Patterico's Pontifications

10/5/2014

Pointing Out The Obvious

Filed under: General — Dana @ 12:26 pm



[guest post by Dana]

Today on Meet the Press, Joe Scarborough neatly summed up why Americans remain doubtful about official reassurances regarding Ebola:

“Meet The Press” panelist Joe Scarborough slammed the White House Sunday, saying simply that no one believes them regarding the recent Ebola scare after a man in Dallas was diagnosed with the virus.

“Right now a lot of Americans are seeing what happened in Dallas and looking at the laundry list, with what happened Secret Service, with the IRS, with the VA, with ISIS being A JV team,” Scarborough said.

“So when any member of the government says relax, everything’s gonna be okay, Americans don’t believe that,” added the “Morning Joe” co-host.

MSNBC host Andrea Mitchell piled on, hammering the Dallas hospital for letting the man walk out of the hospital initially and blaming it on a computer system.

“This was after we were being told by the government, but the CDC, by the White House that doctors and hospitals around the country were prepared,” said Mitchell.

Video here.

–Dana

96 Responses to “Pointing Out The Obvious”

  1. Hello.

    Dana (4dbf62)

  2. thank you Captain Obvious for obviously stating the obvious.

    file this under “duh”

    redc1c4 (abd49e)

  3. They were prepared, more or less – if somebody told them to expect ebola.

    Sammy Finkelman (31cdef)

  4. A few missteps won’t cause an epidemic, and a few mistakes by the secret service still leaves the odds very much against anything.

    It gets out of control when the number of cases reaches 500, 1000, 1500.

    Sammy Finkelman (31cdef)

  5. i had to rewind just to watch the poncey host person stride in all self-important-like

    lil bad-ass got some swagga don’t he

    google says his name is “Chuck Todd”

    happyfeet (a785d5)

  6. Andrea Mitchell ain’t nothin’ but Harry Shearer in a blonde wig.

    Colonel Haiku (2601c0)

  7. Well, they were prepared – and well versed – to Pass The Buck!

    I’m sure there’s some way to blame George Bush, or the Koch Bros. for all this.

    askeptic (efcf22)

  8. let’s hope @peskyvirus will live by the promise of hashtag #easilycontained #installkaspersky #canihaspurell #trustyourgovernment #hosedownthatsidewalk

    happyfeet (a785d5)

  9. W know him as F. Chuck, he started out as an aide to Tom Harkin,

    narciso (ee1f88)

  10. My biggest disappointment is that (as far as I know) Marie Harf has not opined on ebola yet. I always rely on Marie to explain what is going on and say what the government is up to behind the scenes.

    Oh, and has Ezra done a voxplain on the ebola virus yet? His input would probably be reassuring and insightful, too. He is very smart, too, of course. And we know that because both he and Marie wear glasses.

    elissa (d4347f)

  11. Yes, elissa, Vox is on the case with its cards up so you can learn the truth. Right off the bat:

    What is the Ebola virus?

    Most people’s views of Ebola are probably informed by Hollywood — they think of it as a deadly and contagious virus that swirls around the world, striking everyone in its path and causing them to hemorrhage from their eyeballs, ears and mouth until there is no more blood to spill.

    In reality, Ebola is something quite different.

    Dont’ worry, be happy.

    Dana (4dbf62)

  12. whew, Dana!

    elissa (d4347f)

  13. Say what you will about Scarborough and Mitchell, but at least they are not circling the wagons of stupidity.

    Dana (4dbf62)

  14. I know, elissa, because we are all so stupid and uninformed. I bet their Ebola cards are written on stone tablets.

    Dana (4dbf62)

  15. How can you explain anything without a #hashtag?

    askeptic (efcf22)

  16. That hospital apparently quickly reversed itself on the electronic record being the problem. Too late though. Their IRS audit letter will arrive tomorrow.

    Mike K (90dfdc)

  17. Have mercy, been waitin’ on Ebola all day.
    Have mercy, been waitin’ on Ebola all day.
    I got my bag all packed and my take-home pay.

    Have mercy, been bleedin’ from my eyes all night
    Have mercy, been bleedin’ from my eyes all night
    Well, I’m just glad it ain’t out my ass cuz I got that sucker sewed up tight

    Right on, got checked doc says I’m fine
    Right on, got checked doc says I’m fine
    Well, I’ll be leavin’ Texas fast, mister please, where do I sign?

    Colonel Haiku (2601c0)

  18. well it is hemorrhagic, and it is quite contagious, this is why it’s claimed more than 3,0000 lives in West Africa,

    narciso (ee1f88)

  19. The following suggests the problems in west Africa are uniquely bad due to the specifics of the politics and economy in that part of the world. So if Ebola becomes more of an issue in the US, we’ll at least have some breathing space. But that assumes Obama (or his successors) and his minions don’t make America more and more like Liberia.

    cbc.ca, October 3: While the rapid response to the Ebola outbreak in Nigeria was a significant factor in quelling the spread of the deadly disease, the country had other advantages over Liberia, Sierra Leone and Guinea where it continues to run rampant.

    “There’s a series of differences between what happened in Nigeria and what has been happening in other West African countries,” said Dr. Aileen Marty, who spent 31 days in Nigeria leading an international team helping to combat the outbreak.

    Nigeria recorded 19 laboratory-confirmed Ebola cases and one probable one in two Nigerian states, and nearly 900 patient contacts were identified and followed since mid-July when the outbreak took off, the Atlanta-based Center for Disease Control (CDC) said in a statement this week. Meanwhile, there have been no new cases since Aug. 31, “strongly suggesting the outbreak in Nigeria has been contained,” CDC said.

    The disease didn’t spread rapidly, in part, because it was mostly limited to the wealthier population of Nigeria, said Marty, who is also director of the Florida International University’s Health Travel Medicine Program

    “The person who brought the infection was a diplomat,” Marty said. “He was brought to one of the best hospitals in Nigeria, and the people who were infected were individuals who quickly comprehended the importance of following our recommendations.”

    Nigeria is also vastly more politically stable and economically affluent than other West African countries, having not suffered years or decades of civil strife.

