Biblical Reflections on Modern Medicine
Vol. 8, No. 2 (44)
"Wouldn't It Be Nice If We Were All the Same"
The cloning of a cell from an adult ewe has caused headlines in the news and prophecies of a macabre society in which humans are cloned for specific roles or to fulfill the fantasies of rich fanatics. Should these dire predictions be taken seriously? Would human clones have souls? Does God have anything to say on cloning animals and humans?
The answer to the first question is "Yes." In a society virtually without moral restraints, we should worry that every technology can be misused. But, technology in and of itself is not immoral. Would these clones have souls? "Yes" (more later). And, "Yes," God has something to say about every human endeavor.
For those who may not know the details, cells were removed from a mammary gland of a 6-year-old ewe in the last trimester of pregnancy. The cells were placed in a culture dish without nutrients. The theory is that as the cells die, they lose their specificity as mammary cells, allowing genetic expression of the entire organism. After five days, one cell was inserted into an unfertilized sheep egg with its own DNA removed. The embryo was then cultured in a dish and implanted into another ewe, which carried the pregnancy.
Presumably, this same process could be done with human cells. However, at least for the time being, only females could be cloned, unless the state of pregnancy could be induced with hormones in men or another technique could be found to release the full genetic expression of individual cells.
What has not generally been reported is that any number of organisms might be produced from the same fertilized egg. Research in mammals has shown that each cell of an eight-celled embryo (after three cell divisions) is capable of growing into a complete individual, whereas the normal process is for the eight-celled embryo to continue as one individual. This phenomenon occurs naturally when identical twins, triplets, etc., are produced. Something causes individual cells of these first- and second-stage divisions to grow separately from the rest, instead of an aggregate whole.
Thus, one embryo becomes eight, if the cells are separated at that stage. Then, they could be separated again at the eight-cell stage ad infinitum (unless there is some degeneration in the repetition that is not now known). So, unlimited cloning of one individual is entirely possible with today's knowledge and technology!
First, I would like to ask you, "What is 'immorality'?" How would you define immorality? Immorality is simply thinking or doing anything that God has told us not to do. Understood properly, those things that are immoral, unethical, illegal (i.e., defined by God's law), unbiblical, and unspiritual (relative to thinking and behavior) are identical.
I bring these relationships up because we sometimes blur -- even separate -- them, as though they were somehow different. There is a wonderful unity and harmony to the Biblical system (because it reflects the unity of God Himself). If a thought or an act is moral, it is also spiritual, legal, and ethical.
Further, there is no conflict at any level of relationship within this system. What is right for the individual is good for the family, the church, society, the city, the state, the nation, and the universe. Also, it glorifies God. This understanding simplifies ethics for the Christian. It does away with ethics based upon 1) the individual vs. society, 2) the few vs. the many, 3) the poor vs. the rich (ruling elite), 4) the end justifies the means, 5) situation ethics, 6) so-called "Christian" ethics, etc.
True Biblical (Christian) ethics is simply figuring out what God has said that we may and may not do.
For my astute readers, please pardon this aside. I usually deal with this matter in passing, but Christians would solve a lot of problems personally and socially if they only understood and acted upon this unity. Instead, they seek to appear scholarly, friendly, non-judgmental, and "open." Strange, they had rather befriend the world and alienate God. But, enough of this aside.
I see nothing in the Bible to prohibit the cloning of animals. Perhaps, some techniques might involve the mixing of "kinds" (e.g., Leviticus 19:19 and Deuteronomy 22:9-11) that would be prohibited. However, animals were created to serve man. Already, we hybridize them and grow them for specific purposes. Their ends are rightfully determined by their owners. (I am assuming reasonable treatment and not cruelty or substandard care.)
The cloning of humans is entirely another matter.
I can think of two possible reasons for cloning: to reproduce asexually and to produce people for specific tasks. The first could be used as a means of artificial reproduction instead of artificial insemination (AI) or in vitro fertilization (IVF). I am not sure that this end may be Biblically proscribed, if AI and IVF are allowed. I assume several related ethical issues such as genetic material coming from the husband or wife, all embryos are intended for life, abortion is not an "escape" for untoward results, etc. (I have covered these in my book, Making Biblical Decisions, now out of print.)
