There’s a sentiment of uncertainty that I’ve seen echoed lately. In the wake of the coronavirus pandemic, we struggle to find accurate information, conclusive data, and clear guidelines. Evidence-based medicine (EBM) is being put to the test in our scramble to find a treatment for COVID-19. More than ever, we need a collaborative effort to sort through all the data, experts to analyse it, and an open mind to accept information that goes against our beliefs.
So, this week’s post is all about bits and bobs of information, making what I hope to be a small quilt of knowledge to warm your mind.
CHLOROQUINE
A chloroquine clinical trial in Brazil had one of its treatment arms prematurely halted due to safety issues. This small study enrolled 81 hospitalised patients in the city of Manaus and was posted on Medrxiv last Saturday. Preliminary data found that high doses led to an increased QT interval and showed a trend toward increased mortality, thus resulting in the premature halting of the higher dose arm.
In an interview for the NY Times Dr. David Juurlink, an internist and the head of the division of clinical pharmacology at the University of Toronto, said that “this study conveys one useful piece of information, which is that chloroquine causes a dose-dependent increase in an abnormality in the ECG that could predispose people to sudden cardiac death.” While this was expected from what we already knew from this drug, now we have evidence of this toxicity.
The investigators from the Brazilian study state that “it is still not possible to estimate a clear benefit of CQ in patients with severe acute respiratory distress syndrome (ARDS). Preliminary data on viral clearance in respiratory secretions in our confirmed cases are also indicative of little effect of the drug at high dosage. More studies initiating CQ prior to the onset of the severe phase of the disease are urgently needed.” This last part may be addressed soon; based on what I heard from Dr. Daniel Griffin in the latest TWiV podcast episode, he’ll be the principal investigator in a new trial, which will be double-blinded, randomised, and placebo-controlled. I’ll keep you updated about developments in this trial.
HOW TO PRACTICE EVIDENCE-BASED MEDICINE DURING A PANDEMIC?
When data is scarce and constantly changing, there’s a feeling of insecurity that sometimes leads clinicians to relapse to an experience-based practice. Others take in all the new information, many times backed up by a feeble level of evidence, changing their practice almost daily in an effort to provide the best for their patients.
In an article in Stat News, Dr. Neel Shah gives a wonderful account of his struggle with the deluge of “shaky data” to guide clinical decisions. He ends up his piece remembering that we’re in this together, and writes:
“Equally important, all of us — scientists, health care workers, pregnant people, and the public — need to be willing to rethink what we thought we believed last week. We must approach this crisis with humility and empathy: be willing to listen to each other, to learn from each other, and to understand the perspectives others bring to the situation.”
TWO BOOKS FOR YOUR QUARANTINE
I wrap up this week’s roundup with two book recommendations. I’ve devoured one and am making my way through the other. Both are non-fiction: one is a memoir and the other a scientific reference book.
Curious? 🙂
I’ll start with the one I’m currently reading, because it relates to (EBM). How to Read a Paper: The Basics of Evidence-Based Medicine, by Trisha Greenhalgh, is a guide to help you understand EBM, how to assess a paper, and how to choose your information sources wisely. I’m finding it very informative, although at times it requires more attention and focus than my three kids allow, so I’m making slow progress. The ability to understand and quickly sift trough heaps of new studies is a valuable skill, especially now, so this book is a valuable resource.
The second book grabbed me as soon as I opened it, and it was impossible to put down until I finished it. Educated, by Tara Westover, has won several prizes and caused a clamour of controversial voices over her story. For my part, I peered curiously on her story, wondering how one could grow up without attending school, study (and pass!) her GPA and enrol in University for a brilliant academic path. Her strength and resilience inspired me, and I found fascinating how studying subjects like history, psychology, and philosophy led Tara to find her own perception of the world and escape the one imposed by her father. I believe it takes a lot of mental strength to be willing to discard everything one think he or she knows about the world, analyse a different view, and end up with a unique sense of what reality means. This book deserves every honour and distinction, and it’s worth delving into the different arguments that arose from it.
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