MEETINGS * RENCONTRES
Challenge the accepted doctrine on HIV-AIDS link, science writers told David Spurgeon P hysicians may soon begin to notice more newspaper articles and television programs that challenge accepted doctrine about HIV and AIDS. Writers who gathered at the University of Waterloo this spring for the annual meeting of the Canadian Science Writers Association (CSWA) were told by a Michigan State University professor that the generally accepted scientific explanation of how AIDS is caused may be incorrect. Robert Root-Bernstein, a theoretical biologist involved in human physiology and immunology research, suggested that it may be misleading for reporters to tell the public that HIV is the cause of David Spurgeon is a freelance writer living in Mont Tremblant, Que.
AIDS, and to intimate that a vaccine may soon be developed to prevent it. He made the comments to 60 science writers during an evening session called Headline Science: The Science Behind the Stories; his presentation was called Rethinking AIDS: What Science Reporting Has Missed. At the CSWA awards ceremony the following evening, one of the prizes for excellence in science writing went to the author of a CBC radio Ideas program that highlighted the role of syphilis in AIDS. Colman Jones, the writer, interviewed Root-Bernstein for the program, though Root-Bernstein does not agree with Jones's view of the importance of the role syphilis plays in AIDS. Dissident views about the cause of AIDS continue to crop up from sources of varying credi-
bility. Some, for example, emerged at a meeting in Amsterdam in May, which was attended not only by Root-Bernstein and Jones but also by Dr. Luc Montagnier, who with his French colleagues first isolated HIV. That meeting, whose theme was AIDS: An Alternative View, was sponsored by the Foundation for Alternate AIDS Research, which receives funds from the Netherlands' government. Such views will inevitably receive media coverage. Root-Bernstein is a science writer as well as a scientist. He publishes in lay publications and is author of Discovering (Harvard U Pr, Cambridge, Mass, 1989). He is currently working on another book, Re-thinking AIDS, which should be published in January 1993.
Dissident views about the cause of AIDS continue to crop up from sources of varying credibility.
SEPTEMBER 1, 1992
CAN MED ASSOC J 1992; 147 (5)
767
The common public belief is that people infected with HIV are doomed to develop AIDS and die, said Root-Bernstein, because most science writers don't challenge scientific dogma on the disease.
In a study of AIDS/HIV literature, Root-Bernstein has turned up more than 1000 pieces of evidence that run counter to accepted doctrine, and he emphasized them in his talk. The common public belief is that people infected with HIV are doomed to develop AIDS and die, he said, because most science writers don't challenge scientific dogma on the disease. Yet he noted that some HIV-infected people can revert to seronegative
status after having tested seropositive, apparently after ridding themselves of the infection. He also referred to a Swiss study involving two groups of HIV drug abusers. Those researchers found that the group that stopped taking narcotics developed AIDS at one-third the rate of those who continued to use drugs, and concluded that drugs such as cocaine and morphine suppress immune system response, and can activate HIV.
