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Ebola outbreaks: Science versus fear mongering and quackery

Ebola virus particles.jpg
Ebola virus particles” by Thomas W. Geisbert, Boston University School of Medicine – PLoS Pathogens, November 2008 doi:10.1371/journal.ppat.1000225. Licensed under CC BY 2.5 via Wikimedia Commons.

Without a doubt the big medical story of the last week or so has been the ongoing outbreak of Ebola virus disease in West Africa, the most deadly in history thus far. Indeed, as of this writing, according to a table of known Ebola outbreaks since 1976 at Wikipedia, in Guinea, Sierra Leone, and Liberia, the three nations affected thus far, there have been 1,440 cases and 826 deaths. Worse, the World Health Organization (WHO) is reporting that it is spreading faster in Africa than efforts to control it. In particular, late last week it was announced that two Americans who had been infected with Ebola were going to be flown back to the US, specifically to Emory University, for treatment, a development that ramped up the fear and misinformation about Ebola virus to even greater heights than it had already attained, which, unfortunately, were already pretty high. Indeed, the ever-reliably-histrionic Mike Adams of NaturalNews.com wrote a typically hysterical article “Infected Ebola patient being flown to Atlanta: Are health authorities risking a U.S. outbreak?” On Saturday, we learned that Dr. Kent Brantly, an aide worker for Samaritan’s Purse, a Christian charity run by Franklin Graham, son of the well-known preacher, Billy Graham, who had been evacuated from Liberia aboard a private air ambulance, had arrived in Georgia.

This latest development inspired medical “experts,” such as Donald Trump, to stoke fear based on the arrival of two infected Americans in the US. For instance, last Friday, after it was first announced that the Ebola-infected Americans would be flown back to the US, Trump tweeted:


One is tempted to add that ignorant Twitter tirades by billionaires with far more money than sense are also one of the “enough problems” that the US has. After all, besides having embraced conspiracy theories like “birtherism,” Trump has been a raving antivaccinist since at least 2007. So, right there, you know that Trump’s knowledge of medicine is—shall we say?—lacking, to put it kindly. None of that stopped him from following up with more fear mongering:

And:

And:

Trump also re-Tweeted a bunch of equally overheated Tweets about the topic, and meanwhile WorldNetDaily is stoking fears of illegal immigrants massing at our southern border to bring in Ebola and other diseases, bolstered by Dave Hodges and the president of the American Association of Physicians and Surgeons (remember the AAPS?), Dr. Jane Orient, who are claiming that “100,000 West Africans are in Central America, have been taught to speak Spanish and are coming across our Southern border” carrying Ebola, naturally. These claims are based on anonymous and unverifiable “sources.” All of this is why now seems an opportune time to discuss the Ebola outbreak from a science-based perspective and whether or not bringing back these two Ebola patients is such a huge mistake that, if Mike Adams and Donald Trump (and several others) are to be believed, will endanger this country with the possibility of an Ebola epidemic. The time is all the more appropriate, given that, as they all too frequently do, quacks are promoting their remedies as cures for Ebola. So what is the situation, really?

What is Ebola virus disease?

The disease caused by Ebola virus belongs to a class of diseases known as viral hemorrhagic fevers. It’s a diverse group of diseases caused by Ebola virus that range in severity from relatively mild to exceedingly deadly, but all share in common the tendency of being complicated by disseminated intravascular coagulation (DIC), which eats up clotting factors and results in an increased susceptibility to bleeding. Other hemorrhagic fevers include dengue, yellow fever, Marburg virus, Lass fever, and more. There are five classes of viruses, all RNA viruses, that can cause hemorrhagic fever; of these, the Ebola virus belongs to the family Filoviridae, because the viruses form filaments, as you can see from the photo of an Ebola virus at the beginning of this post, and uses negative-sense single-stranded RNA as its genetic material, which is used both to produce more viral protein and to produce an antisense template to produce more viral RNA. The virus was discovered in 1976 and has caused sporadic outbreaks since then. It’s diagnosed by a combination of history (particularly of travel to areas where the disease is found) and clinical history, but definitive diagnosis is made using either enzyme-linked immunoassay (ELISA) for viral proteins or reverse transcriptase polymerase chain reaction (RT-PCR) for the viral RNA.

There are five subtypes of Ebola virus:

  • Ebola-Zaire
  • Ebola-Sudan
  • Ebola-Ivory Coast
  • Ebola-Bundibugyo
  • Ebola-Reston

Ebola-Reston, which is found in the Philippines, doesn’t cause human disease, but all the others, which are found in Africa, do. Of these, the Zaire strain of Ebola is the most deadly, with a greater than 90% case fatality rate. It is the most feared of all the strains of Ebola virus, and quite rightly so. However, it should be remembered that the figure of 90% fatality is the case fatality rate with essentially no treatment. With modern medical care, the case fatality rate, even for Ebola-Zaire is more like 56%, which is still quite bad. In this specific outbreak, thus far the case fatality rate is around 57%.

After infection, symptoms usually begin within 5-10 days. Early signs and symptoms are very much like influenza or other flu-like illnesses and include fever and chills, headache, joint and muscle aches, and weakness. With progression, additional symptoms can include a maculopapular rash, cough, nausea and vomiting, and abdominal pain. The bleeding that gives hemorrhagic fevers their name can, in the case of Ebola disease, manifest itself many ways, including bleeding from the eyes, hematemesis (vomiting blood), hemoptysis (coughing up blood), melena (dark blood in the stool from upper GI bleeding), hematochezia (red blood in the stool), bleeding from orifices (such as ears, mouth, and nose), and internal bleeding. As the disease progresses, multiple organ failure can occur, contributing to death:

EbolaSymptoms3

Those who survive can suffer long-term complications, such as hepatitis, fatigue, headaches, and testicular inflammation.

Worse, Ebola is a master of evading the immune system:

The Ebola virus is also a master of evading the body’s natural defenses: It blocks the signaling to cells called neutrophils, which are white blood cells that are in charge of raising the alarm for the immune system to come and attack. In fact, Ebola will infect immune cells and travel in those cells to other parts of the body — including the liver, kidney, spleen and brain.

Each time one of the cells is infected with the Ebola virus and bursts, spilling out its contents, the damage and presence of the virus particles activates molecules called cytokines. In a healthy body, these cytokines are responsible for provoking an inflammatory response so that the body knows it’s being attacked. But in the case of an Ebola patient, “it’s such an overwhelming release [of cytokines], that’s what’s causing the flu-like symptoms” that are the first sign of Ebola, Bhadelia said.

Yes, Ebola is a very, very bad disease. Worse, there’s not much that even modern science-based medicine can do to treat the virus specifically. Basically, the treatment consists of supportive care: Fluid resuscitation to prevent dehydration, transfusion as needed to replace blood loss; treat the DIC with clotting factor replacement, and respiratory and cardiovascular support if needed. It’s true that there are experimental drugs that has shown promise in preclinical models, and the search for an Ebola vaccine has been put on the fast track, but as of now there is no approved treatment or vaccine for Ebola.

So should we be bringing victims to the US for treatment?

Treat in Africa or treat in the US?

So are the concerns of Donald Trump and Mike Adams justified? One of the two Americans infected with Ebola (Dr. Kent Brantly) is already here. The second, Nancy Writebol, will leave Africa tomorrow. In considering whether bringing these patients back home is so dangerous that it shouldn’t have been done, it’s important to consider two things: how Ebola is transmitted and existing isolation protocols.

Ebola virus, although contagious, is not nearly as contagious as, for example, influenza or measles, both of which are easily spread through the air. Ebola, by comparison, is transmitted through contact with body fluids (blood, saliva, semen, vomit, urine, or feces) in much the same way HIV or hepatitis B is. Although transmission through aerosol has been demonstrated in the laboratory between pigs and primates, it has never been conclusively demonstrated to happen from human to human and the evidence is fairly compelling that it does not. True, the virus, from what I’ve found in my research, persists on surfaces for days, and only 1-10 virus particles are needed to initiate infection. Most people acquire the virus through contact with the blood or bodily fluids of the infected (as in blood from an infected person coming into contact with the mucus membranes of the mouth or eye or with an open cut) or through nosocomial transmission (accidental needle sticks with a syringe containing infected blood, for instance). In Africa, given how poor the countries suffering outbreaks tend to be, the nosocomial route is prominent, because of reuse and improper sterilization of syringes, needles, or other medical equipment contaminated with these fluids. Also in Africa, a common means of acquiring the virus is preparing the bodies of the dead for funerals.

Dr. Bruce Ribner, one of the doctors who will be caring for Ebola patients described the situation nicely:

Ebola isn’t “some mystical pathogen (with) some bizarre mode of transmission,” the doctor noted, adding that it is transmitted similarly to illnesses like SARS or HIV.

So, if patients are brought to the US (as one has already been as of this writing), it’s not as though American hospitals don’t have considerable experience with universal blood and bodily fluid precautions, and it’s not as though they don’t properly sterilize instruments and equipment between uses. In other words, there’s nothing unique about Ebola virus in terms of transmission. No one’s saying the risk is zero, but it’s incredibly low, the blatherings and bloviations of ignorant gasbags like Donald Trump on Twitter notwithstanding. One also notes that the CDC has stocks of the virus, which it studies, which means that Ebola virus is already on US soil (in various universities, an Army facility, and the CDC) and Canadian soil, along with patient blood samples from Africans infected with the various forms of Ebola. As a real infectious disease expert, Tara Smith, pointed out, not only is Ebola already in the US, but US health officials have already dealt with cases and small outbreaks of related hemorrhagic fevers, such as Lassa fever and Marburg.

Moreover, Emory University is better equipped than most hospitals to deal with such patients:

Emory University Hospital, which is slated to care for the patients, has a specially designed wing separate from the rest of the hospital that was created to treat people infected by bioterrorism attacks or pandemics.

But Dr. William Schaffner, an infectious disease specialist and professor of preventive medicine at Vanderbilt University, says almost any American hospital is equipped to take care of an Ebola patient without endangering staff or the public.

Infectious patients are put in an isolation room, and health workers have to put on protective gear before entering the room. They remove the gear when leaving. It is put in red infectious disease waste bags, which are burned.

Even though Ebola isn’t spread through the air, the CDC says that patients probably will be put in negative-pressure rooms that isolate air so it can’t circulate through the building. Those are typically used with patients with active tuberculosis, which is airborne.

It’s also noted that it isn’t the precautions that might fail, but the humans doing the precautions, as Schaffner noted that they were “busy” or “because familiarity breeds if not contempt then casualness.” This was learned in Toronto dealing with the SARS outbreak when hospital workers dealing with SARS patients became infected. Posting monitors outside the patients’ rooms to make sure personnel followed the precautions eliminated any further cases. Emory did the same thing when patients with suspected Middle East Respiratory Syndrome (MERS) were admitted, and, given the level of fear over Ebola virus, you can be quite sure that anal sphincters will be even tighter this time. Moreover, given that, as far as has been ascertained, Ebola does not spread through the air as SARS and MERS do, the likelihood of nosocomial transmission to a health care worker is minimal, particularly given that any staff in contact with Ebola victims will almost certainly be carefully monitored for any signs of viral infection and rapidly quarantined if they exhibit them. Again, the likelihood of an outbreak in the US due to these patients is not zero, but it’s very close.

So, when faced with Americans infected with Ebola virus in Third World hospitals lacking the resources to provide optimal treatment, the options are to send sufficient medical equipment and staff there to take care of them in Africa or to bring the patients back. By far, the most efficient and economical solution is to bring the patients back to the US, and the risk is minimal. However, fear of contagion remains a powerful force, as noted by Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota:

Osterholm said he’s been getting calls from editors and reporters in the United States asking why the sick patients are being brought here. “Their reaction to the virus on the fear and panic side is no different than what you see in Africa,” Osterholm says.

“We’re being critical of the West African population for not understanding,” Osterholm says. “I’m thinking, ‘Oh my God, the U.S. senior media doesn’t get it.’”

Or a conspiracy-minded billionaire with bad hair.

It also helps to put Ebola in perspective. Since 1976, Ebola has infected fewer than 5,000 people and killed fewer than 3,000. That’s in Africa, where over 1 billion people live. By contrast, poor, “boring” measles still kills 122,000 people every year and killed over 2 million a year in 1980, before widespread vaccination campaigns. According to the WHO, in 2012, malaria caused an estimated 627,000 deaths, mostly among African children. Also according to the WHO, since the beginning of the AIDS epidemic (which dates back almost as far as the discovery of the Ebola virus), HIV has infected over 75 million and killed 36 million, with approximately 35 million currently living with the infection. None of this means that we shouldn’t take Ebola seriously or that much larger outbreaks couldn’t happen. Nor does noting this difference minimize the deaths of people infected with the disease. We should note from these observations and others, however, that Ebola is unlikely to reach such numbers because it is simply not infectious enough and Ebola outbreaks tend to “burn themselves out” because, unlike HIV or measles (which are also transmissible human-to-human), Ebola virus disease is so rapidly fatal.

In other words, Ebola is a horrible disease, but because it’s so horrible it’s unlikely to kill as many people as diseases we already know about. And it’s not nearly as dramatic as people think. Tara Smith interviewed representatives of Doctors Without Borders several years ago, and this is what one physician, Armand Sprecher, told her:

As for the disease, it is not as bloody and dramatic as in the movies or books. The patients mostly look sick and weak. If there is blood, it is not a lot, usually in the vomit or diarrhea, occasionally from the gums or nose. The transmission is rather ordinary, just contact with infected body fluids. It does not occur because of mere proximity or via an airborne route (as in Outbreak if I recall correctly). The outbreak control organizations in the movies have no problem implementing their solutions once these have been found. In reality, we know what needs to be done, the problem is getting it to happen. This is why community relations are such an issue, where they are not such a problem in the movies.

“Getting it done” is much easier in the US and other developed nations than it is in Africa.

Enter the quacks

Unfortunately, there is no effective treatment for Ebola virus disease yet. All doctors can do right now is to isolate the patient to prevent others from being infected and to support the patient’s physiology with fluids, antibiotics for secondary infections, and blood products to combat the DIC until the patient either manages to clear the infection or dies. There are experimental drugs being tested against Ebola. (David Kroll has nicely summarized the current state of research and development of Ebola drugs, and there is an antibody-based treatment being tested.) Also, there is no vaccine, although efforts to develop one have been fast tracked. The problem in human testing of such a virus, of course, is that Ebola outbreaks are sporadic and difficult to predict. By the time human tests are ready, this latest outbreak could be over, and scientists would have to wait for the next one to test the vaccine. Worse, the economics of developing effective treatments or vaccines against Ebola are prohibitive.

Not surprisingly (or maybe surprisingly, I don’t know), antivaccine activists are already afraid of an Ebola vaccine, even though one hasn’t been approved yet and is unlikely to be for quite some time:

NAMVEbola1-480x630

I actually agree with the last commenter. If you’re a nurse and antivaccine, you’re in the wrong career. Please, for the good of your patients, change careers. Seriously, how can you be a nurse and be antivaccine? In any case, resisting the vaccination of healthcare personnel against Ebola is a problem for the future, after such a vaccine has been developed. Meanwhile, in Africa itself, faith healing is being promoted by at least one Nigerian pastor, Ituah Ighodalo, as a means of curing Ebola, including laying on hands, which is a great way to infect oneself with the virus if those hands happen to come into contact with any bodily fluids of the sick and then happen to touch a mucus membrane.

Here in the “developed” world, we have similar claims being made, for instance, in this article entitled Can Gingko and Turmeric Help Stop Ebola? I could have saved them the trouble and said “almost certainly not,” but the author of this article insists on all sorts of handwaving about JAK-STAT signaling p38 MAP kinase and the effect of Gingko and Tumeric on these pathways. It might be worth a detailed deconstruction elsewhere. For now, let’s just say it’s “speculative,” to put it kindly. The editors of Inside Surgery should really know better. Or maybe not. I saw another article on Inside Surgery entitled Can Rife Therapy Help Stop Ebola Disease? Then I saw that the editor of Inside Surgery, L. “Skip” Marcucci, MD, has completed “a fellowship in Integrative Medicine at the University of Arizona” and that he’s also “a formally trained medical acupuncturist.” Well, OK, then. That explains a lot. It also rather saddens me to see an article on a website called Inside Surgery that is not too different from this article by Mike Adams about “natural” cures for Ebola (one of which is based on traditional Chinese medicine).

And that doesn’t even count this amazing bit of pseudoscientific nonsense from Robert F. Cathcart III, MD, who touts himself as an allergist and practitioner of orthomolecular medicine. If you know anything about orthomolecular medicine, you know what’s coming next. Yes, according to Cathcart:

Note that the 2005 epidemic in Angola which was first referred to as an Ebola like virus has now been called the Marburg Virus. It does not make a difference from the point of view of treatment with massive doses of intravenous sodium ascorbate. Both diseases kill by way of free radicals which can be neutralized by massive doses of sodium ascorbate intravenously.

[...]

It does not take a genius to figure out that with the increased bowel tolerance to oral ascorbic acid somewhat proportional to the toxicity of the disease that the most serious infectious diseases would rapidly exhaust all the bodies vitamin C, acute induced scurvy, and cause bleeding all over the body and finally free radical deaths.

That’s right. Cathcart claims that Ebola kills by “free radicals,” which exhaust the body’s supply of vitamin C and induce scurvy, resulting in bleeding. Never mind that Cathcart’s view of the pathophysiology of Ebola virus disease and reality are related only by coincidence, and not even very much then.

As if claims for all sorts of herbal and vitamin treatments for Ebola virus disease weren’t bad enough, there are Kelly and Nate Bailey, the makers of dōTERRA® Essential Oils, who say right on their website:

The reason doctors can’t do anything for viruses is because viruses live inside of your cell’s walls, and medicine particles can’t penetrate those walls. Essential oils, however, have super tiny particles and a makeup that allows them to pass through with no problem! They go in, kill the virus while also stopping the viral cells from duplicating, and all the while boost the immune system so the body can continue to fight for itself. We’ve found that we can kill viral infections in 12-48 hours, depending on how quickly we start using oils.

One notes that doctors can do something for certain viruses, just not this particular virus—yet, hopefully. None of this stops them from playing the martyr from the inevitable charges of quackery that will fly:

Again, I expect an outlash from the western medicine community, and those indignant that I would write about using essential oils against such a ruthless virus. I’m okay with that, because my mission since beginning to share about essential oils is to provide hope where there is none, and to empower people to not let life and illnesses happen to them, but rather arm themselves with the tools to do something.

That’s nice. Actually the “outrage” comes about because the Baileys are peddling quackery that will not help patients with Ebola and capitalizing on the fear of Ebola inspired by the current outbreak to sell essential oils through what sure looks like a multilevel marketing system. They are, however, as nothing compared to what practitioners of The One Quackery To Rule Them All, homeopathy, are doing. Yes, homeopaths are claiming they can cure Ebola.

Given the symptoms of Ebola virus disease, here’s what two homeopaths have proposed as a homeopathic remedy for Ebola:

Dr. Gail Derin studied the symptoms of Ebola Zaire, the most deadly of the three that can infect human beings. Dr. Vickie Menear, M.D. and homeopath, found that the remedy that most closely fit the symptoms of the 1914 “flu” virus, Crolatus horridus, also fits the Ebola virus nearly 95% symptom-wise! Thanks go to these doctors for coming up with the following remedies:

1. Crolatus horridus (rattlesnake venom) 2. Bothrops (yellow viper) 3. Lachesis (bushmaster snake) 4. Phosphorus 5. Merc. cor.

If you are not in the U.S., you must locate your closed homeopathic practitioner and ask him or her to order these remedies for you from Hahnemann Pharmacy, (510) 327-3003 (Albany, California, a suburb of Oakland). If your country’s laws allow you to call a homeopathic pharmacy directly, do so. In any case be sure to find a homeopathic practitioner you can work with. Do not try to take care of yourself without the further education and experience that a homeopath can give you.

You know what they call an Ebola victim foolish enough to rely on these five homeopathic remedies to treat his disease, whether administered by a “real” homeopath or not? Almost certainly dead, that’s what! (Well, at least with a 90% certainty, given that homeopathy is the equivalent of no treatment.) Unfortunately, Derin and Menear are not the only homeopaths recommending this nonsense. Homeopathy has been proposed by clueless homeopaths as a valid means of combatting bioterrorism, chief among the bioterrorism agents being Ebola. For instance, homeopath Joetta Calabrese has suggested:

In the case of Ebola, no conventional treatment or vaccine is available. Fortunately for us, homeopathy has great renown for its healing ability in epidemics.

No. Really. No, it doesn’t, except among homeopaths. Among those health care practitioners rooted in science, not so much. Calabrese proposes a variant of Derin and Menear’s delusional treatment:

If a person is infected, the remedies most commonly used would be the following. One dose every hour, but as the severity of the symptoms decrease, frequency is reduced. If no improvement is seen after 6 doses, a new remedy ought to be considered.

Crotalus horridus 30C – Is to be considered for when there is difficulty swallowing due to spasms and constriction of the throat, dark purplish blood, edema with purplish, mottled skin.

Bothrops 30C – Is the remedy to think of when nervous trembling, difficulty articulating speech, sluggishness, swollen puffy face, black vomiting are present

Lachesis mutus 30C ,– when there’s delirium with trembling and confusion, hemorrhaging in any area, consider this remedy. Often, the person cannot bear tight or constricting clothing or bandages and feels better from heat and worse on the left side.

Mercurius corrosivus 30C, – For copious bleeding, better when lying on the back with the knees bent up, delirium, headache with burning cheeks, photophobia, black swollen lip, metallic, bitter or salt taste in mouth.

Secale cornutum 30c,– For thin, slow, painless oozing dark hemorrhage with offensive odor, cold skin and tingling in the limbs. The individual wants to be uncovered and feels WORSE from motion.

Echinacea 30C – For when there’s sepsis or blood poisoning, fetid smelling discharges and enlarged lymph nodes.

Homeopathy is an ideal medical stratagem for survivalists, homesteaders and anyone wanting to be self-reliant in any situation.

