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

return soldiers to active duty, wartime needs outweighed civilian concerns, but this did not sway public opinion that the military was wasting its share of medication.

"While the lack of a plan is the worst-case scenario, even a plan with no public input can backfire if it fails to win local support," says McGough, a research fellow at Hopkins' Institute of the History of Medicine. "It is as important to make sure that the decision-making body is politically legitimate and accountable to the public as it is to agree on the criteria for patient selection to begin with."

The other two precedents are the introduction of hemodialysis for end-stage kidney disease in the 1960s and allocation of livers for transplant in the 1980s and early 1990s.

Like HIV infection, these conditions require expensive, lifelong follow up. Indeed, people who benefit most from hemodialysis are the ones who strictly follow their physician's advice and their dialysis schedule. Initially, however, who would most likely adhere to hemodialysis therapy was determined by using "social-worth" criteria that favored members of the middle class, from whose ranks came the majority of patient selection committee members. Married people with high salaries were favored over singles, working men over stay-at-home moms, churchgoers over non-believers, and parents over children. The public outcry led Life magazine to feature on its cover a picture of a child rejected for treatment, prompting the committee to attempt to change its criteria toward a psychological assessment.

With liver transplants, patient selection was plagued by different interpretations of who medically benefited most from a transplant and by a scoring system that favored patients most likely to survive their surgery over those most likely to die. In this system, the patients getting a liver transplant were often the most likely to benefit from it, but not always in greatest medical need of surgery. Due to pub
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Source:Johns Hopkins Medical Institutions


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