In the David Lynch movie Blue Velvet, Geoffrey Beaumont returns to visit his friendly middle-American hometown Lumberville. Dawdling around in a field he comes across a severed human ear. He finds himself drawn into investigating a surreal criminal netherworld, and is propelled towards dreadful discoveries. For me, stumbling on to AZT has been a bit like that, and my enquiry into the history and pharmacology of AZT has been a Carrollian tour through a chamber of horrors. It’s not the first time that medicine has gone mad, but I think that in time the entry of AZT into the apothecary will be judged the gravest pharmaceutical disaster since the days of strychnine, arsenicals, and mercurous chloride.

Having interested South Africa’s leading investigative journalist Martin Welz in AZT and other problems with the HIV-AIDS paradigm, I was commissioned in October 1998 to write an article for his whistleblowing journal noseweek. After I had done so, Welz decided to publish a general introductory article featuring AIDS sceptic Nobel laureate Kary Mullis first, and to go to press about AZT in a later issue (see January 2000 edition). At this time an intense public controversy was raging about the economics and morality of the South African government’s decision not to provide AZT to rape victims and HIV-positive pregnant women. The angry condemnation that the government drew for this decision from AIDS activists, journalists, opposition politicians, doctors, health workers and others was premised on the conviction that AZT was a life-rescuing miracle drug. The look of it was that desperate supplicants were being denied the sacrament. As the ensuing debate did not concern the drug’s safety or efficacy, I thought publication of my critique shouldn’t be delayed so I sent it to several South African newspapers. Martin Williams at the helm of the Citizen took the lead and published AZT: A Medicine from Hell on 17 March 1999.

South Africa’s leading AIDS treatment authority, Dr Desmond Martin, rose to the piece and mounted a rebuttal two weeks later, entitled AZT: A Medicine from Heaven.

My rejoinder AZT and Heavenly Remedies was printed the following day. I thereafter revised and extended it substantially to incorporate discussion of important papers in the medical press excluded by the newspaper’s space constraints, as well as a torrent of research papers published subsequent to our newspaper debate. Dr Martin’s contentions about the ‘AIDS epidemic’ are treated separately in Appendix I to my reply.

After reading this debate, South African President Thabo Mbeki caused a local and international furore when on 28 October 1999 he ordered an enquiry into the safety of AZT. The following month, Dr Helen Rees and Dr Precious Matsoso, respectively the president and director general of the South African Medicines Control Council, received copies of both this debate and of the seminally important examination of the molecular pharmacology of AZT by Papadopulos-Eleopulos et al, published in a special supplement to the journal Current Medical Research and Opinion in mid-1999. This paper is discussed at the end of my reply to Dr Martin in my literature review AZT and Heavenly Remedies. Neither the toxicity data discussed in this debate nor the Perth group’s explosive review seemed to have made any impression on these ladies. On 11 May 2000, Dr Rees responded to a warning issued by the European Medicines Evaluation Authority concerning “life-threatening skin and liver reactions” and other “potentially lethal side effects” of Nevirapine (Viramune), currently being marketed aggressively in South Africa. After the deaths of several black women on antiretroviral trials (including Nevirapine), she remarked nonchalantly that “many AIDS medications could cause liver and other problems. ‘But the combination therapy can make a huge difference to people’s lives’.” One wonders how the Medicines Control Council would have reacted had the victims been white. To her great credit, when she learned of the deaths, South African Minister of Health Dr Manto Tshabalala-Msimang intervened directly and terminated the trials. Incredibly, “an uproar in South African medical circles” was reported in response to her move to prevent the deaths of more women. (On Sunday 13 August 2000 she announced that she had declined to make Nevirapine available to HIV-positive pregnant women, and directed that it should not be used outside approved research environments.)

Dr Tshabalala-Msimang has rejected two reports on AZT by the MCC on the grounds that they deal inadequately with the drug’s toxicity. On 15 March 2000, in the course of a radio interview, she expressed her dissatisfaction with the failure of a third report to address the issue of AZT’s long term risks, and said that she had commissioned further investigation. But from the minister’s forthright negative public statements on AZT and the even stronger sentiments emanating from Mbeki’s office, it would seem to be ‘game over’ for those calling on the government to buy and supply it to pregnant women and rape victims.

In preparing the manuscript I decided to retain its original case-answer-reply debate format for two reasons. First, AZT: A Medicine from Hell serves as an easy introduction to the subject and a handy summary of the case against the drug, which I elaborate in my detailed reply to Dr Martin under the title AZT and Heavenly Remedies. Second, AZT: A Medicine from Heaven stands as an authoritative statement of the case for AZT by South Africa’s leading AIDS doctor and academic AIDS expert. This lends balance to my treatment of the subject, and better equips readers to form their own conclusions. The research papers discussed in AZT and Heavenly Remedies are cited in an informal manner for the lay readership I had in mind, but they are sufficiently identified to enable any interested reader to locate them. Excerpts from the literature are precisely quoted however, and I have retained American spelling and journal house-styles regarding the use of upper and lower case in the titles of papers.

Concerning my polemical style and sardonic tone, I should explain that I wrote with politicking in mind. (It’s a trick I picked up from Galileo. Unable to sell his discovery of the moons of Jupiter to his peers, he took to pamphleteering to the lay public instead.) This is because, after some dismal early encounters, I realised the futility of engaging with ‘the experts’, and decided to bring this appallingly dangerous drug to the attention of our political leaders and investigative journalists instead. My apprehensions were confirmed by the responses of ‘the experts’ to Mbeki’s extraordinary initiative in directing an enquiry into the safety of AZT. On their own showing they hadn’t examined the important recent medical literature on AZT with which the President was au fait and which founded his concerns, and they condemned him ignorant of it. Among them are Dr William Makgoba, president of the Medical Research Council, and South Africa’s most eminent pharmacologist, Professor Peter Folb of the University of Cape Town. Consulted by Nature correspondent Michael Cherry to comment on the Perth group paper after Mbeki sent it to Cherry and asked him whether he’d read it, Folb contributed a disgracefully glib, uninformed, unreferenced, and tendentious opinion. Mbeki fittingly rejected it.

