Sawbones: A Marital Tour of Misguided Medicine - The Pill that Helps Prevent HIV

Episode Date: October 5, 2021

Were you aware there’s a medicine that with an extremely high degree of efficacy can prevent the spread of HIV? There is! There’s just one problem: It’s costly. … And not enough people know about it. … And many doctors don’t know enough about it. … And it’s the center of a protracted legal battle . . .  Okay, so there are a few problems. This week on Sawbones, we’ll explore them all.

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, two, three, four. I'm not a sense the escalant my cop for the mouth. Hello everybody and welcome to

Saabones, Emerald Tour of Miss. I started too loud. Yes, it is. It was like nowhere to go. You want to take it again? Welcome to Saabones. It's Emerald Tour of Miss Guy in Medicine. That sounded like I was hosting a show about woodworking. Hi, welcome to Saabones. Today in the workshop, we're going to be building this beautiful birch bookcase. And I'm Sydney McAroy.

I don't know this what stuff I made up for the first thing. I just didn't know where I get that. And I'm Sydney McAroy. I didn't know where that would come in. I'm holding the glue for him in our woodworking. I was shocked when you started doing woodworking and I learned how much stuff gets glued. Yeah, it's surprising, right? A lot of people think it's nails, nope, mostly glue. Yeah. Really strong glue. Yeah, strong wood glues. Stronger than wood. I hope it's really strong because you've built these wood things and you put glue there to hold it together and then you're like, hi children, climb on that.

Why are we wasting time with wood is the thing, right? We should just be making it all out of glue. The glue is so strong in the wood. Well, Sydney, we've glued the introduction of this podcast to the body of it by arriving here with that great segue. What is on the docket today? It's a very perred, perred. Well, the introduction of this podcast

was at the beginning. Now we're moving on to the rest. Perred happily. Perred happily, thank you. Couldn't remember his last name. So, Justin, I feel like a really important conversation that people are happening, have a happening, have a happening. It's happening, people are having right now.

It's been a long week. Is how to take steps to prevent something bad from happening, like an illness, perhaps, a sickness, a virus, an infection. And the virus is something. Any virus that you can think of. Instead of waiting instead of waiting

until it already happens and then trying to treat it, I think we've all realized, well, many of us, not a high enough percentage, perhaps, to achieve herd immunity have realized, but definitely some of us have realized how important that is. I have a saying about this. Do you want to hear what an ounce of prevention is with a pound of cure. Yeah, that's, did you just come up with that? Just came up with that myself. So I thought another, we've talked a lot about vaccines in that regard and about COVID vaccine, but I thought another topic that is timely in a sense, in that it's something

that people don't know enough about and is not utilized enough. And it's certainly important I know in our area and maybe in yours too depending on where you live. I live with you I think we live in the same house. Well I'm into our listeners. Ah. Our dear listeners.

Ah and that's HIV pre-exposure prophylaxis or prep. A lot of people talk about HIV prep. Are you familiar, very familiar with the concept? That's embarrassing. You're talking a lot about prep when you started working with it. And I just didn't process, because I know the thing that's like prep or preparation. So I just thought you were kind of like preparing for people to have AIDS. I didn't actually know what you meant.

And I am sorry about that. That's okay, that's okay. That's, if you don't know what it stands for. And I didn't, I've made that clear, I've already owned that. Right, and if you see it written out, you'd know there was something up because there's like another, there's like an extra,

there's some extra capitalizations in there. And you'd be like, wait, why are there more letters capitalized in that word? And you know. Yeah, look at it now, the text. I, can I say that to be fair? I don't feel like you were saying. Prep? I feel like you weren't saying the lowercase r in prep.

