
New York clinical trial quietly tests heartburn remedy against coronavirus - ncavig
https://www.sciencemag.org/news/2020/04/new-york-clinical-trial-quietly-tests-heartburn-remedy-against-coronavirus#
======
warmfuzzykitten
Not quietly. By mid-day people were buying up all the Pepcid AC they could
find.

[https://www.businessinsider.com/heartburn-medicine-pepcid-
sh...](https://www.businessinsider.com/heartburn-medicine-pepcid-shortages-
famotidine-studied-coronavirus-covid-treatment-2020-4)

------
IAmEveryone
Let's hope for the best. But his article reads too much like Michael Crichton
for my taste.

> Hospitalized COVID-19 patients on famotidine appeared to be dying at a rate
> of about 14% compared with 27% for those not on the drug, although the
> analysis was crude and the result was not statistically significant.

That's a pretty large difference. For it not to be statistically significant,
n is unlikely to be >50.

Since I doubt anything close to half of any random sample (?) takes this drug,
we'd ideally want the control group significantly larger than the treatment
group.

The solution I've come up with is 1/7=14% and 3/11=27%. Which also explains
why they don't disclose these numbers.

It's important to note that there's really isn't a single virus that we can
cure with a cheap and benign drug. Or really any drug. HIV took 40 years,
untold billions, and is an uneasy stalemate more than a cure. HEP C is curable
in the sense that most patients will rapidly improve upon hearing about the
costs and side effects. Herpes? Influenza? Nope & no. Rabies? Standard of care
is, or should be, a gun. Measles/Mumps/Ebola/Marburg/Lassa/HEP A/B/D/E? Not
one cure!

Then, there's the "classified" protein docking simulations. I used to work in
unclassified protein docking studies at a Max Planck I. If we had known there
was an option to get our work classified, that would have done wonders for our
careers! Unfortunately, all our failures happened out in the open, just as
everyone else's.

This idea of "designing" molecules to act with some specific mechanism that
you come up with by studying 3d-structures and running molecular dynamics
is... controversial. As of five years ago when I left it was about as useful
as astrology. Maybe it has improved: some parts are near-perfect scenarios for
DNNs. But I somewhat doubt it. Even for molecules where we know the exact
interactions they participate in, we suck at predicting the effect: you meddle
with a bit of NO and every physiological textbook predicts it will lower blood
pressure. Then you test it with some volunteers and they start stashing the
stuff because it gives them a boner. And blue vision, somehow...

In as far as small-molecule drug research is still happening (as opposed to
more lucrative and potentially far more powerful biologicals) it still happens
the old-fashioned way of screening "randomised" candidates, only on far larger
scales than ever: start with some structures that have been successful in
similar situations, collect a few thousand variations based on your gut
instinct, some simulation, and what's left over from that experiment the PhD
candidate was running until she bit of that hamster's head in frustration
Sunday night. Throw away everything that would kill you, throw away everything
that might explode, throw away everything your target bacterium eats like ice
cream, throw away everything that makes the mice question their job choices
and intentionally fail the swim test, throw away everything Martin Shkreli has
patented. Then spend a billion trying to find out how cancerous the two or
three candidates left over _really_ are. Yes, that's the _good_ process.

Maybe we get lucky! This probably deserves to be tested, especially
considering how cheap and safe it is. (Far too much bandwidth was wasted on
you-know-what because of you-know-who that should have been used to go wide).

But I'd put chances of a successful drug treatment at <5%, some improvements
in treatment protocols (ventilation etc) that cuts deaths by half or more at
maybe 25%, and a vaccine at >80%. It also seems to me that our chances of
eradication-through-behavioural-changes are underestimated: finding a way to
sustainably push R<1.0 will, eventually, lead to eradication. Get < .5 (tests!
tests! tests!) and it's a matter of weeks.

~~~
oblib
You're right, and the article does agree with you.

But this is not a story hyping a potential cure. It's a story about how our
front line healthcare workers are trying everything they can in an effort to
find something that works and sharing whatever they get a glimpse of having
potential.

The collaborative effort is impressive. And we're lucky to have the tech to
share information so quickly. That has it's drawbacks too. For example, I
won't expect to see any Pepcid on the shelves already.

