Just because you’re a saint doesn’t mean you’re not infectious

Update: Kaci Hickox’s real friends should have a good long talk with her about her over-reaction to the quarantine for a very good reason.  Hickox does not know what her infection status is.  That’s because the diagnostic for ebola isn’t accurate until a person displays symptoms.  If it turns out that in a couple of days she does get sick, she and all her defenders who are trying to make her out to be a martyr to New Jersey’s oppressive public health system are going to suffer a severe backlash that will undermine their credibility.  Is that wise?? I mean, with all of the lunatic Republicans ready to seal the US off from the rest of the world, do we really need a potentially sick Nurse Hickox to become a poster child for ebola?  I’m surprised that they aren’t thinking about this and begging Hickox to dial it back and set a better example for others to follow.

Also, I am going to reiterate my suggestion to the politicians to work on getting employers to pay the salaries of employees who are involuntarily quarantined, make it possible for those who can work remotely to do so, and prevent discrimination when they return to work.  It’s part of their civic duty.  Oh, and get the states that refused to extend Medicaid to pay for the treatment of indigent patients.  Better to get in front of the problem now.  Ebola is not the only nasty disease in the world.

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I’m blogging from my iPhone because I am irritated with nurse Kaci Hickox’s pathetic whining about being put in quarantine when she returned from Sierra Leone after she treated ebola patients.

Apparently, she is taking umbrage at the fact that she was quarantined in NJ and they were terse with her.  She doesn’t have a fever, says she.  But Dr. Spencer also thought he was magically free of ebola when he returned from West Africa. He was so confident of his superpowers to fight off infection that he rode the subway while he was just shy of being violently ill.

Presumably, Dr. Spencer and other healthcare workers should be aware that they are not invincible and should keep themselves off of public transportation. But we have learned, much to our chagrin, that overconfidence trumps sanity and consideration for the lives of others. I don’t think a travel ban is necessary or useful but it is apparently necessary to keep an eye on health care workers if for no other reason than to keep major metropolitan areas from freaking out.

Quarantines used to be common back in the olden days when we didn’t have cures for deadly diseases, nurse Hickox. (See this PBS Nova primer on the history of quarantine) You are not special. Ebola doesn’t care how self-sacrificing you are.  If you are truly as good and wonderful as you say you are, you will take an old cold tater and wait out your time in isolation. You aren’t a criminal. Just a possible carrier. Grow up.

More on the quarantine: Viral infections don’t have a political ideology but our responses to them apparently do.  Republicans are nauseatingly reflexive when it comes to saving themselves at the cost of pissing off every other interest and people who voluntarily put themselves in danger to aid others.  Some lefties have their minds so wide open that their brains have fallen out and they move too far in the “there’s nothing to worry about, you stupid yahoos” camp.

There most certainly is something to worry about.  The epidemic in West Africa is a genuine crisis that has global implications if it is not controlled.  Ebola has no cure and we don’t know if any vaccine developed so far is safe or effective.  Likewise, we don’t know if ZMapp even works.  Add to this the absence of a “pee on a stick” diagnostic that would allow us to identify infected people before they potentially get on a subway and throw up on everyone within a three meter radius. This is no time to become complacent.

Quarantines are not prison sentences and anyone exaggerating the horrors of involuntarily detention in New Jersey* due to possible infection of a deadly disease is as careless and irrational as the morons calling for us to seal off our borders.  Stupidity, like viral infections, does not respect political affiliation.

One more thing: Yes, Yves, all bodily fluids are potentially infectious once people start getting sick.  Since we don’t know when they will cross that threshold from being merely fatigued to feverish, sweating and throwing up, it’s best they stay away from public transportation.  And here’s something else that is really disturbing: the ebola virus can persist in semen for up to three months after a victim has cleared it from the rest of his body.  So, there, Yves.  Look it up.

