The CDC is now saying that the transmission in TX was caused by a "breach of protocol", which is not surprising given that the barrior protocols are exacting and onerous.
I'll agree that a few cases an "outbreak" does not make. However, what is going to prevent the next case from involving a "breach of protocol?" If a hospital can't contain a single patient's disease, what are they going to do if there actually is an epidemic?
I think we need to take this a bit more seriously and pull out the stops to get ahead of things. Panic obviously isn't going to help anybody, but are we really doing all that we can to prevent an actual outbreak?
That is only counting healthcare workers wearing space suits.
I'm not saying that we should give up hope on containing Ebola. I'm just saying that we should be pulling out all the stops. By all means aid those who have been affected by the disease, but let's be a LOT more serious about quarantines to prevent its spread.
If I called up the FBI and told them that I had anthrax in my basement they'd send in a small army. If I called up the CDC and told them that I had lunch with the guy who had Ebola they'd tell me to stay home and call them if I get a fever. Maybe we should be less worried about saving money, and more worried about whether I decide I get tired of staying home and just make one quick trip to the grocery store.
Fairly ideal is not ideal. According to CNN, the 2nd Patient broke protocol. If One does not do what One is supposed to do, bad things can happen.
Thus proving my point. There is no such thing as truly ideal conditions, and if your disease management program starts with assuming that things are ideal it is going to fail.
You can't do just enough to stop the spread of the epidemic. You need to multiply that by a factor of 10 once or twice, while you still can. If it gets out of control, then there is nothing you CAN do.
My PC doesn't send everything I do to Google's servers, where the NSA can scoop it up.
Neither does mine. But, I run a tor relay so I'd be shocked if they haven't rooted every box I own. You don't need to send your data to Google's servers for the NSA to read it.
And what planet are you living on, exactly, to have missed the news for the last few years? The tinfoil hat wearers were undestimating what the NSA has been doing... they weren't paranoid enough.
And hence why I said that if you're worried about the NSA you need about 10 more layers of tinfoil. If you think that just not having a Google account is enough to keep them at bay, you're not trying hard enough. I don't think it is realistic to keep my data out of the hands of the NSA, so I don't bother to try. I just wish that I could give up on doing backups and just be able to ask the NSA for a copy of my data if I lose it.
So, 3 sick patients leads to 1 sick healthcare worker. That isn't a particularly good ratio. If we had 100 people with Ebola then you'd expect 33 sick healthcare workers, and then you'd expect those to go on an infect another 11, then another 4, and then one more for good measure. If you're keeping count that is 50 healthcare workers in total, from treating 100 sick people.
Extrapolation from small numbers is rarely a sensible idea.
Sure, it is a silly extrapolation. My point is just that we aren't taking this seriously enough.
So long as we have a clear eye on patient zero and everyone in contact with him, we don't need to be terribly worried....
Well, that would be true if we didn't have opportunities for new infections, and if we REALLY had a clear eye on everybody in contact with patient zero. As far as I understand it they were basically all told to stay home and are on the honor system. That really doesn't strike me as a responsible way to manage public health. I don't want to punish anybody, but this is a serious matter - by all means shower them with support, but at least post a guard to ensure nobody goes in or out of their homes.
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.
I think this just points to the need to really step up our game if we want to stay ahead of this.
What do you suggest doing to 'step up our game?'
I would initially greatly restrict travel (air, land, and sea) out of Africa and limit it to those involved in aid efforts. Those workers would be carefully observed. If a tight quarantine could be imposed at a level of granularity smaller than the entire continent, then I'd be willing to lift travel bans on the entire continent after they were effective for an incubation period with no sign of spread. However, it is hard to contain a disease area as large as the current outbreak, and the entirety of the continent provides geographic barriers to spread.
If somebody does develop Ebola then anybody they had contact with would be quarantined, with police enforcement (either monitoring devices as are commonly used in house arrest, or guards outside the door). Anybody infected would be isolated in dedicated facilities, with the healthcare workers quarantined. Of course, without an endless stream of flights out of Africa there would be few infections outside of Africa so these measures would be very limited.
