Experts Decry Randomized Ebola Treatment Trials As Unethical, Impractical 193
New submitter Strangely Familiar writes "A letter in the Lancet calls for alternatives to randomized trials for Ebola treatments: "Leading health experts today urge the deployment of alternative trial designs to fast-track the evaluation of new Ebola treatments. In a letter to The Lancet, 17 senior health professionals and medical ethicists, from Africa, Europe, and USA, argue that although randomised controlled trials (RCTs) provide robust evidence in most circumstances, the lack of effective treatment options for Ebola, high mortality with the current standard of care, and the paucity of effective health care systems in the affected regions means that alternative trial designs need to be considered."
Mmm... (Score:2)
If they are serious they really need to get more big names, institutions, and ethicists on board. A lot more.
There has already been support for basically using time to create control groups, so this is much less of an issue than it could be.
Yea, best form a comitee to consider all options.. (Score:5, Insightful)
Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done. Stick to what is known to work, there is no time to come up with anything better. If something better had been found in centuries of research into medical methods, then it would be the standard-approach. There is nothing. There will not be anything new even if you debate that question to death now.
This continues the series of incompetence, misinformation, self-aggrandizement and general fuck-ups that have become the signature of the fight against Ebola this time.
Re:Yea, best form a comitee to consider all option (Score:5, Insightful)
But randomized trials were designed to be used in a certain set of circumstances. The question is whether these circumstances fall outside of what those would be applicable to and what would be the appropriate protocol if they're not. Being too rigid can be a bad thing but also things should not be done in a knee-jerk fashion.
Re:Yea, best form a comitee to consider all option (Score:5, Insightful)
Any more meaningless generalities to contribute? The field is not static or rigid. The problem is just that generating and validating new drug-trial methods takes decades and cannot really be sped-up. The whole reason we have this gold-standard of randomized trials is that all else has failed. The worst was always the physician on the ground deciding about it, as they have a strong, well-known (and understandable) tendency to always favor their own patients and an inability to clearly see what is happening as a result. That is fine as it is, of course doctors should be strong allies to their patients and try whatever is possible if the patient wants that. It is also catastrophic when objective information about effectiveness or its absence of some treatment is critically needed. All this messing around that these people propose will in the end only cause more victims, potentially a lot more.
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Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done. Stick to what is known to work, there is no time to come up with anything better.
It's not a question of experimentation with uncertain approaches. The alternatives are all well-understood... actually the mathematics is straightforward enough that the characteristics of virtually any approach you can invent can easily be calculated.
The question is whether they should use the approach that provides the fastest route to a given level of certainty at the expense of deliberately leaving a significant percentage of sufferers untreated, or whether to use other methods that provide the treatm
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No, you cannot "easily calculate" the mathematics of an alternate approach. In a clinical trial, you _create_ the experimental conditions and that is the only reason that you know them and can do calculations. Sure, if you have all data, then modeling is easy. You will not even get reasonable approximations in the situation at hand. Remember that hospitals refuse treatment to sick and dying people because they are full? Remember that people there bury their dead themselves? Remember that conditions are bad
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Seriously, starting to experiment with uncertain approaches in a time of crisis is about the most stupid thing that can be done.
But that is "doing something"! Haven't you heard of the First Rule of Bad Decision Making yet?
1. "We must do something!"
2. "Here is something."
3. "Let's do it!"
During a "crisis", doing nothing or doing things the same way you do normally (for whatever reason), is a mortal sin in the eyes of many PHB types.
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Indeed. Unfortunately, if this goes seriously wrong, it is not just one incompetent tribe that gets wiped out this time.
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In this case, one of the most dangerous things you can do is partially apply a cure. Allowing people who have already been treated to remain in close contact with those still infected and resulting in re-infection is the surest way to develop treatment resistance in the targeted infectious agent. Stockpiles of any successful treatment must first be built up in countries not yet infected so that any appearance of the infection can be rapidly treated. Once those stockpiles are built upon, stockpiles to be de
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You appear to be describing antibiotic resistance. Ebola is a virus.
