Sunday, February 12, 2006

Hope It's Verified

I remember sitting in my apartment in 1981 when I read it. I'd just finished the crossword puzzle in the Washington Post. Was it '81? I think so. There was a short piece. A short piece. I don't even know whether it was on the front page, but it hit me like a lightning bolt. A number of patients in San Francisco had died from an ailment that attacked their immune systems. That's not good, I thought. Our Achille's Heel is the immune system. How can we ever develop an immunity to something that attacks our immune system. This is going to be trouble I thought, and I was right. I talked to people at work about it, but no one was worried. No one saw the implications. I was afraid. I felt like Cassandra. You see, I knew about exponential curves. The things we found out in the subsequent years were even more dreadful.

For a while, after we discovered it was a virus of some sort, we expected an easy solution -- just like a polio shot. But it didn't work out that way. We've learned a lot about evolution since then. I had studied it extensively, but the average person thought it was dinosaurs and Neanderthals. No one understood that evolution could take place in real time, within a single human body. Popular magazines and newspapers had explanations with wonderful color charts and graphs explaining the problems.

Then came the new drugs. Everybody breathed a sigh of relief and thought, we're on our way. If we can just keep my friend/son/daughter alive for another few years then we'll have a real cure. It never seemed to come but young people started taking it for granted. Denial set in. Old habits came back.

Well, it's possible that a real cure has been found. There was this short article in the Salt Lake Tribune, pointed out by Prairie Angel. Another one at the BBC.

Why is everyone so tentative? Why do we withhold our rejoicing? Sad experience I suppose. I'm also going to predict that, assuming we have a 100% cure going here, that we are going to screw it up.

Here's how it will happen. The drug will become widely available. Desperate measures will be taken to ramp up production. Third world nations will be producing it too. Maybe their version of the chemical will be pretty good, but a little bit different. An entire generation of Africa's best and brightest has been eviscerated by this disease. There are so many just hanging on to life. Doctors will fall over themselves trying to distribute it. Pretty soon they will start cutting the doses so that they can get more people treated. Pimps in Indian brothels will begin dosing their charges once a week as a prophylactic measure. Gay men in the US will be cured and go out to the bath houses to celebrate, only to be reinfected.

In short, the virus will be given every opportunity to evolve. This is basically what has happened to our best antibiotics. Misuse and irresponsibility have given the pathogens a chance to adapt, to change, to learn to live with the agent. Surely we understand this by now.

Our goal should be nothing less than total elimination of the disease. If we really want to do it, then we have to be supremely responsible. What should happen will require superhuman self-control. It is this: 1) The new drug should not be administered at all until we have at least two effective methods. 2) Patients should be given the two drugs simultaneously so that there is no chance of even the smallest remaining HIV population. 3) Patients should be required to provide credible assurances that their sexual activities will be strictly limited to marriage. Couples must be treated at the same time and refrain from sex until both are cured. 4) Patients must be made to understand that there will be no second treatment once a cure has been achieved. 5) Patients must be registered when cured and physically marked. 6) Possession of the drug by unlicensed individuals must be treated as a crime. -- All this is done to prevent the possibility that the virus will adapt.

I have thought, from the beginning, that HIV could be the end of civilization. I think it still could be. If we have some hope to rid ourselves of this thing, we should grab for it. We can't let half-measures ruin the opportunity.

2/12/2006 8:42PM

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At Monday, February 13, 2006 8:53:00 AM, Blogger mal said...

it almost sounds like the magic bullet that penicillin was at first too. Your outlook for its use is sadly all to accurate. I think the cautionary tone of the article is related to the need for clinical trials. It may also be related to the disappointment in drugs like interferon which initially showed such great promise


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