4 ms·

According to a study [1] it has never been a viable treatment. The treatment has been repeated on at least 12 patients since the original case (Jeanna Giese) an

According to a study [1] it has never been a viable treatment. The treatment has been repeated on at least 12 patients since the original case (Jeanna Giese) and has been a failure every time. No-one know why Ms Giese survived, but the Milwaukee protocol does not seem to have been the reason. Or if it was, it is not repeatable on other patients. [1] https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/critical-appraisal-of-the-milwaukee-protocol-for-rabies-this-failed-approach-should-be-abandoned/8A47C583B24B2B2E43248770F78CC35A/core-reader https://www.cambridge.org/core/journals/canadian-journal-of-...

p49k 8y ago
Sure, but I don't understand what the harm would be in trying the treatment for a patient who will otherwise have a 100% chance of dying in a very short timeframe. I mean, if the Milwaukee protocol did help the one patient, then the treatment has a 5% success rate, which is better than 0, no?
- david-gpu 8y ago
  The outcome of an aggressive medical treatment can be much worse than death, not even taking economic or opportunity costs into account.
- vidarh 8y ago
  The harm is that these patients and their families lose the tiny amount of time together they'd otherwise have left, because the patient is put in a coma. It's a difficult trade-off for a lot of high risk medical interventions to judge the relative worth of the potential chance of survival vs. that last remaining time, and it's certainly not a choice we can objectively make on behalf of other people. In this case it's not certain the protocol have helped any patients. If it did help, then the success rate is so low that there are ethical issues with overselling the potential vs. giving people that extra time together. If a patient wants to try, I'd be all for giving them that choice. But there's a big gap from letting a patient ask for something and promoting it as the recommended course of action without evidence of any efficacy.
  - greiskul 8y ago
    Well, are you aware of how death by rabies happens? Way better for you and your family if you die in a coma, then to have to watch you going through it consciously. If I had rabies in a stage where death is certain, the options I would be looking at would be either the Milwaukee protocol or euthanasia. The other option (doing nothing) doesn't just means death, it means painfully, awful death.
    - vidarh 8y ago
      If people want to take that option, then I'd be fine with that. But it's not for anyone to decide on behalf of others. If MP has no effect - and it's very possible it's effectiveness is actually zero, as we don't know if it was what saved Giese, - then it is wildly unethical to give unjustified hope to people, especially when this will prevent doctors from trying to find other options that might at least give them a chance.
    - deleted 8y ago
      [deleted]
- Brockenstein 8y ago
  That's really up to each individual to decide for themselves. There's not an objective answer to the question.
- exolymph 8y ago
  The opportunity cost of spending a lot of money on an intervention not likely to work. (I have no object-level opinion on the efficacy of the Milwaukee protocol.)
vorpalhex 8y ago
According to a source I've found, it seems there are at least 5 known survivors thanks to the Milwaukee protocol: http://outbreaknewstoday.com/rabies-survivor-milwaukee-protocol-saves-brazilian-teen-96855/ http://outbreaknewstoday.com/rabies-survivor-milwaukee-proto... An NCBI article claims 13: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947331/
- NeedMoreTea 8y ago
  That NCBI article claims there are 13 known survivors of rabies. In total. Nothing to do with whether they got the Milwaukee protocol treatment It also notes the deaths of at least two of the "known survivors", that others received the PEP vaccine either completely or partially, and that one survivor likely didn't have rabies at all due to no anti-bodies being found. That leaves just the original case in 2004 where someone survived without vaccine and received the MP.

p49k 8y ago

Sure, but I don't understand what the harm would be in trying the treatment for a patient who will otherwise have a 100% chance of dying in a very short timeframe. I mean, if the Milwaukee protocol did help the one patient, then the treatment has a 5% success rate, which is better than 0, no?

david-gpu 8y ago
The outcome of an aggressive medical treatment can be much worse than death, not even taking economic or opportunity costs into account.
vidarh 8y ago
The harm is that these patients and their families lose the tiny amount of time together they'd otherwise have left, because the patient is put in a coma. It's a difficult trade-off for a lot of high risk medical interventions to judge the relative worth of the potential chance of survival vs. that last remaining time, and it's certainly not a choice we can objectively make on behalf of other people. In this case it's not certain the protocol have helped any patients. If it did help, then the success rate is so low that there are ethical issues with overselling the potential vs. giving people that extra time together. If a patient wants to try, I'd be all for giving them that choice. But there's a big gap from letting a patient ask for something and promoting it as the recommended course of action without evidence of any efficacy.
- greiskul 8y ago
  Well, are you aware of how death by rabies happens? Way better for you and your family if you die in a coma, then to have to watch you going through it consciously. If I had rabies in a stage where death is certain, the options I would be looking at would be either the Milwaukee protocol or euthanasia. The other option (doing nothing) doesn't just means death, it means painfully, awful death.
  - vidarh 8y ago
    If people want to take that option, then I'd be fine with that. But it's not for anyone to decide on behalf of others. If MP has no effect - and it's very possible it's effectiveness is actually zero, as we don't know if it was what saved Giese, - then it is wildly unethical to give unjustified hope to people, especially when this will prevent doctors from trying to find other options that might at least give them a chance.
  - deleted 8y ago
    [deleted]
Brockenstein 8y ago
That's really up to each individual to decide for themselves. There's not an objective answer to the question.
exolymph 8y ago
The opportunity cost of spending a lot of money on an intervention not likely to work. (I have no object-level opinion on the efficacy of the Milwaukee protocol.)

vorpalhex 8y ago

According to a source I've found, it seems there are at least 5 known survivors thanks to the Milwaukee protocol: http://outbreaknewstoday.com/rabies-survivor-milwaukee-protocol-saves-brazilian-teen-96855/ http://outbreaknewstoday.com/rabies-survivor-milwaukee-proto... An NCBI article claims 13: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947331/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947331/

NeedMoreTea 8y ago
That NCBI article claims there are 13 known survivors of rabies. In total. Nothing to do with whether they got the Milwaukee protocol treatment It also notes the deaths of at least two of the "known survivors", that others received the PEP vaccine either completely or partially, and that one survivor likely didn't have rabies at all due to no anti-bodies being found. That leaves just the original case in 2004 where someone survived without vaccine and received the MP.