First world nations should immediately fund rapid development and testing of promising treatments, offering bounties or fee-for-service models where necessary to get around concerns around marketability of the treatments. Nations really need an Ebola treatment in their bag of tricks even if this outbreak goes away before it is developed. There is no reason there can't be ten thousand greenhouses doing a crash course in wmapp production right now, even if it turns out to be a dud (which seems unlikely). Anybody with a biochem degree could be trained to produce it, and they aren't THAT uncommon. By all means use the drug domestically first, but with the travel ban there won't be much demand for that so you can actually give doctors without borders a good supply of the stuff. The fact is that having a pool of a million people with Ebola anywhere on the planet isn't a good thing for anybody, so even if everybody is completely selfish it is in their interest to fund getting that epidemic under control.
In a nutshell I'd treat this more like a war and less like a recession. The US has an insane 10% unemployment rate or something like that - there are plenty of bodies that could be given the necessary training to get ahead of this if we just got off of our collective rear ends and maybe did something with that nice GDP growth besides build private jets for CEOs. Since this could save the CEOs own hides, they probably won't complain too much about it.
Yeah, the NSA will have a complete database of everything these kids did at school. What could possibly go wrong?
They're going to have that no matter what OS the laptops run, at least for anything they are interested in actually capturing. Do you think that a PC running Windows or OSX is magically immune to NSA snooping?
What Google does with the data may be a differentiator, but if you're worried about the NSA you really need about 10 more layers of tinfoil. Of course, anybody wearing that much tinfoil will probably just be visited by ninjas in the middle of the night who have other ways of bypassing firewalls.:)
Does anyone know how the virus can penetrate a hermetically sealed suit?
It cant, but when the health worker does not use care to disinfect and properly remove the gear, he/she may not as well have worn the suit in the first place. One of the workers infected in africa admitted that that was the cause of their infection; accidentaly touching their bare skin with the outside of the suit.
This is completely true, but it is very much a blame-the-victim mentality. I really don't care whose fault it is that mistakes get made. I think this just points to the need to really step up our game if we want to stay ahead of this. We're acting like the worst possible outcome of this situation is that people will stop going to the mall or getting on planes, and our policies are designed to try to prevent that from happening.
Yup, nothing to worry about. We've had all of about three people in the US with the disease so far with no more than one in any hospital at a time, and yet the workers still manage to get themselves infected. That is under fairly ideal conditions - these patients are actually in specialized isolation wards and they can dedicate personnel to them and generally isolate them from the rest of the hospital.
So, 3 sick patients leads to 1 sick healthcare worker. That isn't a particularly good ratio. If we had 100 people with Ebola then you'd expect 33 sick healthcare workers, and then you'd expect those to go on an infect another 11, then another 4, and then one more for good measure. If you're keeping count that is 50 healthcare workers in total, from treating 100 sick people.
Now, maybe we're just really unlucky or something, but I'd think that if the ERs started filling up with Ebola patients the amount of isolation would go down, not up.
The "nothing to worry about, it is just Ebola" crowd is beginning to sound a bit like the "the space shuttle is designed to not blow up more than once per 100k missions" crowd. All the hand-waving about how hard the disease is to transmit is in complete contrast that in first-world medical centers we already have two infected nurses.
This isn't AIDS. You CAN catch it from a handshake, let a lone a kiss.
We MIGHT (and I stress "might") be getting to time to panic the first time we get an ebola victim who hasn't been to Africa, and hasn't been in contact with any known Ebola victim.
Uh, Ebola spreads through contact, so by your logic it still wouldn't be time to be concerned if every last person on earth contracted the disease...
Panic of course is never helpful. However, extreme vigilance is. I think we're really underestimating the ability of this to get out of control.
Before someone says that China is much worse than the UK, it doesn't matter. The principal is the same. The government decides some things unacceptable to say and uses the law to punish people saying them. The fact that two governments have different ideas of what is unacceptable is irrelevant.
No argument there, but you did manage to pick the western country with some of the worst free speech laws around.
Granted, it seems like the US has been trying hard to be more like the UK in this regard, but things like libel laws are FAR weaker in the US. You can be punished for what you say in the US, but the burden of proof is on the person making the accusation to demonstrate that what you said was both untrue, and caused harm.
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.
