TIME Health Care

Your Next Blood Test Could Cost $10,000

That’s how much one Cal. hospital charges for a routine cholesterol test. Others charged as little as $10 for the exact same assay

We’re used to comparison shopping, and we know where we can get a better deal on the exact same box of cereal or the same pair of sneakers. But when it comes to the routine blood test you get every time you see the doctor, how budget-conscious can you be?

Not very, new research shows. In an eye-opening report published in the journal BMJ Open, Dr. Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco, and her colleagues found that cholesterol panel could cost patients anywhere from $10 to $10,169 — a more than thousand-fold difference. A basic metabolic test for things like blood sugar ranged from $35 to $7,303.

“I was expecting a little variation, maybe two-fold, or even three-fold,” says Hsia, who also studied differences in total costs for procedures like having the appendix or tonsils removed. “But I wasn’t expecting this amount.”

She focused specifically on blood tests because they are automated and not prone to variations in the quality of the technician or other bells and whistles required to spit out results. “It should be like buying a loaf of bread,” she says, with only slight differences in price.

MORE: An End to Medical-Billing Secrecy?

But the thousand-fold range shows just how seemingly random health care pricing can be. “There is probably nothing justifiable [for the high cost] in this case,” she says. Even if the most talented technician were performing the lipid analysis using the most sophisticated machine, it’s hard to imagine those services requiring $10,000 worth of equipment or labor.

And it’s not as if individual hospitals are guilty of overcharging consistently. One hospital may have high fees for one test and lower fees for others. In Hsia’s study of 150 California hospitals, the one that charged more than $10,000 for the cholesterol test was not the same one that billed more than $7,000 for a metabolic test. Factoring in things such as whether the hospital was for- or not-for-profit, whether it was a teaching hospital, and the percentage of patients covered by Medicaid still didn’t explain the gap in pricing.

MORE: Bitter Pill: Why Medical Bills Are Killing Us

Master lists at each hospital set these fees, she says, and in recent years, some hospital administrators have admitted that even quantitative factors such as supply, demand or overhead costs don’t factor into these prices. In 2013, Secretary of Health and Human Services Kathleen Sebelius released the prices of 100 of the most common inpatient services at hospitals across the country in an effort to make the process more transparent.

And if you think you won’t have to worry about these prices because you’re insured, you may be feeling these costs the next time your premium creeps up. While private insurers negotiate with hospitals to accept certain fees, that rate is a percentage of the original charge — the higher the charge, the higher that negotiated fee will be. And insurers pass on those costs to their members.

So can a financially responsible patient comparison shop for hospitals with the most reasonable fees? Not really.

California law mandates that hospital report what they charge for any 25 of the most common outpatient tests. But they don’t specify what those tests are, and hospitals can chose which ones they provide to the public. The entire list of fees is also available, but not as easy to navigate for patients who aren’t familiar with the codes for the tests. “It’s not that transparent, and hard for patients to access the information,” says Hsia.

“When people hear about price variation, they say it’s probably just one hospital, or one blood test or one procedure, and they think it’s the exception rather than the rule,” says Hsia. But evidence is mounting that’s not the case. “It’s not a hospital issue, it’s a fundamental problem because there is not a rational way to determine hospital pricing, and that needs to be addressed.”

 

TIME Cancer

How Aspirin Can Prevent Breast Cancer

Among overweight and obese women, the painkiller could help to prevent tumors from recurring

Doctors are beginning to learn that body weight could have a role in determining a woman’s risk for breast cancer as well as her ability to survive it — and according to new research, a surprisingly simple over-the-counter drug could help with prevention.

“Obesity by itself is the worst prognostic factor,” says Linda deGraffenried, an associate professor of nutritional sciences at the University of Texas at Austin. “Obese women do worse on hormone therapy, chemotherapy and radiation therapy. We used to think that the mechanism involved the fact that they had [other] conditions such as diabetes or heart disease, but now we are starting to appreciate that the obese patient has a different biological disease.”

And that understanding led deGraffenried and her colleagues to the surprising finding that among women with a higher body mass index (BMI), nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin can actually lower their risk of breast cancer.

In a report published Friday in the journal Cancer Research, deGraffenried found that obese and overweight breast cancer patients who used NSAIDs regularly lowered their risk of getting additional tumors by 52% compared with women who didn’t take the pills. “I’ve been doing cancer research for 20 years, and there has been nothing that was able to give that kind of benefit,” says deGraffenried. “So yes, I was extremely surprised that by just reducing inflammation you could get that significant a benefit.”

