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Ebola: Experimental drug ZMapp is '100% effective' in animal trials
- trhway 12y agowhy we still test effectiveness on animals when there are several thousands of people who has no downside and only upside for the drug to be tested on them? Ethics? It would be a strange ethics that had worked only until an American needed the cure. Something isn't right that this drug got out of shadow only when there was a need to cure an American. I mean, of course, thanks God, that i have real chance of soon becoming an American too :)
- lauraura 12y ago"And two out of seven people given the drug, have later died from the disease." Sounds like they're already doing precisely that.
- deleted 12y ago[deleted]
- hdevalence 12y agohttp://mobile.nytimes.com/2014/08/13/world/africa/ebola.html http://mobile.nytimes.com/2014/08/13/world/africa/ebola.html The first four paragraphs describe what happened: different decisions were made by different doctors, and the drug did not "get out of the shadow only when there was a need to cure an American".
- trhway 12y ago>different decisions were made by different doctors that is exactly my point. It is a discernible trait of the system level behavior with many different people involved.
- Crito 12y agohttp://scientiasalon.wordpress.com/2014/08/14/on-the-science-and-ethics-of-ebola-treatments/ http://scientiasalon.wordpress.com/2014/08/14/on-the-science... (related HN discussion: https://news.ycombinator.com/item?id=8189528 https://news.ycombinator.com/item?id=8189528) The second paragraph does a good job of summing up ethical concerns related to this particular outbreak (standard ethical concerns also apply): "The first two patients to be treated were Americans. Prior to this came the old (and historically justified) fear of testing potentially dangerous new treatments on vulnerable populations in developing countries rather than on privileged first world patients. The first ever treatment was not given to an African doctor because of this concern [1]. After Westerners were treated, complaints rose about giving infected Westerners access to a new drug while infected Africans went without. These two concerns are obviously mutually exclusive. People are concerned, they are just not sure about what, sometimes even voicing both concerns in the same article [2]."
- makomk 12y agoOne would hope that African doctors would be reasonably capable of assessing the risks and benefits of taking experimental new treatments themselves. I seem to recall the trials that people have been concerned about involved large-scale testing on poorly-educated members of the general population. (Also, I think that kind of testing still happens even now!)
- DanBC 12y agoTreating an ebola patient is complicated. Treating an ebola patient who has a bunch of weird side effects caused by an experimental drug makes a sub-optimal situation much worse.
- xtrumanx 12y ago> ..makes a sub-optimal situation much worse. I guess the OP's point was how much more sub-optimal can the situation get if the alternative to not trying the experimental drug is the death of the patient.
- roywiggins 12y agoThe alternative is a about a 40% chance of survival without the drug. With the drug, maybe it will be higher, but maybe it will be lower. We don't actually know (though this new trial is very encouraging). A bad drug could also cause suffering beyond what Ebola causes: even if the patient was going to die anyway, it could make their death even more painful.
- selectodude 12y agoI guess that's when you hope you're not in the US, and get someone to inject you with a fatal dose of morphine.
- mrexroad 12y agoif walking dead and zombie movies taught us anything, it's that things can get a whole lot more sub-optimal.
- kvb 12y agoWhy do you say there is no downside? As Jonathan Kaplan points out in the comments of the article Crito links to, Ebola is not 100% fatal and several drugs that have worked in animals have proven to have catastrophic effects when administered to humans (see e.g. TGN1412 [1]). [1] - http://en.wikipedia.org/wiki/TGN1412 http://en.wikipedia.org/wiki/TGN1412
- colanderman 12y agoseveral drugs that have worked in animals have proven to have catastrophic effects when administered to humans This is an argument for animal testing?
- Crito 12y agoThe argument for animal testing would be that several drugs have had catastrophic effects on animals, and would have had those same catastrophic effects on humans had we not tested first on animals. Not all drugs effective for humans will be safe for animals, and not all drugs effective for animals will be safe for humans. Animal testing aims to operate in the middle-ground between the two, where things work similarly in both animals and humans.
- colanderman 12y agoYa, too bad humans with terminal diseases can't give consent to receive experimental treatments. Better to forcibly test on a being that can't say "no".
- Crito 12y agoEven if the established/widely accepted standards of ethics made human testing in lieu of any animal testing the clear ethical choice, it still would not be practical. Think about it, how would you work on potential cures of ebola in the (several times many year long: http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks http://en.wikipedia.org/wiki/List_of_Ebola_outbreaks) gaps between ebola outbreaks? Deliberately infect humans to be used as test subjects? Put all research on hold until the next outbreak came around? You'd be able to find plenty of human test subjects for diseases like malaria or HIV, but for many diseases you would rapidly exhaust your supply of sick humans.
- colanderman 12y agoBecause only humans are made in God's image. Therefore it's ethical to test drugs on enslaved non-human sentients incapable of acknowledging consent. EDIT: Very curious whether the downvoters (a) don't get the sarcasm, (b) get the sarcasm and are offended that I question their religious tenets, (c) think animal testing is justifiable beyond reproach, (d) disagree that monkeys are sentient, (e) think that monkeys consent to testing, or (f) just don't like how I worded things.
- trhway 12y agoopponents of animal testing in particular or anthropocentrism (like in "humans are the top of the God's creation and the Earth is given to humans into their dominion to be [ab]used as they wish") in general don't fair well on this much more conservative than one might expect site.
- colanderman 12y agoYa, unfortunately, humans don't react well when you question their worldview.
- kqr2 12y agoIn this NYT article: http://www.nytimes.com/2014/08/30/world/africa/study-says-zmapp-works-against-ebola-but-making-it-takes-time.html http://www.nytimes.com/2014/08/30/world/africa/study-says-zm... It mentions that all 3 control group animals died. Does anyone know why the control group is so small compared to the test group of 18?
