TIME: Almanac 1993/TIME Almanac 1993.iso/time/072991/0729350.000

Text File | 1992-08-28 | 8.0 KB | 168 lines

                                                                                MEDICINE, Page 50

Should You Worry About Getting AIDS From Your Dentist?


Probably not, but the government is moving to protect patients
and restore their trust in the medical community. Even so, it
pays to be prudent.

BY CHRISTINE GORMAN -- With reporting by Barbara Dolan/Chicago
and Anne E. West/Washington


    Mary Lynne Desmond thought she had found the perfect
dentist. Philip Feldman, a graduate of the School of Dental
Medicine at the University of Pittsburgh, had an engaging manner
and seemed meticulous. Soon Desmond, a fourth-grade teacher who
lives in Coram, N.Y., and her two children, husband, sister and
brother-in-law all became Feldman's patients. "But in the last
five or six years, he changed," Desmond recalls. "He did three
shoddy root canals on me and even left a drill bit in one
tooth." Now she has a lot more than a few botched operations to
worry about. Last week state health authorities confirmed that
they are trying to determine whether Feldman, 45, who died of
pneumonia in June, had unwittingly infected any patients with
the AIDS virus.

    Chances are that Desmond will not test positive. In the
past decade, out of the nearly 200,000 people who have
developed AIDS in the U.S., only five are known to have been
infected by a health-care worker. And epidemiologists quickly
point out that all five cases can be traced to the same Florida
dentist, David Acer. But the fact remains that it did happen,
despite the odds and with devastating results. Already one of
Acer's patients, Kimberly Bergalis, is near death; her plight
and her understandable fury have moved millions to feel insecure
when they go for teeth cleaning or an annual physical exam.
Nearly 6,800 health-care workers in the U.S. are known to have
AIDS -- including 170 dentists and dental hygienists, 730
physicians and more than 1,450 nurses. Should they tell
patients? Should they get out of medicine altogether?

    In response to public concern, the Centers for Disease
Control in Atlanta last week restated the strict standards of
infection control that it began developing in 1982 and that it
believes should eliminate any opportunity for doctor-to-patient
transmission. But for the first time, the federal agency also
urged dentists, doctors and nurses who perform invasive
procedures such as surgery to get tested for HIV, the AIDS
virus. If they are HIV-positive, said the CDC, they should stop
doing operations unless they reveal their condition to patients.

    Soon after that policy was announced, the U.S. Senate
moved aggressively beyond the CDC and passed two measures to
make the agency's recommendations, including disclosure,
mandatory. Under one proposal, sponsored by Senator Jesse Helms
of North Carolina, physicians could receive prison terms of 10
years and fines of up to $10,000 if they refused to reveal their
HIV infection before an operation -- whether or not they passed
on the virus to their patients. The second bill, backed by
Senators Robert Dole of Kansas and Orrin Hatch of Utah,
threatens any state that does not implement the CDC guidelines
over the next year with loss of its federal public-health
funding. Congressional leaders expect the Dole-Hatch proposal
to attract greater support from the House of Representatives.

    Not content to wait for federal action, the Illinois
legislature overwhelmingly passed a new law last week that would
authorize the state's health department to notify patients when
their medical-care providers are diagnosed with AIDS. The bill
was prompted by the revelation that the only dentist in the
town of Nokomis, Ill. (pop. 2,700), died of AIDS last October;
his patients were not notified until early this month, after a
state legislator threatened to make the circumstances of the
dentist's death public.

    Is the rush to legislate a case of hysterical
overreaction? Nothing has happened to make researchers change
their minds on how the AIDS virus is spread. Almost all
infections occur in the expected ways: people share contaminated
needles or have unprotected sex with an HIV-positive partner.
"The risk of getting AIDS from your doctor is lower than the
risk of dying in a car crash on the way to the hospital," says
Dr. James Mason, Assistant Secretary for Health at the
Department of Health and Human Services.

    In fact, medical workers are more vulnerable to being
infected by patients than vice versa. The CDC has documented 40
such cases -- most of them involving accidents with hypodermic
needles that contained contaminated blood. "Because there is
mass hysteria, and because this is a fatal disease, and because
people don't know very much about this, people's common-sense
reaction, including Senators', is to act first and think later,"
says Geri Palast, a lobbyist for the Service Employees
International Union, which represents 350,000 health-care
workers.

    The evidence strongly suggests that good sterilization
procedures will prevent doctors from endangering patients. Last
year, after one of the surgeons at Johns Hopkins Hospital died
of AIDS, officials at the medical center in Baltimore informed
1,800 people on whom he had operated that they may have been
exposed to the virus. So far, none of them have tested positive,
and all the lawsuits filed against his estate have been
dismissed. Delaware health officials have offered free HIV tests
to more than 1,200 patients of a Wilmington dentist who died of
AIDS in March. Of the 600 who have taken the state up on its
offer, none have tested positive.

    The guiding principle of standard infection control is to
act as if everyone and everything is infected with something --
whether it be Staphylococcus bacteria, tetanus toxins or the
AIDS virus. That is why instruments should be sterilized in an
autoclave, physicians should change gloves or wash hands between
patients, and disposable swabs, syringes and other items should
not be reused. Although the CDC's disease detectives are still
not sure what went wrong in Acer's office, they are zeroing in
on just such a breach in infection control.

    The danger is not from the doctor but from slipshod
practices, says Jack Rosenberg, a Manhattan dentist and founder
of a gay and lesbian dental guild. "Asking your dentist whether
or not he is gay is not going to protect you," Rosenberg says.
"Instead, you should ask, `Do you sterilize your instruments?
Do you follow standard infection control?' Those are the
questions that will protect you." Rosenberg caused a ruckus last
week when he publicly declared that he knew several dentists who
are HIV-positive and that he advises them not to tell their
patients.

    Knowing the HIV status of a surgeon or dentist should not
necessarily reassure a patient. "These are people who are
exposed to patients every day," says Dr. Michael Callahan,
chairman of an AIDS task force for the American College of
Emergency Physicians. Yet it can take a person six months after
infection to make enough antibodies against HIV to test
positive. Says Callahan: "If I got tested yesterday and was
negative, I might get exposed to HIV tomorrow." In addition, the
danger of bad sterilization practices is that the virus passes
from one patient to the next, rather than from the doctor.

    Instead of becoming enemies, doctors and patients need to
communicate better about the risk and fear of AIDS. Dr. Nancy
Dickey, a Richmond, Texas, family practitioner and a trustee of
the American Medical Association, says patients should not
hesitate to voice concern if, for example, they see blood on
their doctor's hands, even if the physician says, "Don't worry
about it." They also have a right to ask exactly how each piece
of equipment has been sterilized. As the AIDS epidemic enters
its second decade, professionals and private citizens alike
should choose a path of reasoned caution, rather than dismissive
bravado or irrational hysteria.