What’s happening in obese patients, she says, is that their larger volume of fat tissue promotes production of aromatase, an enzyme involved in producing a form of estrogen called estradiol. Because estrogen is part of the fuel that drives breast-cancer growth, having elevated levels of aromatase is associated with higher rates of breast cancer. The mechanism also explains why drugs that inhibit the enzyme aren’t as effective in obese or overweight women. The fat tissue also promotes release of other factors that are important for tumor survival, creating a feedback loop that keeps the cancer growing in heavier women.

But NSAIDs, which block another enzyme that stimulates aromatase production, could counter this effect. And that’s what deGraffenried and her colleagues found. Among a group of 440 women diagnosed with breast-cancer tumors containing estrogen receptors, those with a BMI greater than 30 and who used NSAIDs regularly had a much lower rate of breast cancer.

Whether women with other types of breast cancer, including tumors without estrogen receptors, can benefit from NSAIDs isn’t clear, but the team is studying those populations as well.

As for whether an aspirin a day should become part of women’s breast-cancer prevention efforts, deGraffenried notes that many already take low-dose aspirin — the same does that most of the women in the study took — to protect against heart disease and colon cancer. “If you are not already on an NSAID or if there is no contraindication for an NSAID, there is reason to consider asking your doctor about it,” she says.

MORE: Osteoporosis Drugs Do Not Prevent Breast Cancer After All

MORE: Breast-Cancer Drug Has a Surprising New Application, Study Finds

TIME medicine

Growth Hormone Linked to Higher Risk of Stroke

Children treated with growth hormone are more likely to experience strokes decades later

Since the Food and Drug Administration approved a synthetic form of growth hormone (GH) in 2003 to treat short stature in kids, it’s become a popular medication not just among parents who want their children to grow but also in locker rooms of professional athletes who believe the collagen-building features of the drug can both protect and improve recovery from injury.

Now the latest study shows that children treated with GH are at risk of bleeding in the brain nearly 20 years later. French researchers report Wednesday in the journal Neurology that among a group of children treated for short stature or low levels of growth hormone had between a 1.5 to 5.3 times higher risk of having a stroke during the follow-up period than the general population.

“Subjects on or previously treated with growth hormones should not panic on reading these results,” the authors said in a written statement. “The results of this study highlight the importance of studies of this kind for the evaluation of the long-term effects of treatment.”

While the researchers can’t explain why the hormone treatments, which are usually given in daily injections over four to five years, led to the strokes, earlier studies on animals with a metabolic disorder in which they produced excessive amounts of the hormone showed that they tend to have more bleeding events. The scientists admit, however, that it’s also possible that short stature itself may have some connection to stroke risk since other disorders in which people don’t grow properly are also linked to abnormal blood flow to the brain.

The study, which involved nearly 7,000 participants, provides good reason for people taking growth hormone to discuss the potential risk of stroke with their doctors, say the authors. Whether the findings apply to others who take growth hormone – athletes who use it for performance enhancement, or those affected by other diseases such as kidney disorders – isn’t clear yet.

TIME Cancer

Treating Cancer With Bacteria Shows Real Promise

Pipetting sample into multi well tray
Rafe Swan—Getty Images

In a groundbreaking study, researchers say injecting bacteria into a tumor helped shrink it

Bacteria are generally considered more foe than friend, but that may change, if results from a pioneering study are confirmed.

Reporting in the journal Science Translational Medicine, scientists led by Dr. Saurabh Saha, a cancer researcher at biotech company BioMed Valley Discoveries, found that directly injecting Clostridium novyi, a common bacteria species that doesn’t need oxygen to survive, into tumors in both dogs and a single human patient shrunk or eliminated tumors and possibly bolstered the immune system to continue targeting tumor cells for up to two years.

“We don’t use the word cure often in cancer. We need to remain humble,” says Saha. “But when we started treating the dogs, we achieved cures. That gets you really excited.”

The fact that bacteria could potentially be a valuable ally in fighting cancer first emerged more than a century ago, when William Coley, a bone surgeon, observed that some cancer patients who developed severe bacterial infections also experienced remission of their cancer. Coley began using Streptococcus pyogenes to treat cancer, but wasn’t able to generate a consistent enough response. The bacteria also produced more toxic reactions than antitumor responses.

