Anyone can be a researcher! If you would like to join the self-indulgent world of research, start by learning how to write a scientific paper. Care of Matt Schultz.
I recently attended the Annual Workshop of Advanced Clinical Care in Durban. I realized – again – how religious physicians can be. The conference opened with the typical call to arms that normally surrounds the AIDS “crisis.” The charge was aimed at the audience of clinical providers present. The front line physicians were told that all of the tools needed to curb the spread of HIV were available to them, and they must only wield them effectively to win the battle. Susan Sontag would be horrified.
It is, in fact, far easier to eradicate HIV than I ever thought. South African doctors must only work harder, then the disease will go away. No, South African doctors only need to improve their clinical abilities when dealing with HIV-positive patients, then the disease will go away.
My sarcasm stems from a simple observation: the average South African doctor is extremely well trained, especially with respect to HIV. From my outside perspective, South African general practitioners routinely perform the tasks usually reserved, in the US, for infectious disease specialists. Is it fair, then, to say to this group of physicians, “You must work harder; you must get smarter”?
But that is exactly what was said. And, the major problem is that there are essentially only two paradigms with which to deal with HIV: Treatment (but not cure) and prevention. The former hinges on provision of HIV medications; and the latter is almost synonymous with modifying people’s behavior.
The news of the day was of the latter category: tenofovir gel. It is an antiretroviral drug that has been formulated into a gel and can be applied in a woman’s vagina before intercourse. A recent paper claimed a 40% decrease in HIV infection when this gel was used. There was much anticipation to hear the head investigator speak and much excitement about her findings. The major benefit is that it empowers women to control their own sexual health, without having to negotiate with their partner about condom use. It makes slightly less hazardous the dangerous sexual situations into which some women are routinely forced.
I found myself thinking rather negatively throughout the entire conference. There is, to me, nothing new here. What we now have is another preventative strategy that works marginally well with intensive education and follow-up. Even under the idealized conditions of the study, it was difficult to get women to use their product.
The most interesting talks at the conference, however, were by Steven Deeks from UCSF. He concisely summed an enormous amount of information and then launched into something completely different. What of the underlying pathogenesis of HIV? Is there some unexploited fault in the virus’ almost perfect reproductive ability? And, more broadly, how does our new knowledge of the immune system affect our understanding of other diseases?
In my opinion, that direction is where HIV research needs to go. What is truly unknown? Why publish a new edition of the tried-and-failing textbook we have written for the last 30 years? The epidemic in South Africa appears to have leveled only because the same number are being infected as are dying. It isn’t working.
And yet, the group of us in HIV research religiously hold to the idea that if we work harder or execute better, we will ultimately win the day.