LIFE SAVING ? forwarded by Dr. Leo Rebello

[Guest guest]

 

 

LIFE SAVING ? forwarded by Dr. Leo Rebello to educate AIDS workers

 

 

LIFE SAVING?

“Participants who initiated therapy with a protease inhibitor were 2.02 times more likely to die than those who did not start therapy with this class of drug” (Rates of Disease Progression by Baseline CD4 Cell Count and Viral Load After Initiating Triple-Drug Therapy. JAMA. 2001 )

“Thirteen of the 49 patients studied developed a hypersensitive reaction to nevirapine within 3–60 days (median 12 and 25 days for reactions affecting the skin and liver, respectively).

Five of these patients had extensive skin rash, five developed liver toxicity (grade III–IV) without cutaneous involvement, three had systemic reactions with skin rash and/or liver toxicity combined with fever (> 388C), myalgia, arthralgia and visceral impairment.

In all 13 patients, nevirapine treatment had to be discontinued and the symptoms rapidly resolved after withdrawal of the drug.” (Littera R et al. HLA-dependent hypersensitivity to nevirapine in Sardinian HIV patients. AIDS. 2006)

“A total of 123 women initiated nevirapine as part of combination antiretroviral therapy in the study period. Eight women developed significant hepatotoxicity, including two women who died from fulminant hepatitis. Women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts”(Lyons F et al. Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy. HIV Med. 2006)

“Of 202 patients, 95 (47%) and 69 (34.2%) developed a rash from all reasons and from NNRTI [Nevirapine-type drugs, now being handed out for free to pregnant women in Africa (thanks Boeringher Ingelheim!)](Ananworanich J et al. Incidence and risk factors for rash in Thai patients randomized to regimens with nevirapine, efavirenz or both drugs. AIDS. 2005)

!http://www.fromthewilderness.com/images/stevenJohnsonSyndrome2.jpg!

Clinical examples of SJS and TEN cases related to Nevirapine.(Top right to bottom left). (a) Erosions of lips and mouth are characteristics of SJS and TEN. (b) Magnification of cutaneous lesions showing purpuric macules, small blisters and positive Nikolski, i.e. detachment of epidermis on pressure. © Skin biopsy showing the detachment of necrotic epidermis. (d) SJS with discrete non-confluent small blisters, involving , <10% of the body surface area. (e) Coexistence of small blisters and detachment of the epidermis on 35-40% of the body surface area in TEN. (f) Detachment of the epidermis is frequent on palms and soles. HERE

Judy, I’ve appealled to your intellect before, but I’m having trouble getting through. Gosh, pretty soon I’m going to have start thinking that you’re in some sort of…denial.

But you seem to feel strongly about helping the poor, which is thoughtful. So how about a debate on either the “life-saving” nature of those drugs, or on the fiction that there are ‘millions of infected’ persons in Africa.

Email me or post at my debate invite blog, if you believe that what you’re posting is true and defensible.

Or please simply post which pharmaceutical company you’re working for.

Liam @ 12/04/06 18:01:34

 

 

“Littera R et al. HLA-dependent hypersensitivity to nevirapine in Sardinian HIV patients. AIDS. 2006”

Did you mention that this study was performed in order to determine how to identify patients that were hyper-sensitive to nevirapine in order to find a pre-screening assay to allow for alternate treatment? And that the results of this study could help prevent future hyper-sensitive reactions to nevirapine by screening for the HLA-Cw8 and HLA-B14 antibodies? Or did you twist the results of the study to fit your own pre-determined conclusions?

.................

“Or please simply post which pharmaceutical company you’re working for”

So people who don’t believe exactly what you believe must be paid shills; nice. You may be comfortable in your intellectual vacuum, but you are more than welcome to join us in civilized discourse anytime you wish.

AIDS drugs are a big business and they are toxic. I do not think that you will find anyone that will argue against that – that nevirapine can cause severe hepatotoxicity1 is well documented.

But the drugs they have now, despite their documented toxicity, can help prevent the spread of HIV. And as the research continues, it is my hope that with a better understanding of retroviral infection, less toxic drugs and drug-sensitivity assays may be introduced.

Unfortunately when they are introduced, they will still be tested on unwilling subjects by multinational business interests (the hidden story, and I commend those such as yourself who are trying to tell it) – but that does not negate the need to find a way to prevent the spread of HIV.

The two largest problems in preventing the spread of HIV are the autonomy of women in developing countries and the transfer of HIV to newborns.

And as vicious as drugs such as nevirapine are, they have been shown to reduce the viral transfer to the newborn during pregnancy, which is fundamental to curtailing the pandemic.

From [2]: “Available evidence from numerous studies indicates that provision of antiretroviral drugs (nevirapine, lamivudine and zidovudine) to infected mothers significantly reduces vertical transmission, with values ranging from 33–63% reduction in transmission3-6.