But in recent decades, researchers at Johns Hopkins led by Dr. Bert Vogelstein, director of the Ludwig Center for Cancer Genetics and Therapeutics, revisited the idea, combing through databases of bacteria for just the right combination of features that included thriving in low-oxygen conditions while producing few adverse reactions from infection such as fever and inflammation.

C. novyi, when stripped of its primary toxin-producing gene, seemed to fit the bill. First in mouse studies, then in trials involving dogs, the bacteria was a precise and effective tool for eliminating tumors. Saha trained under Vogelstein and was galvanized by the promising data. Because it grows best under oxygen-starved conditions, C. novyi targets just the stubborn cancer cells that are hardest for current anticancer treatments to reach.

Among a group of 16 dogs who had soft-tissue sarcomas, six responded to the bacterial treatment. The pets received anywhere from one to four cycles of 1 billion spores each. In three of the animals, the tumors completely disappeared and the animals remain cancer-free nearly two years later. In three others, the growths shrank by at least 30% after 21 days.

That success encouraged the team to consider testing in humans, and the first patient to try therapy in an early trial enjoyed similar results. A 53-year-old woman with a rare cancer that had spread to her liver, lungs, shoulder and leg bones agreed to get an injection of the C. novyi preparation, albeit at a much lower dose than the dogs. Around 10,000 spores were injected directly into a tumor in her right shoulder. She developed an abscess when her immune system tried to battle the bacteria, but after four days, an MRI of the growth showed it had dramatically shrunk. Nearly a month later, the tumor continued to get smaller.

It turns out the bacteria are almost the perfect cancer-fighting weapon, able to target stubborn tumor cells and microscopically destroy just the malignant cells while leaving normal tissue alone. “When the spores reach the [low-oxygen] regions, they germinate and start growing, producing substances and enzymes that are toxic to tumor cells and cause their destruction,” says Nicholas Roberts, a co-author of the paper and a postdoctoral fellow at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.

When they reach the edges of the tumor, says Saha, the bacteria stop their destructive activity. “Once they see the well-oxygenated rim of the tumor, they self-eliminate and can’t grow anymore. They are almost like a surgical, biological scalpel. Surgeons can’t get to that level of precision in terms of cutting out a tumor.”

Saha, whose biotech company is working on further testing of the approach in human patients, hopes that it will become part of the cancer-fighting arsenal in coming years and believes bacteria, used in combination with other immune-based approaches or even chemotherapy or radiation, could help to improve cancer outcomes. Unlike the latest targeted drugs that hone in on specific genetic mutations in cancer cells, the bacteria can be effective against any solid tumor that has a low-oxygen region, regardless of whatever genetic mutation caused it grow out of control.

If the results hold up, the strategy would be among the first in which a bacterial infection is a welcome thing. “There is a lot of hope in moving forward with this,” says Roberts.

MORE: There’s a Vaccine Against Cancer, but People Aren’t Using It

MORE: On the Horizon at Last, Cancer Drugs that Harness the Body’s Own Immune System

TIME Exercise

More Exercise Isn’t Always Better, Study Shows

Men and women run on treadmills at a fitness gym in the West Bank city of Ramallah on June 25, 2012.
Men and women run on treadmills at a fitness gym in the West Bank city of Ramallah on June 25, 2012. Abbas Momani—AFP/Getty Images

The latest research shows there may be an upper limit to how helpful exercise can be on your heart

It’s probably not news to you that Americans just don’t exercise enough. Less than half of us meet the recommended amount of weekly physical activity—despite research that shows exercise can be just as effective as drugs in some cases to treat diseases such as diabetes. So why don’t we prescribe exercise in specific doses, like we would a drug?

In order to do that, you need to know exactly how much activity produces how much benefit, and whether there’s an upper limit, at which point the helpful effects either start waning or begin to do more harm than good. That’s what Paul Williams, a staff scientist at Lawrence Berkeley national Laboratory, and his colleagues wanted to know—and they found out in a new report published in Mayo Clinic Proceedings.