Production of clones for a specific task, however, cannot be condoned for any reason. The designed ends for clones could be high or low. Geniuses might be cloned to advance technology. (Certainly, they could not be cloned to advance morality, as I.Q. has nothing to do with M.Q. -- moral quotient. Some very immoral people are geniuses.) Or, those with low I.Q. might be cloned to be factory workers, sewer cleaners, or soldiers as cannon fodder.
Any intended end for any human being is immoral. A person who is not in charge of his own destiny is a slave, that is, he is owned. "The Biblical law recognizes voluntary slavery, because there are men who prefer security to freedom, but it strictly forbids involuntary slavery except as punishment" (R. J. Rushdoony, Institutes of Biblical Law, p. 120).
Further, it is God who designs humans' lives (Romans 9:14-29). While the context primarily concerns salvation, that cannot be separated from God's spiritual gifts (e.g., Ephesians 4:7-16). A reader may protest that these texts apply only to believers. However, it is only rational, and perhaps logical, to conclude that God's providence includes not only believers, but unbelievers, since He cannot design the end of history without designing all the steps to cause that end.
Interestingly, both believers and unbelievers are called slaves (Romans 6:15-23), but only believers are also described as being set "free" (Romans 6:18 and Galatians 5:1). Thus, designing a purpose for a life is wrong and assumes God's prerogative. Also, applicable within God's providence is what has been called God's "division of labor," providing every type of person needed for a functioning society. Certainly, history (including the present) has shown that man's attempt at design of society is fragmented at best -- totalitarian and deadly at worst.
By Biblical definition, humans are both body and soul (Genesis 2:7), and all are descendants of Adam (all genes come from him). Thus, a human being cannot exist without a soul.
It is also this spiritual nature that makes cloning wrong. As noted above, spiritual gifts may cause the converted to be interested in entirely different works than those for which he was designed. Cloning ignores God's design upon man's soul.
I have commented on the concept of "playing God" before, but I will review it again for emphasis. Using the term "playing God" displaces the proper focus of ethics. As Rushdoony has said, the creation mandates of Genesis 1 makes men God's vice-gerents, that is, we rule as His authorized representatives. So, in a sense, everyone is called to "play God" by God Himself.
The issue is what we are rightfully allowed to do and not to do. That is, we are back to what is right and wrong, Biblically defined and directed.
Also, the issue is that we cannot "play God." God is God and has providentially planned and decreed all that will happen in history. Just to infer that we can "play God" is to slight His Person as God. It is to suggest that God is not in control and that somehow man can make decisions that He does not expect. It is the old illusion that man is "free" to determine his own destiny. No, "playing God" leads us back to where we began, a ploy of ethicists to displace the Bible as "our only rule of faith and practice."
Cloning presents new ethical challenges in a world that seems less and less able to handle the simplest of ethical decisions. Brave New World is more and more a reality. Unfortunately, most Christians who have God's Word for directives on all issues are not being God's vice-gerents, but following the world in its ethical diversions, a broad way leading to destruction.
Hilton P. Terrell, M.D., Ph.D.
Our State Department of Health and Environmental Control (DHEC) continues to generate agendas to eliminate our idleness in medicine. A perennial subject is lead poisoning in children. To read DHEC's missives, one would be forgiven for believing that lead poisoning is Public Enemy Number One. A brief foray of mine into the medical literature produced a mass of studies which have a definite tendency to echo each other, along with a suggestion that a critical study from 1979 may have been fudged. The following questions of mine remain unanswered:
(1) What is actually proven regarding damage from lead levels in lower ranges, vs. what is extrapolated? (2) Are guidelines for lead levels being promulgated on an evidential basis or merely on the basis of regulatory muscle? (3) Since life is risk, who is in the system to see to it that it is the larger risks that received proportionately the most attention? This last concern is the main one, for it seems that primary care in general, and family medicine in particular, has become the beast of burden that is expected to carry everyone's agenda. It reminds me much of the burdens that have been thrust upon public school classroom teachers over the decades to the extent that it now appears those classrooms are failing in their more primary mission.
The primary care physician is to me resembling more and more the public school classroom teacher -- in a key position to be sure, but also ruled, regulated, and relegated into a servile status. Individual judgment is punished. Exit an algorithm, and you will find yourself explaining to someone why. Even if you succeed, you lose, for winning takes time, and there is only so much. You can win every battle and lose the war.
