Ok so here’s the news report (I couldn’t find a paper) showing Remdesivir improves time to recovery in #COVID19https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19 …
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This means a trial on advanced
#COVID19 patients was never gonna tell us jack shit. Viral load in this disease peaks around the onset of symptoms!!Show this thread -
If your drug works by killing virus or blocking it from replicating, you’ve got to test it on *brand new* cases!
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(Mea culpa; I could have known this trial was gonna suck before the results came out, based on trial design, but I didn’t check.)
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Look; this means *mechanism is bullshit*. An antiviral that “works” but doesn’t decrease viral load? Sure, I guess, it can have a different mechanism, but given how often this happens, should we really be framing drugs as having “known” MOAs at all?
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I don’t want to stake out a strong position on “remdesivir is Never good to give a patient” but look, 30% reduction in time to recovery in severe patients, no mortality benefit, is not a cure.
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Remdesivir is not gonna make it safe for everyone to go back to work. It’s just not that big an effect. And we desperately need an effect that big.
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Except now, as
@MarkHoofnagle notes, remdesivir is “standard of care” & now every other drug has to prove noninferiority! Nice power grab, Gilead!Show this thread -
This means “standard of care” is also bullshit, if you didn’t know. It’s a negotiation between power players, not a sober assessment of the science.
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This is
#regulatorycapture in action. Remdesivir, from all I can see, was a reasonable drug to try against#COVID19. There are lots of other reasonable drugs to try. Only the ones with deep pockets and good political relationships will get approved.Show this thread -
And then people will say “Science Says these are the good drugs and the others are bad” but never ask who determines *which* science gets done
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What ordinary lay humans care about — can this drug save lives? can it make
#COVID19 close to harmless? — is not even being tested!!!Show this thread -
“Hydroxychloroquine doesn’t have an RCT and remdesivir does!” Yes, true, and ALSO notice that hydroxychloroquine is a cheap generic so there’s nobody to *pay* for a big RCT.
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And the public only knows about hydroxychloroquine because there’s this one doc with a bee in his bonnet about it (and he’s probably biased and sloppy and goes to the media too early and exaggerates.)
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If it’s a cheap generic that *doesn’t* have a crazed fanboy, it’ll have even less apparent “success.” When was the last time you heard Discourse about indomethacin or niclosamide?
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If you don’t like that the “standard of care” is biased towards the interests of a handful of pharma companies...maybe the problem is that you need to be a hundred-billion-dollar company to run a clinical trial that satisfies today’s FDA?
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End of conversation
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