What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, August 18, 2006

AIDS Conference, A Missed Opportunity

Is there nothing in today’s world that is not a political opportunity? Forty million people in the world today are infected with the AIDS virus and sentenced to declining health, suffering, and eventually, an early death. This is indeed, a humanitarian disaster. One would think that a conference supposedly designed to rally all of mankind to eradicate this disease would bring thoughtfulness, intelligence, compassion, science, innovation, and in general, all those things that pull people together in the face of this ever increasing threat. But no, the major coverage in the MSM pertains to whether Our Prime Minister attended or not.

I suppose it is inevitable. Politics is about power, control, and influence; doing what is right places a distant fourth. Internationally, some highly placed people couldn’t resist a jab at our Prime Minister, and refused to come because he wouldn’t be there to welcome them. Certain movie stars had to have their two-bits worth of say, a past president of the U.S. had to take advantage of the “photo op.”, and Mr. Gates appeared as a major philanthropist. I would have thought the person most deserving to be on the international stage would have been Mr. Gates. If a half billion dollars for the cause doesn’t give you some air time, what does (although I understand the crowd was more appreciative of his money than his advice)? Our Federal Opposition Parties saw Harper’s absence as an opportunity to better their lot, and the MSM, still smoldering over their loss of control over the Prime Ministers Office, joined in frequently with similar criticisms. I heard little during the days of the conference of any worthwhile scientific medical information.

From my perspective, Canada’s Health Minister, Mr. Clements, and Canada’s International Co-operation Minister, Josee Verne, were Canada’s appropriate representative attendees. From a political correctness perspective, Harper could have attended, but haven’t Canadians had enough of politicians doing the “photo-op” thing. Had Harper gone, I imagine the spin from the MSNM and the opposition would have been “usurping minister’s jurisdictions, micromanagement, etc.

The only good medical information that I was able to glean from the News media took place during an interview before the conference began. Two well respected scientists spoke of AIDS, its impact world wide, the various approaches to treatment, and the future hope for a cure. Some of the information that they presented wasn’t new to me as a physician:

  1. A significant rise in AIDS in Canada is being seen in heterosexual women (no mention was made that primarily this is due to bisexual and other unfaithful partners).
  2. Drug usage is the main means of transmission in Canada and the U.S.
  3. Sexual activity is the most common means of transmission in Africa and most other countries.
  4. Aggressive treatment can lower contagiousness and spread.
  5. The resurgence of tuberculosis is largely related to AIDS, and the development of resistant strains of T.B. likely related to the difficulties in treating people who are immuno-compromised with multiple antibiotics.

What I found interesting, from a medical perspective, was that of the 40,000,000 people in the world with HIV infection, only 10,000,000, or ¼ are under treatment. The experts being interviewed felt dramatic progress could be made if all were under treatment, since this would decrease contagiousness. Further, progress in immunization offers hope for the future.

Unfortunately, I am not nearly as optimistic as the specialists being interviewed. HIV infection, like cardiovascular disease, is inherently bound to human nature and human activities. When Mr. Gates tried to address some of these issues at the conference, he apparently was booed. If all the appropriate medications were available to all the people in the world today who have HIV, and there was immunization that was 100% effective to all the others, we would still have an AIDS problem. After all, in Canada today, we have antihypertensive medication that is effective in 99.9% of the hypertensives, but only ¼ of hypertensives are treated to target, with the result that many, many Canadians die an early death from strokes and heart attacks. They may not show the wasting, skin lesions, etc. that AIDS patients do, but dead is dead! We have the best food in the world available to us, but we eat junk food! We know how, and have the means to treat most cardiovascular risk factors, but only 20% of Canadians get adequate exercise, only twenty five percent of those who need their cholesterol problems addressed, do so, and there is actually an increase in teen-age girls smoking. As I’ve stated many times before, the scientific knowledge and capability is extremely important, but cannot achieve the desired benefits unless there is good fidelity (system of application) of that knowledge and a buy-in by the population. But how close are we to addressing this issue when even referring to root causes (the human behavior element) provokes booing?


Blogger michie said...

Those were all good points!

You can't really win in the area of health when behaviour issues raise their finicky heads. Behaviour change is difficult, because even after education, people have to first believe they NEED to change. (That is believe, not think. It's an intellectual AND emotional connection to the information that leads to change.)

Once they believe that there is a true risk to their lives as a result of their behaviour, it then depends on when this danger may occur. In today's society it seems that instant gratification comes before any kind of long term consequences.

Even after people BELIEVE something to be a real possibility, they may not be motivated to change. I think of the ethics of genetic testing and being able to tell someone that they are at an increased risk for some disease. Many of us KNOW that we are at increased risk because our parents have the disease and still don't change our behaviour. Perhaps it's denial or some sort of fatalistic attitude whereby the reaction is, 'If it's going to happen to me anyways, I might as well do what I want!'

Those are just my thoughts, however muddled...

I'm glad that there is something being done about the AIDS issue. I question whether this is the most effective route, as you said it would be great if education was a larger part of the awareness campaign. However, I hope this is a start...

Thanks for your insights!

21/8/06 6:12 PM  
Blogger Al said...

Unfortunately, the crossover from the intellectually "knowing" something and emotionally "believing" it, is very difficult for most people. Accepting that you are at risk (in danger), is sressfull and therefore "uncomfortable. Since most normal creatures move to comfort and away from discomfort, it is easier and more natural to avoid "believing" you are in danger; thus all our defense mechanisms come into play (denial, rationalization, etc.).
Perhaps an approach needs to be taken that says "if you do these things the following good things will happen" instead of "if you don't your goung to die". This has been tried in weight loss to some degree and there have been more long term possitive results.
As you say, problems dealing with human behavior have no quick fixes. Thanks for your comments.

24/8/06 8:09 AM  

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