4 ms·

People are dying of coronavirus because we’re too slow at clinical research

14 points by elsewhen 6y ago

IAmEveryone 6y ago
We kinda do now know that remdesivir and chloroquine are useless. The trials are only continuing in a futile waste of research bandwidth to convince the sort of people that considers a wall in the desert more useful than a post office... The rest is probably true, although maybe not as much now as in "normal" times? An intern with a clipboard and a quarter should currently be able to run a competent trial in NYC. I can't imagine approval being as difficult now as it usually is. Maybe there just aren't that many promising candidates? Maybe availability is a problem for more esoteric ideas? From what I'm understanding, there is a lot of experimentation of various levels of rigour (non-mortis) going on for changes in treatment protocols, such as timing, duration, and setting for ventilation, proning, fluid management, etc. For every debate the public engages in regarding on the pro and cons of bleach-drinking, the medical profession is engaging in twenty debates on the best management of potassium levels to protect liver functions in diabetic patients etc
- tcbawo 6y ago
  There is as active discussion happening between doctors on the front lines here and abroad. The world's healthcare practitioners are linked up through social media in a way that is truly inspiring. The best new ideas are coming from the bottom up.
gus_massa 6y ago
> Obviously, for the patients who receive a placebo, this can be a sacrifice. And it can be a hard one to make. If the new idea is bad, the sacrifice is in the experimental group and the control group are the lucky ones that got the best treatment. Note that in this cases where there is a "standard" procedure the control group receives the "standard" procedure. They are not left alone to die.
- redis_mlc 6y ago
  The problem with your theoretical argument is that we already know there is no standard treatment that works, and ventilators have a mortality rate of 66% to 90%. So ... the control group is "left alone to die."
  - gus_massa 6y ago
    The 90% is probably wrong[1]. Anyway, the current method is saving 10%-34% of the patients. Nobody can guaranty that is perfect, but it's the best guess after years of treating patients with similar symptoms. [1] What is the original source of the 90%? Is it from this article: https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 From the article: > The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. > As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. If you ignore the 831 patients that were still in the hospital, and consider only the 38 that survived and the 282 that died, you get 282/(282+38)=88%. It is a very short time. What are the odds for people that survive more than 4 days in the hospital?
railing1650 6y ago
So a nobel prize winning scientist giving his opinion is banned? Keep bending over buddy.. https://news.ycombinator.com/item?id=23062531 https://news.ycombinator.com/item?id=23062531

14 points by elsewhen 6y ago

We kinda do now know that remdesivir and chloroquine are useless. The trials are only continuing in a futile waste of research bandwidth to convince the sort of people that considers a wall in the desert more useful than a post office... The rest is probably true, although maybe not as much now as in "normal" times? An intern with a clipboard and a quarter should currently be able to run a competent trial in NYC. I can't imagine approval being as difficult now as it usually is. Maybe there just aren't that many promising candidates? Maybe availability is a problem for more esoteric ideas? From what I'm understanding, there is a lot of experimentation of various levels of rigour (non-mortis) going on for changes in treatment protocols, such as timing, duration, and setting for ventilation, proning, fluid management, etc. For every debate the public engages in regarding on the pro and cons of bleach-drinking, the medical profession is engaging in twenty debates on the best management of potassium levels to protect liver functions in diabetic patients etc

tcbawo 6y ago
There is as active discussion happening between doctors on the front lines here and abroad. The world's healthcare practitioners are linked up through social media in a way that is truly inspiring. The best new ideas are coming from the bottom up.

gus_massa 6y ago

> Obviously, for the patients who receive a placebo, this can be a sacrifice. And it can be a hard one to make. If the new idea is bad, the sacrifice is in the experimental group and the control group are the lucky ones that got the best treatment. Note that in this cases where there is a "standard" procedure the control group receives the "standard" procedure. They are not left alone to die.

redis_mlc 6y ago
The problem with your theoretical argument is that we already know there is no standard treatment that works, and ventilators have a mortality rate of 66% to 90%. So ... the control group is "left alone to die."
- gus_massa 6y ago
  The 90% is probably wrong[1]. Anyway, the current method is saving 10%-34% of the patients. Nobody can guaranty that is perfect, but it's the best guess after years of treating patients with similar symptoms. [1] What is the original source of the 90%? Is it from this article: https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184 From the article: > The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. > As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. If you ignore the 831 patients that were still in the hospital, and consider only the 38 that survived and the 282 that died, you get 282/(282+38)=88%. It is a very short time. What are the odds for people that survive more than 4 days in the hospital?

railing1650 6y ago

So a nobel prize winning scientist giving his opinion is banned? Keep bending over buddy.. https://news.ycombinator.com/item?id=23062531 https://news.ycombinator.com/item?id=23062531