Health vs. Medicine

IAPAC doesn't lend itself to live blogging, in part because this fuchachta hotel doesn't have wireless, and in part because it just ain't that kind of thing. It's partly the same cast of characters as the International AIDS Society meeting in Mexico City, which anybody who was watching this space last summer heard more than enough about, and it's just as international. But no demonstrations, no rabble rousing speeches, and no Bill Clinton.

We did, however, get Paul Farmer this morning. I asssume y'all know who he is, but here's the Partners in Health web site in case you want to learn more about the organization he founded and maybe even throw them some of your loose change. Dr. Dr. Farmer (two Drs. because he's an M.D. and a Ph.D., which is just sick) showed a few of his famous Lazarus slides -- people he found in Haiti who were dying of AIDS, who they started treating, and who now look healthier than he does. I hope some of the AIDS denialists out there will look at these pictures.

Anyway, his talk was wide ranging but the core of it was, for many years we heard all sorts of sober, scientific and practical reasons why we couldn't treat people with HIV in poor countries: they won't take the pills (remember Andrew Natsios?), it's not cost effective and we should put all our money into prevention, it will take resources away from other health care needs and undermine existing programs, yadda yadda yadda.

We don't hear that so much anymore because now we know it just isn't so. Believe it or not, people in poor countries are more adherent to their meds than people in the U.S., although what Farmer did not emphasize is that in Africa and Haiti, ARVs come with support programs, community health workers who make sure the people take their meds, and they often come up with other stuff people need such as food. (Farmer says he's completing a study, for which he hopes to win the Nobel Prize, showing that food is the only effective treatment for hunger.) And HIV-related programs don't undermine other programs (even if they exist), they develop health infrastructure which makes everything work better.

The problem is, here in the U.S., health insurance doesn't pay for community health workers. Of course they would also be a lot more expensive than they are in Africa but they're still cheaper than Emergency Department visits, hospitalizations, and second line ART regimens. Not to mention, the people don't get sick and die. But they're considered a luxury. Just one more example of how screwed up our reimbursement policies are.