    “So you have a setting in Liberia and Sierra Leone, which has gone through horrific devastation, and complete depletion of any health-care infrastructure, which means you can’t provide beds, can’t adequately equip medical personal and you can’t identify patients and trace contacts,” said Dr. Peter Hotez, the founding dean of the National School of Tropical Medicine at Texas’ Baylor College of Medicine.

    Because of its oil resources, Nigeria is a relatively wealthy country, compared to others in the region, meaning it had the resources to tackle the outbreak, Hotez added.

    Mark (c160ec)

  20. The only thing this administration is prepared to do is line their pockets with our
    hard earned money.

    Jenny (a343bb)

  21. Mark (c160ec) — 10/5/2014 @ 5:05 pm

    Damn diplomats #muck up everything.

    askeptic (efcf22)

  22. Assuming the article has correct information:
    Nigeria recorded 19 laboratory-confirmed Ebola cases and one probable one in two Nigerian states, and nearly 900 patient contacts were identified and followed since mid-July when the outbreak took off, the Atlanta-based Center for Disease Control (CDC) said in a statement this week. Meanwhile, there have been no new cases since Aug. 31, “strongly suggesting the outbreak in Nigeria has been contained,” CDC said.

    A few things to note. The Nigerian outbreak started when 1 symptomatic person collapsed in an airport and was taken to the hospital.
    1) the outbreak was contained
    2) not until at least 18 other people were infected and nearly 900 “patient contacts” were identified and followed up

    I would say that means there is no reason to panic, but it is also means that the apparent, “Don’t worry, be happy” attitude of government officials is a bit cavalier and counterproductive in the long run. There is no reason to panic, there is every reason to be concerned that things are kept on top of.

    This confirms what we know about Ebola,
    1) It is contagious, but not nearly so as chickenpox and influenza and other things spread through respiratory means.
    2) It is often lethal, even in the setting of good medical care, though in such a setting the mortality is less than the 90% that has been true in some outbreaks
    3) The way to combat the disease is through aggressive identification of contacts and proper levels of isolation, and continuing to do so until no new cases have been identified for a prolonged period of time (I believe the official number i2 42 days).
    4) An Ebola case in a densely populated area requires a significant amount of work, even when the initial case was quickly identified and isolated from the general population.

    5) Liberia is a mess, a disaster getting nothing but worse for the foreseeable future.

    MD in Philly (f9371b)

  23. there was a times piece, in an earlier thread, that showed that Nigeria has or is on it’s way to containment, however we are not pursuing the policies they did, the outbreak began in a small village in South East Guinea last year, then rapidly crossed the borders,

    narciso (ee1f88)

  24. I think the US should be told to expect there to be additional cases in Dallas from contacts the man had, but that there will be no wide spread epidemic. That is the best case scenario as witnessed in Nigeria. if people are told that now, they will not be shocked and dismayed when additional cases are reported.

    The Obama administration is not in the habit of really dealing with anything, just talking as if saying so makes it true, with a press willing to pretend along with them.

    Ebola Hemorrhagic Fever will not likely cooperate.

    If the CDC and others want to reassure that travel is Ok from Liberia, let them take turns welcoming flights and shaking the hand of everyone that gets off of the plane.

    MD in Philly (f9371b)

  25. Oh, and did you hear that the homeless man in the ambulance with Duncan has skipped out of his “compassionate” monitoring? Yes, there was a homeless guy with him, and yes he had escaped and said F-U to the nice CDC folks.

    Then they found him later in the day and are just in a dither about what they are going to do to help him feel more comfortable about being detained!

    No word yet on how many of his fellow Homeless Americans he exposed to Ebola, but that would be homeless phobic so don’t expect anyone to check.

    Patricia (5fc097)

  26. As far as I know, the different strains of Ebola have varied effects.
    Most past outbreaks had shorter incubation periods and were ~90% lethal…which is why they ended so quick: they killed themselves out.
    This one is less lethal, but is thus more readily spread.

    Ibidem (6ff225)

  27. 10. My biggest disappointment is that (as far as I know) Marie Harf has not opined on ebola yet. I always rely on Marie to…

    elissa (d4347f) — 10/5/2014 @ 1:05 pm

    The nice thing about seeing Marie Harf (and Jen Psaki) still have jobs at State is that I know I don’t have to worry about them screwing up my order at my local Olive Garden or Chili’s.

    Steve57 (b50fab)

  28. Patricia (5fc097) — 10/5/2014 @ 6:47 pm

    The good news is that even if he is infected, he may not yet have had symptoms and hence is not contagious.

    from Ibidem (6ff225) — 10/5/2014 @ 6:47 pm

    28.As far as I know, the different strains of Ebola have varied effects.

    True, depending on the outbreak, from 25% (not 35% as I’ve said previously) to ~90%, and I think the main difference was the strain of virus, not the level of medical care.

    Most past outbreaks had shorter incubation periods and were ~90% lethal…which is why they ended so quick: they killed themselves out.
    I don’t think so. I think the main reason has always been the outbreaks were in relatively isolated and sparsely populated areas, so the total number of potential victims was relatively low, and contacts were easily identified and monitored.

    This one is less lethal, but is thus more readily spread.
    I think this is within the historical range of lethality with Liberia over 50%, Nigeria about 40%
    It was said of the Bundibugyo strain, with only a 25% mortality, that it was not readily recognized as Ebola because of the “relatively mild” symptoms. (personal communication with people involved) Though this was the case, the outbreak was not widespread because of the relative isolation and sparse population of the effected area.

    I’ll repeat what I see as the primary point until I learn otherwise-
    the main difference this time is that the outbreak grew to involve a major metropolitan area with a pathetic health infrastructure and widespread poverty and poor hygiene. The number of exposures and people contracting the disease grew rapidly because of the density of the population, and the lack of resources made appropriate follow up impossible and the outbreak is out of control.
    Lagos, Nigeria, likewise is densely populated, but the initial case was quickly identified and known contacts appropriately isolated. Data I saw at one link said there were 20 total cases and 8 deaths.
    That is a double-edged bit of info. The good news is that it was contained with only 20 people getting it and 8 dying,
    The bad news is that was what happened “in the best of circumstances”, one index patient, immediately identified, and all known contacts monitored.

