On October 2nd, Ashoka Mukpo left his father a voice mail from Monrovia, say

游客2024-08-05 35

问题 On October 2nd, Ashoka Mukpo left his father a voice mail from Monrovia, saying he had "unwelcome but not unexpected news. " Mukpo, an American freelance camera-man for NBC News, had tested positive for Ebola virus. Mukpo’s father, Mitchell Levy, a pulmonologist who heads critical care at Rhode Island Hospital in Providence, immediately helped arrange his son’s transfer to the Nebraska Medical Center in Omaha, one of the four specialized Ebola centres in the United States.
The big question then was how to treat the patient.
The medical team, which included Levy, planned to intensively monitor Mukpo and give him intravenous replacement of fluids and electrolytes, antibiotics to combat also had three unproven treatments available. TKM-Ebola, which inhibits viral RNA, has worked beautifully in monkeys, the best animal model. Kent Brantly, a missionary doctor in Liberia who developed Ebola and recovered, offered to donate plasma removed from his blood, which contained antibodies that might help. And there was brincidofovir, a drug being developed for other viral infections that has been shown to stop Ebola virus in test tubes. The most famous drug candidate, ZMapp, was not available at the time. After careful consideration, Mukpo and his doctors opted to use the serum—a proven intervention with other viruses—and brincidofovir, which has a substantial safety record. But they decided to forgo TKM-Ebola, despite its promise, because of worries that it could trigger overproduction of cytokines, a dangerous inflammatory response also caused by the Ebola virus, and scant data from human trials. "I was not quite on my deathbed and didn’t need to take any huge risks," Mukpo says. His doctor father had reached a similar conclusion. "I didn’t have a high degree of confidence that brincidofovir was going to work, but I was loath to try an investigational agent with no data," Levy says.
Mukpo survived, but no one has any idea whether the experimental treatments helped him, did nothing, or even slowed his recovery. The same is true for Brandy and 17 other Ebola patients who received experimental interventions in the United States and Europe.(One other Ebola patient was treated in Germany without any experimental interventions.)Many, like Mukpo, were given several treatments at the same time, making it hard to unravel the impact of anyone of them. The fact that they were taken care of in modern, well-staffed hospitals may also help explain why 75 % have survived. "Probably the best we can say is that the experimental treatments are not killing anyone," says Michael Kurllla, who heads the Office of Biodefense Research Resources and Translational Research at the National Institute of Allergy and Infectious Diseases(NIAID)in Roekville, Maryland.
Now, that’s about to change. As early as next month, researchers will begin trials in West Africa to find a solid answer to the key question: Do the treatments work? Carried out in makeshift e-mergency hospitals by researchers wearing full protective gear in the middle of a deadly epidemic, these will be some of the most unusual drug trials ever done. And they also raise major ethical and practical questions, some of which were intensely debated at a World Health Organization(WHO)meeting in Geneva, Switzerland, on November 11th and 12th. Perhaps the most important one: Is it right to do randomized controlled trials(RCTs), in which some people don’t get the novel intervention ? Doctors without Borders(MSF), which has led the medical response to the outbreak, says no—not with a disease as deadly as Ebola. Instead, on November 13th MSF said it will take part in three trials that will use an alternative design in which everyone who enrolls receives the untested treatment. But others argue that such setups may not give clear answers and squander a precious scientific opportunity.
It’s an uncomfortable and complex debate held under extreme time pressure. " Everyone has stepped outside of their comfort zone in a big way," says Peter Horby of the University of Oxford in the United Kingdom, who is leading one of the upcoming trials and attended the WHO meeting.
Questions 66 to 70
Answer the following questions with the information given in the passage. [br] Among the heated ethical and practical questions, which is the most important one causing a heated discussion among researchers?

选项

答案 It is“Is it right to do randomized controlled trials(RCTs)，in which some people don’t get thenovel intervention?”．

解析 (答案在文中明确给出，参见第五段第五句。)

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