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Experts Decry Randomized Ebola Treatment Trials As Unethical, Impractical
New submitter Strangely Familiar writes "A letter in the Lancet calls for alternatives to randomized trials for Ebola treatments: "Leading health experts today urge the deployment of alternative trial designs to fast-track the evaluation of new Ebola treatments. In a letter to The Lancet, 17 senior health professionals and medical ethicists, from Africa, Europe, and USA, argue that although randomised controlled trials (RCTs) provide robust evidence in most circumstances, the lack of effective treatment options for Ebola, high mortality with the current standard of care, and the paucity of effective health care systems in the affected regions means that alternative trial designs need to be considered."
If they are serious they really need to get more big names, institutions, and ethicists on board. A lot more.
There has already been support for basically using time to create control groups, so this is much less of an issue than it could be.
Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done. Stick to what is known to work, there is no time to come up with anything better. If something better had been found in centuries of research into medical methods, then it would be the standard-approach. There is nothing. There will not be anything new even if you debate that question to death now.
This continues the series of incompetence, misinformation, self-aggrandizement and general fuck-ups that have become the signature of the fight against Ebola this time.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
the news increasingly censors any opinion that would be against socialism or popular accepted opinions
I find it incredible that in the 21st century Internet-connected Scandinavia, there are no independent contrarian news outlets.
Ezekiel 23:20
I understand their concern, but ZMapp hasn't even passed stage 1 clinical trials. We don't know if it's safe for humans or not. It could kill more people than it helps. Having randomized trials is how we establish the safety level of the drug.
It may be useful to 'fastrack' the drug through stage 2 trials, since by that point we know it won't kill you.
"First they came for the slanderers and i said nothing."
argue that although randomised controlled trials (RCTs) provide robust evidence in most circumstances, the lack of effective treatment options for Ebola, high mortality with the current standard of care, and the paucity of effective health care systems in the affected regions means that alternative trial designs need to be considered."
Translation:
Even though randomized trials are the gold standard for determining whether a treatment is effective or not, these places have shitty health care systems so we think should do something else now that we know is a bad idea even though it will be detrimental in the long run rather than engage in the hard work that will really solve the problem.
Conveniently these "alternative trial designs" are not detailed in any way. Doing something different for the sake of doing something different is rarely a good idea.
We use randomized trials for VERY good reasons. If we push a bunch of experimental treatments out there it's possible we may save some lives but it is more likely we will accomplish nothing and even worse we will learn nothing in the process. Yes some people are going to die from ebola while we develop treatments. This is the cold hard fact of medicine - we sacrifice some so that a greater number may benefit eventually. You can try taking shortcuts but the odds are very long against them working and even worse you run a high risk of sacrificing future patients on the altar of compassion.
I get that people are dying and my heart goes out to them. But we do things the way we do them for very good reasons and the middle of a (minor overblown) crisis is hardly the time to start throwing out what we know for a fact works.
I find it incredible that in the 21st century Internet-connected Scandinavia, there are no independent contrarian news outlets.
Oh but there are, they just get censored and publicly ridiculed in the mainstream media for being too extreme, tin foil hat news etc. Some of the news reporters from these sites has been charged with racism, hate-crimes and much more and are thus frowned upon and everyone who support them, visit these sites etc. are seen as extremist supporters, vigilantes and society's troublemakers.
An extreme example would be Sweden's recently 3rd largest political party (SD, Sweden Democrats) who got 13% country wide votes, yet frozen out by ALL the other political parties because they felt they're not worthy of any position. The news report on these just like vigilantes, and claim that the only reason this party got to be so big is because the public voted for "none-of-the-above" by voting for that particular party.
What this world is coming to - is for you and me to decide.
The placebo effect is well-established and real. It is well established that it continues to work with smaller effectiveness even when the subjects _know_ they are getting placebos. Stop bringing some new-age bullshit into the discussion, it is not helping. Medical statistics (unlike medicine as often practiced) is a very mature field and delivers reliable results.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
> the politically correct thing to do would be to bring home our own citizens to treat them in our own country instead of isolating it and treating them where it happened.
> I see the same thing happening in other socialist dominated countries.
Er, it happened in America too and you couldn't exactly describe them as socialist.
But randomized trials were designed to be used in a certain set of circumstances. The question is whether these circumstances fall outside of what those would be applicable to and what would be the appropriate protocol if they're not. Being too rigid can be a bad thing but also things should not be done in a knee-jerk fashion.
Randomized trials worked just fine for syphilis.
The available ZMapp was wasted in a worthless political demonstration "that something can be done".
Quote so. There were only a few doses available and without a trial of statistically significant size we cannot possible know if this treatment was effective. Ebola is serious but it doesn't kill everyone it infects. So if you give a treatment to a tiny group of people you have absolutely no way to know if the treatment was effective. You have wasted time and money and hope and learned absolutely nothing in the process. It's idiotic.
The signatories to that letter in Lancet are willing to shoulder any monetary and/or criminal penalties that, in the future, come about because doctors and pharmaceutical makers haven't followed eatablished best practices in pursuit of effective Ebola treatments.
#DeleteChrome
I think you happen to have a very different idea as to what "censored" means than the rest of the world. But perhaps you simply meant "censured"...
Ezekiel 23:20
Er, well how about use non-treated people as the control group? If the placebo effect is a few percent and the disease kills 70% then it really doesn't matter. If the effect of a drug is so small that it's masked by the placebo effect then the drug is worthless: 65% or so are still going to die of the disease. A worthwhile drug[0] would reduce mortality by at least half, ideally 90%, which is simply not going to be masked by a placebo effect.
[0] I'm not saying that the lives saved by a drug that reduced mortality by 5% wouldn't be worth saving, just that if a drug had such a small effect it would be better investing in more research to find a better drug rather than in mass producing the 5% improvement drug.
