"PHILOSOPHICALLY SPEAKING...":

Which takes precedent: research that could benefit thousands or millions of individuals or the medical needs of a single patient? Doctors have grappled with this question since the early days of the coronavirus pandemic as they have tried, simultaneously, to care for patients and to contribute to medicine's understanding of what works and what doesn't. This article from The New York Times Magazine profiles the debate and the decisions medical professionals were trying to make in the absence of information.

"Narasimhan, who was in charge of more than 20 I.C.U.s across the Northwell Health system, knew heading into the meeting that it might be tense. Adey Tsegaye, a pulmonary-critical-care doctor who was calling in remotely, shared some of Narasimhan’s concerns. The meeting’s agenda included time for remarks from Alex Spyropoulos, a lead researcher at the Feinstein Institutes for Medical Research — the research arm of Northwell — who was running a clinical trial. The research was trying to determine whether a standard dose of an anticoagulant or a higher dose yielded better outcomes for Covid-19 patients who were already on oxygen or a ventilator and were at high risk of organ failure and clotting. A doctor on Narasimhan’s unit had recently been at odds with a member of Spyropoulos’s research team. Stella Hahn, a pulmonary-critical-care doctor, arrived at work the day before the meeting to find that a Covid-19 patient had gone into cardiac arrest. She knew that the patient was enrolled in the clinical trial and had been randomly assigned to receive either the standard dose of the anticoagulant or the higher one. As is always the case in the most rigorous trials, neither the patient nor Hahn was supposed to know to which group this woman belonged. Double-blind, randomized, controlled trials — R.C.T.s — are considered the gold standard in research because they do not allow findings to be muddied by any individual doctor’s biases or assumptions. But Hahn believed that the patient’s condition now called for the higher dose, which could potentially require the patient’s removal from the trial. ... [Hahn] had to rely on her clinical judgment and believed that it was unethical to wait for more information. How could researchers dictate care to a doctor right there at the bedside, especially when a patient’s condition was so dire? ... [Spyropoulos] talked to the group about the importance of high-quality, randomized trials in making scientific progress, and the risks of trying experimental treatments without them. 'I stressed to the group that we should not abandon this principle, even in the very stressful environment of a pandemic that was overwhelming our hospitals at Northwell,' he said. Relying on gut instinct rather than evidence, he told them, was essentially 'witchcraft.'"
www.nytimes.com/2020/08/05/magazine/covid-drug-wars-doctors.html