Highlights of this issue

AIDS and indifference

The most recent AIDS statistics are so overwhelming, they are almost difficult to believe. Many countries in Africa are teetering on the brink of disaster as a growing proportion of their workforce is infected with HIV. Philip Berger attended the 2002 international AIDS conference in Barcelona and reports on the powerful implications of its theme, “knowledge and commitment for action,” and the extent to which Canada must expand its role or risk failing the people who need our help.

Figure. Photo by: MSF

Figure. Photo by: Fred Sebastian

One of the key issues in the struggle against global illnesses is that the most deadly illnesses (tuberculosis, malaria and HIV/AIDS) have defined themselves largely along economic and social boundaries. As such, people who need medicines most are the least likely to be able to afford them. James Orbinski, past president of Médecins Sans Frontières, discusses the missed opportunity that the G8 meeting in Kananaskis had both to endorse strategies to support equitable access to medicines and to offer a meaningful contribution to the fight against our world's biggest killers.

The winning entry for the 2001 CMAJ Essay Prize, “AIDS, Africa and indifference,” written by Joel Pauls Wohlgemut, articulates the difficulty one physician has in truly comprehending the plight of people thousands of miles away. The author describes the helplessness one might feel as a committed, compassionate physician in Canada, “believing that things ought to be otherwise, and chastising [oneself] for doing so little.”

See pages 481, 483 and 485

Income and spending patterns of panhandlers

Panhandlers are common in our urban areas. Most people have decided whether they are prepared to give them money or not. Part of the hesitation one might feel is because it is unclear whether giving panhandlers money is ultimately good for their health. Will the money be used for food and shelter, or for alcohol and drugs? Rohit Bose and Stephen Hwang studied the income of a population of panhandlers in Toronto and describe how it was spent.

See page 477

Elective surgery: indications and outcomes

Issues concerning the appropriateness of elective surgery, and access to it, have stimulated great debate in Canada. One of the most effective tools to measure the outcomes of such surgery is a determination of health-related quality of life (HRQOL). Charles Wright and colleagues examined the indications for surgery and the HRQOL of 5313 consecutive patients booked for one or more of 6 elective procedures in Vancouver. The most striking improvements in HRQOL were seen in lumbar disk surgery and total hip replacement, compared with an absence of change in HRQOL for patients who had cataract surgery.

See page 461

Fine-needle aspiration biopsy of the thyroid

Thyroid nodules are a common clinical problem, and their investigation and management are often challenging. Fine-needle aspiration (FNA) biopsy can be used as a diagnostic test or triage tool, depending on the nature of the thyroid nodule. In this article Kenneth Suen, who is a pathologist, describes the indications for performing FNA and the technique involved in gathering an appropriate sample; he also provides a guide for interpreting the results based on diagnostic groups.