MORE: Short Bursts of Exercise Are Better Than Exercising Nonstop

Williams started with a group of heart-attack survivors who had been enrolled in either the National Runners’ Health Study or the national Walkers’ Health Study. The two studies were designed to measure what impact—measured in deaths due to heart disease—differing amounts of physical activity could have. “The notion that there was increased risk for people at high exercise has been around for a while, but the first thing that came into my mind was that there was something unusual and maybe something wrong about the data,” Williams says. “So I was hesitant to proceed.”

But as the data continued to emerge, it began to appear that exercise, like any other prescription, could be dangerous in high doses. Those who had had heart attacks and ran more than 30 miles a week or spent more than six hours in vigorous activity weekly were at an increased risk—by up to twofold—of dying from a heart event. “I certainly expected a point of diminishing return, but I wasn’t expecting to see the increase in mortality,” says Williams.

MORE: An Hour of Exercise Can Make Up for a Day of Sitting Down

In contrast, those who exercised moderately—which is to say more than the admittedly low recommended minimum but not as much as the extremely active—lowered their risk of heart-related death by 63% compared to those exercising the least.

“I would say the gains of being active are substantial,” says Williams, “but up to a certain point.” The results held after his team adjusted for the potential effects of age, diet and medication.

MORE: Exercise Snacking: How to Make 1 Minute of Exercise Work Like 30 Minutes

Williams stresses that the results only apply to a relatively small group—people who have a history of heart disease and who exercise at high levels—but he’s currently studying the same thing in the general population to see if similar trends are at work. The data could form the foundation for a prescription-based approach to exercise, as researchers become more familiar with how much exercise can influence factors that affect our health. For now, says Williams, “The message is that at least for heart attack survivors, more is better—up to a point.”

TIME Mental Illness

Why We Aren’t Better At Preventing Suicide

Robin Williams attending the Broadway Opening Night After Party for 'Bengal Tiger at the Baghdad Zoo' at espace in New York City
Robin Williams attending the Broadway Opening Night After Party for 'Bengal Tiger at the Baghdad Zoo' at espace in New York City Walter McBride—Corbis

Robin Williams' tragic death re-ignites long-asked questions about why it’s so challenging to identify and help those at highest risk of self-harm

Robin Williams’ death has served as a stark reminder that we have a long way to go in helping people at serious risk for self-harm. Part of the challenge, say experts, is that despite their stigma, suicidal thoughts are quite common, particularly among people who are depressed. “Suicidal thinking is common and widespread, especially among people with mental illnesses,” says Dr. Dost Ongur, chief of psychotic disorders at McLean Hospital and a psychiatrist at Harvard Medical School. “Yet we don’t have good ways of deciding who is at genuine risk, and who is suffering but who won’t go through with hurting themselves. The reality is that there is no established way of saying this person is at higher risk than that person.”

It’s not that anyone is expecting that a simple blood test or brain scan will provide the answer; the machinations of the body and mind are too complex for that. But as researchers learn more about the brain processes that lay the foundation for things like depression or addiction, they are moving toward developing a suite of tools that could help to at least triage people who are most vulnerable to harming themselves. “It’s something that comes over people; it can last hours or days, but not forever. If you can keep somebody safe during that period, it would pass,” Ongur adds. “The depression would remain, and the substance abuse would remain, but the intense feeling of not being able to go on would pass.”

MORE: Suicide in America: The People who Answer the Phone

Identifying people who might be especially vulnerable to those episodes could be a first step in preventing suicide attempts. In July, scientists reported finding that a gene involved in tamping down a stress response is different among those who have tried to end their lives compared to those who had not. The gene is integral to activity in the brain’s prefrontal cortex, which is responsible for things such as impulse control and reining in negative thoughts. It was in short supply in patients who reported suicidal thoughts.

Another group, led by John Mann at Columbia University, is focusing on the brain chemical serotonin, known for its role in mood disorders, and at Harvard, researchers are exploring the use of a bedside test that can probe the brain of patients with mental illnesses for clues to suicidality. All of these strategies, says Ongur, could help to shed more light on the black box that lies at the intersection of thought and action. “We don’t have a good framework for explaining what happens in the moments when a person is preparing to commit suicide.” That provides a window of opportunity for potentially life-saving interventions.

MORE: Robin Williams: The Comic Who Was Hamlet

Mental illness and substance abuse—both of which are correlated with suicide—are treatable, and could be the first step toward shifting patients away from self harm. Strengthening relationships can be another important factor. “The sponsor in AA is an example, a psychotherapist is another example and family relationships are other examples. We live in a relational world and people consider the impact their actions have on people important to you,” Ongur says.

