The Paradox of AIDS and ‘Harm Prevention’ Drugs
Does harm prevention actually prevent harm? This is not always an easy question to answer, for by making dangerous behavior safer it could help to spread the dangerous behavior itself, thus offsetting the harm prevented.
The question is bound to arise with the approval of the combination of emtricitabine and tenofovir, known as Truvada, as a prophylactic against the transmission of HIV to the healthy sexual partners of those who are infected with the virus. Interestingly, the name of the company that produces the drug is Gilead Sciences: “Is there no balm in Gilead; is there no physician there? Why then is not the daughter of my people recovered?” At least there is likely to be consolation for some in the share price of Gilead Sciences.
According to a recent article in the Journal of the American Medical Association, Truvada reduces the rate of HIV transmission from homosexual acts performed between men (one of whom is HIV positive) by 90 percent if the drug is taken consistently, and by 44 percent if taken inconsistently. The drug is expensive, at $10,000 a year; but since the cost of treatment of patients with HIV is even more expensive, prescription of it might save money in the long run. The article suggests that, if the drug were 44 percent effective, it would be cost-effective for prescription to HIV negative male homosexuals who had 5 or more sexual partners a year.
There are two or three ethical problems that trouble the authors of the article. The first is the possibility that the existence of a prophylactic drug against HIV might increase unsafe sexual practices. This they rather airily dismiss as follows:
If unsafe sex were to increase with [such prophylaxis], it could theoretically offset effectiveness in practice. Behavioral disinhibition, however, was not observed in clinical trials. Moreover, a substantial increase in unsafe sex would have to occur to offset the benefits of PrEP on a population level.
It is well-known, however, that what happens in clinical trials is not necessarily what happens in normal, non-trial conditions. It is not safe, then, to conclude that “behavioural disinhibition” would not occur with general availability of the drug.
The authors are also worried that the drug, being so expensive, will not be available to all who might benefit from it, not only in the United States but in the whole world. This raises problems of equity and justice. Would it be better, then, that it should be available to no one, rather than to the well-off alone?
To answer yes to this question would be dog-in-the-manger. But the authors are able to console themselves with the natural history of such innovations: for means are generally found within a relatively short time to make them much cheaper and therefore more widely available than they were to begin with.
What they fail to point out is that, for such innovation to occur, there has to be a period of what they would no doubt consider injustice or inequity, at least if it is admitted (as surely anyone other than a Utopian socialist must) that commercial gain is a powerful, indeed the most powerful, incentive to such innovation. Gilead Sciences would almost certainly not have striven to develop their balm if, from the very beginning, that balm had to be sold to everyone who could benefit from it at a knock-down price.
Injustice and inequity – if that is indeed what the authors of the article are describing – are thus a normal precondition of progress, not an alarming consequence of it. When penicillin was first developed, after all, it was available to very few, whose lives were saved by it most inequitably.
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Thumbnail courtesy shutterstock / Peter Kim
Don’t worry, I am 100% certain that this vital medical treatment will be provided ‘free’ (ie at substantial governmental expense) to the suffering masses who demand slightly-less-likely HIV transmission. After all, catering to the gay libido is one of, perhaps the primary, role of Western governments in our time.
Well, not just gay libido, they are sex obsessed in general. Everything of priority leads back to the genitals. Don’t forget, on election day this year you can leave your brain at home, you must vote with your yani or lingum.
I assume this is the article as no reference is provided:
http://jama.jamanetwork.com/article.aspx?articleid=1262682
It is an editorial by two non physicians, not a guideline or scientific article.
Interim guidelines from the CDC here:
http://jama.jamanetwork.com/article.aspx?articleid=646175
Okay, I’m gonna play devil’s advocate here. Suppose a hetero male becomes HIV positive through drug use or contact with a prostitute. Suppose he cleans up his act, either wants to be married or already is married, and wants to father children who are free of HIV. Drugs like these might make it possible for that to happen.
Yes, I know, there are risks involved, but still…
Marion Winik married a gay ice-dancer. They had two children together. You’re describing a real scenario.
I’d put health-care worker exposed to a random stick, which I’m about two Kevin Bacons from, against a whoremonger going straight. I’d bet on a happier marriage from the gay guy, than the whoremonger.
http://www.amazon.com/First-Comes-Love-Marion-Winik/dp/0679765557
This is a predictable train wreck which we’ve already played out with the birth control pill.
In the 1960′s the Pill was heralded as the antidote to the “alarming” rate of 10% illegitimate births. That rate is now approaching 40%. The vast majority of families on public assistance are headed by single females,divorce and abuse rates are much higher, and a host of venereal diseases which used to be limited to the occasional port whore now regularly appear in suburban middle schools.
The “significant” reduction in risk, even if real, is going to be instantly eclipsed by the exponential increase in the levels of risk-taking.
Bingo!
Also there is the issue of noncompliance. It’s not an easy statistic to track down, but about 8% of pill users get pregnant while taking it. They’re just the unlucky ones because the noncompliance rate is much, much higher- probably over 90%. Few people take any kind of medicine perfectly, and the more doses per day the higher the likelihood of failure.
So the real rate of transmission of HIV may be closer to that 44% they quote in this study. Combine that with an increase in risk taking and it could well be a wash- or worse.
That the pill increased risk, causing an increase in out of wedlock children;is a false premise. Other factors were welfare benefits, anchor babies, high divorce rate and single motherhood as an acceptable lifestyle choice.
While the pill did not increase risk per se, it did end the social contract that said if a man got a woman pregnant he would ‘do the right thing by her.’ With the pill and abortion on demand, any resulting baby is ultimately the woman’s responsibility.
Why should men buy the cow when the get the milk for free?
Women, and therefore society, are left holding the baby.
That’s really good. The pill actually didn’t free women but puts more of a burden on them for pregnancy. The man does not need to be responsible after all since the pill has removed his participation. While the woman “forgets” or outright lies. Its all on her shoulders. No wonder women are so desperate to spread the blame.
Well, not exactly. The logistical disadvantages of universal contraceptive use and abortion on demand were understood by feminists from the get-go. The democrats got right to work offsetting these disadvantages by criminalizing all sexual intercourse by men in the past tense at the whim of the female partner. Morning-after regret? Must have been rape. Forgot to take that pill and got preggers? Onerous one-sided “Deadbead Dad” laws. Want to do the right thing and embrace fatherhood? Sorry, that’s not your decision to make anymore. It’s all a perfect example of how liberal policies gone bad are never rescinded, just covered over with so many layers of bad law that, in the end, nobody remembers what the thing started out as in the first place.
The bill causing an increase in out of illigetimate pregnancies is entirely plausible. Let me explain. The pill along with the factors you mention ‘decrease the risk potential’ of having sex (ie pregnancy). While the pill itself isn’t responsible from going from 10% to 40%, it does factor in.
And this is basic thinking usually observed and applied in economics, but actaully applied everywhere when risk/reward and cost/bennefit are evaluated by a human.
You list the other side-effects of the Pill becoming readily available, and call them other causes. If you don’t understand math, put down the statistic with the sharp end out, and step away from the table.
It has been shown that every person has a certain risk level. For example speeding: some people, if the speed limit is 35 mph will only do 35 mph, some will risk going 40 mph while others will risk doing 50 mph. If you take away one level of risk, people will go to next risk level. Some people would be willing to have sex with a total stranger and risk the chance catching a STD. Others would not risk it. However, if you tell them using a condem dutring sex will lessen their risk by say 60% , some of those same people would now might risk having sex with a total stranger. Insurance companies I think have a term for this, if my recall is correct I think it is called “Risk Homeostatis”
Are these the same drugs that cost 300 a year from India, but are expensive here because of patents?
Maybe, when we have a pandemic, we need a different model for funding drugs and research to treat it.
I’m sorry, but you’re sick and you’ll be sick for the rest of your life. The odds are that if you pass your illness on to anyone else, it will be death sentence for them. What responsible person would even want to take that risk? And further, what responsible person would try to demand that the rest of us pay for the chance that they be able to infect more?
Is this really where we want to go? Denying medical treatment to people because of their moral choices? Do we say instead “better to let them die”? Hardly a Christian view, but perfectly consistent with a Randian world view.
How is declining to provide – *for free* – a 90% effective (or, in other words, 10% defective) chemical equivalent of a condom considered “denying medical treatment?”
In a word, yep!! The make gay lifestyle is perverted to the extreme. They know they are playing with fire-HIV-but they insist on having multiple partners and having unprotected sex. And they want me to help them.
They already suck (no pun intended) too much money from medicine and society that could be spent on other diseases. Let the progs take care of them.
Stupid is as stupid does. I have neither the time nor money to spend on these reprobates whose only thought in life is abnormal sex.
I wish we had spent half the money on heart disease or curing cancer that we’ve spent so about 10% of the male population can use their plumbing in ways it was never designed for.
Does that make me an uncaring beast? Maybe, but as Rhett said to Scarlet……
My God-Son was born a Hemopheliac. I thought it was gone away like polio. At the hospital I asked a younger, tired, doctor why hadn’t this disease been eradicated years ago? “All blood bourne disease funds now go to Aids” He then shrugged his shoulders, and slunk (slinked?) away….seemingly dejected.
Hemophilia is not a blood borne disease. I, nor anyone else, can get the disease from exposure to someone that has it. Its a genetic disorder. Women and men can both carry the disorder, but its is a problem with the Y chrome. Basically a daughter can’t have it because the flaw isn’t present on the X chrome. Only men “suffer” from it. Its impossible to “cure” but it is manageable.
