bb Albert Provocateur: September 2008

Albert Provocateur

Saturday, September 27, 2008

Gun Done!

In a recent, well-publicized news story, some were happy, others sad, to learn that the U.S. Supreme Court in a 5-to-4 decision in District of Columbia v. Heller in June 2008, not only struck down a ban on handgun ownership in Washington, D.C., but also ruled that the District’s law requiring all firearms in the home to be locked away violated the U.S. Constitution’s Second Amendment. Personally, my household, like that of the more than one-third of the others in the U.S., contains a handgun, and I have weighed the pros and cons of firearm possession. Have you? Firearm-related, suicide statistics are, indeed, sobering, and one certainly cannot blame the anti-gun lobby for its “the sky is falling, the sky is falling” proselytizing. In 2005, for example, with suicide in the U.S. reaching the unenviable milestone of second-leading cause of death among Americans 40 years of age or younger, more than half of all suicides were gun suicides, 46 Americans per day committed suicide, and gun suicide outstripped gun homicide by 40%.
Not only is suicide, in and of itself, an impulsive act, usually taking anywhere from 5 minutes to less than 1 hour between the decision to kill oneself and the actual attempt itself, but it is also self-limiting, meaning that once the acute phase of the urge or crisis passes, so, too, does the urge to attempt suicide. One begins to realize here that firearm availability in the household might, indeed, be conducive to a precipitous downward spiral and catastrophic conclusion of events.
If that were not enough, case-control studies have shown that in homes with firearms, the higher risk of suicide also applies to the gun owner’s spouse and children, the risk of suicide increases no matter how the handgun is stored, and adolescent suicide is four times more likely when the firearm is loaded and unlocked. The relationship between household gun ownership rates and suicide has been studied in all 50 states of the U.S. between 2000 and 2002, and it hasn’t taken a descendant of Einstein to determine that those states with higher handgun ownership rates also have higher rates of firearm suicide and overall suicide.
So, we know the problem. What is the solution? While many physicians and public health practitioners continue to adhere to the mistaken belief that someone who is serious enough to attempt suicide can find equally effective means when a gun is not available, there is something that can be done and two roads to follow. The number of suicide attempts can be reduced by recognition and intensified treatment of mental illness, and restricted access to handguns can be and has been proven effective as a suicide deterrent.
The gun can be undone!

© 2008, Albert M. Balesh, M.D. All rights reserved

posted by Dr. Al at 9/27/2008 06:25:00 PM | 0 comments

Sunday, September 07, 2008

HIV/AIDS by Numbers

The XVII International AIDS Conference was held in Mexico City in early August 2008, and, while that clinical showcase was no longer a premier venue for dissemination of information on current, cutting-edge research being done in the field, it nonetheless served as a vehicle for spreading the word internationally and acting as a barometer of the progress in the fight against this viral plague of modern times. A total of 20,716 delegates were present at the conference, with nearly half of them coming from the United States and Mexico, a testimony to the concern and interest in the malady demonstrated by the industrialized world. HIV/AIDS is no longer considered a watershed of developing countries, but also a scourge of some of the most technologically advanced nations in the world. A quarter-century after the discovery of the human immunodeficiency virus (HIV), the conference served as a repository of facts, data, and numbers that was both surprising and encouraging in its scope.
It appears that the fight against HIV/AIDS has made a considerable amount of progress, and clinical and epidemiological evidence demonstrates that with over 25 antiretroviral drugs currently on the market, scientists are making headway in what was once considered a lost cause. That is not to say, however, that the millions of new infections and deaths each year are acceptable, nor is a cure or vaccination for the syndrome imminent. There is still a long road to go, and the statistics presented at the conference were sobering. Currently, an estimated 33 million people live with HIV worldwide, and 2.7 million of them became infected in 2007, with a total of 2 million people dying from AIDS in that same year. No real surprises there, as the picture had always been glum. A silver lining, however, did appear, when it was announced at the conference that for the first time in recent years, fewer children (who currently account for about for about 15% of the infected population) and fewer adults are becoming infected by HIV, and fewer people are dying, than in previous years. Epidemics have stabilized for the most part in Africa, although pockets of increased infection continue to exist in nations such as Kenya, and Eastern Europe, particularly Russia and the Ukraine, now lays claim to some of the largest HIV epidemics. Decreased availability of methadone and clean syringes to injection-drug users would appear to account for the latter.
The pharmacological arsenal in the fight against HIV/AIDS has grown considerably over the years, and, while no “magic bullet” currently exists, the costs of drug development continue to rise, and there is no AIDS vaccine on the current horizon, antiretroviral therapy continues to reduce viral loads to nondetectable levels in many of the afflicted and guarantee heretofore unheard of normal lives and life spans. Barriers to HIV/AIDS reduction and prevention in low- and middle-income countries still exist, however, as poverty, stigma, discrimination, and inadequate health care systems make the logistics of prevention and pharmacological treatment a proverbial distribution nightmare. Effective preventive interventions to encourage male circumcision, prevent mother-to-child transmission, and discourage multiple sexual partners are simply not in place in many areas hit hard by the HIV/AIDS epidemic. Were that not enough, time and time again evidence has shown that antiretroviral therapy, while effective, is not reaching sufficient number of the afflicted. A case in point, although far from the only example, is sub-Saharan Africa, where 2.1 million people and 200,000 children were receiving antiretroviral medications in 2007. Those numbers sound encouraging, until it is realized that only 20% of the people know that they are infected, less than a third of the afflicted are receiving therapy, and only a third of infected pregnant women receive antiretroviral medications to prevent transmission to the child.
So, one might say that although progress in the fight against HIV/AIDS has, indeed, been made, the international medical and political communities still have their work cut out for them, before the XVIII International AIDS Conference convenes in Vienna in July 2010.

© 2008, Albert M. Balesh, M.D. All rights reserved.

posted by Dr. Al at 9/07/2008 02:59:00 PM | 0 comments