Observe the public school classroom teacher. He is charged with reporting suspected child abuse and neglect, organizing teaching modules around the latest politically correct concept, such as black history month, reporting suspected drug abuse, cultivating sexual mores to satisfy the most vocal community members, discovering anorectics and children with "masked" depression, participating in health screening and immunization campaigns, prevention of juvenile delinquency, teenage pregnancy, improving nutrition, etc., etc.
One of the formative moments of my life was in a public sixth grade classroom whence I had been summoned as a school psychologist to discover why the children were not behaving well. The school drew largely from an inner city public housing project, The children were being required to learn who conquered Quebec and the five (sic) layers of the atmosphere. Yet, many did not know how to read or to do basic arithmetic calculations. The state department of education, in its wisdom, sent out regulators who sat in classrooms with stopwatches making sure that the classroom teacher spent the requisite number of minutes per week on each subject matter area. Teachers, allegedly so important to the educational process, were treated as devoid of judgment as to where the priorities lay with the children in their classrooms.
The textbooks and workbooks were prescribed. The teachers had been through government-required training programs which specialized in debunking every effective method of discipline, including those in Scripture. Along with the teachers the parents were stripped of their choice of schools, school hours, teaching methods, and evaluation. In that classroom, the vacillation over whether to return to medical school or remain with school psychology ended. Back to medical school! The children in their own way were more aware of the educational priorities in their lives than the "educrats" on the top floor of their sanctum in the capitol.
Now DHEC and its brethren at the CDC and FDA are beginning to look more and more like the state department of education.
I would maintain that even if it were certain that high levels of lead in children are permanently harmful to some degree in some of them, the issue of what to do would not be settled. To take action, the risk would need to be prioritized with other competing risks so that the finite resources of expense, anxiety, and aggravation are best distributed. The specialist viewpoint tends to see only its own special interest. The generalist is in a potentially better position to see where the relative benefits are most likely to be, while not knowing the special information as well.
Alas. We are not to be so trusted with decisions. Directives arrive, increasingly less optional of fulfillment, to screen for this, to immunize for that, to treat with this drug, to use that form, to report this but keep that a secret. Sometimes the directives are backwards from what ought to be. Many, if not all, represent someone up in the hierarchy -- someone who does not take night call any more, if ever, someone who doesn't get vomit on his shoes -- who has a good idea of what ought to be the primary care agenda.
The legislative, judicial, and regulatory power levers are indeed in the hands of the special interests which populate the offices of DHEC. They must be contended with. However, ultimately, it is the truth of the matter and its true priority, that will have its way, and it is that which I want to know how to teach, while not neglecting the judicial and other consequences.
As I mentioned to you by phone, I took the opportunity of your question regarding miniblinds to activate an environmental medicine information system recently available to me. My "hip shot" response based on general principles of lead poisoning was: (1) it is highly unlikely to be a significant issue for your family and, (2) I suspected that there were some agendas being served other than health. After doing considerable searching, with help from a medical university, I stick with the hip shot reply I made.
The federal government's Consumer Product Safety Commission, as you know, has recommended that the offending types of miniblinds be removed. This is the same federal government which has protected over 30 million abortion deaths and encourages "how to" sex education, so you will immediately sense the correct prioritization it has. I can find that only one (1) child so far has had miniblind-caused lead levels in excess of the government's own conservative maximum. No one has indicated that this child actually suffered any health consequences, which is to be expected, since safe maximum exposures are set so low in most cases that only a very few who have that level would be harmed.
Undoubtedly, more children who had these miniblinds in their home will be found to have elevated lead levels. Since the symptoms of lead poisoning are also symptoms of many other things, especially poor parenting, some of these families will attribute the symptoms to the lead. It is more comfortable to blame something in the environment than something in the hearts of those in the household. In recognition of the impossibility of being sure, and of much money to be made, another of the agendas being served is a call from a legal firm for possible cases. You've probably seen such calls on the worldwide web.
Another agenda that can be served is the restriction of competition from these cheaper miniblind manufacturers. Domestic manufacturers have an incentive to propound the issue. There is money to be made from fear.
