Many people are unaware that if a parent of a newborn child in Illinois feels unable or unwilling to keep their baby, he or she can bring the infant to a hospital, emergency medical facility or police or fire station and legally and anonymously relinquish the baby. The baby will be given any needed medical care and then placed with an adoption agency for permanent placement with an adoptive family. More than 125 babies in Illinois have been surrendered safely in this way since the state passed the Abandoned Newborn Infant Protection Act in 2001 to reduce the risk of a parent under extreme stress harming a newborn.
My son Francis is the 127th of these babies. My husband, John, and I are immensely grateful to be his parents, and to the Safe Haven law for giving babies like our Frankie a chance at a wonderful life.
My family’s Safe Haven story started when we signed up with a local adoption agency to adopt a newborn. We were expecting a more traditional type of adoption, when an expectant mom decides to make an adoption plan and selects a family for her child while she is still pregnant.
I began my medical training in 1986, just a year after HIV, the virus that causes AIDS, was first identified. Already, nearly 25,000 people had died of AIDS in the U.S. alone, and to date more than 650,000 people in just this country have died with an AIDS diagnosis.
In the early part of my career as an infectious disease specialist treating patients with HIV and AIDS, I expected that I would see every person for whom I provided care die. We could prolong their life to some degree, get them through certain infections, but at some point they would progress and die of AIDS.
That’s no longer the case at all. We’ve made extraordinary advances in treating and preventing HIV infection and AIDS in what for medicine is a very short amount of time. As we observe the 30th annual World AIDS Day on Dec. 1, it’s a good time to consider the current state of AIDS prevention and treatment, how far we’ve come, and how much work remains.
Know your status
This year’s theme for World AIDS Day is “Know your status.” In the U.S., guidelines from the federal Centers for Disease Control and Prevention recommend that all sexually active people who are from 13 to 64 years of age get at least one HIV test in their lifetime. Persons at higher risk — gay and bisexual men, transgender women who have sex with men and injection drug users — are candidates for annual testing.
Currently, approximately 36.7 million people are living with HIV worldwide. In 2016 (the most recent year for which data is available), 1.8 million people worldwide were infected with the virus, according to UNAIDS.
In the United States at the end of 2015, approximately 1.12 million people were estimated to be living with HIV infection, with about 162,500 of them undiagnosed, the CDC reports. In 2016, nearly 40,000 people were newly diagnosed with HIV infection in the U.S. The good news is that this number is lower than the nearly 45,000 people that were infected in 2010, but that number still is too high.
In Chicago, 23,824 people were living with HIV in 2016, and 839 people were diagnosed with the infection that year, according to the Chicago Department of Public Health. We are making progress: That number is the lowest we’ve had in a year since 1990.
People at risk for HIV infection should be tested because earlier treatment improves outcomes, and treatment that reduces the presence of HIV to undetectable levels in their blood reduces transmission of the virus. It’s also a way for at-risk people who are HIV negative to learn about PrEP (pre-exposure prophylaxis) –the use of antiviral drugs to prevent HIV infection.
In the mid-1990s, before we had effective antiretroviral therapy, we only were able to add about eight years of life to people who were HIV-infected. There were a lot of people dying and it was a difficult time to be a physician. In 2010, an infected 20-year-old person in the developed world can expect to live another 55 years, nearly a normal lifespan, according to UNAIDS.
When we are able to identify HIV-positive individuals and treat them to bring their HIV down to undetectable levels and maintain undetectable levels, the chance of them transmitting the virus to someone else is zero. A European study followed 888 heterosexual and same-sex male couples, in which one partner was infected but their HIV levels were suppressed for at least six months and the other partner wasn’t infected. They found that after more than 58,000 sex acts without a condom, there was no documented transmission of HIV to the uninfected partner.
Overall, in the United States a person’s risk of HIV infection in his or her lifetime is one in 99, the CDC estimates. However, this risk is not uniformly distributed. HIV is affecting a large part of our community, especially on the West Side of Chicago and among minority populations. Black men are the most affected ethnic group, with a one in 20 lifetime risk of HIV infection, and black and Latino men who have sex with men have a one in two and one in four lifetime risk, respectively. (These estimates come from the CDC.)
People who test HIV negative but are at significant risk for HIV infection should be offered HIV pre-exposure prophylaxis (PrEP). Taking the drug Truvada once daily can reduce the risk of HIV acquisition by more than 90 percent.
Rush is doing its part
Because the West Side communities we serve are at higher risk of HIV infection, Rush has implemented protocols to test for the virus among our patients. Since March of 2015, we’ve had an opt-out HIV testing program in our emergency department based on CDC guidelines. Through this past July, we’ve tested 19,569 people,and 142 of them tested positive, including 47 who were newly diagnosed and 13 with acute HIV (a condition that occurs in the first few weeks after infection and causes flulike symptoms).
Early this year, we expanded our testing program to three primary care clinics, two on our main near West Side campus and one in Lincoln Park which have performed 1,232 tests through October, with two positive results. We plan to expand this program to other clinics in 2019.
We are also working on an initiative to create an alert to prompt clinicians to consider HIV PrEP in at-risk persons.
As difficult as it was to live through the early part of the HIV epidemic, it was also incredible to contribute to the advances that have made HIV into a chronic treatable disease and no longer a death sentence. The collaboration between physicians, scientists, patients, and activists was unprecedented and were critical to these advances. I’m proud to have spent my career at Rush, an institution that has been at the forefront of HIV research via our ongoing participation in the NIH-funded AIDS Clinical Trials Group Network since 1987.
Beverly Sha, MD, is an infectious disease specialist at Rush University Medical Center.