Any more meaningless generalities to contribute? The field is not static or rigid. The problem is just that generating and validating new drug-trial methods takes decades and cannot really be sped-up. The whole reason we have this gold-standard of randomized trials is that all else has failed. The worst was always the physician on the ground deciding about it, as they have a strong, well-known (and understandable) tendency to always favor their own patients and an inability to clearly see what is happening as a result. That is fine as it is, of course doctors should be strong allies to their patients and try whatever is possible if the patient wants that. It is also catastrophic when objective information about effectiveness or its absence of some treatment is critically needed. All this messing around that these people propose will in the end only cause more victims, potentially a lot more.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Honestly I don't want to wave a tin foil here, but you have to admit certain parties would benefit a lot from an eventual panic or a "wide spread" Ebola occurrence.
Context - what's actually on the rise in Scandinavia at the moment is Nazism. So far, the fight against it has been a rather ham-fisted attempt to suppress it in the news, rather than engaging it and letting people see for themselves what it is. OP apparently sympathises with the rise of the far right in his country.
Seriously, THAT DOES NOT WORK. This idea is for armchair-statisticians only. You NEED the same conditions for the control-group or the results are meaningless.
Well, that is not entirely true. With a medically very well-monitored population where in addition all contacts of everyone are closely monitored and well documented, something might be possible to do with advanced, untested, statistics. I hope you can see that not even western societies meet that requirement by a far cry.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
If passengers are lying about having contact with Ebola infected people . . . they will just pop a couple of aspirin to bring down their temperature before landing.
Very un-PC, but it will help them avoid yet even more delays while trying to catch a connecting flight.
Schroedinger's Brexit: The UK is both in and out of the EU at the same time!
drive-by doctoring is Unethical, Impractical but legal and you are on the hook for the fees some at out of network rates.
Indeed. And if you kill that bunch of people without sound conditions to get a statistical handle of what happens, you just make things worse by wasting time.
A lot of emergency medicine is still in its infancy and is risky, bloody and deadly. Done wrong, it becomes a lot more so. Get used to it.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Nothing will ever convince conspiracy theorists, so I am not even going to try.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Er, it happened in America too and you couldn't exactly describe them as socialist.
The Democrat Party is a socialist/populist organization. So while the mantra is by the people for the people, it's still very much authoritarian from the top down once placed in positions of power. This is nothing new.
Notice this is not liberal vs. conservatism as it is so much as rural vs urban. That hold true for all other european nations as well. Rural vs. Urban.
Life is not for the lazy.
IMO you've mistaken political correctness and socialism terms for something else. Your first point about media censoring an opinion is in fact related to political correctness but after that you have no clue. Think about yourself - please answer this sincerely - if you or somebody close to you had contradicted Ebola abroad of your country would you wish your country to help you or not? After all you've had paid for your country's medical care in your taxes - and this is by no means socialism. So how would it be? Would you wish your country to help you or your close one or just leave you to certain death abroad perhaps in some uncivilized African country?
I think you happen to have a very different idea as to what "censored" means than the rest of the world.
Many people that have kooky opinions think they are being censored when others don't take their ideas seriously.
Isolate is the MAIN tool to get rid of this menace. So why would the health organizations insist on bringing them to other countries? SO that they can "help isolate" the organism on their behalf...come up with a very expensive cure. Very profitable if it escapes esp. A sad state of affairs when people are so greedy to "help themselves" to others perils. And what happens if some of these researchers morphs it into a real easily transmitted strain of Ebola? Hey Africa is the next BIG thing afterall..
One of the biggest threats our civilization faces - is our hellbent political correctness at any cost.
I know this is off topic, but the same thing is happening with Islam. It teaches hate and violence, but point that out and people call you racist (as if there was some kind of Muslim race) and froth at the mouth. The only peaceful Muslims are ones that don't follow the Koran - and they will also be targets of the ones that do follow it.
I am way, way more concerned about Islam than Ebola.
OP apparently sympathises with the rise of the far right in his country.
You don't have to agree with someone to believe that they have a right to speak.
WHO is already looking at stepped wedge trials
Let's say you had an alternative statistical method for judging treatments during a crisis situation like Ebola. It's not out of the question. All sorts of statistical methods have been developed for situations where you can't get the number and type of observations you want. Now think about applying that method where the Ebola crisis is happening. You think the data collection is going to be any better than the health care? It's going to be worse. I spent ten years working with data from emergency rooms in the U.S. It's got lots of problems. Of course it does, the doctors are more concerned about healing the patients than they are about collecting data. Which is the way things should be. You think the doctors in Africa dealing with Ebola right now have the time or training to deal with the data collection?
The point of randomised controlled trials is to form a perfect control group for comparison.
More or less correct. You are trying to control for variables between the treated groups and the non-treated groups to see if there is a statistically significant difference in outcomes between them. If there is a better way to do this than a double-blind study, we haven't found it yet. We do use other study designs when a double-blind study isn't possible but other methods have significant problems.
So why not start giving the drug to everyone and compare against historical data?
Several reasons:
1) Which drug? Do we have enough of it? Can we get it to where it is needed? Has it been previously tested in humans for toxicity? Is there any reason to believe it will work beyond mere hope?
2) We do NOT have particularly good information in the historical record. The medical records in the affected areas are quite certain to be of poor quality. So you lose a LOT of information that is relevant for making comparisons and you do not have a particularly good control group.
3) Unless you can control for other variables like public health policies etc you may not know if it worked or how well.
4) Rushing a drug to market can result in losing valuable information about WHY it worked (or didn't) which may be more valuable than IF it worked to future patients
5) Most drugs do not work. Do you REALLY want to spread already scarce resources even thinner on a long shot that probably will not work?
They may do something like what you suggest but I think that would be a mistake. We KNOW how to control this virus through public health policy. Hyperventilating and throwing a bunch of unproven drugs at the problem in the (probably futile) hope that they will do some good is not only bad policy, it is probably counterproductive.
Like frogs being slowly boiled to death, you just haven't noticed.
Yeah, no. That whole "Frogs can be boiled slowly" thing is thoroughly debunked. Source: http://www.snopes.com/critters...
You do realize socialism is an economic system and has nothing to do per se with so-called "political correctness", right?
they're simply desperate to find anything that will stop it.
