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BMJ was misled, apologizes to Dr Rath

September 28th, 2006


But who fed the BMJ false information?

Sleazy actions abound in defense of weak HIV∫AIDS paradigm

Vitamin booster and somewhat loopy world savior Dr. Matthias Rath is still in South Africa, and taking on all comers, even though leading HIV∫AIDS dissenting scientist Dr David Rasnick has returned to the USA, having understandably found him impossible to work for.

Only two weeks ago, Rath leveled a law suit against the British Medical Journal for slander, and today he got results. BMJ backed down, withdrawing the story from its site and issuing an apology.

However, it is not clear at all what the specific falsehoods were, since the original story is gone and they are not specified in the apology, and there is no mention yet of the affair on Rath’s site, which now claims that Bill Gates and Warren Buffett were reacting to Rath’s prediction of pharmacollapse with their recent global charity initiatives (a two year graph shows how many visits from Microsoft the site has collected).

Here’s how the story was described by Knowledgespeak, in its story two weeks ago, “Dutch doctor takes BMJ to court with libel charges – 15 Sep 2006:

Titled ‘Vitamins promoter goes on trial for fraud’, the article is about an alternative medicine doctor, who is blamed for the death of a nine-year-old boy with bone cancer. According to the story, the doctor is sent on trial for fraud in Germany for convincing the boy’s parents to reject conventional medical treatments, and use a ‘miracle cure’ rich in vitamins. The story, which was available online until recently, has been removed on legal advice.

Dr. Matthias Rath of the Netherlands has reportedly filed a lawsuit against BMJ Publishing Group for having published a story in the British Medical Journal, which he alleges is defamatory. He is seeking compensation of over £300,000 for the article published in the July edition of the journal. He has also sought an injunction to prevent any repetition of the allegations.

Titled ‘Vitamins promoter goes on trial for fraud’, the article is about an alternative medicine doctor, who is blamed for the death of a nine-year-old boy with bone cancer. According to the story, the doctor is sent on trial for fraud in Germany for convincing the boy’s parents to reject conventional medical treatments, and use a ‘miracle cure’ rich in vitamins. The story, which was available online until recently, has been removed on legal advice.

Following Dr. Rath’s publicity campaigns, several people have reportedly been giving up antiretroviral drugs to opt for vitamin supplements.

Seems that the BMJ were advised by their lawyers to back down in a hurry, and now they have done so.

Here is the page at BMJ where they have also removed the offending libel – the vanished article page – and here is
28.09.2006″>the BMJ Rath apology page
.

Oh, good, we see it does give the false allegations:

In a news item published in the 22 July 2006 issue of the BMJ (2006;333:166) and on the bmj.com website, it was reported that Dr Matthias Rath had gone on trial in Hamburg “for fraud.”

In this context we suggested that Dr Rath stood accused of the serious crime of fraud in relation to the death in 2004 of Dominik Feld, a 9 year old boy with bone cancer; that he was culpably responsible for Dominik Feld’s death; and, in particular, that he had improperly pressured Dominik Feld’s parents into refusing to allow hospital doctors to amputate the boy’s infected leg in an effort to save him.

We now accept that the allegations we published were without foundation, and in the circumstances the BMJ wishes to set the record straight and to apologise to Dr Rath for publishing these allegations.

Sites such as Health-e which wrote stories based on the BMJ report have also withdrawn the story and apologized to Rath. A search for cached versions on Google shows that most or all of them have been removed.

Defending science with personal smears

Well, fine. A rather unexpected victory, given the circumstances, and the tendency for courts to credit ruling paradigms and conventional medicine as gospel truth, which makes one think the law will never give medical mavericks a fair shake. Whether Dr Rath has the right idea or the wrong idea, or even the right idea for the wrong reasons (we think more the latter), he should not be libelled.

But the residual important question is, who fed the BMJ the wrong information? Could it have been the South African activists who have been trying to drum him out of town? Was John Moore of Cornell involved in any way?

And will Moore et al’s scurrilously misleading AIDS information site, AIDSTruth also now carry this news item?

Poison pen letters as a weapon of science

Just how far are the sleazy group of second tier paradigm defenders prepared to go in combating their rivals on non-intellectual grounds? We note with interest that they indulge in sending letters to the employers of dissenters, hoping to silence them that way. This is a trick which most decent men and women wouldn’t think of, but which has been tried recently in three cases we know of.

Luckily in each case the employer didn’t take very long to work out why he or she was in receipt of such a puerile and perfidious attempt at backstabbing. After all, any sane person immediately recognizes how weak a scientific position has to be, if it must be defended with political means, especially with such ungentlemanly and crude capers.

It reminds us of a letter we were shown years ago by an MIT professor who had offended a certain Nobel prize winner by objecting to his joining the faculty. A libelous piece of trash written behind his back, it had taken a year for him to hear about it.

This kind of behind the back detraction is a standard ploy among the second rate who manoever for position which they do not merit. Scientists who are above board because they deserve their prizes and the respect and position they have earned often have no idea what is going on, and can hardly credit it when they are told.

One known perpetrator in HIV∫AIDS is John Moore of Cornell, and there are others, such as Nancy Padian, and Richard Jefferys, who have defended the paradigm in this way. But of course with Dr Anthony Fauci of NIAID censoring scientific or media review of the conventional wisdom from the very beginning of the HIV∫AIDS era twenty two years ago, perhaps they are merely following his lead and feel that their truth is a Holy War in which the Geneva Convention rules may be ignored.

