WP: CBO says health care repeal would deepen deficit

[gbear]

I was looking for this thread and the talk about how public healthcare has saved so many lives. I agree...upto a point. I am currently reading There Is No Me Without You, which is about a woman who ends up running an orphanage in Ethiopia after her husband and one of her daughters die. It's a nonfiction book written by an American who has written for the Washington Post, the New Yorker, Antlantic monthly, etc. as well being a finalist for the National Book Award. I say all of that so you won't think I'm crazy when I quote a theory she puts forth.

She is a proponent of the spread of HIV and AIDS happening as a direct result of the industrialized world trying vacinate everyone in Africa for a multitude of illnesses. There was a study she quotes in the book where depending on the location and year, the 25% percent of respondents said they had received a shot in the past two weeks. Then she goes into some of the details on the number of syringes available and how many of them were cleamed by simply dumping them in a container of alcohol.

I remember some studies suggesting HIV was simply the human variant of SIV in monkeys. She then points out the number of cases of SIV infections in humans can be counted on our fingers and toes while the the HIV infection rate... She then espouses the theory that humans in that region were probably regularly in contact with SIV and different variants of it, but the common needle sharing would allow the SIV to mutate because it was never fully eradicated in one person before being allowed to attack another immune system until it became a predator rather than prey of the immune system.

It's a small part of a heart wrenching story, but I thought about this thread as I read that part.

Her book also documents how the U.S. has made the choice to promote innovation and bringing to market of technology developed by spending tax payers money, and the further steps the U.S. took to preserve patent protection on the drugs for 20 years. I'm not sure whether our healthcare has been a net saver of lives there or not. The percentage of population lost to AIDS through parts of Africa has been fairly horrific. If this theory on the origins of AIDS is correct, we gave a continent a disease then spent a few decades developing a treatment which we promptly priced out of reach of the largest population in need.

I'm curious whether this history jives with knowledge some on here have of the public health field. (should maybe be a dif thread. if so I will create).

Side note back on the original thread topic: there have been many post on these healthcare debate thread about how cutting edge medical treatments or expensive ones would not be available if we had socialized medicine. I wanted to list a reference to the cost of the MS medication I take and how much it is out of pocket elsewhere. I have Fed BCBS (generally upper end insurance), and I pay $65 for the med and $28 for the infusion. It is free in the UK. http://www.patientslikeme.com/forum/show/2175?view=last#1344623 (page 154). Without insurance here, Tysabri runs $3k to $4.5k every 4 weeks plus the cost of the infusions.

[shk75]

I was looking for this thread and the talk about how public healthcare has saved so many lives. I agree...upto a point. I am currently reading There Is No Me Without You, which is about a woman who ends up running an orphanage in Ethiopia after her husband and one of her daughters die. It's a nonfiction book written by an American who has written for the Washington Post, the New Yorker, Antlantic monthly, etc. as well being a finalist for the National Book Award. I say all of that so you won't think I'm crazy when I quote a theory she puts forth.

She is a proponent of the spread of HIV and AIDS happening as a direct result of the industrialized world trying vacinate everyone in Africa for a multitude of illnesses. There was a study she quotes in the book where depending on the location and year, the 25% percent of respondents said they had received a shot in the past two weeks. Then she goes into some of the details on the number of syringes available and how many of them were cleamed by simply dumping them in a container of alcohol.

I remember some studies suggesting HIV was simply the human variant of SIV in monkeys. She then points out the number of cases of SIV infections in humans can be counted on our fingers and toes while the the HIV infection rate... She then espouses the theory that humans in that region were probably regularly in contact with SIV and different variants of it, but the common needle sharing would allow the SIV to mutate because it was never fully eradicated in one person before being allowed to attack another immune system until it became a predator rather than prey of the immune system.

It's a small part of a heart wrenching story, but I thought about this thread as I read that part.

