DRUGS OR FOOD?
Posted by Henry Bauer on 2007/12/25
A modest proposal:
Billions of dollars have been promised to provide antiretroviral drugs to Africans, and some of those promises have even been met. Do an experiment. Divert a small percentage of that money—say 10%—to buy food and vitamins. Allow Africans to choose between nutrition and antiretroviral drugs. Compare, over time, the health of those making the different choices.
That suggestion appears at p. 228 of my book. I was reminded of it by today’s report from David Tuller in the New York Times (“Cases without borders”): antiretroviral drugs are being provided to Africans who are being left to starve and to suffer “side” effects of those drugs made even worse because they are taken on empty stomachs: “families scramble to survive from meal to meal, never far from the edge of starvation. Many say their H.I.V. drugs have drastically increased their appetites and made them crave food even more”.
The reporter is part of a team of researchers organized by the University of California, San Francisco, in collaboration with Mbarara University of Science and Technology, Kampala, Uganda. The rationale for the study would easily have qualified for one of Senator Proxmire’s “Golden Fleece” awards. It is seeking to discover “whether ‘food insecurity’—a persistent difficulty in finding enough to eat—undermines the effectiveness of H.I.V. treatment. . . . [and] whether costs related to treatment limit their ability to cover basic foods and whether hunger forces women to offer men ‘live sex,’ or intercourse without condoms, in exchange for food or money. . . . Other patients will be followed for two years to monitor how food insecurity affects their drug regimens, and illness and death rates.”
Do we really need a study to find out whether starving people fare worse than properly fed ones, especially when they are taking drugs with nasty side effects? Do we really need a study to discover whether starving women will sell their bodies to feed their families?
And, Oh!, how George Orwell would have relished that “food insecurity” in place of “on the edge of starvation”!
I’m curious to know, among a number of other things: Who dreamed up this study? How are the “Informed Consent” documents phrased? Which oversight bodies approved those documents—and for that matter, this whole study?
What is the ethical warrant for spending money on research whose outcome is already known and that requires observing rather than feeding people? Could not some of the resources being expended in the study be diverted to the provision of food to some of the starving ones?
Apparently, the study’s obvious outcome isn’t obvious to everyone, the investigation is needed “to demonstrate that packaging food aid with H.I.V. drugs or reimbursing patients for travel can actually improve health and save lives”. Demonstrate to whom? To the “international donors [who] demand data and documentation. They want proof that an intervention will reduce the total misery index before they will shell out millions of euros for new programs, even if the need appears self-evident”. [How George Orwell would have relished that “total misery index”!]
Concerned lest we appear to waste resources, elaborate and expensive studies are carried out to “demonstrate” what everyone already knows—because common sense and experience are not sufficient to justify official actions, there must be the paperwork at hand to guard the policy-makers and the bureaucrats against any suggestion that they might actually be responsible for the decisions for which they are responsible.
Merry Christmas and a Happy New Year. I trust that all the researchers, and those who approved this study and those who are funding it, and those who profit from the sales of antiretroviral drugs, will enjoy their customary seasonal feasts.
This entry was posted on 2007/12/25 at 3:33 pm and is filed under antiretroviral drugs, clinical trials, HIV absurdities. Tagged: antiretroviral drugs in Africa, antiretroviral drugs or food, clinical trials, informed consent, research ethic. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.