Root-Bernstein's scepticism about current HIV/AIDS dogma is based on the number of anomalies he has found. For example, he says: 0 HIV transmission from female to male, in which drug abuse, homosexuality and other routes of transmission were not involved, has only been documented in 18 cases in New York City, and in about 10 cases in both England and Germany. Female-male transmission rates for
INDICATIONS AND CLINICAL USES: PONSTAN (mefenamic acid) is indicated for the relief of pain of moderate severity in conditions such as muscular aches and pains, dysmenorrhea, headaches and dental pain. CONTRAINDICATIONS: PONSTAN (mefenamic acid) should not be used in patients who have previously exhibited hypersentivity to it. Mefenamic acid is contraindicated in patients with active ulceration or chronic inflammation of the upper or lower gastrointestinal tract. Ponstan should not be administered to patients who have previously experienced diarrhea as a result of takino the drug. (Mefenamic Acid) Capsules Mefenamic acid should be avoided in patients with pre-existing renal disease. URNINGS: In patients with a history of ulceration or chronic THERAPEUTIC CLASSIFICATION inflammation of the upper or lower gastrointestinal tract, PONSTAN (mefenamic acid) should be given under close supervision and only after consulting Analgesic. the Adverse Reactions Section. Certain patients who develop diarrhea may be unable to tolerate the drug because of recurrence of the symptoms on subsequent exposure. In these subjects, the drug should be promptly discontinued. PRECAUTIONS: If rash occurs, the drug should be promptly discontinued. A false-positive reaction for urinary bile, using the diazo tablet test, may result after mefenamic acid administration. If biliuria is suspected, other diagnostic procedures, such as the Harrison spot test, should be performed. In chronic animal toxicity studies PONSTAN (mefenamic acid) at 7 to 28 times the recommended human dose, caused minor microscopic renal papillary necrosis in rats, edema'and blunting of the renal papilla in dogs, and renal papillary edema in monkeys. In normal human volunteers, BUN levels were slightly elevated following the prolonged administration of mefenamic acid at greater than therapeutic doses. Since mefenamic acid is eliminated primarily through the kidneys, it should not be administered to patients with significantly impaired renal function. As with other nonsteroidal anti-inflammatory drugs, borderine elevations of liver function tests may occur. Meaningful (3 times the upper limit of normal) elevations of SGPT or SGOT occurred in controlled clinical trials in less than 1% of patients. Severe hepatic reactions including jaundice and cases of fatal hepatitis, have been reported with other nonsteroidal anti-inflammatory drugs. Although such reactions are rare, if abnormal liver tests persist or worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (eg. eosinophilia, rash, etc.), mefenamic acid should be discontinued. Mefenamic acid may prolong acetylsalicylic acid induced gastrointestinal bleeding. However, mefenamic acid itself appears to be less liable than acetylsalicylic acid to cause gastrointestinal bleeding. Mefenamic acid 500 mg and acetylsalicylic acid 650 mg four times.a day both caused significant further lowering of the prothrombin concentration (mefenamic acid 3.48% and acetylsalicylic acid 2.75%) in patients in whom the concentration had been initially lowered by anticoagulant therapy. Caution, therefore, should be exercised in administering mefenamic acid to patients on anticoagulant therapy and should not be given when prothrombin concentrations is in the range of 10 to 20% normal. Careful monitoring of blood coagulation factors is recommended. It is recommended that estimations of hemoglobin and blood counts be carried out at regular intervals. Mefenamic acid should be used with caution in known asthmatics. Use In prgnucy med In women of chldbearIg peotnt: The safety of mefenamic acid on reproductive capacity and pregnancy has not been established. Thus, mefenamic acid should be used in women of chiidbearing potential'and during pregnancy only when the potential benefits are expected to outweigh the potential risks. Nursing mohrs: Trace amounts of mefenamic acid may be present in breast milk and transmitted to the nursing infant: thus mefenamic acid should not be taken by the nursing mother because of the effects of this class of drugs on the infant cardiovascular system. Use In children: Safety and effectiveness in children