Ebola Outbreak

[Cyborg Girl]

@Swift: I don't claim to have all the answers. That doesn't mean I can't recognize when something stinks.

And yes, of course my instincts can be flat wrong. I really, really want to believe that they're wrong in this case.

[The Supreme Canuck]

As I mentioned earlier in the thread, this strain seems to be about 60% mortality. Does that change the ethics? If you say "no", what is the magic number: 30%, 40%?

The magic number depends on the risks involved with the drug. If you have a 5% mortality rate, but the drug kills you 95% of the time, that's a no-no. But if you have a 60% mortality rate, and the drug kills you 1% of the time, that's a go.

I assume that the medical professionals made the determination that administering the drug was less risky than not doing so.

How informed can the consent be if the patient is not familiar with modern medicine (I don't know if these people are or not)?

The medical staff need to explain it and be satisfied that it is understood. Otherwise you do not have informed consent and cannot proceed. But that's true of all treatment, including the simplest things like IV saline for re-hydration.

What about some complicated details (this is, I think, how these decisions really come down) - let's say this serum costs $25,000 per person to produce and is believed to drop the mortality rate to about 25%, but that is not yet determined in large scale trials. On the flip-side, standard supportive care (IVs, blood transfusions, respiratory support, etc.) costs $10,000 per person, but the mortality rate is still about 50%, but this is a proven treatment. What say you then?

I say that if the medical professionals deem it's a good idea to administer it, do it. Cost isn't a concern, here - the WHO is spending $100 million on this Ebola outbreak. The money is there.

I'm only giving you (and GJ) a hard time because you seem to have all the answers, ethical and otherwise. I don't, and try hard to not give anyone the impression I might.

I feel that dig's a bit unwarranted. Pointing out things that are wrong and then saying "Hey, this seems like it could help fix them" is not the same as saying I have all the answers.

Besides which, I'm not trying to say how we fix the outbreak. I'm saying that the Americans are getting opportunities that the Africans aren't, and that's fucked up. Maybe there are issues with providing experimental treatments. Whatever; that's immaterial to my point, which is that problems or no, the Americans were offered the treatment and the Africans were not.

That's my real issue.

And, no, I don't have an answer to that. I've said that I don't. I don't want the Americans not to be offered the treatment, and it appears that it is impractical for the Africans to be offered the treatment. So I have no answer. That won't stop me pointing out that it's unjust.

I see that CNN has gone the way of FOX in not bothering to get their facts straight before reporting on a story.

Here is a more accurate summary of what happened. It's not a "secret" serum, and it wasn't created in mice.

I would imagine the hope is to create it with mice, but for now, they have to rely on the antibodies in someone who has survived. Not something that can easily be mass produced.

That's terribly unfortunate, in that case.

[SciFi Chick]

I see that CNN has gone the way of FOX in not bothering to get their facts straight before reporting on a story.

Here is a more accurate summary of what happened. It's not a "secret" serum, and it wasn't created in mice.

I would imagine the hope is to create it with mice, but for now, they have to rely on the antibodies in someone who has survived. Not something that can easily be mass produced.

That's terribly unfortunate, in that case.

I agree. It is terribly unfortunate, for more reasons than one. Why try and get everyone to think there is a "secret" serum that we're with holding from the Africans? That's just disgusting. I would have agreed with you 100% except that I've been following this very closely by listening to NPR every day, so as soon as I clicked on the news story you linked, my bullshit meter went into overdrive. I pretty much don't trust anyone but NPR and BBC, and my trust in them is still limited, but they're closest I've been able to get to objective journalism.

It's sad that we aren't close to a serum, but it's also good to know we aren't hoarding one either.

[FZR1KG]

Besides which, I'm not trying to say how we fix the outbreak. I'm saying that the Americans are getting opportunities that the Africans aren't, and that's fucked up. Maybe there are issues with providing experimental treatments. Whatever; that's immaterial to my point, which is that problems or no, the Americans were offered the treatment and the Africans were not.

That's my real issue.

And, no, I don't have an answer to that. I've said that I don't. I don't want the Americans not to be offered the treatment, and it appears that it is impractical for the Africans to be offered the treatment. So I have no answer. That won't stop me pointing out that it's unjust.

I don't think unjust is the right term.
Tragic might me closer.
Limited supplies, logistics etc mean only some can get the treatment. It is experimental, not mass produced.
That's closer to tragic, and it's certainly not unjust.
Unjust would be if there is plenty to go around and some are denied based on where they were born or how much hey earn or what sex they are.