I feel like you weren't like the accentuating it. Right. Ep. Prep, well, it's as opposed to pep. So in, in HIV, when we're talking about trying to prevent the transmission of HIV, you can do pre-exposure prophylaxis so you give somebody a pill to try to decrease their risk of contracting HIV ahead of time, or there's post-exposure prophylaxis PEP, which is when someone has potentially been exposed to HIV, and you can give them medications to decrease

the risk of actually, you know, having HIV. Yes, got it. Even though they've already been exposed. So these are two separate sort of issues, prep and pet, for short. Now, this is not an episode all about HIV. HIV is such a, I think, such a big topic because of all the cultural significance of it, especially in this country, the denial of its existence and impact for

so long. And there are many, many stories about that that are very well told that you can, you know, watch and learn, not just, you know, what is this virus, what is, what are the treatments for it, but all of the issues, the social issues, cultural issues, that surround that. And I think that there's a lot of different episodes we could do around that topic, but it would take a stays, right? That's why there's whole movies about this. I feel like it doesn't get the play it used to. HIV and AIDS. I feel like there's much less of a conversation about those at this point. Maybe that's obviously as a layman,

I may be just encountering it less, but that is my sense. I think that you're right. I think in the recent going on two years now, it's COVID, but that's whatever it going on two years now, it's COVID, that's what everyone's talking about. And it's hard for me personally because where we live, we have these sort of twin epidemics that are happening

both obviously COVID because that's everywhere. But also in our part of the world, cases of HIV or being spread pretty rapidly, especially considering that we live in a smaller, I mean, we're technically a city, but just barely. And in areas where you've seen a lot more people using injection drugs, you can eventually see these sort of HIV outbreaks. And that is exactly what we're seeing here. And you are, you are absolutely right that because COVID is getting so much attention, which I'm not saying it shouldn't. No, I think there have been pretty clear about that.

Other things like in this instance, HIV, I think are definitely getting neglected. Yeah. And I think there is this sort of, this understanding that we have such effective treatments for HIV that it is not as pressing of an issue in a lot of people's minds, which is true to an extent, right? We have incredibly effective treatments for HIV. But getting them to everyone who has HIV is that's still a barrier, diagnosing everyone who is carrying the virus and doesn't know, and then giving people access to things to prevent contracting HIV. All of those are still giant hurdles that we haven't, you know, some people have crossed, but many, many still haven't, and there's a lot of work to be done.

And PREP is part of that. So the idea of taking something every day to try to prevent something is not a new idea, right? Like ideally we'd have a vaccine. That would be perfect, right? If we just had an HIV vaccine. Wasn't there some work on that? Yeah, it's been in the works. So hopefully, hopefully. That I mean that would be amazing. Imagine a vaccine in the neighborhood everybody will just take it and I mean why wouldn't they? That's what happens right when there's a life threatening virus and then science creates an amazing vaccine that is incredibly effective at preventing serious illness and death, everyone just takes it.

This is not a new idea. By the way, I think a great corollary for this conversation is malaria. So malaria, which we also are working right on a vaccine for, but we do not have one that we can widely give you. They're testing them, but we just don't, you know, we're not quite there. Malaria, the idea of taking a pillage day to prevent that, that dates back to at least the 1700s, maybe earlier, because, and we've done a whole episode about this, about malaria and the history, but we know that the bark of the synconetry contains quinine, and that that was discovered and used very early by people, sort of like

as in indigenous people in folk medicine, using this as a way to treat feverish, which were not known yet to be malaria, but we're almost certainly malaria. And then eventually, within the next 100 years, you see people taking this bark daily, if they're in areas where you might get malaria. So the idea of using something every day to try to prevent you from catching something So the idea of using something every day to try to prevent you from catching something well-established. Yeah, it's very logical. Right, and we do that to this day from malaria.

I have traveled abroad several different times and had to take a pill every day to prevent getting malaria while I was in that area of the world where malaria is more common. It's the only safe thing to do. Like if I know that I'm going to be riding the big dip or at Canon Park, I take a tetanus profile axis.

It's the same idea. You just can't date too many precautions. I will say that the reason you don't talk about taking a pill every day to prevent something as much to prevent contracting an illness is because of vaccines, right? Because we figured out a way to inject you with something that would give you that much longer lasting immunity as opposed to having to take something every day. I just realized that I probably did a fair bit

of narrowcasting there a few seconds ago. Folks, if you didn't know about West Virginia's one lonely theme park, Camden Park, Huntington West Virginia's own, you turn in where you see the happy clown and you're just going to be treated to a day of thrilling adventure. Near death experiences. Yeah, haunted houses there. There's a wall that's covered in ABC gum.

