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.
Day 5, Abu Dhabi Test: At a glance
Moment of the day When Dilruwan Perera dismissed Yasir Shah to end Pakistan’s limp resistance, the Sri Lankans charged around the field with the fevered delirium of a side not used to winning. Trouble was, they had not. The delivery was deemed a no ball. Sri Lanka had a nervy wait, but it was merely a stay of execution for the beleaguered hosts.
Stat of the day – 5 Pakistan have lost all 10 wickets on the fifth day of a Test five times since the start of 2016. It is an alarming departure for a side who had apparently erased regular collapses from their resume. “The only thing I can say, it’s not a mitigating excuse at all, but that’s a young batting line up, obviously trying to find their way,” said Mickey Arthur, Pakistan’s coach.
The verdict Test matches in the UAE are known for speeding up on the last two days, but this was extreme. The first two innings of this Test took 11 sessions to complete. The remaining two were done in less than four. The nature of Pakistan’s capitulation at the end showed just how difficult the transition is going to be in the post Misbah-ul-Haq era.
FIXTURES
Saturday
5.30pm: Shabab Al Ahli v Al Wahda
5.30pm: Khorfakkan v Baniyas
8.15pm: Hatta v Ajman
8.15pm: Sharjah v Al Ain
Sunday
5.30pm: Kalba v Al Jazira
5.30pm: Fujairah v Al Dhafra
8.15pm: Al Nasr v Al Wasl
Normcore explained
Something of a fashion anomaly, normcore is essentially a celebration of the unremarkable. The term was first popularised by an article in New York magazine in 2014 and has been dubbed “ugly”, “bland’ and "anti-style" by fashion writers. It’s hallmarks are comfort, a lack of pretentiousness and neutrality – it is a trend for those who would rather not stand out from the crowd. For the most part, the style is unisex, favouring loose silhouettes, thrift-shop threads, baseball caps and boyish trainers. It is important to note that normcore is not synonymous with cheapness or low quality; there are high-fashion brands, including Parisian label Vetements, that specialise in this style. Embraced by fashion-forward street-style stars around the globe, it’s uptake in the UAE has been relatively slow.
The schedule
December 5 - 23: Shooting competition, Al Dhafra Shooting Club
December 9 - 24: Handicrafts competition, from 4pm until 10pm, Heritage Souq
December 11 - 20: Dates competition, from 4pm
December 12 - 20: Sour milk competition
December 13: Falcon beauty competition
December 14 and 20: Saluki races
December 15: Arabian horse races, from 4pm
December 16 - 19: Falconry competition
December 18: Camel milk competition, from 7.30 - 9.30 am
December 20 and 21: Sheep beauty competition, from 10am
December 22: The best herd of 30 camels
WOMAN AND CHILD
Director: Saeed Roustaee
Starring: Parinaz Izadyar, Payman Maadi
Rating: 4/5
Teams
India (playing XI): Virat Kohli (c), Ajinkya Rahane, Rohit Sharma, Mayank Agarwal, Cheteshwar Pujara, Hanuma Vihari, Ravichandran Ashwin, Ravindra Jadeja, Wriddhiman Saha (wk), Ishant Sharma, Mohammed Shami
South Africa (squad): Faf du Plessis (c), Temba Bavuma, Theunis de Bruyn, Quinton de Kock, Dean Elgar, Zubayr Hamza, Keshav Maharaj, Aiden Markram, Senuran Muthusamy, Lungi Ngidi, Anrich Nortje, Vernon Philander, Dane Piedt, Kagiso Rabada, Rudi Second
More from Rashmee Roshan Lall
Paatal Lok season two
Directors: Avinash Arun, Prosit Roy
Stars: Jaideep Ahlawat, Ishwak Singh, Lc Sekhose, Merenla Imsong
Rating: 4.5/5
FIXTURES
UAE’s remaining fixtures in World Cup qualification R2
Oct 8: Malaysia (h)
Oct 13: Indonesia (a)
Nov 12: Thailand (h)
Nov 17: Vietnam (h)
The Pope's itinerary
Sunday, February 3, 2019 - Rome to Abu Dhabi
