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Hopkins AIDS experts issue warning about global efforts to provide drug therapies

5 percent in Ethiopia, and 7 percent in South Africa," he writes.

Internationally, Zenilman has led clinical studies to determine how best to prevent the spread of sexually transmitted diseases in the Americas, Africa, Asia and, in particular, the Middle East.

In the new article, the Hopkins researchers argue that the history of medicine is packed with examples of immediate demand for new therapies outstripping supply. They also point out that rationing of supplies was necessary in all cases, but that public distrust and outrage arose when patient selection methods conflicted with local principles.

Led by Hopkins medical historian Laura McGough, Ph.D., the team reviewed four major developments in medicine that shared the issues confronting distribution of antiretroviral therapies.

The first two pivotal events were advances to treat if not cure then-fatal diseases: the discovery of insulin for diabetes in 1922 and the mass distribution of the antibiotic penicillin in 1943.

In the case of diabetes, insulin's availability turned a once-fatal disease into a chronic, manageable, lifelong one, like antiretroviral therapy has done for HIV. However, the researchers point out that what ensued was a mess. In a completely haphazard fashion, medication went to family members of prominent politicians, private clinics or friends of the physician discoverers, who were caught off guard and almost instantly flooded with requests from the public.

More controversial was the penicillin case, in which two government-appointed committees, one military and the other civilian, decided who received medications. While the civilian committee allocated drugs to the most seriously ill, its decisions were viewed as cold-hearted and distant in letters to committee members and in press headlines. Further inflaming public sentiments was the military's allocation of supplies to soldiers with non-life-threatening sexually transmitted diseases. Eager to
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Source:Johns Hopkins Medical Institutions


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