where this thing is headed here. clearly i'm texting and i'm old hat with texting. christopher mimms. pleasure. thank yo >> a deadly virus. an untested drug and the ethics of using it when the stakes are still very high. battling ebola in the hot zone is the "inside story." >> hello, i'm libby casey. doctors and health professionals make tough decisions every day, and lives hang in the balance. in places like west africa these

doctors sometimes come from europe or the united states, and other front line fighters of terrible disease that is work hand in hand with poverty, poor health infrastructures and suspicion from those who are sick and dying. none of this makes tough it is any easier for doctors. when there is an outbreak such as ebola burning like a fire across multiple countries doctors use untested drugs to put it outrages hotter than you can imagine. >> reporter: west africa's ebola outbreak is unprecedented. there are 2,000 suspected unconfirmed cases. the three countries hardest hit, liberia, guinea and sierra leone are so desperate to stop the crisis, they have set up a boundary where no one is allowed out.

ebola dates back to europe time when they battled the plague. guinea closed it's borders over the weekend leaving some travelers stranded. >> we have spent four days here. we've suffered a lot since we came here. there is no food. we have asked them to allow us to enter as guineaens but they will not. >> reporter: there are drugs in the early stages of testing. zmap has proven effective when used on monkeys but has yet to go through human experimental trials but th ebola is now so severe it has been ruled ethic ethical. >> the special circumstances of the ebola outbreak it is ethical

to offer unregistered as potential treatment or prevention. >> reporter: three have taken emap so far. two are american aid workers. they were transported back to the u.s. and reportedly getting better. u.s. health officials say they don't yet know if the drug helped. the third patient was spanish missionary who passed away tuesday in madrid. no experiment medications have been given to african patients. further ethical questions have been raised surrounding the dispensing of experimental dru drugs. who should have access to the limited supply? >> we could try the drug. if the basic issues of medicine are taken into consideration. >> reporter: the doctor, sierra leone's leading ebola physician contracted the disease

in july. as his condition deteriorated his colleagues decided against giving him an experimental drug. he died a few days later. >> you can see that they're scared to look at the patients. you know that their chances are very small. it's horrible. >> reporter: the drug behalfer said that it has sent the last of its supply to liberia to treat two more sick doctors. canada is sending up 1,000 doses of an experimental vaccine to the who. it has never been tested on humans. >> it's a tough call and a very difficult situation. so few drugs and so little time. the africa nations infect ready looking for help and the people helping them are not entirely united on what to do. the ethical debate around treating ebola is our inside

story. joiningous discussion, our guests. >> welcome to the program. doctor knew man newman, let's start with you. what is your biggest concern right now? >> what we have is an outbreak that is essentially on the verge of being out of control, but this is an outbreak we may be at the turning point. we may be at the peak right now and anything that can be done to bring this under control can be very helpful. right now the outbreak is spreading because of fear and the presence of a drug even an experimental drug might go some way in lessoning that fear. in that way i think it's a good idea that they begin this testing. >> doctor, give us perspective

of how unproven, untested zmap is. >> well, the first time it ever went into a human was when it went into the two americans, the physician and the missionary nurse. that's the first time it's ever been in a hue man. it's been tested in an animal model with favorable results but we have a lot of experience to indicate that things that sometimes work in animals don't necessarily work in humans. so it really is in the human situation was completely untested. and so far there have been now five treatment courses that you correctly mentioned. two went to the americans. it's impossible to tell with that small number whether or not there was any positive effect. it doesn't seem to have done them any harm, but we certainly can't determine if there was a positive affect. the spanish priest received it. he was very sick, and he died. as you mentioned now two treatment courses have been sent

to liberia for use in liberian physicians who are ill. so the answer to your question is its completely untested in a human trial. >> and to follow up on that, dr. fauci, how will any information be gleaned from the two medical professionals treated, the two americans. is it just more numbers needed before any information can be gleaned from their cases and their treatment? >> well, if you want find out if an intervention is safe and effective, and you really get a definitive answer at the same time as being sensitive to the compelling need to get it to people even if it's an experimental form, what you can do is to design a randomized trial where if you have a limited amount. right now there is no zmap available. but let's say a few months down the pike there may be 50

treatment courses, what you would do to both get those courses to people who might need them and yet perhaps get an answer as to its safety and it's efficacy would be to do a randomized trial where you randomly put people in the control who just received medical care versus medicare plus the intervention, and then after a period of time you can determine was there really any benefit. that's the only way you're going to determine at the same time of getting it to people. >> dr. donovan should that process play out before doses of zmap or other drugs that are given. >> i think its scary to use untested treatments. the reason it's scary is because, a, we don't know if they work. b, we don't know how much harm they might be able to do as opposed to being able to help. why are we talking about it? because ebola is a very square

