It is the year 2020, and we find ourselves in the midst of a rapidly changing, worldwide pandemic of a novel coronavirus. This virus and public knowledge of it has spread and changed with greater speed than our scientific method can accommodate. Science, and the progression of medical knowledge, is by nature and necessity slow and methodical. This pandemic is neither. But we ought not abandon our deliberate striving for truth; not now, not because it feels too slow.
The gold standard in medical science, the randomized controlled trial (or RCT), is a relatively new development in the history of medicine. The British epidemiologist Sir Bradford Hill is credited with designing and publishing the first RCT in medical science, a study of streptomycin in treating tuberculosis, in 1948. Sure, even randomized controlled trials are never perfect, and they require large numbers of patients, time, and investment. However, their design does seek to remove variables that are sure to taint all other trial designs. They are the best we have, especially when it comes to evaluating a therapeutic intervention.
Much speculation has arisen, both in the medical community and the media, about possible drug therapies for this disease: hydroxychloroquine, azithromycin, remdesivir, convalescent plasma, and others. Why have so many physicians and scientists been less-than-fully-enthusiastic about these interventions? It is because we do not have sufficient data yet. There has not been time for any quality randomized controlled trials.
Still, if these things might help, why not just throw them at patients with severe cases of COVID-19? What do we have to lose? The truth is, the history of medicine is flush with examples of therapies that we thought would be helpful – studies in the lab were favorable, we had promising initial observational data, and expert opinion was in favor of it – but, when put to the test, they were not. In many of these cases the interventions turned out not only to be not helpful, but harmful, when they were tested in a randomized controlled trial.
We must demand a high threshold of proof before accepting therapy as effective. History has taught us that mistakes are made if we do not. We want solid evidence that an intervention helps more than it hurts before recommending we give it to everyone with this disease. Yes, even if it seems slow.
One thing is for certain: our collective scientific energy will be best spent investing in developing a vaccine for this highly contagious virus. Fortunately, there are very smart people all over the world working around the clock in this endeavor. A vaccine: now that would be a game-changer.
In the meantime, our best defense against this pandemic continues to be social distancing – so stay home and minimize contact with others. The more we flatten the curve now, the more people will benefit from the hard work of science in the future.
Kelly Evans-Hullinger, MD is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota.