A better title would probably be, "Scientists test to make sure that interesting cancer treatment idea doesn't kill human subjects."
This appears to be a Stage I clinical trial of an interesting idea, that is at least somewhat biologically plausible. I haven't fully reviewed the pulished data, so I don't feel comfortable saying more than that. However, most of us who work in biology and medicine would agree that our understanding of the immune system is still relatively primitive, so there may be potential cures still lurking in plain site.
However, Stage I trials are only the very initial trials in humans - and they evaluate safety as the primary outcome; i.e, trying to make sure we're not going to kill anyone. Stage II trials would attempt to evaluate appropriate dosing, and Stage III trials attempt to compare the new therapy to currently accepted standards.
While this may be a breakthrough (and all of us in medicine are always looking for breakthroughs), there are also huge lists of ideas that worked really well in mice, moved on to Stage I, II, and III clinical trials, and failed utterly. This is extremely far from being any sort of cancer cure at this point - though perhaps 20 years from now we'll look back at this as a step towards that goal.
I think it's always interesting to hear
Indeed, Enterovirus 71 is a true pathogen, and while rare, needs to be considered. In fact, poliovirus, causing paralytic polio, is in the enterovirus family. As a practicing physician I recently saw a case of myelitis (inflammation of the spinal cord), here in the US, in a teenager who presented with leg weakness and sensory changes. EV71 was a possibility, although an unlikely one, and we later excluded it by testing.
Enteroviruses are transmitted via the fecal-oral route. I.e. feces from an infected person is ingested by another, most commonly through unclean water secondary to poor sanitation. While not wanting to minimize the importance of this outbreak, there are regular outbreaks of enteroviruses and other fecally transmitted pathogens around the world including inside the US. The leading cause of childhood death around the world is diarrheal illness - often caused by such viruses (though children usually die from dehydration, not neurologic symptoms).
As other posters have mentioned, the true treatment of these outbreaks is to prevent them through improved sanitation. Insofar as we can expect Beijing sanitation to be better than the rural areas in which this outbreak is being reported, the risk is correspondingly less. In fact, I suspect the Beijing authorities would make sure that athletes have access to toilets and clean drinking water.
This is an interesting point - anything that reduces the overuse of antibiotics is likely to be a good thing.
However, much of the time, especially with less sick patients, it is possible to decide by examining a patient (or with the help of a few basic tests such as a CBC and chest xray) whether an infection is likely to be viral or bacterial. Much of the problem of antibiotic overuse in the US (and around the world) is due to use of antibiotics in cases where it's already clinically unlikely to be a bacterial infection.
With life-threateningly ill patients, it might be less clear. However, often in those cases no physician is going to take the chance of missing a treatable infection and use antibiotics anyway. Even if this test showed the presence of a virus - can one be sure that the patient is not infected with both a common respiratory virus AND and bacterial infection?
There are probably a few cases in which this test might make a real difference in avoiding antibiotics, but I think that, most likely, it will be outweighed by overuse of this test in cases where it will make little difference.
As a pediatrician/internal medicine physician, this is interesting, but not necessarily as revolutionary as it might appear. Generally, we would like to have tests that are going to change our management. Though it might make us feel better to specifically know what virus a patient has, if it's not going to change our management, it's more debatable as to what the true value of this would be.
Currently of the viruses mentioned in the article, only influenza has a specific treatments - oseltamivir (tamiflu)/zanamivir, or amantadine/rimantadine (for influenza A only). We already have cheap, reliable, rapid influenza testing.
For any of the other viruses mentioned, standard of care will only be supportive therapy (IV fluids, oxygen, etc), and it won't change depending on the virus.
I'm sure this new test will not be cheap, so that if we start using this test widely, we may end up spending a lot of money without signficant clinical benefit to patients. As everyone knows, healthcare in the US is already horrifically expensive - tests such as these won't help..
Not actually the case - despite the similarities in name.
The most commonly used local anesthetics are lidocaine and it's related compounds - which are chemically quite dissimilar to cocaine. It's unlikely an antibody to cocaine would bind to lidocaine.