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So how would you do an RCT for something like Ebola, a disease that really only manifests itself when it starts to spread? Would you ask for volunteers to be infected outside of an outbreak in ordered to test efficacy/safety? Is there an IRB board in the country that would authorize something like this?
I actually do agree that you don't want to get all Mavericky with drug experimentation. At a certain point though you need patients with the disease to test efficacy and safety. If the only time you have pa
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Seriously, THAT DOES NOT WORK. This idea is for armchair-statisticians only. You NEED the same conditions for the control-group or the results are meaningless.
Well, that is not entirely true. With a medically very well-monitored population where in addition all contacts of everyone are closely monitored and well documented, something might be possible to do with advanced, untested, statistics. I hope you can see that not even western societies meet that requirement by a far cry.
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Yup. The problem with treating zmapp as a cure without evidence is that it might turn out that it doesn't work at all, and that other research lines were not pursued because zmapp was viewed as a cure. Why might this happen? Well, for starters there actually isn't THAT much money to be made in a cure for Ebola. I don't agree with the tinfoil hat types that anybody would deliberately not develop a cure, because the fact is that a cure would generate a reasonable profit if not a huge one. However, the wo
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Indeed. With the current situation, the delay would be lethal for a lot of people.
And antivirals have been duds before after being heralded as miracle cures. Just think of Tamiflu, for example. Last I heard it had "no effect".
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Really, it is not "for me" where the problem sits. It is for those sick and dying and all those that will get infected in the future. Learn a bit about statistics maybe? And while dead/not dead may be a reasonable approximation for Ebola, it is not for ZMapp, unless you assume zero side-effects. Also, the death-rate is _not_ known, there are just some estimates and in addition it seems to be strongly dependent on factors like medical care. Or in short: The clueless one here is you.
Re:Yea, best form a comitee to consider all option (Score:4, Insightful)
And you can't really be sure without a control.
Is the fact that there are less dead people in the zmapp group vs the current untreated death rate not enough of a control for you?
You're talking about a zmapp group composed of people who are well fed their entire lives, of a different racial composition, and who received care in first world hospitals. Your control group is a bunch of people being given palliative care for the most part in tents and the like, most of which who probably have never been to a doctor otherwise in their entire lives.
No, that isn't a controlled experiment.
You people don't know shit about how medical studies work, there are only two outcomes with this virus, and that is dead vs not dead. It would be very easy to derive the P value of the zmapp treated group relative to the known death rate of the virus.
Anybody can load a pile of data into a statistics program and have that program output numbers. Those numbers only mean something if the data was any good. You can't do an uncontrolled experiment and get a real result out. Sure, you might use this kind of data to decide whether the expense of doing a controlled experiment is worthwhile, but on its own there are so many reasons that the results could turn out wrong they're nearly worthless.
Don't feel too bad though - lots of researchers do things just the way you describe, which is why the US spends all kinds of money on treatments that have little evidence supporting their effectiveness. While everybody likes to pick on drugs, the irony is that at least recently these tend to have quite a bit of rigor behind them. The real black magic are things like surgical treatments and the like.
Oh, and while you're doing your uncontrolled studies you should just try injecting patients with saline solution. I would expect it to have a noticeable impact on Ebola death rates - the placebo effect works on just about anything that has ever been tested.
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Indeed. And if you kill that bunch of people without sound conditions to get a statistical handle of what happens, you just make things worse by wasting time.
A lot of emergency medicine is still in its infancy and is risky, bloody and deadly. Done wrong, it becomes a lot more so. Get used to it.
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I do not claim that doing the statistics right gives you perfect data. Far from it. But If you do the statistics wrong, you are ensured to get bad data and that potentially kills a lot of people with the problem at hand. So doing the statistics right is an ethical imperative, even if the results are only so-so.
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I completely agree. There have been significant discoveries under great pressure. There have been a lot more utter disasters when experimenting under great pressure. Of course, history tends to remember the heroes, and to forget the catastrophes, but realistically, the making things worse is a lot more likely, especially when we have something we know works to a reasonable degree and when we know beyond any doubt that the problem is very, very hard.
