Help Stop Ebola with this One Simple Trick!*

I mean, other than donating to aid organizations that desperately need help, that is.

See, yesterday, it was revealed there was yet another Western person being treated with ZMapp. Yep, that experimental drug that the world supposedly ran out of last week. Except, apparently, when there’s a Briton involved, in which case, someone checked behind the couch cushions, NIH thought to look in an unused cold storage closet, or who knows–because that’s the problem. The world now knows British man Will Pooley received at least one dose of ZMapp and will receive more, and no one has explained how the Royal Free Hospital happened to stumble across these doses that theoretically didn’t exist. In fact, all they’re saying is

[T]he team treating the nurse had sourced the drug through its clinical networks with the help of international colleagues.

-GIF-suspicious-William-Shatner-James-T.-Kirk-Star-Trek-GIFWell, that’s not at all suspicious. Clinical contacts? International experts? Sure, that doesn’t sound at all sketchy.

See, the thing is, we’re going back to risk communication, international relations, and the people who are dying en masse in affected countries who’ve been told that there is just no drug left. When you say “nope, sorry, no drugs left, we are all and completely out of ZMapp” and then manage to suddenly find some when a white British guy needs it, you foster a climate of mistrust–something that’s already a huge issue that doesn’t really need further fuel on the fire.

Which is why, at this point, when these random unaccounted for surprise stores of ZMapp are discovered, there needs to be transparency about where it came from, why we didn’t know about it, and why it was suddenly found. Because otherwise, it sure looks like the double standard of treatment for Westerners vs. native Western Africans is continuing to happen.

(*How does this help to actually stop Ebola? Right now, one of the bigger issues being seen in countries like Liberia and Sierra Leone is a complete lack of trust in Westerner health care workers who are trying to help. Reinforcing the idea that there is a cure for Westerners when people in Liberia, Sierra Leone, and Guinea have been repeatedly told there isn’t a cure for them is going to continue to emphasize this lack of reason to trust, and that trust is an extremely crucial step to all of the very basic things that need to be done to stop this outbreak from spreading any further. At this point, I’m leaning pretty hard on it being unethical for doctors or journalists to report on ZMapp use without also identifying the source of the drug.)

Paternalism, Procedure, Precedent: The Ethics of Using Unproven Therapies in an Ebola Outbreak

The WHO medical ethics panel convened Monday to discuss the ethics of using experimental treatments for Ebola in West African nations affected by the disease. I am relieved to note that this morning they released their unanimous recommendation: “it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention.” WHOsOnFirstThere are, of course, the common caveats about ethical criteria guiding the interventions, but ultimately the recommendation has saved me from a tortured “WHO’s on first”-style commentary.1 I’m sure we all appreciate that.

But just because the WHO recommendation follows what I’ve been arguing for the last 10-odd days doesn’t mean that the argument is actually over. In fact, as far as I can tell, it’s just getting worse, where worse should be interpreted to mean “even more people coming out of the woodwork to argue about ethics when they don’t have any familiarity with ethics.” Granted, Twitter is full of sample bias, but still. It is for this reason that I think it’s still important to post this statement on the ethics of providing unproven interventions that my husband (a real life bioethicist) and I worked on last week. We were side-tracked by needing to actually verify the science behind ZMapp, as well as the additional hands-throwing-up of hearing that ZMapp was provided for a Spanish priest after various US public officials stated there was none left to give.2 I hope that having this information out there–on why yes, it is ethical to provide unproven interventions in pandemic situations–is useful for answering the questions people who don’t have much background in ethics may have, as well as getting into the cultural zeitgeist for discussions not only about future pandemic situations but also discussions about disparate treatment of people from the Developed vs Developing World.3 [Cross-posted at The Broken Spoke.]


Paternalism, Procedure, Precedent
The Ethics of Using Unproven Therapies in an Ebola Outbreak

A “secret serum.” A vaccine. A cure. A miracle. With the announcement of the use of ZMapp to treat two Americans sick with the Ebola virus with apparently no ill effect, the hum and buzz on social media, commentary websites, and even the 24/7 news cycle, has become one of “should the serum be given to Africa? Will it?” The question has dominated for more than a week, and become something that the World Health Organization feels it needs to address by convening a panel of medical ethics experts to offer an analysis of what should be done.

And the general question about untested cures/vaccines in the event of a disease pandemic is an important one; there are already guidelines for what kind of treatments can and will be made available during a flu pandemic, and it seems quite sensible that a guideline be developed for all potential pandemic pathogens. However, it isn’t a question that is relevant in the current context, because we are already past that.

