One of the driving forces behind the development of an inexpensive Covid-19 drug believed to have helped save one million lives says its success shows what the scientific world can achieve.
Prof Sir Martin Landray was a co-chief investigator for a clinical trial of dexamethasone in the early stages of the pandemic.
The steroid, which can cost less than Dh25 per patient, has since proved an invaluable tool – not only to show what works against the virus, but what doesn't.
It was the UK’s Recovery (Randomised evaluation of Covid-19 therapy) trial that demonstrated the drug’s ability to cut deaths by about one third among the sickest patients.
“The Recovery trial has demonstrated just what can be achieved,” Sir Martin said.
Involving 46,000 patients, most in the UK but with others spread around the world, Recovery provided vital insight into which medicines were most and least effective.
Notably, it showed the ineffectiveness of hydroxychloroquine, the malaria drug hailed by some as a wonder cure for Covid-19.
Launched in early 2020 and designed to make the process of managing trials simpler, Recovery is regarded as a shining example of how to test drugs in the midst of a pandemic, when health services and the people working in them face unprecedented pressures.
At the beginning of the pandemic, as the world faced a new virus, a new disease and no known treatments, speed was of the essence, so the focus was on “repurposing” drugs already approved to combat other conditions.
Some drug trials doomed to fail
“We started from the top of the list and we worked our way down,” Sir Martin said. “If we just threw treatments at people, we could end up wasting a lot of drugs for no good.
“We were going to have to know first which ones worked and which ones didn’t.”
At a time when many clinicians were exceptionally busy, evidence had to be gathered in a practical way, but the results had to be high quality to allow decisions about which treatments worked to be made.
Sir Martin, a professor of medicine and epidemiology at the University of Oxford’s Nuffield Department of Population Health, said this often was not the case with other trials of potential Covid-19 medicines. As the renowned scientific journal Nature described it in a headline, “Covid broke the evidence pipeline”.
“95 per cent of all clinical trials for Covid never had any hope of answering or providing a useful answer,” he said. “They weren’t designed to provide a useful answer.”
There were “hundreds” of trials of hydroxychloroquine that were never going to provide rigorous information about the drug’s worth against Covid-19.
Trials were set up without, for example, enough participants to provide statistically robust answers. Others lacked the required control groups – people not given the treatment, for comparison with those who have.
Part of the problem, Sir Martin said, is that researchers are given more academic credit for setting up and leading a trial than for assisting with an existing one.
Helping to lead the recovery
The aim is to extend Recovery into influenza, although this has been delayed because measures to prevent the spread of the coronavirus have meant there is little flu in the UK and some other countries, making trials difficult.
Recovery offers lessons for future pandemics, including that there should be more nimble systems to approve clinical trials.
“The virus can get on a plane and go from Bangalore to Boston in 12 hours,” Sir Martin said. “We cannot have a situation where it takes six to 12 months to get the trials up and running and the approvals in place.”
While getting started is important, the pandemic has also shown the need not for more trials, but for “more better trials”.
Taking lessons from Recovery, Sir Martin has launched Protas, a not-for-profit organisation to run clinical trials. Sanofi, the French pharmaceutical company, will provide up to £5 million (Dh24.6 million) for the venture.
Cutting costs is key
The aim is to cut the cost of trials and, in doing so, enable more drugs to enter clinical trials and potentially be used for dementia, heart failure, kidney failure and arthritis.
Through its work with charities, industry, researchers, clinicians and patient groups to deliver trials, Protas aims to bring more drugs to market and reduce their eventual price.
“Because a single trial may cost $1 billion, many interesting drugs are left in the laboratory,” said Sir Martin, who is Protas's chief executive.
“Or people try to reduce the cost by making the trial too small … so we don’t fully understand the value of the treatment.
“When it comes to market, someone has to pay for that cost – not only for the successes, but also for the failures. So health services are saying, ‘We won’t use it at all, or in a limited way.’”
The cost of major drug trials “could easily be reduced to less than one tenth” of the current spend, Sir Martin believes.
“Exactly what that looks like will vary, but a big trial … may cost $100 million instead of $1 billion. At its most extreme end, the recovery trial is about $15 million, certainly less than $20 million, for 46,000 patients and ten drugs. Trials do not have to be expensive.”
Savings can be made in several ways, including by not using commercial contractors, who are not incentivised to cut costs, to run trials.
Technology can help, too, as participants can use smartphones to input their own details, and much information routinely collected by health services can, with permission, be used.