    Which is why I have said we should expect more cases in Dallas, but hopefully the cases will be relatively few, the death rate will be less than 50% due to the best care available, and it should be contained.
    I think it is reasonable to expect more outbreaks before it is all over, whether we try to shut off travel or not.
    I also think it is reasonable to expect that the total number of cases and deaths in the US will be quite small, and perhaps enterovirus 68 will eventually cause more severe illness, maybe not more deaths, but perhaps a larger number of combined deaths and cases of paralysis.

    MD in Philly (f9371b)

  29. For your interest, the CDC recommendations to healthcare personnel

    MD in Philly (f9371b)

  30. Steve57 (b50fab) — 10/5/2014 @ 7:45 pm

    You know damn well that neither one of them would be considered for employment at either place – even Chuck e-Cheese would be a stretch.

    askeptic (efcf22)

  31. Apparently the CDC has announced that Duncan is not being treated with experimental Ebola drugs, while the stricken journalist gears up for treatment at another hospital. Pointing out the obvious: The journalist is white.

    Another obvious point: Duncan will die from this disease, sending a message to his comrades in Africa that coming to America won’t save you.

    Chris (0ba377)

  32. We can only hope and wish, Chris, we can only hope and wish.

    nk (dbc370)

  33. I don’t think the photojournalist will get any of the previously used experimental drug because there is none left.
    I have read there is another experimental drug available from some company in Canada, and it is available to Duncan if he and his family want it and his doctors want to use it. Experimental drugs are just that, and have an unknown risk of side effects. Africans and African Americans have an aversion to the word “experiment” and “being guinea pigs”. If the photojournalist gets something and Duncan doesn’t, my guess it would be because Duncan’s family doesn’t want it, but the other person’s does.
    “Treatment” in a US hospital primarily means the best supportive care with IV fluids, medications to keep the blood pressure up if necessary, kidney dialysis if kidney failure, etc. So, even without any experimental drugs, treatment in the US is better than in Africa.

    MD in Philly (f9371b)

  34. Africans and African Americans have an aversion to the word “experiment”

    I don’t say that as a criticism, but as a fact from my experience, and I think a reason suspicion to have because of history. But I hope when a person has their own doctor, there can be more trust established.

    MD in Philly (f9371b)

  35. It is a conundrum, MD. On the one hand, we don’t want drugs in limited supply on black people. On the other hand, if they are experimental, we don’t want to test them for side effects on white people.

    nk (dbc370)

  36. shame on you nk, shame on you…
    I know you are making a point, and not necessarily advocating that view,
    but I saw this often when treating folks for HIV
    While the gay community, often educated white males, fought for pushing the envelope in getting treatments developed ASAP, the African American community was often reluctant for “medical treatment”, even when the drugs were no longer experimental.

    MD in Philly (f9371b)

  37. “not necessarily”?

    MD, I was simply agreeing with Chris that the American health care system is a seething cauldron of hatred, bigotry, intolerance, racism and homophobia. If I were Chris, and thought I might need medical care, I would run not walk to the nearest border.

    nk (dbc370)

  38. On your serious point, the Tuskegee airmen. Which may have been only the tip of the iceberg. Black people’s fears are not entirely without basis.

    Anecdotally, one of my secretaries, who was black, told me once that her uncle had gone in for an appendectomy and found out later that they had also taken out one of his kidneys. Without telling him. Her family believed that it had been stolen for transplant.

    nk (dbc370)

  39. 33. Steve57 (b50fab) — 10/5/2014 @ 7:45 pm

    You know damn well that neither one of them would be considered for employment at either place – even Chuck e-Cheese would be a stretch.

    askeptic (efcf22) — 10/6/2014 @ 12:50 am

    Yeah, I know they couldn’t figure out how to work the espresso machine at Seattle’s Best Coffee. But I’m still trying to find the silver lining to Barack Obama giving the sorority girl-extras from Legally Blonde gigs as DoS spokes airheads.

    And I could just barely see them getting some kind of a job at a place like Chili’s if they went to high school with the manager’s girlfriend or something. Somebody would have to know somebody and pull some strings. Which, let’s face it, is how they got the jobs at State.

    Steve57 (b50fab)

  40. 40. A good book on the subject: The Immortal Life of Henrietta Lacks.

    The Truth notwithstanding, here in German Catholic country there is not a hint of that troof.

    Get your azz out of your sh*thole, pronto.

    gary gulrud (46ca75)

  41. 37. Africans and African Americans have an aversion to the word “experiment”

    I don’t say that as a criticism, but as a fact from my experience, and I think a reason suspicion to have because of history. But I hope when a person has their own doctor, there can be more trust established.

    MD in Philly (f9371b) — 10/6/2014 @ 5:12 am

    Obamacare will destroy that trust, doc.

    http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html

    Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her

    …For a patient with asthma, the hospital would be able to score how likely they are to arrive at the emergency room by looking at whether they’ve refilled their asthma medication at the pharmacy, been buying cigarettes at the grocery store and live in an area with a high pollen count, Dulin said.

    The system may also score the probability of someone having a heart attack by considering factors such as the type of foods they buy and if they have a gym membership, he said.

    …Murry, the diabetes patient from Charlotte, said she already gets calls from her health insurer to try to discuss her daily habits. She usually ignores them, she said. She doesn’t see what her doctors can learn from her spending practices that they can’t find out from her quarterly visits.

    “Most of these things you can find out just by looking at the patient and seeing if they are overweight or asking them if they exercise and discussing that with them,” Murry said. “I think it is a waste of time.”

    While the patients may gain from the strategy, hospitals also have a growing financial stake in knowing more about the people they care for.

    Under the Patient Protection and Affordable Care Act, known as Obamacare, hospital pay is becoming increasingly linked to quality metrics rather than the traditional fee-for-service model where hospitals were paid based on their numbers of tests or procedures.

    You are soon to be penalized if you’re not constantly looking over your patients’ shoulders and letting them know you’re monitoring their daily lives.

