3 ms·

Not disagreeing on the caution angle. But, let's imagine we find, by the usual trial and error, a chemical compound whose effects are that of curing patients f

Not disagreeing on the caution angle. But, let's imagine we find, by the usual trial and error, a chemical compound whose effects are that of curing patients from the coronavirus. Trials show that it has some rare side effects, like many other drugs. How much do we need to "understand" its first, second and third (and fourth) order effects before deciding to use it?

roenxi 5y ago
In this case it is using an unproven mechanism that requires proof of a negative ("nothing important in the body uses this mechanism"). It cannot be done safely and quickly. Just because someone survives 12 months and feels fine doesn't tell us anything about the safety of that mechanism. We could literally be injecting people with HIV and it'd only be showing "rare side effects" for the first 12 months as far as symptoms go.
- xorfish 5y ago
  I don't think that the idea is to disable it forever.
  - roenxi 5y ago
    If we disable oxygen to the lungs for 30 minutes then switching it back on doesn't help. The lung owner is probably dead. Some of this stuff causes permanent changes. There is reason to be optimistic, because if for it to be really bad then there'd need to be: * Permanent change * Causing negative symptoms * Which took a long time to be symptomatic (which, coincidentally, HIV/AIDS exposure is a great example of) Now if frameskipping supressing drugs are something we expose people to as a matter of course then very well, probably would work out great. But if this is new then it is absolutely not safe to do a mass rollout in the next decade. There are obvious risks.
    - Clostridium 5y ago
      There are always risks, and ignoring a novel approach is also a risk. The issue is to gauge risk intelligently, based on extensive prior medical, biological and physicochemical knowledge and modelling, and on sound clinical testing using randomized controlled trials (the kind of trial that proved dexametasone and disproved ivermectin, hydroxyquinoline etc. as a therapeutic for covid).
      - pessimizer 5y ago
        And the final step, declaring that disabling a cell mechanism cannot possibly have long term effects.
- ithkuil 5y ago
  my point was: in this case we know this is an unproven mechanism; because we are designing a drug that makes use of a mechanism. But we're using empirically discovered drugs since forever, where we had no idea on how the thing even supposed to act, let alone the consequence of this action.
  - avereveard 5y ago
    Empirical drugs also came from an age where the alternative was cutting the part that hurt and hoping for the best. You have to do better than the alternatives, and it was easier at a time when alternatives had 60% mortality. That said, this could be a good alternative than straight up dying for those in critical conditions. It would however tell us nothing about its safety, as people in critical condition have some deal of damage taken by the coronavirus itself and it'll be hard to control for each secondary effects.
- Clostridium 5y ago
  Corona virus exploiting frame shifting using a pseudoknot is not a at all unproven, has been known and researched since 2005
sokoloff 5y ago
If it cures COVID-19 patients, you can use that drug on exactly those people whose case is severe enough to justify the risk. Many chemotherapy drugs have terrible side-effects. We break people’s ribs from CPR all the time. No one argues we should stop breaking those ribs as that’s a fairly easy balance to strike versus a vaccine that you give prophylactically to healthy people. Far more caution is warranted there. (This article is about a therapeutic drug concept, meaning it’s the former case, but I’d still argue caution and where traditional supportive and therapeutic measures are working, I’d not rush to use this mechanism on mild cases.)

roenxi 5y ago

In this case it is using an unproven mechanism that requires proof of a negative ("nothing important in the body uses this mechanism"). It cannot be done safely and quickly. Just because someone survives 12 months and feels fine doesn't tell us anything about the safety of that mechanism. We could literally be injecting people with HIV and it'd only be showing "rare side effects" for the first 12 months as far as symptoms go.

xorfish 5y ago
I don't think that the idea is to disable it forever.
- roenxi 5y ago
  If we disable oxygen to the lungs for 30 minutes then switching it back on doesn't help. The lung owner is probably dead. Some of this stuff causes permanent changes. There is reason to be optimistic, because if for it to be really bad then there'd need to be: * Permanent change * Causing negative symptoms * Which took a long time to be symptomatic (which, coincidentally, HIV/AIDS exposure is a great example of) Now if frameskipping supressing drugs are something we expose people to as a matter of course then very well, probably would work out great. But if this is new then it is absolutely not safe to do a mass rollout in the next decade. There are obvious risks.
  - Clostridium 5y ago
    There are always risks, and ignoring a novel approach is also a risk. The issue is to gauge risk intelligently, based on extensive prior medical, biological and physicochemical knowledge and modelling, and on sound clinical testing using randomized controlled trials (the kind of trial that proved dexametasone and disproved ivermectin, hydroxyquinoline etc. as a therapeutic for covid).
    - pessimizer 5y ago
      And the final step, declaring that disabling a cell mechanism cannot possibly have long term effects.
ithkuil 5y ago
my point was: in this case we know this is an unproven mechanism; because we are designing a drug that makes use of a mechanism. But we're using empirically discovered drugs since forever, where we had no idea on how the thing even supposed to act, let alone the consequence of this action.
- avereveard 5y ago
  Empirical drugs also came from an age where the alternative was cutting the part that hurt and hoping for the best. You have to do better than the alternatives, and it was easier at a time when alternatives had 60% mortality. That said, this could be a good alternative than straight up dying for those in critical conditions. It would however tell us nothing about its safety, as people in critical condition have some deal of damage taken by the coronavirus itself and it'll be hard to control for each secondary effects.
Clostridium 5y ago
Corona virus exploiting frame shifting using a pseudoknot is not a at all unproven, has been known and researched since 2005

sokoloff 5y ago

If it cures COVID-19 patients, you can use that drug on exactly those people whose case is severe enough to justify the risk. Many chemotherapy drugs have terrible side-effects. We break people’s ribs from CPR all the time. No one argues we should stop breaking those ribs as that’s a fairly easy balance to strike versus a vaccine that you give prophylactically to healthy people. Far more caution is warranted there. (This article is about a therapeutic drug concept, meaning it’s the former case, but I’d still argue caution and where traditional supportive and therapeutic measures are working, I’d not rush to use this mechanism on mild cases.)