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#226259 - 06/21/11 12:20 AM Re: The Beginning of the End for Rabies. [Re: Arney]
Art_in_FL Offline
Pooh-Bah

Registered: 09/01/07
Posts: 2432
Originally Posted By: Arney
This topic also reminds me of dweste's thread we had on science a little while ago. This is an example of how medical science gets advanced in many cases. The doctors are desperate, they have a hunch about something that might work, and they try it. This approach wasn't approved by the FDA first. There were no clinical trials done. Eventually, doctors will decide whether they "think" it works, and if so, it will become the new standard. Maybe after the fact, someone will do the research to figure out exactly how it works or to confirm that it really is better than other treatments. I'm not saying this is right or wrong, but just pointing out that the process really isn't as "scientific" as people imagine in many cases.

Hmmm, I'm curious if Precious has health insurance? And even if she did, I imagine this protocol is still considered "experimental" and therefore not covered by insurance. "Glad you're feeling well, Precious! By the way, when you see your parents, please give them this bill for $750,000, OK?"


As I understand it the FDA doesn't have much to say about any of this because there are no new drugs or medical devices being used. There may be one or more state medical boards who might want to review the case but I suspect that, because inducing coma and supportive care are a standard treatment, in essence using old treatments in unique ways, they won't have much to say.

While there certainly will be a good deal of study of these cases, they are being well documented, two cases aren't really enough to form a statistical base. What seems to be a good sign is that both cases followed a similar progression, which paralleled the expected course. None of that means this is the final word but it pretty clearly seems to be a major advance.

As for the cost, I don't know but these first few cases were likely covered under research funding. This isn't even considered experimental because experiments are more structured. More like a last-ditch, shot in the dark, treatment based on a hunch used on a couple of low odds cases.

Costs, outside the cost of extra testing for documentation, which are likely paid for by the institution, aren't likely to be exceptionally high. In round figures I estimate $200,000 to $250,000 but that is more a WAG. Not so high to avoid a death sentence. With time the prices would likely come down. Here again a lot depends on how much the various researchers, academic, medical, NIH, etcetera, are all willing to chip in.

Lots of groups, people like the DoD and big pharma, are interested in rabies. The former because they spend time in places with infected animals. The later for any opening to a profitable drugs. Both get access to documentation by chipping in.

That is in addition to researchers interested in viruses in general. Figure out the details of how this works and it might lead anywhere. Research on HIV has led to a lot of advances in understand how the human immune defense system works, opened up mechanisms to exploit with vaccines, and illuminated wide areas in medical science. Learning more is good even if you don't produce a cure.

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#226276 - 06/21/11 02:56 AM Re: The Beginning of the End for Rabies. [Re: Art_in_FL]
MDinana Offline
Pooh-Bah

Registered: 03/08/07
Posts: 2196
Loc: Beer&Cheese country
Originally Posted By: Art_in_FL

Costs, outside the cost of extra testing for documentation, which are likely paid for by the institution, aren't likely to be exceptionally high. In round figures I estimate $200,000 to $250,000 but that is more a WAG. Not so high to avoid a death sentence. With time the prices would likely come down. Here again a lot depends on how much the various researchers, academic, medical, NIH, etcetera, are all willing to chip in.

Art, that seems probably not too far off. You might be a bit high, but I'm sure there are lots of misc. costs. A typical PICU bed runs $3-5k/day. Regular floor bed maybe something like $1k.

If they don't have insurance, I'm sure the hospital will work with them. First, it's UC-Davis, so a public hospital. Second, the article makes it sound like it was a collaborative effort between different agencies. While each one probably would charge, they also could potentially waive their fees. Third, it's bad P.R. Fourth, typically in cases like this the kid would be put on Medi-cal (Cali's version of medicaid) to help defray the cost a bit (if non-insured initially). And fifth... most hospitals are pretty reasonable about payment plans if you talk to them. They'd rather collect 20% of a bill than none of it.

