Bone Marrow Transplant Cured AIDS?

BBC News reports that a patient suffering from AIDS and leukemia shows no signs of AIDS infection after receiving a bone marrow transplant from an AIDS-resistant donor.

He had been infected with the human immunodeficiency virus, that causes Aids, for more than a decade and also had leukaemia.

The clinic said since the transplant was carried out 20 months ago, tests on the patient's bone marrow, blood and other organ tissues have all been clear.

In a statement, Professor Rodolf Tauber from the Charite clinic said: "This is an interesting case for research.

"But to promise to millions of people infected with HIV that there is hope of a cure would not be right."

Like many of you, I am skeptical about the long-term efficacy of this treatment and am concerned about the social justice challenges presented should this be determined to be a cure. But this story is valuable for the new direction it offers to medical research; while many researchers focus on preventing the virus from propagating, introducing genetics and possibly retroviruses opens up more possibilities. By pursuing all available angles of this crisis, we increase our chances of finding that elusive cure to this global epidemic.

In the Case of Nataline Sarkisyan

My immediate reaction when first learning of this case, was one of outrage. How dare yet another bean-counting, uncaring, bottom-line thinking insurer, whose job it is to provide health coverage to paying policy-holders, how dare they allow a 17-year old child to die because of petty haggling over approval of a life-saving transplant procedure? How dare they? Particularly given the already tarnished image faced by most of the industry heavy-weights.

Yet, here we are, weighing in on yet another case that at first blush looks like the usual big-guy insurance-giant bullying the little-guy. But is it?
Here is the breakdown:

• Nataline Sarkisyan, 17-year leukemia patient dies after being removed from life support following complications developed after a bone marrow transplant from her brother the day before Thanksgiving. The complications caused Nataline's liver to fail, placing her in a vegetative state.
• Nataline's doctors at the University of California, Los Angeles Medical Center, appealed to the Sarkisyan's insurer, Cigna Corp., to reconsider an initial refusal of a liver transplant, which doctors said was crucial to her survival. Cigna initially refused to authorize the procedure, calling it experimental.
• Cigna later rescinds the earlier decision, agreeing to the transplant in an 11th hour change of heart.
• Nataline dies within an hour of being removed from life support.

Nataline's family has promptly filed suit against Cigna, retaining the legal services of Mark Geragos (remember him from the Michael Jackson and Scott Peterson trials?), who promptly blamed the insurer for Nataline's death. Geragos has asked the California District Attorney's office to press murder or manslaughter charges against Cigna, claiming, the insurer "maliciously killed" her because it didn't want to pay for her transplant and aftercare.

At issue is whether the procedure would indeed have saved her life. Doctors in the case stated the survival rate for patients in similar situations is six months at 65 percent. A complicated case.
Access the article here

Too young to die for religion?

A recent case in the Seattle area of a 14 yr old boy with leukemia who refused a blood transfusion because of his adherence to the doctrine of Jehovah's Witnesses has raised questions about whether a juvenile is sufficiently competent to refuse lifesaving medical treatment due to religious beliefs.

To add more to the story, the boy was living with his aunt, who is a devout Jehovah's Witness, not with his biological parents, who are not.

A lot of the bloggers at ScienceBlogs are commenting on this tragedy to varying degrees, some questioning the patient's age, some considering undue influence from the aunt. Given current laws regarding medical treatment, protection of minors, and indeed, refusal of elective procedures like tubal ligation for competent adult women, this ruling will force us all to rethink our own standards on what is considered sufficiently competent in a patient, to what extent parents and guardians ought to be held accountable to harm that comes to those in their care because of beliefs they enforce, and which reasons are applicable enough to use to choose something as permanent as death.

(Of note: there have been other incidents recently involving Jehovah's Witnesses refusing lifesaving medical treatment, such as a woman who chose to die after giving birth to twins.)