below the age of 14 have not been established. ADVERSE REACTIONS: The most frequently reported adverse reactions associated with the use of PONSTAN (mefenamic acid) involve the gastrointestinal tract. The following disturbances were reported in decreasing order of frequency: diarrhea (approximately 5% of patients), nausea with or without vomiting, other gastrointestinal symptoms and abdominal pain. The occurrence of the diarrhea is usually dose related. Other gastrointestinal reactions less frequently reported were anorexia, pyrosis, flatulence, and constipation. Gastrointestinal ulceration with or without hemorrhage has been reported. Hematopoietic: Cases of autoimmune hemolytic anemia have been associated with the continuous administration of Ponstan for 12 months or longer. Decreases in hematocrit have been noted in 2-5% of patients and primarily in those who have received proinged therapy. Leukopenia, eosinophilia, thrombocytopenic purpura, agranulocytosis, pancytopenia and bone marrow hypoplasia have also been reported on occasion. Nervous System: Dizziness, drowsiness, blurred vision, insomnia, nervousness and headache have occurred. Integumentary: Urticaria, rash and facial edema have been reported. Renal: As with other nonsteriodal anti-inflammatory agents, renal failure, including papillary necrosis, have been reported. In elderiy patients renal failure has occurred after taking mefenamic acid for 2-6 weeks. The renal damage may not be completely reversible. Hematuria and dysuria have also been reported with mefenamic acid. Other: Eye irritation, ear pain, perspiration, mild hepatic toxicity and increased need for insulin in a diabetic have been reported. There have been rare reports of palpitation dyspnea and reversible loss of color vision. ORU INTERACTION: Protein-bound Drugs. Because PONSTAN (mefenamic acid) is highly protein bound, it could be displaced from binding sites by, or it could displace from binding sites, other protein-bound drugs such as oral anticoagulants, hydantoins, salicylates, sufonamide and suifonylureas. Patients receiving mefenamic acid with any of these drugs should be observed for adverse effects. Anticoagulants and Thrombolytic Agents. Mefenamic acid enhances the hypopromthrobinemic effect of warfarin, therefore, concurrent administration of the drugs should be avoided whenever possible. If the drugs must be used concurrently, prothrombin time should be determined frequently and anticoagulant dosage adjusted accordingly; the patient should be observed for adverse effects. In addition, the ulcerogenic potential of mefenamic acid and the effect of the drug on platelet function may further contrbute to the hazard of concomitant therapy with any anticoagulant or thrombolytic agent (eg. streptokinase). DOSAGE AND ADINIR TION: Administration is by the oral route, preferably with food. The recommended regimen in acute pain for adults and children over 14 years of age is 500 mg as an initial dose followed by 250 mg every 6 hours as needed, usually not to exceed one week. For the treatment of primary dysmenorrhea, the recommended dosage is 500 mg as an initial dose followed by 250 mg for every 6 hours, starting with the onset of beeding and associated symptoms. Clinical studies indicate that effective treatment can be initiated with the start of menses and should not be necessary100 more than 2 to 3 days. MILABILITY: PONSTAN (mefenamic acid) is available in No. 1 Coni-snap capsule with an ivory opaque body and an aqua blue opaque can. Each available in bottles of and 500. REFERENCES: 1. Gabka J. Ponstan dental study. Berlin July 9, 1974. 2. Budoff PW. Zomepirac sodium in the treatment of primary dysmenorrhea syndrome. N Eng J Med 307:714-719, 1982. 3. Powell R, Smith RP. Treatment of primary dysmenorrhea with an antiprostaglandin agent. (In) Symposium on "The Role of Prostaglandins in Menstrual Disorders," Academy of Medicine, Toronto, Ontario. June 20, 1980, pp 29-37. 4. Rees MCP, Bernard Al et al. Effect of tenamates on progstaglandin E receptor 5ca nUghia L2X3 binding. The Lancet 2:541-542, 1988. 5. Smith RP, Powell JR. The objective evaluation of dysmenorrhea therapy. Am J Obstet Gynecol 137(3):314-319, 1980. ReTM wamar-LambenCompany lPAAB1 Pari-Davis Div., Wamer-Lambert 6. Ponstan product monograph. IMS, CDTI, September 1991. Product Monograph available on request. ICCPP Canada Inc., auih. user _
768
N.
CAN MED ASSOC J
1992; 147 (5)
LE
Iler SEPTEMBRE 1992
Professionalism
"I'm doing this as much as an intellectual. exercise as anything else."
