Yes, this blog is about so-called alternative medicine (SCAM) – but today is an exception.
There has been much news coverage of potential treatments of coronavirus. Some of the candidates such as hydroxychloroquine, have even been tested in clinical trials. However, due to the preliminary nature of these studies, the value of of the drugs remains uncertain.
What is needed in our present dire situation is a large and rigorous trial of already licensed drugs that might have a positive effect. With a bit of luck, such a study could save thousands of lives.
Unfortunately, setting up a trial of this nature is difficult and takes time.
Now the UK’s government has announced that the world’s largest randomised clinical trial of potential coronavirus treatments has been running since 19 March. It was designed, planned, approved and implemented in record time. The study is aimed at testing several promising treatments. If the findings are positive, they will be given to NHS patients as quickly as possible.
Almost 1,000 patients from 132 different UK hospitals have to date been recruited. The trial is testing a number of medicines recommended by an expert panel advising the Chief Medical Officer for England. They include:
- Lopinavir-Ritonavir, commonly used to treat HIV
- Dexamethasone, a type of steroid use in a range of conditions to reduce inflammation
- Hydroxychloroquine, a treatment for malaria
Adult patients who have been admitted to hospital with COVID-19 are being invited to take part. The trial is designed such that, as further promising drugs are identified, they can be added to the study within days. Patients who volunteer are randomly allocated to
- standard care alone,
- or to standard of care plus one of the additional drugs.
The data will be analysed on a rolling basis so that any beneficial treatments are identified as soon as possible.
This study seems like an excellent idea. I do hope it is successful and manages to find a drug that increases the chances of survival. I keep my fingers crossed.
PS
Please note that the scientists did not include homeopathy or other SCAMs into their trial.
29 Responses to The world’s largest trial of possible treatments for coronavirus has started
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Isn’t this the A versus A+B design?
yes, it seems so.
but it would only matter, if we assume that a placebo effect impacts on survival
I’m very concerned. “… it would only matter, if we assume that a placebo effect impacts on survival.” I presume, then, that survival is the predefined primary outcome measure? Because the attributable mortality rate for COVID-19 infections is pretty low (it depends on which dataset you choose) so survival as an outcome will require reliable extra testing to demonstrate a patient has succumbed to CV-19 and not to something else.
The worst aspect of the A vs. A+B design is that it tempts investigators to seek other outcomes and engage in the kind of shambolic data mining we so often complain about with SCAM trials. I do hope you’re right to be confident about this trial, particularly considering the enormous political pressures it will be under to come up with something.
I am merely assuming that it’s survival or all cause mortality;
and I can see your point.
Thank you for sharing. I haven’t had the time to comment on your blog recently, but your articles are much needed in a time where SCAM artists are looking to capitalise on the uncertain nature of this virus. They’ve been a great read. Keep them coming Prof Ernst!
Hope all is well your end. Non-SCAM update: some of us final year medics are taking our final exams (some have already done so) and will be joining our NHS colleagues in the next few weeks as FiY1 (Foundation interim year 1) doctors. The emotions fly between anxiousness and excitement at this rare/strange opportunity to help (as much as we novices will be able !)
BW
many thanks and good luck to the students.
“Please not that the scientists did not include homeopathy or other SCAMs into their trial.”
And this I think is the biggest mistake they have ever done! And I think future will show this, as they haven´t learned from the past!
https://nesh.com/the-new-england-journal-of-homeopathy/vol-7-no-1-springsummer-1998/influenza-1918-homeopathy-to-the-rescue/
Ceterum censeo:
I think it is DANGEROUSLY UNETHICAL to withhold ANY (!) POTENTIALLY (!)(!)(!) ADDITIONAL (!) therapy from a purely dogmatic stubbornness, especially under the given dramatic circumstances.
This from a practical therapist und not from theorizing cynicism!
People in the homeopathic clinics in New York 1918, where the death rate was strikingly lower, did not ask, if their survival was evident, they were just very-very-very happy!
If YOU are in this state of health with with life-threatening shortness of breath, and schoolmedicin [in this stadium!] can´t help YOU [I don´t talk of the stadium when ICU with ventilation is needed and beneficial lifesaving], YOU will welcome And TRY EVERYTHING which MIGHT help YOU.
And if you want, several patients can tell you personally how threatening it felt bevor and how liberating after the IMMEDIATELY effective remedy! Far beyond placebo!
https://homoeopathiewirkt.wordpress.com/2020/04/04/update-4-4-20-influenza-cough-and-covid19-suggestions-for-genius-epidemicus-can-homeopathy-which-we-therapists-use-responsibly-help-when-conventional-medicine-reaches-its-limits/
hello pigeon!
are you ready for playing chess again?
WE HAVE COVERED THE FACT THAT HOMEOPATHY IS NOT A POTENTIAL THERAPY [FOR ANYTHING]!
so, hush and fly off.
stuff and nonsense!