    Steve57 (b50fab)

  42. OT

    Steve57

    Over at Realcleardefense there are some interesting articles about ship procurement

    EPWJ (e66119)

  43. nk, Tuskegee was correct, but the airmen were a good thing, it was the syphilis study in the jail/prison that was bad
    what border would you run to where you think it would be better?

    About the stolen kidney, hard to believe, but truth is stranger than fiction, harder to believe is that it happened and they knew about it and nothing was done about it.

    Steve57, lot’s of things have been eating away at that trust, ObamaCare is just the latest and most massive assault

    MD in Philly (f9371b)

  44. MD, I was responding to Chris. When somebody plays the race card, I call and raise. (Kind of like what the little old lady said to the sheriff in Blazing Saddles.) I’m not running to any border. Chris, I think, should.

    Thank you for correcting me. I mixed up my Tuskegees. I don’t know where I got the impression that some of the subjects with “bad blood” were airmen, veterans of WWII.

    nk (dbc370)

  45. I knew you were responding to Chris, I did not understand that you intended the reference of running to the border to apply specifically to him,
    but now I see.

    MD in Philly (f9371b)

  46. But it’s an ill wind that blows no good. Chris mentioning the disparity in treatment got me to thinking about what the real problem with Mr. Duncan’s electronic very likely was. Once he told the admitting nurse that he was from Liberia, her focus shifted from “what’s wrong with this patient?” to “we have to document correctly so that Medicaid/Medicare(?) will pay us”. Bet you a dollar, she spent seven out of the ten minutes of typing things into her computer on biographical stuff unrelated to his condition. That treating doctors and nurses would then have to wade through to get to the relevant parts.

    nk (dbc370)

  47. Wait…you don’t actually believe our medical system is a seething cauldron of hate, do you? You were being ironic?

    I mean, Duncan is a black African here illegally and is getting the top level of treatment. The experimental drug ZMapp is gone because we sent a bunch of it to Africa, after complaints of racism about giving it only to Americans. (Apparently now we are on the hook for worldwide racism not just that within the US.)

    Patricia (5fc097)

  48. The obvious point about race was actually a quick afterthought to my initial point, from a combination of the Fahrakan story about the virus being created to kill blacks, the continuing Ferguson riots, the shoddy treatment Duncan’s family is getting and a couple other fleeting thoughts.

    The main point I was hoping to make grows out of an attempt to understand why our govt feels that battling the virus over there will protect us here, while not taking any steps to monitor its entry into this country. Duncan gets really poor treatment (compared to all other US victims), in the world’s most superior healthcare system. is he going to live or die, then think about the consequences/benefits of either, and try to predict the outcome.

    Chris (0ba377)

  49. Yes, I was being ironic, Patricia. I believe Mr. Duncan came here, believing that he was infected, because he knew he would get the best possible care, and possibly survive. I believe he knew all about Dr. Brantley, too, either from news accounts in Liberia or from his relatives here. And I bet his relatives know all about all the benefits our racist (sarcasm) country provides to aliens.

    nk (dbc370)

  50. Chris, Comment 51, that kind of cynicism might exist in somebody like Ezekiel Emanuel, but not in the doctors and nurses whose vocation and avocation is to make people well, and not object lessons.

    nk (dbc370)

  51. Thought so, nk. :)

    Chris, I’m sorry you feel that way. How do you know Duncan is being denied drugs other than ZMapp, now that it’s gone!

    Other than that, he’s getting supportive care like every other victim. And the treatment of his family was shoddy because the idiots in government are stupid and incompetent and haven’t decided how to quarantine.

    Patricia (5fc097)

  52. Quarantine in the outback of Uganda or elsewhere in African jungles consists of, I would think, staying in your hut or shack and letting neighbors leave food on your doorstep.
    Small town neighborliness is all one needs.

    In a big city things don’t usually work the same way, there is supposed to be some government agency to do it if you don’t have the money, and you can pay someone to do it if you do have the money.

    I think it is probably that simple and race has little to do with it.

    White people in rural areas can be neighborly too.

    MD in Philly (f9371b)

  53. nk (dbc370) — 10/6/2014 @ 9:41 am

    I believe Mr. Duncan came here, believing that he was infected, because he knew he would get the best possible care, and possibly survive.

    Then why did he just accept the diagnosis that it was not ebola? They should have been screaming at the doctors.

    It’s possible he was trying to run away from ebola, but didn’t think he had it yet.

    I believe he knew all about Dr. Brantley, too, either from news accounts in Liberia or from his relatives here. And I bet his relatives know all about all the benefits our racist (sarcasm) country provides to aliens.

    Sammy Finkelman (d22d64)

  54. Patricia (5fc097) — 10/6/2014 @ 8:35 am

    I mean, Duncan is a black African here illegally and is getting the top level of treatment.

    It’s hard to come up with a sentence that is so wrong.

    1) Duncan is not living here – he just came.

    2) He is not here illegally – he had a visa, and it was not revoked, and lying in a questionaire administered by the government of liberia is not grounds for revoking the visa.

    3) There are not being clear about what were the grounds for his visa, but it could have been a fiance visa. (to get married)

    4) He is not receiving the best treatment, and they are probably lying about why not. No blood transfusions from recovered ebola patients, which is something he might even have gotten in Liberia if he was extremely lucky, or agile and informed. He is probably receiving excellent palliative care which is extremely important.

    The Canadian drug may very well be a problem, but if so, it never should have reached this stage of development, and nobody should ever have pinned any hopes on it.

    Zmapp was supposed to be able to be manufactured quickly. They probably gave away the last dose on the assumption it wouldn’t be needed.

    Again, ZMapp is nothing but a Rube Goldberg process for producing ebola antibodies using tobacco plants grown ina greenhouse.

    Sammy Finkelman (d22d64)

  55. I believe he knew all about Dr. Brantley, too, either from news accounts in Liberia or from his relatives here.

    Oh, sure.

    He quit his job on September 4, and Brantley was evacuated at the beginnong of August, and he was released from the hospital on Thursday, August 21. there are newspapers published in Monrovia and he could read.

    And I bet his relatives know all about all the benefits our racist (sarcasm) country provides to aliens.

    Pretty much all western democracies would treat anyone sick they were confronted with. It is the Hippocratic Oath.