I thought this might be a joke, but it’s not. All you have to do is to peruse the rest of Calabrese’s website to realize that she actually believes these things. Calabrese also pimps her forthcoming book, The Survivalist Guide to Homeopathy. In any event, all of these remedies, being 30C dilutions, are nothing more than water, likely soaked into sugar pills. I still can’t figure out why homeopaths take their water, press it into sugar pills, and then let them dry out. Why not just administer the water with a bit of salt? In that case, it might at least have a chance to contribute to the rehydration of a vomiting and bleeding patient.

Of course, these recommendations aren’t just the delusional ravings of pseudoscience-believing homeopaths? (Well, actually, they are.) Homeopaths try to show there’s “science” behind them. For example, there’s even a paper in the British Journal of Homeopathy (OK, so it’s not actually science) entitled “Sicarus (Six-Eyed Crab Spider): A homeopathic treatment for Ebola haemorrhagic fever and disseminated intravascular coagulation?” Shockingly, I found this ridiculous paper hosted on a personal page on the Indiana University website. In any case, it’s not just Ebola. Homeopaths are deluded enough to think that they can treat potential bioterrorism agents such as anthrax (Anthracinum and Arsenicum album), smallpox (Variolinum, Malandrinum, Sarsparilla, Thuja, Baptisia (Pestinum and Crotalus horridus for hemorrhagic plague; Lachesis, Arsenicum album for bubonic plague; Phosophorus for pneumonic plague), and Botulism (Botulinum and Gelsemium, Arsenicum album, Belladonna Alternate).

Meanwhile, on Twitter, the homeopathy supporters were out in force, and the WHO tweeted:

It’s sad and also evidence of how loudly homeopaths have been making the claim that homeopathy can cure Ebola virus disease that the WHO felt obligated to state this simple fact. Not surprisingly, the WHO got responses like:

And:

This response from Laurie J. Wilberg, who was told that the burden of proof is not on homeopathy critics, says it all:

Once again, homeopaths get a basic concept of science and medicine wrong. Science is not the legal system. It is thus not up to skeptics to prove that homeopathy doesn’t work. It’s up to homeopaths to prove it does. Indeed, it’s tempting to propose that a homeopath infect himself with the blood of an Ebola victim, wait until the flu-like symptoms start, and then cure himself with homeopathy. I say “tempting” because I won’t really propose it. Some homeopath might actually try it. So if you’re a homeopath reading this, please don’t do something like that. And, if you’re in Africa (or anywhere else) and are unfortunate enough to be infected, please, please, please, please, don’t rely on homeopathy or other quackery for your treatment. If you want to quadruple your chances of surviving (10% chance of survival to over a 40% chance), don’t do it. Seek the best science-based medical care you can find.

Conclusions

This is the largest Ebola virus disease outbreak recorded thus far. Because Ebola virus (particularly the Zaire strain) produces such a nasty disease that kills more than 50% of those infected, even when optimal medical care is available, and over 90% of the untreated, it’s natural that fear and misinformation are running rampant, be they peddled by faith healers, homeopaths, or rich old guys with bad hair and an overinflated opinion of their own knowledge. It’s important for us to remember here in the US that the likelihood of an outbreak due to bringing back two patients with Ebola virus disease is incredibly small, and that conditions here in the US and other developed nations are such that it is unlikely that such an outbreak, even in the unlikely event that it happened, would spread very far, given the differences in medical care, availability of resources, and differences in funeral practices. That’s not to say we shouldn’t be vigilant, but there is really nothing particularly unusual about Ebola virus other than the rapid onset and severity of the disease it causes.

As for Africa, the problem is, as is usually the case in poor and less developed countries, resources. Doctors Without Borders/Médecins Sans Frontières are stepping up efforts to bring real medical care to the victims in Africa, constructing a clinic that looks like this:

ebola-graphic

But:

Already stretched beyond capacity in Guinea and Sierra Leone, MSF is able to provide only limited technical support to the Liberian Ministry of Health. MSF has set up an Ebola treatment center in Foya, in Lofa county in northern Liberia, where cases have been increasing since the end of May. After the initial set up, MSF handed over the management of the center to nongovernmental organization Samaritan’s Purse on July 8.

WHO is also contributing, as is Samaritan’s Purse. If there’s one thing that’s sure, more resources and more effort on the part of developed nations will be required to bring these outbreaks under control and save as many lives as possible. If there’s another thing that’s sure, it will require science-based medicine, not quackery like homeopathy, to succeed.

Posted in: Epidemiology, Health Fraud, Homeopathy, Public Health, Vaccines

Leave a Comment (298) ↓

298 thoughts on “Ebola outbreaks: Science versus fear mongering and quackery

  1. Mike says:

    Thanks for this article, Dr. Gorski.

    I was listening to the Diane Rehm show on ebola the other day and one thing the interviewees noted was that there were low literacy rates in the countries and pervasive superstitious beliefs where these outbreaks occurred.

    Indeed, Wikipedia says Sierra Leone has a 43% literacy rate and this article confirms that patients are refusing treatment because they believe the disease is caused by witchcraft.

    1. Sawyer says:

      I was happy and simultaneously frightened to hear Laurie Garrett’s take on the issue. The witchcraft stuff may seem silly, but after years of civil wars you can’t really blame citizens of these countries for not immediately trusting doctors that claim to be on their side.

      Learning about the hardships that Liberia and Sierra Leone endure also underscores how absolutely pathetic it is when people that do live in a first-world country start promoting bogus medicine or inciting panic.

      1. KayMarie says:

        Today’s reports about there not even being medicine for the fever (even dirt cheap like aspirin) or IV for re-hydration makes me wonder how it would be if they had even the basics of minimal health care available. We seem to assume with modern medical care the death rate would be the same, but I have to think there is at least some supportive care that would help at least a few.

        Apparently the other main belief going around sounds much more first world. Ebola does not exist and it is just a conspiracy made up by the Liberian government to try to extort money from the West. How long until they start putting up signs at grave sites claiming that people’s loved ones never existed and the grieving are just paid actors.

  2. Good to see the Facebook page “Nurses Against Patients” get a guernsey.

    1. Samuel Adams says:

      Dear Doctor, yes the CDC hospital guidlines should prevent infections, if they are followed by everyone 100% of the time, and this does not mean just doctors and nurses. It means visitors, pastors, janitors, those responsible for sterilization, sanitation, and cleaning, labs that do the testing, people calling the labs to inform them, along with local, state and the CDC that they are sending the samples for testing. That is just the short list. God help you if you need help breathing, because the CDC says not to perform ANY aerosol producing procedures. Yeah there is nothing to worry about.

      1. WilliamLawrenceUtridge says:

        This would be true if Ebola patients were free-roaming throughout the hospital. They’re not, because doctors aren’t idiots. And even if Ebola were transmitted to one of those people, or if a vial cracked in transport, you still have to basically lick or drink the fluids for it to be a significant danger.

        Why random mooks on the internet think they’re smarter than doctors, despite never having even read a book on Ebola or immunology, I’ll never understand.

  3. My response to Mr. Trump.

    @realDonaldTrump Standard hospital isolation protocols are sufficient to prevent transmission. Come back when you have an MD degree.— Randy Goldberg (@DrGaellon) August 4, 2014

    @realDonaldTrump You are heartless and stupid, misinformed and hysterical. Sit down and shut up.— Randy Goldberg (@DrGaellon) August 4, 2014

  4. Chris L says:

    What is really sad about this whole situation is that a man like Donald Trump would be able to find the funds to build a top notch facilities in Africa to stop the spread of the disease and help treat it but he chooses the easy route of fear mongering instead .

    If he is so concerned with bringing back infected Ebola patients , put up the money to build a treatment centers in Africa !

  5. Guy Chapman says:

    Interesting to see the three homeopathy shills identified here.

    “Dr.” Nancy Malik is an Indian homeopath whose “science based homeopathy” site is an obvious hat tip to this site. Malik is a tireless comment spammer and routinely Copy-pastes nonsensical comments like “real is scientific homeopathy”. She denounces medicine as CAM (Conventional Allopathic Medicine). Her website briefly had a HealthOnNet HONcode until skeptics complained about the antivax bullshit, quackery etc., and now she uses the logo with some weasel text about it being compliant between certain dates; this fraudulent use of an admittedly low status verification led others to try to verify her claims to be a licensed homeopathic physician – with predictably null results.

    Laurie Willberg, Sandra Courtney (aka @BrownBagPantry, Sandra A. Hermann-Courtney, SAHC etc) and Christine Jahnig (aka @FallIntoSummer, ChristyRedd) are a tag team, I refer to them as the homeopathy Rabid Reaction Farce. They spam comment threads everywhere, and combine vicious personal attacks on skeptics with whining butthurt when skeptics criticise them or refute their claims. Sandra runs a blog called “fighting for homeopathy”, where several of us are proud to be listed as enemies of the faith.

    1. David Gorski says:

      I’m quite familiar with Nancy Malik, but had never encountered Laurie J. Wilberg, Sandra Courtney, or Christine Jahnig until I first mentioned homeopaths promoting quack cures for Ebola on my not-so-secret other blog. Unfortunately, my blogging about Ebola and homeopathy has introduced me to them. Oh, well…

  6. Pat Bowne says:

    Do you have any insight into the mechanism by which Ebola decreases neutrophil response? My quick search found articles blaming soluble glycoprotein and more recent articles refuting that hypothesis.

    1. David Gorski says:

      I don’t know this for sure (so I could be wrong about this and don’t have time to look it up right this moment), but from what I gathered in my reading for this post, Ebola infects the neutrophils, which is how it’s transported all over the body, and then kills the neutrophils when it replicates.

  7. Rob Cordes, DO says:

    Does the CDC have a patent on an Ebola strain?
    I saw this mentioned int he quackosphere but cannot find a legitimate source.
    Could this be something related to vaccine development?

    1. jenmary says:

      I saw something similar, the document they were talking about was a patent application. And I do not understand why it would be a bad thing for the CDC to have a patent enabling them to develop a vaccine unhindered by private intellectual property concerns.

        1. Michael says:

          US Patent application 20120251502

          Human Ebola Virus Species and Compositions and Methods Thereof

          1. Mike says:

            They filed for a patent- They did not get a patent. The application is presently under rejection.

  8. Matt Turner says:

    I was in West Africa at the beginning for this year for 3 months(Senegal, Guinea-Bissau, Guinea, Sierra Leone and Liberia)

    There is a drink over there called Beeta Kola made in Sierra Leone which people drink as a cure to all sorts of things, mainly malaria it seemed.

    The drink was alcoholic, about 15% I think, and cost next to nothing in plastic hip flask type bottle. Last week I spotted a picture of a news board in Monrovia that read “Bitter-kola not a cure for Ebola virus, says Health Minister”
    http://news.bbcimg.co.uk/media/images/76683000/jpg/_76683765_img_0206.jpg

  9. Ed Whitney says:

    I heard a fragment of a report on NPR which said that in parts of Africa, there are conspiracy theories which blame white health workers for the spread of the virus, and that some of them have been attacked. Does anyone have any information on the magnitude of this phenomenon, which parts of Africa are affected, and whether it has been happening with the current epidemic?

    1. David Rach says:

      Doctors Without Borders has been chased out of several villages in Guinea over the last couple months. Here is a recent article http://www.nytimes.com/2014/07/28/world/africa/ebola-epidemic-west-africa-guinea.html?_r=0

  10. Iqbal says:

    Dr. David Gorski

    “During September of 1918, Dr. Victor Vaughan – former president of the American Medical Association and then-dean of the Medical School at the University of Michigan – was summoned to try and figure out why so many people were getting the flu – and dying from it. During the course of his investigation, he observed many sobering situations and reached several startling conclusions:

    “The saddest part of my life was when I witnessed the hundreds of deaths of the soldiers in the Army camps and did not know what to do. At that moment I decided never again to prate about the great achievements of medical science and to humbly admit our dense ignorance in this case.”

    Your blog above seems no different. With all the advancement of science, you and your fraternity have no clue on drug action to be taken. So what do you do next? What happens if the outbreak reaches America and 50,000 people are infected?

    I am not aware what comment Dr. Vaughan made about the homeopaths successfully curing the Spanish flu victims of that time. But I expect it would have been on similar lines, if any.

    Let us follow the disease and see what he out come is.
    http://www.indiana.edu/~psychag/cam/interview/long_lost_manuscript.pdf (Ebola virus).

    1. Angora Rabbit says:

      Is that the best you can do? We’ve got the sequence, we’ve isolated the pathogenic elements, we know what it did and why. We have brilliant vaccines against it. And you’re moaning over something written in 1918? Get over it and try Nature Medicine.

    2. EBMOD says:

      “Your blog above seems no different. With all the advancement of science, you and your fraternity have no clue on drug action to be taken. So what do you do next? What happens if the outbreak reaches America and 50,000 people are infected?”

      In the absolute sense, yeah, a 40% survival rate with modern medicine means that there is much to be learned and improved. But it is a 4 fold improvement in relative terms. Seems a bit of hyperbole to say that no one knows what to do.

      What exactly are you proposing that would be better? Did you read the reasons as to why an outbreak affecting 50k is highly unlikely? Ebola is too virulent for its own good…

      1. David Gorski says:

        In the absolute sense, yeah, a 40% survival rate with modern medicine means that there is much to be learned and improved. But it is a 4 fold improvement in relative terms. Seems a bit of hyperbole to say that no one knows what to do.

        Exactly. There is much room for improvement in the medical management of disease caused by the Ebola Zaire strain, but let’s not forget that with modern medical management chances of survival are increased by more than four-fold. I mentioned that because one thing that irritates me about the press coverage is that it’s so nihilistic about the virus. The overall narrative is that it’s horrible and there’s nothing medical science can do about it. Sure, even with the best medical care, on average fewer than half the people who develop Ebola virus disease survive. that sucks by any measure. However, without that medical care, less than one in ten survive. That’s a big difference, even if medicine still has a long way to go in improving the survival rate.

        1. KayMarie says:

          I’m certain that is enough of an increase in survival rate for the anti-vaxxers to use to show the Ebola vaccine, when developed, is an terrible risk for anyone going into a hot zone.

          And certainly modern medicine will not be given any credit for the change in survival pre-vaccine.

    3. Chris says:

      Iqbal, your last link proves you did not even read the article. That specific paper was actually mentioned, and the same link was used.

      Do you also engage in homeopathic reading comprehension?

      By the way, how much progress has homeopathy had in the last century with type one diabetes, bacterial infections like syphilis and strep, and in preventing diseases like measles, rabies, etc?

      1. David Gorski says:

        One wonders if Lqbal wants me to take a closer look at that paper. :-)

    4. WilliamLawrenceUtridge says:

      What happens if the outbreak reaches America and 50,000 people are infected?

      Did you not read the post itself? Of course you didn’t. Even in Africa, where it is endemic, facilities are beyond primitive, and cultural factors promote transmission, it hasn’t reached 50,000 people infected. Influenza is transmitted by sneezing and breathing. Ebola is transmitted by sex, spit and blood. There’s a window of less than three weeks where it can be transmitted without showing signs of infection. How much sex do you think a newly-returned from Africa person could have with how many partners in three weeks such that it becomes self-sustaining, particularly when AIDS took decades to reach that number?

  11. Dr Dan says:

    Thanks for a great article. While I couldn’t agree more with your assessment of the position of the anti-vaxxers, Donald Trumps and loons and quacks on this subject, I wonder if you haven’t played down the possibility of an Ebola outbreak in the West just a little.

    Yes, fairly basic infection control methods can control Ebola. No, it’s not airborne. But these things can be said about infections that occur commonly in western hospitals and cause serious problems, if not with the virulence of Ebola.

    Think about an outbreak of norovirus on a ward in a western hospital. The virus is not airborne, and it can be contained by contact precautions and isolation of infected patients – but it still spreads like wildfire. I believe the number of virus particles that are required to be ingested to catch norovirus is of the same order as that to catch Ebola – roughly 1 to 10.

    A similar situation occurs with other organisms like the antibiotic-resistant bacteria that have become a problem (MRSA, VRSA, VRE, etc etc). These are not airborne, and can be contained by basic infection control measures, but they currently represent one of the most serious health concerns western health-care systems face.

    You might argue that healthcare workers are likely to be much more careful with Ebola than they might be with norovirus or MRSA – and I’m sure they would. But the care that Kent Brantly and Nancy Writebol undoubtedly took still wasn’t enough. Accidents and unforeseen circumstances will always occur.

    You also make the point that Ebola is almost too efficient, in that it kills so many of those infected so quickly that it doesn’t have a chance to spread and of course you are right. Another “good” thing about Ebola is that is is not contagious until the infected person becomes symptomatic. However, it’s not out of the question that both of these things could change. The selection pressure on the virus to become contagious before it causes symptoms or to prolong the agony of its victims so that it has a better chance of spreading must be relatively strong. It hardly has a chance to respond to these pressures in small African rural villages because the populations are small and it wipes itself out quickly. The situation may be different in a large city – in the West or elsewhere.

    I agree that it was right and appropriate to transfer Brantly and Writebol back to the US for treatment. I also agree that the chances of an outbreak outside rural Africa are small. However, I just wonder if the possibility deserves a little more consideration?

    1. jenmary says:

      Consider the difficulty of adhering to basic universal precaution in Liberia, where the disease has spread in part because medical supplies are so lacking that even needles are reused. Back in March and April, that was the common reason for the initial spread of the disease from the bush into rural communities with almost no health care infrastructure. You cannot compare that with any modern US medical facility.

      1. Dr Dan says:

        … And yet, all modern US facilities have major problems with various infectious / microbiological agents that wouldn’t be a problem if universal precautions were adhered to…

        I’m not trying to suggest that an outbreak is likely – merely that it’s not out of the realms of possibility. I think it naive to completely dismiss the idea out of hand.

        1. David Gorski says:

          I’m puzzled. Who’s “completely dismissing the idea out of hand”?

          What we’re saying is that the risk is so low that it doesn’t come anywhere near justifying the hysterical response we’re seeing from people like Donald Trump.

          1. Dr Dan says:

            I completely agree that the risk doesn’t come anywhere near justifying the hysterical response from people like Donald Trump. I think that was pretty much the first thing I said.

            I’m just questioning whether the risk really is “so low”, and in so doing I’m in no way agreeing with idiots like Trump. I’m suggesting that perhaps – just perhaps – the risk is higher than your article implied.

            1. Andrey Pavlov says:

              I’m just questioning whether the risk really is “so low”, and in so doing I’m in no way agreeing with idiots like Trump. I’m suggesting that perhaps – just perhaps – the risk is higher than your article implied.

              As

            2. Andrey Pavlov says:

              Sorry, managed to post on accident.

              I’m just questioning whether the risk really is “so low”, and in so doing I’m in no way agreeing with idiots like Trump. I’m suggesting that perhaps – just perhaps – the risk is higher than your article implied.

              As KayMarie said, by how much higher are your trying to say the risk is? Is it meaningfully higher? Do you have a number in mind to compare? How did you calculate those numbers?

              Because right now it just sounds like you are making vague claims in a manner that is basically unfalsifiable. And you haven’t actually indicated why it matters that your higher risk is correct.

              1. David Gorski says:

                Exactly.

                Dr. Dan, just what do you mean? How much higher is “higher”? Is it so much higher that we shouldn’t be bringing these two Americans back for treatment because the risk of an outbreak from doing so is too high?

                I’m with Andrey here. You seem to be making vague claims here. Let’s say you’re correct and that the risk of transmission (or even outbreak) is significantly higher than infectious disease authorities are telling us. What, specifically, do you think should be done that’s different than what is already being done? Should we not bring the second American over to the US? In your opinion, should Dr. Brantly not have been brought back, yes or no?

                I’m just trying to get a handle on what, exactly, the point is you are making now, specifically what you think should have been done differently. And if you don’t think anything should have been done differently, then what was your point?

        2. KayMarie says:

          I assume that they took them to a hospital with the additional layers of quarantine and all that makes it fairly clear they aren’t naively assuming that there is no chance of it spreading here. I do have some thoughts that they are doing at least a few more things than they can do in a tent hospital in Africa.

          I’d be a lot more worried if they were acting like a small rural hospital in the patient’s hometown with a few dozen beds and no isolation unit would be appropriate care because well it can’t spread once it is flown across an ocean.

          In the rare instance there could be an outbreak I would be most worried about those who think the quarantine and restrictions for healthy people shouldn’t apply to them because they rubbed some oil on their feet or drank the magic water.

        3. jenmary says:

          Is it naive to be more concerned about the xenophobic fear and jingoistic panic, than a vanishingly small risk that there may be another case at Emory, with the attendant small risk that there might be another case from that case? Don’t borrow trouble.
          Yes, I have read Preston’s “The Hot Zone” and Laurie Garrett’s “The Coming Plague” etc. Haemorrhagic fever is a nightmare disease. From a humanitarian POV, though, unsexy diarrheal diseases like cholera, typhoid and rotavirus kill more in a day than this virus has. Abroad, clean water is a more pressing issue than building isolation wards. In the US, highly infectious diseases like drug resistant TB and measles alarm me much more.

          1. Dr Dan says:

            Quite. And nothing I have said disagrees with those more important public health / humanitarian concerns.

            My suggestion that perhaps the risk of an Ebola outbreak in the US may be a little higher than I felt was implied in the article doesn’t mean I think it’s a bigger problem than cholera / typhoid / rotavirus / MDRTB / measles / HIV / malaria / etc. They are separate issues.

            1. KayMarie says:

              Higher in a way that should significantly change how they are handling this situation?

              Or higher in the one should use the exact same precautions if the risk is doubled from 1 in a million chance to 2 in a million chance.

              1. David Gorski says:

                Or a one in a hundred thousand chance.