It might be difficult in such a situation to do the test in a double-blind fashion, but you are correct that this can be done. Of course, without a placebo you can't rule out that none of the methods are particularly effective if they're comparable. After all, placebos are themselves effective compared to not treating somebody at all.
The folks who consent to a trial give informed consent, are minimized in number based upon the data currently available on the treatment (ie more patients as there is more data supporting the safety of the treatment), and receive their care free of charge.
These factors do not apply to what seems to be proposed. I don't hear the doctors screaming that there will be no hospital bills for anybody who gets Ebola since they're receiving experimental treatments. If they're taking money in exchange for treatment, then they're going to be VERY liable in the US at least for anything that goes wrong.
Then you have the issue of what happens next time there is an outbreak, if there still isn't real data supporting the safety and effectiveness of the treatment. That would mean that the treatment is STILL experimental, and thus nobody wants to mass produce or commercialize it since all those liability issues still exist.
And they SHOULD exist, since science-based medicine only works when you do science. Wishful thinking isn't science. Using fancy and expensive equipment isn't science. The very definition of science is using a controlled experiment to support or refute a hypothesis.
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.
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.
I don't get why they don't just put the keypad on the card itself
In the near future, they will, because "the card" will be your cellphone.
The problem with this is that it is actually not easy to ensure that the path between the TPM and the phone touchscreen isn't compromised. You can secure the credentials in the TPM, but the PIN is harder to secure when it is entered on a device intended for general-purpose computing.
> That is how the NSA probably gets its claws into 99% of the network closets out there. That obviously won't work in China, so there they use other ways.
So, basically you're saying whatever evil you do, it doesn't work with China. So, China is the victim?
I'm not quite sure what you're asking here.
The way the NSA gets into most wiring closets is most likely that they just ask the local government to let them install some boxes, and they do. The local government of course isn't going to advertise that. However, I think that it is unlikely that the Chinese would allow the NSA in, so the way the NSA would probably get intel on what goes on in China is with clandestine/illegal/whatever taps.
Just look at what the Navy+NSA did to the USSR back in the day with Ivy Bells. The USSR was also a lot more naive about the NSA's capabilities so it was a lot easier to just pick up signals sent in the clear or with poor encryption systems (either the algorithm or its use). People are just as naive today with their LAN traffic - chances are that the secret document being sent to your printer goes out over the LAN in the clear, to be trivially intercepted by the compromised IP phone sitting on your desk or whatever. And hey, let's not get started on just compromising the printer itself...
Ebola is really, really, not something I'm worried about, for reasons already mentioned. Don't let people sneeze on you, and that's a good start.
Don't forget not to let people touch you. Also, don't touch anything that has been touched by somebody else.
You can get Ebola from a door knob.
I'm not worried about it right now because it is vanishingly rare in the US. I doubt that will remain the case the way things are going, but there is no way to know. I doubt that New Orleans will be leveled by another major hurricane in my lifetime, but they haven't really done anything to prevent another Katrina so anybody who buys a house there without subsidized insurance or a plan to make back the expenditure quickly is a fool.
Interestingly, the US's friends have also noticed this.
Uh, they've known it all along. Stuff like being "shocked, shocked I tell you" when they find out the German Chancellor's phone is monitored is to reassure the public that they are indeed appropriately shocked about finding out what they've probably known all along.
The NSA spies on everybody. The allies probably even help them with it in exchange for getting access to some of the juicy tidbits. Heck, if there was a place to sign up I'd gladly let the NSA stick an appliance on my home LAN if it meant that I could access things like backup copies of everything on my systems. I run a tor relay so I imagine they've already rooted everything on my LAN anyway, and they probably keep a copy of everything just because it is easier to do that then to go through it all and figure out that I'm boring along with 99% of the rest of the folks they rootkit. Why not actually get some benefit from the situation? That is how the NSA probably gets its claws into 99% of the network closets out there. That obviously won't work in China, so there they use other ways.
Unlucky cases happen. Outright stupid cases happen. But please save the freaking out for when all of those aid workers suddenly fall ill and die. After all for the one nurse who has contracted the disease, thousands haven't and have taken such incredible precautions like wearing gloves and a face mask. Quite the opposite from the freak the hell out and put on the space suit response some people in the west want to apply.