    Sammy Finkelman (d22d64)

  56. palliative
    the word you want here is supportive, palliative refers to controlling symptoms (and not necessarily halping survival)
    supportive refers to doing things to help keep a patient live, even though there is n o specific antibiotic or drug you can use to help the body cure whatever is happening.

    ZMapp is nothing but a Rube Goldberg
    I’m not sure why you want to use the disparaging term “nothing but”
    many drugs and treatments are the result of “nothing but Rube Goldberg” indirect ways of mass producing something that is in nature in very small quantities

    MD in Philly (f9371b)

  57. It is the Hippocratic Oath.
    Sammy Finkelman (d22d64) — 10/6/2014 @ 10:23 am

    Most docs in the West play fast and lose with the Oath as they like, as it originally included no abortions.
    There is (at least was, haven’t looked it up recently) a movement of docs who explicitly call themselves “Hippocratic” Physicians, sticking to the original version that values human life and will not be involved with abortions or euthanasia.

    MD in Philly (f9371b)

  58. ZMapp is nothing but a Rube Goldberg –

    MD in Philly (f9371b) — 10/6/2014 @ 10:33 am

    I’m not sure why you want to use the disparaging term “nothing but” many drugs and treatments are the result of “nothing but Rube Goldberg” indirect ways of mass producing something that is in nature in very small quantities

    Because there are probably many much better, more studied, less complicated ways of producing the antibodies! (that’s what makes it Rube Goldberg)

    Sammy Finkelman (d22d64)

  59. perhaps, Sammy, as I think part of the issue is finding ways to support the tobacco industry in KY other than smoking it, sort of like George Washington Carver finding uses of the peanut.
    But getting bacteria or cell cultures to produce it involves gene splicing and such as well, not necessarily less complicated. Hard to get easier than plant seeds, maybe water it, and let the sun and increasing levels of carbon dioxide go to work.

    MD in Philly (f9371b)

  60. Patricia #54 How do you know Duncan is being denied drugs other than ZMapp, now that it’s gone!

    This article says there is no more ZMapp, but a second experimental treatment is available if he wants it, presumably the Canadian drug. So what about the antibody transfusions, apparent success with HIV drugs, etc?

    It’s not that I’m particularly cynical, it just does not appear they’re trying very hard to save this man’s life, contrasted with the treatments of Dr. Brantley, Whitebol, etc.

    Chris (0ba377)

  61. Ebola bola eliminated from an area in Guinea not near the center of the epidemic:

    http://www.who.int/features/2014/telimele-ebola-free/en/

    Sammy Finkelman (d22d64)

  62. Chris (0ba377) — 10/6/2014 @ 11:07 am

    it just does not appear they’re trying very hard to save this man’s life, contrasted with the treatments of Dr. Brantley, Whitebol, etc.

    He is probably getting onlky standard treatment. Nobody is bending any rules maybe.

    Sammy Finkelman (d22d64)

  63. Interesting link, nk. Notice the doctors got permission from the family in NC (I think reports say Duncan’s mother lives in NC), which may mean Duncan isn’t able to decide for himself. It also tells me that Duncan’s Dallas family — his girlfriend/fiancee and son — may not be making the decisions. Hopefully Duncan designated them before he got too sick. Otherwise, his complicated family situation would make it hard for doctors to know who to talk to.

    DRJ (a83b8b)

  64. It’s interesting how many Liberians are in America, and how easy it seems to be for them to travel here and stay once they are here.

    DRJ (a83b8b)

  65. Anyway, I hope the experimental drug works. Healthcare needs a little success these days.

    DRJ (a83b8b)

  66. DRJ

    Actually we were slated to go, anywhere there is disease, unstable governments and hostile rebels = oil is found.

    Liberia in a few short years will be the wealthiest nation in Africa

    EPWJ (0c89e8)

  67. I’m guessing that we have a special relationship with Liberia, it being sort of our colony in Africa. Or settlement might be a better word? I think they had unopposed self-determination within a generation?

    nk (dbc370)

  68. Chris:
    1) from one article linked above
    His family said he’s on a respirator and kidney dialysis machine.
    Right, they’re not trying very hard to save him.
    2) Your link about using the HIV drug lamivudine, the “science” quoted in the article is so wrong that I’m not going to bother with it. Theoretically, lamivudine should work against Ebola about as well as erythromycin, i.e., no logical reason.

    Please go away unless you have something worthwhile to say.

    MD in Philly (f9371b)

  69. 69. This seems to target replication. It is probably as good as far as it goes. It will only help him if he is getting better, or just might tip the balance if he is near or can brought near the balance.

    It probably will do some good, but it probably is not enough. Or maybe the management of electrolytes etc. will help him pull through.

    This is the kind of thing that might stop things from getting worse. Provided it also doesn’t stop something necessary.

    They probably don’t need anything so super special to try this idea. AIDS antiviral drugs would probably do the same thing (it works for other diseases, I read) although maybe this is less toxic. Or maybe it is more toxic.

    Just an example of a web page that mentions that:

    http://medical-dictionary.thefreedictionary.com/Antiviral+drugs

    In combination with interferons, ribavirin has shown some efficacy against hepatitis C, and there have been anecdotal reports of utility against other types of viral infections.

    As a class, the antivirals are not curative, and must be used either prophylactically or early in the development of an infection. Their mechanism of action is typically to inactivate the enzymes needed for viral replication. This will reduce the rate of viral growth, but will not inactive the virus already present. Antiviral therapy must normally be initiated within 48 hours of the onset of an infection to provide any benefit.

    In sum: This is the wrong kind of treatment (in terms of effectiveness.

    What they are trying, of course, can be gotten for free, while AIDS drugs might not be donated by the companies, since this would be an off-label use, and companies really don’t want to gte caught promoting it, unless they are ready to begin thinking at least of getting it approved for such a purpose.

    Sammy Finkelman (067111)

  70. well it was the Huffington Post, which makes Jenner and Pasteur scream, (vaccine denialists)

    narciso (ee1f88)

  71. Liberia was founded in 1822, and the capital was named after the then-President of the United states, James Monroe (Monrovia) It became independent in 1847.

