Subject: Dr. Sandra Mengele's AIDS plan
From: [email-masked]
Date: Fri, 27 Sep 1996 07:54:11 -0400

New York Native
September 9, 1996
Reprinted with permission.

Dr. Sandra Mengele
--------------------
Will San Francisco turn into Auschwitz Il?

By Neenyah Ostrom

The debate over how, when, and whether to administer the toxic new anti-HIV
protease inhibitor "cocktails" continues to grow; it has now escalated to the
point that some public health officials are calling for "Directly Observed
Therapy" to force "AIDS" patients to take the drugs or presumably-as is the
case in tuberculosis "Directly Observed Therapy"-be jailed until "cured."

In San Francisco, the city's Health Director Sandra Hernandez is advocating
not only "Directly Observed Therapy" (DOT) for individuals taking protease
inhibitors but also identification of every HIV-positive individual and
mandatory reporting of cases to facilitate the implementation of DOT.

While advocating widespread (and potentially coercive) administration of the
new "cocktails" (which include protease inhibitors and AZT or one of its
analogs), San Francisco's Health Department Director appears to be
disregarding the numerous deleterious effects of these drugs, including
episodes of hemorrhaging in hemophiliacs; increased peripheral neuropathy
(pain in the limbs, usually the legs); development of incredibly painful
kidney stones; potentially deadly interactions with common drugs such as
antihistamines, and many others.

ACT UP/San Francisco has strenuously protested Hernandez's support of these
coercive policies.

On Tuesday, August 20, ACT UP/SF protestors invaded the monthly meeting of
the city's health commission to challenge Hernandez's "AIDS prevention
proposal" that would force San Francisco's HIV-infected individuals to take
the experimental drug cocktails.

The action followed publication of an article in the San Francisco Bay Times
by Terry Beswick in which Hernandez described her "AIDS" prevention proposal.
Beswick's July 11 article was titled "Treatment Combinations Herald a New
Era: People Living With AIDS Hope, While Officials Worry."

Beswick enthusiastically described the reported success of the new protease
inhibitor cocktails, commenting that "an irrepressible sense of excitement is
spreading like wildfire as those who are taking the new drugs witness a
dramatic change in their own lives."

Beswick also interviewed San Francisco Department of Public Health Director
Hernandez, M.D., who views these new combinations of toxic drugs (toxicity is
a subject not addressed by Beswick) as having potential for "AIDS prevention"
efforts.

"I think that strictly from a drug therapeutic perspective...the data that we
have seen is a phenomenal breakthrough," Hernandez told Beswick. "I think it
holds a huge promise."

Beswick added, "And while the new drug combos offer individuals the
possibility of controlling their infection and living longer, Dr. Hernandez
and others believe there is a great potential for curtailing the further
spread of the HIV epidemic itself."

Hernandez appears to visualize combining behavior control therapy, if
possible, with protease inhibitor cocktails to reduce the spread of HIV.

"If you assume that we make no further impacts on behavioral change to try to
prevent new HIV infections and transmission, then these protease inhibitors
potentially-in that they reduce viral load so dramatically- could have an
impact on new HIV infections," Hernandez told the Bay Times. "That is, for
that individual who may not be practicing safe sex all of the time, if they
are taking protease inhibitors regularly in combination with other
antiretroviral therapy, then presumably, their infectiousness would also be
somewhat decreased."

Hernandez goes so far as to suggest that protease inhibitors should be used
as "morning after" pills to prevent new infections.

"You can potentially eliminate new infections if you got people started on
protease inhibitors plus one or two other drugs," Hernandez told the Bay
Times.

Beswick added, "The problem is how to identify non-health care workers who
have been exposed to the virus through sexual or needle sharing situations."

While recommending that people who might have been exposed to HIV begin
therapy with protease inhibitors immediately after the suspected exposure and
continue the therapy for an indeterminate period of time, Hernandez also made
the point that once a person begins taking these drug cocktails, he or she
can be considered to be a public health threat if the therapy is
discontinued.