We already know what we stop the epidemic. Appropriately executed public health policies, particularly quarantine. I understand people's fear and desperation but public health policy is not the place for panic. To use a basketball analogy these people are proposing taking half-court shots and hoping for the best rather than doing the hard work of actually doing what we already know will work. We are NOT going to save everyone but rushing things along is very likely to actually kill more people in the long run.
Even if a treatment gives them cancer, or HIV, or leaves them with something like chronic fatigue syndrome, they're still going to enjoy quality of life better than they would if they're dead.
What hypothetical treatment do you think will have this outcome? Hmm? What treatment? Very few drug candidates actually prove effective and there is no reason to believe that things will be any different this time. I'm well aware there is work being done regarding this disease but please share with the class what treatment we expect to have any actual hope of working because I certainly am not aware of it.
If there's any time to drop stages between reasoned research and application on human patients, this is it. Look at each and every patient as they're treated and attempt to monitor them after-the-fact.
I could not disagree more. First off, this is a small epidemic that has gotten blown WAY out of proportion in the media. Second, there is absolutely no reason to expect any particular experimental drug to work. While it is possible one might work, the odds are very long against it. Third, this approach actually hinders our ability to learn about WHY a drug works if by some miracle it actually does work. Fourth, ebola is not universally fatal. Between 20%-50% of patients survive. Unless the effects of a drug are VERY dramatic, you'll never know if the drug is what saved a patient.
Yup. The problem with treating zmapp as a cure without evidence is that it might turn out that it doesn't work at all, and that other research lines were not pursued because zmapp was viewed as a cure. Why might this happen? Well, for starters there actually isn't THAT much money to be made in a cure for Ebola. I don't agree with the tinfoil hat types that anybody would deliberately not develop a cure, because the fact is that a cure would generate a reasonable profit if not a huge one. However, the world probably doesn't need 47 different cures for Ebola and the first one to the market is likely to get 95% market share. If companies perceive that zmapp is basically on the verge of being labeled as the cure, then they're not going to spend a lot of money on another cure just to fight for the scraps.
And you can't really be sure without a control. There are all kinds of bias, perverse incentives, and other factors that can lead to misleading data in the absence of a true double-blind controlled trial. Doctors often falsify data in clinical trials because of perverse incentives. Companies do it less often since they're more closely monitored and falsifying data at that level often requires conspiracy, but they obviously have a huge incentive to do it if they could get away with it. A double-blind trial helps to keep everybody honest.
If passengers are lying about having contact with Ebola infected people . . . they will just pop a couple of aspirin to bring down their temperature before landing.
If they are showing symptoms, a high temperature will not be the only symptom in evidence most likely. Aspirin is VERY unlikely to cover the symptoms of ebola. Plus taking a blood thinner (aspirin) when infected with a disease that results in bleeding is a monumentally stupid idea.
And yet from today's perspective, Eisenhower could be mistaken for a Democrat.
Instead of randomizing with placebo, why not simply randomize with _different_ experimental treatments and then use analysis / datamining to determine which are most effective? That way no one has to have placebo.
And yet from today's perspective, Eisenhower could be mistaken for a Democrat.
And yet from a right / left linear political description, Hitler and Stalin were polar opposites.
You don't necessarily have to subscribe to the Political Compass approach, but it's patently obvious that the social and economic spectrums of politics are orthogonal. Anyone who tries to persuade to believe only the left/right alternatives exist is probably running for office in a first past the post voting system.
Both modern Democrats and modern Republicans are highly in favor of the authoritarian, interventionalist state. Federalism used to be a differentiating factor, but no longer.
That particular party needs to have serious ideas and proposals, clean out their ranks (from said nazis, racists and fascists - who have publicly proclaimed their beliefs), and last but not least, have competent people. There's so many videos out there of "politicians" that can't count or have no grasp of their own political agenda. When they get confronted about shit they've done/said they conveniently have collective memory loss (their favourite phrase is "I don't remember"). I'm sad and quite embarrassed that 13% voted for these idiots.
Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done. Stick to what is known to work, there is no time to come up with anything better.
It's not a question of experimentation with uncertain approaches. The alternatives are all well-understood... actually the mathematics is straightforward enough that the characteristics of virtually any approach you can invent can easily be calculated.
The question is whether they should use the approach that provides the fastest route to a given level of certainty at the expense of deliberately leaving a significant percentage of sufferers untreated, or whether to use other methods that provide the treatment to everyone possible but will take longer to achieve the required level of certainty. There's a legitimate question here, particularly if the researchers strongly believe that the vaccine does work. In that case, using randomized treatment will needlessly allow many people -- and, in particular, healthcare workers -- to die. If, on the other hand, the vaccine really isn't very effective, then delaying the discovery of that fact, and therefore delaying evaluation of alternative vaccines (assuming they exist) will cost more lives.
In any case, this isn't a question of experimenting with uncertain approaches. The pros and cons of all of the options are fully understood. It's just a question of deciding which set of tradeoffs is the best for this situation.
Note to ACs: I usually delete AC replies without reading them. If you want to talk to me, log in.
Actually, with the right shift of politics, Eisenhower is left of republicans AND lower on the authoritarian scale than either Rs or Ds today..
I didn't say he didn't have the right to speak. I was just framing his comments with a bit more context.
Having the right to speak is not the same as having the right to not be called an idiot.
It's not ethical to administer treatment until we have reason to believe it's more likely to do good than harm. With top of the line supportive care, ebola patients seem to have about even odds to pull through. Giving them something toxic or using limited money on unproven medication rather than access to good supportive care could well jeopardize those odds. Initial trials should be done on just big enough groups to establish necessary statistical confidence.
Now if side effects are few and financing is not at the expense of proven medicine, it's a different story. But too often, ethics is violated for experimental cancer drugs. People are given toxic drugs that increase suffering without solid evidence that they will increase remaining quality or even quantity of life.
Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done.
But that is "doing something"! Haven't you heard of the First Rule of Bad Decision Making yet?
1. "We must do something!"
2. "Here is something."
3. "Let's do it!"
During a "crisis", doing nothing or doing things the same way you do normally (for whatever reason), is a mortal sin in the eyes of many PHB types.
Oliver.