* Kaci Hickox’s complaints about her treatment sound like a litany of first world problems.  She was given a granola bar when she told her detainers that she was hungry.  She was held in a “tent” on the grounds of the hospital and it was unheated.  Please.  We’re having a nice Indian Summer here in the Northeast.  Put a fricking sweater on. (Now, she’s complaining to her mother that cell phone reception sucks in her isolation unit.  It’s NEWARK, for Pete’s sakes.  Cell phone reception is notoriously spotty anywhere in the Newark-Manhattan area.  New Jerseyans have to put up with this all year round.  The cell tower is not singling you out.)  Really, you’d think she’d just spent a month at Club Med instead of one of the poorest countries in the world.  I’m embarrassed for her.  Apparently, she’s never volunteered to provide health care in parts of North Philly where there is genuine American hardship and poverty that is rapidly devolving into third world conditions.  Hard to believe she made the front page of the NYTimes with her sob story.

In which I differ with Derek Lowe over NIH funding

Typical private industry lab circa 2014

Derek Lowe, blogmaster over at In the Pipeline, took issue with NIH Director Frances Collins contention that if the NIH budget hadn’t been cut in the past decade, we might have had an ebola vaccine by now.  I remarked on the Vox article about this very same topic last week.  However, I’m siding with Collins on this topic.  True, he might be using the very scary disease of ebola to make his point but it is a valid one.

To get an idea of what the NIH has been up against, I recommend that readers review the congressional testimony on the ebola outbreak from last week.  I believe it was Anthony Fauci who laid out the problem.  It goes like this:

1. The NIH identified the need for an ebola vaccine about a decade ago.
2. (This is the crucial part) The NIH is engaged in basic research.  We are talking very, very basic research.  Like, identifying the genes and sequences and making them available to other researchers, or studying how the virus works and propagates, or figuring out which enzymes chop up the viral proteins, or how the viral proteins are exposed to the rest of the body.  That’s the kind of research the NIH does.  And sometimes, the research is so preliminary that there are mistakes that get published that industrial labs have to figure out when they try to replicate the results in the lab.  Not a criticism.  It happens.  You only have so much money to do the research and sometimes, it’s not enough to double check your results.  I get it.  But it does make it harder for your private industry partners to figure out what’s going on and sometimes means that projects need to take detours to unpack mechanisms and rerun assays and such.  In other words, REAL RESEARCH.  That’s just the way science works, much to the finance industry’s chagrin.
3. So, the NIH tried to get a private industry partner to help finish the research on the vaccine and develop it.
4. But during the same decade, private industry was going through a chaotic destructive process brought on by the “patent cliff”.  That is, the blockbuster drugs that fueled industry research suddenly went off patent.  In response, the shareholders who were not about to take a haircut just so some lab rats could continue to do research for them, decided to take the money and run.  That precipitated Pharmageddon, where I and my colleagues got tossed out of corporate labs by the hundreds of thousands.
5. The NIH couldn’t find a private industry partner until the last couple of years when Glaxo Smith Kline (GSK) decided it would take a risk and start working on one.
6. In the meantime, in the last couple of years, the Republicans have lost their freaking minds over the budget and would rather let every government institution rot in hell before they would approve any funding.  This is about the same time we wrote a blank check to AIG, and other lords of the finance industry (see Neil Barofsky’s book).  Then the Democrats came up with this great idea of a sequester, you know, to call the Republicans bluff.  And the raving mob that calls itself the Republican party took the deal and slashed NIH funding by 20%.  The Democratic leadership that came up with the boneheaded, backfiring sequester idea should be kept away from sharp objects for their own safety.
7. So, to recap: NIH needed a vaccine but couldn’t find a private partner for nearly a decade.  Private industry contracted at a time when additional research and development is crucial.  Regular NIH funding is not sufficient for it to develop a vaccine on its own.

This would probably be a good time to insert some Paul Krugmanesque graph that shows the equilibrium between private and public investment in scientific research.  This one should show that when private industry stopped funding research, the corresponding expected increase in public spending was notably absent.