            2. Kiiri says:

              On Norovirus – as an epi who has worked many outbreaks, generally norovirus patients are not in isolation when they become infected and begin to show symptoms. Almost all outbreaks I have worked in hospitals have been on long stay units (such as inpatient rehab or behavioral units) and not the general wards. Why? On general wards the patients generally aren’t there long enough. On the long stay wards, these patients who are not in any kind of isolation, start to get sick. The first one goes down, with vomiting and diarrhea, the staff clean up, and then the dominoes start to fall. It generally isn’t until the second (or third) wave of cases begins that hospital infection control finds out what is happening and steps in. At that point it does shut down really quickly due to the increased precautions now being taken by staff, isolation, and usually ward admittance closed. I have rarely had a norovirus outbreak in a hospital last more than a week or so. Because they are so good at managing the risk once they figure out what is going on. So using norovirus as an example for Ebola is disingenuous at best. As for the large outbreaks reported in Europe occasionally in hospital settings I have no answers for that other than my hypothesis that not having to push people out the door as soon as possible after surgery or what not makes the hospital more ideal a breeding ground for noro (akin to dormitories) but again they generally get a handle on it pretty quickly. The risk of Ebola transmitting in the US is not zero as Dr. Gorski said, but is extremely low. I have advised my family members of this when they call after all of the fear mongering in the media.

          2. Lawrence says:

            @jenmary – unfortunately, Preston’s descriptions of Ebola symptoms (like the victims “melting” and completely bleeding out through all orifices) borders on shear fiction…..the disease is bad enough without going so over the top as to venture into ridiculous hyperbole.

            A much better take on Ebola can be found in “Spillover” by David Quamman.

    2. WilliamLawrenceUtridge says:

      Norovirus is aerosolized by vomiting. MRSA is generally benign in (and found on) most people, it primarily infects the immune compromised. Selection pressure might drive it to a different mode of transmission, but that seems unlikely, it doesn’t seem to be particularly common with other diseases (otherwise all diseases would be transmitted through airborne particles).

      1. mouse says:

        Hey WLU – I think you are thinking of another sort of infection. Serious MRSA infections have many more risk factors than being immune compromised. I’ve know three people who had to receive IV treatment for MRSA cellulitis and none of them were immune compromised or taking immune suppressing medications.

        Here’s a link on MRSA – http://www.uptodate.com/contents/methicillin-resistant-staphylococcus-aureus-mrsa-beyond-the-basics

        1. WilliamLawrenceUtridge says:

          I don’t know enough about it to really say, I’m sure I could be wrong and uptodate should be trusted far more than my opinion. But still – it does colonize almost everyone in one form or another, and the “MR” part of MRSA is only a factor if you’re trying to treat it with “M”.

          Thanks for the link, I’ll have a look!

  12. Angora Rabbit says:

    How shameful that a man as rich and powerful as Donald Trump would run screaming like a little girl over a rare disease that is readily managed by medicine and inflicts such pain and suffering on its victims. This speaks volumes about Trump’s character. News flash – it’s not about you, Donald. It’s about extending the appropriate medical assistance to fellow humans in need, an even greater obligation when one is blessed with resources to share.

    Maybe I should delete “fellow” in the above sentence. Apparently fabulous wealth isn’t sufficient attention for him.

    Mr. Trump could take a few lessons from his billionaire colleague Bill Gates. That’s how it’s done, sir.

    1. Frederick says:

      I couldn’t have said it better. And Bill Gates is pushing FOR science based solution in Africa, as far as i know. Not like mister Trump or like Steve Jobs was.

    2. Windriven says:

      Donald Trump doesn’t give a crap about Ebola, Sierra Leone, the fate of the health care workers, or much of anything else beyond his personal notoriety and the delusion that he might some day be elected to high office. Trump’s pronouncements belong in the same urinal as Mercola’s and Adams’s.

    3. mouse says:

      Donald Trump isn’t so much running away in fear…it’s more of an ambulance chaser ethic. e.g. “Oh look there’s a tragedy that lots of Americans are paying attention to. How can I make it work for me?” Of course he’s xenophobic and idiotic, that appeals to his target market. (sigh) How depressing.

  13. jenmary says:

    This hits all the points I have shared with online friends, including the crucial perspective comparing EVD with more easily transmitted diseases. One point I reluctantly correct: doTerra essential oils are vended through a MLM scheme. When I shared that website with its ridiculous claims, friends pointed out that the website owners do not make the oils. I suppose other doTerra representatives will jump on this fact to distance themselves from this nonsense. Or not, I have seen too much rabid stupidity to be surprised by any claims.

    1. David Gorski says:

      In all fairness, I did say, “Actually the ‘outrage’ comes about because the Baileys are peddling quackery that will not help patients with Ebola and capitalizing on the fear of Ebola inspired by the current outbreak to sell essential oils through what sure looks like a multilevel marketing system.”

      So even though I didn’t say it was an MLM scheme, to me it looked enough like one that I felt obligated to note that. :-)

      1. jenmary says:

        Check. Just trying to avoid giving the “EOs cure everything” crowd any fodder to pounce on.

        1. EBMOD says:

          Sadly, I have many friends who believe that EO are a cure all. Most alarming? A few months ago one of my friends’ daughters was diagnosed with severe peanut allergies.

          She is a believer in EO’s and takes them to manage her fibromyalgia, supposedly. Thankfully I didn’t see any evidence that she took this advice, but there were actually friends of hers on facebook that were straight up telling her to refuse use of epinephrine; and in the case of anaphylaxis to use some crazy blend of EO’s instead because it was ‘natural’ (how can it get more natural than epipephrine, one of our native neurotransmitters?!). Needless to say I was floored that someone would be so reckless and misinformed as to suggest such a thing. Literally risking a child’s life (and conveniently not her own) over her arrogant belief that doctors are idiots, but she knows the TRUTH and is thus more qualified to handle a deadly peanut allergy…

          1. Frederick says:

            It remember Me of That silver colloid guy I used to workk with ( he produces it, uses it and sells. he also does live blood check with his microscope with 0 background in biology), He told my once, “there is 650 kind of viruses and bacteria, no more” And he talk that anti-bio does not work, “oh they will say they become resistant, A bacteria is a bacteria, it does not change” I was like… Whaaaat? you heard about evolution buddy?
            “all biology is wrong bla bla bla” he is not a creationist or religious, I never spoke about that subject again, He is clearly off the rail on this part of reality, otherwise he is a good person and intelligent.

            He believe nearly every conspiracy ( yes even chemtrails and haarp). The only ones he found ridicule are the dave Icke Lizard and the mayan calendar apocalypse back in 2012, In fact, funny think, He told me about a friend of his of believed in that, and was scare, he offer good skeptism on those 2, but not on all the others, that was weird.

  14. Thor says:

    Fine work as usual, Dr. Gorski.
    I’m willing to bet one of my fingers, that credit will be taken by homeopaths (and other woo-peddlars), for the 10% who survive with no medical treatment, and even for the 43% who survive with medical treatment, if they were given a remedy, or other nostrum. For homeopaths, etc, it is next to impossible to understand that correlation does NOT equal causation. Or that “integrating” unfounded substances (nothing) with real medical care can’t possibly trump it. Or the concept of regression to the mean.

  15. Frederick says:

    Thank Dr Gorski for the excellent article. A lot of details!

    This Article “arrive juste a point” because yesterday I read a newspaper article on it. But the article was no clear about the person, or the vaccine, I thought there was a vaccine, but a new one was underway. Also the Ebola virus came in the conversation yesterday during diner, And i realized I did not know much about that.

    Is it just me or the “evidence-based homeopathy” kind of Insulted my intelligence In all the way that’s possible to do it? They are a bunch of dangerous loon!

    « Essential oils, however, have super tiny particles and a makeup that allows them to pass through with no problem! They go in, kill the virus while also stopping the viral cells from duplicating, and all the while boost the immune system so the body can continue to fight for itself.»

    WOW incredible? so how does it work? What mechanism is use? were can I read that science? and were is your Nobel prize? I really really hate that when charlatans assume a mechanism. they have not tested it, nor see it, but Hey It must be what it does, it goes against all know biology and centuries of sciences ? Well THEY must be wrong! That also pretty insulting to my brain. curing Ebola with Perfume! Oh Come on! ( say with GOB voice).

    1. jenmary says:

      I cannot resist pointing out, in addition to the excellent points made above, that if life-saving therapy depends on medicine getting through your cell’s walls, then you have bigger problems than Ebola. Because you are a plant or a fungus. #ninthgradebiology

      QUOTE:
      “The reason doctors can’t do anything for viruses is because viruses live inside of your cell’s walls, and medicine particles can’t penetrate those walls.”

      1. Frederick says:

        Thanks, And good point! Medicine molecules, with decadse of research in them, can’t do nothing, but their super big oil molecule can! of course, there’s all the other stuff inside the EO that you don’t know what they will do. But hey, it’s NATURAL ( if you don’t count all the processes to press, extracted, distilled etc, ).

        The way they twisted their statement too look “sciency” is so dishonest.

  16. Fahren says:

    Dr. Gorski,

    Let’s put aside the safety issue of bringing Ebola victims to Atlanta for treatment (although it’s worth noting that, according to recent news reports, the CDC doesn’t seem to take its responsibility for following safety protocols with dangerous pathogens all that seriously).

    Is it your position that the U.S. government should take responsibility for the healthcare of any American anywhere in the world who finds himself at risk of not receiving medical care that meets the standards that prevail in the US? If an American gets cholera in Thailand or has a heart attack in Nigeria, are you saying the US should fly that person to Atlanta and treat that person with taxpayer dollars until they recover? And if it’s not your opinion that the US government owes every overseas American treatment in the US at taxpayer expense, then what’s so special about these two Americans. Why should they be getting special treatment?

    1. KayMarie says:

      Last I read the charity that sent them paid for their transport home and will cover the costs for Emory to treat them.

      That being said, I do hope our government does feel some responsibility to citizens both home and abroad. Now I know sometimes we make people pay for their rescues and stuff like that when they should have known better (and insurance often covers the cost of jet ambulances, anyway), but to say anyone who leaves is now persona non grata and deserves no consideration at all seems a bit cold.

      And yeah, sometimes human beings are human and screw up. But do we then say no one is ever allowed to study any infectious diseases, etc because sooner or later someone is going to do something human and there will be a risk to someone because of it.

    2. Angora Rabbit says:

      “And if it’s not your opinion that the US government owes every overseas American treatment in the US at taxpayer expense, then what’s so special about these two Americans. Why should they be getting special treatment?”

      Fahren, your comment chills me to the bone. Because those two people had the Courage to offer medical assistance in an extremely challenging environment and risk their own lives to offer relief and treatment to people afflicted with a horrible disease that is not of their making. What have you done lately?

      But I guess compassion has gone right out the window with the new mantra of “Greed is Good”.

      I cannot believe I actually have to answer this question.

    3. Hillary says:

      Ultimately, Warren Buffet is probably paying. Samaritan’s Purse no doubt carries evacuation insurance for its employees, like almost every US organization operating overseas. Their insurer probably has reinsurance from Berkshire Hathaway, ING, or another huge company. This expense isn’t even a blip yep.

      Five years ago one of my Asia-based coworkers picked up a nasty skin infection and ended up in a hospital in northern China. The overseas insurance company had a representative at his bedside within twelve hours and he was airlifted to either HK or Singapore (I forget which) the next day.

    4. lilady says:

      “Is it your position that the U.S. government should take responsibility for the healthcare of any American anywhere in the world who finds himself at risk of not receiving medical care that meets the standards that prevail in the US? If an American gets cholera in Thailand or has a heart attack in Nigeria, are you saying the US should fly that person to Atlanta and treat that person with taxpayer dollars until they recover? And if it’s not your opinion that the US government owes every overseas American treatment in the US at taxpayer expense, then what’s so special about these two Americans. Why should they be getting special treatment?”

      Perhaps you should reread Dr. Gorski’s post and the links he provided, about the special provisions made to transport Dr. Brantly and the other volunteer worker safely, out of Africa to the special unit at Emory Hospital. Did you read that the plane was outfitted with a special hazmat pod and Dr. Brantly and everyone who had contact with him wore full hazmat gear, including a self contained air pack strapped to their back?

      Would you care to name any company which provides emergency air transport service from a foreign country to the United States, which would be equipped to provide the transportation to an individual diagnosed with Ebola Hemorrhagic Fever?

  17. David Gorski says:

    but to say anyone who leaves is now persona non grata and deserves no consideration at all seems a bit cold.

    One notes that that’s exactly what Donald Trump said in one of his Tweets above:

    1. Peter S says:

      He should go back to proving Obama was born in Kenya…

  18. Koffi Babone says:

    Great article, thank you for the summary. However, I think comparing Ebola to HIV transmission is wrong and doing so is a disservice to science and will decrease credibility of real scientific info. In the long run over simplification of facts or omission of cetain details will confuse the general public and won’t help them choose between pseudo-science and real science.

    Handling HIV requires biosafety level 2, whereas handling Ebola requires biosafety level 4. This means that Ebola is considerably more dangerous. Please also keep in mind that the public is capable of noticing that health care providers that treat Ebola patients are dressed like astronauts whereas those interacting with HIV patients are not suited up.

    We have been told numerous times that sharing utensils with HIV patients is not dangerous (so long as we have no open wounds), I highly doubt that any knowledgeable person would risk sharing utensils with a symptomatic Ebola patient.

    Yes, it is important to address and dispel panic stricken comments and to counter pseudo-science, but we ourselves must be extremely careful with the info we give out.

    1. David Gorski says:

      This is what the CDC says about Biosafety Level 4:

      Biosafety Level 4 is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections and life-threatening disease that is frequently fatal, for which there are no vaccines or treatments, or a related agent with unknown risk of transmission. Agents with a close or identical antigenic relationship to agents requiring BSL-4 containment must be handled at this level until sufficient data are obtained either to confirm continued work at this level, or re-designate the level.

      As I showed above, Ebola does not pose a high individual risk of aerosol-transmitted infection, laboratory or otherwise. Indeed, it is not known to be transmitted by aerosol at all between humans. Also remember, that BSL levels are also designed to account for handling the actual virus in pure form, which is different from normal transmission, and the “space suits” are used not so much because they’re so necessary due to the disease being so contagious but because the consequences to the user if infected are so dire.

      The only reason I can think of that Ebola still BSL4 is because it is frequently fatal and there are no treatments. (That’s part of the definitions.) In other words, BSL4 levels don’t necessarily correlate closely. There’s also a difference in sharing utensils between HIV and Ebola. Most HIV patients aren’t bleeding in their mouths. Most Ebola patients after a certain stage are and would be expected to deposit blood droplets on the utensils.

      Of the three, HIV or Hepatitis B and C, Ebola’s transmission most resembles hepatitis B or C.

      1. Koffi Babone says:

        It does not change the fact that the public sees health care providers all suited up when dealing with Ebola patients, this is not the case for hepatitis B or C…

        1. David Gorski says:

          If you ask infectious disease docs, many of them will tell you that that’s overkill, given the transmissibility of the virus. However, given its lethality, even though the likelihood of transmission is low the consequences of transmission are so dire that a little bit (or even a lot) of overkill is understandable.

          BTW, the CDC is basically agreeing with me in its Twitter chat going on right now:

          Note: In that last one in context, it was obvious that the CDC meant “infection control” not “infection” is better here in the US.

          1. Koffi Babone says:

            Yes, I agree that the possibility of infection is much lower in North America, we have better isolation capabilities and I understand that we have to address the panic and fear, but to trivialize the possibility of infection is wrong….

            Despite the “overkill” in precautions, there are many health care workers that recently have been infected with Ebola. Again, this is not the case with other viral diseases.

            1. Andrey Pavlov says:

              Despite the “overkill” in precautions, there are many health care workers that recently have been infected with Ebola. Again, this is not the case with other viral diseases.

              Really? You are trying to argue that no healthcare workers get HepB or HIV or any other viral infections from their patients? Because a 2012 study shows the incidence of HepC in healthcare workers was nearly 77 cases per year in the US alone. With proper precautions in place. And that is in the good ol’ USA with plenty of resources available for infection control. It is an entirely different beast out in Africa. Not only are you comparing apples to oranges, but your comparison is simply incorrect.

              1. Koffi Babone says:

                No, I am not stating that no health care workers get Hepatitis C or HIV through work. There are approximately 3.2 million people affected with HCV in the US:
                http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm

                And according to your stats, there are 77 cases per year in health care workers…That is about a 0.0024% infection rate and the health care workers are not suited up.
                What are the current stats for Ebola? About 1500 cases ? How many health care workers affected? More than 7 (at least 2 nurses, 3 doctors and the two US health care workers made the news)? That gives an infection of rate of 0.467% and these health care workers are suited up. This is more than 180 fold risk.

                My point is Ebola is very dangerous and we should not trivialize this. It may not be transmitted via air but it is more contagious than Hepatitis or HIV.

              2. Koffi Babone says:

                BTW, I am not the one who initially compared HIV or Hepatitis wit Ebola…..

              3. Andrey Pavlov says:

                @koffi:

                You’ve absolutely entirely missed the point. Comparing apples to oranges is a comparison between ability to control HCW infections in the US vs in Africa. You are also incorrectly comparing the incidence of HCW HepC infection against the background incidence of all people vs the incidence of HCW Ebola infection against the background of a specific epidemic where most all of the affected people are in close contact and proximity with the HCWs.

                The comparison to HepC and HIV is perfectly apt as Dr. Gorski put it. You are simply not thinking about this in a logical manner that can actually make the comparison you are trying to make. Nor is anything you have said supportive of your assertion that “this is not the case with other viral diseases.”

              4. Koffi Babone says:

                I maintain that comparing Hepatitis or HIV to Ebola is wrong and actually I think that it is an apple to orange comparison. Hepatitis and HIV are classified as agents requiring level 2 biosecurity. WHO (not me) classifies Ebola as a level 4 agent, perhaps there is a good reason.

                The tone of the posts imply downgrading Ebola two levels, are you suggesting Ebola is less dangerous than rabies or yellow fever (level 3 agents)??

                Dr Gorski mentions that : “BSL levels are also designed to account for handling the actual virus in pure form, which is different from normal transmission”. But in the main article he states that only 1-10 virus particles are needed to initiate infection, so it sounds like infective material is fairly virulent and does not need to be purified.

                As stated previously, if we scientist omit certain details or oversimplify, the public will turn to pseudo science for guidance. And that is the one thing we should all be countering.

              5. Andrey Pavlov says:

                Hepatitis and HIV are classified as agents requiring level 2 biosecurity. WHO (not me) classifies Ebola as a level 4 agent, perhaps there is a good reason

                Well if you wish to have that be the definition you wish to hinge on fine. But it does not adequately address the point of the comparison.

                Furthermore the distinction between BSL2 and 4 can come about for many reasons. It does not automatically imply that the virus in question is a “downgrade” or “upgrade” relative to the other. It is a description of how it should be handled and why. In the case of Ebola it is BSL 4 because it is an “agents which cause severe to fatal disease in humans for which vaccines or other treatments are not available.”

                If there was a vaccine or effective treatment for Ebola it would automatically become BSL2 just like HepC because it has a vaccine and treatment.

                But that is irrelevant to the point at hand – the risk of transmission of Ebola compared to HepC. Your contention is that BSL2 vs 4 means that 4 must have a higher transmissibility and infectivity. But that is simply not the case. A virus with extremely poor infectivity could be BSL4 if it has a high fatality rate and no vaccine or treatment. The H1N1 flu was initially a BSL 3 and is now a BSL 1 and it has amazingly impressive infectivity and transmissibility.

                So when comparing the risk to people around individuals with a specific disease the question is “is it harder to prevent transmission of Ebola than HepC?” Meaning, do extra precautions above and beyond standard high level isolation precautions needed to prevent transmission? And the answer is no. HepC and Ebola have very similar I&T profiles.

                Your attempt to counter by saying the rate of infection of HCW with Ebola is so much higher than that of HepC. The problem is you are comparing the much more difficult to maintain isolation conditions of Africa to the much better off US as well different populations as the denominator for your rates.

              6. Koffi Babone says:

                From the CDC document (http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf):
                Biosafety Level 2 builds upon BSL-1. BSL-2 is suitable for… agents that pose moderate hazards to personnel and the environment
                Biosafety Level 3 is applicable to… indigenous or exotic agents that may cause
                serious or potentially lethal disease through the inhalation route of exposure.
                Rabies has a vaccine and treatment, yet it is classified as a level 3 agent.

                From : http://www.cdc.gov/h1n1flu/guidelines_labworkers.htm
                The CDC considers H1N1 as a level 2 agent.

                So you are suggesting Ebola requires handling precautions that are similar to Hepatitis, i.e. we should be more careful handling rabies, West Nile or yellow fever virus vs Ebola?? You cannot be serious. As mentionned previously, people working with HIV or Hepatitis are not suited up.

              7. Jopari says:

                The common cold is highly infectious, but you won’t see anyone asking for it to be put under biosecurity level 4. It needs to be evaluated hollisticly. Threat assessment isn’t just aboit how easily it is transmited, also the severity of the virus and it’s lethality.

                With America’s equipment, they are capable of handling such a virus, because they have the ability to do so with ease. However, the people handling Ebola must be reminded that they are handling something that could potentially kill them if not treated correctly. Hence the biosecurity level 4.

                Rabies has a vaccine, yes, treatment, well no, it’s still almost certainly fatal if you start to show symptoms. Therefore, it’s security level is warranted.

        2. WilliamLawrenceUtridge says:

          Hep B at least can be vaccinated against. Hep C only causes problems after years of continuous infection, and it resolves spontaneously in 10-50% of cases.

          Ebola is acutely deadly and kills over 90% if left untreated.

          Comparing the two, hep C doesn’t seem to require near the same degree of protection.

    2. Koffi Babone says:

      @ Jopari:

      You will have to excuse my last post, there were a bunch of quotes from Andrey Pavlov that were not posted. I was trying to point out that some of the info he had posted was wrong.

      Concerning rabies treatment. You are incorrect. There is a vaccine available, yes, where the patient is administered rabies antigens before exposure and then there is a “treatment”. This treatment (post exposure prophylaxis) involves administering a serum of immunoglobulins to the patient. In this case, it is considered a treatment because the patient is receiving ready made antibodies that will neutralise the virus (Louis Pasteur’s treatment) and it is given typically within 10 days of being bitten.

