VIRUSMYTH HOMEPAGE
DEBATING AZT
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 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
CONTENTS
DEBATING AZT
VIRUSMYTH HOMEPAGE