Her book also documents how the U.S. has made the choice to promote innovation and bringing to market of technology developed by spending tax payers money, and the further steps the U.S. took to preserve patent protection on the drugs for 20 years. I'm not sure whether our healthcare has been a net saver of lives there or not. The percentage of population lost to AIDS through parts of Africa has been fairly horrific. If this theory on the origins of AIDS is correct, we gave a continent a disease then spent a few decades developing a treatment which we promptly priced out of reach of the largest population in need.

I'm curious whether this history jives with knowledge some on here have of the public health field. (should maybe be a dif thread. if so I will create).

Side note back on the original thread topic: there have been many post on these healthcare debate thread about how cutting edge medical treatments or expensive ones would not be available if we had socialized medicine. I wanted to list a reference to the cost of the MS medication I take and how much it is out of pocket elsewhere. I have Fed BCBS (generally upper end insurance), and I pay $65 for the med and $28 for the infusion. It is free in the UK. http://www.patientslikeme.com/forum/show/2175?view=last#1344623 (page 154). Without insurance here, Tysabri runs $3k to $4.5k every 4 weeks plus the cost of the infusions.

I know your post does not really pertain to the topic of the thread but I will try to answer it, keep in mind while I have some knowledge of the HIV/AIDS pandemic, it is not my area of concentration.

The problem I have with this theory, and I have not read the book so maybe it goes more in detail, is that it really is not scientific at all. It seems to me she is saying the link is that since dirty syringes can transmit AIDS, and since vaccination rates across Africa have risen, then it is possible that through vaccinating people AIDS has been transmitted at a more rapid rate.

The problem any epidemiologist would have with this argument is that is does not at all account for confounding and does not compare baseline data to a randomized control trial group. There could be millions of reasons for the increase in AIDS and no literature I have seen has espoused this theory she proposes. The common theories are a larger proportion of serodiscordant couples, more partners outside of marriage, lower circumcision rates, lower condom usage rates, and many many others. The truth is nobody knows why Africa has a higher AIDS rate than the rest of the world, especially Southern Africa. There are many theories floating out there but the one you read is something I have never seen or heard before and I do not think it would hold up against a peer review.

[PeterMP]

There's almost no doubt that the use of dirty needles due to various medical operations in Africa (and other countries) helped spread HIV.

Whether the reuse of needles and the passage of SIV (therefore giving SIV more chances to mutate into something that would infect humans and therefore HIV) is less clear, and it wouldn't just be vaccinations, but all medical injections, including things like antibiotics.

But is certainly possible.

[shk75]

There's almost no doubt that the use of dirty needles due to various medical operations in Africa (and other countries) helped spread HIV.

Whether the reuse of needles and the passage of SIV (therefore giving SIV more chances to mutate into something that would infect humans and therefore HIV) is less clear, and it wouldn't just be vaccinations, but all medical injections, including things like antibiotics.

But is certainly possible.

Oh for sure it is possible, I just have not seen any well carried out scientific study in order to evaluate this problem and it seems like that is not what she did, she just theorized about the possibility. It would be interesting to compare groups (those who who had heavy vaccination rates to those that were not vaccinated and see if they had higher rates of HIV post vaccination campaigns).

[PeterMP]

Oh for sure it is possible, I just have not seen any well carried out scientific study in order to evaluate this problem and it seems like that is not what she did, she just theorized about the possibility. It would be interesting to compare groups (those who who had heavy vaccination rates to those that were not vaccinated and see if they had higher rates of HIV post vaccination campaigns).

Your talking about things that happened over 50 years ago for a disease that likely was around years before it was actually identified.

Science is never going to address where HIV originally evolved.

[shk75]

Your talking about things that happened over 50 years ago for a disease that likely was around years before it was actually identified.

Science is never going to address where HIV originally evolved.

Wow you just like to argue, where have I talked about 50 years ago??? I am talking about comparing communities today one that has high vaccination rates versus one that does not and see if there is a higher HIV rate in the high vaccination group.

