Here’s Why Plasma Theory is a Half-Baked Idea | 1st May 2020

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IASbhai Editorial Hunt

It always seems impossible until it’s done.– Nelson Mandela

“Plasma therapy is no silver bullet

       SOURCES:   THE HINDU EDITORIAL/EDITORIALS FOR UPSC CSE MAINS 2020

      HEADLINES:

Plasma therapy is no silver bullet

      CENTRAL THEME:

To recommend it without undertaking a robust scientific study may cause more harm than good

SYLLABUS COVERED: GS 3:Diseases :Therapy :Recent Innovations

      MAINS QUESTION:

What is Plasma Therapy ?  True benefits on initial trials are very thin . Comment -(GS 3)

      LEARNING: 

  • Why this does not seem to be a good idea ?
  • What are the consequences of plasma theory ?
  • How does it happen !

      INTRODUCTION: 

  • The COVID-19 pandemic has posed unprecedented challenges to governments, health professionals and the general public at large, around the world.
  • Every response, administrative, social, economic or medical is being subjected to intense public scrutiny, as it rightly should be in the spirit of mature democracy.
  • Scientific research in medicine is the only means to overcome novel and complex diseases such as COVID-19 and that too thrives on the same spirit of debate and criticism.
So is the case with the convalescent plasma therapy, that is being currently studied by the Indian Council of Medical Research, through open label, randomized controlled trial to evaluate it for both safety and efficacy.
  • The therapy involves infusing patients suffering from COVID-19 with plasma from recovered patients.
  • In theory, the antibodies of the recovered person may help that patient’s immune system fight the virus.

      BODY: 

NEED FOR MORE RESEARCH

  • The most important principle in medical ethics is “do no harm”.
The transfusion of convalescent plasma is also not without risks, which range from mild reactions like fever, itching, to life-threatening allergic reactions and lung injury.
  • To recommend a therapy without studying it thoroughly with robust scientific methods may cause more harm than good.
  • Till date, there have been only three published case series for convalescent plasma in COVID-19 with a cumulative of 19 patients.
  • We cannot conclude the therapy will work on all patients all the time or even believe that the convalescent plasma was the only reason for their improvement.

RISKS INVOLVED : 

1. TRANSFER OF BLOOD SUBSTANCES: As the blood transfusion takes place, there are risks that an inadvertent infection might get transferred to the patient.

2. ENHANCEMENT OF INFECTION: The therapy might fail for some patients and can result in an enhanced form of the infection.

3. EFFECT ON IMMUNE SYSTEM: The antibody administration may end up suppressing the body’s natural immune response, leaving a Covid-19 patient vulnerable to subsequent re-infection.

Further, convalescent plasma therapy requires intensive resources, healthy COVID-19 survivors to donate, a blood bank with proper machinery and trained personnel to remove plasma, equipment to store it and testing facilities to make sure it has an adequate amount of antibodies.

GOLD STANDARD TRIALS :

  • To say with certainty whether a drug is truly effective or not, the gold standard in medicine is to conduct a randomised controlled trial, where half the patients get the experimental drug and the other half do not.
  • Only if patients in the first half show substantial improvement over those in the second half, it indicates the drug is beneficial.

      IASbhai Windup: 

  • While showing great promise, it is a line of treatment that is yet to be validated for efficacy and safety and cannot be deployed widely without caution.
  • The current evidence to conclude anything about the true benefits of this therapy is very thin.
  • Too much focus on one approach can take away the focus from other important therapeutic modalities like use of oxygen therapy, antivirals, and antibiotics for complicated hospital courses.
  • To overcome the pandemic comprehensively, we should focus on strengthening health systems at all levels, including referral systems, supply chain, logistics and inventory management.
  • We need to work on protecting our healthcare workers, improving prevention methods, promoting cough etiquettes, effective quarantining and accurate testing.
  • Even these times of collective uncertainty are no reason to lower scientific temper.

“Science should be driven by reason and evidence with hope as a catalyst but not by either fear or populism.”

 


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