(no subject)
Sep. 2nd, 2012 12:35 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
pktechgirlbackupEverything I know about the new potential prophylactic HIV cocktail I learned from this Savage Love Podcast. I'm very willing to believe that Dan Savage (or his doctor co-host) did not deliver a full and accurate reporting of the research. But my thoughts on the topic are so general I'm prepared to plunge in without learning more.
The reported efficacy is 40-60%, with perfect use. Let's pretend everyone uses it perfectly: that's still not high enough to produce herd immunity. Herd immunity is when you've manipulated the environment (through preventatives or treatment or simply sufficient numbers of the susceptible people) such that the average infected person infects fewer than one person. The disease can't propagate at that point. From a public health standard, it's herd immunity or nothing: anything else is nice for the individual but irrelevant.
But everyone won't use it perfectly. People don't take drugs perfectly even when they're immediately helpful. A preventative drug with nasty like effects (which this is) is going to have severe compliance problems.
Some people are arguing we shouldn't release the drug because it will give people a false sense of security and decrease condom use. I don't care. Adults get to make their own choices even when they're stupid. What concerns me is that intermittent use of preventatives against an entity that can evolve is the perfect way to evolve resistance. You couldn't design a better way to create drug-resistant AIDS if you wanted to.
I think the FDA has no business telling people what drugs they can or cannot take and does a lot of harm in trying. But that's for things affecting individuals. Antibiotics and antivirals are public goods, and degrading their efficacy for a small chance at dodging HIV is exactly the sort of thing government should prevent.
The reported efficacy is 40-60%, with perfect use. Let's pretend everyone uses it perfectly: that's still not high enough to produce herd immunity. Herd immunity is when you've manipulated the environment (through preventatives or treatment or simply sufficient numbers of the susceptible people) such that the average infected person infects fewer than one person. The disease can't propagate at that point. From a public health standard, it's herd immunity or nothing: anything else is nice for the individual but irrelevant.
But everyone won't use it perfectly. People don't take drugs perfectly even when they're immediately helpful. A preventative drug with nasty like effects (which this is) is going to have severe compliance problems.
Some people are arguing we shouldn't release the drug because it will give people a false sense of security and decrease condom use. I don't care. Adults get to make their own choices even when they're stupid. What concerns me is that intermittent use of preventatives against an entity that can evolve is the perfect way to evolve resistance. You couldn't design a better way to create drug-resistant AIDS if you wanted to.
I think the FDA has no business telling people what drugs they can or cannot take and does a lot of harm in trying. But that's for things affecting individuals. Antibiotics and antivirals are public goods, and degrading their efficacy for a small chance at dodging HIV is exactly the sort of thing government should prevent.