ZMapp (Score:2)
It may be useful to 'fastrack' the drug through stage 2 trials, since by that point we know it won't kill you.
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The available ZMapp was wasted in a worthless political demonstration "that something can be done". In the end, it is likely that this utterly selfish and stupid approach will make things significantly worse.
Re:ZMapp (Score:4, Insightful)
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As I said, political reasons. The US administration wanted to demonstrate that it "can do", no matter the cost. At this time there is no ZMapp left, AFAIK, and more will take months to produce. And due to this initial stupidity, we have zero knowledge whether it is even a good idea to use.
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Because randomized trials are difficult to set up properly. It might well be better just to give ZMapp based on availability and common sense clinical judgment and then analyze the data, including natural controls, retroactively.
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That does not work. It is well-established that it does not work. Really, maybe do a tiny bit of basic research before spouting utter nonsense?
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You don't know what you are talking about. Much, if not most, of medical research is based on natural experiments and retrospective analyses. FDA-approved drugs are the exception, not the rule.
Double blind clinical trials are the standard for FDA drug approval because for most diseases, delays and costs don't matter that much: there are already adequate treatments. J
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And this utter fail at understanding how to do statistics is the reason so many of them are wrong or misleading. WHY THE FUCK DO YOU THINK THIS HAS NOT BEEN TRIED BEFORE AND FAILED?????
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You'd be a lot more convincing if you gave actual reasons that it won't work. But you can't, because you're wrong.
The type of trial that you're claiming has "been tried before and failed" is called an "open clinical trial". They are quite common in the medical field. Although they do sometimes show some bias towards success compared with placebos in situations where success is subjective, when the result of failure is death, there's no real risk of experimenter bias changing the outcome. Either the pati
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One issue I can think of is there is selective pressure on viruses for them to become less lethal over time since killing the host is counter productive. You can't compare now to the past for death rates since as the virus spreads and mutate the pressure is to become less lethal.
If you want to compare the effectiveness of a drug on a virus you need to compare in the same population and random is really the only way to do it since you need to make sure that the mutations you are dealing with are in your test
Political pandering (Score:2)
The available ZMapp was wasted in a worthless political demonstration "that something can be done".
Quote so. There were only a few doses available and without a trial of statistically significant size we cannot possible know if this treatment was effective. Ebola is serious but it doesn't kill everyone it infects. So if you give a treatment to a tiny group of people you have absolutely no way to know if the treatment was effective. You have wasted time and money and hope and learned absolutely nothing in the process. It's idiotic.
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Who cares what "we" know? Why not leave the decision up to the individual involved?
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Who cares what "we" know? Why not leave the decision up to the individual involved?
Because people fearing for their life tend to make remarkably dumb decisions, particularly since few of them are actually knowledgeable regarding the facts involved. Because even if we give one person the drug we will have absolutely no way to know if it was effective because ebola doesn't kill everyone it infects. Was it the drug or some other factor that saved them?
We do things the way we do them for extremely good reasons. Rushing things actually ends up hindering things in the long run.
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Maybe if you grow up a bit more you'll realize that most of life's decisions are like that. And in a free society, we ought to leave such decisions to the individuals involved.
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Translation... (Score:4, Insightful)
argue that although randomised controlled trials (RCTs) provide robust evidence in most circumstances, the lack of effective treatment options for Ebola, high mortality with the current standard of care, and the paucity of effective health care systems in the affected regions means that alternative trial designs need to be considered."
Translation:
Even though randomized trials are the gold standard for determining whether a treatment is effective or not, these places have shitty health care systems so we think should do something else now that we know is a bad idea even though it will be detrimental in the long run rather than engage in the hard work that will really solve the problem.
Conveniently these "alternative trial designs" are not detailed in any way. Doing something different for the sake of doing something different is rarely a good idea.
We use randomized trials for VERY good reasons. If we push a bunch of experimental treatments out there it's possible we may save some lives but it is more likely we will accomplish nothing and even worse we will learn nothing in the process. Yes some people are going to die from ebola while we develop treatments. This is the cold hard fact of medicine - we sacrifice some so that a greater number may benefit eventually. You can try taking shortcuts but the odds are very long against them working and even worse you run a high risk of sacrificing future patients on the altar of compassion.
