The Fear That a Doctor or Dentist Has AIDS : Punitive legislation is no substitute for professionalism

Blending contempt for voters with fear of them makes for volatile medical policy, as the U.S. Senate showed last week.

Polls indicate clearly that Americans worry about being infected with AIDS by a dentist or a surgeon during operations in which the virus can enter a patient’s bloodstream. But Americans also know full well that the AIDS epidemic cannot be wished away or simply legislated out of existence.

Yet that is what the Senate tried to do last week. First, it voted to send doctors, dentists or nurses to prison for 10 years if they pull teeth or work on surgical teams without warning patients that they carry the AIDS virus. Then it approved a second bill, sponsored by Senate leaders, to cut off federal financing of health programs in those states that did not require surgeons who specialize in what are called “invasive procedures” to submit to AIDS testing.

WRONG ANSWER: The problem here is that just knowing that a doctor will go to prison if he passes the AIDS virus to a patient is hardly likely to relieve patients’ anxiety. And cutting off state health programs is entirely too blunt an instrument. The rest of the leadership’s bill, introduced in hopes of heading off the prison-term bill by Sen. Jesse Helms (R-N.C.), has merit where it is patterned after a proposal of the federal Centers for Disease Control.

But a far better solution would be for Congress to simply stay out of this for now. That would give the newest guidelines from the CDC, the knowledgeable agency that monitors and analyzes the AIDS epidemic in the United States, a chance to work.

Those guidelines, published days before the Senate acted, call for all health-care workers involved in invasive procedures to volunteer for AIDS testing.

The Senate knew when it approved the Helms bill that although fear of being infected during surgery may be real, it is also irrational.

The CDC strongly suspects that one Florida dentist infected five of his patients, one of whom is now near death. But months of investigation failed to prove just how the disease might have been transmitted. Moreover, there are no other documented cases in which patients have contracted AIDS from a health-care worker.

So the Senate itself acted irrationally when it cast a vote, making the threat seem so immense as to require federal action.

In fact, only doctors, dentists or nurses have the power to reduce whatever small threat may exist.

The CDC seemed to recognize this with its recommendation that health-care workers volunteer for AIDS tests. If they tested positive, CDC said, they would be prevented from performing invasive procedures unless a panel of experts cleared them for practice and their patients were fully informed of the situation.

The proposal would not apply to treatment by infected health-care practitioners whose treatment does not require invasive procedures.

RIGHT PRINCIPLE: The CDC’s new guidelines carry forward a principle that doctors at the center of the fight to control AIDS saw almost immediately after the first appearance of the disease: Attempts to force tests would simply drive Americans who suspected they might be infected underground and make it even harder not just to treat the disease but to learn how to treat it.

That principle is worth preserving as long as voluntary testing continues to protect the American public from infection by health-care workers.

Just as important as the CDC’s proposal for testing was its reminder of the importance of strict adherence to standard procedures for preventing the spread of any disease in surgical settings, such as handling blood with care and sterilizing instruments. That has always been--and remains--a patient’s first line of protection against infection of any kind.