Sunday, January 06, 2008

You're Right! They'd Be Better off Dead!

I can't believe what I'm reading, and I mean that in every sense:

AIDS Patients Face Downside of Living Longer


Mr. Holloway, who lives in a housing complex designed for the frail elderly, suffers from complex health problems usually associated with advanced age: chronic obstructive pulmonary disease, diabetes, kidney failure, a bleeding ulcer, severe depression, rectal cancer and the lingering effects of a broken hip.

Those illnesses, more severe than his 84-year-old father’s, are not what Mr. Holloway expected when lifesaving antiretroviral drugs became the standard of care in the mid-1990s.

The drugs gave Mr. Holloway back his future.

But at what cost?

That is the question, heretical to some, that is now being voiced by scientists, doctors and patients encountering a constellation of ailments showing up prematurely or in disproportionate numbers among the first wave of AIDS survivors to reach late middle age.

1. I have taken the liberty of revising the links in the first paragraph; in the Times, they direct to After reading this article, however, I wouldn't trust the Times to explain a paper cut. You'll see why shortly.

2. Emphasis mine. Relax! "At what cost?" is a question only heretical to some. And you know who those "some" are, don't you? That's right: A bunch of nasty narrow-minded purists who think life matters.

There have been only small, inconclusive studies on the causes of aging-related health problems among AIDS patients.

But don't let that stop you from asking the tough heretical questions.

Without definitive research, which has just begun, that second wave of suffering could be a coincidence, although it is hard to find anyone who thinks so.

Instead, experts are coming to believe that the immune system and organs of long-term survivors took an irreversible beating before the advent of lifesaving drugs and that those very drugs then produced additional complications because of their toxicity — a one-two punch.

That seems plausible. I can see the correlation, also known as the indication for more non-small, non-inconclusive studies.

The Multi-Site AIDS Cohort Study, or MACS, will directly examine the intersection of AIDS and aging over the next five years. Dr. John Phair, a principal investigator for the study, which has health data from both infected and uninfected men, said “prolonged survival” coupled with the “naturally occurring health issues” of old age raised pressing research questions: “Which health issues are a direct result of aging, which are a direct result of H.I.V. and what role do H.I.V. meds play?”

The MACS investigators, and other researchers, defend the slow pace of research as a function of numbers. The first generation of AIDS patients, in the mid-1980s, had no effective treatments for a decade, and died in overwhelming numbers, leaving few survivors to study.

Yeah, and about that. See, I wouldn't call that so much "a function of numbers" as I would "a failure of public health," for which failure older people with AIDS are now paying the price. THERE, fuckhead. There's your fucking story.

Mr. Holloway is uncomplaining even in the face of pneumonia and a 40-pound weight loss, both associated with his cancer treatment. Has the cost been too high? He says it has not, “considering the alternatives.”

I guess we count Mr. Holloway among the non-heretics, then. Imagine thinking your life has value! Imaging preferring being alive to being dead! Crazy!

One 69-year-old member of the group, for example, has had several heart attacks and triple bypass surgery, and his doctor predicts that heart disease is more likely to kill him than AIDS.

My grandfather had several heart attacks and bypass surgery, with his first surgical intervention occurring when he was 61. He's dead now, of, yep, another heart attack. Maybe the last 20+ years of his life weren't worth the hassle, though. Maybe he should have just, you know, died the first time.

At Rivington House, a residence for AIDS patients on the Lower East Side of Manhattan, Dr. Sheree Starrett, the medical director, said that neither heart disease nor diabetes was “terribly hard to treat, except that every time you add more meds there is more chance of something else going wrong.”

If this is an actual quote and not some horrible misrendering out of context, then even though she's got "Dr." in front of her name and I don't, I feel safe calling this doctor an idiot. Heart disease IS hard to treat. Diabetes IS hard to treat. I listen to cardiologists and endocrinologists struggle to keep arteries patent and hemoglobin A1c levels below 6.5% five days a week. It's hard for the patients, it's hard for the health care providers, and holy shit, the medication complications are just insane.