"It is a double-edged sword," Hernandez told Beswick. "The real dilemma is
how do you get a message out there that sort of says 'taking one protease
inhibitor a day is probably worse than taking no protease inhibitors at all.'
What you potentially have out there is highly resistant strains of HIV that
may be resistant to both AZT and the protease inhibitors, and you've got
nothing in your armamentarium to fight it."

Hernandez has a plan to prevent the problem of "mutant" HIV strains from
emerging: the instigation of "Directly Observed Therapy," following the
tuberculosis model, as the Bay Times reported:

Dr. Hernandez says that she is plan,ning an aggressive educational campaign
directed at local physicians, and has also directed her staff to develop a
comprehensive report on the public health implications of protease inhibitors
immediately after the Vancouver conference.

Furthermore, she believes that it may be necessary to consider adopting the
tuberculosis model of Directly Observed Therapy (DOT), in which health care
workers ensure that patients take the complete dose of their medications, on
time and as prescribed. DOT has been shown to be the most effective means of
treating tuberculosis as well as thwarting the emergence of
multidrug-resistant strains of the bacterial infection.

Beswick didn't tell his readers that tuberculosis patients who do not comply
with DOT are jailed for an indefinite period, until they are considered to be
"cured"-a concept that is still undefined, and some believe unachievable, for
"AIDS."

Is the Health Department Director in San Francisco planning to jail
HIV-positive people who refuse to take protease inhibitor cocktails?

According to ACT UP/SF, the Directly Observed Therapy (DOT) plan outlined by
Hernandez "would mandate by law that all HIV-positive San Franciscans show up
at a designated health clinic to consume state prescribed AIDS drugs in the
presence of a public health official. If the patient misses a scheduled
dosing or refuses to take the pills, he or she would be jailed and forced to
comply. Hernandez admitted in the [Bay Times] article that in order for DOT
to work 'you would have to track everybody and [the patient's HIV status]
would have to be reportable as tuberculosis is.' "

ACT UP/SF attended the Health Commission meeting and, when it was underway,
stood in unison, blew whistles, scattered fake death certificates accusing
Hernandez of mass murder, and chanted, "DOT's A Bitter Pill To Force-Feed
Toxic Drugs That Kill," according to the organization.

Other ACT UP/SF supporters climbed on the Health Commission panel's
conference table and unfurled a banner decorated with a skull and crossbones
and the words "Poisons Don't Prevent AIDS."

A statement of demands was presented to Hernandez. The Health Commission
meeting was delayed about 20 minutes, but ACT UP/SF members left before
authorities arrived, the organization reported, and there were no arrests.

"As a Latino gay man, I am outraged that Dr. Hernandez would propose forcing
anyone to take dangerous compounds that cause severe side effects that harm
the immune system and that can kill if mixed with everyday drugs like
Seldane," said activist Ronnie Burk. "We know that these drug pushers don't
have a scientific leg to stand on when promoting fascist schemes like DOT.
It's obvious that health officials, not people with HIV, are San Francisco's
real public health menaces."

In addition to protesting Hernandez's su~ested coercive policies regarding
toxic drugs of unproven effcacy, ACT UP/SF members also questioned the
usefulness of "viral load" testing as a barometer of an individual's health.

An ACT UP/SF document quoted an article by "AIDS" researcher Tim Peto
published in the May 1996 Journal of Antimicrobial Chemotherapy that
enumerated some of the problems inherent in "viral load" testing.

"The disadvantages of [viral load] assays are fundamental," Peto wrote,
according to ACT UP/SF. "First, it is unclear whether circulating plasma
viral products (RNA, viral protein, or intact virions) all give internally
consistent results. Second, it is unclear whether plasma viral load is the
main reason of HIV disease activity. Third. the quantitative relationship
between changes in viral load and drug efficacy is completely unknown.
Finally, the relationship between drug efficacy and changes in viral load may
differ between different classes of drugs. At present, there is no convincing
evidence that current surrogate markers can be reliably used to predict the
clinical eff'cacy of new treatments...."