While people may be stating “should the serum be made available?” that’s not the question being asked.
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  1. For other commentary on the committee composition, see Udo Schuklenk’s short, sweet, and to the point commentary; you can also read his reaction to their statement here. []
  2. After it was confirmed that the Spanish priest received ZMapp, ]
  3. Again, to clarify: This was finished on Saturday afternoon. Obviously, in that time frame, we have learned that a third Westerner was given ZMapp, it was released to two West African doctors, and WHO’s medical ethicspanel convened and–pleasantly–reached the same conclusion we did. This is merely a more detailed argument for the release of unproven interventions. []

Virtually Speaking Science: A New Place to Find Me on the Interwebs

In what is likely the worst “kept under wraps” bit of news in a while, I’m happy to announce that I’m joining the Virtually Speaking Science collective as a new host. But before I get to roll out the welcome mat and chatter with other people about their work, I’m going under the interviewee lens; Jennifer Ouellette is interviewing me Wednesday, May 14, at 8pm ET/5pm PT.

What is Virtually Speaking Science? It is a live webcast ‘radio’ with a digital, Second Life studio audience of:

[i]nformal conversations hosted by science writers Alan Boyle, Tom Levenson and Jennifer Ouellette, who explore the often-volatile landscape of science, politics and policy, the history and economics of science, science deniers and its relationship to democracy, and the role of women in the sciences.

VSSI’ve been having a blast getting to know my co-hosts, setting up my Second Life avatar, and getting to know my producer, Sherry Reson. And for a touch of nostalgia, VSS is hosted by the Exploratorium in Second Life. As some of you know, I not only grew up in the San Francisco Bay Area, I spent many, many hours in the Exploratorium. In some ways, this is very much a coming home for me; a long time later, I’m back–at least virtually–at one of the first places that sparked my interest in and wonder for science.

I hope you’ll tune in and join me. I think we’re going to have a lot of fun.

In Which An Editor Obnoxiously Brags About Her Author

I spent much of the fall grumbling – mostly good-naturedly – about editing a dissertation on the dual-use dilemma in the life sciences. I fell into editing the project rather late,1 which led to some memorable crankiness on my part (I actually sent back one chapter with “no” and “rewrite”), and sleep turned into a precious commodity for a while.

Overall, though, I’m incredibly proud of the small part I had in the project, and extremely proud of the author in general. You can’t read the dis (yet), but you can see a little bit of Nick’s writing over on the Scientific American guest blog, today, where he looks at the proposed DHHS policy on gain-of-function research in the life sciences:

Yet even if we do overcome the hurdle of identifying what is beneficial, and what manifestly dangerous, the proposed actions given by the framework are somewhat alarming. The framework gives the option to transfer dangerous gain-of-function research to agencies that conduct classified research, such as the Department of Defence or the Department of Homeland Security.

Yet classified government research in the life sciences doesn’t have a great track record of being in the public interest: the Defence Intelligence Agency’s attempts to make genetically modified anthrax, the Defence Threat Reduction Agency’s milling weapons-grade anthrax in secret, or the CIA’s creation of Soviet-style “bomblets” that are used to disperse biological agents (in the name, so claimed, of assessing their effectiveness in use against the US), are all example of deeply troubling classified life sciences research purported to be in the public interest.

The possibility of taking research we’ve already ascertained is problematic, and giving it to an agency with a history of misuse of research, is frightening. We should question this new policy to the extent that it leaves open this option. If research is risky to public health, or doesn’t show merit regarding actually emerging infectious diseases, why open the way for that research to be done in secret?

You should go read it because you’re excited about the idea of a new, non-American voice in bioethics, or because you’re interested in the life sciences and dual-use research, or because you want an idea of what I was working on in the fall, or because you see the issues here for corruption, or just because I said so and you know I have fantastic taste.2 Whatever the reason, go read.

  1. Note, fellow editors: don’t take on a large project like that with a two-month window, especially not when you have two academic conferences of your own to prepare for and attend, plus your day job. []
  2. I do. Bias aside. And if you haven’t picked up on the bias yet, you’re just a wee bit slow now, eh? And I don’t know what this lampshade is doing on my head. []

Power Broker Bioethicists

Alice Dreger has a new post up discussing How to be a Bioethicist. She admits, upfront, that she sort of sucks as one, and not for reasons the snarkier or more vindictive readers of this blog might assume. Rather, she sucks as a bioethicist because she has a penchant for naming names and citing her work, because she is concerned about principles, and because she hasn’t figured out how to get a staggeringly high salary, regardless of currency. (Of course, she missed the fourth reason she makes a bad bioethicist: her unfortunate affliction with XX Syndrome.)

Sarcasm, and even personal issues aside, I think Dreger raises a very interesting point about North American bioethics as a whole: what I rather jokingly referred to as the advent of “power broker bioethics” before I realized that this, indeed, was actually and precisely the correct phrase.

A power broker, for those of you who missed the 80s or anything to do with Wall Street, is “a person who is important by virtue of the people or votes they control; a power broker who does you a favor will expect you to return it.” It, in many ways, describes the behavior Dreger details: attempts to suppress dissent via appeals to authority; trading favors for benefits; obfuscating financial details in an effort to hide paper trails; and always, always looking for ways to inflate one’s sense of self via title and position.
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