workingfor You
Robert Root-Bernstein
all other sexually transmitted diseases are usually a little lower than for male-to-female transmission, but in the case of HIV there is a several hundredfold difference. 0 "There have been dozens of studies looking at prostitution as a possible vector for HIV and every major [European] country that has looked at this has concluded that female prostitutes are not vectors for spreading HIV," he said. "If the prostitutes don't use drugs very few of them end up being HIV positive and developing AIDS." The HIV/AIDS situation in Africa is different from that in Western countries, and RootBernstein contends that the two regions cannot be directly compared. Anemia and malnutrition are rampant in Africa, he says, and pregnant females, under greater nutritional stress, tend to get many more infections. The rates of sexually transmitted and other infectious diseases are astronomical compared to those in Western countries, and malaria is common. Malaria, often associated with anemia, is frequently treated with blood transfusions, and most hospitals don't have facilities to test blood for many viruses. "The crucial point for me is that I can find no good evidence of any AIDS patient who has only HIV as the immunosuppressive risk," says Root-Bernstein. In every AIDS patient there are other factors that could trigger SEPTEMBER 1, 1992
autoimmunity, he says. These include exposure to semen, to multiple concurrent infections, to other immunosuppressive viruses, to hepatitis, to repeated blood transfusions (which themselves are immunosuppressive), or exposure to anesthetics or opiate painkillers. Root-Bernstein finds it difficult to get his doubts about the HIV/AIDS question published. Although The Sciences commissioned him to write an article on his views, the magazine withdrew the piece from its publishing schedule. Similarly, The Atlantic's initial interest in one of his articles evaporated for reasons not entirely clear to him. So why does he persist? "I'm doing this as much as an intellectual exercise as anything else," he stresses. "It really doesn't matter to me where we come out in terms of what causes AIDS. I don't think we can write off HIV, or it may be HIV with cofactors, or there may be cases where there isn't any HIV. The point of going through this exercise is simply that there are so many anomalies and so many [infectious disease criteria] that haven't been satisfied that it seems to me that the question of what causes AIDS is still open. The challenge is to come up with enough reasonable arguments and enough anomalies that people will take the problem seriously and do something about it. It's people's lives that matter to me. I'm willing to risk my reputation to make sure that we get the right answer."m
Professionalism demands
a
high level of qualification, through demanding education
programs and examinations. The Council for APMR was
established to fulfil these functions for pharmaceutical representatives to serve you more effectively and professionally. The Council is an independent, non-profit organization which establishes standards for accreditation and administers academic programs and examinations in the health sciences leading to accreditation. Your recognition and support of the professional objectives of the Council are an essential factor in helping us achieve our goal of universal industry adoption of the APMR standard.
The next time you see an APMR, take a moment to ask about our program. Write for our brochure: The Blue Badge of Professionalism
The Council for the Accreditation of Pharmacoutical Manufacturers Representatives of Canada 3489 Ashby Street, Saint Laurent, Quebec H4R 2K3 Telephone (514) 333-8362 Fax (514) 333-1119
CAN MED ASSOC J 1992; 147 (5)
769
Challenge the accepted doctrine on HIV-AIDS link, science writers told David Spurgeon P hysicians may soon begin to notice more newspaper articles and television programs that challenge accepted doctrine about HIV and AIDS. Writers who gathered at the University of Waterloo this spring for the annual meeting of the Canadian Science Writers Association (CSWA) were told by a Michigan State University professor that the generally accepted scientific explanation of how AIDS is caused may be incorrect. Robert Root-Bernstein, a theoretical biologist involved in human physiology and immunology research, suggested that it may be misleading for reporters to tell the public that HIV is the cause of David Spurgeon is a freelance writer living in Mont Tremblant, Que.
AIDS, and to intimate that a vaccine may soon be developed to prevent it. He made the comments to 60 science writers during an evening session called Headline Science: The Science Behind the Stories; his presentation was called Rethinking AIDS: What Science Reporting Has Missed. At the CSWA awards ceremony the following evening, one of the prizes for excellence in science writing went to the author of a CBC radio Ideas program that highlighted the role of syphilis in AIDS. Colman Jones, the writer, interviewed Root-Bernstein for the program, though Root-Bernstein does not agree with Jones's view of the importance of the role syphilis plays in AIDS. Dissident views about the cause of AIDS continue to crop up from sources of varying credi-
bility. Some, for example, emerged at a meeting in Amsterdam in May, which was attended not only by Root-Bernstein and Jones but also by Dr. Luc Montagnier, who with his French colleagues first isolated HIV. That meeting, whose theme was AIDS: An Alternative View, was sponsored by the Foundation for Alternate AIDS Research, which receives funds from the Netherlands' government. Such views will inevitably receive media coverage. Root-Bernstein is a science writer as well as a scientist. He publishes in lay publications and is author of Discovering (Harvard U Pr, Cambridge, Mass, 1989). He is currently working on another book, Re-thinking AIDS, which should be published in January 1993.
Dissident views about the cause of AIDS continue to crop up from sources of varying credibility.
