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Editorial, Opinion Piece Respond To Closure Of Murdered Abortion Provider Tiller's Clinic
Two newspapers recently published an editorial and an opinion piece in reaction to the announcement that murdered Kansas abortion provider George Tiller"s Wichita clinic would be permanently closed. The clinic was one of a handful in the U.S. offering abortion procedures in the second and third trimesters. Summaries appear below.~ Kansas City Star: The closing of Tiller"s clinic is "a tragedy for American democracy," and the "irrational violence" of his death has "trumped public policy," a Star editorial states. "The basis of civilization is that we agree to submit to the rule of law in order for society to flourish," the editorial says, adding that Tiller"s murder is "antithetical to that principle. It is dismaying to see a killer achieve his objective." The editorial notes that Tiller provided abortion services in "tragic cases" involving women "at risk of infertility or death; fetuses with severe abnormalities; and victims of rape and incest." It continues that the "reduction or loss of that service will create hardships and may put women"s lives at risk." Hospitals and doctors who refer such cases to abortion providers "must reassess the circumstances under which they would perform late-term abortions," according to the editorial. In addition, the "medical profession must take a role in training and supporting doctors willing to provide abortions," and the government and local police "must do all they can to protect a legal medical practice," the editorial says. It concludes, "Democracy demands that we not allow murder to make de facto public policy" (Kansas City Star, 6/11).~ Eric Zorn, Chicago Tribune: The announcement that Tiller"s clinic will remain permanently closed "was simply more proof that violence and intimidation can get results where civil discourse and political process fail," Tribune columnist Zorn writes. "The question isn"t whether prominent foes of abortion rights are being honest with us when they decry Tiller"s violent death and express regret over the means used to achieve an end they"ve sought," Zorn writes, adding, "Some are, I"m sure." He continues that abortion-rights opponents "recognize that ... a movement calling itself "pro-life"can"t also be pro-murder" and "are politically savvy enough to know that the gains won by terrorist acts are grudging and difficult to sustain." He continues that to "make terrorism less effective, and thereby discourage it," abortion-rights advocates, the medical profession, politicians and law enforcement officials "need to reopen that clinic in Wichita and assure its safe operation ... to defy terrorism, if for no other reason." He concludes that "as long as abortion remains legal, this same coalition needs to strive to expand the number of facilities where it"s available" (Zorn, Chicago Tribune, 6/11).
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Measurement Affects Racial Variations In Excessive Daytime Sleepiness
According to a research abstrac presented on Monday, June 8, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, white Americans are more likely to report experiencing excessive daytime sleepiness (EDS) more days per month than Asians, African Americans and Hispanics, but African Americans experience more severe EDS.
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Iraq Reports First Cases Of H1N1 Swine Flu
Iraqi health authorities confirmed yesterday that six people recently returned from the US have tested positive for H1N1 epidemic or swine flu,
Diagnostics

Treatment For HIV In South Africa Would Be More Effective If Started Earlier, Study

More people would benefit and it would be more cost effective if HIV treatment with antivirals started earlier in countries like South Africa where medical res are limited, said researchers. The study was led by investigators from Massachusetts General Hospital (MGH) in the US and the Desmond Tutu HIV Centre at the University of Cape Town and is published in the 4 August issue of the Annals of Internal Medicine. The paper is ready to view online and its release coincides with the International AIDS Society Conference meeting which started in Cape Town on Sunday. Rapid control of HIV spread is important in any country, but perhaps more so in re-limited countries with high rates of opportunistic infections, such as South Africa. However, doctors in South Africa don"t have guidelines about when to start therapy. Part of the reason is because they are waiting for the results of trials to determine how low a patient"s CD4 cell count should be before they start antiretroviral therapy (ART). CD4 T cells are an important part of the immune system"s defences against disease that is gradually eroded by HIV. While the decision to start ART is primarily a clinical one, cost-effectiveness is also an important public health consideration. In the US and other developed countries, ART usually starts when the level of CD4 cells reaches a threshold of 350 cells per microlitre of blood, said the researchers. However, because ART is expensive and can also have significant side effects, the World Health Organization (WHO) in 2006 recommended a threshold of 200 CD4 cells per microlitre of blood is reached before starting ART, or until the patient develops AIDS-related complications. Lead investigator Dr Rochelle Walensky, of the MGH Division of Infectious Disease, and associate professor of Medicine at Harvard Medical School, told the press that: "While those standards accommodate the limited res and short supply of medications in many settings, the greater prevalence of tuberculosis and other opportunistic infections in places like South Africa argue for earlier treatment initiation, even before the results of ongoing clinical trials are known." The trials that everyone is waiting for won"t be finished for several years. But countries like South Africa need guidelines today, said the researchers, which is why they decided to investigate the clinical benefits and cost implications of using the 350 threshold compared with one of 250 cells per microlitre of blood and no treatment. Walensky and colleagues developed a mathematical model to simulate HIV treatment and its associated health and economic outcomes. Using the model they worked out the additional costs of earlier treatment, its potential toxicities and its benefits, including TB prevention. They also calculated how much delaying treatment would shorten patients" lives and they estimated the cost per extra year of life gained by starting ART earlier. This is a standard way of measuring cost-effectiveness. The results showed that compared to a threshold of 250, starting ART when the CD4 cell count falls to 350 cells per microlitre of blood is highly cost-effective, even if the chances that a trial might show its superiority were to be as low as 17 per cent. The researchers said that raising the threshold to 350 cells per microlitre of blood would prevent nearly 76,000 deaths and 66,000 opportunistic infections over the next five years. The cost of doing this would be about 1,200 dollars per year of life saved, they said. Co-author Robin Wood, director of the Desmond Tutu HIV Centre at the Institute of Infectious Diseases and Molecular Medicine at the University of Cape Town, a leading HIV clinical research group in South Africa, said: "The time has come to act on the information we now have, nearly all of which supports starting treatment earlier." "We can re-evaluate the situation after the trials, but until those results are available, the evidence points to saving lives with earlier treatment," he added. "When to Start Antiretroviral Therapy in Re-Limited Settings." R. P. Walensky, L. L. Wolf, R. Wood, M. O. Fofana, K. A. Freedberg, N. A. Martinson, A. D. Paltiel, X. Anglaret, M. C. Weinstein, E. Losina and for the CEPAC-International Investigators. Annals of Internal Medicine, 2009, 60520-138. Volume 151, Issue 3, 4 August 2009. Massachusetts General Hospital. Written by: Catharine Paddock, PhD Copyright: Medical News Today Not to be reproduced without permission of Medical News Today


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