      On another note, you are correct that once the symptoms of rabies appear, prognosis is very poor. However, keep in mind that if a victim is bitten by a rabid animal, the virus has to travel to the central nervous system and it may take up to six months for the symptoms to appear.

      1. Jopari says:

        Rereading my comment, I notice I did mention that there is a vaccination. My point was that the biosecurity level is warranted.

        Therefore, not to sound rude, but I don’t see what was countered.

        1. Koffi Babone says:

          @ KayMarie:

          “My guess is the problem with rabies is if you didn’t catch that you got exposed and no one knows until you show symptoms, you got a big problems. For a lot of other serious illnesses with treatments you don’t have to catch it before the symptoms start to get effective treatment.”

          Exposure to rabies is mostly through bites. Most victims are aware of being bitten. It is quite rare for a person to be bitten and not realise this. In cases where a bat is found in the room of a sleeping person, testing the bat for rabies is always an option (in North America), if no bats are available for testing; the health authorities evaluate the situation and decide if PEP is warranted.

          Concerning your 2nd sentence, you will have to give specific examples. Most viral diseases do not have cures and in instances where there is damage done to the nervous system, that usually is irreversible.

          Concerning your 2nd paragraph, currently Ebola treatment is supportive (except for the few who have been treated with ZMapp) this means treating the victim for fever, dehydration, shock etc…
          ZMapp treatment, from what I can gather is based on the same principle as PEP.

          1. KayMarie says:

            I was talking about getting rabies through lab exposure, so why 3 for rabies rather than 2 in biosafety levels if there is a treatment that is effective post exposure.

            I wasn’t talking about people getting bitten. But if a droplet does something weird and gets on a cut (and that happens) or you get a needle stick you didn’t notice (and that happens)…with other diseases that tend to be in the 2nd level if you didn’t know you were exposed at all in the lab until you got symptoms the treatments for that disease (if it is fatal eventually and a lot of level 2′s aren’t necessarily fatal) work even after you find out you got exposed from the symptoms.

            Rabies has a very effective treatment, but if there was a lab slip up and maybe you were one of the ones a pre-exposure vaccination didn’t take (as I know people get vaccinated sometimes if they are at high risk like work with wild animals likely to carry rabies) and no one knows until you start frothing at the mouth….lets just say that is enough to probably keep the extra layer of protection around the virus rather than say well it probably won’t get anyone dead let’s just loosen the restrictions up since there is a treatment available.

            As for the second sentence. I don’t know of any other viral disease where you either get treatment before symptoms hit, or you die. I didn’t think that meant other viral illnesses must have treatments. Many don’t, but most don’t have the kill rate of rabies, either. A virus without any treatment at all may be level 2 as long as it isn’t particularly lethal. I mean just about any illness killed someone. Heck I could die from a cold if my asthma kicks up the wrong way even if I go to the ER. Had a friend die like that.

            As for if Ebola will be 2 or 3 once there is an FDA approved treatment available in sufficient quantities to be in regular use (I expect it won’t stay 4 if you can treat it fairly effectively so no more lethal than any other level 2 virus)…which was the assumptions I was talking about…you are probably looking at the “risk to community” part of the what lab precautions need to be taken. IF and only if you have a treatment that deals with the “risk to individual”. That may depend on if you can treat the people around the victim prophetically or not, and how much that treatment stops any possibility of spread.

      2. Koffi Babone says:

        @ Jopari:

        1) In your initial comment you mentioned that there is no treatment for rabies, I am saying that there is. Post exposure prophylaxis (PEP) is a treatment. Vaccination implies stimulating the immune system to create antibodies (active immunity), PEP does not stimulate the immune system (passive immunity)
        http://www.who.int/rabies/human/postexp/en/

        2) I agree that rabies should be a level 3 agent. The discussion concerning rabies started with Andrey Pavlov’s comment:

        “If there was a vaccine or effective treatment for Ebola it would automatically become BSL2 just like HepC because it has a vaccine and treatment.”

        Rabies was cited as an example where vaccine and treatment are available yet is still classified as a level 3.

        1. KayMarie says:

          My guess is the problem with rabies is if you didn’t catch that you got exposed and no one knows until you show symptoms, you got a big problems. For a lot of other serious illnesses with treatments you don’t have to catch it before the symptoms start to get effective treatment.

          I suspect with Ebola a lot will depend on how effective the treatments are and if you can treat people who are exposed but may not have gotten it safely. Like when there are meningitis outbreaks on campus usually everyone in classes and on the dorm floor of the kid who got sick gets antibiotics that are fairly safe to give to someone who isn’t sick.

        2. Harriet Hall says:

          PEP is a treatment for infection with the rabies virus; if infection is allowed to progress to the actual disease rabies, there is no treatment for that.

        3. WilliamLawrenceUtridge says:

          Karl, your overall point appears to be that people should be afraid of Ebola because it requires biosafety 4 precautions. You seem to think that the level of biosafety precautions required is purely a matter of the seriousness, perhaps even scariness of the infection.

          Allow me to point out that the biosafety precautions are a composite result of many different factors, and the reasons they are used in the lab are different from the reasons they are used in the field with Ebola specifically. Further, the comparisons between HIV and hepatitis are with regards to their mechanisms of transmission, for which Ebola is pretty directly comparable. In fact, the transmission of Ebola is frequently compared to that of HIV and hepatitis. If you’ve got a beef with the comparison, you’ve got a beef with much of the medical publication system, not merely Dr. Gorski.

          1. WilliamLawrenceUtridge says:

            Sorry, Koffi, not Karl. Obviously reading too fast, possibly a little racist. Ahem.

          2. Koffi Babone says:

            @ W.L. Utridge:

            Correct me if I am wrong, but handling HIV or Hepatitis infected material is not particularly dangerous unless you have an open wound. That is, if a positive patient had soiled their sheets with blood, diarrhea or vomit, it should be fairly safe for a family member to wash those sheets correct?

            Is it the same for Ebola?

            1. Windriven says:

              I don’t think that is entirely correct. You wouldn’t want to touch the infected materials and then absentminded lay rub your eyes, pick your nose, or any of the other things that might inoculate mucosa with the agent.

              Face shields, gloves, face masks, frequent hand washing, standard infection control procedures would go a long way.

              And yes, somebody is going to jump me for the face masks but I wouldn’t want to be the dead guy memorialized as the one who demonstrated that Ebola was transmissible by aerosols.

              1. WilliamLawrenceUtridge says:

                I would say the face mask is a judgement call. As max has made clear many times, it is a potential risk. Might be worth wearing if you’re treating patients. Probably not worth wearing if you are worried about catching it on the subway.

              2. MadisonMD says:

                Fun fact. The ordinary types of surgical and cotton masks recommended for healthcare workers function to prevent splashed fluids from entering your mouth/nasal cavity and making contact with mucosa*. These are recommended by CDC as acceptable masks for health care workers treating patients with Ebola (see here for CDC manual). These masks do not preclude inhalation of aerosolized particles because the pores are simply too large and, moreover, they fit on the face with large gaps.

                If you need to prevent infection from aerosolized/airborne particles, you need a well-fitting N95 mask. The N95 is required for airborne communicable illnesses such as influenza, SARS, TB, but is optional for Ebola per the CDC manual, consistent with the known mechanisms of contagion of these viruses.

                *Of course a surgical/cotton mask can also be worn for the benefit of the patient by preventing the wearer from creating aerosolized particles from the mouth–which is why they are worn by staff performing surgery.

              3. Koffi Babone says:

                @ MadisonMD :

                This reference dates from May 2005, the last sentence on the 1st page is interesting:

                http://www.cdc.gov/HAI/pdfs/bbp/VHFinterimGuidance05_19_05.pdf

                The CDC manual you refer to, dates from 1998 (though the webpage was updated in January, 2014)

                This reference was last updated in August of this year, please read the last few sentences of mode of transmission:

                http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

                What is my point? That there is currently insufficient data to say that Ebola is NOT transmissible via aerosol (in fact, according to the Canadian website, the opposite is suspected) and that we should err on the side of caution…

                Better safe than sorry.

              4. MadisonMD says:

                @Koffi: We have been through all these links with Max on this thread. The most recent experimental evidence suggests the lack of airborne spread.

                This is likely why the public CDC website links to the 1998 WHO/CDC guidelines I cited. Moreover, the current CDC guidelines for healthcare worker personal protective equipment in the U.S. has the same recommendation for goggles/faceshield and the option of either a standard or a N95 mask.

                May I ask how you and Max independently got the misinformation? You both seem to dispute the PHAC and CDC statements on on how Ebola is disseminated and then point to the 2010 PHAC page and BSL4 as evidence. This suggests the same source of info.

                Oh, I see you got both these conspirational tidbits from Mikey Adams the old the Y2K spammer. Brilliant of you to get your info from a spammer without medical training than from the CDC, PHAC, and actual physicians. Nevermind.

              5. Windriven says:

                Sonofabitch. Is that true of modern surgical masks? I know the pore size is still substantial but I thought they tended to block gross aerosols electrostatically.

              6. MadisonMD says:

                Here’s the actual link updated 8/5/14 showing that current CDC recommendations are for standard, contact, and droplet precautions. Aerosol precautions are only required for “Aerosol generating procedures” which include “Bilevel Positive Airway Pressure (BiPAP), bronchoscopy, sputum induction, intubation and extubation, and open suctioning of airways.”

                So unless you are performing a bronch, aerosol protection is needless, Koffi, Max. I doubt you will be doing this, guys because somehow you strike me as not medically trained. But I know you both drank Mikey’s cool-aid. It is all some grand nefarious government conspiracy to get rich/oneworldgovernment/destroy/depopulate the world just like Y2K was and only Mikey can help you find Truth. Or maybe, just maybe, Mikey’s just wrong on this one guys, even though he has such a wonderful track record of accuracy.

                Ho-hum. Same as it ever was.

              7. MadisonMD says:

                This reference was last updated in August of this year, please read the last few sentences of mode of transmission: http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

                Wrong again. Read right before references where it says “UPDATED: August 2010.” The webpage appears to have been updated to link to the updated Ebola PHAC main page which actually does not list aerosol as a mode of transmission.

                Even Max had figured that one out. Anyway, good luck to you navigating life while you obtain health info from a spammer.

              8. Andrey Pavlov says:

                Thanks for the sleuthing Madison. I shan’t waste any more time on the sock puppet.

              9. Koffi Babone says:

                @ MadisonMD:
                The 2010 PHAC page as stated previously is the one provided by Dr Gorski’s link. Thank you for the other references. Concerning Mikey Adams, I have no idea who you are referring to, nor have I ever read his work. And you will have to excuse me, but no, I did not follow your discussion with Max.

                Concerning your Nature reference:
                http://www.nature.com/srep/2014/140725/srep05824/full/srep05824.html

                It is interesting to note that in experiment 2, the one where they studied aerosol transmission, half of the EBOV infected monkeys (the ones who were supposed to infect the naïve monkeys) to did not show any viral load in nasal or rectal swabs the day they were euthanized. This could suggest that the incubation period was not long enough especially if the Rhesus monkeys are more resistant to EBOV.

              10. MadisonMD says:

                @Koffi. Why don’t you call the CDC. You apparently know more about them about the difference between droplet and airborne precautions and when each is necessary.

              11. WilliamLawrenceUtridge says:

                Koffi, is there a reason you are citing the PHAC page, with it’s equivocal conclusion that you have to torture to turn into a fact (here’s a hint – it doesn’t say aerosol transmission is definite, it says it is possible), rather than the much clearer CDC page? It’s even got a cute little infographic, in case you are confused by words.

                Concerning Mikey Adams, I have no idea who you are referring to, nor have I ever read his work

                Ha! Of course you haven’t. Well, then just be aware – you are currently agreeing with Mike Adams, perhaps the third most inaccurate source of medical advice on the internet.

                It is interesting to note that in experiment 2, the one where they studied aerosol transmission, half of the EBOV infected monkeys (the ones who were supposed to infect the naïve monkeys) to did not show any viral load in nasal or rectal swabs the day they were euthanized. This could suggest that the incubation period was not long enough especially if the Rhesus monkeys are more resistant to EBOV.

                You’ll notice that free-ranging humans aren’t lab-contained monkeys being given aerosolized Ebola.

                There’s a host of interesting things about Ebola, but the main one is that despite how dramatic it appears to be, in practice it’s far less of a threat than diarrhea.

              12. MadisonMD says:

                It’s even got a cute little infographic, in case you are confused by words.

                I think this infographic might actually be more helpful.

            2. WilliamLawrenceUtridge says:

              As far as I know, but I’m not a doctor. Blood certainly can be dangerous, not sure about diarrhea or poop. Were I said family member, I would wear gloves.

              But taking care of a sick family member isn’t the same thing as conducting research on purified virus. Not even close.

            3. Koffi Babone says:

              @ Windriven & W.L. Utridge:

              My question was not really a question… It was intended to make people reflect on the answer….

              Hepatitis and HIV are not transmissible via vomit nor feces.

              This is obviously not the case for Ebola.

              “taking care of a sick family member isn’t the same thing as conducting research on purified virus. Not even close.”

              W.L. Utridge, you should reread Dr Gorki’s text:
              “INFECTIOUS DOSE: 1 – 10 (aerosolized) organisms are sufficient to cause infection in humans.” (this is Dr Gorski’s own reference: public health agency of Canada, though the word aerosolized was omitted in his text)

              http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

              Given that vomitus, sweat and feces are sure to contain some viral particles, your point about working with purified virus is moot. The public health agency of Canada states on their website that the organism can survive for a number of days outside the host, this is not the case for HIV.

              So if the medical publication system does compare Ebola transmission to HIV and hepatitis, then yes, I do have a problem with this comparison.

              I do not have a problem with bringing back US citizens to have them treated at home, I actually think it was very laudable move. I also have little worries about the US ability to contain Ebola; out of all the countries in the world, the US is probably amongst the best equipped both in terms of training and equipment.

              I have a problem with comparing Ebola to HIV or hepatitis…
              If you look across the globe, health care professional treat HIV and hepatitis patients with miminal personal protective equipment (PPE). For those who can afford it, this is not the case with Ebola (and for their sake, I sure hope they do wear adequate PPE). The general public can certainly notice this. IMO, it is best if we are honest and admit that this is a serious disease and there are real risks of transmission, but we are able to mitigate them. North America deals with Hantavirus yearly, this is another level 4 agent; and we have so far not had any breech in biosecurity.

              1. Andrey Pavlov says:

                Hepatitis and HIV are not transmissible via vomit nor feces.

                WTF are you smoking?

                Hepatitis is not transmissible via feces??? Hepatitis A is primarily transmitted that way. HepB is bloodborne, but tiny amount can do it and so can indeed be transmitted if there are even small amounts of blood in the vomit or feces. Same goes for HepC with the added bonus of sexual transmission.

                Besides, what the heck does it matter if HepC is not transmitted via vomit and feces? It is still a larger risk of infection in populations that Ebola because the basic reproduction number for HepC is higher than that of Ebola. Which means that by all means of transmission combined HepC will infect more people than Ebola given the same population.

                IMO, it is best if we are honest and admit that this is a serious disease and there are real risks of transmission, but we are able to mitigate them

                Holy $hit! I can’t believe you are still hung up on this… particularly in the face of how many ways you are wrong about it.

                You are literally basing your entire analysis on the fact that when dealing with Ebola workers wear more PPE than when dealing with HepC. Without a single thought as to why that is and what it may actually mean. And then dismiss my entire discussion of the ecological fallacy with a single stupid remark about the CDC.

                I’m very near done dealing with your inanity.

              2. Koffi Babone says:

                @ A Pavlov:

                Alright 1 point for you, I forgot about fecal-oral transmission for Hep A… I was focusing on hep C.

              3. Andrey Pavlov says:

                Alright 1 point for you, I forgot about fecal-oral transmission for Hep A… I was focusing on hep C.

                Gee thanks Koffi. Now if only you would acknowledge the dozen or so other points myself and others have been putting forth and actually educate yourself on the topic.

                How about you focus on base rate replication? Because that takes into account any and all means of transmission regardless of whether we know of them or not (which obviates the question of whether Ebola has airborne transmission or not).

              4. Koffi Babone says:

                @ A Pavlov:

                What are you referring to? To the references with the hepatitis C BRN of 1.49 and Ebola BRN of 0.1 and 1.8?
                http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870608/ :
                https://www.aimsciences.org/journals/pdfs.jsp?paperID=8693&mode=full

                A BRN of 1.49 for Hepatitis C is for IV drug users. If I understand correctly, all family members must be IV drugs users to have a BRN of 1.49, therefore if you are living with a hepatitis positive person and are not a drug user, isn’t the risk presumably lower? In addition, (I am guessing here since it is not documented) I am assuming that not all Ebola victims are IV drug users.
                The 0.1 BRN for Ebola is the estimate for burial practice, but you omit to mention that the overall average in both epidemic was estimated at 2.7. Again, I am assuming that family members taking care of the sick will be exposed to a higher risk, therefore a higher BRN than 0.1 (presumably closer to that of 2.7?)

              5. WilliamLawrenceUtridge says:

                Koffi:

                1) What does the CDC say about the risk of Ebola for those not taking care of sick patients?

                2) What does the CDC recommend for those who are taking care of Ebola patients?

                3) Why do you think you are smarter and better-informed than the CDC, despite the CDC being staffed by researchers who actually study Ebola for a living and have read all 1,600 medical papers on the topic?

              6. Koffi Babone says:

                @ W.L. Utridge or A Pavlov:

                Would you please show me a link to a scientific reference or the CDC website indicating that Ebola is just as contagious (or less so) than HIV or Hepatitis?

                Thank you.

              7. Sawyer says:

                @Koffi

                Why should they bother providing a reference when that’s not even what they said? Look at Andrey’s post from yesterday. Did you not see where he clarified that HIV is not as dangerous because it is harder to spread? This whole analogy of which virus is “worse” isn’t really even something that can be determine objectively, and was only being used as a starting point to talk about overall safety protocols. You’re nitpicking at details that quite frankly do not matter in the big picture of battling ebola.

                I know you are probably trying very hard to learn about this topic, but what you are doing here is not research. Please stop and spend a lot more time learning about how experts evaluate strategies to combat infectious diseases. Armchair science just doesn’t cut it.

              8. Andrey Pavlov says:

                Would you please show me a link to a scientific reference or the CDC website indicating that Ebola is just as contagious (or less so) than HIV or Hepatitis?

                Well, as Sawyer said – I already pointed out that HIV is much less contagious than both.

                A BRN of 1.49 for Hepatitis C is for IV drug users. If I understand correctly, all family members must be IV drugs users to have a BRN of 1.49, therefore if you are living with a hepatitis positive person and are not a drug user, isn’t the risk presumably lower? In addition, (I am guessing here since it is not documented) I am assuming that not all Ebola victims are IV drug users.
                The 0.1 BRN for Ebola is the estimate for burial practice, but you omit to mention that the overall average in both epidemic was estimated at 2.7. Again, I am assuming that family members taking care of the sick will be exposed to a higher risk, therefore a higher BRN than 0.1 (presumably closer to that of 2.7?)

                Well, for starters you can read more than just the abstract to gain your insight if you actually want to be scientific and learn stuff. Firstly, the 2.7 is an estimate that they made prior. They have actual numbers from the actual outbreaks.

                Firstly from this paper we can see that the BRN for HepC was about 1.49. However, you misread it – that is not just among IVDU’s – that is based on the seropositivity of the entire population. They note specifically that the seropositivity amongst IVDU’s peaked in the 90′s at around 30-35% but has declined since. They use this as a proxy measure for their BRN as the true population seropositivity is not know but can be estimated from the seropositivity of IVDU’s since it is a good estimate of the overall seropositivity of the population according to their epidemiological analysis.

                Estimates of the contact rate can be inferred from data on incidence and seroprevalence of HCV among IDUs in the absence of widespread treatment. Estimates of HCV seroprevalence in the US vary widely, ranging from 18% to 90% [2]. Also, HCV incidence among IDUs was high in the 1990s (10%-35% per year), but appears to have declined over the last decade. We use a recent estimate for seroprevalence of 34% [2]. The contact rate implied by the chosen baseline parameters and seroprevalence rate is = 2:68. This yields a basic reproduction number R0 of 1.49. The implied R0 value is similar to other estimates in the literature

                Meaning that other literature confirms and that this is a good point estimate for the BRN.

                Your reference to Ebola looks at many different aspects and shows that it is actually highly variable. Compare the BRN of burial between the two models of 1.8 and 0.1 and note the wide confidence intervals. The authors do. This paper shows actual BRN’s for two other outbreaks with much smaller confidence intervals at 1.83 and 1.34. Even in your paper the BRN CI drops it down to 1.9. All roughly within the range the HCV. Certainly not unreasonable to compare the two.

                But that is only one aspect of it. And you are ignoring all the other points I and other have made. Analogies can never be perfect. Is Ebola identical to HepC? No, of course not. Are there instances where it can be more infectious than HepC? Absolutely. Vastly more infective? Not really. Overall close enough to make the analogy reasonable? Absolutely.

                Especially since the point is more about the actual health impact. And I am much more worried about HepC than Ebola as a HCW.

              9. WilliamLawrenceUtridge says:

                My question was not really a question… It was intended to make people reflect on the answer….

                Oh, so you’re just JAQing off then. Well that just makes you an asshole. Good to have further confirmation.

                I have a problem with comparing Ebola to HIV or hepatitis…

                This is what frosts your kidneys? Great, then ignore the comparisons and go right to the CDC recommendations on how to deal with Ebola. I would also suggest ignoring theoretical concerns about how Ebola might be spread in laboratory situations designed to spread Ebola through aerosol. Even if aerosols are a possible way of spreading Ebola, it’s obviously not a common or likely one given the difficulties they have in proving it. Here’s a hint – diseases actually spread through aerosols are extremely contagious, to the point that containment is essentially impossible. Ebola does not have these characteristics. After six months in a heavily populated are, it’s spread to less than 3,000 people. For actual aerosols, that number would be in the millions.

