It is the year 2020, and we find ourselves in the midst of a rapidly changing, worldwide pandemic of a novel Coronavirus. This virus and public knowledge of it has spread and changed with greater speed than our scientific method can accommodate. Science, and the progression of medical knowledge, is by nature and necessity slow and methodical. This pandemic is neither. But we ought not abandon our deliberate striving for truth; not now, not because it feels too slow.
The gold standard in medical science, the randomized controlled trial (or RCT), is a relatively new development in the history of medicine. The British epidemiologist Sir Bradford Hill is credited with designing and publishing the first RCT in medical science, a study of streptomycin in treating tuberculosis, in 1948. Sure, even randomized controlled trials are never perfect, and they require large numbers of patients, time, and investment. However, their design does seek to remove variables that are sure to taint all other trial designs. They are the best we have, especially when it comes to evaluating a therapeutic intervention.
Much speculation has arisen, both in the medical community and the media, about possible drug therapies for this disease: hydroxychloroquine, azithromycin, remdesivir, convalescent plasma, and others. Why have so many physicians and scientists been less-than-fully-enthusiastic about these interventions? It is because we do not have sufficient data yet. There has not been time for any quality randomized controlled trials.