Toward Better Clinical Data in Emerging Infectious Diseases

Abstract

Emerging infectious diseases have been described as a “clear and present danger to humanity” [1, p. 1887]. To protect against this danger, medical care must be advanced through clinical research. The severe acute respiratory syndrome (SARS) outbreak demonstrated the need for clinical research to evaluate medical interventions. For SARS, ribavirin and corticosteroids were frequently used for treatment [2, 3]. Clinicians treating patients who are dying because of a disease with no known treatment should utilize measures that are thought to have potential efficacy. However, definitive data collection should follow the treatment, because the use of medical interventions without supporting clinical studies can have significant implications. During the SARS outbreak, ribavirin was shown to cause hemolytic anemia in 61% of treated subjects, with a mean decrease in hemoglobin levels >2 g/dL [4]. The use of corticosteroids was implicated as a cause of hip pain and osteonecrosis in a significant portion of the treated population [5]. It has subsequently been shown that neither drug has efficacy in the treatment of SARS [6].