HIV and ID Observations

This was going to be about the shiga-toxin-producing E. coli (STEC) outbreak in Germany, and I promise to get there eventually.

But to start:  One very useful concept from psychiatry is “reaction formation.” For those of you who have forgotten your college Psych 101, here’s the definition:

A psychological defense mechanism in which one form of behavior substitutes for or conceals a diametrically opposed repressed impulse in order to protect against it.

Some examples:  the person who controls criminal impulses by becoming a cop, or someone with a fear of heights who fixes cell phone towers.

How about ID doctors?  Do some of us choose this field because we’re scared of catching nasty bugs?

Undoubtedly yes — I have one colleague who, at great personal expense, had all the windows, screens, and vents replaced in his house because he saw some bats flying around his neighborhood on a warm summer evening. He has been observed to wear a surgical mask when he looks in his patients’ ears (“just to protect you,” he lies), gets the tempura at sushi restaurants, and he wouldn’t travel to a developing country even if you gave him, for free, round-trip first-class airfare and the best suite in this resort.

He’d deny it, but I strongly suspect his choice of specialty is directly related to his fear of contagion.  (That interpretation was gratis.  You’re welcome.)

But then there are plenty of us who are relatively cavalier about infectious risks.  In one famous example, a certain sainted ID doc (initials PF) never received vaccination for hepatitis A despite having probably the highest travel/work related risk on the planet.  The result:  a fairly prolonged hospitalization from acute hepatitis A.  Boy was he sick. (Read all about it in this excellent book.)

Even more impressive, there are those who bravely volunteer for outbreak investigations, even for incredibly scary, mysterious, or untreatable diseases. Two recent examples that come to mind are SARS in China and the  extensively drug resistant (XDR) TB cases in South Africa.

With the caveat that any self-reflection is likely to be biased, even in a highly psychoanalytic milieu (my father is a psychiatrist), I consider myself as one of those ID doctor on the less-worried side of the spectrum.  I’ll take my chances with the bats (unless one actually bites me …), choose whether to eat or not to eat sushi based on taste (not because of infectious risk), and believe that most Travel Clinics cater predominantly to the worried-well — or, if you want to be less nice about it, the paranoid. Plus, I have never feared getting HIV from patients, even in the 1980s when we knew a lot less about transmission than we do today.

On the other hand, I doubt very much I’ll be raising my hand anytime soon to volunteer for on-site evaluation of an Ebola outbreak.

But getting back to this toxin-producing E. coli:  here’s one infection that I do take pretty seriously — ok, I admit it scares me — and confess to being kind of rude about it.

You don’t want me at your cookout if you plan to serve hamburgers rare, as I will undoubtedly be obnoxious about sharing my fears not just with you but all the other guests as well.  Maybe it’s because of stories like this one. Or perhaps because my wife has discussed with me a few truly harrowing examples of previously-healthy kids from her practice who ended up on dialysis.  Or that antibiotics not only don’t help, they even increase the risk of disease.  And yes, I also saw the movie “Food Inc.” (review here), which really does make you understand why ground beef in particular is so risky.

So as they investigate the source of this terrible outbreak in Germany — which appears to be non-meat related, at least based on what is known right now — do yourself a favor, and cook those burgers all the way through, and skip the sprouts.  (I know burgers taste worse cooked this way, but most people don’t like sprouts anyway.)  And take some comfort in the fact that at least in the USA, cases of STEC from the O157:H7 strain are actually down (Journal Watch summary here).  Let’s hope it stays that way.