[Swift]

@Swift: I don't claim to have all the answers. That doesn't mean I can't recognize when something stinks.

I'm only giving you (and GJ) a hard time because you seem to have all the answers, ethical and otherwise. I don't, and try hard to not give anyone the impression I might.

I feel that dig's a bit unwarranted. Pointing out things that are wrong and then saying "Hey, this seems like it could help fix them" is not the same as saying I have all the answers.

Besides which, I'm not trying to say how we fix the outbreak. I'm saying that the Americans are getting opportunities that the Africans aren't, and that's fucked up. Maybe there are issues with providing experimental treatments. Whatever; that's immaterial to my point, which is that problems or no, the Americans were offered the treatment and the Africans were not.

That's my real issue.

And, no, I don't have an answer to that. I've said that I don't. I don't want the Americans not to be offered the treatment, and it appears that it is impractical for the Africans to be offered the treatment. So I have no answer. That won't stop me pointing out that it's unjust.

I'm sorry, but this is just really rubbing me the wrong way, and I should probably just go away, but...

It really comes across, at least to me, as "this is wrong and unjust and what are YOU FOLKS doing about it. You are not stepping up on this, you priviledged Americans". Well, what are you doing about? I've been working on social issues that are important to me for almost 40 years. I donated my time and money to these things, and still do (as recently as last Sunday). I feel insulted to be told I am priviledged and am not doing enough.

I'm probably taking this entirely too personally, but that's how I feel. I'm sorry, but I'm out of here...

[FZR1KG]

It really comes across, at least to me, as "this is wrong and unjust and what are YOU FOLKS doing about it. You are not stepping up on this, you priviledged Americans". Well, what are you doing about? I've been working on social issues that are important to me for almost 40 years. I donated my time and money to these things, and still do (as recently as last Sunday). I feel insulted to be told I am priviledged and am not doing enough.

I'm probably taking this entirely too personally, but that's how I feel. I'm sorry, but I'm out of here...

Pretty sure TSC and GJ aren't saying that.
Likewise I'm pretty sure they are reading into this far more and badly than they should be.

There isn't some conspiracy to treat Americans over Africans.
There isn't some block here. There is no reason not to release something if it's proven effective and can be made in quantity.

I imagine anyone that's been in any form of industry where a disaster happens (disaster can be a critical IT server down for example) and everyone is running around like crazy can appreciate what is going on here. The people that have the skill are busting their arses to get it resolved, the people above them are putting pressure on them because the people they answer to are putting pressure on them and so on. Ultimately the decision is made after everyone is near worn out and the people that are the key in resolving the issue are put in a situation no one wants to be in. They know they aren't ready and they have to try anyway.

The straw that broke the camels back might just have been that one of their own was dying. It would probably do it for me, especially if I knew the person or knew of them.

I don't know if GJ or TSC have been in super high stress situations where everyone is relying on you to resolve the problem. I have. That was the core of my job for decades, troubleshooter. No matter what industry I was working in, things were always exactly as I described above. When I contracted for Kodak, the systems went down and I was called in. I had a car accident, writing off the car while on my way there. Not my fault, no one injured but I couldn't sit there and try to comfort the woman who pulled out in front of me that saw her life flash before her eyes. I had a job to do, one that was my lively hood and it was costing the company $10,000 per hour till it was fixed. A process chemical spewing into the waste area requiring not only a clean up which was costly but remaking the chemical which was also costly and time consuming. Get to the job or lose your job. Eyes on the job. Everyone's eyes on you and everyone pressuring you to do something now when you know you aren't ready and a wrong choice could spell irreversible disaster. Seems easy, I was even told how easy it was, shut the valve...yeah, you can, if you want an explosion. Rule 1: don't fuck with chemical processes you don't know about.

Same thing at Federation Square. They had the Prime Minister of Australia coming in along with an entourage of high fliers and diplomats and they couldn't seal the movable wall making it not possible to continue with the function but also a huge security risk. I was called in and told they would fly me in, they don't care. Just fix the fucking thing now. Again, everyone watching and putting pressure on me and me in my motorcycle race suit because that was the only way to get there and I couldn't even get time to change. If I screwed up there was a panel over 8 meters tall weighing about a ton that would fall in a public area which naturally would have put an end to everything.

It's nothing like what these guys have to deal with, but very similar at the same time. You want to take the right precautions and you want to follow a set procedure because when you're so under the pump and tired you make mistakes when you deviate from the SOP you are used to and that was developed to ensure safety for yourself and others. To deviate is risky. Then you have to weigh risk vs the possible outcome as the data comes in. At some point your mind says its' time to take a calculated risk, whereas just moments before it was not.