And all the self-rightous indignation and bold text in the world does not negate that.

...................

1 Severe hepatotoxicity associated with nevirapine use in HIV-infected subjects. J Infect Dis 2005; 191:825–92 Effectiveness of HIV prevention strategies in resource-poor countries: tailoring the intervention to the context AIDS; 20:1217–12353 Low rate of mother-to-child transmission of HIV-1 after nevirapine intervention in a pilot public health program in Yaounde, Cameroon. J Acquir Immune Defic Syndr 2003; 34:274–2804 Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomised trial. Lancet 2003; 362:859–8685 Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999; 354:795–8026 Efficacy of three short-course regimens of zidovudine and lamivudine in preventing early and late transmission of HIV-1 from mother to child in Tanzania, South Africa, and Uganda (Petra study): a randomised, double-blind, placebo-controlled trial. Lancet 2002; 359:1178–1186

tango @ 12/04/06 18:52:06

 

 

I think that the problem that tango dances around is that there’s no evidence that healthy HIV-positive people are better off with drugs. Even if we could eliminate SJS and TEN, we’d still have liver failure, peripheral neuropathy, anemia, cardiac arrest, and hundreds of other clinical and laboratory anomalies.

DavidCrowe @ 12/04/06 21:10:28

 

 

David: As far as your statement that I am ‘dancing around’ this issue, you may have missed when I said: “nevirapine can cause severe hepatotoxicity.”

..............

“Even if we could eliminate SJS and TEN, we’d still have liver failure, peripheral neuropathy, anemia, cardiac arrest, and hundreds of other clinical and laboratory anomalies”

I don’t disagree with that at all. But as you said, it is tangential to my main point, which is that despite their heinous side effects, these drugs have shown efficacy retarding the vertical spread of HIV.

That’s not an endorsement of these drugs, and the literature has varying degrees of agreement with this efficacy. My point was simply that there is a great deal of research that does support their use to stem the spread of HIV from mother to infant that is being ignored because it contradicts the sensational narrative that some tend to issue when conversing about HIV/AIDS medication.

tango @ 12/04/06 21:22:55

 

 

The response to your post is easy – there’s no transmission recorded in any of these studies. There’s no test that measures transmission of any particular particle for this cocked-up disease category.

No standard, no particular proteins, no single response on any of these cock-ups that means any one thing – it’s all up to interpretation.

There’s no such thing as a “spread of HIV” – there’s only a spread of non-specific testing to populations that are pre-determined to be “at risk” for a sex disease that will kill them. It is for these people that the non-specific tests are considered accurate (to have a high “positive predictive value”).

It’s no small irony that the people we drug with these “heinous drugs” die faster, thus fulfilling the dreaded prophecy.

That’s how it goes – and you like it, apparently. You want to drug someone until you get a lower reading (maybe, maybe not) on a test that doesn’t test for any particular thing, with a drug that will give you a terrible rash, permanently damaged liver, and may kill you by peeing your skin off?

As to bold text, you point it out, but you don’t respond to any of it. Do you care to? For example, The incredible, unacceptable rates of toxicity from these ‘life-saving miracle drugs?’ Nope, it’s good enough for you.

Here’s a fair challenge: Why don’t you try a few, and see how you feel about “acceptable risks” afterward? I think medicine would clean up its act faster than shit through a goose if these drugs were tested for safety by the drug company executives, and the docs who peddle them.

Oh, but they’re not sick, you say?

Neither are the majority of people given this focacta diagnosis. All they have is a mythical infection validated by non-existent tests, validated by a culture that’s more-than-willing (and happy) to have a few old prejudices validated by pseudo-scientific shmuckery.

Now, for the record:

I asked Tango for a one-on-one debate but a few days ago: Here

I sent him an email requesting the same, good-natured, but clear debate.

He replied to both, saying “No” adding, that he wanted to remain an observer, that it was not personal, and he wished me luck in my work.

But here he is again, doing the shuck and jive, duck and cover for these drugs and this diagnosis.

You want to debate, we’ll set it up, do it honestly, with a single proposition, a word-limit, a set number of rebutals, and we’ll post it after we’ve both been afforded an opportunity to add cited references and links to the post.

Otherwise, I can’t be bothered to respond to you any longer. You clearly agree with yourself, you think what you think, you like the diagnosis, you won’t respond to the complete falsehood of testing, the blatant and horrific toxicity of the drugs, and none of what anybody says makes a dent.

You’ll say I like my side – that’s what a debate would be for, to let others see our reasoning.

But, no go, you say. “Not my field, not my expertise,” but you still shuck and jive for it.

I’ll wait for Judy’s response, see if she’ll stand up for her points in a debate.

