DEBATING AZT: Mbeki and the AIDS Drug Controversy By Anthony Brink DEBATING AZT: Mbeki and the AIDS Drug Controversy By Anthony Brink Sourced FOREWORD BY MARTIN WELZ DEDICATIONS AND ACKNOWLEDGEMENTS PREFACE AZT: A MEDICINE FROM HELL AZT: A MEDICINE FROM HEAVEN (Dr D J Martin) AZT AND HEAVENLY REMEDIES [1] Dr Martin scolds the editor of the Citizen from a high horse. [3] AZT and muscles. [10] AZT and bone marrow. [14] What does AZT do for opportunistic infections? [15] Does AZT have “long lasting beneficial effects”? [16] What did the Concorde trial in Europe reveal about AZT? [17] The invention of HAART cocktails. [18] Does AZT prolong life – or shorten it? [19] The grim findings of the Claude Bernard Hospital study in France. [21] Pressure from the manufacturer to sweeten the Concorde findings. [22] Does AZT “improve quality of life”? [26] AZT and the liver. [30] AZT, foetal toxicity and birth defects. [37] Is AZT safe for neonates and children? [39] Are the ‘side effects’ of AZT different from AIDS? [40] How well do untreated HIV-positive people do? [41] How are children exposed to AZT in the womb affected? [43] What did the introduction of AZT do for the AIDS death rate in the US? [44] What cancer risks are posed to babies of mothers treated with AZT? [49] Does AZT reduce HIV transmission from mother to child? [50] AZT and the ‘AIDS experts’ at Chris Hani-Baragwanath Hospital. [51] A precedent for AZT: Diethylstilbestrol. [52] Cancer again. [56] AZT, nerve damage and dementia. [58] AZT and hearts. [59] AZT and eyes. [60] A lesson from Japan. [61] More cancer. [66] AZT and needlesticks. [67] Why AZT can never in principle prevent HIV infection. [70] AZT and rape victims. [72] MRC president Dr William Makgoba and the South African experts. [73] Big-shots overseas. [74] The National Minister of Health on AZT. [75] Charlene Smith cheerleading AZT. [84] The puzzling GlaxoWellcome HIV-AIDS Helpline. [86] Mbeki and D P leader Tony Leon debate AZT for rape victims. [88] The New York Times on ‘African AIDS’. [89] Mbeki replies to Leon in his Oliver Tambo Memorial Lecture. [90] South African journalists slap down the government’s concerns. [93] Don’t take HAART - the latest research reports. [111] A Pellagra parable. [112] ACT UP founder Larry Kramer speaks about HAART. [113] A withering indictment of AZT by the Perth group. [114] AZT, Jewish weddings and soccer riots. [115] GlaxoWellcome’s feeble response to the Perth group critique. [116] Mbeki chides the ignorant MRC president and Nature correspondent. [118] The lazy pharmacology professor who let the President down. [124] The AZT campaign peters out, and Nevirapine moves in. [125] AZT and its coy advocates. [126] Justice Edwin Cameron and medical miracles. [130] AIDS Law Project director Mark Heywood sounds off. [134] Dr Neil McKerrow’s caring cures. [135] Mbeki answers an appeal by a judge, church leaders and an AIDS expert to provide AZT to pregnant women. [136] Mbeki explains his reservations about AZT. [138] Journalists react to Mbeki’s grasp of the triphosphorylation problem. [139] Mandela on Mbeki. [140] The calomel calamity. [141] Conclusions APPENDIX I APPENDIX II WHY THE ‘AIDS TEST’ IS USELESS AND PATHOLOGISTS AGREE THE AIDS APOSTATES THE POPE OF AIDS HOW COULD THEY ALL BE WRONG? DOCTORS AND AIDS AN AIDS CASE ILLUSTRATIONS Foreword By Martin Welz The upside of democracy is that every citizen has the right of access to information, the right to express, exchange and debate different points of view and, finally, to a vote. The downside, of course, is that each citizen is burdened with the responsibility of having to think for himself. That, in a nutshell, is what the investigative magazine noseweek is about, and why, prompted by the author of this book nearly two years ago, noseweek published a series of articles titled Rethinking AIDS. For the first time South Africans were exposed to a critical re-evaluation of HIV and AZT undertaken by a number of very eminent scientists. Clearly, many South Africans, reared in a society where for half a century they were forbidden to think for themselves, now find it too onerous a responsibility. They long for the quick fix. If AIDS is a problem, there must be a pill for it - which the government must pay for. Anyone, be it politician or pharmaceutical company, who is prepared to offer them that assurance, no matter how recklessly, is eagerly assumed to be right - because that lets us off the hook and instantly makes us feel good. The fact that it may not make the AIDS sufferers feel any better is, apparently, of no consequence. Conversely, anyone who raises questions about AIDS exposes our vulnerability, and clearly makes many people, including the president of the South African Medical Research Council and the editor of the Mail and Guardian, very, very angry. Some abandon any attempt at thought - such as Sunday Times writer Laurice Taitz, who, in reporting the AZT controversy, gaily