                Would you please show me a link to a scientific reference or the CDC website indicating that Ebola is just as contagious (or less so) than HIV or Hepatitis?

                1) Do your own research, you don’t pay me to be your research gopher.
                2) Who cares? What matters is the inherent infectivity of Ebola, not it’s relationship to HIV and hepatitis. The comparisons to other diseases are analogies to convey the rough degree of concern and precautions to take. If Ebola is 10% less infective than HIV, does that change the precautions you need to take?

                Also note this comment where Andrey basically teabags your ability to understand the research.

              10. Koffi Babone says:

                @ A Pavlov:

                Can you indicate where the BRN of 1.49 for Hepatitis C is “based on the seropositivity of the entire population.”

                It states right at the begining of section 4:
                “Quantitative analysis of the model. In this section……The model considers HCV transmission in a high-risk population. In the United States, the most common mode of HCV
                transmission is injecting-drug use [12].
                …….the quantitative analysis focuses on HCV transmission among currently injecting drug users.”

              11. Andrey Pavlov says:

                Can you indicate where the BRN of 1.49 for Hepatitis C is “based on the seropositivity of the entire population.”

                I don’t know if you are intentionally ignoring things or simply can’t read.

                Let me just copy my own words and the exact quote from the paper:

                However, you misread it – that is not just among IVDU’s – that is based on the seropositivity of the entire population. They note specifically that the seropositivity amongst IVDU’s peaked in the 90′s at around 30-35% but has declined since. They use this as a proxy measure for their BRN as the true population seropositivity is not know but can be estimated from the seropositivity of IVDU’s since it is a good estimate of the overall seropositivity of the population according to their epidemiological analysis.

                Estimates of the contact rate can be inferred from data on incidence and seroprevalence of HCV among IDUs in the absence of widespread treatment. Estimates of HCV seroprevalence in the US vary widely, ranging from 18% to 90% [2]. Also, HCV incidence among IDUs was high in the 1990s (10%-35% per year), but appears to have declined over the last decade. We use a recent estimate for seroprevalence of 34% [2]. The contact rate implied by the chosen baseline parameters and seroprevalence rate is = 2:68. This yields a basic reproduction number R0 of 1.49. The implied R0 value is similar to other estimates in the literature

                So what about that was unclear? They used IVDU seropositivity as a proxy for general population levels, using other analysis in the paper, and compared to other data looking at different ways of quantifying it. And came up with similar numbers.

                I even bolded the important parts for you again.

                Anyways. I’m done wasting my time having a discussion with you when you can’t even read what is being written. You ignore salient points and focus on the tiny details that differ as if they prove your point. Which is a non-point to begin with.

                Have fun being afraid of Ebola Koffi. I, for one, won’t lose any sleep over it.

              12. Koffi Babone says:

                @ A Pavlov:

                “They use this as a proxy measure for their BRN as the true population seropositivity is not know but can be estimated from the seropositivity of IVDU’s since it is a good estimate of the overall seropositivity of the population according to their epidemiological analysis….The implied R0 value is similar to other estimates in the literature. Meaning that other literature confirms and that this is a good point estimate for the BRN.”

                No, you are incorrect.

                1) “Estimates of the contact rate B can be inferred from data on incidence and seroprevalence of HCV among IDUs in the absence of widespread treatment.”

                Contact rate B is the rate at which the susceptible meet the infected. In this case the susceptible population is the IDU population. They are the high risk population, not the general population since Hep C is “transmitted primarily through direct percutaneous exposures to blood. In many countries, the two most common exposures associated with transmission of HCV are injecting-drug use and transfusion of blood from unscreened donors.” Page 1045

                2) Page 1057 of the article clearly states: “The model considers HCV transmission in a high-risk population…. Because blood transfusion rarely accounts for recently acquired infections and other modes are relatively less important and/or not well-defined, the quantitative analysis focuses on HCV transmission among currently injecting drug users.”

                3) “HCV incidence among IDUs was high in the 1990s (10%-35% per year), but appears to have declined over the last decade. We use a recent estimate for seroprevalence of 34% [2]. The contact rate implied by the chosen baseline parameters and seroprevalence rate is B = 2:68.”

                Hep C incidence among IDUs had been declining in the last 10 yrs, so determining R0 (BRN) is important because if it is below 1, it is an indication that Hep C will die out. If it is above 1, it is an indication that HCV infections may become an epidemic. Reference 43 of this paper states that: “The rate of spread of HCV is often derived from seroprevalence data collected over time course of the epidemic”.

                4) “This yields a basic reproduction number R0 of 1.49. The implied R0 value is similar to other estimates in the literature [36, 43].”

                The authors find a BRN of 1.49 which agrees with what was previously published (36, 43). When you look up reference 36, throughout the article they describe transmission rates within the IDUs, not the general population. For reference 43, I could not find the full article only the abstract. However from the title of the paper and the abstract, we can deduce that the article will most probably focus on transmission rates in IDUs, not the general population.

                5) Concerning your comment about just reading abstracts, you are correct. However, what is the purpose of the abstract? It is a summary of the main findings, it is the take home message the authors want the readers to remember from their paper. If the abstract mentions a BRN of 2.7 for the Uganda outbreak and does not mention anything about a BRN of 0.1 for the burial practice, maybe it is because it is a secondary finding.

                6) BTW, these references are the ones you presented in: “Yet another plague panic.”

            4. Andrey Pavlov says:

              @Koffi:
              You are wrong and I am happy to correct you.

              Any of those viruses are similarly dangerous. If you get ebola on your unbroken skin and do not touch any mucous membranes with it prior to proper handwashing it is no more dangerous than HepC or HIV.

              In terms of getting infected, HepC is at least as dangerous as it also requires only a single digit virus inoculum to produce infection, same as Ebola.

              HIV is much less dangerous since it requires a much larger inoculum.

              Either way, none of these viruses can magically infect you. They need to have a proper cellular binding site in order to then lead to infection. That is true of all viruses (and most bacteria, actually). So if you truly have completely unbroken skin and really don’t touch any mucous membranes you can hold purified Ebola or HepC or whatever without getting infected. The trick though is that it is really hard to be 100% sure you have completely unbroken skin and then it is hard to make sure you get 100% of the viral particles out of the skin since they are so small they can settle in between the small crevices of the skin left from the larger spaces between keratinocytes.

              Which is why WLU is correct – working with purified virus vs infectious bodily fluids is wholly different – it is vastly more difficult to get rid of the virus when it is such a concentrated amount of it should you get accidentally exposed.

              So, once again it really and truly is a perfectly reasonable comparison between Ebola and HepC.

              1. Stephen S. Rodrigues, MD says:

                My staff has received the HHS notice and it will be handled by my attorney and my P.O. .

                I did not think you all would stoop so low.

                Kill the messenger and kill the message? Not gonna work!

              2. Jopari says:

                As I said before, Nice, Messiah.

                Messenger of what, exactly?

                Stoop so low? You mean calling you out on a legitimate offense. So in your paradigm, we ought to sit back and watch you perform violations?

                Next, why the heck are you posting this to a completely unrelated comment, high up in the comment tree, some might think you actually didn’t want us to see it.

              3. WilliamLawrenceUtridge says:

                My staff has received the HHS notice and it will be handled by my attorney and my P.O. .

                I did not think you all would stoop so low.

                Kill the messenger and kill the message? Not gonna work!

                You asshat, you posted information that is illegal and violates patient confidentiality, and you’re mad at us for pointing it out? If you were breaking into a house and we reported, you, would you accuse us of “stooping so low”? If you see a hit-and-run and get the license plate, do you not report it because you don’t want to “stoop so low”?

                Jesus, don’t want to get hammered for breaking the law? Don’t fucking break the law.

                Moron.

                Also, acupuncture is a placebo.

              4. Andrey Pavlov says:

                My staff has received the HHS notice and it will be handled by my attorney and my P.O. .

                I did not think you all would stoop so low.

                Kill the messenger and kill the message? Not gonna work!

                I actually would have missed this had WLU’s comment not come across my RSS feed to make me look.

                He and jopari are indeed correct. You violated HIPAA regulations in a particularly flagrant and self-serving way, in order to try and vindicate yourself at the expense of your patients. That is an absolutely unacceptable action. One that the representative of the HHS also felt the same way about when I spoke to her on the phone about it.

                During that conversation I explained how I came to know you, that we had been having a discussion about the validity of acupuncture and how your scientific evidence was woefully lacking, and that you ultimately resorted to posting images and videos of patients in an identifiable manner on your own personal dropbox folder as some sort of desperate attempt at providing “evidence” to support your claims about acupuncture. In addition to the fact that this is not in any way, shape, or form actual evidence unless you had very clear and explicit consent that is rather specific to this sort of use, it is also a blatant violation of HIPAA.

                Given that I had (and still have) every reason to believe that you did not obtain proper consent for such usage it was my ethical duty to report it as a HIPAA violation. If you did have proper consent, then you have nothing to worry about and can provide the documents proving it to be the case. Somehow I am doubtful of this.

                In my conversation with the HHS on the matter the investigator frankly said she was shocked at the evidence I had provided (screen shots of your dropbox folder and images you had shared) and stated that such usage is by far the most difficult to have proper consent for because it can only be construed as self promotional rather than scientific or educational.

                You are free to come to these comments and blather on with your inanity and complete disregard for science and the legitimate practice of medicine. It is perfectly within your right to be wrong and flagrantly so. However when you violate the law it is my ethical duty to report it to the proper authorities.

                As for killing the messenger to kill the message… no Stephen. The message is long dead and in fact stillborn. And as you can see by how you are allowed unfettered space to continue spreading your message, nobody is trying to kill it. But violating medical ethics is a transgression I will not abide by. Thankfully your complete lack of intelligence in scientific discourse carries over to your other actions as well. I can’t imagine any of my colleagues being so stupid as to even remotely think that posting up photos and videos of your patients onto a personal dropbox folder as some sort of “evidence” in an argument about acupuncture on a blog is a reasonable course of action. The fact that you could is reason enough to take appropriate action.

              5. mouse says:

                So happy to see that you reported this violation, Andrey and great to hear that the complaint is being taken seriously.

              6. WilliamLawrenceUtridge says:

                Does HIPAA forbid the use of such images to provide anecdotes or testimonials?

                Also, telling the messenger they are wrong isn’t the same thing as killing them. It can’t be repeated enough.

              7. mouse says:

                WLU – below find the summary from HHS – My understanding – health care providers can’t share information about patients health or care without their consent. Generally, consent for sharing applicable information with insurance companies (for payment) or within a health care system is signed off on before services are provided. Sometimes there are consent forms for sharing medical information with other individuals (spouse, etc).

                A doctor sharing a patient’s health information that has personally identifiable information in it without their consent is a violation.

                I don’t think a chiropractor sharing an anonymous personal testimonial from a patient would be a infringement on HIPPA. Not sure %100 sure, though.

                http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

                Of course you could post whatever anecdotes you want about yourself.

              8. Harriet Hall says:

                Off the subject, but I’m wondering what happens when HIPPA conflicts with state law – doesn’t the federal law override the state? I’m asking because a 1992 Washington State law mandated the collection of information on all Washington residents who are diagnosed with cancer, and they are providing names and addresses to researchers who are contacting patients to invite them to participate in research studies.

              9. MadisonMD says:

                Does HIPAA forbid the use of such images to provide anecdotes or testimonials?

                If they contain or come with patient identifiers the answer is clearly yes. You may publish case reports without IRB approval. However, they may not include any protected health information (basically anything that can be used to identify the individual), without signed written authorization from the person whose information is being disclosed.

                For example, if SSR’s HIPAA authorization form in his clinic signed by all patients says “I may freely disclose your protected health information via public internet sites,” then he might be OK. But (a) I have never seen such an authorization form (b) I doubt anyone would sign it if they actually read it; (c) There may be legal ramifications of requiring your patients to waive their HIPAA rights altogether.

              10. KayMarie says:

                I worked on a project where we got names/addresses from this state’s registry.

                We did have to send a letter to the doctor on listed the cancer registry (usually who did the biopsy) who could veto contact. We had a way to tell the registry when someone asked to not be contacted by any study ever for any reason as well as just marking them in our system as a do not contact again for this study.

                I don’t know, but I believe that somewhere they are told about the registry and probably is an opt out. I vaguely remember something like that when I had a biopsy, but since I’ve done research with human subject I usually always say yes to being a guinea pig to burn off some of my 1000 reincarnations as a lab rat I have coming in this life rather than waiting. :-)

  19. Kelly says:

    Sort of a minor point, but this part was my favorite:

    “The reason doctors can’t do anything for viruses is because viruses live inside of your cell’s walls, and medicine particles can’t penetrate those walls. Essential oils, however, have super tiny particles and a makeup that allows them to pass through with no problem! They go in, kill the virus while also stopping the viral cells from duplicating, and all the while boost the immune system so the body can continue to fight for itself. We’ve found that we can kill viral infections in 12-48 hours, depending on how quickly we start using oils.”

    I’m a social worker at a large public HIV/ID clinic and I’m pretty sure the “medicine particles” of antiretrovirals are able to “penetrate those [cell] walls.” The mechanism of HAART (Highly Active Antiretroviral Therapy) is exactly that – different classes of drugs penetrate the infected CD4 cells in various ways to disrupt the HIV replication process so the virus cannot make more of itself. If this were not possible (presumably, the Baileys think that “medicine particles” are too large or something??) people with HIV wouldn’t be living for decades as they are today.

    So yes, modern medicine DOES know a thing or two about treating viral infections. Provided there is enough political will to fund the research, I imagine we will see either a vaccine and/or antiviral agents to treat Ebola strains as well. Scientific discoveries of that magnitude don’t happen overnight.

  20. Fahren says:

    The issue is not compassion; the issue is fairness. Why should the US government treat these patients any differently than any other Americans who fall ill in a third-world country? Are we treating Americans with cholera in Thailand who we don’t fly to Atlanta coldly and as personna non grata?

    Has anyone considered the possibility that maybe all the attention the CDC is paying to these patients is just an expensive publicity stunt by an agency trying to divert attention from the recently reported multiple failures of that agency to responsibly handle dangerous pathogens?

    http://www.vox.com/2014/7/21/5922795/dangerous-pathogens-in-the-lab

    And it sure looks like the US government is deeply involved in providing for the transportation and treatment of these patients. I presume all this involvement has a cost and I would be very surprised if the CDC or the State Department presents Samaritan’s Purse with a bill that reflects that cost. Here’s a link and the opening paragraphs from the link:

    http://tinyurl.com/nbcebola

    “American health officials were scrambling on Friday to fetch two American patients infected with Ebola virus back from West Africa for treatment.

    The State Department said it was helping organize the evacuations over the “coming days”.

    “The State Department, together with the Centers for Disease Control and Prevention (CDC), is facilitating a medical evacuation for two U.S. citizens who have been infected by Ebola in West Africa,” spokeswoman Marie Harf said in a statement.

    “The safety and security of U.S. citizens is our paramount concern. Every precaution is being taken to move the patients safely and securely, to provide critical care en route on a non-commercial aircraft, and to maintain strict isolation upon arrival in the United States.”

    CDC helps equip a small jet with containment equipment so a patient with any infectious disease can be transported while receiving medical care but without infecting caretakers.

    “CDC protocols and equipment are used for these kinds of medical evacuations so that they are carried out safely, thereby protecting the patient and the American public, as has been done with similar medical evacuations in the past,” Harf said.

    Emory University Hospital said it was ready to take care of them at a special isolation unit that it operates in collaboration with the CDC.”

    1. KayMarie says:

      Sure, it could all be some big scary evil conspiracy theory.

      Or it could be a chance for the charity to pick up a lot of the bill and get some very unusual patients, who had an experimental treatment to a location where maybe we could refine our protocols and procedures in case some patient ends up here on a plane one day before the fever hits and we got to either deal with them no matter where they came from or just let them die on the street and bleed into the gutter and hope no one else gets sick.

      From the NYtimes article.

      Although the State Department said it had been involved in facilitating the evacuations from Liberia, Emory said Samaritan’s Purse was paying for the transportation and care of the workers

      Although I wouldn’t be surprised if the Charity has emergency evacuation/medical insurance on them as that would be the prudent thing to have done and is usually recommended by the US Gov’t/Embassy, etc. whenever you go to abroad.

      And really, this is the only time in all of history that anyone in the US has ever bothered to intervene with an American citizen that fell ill. {sarcasm} I mean it isn’t like the military ever was involved in air dropping breast cancer drugs to one of ours in Antarctica or anything.{/sarcasm}

      I’m sure it is more the docs and scientists who have been preparing for a lifetime for that one person to get here before showing symptoms wanna get a piece of the action and better here with better equipment than there. But your mileage may vary. {sarcasm} No, much better to wait until some poor African dude bleeds out in the gutter before seeing if anything we think we know about containing or treating this thing is a good idea or not. {/sarcasm}

      1. David Gorski says:

        And really, this is the only time in all of history that anyone in the US has ever bothered to intervene with an American citizen that fell ill.

        Indeed. This is one area where the US government often actually does the right thing for its citizens.

        Also, pretty much anyone who has the means, wherever those means come from, can be transported back to the US. If the charity really is picking up the bulk of the expenses to bring the Ebola-infected doctors home, this really isn’t all that much different from the cases of any number of sick Americans who are transported home, at least in terms of “special treatment.” In other words, if you or the organization you work for (or its insurance company) can pay for it, you can get the same “special treatment” as these doctors.

        1. brewandferment says:

          I think KayMarie has a good point about protocols and procedures. You can simulate all the training you want and rehearse with actors but there’s nothing like “live rounds” to make all the pieces and users really pay attention. There’s something to be said for a live performance with only a couple of patients to help re-verify that you’ve worked out the kinks without being in the thick of a mass casualty. So yeah, Samaritan’s Purse probably has had to cough up a lot of money, but it’s a good training opportunity for all the other agencies in the process.

          And yes, we evacuate people from assorted countries when they are at risk due to other causes (typically violence and political instability) even if they went to those places against prudence.

      2. brewandferment says:

        oh, and it wouldn’t exactly be a good thing if they were to just hop on any old plane in economy class, now would it? Seems like the potential for transmission alone could wreak serious havoc, and the cost of any possible infectious spread would quickly dwarf the present costs of bringing them home.

    2. WilliamLawrenceUtridge says:

      Are we treating Americans with cholera in Thailand who we don’t fly to Atlanta coldly and as personna non grata?

      The treatment for cholera is drinking salty water. That’s the main reason we wouldn’t fly someone back from Thailand.

      Most infections caught in third-world countries aren’t acutely deadly. And there are specialists who prevent or offer treatment for these diseases you can consult before you go. Ebola is not one such disease.

      Jebus, that’s a hell of a leap you made – you really think the CDC PR flacks have enough pull to put together a jet to fly people back? What an odd thought.

  21. Windriven says:

    “Although transmission through aerosol has been demonstrated in the laboratory between pigs and primates, it’s never been conclusively demonstrated to happen from human to human and the evidence is fairly compelling that it does not. True, the virus, from what I’ve found in my research, persists on surfaces for days, and only 1-10 virus particles are needed to initiate infection.

    If factual, this demands extreme caution. The absolute risk of transmission may not be extreme but consider the social and political calamity that would erupt if a couple of people came up with Ebola and who have not traveled abroad. You think Trump and other rabble rousers are bad now? Remember the early days of AIDS?

    Bring the health care workers back, but their handling and isolation needs to be Defcon 1.

    1. David Gorski says:

      A little comparison:

      Hepatitis B can also survive outside the host for 7 days, just like Ebola. Similarly, its infectious dose is in the same range as that of Ebola, although maybe not quite as small. Of course, its incubation period is much longer than that of Ebola, which makes infection asymptomatic for a long time, making it arguably more dangerous in some ways than Ebola. Yet we don’t freak out over hepatitis B. Just some random thoughts.

      I agree, though. There’s no doubt Ebola is dangerous, but other than the severity of the disease it causes, there’s nothing particularly unique about the virus’ mode of transmission.

      1. Windriven says:

        “Yet we don’t freak out over hepatitis B.”

        All true. But then there is a good vaccine against HepB and the fatality rate isn’t 90% and prompt.

        It isn’t enough to be right about the facts. It is important to shape the perceptions in the general public. Among a certain set, Mike Adams and Donald “WTF is with that hair?” Trump are much more effective than all the sense-speakers combined. Fear is a powerful emotion and those who shape fear command that power.

        1. Windriven says:

          I had intended to add: and when we minimize their opportunities to grandstand, we diminish their power.

        2. WilliamLawrenceUtridge says:

          The promptness of death by Ebola is actually a point in its favor of being able to contain it – people die too quickly to necessarily spread it.

          Of course it’s hugely complicated, but unlike influenza or measles, the means of transmission are such that the risk of dying from it is much higher than the risk of catching it. For that matter, given an adequate population base it’s possible Ebola might become less deadly over a long time period because of the selection pressures. It could even form the equivalent to an attenuated vaccine.

          Unlikely, but only a bit less likely than Ebola mutating to be both lethal and contagious through aerosol.

  22. Marie says:

    This article strikes me as being more of a tirade than a treatise, and uses an angsty axe rather than a mallet in it’s Whack-A-Mole fun. Dr. Dan seems more thoughtful, humble and honest, and less likely to send patients running to seek alternatives.

    1. David Gorski says:

      What bothered you more (i.e., what was more of a “tirade”?), the criticism of the views expressed by Donald Trump and others, or my criticism of homeopaths and other alternative medicine practitioners for claiming they can treat Ebola virus disease? I’m not being sarcastic here, believe it or not. I’m dead serious. It’ll help me answer.

      1. Marie says:

        I think it was an equal-opportunity attack against any dissenters, with winning as the main point.

        1. David Gorski says:

          There’s a difference between different “dissenters.” For instance, it is possible to express concern about bringing Ebola victims to the US without ramping up fear about it the way Donald Trump did or without stoking xenophobia the way Dr. Orient did. Dr. Dan isn’t so far from where I stand, as far as I can tell. The problem is, I can’t tell for sure, as he seems to be a bit vague about what exactly it is that he means (particularly whether he thinks it was a mistake to bring Dr. Brantley back to the US), and that’s frustrating. I’m not the only one to have experienced some frustration over this.