The aim is to recruit into trials not just patients at large facilities linked to universities in major cities, but also patients at smaller hospitals.
Drawing on lessons from Recovery, duplication can be reduced and trials simplified.
“The way many trials are done is that they take the last protocol, people copy it across, and add more details,” Sir Martin said.
“The protocol becomes more and more complicated, often with information that’s not critical to the key question. It’s a bit like if you try to write a book together, nobody cuts much out, they keep adding to the word count.
“Our approach is, ‘Let’s start with a blank page for each question. What are the critical questions we really need to know? How are we going to deliver this for this particular drug?’”
So the method that proved successful during the pandemic could yield more medical advances, this time for a much wider range of illnesses.
More coverage from the Future Forum
Stormy seas
Weather warnings show that Storm Eunice is soon to make landfall. The videographer and I are scrambling to return to the other side of the Channel before it does. As we race to the port of Calais, I see miles of wire fencing topped with barbed wire all around it, a silent ‘Keep Out’ sign for those who, unlike us, aren’t lucky enough to have the right to move freely and safely across borders.
We set sail on a giant ferry whose length dwarfs the dinghies migrants use by nearly a 100 times. Despite the windy rain lashing at the portholes, we arrive safely in Dover; grateful but acutely aware of the miserable conditions the people we’ve left behind are in and of the privilege of choice.
Should late investors consider cryptocurrencies?
Wealth managers recommend late investors to have a balanced portfolio that typically includes traditional assets such as cash, government and corporate bonds, equities, commodities and commercial property.
They do not usually recommend investing in Bitcoin or other cryptocurrencies due to the risk and volatility associated with them.
“It has produced eye-watering returns for some, whereas others have lost substantially as this has all depended purely on timing and when the buy-in was. If someone still has about 20 to 25 years until retirement, there isn’t any need to take such risks,” Rupert Connor of Abacus Financial Consultant says.
He adds that if a person is interested in owning a business or growing a property portfolio to increase their retirement income, this can be encouraged provided they keep in mind the overall risk profile of these assets.
Race card
6.30pm: Al Maktoum Challenge Round-3 Group 1 (PA) US$100,000 (Dirt) 2,000m
7.05pm: Meydan Classic Listed (TB) $175,000 (Turf) 1,600m
7.40pm: Handicap (TB) $135,000 (T) 2,000m
8.15pm: Handicap (TB) $135,000 (D) 1,600m
8.50pm: Nad Al Sheba Trophy Group 2 (TB) $300,000 (T) 2,810m
9.25pm: Curlin Stakes Listed (TB) $175,000 (D) 2,000m
10pm: Handicap (TB) $135,000 (T) 2,000m
10.35pm: Handicap (TB) $175,000 (T) 1,400m
The National selections
6.30pm: Shahm, 7.05pm: Well Of Wisdom, 7.40pm: Lucius Tiberius, 8.15pm: Captain Von Trapp, 8.50pm: Secret Advisor, 9.25pm: George Villiers, 10pm: American Graffiti, 10.35pm: On The Warpath
RESULTS
6pm: Al Maktoum Challenge Round-2 – Group 1 (PA) $55,000 (Dirt) 1,900m
Winner: Rajeh, Antonio Fresu (jockey), Musabah Al Muhairi (trainer)
6.35pm: Oud Metha Stakes – Rated Conditions (TB) $60,000 (D) 1,200m
Winner: Get Back Goldie, William Buick, Doug O’Neill
7.10pm: Jumeirah Classic – Listed (TB) $150,000 (Turf) 1,600m
Winner: Sovereign Prince, James Doyle, Charlie Appleby
7.45pm: Firebreak Stakes – Group 3 (TB) $150,000 (D) 1,600m
Winner: Hypothetical, Mickael Barzalona, Salem bin Ghadayer
8.20pm: Al Maktoum Challenge Round-2 – Group 2 (TB) $350,000 (D) 1,900m
