Publication

Abstract : The COVID-19 pandemic has fuelled global initiatives to develop vaccines and identify pharmacotherapies. The National Institute of Health Clinical Trials website currently lists 3489 clinical trials as of September 30, 2020. According to the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP)1 website, “there is a need to ensure that all inform decisions about the health care of the available evidence.” Many drug candidates are being repurposed to manage COVID-19 by expedited observational studies and clinical trials across different populations worldwide, even as the search for vaccines is gathering momentum.2 The urgency of the current pandemic demands immediate and pragmatic clinical responses. A surprising dissonance between conventional medical research and clinical practice can be observed during this pandemic, challenging fundamental assumptions of evidence-based medicine and conventional biomedical practice.3 Might this development lead us to a pier of practice-based evidence (PBE) focusing on patient-centered care on compassionate grounds? Or does the global medical community need to strike a better balance between those two approaches to optimizing therapeutic responses to this pandemic? A recent editorial in PLOS Medicine reads, “It is surely time to turn to a more fit-for-purpose scientific paradigm. Complex adaptive systems theory proposes that precise quantification of particular cause–effect relationships is both impossible (because such relationships are not constant and cannot be meaningfully isolated) and unnecessary (because what matters is what emerges in a particular real-world situation).”4