Julia Carrie Wong
“What do you have to lose? Take it,” the president said on Saturday as he boasted that the US had amassed 29m doses of the drug. On Sunday, facing questions from the press about his aggressive promotion of an unproven treatment, he argued against waiting for the completion of clinical trials. “In France, they had a very good test,” he said. “But we don’t have time to go and say, ‘Gee, let’s take a couple of years and test it out, and let’s go and test with the test tubes and the laboratories.’”
Meanwhile, Dr Anthony Fauci, the country’s top infectious disease doctor, has repeatedly warned that there is no conclusive evidence to support using the drug. Asked whether it should be considered a treatment for Covid-19, he said on 24 March: “The answer is no.”
The story of how
But it’s also a story as old as medicine itself. When an epidemic killed thousands in ancient Rome, said Aaron Shakow, a research associate at Harvard Medical School and historian of medicine, the chief physician of the emperor Nero circulated a recipe for an old miracle cure.
“It was an attempt by Nero to sustain his legitimacy in the midst of this catastrophic event,” Shakow said. “Epidemics are dangerous to rulers.”
A deeply flawed studyIn early March, as the
Most small scientific studies live and die within the
Trump made his first endorsement of
The only problem? The study that all this fervid hope is based on doesn’t show what its authors claim it does.
The gold standard for a clinical trial is a double-blinded, randomized controlled trial (RCT). What this means in plain English is that the study has been designed to reduce biases that would render its results meaningless. Neither the physician nor the patients
The treatment group and the control group were drawn from separate populations: the treatment group were all patients at the institution where the researchers worked, the Méditerranée
But even more important than these shortcomings in the design of the study is how the researchers chose to measure and report their results. Forty-two patients were initially included in the study. Three were transferred to the intensive care unit; one died, one left the hospital, and one stopped taking the treatment due to nausea. The other 36 eventually recovered, and those who received the drug cleared the virus from the system faster than those who did not.
If you had only heard about this study from the Fox News assertion of a “100% cure rate”, you might assume that the four patients with poor clinical outcomes (the three ICU visits and one death) had been unlucky enough to be in the group that did not receive the “cure”.
And yet, those four patients, as well as the patient with nausea and the one who left the hospital early, were all part of the treatment group. They were excluded from the
This is how an experiment in which 15% of the treatment group and 0% of the control had poor clinical outcomes could end up being reported as showing a “100% cure rate”.
On 3 April, two weeks after the study was first published online, the International Society of Antimicrobial Chemotherapy, which publishes the IJAA, said in a statement that the group’s board “believes the article does not meet the Society’s expected standard, especially relating to the lack of
Didier Raoult, the corresponding author for the French study, did not respond to questions from the Guardian.
Andrew Noymer, a professor of public health at the University of California, Irvine, described the results of the French study as “meaningless”. “They should have done an RCT,” he said.
“This idea that we’re all manning the lifeboats and there’s no time for that is just absurd,” Noymer added. “They could have already done it. They could have had the answer by now
From Silicon Valley to Fox NewsSo how did one interesting but flawed study out of the south of France make its way to Fox News’s prime time and the White House?
It was not surprising that scientists were interested in testing
What Remdesivir lacked that
Among these is Raoult, the French physician who co-authored the
The Google document, which was formatted in a way that made it appear to be a scientific paper, found an audience among Silicon Valley’s elite. It was shared on Twitter by a number of influential investors before it hit the virality
“When someone who is newsworthy or notable that has an enormous network on social media tweets about something that could be as path-breaking as a medicine that could treat
Musk’s tweet received more than 13,000 retweets.
America’s right wing piles onOnce Trump declared himself a proponent of
“These drugs are helping our
The doctors did not provide any data from their own patients, but referenced the French study, writing: “Researchers in France treated a small number of patients with both
He acknowledged that it is unknown whether the drug is beneficial or harmful for Covid-19 patients, but said that since no drug has as yet been proven effective, “if there is any medication that might give hope, we prefer to try it” as long as it is safe. “We should know in the next few weeks whether such a regimen was a wise decision or not.”
The idea that
Calls for further researchAway from the rancor of the partisan media, scientists and physicians continue to study the effects of the drug. In some states, including the hard-hit New York, hospitals are following Hinthorn’s rationale and using the drug since no proven therapy exists.
A group of French researchers published a refutation of the Raoult study in Médecine et Maladies Infectieuses on 30 March. The researchers, at Saint Louis Hospital in France, followed the same regimen of
But another study – this time a randomized controlled trial – out of Wuhan, China, has sparked hope since it was circulated ahead of publication on 31 March. The trial of 62 patients found that patients with mild cases of Covid-19 who were treated with
The authors of the study urged further research and large-scale clinical trials to better understand how the drug operates and how best to use it.
The danger of presidential misinformationThe hype around
Heightened demand for the drug has left longtime patients – including lupus patients who have long used it as an anti-inflammatory – forced to go without. Overdoses have also been reported in the US and Nigeria as frightened individuals attempt to self-medicate.
Social media companies, who have been proactive about policing misinformation about
But it’s hard to see how these small enforcement actions by internet platforms can have much of an impact when the president of the United States continues to use his platform to promote the drug, as he did during his daily briefings on Saturday and again on Sunday.
Trump’s promotion of the drug has raised questions about his motivation, and on Monday the New York Times reported that the president holds “a small personal financial interest” in Sanofi, the company that makes a
As a piece of viral misinformation, the
Still, Noymer said that the influence that a president can have over a population’s attitude toward a medicine or drug is significant. He recalled President Gerald Ford publicly receiving a flu shot in 1976, amid fear that a new swine flu could lead to a pandemic.
“There was a photograph of him rolling up a sleeve and getting a shot, and the uptake on the flu shot was enormous,” Noymer said. “When the president of the United States does something, it’s quite the endorsement.”
As for Trump, it does not appear likely that he will stop hyping the drug anytime soon, nor that he will take responsibility if anything goes wrong.
“What do you have to lose?” he said Sunday. “They say, take it. I’m not looking at it one way or the other
“I’m not a doctor.”
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