Læknaneminn - 01.04.1997, Blaðsíða 110

Peter Duesberg and David Rasnick
Institute of Child Health and Human Development
concluded that AIDS prophylaxis with AZT also
harms children: “In contrast with anecdotal clinical
observations and other studies indicating that zidovu-
dine favorably influences weight-growth rates, our
analysis suggests the opposite.” 205.
10) Even before the Concorde study a rare publica-
tion critical of AZT by the NCI reported in 1990 that
AZT increased the annual Iymphoma risk 50-fold
compared to untreated controls 19S.
But despite the devastating evidence that AZT
enhances morbidity and accelerates death by causing
AIDS defining diseases on its own, the faith of the
medical orthodoxy in FDA approved AZT seems
unshakable. No news is bad enough to discourage
AZT prescriptions 25,173 (see 7.8.).
Nevertheless, recently a few mainstream AIDS doc-
tors have openly registered dissent, although not in the
form of dedicated articles. Says Jay Levy, professor of
medicine at the University of California at San
Francisco, “With all the hoopla about antiviral drugs,
and you get any virologist aside and they’ll say this is
not how we are going to win, it’s high time we look at
the immune system” 206. Lecturing his medical stu-
dents, another professor of medicine at the University
of California at San Francisco, Donald Abrams, is even
more direct according to a university magazine:
In contrast with many of my colleagues at SFGH
[San Francisco General Hospital] in the AIDS pro-
gram, I am not necessarily a cheerleader for anti-retro-
viral therapy. I have been one of the people who’s ques-
tioned, from the beginning, whether or not we’re real-
ly making an impact with HIV drugs and, if we are
making an impact, if it’s going in the right direction.
Despite the promising evidence, definitive proof of
protease inhibitors’ efficacy can be provided only by
randomized clinical trials with placebo. Because new
antiviral drugs are continuously being developed, con-
ducting such trials is virtually impossible due to the
reluctance of patients to continue treatment with and
”old” drug. Abrams spent the first half of his lecture
describing analogous problems during the testing and
approval of AZT, the first drug used in AIDS therapy.
AZT, a nucleoside analog, belongs to a class of drugs
that inhibit DNA polymerization by terminating grow-
ing DNA chains. The study which demonstrated that
AZT might be of benefit was a placebo control trial
begun in 1986 involving 288 patients. Although the
study was originally intended to last 24 weeks, it was
cut short and unblinded half way through because of
statistically significant differences in deaths between
the two groups.
Abrams lamented that although ”18 more people
made it to this arbitrary milestone of four to eight
months after pneumocystis... I didn’t feel that this was
showing that we were prolonging survival.” Abrams
blamed the ”very powerful rhetoric” of the emerging
community of AIDS activists, who demanded an end
to clinical trials. "Somebody should write a book about
the impact of that decision on HIV clinical trials his-
tory,” added Abrams ”because everything changed
because of that demand.”
Abrams recounted his early misgivings about AZT,
which loses its effect after a year or two because the
virus becomes resistant. He was also disturbed by find-
ings demonstrating that a high dose of AZT resulted in
a smaller rise of CD4 cells than a lower dose. ”Maybe
if we just stop it altogether people will be better off,” he
said.
Members of the audience were surprised to learn of
the paucity of solid, clinical research behind AZT and
other nucleic acid chain terminators, which prevent
infected T-cells from transcribing the RNA viral
genome into DNA, thereby inhibiting viral pathogen-
esis. Abrams exposed the tragic farce of past AIDS
research and therapy—people who thought they were
doing something useful were actually wasting time and
valuable resources. How should the clinician apply the
new therapies? Abrams described his approach with
patients. ”1 have a large population of people who have
chosen not to take any antiretrovirals since I’ve been
following them since the very beginning... They’ve
watched all of their friends go on the antiviral band-
wagon and die, so they’ve chose to remain naive [to
therapy]. More and more, however, are now succumb-
ing to pressure that protease inhibitors are ‘it’... We are
in the middle of the honeymoon period, and whether
or not this is going to be an enduring marriage is
unclear to me at this time, so, I’m advising my patients
if they still have time, to wait.” 18°.
Some of the most damning admissions to the exis-
tence of AZT-specific AIDS diseases come from the
suppliers of the drug themselves. The warnings on the
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