The nurse didn't correctly degown based on the story going around. I get why the problem happened.
The problem is that the official line going around is that it is really hard to get Ebola. That was the message about AIDS, and it is correct for AIDS - you can't get it by just shaking hands with somebody who is infected. The problem is that this isn't the case with Ebola. You CAN get it by shaking hands with somebody who has Ebola if they haven't done a surgical scrub down after sneezing on their hands.
Do you think that a nurse in an isolation ward with an Ebola patient isn't trying to be deliberate about gowning procedures? If she could make a mistake, ANYBODY could make a mistake. And what does that say for some poor guy riding the subway? Last time I checked they weren't even wearing protective equipment let alone following careful procedures when removing it.
I agree that as long as cases are isolated US facilities would make a big impact on survival/etc, and likely infection rates.
NOVA had a recent episode and they showed off a fancy isolation ward in a major hospital. It certainly had all the bells and whistles, but I doubt a major hospital has more than a few of them, and smaller hospitals aren't going to have human-sized gloveboxes but just ICU units designated for isolation. My (fairly well-funded nice suburban area) local hospital has an ICU with maybe 15 beds, and probably half of them are in use at any time just for the usual heart attacks and sepsis and such. They couldn't deal with 100 people with Ebola and provide the ideal standard of care.
Sure, you could set up a tent city with IV bags, but you're going to need the government to do that since nobody else wants the liability.
They really need to stay ahead of this. IMO it is worth the costs and inconvenience to do so.
And, if she was wearing any sort of face mask and eye protection (like you are supposed to do), nothing untoward would have happened.
Contact precautions aren't particularly hard, but they do require a significant degree of vigilance which is not a human being's strong point.
Sure, but the point is that the CDC is using the message that Ebola requires contact to send the message that it is no big deal, like AIDS. If a trained nurse can accidentally get it, then anybody can. Last time I checked the folks at my workplace weren't wearing gloves and facemasks and eye protection. They're safe only because nobody with Ebola is in the workplace, not because it is hard to spread.
Slashdot Mirror
The CDC is now saying that the transmission in TX was caused by a "breach of protocol", which is not surprising given that the barrior protocols are exacting and onerous.
I'll agree that a few cases an "outbreak" does not make. However, what is going to prevent the next case from involving a "breach of protocol?" If a hospital can't contain a single patient's disease, what are they going to do if there actually is an epidemic?
I think we need to take this a bit more seriously and pull out the stops to get ahead of things. Panic obviously isn't going to help anybody, but are we really doing all that we can to prevent an actual outbreak?
That is only counting healthcare workers wearing space suits.
I'm not saying that we should give up hope on containing Ebola. I'm just saying that we should be pulling out all the stops. By all means aid those who have been affected by the disease, but let's be a LOT more serious about quarantines to prevent its spread.
If I called up the FBI and told them that I had anthrax in my basement they'd send in a small army. If I called up the CDC and told them that I had lunch with the guy who had Ebola they'd tell me to stay home and call them if I get a fever. Maybe we should be less worried about saving money, and more worried about whether I decide I get tired of staying home and just make one quick trip to the grocery store.
Fairly ideal is not ideal. According to CNN, the 2nd Patient broke protocol. If One does not do what One is supposed to do, bad things can happen.
Thus proving my point. There is no such thing as truly ideal conditions, and if your disease management program starts with assuming that things are ideal it is going to fail.
You can't do just enough to stop the spread of the epidemic. You need to multiply that by a factor of 10 once or twice, while you still can. If it gets out of control, then there is nothing you CAN do.
My PC doesn't send everything I do to Google's servers, where the NSA can scoop it up.
Neither does mine. But, I run a tor relay so I'd be shocked if they haven't rooted every box I own. You don't need to send your data to Google's servers for the NSA to read it.
And what planet are you living on, exactly, to have missed the news for the last few years? The tinfoil hat wearers were undestimating what the NSA has been doing... they weren't paranoid enough.
And hence why I said that if you're worried about the NSA you need about 10 more layers of tinfoil. If you think that just not having a Google account is enough to keep them at bay, you're not trying hard enough. I don't think it is realistic to keep my data out of the hands of the NSA, so I don't bother to try. I just wish that I could give up on doing backups and just be able to ask the NSA for a copy of my data if I lose it.
