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Wright, CPA CALI Reasonable Rates — Call for Estimate 226-3133 1613 N « K»ANNIv FREE W O M EN'S HEALTH C LIN IC Complete GYN Examination and Wet Prep SATURDAY, FEB. 13th FOR AN APPOINTMENT CALL 255-7355 PORTLAND MWUROPWmC curile Counseling Education Groups Workshops Referrals Retreats 333 SW Fifth, Ste 404 • Portland, OR 97204 • (503) 223-8299 Just Oui • 14 • K*bruar\ I9XK Pap smears available at a reduced rate 11231 S.E. M arket Street PHOENIX R f ^ G ‘ M tK iO N S U S § IA \ <*A> SfRVK f C fN T fR Just news.............. AZT: Genie or viral treachery? In the year since FDA approval of AZT, a cure hysteria has emerged. AZT does not cure AIDS. Nevertheless , HIV-positive individuals flock to physicians for a prescription. B Y D O R I S W I S H E R strongly recommend that we initiate AZT therapy, fully informing him or her of the risks zidothymidine (AZT), manufactured by and benefits, the toxicity we have to watch for.” Burroughs Wellcome Co. under the brand name Retrovir, is the only approved drug Loveless said he is uncomfortable prescrib on the market to combat acquired immune defi ing AZT to an individual whose T cells hover between 400 and 200 because nobody knows if ciency syndrome. To look at it. there is nothing conspicuous or the risks will outweigh the benefits. (Normal T cell count is 600 to 800 or greater.) unusual about a 100 mg. capsule — a white, “ If the patient is asymptomatic and the Tcell opaque cap printed with “ Wellcome. ’ * and a unicorn Iogo.“ Y9C” and“ 100” printed on the counts are stable for two to three months. I say wait and see what happens. If an individual’s body with a dark blue band. T cell counts are dropping and they're still There is more to this innocent capsule than asymptomatic. I have to be concerned that the meets the eye. trend is going in the wrong direction. I would be AZT spells controversy on several fronts. much more likely to propose to the patient to The Federal Drug Administration established consider AZT therapy in spite of the risks indications as to who qualifies for AZT. yet involved. The key is to stop the destruction of doctors have prescribed it to patients outside T-4 cells, which are the best markers for this group. AZT is cost-prohibitive to patients immune function.” with or without medical insurance coverage. Unproved AIDS drugs can be procured without To complicate matters further, in the wake of prescription on the street. AZT carries the FDA’s March 1987 approval of AZT. a cure dangerous, toxic side effects; patient refusal is hysteria has emerged. AZT does not cure common. AIDS. Nevertheless. HIV-positive individuals According to the drug-package insert. AZT flock to physicians for a prescription. Sampson indications are based solely on the results of a said people will take any risk. random, double-blind, placebo-controlled “ You see many patients making their deci study conducted at 12 medical centers in the sion to take AZT based on erroneous informa United States. 59 people took AZT, 62 took a tion. It’s a classic scene just as when a patient placebo. The study stopped when 19 people in comes in with a sore throat and demands an the placebo group died due to opportunistic antibiotic. You know antibiotics don’t even infections. AZT shot through the FDA approval touch viruses. Yet the patient pushes and process in an unprecedented four months. pressures the doctor to prescribe it or he'll go Cancer drugs, in contrast, take a decade to wade elsewhere until he gets it,” he said. through this process. The usual dose in AZT therapy is two 10 mg. The drug-package insert indicates AZT for capsules every four hours. The average cost of AIDS patients who have had a recent bout of AZT is $20 to $25 per day. $6,000 to $8,000 per pneumonia, specifically pneumocystis carinii, year — an expensive endeavor regardless of patients who show no signs of opportunistic perspective. infection such as Kaposi’s sarcoma, and AIDS- Sampson sees an economic benefit for the Related Complex (ARC) patients. Outside of patient. A year’s supply of AZT plus one to four these indications, it’s anybody’s guess whether transfusions “ is still less than one hospitaliza the benefits of taking AZT outweigh the risks. tion with lab work and doctor visits. Taking this Is it ethical to prescribe AZT to patients out medication means decreased hospital costs to side these indications? the patient,” he said. “ Professionals make decisions to prescribe Nevertheless, funding issues of far-reaching medication or not based on risk involved in implications emerge due to the high price of taking that medication.” said Dr. Jim Sampson AZT. Loveless sees economics playing a of Good Samaritan Primary Care Clinic. Fie major role in the future of AZT therapy. contends that doctors can go outside the FDA’s “ Physicians are caught in a bind between indications on any medication, but the real issue what we feel reasonable to do based on current is that AZT is toxic to some individuals. data, and there is justification for being more “ It is important to establish risk management. liberal with AZT than the FDA. On the other I prescribe AZT on a case-by-case basis and hand, third-party providers such as insurance consider factors such as medical history, social companies and welfare agencies are paying for history and patient desire to risk taking the the drug. often only when criteria on the product medication.” Sampson said. insert are met. There are patients who are put in Dr. Mark Loveless, an infectious disease a bind where we know their immune systems clinician at the Oregon Health Sciences Uni are not doing well. We know that AZT is the versity. also steps outside the FDA indications only treatment, yet they don’t meet the arbitrary w hen prescribing AZT. He believes current and criteria of the third-party provider. Therefore, previous studies show a benefit for starting AZT the third-party provider won’t pay for AZT.” he treatment early in the disease. explained. “ When individuals come in who are showing Meanwhile, instances of patients splitting me signs that their immune system has very their doses with HIV-positive friends, who are little reserve left, I have made a decision, ethi shut out by arbitrary criteria, become common cally. to step outside the absolute boundaries as place. defined in the product insert,” he said. Loveless surmises that a number of people Loveless’s personal strategy is this: ” 1 look take AZT without prescription. “ There are for clinical signs that the immune system is not desperate things being done by people feeling functioning such as evidence of yeast in the desperate about their disease.” he said. mouth, evidence of persistent viral infections, Funding remains a key issue. "Ethics become evidence of poorly healing infections like not so directed at the physician but more at the herpes, signs of persistent fungal infections in health-financing organizations, be it the state or the toes and groin, signs of venereal warts or private insurance companies or Medicare. The other warts, persistent diarrhea and things that issue could become. ‘Yes. we know AZT is don ’t particularly fit into the category of AIDS effective, but we’re going to wait until the later that we could classify as ARC. If I see these stages of the disease before we fund it,’ ” said clinical indicators, then I’ll test an individual Loveless. for T cells. If T cells are lower than 200.1 Seemingly, the person holding the purse A