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Medical Forum / General / General / January 2005Ping George: what's going on here? Enforced meds compliance?
This video script from AMA came in this morning George. Enforced meds compliance??? Zee ~~~~~~~~~~~~~~~~~~~~~~~ "RESISTANCE TO HIV MEDICATIONS REACHING EPIDEMIC PROPORTIONS" TV Stations note: Video repeated twice during 30-minute feed; First pass mixed audio / Second pass NAT sound. For more information this or other AMA articles, go to: www.ama-assn.org Soundbites from: John G. Bartlett, MD and Mike Willis AIDS Patient: B-Roll: Mike sorting out medications; Mike putting medications into pill boxes; Dr. Barlett at desk; Lab Video; Dr. Bartlett consulting with patient: GFX: Media Briefing Cover WHAT: It's a viral war breaking out inside the body. For many H-I-V patients, the medications designed to keep them alive begin losing their effectiveness as the infection builds resistance to the drugs on the attack. However, there is strong hope for those who carefully follow their specific drug dosage plan. But as the American Medical Association shows us, it's not always that easy. FINDINGS: Doctor John-G-Bartlett heads the Division of Infectious Diseases at Johns Hopkins University Medical School in Baltimore. He says unlike some chronic illnesses, H-I-V is unforgiving and as he recently pointed out at a media briefing on the H-I-V aids drug resistance epidemic - once the virus becomes resistant to one drug, it can never be used again. Dr. Bartlett says in the presence of high rates of reproduction, and the anti-viral rate, the only one that's going to survive is the one that's going to be resistant, and that will quickly become the dominant virus. Only three classes of Anti-HIV drugs now exist, totaling 20 different medications. Experts must be very methodical in preparing combinations of drugs for patients who've developed drug resistance. A new study in the Journal of Infectious Diseases confirms resistance can be avoided when the patient carefully complies with their prescribed drug regimen. Dr. Bartlett says previous studies have shown most people with chronic diseases are likely to miss half of their medications. The demand for people with HIV is 95 percent compliance in order to control the virus and prevent resistance. That means you can only miss one or two doses a month. Dr. Bartlett says in essence what they are doing is making a stiff demand in compliance or adherence, and it's compounded by pretty harsh consequences if they don't adhere to their lifesaving drug regimen. Barry Cohn, AMA, (312) 464-4579 or (312) 953-4841; Nikki Bonomo, On The Scene Productions, (312) 644-6170 >This video script from AMA came in this morning George. Enforced meds >compliance??? Since you have poor reading comprehension, I'll interpret this for you. (1) Treatment for HIV is difficult because the patient develops resistance to the drugs. (2) In an effort to overcome this, doctors often must prescribe a complicated schedule of many different pills taken at many different times of the day. (3) People with chronic illnesses are well known to have difficulty complying with (following) complicated schedules for long periods of time. They make mistakes and miss or mistime taking the drugs sometimes. (4) With HIV treatment, it's extremely important to follow (comply with) the schedule prescribed in detail all the time, compared to most other illnesses. (5) Therefore the treatments are often less effective than hoped, because people have so much difficulty following (complying with) the schedule, and the consequences of an error are more significant. I hope you understand the meaning of "compliance" in this context now. If you had a less adversary attitude to the use of drugs to treat disease, you might avoid jumping to foolish conclusions, assuming "compliance" means "legal compliance" or "enforced legal compliance". >~~~~~~~~~~~~~~~~~~~~~~~ > [quoted text clipped - 46 lines] >Barry Cohn, AMA, (312) 464-4579 or (312) 953-4841; Nikki Bonomo, On The >Scene Productions, (312) 644-6170 > >This video script from AMA came in this morning George. Enforced meds > >compliance??? [quoted text clipped - 77 lines] > >Barry Cohn, AMA, (312) 464-4579 or (312) 953-4841; Nikki Bonomo, On The > >Scene Productions, (312) 644-6170 *Do you think compliance could lead to enforced compliance and legal compliance? *Do you think this could then be applied to you and any illness or condition you have and any medication you take? *Do you think there might be very good reasons not to want to take a medication, and it might be better addressing that? *Do you think those who do not comply (let us just leave reasons for now) might be denied essential services, incarcerated, forced? Note that the original article was about the difficulty HIV+ patients often have in closely following