I imagine anyone in the military knows how this works. You follow SOP and have that SOP drummed in so you can do it half conscious with your leg blown off. Deviating from it is a last resort and requires a hell of a lot of pressure from everywhere as well as extreme circumstances.

Getting shit for finally deviating is just insulting and I think not only unfair but very ignorant of what is happening behind the scenes.
And yes, I have got shit for that reason.
Dumb responses like, "if it was that simple, why did it take you that long to do it?"
Well fuckhead, if I did it before I knew that was the issue, you would have a multi-million dollar pile of junk now that you'd happily blame me for, but glad to know you'd just try random things in the hope you might fix something. I'll call you next time I have to work in a high voltage panel so you can poke around it. Dumass.
No need to ask if I have had conversations like that. You know I have.

Anyway, that's what I see happening behind the scenes. Not some grand scheme to treat Americans and not others.

[The Supreme Canuck]

Swift, I don't know why you think I'm blaming you for anything. I've specifically said that people in the west have done nothing immoral and are not to blame at all. It's the situation that's fucked up.

[The Supreme Canuck]

SFC: Yeah, I should have known better than to trust CNN.

FZ: To be clear, I don't think (and never said that I think) there's a conspiracy, here. That's silly. That's not how I figure this works. How I figure it works is exactly how you said it works: one of your own getting sick is what kicks you into action.

I'm saying is that that's what's fucked up.

Someone who isn't "one of us" is ill? Well, we need to follow procedure.
Someone who is "one of us" is ill? To hell with procedure! We need to act!

But what differentiates the guy who's "one of us" from the guy who isn't?

It's subconscious. That's just "how the world works." It's no one's fault - that's just the crappy, crappy situation we're in.

[The Supreme Canuck]

You know what? Fuck it - I'm out too. All I'm doing now is arguing in circles and, apparently, pissing people off. So count me out.

Christ, it's the gun thread all over again... why the hell do I talk about things like this?

[FZR1KG]

You know what? Fuck it - I'm out too. All I'm doing now is arguing in circles and, apparently, pissing people off. So count me out.

Christ, it's the gun thread all over again... why the hell do I talk about things like this?

You're not pissing me off.
I always figure it's better to discuss the differences than ignore them.

I know what you are saying about "one of us vs one of them", I just don't think it applies here.
That's where the differences are.

You're calling it unjust but as it turns out the points we were making were pretty much spot on.
There were limited supplies and they don't know the possible results or if the person will remain contagious.
Would you consider picking two random people from a village to test unjust too or tragic?
That's my point. No matter what you do if you don't have enough supplies you will fail to make good by everyone.
So you pick the best case off the worst situation and go with that.

It's exactly what I'd do and it's not because I don't care about the rest.
Let's put it another way, what if the American's hadn't gotten sick and the doctor that is currently sick now was given the serum and asked to try it on a local.
Everything would be good then I presume, even though the other 900 locals wouldn't get it since there obviously isn't any.

If that's the case, what makes you think this is anything about unjust treatment rather than just timing?
Why pick class issues here over what could simply be timing?

More to the point, would you object if the two Americans were left without the experimental treatment but they tested on two locals instead?
Because if you wouldn't object, then it's time to check your own bias as you are making it impossible to treat Americans first under any circumstances without being questioned on it. Positive discrimination. I hate that shit.
Or do we draw a straws when deciding?
I can tell you I'd rather test on someone that may be able to recover and actually help thousands more if/when they recover than someone that can't. Same principle as an emergency on an aircraft, you put on your mask first then help others. To do anything contrary is negligent just to appear politically correct.

I guess the part that bugs me the most is that you and GJ decided that this was about privilege without any real data.
They are presumed guilty and they have to prove themselves innocent of the allegation.
I can see so many reasons why they would do what they did, you guys did not, it was straight to the class issue.
Even when we started pointing out other possibilities your preference was that it is unjust as the first choice and remains that way.

That bugs me because that's happening more and more in society.
It's ok if you do something if you are black, female or gay but do the same thing if you aren't and you are guilty of being racist, sexist or preferencist. I made that last one up. Cool eh?

[The Supreme Canuck]

I'm not going to get back into this, but I want to be clear that what you're saying I think? Not what I actually think.

[FZR1KG]

Okie Dokie.