"AIDS activists" in San Francisco are particularly upset about Hernandez's
proposals, since, as protester Antonia Crane pointed out, "San Francisco is
viewed as a model of how the rest of the nation should respond to AIDS. This
intolerable proposal will ruin the lives of PWAs across the country,
especially in rural, conservative areas."

ACT UP/SF emphasized that their campaign to stop "AIDS" patients from being
coerced into taking toxic and unproven therapies has only just begun.

Meanwhile, computer bulletin boards like sci.med.aids are teeming with
reports of painful adverse reactions to protease inhibitors and "cocktails"
that include protease inhibitors and AZT or a related drug.

One patient wrote that Norvir [a protease inhibitor] is his "last hope," even
though he's experienced nausea and diarrhea while taking the drug. He added
that "the most debilitating side effect is severe leg cramps. Anyone have any
experience with these cramps and how to alleviate them?"

Another patient reports experiencing "slight nausea, slight numbness in both
hands, lack of appetite, unsettled GI tract (not diarrhea) with intermittent
sharp pains, increased pain sensitivity, fatigue, mild depression, headache,
and hot flashes.... Running, working out, and playing tennis have always been
very important to me. But, given how I feel now, there is no way I could do
any of them...."

A medical professional asked, "Anyone hearing accounts of existing neuropathy
[pain] being aggravated by Crixivan [a protease inhibitor]? I have a client
who can't decide if his increased pain is in his head or really in his legs
due to starting Crix six weeks ago."

Another very painful side effect appears to be kidney stones/crystals. A
patient on Crixivan reported to sci.med.aids, "I woke up with intense pain in
the kidney region which kept getting worse. The drug insert listed this as
one of the possible reactions experienced by a small percent of patients. I
called my MD at 5 a.m. to ask if it was, in fact, a reaction to Crixivan and
he blew me off saying he never heard of it!! (I've since given him a piece of
my mind!) After what seemed a painful eternity, the stone passed (I could see
the pencil point-sized stone).... Have I said the pain is incredible. Another
friend just experienced this same reaction and went to the E.R., not knowing
what the hell was going on!"

Additionally, the Food and Drug Administration issued an advisory to
healthcare providers on July 16 noting that the agency had received 15 case
reports of "spontaneous bleeding episodes in HIV positive patients with
hemophilia who were being treated with HIV protease inhibitors at the time of
the event."

What are these drugs actually doing to the bodies of "AIDS" patients?

And to what lengths will public health officials go to force patients to take
these toxic chemicals? Will "Directly Observed Therapy" become the norm for
"AIDS" patients throughout the entire country?

And will that result in "AIDS" patients being jailed, like TB patients, if
they refuse to take their medication?

Unlike tuberculosis, there is no point at which an "AIDS" patient is
considered to be cured. Speculation about patients being incarcerated for
life in what amounts to concentration camps has generally been labeled as
irresponsible and paranoid; now, however, are those fears about to be
realized? 

==========

(Side box)

Adverse Reaction
---------------

Roche's Invirase

Body as a whole: Allergic reaction, chest pain, edema, fever, intoxication,
parasites external, retrosternal pain, shivering, wasting syndrome, weight
decrease.

Cardiovascular: Cyanosis, heart murmur, heart valve disorder, hypertension,
hypotension, syncope, vein distended.

Endocrine/Metabolic: Dehydration, dry eye syndrome, hyperglycemia, weight
increase, xerophihalmia.

Gastrointestinal: Cheilitis, constipation, dysphagia, eructation, feces
blood-stained, feces discolored, gastralgia, gastritis, gastrointestinal
inflammation, gingivitis, glossitis, hemorrhage rectum, hemorrhoids,
hepatomegaly, melena, pain pelvic, painful defecation, pancreatitis, parotic
disorder, salivary glands disorder, stomatitis, tooth disorder, vomiting.

Hematologic: Anemia, microhemorrhages, pancytopenia, splenomegaly,
thrombocytopenia.

