HIV, AZT, big science & clinical failure
By MARTIN J. WALKER
Martin
J. Walker was chairman of the Steering Committee on AZT Malpractice (SCAM)
and the AZT on Trial Conference, London 1993.
INTRODUCTION
In April
1984, Robert Gallo told America that he had found the 'probable' cause of
AIDS in 'a virus' later called the Human Immunodeficiency Virus (HIV). Since
that time, those who have dissented from orthodoxy have been trying to understand
how within two years the general consensual acceptance of Gallo's hypothesis
- which came to be that an HIV was the sole cause of a number of AIDS-defining
illnesses - was transformed into a universal scientific tenet . Gallo's
idea, which has never been scientifically proven, even survived the opinions
of Luc Montagnier, one of France's most eminent virologists who is now credited
with having discovered HIV in 1983 and who in l991 stated that HIV alone
was insufficient to cause AIDS.
AZT specifically, and ongoing work by scientists on attempts at anti-viral
therapies generally, confirmed in both the public and scientific mind, that
a HIV was the sole cause of AIDS. AZT was marketed as the cure for a viral
condition and, lay thinking went, scientists would not have invented an
anti-viral cure if the illness was not caused by a virus. AZT may well have
been the first drug in history which defined the illness it was meant to
treat, rather than the other way around.
In the process of producing and marketing AZT, the Wellcome Foundation set in chain a powerfully persuasive machine which created information, culture and social relations with one purpose, to sell the drug. This network had a life force which would have continued to drive it forward, even if it had occurred that the drug quickly killed everyone who took it.
TRADING PLACES
The production and marketing of AZT can best be viewed within the context of the global pharmaceutical industry in general and the Wellcome Foundation in particular*. The world pharmaceutical industry is worth £130 billion. Over the last ten years the industry has been characterised by high growth and high profits.
Throughout the eighties and nineties, the pharmaceutical industry has been in a state of transition. Mergers, takeovers, the buying up of smaller companies and the divestment of unprofitable productive sections, has left a few large companies jostling for position.
Takeovers and mergers represent one response to a crisis of profitability in the industry, a crisis which has been brought about by cut backs in public health spending in Europe and America and spiralling research and development budgets. This integration into larger global corporations has occurred also because many pharmaceutical companies have been extending their reach into different levels of health care, into hospital management, corporate employee health schemes and cradle to grave health care planning.
AZT ORPHANED AT A YOUNG AGE
AZT was not designed as a drug to combat an HIV. It was developed, from a herring and salmon sperm extract, by Jerome Horowitz in 1964 for the National Cancer Institute (NCI). As cancer chemotherapy, it was designed to destroy dividing cells which were producing tumours. AZT was, however, indiscriminately cytotoxic. It could kill any dividing cells by interfering with the reproduction of DNA.
After development of AZT was dropped it became an 'orphan drug', one with no pharmaceutical company parent to rear it and it languished, on the shelves of the National Institutes of Health. The decision to test AZT in 1985 for anti-viral properties was not due to farsightedness or any sixth sense - in 1985 and 1986, inside NIH research establishments everything which came to hand was being tested for antiviral qualities.
THE TRIALS OF AZT
The traditional form of evaluating research has been peer review, followed by publication in a few established and meritorious journals. This system of gate-keeping clearly had its drawbacks because it meant that orthodoxy retained control not only over standards of research, but inevitably over content. The peer review system attempted to act as a centralised clearing house for research while keeping a continuous if nominal check on standards.
Today, there are no universal standards for the evaluation of non- license application drug trials. Commercial and industrial interests have helped launch a large number of vested interest journals which print the research work which they have funded. Drug trials are overseen primarily by research staff working for the producer company and even the investigators are often supported by the company or work in units which rely for future funding from the company concerned.
