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Snake oil and voodoo - false medicines during COVID-19

A walk through the nonsense remedies we have seen for coronavirus


It's unsurprising that we have seen false medicines suggested for coronavirus. There are plenty of motivators. Fear. Money. Ego. It's one of the more frustrating elements of the crisis. In another life I had a lot to do with medicines from an economics perspective, so the false evidence cuts close to the bone. As an economist many of my posts are about economic topics like recession and economic forecasting. In this post I'll talk about some of the false remedies we have seen throughout coronavirus, the clinical trials process and the importance of health literacy. I am weary of telling you what you already know, odds are if you are reading this post, you already know we need high quality evidence for medicine. Hopefully there is something you can take from this for those who are more susceptible to bullshit.


False hope


These false "cures" can be deadly. In Iran there is the tragic case of people drinking methanol to protect against coronavirus. This has killed hundreds. News of alcohol as a cure spread through social media at a time when people had little trust in the Iranian Government. Cases of methanol poisoning put extra pressure on the health system at just the wrong moment. With no known cure I can understand how this type of thing can happen. Public health authorities have to be especially vigilant at times like this, though I don't know what they can do about it in the moment. Health literacy is built up over the years ahead of a crisis. If you have to devote a lot of resource to fighting false remedies in a crisis you have already lost.


Trump's UV light and disinfectant speech is one of the most egregious examples of false remedies so far during coronavirus. That he is an authority figure makes it so much worse. It goes without saying that treating yourself with disinfectant is ridiculous. That the President of the United States would come out and say those things is beyond belief. Frankly, I don't know where it comes from. No qualified medical people would suggest such a thing. The scary thing is that there is a reasonable chance some people will follow through on his advice.


I don't know if Trump really believed what he was saying on this issue and if he intended it to sound like he was suggesting a cure. Some people do think out loud. Perhaps I am being too generous. The President of the United States though is held to the highest standard and must give excellent quality information. Lapses of judgement (or stupidity, whatever you want to call it) from him are a much worse crime than they are from some random person on the street.


It is critical to review the evidence available for a medicine. Herbal remedies are popular reflecting tradition and the notion that they are natural, however they may not always have a robust evidence base. There has also been plenty of talk of herbal remedies to alleviate the symptoms of coronavirus. Do they work? For any medicine, we need to make sure there is adequate evidence. Fact check. By that I don't just mean google it, I mean find the actual study and make sure it took place. It's entirely possible to make up some nonsense about a clinical trial that never actually happened. Clinicaltrials.gov is your friend. Cochrane Reviews are also useful, they produce high quality meta-analyses of evidence to create event stronger assessments of medical interventions.


I don't blame people for seeking cures. That is a natural human response during a dangerous time. Ignorance and uncertainty are an unfortunate combination and people can be taken advantage of. The people who suggest and sell these cures are criminals. Everybody wants a cure for coronavirus, but there is a proper process for medical research. There is the risk that medicine can do more harm than good if it isn't adequately tested and determined to be appropriate for consumption.



Test, test again, retest, and then, just to be sure, test again


Broadly speaking there are four phases of human testing before a new medicine is brought to market. New medicines don't always go this exact route, they may skip straight to phase one, or be given accelerated designation. But the point is that they are extensively tested before being consumed by lots of people.


Phase zero trials test a very small amount of drug in a very small number of people (e.g. 10). Essentially these studies are exploratory and used to determine if the drug behaves in a similar way in people as it did in animals.


Phase one studies raise the stakes. More people are tested, typically about 50-100. Various doses of a drug are tested to find the right dose. All this is doing is finding out if the drug is safe. Whether the drug works to treat the disease it is meant to treat isn't too important yet. Just because a drug passes a phase one study doesn't mean it can be used to treat cancer.


Phase two is about testing the efficacy of the drug and adverse events. More people are tested, usually 150-250. Optimal dosing might be investigated where researchers determine the appropriate dose given side effects. We start to find out if the drug actually works to treat a disease. Researchers might measure response rates or the time it takes for a disease to get worse..


Phase three is the toughest test of them all. Researchers want to understand if the drug works in a real setting. Usually these are randomised controlled trials where some people get the new medicine and some people get the existing standard of care. There are strict inclusion and exclusion criteria. Additionally, patients and researchers may not even know if they are getting the new drug or the old drug. This is called blinding. Effectiveness measures are tested that tell us if the drug works in a meaningful way, such as overall survival.


Jumping over all these hurdles is a stiff test, and the majority of new drugs fail. That is how it should be. The coronavirus vaccine will have to make it over all these hurdles too. There are no medicines that have been fully tested for coronavirus at this point. We shouldn't treat people with medicine that doesn't work. It isn't enough to sell someone a placebo effect. People deserve better than that.


Health literacy is critical


Some countries had issues with health literacy prior to coronavirus with vaccine hesitancy, and people questioning clinical experts. That doesn't help at times like this. Poor health literacy makes people more susceptible to nonsense health information. Unfortunately we have seen several breakdowns in health literacy with people taking false medicines or protesting in large groups despite potential transmission. Trump's comments are the most notable example of health illiteracy. Having a health literate population in a pandemic situation is critical to controlling the spread of the virus and false information.


To an extent you might feel that on issues like vaccines the battle was already won and it's only stupid people who skip vaccinations. That is very lazy. Some of the most vulnerable who miss out on vaccines are children. Not to mention maintaining high levels of health literacy is critical for herd immunity. I hold governments and the health community responsible for making sure people are health literate. Yes people are stupid and they may not take their medicine. But it is literally part of the job of health professionals to educate them.


Health literacy is built up over years. You can't just show someone the data and expect them to be health literate. People don't change their minds that fast. That's why if society doesn't have good health literacy by the time we hit a pandemic, it's already too late. Building up sufficient health literacy must happen prior to a crisis. From teaching science in schools to effective health promotion through hospitals and primary care it all plays a role. A health literate population is a healthier population. People are able to make better choices around what information they believe or how they interact with others. That is critical during a pandemic.


If a medicine sounds too good to be true, it probably is. We must follow medical advice to keep each other healthy. Coronavirus has tested everyone's patience. Stay safe and stay home. Hopefully it won't be for too much longer.



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A New Zealand based politics and economics blog

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