WebGyan- Dr. C. S. Pramesh: Has COVID-19 research set back evidence-based medicine?

Event date and time: 
Thursday, July 9, 2020 - 15:00


On 9th July, the 5th of the WebGyan series featured Dr. C. S. Pramesh, the Director of the Tata Memorial Hospital, a person who wears many hats in the biomedical field in India. In his talk, Dr. Pramesh tackled the question, ‘Has COVID-19 research set back evidence-based medicine?

The COVID-19 pandemic has emerged as a public health emergency globally, and this has created immense urgency among the biomedical research community. Over 30,000 papers have popped up on COVID-19, while research faces the major challenges of this time: difficult regulatory processes, and the risk of over-interpretation of results remains with each paper.

At this time of high public fear, communication of good science must be careful, and pseudoscience must not be given a place to thrive.

The tests of various treatment options need to be conducted in large-scale trials, with large numbers of patients and appropriate controls.  Randomisation of the trials is important to counter  bias and placebo effects have been seen in many clinical trials in the past. Despite the widespread nature of this pandemic the opportunity to conduct mass trials with multiple stages and branches of testing still exists.

In the case of antibody-mediated immunity, and studies of this, there are still technical concerns about some tests. Antibodies against COVID-19 do not appear in all patients equally, and don’t seem to be long-lasting, disappearing in 2-3 months. The good news is that T-cell immunity is more active than anticipated, and does not appear to depend on severity of the COVID-19 disease.

Dr. Pramesh covered several of the more controversial studies of COVID-19, including the original Remedesivir trial that had more authors than the sample size. In contrast, the RECOVERY Trial (Randomised Evaluation of COVID-19 Therapy) in the UK studied 12,000 patients across 176 hospitals and identified Dexamethasone as a potential drug for treating COVID-19, though this is still under study. Having multiple arms and multi-stage studies of simple design seem to be a good way forward for urgent public health crises such as this.  Clear data can be used to scrap treatments that do not work, and test new treatment options.

The need to put public health over personal credit, and to practise cautious communication of data is something Dr. Pramesh strongly emphasised as well. Ending on a positive note, he highlighted the massive rise in collaboration and research across national borders, recognition of the importance of good public health care, and faster approval for necessary processes.

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