strings will determine who can have AZT.
“ Even now people who meet the criteria for a
prescription are not wealthy. They are too sick
to hold down a job; therefore, they've lost their
medical coverage. They may be too young to
have a job with medical coverage or are along in
the stages of this disease and can't get medical
coverage. So they become dependent on the
state," said Loveless.
It is not difficult to foresee how agencies will
be pushed by data showing that early treatment
is most effective and yet manage a health-care
system that will not bankrupt state, federal and
private health-care providers. Since AIDS in
epidemic proportions was not budgeted for, all
medical-policy holders stand to bear added
costs in higher premiums.
If not AZT, what else is available?
Isoprinosine from Mexico and Ribavirin, two
anti-virals that are far from FDA approval, can
be procured on the street, according to Dr. Estill
Dietz, a physician at a northeast Portland medi
cal clinic.
“ There are other drugs out there but they’re
not effective. We have so little to offer patients.
If my patient wants help, I can’t say no to his or
her going to a chiropractor or faith healer.’ ’ he
said.
Sampson does not encourage people to use
medication for which “ we are not sure of
toxicity.” He doesn't dismiss alternative
therapy either. He contends that patients who
make a rational — not emotional — decision
based on valid information do not use unproved
drugs.
“ I tell patients to read and look. What I find
distasteful is that a number of charlatans are out
there presenting medication, approved or not.
in unbalanced ways— not listing the side
effects or the benefits. These people are making
money off somebody's terminal disease. This I
find unforgivable.”
Five hospitals in Portend are currently in
vestigating Isoprinosine in a double-blind study
with AIDS patients sponsored by the FDA.
Dideoxcytidine (DDC), another unproved
anti-viral which inhibits the ability of the human
immunodeficiency virus to infect cells, is in
clinical trials elsewhere in the United States,
according to Science News (March 28. 1987).
Like Sampson. Loveless informs his patients
about unproved drugs. “ If patients choose to
proceed with it, I don't discharge them from my
care." Loveless said.
This notion extends to other therapies such as
naturopathic remedies, faith healing, acupunc
ture, and hypnosis.
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connection.
“ We just don't have enough information
besides anecdotal reports from patients who
feel better on these things. We don't have any
scientific way to analyze these other therapeutic
approaches.” Loveless added.
Just as succumbing to AIDS is not a picnic,
neither is AZT therapy. According to Dietz, the
worst toxic reactions to AZT are “ anemia and
bone-marrow suppression.” He said the total
white blood cell count drops, making the T-4
cell count drop as well. AZT destroys the bone
marrow's ability to make blood cells, leaving
patients highly vulnerable to bacterial
infections. As a result of toxic reactions,
patients must quit AZT or take a reduced dose.
To date, there is little evidence that a reduced
dose is effective. There may even be cumulative
toxicity connected to reduced doses over the
long term.
“ We just don’t know enough about AZT
yet,” said Dietz.
Nevertheless, anemia and bone-marrow
suppression are life threatening. Other adverse
reactions to AZT include nausea, muscle pain,
insomnia, severe headaches, anxiety, confusion
and depression.
To opt for AZT or not? That is the question.
Sampson said some of his patients refuse
AZT because of its bad reputation as a toxic
medication. Some individuals think AZT is
sanctioned by a drug company and won’t
touch it.
“ I have to respect their wishes and let them
go off AZT if they're on it or turn down the
therapy in the first place."
On the other hand. AZT buys time by delay
ing complications. AZT does not prevent
complications.
“ AZT may improve the AIDS prognosis two
to three times. Instead of a 50 percent mortality
at 11 months, it is now 50 percent mortality at
around two years or more. We've at least
doubled the survival time of patients able to
tolerate AZT," Loveless said.
Loveless suggested the ideal would be that
AZT delay complications for 10 years, during
which time the patient develops other medical
problems or dies of heart disease or stroke —
more acceptable, manageable ways of dying.
AZT focuses how expensive AIDS is and
will be to human life and the pocketbook. Dr.
Loveless summed it up: “ One little treatment
strategy such as AZT has shown us ethical
concerns, difficult treatment and management
issues of risk versus benefit, and difficult
economics. It is a microcosm of the whole
AIDS picture "
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