Re: SOAP BOX CONTINUES!
Nobody is dispensing legal or medical advice any more than are they dispensing legal or medical advice when they inform their friends that the drinking age is 21 (No, you are not advising anything, just making a statement of fact) or advise someone with a headache to take two aspirin. And what kind of ADVICE is this? And as an aside, one does not recommend treatment for a headache unless they know the etiology of the headache. I mean, aspirin will do nothing for a person with hypertension. I would want to know their blood pressure before I advised anything. What you have are seasoned travelers giving their opinion and quoting published sources. I quote from the CDC page and don't even give a personal opinion.
?I believe there is little need to take medicine on the remote chance you might become infected with something that is easily treated within 48 hours.? Quoted as per your post. You are giving a personal opinion and MEDICAL ADVICE. Just a selection of CDC statements that highlights the level of caution of the CDC warnings. I hardly think a tourist visiting a resort has any intention of avoiding drinks with ice, not going barefoot, wearing long sleeves from dusk to dawn, or wearing a life-jacket for a swim in the ocean, dangerous as it might be. This is probably true, however it is THEIR CHOICE and should be their decision AFTER being properly informed of the risks and consequences. To make a choice, one must know the risks and benefits involved. One can not make an ?informed decision? when information is with held or lacking. We all know the CDC has reasons for their recommendations. I would like to think it is for the public health and welfare. I am not aware of a hidden agenda. Statements like, "MALARIA: There is NO cure for malaria. ". That statement standing alone lacks balance and is borderline sensationalism, true as it may be. Sorry, I am not an English Major. I am not sure I understand ?balanced statements.? Does that mean instead of notifying an audience the building is on fire and evacuate immediately! I should instead say, the building is on fire and we should evacuate but the fire department has be notified and we have a functioning sprinkler system. Does that give more balance?
There is no cure for the potentially fatal "common cold" or "the flu" either. In the USA, I suspect a lot more people die from those two than from Malaria. Your analogy is somewhat flawed in that Malaria is endemic in the tropics and the USA is not considered in the tropics. Malaria remains one of the most prevalent infections in the world with over 200,000,000 cases! This is probably equivalent to the adult population of the USA. Add that to the end of your NO CURE statement and it adds a bit of balance, and I don't mean to belittle that fact that Malaria is more serious than the common cold. I for one don't know what the mortality rate is for Malaria, when treated or when not treated. Vivax, malariae, ovale all are ?self limiting? and remiss in about 60 days. However, P. falciparum has a mortality rate of 20%. Why don't you explain what a "chemoprophylaxis" is. Chemoprophylaxis is the use of chemicals (drugs/medications) to treat and/or prevent disease. Tetanus toxoid for example is a chemoprophylaxis against tetanus disease. When you say there is no cure for Malaria, do you mean you have Malaria forever, with symptoms that come back again and again, forever? A cure for malaria is elusive. However, one may go for decades without have a relapse then again, you may go for only several months. I use the analogy of cancer?we do not speak of cancer cures, rather we speak in terms of survival rates. Five year survival, ten year survival, etc. This is why we are cautious to use the word cure, even with very modern medications that seem to be able to prevent recurrences for extended periods of time. Still, blood banks do not want a person infected with malaria to be a donor regardless of when the attack was. If you get it and 10 years from now, if a mosquito bites you and then bites your friend, your friend will get it too, forever? NO, It takes several days for the protozoa parasite in the mosquito to maturate and go thru the sexual cycle (asexual cycle in humans) and it is highly unlikely that this particular mosquito will return to ?bite? your friend. And you use the ten year time frame, there are no chronic ?carrier states? I think you are scaring some of us, including me. It is the unknown that is scary; knowledge and understanding a situation relieves the frightening aspects. If I may use the analogy of AIDS. Before we understood the etiology of AIDS, it was scary. Now that we understand what it is, how it is transmitted, the pathophysiology, we have learned not to fear it but to respect it and avoid it. When it comes to health, ignorance is NOT bliss. I spend a lot of time in the DR and I don't want to have continuously be on some anti-malaria regimen, nor do I want catch some awful disease that never goes away ever and hope I don't catch it based on a mosquito bite. I live in the DR full time and have done so for eight years and love it. Continuous antimalarial regimen has NOT been recommended by the CDC. It has only been recommended to those visitors in affected areas. I am sure with proper mosquito control abatement that prophylaxis will no longer be necessary in these areas either. How easily IS it treated? Chloroquine medication is the treatment of choice presently (however, this does not attack the gametocyte stage in Plasmodium vivax and P. ovale which is necessary to prevent relapses. Primaquine phosphate is the medication of choice for this stage and may be given at the same time as Chloroquine. This is why it is so important to identify the species of Plasmodium one is dealing with in order to adequately treat it. After all, DR1 says their medical experts reported "In the very unlikely case you fall ill with malaria, the adequate dose of Chloroquine will release the sickness in 24-72 hours..." Is this not true? A resounding NO is the answer to this question and if you want first hand knowledge and report?contact a message board regular who has recently been diagnosed with the malady?.TOM. This is one of the things I object to, giving the impression you simply ?pop a pill? and all is going to be OK! After reading <A HREF="http://www.geocities.com/HotSprings/Resort/5403/MalariaFAQ1.htm">http://www.geocities.com/HotSprings/Resort/5403/MalariaFAQ1.htm</A>, it doesn't seem very hard to diagnose or treat, in most cases. Diagnosis of any disease can be extremely difficult?the reason: no patient presents as a classic text book example. There is always little nuances and ?red herrings? that confuse and complicate the picture. That is why medicine is an ART rather than a science. If it were a science, anyone could ?cook book? it and arrive at the diagnosis. And, once the diagnosis is made, it is easy to look up the treatment. And, it is not complicated in malaria because there is only ONE recommended treatment. Not a lot of choices to make. If your doctor does not THINK of the possible diagnosis, he is not going to make the diagnosis. If you do not tell him you have been to an area endemic with malaria, he will never think of it sitting in his office in Iowa City, Iowa! I also read that one should not take the prevention medicine long term because it is toxic. I don?t know what you mean by long term. It is recommended to take it two weeks before arrival to the area and for 8 weeks after departure and all during your stay. Most vacations are 2 to 3 weeks and so I don?t consider that a prolonged time. Primaquine can cause hemolytic anemia in black races due to a metabolic deficiency of G6PD (Glucose 6-phosphate dehydrogenase). Chloroquine is extremely well tolerated and minimal toxicity, the main complaints are desquamation and itching. In the event of allergy to Chloroquine the old stand by of quinine is used but it can produce cinchonism (tinnitus/temporary deafness) and drug fever. So what is your recommendation for frequent visitors? I consider the CDC the world experts in the field of public health and disease control and advise and follow their recommendations in general cases.. I would advise frequent visitors and world travelers to become familiar with CDC recommendations for the area you plan to visit and then to discuss these recommendations with YOUR PRIVATE PHYSICIAN and working in concert with him, decide on a course of action that is BEST for you. ECH, M.D.