For the first five years of AZT's life, Wellcome controlled almost all the known AIDS cases in Europe and America by drawing them into trials. In November 1987, eight months after licensing in the US, Dr Trevor Jones declared in a press release that they soon anticipated clinical studies to involve 6,000 patients, aside from 5,000 patients who were already using the treatment. Nussbaum (1990) reported that in 1988, practically 80% of the patient slots in the NIAID's AIDS clinical trial group were for AZT trials.
By 1992, Dr Jones was able to tell the press that 4,000 separate studies had now been carried out which demonstrated the benefits of AZT.
THE MEDICAL PROFESSION
Since the middle of the last century, first serving the new industrial bourgeoisie and later the working class as well, the general practitioner became the mainstay of the National Health Service. Until the 1960s, many general practitioners had a reputation for independence of mind. Over the last thirty years this independence has been eroded on the one hand by the drug marketing and the introduction of centralised high technology centres of scientific medical excellence and on the other hand by ongoing fiscal crisis.
From the beginning, Wellcome marketed AZT as a complex, high flying and very expensive drug. One of the advantages of this was that Wellcome did not have to depend upon general practitioners to dispense the drug. The ordinary doctor was, in fact, a serious problem for Wellcome as they entered the field of AIDS. What if general practitioners were to find other ways of treating HIV antibody positive patients? Wellcome set out to educate general practitioners to the enormous dangers of HIV and AIDS, ensuring that most general practitioners were so afraid of the highly contagious nature of the 'disease', that they quickly passed patients on to the hospitals. To reinforce this and strike further discipline into doctors, the General Medical Council ruled that it would be a disciplinary offence for general doctors to treat AIDS patients.
In 1987, the year that AZT was licensed, the British Medical Association (BMA), the professional trade union for doctors and an organisation which had substantial links with Wellcome, set up the BMA Foundation for AIDS. In March 1988, Wellcome gave a covenant to the Foundation, a sum of £36,000 annually for four years, totalling £144,000. This meant that at the very heart of the British medical profession, Wellcome had control of the information flow on AIDS.
THE VOLUNTARY SECTOR ORGANISATIONS
The 1968 Medicines Act makes it a criminal offence to advertise medical treatments directly to patients (vulnerably ill people). However, the sale of AZT directly to individuals who had tested 'HIV antibody' positive - using a Wellcome-produced testing kit - was from the beginning the cornerstone of Wellcome's marketing strategy.
Those who suffered AIDS-associated illnesses or who had been diagnosed 'HIV antibody' positive, mainly gay men, were an unknown factor. Pharmaceutical companies had no real experience of dealing with large, youthful, cultural identity groups.
The greatest potential for drug pushing was to be found in the plethora of self-help organisations which were springing up throughout the country.
Here at these focal locations, not only gay men gathered but specifically those who had tested 'HIV antibody' positive.
Wellcome set out to buy up all the self-help groups which had contact with gay men who tested 'HIV antibody' positive in Britain and America. Where they were unable to fund them directly, they gave grants for journals, papers and magazines or for specific projects. There were no overt strings attached to such money but recipients had to adhere to the medical model of AIDS and act as conduits by which off-the-street gay men concerned about their health could be funnelled into the charnel houses of chemotherapy.
The grant funding of self-help groups in the field of AIDS, by vested interest organisations, is perhaps one of the greatest scandals of AIDS medicine. By bombarding newly tested gay men with partial information about AZT and other so-called anti-viral drugs, Wellcome had found a way round the Medicines Act and the perfect way to construct a drugs market. Wellcome adopted a strategy which has been known within politics for hundreds of years. Wellcome didn't need General Practitioners to sell AZT, they mounted their beach heads in the bourgeois sectors of the gay community and developed a colonial class which administered the medical model for them.
The use of self-help organisations was and still is a systematic marketing strategy, and while it is important to list the groups which received drug company money, it is more important to understand the strategy which Wellcome used.
Sally joined an organisation called Positive Life (PL) which had been set up by people who were HIV antibody positive. PL had been set up for five years by the time Sally joined in 1991.
