Be hopeful, but look for good science in medicine
I want to start this post with a caveat: I am not a scientist.
Here are some things I am: A sweater wearer, a complainer, a 90-pound weakling frequently bullied by beach hunks, and a science museum content developer. That last one makes me an “informal science educator,” but it does not make me a scientist. So my takes on scientific research are distinctly non-professional.
But that caveat is sort of the point of this post: Even—or especially—we non-scientists should be able to think critically about science news.
So here’s the news: I’ve recently seen several articles about a promising new treatment for COVID-19 called Remdesivir. This is an antiviral drug that was originally developed to treat ebola...and it didn’t really work. But some experiments suggested that it might be effective against coronaviruses like the one that causes COVID-19.
The Washington Post says “U.S. stocks climb after coronavirus drug trial shows early promise against severe symptoms.” CNN’s headline: “COVID-19 patients recovering quickly after getting experimental drug treatments.” “The best news is that most of our patients have already been discharged, which is great,” is the most prominent quote.
Exciting, right? We’re scared of this thing, and we want everything to return to normal as soon as it’s safely possible. And, gosh, if the stock market likes it, it must be good, right?
No. Not right. Or not just yet. It turns out that this is a good opportunity to practice looking for “good science.”
See, the story originated with the medical news publication STAT, which obtained a copy of a video of the scientist overseeing the Remdesivir research discussing the study with University of Chicago faculty members. The “which is great” quote comes from that scientist. She explains that the University of Chicago Medicine recruited 125 people with COVID-19 for the study, 113 of whom had severe cases of the disease. At the time the tape was made, “most” of those patients had been discharged from the hospital, and two of them had died.
That sounds good, but the fact is, determining whether a drug is safe enough and effective enough to be worth using or recommending requires good science, and good science takes time. Here are some things to consider in the case of Remdesivir:
Is 125 people a big enough group to draw conclusions from? The bigger the sample (the group of subjects studied), the more confident we can be that the results are accurate and will hold true for everyone who might take the drug.
There was not a control group in this particular study. This is super important. A control group in a study like this would be composed of a very similar group of people with similar severity of their infections, but the control group would not get the drug. That way researchers could see whether people who get the drug actually do any better than people who don’t. It could be that a group of 125 people who don’t take Remdesivir would see similar recovery rates and similar death rates. Since there wasn’t a control group, we can’t say for sure.
As I understand it, this drug trial also didn’t include a group that received placebos—something that they would have been told was the drug, but was actually a harmless substitute. Because of the placebo effect, sometimes patients who expect to feel better will actually feel better, even if they didn’t get a real treatment. If people who get the drug do better than the control group, but don’t do much better than people who get a placebo, the drug may not actually be very effective.
Those details may seem kinda tedious, and nobody wants to be overly cautious when there are literally lives on the line, but making sure science is done well is really important when it comes to medicine, and getting people too excited too early can be dangerous.
Case in point: Hydroxychloroquine seemed to show some promise in treating COVID-19, and some people, including President Trump, praised its potential. However, at least one person died from taking too much of a certain form of hydroxychloroquine, while some who needed the drug for other medical conditions had a harder time acquiring it. And to top it off, it now appears that hydroxychloroquine may actually not be effective
at treating COVID-19. Given the drug’s dangerous potential side effects, the FDA has issued a warning that people should not take hydroxychloroquine for COVID-19, unless it’s administered to them in a hospital or as part of a study.
And let’s not forget the lessons learned from the polio vaccine. In the 1940s and ‘50s, polio was killing and permanently injuring thousands of people each year. A vaccine was desperately needed and the science behind the vaccine was sound, but a rushed early version accidentally ended up containing live virus particles, which caused about 70,000 additional polio infections in the U.S. and hundreds of deaths.
It’s important to be hopeful. And we should be hopeful—lots of people are working hard right now to develop treatments for COVID-19, as well as a vaccine. But this isn’t the first time the desire to quickly develop a treatment for a deadly disease has outpaced the careful processes of science and medicine. We have to settle for nothing less than good science, so when treatments or a vaccine are released, even non-scientists like you and I can be confident that the medicines are safe and effective.
Update:
Since I finished writing this post, but before it got published, a couple things have happened:
One new study of Remdesivir, which was larger than the University of Chicago study and included a randomized control group, showed no benefit for COVID-19 patients. Gilead, the company behind Remdesivir, cut the study short, however, and claims that the drug may still have a “potential benefit” for people treated early on in their infection. But, speaking as a layperson observer, it’s not a great look for Gilead. This wouldn’t be the first time for a drug company to pick and choose study results that make their products look better than they are.
On the other hand, another large new drug trial seems to suggest that Remdesivir may have some therapeutic effect after all. The study, sponsored by the National Institute of Allergy and Infectious Diseases (which is headed by Dr. Anthony Fauci) had more than 1,000 participants this time, and also included a placebo group. Researchers found that patients treated with Remdesivir recovered in 11 days on average, while patients who instead took a placebo recovered in about 15 days.
Four days may not seem like much, but if the results hold true in other trials, it’s a good sign for the drug ’s ability to block the coronavirus. It makes me wonder about the discrepancy with the results of the first trial mentioned in the update, and what future trials will show, but hopefully this research will lead to more tools in combating the COVID-19 pandemic.