Last weekend our ER had two people with the same first name. One was a known 45 y/o HIV positive, one was a healthy 16 yr old boy. They accidentally ordered a viral load on the 16y/o instead of the known HIV positive and it came back as 500 copies/ml.
So the director of the ER freaked that he hd a "positive" result on a normal healthy 16 y/o boy with no "risk factors". Of course calls to the reference lab revealed that the viral load test was not to be used as a dignostic test.
When you pay people to see something, it turns out that they tend to see it whether it's there or not.
This is one of those universal truths. And, it's not just the payment of money, but also the psychological gains of a sense of identity, the righteousness of moral superiority, and the prestige from the adoration of fellow travelers.
Please tell me how this is in any way different from the prognostications of our impending doom from environmentalists and their religious devotion to the over-hyped cause of global warming.
Maybe, zach. It really depends. Sometimes you're just asking bullshitters then, like thread commenters ;^D
I was thinking along the lines of cigarette manufacturers vs. life insurers. Doctors stand to make money off cancer, so that blows that out of the water, but the larger point can hold in alot of cases.
I know for a fact that some of my elementary school teachers had aides. It was completely in the open; everyone knew and the administrators even encouraged this.
exactly. The issue is not that the medical establishment wants to throw money at what they (probably very honestly and maybe even correctly) believe is a really very bad disease. The problem is the absence of debate.
Mark, I think your solution is just the same problem from the opposite direction. People who would lose money would have a vested interest in the OTHER outcome, and thus would NOT see things, or would minimize the impact of the things that are there because they would be negatively impacted.
I think the biggest problem is that in these things, one side is allowed to dominate the discussion, using argumentation that is tangential at best to the crux of the matter. Opposing views are shouted down, not because they're incorrect or not backed up by scientific or realistic thought, but because they don't fit the canon, or because they threaten the power and prestige of those who base their lives on the issue.
This goes both ways, and thus just listening to the OTHER side doesn't necessarily make it better. Just different.
Let's be careful to differentiate between rich world AIDs and poor world AIDs. Yes, the AIDs epidemic has been controlled in the rich world, but there is no question that it has become a huge public health problem in the Third World, especially in sub-Saharan Africa.
but there is no question that it has become a huge public health problem in the Third World, especially in sub-Saharan Africa.
Actualy, if you read through Dean's World for articles on AIDS, you'll find there is a lot of question about that "huge public health problem," being AIDS is diagnosed in the Third World mainly by symptoms, which are identical to many other historically common illnesses of poorer regions.
Michael Fumento of the American Spectator (Right-wingers!!!!) had a good piece Yesterday -- Epidemic of Falsehoods
Those who have criticized such gross exaggerations, as I did in my 1990 book The Myth of Heterosexual AIDS, were labeled liars ourselves, whackos, racists, and variety of other colorful epithets. Now I'm being told I should gloat; but personally I'm too busy shaking my head and wondering how despite our best efforts the AIDS alarmists were able to sustain their fiction for so long.
Tom, if you're in the camp that believes that HIV does not cause AIDS, I don't think we have enough in common to have a useful discussion.
I'm a skeptic, Chris. Right now, I'd say it's the best explanation we have, but it isn't a very good one. Last I heard, the math doesn't work. Until someone comes up with a mathematical model that works, we don't have a solid hypothesis.
Chris, I think there's a substantial body of evidence that in sub-Saharan Africa, money for treatment causes the diagnosis of AIDS. Whether or not it actually is AIDS is another matter entirely. That's the point.
The diagnosis and the medical condition are not the same thing.
You Genius! You have thrown spotlights down the darkest alley; you have identified the SUSPECT.
'So the director of the ER freaked that he hd a "positive" result on a normal healthy 16 y/o boy with no "risk factors". Of course calls to the reference lab revealed that the viral load test was not to be used as a
dignostic test.'
Has anything happened since at the ER? Has the director found an aswer to your question, 'so we had 500 copies/ml of what?'
I do not have sources at hand, however, are you aware that the blood is diluted before the test is ran? So your question becomes '500 copies of
what per milliliters of what'? Are we scared yet?
What further actions would have had to be taken for the viral load test to become a diagnostic test? Has the director looked into this? Were those actions taken? Afterall, the child has 500 something. Is it not natural to follow through from a medical standpoint? If they didnot I would like to know the reasons they did not. Did the doctor not have an obligation to follow through?
I would guess that a patient interview is required to make the test a diagnostic test. Something like, 'What risk factors does the patient have?' Imagine deciding that an x-ray confirms a broken leg in a skier but not a
swimmer! Scared? I am.
Help! Push the director for answers? Let us know what comes of this. PUSH. Let's nab the SUSPECT.
