Ebola: what it tells us about medical ethics

Angus J Dawson

doi:10.1136/medethics-2014-102304

Responses

PDF

JME40: Good medical ethics

Paper

Ebola: what it tells us about medical ethics

Free

Compose a Response to This Article

Compose Response

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

PLEASE NOTE:

A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.

I agree to and have read the terms and conditions for rapid responses and BMJ Privacy Notice *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

The use of placebos in Ebola treatment trials
Joseph Ting
Published on: 18 May 2017

Published on: 18 May 2017
The use of placebos in Ebola treatment trials
- Joseph Ting, Adjunct associate professor,
The argument for substantial benefit conferred by the placebo effect in treatment trials has been around for a while. Clinical triallists do not deny that inactive sugar pills and IV medications or sham surgery have some quantifiable benefit when compared with doing nothing at all. Patients who consent to participate in treatment studies tend to be more motivated and confident that they will get better than those who ref...
Show More

The argument for substantial benefit conferred by the placebo effect in treatment trials has been around for a while. Clinical triallists do not deny that inactive sugar pills and IV medications or sham surgery have some quantifiable benefit when compared with doing nothing at all. Patients who consent to participate in treatment studies tend to be more motivated and confident that they will get better than those who refuse to be enrolled, despite only having a one in two chance of receiving a potentially beneficial therapy. Randomised controlled trials attempt to discern whether new therapies result in a clinically relevant benefit (improved survival, reduced symptoms) in addition to that conferred by the human mind's empowerment to enhance immunological and psychological defences from participation in studies. Furthermore the awareness of being closely observed and monitored for clinical progress or deterioration is an incentive for patients to do better (the Hawthorne effect, aiming to gain approval from investigators and other participants), regardless of whether a study subject receive the tested or inactive treatment.
Ebola haemorrhagic fever, with its high case fatality risk, has no reliably proven effective single drug or immune treatment. Although several repatriated adults in advanced health systems have survived with novel immune therapy, it could well have been the excellent critical care and fluid resuscitation that were responsible for their recovery. The latter would almost certainly not be available on a day to day basis in the impoverished West African countries where EHF trials would be conducted. In addition to placebo comparisons, the study of advanced fluid resuscitation, immunomodulators and vaccines in vulnerable people who cannot afford such treatments even if they were found to work remains ethically challenging.
Conflict of Interest:
None declared
Show Less

Conflict of Interest:
None declared.
- Back to top

Main menu

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Conflict of Interest:

Log in using your username and password

Main menu

Log in using your username and password

You are here

Plain text

PLEASE NOTE:

Vertical Tabs

Other responses

Jump to comment:

Conflict of Interest:

Read the full text or download the PDF:

Log in using your username and password

Other content recommended for you