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#226281 - 06/21/11 03:52 AM Re: The Beginning of the End for Rabies. [Re: Art_in_FL]
Pete Offline
Veteran

Registered: 02/20/09
Posts: 1372
Rabies is very bad news. You need to seek treatment if there is any possibility at all that you might be infected. If you wait for symptoms to actually develop ... chances are that you're dead meat.

Pete #2

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#226286 - 06/21/11 05:44 AM Re: The Beginning of the End for Rabies. [Re: Art_in_FL]
Arney Offline
Pooh-Bah

Registered: 09/15/05
Posts: 2485
Loc: California
Originally Posted By: Art_in_FL
As I understand it the FDA doesn't have much to say about any of this because there are no new drugs or medical devices being used.

My point is not whether the FDA okay'd this particular protocol--it's that there wasn't an already-FDA-approved medication around for this particular situation (i.e. administering to a rabies patient after symptoms have developed). My point is that there was little evidence supporting it's use before they decided to try it (in my book, four previous survivors is still "little evidence").

But tying it back to that other thread, here is a case where doctors are pushing the envelope in the treatment of rabies, but the "doing" is ahead of the "science" (at least the formalized clinical trial or other formal study design). Which is why I thought it was appropriate that the definition of science to be broader and not just limited to formal tests of hypotheses. What these physicians did will certainly add to medical knowledge, which probably would never have happened if they had to set up a formal clinical trial and waited for enough rabies patients to enroll in some study.

That said, it is certainly possible that sometime in the future, there is enough additional evidence that points to this protocol not being effective; that these survivors shared some particular unique traits or circumstances that allowed them to survive that had little to do with the protocol.

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#226287 - 06/21/11 05:50 AM Re: The Beginning of the End for Rabies. [Re: Pete]
Art_in_FL Offline
Pooh-Bah

Registered: 09/01/07
Posts: 2432
Originally Posted By: Pete
Rabies is very bad news. You need to seek treatment if there is any possibility at all that you might be infected. If you wait for symptoms to actually develop ... chances are that you're dead meat.


Definitely, this does not change the glaring fact that if there is any significant fact you are exposed your best, only rational, course of action is to get the standard treatment. This medical development is only about cases when for some reason people missed the best-chance treatment and were too far advanced for the standard treatment to do any good. This is not an alternative to early conventional treatment.

It is more a medical Hail-Mary play that seems, so far, to have worked and is the first treatment that showed any promise once the patient showed symptoms. It has a long way to go to become accepted and may never be an alternative to the standard series of antibody shots.

People have to remember that this method starts with inducing a deep coma. Inducing coma is not done lightly because it has serious risks. These can only be justifies by the fact that the alternative is likely death.

So this development is good news. But it must not be taken as an excuse to avoiding conventional treatment for rabies exposure. If there is any significant risk that you have been exposed get thee to a hospital as fast as thou feet will allow. Do not pass Go; do not collect $200. Go directly to the hospital.

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#226320 - 06/21/11 04:46 PM Re: The Beginning of the End for Rabies. [Re: chaosmagnet]
Susan Offline
Geezer

Registered: 01/21/04
Posts: 5163
Loc: W. WA
Quote:
my priority would be to end the threat as quickly as possible without endangering others.


Only/last resort? Of course!

But there are people who think head shots are the only way to kill an animal. There are also people who are incapable of thinking, and they shoot a suspect animal and then walk away, leaving the carcass to contaminate other animals, and failing to notify the authorities so they could be aware of the problem.

As to endangering others, if there is one rabid animal around (esp domestic), there have to be others. It doesn't come from spontaneous generation.

Sue

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#226323 - 06/21/11 05:11 PM Re: The Beginning of the End for Rabies. [Re: Susan]
chaosmagnet Offline
Sheriff
Carpal Tunnel

Registered: 12/03/09
Posts: 3427
Loc: USA
Originally Posted By: Susan
Quote:
my priority would be to end the threat as quickly as possible without endangering others.


Only/last resort? Of course!


We're on the same page here.

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