yes--a very scary disease. we're overlooking the treatments. >> if it were my son, myself, i would be willing to do anything i could to try to fight this disease. reflect on that, dr. donovan. >> that's absolutely right. that's one of the reasons why it's difficult to do a controlled trial because people are very anxious about the potential outcomes. they're anxious about the nearly 50% or better death rate. >> doctor newman, we just heard from dr. donovan concerns about rushing forward to use drugs like this, that haven't been fully vetted. what do you make of that? i think we might have difficulty getting dr. newman's audio to work. this has been a big part of the discussion. >> again, i think you need to

balance the need and compassionate aspect of all of this with the fact that you have to be careful as pointed out by dr. donovan that we're not doing harm. i think its important, because you mentioned the issue of vaccines, and we want to make sure that people don't get confused between the need--the compelling need to get some sort of treatment to a patient who is desperately ill and perhaps dying and the risk benefit of that versus getting a completely untested vaccine that you're going to give to a totally healthy normal person for the possibility that that vaccine might prevent them from getting infected if in fact, healthcare worker, which is going to be the target of a vaccine predominan predominantly would be at risk of getting infected. those are two different ethical

scenarios. namely someone who is going to die if they don't get something, verse someons someone who is perfectly healthy and getting a vaccine. >> dr. donovan, the doses of zmap given to three westerners, they were the guinea pigs to be given an experiment drug. how has that reverbal rated. >> it was given to dr. khan in sierra leone. the doctors in charge of his treatment decided not to. i'm not sure that's entirely a medical decision, although it was partially. they said his viral load was so high they were concerned it would do anyone good. they were afraid they would kill him by giving it, and if that

happened there would be no chance of introducing these drugs in any controlled way. >> concerns about the drugs in the community, africans who would be fearful of the drug that killed the doctor. >> many africans are fearful of any western medicine. being the guinea pigs in the past with adverse results, and they don't always welcome it. >> we'll talk more about that after a short break as we reported earlier parts of three countries in west africa have now been cordoned off, and no one inside that infected area can leave. we'll talk about that next on inside story.

>> al jazeera america presents >> i've been waiting for this... i'm so nervous right now. i'm really scared. >> 15 stories one incredible journey edge of eighteen coming september only on al jazeera america you. >> welcome back to inside story. i'm libby casey. on this edition of the program we're talking about the worst ebola outbreak in history. doctor donovan, the who waited on tuesday and gave it's approval for the use of experimental drugs. with some caveats. dig into that for us. >> well, everybody knows that the ethics panel for the who said that it would be all right ethically to use untested experimental drugs. but most people ignored in the statement was when they went on to say, and i'll quote them, there was unanimous agreement there was a moral duty to evaluate these interventions in

the best possible clinical trials in order to definitively prove their safety and efficacy or provide evidence to stop utilization. that's crucial. i think it is very difficult to try and hold the line on this, but it's not being rule to say we want to know if these things are not going to kill you before we give them to you. >> dr. fauci, what did you read out of the ethics panel statement. it was an unanimous decision and even though they wanted patients to have freedom of choice. nothing was forced on them, respect of community involvement they're saying we're not against using these unproven drugs. >> well, that's the case and if you go back to the answer i gave a few minutes ago, it's exactly what they said in that ethics

statement. it's not unethical at all from a risk standpoint to give an unproven therapy to someone, but you also have an automobile gas station to learn whether or not it is effective, that's what you really need to do. so what was said by the who ethics panel is perfectly compatible to what we're talking about right now. >> doctor, i want to bring you in on the conversation. there are drug companies who have tested drugs in the past, pfizer had a court settlement, and there were questions of how it was handled. what kind of legacy does that leave? >> in that particular case there were alternative treatments out there. with ebola you don't have that

alternative. it is effective. it does reduce the death rate but it is not the same as the treatment and the treatment is what will really give people hope. >> we heard dr. donovan using experimental unproven drugs. dr. newman i want your perspective. what would you do if it was your child, if you were suffering from ebola, and you had a chance to take a drug that was untested. >> i think with something like zmap i think it will be safe in human beings. that appears what we've seen. it's based on similar antibodies that are used on cancer patients. if it was me or my kids, definitely i would think you would have to try at the very least. if it was available. right now the problem is it's not going to be available for a while. >> looking at the case of dr. khan and how that situation was handled, dr. newman, what

questions did that raise for you. we have a report are how healthcare workers wrestled whether or not to treat him with zmap. >> i'm not aware of dr. khan. >> this is the sea sierra leone doctor who was leading the fight there. >> yes. >> what ethical questions does it raise. >> that's ultimately his choice. the ethical questions, when you're talking-- >> go ahead. >> the first principle is that you do not harm. if it was any other situation, any other virus the equation would shift in the other direction and you would worry more about the amen you're doing the people by treating them with a drug than by the benefit they would reap. right now we have such a severe disease that it shifts the equation to the other direction and it makes almost any treatment that won't outright kill a patient at least possible