[SciFi Chick]

And this is why I miss trolls. I like debating stuff. I don't know why y'all have to get all emotional. I mean, yes, I still get emotional, but I wait until passes before posting for the most part.

I submit that swift may be stressed due to something else. I happen to know he's going through one of the top five stressors psychologically speaking, and that can make everything seem more personal.

As for TSC - deep breath. You and I were pretty much agreeing. You and FZ weren't. Swift took it personally. That's three different reactions. No need to leave in a huff.

I'm not suggesting you get into it again. We are not the BABB (can't remember what they're called now). You can pick and choose what you want to respond to and not respond to the rest. If called on it, feel free to say that you've chosen not to respond to it.

I only bring this up because this crisis isn't over yet, and you might think of something else you want to add, and I don't want you to feel guilty because you stopped addressing one aspect of it.

It's good for us to have these conversations People! If a small group of people who respect one another can't hash things out, what hope is there for the rest of the world?

And yes - I was starting to feel attacked as an American. I get that you (TSC) didn't mean that, because I believe you when you tell me your motivations, but you failed at conveying it. I also understand if you don't want to try again, but I just wanted to point out that we aren't questioning your motivation - we just obviously aren't getting what you're saying.

[squ1d]

Did somebody say troll ?

Sorry I have had ebola of the emotions lately.

Apparently 'privilege' is the new hammer of rhetoric and all things are nails.

That doctor guy from the first page died, so I guess he wasn't very lucky at the roulette table.

[Sigma_Orionis]

Well if we're gonna go that way.....

You evil fat over privileged vacuous morally ambiguous capitalists imperialists, how dare you come here and tell us poor oppressed morally superior Latinos how hard you have it?

Give us all your money, and your Nuclear Weapons too

[FZR1KG]

Did somebody say troll ?

Sorry I have had ebola of the emotions lately.

Apparently 'privilege' is the new hammer of rhetoric and all things are nails.

That doctor guy from the first page died, so I guess he wasn't very lucky at the roulette table.

Hey, have all the emotions you want.
Glad to see you here, I can say that much about my emotions.

[Cyborg Girl]

Actually @squid you have a point, the concept of privilege is used incorrectly in rhetoric all the time. Orwell wrote about this:

https://www.mtholyoke.edu/acad/intrel/orwell46.htm

Kind of like with "fascism" (and "communism" and "socialism"). People talking politics tend to use them as pejoratives more often than for their actual meanings, which sucks.

"I'm privileged" is pretty much jargon for "The way people typically treat me gives me an unfair advantage over certain other people." Or maybe more to the point in most cases, it means: "Most people on this planet are treated less fairly by their fellow humans than I am."

(One could extend it to things that are just sheer good/bad luck, but society will always be imperfect; the basic problem is people treating each other unfairly when they don't have to, because they've been taught from day one that this is acceptable in some cases.)

[FZR1KG]

If I was privileged I'd be on the Pacific now.

[Rommie]

Yeah, this isn't a question of privilege so much as what countries do for their citizens. When Egypt breaks out into riots the Western nations all charter flights to get their citizens out of harm's way- it's just what you do, even though we unfortunately don't have the resources to evacuate everyone who might be affected by it in Egypt.

Additional plot twist: Americans are the only citizens who have to pay income taxes when living abroad. I was always told this is because I have an extensive use of embassies/diplomats/evacuations/whatever at my disposal that is above and beyond what other countries offer their citizens. Apparently that includes being evacuated from ebola-stricken countries, so that's cool.

[FZR1KG]

Additional plot twist: Americans are the only citizens who have to pay income taxes when living abroad. I was always told this is because I have an extensive use of embassies/diplomats/evacuations/whatever at my disposal that is above and beyond what other countries offer their citizens. Apparently that includes being evacuated from ebola-stricken countries, so that's cool.

Actually that's not true. Americans for a long time did not have to pay tax on any earnings they made overseas.
Many went to Saudi and earned a lot of tax free dollars. I was tempted years ago but the Australian government would have taxed me at crazy rates based on the Australian system and the cost of living in S.A. was not factored making it hardly worth the effort.

The USA however is one of the few that tax it's permanent residents on what they have/had oversea's BEFORE they became PR.
The guy that did the welding on my boat has property in N.Z. and every year he has to put the value of it in and get taxed on it.
Even though he had it well before he moved here. If he sells it, the US government wants it's share too.
Note that I wouldn't care so much if Oz or N.Z. did that because PR in those countries are eligible for government programs just like citizens.
Not the case for PR's in the USA.

