Two highly recommended products from a couple of my friends in the HIV\/ID world:<\/p>\n
First, the inimitable Joel Gallant — long time of Johns Hopkins, soon to be of Santa Fe <\/a>— has resuscitated his terrific Patient Q & A Forum here<\/a>. He used to answer patients’ questions regularly on www.hopkins-aids.edu, but that whole site appears to be gone — either truly gone, or Harvard Medical School controls our web searches, nixing anything having to do with a top rival.<\/p>\n (Nope — truly gone. Here’s a little archived material<\/a>.)<\/p>\n The questions on the new\u00a0forum are far-ranging in topic — though risk of transmission seems to be a recurring theme — and, not surprisingly with Joel’s writing the answers, the responses are always authoritative, and often very funny.<\/p>\n Fortunately, he’s populated his site with some of his favorites from the Hopkins days:<\/p>\n Is the actual risk of female-to-male transmission greater than the .0001 per contact that I am always hearing? If this is actually the case, it would seem that a policy of promiscuity would actually reduce risk, at least from a male perspective.<\/em><\/p>\n I\u2019ve read your question several times now, and each time I read it my jaw drops lower. First, numbers like these are fairly meaningless because they don\u2019t take into account the woman\u2019s viral load, the nature of the sexual contact, the presence or absence of blood or genital ulcers, etc.<\/p>\n But unless I missed something in high school math, any number greater than zero means promiscuity is a bad idea. Engaging more frequently in an activity that has an identifiable risk, however low, cannot reduce the risk of infection.\u00a0Granted, I took my last math class decades ago. Maybe there have been new developments in the field that I\u2019m not aware of. If you are using an alternative form of mathematics that makes promiscuity not only safe but advisable, please enlighten us! I\u2019m sure there would be great interest!<\/p><\/blockquote>\n This one pretty much crystalizes what’s great about his Forum (and, come to think about it, Joel in general) — he can be academic and racy at the same time!<\/p>\n Meanwhile, over at the New York Times<\/em>, there’s a superb piece<\/a> by ID\/HIV Specialist,\u00a0Times<\/em> staff writer, and Journal Watch<\/em> editor Abbie Zuger<\/a>.<\/p>\n It’s about how challenging it can be in clinical medicine sometimes to … do … nothing. Citing the example of one of her\u00a0patents\u00a0 who has persistent and multiple complaints over a decade of care despite innumerable blood tests, scans, treatments, and referrals to specialists, Abbie realizes that what’s best for her is sometimes taking this passive but difficult approach:<\/p>\n That meant not treating her terrible sinus attacks, not investigating her continuing abdominal pain, not medicating her headaches and her crampy hands, not addressing her depression, her itch, her nausea …\u00a0To really do nothing, all shamanic trappings must be abandoned: stethoscope, prescription pad, weighty pronouncements, the works. And yet \u2014 and this is key \u2014 doing nothing is also quite different from saying, \u201cThere\u2019s nothing I can do for you; goodbye.\u201d Most doctors are masters of this final nothing. But keeping a therapeutic relationship afloat without the usual tools, tricks or enticements \u2014 that is a rare achievement, and surely harder than the hardest microsurgery.<\/p><\/blockquote>\n I kept nodding my head in recognition during the article; perhaps this is the best line of all: \u00a0“In fact, one might hazard that doing nothing is the most subversive activity in all of modern medicine, undermining as it does the agendas of all doctors, all patients and all interested corporate parties.”<\/p>\n