SEPTEMBER 1, 1992
CAN MED ASSOC J 1992; 147 (5)
767
The common public belief is that people infected with HIV are doomed to develop AIDS and die, said Root-Bernstein, because most science writers don't challenge scientific dogma on the disease.
In a study of AIDS/HIV literature, Root-Bernstein has turned up more than 1000 pieces of evidence that run counter to accepted doctrine, and he emphasized them in his talk. The common public belief is that people infected with HIV are doomed to develop AIDS and die, he said, because most science writers don't challenge scientific dogma on the disease. Yet he noted that some HIV-infected people can revert to seronegative
status after having tested seropositive, apparently after ridding themselves of the infection. He also referred to a Swiss study involving two groups of HIV drug abusers. Those researchers found that the group that stopped taking narcotics developed AIDS at one-third the rate of those who continued to use drugs, and concluded that drugs such as cocaine and morphine suppress immune system response, and can activate HIV.
Root-Bernstein's scepticism about current HIV/AIDS dogma is based on the number of anomalies he has found. For example, he says: 0 HIV transmission from female to male, in which drug abuse, homosexuality and other routes of transmission were not involved, has only been documented in 18 cases in New York City, and in about 10 cases in both England and Germany. Female-male transmission rates for
INDICATIONS AND CLINICAL USES: PONSTAN (mefenamic acid) is indicated for the relief of pain of moderate severity in conditions such as muscular aches and pains, dysmenorrhea, headaches and dental pain. CONTRAINDICATIONS: PONSTAN (mefenamic acid) should not be used in patients who have previously exhibited hypersentivity to it. Mefenamic acid is contraindicated in patients with active ulceration or chronic inflammation of the upper or lower gastrointestinal tract. Ponstan should not be administered to patients who have previously experienced diarrhea as a result of takino the drug. (Mefenamic Acid) Capsules Mefenamic acid should be avoided in patients with pre-existing renal disease. URNINGS: In patients with a history of ulceration or chronic THERAPEUTIC CLASSIFICATION inflammation of the upper or lower gastrointestinal tract, PONSTAN (mefenamic acid) should be given under close supervision and only after consulting Analgesic. the Adverse Reactions Section. Certain patients who develop diarrhea may be unable to tolerate the drug because of recurrence of the symptoms on subsequent exposure. In these subjects, the drug should be promptly discontinued. PRECAUTIONS: If rash occurs, the drug should be promptly discontinued. A false-positive reaction for urinary bile, using the diazo tablet test, may result after mefenamic acid administration. If biliuria is suspected, other diagnostic procedures, such as the Harrison spot test, should be performed. In chronic animal toxicity studies PONSTAN (mefenamic acid) at 7 to 28 times the recommended human dose, caused minor microscopic renal papillary necrosis in rats, edema'and blunting of the renal papilla in dogs, and renal papillary edema in monkeys. In normal human volunteers, BUN levels were slightly elevated following the prolonged administration of mefenamic acid at greater than therapeutic doses. Since mefenamic acid is eliminated primarily through the kidneys, it should not be administered to patients with significantly impaired renal function. As with other nonsteroidal anti-inflammatory drugs, borderine elevations of liver function tests may occur. Meaningful (3 times the upper limit of normal) elevations of SGPT or SGOT occurred in controlled clinical trials in less than 1% of patients. Severe hepatic reactions including jaundice and cases of fatal hepatitis, have been reported with other nonsteroidal anti-inflammatory drugs. Although such reactions are rare, if abnormal liver tests persist or worsen, if clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (eg. eosinophilia, rash, etc.), mefenamic acid should be discontinued. Mefenamic acid may prolong acetylsalicylic acid induced gastrointestinal bleeding. However, mefenamic acid itself appears to be less liable than acetylsalicylic acid to cause gastrointestinal bleeding. Mefenamic acid 500 mg and acetylsalicylic acid 650 mg four times.a day both caused significant further lowering of the prothrombin concentration (mefenamic acid 3.48% and acetylsalicylic acid 2.75%) in patients in whom the concentration had been initially lowered by anticoagulant therapy. Caution, therefore, should be exercised in administering mefenamic acid to patients on anticoagulant therapy and should not be given when prothrombin concentrations is in the range of 10 to 20% normal. Careful monitoring of blood coagulation factors is recommended. It is recommended that estimations of hemoglobin and blood counts be carried out at regular intervals. Mefenamic acid should be used with caution in known asthmatics. Use In