There's a wall covered in ABC gum. This places everything. Go get on YouTube and search for the big dinner in a canopark. It is a wild, is a wild room. It's a big wooden roller coaster. The thrilling roller coaster. So shaky. Oh, it's a shaky one, folks.

It looks like one of those, it feels like you're on one of those like when the 1800s, you ever see the ones that are basically just like people in a cart used to carry grains around on a big shoot. Like a my cart from Donkey Kong or something. Yeah, exactly. So it feels like it's great.

Cannon Bar is the best. So we don't think about it as much, I think, because of vaccines, but there are other conditions we use prophylaxis for, just to sort of set the stage for this. Like there are antibiotics that we can use as prophylaxis for different illnesses. Like, when I was younger, I was on antibiotics for a long time to try to prevent me from biotics that we can use as profile access for different illnesses. Like, when I was younger, I was on antibiotics for a long time to try to prevent me from getting UTIs, urinary tract infections. We don't really do that anymore, but we thought we could for a while.

There are people who have to take them. People with, people living with HIV sometimes have to take certain medications to try to prevent different opportunistic infections or infections that you can get when you are immunosuppressed people with a sight ease of condition. We have fluid and your stomach might have to take an antibiotic every day to prevent an infection So there's lots of reasons we might do this and the concept of Doing this for HIV is a newer one. We had that you know, I mean really we're just talking about since the two thousands You know about two thousand four ish is when we started thinking about and trialing this sort of idea.

In the earliest days of the AIDS pandemic, we didn't know what to do about it, right? There wasn't enough detention being paid, nobody knew how to prevent it, how to treat it. What caused it? Anything. So, scared people refuse to shake hands with someone with HIV or share any sort of spaces like public Restrooms, you know, that was a big that was a big problem and you've seen and I've seen it circulating more recently pictures from like the silent Or the minority report the silent majority report or whatever that it's the conservative Christian magazine that was circulating I don't know. I will say it's not the minority report.

I don't think it's from. Well, it was a no, it's not that. It's they would I don't remember what it's called, but it's pictures of a conservative family wearing masks to try to protect themselves from contracting HIV. Well, last time's conservative family was more masked. Yes, I think this is why this this image is circulating. Gotcha. Yeah, exactly.

And of course, none of that is how you prevent contracting HIV and masks are not part of it. You can shake hands, you can share restrooms, all those things are fine. We eventually learned that like condoms are an effective means in reducing the transmission of HIV. Right. In the case of sexual contact, we also learned that people who use injection drugs could decrease their risk of contracting HIV

by using a new needle every time, not sharing needles or reusing that kind of thing or new equipment. And that's where needle exchanges came from, which we've done a whole episode on. But by the 2000s, we had a lot of drugs as well to treat HIV. So we started learning how it was transmitted, learning ways to prevent it, and then eventually we began to develop medications

that could actually effectively treat the virus and by the 2000s, we had lots of those. From 2004 on, we have these medications from Gilead, which are gonna, that's a pharmaceutical company, which are gonna become the focus really of this episode. And our understanding of the virus has greatly increased, right? We knew how these medications work to stop the virus in a variety of ways.

There's a lot of different ways that HIV medications can stop the virus and prevent you from progressing from HIV to acquired immunodeficiency syndrome. AIDS, right? Boy, I'll be honest, folks, it is really hard to not stop you to sing lines from rent every 15 seconds. And I know that that's neither here nor there. And probably I would imagine people who are living with AIDS are tired of hearing about

rent because for a generation of people that is your reference That is the reference point as Tim Robbins once told me Rent taught my gel generations something really important tolerance So I Tells that I tell us that it was so Tim Robbins It was a perfect Tim Robbins thing that it could possibly happen Don't you love when you meet someone and you have all this sort of pre-excieved notion and then they just fit then you're just like,

I knew exactly. We were talking about how Sydney's sister Riley, her generation had grown up on Hamilton. And that was their rent. That was their rent. And I said, but it's cool for them because they're gonna get a fundamental understanding of the American Revolution.

