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Wholistic Picture: Advance and Retreat

By Sue Saltmarsh

September/October 2010

Sue Saltmarsh It seems to be an aspect of human nature that we hardly ever confront a problem head-on and solve it once and for all without setbacks, without trial and error, or "if at first you don't succeed ..."

Medical advancement is just one reflection of this human characteristic.

HIV and AIDS have been consciously with us for almost three decades now and we have indeed witnessed great progress. Who in 1983, desperate for something, anything, to repeal the death sentence of HIV could have imagined AZT or d4T? Who in 1990, taking AZT and thinking the medicine was worse than the disease, could have foreseen Sustiva or Isentress? Who in 1997, suffering kidney stones from Crixivan could have conceived of Atripla -- one pill you take once a day, with or without food.

Of course, there have been flies in the ointment -- metabolic complications, bone loss, cognitive dysfunction, perhaps even cardiac ramifications caused or exacerbated by these medications that provided a reprieve from death. I am still blown away every year when working on our annual drug guide, to read the litany of possible side effects that must be listed with the large majority of drugs currently on the market.

But just as with progress of any kind, the advances and retreats, the pros and cons, must be assessed when choosing your best treatment options. Are the benefits of Sustiva worth the nightmares, the "personality changes?" Is it better in the long run to have an undetectable viral load if the PI you're on makes you diabetic or your NRTI causes lipoatrophy?

So much of life in this world, at this time, seems fraught with seemingly no-win situations. People in Louisiana say they're angry at the Obama administration for "not doing more" about the BP oil spill, but when a moratorium on deep water drilling is announced and the plan to make BP establish a fund to pay damages is achieved, they wail about the loss of jobs on oil rigs and the danger of losing BP's presence (and business) in the Gulf. For years, people have cried out for our soldiers to come home from Iraq and Afghanistan and yet, nothing but criticism is heard about the plan to start bringing them back next year. Every day it seems some new information comes out on the beneficial effects of eating organic food, yet the people who need it the most can't begin to afford to buy it. Legislators in states like California, New York, Massachusetts, and Illinois have resisted raising taxes to solve their huge budget crises and yet people rant against cuts to education, human services, and infrastructure -- do they not understand that the extra $5 or $10 taken out of their paycheck is not so high a price to pay?

And then there is the issue of profit motive in finding a cure. In this time when almost daily we hear about some Wall Street financier who got a bonus of millions while bilking his clients of their life savings; of a governor who worked eight hours a week while taking thousands in kickbacks; of a doctor who diluted cancer chemo drugs in order to sell them while patients died from not getting the correct dose, is it any wonder that there is a prevalent suspicion that even if a cure is discovered, it won't be made available because pharmaceutical companies, hospitals, and insurance companies are making too much profit with the current treatments that keep HIV a chronic condition, not to mention treatment for the related conditions or co-infections that often occur in the HIV-positive?

Having worked in non-profit all my life, I just can't wrap my mind around how, exactly, any sane person could justify putting the acquisition of money before helping to improve or save lives. Thankfully, I've met a number of well-intentioned, altruistic doctors, drug reps, clinic directors, and even one insurance saleswoman who value human life and respect for others above their bank balances and who give me hope for the future.

At this stage in the evolution of HIV/AIDS, it's been proven that, while trade-offs are unavoidable, the potential for continued progress is huge. Every day scientists and doctors and analysts and social workers and HIV-positive people think, invent, experiment, conduct trials, pass tests. Every day a light bulb goes on over somebody's head and progress is made.

Each of us makes choices that affect our quality of life, our relationships, our finances, our health, our sanity. Too often those choices come down to the lesser of two or more evils. But in making them, we continue to go on, we hold out for a brighter day, some even dare to dream of the possibility of being able to choose from a multitude of "goods."

And someday, somehow the oil will stop leaking, wars will end, clean and wholesome food will be available to everyone, the economy will truly recover, programs that help people will be strongly funded because our society knows it's right to do so, and there will be a cure for cancer, Alzheimer's, diabetes, and HIV. We just have to hang on.

Breathe deep, live long.

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