This is a great paper about CQ/HCQ and #COVID19, supporting the argument that we should not be dishing it out like Smarties for compassionate use (same goes for lots of 'promising' drugs). https://www.bmj.com/content/369/bmj.m1432

HCQ/CQ is in RCTs, which is necessary at this juncture, but have we got the selection & prioritisation process right for choosing drugs to enter clinical trials? Will we look back later & say why did we even bother putting drug X forward? (I accept hindsight is a wonderful thing)

I get clinical equipoise, but a robust & transparent prioritisation process is necessary, to ensure we test the most promising agents first; therefore, should we avoid platform trials of candidates that look weaker on paper & instead insist on trials of the better-looking agents?

This is why the role of prioritisation of drugs & coordination of trials is so important, and yet there is no internationally agreed approach. Should there be an accepted hierarchy of supporting evidence, or perhaps even a minimum standard (e.g. must have supportive animal data)?

My own view, for any novel outbreak, is that we should not direct resources to assess drugs with weak supporting evidence until we are sure that drugs with the best supporting evidence are in trials globally & that recruitment will not be compromised by excessive competition.

Balancing this against other considerations may not be easy though, such as various demands that may arise to identify "life-saving" treatments rapidly during a crisis, as well as examples of scientific progress that started out as a gamble, with weak supporting data initially.

Wherever we are in the world, and even if we are in the midst of a health crisis, we must not deviate from "first, do no harm". I also believe we must offer patients the best opportunities available, including access to trials of drugs that appear to have the greatest potential.