OPINION
Following the science
Evidence-based medicine and therapeutics has been the bedrock of healthcare decision-making for the past two or three decades . So how well has it served us during the coronavirus pandemic ?
“ We ’ re following science ”, they cried as every new measure was introduced to control the pandemic , reduce the spread of infection and save the National Health Service . This gave the impression that decisions were based on evidence and had been carefully evaluated . However , it was soon apparent that some good evidence was being ignored or side-lined . So , how well did this turn out ? Two examples of medicines-related decisions serve as examples . One concerns the use of a repurposed ‘ old ’ drug and the other a newly-launched drug .
Before considering the specific examples , it is worth looking at the general question of whether to use repurposed drugs or new drugs in a pandemic situation . In the early days of the pandemic , a large number of possible candidate drugs for repurposing was identified . 1 , 2 Another starting point was reports of research undertaken during the first SARS outbreak .
The case for using repurposed medicines is that they have long-established safety records , are usually cheap , generic drugs , are readily available and likely to be effective against all variants . It relies on finding a metabolic process essential to viral survival that can disrupted or blocked by an existing drug . As we know , most drugs have more than one action – and there are many examples of drugs that have been repurposed including for example , for example , indomethacin for closure of patent ductus arteriosus and minoxidil for hair loss .
New drugs , on the other hand , including vaccines , have been developed rapidly to target specific aspects of viral biochemistry but will necessarily have had limited efficacy and safety testing . Some of the new drugs are biologics so manufacturing is complex and may be capacity-limited ; they are also expensive . Fortunately , we have experienced people in the drug regulatory agencies who are able to scrutinise and evaluate trial data carefully and decide whether new drugs are suitable for use . However , in practice there seems to have been a strong bias in favour of new drugs and this may not be in our best interests .
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6 | Issue 100 | hospitalpharmacyeurope . com