But strengthening such relationships also requires a shift of a different kind, a societal change in how we perceive mental illness and react to those affected. “One of the big issues remains the stigma of mental illness, especially suicide,” says Ongur. “We are still dealing in a very real way with suicide not being something that is talked about openly and commonly. I saw a comment that the best tribute to Robin Williams would be talking more openly about suicide and making it part of a national conversation so that more research can be done and more people can be helped.”

TIME Mental Illness

Robin Williams’ Depression Struggles May Go Back Decades

The storied comedian and actor Robin Williams had spent time at a rehab facility this summer to maintain his sobriety, his publicist said.

“This morning, I lost my husband and my best friend, while the world lost one of its most beloved artists and beautiful human beings,” Williams’ wife Susan Schneider said in a written statement on Monday afternoon. According to the local sheriff’s office, coroners believe Williams may have committed suicide by asphyxia, and the actor’s representative said he had been “battling severe depression of late.”

While the representative did not elaborate on the potential source of his recent depression, one-third of people with major depression also struggle with alcoholism, and Williams admitted to abusing both cocaine and alcohol during the height of his popularity in the 1970s as alien Mork on Mork & Mindy, which showcased his manic improvisational style. He quit using drugs and alcohol in 1983 and remained sober for 20 years after the birth of his first son.

But in a revealing interview in the Guardian, Williams admitted that while working in Alaska in 2003, he felt “alone and afraid” and turned to the bottle because he thought it would help. For three years, he believed it did, until his family staged an intervention and he went into rehab, he told the Guardian. “I was shameful, did stuff that caused disgust — that’s hard to recover from,” he said then.

He said he attended weekly AA meetings, and this July, People.com reported that Williams spent several weeks at Hazelden Addiction Treatment Center in Minnesota, for what his representatives said was an “opportunity to fine-tune and focus on his continued commitment [to sobriety], of which he remains extremely proud.”

Studies suggest that alcoholism and depression may feed each other. People who are depressed are more vulnerable to abusing alcohol than those who don’t experience depressive episodes, and those who drink heavily are also more likely to experience depression. The latest evidence also hints that the same genes may be responsible for both conditions, and depression is a strong risk factor for suicide. About 90% of people who take their own lives are diagnosed with depression or other mental disorders. Suicide is also more likely among baby boomers, according to 2013 data from the Centers for Disease Control and Prevention.

The coroner’s office is continuing its investigation into Williams’ death.

TIME Breast Cancer

Osteoporosis Drugs Do Not Prevent Breast Cancer After All

Some studies had hinted that the bone-building treatments may also have an added benefit in fighting tumors, but the latest study doesn’t support that connection

In recent years, several large studies involving tens of thousands of women found a potentially useful connection between bisphosphonates, the popular bone drugs, and a lower risk of breast cancer. But new research published Monday in JAMA Internal Medicine challenges that long-held belief.

In previous observational studies, women who reported taking medications like alendronate (Fosamax) or zoledronic acid (Reclast) to treat osteoporosis also seemed to have lower rates of breast cancer compared to women who didn’t take the medications. There was biological evidence to support the association as well – bisphosphonates were also correlated with lower rates of cell death and hampered cancer cell activity.

But Trisha Hue, an epidemiologist at the University of California, San Francisco, and her colleagues, wondered if the connection could truly be attributed to the osteoporosis medications, or whether there was something else about the women taking these drugs that could explain the cancer trend.

MORE: Combining Bone-Building Drugs Key to Making Bones Stronger

Indeed, when they focused their attention on two studies that randomly assigned women to either a bisphosphonate or placebo, and followed them for up to four years, they found no difference between the women taking the drug and those who did not when it came to their breast cancer rates.

So why the strong connection in previous studies? Hue points out that those analyses, which were not randomized controlled trials, but rather observational studies, could not account for the fact that the drug-taking group may have been biased in some way. And in fact that’s likely what occurred – women who are prescribed bisphosphonates have low bone mineral density, and they also have low levels of the hormone estrogen, which is known to fuel tumor growth. So the earlier studies were not finding a correlation between bisphosphonate use and a lower risk of breast cancer, but instead were picking up the fact that bisphosphonate users were likely to have lower rates of breast cancer to begin with.