And Tim Robbins said, you know, just in your generation learn something that's important for red tolerance. I was like, this is great. Oh my God, Tyraman. Tyraman's the best. It's so true. I want to get into, so we've established this concept. We have lots of preexisting ideas about like,

what do you mean by prophylaxis and ways that that works and different illnesses that can work for so We have HIV we need to learn a little bit about HIV for me to get into how these medicines work and why I'm talking about them And what the controversy is around them today But before I do that We got it. Yeah, we got ahead of the bar I was getting ran up? Let's go. The medicines, the medicines, the askin' if my car's for the mouse. The medicine, the medicine's the askin' if my car's for the mouse.

Hey, excuse me everybody. I just wanted to say a few words about the beautiful couple. I've known you two for a long time. And you get along like peanut butter and chocolate. Or, you know, like comedy and culture, like a maximum fun podcast. Actually, they're having a block party from October 11th to October 22nd, and that's kind of like your party, right? You have a community of friends and family,

and Max Fun has a community of shows and audiences that support them. You're having a new start with your life together, and Max Fun will be putting out new episodes that are especially welcoming to new audiences. So it's a great time to introduce your friends to your favorite show or jump into one you haven't tried before. He's still talking about podcasts.

And they're setting up a volunteer event where we can help out our local communities. Plus, Max Fun is gonna have games, prizes, episode wrecks, so much other fun stuff. It's wrong with Kyle, is he okay? Oh! Anyways, anyways, sorry for getting carried away there. If it's all right with everybody here, let's always our glasses for a toast. To the Max Fun Block Party, which you can learn more about at maxmomfun.org slash block party. And don't forget to join in on October 11th.

Actually, that, that sounds pretty cool. You know, this is classic broadcasting blunders because I should have teased my great Tim Robinson story to keep people hooked. Did you say Tim Robinson? Tim Robbins. Oh, okay. Story. I should have teased that I had that coming up

after the break, you know what I mean? But I'm about to tell you how the HIV virus works. Just as good. Just as interesting for sure. I said HIV virus, which is, well, this was all, it's a late night recording for for the long week of inpatient hospital service. It is not treating a lot of folks at the hospital who've made a lot of

a lot of very sick people. It's been a long week. Okay. HIV is an RNA virus. Yes. Right. We've got DNA. Some viruses have DNA. Yeah. Not HIV. You're at DNA. Not HIV. It HIV. Not HIV. It's got RNA. But it also has an enzyme called reverse transcriptase, which basically helps it make DNA. It uses its RNA to make DNA. And then it takes that DNA and it puts it into our cells, makes more HIV.

That's it. That's kind of, I mean, that's a simplified version of it, right? The medications that help us, if someone has HIV, that you treat the HIV with, work in a variety of different ways, okay? Because there's lots of different ones. There are some that can stop the virus from entering ourselves. There's a called fusion inhibitors. And then there are medications that can stop the virus from replicating once it's in there. So and those are called nucleoside reverse transcriptase inhibitors and non-nucleuside reverse

transcriptase inhibitors. And those are the things that are really... Can I ask you a question? Was cyberverse in there? Because that sounds awful. No. That would be cool though. It would be cool if you guys snuck cold words into the fancy sounding things.

So, you know, and then the negatron energy waves. I think nuclear cyroverse transcriptase inhibitors is pretty cool sounding. And you didn't say cyroverse. I didn't. Okay. There's an, there's an integrase inhibitor that can stop the viral DNA from getting into ourselves.

There are protease inhibitors that can stop us from putting HIV particles together. There are others too. The medications that we're focusing on are two that are those nucleicide reverse transcriptase inhibitors. They prevent the HIV from replicating. Basically, that's the thing that you need to know about them. There are two medications that are that are in tricitabine and tinofavir. You may have heard them. This is important for the podcast, right? You're not just trotting out, okay.