the complicated drug schedule that is necessary to best control their condition. This is called "difficulty in compliance", i.e the patients have difficulty in their efforts to comply with the doctor's instructions reliably over a long period of time. It has nothing to do with people being legally required to accept treatment, except in Zee's mind. >*Do you think compliance could lead to enforced compliance and legal >compliance? You mean lack of compliance? For HIV? No. At least not for any medical reason. After all, the treatments don't make the patient non-infectious. >*Do you think this could then be applied to you and any illness or >condition you have and any medication you take? Sure. Laws have long been in place for quarantine and sometimes treatment of people with serious infectious diseases, especially if the person is a public health threat due to unwillingness or inability to avoid infecting others. TB and SARS, for example. Even in a democratic country there are tradeoffs between personal freedom and risk to others. >*Do you think there might be very good reasons not to want to take a >medication, and it might be better addressing that? Nobody is requiring AIDS patients to take drugs. Like any mentally competent adult, they can refuse treatment. Some AIDS patients decide to discontinue treatment even if this shortens their lives. That is their right, just as it is the right of a cancer patient to refuse chemotherapy. Similarly, many people refuse to take drugs for other conditions due to side effects or personal beliefs or other issues. As long as they are mentally competent and only harming their own health, they are legally entitled to do so. A doctor can only attempt to educate and persuade, not compel. >*Do you think those who do not comply (let us just leave reasons for >now) might be denied essential services, incarcerated, forced? Only if they are a danger to public health. If they are mentally incompetent, it's a separate problem. No one should be denied "essential services", but what constitutes "essential" is often a matter of opinion, and varies greatly in different jurisdictions. Note that many people are "non-compliant" with drug regimes prescribed for them because they can't afford to pay for the drugs. They would be compliant if they could afford to. This a big, and very real problem, unlike the bizarre scenario you propose of Big Brother enslaving you for your own good. Zee, nobody is going to throw you in jail and force feed you statins. If you don't want to take them, don't. You're entitled to make this decision based on your understanding of the tradeoffs. You have a controllable condition that may shorten your life. If you don't want to use statins to control it, it's your decision not to do so. b...@cs.toronto.no-uce.edu wrote: > Note that the original article was about the difficulty HIV+ patients > often have in closely following the complicated drug schedule that is [quoted text clipped - 53 lines] > controllable condition that may shorten your life. If you don't want > to use statins to control it, it's your decision not to do so. You make assumptions. Not a good idea for one who purports to be a man of science. I have discussed this privately with George, who does not make assumptions, insult me, or denigrate my concerns and opinions. Zee bae@cs.toronto.no-uce.edu wrote. > >This video script from AMA came in this morning George. Enforced meds > >compliance??? [quoted text clipped - 3 lines] > (1) Treatment for HIV is difficult because the patient develops > resistance to the drugs. Actually the virus becomes resistant to the effect on it of the drugs not the patient. > (2) In an effort to overcome this, doctors often must prescribe a > complicated schedule of many different pills taken at many different [quoted text clipped - 4 lines] > time. They make mistakes and miss or mistime taking the drugs > sometimes. That is absolutely true. And it is not as though the drugs are not producing unpleasant side effects from toxicity. That is why HIV-AIDS patients may use cannabis to offset the misery the drugs cause as well as to offset the misery caused by the illness whether HIV-AIDS or cancer treated by chemotherapy, etc. > (4) With HIV treatment, it's extremely important to follow (comply > with) the schedule prescribed in detail all the time, compared to most [quoted text clipped - 13 lines] > > > >"RESISTANCE TO HIV MEDICATIONS REACHING EPIDEMIC PROPORTIONS" [scenario snipped] later bliss -- C O C O A Powered... (at california dot com) -- bobbie sellers - a retired nurse in San Francisco It is by the beans of cocoa that the thoughts acquire speed, the thighs acquire girth, the girth become a warning. It is by theobromine alone I set my mind in motion." --from Someone else's Dune spoof ripped to my taste. |
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