[PeterMP]

Wow you just like to argue, where have I talked about 50 years ago??? I am talking about comparing communities today one that has high vaccination rates versus one that does not and see if there is a higher HIV rate in the high vaccination group.

She then espouses the theory that humans in that region were probably regularly in contact with SIV and different variants of it, but the common needle sharing would allow the SIV to mutate because it was never fully eradicated in one person before being allowed to attack another immune system until it became a predator rather than prey of the immune system.

Modern vaccination programs don't share needles. What is happening today is irrelevant to the question if historical medical practices helped contribute to the evolution of HIV.

You'd have to go back over 50 years to when HIV actually evolved to infect humans.

[gbear]

Her book includes quotes from early 80's news papers, and the story of hte Uganda dictator who realized he was very close to losing his military to the "Slim disease." He ordered them all to wear condems and be faithful to their wives. Uganda had a very open campaign to reduce sex out of wedlock and to wear protection. From the book it souds like the type of campaign only a parnoid dictator could hope to wage, but from all accounts that part was successful. The halting of HIV was an unaccomplished goal. When she repeats the finding of the tudy saying between 25 and 50% of the populations there had a shot with in the last 2 weeks, it's not surprising to see why HIV continued to spread.

She also quotes the Journal Medical Primatology (2004 so hopefully more is known now). It said should me more evidence of it coming from SIV if indeed that is where it comes from because there were only 11 known transmissions of the SIV virus (the one HIV closely resembles) despite human exposure for thousands of years. It appears SIV provided the building blocks for SIV, but it's not a direct pass along. It quotes Drucker (an author of the above book) saying it is interesting that the first documented cases of HIV were from 1959 in the Congo at around the time of the first massc campaign for penicillin for the Yaws erradication.

Now I know correlation does not equal causation, but the two parts of the story together lead at least me to suspect the needles as a prime spreader and likely source for the needed mutations from SIV to HIV.

[PeterMP]

Now I know correlation does not equal causation, but the two parts of the story together lead at least me to suspect the needles as a prime spreader and likely source for the needed mutations from SIV to HIV.

Okay, now you are mixing and matching things:

1. Once you have HIV, I don't think anybody doubts that the reuse of needles, espeically without proper sanitation helped spread HIV in Africa. There's essentially no doubt about that. However, that process was happening during the 60's, 70's, and even into the 80's during massive medical aid campiagns and vaccination programs in Africa. So that essentially explains why in a population using condoms where monogamy was emphasized why HIV would still spread, but it is spreading and not re-evolving from SIV.

2. The other issue is did the reuse of needles cause the HIV to evolve from whatever (presumably a strain of SIV), which first lead to HIV. HIV presumably only evolved once.

The earliest cases of AIDS goes back to the late 1950's. A combination of genetic, molecular biology and epidemiology work suggests that HIV as we know it today evolved somewhere between the late 1800s and the 1940s.

The polio vaccine wasn't developed until the 1950's so that would seem to rule that out. The smallpox vaccine was invented much earlier, but global vaccination programs related to eradication didn't get really get started until about 1950 and didn't kick into full gear until the late 1960's. Eradication wasn't achieved until the late 1970's.

There was undoubtedly some vaccinations (and needle reuse) prior to the large scale efforts to eradicate it, and there were also needles used for other medical purposes.

We can't state absolutely that HIV did not evolve because of medical practices and needle reuse, but its origin appears to pre-date the wide scale spread of western medical practices in Africa so they were unlikely related to the orgin of HIV. Under the conditions of relatively few medical practices and therefore relatively little "rapid" needle reuse as was seen in Africa in the time frame that HIV lively evolved to infect humans, the likelihood of these practices resulting in the transmission of the SIV virus, which then evolved into HIV is less likely.

But certainly not impossible.

The global vaccination programs and other medical procedures where needles were reused almost certainly helped it spread.