You may have heard them called truvata or dysgovie. Those two combine, make those two medicines that are slightly different, but basically the same. Okay. These are the medications that you can use for pre-exposure prophylaxis, like an HIV. Okay.

It's a pill a day. Pillow day keeps the HIV away. One would help. Yes, that is the goal. Well, I mean, they can greatly reduce your risk. Okay. Okay. What is the efficacy, do you know?

Like, like, about part? Yeah, they can. So if you used perfectly, hold on, I have my stat. I wrote it down on here. They are upwards. They're in the 90s, 90% effective. Wow. Even when you use imperfectly, they greatly reduce your risk.

But like, in some studies up to 99%, but definitely in the 90s, all the studies said that if you use them, yeah, up to 90% and then in some other studies even higher, if you use them though you're supposed to. Okay. So incredibly effective medications. They tried this first. So starting in the early 2000s is when we really see this research take off.

So you have all these drugs and like I said, these that I just mentioned have been approved for the treatment of HIV since about 2004. Truvada has. It's been around for a long time. So they started with animal models. There is something called a simian immunodeficiency virus, SIV. Same thing we get, but in simians. So they tried it in animals first, both oral meds, pills, and they started

creating like a vaginal gel. That was one concept of it was if we could insert this vaginal gel prior to receptive vaginal intercourse, then maybe we could prevent it that way. So they tried it in these animal models that seemed to work. So they started to investigate this possibility in humans. Their first, like to work. So they started to investigate this possibility. In humans, the first thing they really tried was this gel, and it was a little cumbersome to use. That was one of the big problems with it, is that you had to, in a certain amount of this gel,

prior to sex, you had to do it again after sex. You could only do it twice in 24 hours. It's a lot. And you had to do it twice in 24 hours. It was a lot. And you had to do it perfectly. Now, it did work. If you use it right, it did reduce your risk of contracting HIV. So it was effective, but it was just hard to do right.

And obviously, it's only a solution for someone with a vagina. So it's limited in how many people can help. So then studies, more focusing on the oral medications began. And it took a little longer, but by 2010, we have a study published in the New England Journal of Medicine at the University of California in San Francisco that showed that when taken daily, true vodka could reduce the risk of getting HIV up to 90% in men who have sex with men and transgender women who have sex with men.

And this led to the approval of it for this year's pre-exposure prophylaxis in 2012. And then they did subsequent studies to expand on their knowledge. So they have this certain patient group that they know that it works in. So they started trialing it more in people who have vaginas and trialing it in people whose main risk of getting HIV is actually injection drug use because that was the next question. What works when your risk is sexual contact? Does it still work if your risk is injection drug use? So, which it seems like it should be the same, but we actually have different exposure sort of like timeframes, like how often are people being exposed to the virus?

And will that change if it's effective? And you know, because if someone is using, is sharing needles multiple times throughout the day and being exposed, possibly to HIV multiple times throughout the day, as opposed to sexual contact, which may only be once every few days or whatever, you know, different risk profiles. Anyway, they found it effective in all of these patient groups, very, very effective. And of course, the more regularly you take it, the more effective it is. So, you know, if you do have a patient population that has a lot of trouble accessing the medication, taking the medication daily, getting refills, seeing a healthcare professional, of course, it's not going to be as effective,

but if you can get people to take it, it works. And that led to the approval of both truvada for these groups, and then eventually, very recently, another medication, discovie, which is almost exactly truvada, it has like a slight difference in one of the two drugs in it. Orange flavor, humma. Yeah, yeah, one's orange, one's great. That's perfect Yeah, yeah. One's orange one's great.

That's perfect. That's so much better than that. No, Sid, was there? You were telling me before we were starting to chat about this, and there was some hesitation from people like leading up to this that maybe it would, I mean, it's the same argument that you hear about prophylaxis like for pregnancy, right? Like if you, if you have this, then people are just going to the teens, we'll just go have all the pre-barrel sex they could sell it.

