but at best slow down the disease progression a bit. Why did my patient seem to benefit so much? His improvement may have been totally unrelated to the Aricept. Many things can worsen dementia, including infections and over-the-counter drugs such as Benadryl, and if I had prescribed green tea I would have seen the same improvement.

I tell this story because physicians now know that only carefully designed trials with adequate numbers of patients are reliable ways to find out if a medicine is truly effective and safe. Or, as I have heard said, the plural of anecdote is not data. The fact that my patient seemed to benefit did not prove that there was a cure for Alzheimer’s.

We are in a similar stage with the coronavirus and COVID-19. With no proven treatment available, we want to believe there is “cure” out there. The latest “cure” is the anti-malarial drugs chloroquine and hydroxychloroquine. The basis for these claims appears to be a single study done in France. Unfortunately for those who want a miracle, the study is a slim reed on which to base our hopes. The authors started with 36 patients, six with no symptoms but a positive swab, 22 with only upper respiratory symptoms and eight with probable pneumonia. Eight were admitted to the ICU and not followed, one left the hospital and was not followed, and they reported on only 20 patients. Moreover, they did not randomly split them into treated and untreated groups as is expected in clinical trials but used untreated patients from another center and patients who refused to be tested as their control group. The results showed that the 20 treated patients had less virus in their nasal secretions at the sixth day than the “controls.” While mildly encouraging, this is hardly a cure – and the patients studied were not the sickest, who really need effective medication.

A Chinese trial, done in a much more robust manner, tested a combination of two anti-viral drugs on more severely ill COVID-19 patients and found no benefit.

All drugs are potentially dangerous. Since Trump pronounced the anti-malarials a cure, at least three people have died from overdosing on chloroquine.

The World Health Organization is coordinating an international trial that will look at four different treatments for COVID-19: a new drug developed by Gilead for Ebola, the same anti-viral drugs found ineffective in the Chinese trial with and without interferon-Beta and chloroquine. These will be compared to each other and to “standard” care, which is support with IV fluids and respiratory support as needed. The same four treatments are also being studied by a European cooperative group headed by France.

Until the preliminary results of these trials are available, take any claims of “cure” with a grain of salt. Practice social distancing, keep up good general health habits and wash your hands.

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  1. I am grateful to get the info on this so-called study from France, as this is valuable information. From 36 patients they followed only 20 and obviously the least sick of the 36. How hard would it have been to follow the care of the 8 who went into the ICU--assume that they were the probably pneumonia group. That info would have been far more relevant!

    If you can provide a link to an English version of this report, it will likely be shared widely. Will share this post with my other patient advocates and on several patient forums.
    Peggy Zuckerman

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