I think this "former GOP president would now be considered a modern Democrat" meme (usually Eisenhower or Reagan) is either deliberately disingenuous or ill-informed.
Got a lot of calls from modern Democrats for crash nuclear weapons program expansions? Maybe these calls are from the pro-life wing of the Democratic party that's in favor of government deregulation and privatization.
The assertion made by this meme isn't any more apt than trying to claim all modern Democratic presidents could be mistaken for Republicans because the Democrats were on the wrong side of history by being the pro-slavery party while the Republicans made abolition a key plank.
Both parties have changed significantly over the past 100 years, and not for the better.
All religions teach hate and violence of some form or other. Organized religion itself is nothing more than political control of a given populace. The whole concept of "hell" is using the threat of violence to control behavior. The point is, most, if not all, religions have their violent tendencies.
This is a sig. This is only a sig. Had this been an actual sig you would have been informed where to tune for more sigs.
The point is, you can define "liberal" to the stage where Reagan, Nixon, and even Goldwater were 'liberals", just as Fox news insists that ALL the other media outlets are liberal.
Remember the tax rebates of 2008 and 2009? It's estimated that individual consumer spending drives about 68-70% of all economic investment in the USA - in fact, the 2014 estimate for that is exactly 70.0%. Just about everyone in economic circles accepts this number, maybe with a few minor quibbles. That means a neutral (not conservative, not liberal, not supply side, not demand driven tax rebate would have been about 70% to individual consumers). Both the Bush and Obama year tax rebates were about 32-33% individual consumer and 68-67% business breaks, ergo, the "liberal" Obama tax rebate was weighted about 2 to 1 towards the ultra conservative end of supply side economics. Here's one of very few areas where there is a clear, unbiased, objective definition of where the line between left and right is, and by that test, the Obama administration is extremely conservative, as is damned near everybody elected these days.
As much as I like treating the whole left v. right model as terribly over-simplified and using at least a dual axis model, and as much as I can respect your arguement about autoritarianism, the position that Eisenhower looks like a (modern) Democrat is simply factual. The Republicans may have shifted more towards an interventionist model in foreign affairs, or supported big government spending more than they once did, but that's not the biggest change - the Republicans haven't failed by drifting towards the Democrats on a few key issues, and only need to reform themselves merely by getting back to their "small government" roots. The real difference is between a party that is now 99% for whatever the MIC stakeholders want and a party that is only about 55% for the same thing. Until there are Republicans who want to cut MIC related spending and not just "social" spending to reign in big government, there is no meaningful distinction between a fiscal conservative and a neocon or a tea-partyist. Hell, until the Republicans get a single candidate that even admits the objective fact that cutting ALL of what they themselves define as social spending includes cutting the VA budget too, the idea of a populist Republican remains an oxymoron on the level of Nice, Sweet, Wholesome, Axe-wielding, Coked-up, Nazi, Mansonite Xenomorph. Not that I'm saying Republicans are monsters, just that their policies nowdays have contradictions that are ultimately at the very far ends of ANY normal or same spectrum, and leave them saying things that are literally impossibly self contradictory with every position they take.
Who is John Cabal?
The Placebo Effect is known to have at least one huge flaw in its theory. There have been several experiments involving Placebo Opiates and Placebo Opiate Antagonists in double blind studies with real drugs of both kinds, and the researchers doing them have pretty much disproved that the Placebo Effect works in any of the ways theories say it might.
In fact, one prominent researcher said of these studies, he was now of the opiniion that it was not possible to phrase whatever was really happening in a natural language, and he could not offer a theory that fit all the facts without it sounding like "Four-sided, colorless, green triangles meditate furiously. Other researchers have simply pointed out that, in their tests, the explanations of what should be expected in using placebo opiates simply don't have any pedictive ability when the tests also mix in treating those addicted patients with possible placebo antagonists, and left it at that.
Who is John Cabal?
Randomized trials are essential withholding potential treatment from some suffering patients, to satisfy some of the experimenters' goals.
So why not allow the experimental product to be administered outside of the trial, having only passed safety standards? That can provide solid evidence for a large category of illnesses (those that people are not known to recover from spontaneously).
Then, if some folks want more rigorous evidence of efficacy, they are welcome to find patients who accept to participate in the randomized trials. Maybe by compensating them in some way for the risk they are taking? (It's possible that nobody would accept such a deal, so what?)
Or maybe by modifying the protocol so that they get the treatment for sure if their condition worsens?
These comments are mine; I do not speak for my employer.
http://www.cnn.com/2014/09/27/...
Assuming this is honest, it seems amazing. Mortality rate down to 13%. When you're talking epidemic, throwing everything against the wall to see what sticks seems like the only way to do it. You think they have problems getting people to go to the hospital now, imagine how hard it would be if word went around that you might wind up in a control group?
Er, it happened in America too and you couldn't exactly describe them as socialist.
Yeah, our socialists prefer to be called Progressive. Used to be Liberal. They change their name every decade or so once people figure out what they really want.
Actually, it was my own conclusion just by looking at him. It's really quite obvious that there is no 'left' in the U.S. and that the closest we have was once called 'right'. The 'right' we have now would once have been known as the crazy wingnuts.
Consider, Universal healthcare turned into insurance bought from private entities. A few years ago it was called 'Romneycare'.
There's nothing inapt about it. It is a perfectly valid observation of how quickly the actual positions of the parties have shifted and is worthwhile for those whose position has NOT shifted so much. Perhaps it's time for people to re-evaluate the party they affiliate with.
I do not claim that doing the statistics right gives you perfect data. Far from it. But If you do the statistics wrong, you are ensured to get bad data and that potentially kills a lot of people with the problem at hand. So doing the statistics right is an ethical imperative, even if the results are only so-so.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Indeed. With the current situation, the delay would be lethal for a lot of people.
And antivirals have been duds before after being heralded as miracle cures. Just think of Tamiflu, for example. Last I heard it had "no effect".
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Um, the positions of the parties have been shifting more authoritarian, on average.
The USA was kind of founded on radical individual liberty and freedom. Today you can't find a party wanting to touch the war machine, drug laws, social security, or other massive programs that the Framers couldn't even have dreamt about.