- deleted 12y ago[deleted]
- skosch 12y agoI would hazard a guess that we know Ebola to be pretty close to 100% lethal, and if you know that three out of three control animals died, then the virus is "working" and there's no need to sacrifice many more animals.
- hga 12y agoExactly. The control group is there to, for example, make sure your culture of Ebola is really that, viable and so on. If they didn't get sick, let alone die, you'd know your experimental group results were invalid. Monkeys are also very expensive animals to do research on, and no one likes to kill them, or at least we don't tend to have the same sentiments about mice and rats.
- OldLikeDos 12y agoIt looks like the 18 animals were actually sub-divided into at least three test groups. One test group got the drug after 3 days after exposure, one at 4 days and one at 5 days. So the number of animals in each sub-group is closer to the control. It wouldn't surprise me if there were actually six test groups of three animals each (perhaps divided by both day-of-treatment and something else like drug amount), thus matching the control. But the article doesn't actually imply that.
- state 12y agoI'm surprised that so much of the coverage of ZMapp doesn't include the fact that the drug is produced in tobacco plants. To me, this is the single most interesting and impressive fact. It's also likely the main reason why "the limited supplies will not help the 20,000 people predicted to be infected during the outbreak in West Africa." Scaling production of antibodies grown in plants can't possibly be straightforward.
- rch 12y agoDARPA thinks it's a scalable method, at least for producing flu vaccines: "Accelerated Manufacture of Pharmaceuticals (AMP), companies in four states are building facilities where they can quickly produce vaccine-grade proteins grown in the cells of tobacco plants. Once they produce the proteins, the goal is for each company to scale up its process to produce 100 million doses of H1N1 flu vaccine per month." http://www.defense.gov/News/NewsArticle.aspx?ID=61520 http://www.defense.gov/News/NewsArticle.aspx?ID=61520
- state 12y agoRight. It certainly seems like a much more scalable way to produce antibodies. It's just getting all the infrastructure in place that's going to be a challenge.
- rch 12y agoThat article was from 2010. I hear this place is pretty impressive: http://nctm.tamu.edu/facilities.html http://nctm.tamu.edu/facilities.html
- dnautics 12y agoIt's actually not very scaleable. The yield is incredibly low. Processing plants is also difficult because you have to deal with a bunch of stupid stuff like tough cell walls, etc. I'm not even sure that the glycosylation patterns that tobacco puts on the antibodies are human-compatible (i.e. problems could occur if you try to use tobacco-derived antibody therapeutics in a patient more than once). The choice to use tobacco was very likely a symptom of "if you have a hammer," common in biology and chemistry, where some tobacco researcher (tobacco is a well-studied model organism) wrote a convincing grant with a handful of accurate but marginal improvements over contemporary systems (in this case glycosylated vs. unglycosylated) that would enable commercialization, and downplayed some of the setbacks (low yield). Meanwhile other technical approaches have matured that are really good at tackling those problems but without the other setbacks... but just weren't awarded seed money.
- coldcode 12y agoIt's interesting to me that people are working on a cure for Ebola yet no one is deeply interested in working on new antibiotics. Ebola is a scary disease yet rare (across the entire planet) so there doesn't seem to be a lot of monetary reason to invest in it. Antibiotic resistance is far more widespread. I guess I don't always understand how the pharmaceutical industry decides what to look at.
- legomylibrum 12y agoI don't know if Ebola qualifies, but there are 'orphan drug' laws in many places that help pay for the development of medicine to treat rare diseases or conditions.
- lutusp 12y ago> Ebola is a scary disease yet rare (across the entire planet) so there doesn't seem to be a lot of monetary reason to invest in it. Antibiotic resistance is far more widespread. All true, but once one understands the microbiology, it becomes obvious why drug companies are giving up on antibiotics. It's perfectly rational behavior -- no matter what antibiotics we invent, the microbes will evolve resistance to them in a short time. That's been the history of antibiotics until now, and there's no reason to expect the future to be any different -- if anything, it will probably become worse. http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/dr-arjun-srinivasan-weve-reached-the-end-of-antibiotics-period/ http://www.pbs.org/wgbh/pages/frontline/health-science-techn... Title: "Dr. Arjun Srinivasan: We’ve Reached 'The End of Antibiotics, Period'"
- argonaut 12y agoEbola has been around for decades, and this is an experimental drug. The fact is that interest in experimental drugs for Ebola has only cropped up recently, so this doesn't really prove any point about interest in antibiotics.
- sliverstorm 12y agoNew antibiotics are in the works all the time. We are currently in an arms race with infections; I recall reading that new antibiotics are expected to last for only 10 years, and future antibiotics are going to last even less time (before resistance develops) Why doesn't it get more press? I don't know for sure, but it is: - Ongoing, which makes for bad news - Kind of depressing, because we are slowly losing the battle - Feels a little bit hopeless, because foolish choices by individuals accelerate the development of resistance, and inventing new antibiotics doesn't fix that fundamental problem
- contingencies 12y agoDoes anyone know why the WHO reporting frequency seems to be irregular? Recently it seems to be timed with the release of defensibly bad versus downright scary figures. https://en.wikipedia.org/wiki/2014_West_Africa_Ebola_virus_outbreak#Timeline_of_the_outbreak https://en.wikipedia.org/wiki/2014_West_Africa_Ebola_virus_o...
- hga 12y agoI would suspect that reporting figures to the WHO, which I'll add is not providing a whole lot of help, is a rather low priority to these countries. Plus the way this epidemic is playing out in the 3 major countries makes the figures altogether iffy (Nigeria is an obvious exception, with one index case caught quickly).