Coronavirus, Hydroxychloroquine, and the Death of Evidence-Based Medicine

In a crisis, do we need to abandon the principles that have advanced medical science so profoundly?

Coronavirus has caused us to re-evaluate so many things. I’m doing renal consults today from my office, only physically going to see patients if absolutely necessary — something unthinkable just a few weeks ago. It’s also causing us to re-evaluate what we mean by “evidenced-based medicine”. In the days before the pandemic, many of us were of the “randomized trial or bust” mindset, often dismissing good observational studies without rigorous review, and likewise embracing even suspect studies just because they happened to be randomized.

But with the coronavirus, we don’t have the luxury to wait for those big, definitive, randomized trials. We need to act on the data we have. We need to remember what evidenced-based medicine is really about. It’s not just randomized trials. It’s integrating each study into the body of existing data, combining the best available science, reaching defensible conclusions.

I like to read a new study in the context of what I call the pre-trial probability of success. In other words, how likely was this drug to work before we got the data from the trial. Let me show you how this…