Liam @ 12/04/06 23:09:11

 

 

you won’t respond to the complete falsehood of testing, the blatant and horrific toxicity of the drugs, and none of what anybody says makes a dent.

AIDS drugs are a big business and they are toxic. I do not think that you will find anyone that will argue against that – that nevirapine can cause severe hepatotoxicity1 is well documented.

That’s not an endorsement of these drugs, and the literature has varying degrees of agreement with this efficacy.

Let’s argue fair, gentlemen. No strawmen, no words that weren’t originally in the other’s mouth.

Snark @ 12/04/06 23:17:41

 

 

If, as Snark says, we all agree that the drugs are extremely toxic,

then we’ll move into the presumed basis for giving the drugs:

What does “HIV Positive” mean?

So let it be debated. That and nothing else, because that’s the crux of the reasoning for giving drugs that ‘everyone knows are extremely toxic’ to poor persons world-wide.

Anybody wants to defend the orthodoxy in fair, organized debate, let me know here or by email.

The problem is, we don’t all agree that the drugs are extremely toxic.

Snark might be able to say that, and Tango may give it a little space in his general favor of the paradigm, but,

At the top of this thread, (by Judy), mouthing the words of The Independent, NY Times, the BBC, UNAIDS, the WHO, CDC, CBS, ABC, VH1, MTV, et al, the drugs are called:

“vital”

“high-quality”

They are usually referred to as

“life-saving.”

Which of these is reality?

The studies of the drugs, plainly, without assumption of early death to validate their morbidity, or the PR surrounding the drugs?

We have two scenarios:

The tests don’t mean a thing, you give brutally impoverished people drugs that kill them, you assumed they were going to die early anyway – and they probably were, compared with you and me, living off the fat of the land in America and Europe.

Or

These poor folks have a sex disease (from normative, heterosexual, procreative intercourse) that kills them, but only after 10, 20 or 30 years, (we don’t know), so we give them life-saving drugs (that have some unfortunate side-effects, like death), and we’re noble heros for the cause of righteousness, justice, and we love gay and black people all the more for it…

Which is it?

Liam @ 12/04/06 23:36:55

 

 

The purpose of preventing mother-to-child transmission to drugs like Nevirapine (and in rich countries, AZT) is to prevent the development of antibodies that register on the HIV test. There are no tests for the virus. Viral Load has not been approved for diagnostic purposes and anyway the test is prone to false positives and only uses a tiny fraction of the consensus genome. Because nobody has ever purified HIV nobody knows for sure what the genome is.

And to prevent these tests from lighting up we give mothers and children extremely toxic drugs on the basis that they might be toxic, but HIV is always fatal.

But is it? What about those people walking about 20 years later who’ve never taken AIDS drugs?

What if HIV wasn’t always fatal, are we sure that the cost/benefit tradeoff is positive? Are we sure that the multinational drug companies and the massive bureaucracies like CDC and WHO really have the best interests of poor women and their babies in mind … or is it massive profits and increasing budgets that they are really most concerned about?

DavidCrowe @ 12/05/06 00:17:55

 

 

But the drugs they have now, despite their documented toxicity, can help prevent the spread of HIV.

Makes me think of a guy who got into a cab in New York City. During the ride, he took a bottle of pills out of his pocket, and at every street corner he threw a pill out the window.“Why are you doing that?” asked the taxidriver.“Against the lions”, said the passenger. – “Excuse me, but there are no lions in New York City!” – “You see? That’s because these pills really work”.

WilhelmGodschalk @ 12/05/06 06:37:35

 

 

“The purpose of preventing mother-to-child transmission to drugs like Nevirapine (and in rich countries, AZT) is to prevent the development of antibodies that register on the HIV test ...”

Hmm, that’s interesting David, I’ll look into that – thanks.

..................

Liam: I’ll respond to your post later, if I have time. For now, read Snark’s post again. Those quotes in the dreaded bold text were made by me – they directly contradict what you were claiming as my position. If you are unable or unwilling to read my posts and respond with honesty, your claim that you wish for an honest debate is laughable.

But, to clear up one point – you asked me to a debate, which I declined for various reasons. It’s not personal, despite your attempts to make it so. I would rather discuss and share ideas than take a rigid, inflexible position and defend it tooth and nail.

I have however, noticed a number of times where you knowingly or unknowingly misinterpret other’s research – and my short post above was simply trying to clarify this.

If it was a bit more aggressive than I had intended, then I apologize, but the condescending, downright dick-ish tone that you used to address someone I consider a friend precluded a more embracing tone on my behalf. Again, that it my error.

Hopefully we can continue a more friendly discussion at your leisure.

All the best.

