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What The Spanish Flu From 1918 Can Teach Us About COVID-19 Drug Trials

After the coronavirus has attacked the world, a lot of people started making a comparison between this pandemic and the previous ones.

For example, the regulatory agencies have started immediately authorizing the antimalarial drug, hydroxychloroquine, for the treatment of hospitalized coronavirus patients.

When the Brazilian president Jair Bolsonaro and the president of the US, Donald Trump, have expressed their enthusiasm for this drug, people started breaking the rules of social distancing to get it. This, in turn, has led to numerous cases of poisoning caused by improper self-medication.

The decision to incorporate hydroxychloroquine in the hospital treatment is due to a small trial that was conducted at a Marseille hospital which hasn’t provided yet the necessary evidence to establish proof that this drug works for coronavirus.

Although more extensive trials are underway, they can’t provide even the preliminary findings in the weeks that come.

In the middle of the flu pandemic in 1918, doctors everywhere around the world prescribed another antimalarial drug, known as quinine, without having any available evidence showing that it worked for flu.

However, at that time, doctors couldn’t conduct a sufficient number of trials to prove the effects of the drug due to the lack of advanced methods and techniques. This, in turn, has resulted in over-prescription of quinine which caused various side-effects such as vomiting, vertigo, and tinnitus.

These examples reveal the truth that politicians and doctors are forced to make ethically loaded decisions in a time of crisis. It would be better for everyone if politicians made decisions based on facts. Unfortunately, the division of labor in our world is an illusion.

David Kinney, a philosopher of the Santa Fe Institute, emphasized that scientists rarely have available facts during a crisis. The best they can offer is a broad range of possible outcomes and probabilities which are almost useless for policymakers.

As a result, scientists are forced to leave their comfort zone and narrow that range based on criteria. That is why, today, as in 1918, scientists are scolding each other in the media.

In the current study, coronavirus patients are treated with a combination of an antibiotic, azithromycin, and hydroxychloroquine, which is considered less toxic than chloroquine. Azithromycin, on the other hand, is usually prescribed for bacterial pneumonia, a potential complication of coronavirus infection.

It is revealed that this drug combination, as well as doses being used, are completely safe in other groups of patients. However, it still unclear, how safe they are in COVID-19 patients.

Some evidence points out that this combination may have a cardiotoxic effect, so before treating the patients, the doctors in Marseille hospital screen them with an electrocardiogram.

So far, they have published results on 80 patients only. Reductions in viral load have been reported, which means the patients were infectious for a shorter period. They have also noticed an improvement in their symptoms, compared with coronavirus patients that are hospitalized in other hospitals.

They have posted their reports on the hospital’s website without being peer-reviewed. By normal clinical trial standards, these numbers are too small and there are some evident inconsistencies in their reports.

Moreover, according to the critics, there is no control group, no group of age, or gender-matched patients who don’t receive these medications.

The doctor who has led the study, Didier Raoult, said that it would be unethical to have a control group in a situation where healthcare workers are risking their lives to save the patients who are fighting for their lives, while there isn’t any other alternative drug that would be effective enough.

Raoult is on the list of the world’s most highly cited scientists in his domain. He is aware that he has made an ethical decision instead of an evidence-based one. This is because he gives priority to his patients, not to the scientific methods.

The time may prove him right, but the ethical decision Sir Arthur Newsholme has made in 1918, turned out to be wrong. Raoult added that doctors cannot be judged by history but by their patients.

There have been made a lot of ethical decisions too, such as the one advising elderly people to stay home. The conclusion is if the scientists had all the answers we need, the world wouldn’t be where it is now.


Source: The Guardian

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