NBC's Shameless Attempt to Scare You About Pfizer's COVID Drug

Today, NBC News managed to spoil the coming-out party of a desperately needed, lifesaving drug with its lead headline of the morning:

"Pfizer antiviral pills may be risky with other medications."

Damn, here we go again—another failure. The NBCNews.com headline was so tempting that it was picked up word for word on the sensationalist Drudge Report, which gets about 2 million unique visitors per month, and subsequently on multiple other news sites. People who read only headlines (translation: pretty much everyone) will take home precisely the wrong message: that we now have a dangerous drug to (finally) treat COVID when, in fact, it's pretty much the opposite.

Neither Science nor Medicine are Perfect

The vaccines were supposed to be our salvation, except, as so many people take delight in pointing out, they're not perfect. The level of protection wanes with time, so instead of one or two shots and back to your bowling league, some of us have been subjected to the unspeakable indignity of needing a third shot (all at no cost) to provide better protection. Worse still, our newly-minted crop of armchair immunologists – seemingly millions of them – bitterly complained that this "funky" new mRNA technology is the problem, even though people who got more traditional vaccines fared worse than those who got the microchip mRNA shots.

And the variants! Let's run the clock back to the end of 2020, comb through the literature to find the zero people who would have imagined, let alone predicted, that a series of variants, each more vicious than the last, would overrun the world at an unprecedented and unimaginable speed. Some NMIs (newly-minted immunologists) even blame the vaccines for creating these variants, even though this is impossible (1).

As Professor Katherine Seley-Radtke and I wrote in the Baltimore Sun back in July 2020 – four months before Pfizer announced its first positive vaccine findings – "Vaccines might not be the only way to treat COVID-19." In that article, we discussed the need for antiviral drugs either in place of (2) or in addition to vaccines so that we could throw whatever we had at COVID.

Now 2.5 years later, we have vaccines that have done a fine job of keeping people off ventilators and out of the morgue (but not such a good job in preventing transmission), as well as two FDA-approved (3) direct-acting antiviral drugs, at least one of which will be a game-changer in its own right. Too bad NBCNews.com felt the need to scare the hell out of an already frightened world when they could have used a less sensational (and also more accurate) headline. For example...

"Pfizer's Wonder Drug Paxlovid is Safe and Effective. You and Your Pharmacist Just Have to be a Little Careful"

Instead of celebrating what may end up being the most important drug in a generation, NBCNews.com did its best to make it sound "risky," as if serious COVID isn't. Paxlovid is so effective because its time in the bloodstream is enhanced by a "helper" drug, ritonavir – the drug responsible for the "woe is me" headline. Nirmatrelvir, the actual antiviral drug, is (as is the case with many drugs) metabolized by an important liver enzyme called CYP3A.

Ritonavir inhibits CYP3A enabling the nirmatrelvir to stick around long enough to do its job; this is hardly the first time it's been used for this purpose. Ritonavir was initially developed as an HIV protease inhibitor but is now primarily used to extend the half-life of other drugs. This is a classic example of drug-drug interactions, hardly unique to Paxlovid.

I suspect that the scary headline came from the FDA's fact sheet, warning about potential interaction of Paxlovid with about 100 drugs, including statins, blood thinners, sedatives, cancer drugs, and heart drugs. This is what NBCNews.com chose to emphasize, as if this is some unique case. No, it isn't. There are hundreds/thousands drugs that are affected by the action of other drugs, primarily on the liver and this can be managed by your pharmacist or doctor by adjusting the dose or discontinuing the drug for the five-day course of Paxlovid. Had NBCNews.com done five minutes of research, they would have seen that although some important drugs should not be taken with Paxlovid, this is the case with most other drugs. And then some.

Medscape provides a drug interaction database where you can plug in a drug and see what other medications might cause problematic interactions if taken with it. Try aspirin, and you'll find more than 400 other drugs that can cause drug-drug interactions. Advil has 250. Taking St. John's Wort for depression? You'll find a list of 450 drugs that cause on the list. For Prozac, it's 480. Here are a few more examples of common drugs and the numbers of other drugs that can cause problems if taken with them:

• Valium - 310
• Azithromycin - 250
• Ritalin - 250
• Propanolol - 320
• Diltiazem - 250

You can see that this is nothing new, something that was implied by the NBCNews.com headline. Yes, like plenty of other drugs Paxlovid can be risky if taken with other drugs, but this can be managed. 

One of the (many) things that drive us nuts at ACSH are misleading (and fear-mongering) headlines, and this is one by any measure. Instead of focusing on what is no less than a monumental accomplishment, NBCNews.com took the low road. Any wonder people don't trust the press?

NOTES:

(1) Dr. Paul Offit, private communication

(2) In mid-2020 it was far from certain that there would be a COVID vaccine at all. At that time health officials were considering 50% efficacy to be the minimum acceptable protection, but no one knew.

(3) Both Paxlovid and Merck's molnupiravir have been Emergency Use Authorization at this time, not full approval.

#Conflict of interest statement: My IRA contains Pfizer stock.