It would have been completely irresponsible for Trump to hype his “feelings” about the efficacy of the off-label use of malaria drug hydroxychloroquine for coronavirus had he been qualified to offer any opinion on drugs.
Of course, if you take your pharma advice based on Trump’s feelings, you get what you paid for. “What have you got to lose?” is not quite a sound basis to ingest things, but when the alternative is death, it’s a fair question. Using the concept of “compassionate care,” using unproven therapies for people who will die without it gives them a chance. Doing nothing does not.
As it turned out, hydroxychloroquine hasn’t panned out well.
For weeks now, doctors around the country have been giving the drug to patients at various stages of the disease, and as a preventive measure to some if they’ve been exposed by family members or in health care settings. But even after treating hundreds of patients with the antimalarial drug, the doctors interviewed did not report clear results or remarkable recoveries that can be traced to the drug.
China did a study as well, which failed to show much efficacy in treating COVID-19.
This week, researchers in China made public the results of another study of hydroxychloroquine, of 150 hospitalized patients. The study, which has not been peer-reviewed, found that patients who were given the drug did not fare significantly better than those who did not receive it, nor did they experience more serious side effects.
But as much as hydroxychloroquine captured the nation’s attention because Trump took a blind stab at promoting it — hey, if it worked, he would look like a medical stable genius, and if not, he’s not a doctor so it’s not his fault — a new drug has quietly caught fire.
Dr. Brainard is the head of antiviral clinical research at Gilead Sciences, the Bay Area biotech giant whose drug portfolio includes the antiviral medicine remdesivir. On Thursday, Stat, the superb medical-news website, reported some of the leaked results of a pair of Phase 3 clinical trials of the drug at the University of Chicago. Of 113 patients with severe cases of Covid-19 who were treated with daily infusions of remdesivir, most were discharged from the hospital in under a week, and only two died.
The word from friends who trade stock for a living is that what appeared to be the market’s irrational exuberance in the face of cascading bad news and a plan to reopen the economy by having letting people out slowly to see whether they drop dead on the assembly line (which Trump understood to mean LIBERATE MICHIGAN, et al.) was really aspirational thinking about remdesivir. This would be the fix that would cure us of the ‘rona, allowing us to return to work, let out all that pent up demand and spend the pittance Congress provided us.
But like Trump, in a weird way, the market can make dumb bets on rumors, mostly because it adores rumors.
That sounds like fantastically good news, but Dr. Brainard has caveats and cautions. The Chicago story, she told me in a phone interview this week, is still anecdotal. The trial did not include a control group. Hard data, once it comes, can be hard to interpret. “We have to assess whether the drug is working without having a clear picture of what is typical with this disease,” she says.
Will remdesivir be the fix we’ve been waiting for? How the hell should I know. I’m a lawyer, not a doctor, but it hasn’t been as effective as the monkey blood in Outbreak. Yet, there is a point about hopes and wishes, whether it turns out to be remdesivir or something else.
But whether remdesivir turns out to be effective or not — and it’s always wise to curb one’s enthusiasm about supposed miracle cures — the remarkable thing is that it’s available at all.
It was developed by a pharma company named Gilead, no doubt in the hope of making a profit off the drug because companies that don’t make a profit go bankrupt. Had it never been created, it wouldn’t be there to be tested. It may prove useless, but it can’t prove anything if it doesn’t exist.
Given the stakes involved, it seems perverse not to root for Gilead’s success. Just as there are no atheists in foxholes, there should be no big-pharma haters in pandemics. Last year, Elizabeth Warren wrote that “giant drug companies only care about one thing: raking in profits on the backs of patients.” I wonder if the Massachusetts senator would have the nerve to say that to Dr. Brainard and every other private-sector scientist laboring to find cures under the intense strain of this global emergency.
Big pharma sucks. It’s greedy and uncaring. It will let people die if they don’t have the money to pay its outrageous demands. Who doesn’t hate Big Pharma for being awful?
But without Big Pharma, who would have created remdesivir? Or maybe it will turn out to be some other drug that ultimately proves to be an effective treatment, or cure, or palliative or prophylaxis, or whatever it turns out to be. Still, it will happen in some clean room at Big Pharma because of their greed and their investment in the ability to do so.
Like so many things that occur in a complex society, the only thing worse than Big Pharma is not having Big Pharma, as we would win the battle for inexpensive drugs that already exist and lose whatever they would create in the future. This isn’t to say that there can’t be checks and limits on their greed, or negotiations on how many people can die so they can make a profit by selling a $3 pill for $12,495, but wishing them out of existence and wishing for a cure isn’t going to work either.
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