1pm: departure by plane from Rome / Fiumicino to Abu Dhabi
10pm: arrival at Abu Dhabi Presidential Airport
Monday, February 4
12pm: welcome ceremony at the main entrance of the Presidential Palace
12.20pm: visit Abu Dhabi Crown Prince at Presidential Palace
5pm: private meeting with Muslim Council of Elders at Sheikh Zayed Grand Mosque
6.10pm: Inter-religious in the Founder's Memorial
Tuesday, February 5 - Abu Dhabi to Rome
9.15am: private visit to undisclosed cathedral
10.30am: public mass at Zayed Sports City – with a homily by Pope Francis
12.40pm: farewell at Abu Dhabi Presidential Airport
1pm: departure by plane to Rome
5pm: arrival at the Rome / Ciampino International Airport
UAE currency: the story behind the money in your pockets
Infiniti QX80 specs
Engine: twin-turbocharged 3.5-liter V6
Power: 450hp
Torque: 700Nm
Price: From Dh450,000, Autograph model from Dh510,000
Available: Now
Sweet%20Tooth
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The specs: 2018 Mercedes-Benz E 300 Cabriolet
Price, base / as tested: Dh275,250 / Dh328,465
Engine: 2.0-litre four-cylinder
Power: 245hp @ 5,500rpm
Torque: 370Nm @ 1,300rpm
Transmission: Nine-speed automatic
Fuel consumption, combined: 7.0L / 100km
SERIE A FIXTURES
Friday Sassuolo v Benevento (Kick-off 11.45pm)
Saturday Crotone v Spezia (6pm), Torino v Udinese (9pm), Lazio v Verona (11.45pm)
Sunday Cagliari v Inter Milan (3.30pm), Atalanta v Fiorentina (6pm), Napoli v Sampdoria (6pm), Bologna v Roma (6pm), Genoa v Juventus (9pm), AC Milan v Parma (11.45pm)
Mission%3A%20Impossible%20-%20Dead%20Reckoning%20Part%20One
%3Cp%3E%3Cstrong%3EDirector%3A%3C%2Fstrong%3E%20Christopher%20McQuarrie%3Cbr%3E%3Cstrong%3EStars%3A%3C%2Fstrong%3E%20Tom%20Cruise%2C%20Hayley%20Atwell%2C%20Pom%20Klementieff%2C%20Simon%20Pegg%3Cbr%3E%3Cstrong%3ERating%3A%3C%2Fstrong%3E%204%2F5%3C%2Fp%3E%0A
Scoreline
Saudi Arabia 1-0 Japan
Saudi Arabia Al Muwallad 63’
ONCE UPON A TIME IN GAZA
Starring: Nader Abd Alhay, Majd Eid, Ramzi Maqdisi
Directors: Tarzan and Arab Nasser
Rating: 4.5/5
Haemoglobin disorders explained
Thalassaemia is part of a family of genetic conditions affecting the blood known as haemoglobin disorders.
Haemoglobin is a substance in the red blood cells that carries oxygen and a lack of it triggers anemia, leaving patients very weak, short of breath and pale.
The most severe type of the condition is typically inherited when both parents are carriers. Those patients often require regular blood transfusions - about 450 of the UAE's 2,000 thalassaemia patients - though frequent transfusions can lead to too much iron in the body and heart and liver problems.
The condition mainly affects people of Mediterranean, South Asian, South-East Asian and Middle Eastern origin. Saudi Arabia recorded 45,892 cases of carriers between 2004 and 2014.
A World Health Organisation study estimated that globally there are at least 950,000 'new carrier couples' every year and annually there are 1.33 million at-risk pregnancies.
RESULTS
6.30pm UAE 1000 Guineas Trial Conditions (TB) US$100,000 (Dirt) 1,400m
Winner Final Song, Christophe Soumillon (jockey), Saeed bin Suroor (trainer).
7.05pm Handicap (TB) $135,000 (Turf) 1,000m
Winner Almanaara, Dane O’Neill, Doug Watson.
7.40pm Handicap (TB) $175,000 (D) 1,900m
Winner Grand Argentier, Brett Doyle, Doug Watson.
8.15pm Meydan Challenge Listed Handicap (TB) $175,000 (T) 1,400m
Winner Major Partnership, Patrick Cosgrave, Saeed bin Suroor.
8.50pm Dubai Stakes Group 3 (TB) $200,000 (D) 1,200m
Winner Gladiator King, Mickael Barzalona, Satish Seemar.
9.25pm Dubai Racing Club Classic Listed Handicap (TB) $175,000 (T) 2,410m
Winner Universal Order, Richard Mullen, David Simcock.
