Bob Garfield: This is Bob Garfield with an OTM podcast extra in about 60 seconds. Look, the production of On the Media has never been cheap or easy. Now, the process is crazy and expensiver too. Now more than ever, as they say, we need listeners' financial support. Obviously, many of you are absolutely strapped at the moment, and we surely expect you to sit this one out, but that only increases the need for everyone else to step up. Please support OTM when we, and you need it most. Go to onthemedia.org and hit donate, or text OTM to 70101. Thank you. Gosh, can this really be from only a month ago?

Speaker 1: What do you have to lose? Take it? I really think they should take it, but it's their choice and it's their doctor's choice or the doctors in the hospital but hydroxychloroquine, try it.

Reporter 1`: There's more than ample evidence that hydroxychloroquine saves lives, speeds up recovery time, and cuts down on hospitalizations. It's also one of the safer drugs out there just by virtue of the fact that it's been around for what? 65 years.

Bob Garfield: Yes. Amid a panic to find a treatment for COVID-19, certain politicians and certain corners of the media fell in love with a drug proven a few weeks later to present mortal risks, outweighing any potential efficacy. This is what happens when hope triumphs over-caution, the hydroxychloroquine debacle should have been a lesson learned, but now comes the bandwagon for the antiviral drug, Remdesivir.

Reporter 2: Gilead, the biopharmaceutical company behind the experimental drug today reveals significant positive results in trials of the drug.

Reporter 3: Yesterday, Dr. Anthony Fauci was very positive about a study of an experimental drug to treat coronavirus called Remdesivir.

Reporter 4: The New York Times reports that the FDA is planning to announce approval for emergency use of this drug.

Derek Lowe: You get to choose. You want good data or you want fast data, and we've been getting fast data mostly up until now with all the problems that come with it.

Bob Garfield: Derek Lowe is an organic chemist. Who's In the Pipeline blog for Science magazine, explores drug discovery and the pharma industry. The headlong rush toward Remdesivir began with the publicizing of a trial conducted at the University of Chicago.

Derek Lowe: Publicised is the right word. It got a lot of publicity because what happened was this was the study being run by Gilead, the makers of, Remdesivir, it was open-label. It wasn't the conventional blinded trial where no one knows who's getting what. This one was open-label, being done in, I believe, moderate to severe coronavirus patients. There was a video chat going on between some of the physicians at the University of Chicago's health system. One of them talked about what they'd been seeing with the drug, as far as she could tell someone, and we don't know who, was recording this video chat and later leaked the whole thing to the press.

Bob Garfield: There's some suspicion that it may be somebody connected with Gilead or someone who holds a large position in the company's stock because this news sent the Gilead shares soaring in value.

Derek Lowe: It's a moral hazard because clinical trial resorts are the real currency of biopharma finance. Do you have a drug that works in people or do you not? So gigantic moves and stock prices occur on the basis of these things? You have to discourage people extremely strongly from doing this kind of leaking. Now, in this case, the data had already been collected. As far as I know, they had finished up the trial and this person was talking about what they'd seen so far.

Bob Garfield: It didn't contaminate the results of the experiments, such that it was.

Derek Lowe: Not really, but you can contaminate the results very easily by leaking along the way. In that case, contamination is the real word. You can mess up the trial to the point that the FDA will say, we're not taking any of these data.

Bob Garfield: It found its way to the world through STAT News,

Derek Lowe: Right, and STATS are very reliable application. If they hadn't reported it, someone else would have. Journalists report news and this is news. It would have been different. If this had been an ongoing trial and reporting it would have blown the entire thing. I'm not sure what they would have done in that circumstance. A lot of the people who work at STAT have been doing this for a long time and they know exactly what those stakes are.

Bob Garfield: In any event, with the publication by STAT News, the spread of the story began and the potential cure narrative with it. How hyperventilated was the reporting?

Derek Lowe: Some of it was bad. Honestly, no matter what, the tone of the reporting, a lot of the people seeing the headlines were going to run off with the wrong idea. Anyway, someone was telling me that they were sitting at home when this news started to hit and one of their family members ran in shouting. They found a cure. They found a cure. That just makes me sad,

Bob Garfield: At the same time as the press and the public perhaps was overreacting to these very preliminary research results, the scientists were also paying attention. It's my sense that virologists and pharmacologists and immunologists were not themselves getting all hepped up.

Derek Lowe: No one who really was knowledgeable about the fjord, expected anything gigantic from this. The hope was that there would be something. The drug did shorten the amount of time that people were in the hospital. It had a trend to possibly helping with mortality that didn't reach statistical significance, but it might be real. That's all we know. We know nothing else yet.

Bob Garfield: That's the Chicago study. There have been other data points that have trickled in. Could you tell me about them?

Derek Lowe: Unfortunately, the one controlled trial we have is the one that we don't have all the data for. That's the National Institute for Allergy and Infectious Disease, NIH trial. Gilead has published some more retrospective, uncontrolled data. It's almost impossible to know what to make of that kind of data. That's what I was referring to earlier when I talked about fast data and good data. The quickest thing you can collect is to say, okay, we're already giving people this drug because, remember, Remdesivir has already been tried on other Coronavirus.

It's been tried on Ebola, any kind of RNA virus, but to say, we're already giving people this drug, let's just collect the numbers on what happens to the people that we're giving it to, but that's not controlled. You don't have any standard of comparison. At the end of that, you can say, okay, we gave it to whatever, 53 people. Here's what happened to them. You don't know what would happen to 53 people, similar disease severity, similar balance of genders and age, and pre-existing conditions who got everything except Remdesivir. Without that, you really can't tell.

