4 ms·

Once again, every single comment is picking apart the least important aspect of a comment. Though it works a small percentage of the time or not, the Milwaukee

Once again, every single comment is picking apart the least important aspect of a comment. Though it works a small percentage of the time or not, the Milwaukee protocol is evidently not nearly effective enough, thus necessitating this research into a cure. Your question stands: why not test it? There's precedent for testing unproven drugs on humans in extremis, so it's not that. As a halfhearted stab in the direction of an answer: I assume they will try it in human rabies victims in a later phase, they're just testing it in mice first.

bsder 3y ago
> Your question stands: why not test it? Because there are so few late stage rabies victims that you simply can't get the data? By and large in the US, people know the protocol--get bitten by a strange animal, head to the ER and get ready for rabies shots. And it almost always works. Apparently, the US never had a post-treatment death until one 84-year-old man with an immune deficiency (and a bunch of other health issues) died of it. It's not clear anything would have worked for him. https://www.unmc.edu/healthsecurity/transmission/2023/04/04/rabies-patient-becomes-first-fatal-case-in-us-after-post-exposure-treatment-report-says/ https://www.unmc.edu/healthsecurity/transmission/2023/04/04/... Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. And there just aren't that many of them.
- gambiting 3y ago
  >>Because there are so few late stage rabies victims that you simply can't get the data? In India, estimated 20k(!!!) people die of rabies each year. Surely that's enough to warrant human testing. https://www.who.int/india/health-topics/rabies https://www.who.int/india/health-topics/rabies
  - contravariant 3y ago
    I think there are some ethical issues with trying to find those people and not treat their disease before it is too late, most of the testing will consists of preventing people from becoming good test subjects. I'm not saying it's bad, but it will be expensive and may fail to yield much result (as far as testing the cure goes).
    - throwaway290 3y ago
      Treating them is the point. Find people who's too late to get the old rabies shot and give the new treatment to them. The difficult part is control group but that's always the difficult part. Without control group they can probably just compare statistics with the past...
      - contravariant 3y ago
        I don't think you really need a control group for something with a well established nigh 100% fatality rate.
  - bsder 3y ago
    The fact that 20K people die to a disease that has a set of proven, relatively inexpensive treatments tells me that 20K people already can't get to a medical facility. Getting to those people to a medical facility to test a new, unproven, expensive treatment simply isn't going to happen. This is especially so since there are a vast number of diseases that are much higher priority than rabies in India.
    - LegitShady 3y ago
      I have unfortunately seen some heartbreaking videos where it's children who got it. Some for sure can't get access to medical care in the rural areas, but sometimes the kids might not even know.
- jopsen 3y ago
  > Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. Lots of people are dumb enough not to go to the ER following a harmless animal bite. Maybe, if it's a bat, but lots of people won't bother (and 99% of the time, they'll be fine either way)
- AbortedLaunch 3y ago
  Post exposure vaccination alone is not sufficient to prevent death for all cases. Immunoglobulins (HRIG) must also be administered. HRIG is not commonly available in many developing countries or rural areas. This is why preexposure vaccination is recommended for vulnerable groups (children) when traveling to such areas.
graeme 3y ago
I might have been unclear: the Milwaukee protocol was not effective. My point was, normal medical ethics seem to go out the window here. With most interventions, you can harm the patient, so you had best not give them anything until you test it. But a symptomatic rabies patient is default dead. Given these results, it strikes me that we ought to move much faster through our usual phases and make it available for immediate use in centres which are symptomatic rabies patients. If any of those patients start surviving, the drug has proven itself for general use and stats can be gathered. The control group is every prior symptomatic rabies patient: they all died. The article made it sound like this will be something rolled out over several years. If that, as investment is required. An estimated 59,000 people die of rabies each year globally. Each year of delay kills them. My question is should we not make this available immediately and see what happens? It isn’t like heart disease where the patient will often live many years and so a new treatment must prove itself. Literally everyone dies of rabies if symptomatic.
- jopsen 3y ago
  > An estimated 59,000 people die of rabies each year globally. Each year of delay kills them. How many are diagnosed before it's too late? In the developed world where you're likely to get tested and diagnosed, we probably don't have many cases. And you probably can't give the treatment to suspected cases. But yes, there is little risk in testing on diagnosed patients.