When did I advocate panic? In fact, I said the post you replied to that panic was useless.
What is necessary is treating the issue seriously, and not just like an outbreak of food poisoning.
So, 3 sick patients leads to 1 sick healthcare worker. That isn't a particularly good ratio. If we had 100 people with Ebola then you'd expect 33 sick healthcare workers, and then you'd expect those to go on an infect another 11, then another 4, and then one more for good measure. If you're keeping count that is 50 healthcare workers in total, from treating 100 sick people.
Extrapolation from small numbers is rarely a sensible idea.
Sure, it is a silly extrapolation. My point is just that we aren't taking this seriously enough.
So long as we have a clear eye on patient zero and everyone in contact with him, we don't need to be terribly worried....
Well, that would be true if we didn't have opportunities for new infections, and if we REALLY had a clear eye on everybody in contact with patient zero. As far as I understand it they were basically all told to stay home and are on the honor system. That really doesn't strike me as a responsible way to manage public health. I don't want to punish anybody, but this is a serious matter - by all means shower them with support, but at least post a guard to ensure nobody goes in or out of their homes.
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.
I think this just points to the need to really step up our game if we want to stay ahead of this.
What do you suggest doing to 'step up our game?'
I would initially greatly restrict travel (air, land, and sea) out of Africa and limit it to those involved in aid efforts. Those workers would be carefully observed. If a tight quarantine could be imposed at a level of granularity smaller than the entire continent, then I'd be willing to lift travel bans on the entire continent after they were effective for an incubation period with no sign of spread. However, it is hard to contain a disease area as large as the current outbreak, and the entirety of the continent provides geographic barriers to spread.
If somebody does develop Ebola then anybody they had contact with would be quarantined, with police enforcement (either monitoring devices as are commonly used in house arrest, or guards outside the door). Anybody infected would be isolated in dedicated facilities, with the healthcare workers quarantined. Of course, without an endless stream of flights out of Africa there would be few infections outside of Africa so these measures would be very limited.
First world nations should immediately fund rapid development and testing of promising treatments, offering bounties or fee-for-service models where necessary to get around concerns around marketability of the treatments. Nations really need an Ebola treatment in their bag of tricks even if this outbreak goes away before it is developed. There is no reason there can't be ten thousand greenhouses doing a crash course in wmapp production right now, even if it turns out to be a dud (which seems unlikely). Anybody with a biochem degree could be trained to produce it, and they aren't THAT uncommon. By all means use the drug domestically first, but with the travel ban there won't be much demand for that so you can actually give doctors without borders a good supply of the stuff. The fact is that having a pool of a million people with Ebola anywhere on the planet isn't a good thing for anybody, so even if everybody is completely selfish it is in their interest to fund getting that epidemic under control.
In a nutshell I'd treat this more like a war and less like a recession. The US has an insane 10% unemployment rate or something like that - there are plenty of bodies that could be given the necessary training to get ahead of this if we just got off of our collective rear ends and maybe did something with that nice GDP growth besides build private jets for CEOs. Since this could save the CEOs own hides, they probably won't complain too much about it.
Yeah, the NSA will have a complete database of everything these kids did at school. What could possibly go wrong?
They're going to have that no matter what OS the laptops run, at least for anything they are interested in actually capturing. Do you think that a PC running Windows or OSX is magically immune to NSA snooping?
What Google does with the data may be a differentiator, but if you're worried about the NSA you really need about 10 more layers of tinfoil. Of course, anybody wearing that much tinfoil will probably just be visited by ninjas in the middle of the night who have other ways of bypassing firewalls. :)
Does anyone know how the virus can penetrate a hermetically sealed suit?
It cant, but when the health worker does not use care to disinfect and properly remove the gear, he/she may not as well have worn the suit in the first place.
One of the workers infected in africa admitted that that was the cause of their infection; accidentaly touching their bare skin with the outside of the suit.
This is completely true, but it is very much a blame-the-victim mentality. I really don't care whose fault it is that mistakes get made. I think this just points to the need to really step up our game if we want to stay ahead of this. We're acting like the worst possible outcome of this situation is that people will stop going to the mall or getting on planes, and our policies are designed to try to prevent that from happening.
