The Unsung Story: George W. Bush’s Overwhelming Success in the Battle to Fight HIV and Aids

Despite continued focus and attention on America’s healthcare crisis – And the Obama administration’s crafting of a reform bill that will drive the final nail into the coffin – there is a true “feel good” story about healthcare that’s been largely ignored.  In their fury to blame George W. Bush for everything from the failing economy to global warming, the media have ignored the overwhelming and sustained success of his efforts to address HIV and AIDs in Africa.  


AIDs activists, NGOs and media elites are quick to heap praise on Obama for expanding AIDs-fighting programs, but the real credit belongs to his predecessor.

The “secret” to Bush’s formula for success was a departure from previous multi-billion dollar aid initiatives. Bush envisioned a new kind of aid program – One that focused on creating partnerships with businesses and private industry rather than delivering trucks full of cash to corrupt local governments and inefficient aid organizations.  He proved that large scale treatment and aggressive prevention programs can be implemented by leveraging relationships with the pharmaceutical companies that produce retroviral drugs, and the private sector, including churches, to deliver care.

Both the 2002 Global Fund to Fight AIDs, Malaria and Tuberculosis and his 2003 President’s Emergency Plan for AIDs Relief (PEPFAR)delivered remarkable and measurable impact on a hugely suffering population.  Indisputably, the programs helped to save 30 million lives from the scourge of AIDS, and proved to be one of the most successful foreign aid initiatives ever.   Recent economic development and free market reforms have been possible in Africa largely as a result of its people being yanked back from the brink of near certain death.

In addition to markedly decreasing the incidence of new HIV infection and deaths from AIDs, Bush’s efforts engendered significant good will and gratitude from the peoples of Kenya, Sudan, Tanzania, Zimbabwe, and Uganda – an important and rarely reported side-effect by those propagating the myth of the U.S’s dismal reputation around the globe.

Today, PEPFAR and the Global Fund continue to provide retroviral drug therapy to suppress HIV infection and programs to prevent maternal transmission of HIV to children.

But that’s not all: Bush’s healthcare legacy extends beyond these initial programs to the work that his twin daughters, Jenna and Barbara, are now pursuing.  The Bush daughters helped to formulate the concept for Global Health Corps, an NGO with a mission to improve access to healthcare in impoverished communities in the Unites States and around the world. Both are now actively involved in its operations.  


Similar to their father’s approach with PEPFAR, the Global Health Corps leverages people with operating experience and connections to supply chains rather than simply providing cash and supplies – the only truly sustainable way to manage global health crises.  Given our country’s current financial constraints, we can anticipate growing challenges to our commitment to many humanitarian efforts; this model for foreign aid provides our best hope for continued success.

Whether this story has been simply over-looked or actively suppressed by the main stream media is unclear.  Without question, the media and the current administration remain obsessed with unfairly blaming Bush for a host  of economic and other ills, and he rarely receives the recognition he deserves for his accomplishments.  Many have predicted that history will ultimately paint his presidency quite attractively.  


In the near term, however, the irrefutable, if oft ignored, legacy of George W. Bush may well be the story of his optimism, creativity, commitment and success in addressing suffering and a true healthcare crisis on another continent, and his vision for a sustainable approach to humanitarian aid.

                                                    blog founded by Kelly Victory

                           written by Kelly Victory MD copyright 2012 all rights reserved

The Obama Administration's Covert Healthcare Rationing

I spent over 15 years practicing as a trauma and emergency medical specialist. During those years, I learned that many patients -- especially those facing death, imminent limb loss, or another devastating outcome -- are willing to try potentially risky, but cutting-edge interventions, as long as there's a reasonable chance of improving their outcomes.

Indeed, if you're suffering from a life-threatening illness or injury and traditional treatments aren't working, there's nothing to be lost by trying a riskier treatment -- and everything to gain.

