the Natural Condition

“Count something.”

This keen piece of advice comes from Dr. Atul Gawande, as espoused in his most recent book, Better: A Surgeon’s Notes on Performance. Gawande is a general and endocrine surgeon at the Brigham and Women’s Hospital in Boston, MA. Although he is a surgical fledgling, completing his residency in 2003, Dr. Gawande’s insights blossom from his experience in public health issues, at one point serving as a senior health policy adviser for the Clinton administration.¹

The thesis of Better is that, while advances in medical technology, new drugs, and the like can lead to an overall healthier humanity, the most effective — and commonly overlooked — way to improve well-being is to make better use of what we already have. When he proposes that everyone in the healthcare community ‘count something,’ he means that evaluation and reevaluation of current methodology and practice are the true keys to success. We must measure ourselves, and then use those measurements to understand where shortcomings occur. He also makes it gravely clear that all doctors are not created equal in their ability to treat patients.
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The Swiss Federal Commission for HIV/AIDS recently released a public statement, indicating that there is no plausible threat of sexual transmission of HIV for HIV+ persons undergoing antiretroviral therapy. Of course, there are several caveats to this rather consequential statement. For example, the person must receive active physician-supervised antiretroviral therapy, and must demonstrate low levels of virus in the blood consistent with an effective therapy for at least six months (viral load less than 40 copies/ml). Most importantly, the individual must not have an STI (sexually transmitted infection), which would exclude patients with AIDS from this zero-risk group.

This is a promising piece of news that may allow HIV+ people to lead more normal lives. However, do recall that the good news only benefits patients who have access to the expensive antiretroviral regimens. In poor countries, only 1 in 4 people has such access.¹

References: (1)