UAE'S%20YOUNG%20GUNS
%3Cp%3E1%20Esha%20Oza%2C%20age%2026%2C%2079%20matches%0D%3Cbr%3E%0D%3Cbr%3E2%20Theertha%20Satish%2C%20age%2020%2C%2066%20matches%0D%3Cbr%3E%0D%3Cbr%3E3%20Khushi%20Sharma%2C%20age%2021%2C%2065%20matches%0D%3Cbr%3E%0D%3Cbr%3E4%20Kavisha%20Kumari%2C%20age%2021%2C%2079%20matches%0D%3Cbr%3E%0D%3Cbr%3E5%20Heena%20Hotchandani%2C%20age%2023%2C%2016%20matches%0D%3Cbr%3E%0D%3Cbr%3E6%20Rinitha%20Rajith%2C%20age%2018%2C%2034%20matches%0D%3Cbr%3E%0D%3Cbr%3E7%20Samaira%20Dharnidharka%2C%20age%2017%2C%2053%20matches%0D%3Cbr%3E%0D%3Cbr%3E8%20Vaishnave%20Mahesh%2C%20age%2017%2C%2068%20matches%0D%3Cbr%3E%0D%3Cbr%3E9%20Lavanya%20Keny%2C%20age%2017%2C%2033%20matches%0D%3Cbr%3E%0D%3Cbr%3E10%20Siya%20Gokhale%2C%20age%2018%2C%2033%20matches%0D%3Cbr%3E%0D%3Cbr%3E11%20Indhuja%20Nandakumar%2C%20age%2018%2C%2046%20matches%3C%2Fp%3E%0A
HOW%20TO%20ACTIVATE%20THE%20GEMINI%20SHORTCUT%20ON%20CHROME%20CANARY
%3Cp%3E1.%20Go%20to%20%3Cstrong%3Echrome%3A%2F%2Fflags%3C%2Fstrong%3E%3C%2Fp%3E%0A%3Cp%3E2.%20Find%20and%20enable%20%3Cstrong%3EExpansion%20pack%20for%20the%20Site%20Search%20starter%20pack%3C%2Fstrong%3E%3C%2Fp%3E%0A%3Cp%3E3.%20Restart%20Chrome%20Canary%3C%2Fp%3E%0A%3Cp%3E4.%20Go%20to%20%3Cstrong%3Echrome%3A%2F%2Fsettings%2FsearchEngines%3C%2Fstrong%3E%20in%20the%20address%20bar%20and%20find%20the%20%3Cstrong%3EChat%20with%20Gemini%3C%2Fstrong%3E%20shortcut%20under%20%3Cstrong%3ESite%20Search%3C%2Fstrong%3E%3C%2Fp%3E%0A%3Cp%3E5.%20Open%20a%20new%20tab%20and%20type%20%40%20to%20see%20the%20Chat%20with%20Gemini%20shortcut%20along%20with%20other%20Omnibox%20shortcuts%20to%20search%20tabs%2C%20history%20and%20bookmarks%3C%2Fp%3E%0A
WORLD CUP SEMI-FINALS
England v New Zealand
(Saturday, 12pm UAE)
Wales v South Africa
(Sunday, 12pm, UAE)
SRI LANKA SQUAD
Upul Tharanga (captain), Dinesh Chandimal, Niroshan Dickwella
Lahiru Thirimanne, Kusal Mendis, Milinda Siriwardana
Chamara Kapugedara, Thisara Perera, Seekuge Prasanna
Nuwan Pradeep, Suranga Lakmal, Dushmantha Chameera
Vishwa Fernando, Akila Dananjaya, Jeffrey Vandersay
Apple%20Mac%20through%20the%20years
%3Cp%3E1984%20-%20Apple%20unveiled%20the%20Macintosh%20on%20January%2024%3Cbr%3E1985%20-%20Steve%20Jobs%20departed%20from%20Apple%20and%20established%20NeXT%3Cbr%3E1986%20-%20Apple%20introduced%20the%20Macintosh%20Plus%2C%20featuring%20enhanced%20memory%3Cbr%3E1987%20-%20Apple%20launched%20the%20Macintosh%20II%2C%20equipped%20with%20colour%20capabilities%3Cbr%3E1989%20-%20The%20widely%20acclaimed%20Macintosh%20SE%2F30%20made%20its%20debut%3Cbr%3E1994%20-%20Apple%20presented%20the%20Power%20Macintosh%3Cbr%3E1996%20-%20The%20Macintosh%20System%20Software%20OS%20underwent%20a%20rebranding%20as%20Mac%20OS%3Cbr%3E2001%20-%20Apple%20introduced%20Mac%20OS%20X%2C%20marrying%20Unix%20stability%20with%20a%20user-friendly%20interface%3Cbr%3E2006%20-%20Apple%20adopted%20Intel%20processors%20in%20MacBook%20Pro%20laptops%3Cbr%3E2008%20-%20Apple%20introduced%20the%20MacBook%20Air%2C%20a%20lightweight%20laptop%3Cbr%3E2012%20-%20Apple%20launched%20the%20MacBook%20Pro%20with%20a%20retina%20display%3Cbr%3E2016%20-%20The%20Mac%20operating%20system%20underwent%20rebranding%20as%20macOS%3Cbr%3E2020%20-%20Apple%20introduced%20the%20M1%20chip%20for%20Macs%2C%20combining%20high%20performance%20and%20energy%20efficiency%3Cbr%3E2022%20-%20The%20M2%20chip%20was%20announced%3Cbr%3E2023%20-The%20M3%20line-up%20of%20chip%20was%20announced%20to%20improve%20performance%20and%20add%20new%20capabilities%20for%20Mac.%3C%2Fp%3E%0A
FROM%20THE%20ASHES
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All%20The%20Light%20We%20Cannot%20See%20
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EA Sports FC 25
Developer: EA Vancouver, EA Romania
Publisher: EA Sports
Consoles: Nintendo Switch, PlayStation 4&5, Xbox One and Xbox Series X/S
Rating: 3.5/5
UK%20record%20temperature
%3Cp%3E38.7C%20(101.7F)%20set%20in%20Cambridge%20in%202019%3C%2Fp%3E%0A
It Was Just an Accident
Director: Jafar Panahi
Stars: Vahid Mobasseri, Mariam Afshari, Ebrahim Azizi, Hadis Pakbaten, Majid Panahi, Mohamad Ali Elyasmehr
Rating: 4/5
more from Janine di Giovanni
A cheaper choice
Vanuatu: $130,000
Why on earth pick Vanuatu? Easy. The South Pacific country has no income tax, wealth tax, capital gains or inheritance tax. And in 2015, when it was hit by Cyclone Pam, it signed an agreement with the EU that gave it some serious passport power.