It seems that a load number of 500 is way low for someone with HIV who is not on a treatment regimen. People with HIV typically test in the thousands to tens of thousands and some even higher. Load numbers can be affected by such things as vaccinations, infections and recreational drug use. Five hundred seems like just enough to keep the immune system from getting bored.
I think too that this is a very important discovery on your part. The boy was presumably HIV antibody negative, right? It seems that what you are rightly asking is: How can a person who doesn't "have" HIV still have a detectable HIV viral load, regardless of the number. Am I right?
Could it be correct as those "denialists" have said, that PCR does not measure infectuous virus, and that the antibody tests themselves (as the test inserts themselves say) are "not proof of infection with HIV?"
What then IS HIV?
It is a molecular signature that varies from lab to lab, country to country.
There are countless proteins that coincide with HIV's designated proteins, such as those found in pregnancy, Tuberculosis, malaria, etc. This, in turn, is what lies beneath the now cracked foundation of the UNAIDS massively inflated estimates of how many people in the developing world are "living with HIV."
UNAIDS drew samples from ante-natal clinics and then generated their elephantine estimates from those figures, which were then sent to Geneva, where the scare figures were modeled on computers. Now the media has coughed up, at LAST, the fact of the matter, but they can't bring themselves to explain it.
Is an 'estimate' cut by 40% suddenly more reliable than the original? No. Nothing is reliable.
Question for the panel:
Why would sex in the developing world cause "HIV" to spread more rapidly than in the developed world?
Why would sex in the developing world cause "HIV" to spread more rapidly than in the developed world?
It isn't sex itself, per se, but: Lack of testing, rampant prostitution, lack of adequate medical care and public health infrastructures. Some unusual sexual practices contribute, like: The use of astringent douches to eliminate lubrication in the vagina [considered disgusting in some African cultures], female circumcision [of course] and the general refusal to use condoms.
There may also be an element of racism going on [with the labeling/suppositions], but I'm undecided on that.
Didn't Celia Farber (hello) cover the African AIDS question in detail, in SPIN magazine circa 1994 give or take? I recall reading about large numbers of death certificates with "le slim" or "le SIDA" filled in based on symptoms alone. Granted, it's been a while, but it rings a bell to me.
Kaiser health insurance offers an AIDS test for pregnant women to find out if their babies have AIDS. It's optional, along with blood testing for Down's and spina bifada. The latter test has a high rate of false positives, sort of a pre-screening for amnio.
I wonder how many pregnant women get all the tests because they think they should, then freak out when false positives come back. Anyway. If you're worried about your baby having AIDS, you either know that you or your partner have it— or there's a trust issue that needs to be addressed well before the baby arrives.
11.29.2007 9:19pm
Commenting on Dean's World is a privilege, not a right. Dean is your host, you are his guest, and you should behave in that fashion. Dean is not your babysitter, nor is he your punching bag. Please remember this. In general, you are free to disagree with anyone on any subject you wish, but abusive behavior will not be tolerated.
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.
Last weekend our ER had two people with the same first name. One was a known 45 y/o HIV positive, one was a healthy 16 yr old boy. They accidentally ordered a viral load on the 16y/o instead of the known HIV positive and it came back as 500 copies/ml.
So the director of the ER freaked that he hd a "positive" result on a normal healthy 16 y/o boy with no "risk factors". Of course calls to the reference lab revealed that the viral load test was not to be used as a dignostic test.
So we had 500 copies/ml of what?
This is one of those universal truths. And, it's not just the payment of money, but also the psychological gains of a sense of identity, the righteousness of moral superiority, and the prestige from the adoration of fellow travelers.
Please tell me how this is in any way different from the prognostications of our impending doom from environmentalists and their religious devotion to the over-hyped cause of global warming.
it's probably better to ask those who don't have a stake either way.
Definitely, although if that's not possible then having pro- and anti- debate it is a decent back-up plan.
I was thinking along the lines of cigarette manufacturers vs. life insurers. Doctors stand to make money off cancer, so that blows that out of the water, but the larger point can hold in alot of cases.
exactly. The issue is not that the medical establishment wants to throw money at what they (probably very honestly and maybe even correctly) believe is a really very bad disease. The problem is the absence of debate.
I think the biggest problem is that in these things, one side is allowed to dominate the discussion, using argumentation that is tangential at best to the crux of the matter. Opposing views are shouted down, not because they're incorrect or not backed up by scientific or realistic thought, but because they don't fit the canon, or because they threaten the power and prestige of those who base their lives on the issue.
This goes both ways, and thus just listening to the OTHER side doesn't necessarily make it better. Just different.
Actualy, if you read through Dean's World for articles on AIDS, you'll find there is a lot of question about that "huge public health problem," being AIDS is diagnosed in the Third World mainly by symptoms, which are identical to many other historically common illnesses of poorer regions.