took it upon herself to declare to her readers: “the truth is the drug is not toxic.” Read this book and you will know why I say the Sunday Times clearly does not take AIDS seriously when it assigns a writer of Ms Taitz’s intellectual ability to the subject. And that when Dr William Makgoba, president of the Medical Research Council, declares he has read nothing critical about the effects of AZT on infants, this is a reflection not of the state of science on the matter, but of his own arrogant indolence. Anthony Brink is a citizen who takes his rights and his responsibilities seriously. He has written a book for every intelligent citizen to read. If you are not a member of those professions, do not be intimidated by the medical and pharmacological terminology. Simply stick with the argument. It is devastatingly clear. Reading this debate about AZT between Brink, a Pietermaritzburg advocate, and Dr Des Martin, president of the Southern African HIV-AIDS Clinicians Society, leads one to reflect on the question: “What is an expert?” Dr Martin may have the credentials of expertise, but Brink has the intelligence, investigative zeal and adherence to the principles of scientific enquiry that make for authority on this subject. He has tracked and digested every important reference to AZT in contemporary medical literature. The result is a comprehensive and alarming review of the findings of medical researchers on the clinical use of the drug. AZT was originally prescribed in high doses on its own as a therapy for people who tested HIV-positive. Other journalists have reported the fraudulent nature of the clinical trials on which this usage was based. When independent, much larger trials eventually showed that when HIV-positive individuals who showed no sign of illness used AZT, it significantly increased, rather than decreased, their chances of developing AIDS - and of dying - this regimen was quietly dropped. That this has not yet become a major medical scandal is testament to the power and resources of pharmaceutical giant GlaxoWellcome, and, by extension, the industry as a whole. Now there are new, even more dangerous claims made for AZT, supported by well-funded lobbies. Anthony Brink demonstrates the sort of ability and dedication needed to properly scrutinise those claims. If you have any better information and arguments, let me know. Martin Welz Editor, noseweek Cape Town. Dedications and Acknowledgements To Thabo Mbeki, President of the Republic of South Africa, for his sterling moral and political leadership in the AZT controversy in South Africa; to Dr Manto Tshabalala-Msimang, National Minister of Health in South Africa, for equal integrity and political courage; to Dr Ian Roberts, former special advisor to the Minister of Health, for passing this debate on; to my family for enduring a completely preoccupied and distracted husband and father during the hundreds of hours stolen from them to research and write this work; to my late father Robin Brink, whose enthusiasm for his medical negligence law practice seems to have infected me with a similar interest in medical malfeasance; to Arthur Wilke, my late grandfather by marriage, who developed my fascination for microbiology as a boy; to journalists Martin Williams, Martin Welz, Martin du Plessis, Vivienne Vermaak and Albertus van Wyk for their commitment to ventilating the little-known facts about AZT in South Africa; to John Lauritsen, Michael Ellner, Celia Farber and Joan Shenton for pioneering exposes of the drug; to Dr Manu Kothari, Professor of Anatomy at Seth Gordhandas Sunderdas Medical College, King Edward Memorial Hospital, Mumbai, India, for the deepest spiritual and intellectual inspiration; to my friend in politics, Lluis Botinas of Barcelona, Spain, executive director of Plural-21, for amour-piercing discussions about the ideological and metaphysical substrates of modern medicine that made the AZT disaster not merely possible but its logical consummation; to Ivan Illich for Medical Nemesis: The Expropriation of Health, perhaps the most incendiary book I have ever read; to Dr Peter Duesberg, Professor of Molecular Biology at the University of California at Berkeley, for kind encouragement - fundamental disagreements about ‘HIV’ notwithstanding; to Dr Val Turner, consultant emergency physician at the Royal Perth Hospital, for invaluable friendly advice and guidance throughout this project; to Dr Todd Miller, molecular pharmacologist at the University of Miami, for similar help; to Eleni Papadopulos-Eleopulos, biophysicist at the Department of Medical Physics, Royal Perth Hospital, everything. Finally, to my very many unnamed friends in this subject world-wide for your personal support and assistance, and for all that you have done, and in many cases sacrificed, to bring the terror to an end. Preface By Anthony Brink 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 … truncated (434,555 more characters in archive)