COVID-19 Quackery: Treatments that don't work or worse
Today's Managing Health Care Costs Number is 43
There's now good evidence that some therapies improve the outcome of patients with severe COVID-19. Oxygen therapy, steroids, and Remdesivir help the sickest of patients, but there is no medical therapy that has been proven to prevent infection or to improve outcome for cases that are milder. There's excellent evidence that masks, physical/social distancing, and hand washing prevent spread of the novel coronavirus.
But there are many unproven approaches out there, too. Yesterday, a colleague told me that while he was at his physician's office he discovered some people were waiting to have ozone therapy. This week's Journal of the American Medical Association had a report of companies promoting stem cell therapy (also known as regenerative therapy) to prevent or treat COVID, although there is no evidence that this is effective. There is a professor at East Virginia Medical School who is promoting a preventive "cocktail"with 5 (or 6) drugs that must be taken at least twice a day. The evidence of efficacy of these drugs is poor or nonexistent.
The Food and Drug Administration has sent 43 warning letters to companies promoting unproven or even harmful treatments for COVID. These include
Vitamins (C, D, thiamine)
Minerals (iodine, silver)
Herbal supplements
Essential oils
CBD products
Homeopathic remedies
Chinese medicines
Stem cell products
Two of the ingredients of the East Virginia "cocktail" are in FDA warning letters.
There is clear danger of ozone therapy (patients have blood removed, it is mixed with ozone, then it is reinfused). There are also significant risks of stem cell therapy (patients have blood removed, it is centrifuged and a portion of the blood is reinfused). Stem cell clinics have been sanctioned by the FDA multiple times in the past, although they continue to promote their services for multiple diseases, including COVID-19. Either of these two therapies can lead to infection, and if there are administrative errors people could have a blood transfusion reaction.
There's even some potential public health danger to recommending taking supplements to protect against COVID like the East Virginia "cocktail", though they are not especially hazardous.
There are two problems, both are related to behavioral science (AKA behavioral economics). One is the issue of depletion. If there are too many choices about what to do, people often do nothing. Grocery stores that offer jam samples find that if they offer too many flavors, the sampling is not associated with increased sales. So it's best not to promote unnecessary interventions, which could crowd out what actually works.
The other is the issue of moral licensing. If people do something "good," they feel the permission to do something bad. This might be why people who exercise with a wearable have been shown to lose less weight - they feel that as long as they've exercised, it's fine to have a cupcake! If people are investing a lot of energy in taking supplements of no proven valuable, they might be less committed to social/physical distancing, masks, and hand washing.