Yes, there is a question as to whether AIDS has become a huge public health problem in the Third World, especially in sub-Saharan Africa.
One counter-hypothesis is that diseases in the Third World which aren't AIDS are being diagnosed as AIDS because then treatment money is available.
In fact, there's also a question as to whether it ever was an epidemic in the rich world.
One counter-hypothesis is AIDS was only an epidemic among intravenous drug users and people who practiced anal sex.
And then there is the question whether HIV causes AIDS....
There are all sorts of questions of which you may not be aware on this topic, many of which have been discussed on this blog.
Yours,
Wince
Those who have criticized such gross exaggerations, as I did in my 1990 book The Myth of Heterosexual AIDS, were labeled liars ourselves, whackos, racists, and variety of other colorful epithets. Now I'm being told I should gloat; but personally I'm too busy shaking my head and wondering how despite our best efforts the AIDS alarmists were able to sustain their fiction for so long.
However, for those really interested, a Professor of Economics at Mississippi has provided the most incisve, succint, coherent explanation (in 4 pages) of the entire problem.
Hank "Yes, I'm a lawyer, but Yes I served my country" Barnes!
I'm a skeptic, Chris. Right now, I'd say it's the best explanation we have, but it isn't a very good one. Last I heard, the math doesn't work. Until someone comes up with a mathematical model that works, we don't have a solid hypothesis.
Yours,
Wince
The diagnosis and the medical condition are not the same thing.
You Genius! You have thrown spotlights down the darkest alley; you have identified the SUSPECT.
'So the director of the ER freaked that he hd a "positive" result on a normal healthy 16 y/o boy with no "risk factors". Of course calls to the reference lab revealed that the viral load test was not to be used as a
dignostic test.'
Has anything happened since at the ER? Has the director found an aswer to your question, 'so we had 500 copies/ml of what?'
I do not have sources at hand, however, are you aware that the blood is diluted before the test is ran? So your question becomes '500 copies of
what per milliliters of what'? Are we scared yet?
What further actions would have had to be taken for the viral load test to become a diagnostic test? Has the director looked into this? Were those actions taken? Afterall, the child has 500 something. Is it not natural to follow through from a medical standpoint? If they didnot I would like to know the reasons they did not. Did the doctor not have an obligation to follow through?
I would guess that a patient interview is required to make the test a diagnostic test. Something like, 'What risk factors does the patient have?' Imagine deciding that an x-ray confirms a broken leg in a skier but not a
swimmer! Scared? I am.
Help! Push the director for answers? Let us know what comes of this. PUSH. Let's nab the SUSPECT.
I think too that this is a very important discovery on your part. The boy was presumably HIV antibody negative, right? It seems that what you are rightly asking is: How can a person who doesn't "have" HIV still have a detectable HIV viral load, regardless of the number. Am I right?
Could it be correct as those "denialists" have said, that PCR does not measure infectuous virus, and that the antibody tests themselves (as the test inserts themselves say) are "not proof of infection with HIV?"
What then IS HIV?
It is a molecular signature that varies from lab to lab, country to country.
There are countless proteins that coincide with HIV's designated proteins, such as those found in pregnancy, Tuberculosis, malaria, etc. This, in turn, is what lies beneath the now cracked foundation of the UNAIDS massively inflated estimates of how many people in the developing world are "living with HIV."
UNAIDS drew samples from ante-natal clinics and then generated their elephantine estimates from those figures, which were then sent to Geneva, where the scare figures were modeled on computers. Now the media has coughed up, at LAST, the fact of the matter, but they can't bring themselves to explain it.
Is an 'estimate' cut by 40% suddenly more reliable than the original? No. Nothing is reliable.
Question for the panel:
Why would sex in the developing world cause "HIV" to spread more rapidly than in the developed world?
It isn't sex itself, per se, but: Lack of testing, rampant prostitution, lack of adequate medical care and public health infrastructures. Some unusual sexual practices contribute, like: The use of astringent douches to eliminate lubrication in the vagina [considered disgusting in some African cultures], female circumcision [of course] and the general refusal to use condoms.
There may also be an element of racism going on [with the labeling/suppositions], but I'm undecided on that.
Right you are. Aren't you a doll for remembering. Thank you.
Here are the two articles (part two at the end, linked)
http://www.virusmyth.net/aids/data/cfafrica1.htm
http://www.whatisaids.com/rollingstone.htm
I wonder how many pregnant women get all the tests because they think they should, then freak out when false positives come back. Anyway. If you're worried about your baby having AIDS, you either know that you or your partner have it— or there's a trust issue that needs to be addressed well before the baby arrives.
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.