bsder 3y ago

> Your question stands: why not test it? Because there are so few late stage rabies victims that you simply can't get the data? By and large in the US, people know the protocol--get bitten by a strange animal, head to the ER and get ready for rabies shots. And it almost always works. Apparently, the US never had a post-treatment death until one 84-year-old man with an immune deficiency (and a bunch of other health issues) died of it. It's not clear anything would have worked for him. https://www.unmc.edu/healthsecurity/transmission/2023/04/04/rabies-patient-becomes-first-fatal-case-in-us-after-post-exposure-treatment-report-says/ https://www.unmc.edu/healthsecurity/transmission/2023/04/04/... Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. And there just aren't that many of them.

gambiting 3y ago
>>Because there are so few late stage rabies victims that you simply can't get the data? In India, estimated 20k(!!!) people die of rabies each year. Surely that's enough to warrant human testing. https://www.who.int/india/health-topics/rabies https://www.who.int/india/health-topics/rabies
- contravariant 3y ago
  I think there are some ethical issues with trying to find those people and not treat their disease before it is too late, most of the testing will consists of preventing people from becoming good test subjects. I'm not saying it's bad, but it will be expensive and may fail to yield much result (as far as testing the cure goes).
  - throwaway290 3y ago
    Treating them is the point. Find people who's too late to get the old rabies shot and give the new treatment to them. The difficult part is control group but that's always the difficult part. Without control group they can probably just compare statistics with the past...
    - contravariant 3y ago
      I don't think you really need a control group for something with a well established nigh 100% fatality rate.
- bsder 3y ago
  The fact that 20K people die to a disease that has a set of proven, relatively inexpensive treatments tells me that 20K people already can't get to a medical facility. Getting to those people to a medical facility to test a new, unproven, expensive treatment simply isn't going to happen. This is especially so since there are a vast number of diseases that are much higher priority than rabies in India.
  - LegitShady 3y ago
    I have unfortunately seen some heartbreaking videos where it's children who got it. Some for sure can't get access to medical care in the rural areas, but sometimes the kids might not even know.
jopsen 3y ago
> Basically, the only people who die of rabies are those who missed that they got bit or those who were dumb enough to refuse the vaccine. Lots of people are dumb enough not to go to the ER following a harmless animal bite. Maybe, if it's a bat, but lots of people won't bother (and 99% of the time, they'll be fine either way)
AbortedLaunch 3y ago
Post exposure vaccination alone is not sufficient to prevent death for all cases. Immunoglobulins (HRIG) must also be administered. HRIG is not commonly available in many developing countries or rural areas. This is why preexposure vaccination is recommended for vulnerable groups (children) when traveling to such areas.

graeme 3y ago

I might have been unclear: the Milwaukee protocol was not effective. My point was, normal medical ethics seem to go out the window here. With most interventions, you can harm the patient, so you had best not give them anything until you test it. But a symptomatic rabies patient is default dead. Given these results, it strikes me that we ought to move much faster through our usual phases and make it available for immediate use in centres which are symptomatic rabies patients. If any of those patients start surviving, the drug has proven itself for general use and stats can be gathered. The control group is every prior symptomatic rabies patient: they all died. The article made it sound like this will be something rolled out over several years. If that, as investment is required. An estimated 59,000 people die of rabies each year globally. Each year of delay kills them. My question is should we not make this available immediately and see what happens? It isn’t like heart disease where the patient will often live many years and so a new treatment must prove itself. Literally everyone dies of rabies if symptomatic.

jopsen 3y ago
> An estimated 59,000 people die of rabies each year globally. Each year of delay kills them. How many are diagnosed before it's too late? In the developed world where you're likely to get tested and diagnosed, we probably don't have many cases. And you probably can't give the treatment to suspected cases. But yes, there is little risk in testing on diagnosed patients.