Many wonder whether potentially promising announcements about medications like hydroxychloroquine and azithromycin, or the re-purposed Ebola drug remdesivir, represent the long-awaited cure. How about interleukin-6 inhibitors, or even marijuana? Others ask whether the vaccine is going to work, and if that breakthrough will allow us to return to normalcy. (READ: The latest in the global race for a coronavirus vaccine)
Unfortunately, the answer is not so simple.
What constitutes a cure or prevention strategy for one may not work for another. In medicine, we gauge the efficacy of most treatments based on probabilities: vaccines for the common flu decrease the likelihood of getting the flu that year, but do not guarantee prevention. Many blockbuster anti-cancer drugs work only for a fraction of patients. This variation is simply a function of the inherent variability in biological systems.
Something that has become clear to me, in working in science and medicine, is that there are no silver bullets. Believing in a miracle cure – perhaps a more comforting, black-and-white heuristic – especially in our era of pandemic, can be a very dangerous way of thinking.
The promising results of an early hydroxychloroquine and azithromycin study suggested that for a particular severity of COVID-19, the treatment may expedite the decrease in viral load. On closer read, however, the “trial” was hampered by several critical methodological flaws (small sample size, faulty control groups, and exclusion criteria). Taking this treatment without first seeking medical advice puts patients with particular prior illnesses at risk for potentially dangerous side effects. Following the American President Trump’s pseudo-prophetic exaltation of this therapy, we heard news of many people being harmed and even dying from attempts to make use of this medication. A treatment that is potentially helpful for some may therefore not be the best option for others.
My time in medicine has shown me that it is next to impossible to “know” something for sure. Even the gold standard in medical research, the randomized controlled trial (often, “RCT”), which attempts to control for biologic variability, ultimately reports probabilities. Something is more or less probable to improve symptoms. The findings of a study reflect truth to a certain degree of probability.
We can have evidence that some things are more likely than others, but are still betting on non-zero odds that we may be wrong. Therefore treatments, whether for cancer or coronavirus, can modulate the odds of improvement but offer no guarantees. Certainty remains elusive.
The lessons here have applications that go well beyond medicine. In the same way that a drug may work for some but not others, so too do political reforms, belief systems, and even food preferences. Things are very seldom fully right or fully wrong.
Take for example the political divides that exist in our country and many others. I don’t think any one political system or leader can singlehandedly end our societal ills. Much in the same way that hydroxychloroquine and azithromycin may help some but not others, so too do political ideologies benefit some aspects of our lives (and societies) and impair others. (READ: U.N. adopts resolution calling for ‘cooperation’ on virus)
Those of us who grew up reading the Bible can often feel that the world must be seen as good and evil, dichotomized between God and the devil. But on closer read, as one sheds the simplistic view of good-cop-bad-cop (or good-Samaritan-bad-Pharisee), it becomes clear that such a wizened text also invites the consideration of nuance. Think back to the scene in which Christ is put before a woman caught amidst adultery, and is asked whether or not by the law of Moses she should be stoned. Jesus turns to the elders, saying: “He that is without sin among you, let hm cast the first stone.” And they peel off one by one. Neither the woman nor her accusers were fully good or fully evil.
History has demonstrated that a sledgehammer (or hammer and sickle) approach to leadership very rarely ends well. The militant adherence to communism that was at the heart of the Bolshevik Revolution resulted in untold loss of life. Hitler’s Germany swore total allegiance to the Third Reich and to racist and anti-Semitic ideologies. Many must have felt so certain as to die for these ideologies. Today, the black-and-white rhetoric that suffocates much of social media erases the potential for productive dialogue. In so doing, we often forget to listen to the other side. Thinking and deciding without nuance is the equivalent of covering our ears and shouting.
This, too, can be a very dangerous way of thinking.
I am by no means sounding a call to give up on our ability to improve our human condition, whether through medicine or through societal reform. This is instead an invitation to think critically about the choices that we make in these trying times. In the wake of the COVID-19 pandemic, we will be asked to reexamine our global priorities, the structure of businesses and government, and perhaps even our interpersonal relationships. The global tragedy has illuminated the contrasts in the ways in which we live. In knowing that in science, morality, politics, we can very rarely know anything for sure, we must therefore be careful to ask what the other side has to offer.
This framework should not represent an admonition of our attempts to elucidate treatment or progress. Instead, it should serve as an invitation to examine the world around us with a little more nuance, and perhaps with a little more humility.
Lest in covering our ears and shouting we drown out the whispers of truth. – Rappler.com
Edward Christopher Dee is a fourth year medical student at Harvard and a research fellow at the Dana-Farber Cancer Institute in Boston, Massachusetts. He is from Metro Manila, Philippines.