Another agenda is that of the regulatory agencies. If there never were any issues like this, the "need" for their services would decline and their funding might diminish. Environmental contamination is good for regulation the way the obituary page is good for life insurance salesmen. Physicians also tend to profit from fear, visits, and tests.
I think your agenda is just to raise safely God-fearing children. From what I have seen, you two are doing a splendid job. I am willing to test your children for lead if you want, since I cannot tell you certainly that they do not have lead levels above 10 micrograms/ml. However, I believe that if we start checking for risks to them as small as this one is, we have no logical reason not to do many other things, some of them absurd, such as removing the toilets from your home. More children drown in toilets annually than have yet been shown to be damaged by miniblind lead. At some level of risk we must simply trust in the providence of God and cease trying to be omniscient.
I think it fair to tell you that many, perhaps a majority, in my profession, would simply have responded by telling you to bring them in for a test. It is the path of least resistance for us, not to mention profitable.
We cannot research all the questions that can be generated. I have written out of a particular interest in the issue. The letter is my attempt to generalize the finding to other risks. I have enclosed a copy of an article that relates to this matter, though not at all on the surface, since it is about silicone implants. If you care to see how these things develop, the story of silicone breast implants is instructive. Having decided that a sovereign, provident God is dead, we are tearing our society apart in vain attempts to replace Him with our version of the knowledge of good and evil. The Psalmist tells us that God laughs at this effort.
Commentary: Reasons for these differences were not researched, but conjectured within the "Discussion" portion of the article. I do not want to conjecture either except for psychiatrists.
Psychiatrists (along with their non-M.D. colleagues, psychologists) are the priests of American society. They are called for "counseling" after catastrophes (Oklahoma City, plane crashes, tornadoes, hurricanes, floods, etc.). They are called for "expert" testimony about all issues of human behavior in the courtroom and outside of it. They give the expert testimonies on talk shows and other news events. And so on.
What hope is there for marriages when the experts on marriage fail half the time? You say, "That's unfair. They are stressed professionals dealing with abnormal behavior every day."
I think that it is fair. Among physicians, psychiatrists have more regular hours and little interruption at night. Further, if they are unable to apply their "insights" to themselves in their daily stresses including their marriages, what is the real importance of their wisdom?
"Husbands, love your wives as Christ loved the Church... as your own bodies..." "Wives, be submissive to your husbands" These and other Biblical commands will never fail to develop deep and non-divorcing marriages. Where is the standard in all of psychology and psychiatry that rivals those commands. Nowhere.
Commentary: The Preacher of Ecclesiastes said, "There is nothing new under the sun." However, the news media can make headlines of facts known for decades, as though the light of research had shown through a revelation never before known.
Autopsies on soldiers killed in the Korean War shown evidence of fatty deposits in their major arteries. Two decades later, fatty streaks were discovered in the aortas of unborn children. So, what's new? Only that another researcher spent taxpayer money to look at the problem from a slightly different population -- and he makes headlines (literally, the headline for the front page of The Augusta Chronicle).
This "making news" of medical research seems to occur every day. But, have you noticed that very little has changed in the actual practice of medicine and even less in the outcomes for patients?
Occasionally, there is something "new under the sun" in medicine -- a real advance or breakthrough. However, nothing recent and remarkable comes to mind. Overall, I still make the claim that modern medicine contributes more to ill health, both moral and physical, than to good health. Caveat emptor.
Commentary: Sound like today's editorial? The above was written more than 100 years ago by Robert L. Dabney. Reprinted in the Spiritual Counterfeits Newsletter, Vol. 21, No. 2, p. 7, and more recently in The Forecast, December 1996, p. 9).
While political in nature, this comment is relevant for medicine with the ever encroaching strong arm of the federal and state governments into medical care. We need a third political party that might take 40 years to grow into an influential and competitive force, but the Republican party is only going to continue the trend described by Dabney.
Tax-deductible medical savings accounts (MSAs) began January 1, 1997, as authorized by the new Kassebaum-Kennedy health insurance reform law. Interest by potential users and employers has run high. It applies only to businesses with 2 to 50 employees, and it must be accompanied by a high-deductible health insurance plan. Certain portions of the plan have specified dollar amounts, e.g., out-of-pocket expenses cannot exceed $3,000 for individual coverage and $5,500 for a family. (American Medical News, January 27, 1997, pp. 1, 25)
Commentary: Medical savings accounts establish a "savings account" from which money can be withdrawn only for medical expenses. Like all plans, there are many varieties. E.g., some allow participants to purchase their own backup insurance programs, others specify what that program must be. (For a basic text on MSAs, send $4.00, which covers postage, to Covenant Enterprises.)
