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Benjamin Rush MD

Benjamin Rush was a Founding Father of the United States. Rush was a civic leader in Philadelphia, where he was a physician, politician, social reformer, educator and humanitarian, as well as the founder of Dickinson College.

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It’s been a year since your book Lethal Decisions. The Unnecessary Deaths of Women and Children from HIV/AIDS was published. I am wondering what kind of response you have received. I have experienced two different emotions after reading the book. Clearly the first part is about the amazing contributions of science to discovering a new disease, finding a way to diagnose it, and then developing treatment that could treat the viral infection and prevent new infections. I know that in your book you emphasized the significance of the 1994 discovery that treating HIV-infected pregnant women reduced infection of their infants by 60%. But newer studies are equally dramatic showing that individuals who are HIV-infected are less likely to transmit the virus to a sexual partner if they are on treatment that reduces the viral load. Additionally, if the drug is taken regularly by an uninfected sexual partner, HIV infection can be prevented. The second part of your book was discouraging―you documented how academic and bureaucratic institutions actually contributed to the delayed implementation of treatment and prevention discoveries in poor countries. Have individuals in these disciplines challenged you?.  What are you hearing back?

By Benjamin Rush

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I noticed that your book does not index the term “conflict of interest.” This seems to me to be an important consideration when examining the scientific and ethical decisions that determine whether or not a clinical research trial moves forward. A recent issue of the Journal of the American Medical Association (May 2, 2107) focused on issues of conflict of interest in medicine and research, but they seemed not to address issues you raised in “Lethal Decisions.”  JAMA articles discussed conflict of interest that focused on payments and other benefits that might be given to physicians and researchers from pharmaceutical companies and other commercial healthcare related sources. One article pointed out that, “Meta-research studies have shown that financial conflicts of interest, including commercial research sponsorship, are associated with publication of research outcomes that favor the financial interest. The association between financial conflicts of interest and favorable outcomes has also been established for meta-analyses, systematic reviews, editorials, and letters to the editor. The influence of financial ties on research outcomes appears to be due to a variety of types of biases. For example, research agendas can be influenced by funding sources.” But the JAMA articles implied that the financial sources were primarily industry related.

I believe you are trying to say that concern about conflict of interest can result from financial gain, whether direct or indirect, and should be considered no matter the funding sourceindustry, government, USPHS, NIH, charitable organizations.  

 

By B. Rush MD

Lethal decisions - what must be done now to correct them?

Isn’t it true that by 1996 all of the means of preventing and treating HIV were in place but that public health organizations and certain clinical researchers failed to implement them. By 1998 , in the US and Europe, where implementation was occurring quickly, new HIV infections were rapidly falling, individuals treated with highly active antiretroviral therapy (HAART) were living longer/healthier lives with fewer clinical visits and hospitalizations, and new HIV infections in infants were disappearing. Instead of implementing successful measures for prevention and treatment, WHO made the unscientific and unprecedented recommendation to delay treatment. WHO, UNAIDS, and certain clinical researchers, in defiance of HIV experts, incorrectly hypothesized that women and children in Africa and other poor regions of the world might not respond in the same manner to the treatments that were being successfully used in wealthy countries. The delays allowed the HIV epidemic to continue at a rate that cost the lives of millions over the decades that followed.

By B. Rush MD

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