I'm surprised that so much of the coverage of ZMapp doesn't include the fact that the drug is produced in tobacco plants.
To me, this is the single most interesting and impressive fact. It's also likely the main reason why "the limited supplies will not help the 20,000 people predicted to be infected during the outbreak in West Africa." Scaling production of antibodies grown in plants can't possibly be straightforward.
DARPA thinks it's a scalable method, at least for producing flu vaccines:
"Accelerated Manufacture of Pharmaceuticals (AMP), companies in four states are building facilities where they can quickly produce vaccine-grade proteins grown in the cells of tobacco plants. Once they produce the proteins, the goal is for each company to scale up its process to produce 100 million doses of H1N1 flu vaccine per month."
I've seen it widely mentioned, but most of the commentary on it went along the lines of 'take that, health Nazis!', as if this was the culmination of a years-long effort by Smokers Against Ebola.
I agree that it's not straightforward, but there are lots of industrial processes that take as long as growing a plant. Scaling physical production is always a huge problem. There have been years where it was difficult to manufacture the flu vaccine in the required quantities, and I believe that generally involves incubating the vaccine in an egg.
I would hazard a guess that we know Ebola to be pretty close to 100% lethal, and if you know that three out of three control animals died, then the virus is "working" and there's no need to sacrifice many more animals.
It looks like the 18 animals were actually sub-divided into at least three test groups. One test group got the drug after 3 days after exposure, one at 4 days and one at 5 days. So the number of animals in each sub-group is closer to the control.
It wouldn't surprise me if there were actually six test groups of three animals each (perhaps divided by both day-of-treatment and something else like drug amount), thus matching the control. But the article doesn't actually imply that.
why we still test effectiveness on animals when there are several thousands of people who has no downside and only upside for the drug to be tested on them? Ethics? It would be a strange ethics that had worked only until an American needed the cure. Something isn't right that this drug got out of shadow only when there was a need to cure an American. I mean, of course, thanks God, that i have real chance of soon becoming an American too :)
The second paragraph does a good job of summing up ethical concerns related to this particular outbreak (standard ethical concerns also apply):
"The first two patients to be treated were Americans. Prior to this came the old (and historically justified) fear of testing potentially dangerous new treatments on vulnerable populations in developing countries rather than on privileged first world patients. The first ever treatment was not given to an African doctor because of this concern [1]. After Westerners were treated, complaints rose about giving infected Westerners access to a new drug while infected Africans went without. These two concerns are obviously mutually exclusive. People are concerned, they are just not sure about what, sometimes even voicing both concerns in the same article [2]."
Why do you say there is no downside? As Jonathan Kaplan points out in the comments of the article Crito links to, Ebola is not 100% fatal and several drugs that have worked in animals have proven to have catastrophic effects when administered to humans (see e.g. TGN1412 [1]).
The first four paragraphs describe what happened: different decisions were made by different doctors, and the drug did not "get out of the shadow only when there was a need to cure an American".
Because only humans are made in God's image. Therefore it's ethical to test drugs on enslaved non-human sentients incapable of acknowledging consent.
EDIT: Very curious whether the downvoters (a) don't get the sarcasm, (b) get the sarcasm and are offended that I question their religious tenets, (c) think animal testing is justifiable beyond reproach, (d) disagree that monkeys are sentient, (e) think that monkeys consent to testing, or (f) just don't like how I worded things.
I would suspect that reporting figures to the WHO, which I'll add is not providing a whole lot of help, is a rather low priority to these countries.
Plus the way this epidemic is playing out in the 3 major countries makes the figures altogether iffy (Nigeria is an obvious exception, with one index case caught quickly).
It's interesting to me that people are working on a cure for Ebola yet no one is deeply interested in working on new antibiotics. Ebola is a scary disease yet rare (across the entire planet) so there doesn't seem to be a lot of monetary reason to invest in it. Antibiotic resistance is far more widespread. I guess I don't always understand how the pharmaceutical industry decides what to look at.
> Ebola is a scary disease yet rare (across the entire planet) so there doesn't seem to be a lot of monetary reason to invest in it. Antibiotic resistance is far more widespread.
All true, but once one understands the microbiology, it becomes obvious why drug companies are giving up on antibiotics. It's perfectly rational behavior -- no matter what antibiotics we invent, the microbes will evolve resistance to them in a short time. That's been the history of antibiotics until now, and there's no reason to expect the future to be any different -- if anything, it will probably become worse.
New antibiotics are in the works all the time. We are currently in an arms race with infections; I recall reading that new antibiotics are expected to last for only 10 years, and future antibiotics are going to last even less time (before resistance develops)
Why doesn't it get more press? I don't know for sure, but it is:
- Ongoing, which makes for bad news
- Kind of depressing, because we are slowly losing the battle
- Feels a little bit hopeless, because foolish choices by individuals accelerate the development of resistance, and inventing new antibiotics doesn't fix that fundamental problem
The treatment in question (Zmapp) are heavily funded supported by various DoD entities. Weaponized ebola (along with smallpox) were always something of a bogey-man that received perhaps outsized attention from various sources.
Secondly, if it weren't for this outbreak, all of these treatments and vaccines would likely sit around in clinical trial hell for quite a while.
Cynically speaking, since clinical trials are so risky and expensive, its best if the developers can off-load some of that risk and expense. Picking something like Ebola, surviving on government funding (because its seen as strategic), and waiting for an emergency to allow you to skip a lot of red tape, and get dollops of support, isn't really a terrible choice.