As I recall, advocates of MSAs had great difficulty getting them into this bill. And, then, the program was limited in the number of participants, and criteria are quite specific. However, as I read the programs being developed, enough basics of the concept are present to allow a workable and effective trial.
Many conservatives (see "Are You a Conservative?" above) and Christians are enamored with MSAs. And, in the current medical marketplace, they have far more answers to the high cost of medical care than traditional insurance and managed-care. But, there is still one problem with them -- they are governed by federal and state laws.
What is currently happening with managed care? Federal and state legislatures are manipulating it, e.g., mandatory stays for women who have delivered babies. Such manipulation is what caused the high cost of medical care in the first place. Most managed care programs are expecting cost increases this year after several years of relatively flat costs to consumers.
What is needed is for the government to get out of medical care entirely. However, I don't think that we will see that in my lifetime, and maybe for a long time in the future.
By the way, for those who may not know, MSAs have been in existence for a long time. The above program is different only that it allows tax-deductibility. Some large companies have instituted them with great success with the records to document that achievement. But, remember, MSAs are a temporary fix. The permanent fix is a truly free market in medical care. It would be a zoo, but it would be fun! And, people would get better care overall!
Commentary: I have little to say. This excerpt says much. I only lament that most Christians participate in this "disease mongering," from both sides as patients and physicians. And, they want someone else to pay for it. To Modern Medicine be the glory!
The mortality of 696,516 American soldiers who served in the Gulf War was compared with 746,291 active-duty military personnel who did not go to the Gulf. The Gulf War Veterans had a 9% higher death rate, but the excess deaths were due to accidents, especially automobile accidents.
The rate of hospitalization of 547,076 members of the Armed Services who served in the Gulf and remained on active duty was compared with 618,335 military personnel who did not go to the Gulf. The rates of hospitalization were similar. "The pattern of hospitalizations according to diagnostic category suggests no excess of any particular disease after the Gulf War." (The New England Journal of Medicine, November 14, 1996, pp. 1498-1513, 1525-1527)
Commentary: The "Gulf War Syndrome" is a repeat of the Agent Orange saga of the Vietnam war. In the best defined study, 1,200 Air Force personnel with the greatest exposure to Agent Orange were as healthy as their control group with a 13 percent lower incidence of cancer.
As I have noted and documented often on these pages, the science of medicine is weak at best. However, its science is the only factor that makes modern medicine any better than its leeches and brews of the past or most alternative medical practices.
Yet, for the most part, both physicians, the public, and the news media choose to ignore this science. The Gulf War Syndrome is one more example. Politicians, Bill Clinton in particular, are capitalizing on public sentiment. Taxpayers will pay (are paying) for this politicalization.
In the public arena, the fad of hypoglycemia (low blood sugar) of the late 1970s and early 1980s and the more recent chronic fatigue syndrome compare to the Agent Orange and Gulf War Syndrome of the military. Science eventually won with hypoglycemia and is winning with chronic fatigue.
Politics, the delusions of psychiatry, the willingness of physicians, and the ignorance and demands of patients have more than destroyed sound scientific medicine. Non-discerning physicians and patients are hardly better off relative to medical care than those of the Dark Ages. In fact, those in the Dark Ages may have been better off -- at least they had a Christian worldview that provided moral principles that could lead to better health. The pagan worldview of today offers only disease and death.
Readers may recall the study last year that showed that zinc lozenges shortened the length of the common cold. Dr. Michael Macknin, the researcher of that study, received 9,000 shares of stock in a lozenge company after the data were compiled, but before publication. After publication of his findings, Dr. Macknin sold the stock for $145,000. (Stats 2100, March 1997, p. 2)
Commentary: This report needs no further comment by me. Its problems are evident. However, I wanted to report on this source.