Musculoskeletal: Arthralgia, arthritis, back pain, cramps muscle,
musculoskeletal disorders, stiffness, tissue changes, trauma.

Neurological: Ataxia, bowel movements frequent, confusion, convulsions,
dysarthia, dysesthesia, heart rate disorder, hyperesthesia, hyperreflexia,
hyporeflexia, mouth dry, numbness face, pain facial, paresis, poliomyelitis,
progressive multifocal leukoencephalopathy, spasms, tremor.

Psychological: Agitation, amnesia, anxiety, depression, dream excessive,
euphoria, hallucination, insomnia, intellectual ability reduced,
irritability, lethargy, libido disorder, overdose effect, psychotic disorder,
somnolence, speech disorder.

Reproductive System: Prostate enlarged, vaginal discharge.

Resistance Mechanism: Abscess, angina tonsillaris, candidiasis, hepatitis,
herpes simplex, herpes zoster, infection bacterial, infection mycotic,
infection staphylococcal, influenza, lymphadenopathy, tumor.

Respiratory: Bronchitis, cough, dyspnea, epistaxis, hemoptysis, laryngitis,
pharyngitis, pneumonia, respiratory disorder, rhinitis, sinusitis, upper
respiratory tract infection.

Skin and Appendages: Acne, dermatitis, dermatitis seborrheic, eczema,
erythema, folliculitis, furonculosis, hair changes, hot flushes,
photosensitivity reaction, pigment changes skin, rash maculopapular, skin
disorder, skin nodule, skin ulceration, sweating increased, urticaria,
verruca, xeroderma.

Special Senses: Blepharitis, earache, ear pressure, eye irritation, hearing
decreased, otitis, taste alteration, tinnitus, visual disturbance.

Urinary system: Micturition disorder, urinary tract infection.

---------------

Merck's Crixivan

Body as a whole/Site unspecified: Abdominal distention, chest pain, chills,
fever, flank pain, flu-like illness, fungal infection, malaise, pain,
syncope.

Cardiovascular System: Cardiovascular disorder, palpitation.

Digestive System: Acid regurgitation, anorexia, aphthous stomatitis,
cheilitis, cholecystitis, cholestasis, constipation, dry motuh, dyspepsia,
eructation, flatulence, gastritis, gingivitis, glossodynia, gingival
hemorrhage, increased appetite, infectious gastroenteritis, jaundice, liver
cirrhosis.

Hemic and Lymphatic System: Anemia, lymphadenopathy, spleen disorder.

Metabolic/National/Immune: Food allergy.

Musculoskeletal System: Arthralgia, back pain, leg pain, myalgia, muscle
cramps, muscle weakness, musculoskeletal pain, shoulder, stiffness.

Nervous system and Psychiatric: Agitation, anxiety, anxiety disorder,
bruxism, decreased mental acuity, depression, dizziness, dream abnormality,
dysesthesia, excitement, fasciculation, hypesthesia, nervousness, neuralgia,
neurotic disorder, paresthesia, peripheral neuropathy, sleep disorder,
somnolence, tremor, vertigo.

Respiratory System: Cough, dyspnea, halitosis, pharyngeal hyperemia,
pharyngitis, pneumonia, rales/rhonchi, respiratory failure, sinus disorder,
sinusitis, upper respiratory infection.

Skin and Skin Appendage: Body odor, contact dermatitis, dermatitis, dry skin,
flushing, folliculitis, herpes simplex, herpes zoster, night sweats,
pruritus, seborrhea, skin disorder, skin infection, sweating, urticaria.

Special Senses: Accommodation disorder, blurred vision, eye pain, eye
swelling, orbital edema, taste disorder.

Urogenital System: Dysuria, hematuria, hydronephrosis, nocturia, premenstrual
syndrome, proteinuria, renal colic, urinary frequency, urinary tract
infection, urine abnormality, urine sediment abnormality, urolithiasis.

Sources: Merck and Hoffman-LaRoche package inserts for Crixivan and Invirase.