How would you persuade someone to be tested for HIV-AIDS if you had nothing to offer but stigmatization?Early in the epidemic this was the problem in the United States.It is still a major problem in the underdeveloped world because the expense of treatment is out of the question for the vast majority of people there.Treatment, although not curative, greatly prolongs useful life for persons with HIV-AIDS here in the United States.Widespread testing of high-risk groups also promotes education for prevention, where a given effort has the greatest effect.


The World Trade Organization (WTO) has a protocol which they hope will be ratified by all participating countries (including the most underdeveloped) by 2006. This protocol is called TRIPS and stands for Trade and International Property Rights Agreement.TRIPS would cast in stone the unsatisfactory dilemma described in the beginning of this article. In other words after 2006 there would be no legal exceptions to patent protection of essential drugs evenfor vital public health uses anywhere in the world.


The Department for International Development of The British government set up a commission to study the consequences of TRIPS.The report prepared by this commission, recently released, states unequivocally that patents in the area of public health can be bad for poor countries.The commission had lawyers, scientists, a bio-ethicist, and a senior executive from Pfizer (a drug company) as a member.Presumably the Pfizer executiveís presence on the commission indicates that the radical remedies of the report would not do serious harm to the pharmaceutical industry.Clare Short, Secretary of the British Agency for International Development, and her Agency seem pleased with the report which recommends compulsory licensing for manufacture of generic versions of patented drugs deemed necessary for public health purposes.Reality requires permitting the export of such licensed drugs to underdeveloped countries unable to manufacture these products within their own borders.Some countries, such as India, are already exporting such drugs.The recommended amendments to TRIPS would extend this activity beyond 2006.


It is encouraging that GlaxoSmithKline is already shipping reduced price AIDS drugs to Africa before any formal change in the TRIPS protocol has been ratified.Also noteworthy: since 1987 Merck has been donating ivermectin throughout the endemic area in Africa for river blindness with the intention of wiping out the disease.


Malaria and tuberculosis (particularly the multi-drug resistant variety) are in both cases widespread and research for treatments is under-funded because of lack of affluent customers.They are basically poor peopleís diseases today although malaria could affect North America by way of global warming or inadvertent importing of exotic vectors (in malariaís case--mosquitoes).Malaria was present in southeast United states 50 to 100 years ago from Texas to New Jersey.An exotic vector mosquito plays a role in the current outbreak of West Nile fever as well: Aedes albopictus (Asian tiger mosquito) probably brought over in rain water in second hand tires on the deck of a freighter.Donor funding for malaria control is $100 to $200 million per year including funding of $30 million per year from the Gates Foundation estimated to produce about one new anti-malarial drug every five years ($150 million per drug) and the commitment is long term. But there are myriad small, boring chores that only public funding can seem to accomplish over time, for instance, re-dipping bed nets in insecticide about every six months.People donít seem to get around to doing such things unless they are organized to be convenient.So, public health funding does not lend itself to privatization.The Center for Disease Control (CDC) in Atlanta and state labs of hygiene are being beefed up in response to the bioterrorism threat.After all, at the beginning of an epidemic public health activities are the same whether the epidemic is caused by bio-terrorism or not.

World Health Organization (WHO) has done some remarkable things that include ridding the world of small pox (and very nearly doing the same with poliomyelitis).It has been under very competent management for some time and, if adequately funded, should play an increasing part in keeping us safe.I speak as a physician with an interest in public health.


John A. Frantz, M.D.

October 18, 2002



†††††††††††††††††††††††††††††††††††† PerverbsaredoctoredupProverbs


††††††††††††† One manís Mede is another manís Persian†††††††††† ††††† ††††††††††††One manís meat is another manís poison.


†††††††††††† Too many crooks spoil the brothel.††††††††††††††††††† †††††††††††††††††† Too many cooks spoil the broth.


†††††††††††† Many are cold but few are frozen (for sex††††††††††† †††††††††††††††† †††Many are called but few are chosen.

†††††††††††† therapists)††† .


†††††††††††† All jack and no work makes a dull playboy.†††† †††††††††††† ††††††††††††All work and no play makes Jack a dull boy.


†††††††††††† All work and no play makes jack (archaic slang for money).††††††††


†††††††††††† A manís best friend is his dogma.†††††††††††††††† †††††††††††† †††††††††††††Obvious


†††††††††††† Many hands make light work harder††††††††††††††††††††††††††††††††††††††††††††††††† ď


††††††††††† Rush fools in where angels fear to tread††††††††† ††††††††††††† †††††††††††††Devised by a friend of a signer of The

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† ††††††††††† ††††††††††††††Declaration of Independence


††††††††††† Partying is such sweet sorrow (subsequent††††† ††††††††††††† †††††††††††††Parting is such sweet sorrow.

††††††††††† hangover).


††††††††††† You can lead a horticulture, but you canít††††††† †††††††††††† ††††††††††††You can lead a horse to water, but you canít

††††††††††† make Ďem think.††††††††††††††††††††††††††††††††††††† †††††††††††† †††††††††††††make him drink.


††††††††††† This last one isnít a perverb, but it is close.††††† ††††††††††† †††††††††††††An Irish pervert likes women better than he likes whiskey


The author discovered perverbs in the mathematics and puzzles section of the old ScientificAmerican

Magazine.Perverbs make a nice minor hobby.Only some of the above are original.

January 23, 2003.