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Peter, I'll let JLL (or any other M.D.) give his perspective. I will give you my initial thoughts without trying to write a thesis. There are many factors: 1) Doctor's training, experience, and HIV interest, 2) Patient cooperation (eg., avoidance of continued drug abuse, etc.), compliance, 3) Availability, cost of medications, 4) Progress, results of clinical trials of old/new anti-HIV therapies, 4) Policies of federal, state health plans; guidelines of HMOs, "Managed Care Organizations", 5) FDA drug approvals, 6) Lack of a recognized HIV specialty, 7) Miscellaneous. The most important and crucial factor is a well-informed patient. If needed, I will add additional input after the others have replied. From a personal standpoint, I have been a doctor for 30+ yrs, 8 yrs post-graduate training (after medical school), treatment of HIV patients since 1985, medical director of the 4th largest publicly owned HMO (1980s), board certified, and continued interest in HIV (I'm not trying to be self-aggrandizing but just trying to point out the differences in doctor qualifications; patients should check the credentials of their doctors, IMO). Enough said for now. Didn't mean to belabor the point but have been trying to give you honest answers to your excellent questions. |
