Who Lives? Who Dies? You Decide.

Medical history is rife with the stories of unethical research (e.g., Tuskegee syphilis experiments; Centers for  Disease Control comments here), and African history is rife with stories of the horrific exploitation of native populations by colonizing countries (Wikipedia article on Africa colonization, here).

Put the two together, and you have the potential for a highly toxic brew.

So what would you do, in the face of the current outbreak of Ebola hemorrhagic fever in West Africa? There is an experimental drug, available in tiny quantities. It is just finishing up animal testings, and is due to start in soon on clinical trials. It shows promise, but its actual effectiveness is unknown. Should it be distributed to current Ebola sufferers? And if so, to whom should it be given?

Do you give to front-line African medical workers, as the ones who have put themselves at the greatest risk, but who may already be too sick to benefit, or whose medical care may not be "up to" Western standards? Or do you give to Western aid workers, who have been airlifted home, and can be treated in high-isolation sterile wards?

If you give it to the Africans, and they die, is this just another example of using non-whites as guinea pigs for First-World medicine?

If you give it to the Westerners, and they survive, is this just another example of valuing Westerners' lives more highly?

The question is now more-or-less moot, as there are virtually no supplies of the experimental drug, ZMapp, left (click here for CDC's explanation of Ebola, and here for CDC's Q-and-A on ZMapp). At most, there are a few hundred doses remaining; to date. more than 1,800 cases have been reported and more than 1,000 people have died.

The questions are discussed at length in two Andrew Pollack articles for The New York Times (August 8 piece, here; August 12 piece, here). Pollack's most recent article reported that

On Tuesday, the World Health Organization endorsed the use of untested drugs to combat the outbreak, which has already killed more than 1,000 people and continues to spread. But ZMapp and other potential treatments are in such short supply that another politically charged question remains: Who should get them?

Marie-Paule Kieny, assistant director general of the World Health Organization, said at a news conference in Geneva on Tuesday that several drugs and vaccines had shown some promise in animal testing and might conceivably be used.

But none are “available in unlimited supplies right now,” Dr. Kieny said. “I don’t think that there could be any fair distribution of something which is available in such a small quantity.”

So -- who would you choose?

And let's make the discussion a little tougher. The Times' Donald G. MacNeil Jr. reported today (full article, here) that

The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the “cordon sanitaire,” in which a line is drawn around the infected area and no one is allowed out.

Troops in Sierra Leone and Liberia are closing off roads in infected areas, not allowing people in or out. So... do you just let the people inside that "cordon" fend for themselves, and die or not? Do you provide the limited medication you have to the ones living in the area with the highest levels of disease? MacNeil reports:

“It might work,” said Dr. Martin S. Cetron, the disease center’s chief quarantine expert. “But it has a lot of potential to go poorly if it’s not done with an ethical approach. Just letting the disease burn out and considering that the price of controlling it — we don’t live in that era anymore. And as soon as cases are under control, one should dial back the restrictions.”

Experts said that any cordon must let food, water and medical care reach those inside, and that the trust of inhabitants must be won through communication with their leaders.

 How ethically will panicked people behave? And how much trust in Western medicine and aid do you think exists in West Africa today?