Map of life expectancy at birth from Global Education Project.

Friday, April 10, 2009

And there's more

First of all, don't be shy about commenting on this subject -- I just study HIV because it's a good example, but this is about all patients and all doctors and all treatments, okay? Your experiences and your thoughts are 100% relevant whether you're dealing with male pattern baldness or metastatic cancer.

Even when people are committed to taking their pills -- when those basic psychological reasons I talked about yesterday aren't staying their intentions -- it can be difficult to do it precisely, every day. I mean sure, you have lots of regular habits -- you get up every morning, perform your ablutions, eat something, etc. But think about it -- do you even do those things at the same time every day? Maybe you sleep late on the weekends, or travel, or go camping or skiing or you're sick for 3 days and the routine gets disrupted. And these are basic habits that you've learned since you were a toddler. It doesn't matter if you sleep in for a couple of hours on a Saturday, but it does matter if you were supposed to take your antiretrovirals and you're three hours late. It might matter a lot, because that gives the virus a chance to replicate, and then you've got a whole lot of virus particles floating around, then you take your next dose and if there happens to be a drug resistant mutant among those millions of virions, you are screwed, because all the others will be wiped out and that mutant will take over and the drug will do you no good any more.

I've heard people tell their doctors a million stories: I missed a day because my daughter gave birth and I was at the hospital; I was on a vacation and we took a side trip and I forgot to bring the meds; I broke my leg; my boyfriend beat me up and stole the pills (really); the cops picked me up and I was in jail for 4 days and they didn't give me my meds (really -- and it was some other people in the house who had the drugs, nothing to do with me . . . Might even be true, who knows?); I couldn't get to the pharmacy for a couple of days; etc.

So this is actually very hard to do for 40 or 50 years. In order to truly succeed, you actually may have to reorganize your life around this central discipline. But unless you truly believe that very strange story I just told you about mutant viruses, why would you do that? Sounds like a crock, doesn't it?


kathy a. said...

i think my friend with type I diabetes is so successful because he has organized his life around it. nope, it isn't by far his whole life -- he gets to have a whole life because of his diligence. i suspect some of teh consequences of non-compliance could be, for him, more immediate than viral replication gone wild.

i think you are on the money about how hard it can be do do meds same time, every day, ad infinitum. all the stories you excerpted sound perfectly plausible to me.

C. Corax said...

The slightest deviation from my routine and I just about forget my own head. I'd be screwed if I had a medical regimen such as that for HIV.