Yup, nothing to worry about. We've had all of about three people in the US with the disease so far with no more than one in any hospital at a time, and yet the workers still manage to get themselves infected. That is under fairly ideal conditions - these patients are actually in specialized isolation wards and they can dedicate personnel to them and generally isolate them from the rest of the hospital.
So, 3 sick patients leads to 1 sick healthcare worker. That isn't a particularly good ratio. If we had 100 people with Ebola then you'd expect 33 sick healthcare workers, and then you'd expect those to go on an infect another 11, then another 4, and then one more for good measure. If you're keeping count that is 50 healthcare workers in total, from treating 100 sick people.
Now, maybe we're just really unlucky or something, but I'd think that if the ERs started filling up with Ebola patients the amount of isolation would go down, not up.
The "nothing to worry about, it is just Ebola" crowd is beginning to sound a bit like the "the space shuttle is designed to not blow up more than once per 100k missions" crowd. All the hand-waving about how hard the disease is to transmit is in complete contrast that in first-world medical centers we already have two infected nurses.
This isn't AIDS. You CAN catch it from a handshake, let a lone a kiss.
We MIGHT (and I stress "might") be getting to time to panic the first time we get an ebola victim who hasn't been to Africa, and hasn't been in contact with any known Ebola victim.
Uh, Ebola spreads through contact, so by your logic it still wouldn't be time to be concerned if every last person on earth contracted the disease...
Panic of course is never helpful. However, extreme vigilance is. I think we're really underestimating the ability of this to get out of control.
Before someone says that China is much worse than the UK, it doesn't matter. The principal is the same. The government decides some things unacceptable to say and uses the law to punish people saying them. The fact that two governments have different ideas of what is unacceptable is irrelevant.
No argument there, but you did manage to pick the western country with some of the worst free speech laws around.
Granted, it seems like the US has been trying hard to be more like the UK in this regard, but things like libel laws are FAR weaker in the US. You can be punished for what you say in the US, but the burden of proof is on the person making the accusation to demonstrate that what you said was both untrue, and caused harm.
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.
It might be difficult in such a situation to do the test in a double-blind fashion, but you are correct that this can be done. Of course, without a placebo you can't rule out that none of the methods are particularly effective if they're comparable. After all, placebos are themselves effective compared to not treating somebody at all.
The folks who consent to a trial give informed consent, are minimized in number based upon the data currently available on the treatment (ie more patients as there is more data supporting the safety of the treatment), and receive their care free of charge.
These factors do not apply to what seems to be proposed. I don't hear the doctors screaming that there will be no hospital bills for anybody who gets Ebola since they're receiving experimental treatments. If they're taking money in exchange for treatment, then they're going to be VERY liable in the US at least for anything that goes wrong.
Then you have the issue of what happens next time there is an outbreak, if there still isn't real data supporting the safety and effectiveness of the treatment. That would mean that the treatment is STILL experimental, and thus nobody wants to mass produce or commercialize it since all those liability issues still exist.
And they SHOULD exist, since science-based medicine only works when you do science. Wishful thinking isn't science. Using fancy and expensive equipment isn't science. The very definition of science is using a controlled experiment to support or refute a hypothesis.
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.
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.
I don't get why they don't just put the keypad on the card itself
In the near future, they will, because "the card" will be your cellphone.
The problem with this is that it is actually not easy to ensure that the path between the TPM and the phone touchscreen isn't compromised. You can secure the credentials in the TPM, but the PIN is harder to secure when it is entered on a device intended for general-purpose computing.
> That is how the NSA probably gets its claws into 99% of the network closets out there. That obviously won't work in China, so there they use other ways.
So, basically you're saying whatever evil you do, it doesn't work with China. So, China is the victim?
I'm not quite sure what you're asking here.
The way the NSA gets into most wiring closets is most likely that they just ask the local government to let them install some boxes, and they do. The local government of course isn't going to advertise that. However, I think that it is unlikely that the Chinese would allow the NSA in, so the way the NSA would probably get intel on what goes on in China is with clandestine/illegal/whatever taps.
