Don’t be fooled: Covid will not be cured by a panacea | Coronavirus

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 Don't be fooled: Covid will not be cured by a panacea |  Coronavirus


isIf the coronavirus had struck in the Middle Ages, there would have been a cure. You could have had it in any good apothecary, but not on the cheap. It was called theriac and also cured epilepsy, indigestion, heart troubles and swelling and fevers of all kinds. The recipes were often secret, but they were said to include the roasted flesh of vipers – this was the original snake oil remedy. Sugar is perhaps also a common ingredient, as the name is the root of the English “treacle”.

Theriac dates back at least to Roman times: Marcus Aurelius would have taken a dose of precaution every day. Of course, that was totally unnecessary – other than, perhaps, giving a sugar rush in these times of calorie deprivation. But it speaks to the long-held wish for a panacea. No medical historian will have been surprised by the bogus or questionable cures touted for Covid-19, from zinc supplements to hydroxychloroquine. Even Donald Trump’s proposal for bleach injections seems light compared to some of the medical interventions attempted in the past, which have included concoctions of mercury and sulfuric acid.

As it is now familiar usage, panaceas are based on our desire for a simpler world, where all problems can be solved with just the push of a button or a spoonful of sugar. They come from a time when all human health was thought to involve balancing the four “humors” of the body, just as all substances could be reduced to the four classical elements. Such confidence in simplicity was fundamentally theological: What kind of mad God would have made a world as complicated as we find it today?

But medicine is walking a fine line in its search for cures. Traditional herbal remedies used by indigenous peoples have sometimes been found to rely on natural active ingredients with real effectiveness. After all, this is how aspirin was developed, from a willow bark extract. And it was while studying a traditional Chinese remedy made from sweet wormwood that 2015 Nobel Prize winner Tu Youyou extracted the anti-malarial artemisinin. Despite all that pharmaceutical science aspires to be a rational profession that develops drugs by design, many are still discovered today through informed trial and error: testing many related chemical compounds on a hunch to find which ones work. It doesn’t pay to exclude candidates just because there isn’t a clear rationale for how they would do the job.

This is why recent testing of vitamin D as an immune treatment for Covid, for example, was worth it. The tests, conducted by a team in Brazil, found no detectable benefit for Covid patients (measured by length of hospital stay), although the patient sample size may have been too small for any conclusions. solid. It’s hard not to suspect, however, that a potential cure from such a common substance still sounded too good to be true.

The same goes for trials with ivermectin, an antiparasitic drug that also has antiviral properties. Identified in the 1970s, ivermectin can fight parasitic infections such as head lice and scabies, and is widely used in animal husbandry. The generality of its effects led to qualify it as a “miracle drug”.

Because ivermectin can also have anti-inflammatory effects, it wasn’t unreasonable to wonder if it might work against Covid – where the body’s excessive inflammatory immune response to the virus causes some of the worst damage. Initially promising animal tests have led to the administration of ivermectin prophylactically with blind optimism in some countries. But an extensive study in Colombia showed no noticeable effectiveness. Another trial in Spain showed that the drug could lower the viral load in patients with Covid and possibly also some of the symptoms, such as coughing. But while this small pilot study suggests we shouldn’t give up on ivermectin just yet, it seems unlikely to be the near cure some had hoped for.

Ivermectin’s extensive antiparasitic action resembles the versatility of antibiotics such as penicillin – at least in the days before pathogenic bacteria developed resistance to “superbugs”. Such versatility is not a panacea, but shows that it is possible for a single drug to reach multiple targets. There are downsides, however: Antibiotics are indiscriminate, so our gut bacteria take the hit as well. Likewise, anticancer agents tend to be indiscriminate cell killers, and the challenge is to give them the specificity of the “quick fix” that hits the right target (the tumor) without too much collateral damage.

The simple truth is the one advocated by the doctors who defied the therapeutic cure-alls in the Renaissance: most diseases tend to require specific drugs. This is really the basis of vaccines, for example: they allow the immune system to develop defenses against specific pathogens by presenting it in advance with a harmless form of the rogue agent. It is hoped that the Covid-19 vaccines can be revamped to make them effective against all variants that may arise in the future, but it is unlikely that a single vaccine could protect against all coronaviruses (such as Sars and Mers) , not to mention all the viruses.

Antivirals are another matter. As with Covid, often problems caused by pathogenic viruses act through the immune system itself, whether through the ‘cytokine storm’ of Covid-19, in which an overreaction causes tissue damage in the lungs. and other tissues, or the damage that HIV inflicts on immune cells, leaving the body vulnerable to secondary infections.

If there is anything remotely resembling a modern panacea, it would be a better understanding of our immune system – possibly the most complex aspect of the human body after the brain – and a corresponding ability to intervene in it. Even some cancers can be treated this way. What this suggests is that if there are no universal medicines in the world, for new global health solutions, we might be advised to look within.

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