Words From The Front
AZT Is Death
is death. Celia Farber picks up the pieces of a shattered medical
establishment at the Ninth International Conference on AIDS in
I emerged from
the organized madness known as the Ninth International Conference
on AIDS feeling strangely muted, a logjam of emotions caught in
my throat: Despondency and rage among them, but also something bordering
on joy, the joy of truth long held captive and finally released.
The famous Concorde study has driven a stake through the heart of
the seemingly endless AZT mythology that has enveloped and governed
the AIDS treatment debate for six years now. It's baffling to see
how truth can be suspended for long periods - endlessly subdued,
rerouted, rejected. But like an airplane in a holding pattern, eventually
it has to land.
In the past
I have described my feeling that AIDS research is driven by ideological
undercurrents - that it tends to mold all observations in such a
way as to confirm, rather than challenge, its central believe system.
A veteran attendee of these gigantic conferences, I have finally
realized that simply to report the bits and pieces of data one has
absorbed misses the point; it is not so much the data that changes
from year to year, it's the AIDS establishment's response to and
interpretation of the data. What reporters are really reporting
on year is the zeitgeist of the establishment - which data they
reject, endorse, ignore or trumpet. That is what shapes the forthcoming
"reassessment," and "open-mindedness" were the
buzzwords of this year's conference and normally arrogant AIDS figureheads
gathered in roundtable discussions and spoke in hushed tones about
the need to reexamine their old convictions about treatment, pathogenesis,
and epidemiology. The reason for this remarkable soul-searching
was that 1992-93 was a period that saw several cornerstones of AIDS
- That "early
intervention" with AZT is in any way beneficial to people
with HIV antibodies but no symptoms.
- That HIV
causes the immune system to collapse by a direct cell-killing
mechanism. (Instead, "indirect" mechanisms and cofactors
- That CD4
cell counts are a good marker for immune status, health, or drug
efficacy. Instead, it was revealed that large segments of the
"healthy"-HIV-negative population have the same low
CD4 counts typically associated with AIDS.
- That everybody
with HIV will eventually succumb to AIDS and die. An estimated
5 percent of the HIV-infected population are now expected never
to develop AIDS.
in Amsterdam, the great conference revelation was that an "AIDS-like
illness" had occurred in people who showed no sign of infection
with HIV. Health officials scrambled for plausible responses to
the startling "mystery," which, in fact, had been documented
in the medical literature since 1986. This year, in Berlin, the
headline in the "news" that AZT, the pinnacle drug of
AIDS treatment and research since 1987, is a failure.
who has followed the literature on AZT throughout, this is not news
at all, but merely "official" confirmation of what has
been known for years. If one had launched a full-scale truth-finding
expedition - groping through the fallen rubble of AZT propaganda
to find the kernel of truth underneath it all - the Anglo-French
Concorde study would not have seemed revelatory at all.
on for three years, examining 1,749 HIV-positive but healthy people
at 38 health centers in the U.K., Ireland, and France. Because the
research lasted the longest of all AZT studies to fate, and its
pedigree was unassailable (it was conducted by the highly reputable
British Medical Research Council and its French equivalent), Concorde
could not be dismissed. The team concluded that AZT - a highly toxic
and carcinogenic drug - neither prolongs life nor staves off symptoms
of AIDS in people who are HIV-antibody positive but still healthy.
for the Concorde "disappointment" has been in the literature
for many years. As we reported in November 1989, the first objective
study was completed in France in 1988 and was published with very
little fanfare in the Lancet, a British medical journal. The study
found that AZT was too toxic for most people to tolerate, had no
lasting effect on HIV blood levels, and left the patients with fewer
CD4 cells than they had started with.
appeared surprising, it was because we in the U.S. have been captivated
by self-induced AZT mythology for so many years. It was our FDA
that approved AZT for use in 1987 based on very flimsy data and
with a little arm-twisting, and it was our National institutes of
Health (NIH) that expanded the parameters for AZT to be given to
all healthy, HIV-positive people. In 1989, the NIH cited a study,
known as Protocol 019, that it said had "clearly shown"
that early administration of AZT would keep AIDS at bay in that
population. Dr. Anthony Fauci, director of the National Institutes
of Allergy and Infectious Diseases (NIAID), recommended that anyone
with HIV antibodies and less than 500 CD4 cells should start taking
AZT at once. At that time, that meant 650,000 people in the U.S.
I had heard
that the Concorde team had been under tremendous pressure from AZT's
manufacturer. Burroughs Wellcome, to soften its results. After one
of the sessions in which the results were discussed, I walked up
to Dr. Ian Weller, a chief investigator of Concorde, and congratulated
him. I asked whether there had indeed been pressure from Wellcome.
He nodded. A woman standing next to him, also on the Concorde team,
nodded emphatically and finally burst out: "Yes, there has
been pressure, and it has been placed at the very highest level."
I asked, frustrate and infuriate you? She nodded, furiously, and
said, "The most frustrating thing is that I can't tell you
about it." Much of that raw Concorde data, particularly on
toxicity, remains to be revealed.
carried out this study against incredible adversity, but we are
not going to cave in to any pressure," he said. "We'll
win the battle in the end. We show the science, that's all that
I asked him
how he felt about the fact that doctors in the U.S. still prescribe
AZT to asymptomatics (people who have HIV antibodies but no symptoms
of AIDS). "I think Concorde is going to take time to sink in,"
he said. "How you take on board the results very much depends
on what you believe in before you saw them." As an afterthought
he added, "I think it's very hard, if you've been giving AZT
to large numbers of patients, to swallow this result." *