    There was a small population of liberated slaves – not quite 1% – and a big population of people who had never been taken to America – there was an effort, mostly ineffective – to bring them up to that level.

    It had a constitution like that of the United states, except longer terms, (actually the Presidents first term was 8 years, if re-elected 4 years) and the dominant political party was the same one dominant in the United States in 1847 – the Whig Party – called the True Whig party there.

    The Whig party lived on 125 years longer in Liberia than in the United States. The President just kept on getting re-elected. William S. Tubman was president for about 30 years till he died in 1971 in his 6th term – then his Vice President, William R. Tolbert Jr. became president

    In 1980 there was a military coup and shortly after the President of Liberia and 27 other officvials were executed, and master Seargent Samuel K. Doe became ruler.

    Later on he was killed and there was tremendous violence and chaos, which was really over only on the last few years.

    Sammy Finkelman (067111)

  72. Re: the anti viral treatment:

    The big reason for trying this, and not AIDS antvirals, is probably that it is free because it is new and at just the point in the drug approval process where the company might donate it. I don’t think one antiviral has ben evalauated against the other. The reasons for picking it ae more bureaucratic than medical.

    This doesn’t target the effects of ebola, and that’s the most important thing. Statins have been proposed as something that would work, and a couple of other things..

    Here it is:

    http://www.nytimes.com/2014/08/16/opinion/can-statins-help-treat-ebola.html?_r=0

    More than a decade ago, clinicians noted striking similarities between patients with Ebola and those with bacterial sepsis. Both diseases involve severe dysfunction of the endothelial cells that line blood vessels throughout the body. This dysfunction in turn precipitates major abnormalities in blood coagulation. Both can eventually lead to the failure of internal organs, primarily the liver and kidneys, and organ failure often leads to death. Something similar is seen in many patients with other forms of acute critical illness, including pneumonia and influenza.

    Researchers have since discovered that abnormalities of endothelial function and coagulation can be modified or reversed by treatment with drugs such as statins, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), which were developed to treat patients with cardiovascular diseases and diabetes. Known as immunomodulatory drugs, they also have the ability to modify the body’s response to infection. While they don’t prevent infection itself, they can prevent complications like organ failure. A clinical trial published in the journal Critical Care in 2012 demonstrated, for example, that early treatment of sepsis patients with a statin reduced the occurrence of organ failure (a complication that often kills Ebola patients) by 83 percent.

    Unlike experimental Ebola treatments, these immunomodulatory drugs have been approved and are produced as inexpensive generics. They are available to anyone who lives in a country with a basic health care system, and this includes the countries in West Africa that are struggling to cope with Ebola.

    Representatives from the World Health Organization have expressed reservations about what we are proposing. They have suggested, for instance, that the use of such drugs could increase viral replication and worsen the disease. But several studies have shown that statins actually reduce viral replication in human diseases like hepatitis C and improve clinical outcomes.

    What? You can only try one kind of experiment at a time? They don’t work against each other.

    Sammy Finkelman (067111)

  73. Interfering with the replication of a virus is all one needs to do and all one can do. HIV drugs, Hep C drugs, all work by interfering with the virus replicating in one way or another.
    -The drug stops the virus from making more virus
    -the body destroys the virus already present
    -doctors keep the kidneys and lungs and circulatory system working while the first two things are taking place

    That said, the various enzymes it takes for a virus to reproduce are specific to the virus. Sometimes the enzymes are close enough in structure that on drug will work in more than one organism
    But in general drugs work by targeting a specific kind of enzyme found in a specific class of organism
    for example, bacteria and humans both use ribosomes to manufacture proteins. Erythromycin poisons ribosomes and prevents them from making proteins. But erythromycin does this specifically for many bacteria ribosomes and not for humans, so it doesn’t kill humans, who need their proteins synthesized too.
    just because a drug works in one virus doesn’t mean it will work in another.

    MD in Philly (f9371b)

  74. The interesting thing is they did a little experiment (tested it on a sample of his blood) and it was active. Now they could do that a lot more.

    This is the kind of experimental medicine that hasn’t been done, except for surgery, in 65 or 70 years or longer.

    They also are not giving him antibodies, although this does something close to what antibodies do – cuts down on the amount of viral proteins in the blood. But antibodies attack the problem at a later stage. It gets rid of ebola virus, not just prevents more.

    He also needs something to help him fight the disease. The right nutrients can help.

    When people are asked for consent, I don’t think any kind of reasoning is explained. so it always probably sounds to hem more like it is the best thing to try than it is. It is a good thing to and right to ask – there might be somereason not to do something. But I don’t think they try to explain the mechanism, nor that there are other, possibly a lot better, ideas floating around.

    Sammy Finkelman (067111)

  75. #72 MD re, HIV drugs for Ebola: Please go away unless you have something worthwhile to say.

    Well, I can’t vouch for the accuracy of the article, but taking it at face value, a 13% mortality rate vs. the typical 55-70% rate sure does have the effect of raising one’s hopes. I’m sorry you’re unwilling to explain why it isn’t so, because I’d like to know why it won’t work despite the results of mini-trial reported in the article. I think if I were an ebola sufferer, I’d be damn grateful to get it if nothing else was available.

    Chris (0ba377)

  76. The big reason for trying this, and not AIDS antvirals, is probably that it is free
    No. The cost for AIDS drugs is trivial compared to the cost of him being in the ICU on a ventilator and getting dialysis.
    the reason to try any drug is because of the theoretical explanation why it should work and observations in the lab and in animals and in humans, if any

    You can only try one kind of experiment at a time? They don’t work against each other.
    You don’t know for sure that they won’t work against each other until they are tested. There may be no known reason for two treatments to conflict, but that doesn’t mean that there isn’t a very good reason that we don’/t know.

    MD in Philly (f9371b)

  77. Wall Street Journal Op-ed that discusses the principle of experimentation (getting rid of bureaucratic obstacles)

    http://online.wsj.com/articles/scott-gottlieb-and-tevi-troy-stopping-ebola-before-it-turns-into-a-pandemic-1412376544

    It’s actually not so likely to turn into a pandemic. And to talk about Zmapp like it’s sa big thing — like it is something really special – the only thing special about it is tghe method of manufacturing it, which is really a Rube Goldberg process – and tha other ways of getting and concentrating antibodies would work, shows they are not really paying attention, or are fooled by the fact that every single treatment is treated as if it were something totally separate and unrelated to anything else that might be tried.

