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Medicine and Public Policy |

Have We Treated AIDS Too Well? Rationing and the Future of AIDS Exceptionalism

David J. Casarett, MD, MA; and John D. Lantos, MD
[+] Article, Author, and Disclosure Information

From University of Iowa Hospitals and Clinics, Iowa City, Iowa; and the University of Chicago, Chicago, Illinois. Grant Support: The MacLean Center for Clinical Medical Ethics receives support from the Dorothy J. MacLean Family, the Henry J. Kaiser Family Foundation, the Andrew W. Mellon Foundation, and the Pew Charitable Trust. Requests for Reprints: John D. Lantos, MD, MacLean Center for Clinical Medical Ethics, University of Chicago, Department of Medicine, 5841 South Maryland Avenue, Chicago, IL 60637-1470. Current Author Addresses: Dr. Casarett: Department of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(9):756-759. doi:10.7326/0003-4819-128-9-199805010-00009
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During the past decade, medical therapy for AIDS has become more effective but also prohibitively expensive.A medical tragedy has been transformed into a financial crisis, and society has responded by establishing special programs and sources of funding for AIDS. These maneuvers parallel earlier approaches to HIV testing and reporting that have collectively come to be known as “exceptionalism.”

This paper suggests that exceptionalism in resource allocation is a fragile, short term solution.In the long run, AIDS exceptionalism will create growing injustice and should be avoided. However, we should not eliminate the advances that this exceptionalism has already achieved. Instead, we need a working dialogue between these advances and public policy.





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