Wikipedia has nice pictures
lidocaine: http://en.wikipedia.org/wiki/Lidocaine
cocaine: http://en.wikipedia.org/wiki/Cocaine
Happily (and thankfully) we don't use a lot of pharmacologically similar compounds in medicine (or dentistry) these days. Even the medical/dental use of cocaine is rather rare these days as safer medications, or combinations of medications, can be used for similar effects. Despite their similar names, most of the "local anesthetics" that one would use in the dentist's chair (lidocaine, benzocaine, etc) have quite different chemical structure than cocaine. Cocaine has effect on both sodium channels (blocking depolarization and nerve conduction thus providing local anesthesia) as well as dopamine and norepinephrine reuptake (more responsible for its CNS effects). Lidocaine and related compounds only block fast sodium channels.
Thus, it's unlikely that this vaccine is going to cause serious dental pain problems.
As a physician who deals with in-hospital cardiac arrests on a regular basis, and whom has RTFA, there are couple important points.
First, this study really only looked at bystander-provided CPR. The paramedics/other trained professionals who arrived still intubated and ventilated these patients - as this is standard of care. The authors of the study say that the likely explanation for their finding is likely that bystanders interrupted chest compressions to give rescue breaths. So, we may need to change the training for the lay public regarding CPR, but professional responders will still need to give ventilations, and once an airway is secured simultaneous compression and ventilation can be given. If you don't breath - you don't live.
Second, while this is likely one of the better studies that can be done on a topic like this, it was not randomized, it was not controlled, nor was it even comprehensive/population-based. There are multiple types of errors that can creep in and cause erroneous results in these types of studies.
Finally, we need to keep results in perspective. While any improvement is important - and should be pursued - the overall statistics they report for outcomes are still pretty dismal. The overall survival rate for out of hospital arrest was 8-9%, and the number of people with only moderate/mild disability afterward (ie able to walk, talk, etc) was ~6% if you only got chest compressions, ~4% if you got compressions and rescue breaths. So, even with the "chest compressions only" strategy, the absolute difference is relatively small.
Slashdot Mirror
A better title would probably be, "Scientists test to make sure that interesting cancer treatment idea doesn't kill human subjects." This appears to be a Stage I clinical trial of an interesting idea, that is at least somewhat biologically plausible. I haven't fully reviewed the pulished data, so I don't feel comfortable saying more than that. However, most of us who work in biology and medicine would agree that our understanding of the immune system is still relatively primitive, so there may be potential cures still lurking in plain site. However, Stage I trials are only the very initial trials in humans - and they evaluate safety as the primary outcome; i.e, trying to make sure we're not going to kill anyone. Stage II trials would attempt to evaluate appropriate dosing, and Stage III trials attempt to compare the new therapy to currently accepted standards. While this may be a breakthrough (and all of us in medicine are always looking for breakthroughs), there are also huge lists of ideas that worked really well in mice, moved on to Stage I, II, and III clinical trials, and failed utterly. This is extremely far from being any sort of cancer cure at this point - though perhaps 20 years from now we'll look back at this as a step towards that goal. I think it's always interesting to hear
Indeed, Enterovirus 71 is a true pathogen, and while rare, needs to be considered. In fact, poliovirus, causing paralytic polio, is in the enterovirus family. As a practicing physician I recently saw a case of myelitis (inflammation of the spinal cord), here in the US, in a teenager who presented with leg weakness and sensory changes. EV71 was a possibility, although an unlikely one, and we later excluded it by testing. Enteroviruses are transmitted via the fecal-oral route. I.e. feces from an infected person is ingested by another, most commonly through unclean water secondary to poor sanitation. While not wanting to minimize the importance of this outbreak, there are regular outbreaks of enteroviruses and other fecally transmitted pathogens around the world including inside the US. The leading cause of childhood death around the world is diarrheal illness - often caused by such viruses (though children usually die from dehydration, not neurologic symptoms). As other posters have mentioned, the true treatment of these outbreaks is to prevent them through improved sanitation. Insofar as we can expect Beijing sanitation to be better than the rural areas in which this outbreak is being reported, the risk is correspondingly less. In fact, I suspect the Beijing authorities would make sure that athletes have access to toilets and clean drinking water.
