Sure, sure, we can go on and swear about the damn lies and statistics. We can argue that poor people shouldn't get treatments because they are poor, or rich drug companies need encouragement to do R&D, or everybody should be treated equally, etc etc. There are a million arguments to be made. Perhaps the heart surgery done for a fraction of the price also doesn't need expensive insurance for malpractice, or maybe it fails at .5% of the time compared to .1% of the time and that .4% is 99.9% of the cost. There are tons of things going on.

But when we come down to some of the cases, like HIV/AIDS in africa, we realize that lots of the dogmatic statements about who should be cared for are not a question of better/best - they are a question of good/bad.

There is medical care which is anti-productive for society. In particular, things that cure symptoms but leave people infectious tend to cause epidemics. Imagine a case of malaria that forces the person to stay inside all day, under mosquito netting (this isn't really the way this case works..., I know). If you treat the fever and the person walks around and gets bitten by mosquitos that pass the infection, then treating his fever just caused more cases of malaria, with all the pain and suffering that causes.

This is the case of intermediate quality nursing care for Crimean-Congo hemorrhagic fever (CCHF) or cholera. The proximity of nurses to cases causes a spread of the disease. It would be better to have great, aseptic nursing care - or none at all. But some care is worse than nothing.

Same with AIDS. Currently we are making sure that Africa will die, as a culture and a continent, by getting people strong enough to be 'functional' but also leaving them infectious. If we treat them, frankly, we need to monitor their pill taking. And to do that, we can't have them migrating all over from city to city or working as truck drivers, etc. We can't have them working in the sex industry or raping people. We need to have them monitored, and in africa, that means confined.

It would be better to not have them treated than to make it possible for them to spread the virus.

The AIDS care without abstinence, at least between infected and uninfected (and don't we know the uninfected parties often have no choice?), is an irresponsible, genocidal strategy.

So lets stop arguing about whether care 'costs too much' or whatever - we should first start by doing no harm.

BenK, unfortunately your analysis is way too logical and spot on economically to make any sense to people who have no concept of the law of unintended consequences. Most people want to stop short at "feeling good" about "doing something" rather than face the possibility that doing nothing in the long run may be infinitely better than any of the alternatives. K

And then there are the people who do nothing but still 'feel good' about 'writing something' in a chat room.

So tell me all the great things that you are doing, the sacrifices that you are making, and the fraction of your earning potential you sacrifice or the miseries you endure to help your fellow man - or are you just a blowhard who wants to force other people to sacrifice but never does it voluntarily yourself?

Benk , "timeforsanity" is probably too busy organizing his/her "candlelight vigil" against hunger in Darfur to answer your question. :-) K

The thing is this- treatment of HIV/AIDS reduces viral loads to undetectable levels and therefore dramatically reduces the chance of transmission. Wow, treatment and prevention all at the same time! Besides that deciding to subject people to a slow, painful death rather than treat them is morally despicable, prevention vs. treatment turns out to be not a choice at all! It's great when things work out in such a win/win way.

wow, if people all followed the protocols, resistance didn't evolve, and transmission couldn't occur in the presence of relatively low titers, then you'd be right. But people take their drugs irregularly, have plenty of unprotected sex - sometimes rape, often with sex workers, resistance evolves and low titers don't mean no virus. So... subjecting millions to a slow painful death happens to be the result of the current treatment strategies.

The refusal to take into account the human element, and to understand that the availability of free AIDS drugs (and condoms, the Pill, etc, etc) often changes the behavior of individuals so dramatically that all the medical good is offset by increased incidence of harmful behavior, is one of the great failings of the modern technocrat.