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I have many, many reasons to give thanks this Thanksgiving Day, some of which will be enunciated around the dinner table later today. In this post, however, I choose to give thanks to the 2,499 men who participated in a research trial testing the effectiveness of taking an anti-HIV medication to prevent HIV infection. In a major new study published recently in the New England Journal of Medicine, it was shown that taking a daily anti-HIV pill reduces the risk by 44% of becoming infected with HIV among gay men. This is an incredibly important finding with significant implications for HIV prevention in the 21st century. Here’s the link to a New York Times article about the study.For this study to occur, however, men from around the world (Brazil, Ecuador, Peru, South Africa, Thailand and the United States) had to agree to participate. This means that each participant consented to being evaluated every four weeks for several years, knowing that he had a 50% chance of being randomly assigned to the placebo group (unbeknownst to him). While all participants received safe sex education, condoms and STD treatment, as indicated, being in the placebo group meant that the individual did not receive the study medication with its potential value of preventing infection. The result is that a number of men in the placebo group became infected with HIV, some of whom very likely would not have been infected had they been selected for the treatment group. In essence, they risked their lives for the sake of health research. While there are still many knotty issues surrounding this new HIV prevention medication (e.g., efficacy outside the group of gay men, cost, drug accessibility, and drug resistance, to name a few), it’s certainly a time for celebration and thanks. Many millions of people will benefit from the results of this study. My hat is off to all 2,499 men who participated in the study. From those of us working in the HIV/AIDS field in the past, present and future: we salute you. -Doug Hirano, MPH, APCA Executive Director
Recently, I had the good fortune of spending some time with Dr. Leonard Syme. Dr. Syme is Professor Emeritus at the UC Berkeley School of Public Health and for some time now has been decrying the traditional public health approach that would have experts descending upon stricken communities with “risk factor” based interventions. Indeed, he is quite fond of recounting the failure of his five-year project funded by the National Cancer Institute that attempted to reduce smoking rates in Richmond, California.
“Richmond is a poor city with high rates of unemployment, crime, and drug use. It also has heavy levels of air pollution from nearby oil refineries. At the time, there were few health facilities. And our research team descended on this troubled community with a brilliant plan to do a smoking cessation project! It is doubtful that smoking was high on the priority list of people in this community, but our team paid little attention to that.”
Dr. Syme emphatically states that these types of community interventions have not worked in the past and will not work in the future. However, one approach he believes has promise is to involve communities in addressing their own concerns.
“The evidence now shows that no matter how elegantly wrought a physical solution, no matter how efficiently designed a park, no matter how safe and sanitary a building, unless the people living in those neighborhoods can in some way participate in the creation and management of these facilities, the results will not be as beneficial as we might hope.”
In other words, assisting individuals and communities to develop a sense of control over their own destinies, he believes, is an important part of the equation of good health.
Those of us working to improve the health of communities would be wise to consider Dr. Syme’s insights. He has only come to these conclusions after a quarter of a century of study of risk factors and associated interventions. By the way, I don’t think Dr. Syme is necessarily advising us to drop a disease-based focus (e.g., breast cancer, smoking and hepatitis B), but it certainly seems advisable to acknowledge the interests of the communities and to ensure their maximal involvement in their own health.
- Doug Hirano, MPH, APCA Executive Director
We have been working closely with the Arizona Cancer Registry of the Arizona Department of Health Services (ADHS) for the past two years. The result is a brief report entitled “Cancer Cases by AAPI Race Distribution 1995 – 2007” that examines cancer reporting by ethnic subgroup of Asian Americans and Pacific Islanders in Arizona. The report makes a case that reporting of specific AAPI subgroups can help with cancer control efforts. Here’s a directive from ADHS that will be released in conjunction with the report:
The Arizona Department of Health Services (ADHS) reminds physicians to list the specific race of patients when sending disease reports to the Department. Race-specific information is important for planning and delivering effective public health programs. It also can be helpful at the clinical level. For example, persons born in Korea or China have an elevated risk for cervical cancer, and rates of stomach cancer are elevated in China and Japan. Unfortunately, the use of the generic term “Asian” without further specification has increased from 35% in 1995 to 50% in 2007. The Arizona Cancer Registry is partnering with the Asian Pacific Community in Action to promote the collection of demographic data regarding patient race, Hispanic ethnicity, tribal affiliation, and place of birth. When these factors are framed as clinically important, patients are unlikely to perceive the questions as intrusive. Including these data elements in the patient registration form or physician notes will greatly facilitate the accurate classification of patient race.
As a colleague once stated, there is a lot of suffering hidden by the aggregation of the many AAPI ethnicities and nationalities into a monolithic category of “Asian/Pacific Islander”. We strongly support disease reporting by the racial/ethnic categories as outlined in guidelines developed by the federal Office of Management and Budget.
We thank the Arizona Cancer Registry, and Dr. Tim Flood and Ms. Lana Khatib specifically, for their generous assistance in developing and disseminating this report.
- Doug Hirano, MPH, APCA Executive Director
I had the pleasure of spending my Saturday afternoon with a roomful of catalysts and optimists at TEDxPhoenix. For the uninitiated, TED stands for Technology, Entertainment and Design, and it’s a forum in which thought leaders take about 18 minutes to share “ideas worth spreading." The talks are thought provoking, funny, challenging, and inspirational. I would recommend a quick visit to the TED website to view a few of the presentations from their annual conferences. Some are truly extraordinary. My personal favorite is a talk by a global health professor named Dr. Hans Rosling.
Today’s speakers at TEDxPhoenix (a locally produced version of TED) included folks such as Jany Deng, program manager of the Arizona Lost Boys Center, Jolyana Bitsuie, Navajo Language Instructor, Phoenix Indian Center (and former Ms. Navajo Nation), and Helene Neville, nurse, fitness coach and trainer. Each had a very different story, but each was compelling and inspirational.
It was a pleasant afternoon. Each talk had something of interest. However, I couldn’t help but wonder whether I could muster an interesting TED-type presentation some day. There is some discussion about a TEDMed conference in Phoenix in the near future. This of course would focus on innovative and creative ideas about health and medicine. Perhaps my day will come . . .
-Doug Hirano, MPH, APCA Executive Director
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