Editorial

In the world of medicine, there is no “one size fits all.”

The FDA is reminding health care professionals who prescribe antibiotics that there are new safety labeling changes for systemic fluoroquinolones. The purpose of the new prescribing information is to strengthen and clarify previous label warnings about the risks for serious blood sugar disturbances and psychiatric side effects associated with these medications. The changes are summarized below:

So far, we have lucked out. After 2 months, the latest Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, although awful, has not been as bad as some of us in the public health community had feared. It has not spread to neighboring Uganda, or to Kenya, then on to Europe or the United States, triggering panic and a global public health and economic crisis. Yet.

Ted Eickhoff understood the intersection of public health and the infectious disease practitioner, effectively using his editorial pulpit at Infectious Disease News to promote dialogue and discourse on the rapidly changing circumstances that would dictate public health policy. He recognized the ever-evolving microbial world’s impact on not only the individual patient, but on the community at large, and remained at the forefront, ensuring that infectious disease practitioners received needed information in a timely manner so they could remain staunch public health partners. A profession is traditionally defined by its common body of knowledge. As with the 1910 Flexner Report that proved revolutionary for medical education in the United States, the 1915 Welch-Rose report presented to the General Education Board of the Rockefeller Foundation outlined public health as a profession in which “Unity is to be found rather in the end to be accomplished. ... Public Health is not a single profession in the traditional sense and is best defined by its shared goals rather than its disparate means. Articulating who we are and what we do remains one of our greatest challenges.”

As ID professionals, we all are familiar with the concept of HIV treatment as prevention, or TasP. The science establishing TasP as an effective medical and public health strategy was established by HPTN 052, a randomized clinical trial involving 1,763 serodiscordant couples from nine different countries, which showed a 93% reduction in transmission risk in couples in which the infected partner was assigned to early ART. The implications of this finding were so significant that in 2011, Science highlighted the study as its “Breakthrough of the Year.” Collectively, results from HPTN 052 and several other landmark studies have validated that people living with HIV who have maximally suppressed virus on ART do not sexually transmit HIV to their partners. But surprisingly, this information has not been conveyed to the affected community in a meaningful way that would allow them to share its benefits.

In July 1988, the first issue of Infectious Disease News was published (Figure 1, that’s right, I kept it all these years), with Dr. Ted Eickhoff as the Chief Medical Editor. Virtually all adult and pediatric infectious disease specialists received it at no cost. And although unsolicited publications (freebies) are often mostly a glorified collection of advertisements, IDN seemed different, with meaningful, well-written pieces, by very reputable experts, supplemented by high-quality pictures on glossy paper. It took the reputation of Dr. Eickhoff to recruit leading experts to contribute and his academic leadership to ensure overall quality.

Malaria has been one of the most important infectious diseases of humans for millennia. Our understanding of malaria has progressed steadily, from the discovery of the parasite by Laveran and the elaboration of its life cycle by Ross, both in the late 19th century, to progress in characterizing malaria clinical features and epidemiology through the 20th century, to an explosion in our understanding of parasite biology, vector mechanisms and host responses in recent years. But has all this progress in our understanding of malaria gotten us closer to eradication of this deadly disease?

Antibiotic overuse in the United States has been notable, with prescribing rates far exceeding other developed nations. Prescribing of unnecessary or inappropriate antibiotics in the ICU is estimated to be 30% to 60%.

Recently, the Canadian HIV Trials Network published its guidelines for pre-exposure prophylaxis, or PrEP, and nonoccupational post-exposure prophylaxis.

The slogan of this year’s National Black HIV/AIDS Awareness Day was “Stay the course, the fight is not over!” Yet for health professionals and people living with HIV, or PLWH, “staying the course” is simply not good enough. The “blackening” of the HIV epidemic in America has been going on for decades, and now blacks account for 43% of PLWH and 45% of deaths among PLWH, while making up only 12% of the U.S. population. Georgia, where I practice, has the highest rate of new HIV diagnoses among states, and blacks there account for nearly three-quarters of new diagnoses. Although new diagnoses have decreased nationally overall, among black gay and bisexual men the rate has continued at a steady pace, starkly illustrating that our progress in both treatment and prevention is not sufficiently reaching those who need it most. Transgender populations, especially those of color, are largely not counted but they experience especially severe disparities.