Ebola Is Now Curable • Hacker News Board

Re: Ebola Is Now Curable

#111

Post by mlevental » Tue, Aug 13, 2019, 11:21 AM UTC

IfOnlyYouKnew wrote: post #53

jcranmer wrote: post #43

Earlier quoted context omitted.

Actually, it's quite terrifying when you remember that stopping a clinical trial early is a great way to create statistical fraud. https://blogs.sciencemag.org/pipeline/archives/2019/08/08/st... cites an example of a drug whose clinical trial was stopped early due to obviously effective success... only to discover later on that the "obviously effective" was a statistically spurious event, and the drug did not confer…

It's only a "great way to create statistical fraud" if you assume that the statisticians, and the FDA, are either stupid or corrupt. And contrary to popular belief, they tend to be competent enough to at least cope with the sort of hair-brained schemes HN believes would fool them.[0] Stopping a trial early and it's statistical implications should, by the way, be somewhat familiar with web developers: it's commonly do…

rule #1 of hn: anyone on hn is smarter than everyone not on hn no matter the domain. we could solve all the world's problems by just getting everyone into hn!

Re: Ebola Is Now Curable

#112

Post by learnstats2 » Tue, Aug 13, 2019, 11:45 AM UTC

jcranmer wrote: post #43

dankohn1 wrote: post #29

There is no news I enjoy reading more than that a clinical trial had to be ended early because the treatment was so effective that it would be unethical to continue with alternative treatments (or a placebo).

Actually, it's quite terrifying when you remember that stopping a clinical trial early is a great way to create statistical fraud. https://blogs.sciencemag.org/pipeline/archives/2019/08/08/st... cites an example of a drug whose clinical trial was stopped early due to obviously effective success... only to discover later on that the "obviously effective" was a statistically spurious event, and the drug did not confer…

That's not statistical fraud.

It can be important to ethically stop a trial based on the information available, even if the information available later turns out to be incorrect.

Re: Ebola Is Now Curable

#113

Post by sjnair96 » Tue, Aug 13, 2019, 11:55 AM UTC

DoreenMichele wrote: post #22

throwaway5752 wrote: post #5

It's great news, but they're observing a 30% mortality rate for the "cure". Absent medical intervention there is still a nontrivial survival rate (mortality rate of 75-90%). With supporting medical treatment before this new treatment - fluid support, etc - I think it's up to 50%? It sounds like the monoclonal antibody treatment has improved odds of survival from 1:10-1:2 to 2:3. edit: The 6% figure is population rest…

Just as a point of comparison: Toxic epidermal necrolysis, a severe form of Stevens-Johnson Syndrome, has about a 30% mortality rate. I understand it to be a first world problem typically caused by taking certain strong medications. It's a severe and often deadly allergic reaction. (I'm not going to provide links because both Wikipedia entries have disturbing photos. I've verified that I'm spelling both correctly so…

It's interesting to note that even APAP/paracetamol/acetaminophen can cause TEN or SJS, although very very rare. [1]

For those bipolar folks out there, remember even lamotrigine can cause SJS (still very rare), which is why you should always ramp up the dose gradually. [2]

[1] https://www.fda.gov/drugs/drug-safety-and-availability/quest...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905385/

Re: Ebola Is Now Curable

#114

Post by krageon » Tue, Aug 13, 2019, 12:18 PM UTC

sjnair96 wrote: post #113

DoreenMichele wrote: post #22

Earlier quoted context omitted.

Just as a point of comparison: Toxic epidermal necrolysis, a severe form of Stevens-Johnson Syndrome, has about a 30% mortality rate. I understand it to be a first world problem typically caused by taking certain strong medications. It's a severe and often deadly allergic reaction. (I'm not going to provide links because both Wikipedia entries have disturbing photos. I've verified that I'm spelling both correctly so…

It's interesting to note that even APAP/paracetamol/acetaminophen can cause TEN or SJS, although very very rare. [1] For those bipolar folks out there, remember even lamotrigine can cause SJS (still very rare), which is why you should always ramp up the dose gradually. [2] [1] https://www.fda.gov/drugs/drug-safety-and-availability/quest... [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905385/

Almost every bipolar medication has some very scary side effects (either in the medium or the long term). Sadly receiving treatment for it is a constant balance of "If you do not treat it it might destroy your life" and "if you do treat it it might destroy your life".

Re: Ebola Is Now Curable

#115

Post by hanniabu » Tue, Aug 13, 2019, 12:32 PM UTC

IfOnlyYouKnew wrote: post #53

jcranmer wrote: post #43

Earlier quoted context omitted.

Actually, it's quite terrifying when you remember that stopping a clinical trial early is a great way to create statistical fraud. https://blogs.sciencemag.org/pipeline/archives/2019/08/08/st... cites an example of a drug whose clinical trial was stopped early due to obviously effective success... only to discover later on that the "obviously effective" was a statistically spurious event, and the drug did not confer…

It's only a "great way to create statistical fraud" if you assume that the statisticians, and the FDA, are either stupid or corrupt. And contrary to popular belief, they tend to be competent enough to at least cope with the sort of hair-brained schemes HN believes would fool them.[0] Stopping a trial early and it's statistical implications should, by the way, be somewhat familiar with web developers: it's commonly do…

> It's only a "great way to create statistical fraud" if you assume that the statisticians, and the FDA, are either stupid or corrupt.