          As for homeopaths, describing homeopaths and other quacks as “dissenters” is just plain wrong, I’m afraid. There’s no other way to put it and be scientifically honest: They are peddling pseudoscientific remedies that don’t work and would be dangerous to rely on. I make no apologies for coming down hard on them because they endanger lives and will continue to do so, just as I did when the same sorts of quacks glommed onto the Fukushima nuclear accident to peddle quack remedies to neutralize radiation and just as I do when antivaccinationists claim vaccines cause autism.

          1. Marie says:

            Black and white feels very secure, but the apparent enemies are often not the most threatening ones.

            1. R Miller says:

              That was almost as profound as my last fortune cookie. Almost.

            2. mouse says:

              Well it’s not so much black and white. The dispute with Dr. Dan could be expressed better in pantone colors. He suspects that David Gorski is committed to PMS 422 while he believes PMS 429 is more accurate.

              The old joke about a couple’s response when asked how often they have sex comes to mind.

            3. David Gorski says:

              Black and white feels very secure, but the apparent enemies are often not the most threatening ones.

              OK, I’ll bite. Who, in this case, are the most threatening enemies, if not Donald Trump (and those like him) and the people peddling quack remedies as cures for Ebola? Please be specific.

              Second, how is it not a “black and white” issue when it comes to homeopaths claiming to be able to cure a highly deadly disease with water?

            4. WilliamLawrenceUtridge says:

              Black and white feels very secure, but the apparent enemies are often not the most threatening ones.

              Sometimes things are black and white. You can’t jump to the moon. You can’t survive decapitation. Homeopathy doesn’t work.

              If you’ve got a point, why not make it instead of hiding behind vague platitudes?

    2. WilliamLawrenceUtridge says:

      What part of Dr Dan’s post did you like best, the part where he disagreed with public health and Ebola experts, the part where he compared the incredibly contagious norovirus to the incredibly not contagious Ebola, or the part where he compared viral Ebola to antibiotic-resistant bacteria?

      Dr. Gorski’s whole point is that Ebola isn’t the killer plague people have been fear-mongering over; no matter how thoughtful and humble Dr Dan is, that doesn’t make him right. His entire first comment was an example of the precautionary principle taken to a degree that actual experts in Ebola and public health think is incredibly unlikely. Meanwhile Dr. Gorski’s heavily referenced post linked to those actual experts.

      Also, tone trolling.

  23. Elijah Nadeau says:

    Great article, very detailed, and you answered pretty much all available questions without sarcasm, which surprised me. Even with those who are ignorant of reality, and refuse to believe what’s right in front of them, you still refuted their claims respectively, and that’s pretty admirable. Now, I’m 17, and I can see this clearly, it makes me wonder why so many in our country choose to remain ignorant and live in fear. We know the origin point of Ebola, where it comes from, and that right there, should tell a person all they need to know about the risks of this virus.

    Africa is a big continent, and is no way united at this point in time. Organizing medical relief like they have thus far has been far above what I expected to be possible, it really has been a fantastic effort by these communities. However, expecting two patients in a secure hospital, with doctors that know what they’re doing, to somehow miraculously collapse the infrastructure of our medical care system and spread through the country like wildfire, is pretty much the most unlikely thing that could ever happen. If Trump was so worried about this, all he would have to do is ask his personal physician, who would then tell him to relax his sphincter.

  24. mouse says:

    Can I just add how glad I am that tweeting for the CDC is not my responsibility.

  25. Lucas Beauchamp says:

    Mike Adams has been asking, “Why does the CDC own a patent on an ebola strain?
    http://www.naturalnews.com/046290_Ebola_patent_vaccines_profit_motive.html. He has concluded that the CDC does so in order to create biological weapons.

    Except that the CDC doesn’t own the patent at all. The page to which the Health Ranger links states that the CDC applied for the patent back in 2009. A quick search with the Patent and Trademark Office, however, does show that the US government owns, however, 13 patents with “ebola” in the title, and more than 46,000 others.

    I am not sure why Uncle Sam owns patents, but it does so commonly that we should not immediately jump to conclusions and think the worst.

    1. Lucas Beauchamp says:

      Formatting error. I only wanted to italicize “own.”

    2. Frederick says:

      Mike Adams seems to be in the whole “depopulating the world” conspiracy.( Yeah right, companies wants to have LESS clients, so logical…). So you can easily guess what he thinks about that.

      1. MadisonMD says:

        Adams should be worried. If those doggone depopulation conspirators are any more successful, it could be the end of our species.

        1. Frederick says:

          Yeah, guys like Adams promote stuff that will, in the end, kills ya, So they are the persons depopulating the world. They should be worried about overpopulation, which gonna be a problem someday, unfortunately.

    3. WilliamLawrenceUtridge says:

      I am not sure why Uncle Sam owns patents, but it does so commonly that we should not immediately jump to conclusions and think the worst.

      Great idea, but if we did that, how could Mike Adams sell you black helicopter repellent spray and emergency “They cummin’ fer yer guns!” kits, complete with gas masks and virgin coconut oil sexual lubricant?

  26. Nemo_from_Erehwon says:

    Very informative and valuable article, weakened only by the author’s need to keep circling back to the fact that he does not like Donald Trump’s hair. The added air of third-grade-level insults does nothing to the piece, and in fact detracts significantly from it

    If the author is really convinced that Trup’s hair is important to his case, and that Trump’s being wrong on the basis of the facts is insufficient rebuttal, one mention would probably have been sufficient.

    1. David Gorski says:

      But, as we all know, Donald Trump’s hair is inherently funny in and of itself, and I felt as though I needed to provide a little comic relief for such a serious subject. :-)

    2. Windriven says:

      Trump’s hair is fair game. “The Donald” has enough money to afford a wig that doesn’t make him look like the mutant issue of a mating of Don King and Tammy Fay Baker. Trump obviously keeps it that way because it attracts attention, not unlike Vlad, the rope worm wrangler, in another thread.

      Drs. Gorski and Crislip* have senses of humor that often shine through in their columns. It adds humanity to the subject matter. Retire to Erehwon and spend your time reading the IRS code. Not a single effing joke to be found.

      1. Windriven says:

        * No aspersions cast on the other fine bloggers, all of whom undoubtedly have keen senses of humor but choose to display them less conspicuously.

    3. goodnightirene says:

      I suspect that you possibly have hair that resembles that of Mr. Trump.

  27. Peter S says:

    How predictable that some effing homeopaths would claim they can cure ebola. Shameless and totally vile. I wish there was some recourse against these people. Has Mercola been heard from yet? Russell Blaylock?

    1. Windriven says:

      I couldn’t agree more, Peter. The notion that these vermin would toy with people’s lives in this way leaves me brimming with loathing and rage.

      1. Peter S says:

        Bad enough that there are some who purport to treat and even claim to cure autism, and bad enough that I wasted time and money on a few back in my own naïve CAM days — including one jerk who actually had an MD. But this is truly beyond the pale, we are talking about life and death here not indigestion or a cold or muscle aches or whatever the bleep else these people who obviously have success only by placebo claim to cure.

  28. David Hudson says:

    The big problem I see here regardless of the level of protocols involved is why in the name of the flying spaghetti monster are almost all these BSL4 facilities located in high population areas. Surely public safety is more in important than convenience. CDC should be in the middle of nowhere surrounded by walls and a fence guarded by our meanest dudes and dudettes. Not in the middle of Atlanta surrounded by six million guinea pi…I mean people.
    Maybe they’ll see the madness of this one day. We used to smoke too, now not so much.

    1. Angora Rabbit says:

      Sadly, it’s the reality that people prefer to work not in the middle of “nowhere.” Although your definition and mine of “nowhere” may differ. Plum Island off NY hosts APHIS, deliberately selected because it is an island. But the workers complained vociferously about the commute across the water to work in the labs. There was a bid process a few years back for a new quarantine facility, and last I heard it was going (IIRC) to Kansas* or some such because the employees were dead-set against traveling to the island, even though renovation of the current facility was cost-effective. I don’t know the current status of all this – only followed it because my institution was one of the early finalists.

      *With attendant complaints of why would one work with animal pathogens in the heart of farming country? Maybe in that instance APHIS is better off in Manhattan?

      1. Sawyer says:

        I think you’re only scratching the surface of why David’s plan would never work. Talk to literally any HR person that works for a company with over 5000 employees. Most of them will start laughing when you tell them to A) hire competent, hard-working employees and B) convince them to live 200 miles away from a major city. There are a few large companies that have pulled this off, but there’s a big difference between a BSL4 lab and Wal-mart headquarters

        Doctors, engineers, accountants, managers, economists, city planners, and investors have been looking at for decades. If it made sense to build hospitals and research labs in the middle of nowhere, we’d be doing it already. You would need to completely reinvent our economy and workforce to pull this off.

        1. David Hudson says:

          Astronomers do it all time. They seem to be ok going where the science is. I have to feel that researchers in Biology would feel the same way.
          The whole thing wouldn’t have to be there just the very dangerous parts.
          High explosive research isn’t conducted in the middle of cities either.

          1. KayMarie says:

            One other thing to add to the equation is what kind of infrastructure do you need to support the work. Can you have adequate power, water, sewage treatment, etc out in the middle of nowhere. Can you have enough people with specialized skills just sitting around doing nothing 95% of the time and how good will those skills remain compared to having them in a level one trauma center having to use their skills day in and day out.

            Some science can basically be done in isolation with a back up generator and very little need for complex waste management and other systems that all need highly skilled people to maintain.

            So in addition to the HR issues there can be issues of how many people you gotta drag out there and how often do you need those skills and what additional infrastructure do you need to build besides just the isolation unit to have it actually work.

            1. Angora Rabbit says:

              Sorry – I was being semi-facetious about Mayo. I live not so far from there and in my opinion it’s definitely not nowhere – in fact, the Mississippi bluffs are a favored vacation site and I’d be hard-pressed to leave.

              I was dissing (badly) the amazingly provincial attitudes of “coasters”, which is I guess is good for the rest of us since they will never be our neighbors. When I moved from Boston back to the Midwest, my deptal admin was horrified that I could leave. Sarcastically I pointed out that we now have flush toilets, and I’m pretty sure she missed the sarcasm.

          2. Angora Rabbit says:

            Good example – Mayo Clinic in Rochester, MN.

            Personally, I spent 3yrs at Harvard Med and I was sooo happy to leave the big city. Ugh. I’m happiest in the middle of what some people call “nowhere.”

            When Mario Capecchi moved to Utah, his colleagues teased him about moving to “no where”. His response was “You can do good science anywhere” and his Nobel proved him right.

            1. Chris says:

              I have not caught up on the thread, but I noticed this on the comment feed: “Good example – Mayo Clinic in Rochester, MN.”

              As a parent of someone who had to go there for a specific type of surgery, that is a very weird place. Yes, it is in the middle of nowhere, but it is full of lots and lots of highly trained professionals. Plus patients from around this planet, along with low income folks from the area who benefit from its social workers (which we learned about when we helped a woman load her things from the Mayo shuttle where we met her to the Mayo provided temporary apartment next to our hotel because she had been discharged from the downtown hospital after her emergency surgery).

              It even has its own travel agency… a tiny hard to find windowless office on a twisty odd hallway with two very overworked but extremely patient women.

              1. David Gorski says:

                The Mayo Clinic isn’t exactly in the middle of nowhere.

                I would concede, however, that Rochester, MN, where the Mayo Clinic is located, is in the middle of nowhere, but Rochester is Minnesota’s third largest city, with over 100,000 people in the city itself and a metro area with over 200,000 people:

                http://en.wikipedia.org/wiki/Rochester,_Minnesota

                Still, if you like a medium-sized city and don’t mind having to drive a long way to get to a major city, you can have a nice, civilized life in Rochester. Coupled with the prestige of the Mayo Clinic, that’s more than enough attraction; that is, if you can handle the brutal winters.

          3. WilliamLawrenceUtridge says:

            Astronomers’ work is interfered with by light pollution from cities. High explosive research would, of necessity, disrupt the functioning of a wide area on a regular basis. And the people working at these labs aren’t just highly motivated scientists. Also needs janitors, admin assistants, students, accountants, HR people, etc. And even highly motivated scientists have to commute to work. There’s a reason we laud those people willing to work for three days straight for the love of science – they are rare.

  29. RobLL says:

    I have not found a source for what percent of those exposed to these viruses actually get sick. Isn’t it likely that a certain percent are somehow naturally immune?

    1. sciencejaney says:

      We-ell, there is no ethical way for sure to innoculate people with Ebola to get a guaranteed scientific assessment of transmission rates….

      …though this study of the 1995 outbreak shows that Of 173 household contacts of the primary cases, 28 (16%) developed EHF.

      “The surviving members of 27 households in which someone had been infected with Ebola virus were interviewed in order to define the modes of transmission of Ebola hemorrhagic fever (EHF). Of 173 household contacts of the primary cases, 28 (16%) developed EHF. All secondary cases had direct physical contact with the ill person (rate ratio [RR], undefined; P < .001), and among those with direct contact, exposure to body fluids conferred additional risk (RR, 3.6; 95% confidence interval [CI], 1.9-6.8). After adjusting for direct contact and exposure to body fluids, adult family members, those who touched the cadaver, and those who were exposed during the late hospital phase were at additional risk. None of the 78 household members who had no physical contact with the case during the clinical illness were infected (upper 95% CI, 4%). EHF is transmitted principally by direct physical contact with an ill person or their body fluids during the later stages of illness.

    2. sciencejaney says:

      We-ell, there is no ethical way for sure to innoculate people with Ebola to get a guaranteed scientific assessment of transmission rates….

      …though this study of the 1995 outbreak shows that Of 173 household contacts of the primary cases, 28 (16%) developed EHF.
      http://www.ncbi.nlm.nih.gov/pubmed/9988169
      “The surviving members of 27 households in which someone had been infected with Ebola virus were interviewed in order to define the modes of transmission of Ebola hemorrhagic fever (EHF). Of 173 household contacts of the primary cases, 28 (16%) developed EHF. All secondary cases had direct physical contact with the ill person (rate ratio [RR], undefined; P < .001), and among those with direct contact, exposure to body fluids conferred additional risk (RR, 3.6; 95% confidence interval [CI], 1.9-6.8). After adjusting for direct contact and exposure to body fluids, adult family members, those who touched the cadaver, and those who were exposed during the late hospital phase were at additional risk. None of the 78 household members who had no physical contact with the case during the clinical illness were infected (upper 95% CI, 4%). EHF is transmitted principally by direct physical contact with an ill person or their body fluids during the later stages of illness.

      1. RobLL says:

        Thanks for the reply. It doesn’t tell a lot, but perhaps more than nothing. Of the 95 who contacted the case 28 developed the disease, 67 did not – but of course they may not have picked up any virus . The 78 who did not contact the case did not develop the disease.

  30. Michael Busch says:

    ” One also notes that the CDC has stocks of the virus, which it studies, which means that Ebola virus is already on US soil”

    Along with a few other labs that work with active virus and more that work with inactive samples, correct?

    And if you were so inclined, you could pull one of the publicly-available genomes of various filovirus strains: http://www.ncbi.nlm.nih.gov/genomes/GenomesGroup.cgi?taxid=11266 , and place an order for that sequence from various commercial synthesis companies. Fortunately, regulatory controls on the DNA/RNA synthesis industry apparently are good enough that if you did so you’d be asked a very large number of extremely pointed questions

  31. Peter S says:

    Kelly and Nate Bailey: is it any surprise?

    “Nate

    I come from a family of chiropractors. There are 8 in my family and my parents are two of them! So, natural health care is not a foreign concept to me.”

  32. Peter S says:

    The Health Ranger is right on top of it. I am sure this would be effective treatment.

    “To my knowledge, there are no known natural cures for Ebola, but because it is an immunosuppressive disease, it makes sense to follow many of the same rules you’d follow for other viral infections: stay fully hydrated, boost your vitamin D blood levels, get plenty of rest and don’t stress yourself.”

    Learn more: http://www.naturalnews.com/046260_Ebola_natural_cures_medicinal_herbs.html#ixzz39TQIHHS8

    1. Frederick says:

      Just a small tips, link bad science website using http://www.donotlink.com, So people can click on them without increasing the “ranking” of garbage web site like http://www.Mikey‘s BS.com. Each time a skeptic goes directly there to see what’s going on, he increase his hit, and his ranking on searchs engine. We do not want that. :)

    2. WilliamLawrenceUtridge says:

      The Health Ranger is right on top of it. I am sure this would be effective treatment.

      “To my knowledge, there are no known natural cures for Ebola, but because it is an immunosuppressive disease, it makes sense to follow many of the same rules you’d follow for other viral infections: stay fully hydrated, boost your vitamin D blood levels, get plenty of rest and don’t stress yourself.”

      Because if there is anything that Africans are low in, it’s vitamin D. Because of the extensive number of cloudy days.

  33. Cancerkiller says:

    Relax, everybody! Science can not kill Ebola Virus, but I can. Ebola virus disease is not a problem at all – everybody can be his own Jesus – by doing the Personal Virus/Cancer Killer – those infected will be cured and will join all the rest in staying absolutely healthy all the time – by doing just an exercise for a minute a day for prevention and for 3 minute a day for the cure – any infections (Ebola, West Nile, Colds, Flues, HIV-AIDS, Tuberculosis, Malaria, Yellow Fever, etc.), are cured for max. 7 days and any cancers (Leukemia, Breast, Cervical, Ovarian, Bone, Brain, etc.), Diabetes and Strokes – for max. 30 days – no metastases or recurrences of any cancers are at all possible – any bio-terrorist bugs are killed the moment they touch us.
    I leave it to everybody to estimate how much the greatest discovery in more than 2 million years of humankind on the planet should be paid for. Then I will disclose the Personal Virus/Cancer Killer to everybody on Earth. That will keep all the people absolutely healthy all the time, all their lives – never getting sick of any diseases even for a second.

    1. KayMarie says:

      I say $2.95, don’t spend it all in one place.

      1. mouse says:

        I read cancerkillers whole comment waiting for a punch line. It took me several minutes to think…what, really? This isn’t a spoof?

        No, come on – “everyone can be their own Jesus” – That’s brilliant satire.

        1. KayMarie says:

          I googled and she/he/it/they have posted this on other blogs and such talking about Ebola. Here she/he/it/they is letting us decide but apparently everywhere else the ransom on this wonderful knowledge is $50 billion.

          Can anyone remind me of where in the bible Jesus (personal or otherwise) demanded to become #8 or so richest person in the world?

          1. mouse says:

            $50 billion? The funny thing is that greedy scam artists usually manage to tell people where to send the checks (don’t they?). So either a satire, an incompetent greedy person, someone using mystery(tm) in an attempt at a viral promotion of some sort, possibly a delusion.

            It sounds like the health version of Bob Dobbs and the Church of the Subgenius. I kinda love it as a satire.

            1. KayMarie says:

              And that may be a bargin, I found some payments requested in the trillions.

              And this lovely exchange between what appears to be this guy and someone who can cure you in even less time. http://bit.ly/1kkRUPL

              1. mouse says:

                Oh
                my
                god
                (slap face)

          2. Windriven says:

            @mouse and KayMarie

            This has to be satire.

            1. KayMarie says:

              I hope so, especially the who can cure all diseases in all humans the fastest exchange in the comment section I linked above.

            2. David Gorski says:

              I don’t think it is. I’ve seen this one before.

        2. Frederick says:

          Personal jesus? lol A great song, Both the original, and the Marilyn Manson version

          1. Windriven says:

            Check out “sweet butter jesus” on Youtube. It’ll make you smile.

          2. Windriven says:

            Correction, Frederick. It is “Sweet Butter Jesus.”

            1. Windriven says:

              Goddamit! Big Butter Jesus.

              1. Frederick says:

                LOLOL 3rd time’s the charm. I’ll check that out

              2. Frederick says:

                LOL funny song, that Statues really has really burned down?
                now it is steel frame jesus

            2. Windriven says:

              “LOL funny song, that Statues really has really burned down?
              now it is steel frame jesus”

              The new one is a butter Jesus built to last ;-)

              1. Frederick says:

                Solid Rock 50 foot tall Jebus! At least it is less creepy than the first one, which looked, to me, more like a zombie getting out of the ground than a touchdown Jesus.

  34. Paul Avlo says:

    Dr Cathcart has passed on as has Dr Klenner, but their research is genuine not quackery. It is Big Pharma that keeps the use of Vit C for infectious diseases out of the medical schools.

    1. Windriven says:

      Yeah, it is all a conspiracy. Thank dog we have canaries like you to sound the alarm.

    2. Frederick says:

      Since it is Big pharma and big chemicals that sells Vit C supplement, and it is easy to produce at low cost, (no research is needed on how to make it, it as been done long ago) If it could cure as much diseases as some think it can, Don’t you think they would cash in on that? The supplement industries make billions of dollars just selling them for people who use Vitamin “just in case”, so if people could take them to heal disease, In Quebecois I will Say “Ils en vendraient en TABARNAK” ( notice the swear here, that i won’t redacte, because most of you don’t get it lol), which transalt, The would sell those a Sh** load of them, making more money. So on the contrary, the would have big interest if the cure was so simple.

    3. David Gorski says:

      Dr Cathcart has passed on as has Dr Klenner, but their research is genuine not quackery.

      I beg to differ.

      1. Interrobang says:

        Is it just me, or would having a vitamin C IV hurt like blazes? I mean, I’m basically ignorant when it comes to that sort of thing, but it seems like it should.

    4. Angora Rabbit says:

      SInce Vit C isn’t patentable, your argument is vacuous. What keeps superpharmacologicalcalogisticexpialodocious doses of VC out of infectious diseases is Lack of Efficacy.

      Not that it has occurred to you that s…docious VC is contraindicated for infectious disease, because it interrupts the function of all that good peroxide and superoxide that your immune system is making to Kill the Pathogen.

