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Topic: World Health
November 3, 2014 | Posted By Luke Gelinas, PhD

Recently prominent bioethicists have voiced disagreement over whether it could be ethical to test experimental Ebola vaccines in placebo-controlled randomized trials.  Such trials would involve taking a group of people currently infected with Ebola and randomizing half of them to an arm that receives the experimental vaccine (plus, let us assume, the best current standard of care for Ebola), and the other half of them to an arm that receives a placebo instead of the vaccine (plus the same standard of care).  

The main worry with these trials is that it is unethical to give Ebola-sufferers a placebo when an experimental vaccine is available that holds the prospect of benefit. (The prospect of benefit is typically inferred from success in trials with animals; at least one experimental vaccine, ZMapp, has showed notable efficacy at preventing deadly disease in macaque monkeys inoculated with a virulent strain of Ebola.)  As a prominent group of bioethicists recently pointed out, conventional care for Ebola “does not much affect clinical outcomes,” resulting in a mortality rate as high as 70%.  “When conventional care means such a high probability of death,” they continue, “it is problematic to insist on randomizing patients to [a placebo arm] when the intervention arm holds out at least the possibility of benefit.”  Moreover, they insist, “none of us would consent to be randomized in such circumstances.” 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

August 14, 2014 | Posted By Jane Jankowski, DPS, LMSW

I was struck by the NY Times article that described tracing the path of the recent Ebola outbreak back to a two year old boy living in Guinea, Africa (NY Times) on the border of Sierra Leone. Not only does it forever impress me how epidemiologists and health officials are able to map the transmission of a rapidly spreading disease back to a likely origin, but the mystery surrounding how it all began is not, nor likely to ever be, known. Was it a bat? A piece of contaminated fruit? It is staggering to think that perhaps natural childhood curiosity set the stage for this kind of significant international health crisis.

Compounding the tragedy of the numbers of lives lost is the fear. While the World Health Organization (WHO) have made recommendations to attempt to limit further spread through education and travel restriction (WHO) the world is watching and waiting to see what happens, hoping enough help and support can be mobilized to halt the spread of this epidemic (West Africa Health Emergency). Though this health emergency is playing out in West Africa, it is a stark reminder to all just how vulnerable humans are to existing disease. There is no vaccine and no clear treatment protocol, though US health workers did receive experimental treatment with good effect (see blog by John Kaplan). In Africa, however, it is a matter of containment.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

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ABOUT BIOETHICS TODAY
BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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