Stats 2100 is a great new publication, and it's free -- for now. (Address is Statistical Assessment Service, 2100 L St., NW, Washington, DC 20037.) Mark Twain said, "There are lies, damned lies, and statistics." No one would doubt that statistics are useful, but they must be carefully discerned. This publication does that. Its reports frequently deal with medicine, as it is a major focus in American society.
Commentary: Over the past year, I have commented on the misuse of antibiotics for the common cold by physicians because of ignorance and patient pressure (real or perceived). Drug companies with their marketing experts are capitalizing on this process.
American Family Physician is perhaps the major medical publication for family physicians, with a circulation that must be well over 100,000, possibly much larger. A four-page ad appeared for an antibiotic with only these words on the first page, "Put the bite on common respiratory infections." Then, followed three pages of supportive advertising. Almost entirely, "common respiratory infections" are caused by viruses against which antibiotics for bacteria have no effect.
Of course, the text reads "________ is indicated for acute bacterial exacerbation of chronic bronchitis and acute maxillary sinusitis." Since these are "common," the ad is technically correct. However, these "exacerbations occur (at most) in 1-3 percent of "colds." So the practice of antibiotics for colds is continued at every level: patients, physicians, and drug companies. Physicians (usually) know better when pressed, but they continue the charade. (Another ad in the same journal read, "So many success stories. Dotty's bronchitis got fast service. That's the power of ________" -- another antibiotic.)
Relative to the science of medicine discussed in the Gulf War Syndrome above, the science of medicine shows that antibiotics are ineffective, even harmful for colds. However, the practice of medicine ignores that science. Hence, modern medicine's claim above and beyond medicine of the past and alternative medicine today is made null and void.
Commentary: A thought struck me, as I was reading another Christian publication that strongly advocated alternative medicine. Where are the hospitals and emergency rooms of alternative medicine?
If alternative medicine is so wonderful for chronic (non-acute, non-life threatening) problems, it is only logical that it should also be effective in severe and emergent situations!
I'll tell you why these institutions are not present for alternative medicine: because they would lose a lot of their patients and this bad news would cut into their profits! They would then have negative anecdotes (personal stories of patients), instead of positive ones.
You see, dear readers, alternative medicine thrives on cycles of patients' illnesses and emotions. They feel bad or have some chronic (ongoing) problem. Over time, almost every physical and psychological problem will cycle from bad to good and back.
When these problems are bad, alternative medicine is applied, and the problems often get better -- not because of the medicine, but because of their cycle. However, alternative medicine gets the credit.
Now, most of orthodox medicine gets credit in the same way. Patients get better in spite of what we do. However, at least we provide acute and emergency care.
What do you think happens when a patient in an alternative medicine clinic gets a heart attack or stroke? Are they treated there? Not at all -- bad for business. An ambulance is called, and they are trucked off to an orthodox institution.
I think little of the efficacy of modern medicine. I think much less of the efficacy of alternative medicine. At least, we take the hard cases. At least, we have some semblance of science.
Alternative medicine advocates are not playing fair, and Christians who advocate them are deceived (with rare exceptions).
Commentary: I loved it! In a rare moment of honesty, this panel said "We don't know. We can't recommend." Well, you know what happened. Modern medicine has too much invested in "preventive medicine" to allow this position to stand.
In the time since this announcement was made, this panel has been put down by every physician and "expert" that the news media could get in front of a camera or microphone.
But, the brief moment of honesty and forthrightness was refreshing in the sleight of hand and typical delusions of most modern medical pronouncements.
Vol. 11, No. 2 (69) March 1997
During the first six months of 1996, AIDS deaths declined 13 percent (22,000 vs. 24,900) over the same period of 1995. The decline, however was not uniform across all demographic groups: American Indians and Alaskan natives - 32 percent; non-Hispanic whites - 21 percent; Hispanics - 10 percent; Asians - 6 percent; non-Hispanics blacks - 2 percent; homosexuals - 18 percent; and IV-drug abuse - 6 percent. In those who acquired HIV by heterosexual exposure, there was a 3 percent increase in deaths.
In New York City, deaths declined by 50 percent between November 1995 and November 1996. In King County, Wash. (includes Seattle), deaths fell by 43 percent. In San Francisco, deaths decreased 15 percent over the first 6 months of 1996.
Two explanations are given for these declines. 1) The number of HIV-infected people who progress to AIDS is leveling off. 2) Better medical therapies are prolonging survival.