T.-

tango @ 12/05/06 07:21:57

 

 

“At the top of this thread, (by Judy), mouthing the words of The Independent, NY Times, the BBC, UNAIDS, the WHO, CDC, CBS, ABC, VH1, MTV, et al, the drugs are called: “vital” “high-quality” They are usually referred to as “life-saving.””

It’s been a successful marketing campaign, referring to the various “AIDS drugs” as “life-saving”. It’s been so successful that normally questioning minds conveniently switch off in favor of this mantra.

Not too long ago, Liam repeatedly asked an epidemiologist a hypothetical question. The question was: would she give her children AIDS drugs if they were diagnosed HIV-positive?

No matter how many times he asked the question, she wouldn’t answer.

It seems that those drugs are just fine for “others”. Those with dark skin, or who have sex with the wrong gender. Are we “saving” them? Or just killing them via political correctness?

Are Africans dying from sex? Or are they dying from the same diseases and poverty they’ve experienced for centuries, conveniently renamed as “AIDS”?

notdansavage @ 12/05/06 09:01:44

 

 

“Knowingly or unknowingly misrepresent”?

Put it out there, if you think you’ve seen something. But I’ve misrepresented nothing. I have, however, clarified the basic, incredibly dishonest premise of the Aids establishment. No test, no standards, no meaningful diagnosis, all wrapped up in the old biases of every culture (and ours).

But you do misinterpret, like all expert ‘non-experts,’ by not getting to the bones of the research, and accepting the terminology as reality.

The term ‘hiv’, as used in the journals, doesn’t mean a damn thing – it means no one, particular thing, or even a total thing. It always is an excuse – a short-cut to saying ‘some strand of protein, some antibody reaction we’ll puzzle over (but that we know is not specific), some rogue strand of genetic material – but one which will now be counted toward the holy paradigm.

“dickish to someone who is your friend?”

I asked, pointedly, what her conflicts-of-interest are. You’d better be clear about what business this is that you’re supporting.

The pictures at the top may give you a clue, but they don’t seem to be making much of a dent.

I’m always delighted and simultaneously nauseated when I hear microbiologists defend each other (and refuse to counter each other) on the basis of “friendship.”

I’ve never met a bunch of sheepish cowards like those I knew when I was dating/living with a molecular biologist a couple years ago. Nice enough girl, on many counts – she reviewed all the data I brought, and tried and tried to crash my conclusions, but was forced, by integrity, to concede every one.

But she couldn’t take a position, she told me, plainly and pitiably, and I quote, “because I have friends who work in the field.”

This reductionist, academic Science – it is something to witness from the inside out.

As to “Interesting, David,” – sweet Jesus, Tango, this is the point I’ve been making for about 2 years here at the gorilla noise network. Glad you’re perking up.

It is an antibody test, and a non-specific one that they are talking about when they talk about “hiv rates and infection”. Dave knows it, Dan gets it, Wilhelm knows it from the inside out.

I’ve asked you to debate on the topic, because you’re always standing up for the paradigm – and misunderstanding the material you post.

So, you want to debate, then let’s debate. We can do it as a decent discussion, by email, to be published after with appropriate footnotes and refs by both – but no more of this hiding out in the threads.

This is life and death to millions of people. These drugs, this diagnosis – it’s not some academic debate – and given the results with the drugs in question – as a scientist, a rationalist, you should really give a flying fuck who your friends are in this.

Figure out what’s true, what’s actual, what’s consistent, what satisfies the most cartesian logic – and if your friends don’t like it, then maybe they’re not worth friendship.

Liam @ 12/05/06 13:51:40

 

 

“Put it out there, if you think you’ve seen something”

I did.

“I’m always delighted and simultaneously nauseated when I hear microbiologists defend each other (and refuse to counter each other) on the basis of “friendship.”

Again, you misunderstand. My point would have been made regardless. The tone, however, was in response to you being unable to fathom that anyone who disagrees with you may not, in fact, be a corporate shill.

I will however, apologize again for the aggressive tone of my first post.

“sweet Jesus, Tango, this is the point I’ve been making for about 2 years”

He made the point in such a way that was non-confrontational and devoid of ego. I appreciated it and am serious about following up on what he said.

“I’ve asked you to debate on the topic, because you’re always standing up for the paradigm – and misunderstanding the material you post”

I don’t want to debate you; I’ve been quite clear about this. If I am misunderstanding something I would prefer a friendly conversation about why – in that regard, I will attempt to a bit nicer if I ever choose to discuss this topic with you again.

Now, we’re off topic and I have work to do.

So I will say good day to you sir.

tango @ 12/05/06 14:09:50

 

 

The Pharma giants need a lesson in sex ed, I learned early in my life that the “pull out” method doesn’t stop AIDS or pregnancy…

(come on people. A day goes by and nobody made that joke yet?! I’m disappointed in you guys…)

Not_Uberche @ 12/05/06 19:40:30

View Full Thread