@Dr. Hummer
You may be interested in something I just tweeted with a link to the statistics: “Daily stats show countries where the use of #homeopathy & #homeopathic treatment is not discouraged, the % of deaths per 1 million patients with #coronavirus #covid19 is low. India 0.07; Cuba 0.5, Germany 18; Greece 7; Mexico 0.6.
https://www.worldometers.info/coronavirus/?fbclid=IwAR3daOZjCNAVFyHSREqL-BDBxBftWn9B9AFVnr-j6AuUMIj_WqQeZ49U-xA#countries
Link to my tweet: https://twitter.com/BrownBagPantry/status/1246807253027450880
Hello Sandra, would you like to apologise for the fraudulent tweet you put out about Kevin Smith’s post?
AS TO YOUR COMMENT:
that is the weirdest statistic I have seen for a long time [it reminds me of the one where someone correlated the number of storks in different areas to the number of births.
HERE IS SOME NEWS FOR YOU:
children are not brought by storks, and homeopathy is not effective beyond placebo
Hi Sandra!
Did you know that per capita cheese consumption in the US correlates well with the number of people who died by becoming tangled in their bedsheets? Correlation: 94.71% (r=0.947091) Data sources: U.S. Department of Agriculture and Centers for Disease Control & Prevention
See here for more fascinating spurious correlations.
Thanks. I used to like cheese. Maybe I’ll just sleep without sheets.
You don’t think that the number of deaths per million patients with coronavirus might vary according to how well each country is able to record them?
In any case, your numbers are completely wrong. Today’s statistics are as follows:
India: 722 cases, 16 deaths, deaths per million cases = 16 x 1,000,000 / 722 = 22,161 (not 0.07)
Cuba: 67 cases, 1 death, deaths per million cases = 1,493 (not 0.5)
Germany: 43,938 cases, 267 deaths, deaths per million cases = 6,077 (not 18)
Greece: 892 cases, 26 deaths, deaths per million cases = 29,148 (not 7)
Mexico: 475 cases, 6 deaths, deaths per million cases = 12,632 (not 0.6)
Not that these figures actually tell us anything useful.
Sorry, my figures are out of date – I forgot to refresh the Web page I got them from (worldometers.info). These are today’s figures:
Cases Deaths Deaths per million cases
India 3,588 99 27,592
Cuba 320 8 25,000
Germany 100,009 1575 15,749
Greece 1,735 73 42,075
Mexico 1,890 79 41,799
However, they are meaningless as we don’t actually know the total number of infections in each country, only those officially recorded, we don’t know the number of actual deaths, and the numbers are changing so quickly that dividing one by the other will give you a different answer depending on when you do it. So I’m really not sure what point Sandra is trying to make, unless she is intending to compete in the next Maths Olympiad against Diane Abbott.
Whaaaat?!?
Dr. Money-Kyrle… are you suggesting that Sandra isn´t able to do even simple rule of three calculations?!!
I am shocked…
🙂
You are absolutely correct. That would be dangerously unethical IF—and I stress IF—the therapies had potential. They do not. So, stop crapping all over the chessboard and be thankful there are professionals out there looking after your best interests. Clearly, you cannot do it yourself.
@Dr. Hummer
Sad that Prof Ernst did not suggest a trial that would includie homeopathy. According to the updated stats on April 5 from the same source I referred to in my last comment, the UK has reported 47,806 patients with coronavirus. Of those, there have been 4,934 deaths and only 135 recovered.
https://www.worldometers.info/coronavirus/country/uk/
I think the new Florence Nightingale hospital in London, announced by Prince Charles, will supply interesting statistics in the near future.
… not that you are in the least able to interpret statistics, fraudulent Sandra dear!
Edzard, time will tell, who is the pigeon!
and although your type of discourse is associated with many ad homin deprivation strikes, I give heartfelt advice to have Lob-p with you, because it could be quite important for someone in your area to take a breath, like many here were allowed to experience …
Far beyond Placebo!
Heinrich:
“Edzard, time will tell, who is the pigeon!”
Is 200 years not enough?
@ Ernst
You’re such a sweetie! We really must meet the next time you visit the United States.
Or, we could meet at your favorite upscale eatery the next time I’m in London. My treat.
You could share a glass of homeopathic wine aka water.
Homeopathic lager, surely?
Sandra
Why should a trial include homeopathy? It is nonsense. Medicine knows this. The fact that your imaginary therapy is completely and utterly ignored by medicine should demonstrate to you the contempt in which it and its delusional supporters are held.
This is not a small group of vocal skeptics telling homeopaths, homeopathy, and its witless proponents to f**k off. It is the whole of western science-based medicine.
You’re old, Sandra. And in the vulnerable group. And plainly confused. Stay isolated, wash your hands and take care. Your sugar pills will do nothing to protect you. Taking sensible precautions will.
Exclamation marks are not pack animals!!!einself111
more info here:
https://www.ft.com/content/f4e3055e-72e2-459d-ba66-05af7d2c8915?sharetype=blocked
good BMJ article on the trial
https://www.bmj.com/content/369/bmj.m1626?utm_source=etoc&utm_medium=email&utm_campaign=tbmj&utm_content=weekly&utm_term=20200501