AIDS; Words from the Front
By Celia Farber
Spin Aug. 1993
AZT is death. Celia Farber picks up the pieces of a shattered
medical establishment at the Ninth International Conference on AIDS
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 reality.
"Confusion," "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 ideology crumble.
- 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 were explored.)
- 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.
Last year, 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.
To anybody 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.
Concorde went 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.
The blueprint 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.
If Concorde 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
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."
Doesn't that, 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.
Weller cleared his throat.
"We've 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." *