On Monday, Nov. 19, my daughter’s eighth birthday, I was watching my children play at the school playground, when suddenly sirens began blaring all around. Staff ushered everyone into the school, stating there was a shooting nearby, and we were going on lockdown.
For a few chaotic minutes, I lost my son in the crowd. All of us at the school were safe, but we soon learned of the tragic shooting at Mercy Hospital just a few blocks away. On this day, the innocent lives of Dr. Tamara O’Neal, an emergency medicine physician, Dayna Less, a pharmacist, and Officer Samuel Jimenez were victims of gun violence. The shooter also died.
Chicago and the entire nation grieve these losses. My husband knew Officer Jimenez from his time working as a security guard at Skokie Hospital. He tells me what an honorable and good man he was. Many of our Rush family knew the other victims personally. And while these deaths are soul wrenching, they are all too familiar. As of Nov. 24, the Chicago Tribune reports there have been 518 homicides and at least 2,710 people shot in Chicago in 2018. According to the Centers for Disease Control and Prevention, over 14,000 of the 19,000 who died from homicides in 2017 were from firearm-related deaths. Study after study shows how dramatically higher our rate of death from gun violence is compared to other developed countries. Gun violence is undoubtedly a public health crisis.
Jill Feldman with radiation oncologist Gaurav Marwaha, MD, left, and medical oncologist Philip Bonomi, MD.
By Jill Feldman
I have been fighting lung cancer indirectly, and now directly, for 36 years, and most of it has been an uphill battle. I lost my dad and two grandparents to lung cancer when I was 13, and then my mom and aunt, Dede, died of lung cancer when I was in my 20s. I was shocked and upset that in the 14 years between my dad being diagnosed with lung cancer and my mom being diagnosed, there was not a single advancement in lung cancer treatment, despite it being the No. 1 cancer killer. My family and I felt helpless and hopeless, and while there wasn’t any research on hereditary lung cancer, I knew our familial lung cancer wasn’t just a coincidence.
I did what I could to get educated, be an advocate for myself and my family and to help advance a cause that many were not aware of and/or not interested in. While doing so, in 2009, I was diagnosed with lung cancer at 39 years old. My kids were 6, 8, 10 and 12 — and their only association with the disease was death. They were scared, and my greatest fear was becoming a reality. I was following in my family’s footsteps, and there wasn’t any promising research that convinced me the path would change.
For many years, the only distinction doctors could make was whether a person had small cell or non-small cell lung cancer, and patients had three treatment options: surgery, radiation and chemotherapy. It wasn’t even until the 1990s that combination chemotherapy regimens were approved. Still, there was debate whether it was even worth treating lung cancer because in many cases, the toxicity was worse than the disease, and the benefits from chemotherapy were marginal.
Immunotherapies have changed how we treat the disease
By Philip Bonomi, MD
One of the things I learned early on in medical school is never to forget that it’s a privilege when a patient puts his or her trust in you to take care of them. I have never taken that privilege lightly. My goal has always been to prolong meaningful life and relieve suffering for my patients. That’s been my personal mission statement throughout my career.
And those goals are not always easy when it comes to treating lung cancer. When I started out in medicine, some of the treatments we tried for lung cancer were simply not effective. There were not a lot of options for our patients and often the prognosis was poor.
But through my long career, I have seen that perseverance, believing in an idea and not giving up on it can pay off.
Enter immunotherapies. When I was in medical school in the late 1960s, we had high hopes for immunotherapy. We thought it was going to be very important for treating patients with cancer. But then, we saw one failed study after another over the next few decades.
My mother died two years after being diagnosed with stage 4 ovarian cancer. She had for years believed strongly in naturopathy, so after a six-month period of remission, when her cancer returned after a round of integrating complementary medicine with chemotherapy, she chose to treat her cancer solely with alternative treatments.
I am a nurse who believes in evidence-based practice and also in innovation. I accepted my mother’s decision not to use chemo when her cancer came back because I knew from researching the disease that when ovarian cancer comes back, life expectancy is similar with or without chemo.
So, despite my reluctance to trust treatments that have not been tested for safety or efficacy, I reasoned that little harm could come from alternative treatment methods at this point.
I watched as my 73-year-old mother spent the last year of her life replacing the foods she loved with concoctions of cottage cheese mixed with flaxseed oil. I listened as she justified spending thousands of dollars and hours of her precious remaining time traveling many miles to receive vitamin C infusions.
Hope for ‘miracles’
As she grew more ill, I gently questioned the supplements she was taking — often so many that there was no room left in her shrinking stomach for any food. And at times, when I could find evidence that a treatment had been scientifically tested — and proved not to be effective — I shared a strong opinion.
Statistics often feel unrelated to everyday life, however the recent BMJ report on the increasing incidence of alcohol-related liver disease in our younger population mirrors my real life experiences in clinical practice. In the last few months alone, I have seen an increase in young adults being admitted for alcohol-related liver injury.
Many of these young people struggle with depression or addiction and often use alcohol as a coping mechanism. While most recognize they’re drinking, they don’t realize how dangerous their habit has become until they present with jaundice, malnutrition and multi-organ failure. Unfortunately, what is often accompanied with the progression of liver disease, several of these young patients have died.
As both a parent and a physician, it is a challenge to care for these young patients who should have a long life ahead of them. But instead, I find myself speaking with their families about hospice and end-of-life arrangements. From my point of view, this means there is an urgent need for physicians to speak with their patients, especially those who are younger, about alcohol consumption. Alcohol is ever-present in our society, from advertising to social events, it’s around every turn. Meaning it is our responsibility to discuss what safe alcohol consumption really looks like with our patients and discuss it often.