Scramble to find a cure causing chaos

‘Gunslinger medicine’ wasting valuable time, scientists warn

DESPERATE to solve the deadly conundrum of Covid-19, the world is clamouring for fast solutions from a research system not built for haste.

The ironic, and perhaps tragic, result is that scientific short cuts have slowed understanding of the disease and delayed the ability to find out which drugs help, hurt or have no effect at all.

As deaths from the coronavirus relentlessly mounted into the hundreds of thousands, tens of thousands of doctors and patients rushed to use drugs before they could be proved safe or effective. A slew of low-quality studies clouded the picture even more.

“People had an epidemic in front of them and were not prepared to wait,” said Dr Derek Angus, critical care chief at the University of Pittsburgh Medical Center. “We made traditional clinical research look slow and cumbersome.”

It wasn’t until mid-june – nearly six months in – when the first evidence came that a drug could improve survival. Researchers in the UK managed to enrol one of every six hospitalised Covid-19 patients into a large study that found a cheap steroid called dexamethasone helps and that a widely used malaria drug does not. The study changed practice overnight, even though results had not been published or reviewed by other scientists.

In the US, one smaller but rigorous study found a different drug can shorten recovery time, but many questions remain about its best use.

Doctors are still frantically reaching for anything else that might fight the many ways the virus can do harm, experimenting with medicines for stroke, heartburn, blood clots, gout, depression, inflammation, Aids, hepatitis, cancer, arthritis and even stem cells and radiation.

“Everyone has been kind of grasping for anything that might work. And that’s not how you develop sound medical practice,” said Drsteven Nissen, a Cleveland Clinic researcher. “Desperation is not a strategy. Good clinical trials represent solid strategy.”

Few definitive studies have been done in the US, with some undermined by people getting drugs on their own or lax methods from drug companies sponsoring the work.

And politics magnified the problem. Tens of thousands of people tried a malaria medicine after President Donald Trump promoted it, saying: “What have you got to lose?” Meanwhile, the nation’s top infectious disease expert, Dranthony Fauci, warned: “I like to prove things first.” “The problem with ‘gunslinger medicine,’ or medicine that is practised where there is a hunch… is that it’s caused society as a whole to be late in learning things,” said Johns Hopkins University’s Drotis Brawley. “We don’t have good evidence because we don’t appreciate and respect science.”

He said if studies had been conducted correctly in January and February, scientists would have known by March if many of these drugs worked.

Even researchers who value science are bending rules to try to get answers more rapidly. And journals are rushing to publish results, sometimes paying a price for their haste with retractions.

Research is still chaotic – more than 2 000 studies are testing Covid-19 treatments from azithromycin to zinc. The volume might not be surprising in the face of a novel virus, but some experts say it is troubling that many studies are duplicative and lack the scientific rigour to result in clear answers.

“Everything about this feels very strange,” said Angus, who is leading a study using artificial intelligence to help pick treatments. “It’s all being done on Covid time. It’s like this new weird clock we’re running on.”

To scientists, it was a recipe for disaster: in a medical crisis with no known treatment and a panicked population, an influential public figure pushes a drug with potentially serious side effects, citing testimonials and a quickly discredited report of its use in 20 patients.

Trump touted hydroxychloroquine in dozens of appearances starting in mid-march. The Food and Drug Administration allowed its emergency use even though studies had not shown it safe or effective for coronavirus patients, and the government acquired tens of millions of doses.

Trump first urged taking it with azithromycin, an antibiotic that, like hydroxychloroquine, can cause heart rhythm problems. After criticism, he doubled down on giving medical advice, urging “You should add zinc now… I want to throw that out there.” In May, he said he was taking the drugs himself to prevent infection after an aide tested positive.

Dr Rais Vohra, medical director of a California poison control centre, told of a 52-year-old Covid-19 patient who developed an irregular heartbeat after three days on hydroxychloroquine – from the drug, not the virus.

Craving better information, a University of Minnesota doctor spent $5 000 of his own money to buy hydroxychloroquine for a rigorous test using placebo pills as a comparison. In early June, Dr David Boulware’s results showed hydroxychloroquine did not prevent Covid-19 in people closely exposed to someone with it.

A UK study found the drug ineffective for treatment, as did other studies.

Boulware’s colleague, Dr Rahda Rajasingham, aimed to enrol 3 000 health workers to see if hydroxychloroquine could prevent infection.

When the study started, “there was