Bob Garfield: Hydroxychloroquine was a fiasco of over-hyping from the president and Fox News and others before the evidence started mounting up that it's for many patients, quite dangerous and not necessarily effective in fighting COVID-19. The hyp over Remdesivir doesn't reach that scale of distortion, does it?

Derek Lowe: It doesn't, Remdesivir seems to be a lot cleaner as far as adverse events go. It's a little easier to make the call to give it to people.

Bob Garfield: One of the reasons that a cure is so elusive, and perhaps a vaccine as well, is that COVID-19 has properties that are baffling. All the King's horses of science and all the King's men of pharma have failed to have much success in curing viral illness of any sort.

Derek Lowe: I've done antiviral research myself. It is like breaking rocks for a living. They are very tough, viruses have very few moving parts in them as compared to a living cell, so you don't have too many shots on goal. That's why when you look at hepatitis C or at HIV, where we can at least stop it, if not completely eliminate it, both of those are cocktail therapies. There are several different drugs given simultaneously, each of which attacks the virus in a different way. There are no single drugs that knock out a viral infection and there's precious few combinations. Hep C really is a success story. The Gilead combination for that cures hepatitis C.

Now, a lot of companies put a lot of effort into that. Over the years, there were a lot of competitors all working on it. There are other companies on the markets until Gilead finally blew them out of the water, but it took years of work. I could not begin to tell you how many billions of dollars and how many man-hours to get that far. That's the targeted small molecule therapy that people are used to in a drug. That's what it will take a long time to get for the coronavirus, which is why personally, I'm putting my faith more in the monoclonal antibodies and vaccine work.

Bob Garfield: Dr. Fauci has not dismissed the notion that a vaccine could emerge within the next 12 to 18 months. Does that seem overly optimistic to you?

Derek Lowe: It's optimistic but is not impossible. The only thing that is on our side with this is that there are so many large organizations working on this simultaneously, each with their own angle. The failure rate for new drugs is about 90% across clinical trials, no other industry deals with that. I mean, 90% of Boeing's planes get off the ground. 90% of Pizza Hut pizzas are perfectly edible, but 90% of clinical candidates fail.

94% of vaccine candidates fail, but if we have dozens of companies working, each with their own take on this, the odds of one of them getting through, I think are pretty good. We already had done a lot of work on SARS and MERS, which gives us a leg up. There are coronavirus vaccines for animal diseases. We know that in theory, it's possible. I think we'll get there.

Bob Garfield: As we've often reported on this show, the media are generally terrible, terrible, about maintaining skepticism and perspective about potential miracle cures. In this drug development warp speed moment in which we reside, I suppose the media are especially prone to oversimplification, excessive hope, and worse. What are you seeing out there?

Derek Lowe: As you say, they've been hyping early results forever. I've been writing the blog for 18 years now. That's been a constant throughout the whole thing. I long ago gave up any hope of that ceasing to happen. I'm just writing a blog about this. I do drug research as a day job. Even I can't keep up with everything that's going on. It just does seem like too much some days. I really am not too down on journalists under these conditions. I'm willing to cut people a break.

Bob Garfield: Do you have any advice for journalists who are coming up against these tensions for the first time?

Derek Lowe: There's a narrative bias in journalism. Indeed, I think in the human spirit, that we want stories, we want things that have a beginning, a middle, an end, a hero, a villain, a big wrap up where all the loose ends are put together. The coronavirus doesn't care. The cells and dividing in the dish don't care, the mice in cages don't care. The world doesn't care how great an inspiration this was, or how beautifully it all fits together.

You will look at an explanation that someone has for virus therapy and it just hangs together so beautifully. Honestly, the more beautifully it hangs together, the less likely I think it is to be true. It's messy. A lot of really, really compelling storylines, are wrong. I would advise people to get ready for that.

Bob Garfield: Got one more question for you. I'm asking you to give me a moral judgment place. You're speaking to somebody who is on eight different pharmaceuticals, and I have been for decades, and they have prolonged my life, in a way measured in years, and perhaps someday, in decades. I am alive because of Big Pharma. That's a big thumbs up there. On the other hand, I've spent decades observing the industry and seeing its corruption like the apotheosis of capitalist malice and I wonder, which is right.

Derek Lowe: Why not the sum of both? We are people, and I say we as in the pharma industry. Like every other organization run by people, there are grievous faults out of the crooked timber of humanity, no straight thing was ever made, but the idea is that we can harness the self-interest, the desire of companies to make money. To do good for the rest of people by putting the insane amounts of money and effort that it needs to find these new drugs.

Believe me, there are things that happen in the drug industries, the Martin Shkrelis of the world that make everyone in the industry want to spit on the floor. SO, it's an odd place to be, there's fallible humans trying to do things that could change the world. Sometimes the world-changing part wins out and sometimes the fallible human part wins out.

Bob Garfield: Derek, thank you so much.

Derek Lowe: oh, thank you enjoyed it.

Bob Garfield: Derek Lowe is an organic chemist. His blog, distributed by Science magazine is called In the Pipeline. This has been an OTM podcast extra. Come back this weekend for The Big Show and a deep dive into the stagnant waters of the newspaper business. Meantime, for all the thrills and spills you've come to expect from the OTM brand, subscribe to our weird-ass weekly newsletter at onimedia.org/newsletter.

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