Oh, and antibiotics are hard. For an overview of the current state of antibiotic development, you can take a look here:
Ebola has been around for decades, and this is an experimental drug. The fact is that interest in experimental drugs for Ebola has only cropped up recently, so this doesn't really prove any point about interest in antibiotics.
I don't know if Ebola qualifies, but there are 'orphan drug' laws in many places that help pay for the development of medicine to treat rare diseases or conditions.
[+] [-] state|11 years ago|reply
To me, this is the single most interesting and impressive fact. It's also likely the main reason why "the limited supplies will not help the 20,000 people predicted to be infected during the outbreak in West Africa." Scaling production of antibodies grown in plants can't possibly be straightforward.
[+] [-] rch|11 years ago|reply
"Accelerated Manufacture of Pharmaceuticals (AMP), companies in four states are building facilities where they can quickly produce vaccine-grade proteins grown in the cells of tobacco plants. Once they produce the proteins, the goal is for each company to scale up its process to produce 100 million doses of H1N1 flu vaccine per month."
http://www.defense.gov/News/NewsArticle.aspx?ID=61520
[+] [-] anigbrowl|11 years ago|reply
[+] [-] nsxwolf|11 years ago|reply
[+] [-] krschultz|11 years ago|reply
[+] [-] kqr2|11 years ago|reply
http://www.nytimes.com/2014/08/30/world/africa/study-says-zm...
It mentions that all 3 control group animals died.
Does anyone know why the control group is so small compared to the test group of 18?
[+] [-] skosch|11 years ago|reply
[+] [-] OldLikeDos|11 years ago|reply
It wouldn't surprise me if there were actually six test groups of three animals each (perhaps divided by both day-of-treatment and something else like drug amount), thus matching the control. But the article doesn't actually imply that.
[+] [-] unknown|11 years ago|reply
[deleted]
[+] [-] trhway|11 years ago|reply
[+] [-] Crito|11 years ago|reply
The second paragraph does a good job of summing up ethical concerns related to this particular outbreak (standard ethical concerns also apply):
"The first two patients to be treated were Americans. Prior to this came the old (and historically justified) fear of testing potentially dangerous new treatments on vulnerable populations in developing countries rather than on privileged first world patients. The first ever treatment was not given to an African doctor because of this concern [1]. After Westerners were treated, complaints rose about giving infected Westerners access to a new drug while infected Africans went without. These two concerns are obviously mutually exclusive. People are concerned, they are just not sure about what, sometimes even voicing both concerns in the same article [2]."
[+] [-] kvb|11 years ago|reply
[1] - http://en.wikipedia.org/wiki/TGN1412
[+] [-] DanBC|11 years ago|reply
Treating an ebola patient who has a bunch of weird side effects caused by an experimental drug makes a sub-optimal situation much worse.
[+] [-] hdevalence|11 years ago|reply
The first four paragraphs describe what happened: different decisions were made by different doctors, and the drug did not "get out of the shadow only when there was a need to cure an American".
[+] [-] lauraura|11 years ago|reply
Sounds like they're already doing precisely that.
[+] [-] colanderman|11 years ago|reply
EDIT: Very curious whether the downvoters (a) don't get the sarcasm, (b) get the sarcasm and are offended that I question their religious tenets, (c) think animal testing is justifiable beyond reproach, (d) disagree that monkeys are sentient, (e) think that monkeys consent to testing, or (f) just don't like how I worded things.
[+] [-] contingencies|11 years ago|reply
[+] [-] hga|11 years ago|reply
Plus the way this epidemic is playing out in the 3 major countries makes the figures altogether iffy (Nigeria is an obvious exception, with one index case caught quickly).
[+] [-] coldcode|11 years ago|reply
[+] [-] lutusp|11 years ago|reply
All true, but once one understands the microbiology, it becomes obvious why drug companies are giving up on antibiotics. It's perfectly rational behavior -- no matter what antibiotics we invent, the microbes will evolve resistance to them in a short time. That's been the history of antibiotics until now, and there's no reason to expect the future to be any different -- if anything, it will probably become worse.
http://www.pbs.org/wgbh/pages/frontline/health-science-techn...
Title: "Dr. Arjun Srinivasan: We’ve Reached 'The End of Antibiotics, Period'"
[+] [-] sliverstorm|11 years ago|reply
Why doesn't it get more press? I don't know for sure, but it is:
- Ongoing, which makes for bad news
- Kind of depressing, because we are slowly losing the battle
- Feels a little bit hopeless, because foolish choices by individuals accelerate the development of resistance, and inventing new antibiotics doesn't fix that fundamental problem
[+] [-] icegreentea|11 years ago|reply
Secondly, if it weren't for this outbreak, all of these treatments and vaccines would likely sit around in clinical trial hell for quite a while.
Cynically speaking, since clinical trials are so risky and expensive, its best if the developers can off-load some of that risk and expense. Picking something like Ebola, surviving on government funding (because its seen as strategic), and waiting for an emergency to allow you to skip a lot of red tape, and get dollops of support, isn't really a terrible choice.
Oh, and antibiotics are hard. For an overview of the current state of antibiotic development, you can take a look here:
http://www.pewtrusts.org/en/research-and-analysis/issue-brie...
Note that 43 drugs are in the pipeline.
[+] [-] argonaut|11 years ago|reply
[+] [-] legomylibrum|11 years ago|reply