Too Much Caution Is Killing Covid Patients

Doctors should follow the evidence for promising therapies. Instead they demand certainty.

By Joseph A. Ladapo. Dr. Ladapo is an associate professor at UCLA’s David Geffen School of Medicine. Excerpts:

"For diseases with established treatment options, holding out for certainty may be prudent. But when options are limited and there are safe treatments with evidence for effectiveness, holding out for certainty can be catastrophic. Requiring a high degree of certainty during a crisis may elevate the augustness of medical organizations and appease the sensibilities of medical professionals, but it does nothing for patients who need help.

The penchant for certainty is visible in the frequently updated treatment guidelines for Covid-19 from the National Institutes of Health. These guidelines were developed by scientists around the country, but because of a mentality that is biased toward virtually irrefutable evidence, no distinction is made for treatments with evidence for effectiveness that falls below the mark of certainty. This framework almost certainly has contributed to many avoidable deaths during this pandemic.

Take the antidepressant fluvoxamine. A high-quality, randomized clinical trial of 152 patients published in the Journal of the American Medical Association found that zero patients treated with fluvoxamine within seven days of the onset of symptoms experienced clinical deterioration compared with 8% of patients receiving a placebo. 

Another randomized trial of 200 health-care workers and other adults at high risk of exposure found that 2% of those treated with the antiparasitic ivermectin developed Covid-19 compared with 10% of patients in a control group. A meta-analysis of five randomized clinical trials showed that early use of hydroxychloroquine reduced infection, hospitalization and death by 24%. All of these findings were statistically significant. These medications have been used for decades and have safety profiles comparable to other commonly prescribed medications. This includes hydroxychloroquine, a medication routinely prescribed to pregnant women and breast-feeding mothers.

Uncertainty may remain, but all three medications have demonstrated at least a reasonable likelihood of success when used in early Covid-19 illness or for prevention. Other promising agents include the plant-based compound quercetin—which is being studied in a clinical trial and was used by Sen. Ron Johnson, chairman of the Homeland Security Committee, after his Covid-19 diagnosis in October—and the congestion medication bromhexine, which reduced death rates among hospitalized patients in a randomized study published by BioImpacts."

"While some health officials dismiss nonrandomized studies, the Cochrane organization, an international leader in evidence-based medicine, published a review of several hundred studies showing that randomized clinical trials and nonrandomized studies of treatments generally yield similar findings. Modern epidemiologic and statistical methods can usually overcome biases inherent in nonrandomized study designs."