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Optimizing the Trade-off Between Learning and Doing in a Pandemic

Educational Objective
To understand the challenges of RCTs during a pandemic and potentional solutions
1 Credit CME

The world is united regarding the goal of ending the coronavirus disease 2019 (COVID-19) pandemic but not the strategy to achieve that goal. One stark example is the debate over whether to prescribe available therapies, such as quinine-based antimalarial drugs (eg, chloroquine or hydroxychloroquine), or test these drugs in randomized clinical trials (RCTs). At the heart of the problem is one of the oldest dilemmas in human organizations: the “exploitation-exploration” trade-off.1 Exploitation refers to acting on current knowledge, habits, or beliefs despite uncertainty. This is the “just do it” option: give various therapies (eg, chloroquine) to affected patients based on current knowledge or a hunch. Exploration refers to actions taken to generate new knowledge and reduce uncertainty, eg, testing therapies in an RCT. This is the “must learn” option.

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Article Information

Corresponding Author: Derek C. Angus, MD, MPH, University of Pittsburgh, 3550 Terrace St, 614 Scaife Hall, Pittsburgh, PA 15261 (angusdc@upmc.edu).

Published Online: March 30, 2020. doi:10.1001/jama.2020.4984

Conflict of Interest Disclosures: None reported.

Additional Contributions: I thank Julie Donohue, PhD, University of Pittsburgh, for her input. Dr Donohue received no compensation for her contributions.

References
1.
March  JG .  Exploration and exploitation in organizational learning.   Organization Science. 1991;2(1):71-87.Google ScholarCrossref
2.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Belmont Report. Published April 18, 1979. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html
3.
Kalil  AC .  Treating COVID-19—off-label drug use, compassionate use, and randomized clinical trials during pandemics.   JAMA. Published online March 25, 2020. doi:10.1001/jama.2020.4742Google Scholar
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