prgnucy med In women of chldbearIg peotnt: The safety of mefenamic acid on reproductive capacity and pregnancy has not been established. Thus, mefenamic acid should be used in women of chiidbearing potential'and during pregnancy only when the potential benefits are expected to outweigh the potential risks. Nursing mohrs: Trace amounts of mefenamic acid may be present in breast milk and transmitted to the nursing infant: thus mefenamic acid should not be taken by the nursing mother because of the effects of this class of drugs on the infant cardiovascular system. Use In children: Safety and effectiveness in children below the age of 14 have not been established. ADVERSE REACTIONS: The most frequently reported adverse reactions associated with the use of PONSTAN (mefenamic acid) involve the gastrointestinal tract. The following disturbances were reported in decreasing order of frequency: diarrhea (approximately 5% of patients), nausea with or without vomiting, other gastrointestinal symptoms and abdominal pain. The occurrence of the diarrhea is usually dose related. Other gastrointestinal reactions less frequently reported were anorexia, pyrosis, flatulence, and constipation. Gastrointestinal ulceration with or without hemorrhage has been reported. Hematopoietic: Cases of autoimmune hemolytic anemia have been associated with the continuous administration of Ponstan for 12 months or longer. Decreases in hematocrit have been noted in 2-5% of patients and primarily in those who have received proinged therapy. Leukopenia, eosinophilia, thrombocytopenic purpura, agranulocytosis, pancytopenia and bone marrow hypoplasia have also been reported on occasion. Nervous System: Dizziness, drowsiness, blurred vision, insomnia, nervousness and headache have occurred. Integumentary: Urticaria, rash and facial edema have been reported. Renal: As with other nonsteriodal anti-inflammatory agents, renal failure, including papillary necrosis, have been reported. In elderiy patients renal failure has occurred after taking mefenamic acid for 2-6 weeks. The renal damage may not be completely reversible. Hematuria and dysuria have also been reported with mefenamic acid. Other: Eye irritation, ear pain, perspiration, mild hepatic toxicity and increased need for insulin in a diabetic have been reported. There have been rare reports of palpitation dyspnea and reversible loss of color vision. ORU INTERACTION: Protein-bound Drugs. Because PONSTAN (mefenamic acid) is highly protein bound, it could be displaced from binding sites by, or it could displace from binding sites, other protein-bound drugs such as oral anticoagulants, hydantoins, salicylates, sufonamide and suifonylureas. Patients receiving mefenamic acid with any of these drugs should be observed for adverse effects. Anticoagulants and Thrombolytic Agents. Mefenamic acid enhances the hypopromthrobinemic effect of warfarin, therefore, concurrent administration of the drugs should be avoided whenever possible. If the drugs must be used concurrently, prothrombin time should be determined frequently and anticoagulant dosage adjusted accordingly; the patient should be observed for adverse effects. In addition, the ulcerogenic potential of mefenamic acid and the effect of the drug on platelet function may further contrbute to the hazard of concomitant therapy with any anticoagulant or thrombolytic agent (eg. streptokinase). DOSAGE AND ADINIR TION: Administration is by the oral route, preferably with food. The recommended regimen in acute pain for adults and children over 14 years of age is 500 mg as an initial dose followed by 250 mg every 6 hours as needed, usually not to exceed one week. For the treatment of primary dysmenorrhea, the recommended dosage is 500 mg as an initial dose followed by 250 mg for every 6 hours, starting with the onset of beeding and associated symptoms. Clinical studies indicate that effective treatment can be initiated with the start of menses and should not be necessary100 more than 2 to 3 days. MILABILITY: PONSTAN (mefenamic acid) is available in No. 1 Coni-snap capsule with an ivory opaque body and an aqua blue opaque can. Each available in bottles of and 500. REFERENCES: 1. Gabka J. Ponstan dental study. Berlin July 9, 1974. 2. Budoff PW. Zomepirac sodium in the treatment of primary dysmenorrhea syndrome. N Eng J Med 307:714-719, 1982. 3. Powell R, Smith RP. Treatment of primary dysmenorrhea with an antiprostaglandin agent. (In) Symposium on "The Role of Prostaglandins in Menstrual Disorders," Academy of Medicine, Toronto, Ontario. June 20, 1980, pp 29-37. 4. Rees MCP, Bernard Al et al. Effect of tenamates on progstaglandin E receptor 5ca nUghia L2X3 binding. The Lancet 2:541-542, 1988. 5. Smith RP, Powell JR. The objective evaluation of dysmenorrhea therapy. Am J Obstet Gynecol 137(3):314-319, 1980. ReTM wamar-LambenCompany lPAAB1 Pari-Davis Div., Wamer-Lambert 6. Ponstan product monograph. IMS, CDTI, September 1991. Product Monograph available on request. ICCPP Canada Inc., auih. user _
768
N.
