6 ms·

Yeah, the devil is really in the details about exactly when and how you administer it. Doctors are already saying that it's definitely no magic bullet, but the

Yeah, the devil is really in the details about exactly when and how you administer it. Doctors are already saying that it's definitely no magic bullet, but they debate whether it is effective at a certain stage of illness. What I don't understand is why we're focusing so much on this specific drug when there are some great antivirals out thee that have a more effective theoretical mechanism of action. (eg Remdesivir)

simcop2387 7y ago
It's being focused on in the news, but the others are also being tested. The big problem is like the GP raised, we need proper testing to really be able to say much about the ability of any of these drugs to help. [1] https://www.fiercebiotech.com/biotech/gilead-clinical-data-hint-at-efficacy-remdesivir-covid-19 https://www.fiercebiotech.com/biotech/gilead-clinical-data-h...
frgtpsswrdlame 7y ago
Because this drug can be cheaply manufactured out of patent. Let's say Remdesivir is the only drug that works, it's basically an admission that Gilead is going to have us over a barrel.
- munk-a 7y ago
  Only if we chose to let them bend us over said barrel? The US government could simply seize the patent if Gilead acted in a manner against the public good.
  - lonelappde 7y ago
    The US government is not "we", even if we are in the US.
  - tomohawk 7y ago
    And then what happens next time? Why spend all the time and effort, only to have what you did nationalized? Incentivizing people to not do productive things like develop drugs seems like a really bad idea.
    - sadfklsjlkjwt 7y ago
      I used to agree with you. Then I realized that drug companies spend more on lawyers than scientists.
      - _n_b_ 7y ago
        This isn’t even remotely close to true. 0.67% on legal[1] versus 17% on R&D[2]. [1] https://ccbjournal.com/articles/benchmark-metrics-pharma-companies-indexing-allows-cross-industry-law-department-comp https://ccbjournal.com/articles/benchmark-metrics-pharma-com... [2] https://www.investopedia.com/ask/answers/060115/how-much-drug-companys-spending-allocated-research-and-development-average.asp https://www.investopedia.com/ask/answers/060115/how-much-dru...
        FireBeyond 7y ago
        And how much on marketing?
        sadfklsjlkjwt 7y ago
        You are right of course. My mistake. Marketing is where they spend their money!
    - smacktoward 7y ago
      Nobody’s saying Gilead can’t make a profit. Just that they can’t make an obscene (“have us over a barrel”) profit.
      - tomohawk 7y ago
        The post I was responding to had the strong implication of a Mafiosi stopping by a store and saying "Nice store you have here - it would be a shame if something happened to it". "You might want to consider our needs and sell us stuff at what we consider a good price".
        roywiggins 7y ago
  - wbl 7y ago
    So the reward for spending millions on neglected tropical diseases is nothing. That's a great motivator for the company that cured HIV and Hep C to keep working.
- subsubzero 7y ago
  > it's basically an admission that Gilead is going to have us over a barrel That's absolutely not what would happen. I was chatting with a family member who used to work in biotech/pharma and posed the question what would happen if Remdesivir is found to have efficacy against covid-19. What they said is basically there would be licensing done immediately to other pharma companies which would run manufacturing in parallel with what Gilead is doing. Gilead will be getting profits from each pharma company that gets a license. I am unsure why the lead time is so long, however it may be that the company does not want to create a huge supply of a drug that may not be effective. But this is very interesting, the pentagon is getting lots of remdesivir for troops so there must be some info that leadership has about its success rate: https://qz.com/1834939/how-the-military-secured-experimental-covid-19-drug-remdesivir/ https://qz.com/1834939/how-the-military-secured-experimental...
hjnilsson 7y ago
Remdesivir (and other antivirals / T-inhibitors on trial) are all extremely difficult to manufacture (and expensive) compared to hydroxychloroquine. Most hospitals and countries will be unable to acquire the amounts required for even small trials. It will be many months before we can begin to see results for these drugs.
johntb86 7y ago
Remdesivir could be great, and there are a lot of studies ongoing about it. However, it has a long production time - Gilead says 6 to 8 months: see https://www.gilead.com/purpose/advancing-global-health/covid-19/working-to-supply-remdesivir-for-covid-19 https://www.gilead.com/purpose/advancing-global-health/covid.... They're only projecting to have 500,000 treatment courses by October, so it could only help a relatively small fraction of the people that will have coronavirus.
- smacktoward 7y ago
  Even a small volume of an effective treatment could still be helpful. Usage could be restricted just to patients with cases serious enough to otherwise require ventilators, for instance, which would both ease the strain on limited ICU resources and save lots of people who would otherwise die (since only around 10-30% of ventilated patients survive even with that treatment).
  - gvjddbnvdrbv 7y ago
    But antivirals tend to need to be given early to have a good effect. How will be know who is going to be severe?
    - roywiggins 7y ago
      By the time we have lots of it, we will have good statistics on demographics of people most likely to need it, so you could make educated guesses and still see a benefit.
      - randcraw 7y ago
        To offer some perspective, in Montgomery County, just north of Philly (a suburban metro county harder hit than most), 10% of positive tests have been admitted to hospital, and 2.6% of positive tests have gone on ventilators. So the subpopulation needing remdesivir is probably less than 5% of the positive cases (or 1250 of the 25,000 who tested positive here). BTW, the county population is 900,000.
lonelappde 7y ago
Because it's become an arbitrary political football to separate "left" vs "right"
- SlowRobotAhead 7y ago
  As insane as that is. And how funny is it (at least to me) that this is only because Trump came down on one side initially. If he had come out saying exactly the opposite, that HCQ was bad and we should be skeptical, everyone hoping it doesn’t work now would be looking for the 10 person studies saying it totally works and defending its use. It’s almost beyond reason how hyper partisan this specific issue is.
  - lalaland1125 7y ago
    The fundamental difference is that one side is backed by neutral experts such as Anthony Fauci and the other side has shown nothing but disdain for science in countless issues (global warming, evolution, election fraud, etc).
    - Bendingo 7y ago
      > neutral experts such as Anthony Fauci Fauci isn't close to being a neutral expert.
    - SlowRobotAhead 7y ago
      Sorry, I don’t buy into pole riding / hero worship, nor do I believe that theoretical-you on the theoretical-“other side” wouldn’t have an equal but opposing argument. It’s all game, do you really not see that? ... If you’ve been following this topic, shouldn’t you be able to make the steelman argument for it?
  - rsynnott 7y ago
    This isn't left vs right; it's an unqualified politician vs pretty much all of the scientific community.
    - 7y ago
dTal 7y ago
Because it's easy to make, there's tons of it lying around already, and it doesn't need human safety trials (we already know safe dosages). If it works, it'll be a near-miracle.
- SiempreViernes 7y ago
  No, that explains the initial attention, not the sustained attention in the face of clear and severe problems it is now getting.
ldng 7y ago
They always were saying it wasn't magic bullet, but some people did not keep the context and started to spread only part of the story.

