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-近日，卫生专家敦促选出一种备用方案用来快速评价出新的埃博拉治疗方法的优劣。在写给《柳叶刀》杂志的资料中显示，来自非洲，欧洲，和美国的17个高级卫生专业人员和医学伦理学家，认为尽管随机对照试验(RCTs)在大多数情况下提供坚实有力的证据，但是针对埃博拉仍缺乏有效的治疗方案。如当前的常规治疗后的高死亡率，在受影响的地区缺乏有效的卫生保健系统意味着备择试验设计需要再考虑。
他们写道，“没有人坚持认同西方医疗工作者提供的zMapp方法和其他只是为了得到药物或常规治疗加安慰剂的随机调查研究。没有人在这种情况下会同意随机实验。在预后不良癌症中没有很好的治疗方法，没有实验对照组的研究证明可以被接受进行充分的部署，甚至在全面分析后科得到监管部门的许可。没有必要为了规则而不能直走捷径：必要的程序已经存在，并且已经在使用。”
“在普通情况下我们接受随机对照试验因为它能产生强有力的证据，但这种情况不适合处于历史上最严重的埃博拉病毒疫情中”他们总结道。“我们迫切需要能够提供生存机会的新的临床实验药物，因此，如果有该种药物的话应由世卫组织推荐使用从而来拯救生命。我们有创新项目但需要试验设计来证明它的实用性。我们应该使用这些创新性药物，而不是固执地坚持黄金标准用来开发不同的设置和目的。
doi:10.1016/S0140-6736(14)61734-7
PMC:
PMID:
trials for Ebola: practical and ethical issues
1.Clement Adebamowo, Oumou Bah-Sow, Fred Binka,et.al
2 months ago, when the numbers known to have died from Ebola in west Africa could still be counted in hundreds, WHO made an important statement about investigational drugs and vaccines. This crisis is so acute, WHO declared, that it is ethical to offer interventions with potential benefits but unknown efficacy and side-effects, though every effort should be made to evaluate benefits and risks and share all data generated. The need for drugs and vaccines was urgent then. With cases now rising exponentially and health systems overwhelmed, it is even greater today. Vaccine safety trials are underway in the USA and the UK, and poised to roll out to Africa soon. But treatments for those with infection are required too. Besides playing a direct part in containing the epidemic, interventions that could improve outcomes for the sick would help to rebuild the confidence of affected communities in health services, a critical step if Ebola is to be overcome.
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