Go back and look at the conflicts that the two parties fought over back then. It seems like a joke now. There was a time we actually fought over a centralized banking system? Light houses? Slavery?
Wonder what the public key field is for?
Really, it is not "for me" where the problem sits. It is for those sick and dying and all those that will get infected in the future. Learn a bit about statistics maybe? And while dead/not dead may be a reasonable approximation for Ebola, it is not for ZMapp, unless you assume zero side-effects. Also, the death-rate is _not_ known, there are just some estimates and in addition it seems to be strongly dependent on factors like medical care. Or in short: The clueless one here is you.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
I completely agree. There have been significant discoveries under great pressure. There have been a lot more utter disasters when experimenting under great pressure. Of course, history tends to remember the heroes, and to forget the catastrophes, but realistically, the making things worse is a lot more likely, especially when we have something we know works to a reasonable degree and when we know beyond any doubt that the problem is very, very hard.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
No, you cannot "easily calculate" the mathematics of an alternate approach. In a clinical trial, you _create_ the experimental conditions and that is the only reason that you know them and can do calculations. Sure, if you have all data, then modeling is easy. You will not even get reasonable approximations in the situation at hand. Remember that hospitals refuse treatment to sick and dying people because they are full? Remember that people there bury their dead themselves? Remember that conditions are bad enough that likely quite a few people die that would have survived with reasonable care? You are _not_ going to get any useful numbers unless you control the experimental situation. And you make a second mistake: Even in completely controlled clinical trials, you have to estimate uncertainty before you can do any modeling. That requires intuition and experience. This nos mostly not a mathematical problem.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Indeed. Unfortunately, if this goes seriously wrong, it is not just one incompetent tribe that gets wiped out this time.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Studies without control group that use a placebo will prove nothing about a treatment, but are they unethical? Will it be ethical to give a placebo to someone suffering a deadly sickness?
I have a friend that worked at the Stanford medical center's pediatric intensive care unit, where his patients were often flown in/helicoptered from all over the state. There are certain diseases that have a 100% mortality rate in children, where they could be fine two weeks before, and near death when he gets them. He developed a cure that saves about half the kids, and attributes most of the lost ones for not getting then to him fast enough. Everywhere else in the world they die. Stanford, being a research hospital, allowed him to experiment. He had a dilemma that bothered him immensely-- In order to gain wider acceptance, the medical community wanted to have a double blind test to see if the test, and show statistics.. When I last spoke with him, he was thinking about the minimum set of kids that would have to die and still be statistically acceptable. This was about 8 years ago, and don't know the current status. I'm not a doctor, and may have some of the details wrong. He did mention that his point of view was controversial, and it's hard for other doctors to reconcile that his patients lived though was was normally consider a death sentence.. He mentioned that he had to manage multiple organ failure trying to restore them to health. If a child was flown in fast enough, there was a good chance of a 100% recovery.
He had an interesting theory about the body and death (if I recall correctly) -- He believes that under some conditions, the autoimmune response goes out of control and starts actively trying to kill you. A lot of disease vectors and allergies can trigger this. . He said your body actively produces a lot of nasty toxins that cause multiple organ failures.. He did research on dialysis filters, and made sure to continuously purge the blood stream for the toxins. He would also follow up with chemotherapy to aid in autoimmune response suppression.. His method called for a very high volume of IV fluid which was pretty expensive. Stanford was willing to fit the bill. He believes that this method could be used to treat older patients as well.
Through a fog of memory, I'd like find out how this guy is doing. He's still doing pediatric critical care work, but moved on to Samaritan Hospital. He tells me that a lot of doctors he knows can't handle children dying in intensive care wards. He's an optimist and thinks about the number of children he's saved.. There are unsung heroes all around us.
In this case, one of the most dangerous things you can do is partially apply a cure. Allowing people who have already been treated to remain in close contact with those still infected and resulting in re-infection is the surest way to develop treatment resistance in the targeted infectious agent. Stockpiles of any successful treatment must first be built up in countries not yet infected so that any appearance of the infection can be rapidly treated. Once those stockpiles are built upon, stockpiles to be deployed in already infected regions can be built up so that an entire quarantined region can be treated in order to significantly reduce the risk of reinfection.
Peace meal application of a treatment will guarantee the spread of the infection globally and the build up of resistance due to reinfection. The greater the spread and infection the far greater the risk of mutation into more harmful varieties.
Chaos - everything, everywhere, everywhen
Yes, as I indicated, both are more authoritarian today as well as being further right.
> most, if not all, religions have their violent tendencies.
But only on paper. In reality, the only major religion that will have you beheaded for drawing a picture is Islam. And that threat is in practice so convincing, that liberals who made careers mocking "religion" (i.e. Christianity only) will refuse to touch Islam with the excuse "sorry, i cant, i have kids".
* http://www.barenakedislam.com/...
You appear to be describing antibiotic resistance. Ebola is a virus.
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
I tried hard to decipher what could have triggered what I wrote into the obvious troll thread it became
It was an obvious troll from the start.
the news increasingly censors any opinion that would be against socialism or popular accepted opinions
I find it incredible that in the 21st century Internet-connected Scandinavia, there are no independent contrarian news outlets.
There are. Don't conflate Sweden with the rest of Scandinavia, and even if Sweden there are contrarian outlets, it is just that most Swedes pretend opions they don't like don't exits.
It also means that for those that are infected, there's so little chance of survival with "traditional" treatments that they have very little to lose by trying something experimental. Even if a treatment gives them cancer, or HIV, or leaves them with something like chronic fatigue syndrome, they're still going to enjoy quality of life better than they would if they're dead.
I would posit that the problem is not that the currently infected individual faces any fate worse than death.
The problem is that lack of high-quality data may forestall the development of more effective therapies, which means you are condemning people infected in the future to death. This latter group seems abstract and hazy, compared to the concrete suffering we can see before us, but eventually the future becomes the now, and we'll have to deal with it.