Derek has a libertarian streak and works for one of the last small molecule drug discovery companies in Cambridge.  That’s not necessarily a bad thing but it does skew his perspective just a tad.  Not only that but Derek is operating in the old world order when we tested every therapeutic treatment to death.  That’s clearly not happening with the ebola treatments.  Those suckers have been fast tracked like nobody’s business.  We are treating ZMapp like it’s a cure for ebola when it’s nothing of the sort.  It’s just that it’s the only thing we’ve got.  ZMapp is so early in development that back in the old days of real drug discovery, it might have been killed in a project portfolio review before it ever made it to development.  And the vaccines?  Well, normally, they’d go through many stages of development and testing for safety, efficacy, and side effects with an expanding number of trial recipients at each stage before it was approved by the FDA.  Forget that.  In this epidemic in West Africa, with number of exposures increasing exponentially, no one has time for these niceties (though I can just see some lefties screaming about how we killed West Africans with an untested vaccine that triggered a cytokine storm or autoimmune disease.  Wait for it.  You know it’s going to happen.  There will probably be a movie about it featuring some ruggedly handsome Liam Neesom type and a earnestly beautiful lady scientist detective out to uncover the awful truth of corporate exploitation of poor third world citizens.).

The real world is not so simple but there definitely is money at the bottom of this mess.

I’ve worked on both sides of the problems in both industry and in academia, if only briefly.  But I got a good look at what it’s like to do research on NIH grant money and it’s not pretty.  Most of a principal investigator’s time is spent preparing grant applications.  It’s very bureaucratic and, I suspect, very political.  If there isn’t a retrospective analysis on the amount of grant money that goes to the Ivies that leave the rest of the academic labs starving for funds, there really should be.  Not every breakthrough has to happen at Harvard.  The polio vaccine, for example, was developed in Pittsburgh.  Oh, yeah, how many of you knew that Jonas Salk worked for the University of Pittsburgh? True story.

And yet, it was about a year ago that I got a call in my office at Pitt from a researcher in the immunology group who had just lost her job because of the sequester.  It was last year at about this time that we had to cut back sharply on ordering chemicals and lab supplies for my lab because grants were on hold, also due to the sequester.  Even today, I see positions at Pitt for the kind of work that I used to do but the hours are part time.  Really??  You expect scientists to do protein production, extraction and crystallization experiments on a part time basis?  That’s the craziest thing I have ever seen.  You can’t just interrupt an experiment half way through the week because you’ve run out of hours.  That makes me think that the people posting the positions aren’t serious about how many hours they expect the researcher to be available.  It’s deceptive and weird and unrealistic.  But that’s life on soft money.  Here today, gone the next.  Yet the cells still need to be fed, lysed, protein collected, spun, purified, etc, etc, etc.

Friends, Americans, countrypersons, this is no way to run a research infrastructure.  Ok, sure, it’s the way to run a research infrastructure if you don’t want to do it like Americans used to do it.  If you are content to run a research infrastructure like Bolivians do it, fine, do it this way.  But don’t complain later that nothing of significance happened on the science front from 2008 onward.  Don’t complain that the NIH is not telling the truth about funding.  It can’t be all things to all people without a steady funding mechanism that isn’t going to be subject to violent shocks brought on by crazy people who get elected to Congress.

Here’s the bottom line.  If liberals expect the NIH to do all of the things that they *think* it already does, it needs more funding.  It needs waaaaaaaay more funding than it already has.  It needs as much funding as private industry used to pump into its own research coffers but no longer does.  It needs billions and billions more.  It has to become what private industry used to be but no longer wants to be.

And if Republicans are committed to free enterprise at all costs, it’s going to have to get tough with private industry drug discovery and force it to take on research that it sees as unprofitable.  It needs to have a serious talk with the bonus class and shareholders about greed at the expense of public health.  Isn’t that what the GOP is all about?  Morality?

That’s just the honest truth.  The NIH is not private industry.  If we want the NIH to replace private industry, which has abandoned certain, critical research areas because it can’t make the kind of profits that shareholders demand nowadays, we need to put more money into the NIH and fund researchers properly and seriously.  That is the point that Frances Collins has been trying to make.

Liberals have a complete misunderstanding of what the NIH does or is capable of doing.  Libertarians have an inflated view of what private industry can do, sometimes because they are living in one of the last holdouts of productive private industry drug discovery (that could end at any time, so don’t get too comfy, Derek).  But once you have lived in both worlds, you can see what a shambles the whole system is.  It’s unsettling and alarming.