Soon after starting work, Sally was asked to write a number of articles about AZT. Sally was nervous about writing the articles because she felt the need to be critical but responsible and she was worried she might upset people by suggesting AZT was toxic.
Not long after her first article came out she was contacted by the head of the Health Education Authority AIDS programme who suggested that her article might contain inaccuracies. She was insistent that Sally should have lunch with her. When Sally went to lunch she found that a media relations manager from Wellcome's Public Relations Department was also there.
The conversation over lunch centred upon Wellcome's relationship with voluntary sector organisations and the problems of marketing AZT. Not long after the lunch, the coordinator of PL received a phone call from a public relations company informing them that Wellcome wanted to fund their organisation. PL did not accept the money.
Wellcome did not always have to make such direct advances to groups. From an early stage they managed to gain influence on the committees and boards of the major fund-dispensing bodies which acted as gate-keepers for voluntary sector funding. These strategically placed individuals, on the board, for example, of CRUSAID, an organisation which in the early nineteen nineties was controlling in excess of £4 million in funding, made sure that funds were channelled only to organisations which believed in the use of anti-viral drugs.
BIG SCIENCE RIDING OFF INTO THE BLACK HOLE
Much dissent especially in politics is based upon an intuitive and heart-felt sense of right and wrong; arguments take place around moral or ethical issues which are often impossible to prove. In AIDS, the principal orthodox proposition - that a Human Immunodeficiency Virus is the cause of AIDS - appeared to be based upon a scientific truth.
While it appears at first that only the idea of Gallo's retrovirus and its transmission has shaped our perception of AIDS and its social relations, it is more complex than this. Gallo and Gallo's idea are themselves a product of the social and commercial relations which exist inside science and the production of scientific knowledge.
Had Gallo presented his theory thirty years ago in a reputable scientific journal, rather than at a fin de sciècle press conference in Washington, his proposal would have been tested by his peers. A focused and centralised authority which had responsibility for evaluating scientific knowledge would have made a judgment, its clinical basis would have been replicated and a dialectical process would hopefully have forged the truth. As it was, there was no proving, no dialectical process, no clinical proof and no biological proof, no peer review, no open public critique. Gallo's idea was passed down in tablets of stone and 'HIV' was found guilty without any kind of trial or search for the truth. Science by absolute decree of the idea.
This is not how science has been practiced nor how truth has been arrived at over the last two centuries.
The fact that people were ill with greater frequency and died more quickly when they took AZT, did not affect the the public perception that users of AZT got better, or lived longer lives of better quality than people who unfortunately did not have access to the drug. From a very early stage, the great, mysterious and very male-oriented adventure of science began to depart from the real record of absolute clinical failure of so-called antiviral remedies. This total failure was in part disguised by the increasing understanding of doctors, and their ability to treat the individual infections and other illnesses which made up the spectrum of AIDS.
Wellcome's strategy of hegemony, brilliantly orchestrated, was highly successful. In 1992, five years after AZT was licensed, the 44.7 tonnes of AZT produced that year returned Wellcome over £250 million profit. The profits for the following year were even higher.
Over the last few years, AIDS science, which has as its only aim the production of magic-bullet drugs, has moved further and further away from the conditions of people's living illnesses. The mad scramble of science to understand the intricacies of 'HIV' has given new meaning to the old axiom, 'The operation was successful but the patient died'. AIDS scientists are now openly declaring that clinical end-points are no measure of the success of their work. To protect their authority, they have created an impenetrable wall around themselves, and within this wall its practitioners discuss mutual ideas which over the years have come to develop their own inner logic.
To people knowledgeable about AIDS but beyond the pale of orthodoxy, it appears as if AIDS scientists are slipping deeper into some kind of group psychosis. Apparently considered statements by scientists take on the meaning and form of mantras or cultish utterances which are nonsensical to those outside AIDS science. Such statements as: 'If antivirals don't work it's because the virus is very intelligent and keeps mutating'; or 'Non-infectious HIV is pathogenic' or 'Protease inhibitors mean AIDS is over'.