Just look at what the Navy+NSA did to the USSR back in the day with Ivy Bells. The USSR was also a lot more naive about the NSA's capabilities so it was a lot easier to just pick up signals sent in the clear or with poor encryption systems (either the algorithm or its use). People are just as naive today with their LAN traffic - chances are that the secret document being sent to your printer goes out over the LAN in the clear, to be trivially intercepted by the compromised IP phone sitting on your desk or whatever. And hey, let's not get started on just compromising the printer itself...
Ebola is really, really, not something I'm worried about, for reasons already mentioned. Don't let people sneeze on you, and that's a good start.
Don't forget not to let people touch you. Also, don't touch anything that has been touched by somebody else.
You can get Ebola from a door knob.
I'm not worried about it right now because it is vanishingly rare in the US. I doubt that will remain the case the way things are going, but there is no way to know. I doubt that New Orleans will be leveled by another major hurricane in my lifetime, but they haven't really done anything to prevent another Katrina so anybody who buys a house there without subsidized insurance or a plan to make back the expenditure quickly is a fool.
Interestingly, the US's friends have also noticed this.
Uh, they've known it all along. Stuff like being "shocked, shocked I tell you" when they find out the German Chancellor's phone is monitored is to reassure the public that they are indeed appropriately shocked about finding out what they've probably known all along.
The NSA spies on everybody. The allies probably even help them with it in exchange for getting access to some of the juicy tidbits. Heck, if there was a place to sign up I'd gladly let the NSA stick an appliance on my home LAN if it meant that I could access things like backup copies of everything on my systems. I run a tor relay so I imagine they've already rooted everything on my LAN anyway, and they probably keep a copy of everything just because it is easier to do that then to go through it all and figure out that I'm boring along with 99% of the rest of the folks they rootkit. Why not actually get some benefit from the situation? That is how the NSA probably gets its claws into 99% of the network closets out there. That obviously won't work in China, so there they use other ways.
Unlucky cases happen. Outright stupid cases happen. But please save the freaking out for when all of those aid workers suddenly fall ill and die. After all for the one nurse who has contracted the disease, thousands haven't and have taken such incredible precautions like wearing gloves and a face mask. Quite the opposite from the freak the hell out and put on the space suit response some people in the west want to apply.
The nurse didn't correctly degown based on the story going around. I get why the problem happened.
The problem is that the official line going around is that it is really hard to get Ebola. That was the message about AIDS, and it is correct for AIDS - you can't get it by just shaking hands with somebody who is infected. The problem is that this isn't the case with Ebola. You CAN get it by shaking hands with somebody who has Ebola if they haven't done a surgical scrub down after sneezing on their hands.
Do you think that a nurse in an isolation ward with an Ebola patient isn't trying to be deliberate about gowning procedures? If she could make a mistake, ANYBODY could make a mistake. And what does that say for some poor guy riding the subway? Last time I checked they weren't even wearing protective equipment let alone following careful procedures when removing it.
I agree that as long as cases are isolated US facilities would make a big impact on survival/etc, and likely infection rates.
NOVA had a recent episode and they showed off a fancy isolation ward in a major hospital. It certainly had all the bells and whistles, but I doubt a major hospital has more than a few of them, and smaller hospitals aren't going to have human-sized gloveboxes but just ICU units designated for isolation. My (fairly well-funded nice suburban area) local hospital has an ICU with maybe 15 beds, and probably half of them are in use at any time just for the usual heart attacks and sepsis and such. They couldn't deal with 100 people with Ebola and provide the ideal standard of care.
Sure, you could set up a tent city with IV bags, but you're going to need the government to do that since nobody else wants the liability.
They really need to stay ahead of this. IMO it is worth the costs and inconvenience to do so.
And, if she was wearing any sort of face mask and eye protection (like you are supposed to do), nothing untoward would have happened.
Contact precautions aren't particularly hard, but they do require a significant degree of vigilance which is not a human being's strong point.
Sure, but the point is that the CDC is using the message that Ebola requires contact to send the message that it is no big deal, like AIDS. If a trained nurse can accidentally get it, then anybody can. Last time I checked the folks at my workplace weren't wearing gloves and facemasks and eye protection. They're safe only because nobody with Ebola is in the workplace, not because it is hard to spread.