    What they say – that’s important – is this:

    We’re only going to learn whether drugs and vaccines work by getting real-world information. Conventional, randomized and double-blind clinical trials are not possible in the throes of an epidemic of a deadly pathogen. Given the urgency of the situation, we’re going to have to tolerate more uncertainty than usual.

    They are actually not necessdary ever. There are more enough mathematical tools to do away with a lot of this. What is necessary is a lack of stupidity and learning quickly from experience.

    Medicine, especially in this kind of situation, is an art and not a fully developed science. I would suggets maybe a panel of 60 to 100 master doctors be appointed, and if a significant fraction say it is worth trying it should be tried. That can maybe screen out some stupid ideas, and promote good ones. The doctors should not be all from the same school, or training, and they should be people who have tried thinbgs and have wide knowledge so they can evaluate thinbgs not in ther area of expertise.

    You’ll cerytainly find out what works much more quickly.

    The same system could be used to find new antibiotics.

    Sammy Finkelman (067111)

  78. Chris, I’ll humor you a little bit, though I find your suggestions disgusting, especially when confronted with the realities. To give him some lamivudine would be ridiculously cheap and easy compared to what else they are doing, and they are not giving all of this care just to withold a cheap way to get him out of their ICU.

    First, It’s CNN
    second:

    Logan said he got the idea to try lamivudine when he read in scientific journals that HIV and Ebola replicate inside the body in much the same way.

    That is equivalent to saying baseball and basketball are similar because they both use a round ball, and I will not bother more detail unless you want to pay me a tutorial fee.

    “Ebola is a brainchild of HIV,” he said. “It’s a destructive strain of HIV.”
    Pure garbage. Ebola and HIV are both viruses. They also happen to both be RNA viruses, but HIV is a retrovirus, Ebola is not. It’s like saying Liberians and Egyptians are the same because they both live in Africa.
    If lamivudine works it is happenstance. the fellows description of acyclovir is pretty lame as well.

    MD in Philly (f9371b)

  79. There are more enough mathematical tools to do away with a lot of this. What is necessary is a lack of stupidity and learning quickly from experience.

    No, back to work

    MD in Philly (f9371b)

  80. Scott Gottlieb And Tevi Troy suggest further that the manufacturing should be started before the testing is finished, and more than one thing should be manufactured, so the thing that turns to actually work, or work best, would be ready to go as soon as you figure out that that’s what you want.

    Stockpile them before you figure out what is working. It wouldn’t cost very much at all. Just $50 million on average per therapeutic. (you can afford to throw out what turns out to be a dud – and youll have what you need when you need it)

    Now this requires large doses of common sense and good judgement, so as to evaluate things correctly..

    Sammy Finkelman (067111)

  81. MD in Philly (f9371b) — 10/6/2014 @ 1:38 pm

    If lamivudine works it is happenstance. the fellows description of acyclovir is pretty lame as well

    They could tell in a few hours in an in vitro experiment if it would work or not. That’s what they did with what they are using.

    Now to talk of ebola being a form of HIV is just nonsense, but they are both viruses, and even RNA viruses, and it could be – in fact should be – that these antivirals have very general effects, just like antibiotics have effects against many different kinds of bacteria.

    Now maybe some of the anti-AIDS antivirals would also work against ebola and others would not.

    What they are trying wasn’t designed for use against ebola, but it seemed to be promising when they tested it out in vitro. Similarly they could test out a lot of other things.

    And there is no reason whatever to suppose the anti-AIDS antivirals are specific for HIV, and they are not. It’s just that they are pretty toxic and most other situations have better treatments, so aren’t used very much, and the whole drug approval process treats everything as being specific only for what it is double blinded and tested for, so people didn;t think of it. But drugs are not like magic potions. There’s a reason they work, and the reason would cover a lot of other situations than what they were approved for.

    I don’t all the lawyers who write the laws understand this, although this is elementary.

    Nowadays the drug application process os so demanding and expensive and time consuming companies often just get a drug approved for something.

    Sammy Finkelman (067111)

  82. wow, that is the Venkman school of etiology, that CNN guy was touting.

    narciso (ee1f88)

  83. This must be the round ball you’re talking about, MD (#82):

    “In a healthy cell, the normal business of Tsg101 protein is as part of the machinery for protein trafficking. It now emerges that two deadly but unrelated viruses, HIV-1 and Ebola, both subvert Tsg101 as an essential step in their life cycles—exiting a cell to restart the cycle of infection. (pages 1313–1319)” Nature Medicine Journal, December 2001.

    Chris (0ba377)

  84. Thank you, MD in Philly. Chris, you are really reaching. In fact, Duncan is getting a really long shot experimental drug now. If they could give him a cheap drug, why wouldn’t they??

    But since you and Sammy think this is all a conspiracy to kill black people, why don’t you call the CDC and give them all your advice?

    Patricia (5fc097)

  85. First, my comments were posted based on information available this morning: Duncan was not receiving any treatment for the virus itself. None, nada. Shocking, that he’s been hospitalized over a week already and still only receiving supportive care only, when you have reports of other therapies besides ZMapp that may help treat the virus. Why is that, when the other ebola patients received ebola-specific therapies alot faster? Then this afternoon it’s announced that he’s receiving, by your own words, “really long-shot” experimental drugs, again when there are other therapies showing some successes already.

    Second, the HIV drug article was an interesting case that actually seems very promising, just based on the article itself. What does MD do? Jump all in my shit for believing the article and essentially calling the doctor in the article a quack for even trying the drugs. My next few replies were attempts to defend the doctor’s choices, even digging up published research that helps support the doctor’s assertions. Yeah, I’m really stretching it alright, when MD is all about defending the same medical establishment that still says the oldest drug in the history of mankind has no medicinal value.