This was exactly the initial fear. Once Truvato was approved, there were a lot of people who were against this concept. Based on the idea that if you could take a pill every day to prevent, you know, contracting HIV or spreading HIV, if you already, well, no, you wouldn't take this if you had HIV ever. You would hopefully be on treatment, but to reduce your risk of contracting HIV, that you would engage in riskier sexual behaviors or injection drug using behaviors than you would have otherwise. And so what they really focused on is people won't use condoms. I mean,

that's what that was the, that was how this was. I'm on the, the purple axis. Yes, I don't need a condom. I, and I mean, a lot of this was, was also based in a lot of sort of prejudice. View of the groups of people who are at risk. So like specifically, a lot of this was focused on gay men. Gay men are going to use this as an excuse not to have to wear condoms. And there was a lot of fear around this, even though in the studies when they were getting Truvada approved and then you know trying it out in different patient groups and all this, they actually looked at that. out in different patient groups and all this, they actually looked at that. One way that's really easy to look at that is check the risk of other sexually transmitted infections.

Because if you're testing this out and you have a group that's getting truvaata, that's getting the medication, if they're really using condoms that much less, they're probably going to be at higher risk for other sexually transmitted infections that aren't prevented, right? They weren't, they weren't getting them, because they were still using condoms. Or if they weren't using condoms, they still weren't, but either way, the point is,

it didn't really change their behavior. There was actually some predisposition for people who were on prep to use condoms a little more in some of the studies, but either way the point is being on prep did not make someone more likely to engage in a high-risk sexual behavior otherwise, right? So even though that data was there and the evidence showed that, this myth of what, is this a bad word? Can I say this word on our show? Don't ask me, I'm a literal worst person, you could ask. I don't know if I can say this word.

There was a phrase that was coined on the chart. Oh, I see what you're saying. For people who would start taking truvada and use it as an excuse to. I think this is okay. Okay. For solbons, I think this is all right. Folks, if you're worried about sort of,

no, how do you, I think I would have used this word in my day to day. But it is exactly, it's a problem. Well, there was an article that was published. A Term of Art. Like a popular science article who said like that these people, they called them Truvada horse was the term that started being used.

You said that in a very clinical fashion that I don't think anybody could be upset about. Well, it's obviously an incredibly offensive term. Obviously. Because it assumes, well, it assumes a couple things, right? That like if people are taking Trivada, they will engage in high-risk sexual behaviors, maybe be thoughtless about their behaviors, be more likely to have more partners,

not use condoms or other forms of protection. And it also assumes that having multiple sexual partners is bad inherently, right? So like it's a double, it's a double bad. Right, it's all bad. Double plus bad. It's double plus bad. But because of that, this myth that started to be perpetuated, it made it really difficult for people to access care because one, if that was what the narrative around this drug

is, people are going to be less likely to ask for it. And two, if you have healthcare providers who aren't well educated on this topic, they're going to be nervous about prescribing it, because they're not going to know. They're not going to have done all the reading. And if a patient does ask for it, they're going to say, I think that makes my patient more likely to engage in high-risk sexual behavior. Oh, I shouldn't let them have it. And the truth is like, in this case, the doctor, the healthcare professional who's probably going to be asked about it

is gonna be like your primary care doctor. So you're not necessarily talking about, and I say this as a primary care doctor, we are not necessarily always the best educated on things like this. Like, I was not taught about prep. I taught myself. So, you may have somebody who's hesitant to ask,

even when they muster the courage to ask their doctor about it, gets refused. So, there were a lot of people arguing that if we normalize it, we're going to do more harm than good. And this really limited, you know, it's uptake. Like even from the beginning, even though we've had this drug around since 2012 and then a new drug since 2019, like there just aren't that many people

on pre-exposure-profil access. Even though again, they're incredibly effective. To add to all of this, there is a legal controversy around these medications. So both drugs are made by Gilead. It's like a really, isn't that, it's like a really unfortunate name for a drug company to have right now, right?

