Dear Editor,
I remain puzzled by the continuing failure to understand that one does not need to generate usable evidence when the evidence already exists. While the Recovery trial was indeed rapidly conducted and well coordinated it was not necessary unless the organisers had failed to follow the most important tenet of information-gathering, which computer geeks call RTFM but which is, in medical parlance, reading the textbooks. I suppose that if the connection was not initially made between Covid-19 and cytokine storm syndrome then that may be forgiven, but not when I had repeatedly and vainly tried to draw the reference work to the attention of those in charge (1). Indeed I wonder still how many of them have read it, two and a half years after I suggested they should. If they do they will be appalled and I hope ashamed that they “missed” reading that (a) cytokine storm is known to be triggered by other coronaviruses and (b) that the appropriate treatments had already been tested and proven.
While the adaptive trials proved a point for SARS-CoV-2 (in relation to tocilizumab and steroids) the references quoted by Ahmad and colleagues were published in September 2020 and April 2021. I suggested that both should be used in April 2020, when my BMJ Rapid Response was published. At best, therefore, even if the results were “incorporated into NHS treatment guidelines the day after they became available”, five months (for steroids) and a year (for tocilizumab) elapsed from the time of my recommendation.
Is this really effective knowledge mobilisation? I attempted to disseminate my information in a timely fashion – in other words as soon as I had worked out what Covid-19 was – so people could use it. I failed. I suggest that the next research step should be to gather the death statistics for Covid for April to September 2020, allow for the possibility that some were with rather than from Covid-19, multiply by the success rate of steroids/tocilizumab and thereby calculate the number of deaths that would not have occurred had my recommendations been acted upon when I made them. It will run into several thousands, and all because no-one understood the disease, no-one read the existing literature and no-one took any notice of those who did understand.
Many a scientific hypothesis has been treated with contempt when it did not fit official thinking – think Galileo and Semmelweis. To me, this is another example of the same failing.
Reference
1. Cron R, Behrens E. Cytokine Storm Syndrome. Springer, 2019
Re: Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence