Minerva
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7259.520 (Published 19 August 2000) Cite this as: BMJ 2000;321:520
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Dear Sir,
As a doctor working in a rural KwaZulu Natal hospital, and seeing
many AIDS patients, I was amazed to read about suggesting drug treatment
for those patients with AIDS who are impotent(BMJ Vol 321 19 - 26 August).
I certainly have compassion for these patients, who have many problems to
handle as a result of their disease, but I do not think their impotence
should be treated. We know that the only certain way of not spreading the
disease is to abstain from sexual intercourse (apart from the other
methods of HIV transmission which are not being considered here). We also
know that many find this so difficult that they prefer the risk of using
condoms, despite the knowledge that these are not 100% effective. However,
if they are impotent, they no longer have to struggle with that self-
control and risk infecting others. Even if the partner is also infected,
we know that repeated infection, with possibly different strains can make
the illness worse, and should be avoided.
Perhaps one might argue that a person with AIDS should have the same
choices as others, but realistically, is that so? What about someone with
AIDS undergoing embryo implantation? I would suggest this is would also
not be appropriate, with the known risks of the child being born infected,
or being affected by treatment the mother needs during the pregnancy. We
would 'discriminate' in other situation too, not just in the case of AIDS.
If a woman with severe motor neurone disease wants a baby, would we agree
to embryo implantation? We would use our common sense.
Let's also use our common sense with the treatment of people with
AIDS. It's not punitive, it's not discrimination, but just old-fashioned
common sense - and that doesn't seem very common these days.
Yours faithfully,
Dr. Anne B. Hyams
Competing interests: No competing interests
Minerva seems to have lost her self-claimed feminine intuition in
taking the
Lancet article on head lice treatment at face value. (Lancet 2000;
356:540-4). The outcome measurement of freedom from infestation after 2
weeks
is not as useful as the more pragmatic comparison which would be the
number
of infestations per year. The study findings certainly do not form the
basis
for rejecting "bugbusting" as a general policy, as the authors claim.
Schoolchildren and their carers alike must learn that weekly combing for
headlouse detection is the key step, whereafter bugbusting will stand more
of
a chance. Insecticide treatment is really only needed in situations where
the
realistic assessment is that adequate bugbusting will not occur. In those
cases there is an argument for directed school nurse supervision.
More evidence of a lack of usual tenacity in the report on the same page
where she highlights Swedish research which shows that certain drugs
"...could be partly to blame...for (oesophageal cancers)" and that the
researchers "...estimate that a tenth of (cancers) could be linked to
...these drugs.
More like Weasel than Minerva. Is she unwell or like a Canadian
oncologist,
just emotionally exhausted?
Competing interests: No competing interests
AIDS and Viagra
Thank you Dr Hyams for bringing this matter to general medical
attention. You make good sense in the points which you have raised.
Unfortunately the invocation of 'common sense' and conventional AIDS
management in western medicine is an oxymoron.
The disease after all has been designated exceptional and a caveat to
it's inclusion in general differential diagnosis cannot be made without
specifically warning the patient. In effect 'Miranda rights' have been
conferred on a medical condition!. The specific whereabouts of infection
appears to be the one thing AIDS policy makers do not wish to know.
One wonders if perhaps the administration of Viagra to AIDS patients
may be considered in the same light as condoms and free injection
equipment - Harm Reduction !!
James E Parker
Competing interests: No competing interests