So it's not about providing you extra protections at all. Most countries do that anyway.
It's about money and particularly lately since the wealthy people (the corporations) have started taking money outside the USA to avoid tax they need all they can get and guess where that is starting to come from.

[Rommie]

No, I still have to file with the IRS every year on all my income including that made abroad (I don't make enough for them to take extra due to Dutch-American reciprocity). In fact, due to obscure reasons it's a complete nightmare now for Americans who live abroad to file properly- good summary here. The latter is due to laws applying to a lot of random stuff it shouldn't and expats not exactly having a big voice or a government representative.

I mean there might have been something worked out specifically with Saudi Arabia (or it was just a helluva lot easier to hide your income a few years ago- my Canadian second cousin did that route too), but you've definitely had to file even if an expat as long as I remember.

[FZR1KG]

No, I still have to file with the IRS every year on all my income including that made abroad (I don't make enough for them to take extra due to Dutch-American reciprocity). In fact, due to obscure reasons it's a complete nightmare now for Americans who live abroad to file properly- good summary here. The latter is due to laws applying to a lot of random stuff it shouldn't and expats not exactly having a big voice or a government representative.

I mean there might have been something worked out specifically with Saudi Arabia (or it was just a helluva lot easier to hide your income a few years ago- my Canadian second cousin did that route too), but you've definitely had to file even if an expat as long as I remember.

I didn't make myself clear.

You stated that Americans are the only ones that pay when overseas. That's just not the case.
I get taxed in Australia while I am here. Always have. That was my point.

Taxing US citizens abroad is a recent thing but the US has always provided the same service to it's citizens.
I don't know what year it changed because I didn't follow it in depth.
At one point in the last 20 years or so they didn't tax overseas income, then all of a sudden they changed.
I think recent for you and recent for me are two completely different things rofl

Right now it's the worst it's ever been for US citizens abroad.
Many have decided to give up their citizenships over it.

[squ1d]

i have a friend who is now a teacher in New York and apparently the ATO just asked him for his last 5 years of tax returns. LOL !

[Rommie]

So every once in awhile the university here organizes a "beta break" during lunch where they bring in a few guest speakers to discuss a science topic or another, and today was on Ebola. Which was interesting enough that I'll highlight a few points here for y'all-

- You can tell all the experts (public health official, virologist, doctor from a hospital in the Parisian suburb w lots of West Africans who come in) were frustrated by how the narrative in the media has been dominated by "it can mutate and kill us all in the West" and what not. While anything is possible (the virologist said "like a meteor crashing in right now and killing us all") and it can mutate all the more times it transmits to someone else, it's a complex enough virus that this isn't anyone's serious worry when it comes to the discussion.

- Rather what public health officials are really worried about with ebola is that it's going to become endemic in this region of West Africa like a host of other tropical diseases. Beyond the fact that it's an awful disease, it also means the rest of the world will stop covering it and it'll become a "normal" disease like the host of other tropical diseases already endemic like malaria (also big emphasis on how things like malaria kill far more people each year than Ebola will this year, in the same region of the world primarily, but we don't really care).

- It should also be noted that one of the biggest issues w Ebola and containing it is it really looks just the same as a host of other tropical diseases you can get in that part of the world. Paris doc was saying how just a few days ago there was a girl straight off the plane from West Africa w a 40C fever, convulsions, all the other stuff... and it was cerebral malaria. So the real issue in that part of the world is just spotting it in the first place.

- Finally, even if a boatload of illegal infected immigrants were to turn up (or whatever your worst case scenario is) there was a huge emphasis on how it's really not an issue for the Western world because we have developed health care. If someone were to walk into Amsterdam and potentially infect a dozen health care workers meaning they can't work that's just a drop in the bucket; in all of Liberia there are only 40-something doctors in the entire country. It's been expected for awhile now that something like this Ebola epidemic was going to happen in this part of the world considering how little the health care system was supported (at this point one of the experts went on a rant about privatization and how awful it is, but honestly I think the whole "we don't want to give foreign aid because it just goes into a dictator's pocket" angle is more what affects Africa these days). In fact, one guy was skeptical that you're going to see much really change now with the new initiatives announced by Obama etc, as virtually no international aid workers want to go there.

Anyway, thought some of y'all would appreciate the non scaremonger angle to the story described today. Wish I had a connection on the medical science angle of journalism, it'd make a good article.

[Sigma_Orionis]

All sounds reasonable.

Please don't mention Malaria, after having that disease licked for decades, it's making a comeback here. No need to explain why do we?