MORE: How Often Do Women Really Need Bone Density Tests?

It’s not the first time the benefits of the bone drugs have been called into question. In 2011, some studies found that the therapies could increase the risk of rare bone fractures in the strong bones such as the thigh.

While some doctors and patients may have turned to the bone-building drugs to potentially avoid getting cancer, Hue says “our take-home message is that if you are already on bisphosphonates for prevention of fractures, it’s very effective for preventing fractures. But they shouldn’t be taken specifically for the primary prevention of breast cancer.”

TIME Infectious Disease

We’re Getting Closer to Vaccines and Drugs for Ebola

Researchers have developed vaccines and treatments that show promise in fighting Ebola in animals, so is the outbreak a good opportunity to test them in people?

On Monday, National Institutes of Health immunologist Dr. Anthony Fauci told CBS This Morning that his research team is working on a vaccine to prevent Ebola, which is completely effective in monkeys, and will be tested in humans in September. And he’s not the only one developing a treatment for the deadly disease. The question is: Should experimental treatments be rushed into practice, given the breadth of this outbreak?

For the nearly 1,400 people who have been infected with Ebola, there isn’t much they can rely on to help them battle the vicious virus. Because the virus hones in on the liver and disrupts the formation of liver cells, which affect blood clotting, people eventually die from shock, when their blood pressure drops too low due to the build up of microscopic clots in the vessels. The only thing that can improve survival is intervening early with proper hydration and nutrition to keep the circulation strong.

But there are several promising interventions in the pipeline, all of which have been very effective in fending off the virus in monkeys, who experience the same symptoms and disease course as humans. Most of these vaccines and drugs, however, have not passed even the Food and Drug Administration’s (FDA) more lenient standards for therapies against exotic viruses like Ebola.

Should drugs get rushed to market?

Normally, companies must prove that a therapy or drug is safe and effective in people through rigorous clinical trials, but no trial would allow participants to ethically get infected with Ebola, given that it’s mortality rate ranges from 50% to 90%. So the FDA recently approved a different pathway for such products in which companies can first prove that the disease progresses similarly in an animal model as it does in people, and that the product is safe when tested in healthy people.

MORE: Picturing Ebola: Photographers Chase an Invisible Killer

Only one of the Ebola vaccines, which uses the cold virus as a vector to introduce the Ebola antigens, has reached the second stage, and public health officials are likely reluctant to introduce them widely in west Africa given their untested status and the fear and suspicion of western medicine that already makes the outbreak so difficult to contain.

“To bring a strictly experimental approach to this population – most people think that’s not a good idea, and not doable,” says Dr. Heinz Feldmann, chief of the laboratory of virology at the National Institute of Allergy and Infectious Diseases.

In order to even consider using such unapproved drugs in the crisis, they have to be requested. So far, neither the governments of the west African countries affected, WHO, nor humanitarian groups like Doctors Without Borders have done so. If they did, then regulatory officials in the U.S. would discuss whether they could be provided on a “compassionate use” basis.

Testing the vaccine on a human

That happened in 2009, when a German researcher received the shot after accidentally pricking herself while working with Ebola in the lab. The immunization she got was developed in 2005 by Feldmann and his colleagues, including Thomas Geisbert, professor of microbiology and immunology at the University of Texas Medical Branch at Galveston. The vaccine both protects against Ebola infection and treats those who are recently infected with the virus.

While it’s not clear whether the lab workers was actually infected – she got the shot 40 hours after the accident – she did not develop symptoms and did not show evidence of the virus in her blood.

“There’s just no financial incentive”

Feldmann says there are other strategies that look equally promising — but taking the next step of testing the products in people is proving more difficult, says Geisbert. “Globally, [Ebola] is not a huge problem in terms of infectious diseases in general. It’s devastating and sad for the people involved but it’s a small market for big pharmaceutical companies. There’s just not a financial incentive to develop a drug or vaccine.”

Unfortunately, it often takes outbreaks like the current one in west Africa, which is the largest in Ebola history (see Infographic: Ebola By the Numbers), to ignite interest in developing treatments. That, Feldmann notes, and the fear that a virus like Ebola could be used as a form of bioterrorism. “The fact is that biothreat countermeasure activities are what pushed multiple governments to do this work,” he says. Some of that investment may pay off in public health benefits, however, since a bioterror event is essentially an intentional and concentrated outbreak. Geisbert recently received a $26 million grant from the National Institutes of Health to study the three strategies, including in combination, to take the interventions to the next step.