"Epidemiologists estimate that, in all, 600,000-900,000 Americans are infected with HIV." (The Augusta Chronicle, February 28, 1997, pp. 1A, 8A)
Commentary: My explanation for the decline in AIDS deaths is the dying out of the primary epidemic that occurred in the late 1970s to mid-1980s. My evidence is that the declines primarily have occurred in those groups which had the greatest increases early in the epidemic by mode of infection (homosexuals), race (whites), sex (men), and demographics (cities).
Perhaps, some of this decline is due to newer and better medications. However, in most cases, efficacy among populations studied is measured in weeks and months -- not sufficient statistically to contribute much to the numbers above.
Commentary: As I have commented often on these pages, HIV/AIDS is almost entirely contained within homosexuals, IV-drug abusers, and their sexual consorts. What I call "true heterosexual" spread of HIV occurs in heterosexual partners who are at least one sexual contact removed from that HIV-spreading group. Currently, if all cases in the "Undetermined" category (in which investigations are complete) of the Centers for Disease Control (CDC) were "true heterosexual," then heterosexual AIDS would comprise only 0.16 percent (1 in 625) of all cases of AIDS.
However, genital herpes (Herpes simplex - type II) could provide the avenue for "true heterosexual" spread. Herpes-II is one of the most common forms of sexually transmitted disease in the United States. Syphilis and gonorrhea are rare by comparison. Anyone with "cold sores" (Herpes simplex - type I) knows the weeping, cracking, and sometimes bloody lesions that occur. Type II is at least as bad, and it recurs every several months in the person infected.
Heterosexual spread of HIV/AIDS (as defined by the CDC above) is the fastest increasing category. With the promiscuous heterosexual lifestyle, the potential for HIV spread through the heterosexual community is possible.
Acyclovir is effective to reduce the number and severity of lesions, but it is not a cure and it is often administered after lesions have formed. In all honesty, I don't think that this "second epidemic" will occur. A hindrance to the spread of HIV through Herpes-II is that the herpetic lesions are very painful, interfering with sexual activity (although those infected are still infectious when no symptoms are present). Also, the epidemic of Herpes-II preceded the AIDS epidemic and expanded in numbers with it. Yet, there has not yet been significant "true heterosexual" spread. However, stay tuned.
One of my predictions concerning HIV/AIDS is that the "epidemic" of AIDS would pass and that it would become "just another (deadly) chronic (sexually transmitted) disease." A piece of evidence that I didn't consider was the medical literature itself.
My approach to "AIDS: Issues and Answers" is somewhat random. I rarely search the medical literature for specific articles on AIDS, but accumulate them as I encounter them in the course of my daily work and as other people send them to me. These "random" contributions are usually sufficient for this page. (The ratio of articles reviewed vs. articles used is about 5:1, so there is some selectivity involved. I choose those most interesting to me with readers in mind, particularly those that concern specific ethical issues.) However, I sometimes don't have enough material with this random method, so I go to newsletters and journals lying around my office to complete this page.
When I devoted a whole newsletter to AIDS, I rarely picked up any medical newsletter or journal without finding some article on HIV/AIDS. However, in my search this month, there was a dearth of articles on HIV/AIDS. The thought struck me that the newsworthiness and excessive attention to HIV/AIDS has passed. It has indeed become routine to the daily practice of medicine.
Even so, two striking effects of HIV/AIDS continue. 1) HIV/AIDS is deadly, and treating HIV/AIDS patients is still different from treating patients with other diseases, even highly infectious ones. 2) The management of HIV/AIDS in priorities and funding, i.e., its political correctness, continues.
It has now been 16 years since AIDS first manifested itself in the homosexual community. HIV/AIDS has secured and will continue to be a major force within the societies of the world. But, its newsworthiness has decreased. The medical literature reflects that change.
Born February 14, 1997
In the May 1996 Reflections, I shared with readers the sad loss of a grandson at 31 weeks of pregnancy. God in His wisdom sent another grandson at 33 weeks of pregnancy, but alive and fighting! After a few days of IVs and breathing tubes, he "turned the corner," and is now growing and progressing normally. My daughter and son-in-law, Sherry and Jon, thank you for your prayers. Rejoice with us in this bundle of joy!
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