Yet, a recent ruling from the Food and Drug Administration eliminates that option for thousands of late-stage breast cancer patients. And, even worse, that decision appears to be part of a broader push to put the government and its regulators between patients and their doctors, and to weigh cost over outcomes.

In December, the FDA rescinded approval for Avastin in the treatment of advanced breast cancer. Initially approved for the disease in 2008, the drug has been shown, when coupled with chemotherapy, to delay tumor growth by a median of 11 months -- almost five months more than chemotherapy alone.

But upon re-evaluating Avastin, FDA officials decided that the drug's potential side effects outweighed its benefits for breast cancer patients and voted to withdraw its approval for that disease.

 That decision is now being appealed, but assuming FDA approval for Avastin is withdrawn, public and private insurers will likely scale back their coverage of the drug for breast cancer, leaving these patients to either pick up the drug's $90,000 per-year price tag on their own, or forgo it. Most simply cannot afford it.

People in truly life-or-death situations will take on extra risk for the chance of months or years of additional life. Many advanced breast cancer patients are in exactly such a situation. Conventional treatments haven't worked, and the disease continues to progress. Without action, they can, and will, die quickly.

Avastin won't save all of them; for some, however, it could provide a significant extension of life. Yes, the drug might have some adverse side effects, but shouldn’t the ultimate determinant of that risk be the individual who stands both to benefit or to suffer from that choice? Neither I, as a physician, nor the government, have the right to make that choice for someone else.  

The Avastin ruling seems to be driven largely by cost concerns, and public insurance programs no doubt, stand to reap huge savings if they stop paying for the drug for breast cancer.

Unfortunately, the Avastin decision isn't an isolated incident. The Obama administration is pushing rationing, insidious as it may be, on multiple fronts.

Last year, the Agency for Healthcare Research and Quality changed mammography guidelines to tell women they shouldn't get their first exam until age 50. This modified guideline wasn't based on a new study evaluating the effectiveness of mammograms; it was based on an actuarial evaluation indicating that exams for women under 50 didn't have sufficiently high cost-benefit ratios.

In May, the National Institute of Health (NIH) released the results of a comparison study between Avastin and the biological drug, Lucentis, for the treatment of age-related, "wet" macular generation (AMD).

This time, however, the government looks to be coming down in favor of Avastin -- but for the same purpose of blind cost-cutting.

Lucentis is officially approved by the FDA to treat wet AMD, which can cause blindness, while Avastin is not. However, when broken up into small bits and injected into the eye, Avastin has been shown to stop the progress of the disease, and doctors have taken to prescribing it off-label for this purpose.

These two drugs drew the government's attention because of their price difference: A Lucentis regimen for AMD costs about $2,000 per year. A similar course of Avastin clocks in at just $50.

The NIH found that Avastin is "as effective" as Lucentis -- even though 5 percent of patients on Avastin encountered more "serious adverse events" than those on Lucentis. Many fear that the government will use the NIH comparison to influence its public insurance policies. Specifically, officials could impose a "fail first" in Medicare for wet AMD treatment, forcing patients to try Avastin first.

There is a serious danger in such a policy. While these two drugs might be comparable for most wet AMD patients, there is a select group for whom Lucentis works better. Human bodies are amazingly complex and can react to drugs in vastly different ways, for reasons we don't yet understand. If that select group is forced to use less effective Avastin first, their eyesight could be permanently compromised.

In all these cases, the message from the government is clear: we're putting cost savings before human lives and outcomes.

Lowering healthcare costs will require identifying and eliminating wasteful spending and fraud in the system, improving the overall health of Americans, and allowing the free market to create natural cost pressures. But giving breast cancer patients a serious shot at additional years of life isn't a waste. Neither is screening women in their 40s for the disease. Or giving people facing permanent blindness the best options for saving their eyesight.

Our government needs to get out of the doctor's office.

                                                  blog founded by Kelly Victory
                                    Kelly Victory MD copyright 2012 all rights reserved