7 ms·

The suggestion on the table is to give this drug to extremely ill patients who suffer from a new viral disease on the basis of anecdotal evidence and without cl

The suggestion on the table is to give this drug to extremely ill patients who suffer from a new viral disease on the basis of anecdotal evidence and without clinical trials. The suggestion was to massively prescribe it. What health authorities want to do is to allow physicians to use the drug if the patient agrees, but only in a controlled setting in which data is collected and there is a control group. So at least afterwards we could draw conclusions about whether it killed more people or helped saving people. Does that not make sense to you?

ignoramous 7y ago
> Does that not make sense to you? It does, but why can't one can have the control groups at the same as blanket prescribtion? In times like this when the health care apparatus is overwhelmed, is it a good alternative to do that, since side effects are well-known and given the fact that the drug might be ineffective if used late in the infection cycle [0]? [0] https://news.ycombinator.com/item?id=22662849 https://news.ycombinator.com/item?id=22662849
chasil 7y ago
There are actually several suggestions, which were repeatedly discussed a decade ago in multiple SARS studies (see my post below). First is prophylaxis for front line health care workers, who are suffering grave infections likely exacerbated by long hours and low morale. Long term use of chloroquine or alternatives is a concern for this audience. There were fatalities last time, just like this time. The second is for the patients themselves, who will otherwise endure uncontrolled viral replication for up to two weeks until the adaptive immune response recognizes the pathogen. Reducing transmission requires an earlier end to this stage. Is the data from the previous studies worthless for these goals?
bsaul 7y ago
i absolutely don't see the need for a control group. We just need to monitor which patient had the treament and which didn't, globally. But if a doctor wants to prescribe all its patient with it, he should be allowed to, as long as it doesn't go against the traditional counter-indication for this very well known and very widely used on a global scale drug.
- mbreese 7y ago
  > We just need to monitor which patient had the treament and which didn't, globally And you just described the reason for a control group. We simply do not have that information. Things are moving too fast and treatments have not been standardized yet, not to mention the built in variability between locations. If you want to know if a treatment is effective, you must have to comparable groups. The point of the control group is to gather that information. Just because there are many, many, global cases doesn’t mean you actually have been able to capture the data for a control. Things are moving that fast. > But if a doctor wants to prescribe all its patient with it, he should be allowed to And what about the supply of these drugs? There are people who do need these drugs for other conditions (I’ve read Lupus patients sometimes need it). These patients need the drug and the supply is getting scooped up by people who don’t know (a) if they have the virus and (b) if the treatment is effective. And if it is effective, is it effective for treatment of infection or prophylactically? Just because a drug is widely used does not mean that there is enough supply to distribute it to anyone who wants to try it. These are major issues that can be answered with proper clinical trials. We know how to do this and they can (and are) being done as fast as possible.
  - hinkley 7y ago
    I saw a retweet the other day by a Lupus patient who couldn't get their prescription refilled. That's going to make a crappy situation much worse for a whole class of people.
bluecalm 7y ago
As noted in the original post you replied to we don't really need a control group because we already have a lot of experience with people who didn't get any drugs. Quoting that post: "all that is needed is a proper categorization". The goal here is to get enough evidence the treatment works or doesn't work. Conducting double blind studies is not the most efficient and fastest way to do that when you already have a lot of preexisting knowledge about both the patients not receiving any drugs and the safety profile of the drug in question. This is again a situation where statisticians should be asked for help as medical professionals very often operate on very simplistic model (double blind or gtfo) which we just don't have time for this time around.
- lonelappde 7y ago
  Past cases not a great control group because there's are different biases in "everyone who was sick" vs "people who asked for chloronique".
- IAmEveryone 7y ago
  We have far more experience with AIDS, or heart attacks, or hair loss, or really any disease. And yet trials for new medication against these diseases always include a control group.
  - bluecalm 7y ago
    Yeah because it's not urgent and it's a clean understood protocol. It's absolutely not optimal if your goal is to get to enough confidence fast.
mrfusion 7y ago
Your idea sounds great. I don’t think anyone in the thread knows what’s being proposed. I’d suggest we need to get it to people before they end up in the hospital to try to keep the resources available.
pbreit 7y ago
"The suggestion on the table is to give this drug to extremely ill patients" No. Likely needs to be given closer to onset of symptoms. "The suggestion was to massively prescribe it." No. The suggestion is to generate more evidence as fast as possible since it looks promising. Cannot wait for full clinical trials. 1500+ deaths per day in the mean time. Why are you fighting it so hard? If this is a useful treatment, don't you want us to find out? Let the doctors do their thing.
- jdhn 7y ago
  I feel like this thread and the arguments contained in it are a microcosm of what's going on in the world at large right now, and also explains why people were so slow to respond. Perfect is the enemy of good, after all.
  - akiselev 7y ago
    In medicine, bad is the enemy of good. Improperly studied medicine rushed into a clinical setting can make things worse and are perfectly capable of making things worse on a grand scale, regardless of how terrible people's understanding of statistics and variance are. Doctors have the authority in many countries to prescribe it off label based on their own review of the evidence and their patient's consent. That's the best we can do right now without risking something much worse.