Furthermore, "heart disease" is a blanket term--it could refer to atherosclerosis, prior myocardial infarction(s), valvular disease, congestive heart failure, arrhythmia, hypercholesterolemia--I haven't covered even a fraction of the possibilities here, and of course it's possible for multiple cardiac problems to exist in combination. No. No physician in her right mind would say all that was not "terribly hard to treat," but it's a useful quote if your premise is that everything would be simpler if only patients with AIDS would stop living already.

Statins, for instance, which are the drug of choice for high cholesterol, are bad for people with abnormal liver function, also a greater risk among blacks.

Oh, I skipped that part! I skipped the part where the reporter made sure to mention how much riskier it is to get the AIDS, and the AIDS-related complications, and complications that may be related to AIDS or may be related to any number of other factors, we don't know because the only studies to date have been small and inconclusive, if you're black. I am not really sure why that was brought up, but it is first mentioned here:

Cardiovascular disease and diabetes are associated with a condition called lipodystrophy, which redistributes fat, leaving the face and lower extremities wasted, the belly distended and the back humped. In addition, lipodystrophy raises cholesterol levels and causes glucose intolerance, which is especially dangerous to black people, who are already predisposed to heart disease and diabetes.

Just so you know.

Many AIDS patients have end-stage liver disease, either from intravenous drug use or alcohol abuse.

Nothing else causes end-stage liver disease--not primary biliary cirrhosis, not portal hypertension, not certain medications, not nonalcoholic fatty liver disease, not genetics--nothing. It has to be something You, the Naughty Person with AIDS, Did to Yourself, so either you shot up or you drank too much. Would it be heretical to ask whether you should still be here?

Among Dr. Starrett’s AIDS patients is 58-year-old Dominga Montanez, whose first husband died of AIDS and whose second husband is also infected.

“My liver is acting up, my diabetes is out of control and I fractured my spine” because of osteoporosis, Ms. Montanez said. “To me, the new things are worse than the AIDS.”

Of course they are, but you see, it's the AIDS we're concerned about here. We'd be fine with your continued existence, Ms. Montanez, if you just hadn't gotten that dirty old AIDS.

There are no data that compare the incidence, age of onset and cause of geriatric diseases in the general population with the long-term survivors of H.I.V. infection. But physicians and researchers say that they do not see people in their mid-50s, absent AIDS, with hip replacements associated with vascular necrosis, heart disease or diabetes related to lipodystrophy, or osteoporosis without the usual risk factors.

But they do see them with the usual risk factors, and some of those risk factors are quite common in the United States, and yet no one's written "Sedentary Diabetics Face Downside of Living Longer" yet.

You know, I get it. I get what the article was trying to say, I think, but it's just said so callously, so ineptly, and so inaccurately that I'm going to laugh extra hard the next time some wingnut starts raging about what a liberal paper the NYT is.


Anonymous said...

No physician in her right mind would say all that was not "terribly hard to treat," but it's a useful quote if your premise is that everything would be simpler if only patients with AIDS would stop living already.

I'm confused. Wouldn't it be more useful to the premise of the story if she said that heart disease was difficult to treat? (Implied: too difficult to bother.)

Mark S. said...

Some people say that HIV patients would be better off dead.

ilyka said...

Wouldn't it be more useful to the premise of the story if she said that heart disease was difficult to treat? (Implied: too difficult to bother.)

Oh, I see what you mean! I took it as "neither of these diseases are difficult to deal with on their own, but factoring in that damn AIDS complicates them terribly." But I may have been biased by the appalling headline that, if it only rhymed better and used more slang, would be right at home in the Post.

Yeah, "heart disease is too difficult to bother with" works too, except that I imagine that would get some angry letters from cardiac patients and we can't have that.

Magniloquence said...


That's some impressively biased (and lazy!) reporting. I've seen elementary school children with better journalistic skills.

A first-rate fisking on your part, of course... though given your years of expertise, it's a little like shooting plushie fish manacled to a barrel with an ICBM.

On the plus side, I read bits of it aloud to the boyfriend and he laughed and said we should adopt you. I agree, natch. :)

maxx said...

this reminds me of quality of life issues. the pharmas want to give us anti-HIV meds but then say--oh, yeah, there are side effects, often devastating but hey at least you're alive so take your pills. is it worth living if your quality of life is suffering to an extent you find hard to tolerate? maybe, maybe not. we deserve anti-HIV meds with fewer side effects! let's get after the pharmas about that!