Winner: Hot Rod Charlie, William Buick, Doug O’Neill
8.55pm: Al Bastakiya Trial – Conditions (TB) $60,000 (D) 1,900m
Winner: Withering, Adrie de Vries, Fawzi Nass
9.30pm: Balanchine – Group 2 (TB) $180,000 (T) 1,800m
Winner: Creative Flair, William Buick, Charlie Appleby
JAPANESE GRAND PRIX INFO
Schedule (All times UAE)
First practice: Friday, 5-6.30am
Second practice: Friday, 9-10.30am
Third practice: Saturday, 7-8am
Qualifying: Saturday, 10-11am
Race: Sunday, 9am-midday
Race venue: Suzuka International Racing Course
Circuit Length: 5.807km
Number of Laps: 53
Watch live: beIN Sports HD
The Vile
Starring: Bdoor Mohammad, Jasem Alkharraz, Iman Tarik, Sarah Taibah
Director: Majid Al Ansari
Rating: 4/5
Saturday's results
Women's third round
- 14-Garbine Muguruza Blanco (Spain) beat Sorana Cirstea (Romania) 6-2, 6-2
- Magdalena Rybarikova (Slovakia) beat Lesia Tsurenko (Ukraine) 6-2, 6-1
- 7-Svetlana Kuznetsova (Russia) beat Polona Hercog (Slovenia) 6-4. 6-0
- Coco Vandeweghe (USA) beat Alison Riske (USA) 6-2, 6-4
- 9-Agnieszka Radwanska (Poland) beat 19-Timea Bacsinszky (Switzerland) 3-6, 6-4, 6-1
- Petra Martic (Croatia) beat Zarina Diyas (Kazakhstan) 7-6, 6-1
- Magdalena Rybarikova (Slovakia) beat Lesia Tsurenko (Ukraine) 6-2, 6-1
- 7-Svetlana Kuznetsova (Russia) beat Polona Hercog (Slovenia) 6-4, 6-0
Men's third round
- 13-Grigor Dimitrov (Bulgaria) beat Dudi Sela (Israel) 6-1, 6-1 -- retired
- Sam Queery (United States) beat Jo-Wilfried Tsonga (France) 6-2, 3-6, 7-6, 1-6, 7-5
- 6-Milos Raonic (Canada) beat 25-Albert Ramos (Spain) 7-6, 6-4, 7-5
- 10-Alexander Zverev (Germany) beat Sebastian Ofner (Austria) 6-4, 6-4, 6-2
- 11-Tomas Berdych (Czech Republic) beat David Ferrer (Spain) 6-3, 6-4, 6-3
- Adrian Mannarino (France) beat 15-Gael Monfils (France) 7-6, 4-6, 5-7, 6-3, 6-2
MATCH INFO
League Cup, last 16
Manchester City v Southampton, Tuesday, 11.45pm (UAE)
Red flags
- Promises of high, fixed or 'guaranteed' returns.
- Unregulated structured products or complex investments often used to bypass traditional safeguards.
- Lack of clear information, vague language, no access to audited financials.
- Overseas companies targeting investors in other jurisdictions - this can make legal recovery difficult.
- Hard-selling tactics - creating urgency, offering 'exclusive' deals.
Courtesy: Carol Glynn, founder of Conscious Finance Coaching
The specs
Engine: 3.0-litre six-cylinder turbo
Power: 398hp from 5,250rpm
Torque: 580Nm at 1,900-4,800rpm
Transmission: Eight-speed auto
Fuel economy, combined: 6.5L/100km
On sale: December
Price: From Dh330,000 (estimate)
How to watch Ireland v Pakistan in UAE
When: The one-off Test starts on Friday, May 11
What time: Each day’s play is scheduled to start at 2pm UAE time.
TV: The match will be broadcast on OSN Sports Cricket HD. Subscribers to the channel can also stream the action live on OSN Play.
Jetour T1 specs
Engine: 2-litre turbocharged
Power: 254hp
Torque: 390Nm
Price: From Dh126,000
Available: Now
Abu Dhabi traffic facts
Drivers in Abu Dhabi spend 10 per cent longer in congested conditions than they would on a free-flowing road
The highest volume of traffic on the roads is found between 7am and 8am on a Sunday.
Travelling before 7am on a Sunday could save up to four hours per year on a 30-minute commute.
The day was the least congestion in Abu Dhabi in 2019 was Tuesday, August 13.
The highest levels of traffic were found on Sunday, November 10.
Drivers in Abu Dhabi lost 41 hours spent in traffic jams in rush hour during 2019
Tips for job-seekers
- Do not submit your application through the Easy Apply button on LinkedIn. Employers receive between 600 and 800 replies for each job advert on the platform. If you are the right fit for a job, connect to a relevant person in the company on LinkedIn and send them a direct message.