ignoramous 7y ago

> Does that not make sense to you? It does, but why can't one can have the control groups at the same as blanket prescribtion? In times like this when the health care apparatus is overwhelmed, is it a good alternative to do that, since side effects are well-known and given the fact that the drug might be ineffective if used late in the infection cycle [0]? [0] https://news.ycombinator.com/item?id=22662849 https://news.ycombinator.com/item?id=22662849

chasil 7y ago

There are actually several suggestions, which were repeatedly discussed a decade ago in multiple SARS studies (see my post below). First is prophylaxis for front line health care workers, who are suffering grave infections likely exacerbated by long hours and low morale. Long term use of chloroquine or alternatives is a concern for this audience. There were fatalities last time, just like this time. The second is for the patients themselves, who will otherwise endure uncontrolled viral replication for up to two weeks until the adaptive immune response recognizes the pathogen. Reducing transmission requires an earlier end to this stage. Is the data from the previous studies worthless for these goals?

bsaul 7y ago

i absolutely don't see the need for a control group. We just need to monitor which patient had the treament and which didn't, globally. But if a doctor wants to prescribe all its patient with it, he should be allowed to, as long as it doesn't go against the traditional counter-indication for this very well known and very widely used on a global scale drug.

mbreese 7y ago
> We just need to monitor which patient had the treament and which didn't, globally And you just described the reason for a control group. We simply do not have that information. Things are moving too fast and treatments have not been standardized yet, not to mention the built in variability between locations. If you want to know if a treatment is effective, you must have to comparable groups. The point of the control group is to gather that information. Just because there are many, many, global cases doesn’t mean you actually have been able to capture the data for a control. Things are moving that fast. > But if a doctor wants to prescribe all its patient with it, he should be allowed to And what about the supply of these drugs? There are people who do need these drugs for other conditions (I’ve read Lupus patients sometimes need it). These patients need the drug and the supply is getting scooped up by people who don’t know (a) if they have the virus and (b) if the treatment is effective. And if it is effective, is it effective for treatment of infection or prophylactically? Just because a drug is widely used does not mean that there is enough supply to distribute it to anyone who wants to try it. These are major issues that can be answered with proper clinical trials. We know how to do this and they can (and are) being done as fast as possible.
- hinkley 7y ago
  I saw a retweet the other day by a Lupus patient who couldn't get their prescription refilled. That's going to make a crappy situation much worse for a whole class of people.

bluecalm 7y ago

As noted in the original post you replied to we don't really need a control group because we already have a lot of experience with people who didn't get any drugs. Quoting that post: "all that is needed is a proper categorization". The goal here is to get enough evidence the treatment works or doesn't work. Conducting double blind studies is not the most efficient and fastest way to do that when you already have a lot of preexisting knowledge about both the patients not receiving any drugs and the safety profile of the drug in question. This is again a situation where statisticians should be asked for help as medical professionals very often operate on very simplistic model (double blind or gtfo) which we just don't have time for this time around.

lonelappde 7y ago
Past cases not a great control group because there's are different biases in "everyone who was sick" vs "people who asked for chloronique".
IAmEveryone 7y ago
We have far more experience with AIDS, or heart attacks, or hair loss, or really any disease. And yet trials for new medication against these diseases always include a control group.
- bluecalm 7y ago
  Yeah because it's not urgent and it's a clean understood protocol. It's absolutely not optimal if your goal is to get to enough confidence fast.

mrfusion 7y ago

Your idea sounds great. I don’t think anyone in the thread knows what’s being proposed. I’d suggest we need to get it to people before they end up in the hospital to try to keep the resources available.

pbreit 7y ago

"The suggestion on the table is to give this drug to extremely ill patients" No. Likely needs to be given closer to onset of symptoms. "The suggestion was to massively prescribe it." No. The suggestion is to generate more evidence as fast as possible since it looks promising. Cannot wait for full clinical trials. 1500+ deaths per day in the mean time. Why are you fighting it so hard? If this is a useful treatment, don't you want us to find out? Let the doctors do their thing.

jdhn 7y ago
I feel like this thread and the arguments contained in it are a microcosm of what's going on in the world at large right now, and also explains why people were so slow to respond. Perfect is the enemy of good, after all.
- akiselev 7y ago
  In medicine, bad is the enemy of good. Improperly studied medicine rushed into a clinical setting can make things worse and are perfectly capable of making things worse on a grand scale, regardless of how terrible people's understanding of statistics and variance are. Doctors have the authority in many countries to prescribe it off label based on their own review of the evidence and their patient's consent. That's the best we can do right now without risking something much worse.