[shk75]

The global vaccination programs and other medical procedures where needles were reused almost certainly helped it spread.

All vaccination programs I have seen in developing nations have never reused needles but I am only 27 and have only actively been involved with these campaigns in the last 5 years so it is possible that maybe prior to the increased awareness of the dangers of needle sharing that proper medical procedures were not followed as strictly in the past. The question then becomes have the vaccinations themselves saved more life years than those taken by HIV/AIDS if the vaccinations did in fact lead to the spread.

[PeterMP]

All vaccination programs I have seen in developing nations have never reused needles but I am only 27 and have only actively been involved with these campaigns in the last 5 years so it is possible that maybe prior to the increased awareness of the dangers of needle sharing that proper medical procedures were not followed as strictly in the past. The question then becomes have the vaccinations themselves saved more life years than those taken by HIV/AIDS if the vaccinations did in fact lead to the spread.

Reuse of nonsterile needles was an issue not just in Africa and developing countries, but even in Eastern European communist countries, including the Soviet Union, even into the late 1980's.

http://www.ncbi.nlm.nih.gov/pubmed/8060542

[gbear]

Fair enough. The SIV link to HIV was one she attributes to the author of the 2004 report, and he had the first reported case of HIV being in 1959 in Congo.

Has HIV evolved during the time we have been tracking it, and if a disease successfully kills its host, does that slow down the mutation to new and badder baddies? Sorry, I ask because I was terrible in bio.

As for the reuse of needles, it was an issue well into the 90's. Until reading this book, the refusal to talk about and endorse a needle exchange program was my biggest beef with the Clinton administration. When they said the issue made good econ sense and good public health sense, and then sited it being terrible political sense as a reason to never promote it is when I first became aware of how spineless his administration could be on issues confronting the conservative right on social issues. For all my problems with the younger Bush, he got that one correct.

[PeterMP]

Fair enough. The SIV link to HIV was one she attributes to the author of the 2004 report, and he had the first reported case of HIV being in 1959 in Congo.

Has HIV evolved during the time we have been tracking it, and if a disease successfully kills its host, does that slow down the mutation to new and badder baddies? Sorry, I ask because I was terrible in bio.

As for the reuse of needles, it was an issue well into the 90's. Until reading this book, the refusal to talk about and endorse a needle exchange program was my biggest beef with the Clinton administration. When they said the issue made good econ sense and good public health sense, and then sited it being terrible political sense as a reason to never promote it is when I first became aware of how spineless his administration could be on issues confronting the conservative right on social issues. For all my problems with the younger Bush, he got that one correct.

I think it is pretty clear that HIV evolved from SIV. The question is exactly how did the SIV get into a person that evolved into HIV. That's going to be a very difficult question to answer, if not impossible, at this point in time.

I think it is enough to say that it is very possible that it came from an injection related to medical care- a vaccine or otherwise.

How likely depends on when the jump to "real" HIV occurred, which we'll probably get a better idea of in time. The further back it happened the less likely.

I imagine amongst illegal IV drug users, reuse of needles, without sterilization is still a problem, but that's not really what people are talking about in terms of the orgins of HIV.

HIV has certainly evolved. For the virus, there is a trade off. It needs to take over your immune cells to replicate, which it needs to do to survive. If it doesn't replicate, it can't be passed onto other people and will go extinct.

If it happens to quickly, you die before it can get itself passed on (this is a problem with something like Ebola. People so obviously become symptomatic pretty quickly and for the most part even die pretty quickly that it doesn't spread very much so you only see outbreaks.).

I don't think there is much evidence that its lethality is a major issue in terms of HIV evolution. It is there for so long normally even in the normal course of action before the people actually get really sick I don't think it is much of an issue (there is a large ammount of supposition here on my part).

Our drugs have been a potent force with respect to HIV evolution because they really stop the ability of the virus to trasmit itself (i.e. prevent replication). If it doesn't get transmitted to another host, it dies.