Never-Never Land
Question AZT for Babies and People Get Hot Under
the Collar
Considering the many side effects of the AIDS drug AZT,
the question of giving it to pregnant women should be weighed carefully
instead of being blindly accepted.
By Nicholas Regush, ABCNEWS.com
(1999)
PASSIONS CAN run high in scientific
circles when questions are raised about conventional thinking in
AIDS research. The use of the anti-HIV drug AZT in children of HIV-positive
mothers is just such an issue.
Consider the telephone call I made this week
to Dr. Mark Wainberg (mdwa@musica.mcgill.ca), head of the International
AIDS Society; I had called Wainberg, who conducts AIDS research
at Montreal's Jewish General Hospital, to interview him on the science
underlying the view that HIV-positive women and their newborns should
take AZT.
(Last week, I wrote about HIV-positive women taking
action in court to prevent government authorities from seizing their
children if they don't agree to AZT treatments. Closely related
is the question of whether HIV is the cause of AIDS.)
Holocaust Equation
I called Wainberg because the Ottawa Citizen
, a major Canadian daily, quoted him saying that the dissidents
were "fringe people," and that "There are people out there who deny
that the Holocaust happened. Do we want to give them equal credibility?"
This article quoting Wainberg had been circulated on the Web. That's
how I learned about it.
Did Wainberg really make the Holocaust comment?
If so, did he really believe a comparison between mothers fighting
for their rights in the courts and those denying the Holocaust was
valid? If he indeed felt so strongly, then maybe he could document
the AZT science underlying his views.
Not only did Wainberg verify what he had said in
regard to the Holocaust in the Ottawa Citizen , but
he began shouting at me, saying that if I wrote anything at all
on this issue, I would be a "child murderer." He threatened that
if I wrote anything, he would do everything possible to get me fired
from my column and my "bosses" fired. He taunted me, saying that
I wouldn't have the guts to print these comments.
I asked him if he therefore believed that this AZT
issue should never be reported by the media. "Never," he continued
to shout. "Absolutely never." He then went on to condemn me again
and again as a "murderer." He also told me that he considered any
other journalist raising questions about the use of AZT in children
of HIV-positive mothers to be a child killer.
Just Don't Ask
Wainberg, a well-recognized AIDS researcher who
is one of the developers of the anti-HIV drug 3TC, never once asked
me what science questions I wanted to explore with him, and I could
barely get a word in edgewise. He had remembered me from more than
a decade ago as a Canadian medical reporter who had included nonconventional
features and commentaries on AIDS among my more mainstream AIDS
stories. Though Wainberg had taken issue with some of my reporting
in those days, I had been totally unprepared for this week's savage
assault on anyone (including myself) who had questions about AZT
treatment in pregnant HIV-positive women and their newborns.
Considering that there is usually room for argument
on scientific studies, that there are reasonable fears about the
potentially powerful side effects of AIDS drugs, and that there
may be legitimate concerns about human rights involved in such a
complex situation, I shook my head in amazement when I put the phone
down. Given that other scientists have also shown strong emotion
in denouncing challenges to AIDS orthodoxy, it made me wonder what
in the world is happening to scientific debate.
Final Answers?
One key study was published on Nov. 3, 1994, in
the New England Journal of Medicine . It showed that
HIV-infected mothers who received AZT gave birth to 13 HIV-positive
infants, while mothers on placebos gave birth to 40 HIV-positive
infants. This small study was stopped early because of the significant
difference between the two groups, and the results were immediately
touted as grounds for making AZT standard therapy for HIV-positive
mothers and their newborns.
But no study comes with all the facts. The NEJM
authors note, for example, that the risks and the benefits of initiating
(AZT) treatment during the first trimester of pregnancy, after 34
weeks' gestation, or in labor, or of treating only the newborn were
not assessed. In an editorial accompanying the study, the authors
state: "The results, however, raise many questions about the mechanism
of action of (AZT), the timing of transmission, the effectiveness
of the regimen in women with clinical characteristics that differ
from those women in the trial, the long-term effects of exposure
to (AZT) during pregnancy, and the type of counseling that is appropriate
to ensure that HIV-infected women understand the benefits, risks
and uncertainties of the therapy."
No Absolutes Except One
The authors also note that in its recommendations
for AZT therapy, the public health service emphasizes "the need
for a thorough discussion of the benefits and risks. The final decision
on therapy should be made by the woman in consultation with her
health care provider." A properly informed health provider, I might
add.
No study has since been published that should change the spirit
of that recommendation. While some proponents speak of the steady
decline of infant and child AIDS cases after a 1992 peak, factors
such as declining births to HIV-positive women and better prenatal
care may have played a role.
Then there are the voluminous reports of adverse
reactions to AZT to consider, including the drug's ability to damage
bone marrow, kill growing cells (particularly immune cells) by interrupting
their synthesis of DNA (life's blueprint), and to establish itself
in DNA with the potential for long-term consequences, which includes
the possibility of cancers.
Should there be widespread reporting and discussion
about this entire issue? Absolutely!
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