Researchers may well end up heading down blind alleys, trying to optimize ineffective strategies that end up sucking up resources (money, scientists, labs, mindshare). The history of medicine is full of useless or even harmful therapies that were developed without the benefit of rigorous clinical trials -- difficult to treat conditions like cancer were especially prone to this phenomenon (for instance, the radical mastectomy procedure for breast cancer -- painful, disfiguring and debilitating, developed during an age of heroic surgery... a "gold standard" treatment yet much much later proven to offer no survival benefit in the majority of situations).
And you can't really be sure without a control.
Is the fact that there are less dead people in the zmapp group vs the current untreated death rate not enough of a control for you?
You're talking about a zmapp group composed of people who are well fed their entire lives, of a different racial composition, and who received care in first world hospitals. Your control group is a bunch of people being given palliative care for the most part in tents and the like, most of which who probably have never been to a doctor otherwise in their entire lives.
No, that isn't a controlled experiment.
You people don't know shit about how medical studies work, there are only two outcomes with this virus, and that is dead vs not dead. It would be very easy to derive the P value of the zmapp treated group relative to the known death rate of the virus.
Anybody can load a pile of data into a statistics program and have that program output numbers. Those numbers only mean something if the data was any good. You can't do an uncontrolled experiment and get a real result out. Sure, you might use this kind of data to decide whether the expense of doing a controlled experiment is worthwhile, but on its own there are so many reasons that the results could turn out wrong they're nearly worthless.
Don't feel too bad though - lots of researchers do things just the way you describe, which is why the US spends all kinds of money on treatments that have little evidence supporting their effectiveness. While everybody likes to pick on drugs, the irony is that at least recently these tend to have quite a bit of rigor behind them. The real black magic are things like surgical treatments and the like.
Oh, and while you're doing your uncontrolled studies you should just try injecting patients with saline solution. I would expect it to have a noticeable impact on Ebola death rates - the placebo effect works on just about anything that has ever been tested.
We aren't going to agree about this, because you are insistent upon conflating the social policy spectrum with the economic policy spectrum when they are orthogonal.
Consider gay rights. A "few" years ago, support for gay rights was reserved for the likes of anarchists like Emma Goldman. Now, the cultural/legal shift is all over but the whining. The Democrats were on the leftist/liberal aspect of this. So, despite your claim that there is no "left" in this country, there is indeed a true social "left" as demonstrated by this cultural revolution.
Unless you are shilling for one of the two main particular political parties, why not present objectively true statements? Here, I'll help you out: Eisenhower came into office when the top marginal tax bracket had a tax rate of 92%. He presided over having that lowered to a 91% rate... and helped to lower the deficit while still embarking on a crash program to expand our nuclear weapons program. Subsequently, LBJ lowered the top tax rate from that 91% to 77%. Who looks more Republican now?
Oh, wait, I only took a single fact out of context, and we didn't discuss LBJ's mammoth "Great Society" social programs (economic leftist) and warmongering (is "being from Texas" a pole on the warmongering political spectrum?)
Furthermore, to take your cherry-picked choice of "universal healthcare", you should probably provide a cite indicating that Eisenhower supported such a social program because apparently 100% of modern Democrats support this. I think you'll face an uphill battle trying to paint him as a Democrat given this excerpt from his message to Congress: "For most Americans, insurance--private, voluntary insurance-provides a sound and effective method of meeting unexpected hazards which may be beyond the capacity of the individual to bear. [...] I recommend, consequently, the establishment of a Federal health reinsurance service to encourage private health insurance organizations in offering broader benefits to insured individuals and families and coverage to more people."
My point is to illustrate that the economic and social policy spectra are indeed orthogonal, that the Overton Window shifts, and therefore qualitative comparison statements like yours are misleading and/or disingenuous unless qualified to the point of being objective comparisons of fact. Otherwise, I could claim that all modern GOP presidents, including GWB, were basically Democrats because they are all deficit-spending Keynesians as opposed to the GOP of the pre-FDR era. Or that all modern Democratic presidents are basically Republican because they don't support slavery. Such a debate devolves to cherry-picking comparison points—typically outside of historical context—and it is absurd.
romneycare - 1 state out of 50 - abides by the 10th amendment
obamacare - all 50 states, fine if you dont buy it
no, they are not the same thing no matter how much the democrats want to try and run away from the disaster now
have you seen my sig? there are many others like it but none that are the same
Today you can't find a party wanting to touch the war machine, drug laws, social security, or other massive programs that the Framers couldn't even have dreamt about.
www.lp.org . you are welcome
have you seen my sig? there are many others like it but none that are the same
except for there were actually more white slaves at the time then there were black. Can we stop with the blanket racism???
have you seen my sig? there are many others like it but none that are the same
yes because the first rule of political correctness is we dont talk about political correctness.
have you seen my sig? there are many others like it but none that are the same
not really fair to say "well, we tried this test with 1 chem compound (opiates) and it didnt work, therefore the effect is fake"
have you seen my sig? there are many others like it but none that are the same
So how would you do an RCT for something like Ebola, a disease that really only manifests itself when it starts to spread? Would you ask for volunteers to be infected outside of an outbreak in ordered to test efficacy/safety? Is there an IRB board in the country that would authorize something like this?
I actually do agree that you don't want to get all Mavericky with drug experimentation. At a certain point though you need patients with the disease to test efficacy and safety. If the only time you have patients is during an outbreak then when else can you test in vivo responses?
-- The Genesis project? What's that?
Socialists at least used to be noted for building large-s ale infrastructure, like Hoover Dam. Today all they can do is ladle out welfare benefits and fight meaningless academic battles involving identity groups.
It's time we came up with a twenty-frst century alternative to the randomized trial, like creating a supercomputer model of the human body to test drugs agaionst,
Giving half your test population of cancer patients a placebo may be merely unethical, but giving half your population of Ebola patiets a placebo could take out an entire country.
The issue of liability can be solved with consent, just as it is in the randomized trial. The number of patients to receive the treatment doesn't seem to affect liability, nor does the cost of the treatment.
Also showing product safety is generally much easier than showing effectiveness, and different people (especially those with a terminal condition) have different tolerances for risk.