      You feel better when you take VC for an infection, not because it is antiinfective (that would be Vit A, darlin’) but because it blunts your synthesis of all those good anti-infective compounds that would normally kill the pathogen, but have the side effect of making you feel better. Thus you are only Pretend Better, not Really Better.

      But, hey, why let reality get in the way of a good argument? Go ahead and do this if you like, but please stay home anyway so that you don’t infect the rest of us.

      1. John Truth says:

        Lack of efficacy? So it has been tested on Ebola? Do you have a reference to this trial, it would save a lot of time if your could provide a link, I can’t find one.

        1. Jopari says:

          Since what she says applies to the immune system, I honestly have no idea why you would need to test it on Ebola, since it is not what is affected.

        2. WilliamLawrenceUtridge says:

          Lack of efficacy? So it has been tested on Ebola?

          Certainly a lack of reason to consider it possibly efficacious, we know how vitamin C interacts with the rest of the body.

          But your implied argument can be turned to nearly anything. Does water cure Ebola? Does fire? Colloid iron? Methylated alcohol? Massive decompression? High-altitude bombing? Why should we believe that vitamin C magically cures Ebola just because it is an essential nutrient? It’s not like Ebola causes vitamin C deficiency, unless you’ve got some evidence there champ.

    5. WilliamLawrenceUtridge says:

      Dr Cathcart has passed on as has Dr Klenner, but their research is genuine not quackery.

      That’s funny, because if I look up either of those on pubmed paired with “Ebola”, I get no results.

      It is Big Pharma that keeps the use of Vit C for infectious diseases out of the medical schools.

      Why would Big Pharma do this? They sell vitamin C, if high-dose vitamin C were proven to cure Ebola they could make a ton of money. A hell of a lot cheaper and easier than testing a vaccine or producing purified monoclonal antibodies.

      I’m pretty sure vitamin C is in medical schools, both literally (they probably have fruit there) and metaphorically (nutrition, and particularly the molecular pathways followed by vitamin C as it mops up free radicals and promotes the regeneration of proteinaceous tissues.

      Keep trying though, maybe one day you’ll hit on a conspiracy theory that makes sense.

  35. Peter S says:

    Selenium, too, can cure ebola, it turns out.

    http://drsircus.com/medicine/ebola-saving-lives-natural-allopathic-medicine

    Is Dr. Sircus actually a doctor. Sorry, that would be no. He is according to his website an acupuncturist and “doctor of oriental and pastoral medicine.”

    1. David Gorski says:

      Of course it can. EVERYTHING “natural” can cure Ebola, if you believe the quacks.

    2. Frederick says:

      Selenium? Is this the stuff with what they kill a giant Alien Cell ( well with head and shoulders shampoo) in Dan Aykroyd movies “evolution” ?

      So it must kill virus too, it is in a movie!

  36. Bo Gardiner says:

    What a great resource this post is, Steven. A lot of effort went into it, and it’s much appreciated. It will be extremely helpful to me.

    1. Bo Gardiner says:

      Oops, I mean David.

  37. Kaylee says:

    Great piece, with which I agree 99%. ;)

    My only concern is that perpetuating the comparison with AIDS could cause people to react in two unfortunate ways:

    1. Family or friends could have a false sense of security and thus be lax in their precautions. (Note the man who died in Nigeria could have easily not become ill until after he arrived here at home, in Minneapolis.)

    2. I think even people who have not read the details of transmission at the CDC can see that it’s more easily spread, which makes them feel less trusting of the entire message… And messengers. This only adds to the hysteria.

    Because of these things, I don’t see a benefit in downplaying the need to observe a few extra precautions, such as avoiding coughs and sneezes, as well as more careful hand and surface hygiene.

    1. WilliamLawrenceUtridge says:

      Seeing as most of the people reading this aren’t actually coming in contact with Ebola, it’s a bit of a moot point. Most of the people actually at risk of Ebola infection probably have a lot more information and guidance than given here.

  38. John Peter says:

    I have not found a supply for what % of these exposed to those viruses truly get sick

    1. Jopari says:

      It is highly unethical to expose people to virulent and lethal viruses, so likely you’ll continue to draw blanks.

  39. Renate says:

    I can remember seeing Donald Trump in Orange County Choppers, ordering a chopper. The end result was butt ugly and it’s only purpose seemed to be, to scream: “Look at me I’m really, really rich.” Which painted a perfect picture of Donald Trump.

  40. Jackie T. McCraw says:

    On a long enough timeline, the survival rate for everyone who trusts doctors drops to zero.

    1. David Gorski says:

      On a long enough timeline, the survival curve for everyone who DOESN’T trust doctors approaches zero. The question is, which curve approaches zero faster?

    2. Jopari says:

      And what is your inference from this Jackie?

    3. Angora Rabbit says:

      Exactly. This is because death is inherited. In fact, it has 100% penetrance.

      Eastern J, Drucker C, Wolf JE, from Baylor College of Medicine, no less. Journal of Irreproducible Results.

      1. MadisonMD says:

        Thanks, AR:

        Variation in death rates in different epidemiologic studies has long been a source of controversy, with prominent authorities hypothesizing that differences in disease incidence or case-fatality rates were responsible. A careful review has led us to an alternative explanation: differential case ascertainment bias, owing to discrepant methods of case definition and ascertainment. For example, close scrutiny of the methods used in the National Death Interview Survey[1] suggests that the investigators obtained low death rates because they ascertained death by structured interview (“Are you dead?”) and excluded non-responders from the analysis.

        This whole study is worth a read: pdf here.

        1. Windriven says:

          That is the funniest thing I have read in a very long time. :-)

        2. David Gorski says:

          Oh, that’s awesome.

        3. brewandferment says:

          the list of references was the best part

    4. WilliamLawrenceUtridge says:

      On a long enough timeline, the survival rate for everyone who trusts doctors drops to zero.

      Sure, they just die a lot later than people who trust naturopaths, chiropractors, acupuncturists, homeopaths, herbalists and vitamin quacks.

      Everyone dies. You die a lot quicker without the intervention of real medicine.

  41. worriedbutrational says:

    Dr Gorski, thank you for an informative piece. I have four questions and two comments: (1) does the advice that the virus to difficult to transmit depend on the view that “people are only contagious once symptoms” appear, and if so, how good is the science on that? Aren’t most viruses infective when the host is asymptomatic? (2) does ordinary handwashing kill the virus, assuming small quantities? (3) where do you stand whether the current virus — not some future mutated virus — is transmissible through the air? (4) If it takes only a small number of virus particles to infect, and viruses can live on surfaces for several days, and mucus membranes are ports of entry — then isn’t there a scenario where given enough infected individuals, it begins to spread in crowded conditions (think the NYC subway system, where you are in contact with sweat from the hands of others on the famous strap-hangers and poles) since people do rub their eyes and put their fingers in their mouth?
    Comments: (1) Why spend so much valuable time/effort/knowledge on the homeopaths? You are squashing moths with bricks. (2) I thought your jokes about Trump’s hair undermined the persuasiveness of your argument. The best way to restore rationality is to be calm and not show personal animus (annoying) as Trump can be). And didnt Einstein, for example, have weird or perhaps “bad” hair, without affecting his scientific genius?
    Again, thanks for the article.

    1. WilliamLawrenceUtridge says:

      1) It depends on how the virus is spread; influenza is spread by sneezing, norovirus by projectile vomiting and diarrhea. They drift through the air. Ebola does not.

      2) I don’t think handwashing ever kills viruses and bacteria, I think it physically disrupts their attachment to the skin (i.e. they get washed off).

      3) Evidence suggests that Ebola is not transmissible via the air; blood or other fluids are required. Only tentative animal studies in lab conditions have shown some evidence.

      4) Sure, theoretically – assuming someone made it from Africa where Ebola is now spreading, then managed to make it to somewhere with a subway without knowing about the outbreak or showing symptoms, then they take a bunch of sweaty subway trips, then a bunch of people lick their hands after touching subway poles. It’s considered pretty unlikely.

      As for your comments, I can’t claim to speak with him, but I would guess Dr. Gorski’s reply would be “feel free to start your own blog and write about whatever you want, using whatever style you want.”

      I’ll add Trump is a douche and should be mocked as often as possible. His hair looks like orange fungus.

  42. Jason says:

    Thank you very much Dr. Gorski. I’m not going to lie, I have been freaking out a little about this Ebola thing too because the media has hyped it way up. Thank you for giving us a science based run down on what Ebola is and isn’t and restoring clarity and sanity back to my life. I appreciate all the work you and the other Doctors do to give us information we can trust.

  43. bill hughes says:

    How silly. An outbreak here is next to impossible because why? Superior medical care? There isn’t a hospital in the US that has been able to contain a staphylococcus infection. Were now to believe that the one virus that routinely kills abroad somehow looses strength once it crosses the Atlantic?

    The WHOs and CDC guidelines both state that infected patients should be isolated as quickly and absolutely as possible. I’m pretty sure that meant the wheeling in of two Ebola sick patients through the FRONT DOOR of a large COMMUNITY HOSPITAL, which is in the sixth largest city in America is not what they meant. At least, they should have been put in isolation on a military ship off shore. Or put them in the isolation suites at Fort Derrick. Those guys are pros at highly infectious agents since they grew them and or cooked them for almost 40 years before they were outlawed. Now Fort Deitrick is THE defacto research facility with the experience and tools to properly handle level 4 disease. But no… Were so hell bent on saying it is only a problem in Africa by walking them into a community hospital where half of the staff supporting them are interns with ZERO experience in keeping such a bug completely contained.

    OK… So call me crazy and a quack for believing that there is a significant risk there. How about all of the people who have gone through the hot zones and come to America? How many people have they come into contact with? Yeah yeah…I know you have to bathe in the blood and fecal matter of an Ebola victim to get sick. That’s why over a so many doctors in this outbreak have gotten sick, despite using the same protections that have been used in the past while working in a Level 4 zone in the field.

    It is also interesting that both the CDC and WHO warn of the virus being transmitted like the flu when a sick patient coughs. They both also warn that ebola can remain alive outside the body, on surfaces at room temperature for many hours. Additionally, they warn that it has been found in the skin before the more severe bleeding symptoms appear. So the sweat and cough that we don’t pay much attention too is a highly viable mode of transmission.

    But we are to believe now that the CDC and WHO are fear mongering quacks?

    1. Windriven says:

      “There isn’t a hospital in the US that has been able to contain a staphylococcus infection. ”

      Are you drunk or stupid? Hospitals routinely manage serious infectious agents quite well. Staph, strep, TB.

      “It is also interesting that both the CDC and WHO warn of the virus being transmitted like the flu when a sick patient coughs.”

      Do you have citations for this? My understanding is that transmission by aerosols is considered theoretically possible but has never been demonstrated.

      1. Sawyer says:

        Gosh Windriven, you are so ignorant. All doctors in the US make out with their patients during between rounds. I saw it once on an episode of Grey’s Anatomy, so it must be true. Don’t you know anything?!?!

        1. Windriven says:

          I don’t want to make out with Gregory House. Meredith Grey either. Am I alone in thinking the woman who plays her can’t act? Now Sandra Oh … :-)

    2. Sawyer says:

      You’ve crammed an incredible amount of misinformation into such a small space so there’s no way anyone can possibly address it all. Many of the readers here are probably not 100% on board with Dr. Gorski’s take on the issue, but if you want to get more people in the “keep ebola out of the US” camp, this was an incredibly stupid way to do it.

      Just to highlight the most glaring mistake – you really can’t think of ANY reasons why doctors (even with proper training and medical supplies) might have higher risk of contracting Ebola in Sierra Leone than in the United States? Seriously? I have practically zero medical expertise compared to everyone else here, but I can come up with a half-dozen factors that will all drastically reduce the likelihood of an outbreak starting in Atlanta.

    3. Max says:

      Yes, Fort Detrick, the origin of Amerithrax (a.k.a. the 2001 anthrax attacks).

    4. WilliamLawrenceUtridge says:

      There isn’t a hospital in the US that has been able to contain a staphylococcus infection.

      Look, just because they’re both small doesn’t mean they’re the same. One is a virus, one is a bacteria. You’re not comparing apples and oranges, you’re comparing blue whales and button mushrooms. The two are from totally different kingdoms.

      Were now to believe that the one virus that routinely kills abroad somehow looses strength once it crosses the Atlantic?

      Did you read the article? How many times have I had to type that out. The issue isn’t that the virus isn’t deadly – it is. The issue is that the virus isn’t particularly infective without pretty specific circumstances – notably those surrounding the funeral rites of the region in question.

      The WHOs and CDC guidelines both state that infected patients should be isolated as quickly and absolutely as possible. I’m pretty sure that meant the wheeling in of two Ebola sick patients through the FRONT DOOR of a large COMMUNITY HOSPITAL, which is in the sixth largest city in America is not what they meant.

      Because you, internet commentor, knows better than the CDC and the infectious disease staff? Quarantine guidelines exist because of severity, not infectivity.

      At least, they should have been put in isolation on a military ship off shore.

      You learned that in med school, where you also learned about the transmission methods of Ebola?

      Now Fort Deitrick is THE defacto research facility with the experience and tools to properly handle level 4 disease.

      Here’s a tip champ, there’s a difference between researching a disease and treating it. For the same reason you don’t ask the guy who manufactures the car to also repair it.

      Were so hell bent on saying it is only a problem in Africa by walking them into a community hospital where half of the staff supporting them are interns with ZERO experience in keeping such a bug completely contained.

      Fortunately they are trained in containing other, even more infectious diseases. Also, maybe they’ll put their A-team on it, y’think? Maybe they won’t just hand the keys to the janitor and say “do what feels right.”

      OK… So call me crazy and a quack for believing that there is a significant risk there.

      Less crazy and quacky, more ignorant and arrogant. Why do you think you’re smarter than actual infectious disease and public health experts?

      That’s why over a so many doctors in this outbreak have gotten sick, despite using the same protections that have been used in the past while working in a Level 4 zone in the field.

      Sorry, you left a curious ellipsis there where you were going to say how many doctors have gotten sick. I’m aware of…two. Are there more?

      It is also interesting that both the CDC and WHO warn of the virus being transmitted like the flu when a sick patient coughs. They both also warn that ebola can remain alive outside the body, on surfaces at room temperature for many hours. Additionally, they warn that it has been found in the skin before the more severe bleeding symptoms appear. So the sweat and cough that we don’t pay much attention too is a highly viable mode of transmission.

      But we are to believe now that the CDC and WHO are fear mongering quacks?

      You might be. There’s a difference between “could be” and “is the primary means of transmission”. You basically can’t stop viruses spread by aerosol without an extensive infrastructure of prophylactic vaccination. Not an issue with Ebola.

  44. suzie wong says:

    I am not a fan of Mr. Trump nor am I a doctor but I agree with Mr. Trump. We do not know what ebola can or can not do. It is very clear that common sense is used. Keep the ill where they are at and give them the highest of medical care with out even a chance that it could be transferred to the U.S. or any other country. I know this is not a popular view but it is the best and safest way NOT to spread the illness.

    P.S. Any news on the Doctor’s family that flew back to the U.S.? Common sense again, they can very likely be carriers as well as all the people that were on that plane. If the people and their families scheduled to be on that plan with that doctors family were told who they would be flying with, does anyone think that they all would just take their sets on that flight or wait for another flight not risking ebola? Be truthful with yourself.

    1. Sawyer says:

      “Be truthful with yourself.”

      I give money every year to MSF because I place a tremendous amount of trust in their abilities to help the needy and follow safe, science-based practices in medicine. I visit this and several other infectious disease websites on a regular basis because I respect the expertise of people that write for them. If everyone that I trust and respect is coming to the same conclusions about how to combat ebola and save the maximum number of lives, then hell yes I would listen to them.

      I’d happily endure the miniscule odds of contracting ebola on a plane to double another person’s odds of survival. I question the morality (or the medical knowledge) of others that wouldn’t do the same.

    2. WilliamLawrenceUtridge says:

      We do not know what ebola can or can not do.

      We do know a pretty substantial amount about ebola.

      It is very clear that common sense is used. Keep the ill where they are at and give them the highest of medical care with out even a chance that it could be transferred to the U.S. or any other country. I know this is not a popular view but it is the best and safest way NOT to spread the illness.

      I’ll be really happy when this dies down. Look, the fear you feel about Ebola is disproportionate to it’s actual danger. It’s highly lethal and dramatically so, but despite that the number of deaths are many orders of magnitude lower than malaria. Are you afraid of malaria? And I wonder if you’d be similarly sanguine about keeping the sick where they are if you were the one with Ebola who could quadruple your chances of survival with care in the US.

      .S. Any news on the Doctor’s family that flew back to the U.S.? Common sense again, they can very likely be carriers as well as all the people that were on that plane. If the people and their families scheduled to be on that plan with that doctors family were told who they would be flying with, does anyone think that they all would just take their sets on that flight or wait for another flight not risking ebola? Be truthful with yourself.

      Take your own advice – realize that you don’t know much about Ebola, far less than the people actually making decisions about preventing and treating Ebola. “Common sense” when you have minimal knowledge about the topic will get you to the wrong place. Common sense says the earth is flat, it takes a fair amount of math to suss out it’s true dimensions. Common sense says the sun revolves around the earth, it takes a fair amount of observation to reveal the first hints of a problem with that.

      “Common sense” is another name for the Dunning-Kruger effect. Look it up.

  45. Mark W says:

    Some doctors fear watching to much coercive persuasion could mutate critical thinking and spread totalitarianism.

    1. Windriven says:

      @Mini-Mark

      “Some doctors fear watching to (sic) much coercive persuasion could mutate critical thinking and spread totalitarianism.”

      Huh? Your comment appears out of thin air with no apparent link to anything in the post or subsequent commentary. To what coercive persuasion do you refer?

    2. WilliamLawrenceUtridge says:

      Some doctors fear watching to much coercive persuasion could mutate critical thinking and spread totalitarianism.

      Even more paranoid militia nutjobs think this. So far they’ve been wrong.

      Many times fears don’t come true, particularly when they revolve around curiously unlikely plots about “taking away our freedom”. To what end incidentally?

  46. Max says:

    We have top men working on it right now.
    What, no mention of the recently exposed (no pun intended) CDC mishandling of bird flu and anthrax?
    “The CDC disclosed the bird flu incident as part of an internal investigation into the agency’s mishandling of live anthrax in June, potentially exposing dozens of its own lab workers to the pathogen.”

    Dr. Kent Brantly reportedly caught Ebola despite following strict protocols.
    NPR reported, “Samaritan’s Purse is working with the WHO and the CDC to identify the source of contamination at the ward, says the group’s spokesperson, Melissa Strickland.
    Brantly was working with nearly two dozen Ebola patients, but Strickland says he followed strict protocols. He covered every inch of his body before entering the Ebola ward in a protective suit.”

    Does Emory University have as many safety measures as Biosafety level 4 labs that handle Ebola? Multiple showers, an ultraviolet light room, negatively pressurized facilities?

    1. WilliamLawrenceUtridge says:

      The reason why bird flu is scary is because it is influenza. Influenza is strongly transmissible through respiration. Ebola is not. Ebola is cat 4 because it’s really, really deadly; bird flu is cat 4 because it is really, really infectious (and more deadly than most types of regular flu).

      But hey, if what you’re saying is we shouldn’t research infectious diseases, you’re basically saying we should never, ever learn anything new about deadly diseases. If you think about that for a second, you’ll figure out the flaw in your plan.

      1. Sawyer says:

        But hey, if what you’re saying is we shouldn’t research infectious diseases, you’re basically saying we should never, ever learn anything new about deadly diseases.

        This topic has been brought up on the TWiV podcast almost every week for the past few months. I still haven’t entirely made up my mind about whether current safety protocols in BSL4s are sufficient, but it’s become very clear that the people that work at these facilities are genuinely interested in an honest conversation about risk versus benefit. The people fighting have zero interest in this conversation.

        I have yet to see the problem WLU brought up even *acknowledged* by most of the fear-mongers, let alone answered.

    2. KayMarie says:

      http://gizmodo.com/what-an-isolation-ward-for-u-s-ebola-patients-is-like-1616033868 is a discussion of the isolation ward at Emory.

      You really think they just brought them back to some hospital without special isolation wards?

      Hopefully you aren’t convinced they brought them back in order to kill us all so of course they wouldn’t use a hospital with additional precautions.

  47. Todd Millions says:

    You had a good argument till you mentioned US Military and competence without negating qualifier or implied drollery.D.Trump notwithstanding.
    In fact I have treated mystery viral infections in the bush with Vit C,and no sign of bowel eruptions were observed at doses well above when I normally get them,as well as the persistant symptoms quickly clearing up. Others presenting same symptoms and not given the vit C ,were looking at surgery-Till I clued in a local doctor who ask me not to tell anyone he used vitiamin theraphy,for his own treatments. Given the inherently contaminated nature of modern vaccines and serums(publicly owned labs were set up to produce better and adequate grades of vaccines BEFORE WW1.),I think Dr Cathcart’s reccomendations (he noticed the increase in bowel tolerance when sick years before I did.) on Vit C should be given more weight-with a coulpe qualifiers;
    1-Taper off from high dose slowly.At 10gram per day,I reduce dose over a week.Over this,longer is vital.
    2-Quality and contamination of the ascorbic acid stocks-This has become serious,GMO and herbiside residues are producing toxins in the conversion products that aren’t being tested for(so no problems can be detected)-Add to this the contaminated additives to the tablets-Bt cotton cellulose ,clorinated sugar incecticides ect.
    Of course the military is mad to gather victums as sources for officially none existant biowar programs,they will with or with out humanitarian camo but with Hillary making a presidential rum I would trottle this-She lubricates as the kill count goes up.
    Cheers Todd Millions

    1. WilliamLawrenceUtridge says:

      One should generally avoid giving medical advice on the internet.

      When one is a patent loon who believes vitamin C is magic, one should really avoid giving advice on the internet.

      Vitamin C doesn’t cure cancer, and claiming it does, does not make it so.

