Risks and remedies

National | Homosexual AIDS stages a comeback; researchers challenge placebos; and a new polymer kills bacteria

Issue: "Abolition of C.S. Lewis?," June 16, 2001

A deadly "fatigue"
The AIDS virus is spreading at alarming rates among the homosexual population-rates reminiscent of the virus's 1980s explosion. A government survey reports that 4.4 percent of homosexual and bisexual men ages 23 to 29 are newly infected each year with HIV. Among black homosexuals, the resurgence is staggering: One in seven becomes HIV-positive each year. The Centers for Disease Control and Prevention, which reported the numbers, say rising infection rates threaten years of progress to control the disease's spread. The CDC's goal is to cut the number of new infections nationwide by over 50 percent in the next five years: from 40,000 to below 20,000. Yet the government's anti-AIDS fight may be a victim of its own success. Since improved medicine allows AIDS patients to live longer, fears about infection have dropped. Atlanta social worker Anthony McWilliams said the homosexual world is numb from years of endless warnings. "It becomes blah, blah, blah-noise to them," he said. "It's just not getting through to them." A United Nations report states that HIV has infected 58 million people around the world since 1981. Of these, 22 million have died. The brunt of the problem remains in Africa, where more than 25 million people are infected. In the United States, homosexuals face another growing threat: gonorrhea. A CDC study found that homosexual men made up 13.2 percent of gonorrhea cases in 1999, up from 4.5 percent in 1992. Investigator Kimberley Fox said one theory for the boom was "safe-sex fatigue": More homosexuals are interested in dangerous practices because they believe new medical advances will come to their rescue. Better than nothing?
Do placebos really cause people to will themselves to health? The New England Journal of Medicine recently published a study that challenges the popular belief that dummy pills help many patients. Placebos are inert substances that doctors give patients as "medicine," but their only effect is psychological. In many medical studies, doctors give an experimental treatment to one group of patients, a dummy treatment to a second group, and often nothing at all to a third group. Researchers at the University of Copenhagen combined the findings of 114 such studies to see how the sham treatment stacked up to no treatment. Usually they fared about the same. The placebo effect typically appeared in studies that lacked an objective measurement, such as blood pressure, for a treatment's effectiveness. Such studies relied on patients' subjective responses, and the researchers suspect that many of these patients misstated improvements to please their doctors. Placebo recipients in pain-treatment studies averaged only a 15 percent reduction in pain, and patients in other subjective studies had even smaller improvements. "I was shocked by this study," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "This just goes completely against the grain." He said doctors routinely give placebos to patients who want every possible treatment. "The shoe is on the other foot now," said Dr. John C. Bailar, a retired professor of health studies at the University of Chicago. "The people who claim there are placebo effects are going to have to show it." Anti-bacterial door knobs
MIT researchers say they've found a new polymer than can kill most common infectious bacteria. The special coating for door knobs, keyboards, and even surgical equipment could help prevent the spread of serious infections by sneezes and dirty hands. The researchers tested the polymer, known as hexyl-PVP, on glass slides and found that it killed up to 99 percent of the common bugs Staphylococcus, Pseudomonas, and E. coli. The coating, says researcher Joerg Tiller, has a positive electrical charge that kills bacteria, destroying the outer membrane of the microbes. And bacteria probably won't be able to develop an immunity to the coating, as they often do to antibiotics. "It is a chemical kill" he said. "For them to develop resistance, the bacteria would have to change their whole composition, and I don't think this can be done." Once attached to an object, the polymer sticks permanently. The object would be essentially sterile, Dr. Tiller said, but would require occasional washing to remove dead bacteria. So far, experiments with mouse cells have not found hexyl-PVP to be toxic. Dr. Tiller said the polymer could be used in the manufacturing process on everything from telephones to toys. Such commercial use for hexyl-PVP, however, awaits more testing.

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