The question your raise is whether you learn something from non-randomized trials (which I agree are the gold standard procedure). If there is a very lethal disease (that we're able to test for but not treat), and the people taking the treatment (in various locations, conditions, etc) fare significantly better, while the people who don't continue to die, can you draw any conclusions as to the effectiveness of the treatment? I think you can make inferences, although with lesser confidence.
The question that follows from that is, if you are a doctor or producer and have such a treatment, is it ethical or desirable for you to withhold it? That seems selfish to me (putting your preference for experiments over my preferences as a patient).
Is it ethical for prohibit the doctor or producer from delivering to consenting patients? To me, that seems paternalistic and unhelpful (not to mention of questionable political authority). It would seem much better to help inform the patients and give them support for their own choices.
As I suggested in another comment you could imagine a two prong approach: customers are allowed to get a safe but unproven product, or participate in experiments with some compensation/incentives. So you could still conduct experiments on people who accept that bundle (risk and compensation including the satisfaction of knowing they are helping science).
Whether people SHOULD participate in those experiments and therefore those experiments SHOULD continue to exist doesn't seem a categorical/universal question to me. It seems a question of preferences (demand). Assuming enough people demand the extra confidence and rigorousness, and enough people are willing to take the risk of receiving a placebo, then they will exist. Otherwise you are imposing your own will and preferences on people, which hardly seems civilized or peaceful.
These comments are mine; I do not speak for my employer.
Well it's a bit difficult to know for sure. There are kooky people who are rightfully dismissed, who then harbor resentment for being shut-down in the conversation. Then there are people who make a good point, but are dismissed for emtional/political/irrational reasons, and who are rightfully upset that their objections go unheeded.
In a conversation when someone is being dismissed, we tend to see anyone who disagrees with us as the former, and anyone who agrees with us as the latter. How to tell the difference is a real philosophic problem. Of course, you're right that either way, dismissing someone's argument is not equivalent to censorship. Worse is when people claim it's a violation of a the first amendment. It's not censorship to dismiss and disregard another person's opinion; it's only censorship to use some kind of force/leverage to punish someone into silence.
The assertion made by this meme isn't any more apt than trying to claim all modern Democratic presidents could be mistaken for Republicans because the Democrats were on the wrong side of history by being the pro-slavery party while the Republicans made abolition a key plank.
I'm not sure it's the same thing, since Democrats aren't holding up those pro-slavery candidates as heroes who share their views. Yes, cultural views shift over time, but the Republicans are generally claiming that their views are timeless and traditional. They want to claim that they believe all the same things as "the founding fathers", Lincoln, Eisenhower, and Reagan, as though all of these people believed the same thing, and they were all tapping into some kind of universal truth that modern Republicans also have unique access to.
So the meme isn't meant to argue that opinions shouldn't shift over time, but only to point out some absurdity in some of the Republican rhetoric.
Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done. Stick to what is known to work, there is no time to come up with anything better. If something better had been found in centuries of research into medical methods, then it would be the standard-approach. There is nothing. There will not be anything new even if you debate that question to death now.
This continues the series of incompetence, misinformation, self-aggrandizement and general fuck-ups that have become the signature of the fight against Ebola this time.
May I be polite and say that "You don't have exclusivity on intelligence". The decision to try experimental medication is a "last chance" possibility to save a life. And if it works, then perhaps it will work with others. If my life was in peril from Elboa, and I knew I had a 60% chance of dying, I would go for it.
I had a flesh eating disease(Necrotizing fasciitis) on one leg, and was told "Tomorrow we amputate, because the existing anti-biotics are not working. I responded, give me a stronger dose, and try a different medication. Result-- I still have both legs.
Yes, it is ethical, and even if it failed, we know the person would have died.
Leslie Satenstein Montreal Quebec Canada
Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done.
Not necessarily. If you have limited resources and a solution that's certain to work, then yes, it's kind of dumb to waste resources by experimenting with solutions that are unlikely to work. However, if you're having a crisis and you have no solution that's certain to work, then it may be smarter to "leave no stone unturned" and test any approach that seems like it might yield results, so long as you're pretty sure it won't make the problem worse.
If something better had been found in centuries of research into medical methods, then it would be the standard-approach.
Again, this is pretty silly. First of all, modern medicine really has only been around for a couple of hundred years. Before that, "medicine" wasn't much better than witch doctors. So when you say "centuries", it's only just barely accurate. And during those centuries, we've seen countless innovations, and we continue to see developments of better medical methods of various kinds. There's no reason to say, "Let's stop trying to innovate in medicine. If there were any room for improvement, we would have found it already."
Yeah, Gandhi and Hitler, other than monor disagreements on genocide, practically twins!
Yeah, I'll buy that. The typical drug might have a 30% improvement in survivability vs a 20% improvement with a placebo. I suspect that when it comes to Ebola an effective treatment might have a 90% effective rate vs a 30% rate for placebo. The disease probably is lethal enough that you could be pretty sure about the results unless the treatment was only mildly effective.
Yes, damn those white people for SIMPLY WANTING TO LIVE AROUND THEIR OWN KIND.
Yes, damn them for that. Yes, damn them for being so self centred, biggotted and idiotic for believing that somehow people who were born in another country are not worthy of being around them.
Apparently, YOU believe that white people are so 'superior' to non-whites, that to prevent non-whites from living around is to deprive them of something,
I'm sorry, but what the hell? You literally just claimed that depriving them of something (in this case the ability to live around you) is not depriving them of something.
Where have these "experts" been the last 25 years ?