      Adding the gloss of “teh militareh wurnts teh tek away our guuuunnnnsssss andkilluswthantrhax” really doesn’t help your credibility. Spend a lot of time listening to Mike Adams? Do you buy all of his recommended products right from the store? Don’t you know that the military tracks every package that comes out of his warehouses, so they can eliminate the smart ones first? You should be more careful, your IP address is probably being monitored by Bill Gates nanobots because lizards rule the world Bilderberg Group Jews Moon Landing Black Helicopters!

  48. John Truth says:

    Before trash talking vitamin C therapy you should read “Curing the incurable” by Thomas Levy. It documents high dose vitamin C used to successfully treat numerous viral infections including polio.

    As for you dismissal of the idea that a condition that clearly causes the destruction of blood vessels would not benefit from vitamin c. Vitamin C which is needed to make collagen which is the protein that provides blood vessels with their strength.

    Can you cite any studies to back up your conclusion. I looked but nothing about testing Ebola patients for scurvy or treating people for it. So how do you know? This site is called science based medicine, so where is the science?

    Sounding condescending is no substitute for hard science, so what have you got?

    Vitamin C is a universally kills all viruses in vitro. Has Ebola been tested? I can’t find a study can you?

    1. KayMarie says:

      Lots of things kill viruses on a petri plate, doesn’t mean all are effective or safe medications. I wouldn’t drink hospital disinfectant because it universally kills viruses (or at least most of them, very few things are universal as nature usually finds a way to get something to not go with the program)

      It actually takes a fair amount work to give yourself scurvy, and high dose vitamin C therapy is not needed to treat scurvy. We had a kid at one university that managed to get scurvy because he decided when he moved out of the house to avoid all fruits and vegetables completely as he hated how Mom made him eat them. He didn’t need super high mega doses of vitamin C to treat what months and months of no vitamin C caused. Just have a small glass of OJ with his McDonald’s breakfast on a semi-regular basis.

      Do we have any evidence anyone ever got scurvy bad enough to bleed out the way Ebola victims do?

      I mean why not pick any other random viral treatment to promote and say it must work for Ebola? Or why not pick any other random thing that increases bleeding and say that is what needs to be treated?

    2. simba says:

      I can play this game too: “Iron is involved in blood somehow so if I give someone iron, that can prevent bleeding!”

      “I looked but nothing about testing Ebola patients for scurvy or treating people for it. So how do you know? This site is called science based medicine, so where is the science?”

      Do you really think that you are supporting your position by outright stating you have absolutely no evidence for it? “I have no good reason to think this thing is true, so clearly your attitude of scepticism towards it is unwarranted.”

      Why is your position (vitamin C cures all viral diseases ) any better supported than the thousands of other beliefs people hold for similar reasons (rope worms, homeopathy, rub a toad on it and it will get better, magic trees)?

      A book documenting numerous cases of patients who were treated with something and got better is not good evidence. If it was we would still be bloodletting and eating Lydia Pinkerton’s vegetable pills. You need to have an actual randomized controlled trial, a well-documented and plausible correlation, heck, even a good solid well-supported case series could be useful.

    3. WilliamLawrenceUtridge says:

      Oh look, proof that the use of “Truth” in a user name is evidence of being a loon.

      Look, Levy is a loon. He has no pubmed publications about vitamin C, only books published by what looks like vanity press that he set up himself. If you look at his CV, you can even pinpoint when he went crazy – 1997, the pivot point where his rational publications stop and his alternative ones start.

      Incidentally, Levy is proof that the claim “you can’t profit off of vitamin C” is a lie. You just need to publish and sell quacky books instead of the actual pills.

      Vitamin C which is needed to make collagen which is the protein that provides blood vessels with their strength.

      Oh, yes, thanks for that, because doctors don’t learn about that in med school. Yeah, Ebola kills by using up the clotting factors, causing strokes, and by having none left, causing bleeds. Not scurvy.

      Can you cite any studies to back up your conclusion. I looked but nothing about testing Ebola patients for scurvy or treating people for it. So how do you know? This site is called science based medicine, so where is the science?

      That’s not how science works. The burden is on the claimant – if you claim that vitamin C would cure Ebola, then you need to provide the proof of this fact. Theory is great, but you need to conduct empirical trials to see if your theory is great. Paraphrasing, many theories have been killed due to the existence of an inconvenient fact.

      Sounding condescending is no substitute for hard science, so what have you got?

      A suggestion that you take your own advice?

      Vitamin C is a universally kills all viruses in vitro. Has Ebola been tested? I can’t find a study can you?

      So does fire, should we incinerate Ebola patients?

  49. Andrey Pavlov says:

    It seems to me that the folks here trying to assert that Ebola is vastly more dangerous than the flu and use the BSL-4 status of Ebola as evidence that an outbreak is indeed possible and that having Ebola infected folks in the US is a huge danger are committing the ecological fallacy.

    You must differentiate between whether the infection is scary for you if you get it or for society as a whole. I would personally much rather catch the flu than ebola. No doubt about that. But when we are discussing the likely damage to the health of a population the fact that an individual would rather have the flu than ebola does not mean that a population would rather have people infected with flu than with ebola.

    Because even though the mortality of ebola is vastly higher than that of the flu, the transmissibility of the two are vastly different. Having a small mortality with an infection that can infect millions or even hundreds of millions in less than a year (or 500,000 in just 8 months in just the Caribbean as is the case with Chikungunya) is vastly worse than having a high mortality with an infection that can only realistically manage to infect thousands. The largest Ebola outbreak ever was 2,127 and that is the current one. The next largest was 425 people. And that is in Africa, with minimal means by which to prevent an outbreak. It is simply wrong to worry about the effects of an outbreak of Ebola more than the effects of an outbreak of influenza or Chikungunya on a population level. Roughly 15,000 times more people die from the flu every year in just the US alone than have ever even been infected from Ebola in the history of the world (that we know of).

    Why is Ebola BSL-4 and the flu BSL-2? Not because of the difference in ability to become an outbreak. But because if someone accidentally gets infected with the flu they are very likely to be fine. If even a single person gets infected with Ebola they have at best a 50/50 shot of surviving the experience.

    So when we talk about bringing Ebola infected individuals back to the US you can say “Man, I would not want to be one of the people taking care of those folks!” and we would all agree. But you cannot say “Man! That is a stupid idea because it could cause an outbreak that would be a horrendous toll on society, way more scary than the flu.” Because even if there was an outbreak it is simply stupid to think that it would be bigger than what is currently going on in Africa. And more people die every single day from the flu than have been infected in this current outbreak of Ebola in Africa.

    1. Koffi Babone says:

      “folks here trying to assert that Ebola is vastly more dangerous than the flu…..It is simply wrong to worry about the effects of an outbreak of Ebola more than the effects of an outbreak of influenza or Chikungunya on a population level.”

      Well the WHO, CDC and MSF seem to worry enough about Ebola. You forget that when there is an Ebola outbreak, we do implent quarantine measures.

      Do public health authorities regularly impose quarantines for influenza?

      1. WilliamLawrenceUtridge says:

        Influenza is already endemic, and only has a relatively high number of total deaths because of the number of people infected.

        Public health authorities do recommend annual vaccination for influenza. If such a vaccine existed for Ebola, it would be used extensively in Africa.

        You seem to demand a single standard of care and intervention based on…perhaps the biosafety containment level? That’s stupid, each disease is different. There are different reasons for different types of protection. Just accept it.

        1. Ralph Gardner says:

          A vaccine for tetanus has existed for many years and it still kills 100,000 people a year in Africa.

          1. Windriven says:

            What percentage of Africans have ever been vaccinated against tetanus? Of those, how many receive the booster every 6 years.

            Don’t be a douchedribble. Think before you write.

          2. WilliamLawrenceUtridge says:

            That rather underscores my point – as Windriven says, the limiting factor is access to the vaccine, on a regular basis. If it were the oral polio vaccine, a single dose would be sufficient. Regular boosters are required, which is part of the context required to assess each vaccine and disease individually.

      2. Andrey Pavlov says:

        Well the WHO, CDC and MSF seem to worry enough about Ebola. You forget that when there is an Ebola outbreak, we do implent quarantine measures.

        Do public health authorities regularly impose quarantines for influenza?

        Once again, WLU is correct.

        You really seem to have no grasp of the finer (well, not even quite so fine) points here Koffi.

        As WLU said, flu is endemic. There is no possible way to actually have a quarantine. Explain to me how there can be a quarantine for the flu, Koffi. But when there is a threat and there is a possibility, yes they do! I happened to fly to Germany during the early part of the H1N1 pandemic. Getting off the plane workers with airborne protection gear and bunny suits (basically a “light” version of a hazmat suit) were waiting for us on the gangway. We were decontaminated and asked many questions about our health status.

  50. Michael says:

    I find it disturbing that IV sodium ascorbic is dismissed so cavalierly.There were studies done by Dr Fred Klenner and published in peer reviewed journals describing the successful treatment of Poliomyelitis with 60 out of 60 cases successfully resolved.I cannot find mention of any followup studies of this treatment modality.
    Would it not be wise to attempt corroboration of Klenners’s findings? That way,one could simply point to results of such a study to disprove the idea once and for all,albeit only for serious researchers-the quacks will never be completely silenced.

    1. simba says:

      To treat what? To treat polio, a disease which is (thankfully) well-controlled by vaccination? Or to treat ebola, which you have no evidence for? Or to treat all of the 101 things Dr Klenner claimed it could treat?

      Presumably researchers will pick up on this idea if it looks promising, and then the results will be published (and are more likely to be published if positive.)

      The evidence for it doesn’t seem to be promising which in itself is a reasonable reason for people not to spend their time and money researching it. If the best proof is self-published books, testimonials, and a few lone doctors who thought it was a cure-all and authored positive papers on it, then there are more promising avenues to follow. Those three types of ‘evidence’ have been present for many other ‘cures’ which have been shown to be useless.

      Dr Klenner’s advice: “get large doses of vitamin C in all pathological conditions while the physician ponders the diagnosis.”

      Or it has been studied, didn’t seem to work particularly well, and thus wasn’t followed up or published on.

      I realise this evidence looks promising to you- but remember that there are lots of people who would say the same about cannabis for cancer, or rope worms, and people said it about Mesmerism, Perkins Tractors and Lydia Pinkham’s vegetable compound.

      When you read across different therapies and modalities, you realise that the above is not sufficient evidence even to believe that a treatment is promising. If you think there’s more to it, then you have to come up with more evidence.

      It’s not up to the skeptics to design studies on each of these claims, it’s up to those doctors who believe this is a useful treatment, those people who are profiting or will profit off the sales of vitamin C, and people who put forward these theories. Those are the people who should attempt well-controlled testing of vitamin C for certain indications.

      Bear in mind that Klenner’s theories, given that his theory seems to be ‘Vitamin C will work wonders in every disease, fix allergies, cure snake bites’, are so improbable as to not garner serious consideration unless some very good evidence is forthcoming. There have been too many similar cases where a doctor decided they had found the One True Cure. ‘Extraordinary claims require extraordinary evidence’, as they say.

      http://seanet.com/%7Ealexs/ascorbate/198x/smith-lh-clinical_guide_1988.htm

    2. WilliamLawrenceUtridge says:

      Last time Klenner published anything on vitamin C was 1952. I like my research to be too young to drive, not so old it probably shouldn’t be.

      And who cares about the treatment of polio when we can reliably prevent it. It’s almost extinct FFS.

      Also, in order to duplicate Klenner’s results, what do you plan on doing, taking 60 unvaccinated patients and deliberately infecting them with polio? Could you perhaps elaborate on the ethical justification for this?

  51. MadisonMD says:

    Klenner’s 1952 article is entitled “The vitamin and massage treatment for acute poliomyelitis.” Perhaps Michael is also troubled that we aren’t taking massage as a serious treatment for Ebola. After all, Klenner did write about the efficacy of massage for a completely different virus 62 years ago, which appears to be sufficient to confince him. Well, perhaps Mike is still confused about whether to recommend the Swedish or Turkish type or maybe doesn’t want to volunteer as the masseur.

    Makes me wonder what Klenner thought about the efficacy of sticking pins into dolls.

  52. varsha says:

    If patient dies in hands of allopathic doctors because they have no treatment for Ebola, then it is accepted. If Homeopath claim that they can treat Ebola, then you label them as quacks?
    Big Hippocrasy.

    1. KayMarie says:

      So do you think allopathic doctors have a treatment, they just won’t admit it, so they let them die. Now there are treatments (supportive care) which seem to increase your chances of survival. Do they get the credit for that? Usually not from anyone supporting homeopathy or any other alternative.

      And a homeopath claiming I think that A or B might be the cure is a little different from actually testing treatments.

      What do you think of the not at all homeopaths that claim they can cure ebola with huge doses of vitamin C that are not in anyway diluted down to nothing?

    2. WilliamLawrenceUtridge says:

      If patient dies in hands of allopathic doctors because they have no treatment for Ebola, then it is accepted. If Homeopath claim that they can treat Ebola, then you label them as quacks?

      Doctors don’t claim they can treat Ebola, only provide supportive care that increases your chances of surviving.

      Homeopaths claim they can cure Ebola.

      Oh, and homeopaths also employ an irrational, anti-scientific, disproven system that essentially comes down to “magic”, whose knowledge base and basic approach hasn’t progressed in over two centuries.

      Even if doctors were the worst people in the world and actively killed Ebola patients faster than Ebola itslef; even if doctors were actually snipers picking off pedestrians; even if doctors were atomic bombs that were responsible for destroying every single living thing on the planet – that still wouldn’t make homeopathy effective. It’s rank nonsense.

    3. MadisonMD says:

      If Homeopath claim that they can treat Ebola, then you label them as quacks?

      How did you draw this conclusion from what is written? Homeopaths are quacks regardless of whether or not they claim to treat Ebola.

  53. bernadette sullivan says:

    In response to the comments in your article, here are some links you should read fully. Remember that the allopathic medicine you blindly follow exclusively is Newtonian and we all know that is long before Einstein, Quantam Physics and the String Theory. Science has moved forward, but it seems that modern medicine has not moved beyond Newton.
    ‘In the case of Ebola, no conventional treatment or vaccine is available. Fortunately for us, homeopathy has great renown for its healing ability in epidemics.
    No. Really. No, it doesn’t, except among homeopaths. Among those health care practitioners rooted in science, not so much. Calabrese proposes a variant of Derin and Menear’s delusional treatment:
    Links below are very interesting, regardless of whether you believe in homeopathy or not.
    http://homeopathyplus.com.au/homeopathy-works-and-the-skeptics-cant-stand-it/
    http://www.subtleenergies.com/ormus/tw/QuantumHomeopathy.htm
    http://www.homeopathic.com/Articles/Homeopathic_research/Scientific_Evidence_for_Homeopathic_Medicine.html
    http://drnancymalik.files.wordpress.com/2014/04/homeopathy-science-and-evidence-based-medicine.pdf
    http://www.dailymail.co.uk/health/article-184501/Proof-homeopathy-works.html
    http://www.wicklowhomeopathy.com/research.htm
    http://hpathy.com/scientific-research/string-theory-homoeopathy/

    Sincerely
    Bernadette

    1. Jopari says:

      Homeopathy cannot work, it violates basic principles of physics and chemistry, the principles used to determine this are not Newtonian.

      Newton has very little to do with medicine, and just because it’s old doesn’t mean it’s wrong, life is not so. If it isn’t broken, don’t “fix ” it. Likewise, not everything new is right. Based on your point, nothing can be trusted, because “new” is relative, everything was new once and everything will be old one day.

      Arnt Schultz law, overturned by hermesis, requires that the active ingredient still exist within the dosage. Homepathy contains no active ingredient. While one day previously unexplained phenomenon may be explained, what’s jarring to me is that by the way it’s done, almost everything ought to be homeopathic, since everything probably has mixed with something in the past and left it, and with water that’s even more so. The first link says theat there were positive benefits compared to placebo, were they on par with the claims? Or so low we could barely detect it?

      Some try to explain how homeopathy works, but use laws of chemistry, physics and biology out of context, like that Arndt Schultz law. While others say that they have no idea, but they think it will be explained one day.

      Please provide a clinical trial and not people writing about how skeptics are denying the evidence. I would rather see the evidence being denied.

      1. Jopari says:

        Sorry, Newtonian principles are not the major principles used in medicine, it probably plays an obscure part somewhere.

        Besides, Newton’s three laws are still being taught in school.

        1. Chris says:

          That is because living on this planet they are good enough. The relativistic corrections are for the extremes of big and small, which can be used in medicine. But the homeopaths do not have a clue, especially when some like Dana Ullman do not understand what “nano” means.

          Newton’s three laws are very much used in medicine. Having a child with obstructive hypertrophic cardiomyopathy I have had echocardiograms and a cardiac MRI explained to me in depth. The fluid dynamics of the blood flow (which can damage heart valves) and the contractions of the damaged heart muscle are all governed by Newtonian physics.

          I am presently reading Working Stiff by Melinek and Mitchell about a forensic pathologist in New York City. They go into forces to cause damage and movement mechanics to learn what happened to kill a person.

          Then there are all of those machines. After my son got out of open heart surgery (which used a heart/lung machine) he was put into an ICU that was full of pumps, monitors and lots of other equipment.

          1. Jopari says:

            Sorry, I was having a case of tunnel vision there. Was looking at drugs and medicines and considering that the guiding principles were probably chemistry. I knew physics plays a part, just didn’t think of it.

            Apologies.

    2. Chris says:

      “Quantam Physics”

      Show us how much you know about the above subject. Explain the origin and meaning of the word “quantum.”

      What is the difference between kinetic energy and potential energy, and how are they related?

      What is relativistic momentum? Do you know the equation? Can you explain all the variables?

      In order to show homeopathy works, you much show that it works. So to that effort please provide the PubMed indexed random controlled studies that homeopathy works for non-self-limiting diseases.

      Andre Saine claims that homeopathy works better for rabies than the modern treatments. Please provide us the random controlled animal studies proving his contention.

    3. WilliamLawrenceUtridge says:

      Dear Bernie,

      Quantum effects are incredibly fragile, you need incredibly expensive and complicated equipment to be able to measure them. They also operate at incredibly tiny scales, generally at the level of single photons. Once you move up to even molecules, let alone people, quantum effects essentially vanish.

      String theory is very much a theory, there’s no proof it is true. It’s sole claim to authority is internal consistency (much like homeopathy).

      But please – entertain us. Explain how quantum explains homeopathy.

      Also, most of the links you provide are to people who sell homeopathic remedies. And if there’s anything Big Pharma has taught us, it is this – anyone who sells anything can’t be trusted to be honest about the proof behind it.

      Also, your Daily Mail article at best describes how homeopathic preparations might differ from conventional ones, when tested with thermoluminescence. That doesn’t mean that homeopathy works.

  54. Ralph Gardner says:

    We have 400,000 people a year dying and 4 million injured from preventable medical errors here in the US each year.

    That’s over 1000 friends and relatives dying, each day, two world trade centers a week, and our top news is 10 people dying each day of Ebola in Africa?

    Of course it is sad, but top news?

    If things don’t change the 400,000 per year figure times our 80 year lifespans mean that 32 million people will die from medical mistakes or 1 in 10 and most everybody will be injured by medical mistakes.

    http://www.hci3.org/content/over-400000-deaths-preventable-medical-errors-over-400000-too-many

    1. Windriven says:

      “If things don’t change the 400,000 per year figure times our 80 year lifespans mean that 32 million people will die from medical mistakes or 1 in 10 and most everybody will be injured by medical mistakes.”

      Think about that for just a moment, Ralph. (tic-toc-tic-toc) Ok, having considered that statement, do you still believe it?

      ( )Yes : Good luck to ya, fella. Try not to slip and fall in a puddle of your own drool.

      ( )No : Great to hear it, Ralph. You’re actually capable of logical thinking.

      Medical errors happen. Sometimes they result in injury, sometimes they result in death, sometimes they are simply incidental. Many of the errors are identified and corrected before substantial harm occurs. I expect you have little idea how much effort doctors, their professional groups, hospitals and regulatory agents invest in minimizing even the tiniest threats.

      For instance the mortality rate for general anesthesia – a field of which I have some knowledge – in 1973 was in the neighborhood of 8 per 1,000 anesthetics. Today, the rate is well under 1 in 1000. In 2009, Guohua, et al pegged the number of anesthetic deaths in the entire country at 34. And remember those deaths aren’t all from anesthesia misadventures; that number is much smaller still.

    2. WilliamLawrenceUtridge says:

      Yes, medical error in the United States, where having access to health care, clean drinking water and public health officials means you basically don’t have to worry about disease, is a bad thing. That doesn’t chnage the fact that Ebola is a terrifying disease that needs attention and resources. But they’re just Africans, right? Who cares if a bunch of black people speaking in clicks die, right Ralph?

      Consider this – people in the US die of medical error. Many people in Africa don’t have medicine.

      Who do you think is better off? How many people would die in the US if we didn’t allow medical care in order to prevent medical error?

      I see people dying and being injured by medical error and I see a need to reduce medical error. I see people dying of Ebola and I see a need to reduce the spread of Ebola. I don’t see these things as mutually-exclusive.

      As for why it is news – medical error is a reality of medical care that will never be solved completely until we are ruled by hyperintelligent robots. It is an expected outcome and unfortunate reality that actual doctors are attempting to address on a daily basis with research and practice changes.

      Ebola is a terrifying, deadly disease that has, for the first time in human history, spread to major population centers. It’s totally new, totally unexpected, and horrifying. It deserves news.

      Though so does medical errors, in fact arguably there should be more resources and oversight put into reducing them. In a rational and just world, there would be.

  55. KayMarie says:

    Egad, and adding to the conspiracy theories we have Professor Broderick.

    http://www.washingtonpost.com/news/morning-mix/wp/2014/09/26/an-american-professor-is-telling-liberians-that-the-u-s-manufactured-ebola-outbreak/?tid=hp_mm

    Doesn’t seem concerned that this is going to just keep people away from getting help and get more aid workers killed.

    And does the “I hope you can understand them” trope about reading his references.

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