simcop2387 7y ago

It's being focused on in the news, but the others are also being tested. The big problem is like the GP raised, we need proper testing to really be able to say much about the ability of any of these drugs to help. [1] https://www.fiercebiotech.com/biotech/gilead-clinical-data-hint-at-efficacy-remdesivir-covid-19 https://www.fiercebiotech.com/biotech/gilead-clinical-data-h...

frgtpsswrdlame 7y ago

Because this drug can be cheaply manufactured out of patent. Let's say Remdesivir is the only drug that works, it's basically an admission that Gilead is going to have us over a barrel.

munk-a 7y ago
Only if we chose to let them bend us over said barrel? The US government could simply seize the patent if Gilead acted in a manner against the public good.
- lonelappde 7y ago
  The US government is not "we", even if we are in the US.
- tomohawk 7y ago
  And then what happens next time? Why spend all the time and effort, only to have what you did nationalized? Incentivizing people to not do productive things like develop drugs seems like a really bad idea.
  - sadfklsjlkjwt 7y ago
    I used to agree with you. Then I realized that drug companies spend more on lawyers than scientists.
    - _n_b_ 7y ago
      This isn’t even remotely close to true. 0.67% on legal[1] versus 17% on R&D[2]. [1] https://ccbjournal.com/articles/benchmark-metrics-pharma-companies-indexing-allows-cross-industry-law-department-comp https://ccbjournal.com/articles/benchmark-metrics-pharma-com... [2] https://www.investopedia.com/ask/answers/060115/how-much-drug-companys-spending-allocated-research-and-development-average.asp https://www.investopedia.com/ask/answers/060115/how-much-dru...
      - FireBeyond 7y ago
        And how much on marketing?
      - sadfklsjlkjwt 7y ago
        You are right of course. My mistake. Marketing is where they spend their money!
  - smacktoward 7y ago
    Nobody’s saying Gilead can’t make a profit. Just that they can’t make an obscene (“have us over a barrel”) profit.
    - tomohawk 7y ago
      The post I was responding to had the strong implication of a Mafiosi stopping by a store and saying "Nice store you have here - it would be a shame if something happened to it". "You might want to consider our needs and sell us stuff at what we consider a good price".
      - roywiggins 7y ago
- wbl 7y ago
  So the reward for spending millions on neglected tropical diseases is nothing. That's a great motivator for the company that cured HIV and Hep C to keep working.
subsubzero 7y ago
> it's basically an admission that Gilead is going to have us over a barrel That's absolutely not what would happen. I was chatting with a family member who used to work in biotech/pharma and posed the question what would happen if Remdesivir is found to have efficacy against covid-19. What they said is basically there would be licensing done immediately to other pharma companies which would run manufacturing in parallel with what Gilead is doing. Gilead will be getting profits from each pharma company that gets a license. I am unsure why the lead time is so long, however it may be that the company does not want to create a huge supply of a drug that may not be effective. But this is very interesting, the pentagon is getting lots of remdesivir for troops so there must be some info that leadership has about its success rate: https://qz.com/1834939/how-the-military-secured-experimental-covid-19-drug-remdesivir/ https://qz.com/1834939/how-the-military-secured-experimental...