At some point early on in the bang of big AIDS science and its widening galaxy of abstract theorising it became impossible to readdress fundamental ideas. At issue in this reluctance was not only the plausibility of science and the authority of individual scientists but the continuing production and the profitability of anti-viral drugs. AZT was undoubtedly one of the factors which pushed the handcart of early AIDS speculation over the hill, and transformed it into the juggernaut of premature consensus.
If any doubt did begin to creep like cracks through the cultural hegemony created around AZT, at the end of the Concorde trials, these cracks were quickly filled by the culture of pharmaceutical influence which stood ready with the cocktail of combination therapy. The 'combo' approach which after all still had AZT as its central support, quickly came to be reflected upon with gothic disbelief but even then, science and medicine was saved at the last minute by protease inhibitors. These miracle drugs, despite the fact that they had been trialed for only two years will, it was said, give all those who are 'HIV antibody' positive, a happy and contented old age. The grim deception of that view is already apparent.
We are all in awe of science, especially medical science for it appears inarguable. What science does, is, and what science says can happen, scientists make happen. Like the stone masons and architects of the seventeenth century, scientists are constructing the everyday reality within which contemporary society lives.
When we look closely at the science of AIDS, and particularly at Gallo's hypothesis, we realise quite quickly that we are not dealing with scientific truth in the normal sense of the expression. The idea that an HIV is the cause of AIDS-associated illnesses, is just that - an idea - there is, even now, no evidence but only supposition to support it.
This idea, however, has achieved a materiality of considerable proportion, and it has spurned an industry. An understanding of how this happened is important - important because in understanding it, we understand not only how knowledge is reproduced in our society, but also how power is mediated.
Without this information we can not know how to dissent. We have to have this intimate understanding of the way in which the power relations of orthodoxy shape the world in order that we can resist it.
We do not believe power resides in slogans and our dissent does not become real when we say 'HIV is not the cause of AIDS'. Nor does our dissent become real if we simply argue the opposing scientific perspective. We have to dissent with who we are, with our acts; this is why the intimate knowledge of the orthodoxy's power is important to us. To oppose them we must behave differently, resist their social and institutional relations and the way in which they produce and make material knowledge.
People have to empower themselves, in every area where industry and capitalist production have taken over the basic functions and interchanges of everyday life. People have to fight back by finding themselves and a better way of treating themselves.
BIBLIOGRAPHY
(Parts I & II) Burkett, E. (1995) The Gravest Show on Earth. Houghton Miflin, New York.
Duesberg, P. (1996) Inventing the AIDS Virus. Regnery, Washington.
Hodgkinson, N. (1996) AIDS: The Failure of Contemporary Science. Fourth Estate, London.
Kennedy, I. (1983) The Unmasking of Medicine. Sutton, Surrey: Paladin.
Schiff, M. (1996) The Memory of Water. Thorsons, London.
Lauritsen, J. (1993) The AIDS War. Asklepios, New York.
Lauritsen, J. & Young, I. (1997) The AIDS Cult : Essays on the Gay Health Crisis. Asklepios, Provincetown.
Marks, K. and Engls, F. (1942) The German Ideology. Laurence and Wishart edition, London.
Miller, J. (1994) The Passion of Michel Foucault. Flamingo, London.
Nussbaum, B. (1990) Good Intentions. Atlantic Monthly Press, New York.
Papadopulos-Eleopulos, E. (1993) Is a positive Western blot proof of HIV infection? Bio/technology vol. 11.
Root-Bernstein, R. (1993) Rethinking AIDS. Free Press, New York.
Walker, M.J. (1993) Dirty Medicine: Science, Big Business and the Assault on Natural Health Care. Slingshot, London.
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21st Nov 2000
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