Ebola, Rats, Lice, and History, and Hans Zinsser Part 2

And so, the caution inspired by Swine Flu Fiasco of 1976, with 25 deaths and 500 illnesses, and some delayed mortality, is a significant impediment in the response to Ebola. Although other reasons can be cited, such as safety profile concerns that affect all vaccine development, the Swine Flu Fiasco is special. It had a uniquely visceral effect on the public at large, who don’t read or know about vaccine trials.

The CDC numbers, with the current 71% mortality rate, directly refer to two outcomes, and are permissive of a third:

  • Infection of 550,000, resulting in 390,500 deaths.
  • Infection of 1.4 million, resulting in 994,000 deaths.
  • Depopulation of the African continent, in a manner and experience similar to that of the Black Death.

When two American healthcare workers contracted Ebola, and their survival was probably influenced by the experimental drug, ZMapp, a U.N. medical ethics panel was convened and concluded, “WHO-convened ethics panel endorses use of experimental drugs”. Now we have an opportunity to convene a little gedanken experiment:

  • You have been tasked to decide whether an experimental drug should be used against Ebola. You are not permitted to decline.
  • The recipients would be aid workers, who, being at higher risk than the public, can tolerate a higher risk with the drug.
  • The safety profile of the drug, and effectiveness, has been ascertained for an animal model. It has been informally trialed by a few members of the research staff, using themselves as guinea pigs. The side effects are only modestly discommoding.
  • The drug appeared to benefit two patients who were seriously ill. One made a remarkable recovery, while the other died. A third patient with lesser illness also survived; side effects were minor.
  • This presents a picture of mild or negligible toxicity, good anecdotal evidence of an effective treatment, and potentially¬† great prophylactic value.
  • The proposed subjects, working in primitive conditions, where it’s very hot, spend their days sweating buckets in rubber suits. The environments are highly contaminated. Slip-ups are almost inevitable, with lethal consequences. They are eager to try the drug.
  • Your role as the decision-maker is secret, and cannot be attributed to you. Regardless of whether your decision is the right one, your conscience¬† grants you a special exemption. In other words, there is absolutely no cost to you, social, mental, or physical. But, being a good person, you would like to make the right decision. Which is?

I think most of you would decide in favor of administering the drug. You might remark that it was not a very difficult decision to make, and the reasons would come from the facts of the epidemic. So why do we need an “ethics panel?”

The purpose of the thought experiment is to demonstrate, by exclusion, that the reason for convening the ethics panel is divorced from the logic of the decision itself. Among the reasons not excluded, I have a favorite: The panel diffuses individual responsibility. The more elaborate the process of approval, which in this case, involves a panel, the more the moral responsibility devolves to the process, as opposed to the people using the process. In the end, it becomes very similar to the firing squad executioner who takes solace that his gun held the blank.

The potential depopulation of Africa is not a small news event. It may result in something called, by the popular press, “soul searching”, with calls for a new this or a new that. But it will not get to the bottom it, because this is a meta-problem, and politics doesn’t even know such a thing exists.

The meta aspect of it is this. The phlegmatic policy of the CDC, and the rest of the First World, is itself the result of a policy, a general management method. The method is itself the product of a general problem-solving approach, which is the product of a certain kind of education…and so on, progressing to the psychology of the individual, and ultimately, brain chemistry.

Policies have recursive origins. A fix must dig into that recursion, or the new policy will be a simple reaction to the failure of the old. Things being what they are, good luck can fall off the table in any direction.

This being a catastrophe, next: Catastrophe Theory for Dummies.