Obviously RCTs are the gold standard. But the more you know the natural history of the disorder, the less you need RCTs Let me give an example. Say you were testing a drug for grade IV glioblastoma. Say it was single arm. And say you had 30% five year survival with your drug. You would then know that either the drug was a winner, or that the data was fabricated. This is because the 5 year survival rate is almost zero for Grade if gb.


Anyway, I am not saying that we understand the natural history of Covid jthat well. But it has received intense scrutiny. And I would be very surprised if at places like Columbia Presbyterian chloroquinine is not being used frequently. So it seems like we would have seen a better signal by now—more series of case reports. BUT I HOPE I AM WRONG. Bookmark this page, and if I am wrong I will happily admit it.

The current state reminds me of part of my medical training—at UCLA right before protease inhibitors for HIV. There was so much pressure to “do something”, and so everything was tried, but no meds were effective. Azt was approved, but did it really help? Public health measures—condoms, fewer partners, were what made the difference.