RESEARCH
RESULTS, DISCUSSION, LIMITATIONS RA RE A IR SMHS grad Caleb Skipper (MD, ‘14) in Ethiopia’s Simien Mountains, February 2020.
“Minimal harm, but minimal benefit” at best. That’s the conclusion of a recent clinical trial that explored the efficacy of early hydroxychloroquine use in COVID-19positive patients. But even the word “minimal” might be too charitable. “The good news is that outcomes weren’t worse among those who got a placebo,” explains the paper’s lead author Caleb Skipper, M.D., a 2014 UND School of Medicine & Health Sciences graduate and NIH research fellow who saw his study, “Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19” published in the Annals of Internal Medicine in July 2020. “But the question was if hydroxychloroquine reduced symptoms or disease severity in a statistically significant way, and while the drug was relatively safe, that answer was ‘no.’” Skipper should know. Having spent years in Uganda and Ethiopia studying health outcomes and infectious diseases like malaria and HIV-AIDS, Skipper has a wealth of experience with the anti-malarial drug that has made a splash in the American news media lately. 24
North Dakota Medicine Fall 2020
SMHS alum Caleb Skipper, M.D., examines hydroxychloroquine during COVID-19 and ends up learning less about the drug than the politics of science.
For all the bluster about the drug, he says,
understand the complexities of especially
the science doesn’t lie: the best, randomized
novel pathogens, pharmaceuticals and
clinical trials—on prevention, early treatment
human biochemistry.
and in-hospital treatment—all consistently show that there’s no substantial benefit, if any, to hydroxychloroquine use on COVID-19 patients. Getting the Science Right So why do so many people, whether average citizens or political leaders, seem to believe otherwise? The question has the Rugby, N.D., native as perplexed as anyone else dedicated to science. And his answer is that not only is science an imperfect and nuanced process—so is
Imagine trying to do so as a non-scientist. This is why physician-scientists not only should work hard to communicate their work clearly, but should “express some humility knowing that one trial is not the end-all answer,” he says, acknowledging that there are always more trials that could be run and that different people will be coming at not only scientific papers but news reports from very different levels of experience and education.
communication.
This is why empathy is also important.
“One thing you learn about doing any
“If you get diagnosed with COVID-19,
research is that there are limitations, even in well-conducted trials,” Skipper tells North Dakota Medicine. “So, I can’t say that for certain there isn’t possibly some benefit to the use of hydroxychloroquine in some people some of the time. But within the population we studied, that wasn’t the case, which is part of that nuance.” So particular is science, Skipper continues, that it can be hard for even physicians and researchers to tease out and truly
that’s a scary diagnosis,” says the researcher who was working on HIV-AIDS in Uganda for the University of Minnesota when the pandemic forced him to come home in March 2020. “Most people will do fine, but some people won’t. And we don’t yet know the long-term ramifications. That’s scary.” And when people are scared, they can think and react in extreme ways, he says, contributing to the misunderstanding of
