February 07, 2006
AIDS Drugs and the End of the Plague
A few years ago, I engaged in an online back-and-forth with Andrew Sullivan, a conservative writer and blogger, about the cost of drugs and pharmaceutical innovation. My view, of course, is that they are not related. He took the opposite point of view. We even appeared on a panel together sponsored by the New Republic.
It would be easy to say he was in the back pocket of the drug industry, but if you knew his background, you would realize that isn't the case. Andrew is HIV positive and penned a famous article in the New York Times magazine shortly after the protease inhibitors became FDA approved in the winter of 1995-96 that was headlined, "When Plagues End." The point of the article was that the arrival of PIs allowed triple cocktail therapy (now called HAART for highly active anti-retroviral therapy) to save lives, thousands of lives. The anecdotes in his article were about young men who literally got up off their death beds as their immune systems recovered.
The triple cocktail didn't cure AIDS. But it did and does enable infected people to keep the virus in check. And that is life saving.
The reason why I am bringing all this up is that the morning papers bring news about an NIH-funded trial showing that stopping HAART intermittently carries a small but distinctly higher risk of mortality. This is a grave disappointment to AIDS patients who suffer terrible side effects from the drugs, not just the complicated and never-ending regimens, but disfiguring lipidystrophy where the body's fats get redistributed in all the wrong places. No wonder people want off the drugs.
Moreover, I have received several emails in recent days and had lunch with a physician who articulated a theory that appears to be coming back around: that AIDS drugs have nothing to do with controlling this disease, that the HIV (human immunodeficiency virus) doesn't cause AIDS, and perhaps lifestyle factors are the reason for immunosuppression.
Well, it's all hogwash. I suppose the drug companies have no one to blame but themselves for the steady reappearance of these theories. They charge ridiculously high prices for drugs that were largely the result of government research and public sector investment (read chapters four through six in my book for the entire story). People who get angry about that fact can become irrational.
Why do I say irrational? Well, to answer one writer, I decided to go back into the data about AIDS deaths. As you look at this chart below, think about this timeline. The protease inhibitors went into clinical trials in 1992-93. They went into their third stage (final) proof of efficacy trials in 1994. Deaths from the epidemic were at a peak in those years and climbing skyward. People were clamoring for the new drugs. And as soon as they got them, the death rates began to decline. By the time they were approved in late 1995/early 1996, huge numbers of people who might have been dying at that point were in "compassionate use" programs set up by the drug companies to provide the still experimental drugs in combination with other approved drugs. It was saving their lives.
If you don't believe it, here are the numbers, drawn straight from the Centers for Disease Control mortality statistics website:
AIDS Public Information Data Set
YEAR Number
Before 1982 154
1982 . . . 584
1983 . . . 1,940
1984 . . . 4,250
1985 . . . 7,954
1986 . . . 12,558
1987 . . . 20,624
1988 . . . 29,582
1989 . . . 32,072
1990 . . . 38,972
1991 . . . 40,358
1992 . . . 41,177
1993 . . . 76,428
1994 . . . 50,436
1995 . . . 37,633
1996 . . . 25,862
1997 . . . 17,273
1998 . . . 11,599
1999 . . . 8,549
2000 . . . 2,926