There’s yet another new report out this week on hydroxychloroquine, the anti-malaria drug promoted (without evidence) by President Trump as a treatment for COVID-19. Bottom line: the nurses who took medication in hospital did not appear to be any better off than people who did not take the drug. Because of heart side effects certain people had to avoid taking the drug.
The study is not yet released and has not gone through the normal examination process but doctors are starting to work through their conclusions. For medication it is not a positive indication. Yet this one analysis is not, either, a killer blast.
That’s because a single study or clinical trial seldom offers incontrovertible evidence to disprove or support a claim—especially if the research is small, like this one. Rather, to direct patient decision taking, it takes evidence from several broad trials and experiments to build up. Everyone is looking for information around COVID-19, and any new data point added to the pile has more eyes. Seeing real-time at the cycle reveals how complicated research can be.
This particular study of hydroxychloroquine involved 181 individuals, which is limited enough that scientists would fail to draw substantial conclusions from its results. This was also carried out on people who were not ill enough to be admitted to hospital. Other treatment trials have since been conducted in sick patients, and also drawn equally negative findings about how well it performed. But other clinical trials are also investigating how well it performs in patients who are not as infected, and how it can prevent individuals who have not yet contracted the virus from having the most serious COVID-19-related symptoms.
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Scientific analysis typically does not have yes or no responses. Any new piece of evidence, however, tilts the balance in one direction or another. As it’s happening, physicians make tentative decisions depending on where they see the balance moving — as more research on hydroxychloroquine begins to be published, others opt not to use it, and some will choose to seek. They cannot honestly say they know for certain whether it would operate or not. It is still a largely unanswered issue so for now, patient-by-patient decisions on treatment must still be made.
The balance of facts will ultimately converge into a finding where experts are more secure. This could happen if researchers collect all the evidence from several small experiments and analyze it in a meta-analysis as a group — that’s what could happen with the dozens of small hydroxychloroquine trials that have already been published.
Perhaps better, from broader trials, we might be having more definitive results. For example, Solidarity Experiment by the World Health Organization is researching several drugs (including hydroxychloroquine) in hundreds of countries. The anti-viral remdesivir trial, which aims at affecting hundreds of patients, may also offer a better signal. It takes more time and money for these types of studies but they yield more definitive outcomes.