Being open to criticism is not the same as being open to insane ramblings that ignore reality.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
May I point out that this is experimentation that will result in definite action much later (due to manufacturing delays) and that it is being done in the face of something growing exponentially? Really, any risk of going in the wrong direction here will result in a couple of million more dead at the very least. That is what makes this highly unethical. Your case is not even remotely comparable.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
I seenothing at all wrong with random treatments for conditions that are dire. A cancer patient who is near death, for whom all treatments have failed, has nothing to lose by trying an unreleased, not properly field tested, drug. Think about it. The doctors know that the patient will be dead in a week and have no good answers. It the new idea happens to kill the patient he simply will not suffer another awful week. On the other hand every now and then you have a "bingo" moment and the patient is helped or you learn the dose was too low or too high which helps the next patient. And even forgetting all of that it does another huge, good, thing. It gives the patient hope. People in the depths of dispair often feel like God and mankind have betrayed them, abandoned them or worse. Frankly they are right. Many times only a priest waits in the wee hours for that last awful gasp. Sometimes there is not even a priest. The medical staff sort of avoids the last hours of life as well as it frightens the staff as well. But that tiny bit of hope that the new treatment will work gives the patient some relief. Even lies can help. A patient who is in and out of consciousness can be told that he will have a new liver transplanted when he wakes up. For soem patients that is a mercyful lie that provides relief. For my two cents it makes good sense to gamble when all is almost lost. And we should have no restraints on the nature of pain killers or feel good types of dope for those who are passing even if such drugs speed up the death process. Morality and kindness do walk hand and hand.
That's naïve. You seem to ignore a number of significant facts such as: Muslims are easily identified; their radicalism usually takes months to ferment into deadly action; radical activity can to a great degree be remotely monitored for signs of potential dangerous plots; and their movements are easily monitored. None of those apply to a microscopic organism that is unseen, can easily spread to a large area undetected and is more deadly than any terrorist because the infection can kill within days. Few (of any) global conflicts have killed (or maimed) as many people as bacteria and viruses.
"Those who can make you believe absurdities can make you commit atrocities." - Voltaire
What in the world are thinking! Are you proposing that viruses don't mutate? Fact is, any microscopic organism can and do mutate all the time. Ever hear of influenza? HIV? Cold? Plus hundreds of other viruses?
"Those who can make you believe absurdities can make you commit atrocities." - Voltaire
I see you have decided to recuse yourself from rational debate. Your fallacy is... strawman!
So sorry, but we do have some lovely parting gifts for you, though.
You raise better, more coherent points than sjames did.
However, it occurs to me that Washington and Jefferson are still venerated across the political spectrum despite being unelectable today. Mostly because of their status as slaveholders, and in our modern society we see that past sins of certain kinds are rarely forgiven.
I guess I hadn't noticed that Democrats don't hold up their historical figures as champions of their perspective. Not too many are still fond of LBJ, I take it, despite holding dear to his legacy of massive expansion of the welfare state.
I will pay closer attention to this party idiosyncrasy in the future.
However, it occurs to me that Washington and Jefferson are still venerated across the political spectrum despite being unelectable today.
I'd put that in a different category altogether. People like Washington and Jefferson are quasi-mythological figures at this point. Almost everyone admires them for reasons that may even be fictional (Washington can't tell lies?), while very few would actually condone their ownership of slaves-- except maybe on the grounds that we should judge them in their historical context as opposed to judging them against our current social mores.
And I don't think it's necessarily that Democrats don't admire some historical figures. I'm just saying their rhetoric doesn't include the appeal to authority of those figures. They don't seem to feel the same need to invoke them in debates, to claim that we should do something *because* a historical figure said it was the right thing to do. There isn't the same sense of "[whichever historical figure] said [x], and he was a great man who was smarter than we are today, so we should follow that advice."
I could be wrong-- I haven't done a statistical analysis of this or anything-- but that's my sense. So because of this kind of appeal to authority, if an opponent can demonstrate that those same authority figures would disagree with what Republicans are saying, then it *is* sort of damning. If I say "We should do [x, y, and z] because Ronald Reagan said so," you may or may not find that argument compelling. However, if that is the basis of my argument, and then you say, "Well actually, I have quotes where Reagan said [x, y, and z] are all bad ideas," then you pretty well blew my argument out of the water.
Since we don't appear to speak a common language, I saw no point.
Do they mutate in response to treatments against them, in a similar way to how bacteria develop resistance to antibiotics?
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
Of course they do. Viruses are no different than other microbes. They will eventually do whatever it takes to propagate and survive. Which in many cases is in response to changes in their environment.
"Those who can make you believe absurdities can make you commit atrocities." - Voltaire
This is all very reasonable and seems like a good critique to put forth in the context of debating Republicans. I certainly hadn't noticed this contrast before you pointed it out.
I still assert that the meme that claims Eisenhower or Reagan would be considered Democrats today is demonstrably false. It is apt, of course, to note how the ratchet of an increasingly authoritarian federal government has turned, particularly after the election of Woodrow Wilson. Therefore, I would concur that Eisenhower (and potentially even Reagan) might not be considered electable today given their vision of a more limited role for the federal government.
Not even the GOP wants federalism anymore.
The progressives' vision has shifted the Overton window on that. No one can be elected on a platform calling for the repeal of the present incarnation of Johnson's Great Society or FDR's New Deal programs, for example. So, from that perspective, all GOP presidents have been Democrat, even at the time when they were elected. It's just yet another example why the meme is absurd.
Where the Republicans and Democrats really clash is on the social spectrum. Both parties wield the federal government as a cudgel against freedom, but they differ in which rights they wish to suppress. And unless people can start pointing to how Eisenhower/Reagan were pro choice, gay rights, etc advocates and the GOP has shifted rightward from that... it's obvious the meme just doesn't work.
Compared to 1950's America, the America of today is less "socialist", not more. In 1953, you'd pay 48% personal income tax on all income above $12k (in 2013 adjusted dollars, this is ~$100k), and 90% on income above $100k (~$860k in 2013 dollars).
It was also the time when Gini (economic inequality) index, arguably one of the best metrics of "socialism", was at one of the lowest points ever in US history, only matched later in 70s - it was 35 then. Today, it's over 45, and growing. For comparison, UK has Gini of 34 - so US in 1950's was as socialist as UK today.
I never said they didn't. But do they respond to this type of treatment in the way that bacteria respond to non-fatal doses of antibiotics?
From your original post: (http://slashdot.org/comments.pl?sid=5816263&cid=48122531) "partially apply a cure" "Allowing people who have already been treated to remain in close contact with those still infected" "develop treatment resistance".
Show me a case of something akin to antibiotic resistance in bacteria, or fuck off.
Confucius say, "Find worm in apple - bad. Find half a worm - worse."