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UN AIDS report suggests AIDS epidemic has plateaued. The New York Times (11/22, D5, McNeil, Subscription Publication) reports, "The world's AIDS epidemic has hit a plateau, with 2.7 million people becoming newly infected each year for the last five years, according to the annual report (pdf) released Monday by UNAIDS, the United Nations agency fighting the disease." The report also notes that "last year, 1.35 million got on treatment for the first time, meaning 200 people were newly infected for each 100 newly treated," compared with "two years ago, when 250 were infected for each 100 treated." However, "donor funds dropped about 10 percent last year as the worldwide economic crisis made some countries cut their donations." The report also compares a number of countries, pointing out that a large number of new cases are driven by "drug addicts, who are notoriously hard to reach, and also by groups like gay men and prostitutes who in conservative societies...have furtive, rapid sex -- a high-risk behavior." The Washington Post (11/22, Brown) reports, "The biggest advances have occurred in sub-Saharan Africa, where a massive rollout of antiretroviral drugs, increasing acceptance of circumcision and changes in sexual behavior are driving new cases of infection to the lowest number in years." In contrast, "the big exception to the global trend is in the countries of the former Soviet Union and Central Asia, where there has been a 250 percent increase in people with HIV from 2001 to 2010. Bloomberg News (11/22, Bennett) details, "A failure in Russia to implement harm-reduction programs such as offering drug users clean needles, or switching them to methadone tablets from heroin injections, is fueling the spread of the virus, said Paul De Lay, the deputy executive director of the Geneva-based agency." De Lay added that "five years ago they were really starting to see a turnaround," but now the progress has "pretty much fallen apart" and UNAIDS is pushing "for the surrounding countries not to follow the Russian Federation model." The AP (11/22) reports that while "UNAIDS says it is working toward zero new HIV infections, zero discrimination and zero AIDS-related deaths," critics contend "that the body's aim of wiping out the disease is overly optimistic...considering there is no vaccine, millions remain untreated and donations have slumped amid the economic crisis." CQ (11/22, Bristol, Subscription Publication) notes, "New infections reduced by 21 percent since they topped out in 1997. Deaths, which peaked in 2005, had also fallen by 21 percent by the end of last year. ... The report attributed progress in reducing the disease to changes in sexual behavior, especially among younger people who are reducing their number of sexual partners and using condoms more." The UK's Telegraph (11/22) reports, "A significant expansion in access to treatment helped slash the number of Aids-related deaths in 2010, bringing the number of people living with HIV to a record 34 million," according to the United Nations. Also covering the story are Reuters (11/22, Kelland) and BBC News (11/22)"
Although my roommate has thus far been unable to convince me to join her at bikram yoga, a couple of news items this week attest to the powers of peer pressure in changing one’s lifestyle.
The first is a study out of Stanford about the families of patients who underwent gastric bypass surgery. The investigators found that obese family members of bariatric patients lost an average of 3% of their total weight in the first year following the surgery – this is equivalent to the amount of weight loss achieved on the average diet plan such as the Atkins diet. So although the family member wasn’t officially on the post-op bariatric diet, it is as if they were.
The second is a program called the “Daniel Plan” created by Rick Warren (best known for “The Purpose Driven Life”) at his church in California. Warren has used what he calls “the healing power of the group” to motivate members of his church to lose weight; he effectively utilizes the existing foundation of church small groups not only for spiritual growth but also physical betterment. The first point of his six-point program is to “connect” or create partnerships that foster positive change. Fourteen thousand people signed up and 72% lost weight. A survey found that participants lost nearly 7 more pounds following the plan in a group than they following the plan on their own.
Both of the above examples involve groups – either natural or constructed. What is fascinating about the Stanford study is that the weight loss was unintentional – it was purely a product of environment. The other interesting thing is that there is really nothing inherently special about either diet plan. What is amazing is the difference the support of a group makes in adhering to that plan. Not surprisingly, this has great implications for global and public health. It is one of the reasons why Alcoholics Anonymous and Partners in Health have been so successful.
Message to my roommate: if exercise is anything like nutrition, the stats are on your side! Eventually, I may succumb to your good example.
(Arch. Surg. 2011;146:1185-90)
In some ways, rendering aid after the disaster works a bit like this. There's an immediate need we need to help out with, but for a lasting change, aid needs to be delivered in a sustainable way that seeks to build up the infrastructure and the economy of the country in need."Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."
by Nicholas J. Rohrhoff
Each generation of physicians has no choice but to take on the responsibility of learning the science of medicine – how best to care for patients. But current circumstances dictate that we must also bear the burden of developing policy that creates the best system in which to provide that care.
Creation of a 21st century American healthcare system will require engagement and effort from everyone. In this endeavor, the role of physicians is special. We are, first and foremost, the chief advocates for patients. Far too often, this role absconds when we leave the exam room, hospital or clinic.
Read the rest of If you’re in medicine, you’re in politics