Learning the history of medicine, and particularly the history of oncology is something that has been occupying more of my time as I progress through the years. I think it’s neat (and important) to know the historical perspective of how we got to where we are. In fact, this blog and this project of mine has sort of ‘forced’ me to look into some of these cases. I’ve found it to be pretty rewarding and it often comes up in conversations with the parents of the kids I treat.
Anyway, on to the topic at hand. Pneumocystis jiroveki (the bug formerly known as Pneumocystis carinii) is a type of deadly pneumonia, Pneumocystis jiroveki pneumonia (PJP for short), that affects people with poor immune systems. The causative organisms responsible for PJP affect the ability of oxygen to diffuse across the lungs, and if it is left untreated, the mortality rate nears 100% as essentially the patient will suffocate.
In 1977, Walter Hughes conducted a trial in pediatric leukemia patients using Bactrim (an antibiotic) to prevent PJP and it worked marvelously. Much like the initial studies conducted by Sidney Farber, pediatric oncology led the way in preventing this deadly disease. The cheap and generic antibiotic, Bactrim, when used properly can reduce the rate of PJP infections more than 85% in immunocompromised cancer patients. After that initial trial by Hughes, formal recommendations were made in 1981 that leukemia patients and other similarly immunocompromised patients should receive PJP prophylaxis with Bactrim. .
Unfortunately, as often is the case, there is a dark side to the history of PJP and Bactrim as prophylaxis. As the HIV and AIDS epidemic was starting to take hold across the United States in the early 1980s, practitioners started noticing that the AIDS patients were contracting PJP at much higher rates than would be expected. By 1984/85 it was clear that the AIDS patients were significantly at risk for PJP and death by PJP. However, for multiple reasons, none of which appear to be based off of sound scientific facts, it wasn’t until 1989 and over 30,000 PJP deaths later that the CDC put out a statement regarding PJP prophylaxis and HIV/AIDS patients.
There is much more to this sad story of an ostracized group that you can read about here. It is written by an infectious disease doctor who was treating the HIV and AIDS patients in the early 1980s and saw this unfold.
It is important to study history, so that we may never repeat its mistakes.