hjnilsson 7y ago

Remdesivir (and other antivirals / T-inhibitors on trial) are all extremely difficult to manufacture (and expensive) compared to hydroxychloroquine. Most hospitals and countries will be unable to acquire the amounts required for even small trials. It will be many months before we can begin to see results for these drugs.

johntb86 7y ago

Remdesivir could be great, and there are a lot of studies ongoing about it. However, it has a long production time - Gilead says 6 to 8 months: see https://www.gilead.com/purpose/advancing-global-health/covid-19/working-to-supply-remdesivir-for-covid-19 https://www.gilead.com/purpose/advancing-global-health/covid.... They're only projecting to have 500,000 treatment courses by October, so it could only help a relatively small fraction of the people that will have coronavirus.

smacktoward 7y ago
Even a small volume of an effective treatment could still be helpful. Usage could be restricted just to patients with cases serious enough to otherwise require ventilators, for instance, which would both ease the strain on limited ICU resources and save lots of people who would otherwise die (since only around 10-30% of ventilated patients survive even with that treatment).
- gvjddbnvdrbv 7y ago
  But antivirals tend to need to be given early to have a good effect. How will be know who is going to be severe?
  - roywiggins 7y ago
    By the time we have lots of it, we will have good statistics on demographics of people most likely to need it, so you could make educated guesses and still see a benefit.
    - randcraw 7y ago
      To offer some perspective, in Montgomery County, just north of Philly (a suburban metro county harder hit than most), 10% of positive tests have been admitted to hospital, and 2.6% of positive tests have gone on ventilators. So the subpopulation needing remdesivir is probably less than 5% of the positive cases (or 1250 of the 25,000 who tested positive here). BTW, the county population is 900,000.

lonelappde 7y ago

Because it's become an arbitrary political football to separate "left" vs "right"

SlowRobotAhead 7y ago
As insane as that is. And how funny is it (at least to me) that this is only because Trump came down on one side initially. If he had come out saying exactly the opposite, that HCQ was bad and we should be skeptical, everyone hoping it doesn’t work now would be looking for the 10 person studies saying it totally works and defending its use. It’s almost beyond reason how hyper partisan this specific issue is.
- lalaland1125 7y ago
  The fundamental difference is that one side is backed by neutral experts such as Anthony Fauci and the other side has shown nothing but disdain for science in countless issues (global warming, evolution, election fraud, etc).
  - Bendingo 7y ago
    > neutral experts such as Anthony Fauci Fauci isn't close to being a neutral expert.
  - SlowRobotAhead 7y ago
    Sorry, I don’t buy into pole riding / hero worship, nor do I believe that theoretical-you on the theoretical-“other side” wouldn’t have an equal but opposing argument. It’s all game, do you really not see that? ... If you’ve been following this topic, shouldn’t you be able to make the steelman argument for it?
- rsynnott 7y ago
  This isn't left vs right; it's an unqualified politician vs pretty much all of the scientific community.
  - 7y ago

dTal 7y ago

Because it's easy to make, there's tons of it lying around already, and it doesn't need human safety trials (we already know safe dosages). If it works, it'll be a near-miracle.

SiempreViernes 7y ago
No, that explains the initial attention, not the sustained attention in the face of clear and severe problems it is now getting.

ldng 7y ago

They always were saying it wasn't magic bullet, but some people did not keep the context and started to spread only part of the story.