Pharmacology and COVID-19

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Ali Yağız ÜRESİN
İstanbul Üniversitesi İstanbul Tıp Fakültesi, Tıbbi Farmakoloji ABD, Klinik Farmakoloji BD, İstanbul, Türkiye
Article Language: TR
COVID-19 pandemisi, 2019 yılı sonundan başlayarak, 2020 yılının tamamını kapsayan ve 2021'de de devam edecek gibi gözüken, dünyanın en önemli sağlık sorunudur. Hastalığın İngilizce ismi olan COrona, VIrüs ve Disease kelimelerinin kısaltılması ve ilk defa tanımlandığı 2019 yılına atfen oluşturulmuş ve resmi kısaltma olarak kabul edilmiş bu isim, aynı zamanda özel bir ülke, konum, hayvan veya insan grubuna atıf yapmayarak damgalamayı önlemeyi amaçlayarak belirlenmiştir. Hoş bu günlerde 'Güney Afrika Mutasyonu' oralılarca böyle bir damgalamaya aday gösterilmektedir.

Tıpkı COVID-19 pandemisi gibi, Şubat 2020'den bu yana salgın ile ilgili günde ortalama 140 bilimsel makalenin yayınlanması, daha önce bilim dünyasını alışılmadık bir durum ile karşı karşıya bırakmıştır. Konunun aciliyeti, küresel bir sorun olması, bilimsel işbirliklerin veya veri paylaşımının getirdiği ivmenin yanı sıra, ilginin fazla olmasına bağlı olarak yayınevlerinin de gerek makale gerekse kitap veya benzeri şekillerde yapılacak çalışmaları yayınlama isteklerinin de yüksek olmasına neden olmuştur. Kısa sürede bu kadar çok yayın üretilmesindeki niceliksel artış, maalesef aynı derecede yayınların niteliğine yansıyamamıştır. En büyük problem; makalelerin düşük düzeyde kanıt içeriyor olması, deneysel sistematik kanıtlardan çok teorik çıkarımlardan veya anekdotal kullanımlardan sonuçlara ulaşılması veya değerlendirme süreçlerinin çok hızlı gerçekleşmesi gibi nedenlere bağlı olarak kasıtsız hatalar ve yanlışlıklar olarak görülmektedir. Bu tip yayınların bazıları geri çekilmekte, bazıları düzeltilerek yayınlanmaktadır. Elbette bu kadar kısa bir sürede deneysel kanıta ulaşmanın güçlüğü göz önüne tutulmalıdır. Ancak unutulmamalıdır ki buradaki asıl hedef; yayınlamak için veri derlemekten öte, pandeminin ortaya çıkardığı gereklilikleri karşılayacak nitelikte bilgi üretip, bilim dünyasının görüşlerine ve toplumun faydasına sunmak için yayın üretmek olmalıdır.

COVID-19 pandemisinde bilimsel bilginin üretilmesindeki sorunlar, üretilen bilgilerin topluma yansımasında katmerlenerek büyümüş ve en az pandemi kadar zarar veren bir infodemiye dönüşmüştür. Burada sosyal bilimsel çıktıların pandemi sürecinde sağlık alanında elde edilen kazanımlar kadar başarı gösterip göstermediği tartışılabilir. Sağlık alanında ortaya çıkan bilimsel bilginin, etik, hukuk, iletişim, ekonomi gibi alanlardaki kabul edilmiş standartlarla oluşturulacak bir sistem içinde toplumsal kullanıma sunulması gerekmektedir. Bu da Çevrimsel Bilim için rüştünü isbat edebileceği bir uygulama alanı olabilir. Ancak bu şekilde, pandeminin her alanda atlatılabilmesi mümkün olabilecektir.

Pandemide araştırma değil geliştirmede de alışılmışın dışında uygulamalarla karşılaşılmıştır. En belirgin örneği ilaç ve aşı AR-GE'sinde görülmüştür. Alışıldığın dışında, normal araştırma süreçlerine göre çok daha uzun tanımlanmış klinik çalışmalar çok kısa sürede gerçekleştirilmiş ve neredeyse 1 yıl gibi bir zamanda aşı uygulamalarına başlanmıştır. İlaçta klinik çalışmaların çok sayıda ve hızla gerçekleştirilmesinde, bilinen ilaçların yeniden konumlandırması etkili olmuştur.

''Farmakoloji ve COVID-19'' kitabında; pandeminin ortaya çıkışından bugüne kadar, hastalığın tedavi edilmesindeki kullanılan farmakolojik yaklaşımlar ele alınmıştır.

