Some experts are optimistic that this will indeed be a "huge advance" or "profound game-changer" based on a study in which people in high-risk groups who took the drug during the early stages of COVID were 50-ish percent less likely to require hospitalization compared to a placebo group.
My initial reaction is that does seem great. Of course, I also have questions. And I can't wait til "game-changer" is over. (Game's the same.)
This is probably good news, but we also shouldn't get ahead of ourselves again. The drug won’t (and doesn’t claim to) stop people from getting COVID, but it does seem to help make the disease less severe if taken early on. Assuming that people are willing to take it.
I’m not being glib in suggesting that; it’s an unknown, and I'm taking nothing for granted at this point in the pandemic.
Merck also makes ivermectin, for example, and the company urged people not to take its productto fight COVID because there was "no scientific basis for a potential therapeutic effect" and "a concerning lack of safety data." People took it nonetheless. And when they couldn't get a prescription, they bought a veterinary version. Now the horses can't get their medicine, and some horse owners are apparently worried about the stigma of attempting to procure it. Weird times.
The drug is also, it's worth noting, not as effective as being vaccinated. And far more expensive (more on that later).
Its existence is absolutely not a reason to forego vaccination. If people believe it is, there could be a paradoxical decrease in vaccination rates. In the process, more people would be leaving themselves open to spreading the virus to others.
But maybe this drug will exist in a middle ground that appeals to a segment of the population that doesn’t feel comfortable preventing COVID entirely but would seek medical treatment at the onset of mild symptoms—and take 4 pills every 12 hours for 5 days, even if they start to feel better after two or three. (Antibiotics have taught us that people very often stop taking things as soon as they feel better.) That sort of regimen would likely work well for patients who seek treatment early and take medical advice very seriously. Which patients are also likely to have been already vaccinated.
Being sick has a way of making people suddenly less skeptical of medical science. Maybe this drug will supplant horse paste in the popular imagination and unvaccinated people will take it in evidence-based regimens and doses, even despite emphatic recommendations of doctors that they do so.
That's key, because it doesn't work if people wait until they're gasping for air. The big caveat is that the drug won’t help if you’re already very sick. If you wait too long, the virus just isn’t the issue, as ICU doctor Darren Markland this week described in a [emoji of a thread] about what it’s like to be treated then, where you’re unable to speak and hurdling towards death, unconscious and being constantly infused with myriad medications to which you can't even consent because you didn’t trust a 0.3 milliliter shot:
Truly, I hope this medication helps people before they get to that point. It clearly seems to have the capacity to. Whether we let it is up to us.
Human behavior has been the only real variable in this pandemic, and no one seems able to predict, explain, or understand it. I've never presumed to begin to.
The invisible hand of the free market has determined that if an industry has enough money they can lobby effectively enough to avoid being subject to the invisible hand of the free market.
For example, the U.S. government long ago agreed to buy $1.2 billion worth of the above Merck drug (molnupiravir) at a cost of around $700 per course of treatment, even before we knew if it would work. That means it’s roughly 15 times more expensive than getting vaccinated. It’s also less effective and doesn’t prevent you from getting sick. So you might think there would be grounds to negotiate that price. But no. We had to agree to buy it, even if it didn't work, just to incentivize development of the drug.
This is false. The truth is that the vaccines we have, and this new drug and others, were born of years of forward-thinking research that no drug company would invest in until enormous profit was almost certain. Which may be smart business, but isn’t how you stay ahead of pandemics. Or anything else.
Some of you have asked me about this, and I’ll direct you to infectious-disease doctor Stephen Thomas (who was also a regular guest on Social Distance) who wrote this week to clarify a few misconceptions. Among them, fears of vaccination during pregnancy:
Whatever happens, I’m reminded, we’ll find something to worry about.
I’m not quite ready to go back to engaging in the fat-versus-carbohydrate wars again, but the Times is. They're also back to debating the health effects of social media. In both cases, the consequences are clearly substantial, but the solutions are not simple. As for social media platforms, debates usually return to the same old "good or bad" binary that defines so much in health. It's never so simple. Except in the case of Bud Light pumpkin spice seltzer.
Like most of you, I have a love-hate relationship with all platforms. I appreciate products that cater to my interests and preferences, and then I resent them when they do. (This is also how human relationships work.)
The health effects of social media are both serious and complex, and I'm still not sure of much in terms of regulation. Killing companies and banning platforms is still a reflexive suggestion that feels like playing Whac-A-Mole. (If you're new here and coming from Twitch, Whac-A-Mole was a game developed in the 1970s where innocent children were implored to smash animatronic mammals with an enormous mallet before they could return to their homes in exchange for paper tickets.)
I'm old enough to remember when we worried that Google was making us stupid, and the answer was yeah but it's easy and I like it so meh ... sorry what were we talking about? Ultimately we kept using it because no one wanted to use Bing.
And when we do manage to ban things, like marijuana or (briefly) alcohol, new problems arise. (Mass incarceration makes us all sick.) Though I get the impulse. My immediate reaction upon seeing that Bud Light was launching a pumpkin-spice seltzer was to yell for it to be banned (to myself, alone in my office).
But it won’t be banned, and people will drink it ironically, and then the irony will fade and they’ll just be drinking it. No good will come to anyone, and we'll act like there's nothing to be done about it. MarketWatch will ask if this product needs to exist, and the answer will be a resounding no. If you really watch the market, MarketWatch, you'll notice that the abiding interest is profit. Products don’t firstly exist because they’re needed; it's just a nice bonus when they are. More often, the sense of need is artificially created by the invisible hand of marketing and advertising.
One of the clearest lessons of this pandemic—as we look toward the next one—is that this system of creating, making, and buying is an enormously costly vulnerability. It's like waiting to build tanks until war has broken out, and then letting the tank makers (tanksmiths?) name their price. The approach is unsafe, untenable, unjust, and almost everyone dislikes it. We could take disease preparedness as seriously as we do military preparedness. But apparently it's not going to change.
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Sarah Conrad Yoder
i absolutely love this weekly newsletter. i didn't necessarily want to have to subscribe through FB, as I've been trying to stay off FB, but to comment I had to apparently. Anyway, keep up the good work. You make me think AND you make me laugh. Bot…
Erma Bombeck & David Sedaris all wrappeed up in a physician's lab coat (ever so lightly splattered with pumpkin-spice hard seltzer?) With facts and supporting links to boot! Thank you for this, and for you wickedly dry sense of humor. Looking forward t…