Ok so here’s the news report (I couldn’t find a paper) showing Remdesivir improves time to recovery in #COVID19 niaid.nih.gov/news-events/ni…
And here’s the Lancet study from China showing no mortality benefit from remdesivir: thelancet.com/journals/lance…
You’ll notice the NIH study...also doesn’t show a statistically significant mortality benefit for remdesivir!!
As @MarkHoofnagle pointed out, remdesivir is supposed to work via viral replication inhibition; it prevents RNA viruses from copying their genetic material.
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!!
If your drug works by killing virus or blocking it from replicating, you’ve got to test it on *brand new* cases!
(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.)
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?
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.
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.
Except now, as @MarkHoofnagle notes, remdesivir is “standard of care” & now every other drug has to prove noninferiority! Nice power grab, Gilead!
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.
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.
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
What ordinary lay humans care about — can this drug save lives? can it make #COVID19 close to harmless? — is not even being tested!!!
“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.
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.)
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?
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?