Buradaki bakış açısı, durağan bir kitap mantığında tüm başlıkların yerleştirilmesinden ziyade dinamik olarak araştırma-geliştirme sürecinin ele alınması şeklinde olmuştur. Genel olarak COVID-19 pandemisine bilimcilerin bakışı, preklinik ve klinik araştırma süreci elde edilen bilginin niteliği, veri kullanımı, etik standartlara ve yasal süreçlere kadar birçok başlık içeren derlemeler yer almaktadır. Hâlâ Faz 3 ve erken erişim onayının anlaşılmadan tartışıldığı; kitap okuyarak kitap yazan hocaların kitaplarını okuyarak bilgi yarıştırmaya alışık iklimimizde faydalı olacaktır düşüncesindeyiz. Bahusus; Türkiye Klinikleri COVID-19 serisi altında yayımlanan diğer yayınlarda yer aldığını gözlemlediğimiz Göğüs Hastalıkları ve Yoğun Bakım alanına gelen tedaviler bu çalışmaya katılmamış, buna mukabil araştırma-geliştirme-kanıt oluşturma süreçleri bir bütün olarak mütalaa edilmesi icap eden ve esasen bir mütemadiyet kesbeden; bitkisel ürünler, vitaminler ve besin takviyeleri ilaçlarla beraber incelenmiş, klinik araştırma süreçleri açısından biricik nitelik taşıyan aşılar da yalnızca klinik araştırma kısmıyla kısaca ilgili bölüme dâhil edilmiştir.


Prof. Dr. Ali Yağız ÜRESİN
Editör
The COVID-19 pandemic is the most important health problem in the world, starting at the end of 2019, covering the whole of 2020 and appearing to continue throughout 2021. The English name of the disease is the abbreviation of the words COrona, VIrus and Disease, and this name, which was created with reference to 2019, when it was first defined and accepted as an official abbreviation, was also determined with the aim of preventing stigmatization by not referring to a specific country, location, animal or human group. Nevertheless, these days the "South African Mutation" is nominated for such a stigmatization by the locals.

Like the COVID-19 pandemic, the publication of an average of 140 scientific articles a day on the February 2020 pandemic presents the scientific world with an unusual situation. The urgency of the subject, which is a global problem, as well as the momentum caused by scientific collaboration or data sharing due to the great interest, also caused a great desire of publishers to publish articles, books or similar documents. Unfortunately, the quantitative increase in the production of so many publications in a short time is not reflected in the quality of publications at the same level. The biggest problem is seen as unintentional errors and inaccuracies due to the fact that the articles contain a low level of evidence, the conclusions are derived from theoretical conclusions or anecdotal use rather than experimental systematic evidence, or the evaluation processes occur very quickly. Some of these publications are withdrawn, others are edited and printed. Of course, the difficulty of obtaining experimental evidence in such a short time should be considered.

But it must be borne in mind that the main goal here must be to produce information that meets the requirements of the pandemic, and to produce publications for the benefit of the scientific world and society, rather than collecting data for publication.

In the COVID-19 pandemic, the problems in the production of scientific knowledge have grown exponentially in the reflection of the produced information to the society and turned into an infodemic that is at least as damaging as the pandemic. It can be argued here whether the results of the social sciences show as much success as the health benefits during the pandemic process. Scientific knowledge emerging in the field of healthcare must be made available to the public, in a paradigm that will be established by accepted standards in areas such as ethics, law, communication and economics. This could be a field of application for translational science where it can prove its competence. Only in this way will it be possible to overcome the epidemic in all fields.

Whilst the pandemic, unorthodox practices were encountered not only in research but also in development. The most obvious example is seen in the research and development of drugs and vaccines. Clinical trials, which were expected to last much longer than other research processesses were carried out in a very short time and vaccine applications were completed in less than one year. The repositioning of known drugs has been effective in the rapid and large number of clinical trials. In the ''Pharmacology and COVID19'' book, the pharmacological approaches used in the treatment of the disease have been discussed since the emergence of the pandemic.

The point of view here is to dynamically handle the research and development process rather than aligning all the titles in a static book logic. In general, there are reviews that include many topics from scientists' perspective to the COVID-19 pandemic, the quality of the information obtained from the preclinical and clinical research process, the use of data, ethical standards and legal processes. We think it will be useful in these days, when phase 3 and early access approval are still discussed by those who learn clinical research by reading textbooks written by people via reading books. In this respect, Pulmonary Medicine and Intensive Care medications which were the subject of other publications that had been published under ''Türkiye Klinikleri COVID-19 series'' were not included in this study. On the other hand, research-development-evidence generation processes should be applied as a whole and herbal products, vitamins and nutritional supplements and drugs are to be evaluated as a continuum. Vaccines, which are unique in terms of clinical research processes, were included as a small section in the clinical research chapter.

Prof. Dr. Ali Yağız ÜRESİN
Editor

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