This is an interesting point - anything that reduces the overuse of antibiotics is likely to be a good thing.
However, much of the time, especially with less sick patients, it is possible to decide by examining a patient (or with the help of a few basic tests such as a CBC and chest xray) whether an infection is likely to be viral or bacterial. Much of the problem of antibiotic overuse in the US (and around the world) is due to use of antibiotics in cases where it's already clinically unlikely to be a bacterial infection.
With life-threateningly ill patients, it might be less clear. However, often in those cases no physician is going to take the chance of missing a treatable infection and use antibiotics anyway. Even if this test showed the presence of a virus - can one be sure that the patient is not infected with both a common respiratory virus AND and bacterial infection?
There are probably a few cases in which this test might make a real difference in avoiding antibiotics, but I think that, most likely, it will be outweighed by overuse of this test in cases where it will make little difference.
As a pediatrician/internal medicine physician, this is interesting, but not necessarily as revolutionary as it might appear. Generally, we would like to have tests that are going to change our management. Though it might make us feel better to specifically know what virus a patient has, if it's not going to change our management, it's more debatable as to what the true value of this would be.
Currently of the viruses mentioned in the article, only influenza has a specific treatments - oseltamivir (tamiflu)/zanamivir, or amantadine/rimantadine (for influenza A only). We already have cheap, reliable, rapid influenza testing.
For any of the other viruses mentioned, standard of care will only be supportive therapy (IV fluids, oxygen, etc), and it won't change depending on the virus.
I'm sure this new test will not be cheap, so that if we start using this test widely, we may end up spending a lot of money without signficant clinical benefit to patients. As everyone knows, healthcare in the US is already horrifically expensive - tests such as these won't help..
Not actually the case - despite the similarities in name. The most commonly used local anesthetics are lidocaine and it's related compounds - which are chemically quite dissimilar to cocaine. It's unlikely an antibody to cocaine would bind to lidocaine. Wikipedia has nice pictures lidocaine: http://en.wikipedia.org/wiki/Lidocaine cocaine: http://en.wikipedia.org/wiki/Cocaine
Happily (and thankfully) we don't use a lot of pharmacologically similar compounds in medicine (or dentistry) these days. Even the medical/dental use of cocaine is rather rare these days as safer medications, or combinations of medications, can be used for similar effects. Despite their similar names, most of the "local anesthetics" that one would use in the dentist's chair (lidocaine, benzocaine, etc) have quite different chemical structure than cocaine. Cocaine has effect on both sodium channels (blocking depolarization and nerve conduction thus providing local anesthesia) as well as dopamine and norepinephrine reuptake (more responsible for its CNS effects). Lidocaine and related compounds only block fast sodium channels. Thus, it's unlikely that this vaccine is going to cause serious dental pain problems.
As a physician who deals with in-hospital cardiac arrests on a regular basis, and whom has RTFA, there are couple important points. First, this study really only looked at bystander-provided CPR. The paramedics/other trained professionals who arrived still intubated and ventilated these patients - as this is standard of care. The authors of the study say that the likely explanation for their finding is likely that bystanders interrupted chest compressions to give rescue breaths. So, we may need to change the training for the lay public regarding CPR, but professional responders will still need to give ventilations, and once an airway is secured simultaneous compression and ventilation can be given. If you don't breath - you don't live. Second, while this is likely one of the better studies that can be done on a topic like this, it was not randomized, it was not controlled, nor was it even comprehensive/population-based. There are multiple types of errors that can creep in and cause erroneous results in these types of studies. Finally, we need to keep results in perspective. While any improvement is important - and should be pursued - the overall statistics they report for outcomes are still pretty dismal. The overall survival rate for out of hospital arrest was 8-9%, and the number of people with only moderate/mild disability afterward (ie able to walk, talk, etc) was ~6% if you only got chest compressions, ~4% if you got compressions and rescue breaths. So, even with the "chest compressions only" strategy, the absolute difference is relatively small.