How South Africa’s leading medical experts failed to meet their responsibilities to President Mbeki and to the South African public in the AZT controversy is a tale told in the latter part of AZT and Heavenly Remedies. We’ll also have a look at the performance of some prominent journalists, AIDS activists, church leaders, the leader of the official opposition in parliament, and a constitutional court justice. And finally, Mbeki’s remarkable knowledge of AZT’s pharmacology and his insights into the inarticulate dynamics of the controversy are revealed in his own words, in letters and interviews quoted in full. He also gives the world an exemplary lesson in democracy in practice – the importance of independent enquiry, and the dangers posed by unthinking deference to ‘the experts’ in any institution or profession, especially the buffoons who run the medical show here.

No thanks from me to South Africa’s AIDS activists and Human Rights lawyers, all of whom have looked away - one of whom said that she could not afford to examine the issues raised by me or she would be out of a job, and another who opined that I was a public menace and should be killed.

I’m frequently asked why this subject seized my interest. At heart I’m a science geek. I had a provisional patent when I was ten, and was keenly interested in chemistry and microscopy as a boy. From impressive experiments with high-explosives to triple-stained microscopic slides and photomicrographs of blood, assorted microbes and cross-sections of my grandmother’s appendix, I drifted into audio electronics and equipped a recording studio and concert sound rig with most of the gear home-made. On my father’s ill advice, I took Latin at school but biology has long been my fascination. Part of it has been that the more I read and the more I reflect on it, the more textbook biology drifts from fact and begins to resemble the holy doctrines of the Roman Catholic Church, supporting aggressively defended commercial and professional empires. I’m also one of those annoying inquisitive types with little respect for ‘authority.’ Being interested in cancer, the immune system and all that, I closely followed the drama of HIV-AIDS from the very beginning. Having accepted everything I read about it hook, line and sinker for years, I was inspired to examine the scientific foundations of the infectious AIDS paradigm afresh when I discovered in late 1996 that two of the most accomplished biologists in our time, Nobel laureates Walter Gilbert and Kary Mullis (discussed in my piece The AIDS Apostates) did not subscribe to it. That led me on to AZT. An irresistible imperative then possessed me. I couldn’t just carry on with my picnic while a child was drowning, so I jumped in. Or to mix metaphors, it was like finding a grave in my garden, and then more the deeper I dug. Or watching good neighbours carted off by secret police, never to be seen again. Not the kind of thing one can walk away from. Not me anyway.

After the conclusion of my brief newspaper debate with Dr Martin, I was moved to amplify my reply to him by the publication of a sudden flood of papers during the rest of 1999 and in 2000 - all with serious implications for the continued medical use of AZT, but none of which were surfacing in the public discourse about the drug. The death of a legal colleague after a single month’s course of AZT in combination with a similar drug 3TC was an added impetus. That’s how this book grew, its thread ripped undone and a new patch sewn in every time another paper on AZT came out in the medical press. And with every development in the controversy on the home front. It’s updated to September 2000.

Because I amplified AZT and Heavenly Remedies considerably after it was printed in its original form, I thought it proper to afford Dr Martin an opportunity to respond. I wondered what he would make of the Olivero papers on the transplacental carcinogenicity of AZT, the Ha, Blanche and De Martino papers on AZT’s foetal toxicity (and many more have since come in), and the vast survey of the literature on AZT and analysis of its pharmacology by Papadopulos-Eleopulos et al, which decisively debunks its manufacturer’s claims. Dr Martin’s colleague, fellow virologist Dr John Sim, intercepted the invitation, declined it, and proffered a sympathetic psychiatric diagnosis that I suffer mental perturbation. For an amusing exercise in Foucaultian deconstruction, Dr Sim’s response is a priceless little treasure, and I have put it up as Appendix II.

On 28 June 2000, Cape Town architect Richard Hepner, the editor of the Health Independent, asked Dr Martin again whether he would like to refute or comment on my extended reply, AZT and Heavenly Remedies - specifically the kernel of it, an excerpt I had prepared entitled Is AZT safe for babies? He declined the offer and said he stood by his piece AZT: A Medicine from Heaven, and suggested that Hepner simply publish it again. Offered the same opportunity, fellow AZT advocate Professor Gary Maartens at Groote Schuur Hospital in Cape Town asked Hepner, “What’s in it for me?” and likewise declined it.

The value of this work, I hope, has been to systematise a large body of clinical and research data on AZT, render it in prose transparent to non-experts and to launch it into the popular domain. I daresay the ‘AIDS experts’ could learn a thing or two from it too, but for reasons you’ll see, I’m not optimistic. For locating the papers I’ve cited, all credit to David Crowe, Peter Duesberg, Bryan Ellison, Celia Farber, Billi Goldberg, Neville Hodgkinson, Matt Irwin, James Jerome, Heinrich Kremer, John Lauritsen, Todd Miller, Eleni Papadopulos-Eleopulos, David Rasnick, Val Turner, and Penn Xarwalyczha.

ANTHONY BRINK
Pietermaritzburg,

South Africa

arbrink@iafrica.com

September 2000