Yeah. Pull that from the handmaids to you. I don't know. Could just be an old person's name. I couldn't watch that show the handmaids tale. I don't know. Could just be an old person's name. I couldn't watch that show because it just was too. Too real. It was too real. It is important to know that when we talk about like the early studies of HIV pre-exposure

profile access and we're looking specifically at Truvada and that study that I mentioned from University of California. A lot of government money was used to fund that study. So the government thought they should control the money? Well, also the money that wasn't from the government was like donated by the Bill and Melinda Gates Foundation. So you have the struggle that was developed or well, it was already developed. It was approved for this new use using money that taxpayers put in and that was donated by charitable organizations. And then of course, Truvada, and then of course, once Gilead releases it for this new indication

is making a lot of money off of it. It is, by the way, named after the, uh, the bomb of Gilead, yeah, a rare perfume used me recently. Oh, okay. In the Bible. Right. I know it was something biblical. Yeah. Anyway, so the point is we funded it. Right. Right. Tax taxpayers and Bill Gates just like the Panama Canal over down funded it How and so the government actually applied for patents on it? They should be in control right right they funded it right But they weren't approved until after Gilead had already patented it and released it and started making money off of it. Classic, classic.

Right? Yeah, it's good stuff. So now we have a conflict because who should be making money off of this? Maybe nobody. Whoa. Because the thing is like it started to become apparent that a lot of people weren't being able to access this. And the government's going, I mean, we help make this thing.

Yeah, why don't we let them do this? Why are we letting them do that? So in 2019, Gilead asked the patent office to deny the government patents on the basis that, basically what they were saying is like, yeah, sure, sure, sure, the government helped out or whatever, but it wasn't their idea either. A lot of people had these ideas.

These were all just free ideas that were out there. And we just happened to be the first one. We jumped on it first. Yeah, and like we're making this drug and it's life saving. And also we're gonna strike this deal where tell you what, we'll donate a certain number of like so many thousand pills, you know,

to people who need it. And like we're really gonna, we're good to people who need it. And like, we're really going to, we're good guys. Look at us donating on these meds. We really want to help out, right? So they do this PR thing. It, yes, they donated free meds in the big picture. It was a drop in the bucket. But like they did, they did this thing to look good and charitable. And at first, and this is all happening under the Trump administration. And at first, the Trump administration and Giliator just like best buds, right? This is great. Look, they're helping us.

We're going to end HIV by 2030. Yeah, right. Was their big announcement. They're going to do this, okay? Big news. Except then later, the government changed course and said, never mind, we're going to sue you for infringing on our past. And the Department of Health and Human Services sued Gilead. And so now they're locked in

this legal battle that is still ongoing and still hopeful to the everyday American. That's the important thing because the government is saying we want to get this pre-exposure prophylaxis out to everybody as quickly as possible and as cheaply as possible. And Gilead's like, no, but G any like side effects? Obviously. Yeah, I mean, there definitely are. So most people tolerate it. Like you said that everybody should be on. No, it is indicated for people who are at high risk of contracting HIV.

And they're specific like risk categories. If you think that you are in one, you should talk to your primary care physician, they should be able to, you know, to, they should know about it or be able to, you know, to, they should know about it or be able to look into it. But there are specific risk categories. What I am most involved in is the prescribing of pre-spezure perphylaxis for people who

use injection drugs, and that is their risk factor, especially in our area where the rate of HIV transmission is higher than average. And it could be an excellent tool, right? It's one more tool we have in fighting another virus that, like you said, has been neglected while we all spend so much time talking about COVID, and that is HIV, which is still a problem on which people are still getting and people are still having trouble accessing care. Only about 270,000 Americans, a little bit more than that now, probably are on pre-exposure peripheral

access. I'm assuming many more should be. Yes, yes. The big limitations are costs. There is still a cost. You got to have insurance. They are still patented. You know, we are, the is our brand name medications that you have to be prescribed and if you don't have insurance, they're gonna be way too expensive. There are programs that can help pay for these things,

still not enough, knowledge of them at all. A lot of people don't know they're out there. Well, that's fixed. I mean, that now that we've recorded a podcast about it is corrected, so that one you can actually scratch off your notes. And we need a, and the education on the medical end has to improve too, because a lot of prescribers are not familiar with it, and so they have some discomfort. Even if it's not something that they have some sort of weird moral opposition to, it's

