Medicine is littered with crooked roads to answers. Yet we’ve been able to understand COVID-19, a virus that snuck up on us 19 months ago, bared its teeth and fatally dug them into millions of the world’s inhabitants. Astonishingly, we now know more about how to prevent and treat COVID-19 than we do about the common cold, for which there is no vaccine and no cure.
We are nowhere near the end of this beast, but this may be a moment for gratitude for how far medical research on this virus has come.
Under the best of circumstances, medical advances take years to achieve, not months like it did with COVID-19. And even when an apparent truth seems in sight, it may not hold up to scrutiny for too long. A generation of women, for example, were told that hormone replacement therapy would prevent heart disease and stroke. It took years to show that it was actually associated with those ailments, but even that isn’t entirely certain.
These contradictions occur because our knowledge changes as the science evolves, but also because medical research, by its very nature, is fraught. Nearly all modern medical knowledge derives from evidence-based research, where the data is gathered, the studies are performed and then those results are relied upon in the medical community. But the way the evidence is gathered is a tricky business. One research tool is the epidemiological study in which researchers look at wide swaths of different populations to tease out what seems to be the drivers of certain diseases. Populations, however, are varied, and difficult to get a fix on — think of the many layered vicissitudes on your own street, then in your neighborhood. Try casting that net to an entire demographic group, say, all women over 50, or even an entire country. What truths can really be gleaned through all the noise?
Other types of studies rely on retrospective “self-reporting.” That’s what happens when subjects are asked to recall very specific details about their lives — how much butter they eat, how much exercise they get, or exactly how they feel on a certain drug. Yet who can accurately remember the specifics? These data are gathered anyway, numbers are crunched, and a study is published that meets all scientific requirements. It may appear accurate for a while, but chances are that one day more objective prospective data, in which people are followed in real time, will override the retrospective reported findings.
Even the most respected type of study — the double-blind, randomized trial — has its own problems, which is a sincere surprise since these are the gold standard studies, the glittering crown jewel of all modern medicine. In a double-blind trial, one group of subjects is given the agent being tested and the other a placebo — a sugar pill — without knowing which one they have been administered. To maintain complete objectivity, the researchers don’t know which ones are the real deal, either.
So watertight, and yet distortions seep in from the get-go. It starts with the subjects who are recruited to participate. The scarcity of human subjects for clinical trials accounts for one of the biggest delays in getting a drug to market. To push that process along, drug companies and contract research organizations can offer payments to doctors to enroll patients in trials. This system can easily push subjects into trials who don’t necessarily fit the proper criteria. In an early study on remdesivir’s ability to fight COVID-19, researchers couldn’t even find a requisite number of subjects.
And even when precautions are taken to keep the trial double-blind, and thus objective, the entire endeavor could wind up corrupted if researchers surmise which subjects are on the real drug if one group starts to manifest obvious side effects. There’s also the nature of the questions that researchers ask, which can unwittingly drive subjects to certain answers. Researchers are naturally predisposed to look for a finding that supports their aim; this bias and predisposition may make them figure out a way, even subconsciously, to get what they want.
Yet, lucky us. In spite of it all, we are on solid footing in our knowledge of COVID-19. And we have vaccines for which clinical trials were conducted on tens of thousands of subjects when many drug trials include far fewer. Pharmaceutical companies managed to proceed under a harsh microscope of a terrified public, where every side effect, and every rare fatality, were lit up for a full public viewing. (If the same spotlight was shined on brain bleeds from low-dose aspirin therapy, we’d be reading about them all too often). Now, more people have received a COVID-19 vaccine than any other, even more than the top five vaccines combined, according to Mount Sinai. Let’s embrace the research for getting us here — and, if you haven’t already — get your shot in gratitude.
Janice M. Horowitz covered health for Time magazine for nearly two decades; created and hosted the public radio segment Dueling Docs: The Cure to Contradictory Medicine; and contributed to The Economist, Allure, and The New York Times. She’s the author of the new book Health Your Self: What’s Really Driving Your Care and How to Take Charge.