To treat Ebola patient, Omaha doctors fast-tracked medical science

[Omaha Steve]

http://www.livewellnebraska.com/health/to-treat-ebola-omaha-doctors-fast-tracked-medical-science/article_57a54b25-210d-549d-9f07-53b765c4bb5f.html

Posted: Thursday, September 18, 2014 1:00 am
By Bob Glissmann / World-Herald staff writer

The few treatments that are available for the Ebola virus showed promise — in monkeys, not humans.

Before an American Ebola patient arrived in Omaha 13 days ago, doctors here had just days to select the best course of action from their limited options. And they worked up to the last minute to get the necessary permission to administer the experimental drug the patient has received.

Doctors caring for Dr. Rick Sacra, the American medical missionary who contracted the Ebola virus in Liberia, said Wednesday that his lab results show a decreasing amount of the virus in his blood, confirming the improvement they’re observing.

“Based on what we’re seeing now, we expect him to make a full recovery,” said Dr. Angela Hewlett, associate medical director of the biocontainment unit at the Nebraska Medical Center. “However, we are still somewhat cautious because of the severity and unknown factors of this disease.”

FULL story at link.

[longship]

1. Unfortunately it is probably unethical to do a double blind placebo controlled human trial.

Which would determine definitive curative effects.
Under the current increasing spread of the disease, nobody would want to be in the placebo group. And who could blame them.

[My Pet Goat]

2. Getting new Ebola drugs into the field as fast as possible..

is such an important and interesting area of medical ethics right now. I don't understand all of the issues involved, but surely the crisis warrants pushing the limits, especially with regard to waivers and protection from liability. What I don't want to see right now is anything that looks like CYA. For example, the most compelling argument I've read against bringing out the drugs too soon is doing so could actually make the situation in the field worse (medically).

[longship]

3. Also, without a double blind trial, efficacy would be undetermined.

Pragmatic studies just aren't up to determining that.

I agree that fast tracking these drugs would be a good thing. I've not seen the contrary argument, but maybe that's because it is possible that the drugs do not work very well and without a proper trial, one would not know it.

[Avalux]

4. It is unethical; a double-blind RCT isn't appropriate in this scenario.

Emergency use of experimental drugs to save lives is the track we're on here. It's all about risk vs. benefit, with patient safety at the forefront. The possible risks of the new drug are considered against the backdrop of an ever expanding epidemic but ultimately, if a patient is faced with death and there's a drug that *may* work, they should be treated with it.

[longship]

5. That's what I thought. Thanks. nt