CAN MED ASSOC J
1992; 147 (5)
LE
Iler SEPTEMBRE 1992
Professionalism
"I'm doing this as much as an intellectual. exercise as anything else."
workingfor You
Robert Root-Bernstein
all other sexually transmitted diseases are usually a little lower than for male-to-female transmission, but in the case of HIV there is a several hundredfold difference. 0 "There have been dozens of studies looking at prostitution as a possible vector for HIV and every major [European] country that has looked at this has concluded that female prostitutes are not vectors for spreading HIV," he said. "If the prostitutes don't use drugs very few of them end up being HIV positive and developing AIDS." The HIV/AIDS situation in Africa is different from that in Western countries, and RootBernstein contends that the two regions cannot be directly compared. Anemia and malnutrition are rampant in Africa, he says, and pregnant females, under greater nutritional stress, tend to get many more infections. The rates of sexually transmitted and other infectious diseases are astronomical compared to those in Western countries, and malaria is common. Malaria, often associated with anemia, is frequently treated with blood transfusions, and most hospitals don't have facilities to test blood for many viruses. "The crucial point for me is that I can find no good evidence of any AIDS patient who has only HIV as the immunosuppressive risk," says Root-Bernstein. In every AIDS patient there are other factors that could trigger SEPTEMBER 1, 1992
autoimmunity, he says. These include exposure to semen, to multiple concurrent infections, to other immunosuppressive viruses, to hepatitis, to repeated blood transfusions (which themselves are immunosuppressive), or exposure to anesthetics or opiate painkillers. Root-Bernstein finds it difficult to get his doubts about the HIV/AIDS question published. Although The Sciences commissioned him to write an article on his views, the magazine withdrew the piece from its publishing schedule. Similarly, The Atlantic's initial interest in one of his articles evaporated for reasons not entirely clear to him. So why does he persist? "I'm doing this as much as an intellectual exercise as anything else," he stresses. "It really doesn't matter to me where we come out in terms of what causes AIDS. I don't think we can write off HIV, or it may be HIV with cofactors, or there may be cases where there isn't any HIV. The point of going through this exercise is simply that there are so many anomalies and so many [infectious disease criteria] that haven't been satisfied that it seems to me that the question of what causes AIDS is still open. The challenge is to come up with enough reasonable arguments and enough anomalies that people will take the problem seriously and do something about it. It's people's lives that matter to me. I'm willing to risk my reputation to make sure that we get the right answer."m
Professionalism demands
a
high level of qualification, through demanding education
programs and examinations. The Council for APMR was
established to fulfil these functions for pharmaceutical representatives to serve you more effectively and professionally. The Council is an independent, non-profit organization which establishes standards for accreditation and administers academic programs and examinations in the health sciences leading to accreditation. Your recognition and support of the professional objectives of the Council are an essential factor in helping us achieve our goal of universal industry adoption of the APMR standard.
The next time you see an APMR, take a moment to ask about our program. Write for our brochure: The Blue Badge of Professionalism
The Council for the Accreditation of Pharmacoutical Manufacturers Representatives of Canada 3489 Ashby Street, Saint Laurent, Quebec H4R 2K3 Telephone (514) 333-8362 Fax (514) 333-1119
CAN MED ASSOC J 1992; 147 (5)
769