I get that people are dying and my heart goes out to them. But we do things the way we do them for very good reasons and the middle of a (minor overblown) crisis is hardly the time to start throwing out what we know for a fact works.
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Short cuts make long delays (Score:2)
they're simply desperate to find anything that will stop it.
We already know what we stop the epidemic. Appropriately executed public health policies, particularly quarantine. I understand people's fear and desperation but public health policy is not the place for panic. To use a basketball analogy these people are proposing taking half-court shots and hoping for the best rather than doing the hard work of actually doing what we already know will work. We are NOT going to save everyone but rushing things along is very likely to actually kill more people in the lo
Re: Short cuts make long delays (Score:2)
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How about an immune system that attacks its own body endlessly such that treated subjects balloon every day to twice their normal surface area, losing enough bo
Good reasons not to rush to unguided usage (Score:2)
It also means that for those that are infected, there's so little chance of survival with "traditional" treatments that they have very little to lose by trying something experimental. Even if a treatment gives them cancer, or HIV, or leaves them with something like chronic fatigue syndrome, they're still going to enjoy quality of life better than they would if they're dead.
I would posit that the problem is not that the currently infected individual faces any fate worse than death.
The problem is that lack of high-quality data may forestall the development of more effective therapies, which means you are condemning people infected in the future to death. This latter group seems abstract and hazy, compared to the concrete suffering we can see before us, but eventually the future becomes the now, and we'll have to deal with it.
Researchers may well end up heading down blind alley
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Well I would argue something different. The point of randomised controlled trials is to form a perfect control group for comparison.
We have a pandemic which has so far been treated without the drug. For the most part we have a lot of data about the control group already. Changes in care in West Africa have had little effect on the mortality rate of victims. So why not start giving the drug to everyone and compare against historical data?
Quackery is not a solution (Score:2)
The point of randomised controlled trials is to form a perfect control group for comparison.
More or less correct. You are trying to control for variables between the treated groups and the non-treated groups to see if there is a statistically significant difference in outcomes between them. If there is a better way to do this than a double-blind study, we haven't found it yet. We do use other study designs when a double-blind study isn't possible but other methods have significant problems.
So why not start giving the drug to everyone and compare against historical data?
Several reasons:
1) Which drug? Do we have enough of it? Can we get it to where it is needed? Has it bee
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Nothing is being tested without success in animal models. That's not a guarantee, but AFAIK viruses in humans replicate in basically the same way that they do in animals, so odds are
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1) Which drug? Do we have enough of it? Can we get it to where it is needed? Has it been previously tested in humans for toxicity? Is there any reason to believe it will work beyond mere hope?
All of them, individually with their own studies on successes. As for has it been tested, we are beyond that stage. Once we get to the point where we are arguing the specific scientific method of a clinical trial we can guarantee that we're at the point where the drug has matured beyond this question. I.e. it's already worked in labs / animals and been presumed safe to administer. (Despite what people think, signing up for clinical drug trials is actually incredibly safe).
2) We do NOT have particularly good information in the historical record. The medical records in the affected areas are quite certain to be of poor quality. So you lose a LOT of information that is relevant for making comparisons and you do not have a particularly good control group.
My argument is that you don't need
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Conveniently these "alternative trial designs" are not detailed in any way. Doing something different for the sake of doing something different is rarely a good idea.
The alternative I've repeatedly seen mentioned is the stepped wedge trial.
Basically, you take your sample, create subgroups of random patients, then give the treatment to one group at a time.
This allows you to use the upcoming subgroups as controls, while avoiding the ethical problems of denying people treatment. [wikipedia.org]
The ethics are something reasonable people can and do disagree about. The problem in this particular situation is that you're trying to run a clinical trial during an active pandemic against a disea
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I suspect these 'experts' are just panicky people who an incompetent journalist mistook for actual experts.
If anything people genuinely interested in the cure will *not* want to compromise actual clinical trials.
Perhaps some alternatives could be tried in parallel, and - by random chance - they might help, but they will be nothing more than folk remedies until there are proper trials.