- Make sure you are an exact fit for the job advertised. If you are an HR manager with five years’ experience in retail and the job requires a similar candidate with five years’ experience in consumer, you should apply. But if you have no experience in HR, do not apply for the job.
David Mackenzie, founder of recruitment agency Mackenzie Jones Middle East
Points Classification
1. Marcel Kittel (Germany / Quick-Step) 63
2. Arnaud Demare (France / FDJ) 38
3. Andre Greipel (Germany / Lotto) 25
4. Sonny Colbrelli (Italy / Bahrain) 24
5. Mark Cavendish (Britain / Dimension Data) 22
6. Taylor Phinney (U.S. / Cannondale) 21
7. Geraint Thomas (Britain / Team Sky) 20
8. Thomas Boudat (France / Direct Energie) 20
9. Stefan Kueng (Switzerland / BMC Racing) 17
10. Michael Matthews (Australia / Sunweb) 17
Defence review at a glance
• Increase defence spending to 2.5% of GDP by 2027 but given “turbulent times it may be necessary to go faster”
• Prioritise a shift towards working with AI and autonomous systems
• Invest in the resilience of military space systems.
• Number of active reserves should be increased by 20%
• More F-35 fighter jets required in the next decade
• New “hybrid Navy” with AUKUS submarines and autonomous vessels
SERIE A FIXTURES
Saturday (All UAE kick-off times)
Lecce v SPAL (6pm)
Bologna v Genoa (9pm)
Atlanta v Roma (11.45pm)
Sunday
Udinese v Hellas Verona (3.30pm)
Juventus v Brescia (6pm)
Sampdoria v Fiorentina (6pm)
Sassuolo v Parma (6pm)
Cagliari v Napoli (9pm)
Lazio v Inter Milan (11.45pm)
Monday
AC Milan v Torino (11.45pm)
UAE currency: the story behind the money in your pockets
Sreesanth's India bowling career
Tests 27, Wickets 87, Average 37.59, Best 5-40
ODIs 53, Wickets 75, Average 33.44, Best 6-55
T20Is 10, Wickets 7, Average 41.14, Best 2-12
MATCH DETAILS
Barcelona 0
Slavia Prague 0
UPI facts
More than 2.2 million Indian tourists arrived in UAE in 2023
More than 3.5 million Indians reside in UAE
Indian tourists can make purchases in UAE using rupee accounts in India through QR-code-based UPI real-time payment systems
Indian residents in UAE can use their non-resident NRO and NRE accounts held in Indian banks linked to a UAE mobile number for UPI transactions
MOUNTAINHEAD REVIEW
Starring: Ramy Youssef, Steve Carell, Jason Schwartzman
Director: Jesse Armstrong
Rating: 3.5/5
Kamindu Mendis bio
Full name: Pasqual Handi Kamindu Dilanka Mendis
Born: September 30, 1998
Age: 20 years and 26 days
Nationality: Sri Lankan
Major teams Sri Lanka's Under 19 team
Batting style: Left-hander
Bowling style: Right-arm off-spin and slow left-arm orthodox (that's right!)
What can victims do?
Always use only regulated platforms
Stop all transactions and communication on suspicion
Save all evidence (screenshots, chat logs, transaction IDs)
Report to local authorities
Warn others to prevent further harm
Courtesy: Crystal Intelligence
Our legal columnist
Name: Yousef Al Bahar
Advocate at Al Bahar & Associate Advocates and Legal Consultants, established in 1994
Education: Mr Al Bahar was born in 1979 and graduated in 2008 from the Judicial Institute. He took after his father, who was one of the first Emirati lawyers
The burning issue
The internal combustion engine is facing a watershed moment – major manufacturer Volvo is to stop producing petroleum-powered vehicles by 2021 and countries in Europe, including the UK, have vowed to ban their sale before 2040. The National takes a look at the story of one of the most successful technologies of the last 100 years and how it has impacted life in the UAE.
Read part four: an affection for classic cars lives on
Read part three: the age of the electric vehicle begins
Read part one: how cars came to the UAE
Moon Music
Artist: Coldplay
Label: Parlophone/Atlantic
Number of tracks: 10
Rating: 3/5
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Washmen Profile
Date Started: May 2015
Founders: Rami Shaar and Jad Halaoui
Based: Dubai, UAE
Sector: Laundry
Employees: 170
Funding: about $8m
Funders: Addventure, B&Y Partners, Clara Ventures, Cedar Mundi Partners, Henkel Ventures
