Earlier in the semester, I blogged about diarrhea and disease
transmission:
There is an idea that, if mode of transmission of the disease is
destroyed, it will have to find another way to be transmitted. Diseases that
are transmitted through environmental factors are known to be harsher than
other diseases. Examples of this include malaria, which is transmitted through
mosquitos, and dysentery, which is transmitted through water. They do not rely
on being transmitted from person to person. Diseases like the common cold, which
do rely on being transmitted from person to person, are not as harsh. This
postulated because in order to be spread to other people, it is advantageous
for the disease to have milder symptoms so the people can get into contact with
other people. In theory, if we were to completely remove the source of
transmission of these diseases, they would have to change in order to survive.
Similarly, as I learned in microbiology, there is the idea of moderation
of diseases over time. When a virus or bacteria first evolves into a new
strain, it starts out with harsh symptoms. For example, new strains of flu,
such as H1N1, are notoriously dangerous. After a few years of moderation,
however, their symptoms become less harsh. The idea is that they can not
survive for very long if you die. The virons that mutate and do not kill you
are ultimately the ones that are spread.
There is also the problem of bacterial resistance to antibiotics.
Instead of continually trying to create new antibiotics that become resistant
within a few years, what if we simply made diseases that are as awful as
dysentery as mild as the common cold? This could potentially be done if their
mode of transmission was removed completely.
Here is an extremely interesting article on how HIV is
evolving to become less severe:
It really explains well what I was trying to get at in my
original post. Because HIV has been around for a while now, it has had to
evolve in order to continue to survive. This has made the progression of the
disease slower. Now, symptoms are taking longer to appear after a person has
been infected with the virus.
It is also interesting that the article points out that
antiretroviral medication may be part of the reason the virus has evolved.
Normally, we think of viruses and bacteria becoming resistant to treatment.
While this is also the case, this article suggests that in order to survive
with antiretroviral drugs, HIV had to become less severe.
The article also mentions that in apes, which HIV came from,
the virus is not severe. It predicts that eventually, HIV will become harmless
in humans as well. This, however, will take a long time. Hopefully a cure will
be available before this happens.
The article also mentions that because HIV is replicating
slower, controlling the spread of the virus will become easier. In the article,
Professor Philip Goulder, from the University of Oxford, stated, “It is quite
striking. You can see the ability to replicate is 10% lower in Botswana than
South Africa and that’s quite exciting.”
Of course, if we all wear condoms and prevent
mother-to-child transmission with antiretroviral medications and formula, HIV
would become eradicated. A cure, on the other hand, will cost lots of money in
research and development to find. While this is important to those who are
currently infected, I feel that the most efficient way to stop HIV is simply to
prevent its transmission. If the money that is being spent on research and development
on this cure for HIV was instead redirected to stopping its transmission globally,
a cure would not be necessary.
In a way, prevention of transmission is an idealistic solution, as humans do not always avoid harm. Not everyone decides to use condoms, even if they are readily available. Because of this, some sort of educational entertainment would be required, and even then there may still be some people who refuse to wear condoms. These people would certainly need a cure. However, if a person chooses a risky health behavior, are they still entitled to treatment? The same question can be asked for a smoker who develops lung cancer. Are they entitled to treatment as a human right, or should they have to pay for their own treatment? Many antineoplastic agents can cost hundreds of thousands of dollars for an increased survival of only a few months.
Even if pharmaceutical companies do develop a cure, only the
rich will likely be able to afford it. It would likely be easier to control the
spread of HIV, however, if medications were not required continually throughout
a person’s life. For now, prevention of transmission is the best tool we have
to contain the spread of HIV.
Your statement about whether or not a person should have treatment if they are involved in risky behavior is something that I have discussed a lot throughout this semester in one of my classes. I took a class that discussed a variety of ethical issues seen in healthcare, and this topic came up quite a lot.
ReplyDeleteWhen a patient comes into an E.R., medical professionals are required to treat the patient. Regardless of the patient's immigration status, health behaviors, age, gender, etc. I believe that this principle still holds when interacting with patients in a public health perspective. There are times when non-compliant patients become "frequent fliers" and come into the hospital for the same thing. Regardless of how frustrating it is to care for someone who does not appreciate the care we deliver, we still must provide them the same care as we would to someone who do not indulge in risky health behaviors. As a professor once stated, we are not God. We cannot let someone die if we can prevent it--regardless of whether we think they deserve it.