Cost: A minimum investment of $130,000 for a family of up to four, plus $25,000 in fees.
Criteria: Applicants must have a minimum net worth of $250,000. The process take six to eight weeks, after which the investor must travel to Vanuatu or Hong Kong to take the oath of allegiance. Citizenship and passport are normally provided on the same day.
Benefits: No tax, no restrictions on dual citizenship, no requirement to visit or reside to retain a passport. Visa-free access to 129 countries.
Company Profile:
Name: The Protein Bakeshop
Date of start: 2013
Founders: Rashi Chowdhary and Saad Umerani
Based: Dubai
Size, number of employees: 12
Funding/investors: $400,000 (2018)
MOUNTAINHEAD REVIEW
Starring: Ramy Youssef, Steve Carell, Jason Schwartzman
Director: Jesse Armstrong
Rating: 3.5/5
THE SPECS
Engine: 1.5-litre
Transmission: 6-speed automatic
Power: 110 horsepower
Torque: 147Nm
Price: From Dh59,700
On sale: now
More from Neighbourhood Watch
Specs
Engine: Dual-motor all-wheel-drive electric
Range: Up to 610km
Power: 905hp
Torque: 985Nm
Price: From Dh439,000
Available: Now
What is 'Soft Power'?
Soft power was first mentioned in 1990 by former US Defence Secretary Joseph Nye.
He believed that there were alternative ways of cultivating support from other countries, instead of achieving goals using military strength.
Soft power is, at its root, the ability to convince other states to do what you want without force.
This is traditionally achieved by proving that you share morals and values.
Sri Lanka-India Test series schedule
1st Test July 26-30 in Galle
2nd Test August 3-7 in Colombo
3rd Test August 12-16 in Pallekele
TO A LAND UNKNOWN
Director: Mahdi Fleifel
Starring: Mahmoud Bakri, Aram Sabbah, Mohammad Alsurafa
Rating: 4.5/5
La Mer lowdown
La Mer beach is open from 10am until midnight, daily, and is located in Jumeirah 1, well after Kite Beach. Some restaurants, like Cupagahwa, are open from 8am for breakfast; most others start at noon. At the time of writing, we noticed that signs for Vicolo, an Italian eatery, and Kaftan, a Turkish restaurant, indicated that these two restaurants will be open soon, most likely this month. Parking is available, as well as a Dh100 all-day valet option or a Dh50 valet service if you’re just stopping by for a few hours.
Jigra
Starring: Alia Bhatt, Vedang Raina, Manoj Pahwa, Harsh Singh
Killing of Qassem Suleimani
ADCC AFC Women’s Champions League Group A fixtures
October 3: v Wuhan Jiangda Women’s FC
October 6: v Hyundai Steel Red Angels Women’s FC
October 9: v Sabah FA
The past winners
2009 - Sebastian Vettel (Red Bull)
2010 - Sebastian Vettel (Red Bull)
2011 - Lewis Hamilton (McLaren)
2012 - Kimi Raikkonen (Lotus)
2013 - Sebastian Vettel (Red Bull)
2014 - Lewis Hamilton (Mercedes)
2015 - Nico Rosberg (Mercedes)
2016 - Lewis Hamilton (Mercedes)
2017 - Valtteri Bottas (Mercedes)
MATCH INFO
What: 2006 World Cup quarter-final
When: July 1
Where: Gelsenkirchen Stadium, Gelsenkirchen, Germany
Result:
England 0 Portugal 0
(Portugal win 3-1 on penalties)