In a similar vein, I was born with spina bifida. Its a genetic disease that results in having an open spine, along with other developmental problems. I can never be “cured” of it but I have had numerous surgeries that have not only saved my life, but allowed me to live a normal life. I actually managed to serve six years of active duty.
One factor not mentioned by Stergeye is the result in the next generation. What I mean is that if some reckless lothario sires a son by one woman and a daughter by another, and neither know they share a biological parent in common, the possibility can never be ruled out that they might meet, have sex, even get married, and before the law can catch up with them they’re in another jurisdiction—and wondering why any children they have are displaying factors they’d never heard of. Here the law can be merciless in its mantra about “ignorance being no defence”. And, given the merciless character of US sex offence laws and the instant demise of rationality among Joe Public, one can take it for granted that the generation that produced such a problem will simply wash its hands of it. Is this what we want?
9. Old School Conservative
What you said. There are much more cost effective ways of curing the disease. That 30K is being spent on symptoms. The actual disease is homosexuality.
Round them all up and put them in camps were they can be studied. Put science to work on a cure. Not for the symptoms (AIDS, HIV, etc.) but for the disease. Getting them off the street will help cut down on recruiting. Fathers all across northeast America are sleeping better now that coach Jerry is behind bars.
Charlie don’t surf.
Mandatory condom use for homosexuals. Got Aids, to the ward w/you. Or as Cuba does it, special colomies mandated for Aids patients. Per NYT.
http://www.nytimes.com/1989/02/06/opinion/the-editorial-notebook-cuba-s-quarantine-for-aids.html
Out of your bedroom (fluke)..out of my wallet!
If I have to wear a seltbelt who don’t TehGhey have to wear condoms? The theory w/seatbelts was it would cut down on costs of treating accident victims. Airbags were mandated, and ppl walk away from 50 mph crashes every day. But they are about $500 ea x 4-6 per car.
I was at a Rally in Harrisburg for the Helmet Law repeal. Helmets prevented bikers from becoming veggies, and in a coma for years. Allegedly. But hey, take our organs..I’m signed up! Anywho.. one speaker said “if bikers have to wear helmets to protect ourselves during our sport/hobby/recreation…than why not make homosexuals wear condoms?”. By LAW! Biker in ditch w/no helmet, no extrordinary measures. Ghey w/AIDS w/o condom…same deal.
I have pity for all ppl w/an incurable disease. But if ya don’t wanna “suffer” the insensitivity of a latex membrane condom during sodomy, you’re taking your chances.
Here’s another situation to consider. When a woman gets raped the prescribed medical treatment is to take a whole course of HIV drugs plus heavy duty antibiotics. Cost to victim, even with insurance, is in the thousands of dollars. I’m okay paying taxes to have the state cover that cost up front for rape victims while going after the rapist and making him pay the full cost for medical/psych treatment plus pain and suffering for the victim and lots of jail time. While we often hear about rapists getting jail time there is never any mention of the substantial financial cost to the victim.
This thread is taking a turn for the limp-wristed. Try to keep the focus on who the actual enemy is here, folks:
“HIV needs two things in order to flourish. The first is extreme amounts of body-fluid-swapping to be going on. Among America’s urban gay swinging set, promiscuity levels during the ’70s rose to hard-to-imagine heights. Meanwhile, condom usage was laughed-at. A real man — a real gayguy anyway — wanted his friction skin-to-skin. He wanted to revel in body fluids. According to one survey, the average high-risk early-days AIDS victim had had 1160 sexual partners. Not very sanitary.
The other factor the HIV bug needs to flourish in a population is for that population to be in an already-weakened state. Healthy vigorous groups tend to resist HIV, while the previously-compromised quickly fall prey. Berkowitz (like Gabriel Rotello) does a splendid job of making vivid how bad the health of many of the catting-around gays already was, even pre-AIDS. But you’d expect that to be the case, wouldn’t you? After all, the gays who were regulars on the Christopher Street and Fire Island scenes were having unprotected sex with strangers on a regular basis.”
And according to on of the early AIDS activists:
“At age twenty-seven I’ve had: gonorrhea, syphillis, hepatitis A, hepatitis B, and hepatitis non-A, non-B; intestinal parasites including amebiasis, e. historicia, shigella, giardia; herpes simplex types one and two; venereal warts, mononucleosis, cytomegalovirus, and now cryptosporodiosis, for which there is no known cure.”
“Crypto-what-siosis? Berkowitz helpfully informs us that cryptosporodiosis was a parasite “previously found only in livestock.”
When Man does not enforce on crimes against Nature, she’s perfectly capable of doing it herself. The average gay man is a petri dish of all sorts of diseases; giving such a creature antibiotics makes sense only if you want to see an even more resistant strain of the disease crop up. (Or worse, one that’s not merely sexually transmitted.)