And while an outbreak might seem like an ideal opportunity to test new treatments, it may actually be of little use, and may even do more harm than good. “My concern is that if you give the treatment to people in late stage disease, and if the person dies, then everybody is going to blame whatever was given,” says Geisbert. “If the person survives, you may never know if the product worked because it was somebody who was going to survive anyway, without the drug.”

Feldmann agrees. “People like me and others who have worked for years in vaccines and countermeasures are frustrated. But on the other hand, we don’t want to make a step that isn’t well thought through, and ruin the whole approach in the future.”

TIME Infectious Disease

Containing Ebola Is Extremely Labor Intensive, Former CDC Researcher Says

GUINEE-HEALTH-EBOLA
Members of the Red Cross provide information on Ebola to residents in Conakry, Guinea on April 11, 2014 at the start of the largest Ebola outbreak in history CELLOU BINANI—AFP/Getty Images

It's not about high-tech solutions but good old-fashioned legwork

Given the fact that the Centers for Disease Control and Prevention (CDC) is now urging Americans to avoid non-essential travel to Sierra Leone, Liberia and Guinea, which are battling the largest outbreak of Ebola in history, and the Peace Corps has pulled out its volunteers from the region, the key to bringing the epidemic under control will rest not with the highly trained scientists flown in from around the world, but with local volunteers.

In outbreaks like this, which has so far claimed more than 720 lives, the only way to control the spread of disease is by ensuring that anyone who is infected is isolated in a hospital, and that anyone they contacted are also monitored for symptoms. “The main way we have of controlling the outbreak is by preventing further spread of cases,” says Dr. Eileen Farnon, associate professor of medicine at Temple University School of Medicine. “You have to take people who are symptomatic out of the community so they don’t continue to spread disease.”

MORE: Here’s What You Need to Know Now About the Ebola Crisis

In 2007, Farnon, then at the CDC, traveled to the Democratic Republic of Congo and Uganda to help those nations battle smaller Ebola outbreaks. Farnon helped local health officials coordinate contact tracing, which involves asking every infected patient for a list of people they had contact with since they started experiencing symptoms, and then finding and monitoring those contacts for 21 days. “As you can imagine, the more infected patients there are, the number of contacts really grows exponentially,” she says.

The follow-up required an army of volunteers to visit the contacts daily during the incubation period, often taking their temperature and asking them about any unusual health symptoms. If people started showing signs of illness, the volunteers were responsible for contacting a hot line and arranging for them to come to a hospital for further testing and possibly isolation if they were infected.

MORE: Everything You Need to Know About the Deadly Ebola Virus Outbreak

Such contact tracing is also occurring now in West Africa, but it’s likely more challenging because of the denser and more fluid nature of the populations there, says Farnon. In the Democratic Republic of Congo and Uganda, the outbreaks occurred in remote regions and the contacts weren’t mobile and potentially infecting others in densely populated places like airports.

Farnon guesses that if contacts in the current outbreak mention that they are intending on traveling to another country, the health workers will likely discourage them from doing so, but that some, if they aren’t feeling sick, may still continue with their trip. That’s why national health officials need to coordinate screenings at border crossings to ensure that people who become ill are identified and cared for before they can spread the virus.

MORE: Infographic: Ebola By the Numbers

Farnon says there are social challenges as well. “People in the community will realize early on that patients who get admitted to the hospital, usually late in their infection, may die. And many start getting fearful about going to the hospital because they think it means they are going to die,” she says. While there are no treatments for Ebola infection, early care with proper hydration and nutrition can keep patients strong enough to overcome the virus. But even patients who survive are stigmatized because their neighbors think they are still contagious. Farnon says her groups provided a volunteer to accompany patients back to their homes to help them and their community to understand that they were no longer a threat.

The volunteers were the key to keeping the virus contained, says Farnon, and contact tracing, while labor intensive, was the key to managing the outbreaks in which Farnon was involved—and certainly essential to the west African situation as well. “The village health workers and volunteers are the primary means of getting messages to communities, because they have the relationships with the communities and the ability to mobilize others to help people look for the signs and symptoms of Ebola,” says Farnon.

“It’s a huge logistical undertaking,” she says—but it’s necessary.

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser