Is the Confusion over Covid Treatments Political or Medical?
By Thomas Neuburger
There's much to be confused about these days. Are the new mRNA Covid vaccines a kind of "modern miracle," proofs of our greatness, as the hosts on MSNBC keep assuring us, or do they offer an undertested solution that could exacerbate the problem?
I suppose we'll find out in the next six months, after thousands of America's health care workers — women and men who are more exposed to the disease than the general population — have added their experience to the data gathered by the brief Phase III trials already run. Most phase III trials last over a year with many lasting a good deal longer, while these trials have lasted just a few months.
America's health care workers will thus form the virtual second cohort, the next test group for these vaccines, and their outcomes — degree of protection, side effects, any catastrophic outcomes — will be watched rather closely. Here's hoping, for all our sakes, that all goes well with them.
Is Ivermectin an Effective Treatment?
At the treatment end of the spectrum, there's much to be confused about as well. Does hydroxychloroquine (HCL) do nothing, or does it do much good? Does ivermectin do nothing, or do the anecdotal claims for its efficacy merit examination? Both drugs are inexpensive, already approved for other conditions, and both are being used locally to treat the disease.
For anecdotal claims for ivermectin, see here and here. To watch a viral video of Senate testimony advocating that ivermectin be further tested, see here. For some mainstream media debunkage, read this from the AP.
If you watch the video by Dr. Kory, you'll notice his opening remarks included an unscripted criticism of the opening remarks by Gary Peters (D-MI) the ranking member. (Dr. Kory's prepared remarks can be read here. Sen. Peters' comments can be watched or read here; jump to 8:53 in the video or transcript.) The essence of Sen. Peters' case is that outpatient treatment results in general are "unverified theories" that don't "meet the same [scientific] standards" as the those of the FDA. The FDA, for its part, recommends against the use of ivermectin for the treatment of COVID-19, except in a clinical trial".
Yet it's not just pro-Trump outlets like Newsmax touting ivermectin. Even WebMD has good things to say:
April 7, 2020 -- An inexpensive drug used to treat parasitic infections killed the coronavirus that causes COVID-19 in less than 48 hours in a laboratory setting, Australian researchers say.
The drug, ivermectin, has been used widely used for decades. It was introduced as a veterinary drug in the 1970s. Doctors also prescribe it to treat head lice, scabies, and other infections caused by parasites. According to a report published online in the journal Antiviral Research, the drug quickly prevented replication of SARS-CoV-2, the virus that causes COVID-19. The study has been peer-reviewed and accepted for publication, although it is not yet a "definitive" version of record.
Researchers infected cells with SARS-CoV-2, then exposed them to ivermectin. "We showed that a single dose of ivermectin could kill COVID-19 in a petri dish within 48 hours, indicating potent antiviral activity," says study co-author David Jans, PhD, a professor of biochemistry and molecular biology at Monash University in Melbourne.
Even at 24 hours, "there was a really significant reduction" in the virus, study leader Kylie Wagstaff, PhD, a senior research fellow in biochemistry and molecular biology at Monash University, said in a statement.
The spoken argument against ivermectin's use is that it's only been tested in a petri dish, and those results that may not apply, or may apply dangerously in the real world of Covid patients and treatment. Advocates point out that ivermectin has been used safely for decades, though for other purposes.
The unspoken arguments against ivermectin are two: that's it's what the Trumpians want us to believe (do therefore don't believe it), and that inexpensive treatments reduce the profit potential of expensive ones.
The Political Approach to Medical Treatment Preferences
This battle over treatments, the pro and con fighting, seems clearly connected to our hyper-political world. Are treatments like HCL or ivermectin part of the "We hate Trump"–"No, we hate Democrats more" war that's been raging among political and media actors for the last four years? Or are these treatments just innocents caught in that war?
Are they vilified or praised — stigmatized as straws grasped at by Trump-following fools (remember the widely spread "drinking bleach" story), or touted as cures that will prove Trump right all along — just to serve a non-medicinal end?
Is Dr. Kory a quack, or a practicing pulmonary physician caught up in the war? Is much of the nation, members of the anti-Trump army, ignoring real avenues of help in our mad desire to depose our own mad king?
Why No Clinical Trials?
To answer these questions we need clinical trials that test these avenues of treatment. But that leads to the next problem: How much money will be spent by drug manufacturers to verify the efficacy of existing, fully developed and inexpensive drugs? Where's the money in that?
In a year or so, we may have answers. After all, as Dr. Kory pointed out in earlier testimony before the Senate:
The third alarming factor we have witnessed, many of us firsthand, is the increasingly widespread insistence within institution, medical journals, and health societies that any proposed medical therapies for COVID-19 only be given to patients who participate in clinical trials. We are aware of instances whereby “restrictions” were proposed and placed against commonly used FDA approved medicines if used off-label in COVID-19, a practice that all doctors do every day.
1 - The Declaration of Geneva of the WMA binds the physician with the words, “The health of my patient will be my first consideration,” 2- International Code of Medical Ethics declares that, “A physician shall act in the patient’s best interest when providing medical care.” 3- Article 37 of the WMA declaration of Helsinki, titled: “Unproven Interventions in Clinical Practice”[.]
It reads, and I paraphrase: "In the treatment of an individual patient, where proven interventions do not exist, a physician may use an unproven intervention if in the physician’s judgement it offers hope of saving life, re-establishing health or alleviating suffering." [emphasis his]
Which means, we're going to see these treatments used whether the drug companies want us to use them or not. At some point we'll have enough anecdotal data to say that they work, or mostly work, or don't — in much the same way that people take zinc lozenges to treat oncoming colds because, yes, there's enough anecdotal data that says zinc works, mostly.
But beyond the political fighting, it's the fatalities that matter. If treatments like HCQ and ivermectin really do work, do prevent deaths in large number, at whose door do we lay those bodies that could have been saved absent the vilification? Surely, if the anti-Trump brigade can put 300,000 deaths at Trump's door — and I among them — the preventable deaths of those untreated by politically discouraged intervention can be laid at the doors of a few Resistance senators as well.
What If These Were "Trump's Vaccines" Instead?
The election is over and these are now Biden's vaccines. But consider a thought experiment: What if they were Trump's vaccines instead? What if they had been rolled out three months ago under a Donald Trump umbrella, or, if Trump had been re-elected, they were rolled out today as Republican solutions to the crisis? Would our MSNBC hosts still be touting them as "modern miracles" and proofs of our greatness, and still be saying it's our sacred duty to take them? Or would these drugs be treated with the suspicion some say they deserve?
I'm not sure; Pfizer and Moderna have a lot of money to spread around under any administration, useful reputations to deploy, and MSNBC is as susceptible to corporate influence as any corporate operation.
Besides, who knows, maybe these are the wonders of the age, these companies, these vaccines, and the world is right to be eager to add their wealth.
But questions like that, unbidden, do keep me awake, keep me confused and bewildered as I watch the work of the world we've been swept into.