    Chris (0ba377)

  86. last time
    HIV uses reverse transcriptase to turn RNA into DNA, Ebola does not, the entire replication cycle has a different first step. All of the drugs that do this have no direct reason to work for any other viruses. In fact, some drugs that work for HIV-1 do not work well against HIV-2, and HIV itself can develop mutations so that some drugs will not work in even different strains of HIV.
    The idea that, “there is no reason whatever to suppose the anti-AIDS antivirals are specific for HIV” misses the boat entirely. The reason we have drugs at all is that the biochemical machinery from cell to cell in the human body, and much more so from bacteria to bacteria and virus to virus is so complex and intricately balanced that one medicine does not typically work for a wide variety of purposes.

    Chris (0ba377) — 10/6/2014 @ 2:01 pm
    So, what did you do, do a search of “Ebola” and “HIV” and look to hit a reference that had both, without understanding a word you read?
    But drugs are not like magic potions. Right, they are like keys to a lock or combinations to a safe, just because that key looks a lot like the other key doesn’t mean they will work in the same lock.

    You are right about the FDA approval process looking at only specific uses when trying to get approval, but that has nothing to do with why one antiviral drug isn’t used for something else.

    MD in Philly (f9371b)

  87. Patricia (5fc097) — 10/6/2014 @ 2:19 pm

    Chris, you are really reaching. In fact, Duncan is getting a really long shot experimental drug now.

    It looked like for a while they were not trying anything out of the ordinary, but it seems like they did.

    If they could give him a cheap drug, why wouldn’t they??

    It’s not cheaper. What they are getting, they are getting for free, but (at least the hospital) would have to pay for the AIDS drugs.

    Where the AIDS drugs are better (if they worked) is the question of availability, or the speed with which they might administer it, once they decided to do it. It’s there in the hospital pharmacy, and also, if it works, could be done in other cases too with no problem and no delay. It would be much better in general if something readily available turned out to work. It couldbe a failure of imagination.

    SF: But drugs are not like magic potions.

    MD in Philly (f9371b) — 10/6/2014 @ 3:16 pm

    Right, they are like keys to a lock or combinations to a safe, just because that key looks a lot like the other key doesn’t mean they will work in the same lock.

    That’s what is true about antibodies, but it is not so true about antibiotics.

    Some drugs target something more general – they work against a class of organisms. There are some things that work against everything alive, like chlorine, and are toxic and close to useless as therapy. And other things work against a category of pathogens.

    Now are the anti-AIDS drugs more like antibodies than antibiotics?

    In any case there are some things in common use that might work against ebola, because we know there are things that work against more than one virus, even ifone of those virsues isn’t HIV, and HIV is off in a corner by itself. I don’t know if the following only applies to antivirals NOT used for HIV, (or not the primary ones)

    http://www.ncbi.nlm.nih.gov/pubmed/21964179

    Antiviral drugs for viruses other than human immunodeficiency virus.

    Razonable RR.

    Author information Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA. razonable.raymund@mayo.edu

    Abstract

    Most viral diseases, with the exception of those caused by human immunodeficiency virus, are self-limited illnesses that do not require specific antiviral therapy….Some antiviral drugs possess multiple potential clinical applications, such as ribavirin for the treatment of chronic hepatitis C and respiratory syncytial virus and cidofovir for the treatment of cytomegalovirus and other DNA viruses. …

    I would think the AIDS drugs fit into that category, because originally they weren’t developed specifically for HIV, and furthermore what they are trying also was not developed as something specific to ebola, and yet it seemed to work in the laboratory, unless they are fooling themselves, but why would they even think of this idea unless it was somethinbg expected to work against a class of pathogens?

    Some keys work in different locks, because they use the same lock. (The protein coat of every virus is different, but something that interferes with something else or something that if the virus loses, it fails to infect, might be presentamong many different viruses.

    Sammy Finkelman (067111)

  88. That’s what is true about antibodies, but it is not so true about antibiotics.

    Once again you are taking a little bit of knowledge and running to false conclusions.
    My scientific (short) career before I went into medicine focused on enzyme mechanisms and synthesizing things that would block them.

    If you want to say, for example, that bacterial ribosomes are all more generally alike to each other than to human ribosomes, or that DNA or RNA polymerases used by viruses are often more like each other than polymerases in mammals, that is correct.
    But what you think is implied, that there is widespread similarity between viruses such that drugs for one virus routinely work in others is completely mistaken. There are who knows how many viruses out there, to reason that because we know a hand-full of cases where some drugs work for more than one virus suggests that such a phenomenon is widespread is mistaken.

    Why do you think there are so many antibiotics by the way?
    Yes, some is marketing to make money,
    some is because some antibiotics are easier to take or have less side effects than others,
    but a lot is because any antibiotic only works against a specific subset of bacteria, so you need many types of antibiotics to treat the wide spectrum of infections.

    MD in Philly (f9371b)

  89. Sammy, AZT was not developed specifically for HIV, it was a drug that interfered with DNA synthesis and was once considered to be used in cancer. It was not useful for that.
    It turned out that it was much more specific against the reverse transcriptase of HIV than human DNA synthesis enzymes. Further research into that type of drug, and HIV protease inhibitors, etc., etc. were indeed much more focused specifically for HIV.
    But I can’t say much more on that, as that was not within my sphere of specialization.

    MD in Philly (f9371b)

  90. MD in Philly (f9371b) — 10/7/2014 @ 8:28 am

    but a lot is because any antibiotic only works against a specific subset of bacteria, so you need many types of antibiotics to treat the wide spectrum of infections.

    It depends if what the antibiotic interferes with or attacks is something that bacterium uses. And my impression is that four or five lines of attack will get pretty much everything.

    Now I didn’t think there could be a general line of attack against viruses, but if there is something that attacks replication, maybe yes. Here seem to be some things that affect more than one virus, and that can only be becase they are attacking something other than the protein coat, which is what an antibody does.. The protein coat is very specific to a virus and constantly changes unless it is the very thing necessary for it to infect a cell.

    Sammy Finkelman (067111)

  91. Now there is something else: enterovirus 68, which sounds veyr much like Polio II.

    Sammy Finkelman (067111)

  92. Clearly a new mutation of an old virus, which was what polio was in 1887. I don’t know why they are so slow to pick up on this.

    Sammy Finkelman (067111)


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