Cui Bono? Or Better Yet, Who Should?

I was chatting with my Aunt from Indiana the other evening and because we have a strong relationship that encourages critical thinking mixed with a large dose of mutual respect, we can -and do – often discuss hot button political and social issues. We agree to disagree on occasion, but we always offer food for thought to the other. Which is, I think, EXACTLY the way to promote open communication and encourage the free flow of ideas and solutions to problems. Last evening, she asked me my thoughts on the use of the HIV treatment antiviral drug Truvada which was just approved for use as a prophylactic against HIV and not just a treatment for established cases. I responded I was happy that partners of infected people can now breathe a little easier, knowing that if they take the drug the chances of getting infected with HIV are significantly decreased. She asked me to look a little deeper at this, so I’ve been doing that. And I’m ending up in a very conflicted spot. The “Ye olde consequences, morality, and personal responsibility” spot. You know, the one I so often find myself in, and then am compelled to write about.

So I had to really start thinking. HIV is contracted by engaging in unsafe sex practices, by IV drug use utilizing infected needles, via blood transfusions from infected sources, cross-placental mother to fetus infection, and contact with infected body fluids via an open wound. Except for the last 3, is it not a matter of personal choice to engage in risky behavior? There are consequences for these behaviors which will kill you. And yet, people continue to do these things. Enter Truvada. So now what? Do we provide this medicine to the junkies and hookers? The promiscuous? Please note that doing so actually ENABLES them to continue engaging in their immoral behavior with fewer serious consequences. And I am NOT talking about being gay, which is not in and of itself immoral. I’m talking about secrets, criminal drug use, criminal sexual activity, and sex outside of committed relationships. Promiscuity. Moral turpitude. Moral dissipation. Folks that don’t have the maturity to keep it in their pants when they should. One of the study groups  – high exposure risk gay and bisexual men, (ie those sleeping with multiple partners) transgendered women who were having sex with men –  even though taking the pills every day could potentially  provide  a significantly high protection rate, had a great deal of difficulty complying with the medication regime/daily dosing schedule. (which was one pill once a day btw)  So even with a proven shield they still appeared to have a death wish.

“In two clinical trials, daily use of Truvada was shown to reduce the risk of HIV infection by 42 percent among HIV-negative gay and bisexual men and transgender women, and by 75 percent among serodiscordant heterosexual couples, where one partner is infected with HIV and the other is not. According to Birnkrant, adherence rates to the full regimen, including testing, counseling and safer-sex practices, were about 30 percent in the first group and 80 to 90 percent in the second group.”  Source: Truvada Gets PrEP Approval

Why should we waste this valuable resource on people who demonstrate by their behavior that they don’t care? Can we, should we, save this potential miracle pill for the deserving? Cui Bono?  Who benefits? Those who, through no fault of their own, are potentially exposed to this horrible virus? The EMT’s, Police, Firemen, and Hospital Workers – the First Responders who deal with PIM daily – and without doubt are deserving of that extra protection?  How would we decide who else deserves to get the medication? Should we even be deciding?   These are really tough, even gut-wrenching questions – but ones we need to be asking. Where’s the line in the sand we should be drawing to hold people accountable for their choices.? Is there a line?  What about natural consequences? .  “Make poor choices, live with the results”.?!?!   “You know where you are?  You’re in the jungle, baby. You’re gonna die”.  I don’t have any answers, just opinions (I’m sure you can figure them out) – and more questions.  Like, how do you place a value on any human life?  Should we start playing God?

English: World map of travel & residence restr...

English: World map of travel & residence restrictions against people with HIV/AIDS: http://www.aidsmap.co. (Photo credit: Wikipedia)

We can, we did, come up with a potentially life saving, certainly life altering, treatment / new treatment option.  We now have to figure out who should be given the opportunity to benefit. Or, opt for the more likely scenario and just let the doctors decide.

At almost  $14,000 per year for the treatment, this is a staggeringly expensive conundrum.

“The pill’s cost could be a problem, however: A year’s supply costs $13,900, according to the manufacturer. Financial aid is available for HIV-positive patients, but not for those testing negative. “The problem is that people at the greatest risk are not only uninsured but not connected with the healthcare system,” Gallant said. The FDA’s Birnkrant said the studies offered no evidence that people using Truvada stopped using condoms. But opponents worried that the drug’s approval would lead to riskier behavior outside the confines of a clinical study. Gallant said the issue could be a red herring, however, because many people at high risk have already stopped using condoms as the fear of AIDS has weakened. “Condoms do detract somewhat from the pleasure of sex, and some people feel it’s not worth it,” he said.”

Source: FDA Approves Truvada, drug to reduce HIV Risk

Who ultimately benefits? Big Pharm.  The taxpayers foot the bill for the junkies,  etc.  Business as usual.  The pot’s not bottomless, there’s only so much money/so many resources to go around. Sooner or later we WILL be forced to make some very hard unpleasant decisions. And just something else to think about: please note that the root word in “decide” means “to kill”.  We need to be careful what we kill.

Related Article:

http://www.hvtn.org/community/iprexbackground.pdf

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7 thoughts on “Cui Bono? Or Better Yet, Who Should?

  1. What a thought provoking issue you have brought forth… People are their own guides and their inner voices should be their conscience. Question: Who will make the final decision on who receives this, and who will not. That will be the final question and it will be the most difficult. All people are worthy, but some will be left behind. God Bless them all. Auntie H.

  2. What a great, and thought provoking post. I’m so worn out with careless, thoughtless people who demand society “take care of them” so they can behave as they wish, that I think you could probably guess what my response leans towards. Why should society have to sacrifice for those who are truly just immature and refuse to take responsibility for their actions. I just can’t even go there. Our world has been footing the bill for these irresponsible individuals for far too long, all the way down to terrorists and how they’ve increased travel expenses due to increased security. I’m ready to rid of the whole lot of all of them.

  3. I’d like to think a bit more about your thoughtful blog, but I will offer one thought to counter your assumptions about risky behavior; well maybe two.

    Numerous patients with HIV caught it thru no fault of their own. Saddest cases are hemophiliac patients, often children, who caught it thru blood transfusions. Red Cross was the bad guy in lots of these cases.

    Children in sub-Sahara Africa born with it, because upwards of 90% of the population has it. A dark sided benefit of US aid that prevents birth control and teaching birth control.

    So, as you imply, there are no easy solutions out there in today’s world.

    Great post.

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