Considering how much money is in pharmaceuticals, I'd definitely go with corrupt, especially considering this explains how a majority of the world works now and also since there's currently an outbreak and likely want to capitalize on it.

I'm not at all saying this is the case, but that if something like that did come out then I really wouldn't br surprised considering it seems to be a weekly occurrence that you hear about corrupt behavior now.

Re: Ebola Is Now Curable

#116

Post by hanniabu » Tue, Aug 13, 2019, 12:34 PM UTC

justinclift wrote: post #76

singingboyo wrote: post #45

Earlier quoted context omitted.

While I agree in general, the article indicates this was stopped after 681 of a planned 725 patients, which seems okay. Additionally, my understanding from a quick read is that the SPMS trials were aiming to delay progression in disability, rather than eliminate the effects altogether. That seems trickier to measure, and also more subject to just... not spending enough time looking at it. Ebola, on the other hand, ha…

> Ebola, on the other hand, has a binary outcome (dead vs cured) with a timeline of a couple weeks, IIRC. Doesn't it leave (cured) people potentially permanently damaged as well? eg whatever organs were damaged, are still damaged

I think what the parent meant was that it's terminal, so if you're alive then you win, even if you're not in the condition you were before.

Re: Ebola Is Now Curable

#117

Post by mlrtime » Tue, Aug 13, 2019, 12:50 PM UTC

rossdavidh wrote: post #63

bifrost wrote: post #2

This is awesome that we've seen another horrendous disease go from incurable to curable in my lifetime. While ebola hasn't touched my community like AIDS/HIV has, reading this cracked my RBF and I smiled.

It is great news, and also evidence of how much better it is to be aware of diseases that happen in remote, poor parts of the world. If the rich world had ignored Ebola because it was happening to poor people (mostly, so far), then it could have become an AIDS/HIV sized epidemic (including in the rich world) before these treatments were developed. Plus the good karma of not just sitting there while your neighbor's ho…

Not everything needs to be rich vs poor, I know your message is positive however we are not living in such a dire world where this needs to be pointed out.

Re: Ebola Is Now Curable

#118

Post by Medicalidiot » Tue, Aug 13, 2019, 12:51 PM UTC

Dylan16807 wrote: post #83

Medicalidiot wrote: post #47

Earlier quoted context omitted.

In practical terms, there will be a resistance that develops eventually. Even though the reservoir is hypothesized to be bats, that doesn't have much significance because of its ability spread from person to person without a vector. What is notable about Ebola is that its virulence keeps dropping while its ability to spread has significantly increased. The larger issue is that Ebola is in areas that don't have the re…

For a resistance to develop, ebola that has been exposed to the treatment inside a hospital has to escape back into the wild. There are significant barriers in the way of that. If everyone on penicillin was kept in an isolation chamber, the effectiveness over time would be different.

As someone who works in a hospital, we can bleach every single patient room, wear all the PPE we want, but pathogens will always spread; the only question is when, not if. Even in an isolation chamber a resistance to penicillin would develop independently of each other as penicillin resistance is usually predicated on a mutation in the penicillin binding protein.

Re: Ebola Is Now Curable

#119

Post by powerbroker » Tue, Aug 13, 2019, 12:54 PM UTC

mlevental wrote: post #111

IfOnlyYouKnew wrote: post #53

Earlier quoted context omitted.

It's only a "great way to create statistical fraud" if you assume that the statisticians, and the FDA, are either stupid or corrupt. And contrary to popular belief, they tend to be competent enough to at least cope with the sort of hair-brained schemes HN believes would fool them.[0] Stopping a trial early and it's statistical implications should, by the way, be somewhat familiar with web developers: it's commonly do…

rule #1 of hn: anyone on hn is smarter than everyone not on hn no matter the domain. we could solve all the world's problems by just getting everyone into hn!

rule #2 of hn: High signal to noise is preferred over low signal to noise. HN > twitter.

Re: Ebola Is Now Curable

#120

Post by TeMPOraL » Tue, Aug 13, 2019, 1:11 PM UTC

IfOnlyYouKnew wrote: post #53

jcranmer wrote: post #43

Earlier quoted context omitted.

Actually, it's quite terrifying when you remember that stopping a clinical trial early is a great way to create statistical fraud. https://blogs.sciencemag.org/pipeline/archives/2019/08/08/st... cites an example of a drug whose clinical trial was stopped early due to obviously effective success... only to discover later on that the "obviously effective" was a statistically spurious event, and the drug did not confer…

It's only a "great way to create statistical fraud" if you assume that the statisticians, and the FDA, are either stupid or corrupt. And contrary to popular belief, they tend to be competent enough to at least cope with the sort of hair-brained schemes HN believes would fool them.[0] Stopping a trial early and it's statistical implications should, by the way, be somewhat familiar with web developers: it's commonly do…

> Stopping a trial early and it's statistical implications should, by the way, be somewhat familiar with web developers: it's commonly done with A/B tests

AFAIK stopping an A/B test early is the way to go if you want to convince yourself (or your customer) that something has an effect, even though it hasn't.