EPM presents a weekly rundown of critical reads from around the web, along with commentary by EPM senior editors. This week, we look at stories from the New York Times, the BBC, and CNN about the consequences of making rushed diagnoses, the ebola outbreak in West Africa, and an ebola vaccine that's about to enter human trials.
FAST DOESN'T ALWAYS MEAN EFFICIENT -- OFTEN THE OPPOSITE
Original article: NYT: Busy Doctors, Wasteful Spending
William Sullivan, MD: I like it. Offers a different perspective. Reminds me of a quote from the book Seven Habits of Highly Effective People: Slow is fast and fast is slow. Rushing through a visit may seem like we're being efficient, but by spending less time with patients, we make it less likely that we will be able to develop a true understanding of their problems. The lack of understanding may result in one or more referrals to other physicians with similar time crunches in the hopes that someone happens to ask the right question or do the right test in their allotted visit length. For example, it may be quick and efficient to label a patient with palpitations as having "anxiety," give them a benzodiazepine, set them up for an outpatient Holter monitor, and refer them to a cardiologist. However, spending a few extra minutes taking a history to understand the problem may reveal that the patient has been drinking energy drinks to stay awake during the day because he is up all night with a newborn infant. Changing a few social issues would have saved thousands of dollars in medical expenses. Think of all the ways that short term "savings" result in long term expenses in medical care. A bigger problem is that once providers have been conditioned to provide "efficient" care, it will be difficult and will take a long time to change those habits - even if emphasis shifts to encourage more "quality" care.
SUDDEN SPIKE IN EBOLA MUST HAVE AN EXPLANATION
Original article: BBC: Ebola crisis: Virus spreading too fast, says WHO
William Sullivan, MD: The spread of ebola concerns me. It was first discovered nearly 40 years ago and we heard nothing about it for decades. Why all of a sudden has it has become an epidemic? Something must have changed to cause this sudden spike in illness and I think we need to look at epidemiology as much if not more than we look at treatment. The CDC has more info: http://www.cdc.gov/vhf/ebola/index.html.
EBOLA VACCINE: WHY NOW?
Original article: CNN: NIH: Ebola vaccine to be tested in human trials soon
William Sullivan, MD: The question I had after reading this article was why, for the past few years, the NIH is working so diligently on a vaccine for a disease that has been around for 38 years and has never been diagnosed in this country? Did you know that the US Dept of HHS and CDC hold a patent on one strain of ebola virus? If they've patented it, that means it has already been in the country and explored for several years prior to the 2009 patent. If you want to explore some interesting conspiracy theories about ebola, check out this link: http://theeconomiccollapseblog.com/archives/25-critical-facts-about-this-ebola-outbreak-that-every-american-needs-to-know
Nick Genes, MD, PhD:Of course Ebola is in the US - has been, for decades. Richard Preston's the Hot Zone (which was practically required reading for my generation of med student) goes into suspenseful details about US efforts to study similar viruses. There was almost an outbreak of Reston ebolavirus in 1989-1990 when monkeys imported from Manila started getting sick - a human handler was also exposed but survived. http://en.wikipedia.org/wiki/Reston_virus. Ebola was also a major player in the last great Tom Clancy novel (Executive Orders - http://en.wikipedia.org/wiki/Executive_Orders) - so it's been on my radar for a while and I do see headlines every few years about new outbreaks in Africa. This one's different, I think, because it's less lethal - instead of 90% mortality it seems to be closer to 50%. Perhaps if it's less lethal it's also moving slower through people - and that could be why, this time, infected people are well enough to travel to cities, or board planes. Remember, there's a "sweet spot" between virulence, infectivity and transmissibility that favors pandemics ... ebola may have inched closer to that sweet spot in recent years.
William Sullivan, MD: Doesn't the idea that "it's been here for decades" create a cognitive dissonance with all of the recent press and public concern about how two medical providers with ebola infections are being repatriated while still infectious?
Nick Genes, MD, PhD: I guess there's a difference between here in the lab, or here in the cage, versus here on the subway. Tara Smith from the Aetiology blog talks about this.