Thursday, September 24, 2009

More on Healthcare

Sorry for the blitz of postings-- I have a lot of thoughts to catch up on.

The posting I did on healthcare leaped off a post at feministe about healthcare, and the conversation ensued in the comments. I don't want to lose the points from that conversation, so here goes:

Quick Hit: AIDS Vaccine

Quick hit for me, anyway. There's some stuff circulating now about a new AIDS vaccine that was tested in Thailand and reduced AIDS transmission by 31%. Some thoughts:

- This study was totally and completely immoral, which is why it was done in a third world country. It's like using human subjects to test whether a new bullet-proof helmet will work, by shooting people in the head with bullets. It's only a small step above intentionally having these people have sex with someone who has AIDS. Working with an at-risk population and standing mutely by while you know some of them are going to get infected is obscene.

- A population that's adjudged to be at-risk for HIV tends not to be a population that medical researchers can rely on for clinical honesty; there are cultural barriers, issues of mistrust between researcher and patient, and, with regard to the particular communities at risk for HIV, issues of mental illness (not all hookers or heroin addicts are crazy, but lots and lots are) and understanding of veracity and consent.

- There are different strains of HIV, and I haven't seen any discussion of whether that accounts for the weird statistics here: why 31%? Maybe this just works on certain strains, in which case those strains should be deduced and some level of statistical analysis done on which strains are prevalent in which geographic and demographic populations.

- Going back to the morality issues and cultural issues: why do you think this was done in Thailand? I'm going to go read the research and update this if necessary, but it seems like Thailand's a good place to do this kind of study because of the huge sex trade, which means we're using a tragedy of humanity as the forum for medical research, and while it makes sense, it's discomforting. Why not do this in South Africa, where 10% of the population has AIDS/HIV? My point is that the forum selection in this case is not irrelevant to the clinical findings-- sex-work-driven epidemiology is a factor in interpreting these results, just as rape-driven epidemiology would be a factor in interpreting results in an African population. AIDS is a highly-demographically sensitive epidemic, and these differences are more salient factors in understanding the usefulness of any vaccines than they would be for many other diseases-- even STD/Is.

- Every year we have to update the flu vaccine, because the flu is a virus, and viruses mutate rapidly. If we do find a vaccine for AIDS, we're going to need to update it constantly to accommodate different strains, UNLESS the AIDS vaccine represents a leap forward in Basic Science understandings, which it sounds like it might, and the lessons will be applicable to all virus vaccines, not just AIDS.

- Asshole-blunt: you can't trust studies conducted in third world countries.

- There's moral hazard left, right and center on this. Post coming.

Wednesday, September 23, 2009

Race Politics

There was a recent post up at Feministe discussing the fallacies inherent in any reference to "The Black Community", and how toothless it is to suggest that The Black Community should be policing its own youth and cracking down on its problems, because there are no institutions that unify The Black Community that would facilitate this, or that even define these problems in the context of a coherent whole body.

Health Care

There’s a calculus that’s going on in the minds of most insured Americans (the ones I talk to in my white urban professional upper middle class bubble, and the ones represented in plenty of coverage, whether or not reflective of real pluralities) that President Obama tried to speak to in his address to the nation, and it goes something like this (also, most doctors are doing this math from a more educated, and differently interested, position):

There’s X number of doctors in the U.S., and most of them work way beyond 9-5, five days/week. They already currently don’t give enough time to patients as it is. There’s Y number of people who currently have access to medical care. That number Y could as much as double (since most insurance is crummy anyway and people don’t have unlimited access now), but number X is staying right where it is. So the access of people who currently have insurance either has to be reduced, or the quality of the care they receive has to be reduced by longer waits between visits and less time with the doctor. This math doesn’t just have to be applied to doctors; it applies to MRI machines, operating rooms… these are limited resources. Currently, we ration these resources out by giving them to people with better jobs, better healthcare, some combination of the two, or people who have lived past 65, while people who aren’t in those categories die.