Reading deeply

A provocative article in WIRED magazine about rabies; specifically about a remarkable story of survival. The nub of the articles centers on a doctor, who with only one day to get up to speed, launches an untried regimen based on his "day of reading and thinking":

With less than a day to formulate a plan, Willoughby attacked the problem with quick but deliberate reading, using his limited time to review the basic neuroscience of rabies. On Jeanna’s second day of hospitalization in Milwaukee, her results came back from the CDC: Her blood serum and cerebrospinal fluid contained antibodies against rabies. An hour later, her physicians met at the hospital to discuss what to do next.

At the meeting, Willoughby laid out a last-ditch idea, the surprising result of his day of reading and thinking. The solution, he says in retrospect, had been “hiding in plain sight.” From the literature, he had developed an understanding—though the science remains far from settled on this subject—that rabies does not kill by destroying neurons or causing inflammation in the brain, the two routes by which most other viral encephalitides cause death. Instead, this theory went, rabies primarily affects neurotransmission, the electrochemical communication that takes place between cells in the central nervous system. Through a mechanism called excitotoxicity, the disease sends the brain into overdrive, causing its cells to outstrip their energy supply and eventually die.

Willoughby knew that the human immune system did mount a response to rabies, a counterattack that could, in principle, fight off the infection. Therefore, he reasoned, the battle against rabies might actually be a battle for time. Rabies might not be killing the brain directly, but it was causing the brain to kill the body before the body had time to fight it off. Willoughby put this question to his colleagues at the Children’s Hospital of Wisconsin: What if they induced a coma? By suppressing Jeanna’s brain activity and taking over her vital functions, they might give her immune system the time it needed.