Not sure what the problem is (Score:3)
Randomized trials worked just fine for syphilis.
So, of course, it goes without saying (Score:4, Interesting)
The signatories to that letter in Lancet are willing to shoulder any monetary and/or criminal penalties that, in the future, come about because doctors and pharmaceutical makers haven't followed eatablished best practices in pursuit of effective Ebola treatments.
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The folks who consent to a trial give informed consent, are minimized in number based upon the data currently available on the treatment (ie more patients as there is more data supporting the safety of the treatment), and receive their care free of charge.
These factors do not apply to what seems to be proposed. I don't hear the doctors screaming that there will be no hospital bills for anybody who gets Ebola since they're receiving experimental treatments. If they're taking money in exchange for treatment
drive-by doctoring is Unethical, Impractical (Score:2)
drive-by doctoring is Unethical, Impractical but legal and you are on the hook for the fees some at out of network rates.
Stepped Wedge Trials (Score:2)
WHO is already looking at stepped wedge trials [umn.edu]
Only after SAFETY is established (Score:2)
It's not ethical to administer treatment until we have reason to believe it's more likely to do good than harm. With top of the line supportive care, ebola patients seem to have about even odds to pull through. Giving them something toxic or using limited money on unproven medication rather than access to good supportive care could well jeopardize those odds. Initial trials should be done on just big enough groups to establish necessary statistical confidence.
Now if side effects are few and financing is not
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Never forget the big picture in
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"Something has to be done. This is something. Therefore it needs to be done"
Withholding potential treatment (Score:2)
So why not allow the experimental product to be administered outside of the trial, having only passed safety standards? That can provide solid evidence for a large category of illnesses (those that people are not known to recover from spontaneously).
Then, if some folks want more rigorous evidence of efficacy, they are welcome to find patients who accept to participat
Ethical (Score:2)
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That's simply not true. Non-placebo-controlled open clinical trials are used all the time to determine the efficacy of treatment. They aren't nearly as airtight as double-blinded, placebo-controlled studies (because of the placebo effect), but to say that they prove nothing is overstating things quite a bit, particularly in situations where success or failure is black-and-white (because the patient either died or didn't).
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Pediatric intensive care delema /cure (Score:2)
I have a friend that worked at the Stanford medical center's pediatric intensive care unit, where his patients were often flown in/helicoptered from all over the state. There are certain diseases that have a 100% mortality rate in children, where they could be fine two weeks before, and near death when he gets them. He developed a cure that saves about half the kids, and attributes most of the lost ones for not getting then to him fast enough. Everywhere else in the world they die. Stanford, being a rese
We need a new testig paradigm (Score:2)
It's time we came up with a twenty-frst century alternative to the randomized trial, like creating a supercomputer model of the human body to test drugs agaionst,
Giving half your test population of cancer patients a placebo may be merely unethical, but giving half your population of Ebola patiets a placebo could take out an entire country.
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the news increasingly censors any opinion that would be against socialism or popular accepted opinions
I find it incredible that in the 21st century Internet-connected Scandinavia, there are no independent contrarian news outlets.
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I find it incredible that in the 21st century Internet-connected Scandinavia, there are no independent contrarian news outlets.
Oh but there are, they just get censored and publicly ridiculed in the mainstream media for being too extreme, tin foil hat news etc. Some of the news reporters from these sites has been charged with racism, hate-crimes and much more and are thus frowned upon and everyone who support them, visit these sites etc. are seen as extremist supporters, vigilantes and society's troublemakers.
An extreme example would be Sweden's recently 3rd largest political party (SD, Sweden Democrats) who got 13% country wide
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Re:Our PC society will be our demise! (Score:4, Insightful)
I think you happen to have a very different idea as to what "censored" means than the rest of the world.
Many people that have kooky opinions think they are being censored when others don't take their ideas seriously.
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Well it's a bit difficult to know for sure. There are kooky people who are rightfully dismissed, who then harbor resentment for being shut-down in the conversation. Then there are people who make a good point, but are dismissed for emtional/political/irrational reasons, and who are rightfully upset that their objections go unheeded.
In a conversation when someone is being dismissed, we tend to see anyone who disagrees with us as the former, and anyone who agrees with us as the latter. How to tell the dif
Re:Our PC society will be our demise! (Score:5, Insightful)
Context - what's actually on the rise in Scandinavia at the moment is Nazism. So far, the fight against it has been a rather ham-fisted attempt to suppress it in the news, rather than engaging it and letting people see for themselves what it is. OP apparently sympathises with the rise of the far right in his country.
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OP apparently sympathises with the rise of the far right in his country.
You don't have to agree with someone to believe that they have a right to speak.
Re:Our PC society will be our demise! (Score:4, Insightful)
I didn't say he didn't have the right to speak. I was just framing his comments with a bit more context.
Having the right to speak is not the same as having the right to not be called an idiot.
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the news increasingly censors any opinion that would be against socialism or popular accepted opinions
I find it incredible that in the 21st century Internet-connected Scandinavia, there are no independent contrarian news outlets.
There are. Don't conflate Sweden with the rest of Scandinavia, and even if Sweden there are contrarian outlets, it is just that most Swedes pretend opions they don't like don't exits.
Aspirin (Score:2)
If passengers are lying about having contact with Ebola infected people . . . they will just pop a couple of aspirin to bring down their temperature before landing.
Very un-PC, but it will help them avoid yet even more delays while trying to catch a connecting flight.
Not worried about aspirin (Score:2)
If passengers are lying about having contact with Ebola infected people . . . they will just pop a couple of aspirin to bring down their temperature before landing.
If they are showing symptoms, a high temperature will not be the only symptom in evidence most likely. Aspirin is VERY unlikely to cover the symptoms of ebola. Plus taking a blood thinner (aspirin) when infected with a disease that results in bleeding is a monumentally stupid idea.
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intentionally risking the infection of people in order to save your own ass is monumentally stupid. But people tend to act in ways of self preservation when the issue is pressed and you will see things like this often. It's no different than a criminal who rats on his buddies for a lesser term in prison or the conscripted soldier who flees to another country to avoid the conscription.
So aspirin, Pepto bismol, [pepto-bismol.com] and hydrocodone or Vicodin will cover up most early symptoms of Ebola. [mayoclinic.org] I guess the issue is will th
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IMO you've mistaken political correctness and socialism terms for something else. Your first point about media censoring an opinion is in fact related to political correctness but after that you have no clue. Think about yourself - please answer this sincerely - if you or somebody close to you had contradicted Ebola abroad of your country would you wish your country to help you or not? After all you've had paid for your country's medical care in your taxes - and this is by no means socialism. So how would i
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Re: Our PC society will be our demise! (Score:2)
Socialists at least used to be noted for building large-s ale infrastructure, like Hoover Dam. Today all they can do is ladle out welfare benefits and fight meaningless academic battles involving identity groups.
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Er, it happened in America too and you couldn't exactly describe them as socialist.
Yeah, our socialists prefer to be called Progressive. Used to be Liberal. They change their name every decade or so once people figure out what they really want.
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And yet from today's perspective, Eisenhower could be mistaken for a Democrat.
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And yet from today's perspective, Eisenhower could be mistaken for a Democrat.
And yet from a right / left linear political description, Hitler and Stalin were polar opposites.
You don't necessarily have to subscribe to the Political Compass approach, but it's patently obvious that the social and economic spectrums of politics are orthogonal. Anyone who tries to persuade to believe only the left/right alternatives exist is probably running for office in a first past the post voting system.
Both modern Democrats and modern Republicans are highly in favor of the authoritarian, interventio
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Actually, with the right shift of politics, Eisenhower is left of republicans AND lower on the authoritarian scale than either Rs or Ds today..
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I think this "former GOP president would now be considered a modern Democrat" meme (usually Eisenhower or Reagan) is either deliberately disingenuous or ill-informed.
Got a lot of calls from modern Democrats for crash nuclear weapons program expansions? Maybe these calls are from the pro-life wing of the Democratic party that's in favor of government deregulation and privatization.
The assertion made by this meme isn't any more apt than trying to claim all modern Democratic presidents could be mistaken for Re
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Actually, it was my own conclusion just by looking at him. It's really quite obvious that there is no 'left' in the U.S. and that the closest we have was once called 'right'. The 'right' we have now would once have been known as the crazy wingnuts.
Consider, Universal healthcare turned into insurance bought from private entities. A few years ago it was called 'Romneycare'.
There's nothing inapt about it. It is a perfectly valid observation of how quickly the actual positions of the parties have shifted and is
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Um, the positions of the parties have been shifting more authoritarian, on average.
The USA was kind of founded on radical individual liberty and freedom. Today you can't find a party wanting to touch the war machine, drug laws, social security, or other massive programs that the Framers couldn't even have dreamt about.
Go back and look at the conflicts that the two parties fought over back then. It seems like a joke now. There was a time we actually fought over a centralized banking system? Light houses? Sla
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Yes, as I indicated, both are more authoritarian today as well as being further right.
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Today you can't find a party wanting to touch the war machine, drug laws, social security, or other massive programs that the Framers couldn't even have dreamt about.
www.lp.org . you are welcome
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We aren't going to agree about this, because you are insistent upon conflating the social policy spectrum with the economic policy spectrum when they are orthogonal.
Consider gay rights. A "few" years ago, support for gay rights was reserved for the likes of anarchists like Emma Goldman. Now, the cultural/legal shift is all over but the whining. The Democrats were on the leftist/liberal aspect of this. So, despite your claim that there is no "left" in this country, there is indeed a true social "left" as dem
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obamacare - all 50 states, fine if you dont buy it
no, they are not the same thing no matter how much the democrats want to try and run away from the disaster now
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The point is, you can define "liberal" to the stage where Reagan, Nixon, and even Goldwater were 'liberals", just as Fox news insists that ALL the other media outlets are liberal.
Remember the tax rebates of 2008 and 2009? It's estimated that individual consumer spending drives about 68-70% of all economic investment in the USA - in fact, the 2014 estimate for that is exactly 70.0%. Just about everyone in economic circles accepts this number, maybe with a few minor quibbles. That means a neutral (not conserv
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All religions teach hate and violence of some form or other. Organized religion itself is nothing more than political control of a given populace. The whole concept of "hell" is using the threat of violence to control behavior. The point is, most, if not all, religions have their violent tendencies.
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The placebo effect is well-established and real. It is well established that it continues to work with smaller effectiveness even when the subjects _know_ they are getting placebos. Stop bringing some new-age bullshit into the discussion, it is not helping. Medical statistics (unlike medicine as often practiced) is a very mature field and delivers reliable results.
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The Placebo Effect is known to have at least one huge flaw in its theory. There have been several experiments involving Placebo Opiates and Placebo Opiate Antagonists in double blind studies with real drugs of both kinds, and the researchers doing them have pretty much disproved that the Placebo Effect works in any of the ways theories say it might.
In fact, one prominent researcher said of these studies, he was now of the opiniion that it was not possible to phras
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Nothing will ever convince conspiracy theorists, so I am not even going to try.
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In vitro (test tube) tests of lamivudine showed zero efficacy, and the CFR for that doctor's patients is now reportedly up to 5/15, which isn't statistically significantly different from the CFR anywhere else with proper supportive care and no drug treatment. So unfortunately, it appears to have no effect.
However, favipiravir (an anti-influenza drug) shows promise in mouse trials, so it may start to be used in the not-too-distant future. They're also testing brincidofovir. And both of those treatments ar
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I tried hard to decipher what could have triggered what I wrote into the obvious troll thread it became
It was an obvious troll from the start.
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Instead of randomizing with placebo, why not simply randomize with _different_ experimental treatments and then use analysis / datamining to determine which are most effective? That way no one has to have placebo.
It might be difficult in such a situation to do the test in a double-blind fashion, but you are correct that this can be done. Of course, without a placebo you can't rule out that none of the methods are particularly effective if they're comparable. After all, placebos are themselves effective compared to not treating somebody at all.