on the table. >> kevin donovan, dr. khan was not consulted. >> that is the issue. >> he was never even consulted whether or not to be given the drug because they were wrestling with the medical question and the political question whether to give it. >> that was an egregious ethical breach. i can't believe they didn't bring a physician who had been treatin treating this disease into the discussion about whether or not he ought to accept an experimental treatment. i don't know what he would have said. unfortunately, neither does anyone else because he was never asked. >> dr. fauci, there is a lot of talk if there are some more doses of zmap. if there is a way to find drugs that will treat ebola that healthcare workers are a localcal first group to treat

not only because they're on the front lines, but also because they understand the implications of taking an ex-personal drug. >> getting back to what i was saying before, yes. whenever we have interventions and we're dealing with a pandemic flu, there is a tendency, a justifiable tendency to protect those who would protect others. you get a multiplying effect. if you save a healthcare worker or prevent a healthcare worker from getting sick the benefits of that go beyond the healthcare worker because they'll be helping others. as a fundamental principle when considered, there is a good logical reason to favor the healthcare worker. that's even more so when you're dealing with a vaccine to prevent an infection why you don't want them to get sick because you're taking them out

of action when they get sick. it's a little bit less clear when you have a suffering, dying healthcare worker and a suffering, dying patient. that boundary is a little bit less clear than the availability of a vaccine to prevent someone from getting infected. >> libby, you're right. there have been criticisms laid at the feet of the decision to treat basically three healthcare workers. and offer the last two treatments to two more liberian doctors, but i think its justifiable and you can break it down into four categories. the first would be--the first two would be really consequencalist like tony fauci was pointing out. you want to treat healthcare workers because you want to keep themselves healthy and in the field and doing this work and treating the patients. also, if you don't treat them, then the others who are even now

coming to join their ranks might have pause thinking if they were to become infected themselves they would have to go to the back of the line waiting for treatment. this all pre-supposes that a treatment becomes available. at the same time if there is a treatment available we have a duty to those who are first-time responders who have voluntarilily put themselves in harm's way to treat others. this is the highest altruistic part of the profession. then finally as you pointed out, if we're going to get informed consent from anybody it ought to be medical people. >> we'll take a short break and continue our conversation in a moment. this is itsel "inside story."

>> welcome back to inside story. i'm libby casey. on this edition of the program we're talking about the ebola

crisis, and the ethical debate surrounding the use of ex-personal drugs and other treatments. from bethesda dr. anthony fauci, from our d.c. studio dr. kevin donovan, and from oxford ben newman, a neurologist. dr. donovan we were looking at cordon has not really been used in 100 years. what are the ethical dilemmas of setting one up. >> it certainly does restrict people's freedom. as you saw in the intro people don't really like that. it's a terrible inconvenience and it worries them. >> that seems scary if you're trapped in an area where the virus is spreading in an area and you're not infected. >> the focus needs to be on the

public health measures and supportive measures that will probably be the way that this infection is brought under control. >> as we look at the scarcity of drugs, dr. fauci, it brings the question up of what is happening next, what is in the pipeline of being developed? what is nih doing? >> well, we've been working on ebola now for several years trying to develop both drugs and vaccines. fortunately, we've vaccine going to clinical trial in early september, but with regard to drugs the pipeline of drugs is not very robust. there are about three or four that are in what we call pre-clinical stage namely they're still either in an animal model or test tube getting ready to go into early phase studies in humans. one of the issues that is important for people to understand is that there has been very little pharmaceutical company interests in ebola because it was thought of as an

oddity there have been two dozen outbreaks scattered over the years with a total of less than two thousand people. so there wasn't any incentive that this would be something that could possibly be a profit margin. that's the reason why government agencies like the nih had to step forward to start doing the research to early develop drugs that could be taken up by the pharmaceutical company. but we need to get the pharmaceutical industry engaged. >> what are some of the challenges when you look at basic drug distribution and getting communities to trust the doctors in west africa? we may have lost dr. newman there. let me throw that to you.

>> maybe the answer-- >> can you repeat that? >> we were looking at the challenges of even drug distribution in west africa. >> there are certainly are challenges. right now the drugs being proposed, the treatments being proposed would require a person to be in the hospital. these are things that has to be given inter convenientously. right now the problem is getting people to come to the hospital you have people who have ebola and they're running from the doctors. >> dr. fauci brought up a question from the pharmaceutical industry. what incentive do they have to work on problems like this more. >> those are two different responsibilities. drug companies as dr. fauci pointed out are actually in business for a profit, and they will go to treat the diseases

where they can find appropriate profits. they'rthat's the way it is. governments have a different inventive. they want to protect their people. the ebola virus is a weaponnizible virus. >> thank you for watching. that brings us to the end of "inside story." in washington, i'm libby casey. >> u.s. troops in iraq to help rescue thousands of people trapped by. >> michael: s. fighters. but the obama administration said it will not send in ground

forces. also, more protests outside of st. louis as racial tension increase between police and civilians. and torrential rain in the northeast. we have more coming up at 6:00. "techknow" >> announcer: this is "techknow", a show about innovation, we explore humanity, and we'll do if in a unique way. this is a show about science by scientists. tonight military technology in the e.r. >> night vision goggles show surgeons something they could never see before.