just they don't know it. And so they don't know how to do it. It's really, you ask about side effects. Most people tolerate them extremely well. You just have to make sure one that the patient doesn't already have HIV because you do not want to, this would not be alone a treatment and that you'd be treating them inappropriately, right? So you gotta make, you have to test for that first. You do have to check a kidney function because for people with reduced kidney function, it could be dangerous. And then other than that, there's not a lot of monitoring, other than checking periodic HIV tests to make sure that the person hasn't contracted HIV. And some people have some GI symptoms at first, a little bit of nausea.

In my experience, most people tolerate it well. That's what the data says. Like I said, it's a pretty low-risk intervention. It does need to be monitored. You do need to have somebody who can check you periodically for HIV and you do need to have somebody who can, if you have any kidney problems, you need to be watched. But other than that, the main thing is just, you gotta take it every day. So you have to have access to it

and you have to be able to afford it. I don't know where the the lawsuits will land or what good that will do. How long that will be tied up. I would like to mention a lot of why these lawsuits are happening and why there is a push to get prep out to people. Once again, this is true over and over again in the story of HIV and AIDS activism. It was an activist group called Prep for All that did a lot of that heavy lifting. One excitable, one excitable, one excitable injectable, that could be approved by the FDA in January is a long acting injectable form of pre-exposure profile access. It's one shot every eight weeks that could reduce your risk

of contracting HIV. It would help to get to that standard of like how effectively it's being used, right? It lowers the margin of error there considerably. Right, because you don't have to take a pill every day. So that could be a really exciting evolution in this field. Again, we have to be able to afford it. People have to know it exists so that they can ask for it.

Or doctors have to know that it's out there so they can recommend it. And feel comfortable prescribing it and monitoring it. But this is a really underutilized tool that we have. And if you are someone who is in, if you do meet the criteria for high risk for contracting HIV, somebody who's a partner of someone who's who's living with HIV, that is somebody who who would be a candidate for this. Again, people who use injection drugs,

typically men who have sex with men or transgender women who have sex with men, but talk to your healthcare provider. If you think you might be in a group, talk to them because these medications are out there and you may be a candidate for them. And they can, you know, they can prevent spread of HIV. So they're great tools that we have. Excellent. Not enough people know about that.

Well now at least six or seven more do. Thank you so much for listening to our podcast. We hope you've enjoyed yourself. Next week's exciting, it's the max fun block party We're going to be kicking off a week of fun and frivolity We're gonna be pointing towards some some new favorite shows To check out we're going to be everybody's gonna have really accessible Episodes for for newcomers. It's gonna be a lot of fun. We're gonna be hanging out. I think Sid and I are gonna do a live stream of the hit film

Fast 9 on That yeah, I know you are I think I bet it's about family. It probably this one is probably gonna be about family I think there'll be Saturday at 9 p.m At least is the the plan that we have talked about. So that's exciting. And a lot more good stuff. So that'll be our YouTube channel, probably the McWare Family YouTube channel.

If you want to check that out. But please, can I say something? Yeah. Please, if you haven't been vaccinated against COVID-19, please get vaccinated. Yeah. If you know someone who hasn't been vaccinated and is hesitant, please keep having those conversations, please

This has been the hardest week of inpatient hospital service. I've ever had in my life and I did a residency I did a medical residency for three years that was grueling No one week was comparable to this past week So please please get vaccinated get your flu shot while you're out there was grueling no one week was comparable to this past week. So please, please get vaccinated. Get your flu shot while you're out there. Those are out there unavailable. Get your flu shots, get your COVID shots. Please.

Whatever shots. There's a lot of suffering that could be prevented right now and it's just a little jab. Thanks to the taxpayers for these. There's some medicines's the intro and outro and a program and thanks to you. Feel us to make sure to appreciate you. That's gonna do it for us until next time.

My name is Justin McRoy. I'm Sydney McRoy. And as always, don't drill a hole in your head. Alright! Audience supported.