I wonder if this is being used for other drugs. My curiosity stems from personal experience: I had Migraine headaches from age 17 to about 35. I was put on ancient seizure medication that's common prescribed for Bipolar[0] because this doctor had three other patients that it nearly eliminated Migraine from. It was fall, a time when I'd get about one a week. After five days of taking it, I had my first Migraine ... if you could call it that -- I could only identify that it was a Migraine by the aura; the pain was about 10% what I'm used to).

Searching through the web, I found a forum that was filled with Migraine sufferers. Sure enough, there were a handful of people who swore by it. There were also a handful of people who it didn't work for. Looking at the more official sources, there was no indication that this drug could have any effect on Migraine; they listed all of the other off-label uses[1], but Migraine was not among them.

This medication had been in the news several times (and on the front page, here[2]) over the last few years and a year ago (or so), I looked it up on the "official sources", again. It now indicated that it was prescribed for Migraine.

It made me wonder ... how are things like that figured out/communicated down-stream? Is it entirely informally amongst doctors? I went to four different specialists before I found one who suggested this drug -- and he did so in a "half-hearted manner" not truly expecting it would work. It'd be nice if this was centrally tracked/managed as it might surface both "new uses for old drugs" and "new problems with old drugs."

[0] Which I do not have.

[1] It's rarely, if ever, prescribed for what it was originally approved for.

[2] It's Depakote, I'm not being cagey for nefarious purposes, I just didn't want this to be a drug advertisement.

Also highly recommend the book.

Turns out, a drug developed by Gilead Sciences (GS-441524) which is the active metabolite of remdesivir, is remarkably effective at treating the disease. It's a nucleoside analog, so it essentially is a slightly modified adenosine molecule which disrupts the virus RNA replication process.

Within 12 hours of the first dose our cat went from dying to making a full turnaround and complete recovery following treatment. For us it was truly a miracle drug, and it only gained awareness recently due to the COVID-19 pandemic [1]. It still isn't technically "approved" for this use case, but is prescribed off-label by vets as of 2024 once the FDA relaxed its position [2]. Folks needed to seek it out on the black market (and still do in some areas).

[1] https://www.theatlantic.com/science/archive/2020/05/remdesiv...

[2] https://www.fda.gov/animal-veterinary/cvm-updates/fda-announ...

During COVID, I actually wrote a small sample app that pulls info from this DB: https://www.covidcureid.com/

And gave a talk on it: https://learn.microsoft.com/en-us/shows/azure-serverless-con...