Smokers, quit or you’ll likely be HIV positive

September 28th, 2006


Smokers often score positive, another baffling paradigm mystery

Could it be the obvious? Not in HIV∫AIDS dreamland

While in the aftermath of the last post we can all contemplate the AIDS industry embarking on an “exciting” and no doubt expensive search for a reason for CD4 counts to go down other than HIV “viral load”, we can add one more possible reason why positive HIV tests may not mean what we think they mean.

Seems smokers (watch out, Martin!) are more like to be “at risk of HIV” than the rest of us, notes the newspaper of HIV∫AIDS record.

The study, which appears in the journal Sexually Transmitted Infections, says it is not clear why smokers would be more likely to become infected with the virus, H.I.V., than nonsmokers.

The difficulty the researchers have in explaining their finding is clear. Apparently their “broad review of earlier research” didn’t include calling up the Perth Group or reading their copious papers on test cross reactions.

They stumble from one speculation to the next, as they ignore the elephant in the room.

The study was based on a broad review of earlier research that looked at the relationship between smoking and H.I.V. or AIDS. The authors, led by Dr. Andrew Furber, a British researcher, said they had found a “striking” consistency in the evidence that smokers were more likely to become infected. They did not, however, find strong evidence that smoking made AIDS worse.

The whole performance reeks of the basic intellectual corruption of the entire field, which is never, ever question the basic premises of the paradigm, in this case that the tests reliably indicate the presence of “the virus that causes AIDS”.

We would suggest quite simply on the basis of everything else that has been established in correcting the HIV∫AIDS paradigm in every respect that there is some reaction that goes on in the body of a smoker which triggers a positive response on the few parameters involved in an HIV test. But heck, what do we know, before reading the paper, and seeing how much more often smokers score positive, which the Times item forgets to mention.

Only that the Perth Group has written papers counting as many as sixty sources of cross reaction leading to a false positive, and we do know for example that pregnant females tend to score positive much more often. In fact we suspect that simply being young and female sends scores up in South Africa, judging from the numbers they give us.

That pregnancy cross reaction is one of the factors that makes a mockery out of the WHO extrapolations of prevalence of HIV from a few neonatal clinics in Durban and Johannesburg to the entire population of the sub-Sahara, according to critics such as Rian Molan and the Perth Group, among others, whom we believe.

Just how reliable HIV tests really are is a topic worthy of expansion here, but we have to sign off at this moment.

The least we can say is, come on guys, wake up. Isn’t it obvious why smokers should rate positive more often, without any other correlation with “AIDS”? Either the tests aren’t accurate, or HIV doesn’t cause AIDS, or both.

The New York Times

September 26, 2006

Vital Signs

At Risk: Smoking Tied to Increased Risk of H.I.V.

By ERIC NAGOURNEY

Researchers have found that smokers may be at higher risk for becoming infected with the virus that causes AIDS.

The study, which appears in the journal Sexually Transmitted Infections, says it is not clear why smokers would be more likely to become infected with the virus, H.I.V., than nonsmokers.

But the authors pointed to growing evidence that smoking increases the risk of all types of infections, perhaps by changing the structure of the lung or weakening the immune system. They also noted that tobacco use tended to be higher among the groups of people most likely to get AIDS, like prostitutes.

AIDS and tobacco use, the study said, are the only two major causes of death that are on the rise, with tobacco projected to play a role in perhaps eight million deaths in a little over a decade.

The study was based on a broad review of earlier research that looked at the relationship between smoking and H.I.V. or AIDS. The authors, led by Dr. Andrew Furber, a British researcher, said they had found a “striking” consistency in the evidence that smokers were more likely to become infected. They did not, however, find strong evidence that smoking made AIDS worse.

“It may be the case,” they wrote, “that smoking contributes little to the risk of developing AIDS. This may be because the immune mechanisms that smoking affects are less relevant in progression to AIDS than in acquiring the infection in the first place.”

JAMA confirms HIV load doesn’t govern CD4 loss

September 27th, 2006


Lynchpin falls out of paradigm

No explanation yet from Dr Fauci, and we think we know why

Interesting JAMA story moving on the UPI ticker just now: HIV measurement is questioned. Seems viral load has little to do with CD4 loss in untreated HIV + patients.

Dr. Benigno Rodríguez of Case Western Reserve University and colleagues conducted a study to estimate the extent to which presenting blood levels of HIV can account for the rate at which CD4 cells are depleted among an untreated HIV-infected population of patients.

The researchers found only a small proportion of the rate at which CD4 cells are lost could be explained by plasma HIV RNA level, suggesting more than 90 percent of the determinants of CD4 cell decline are not reflected in the amount of virus in blood.

So don’t hurry to take HAART just because your HIV count is high. Is that right?

If so, where does that leave the paradigm and Anthony Fauci’s assurance that HIV causes depletion of CD4 cells, directly, indirectly and some other mysterious way as yet undefined but characterised by the paradigm defense team’s head man, Zvi Grossman, as a “conundrum”.

Seems we don’t even have to work out what the conundrum is. HIV doesn’t correlate with CD4 loss, period. Not in untreated patients. Not before HAART messes with your constitution.

Ah well, it’s late, maybe we got it all wrong. But looks to us as if the paradigm is failing on every front. Viral load doesn’t govern CD4 loss. That’s a problem to explain, unless you are a dissenter, ie someone with a few working brain cells left in this field.

Is it time for Gallo et al to pack for Rio? He should buy his ticket, the way things are crumbling.

Still, since Fauci presumably has been forewarned, he probably has an answer for us tomorrow, and Larry will let us know at the Times.

UPDATE: here is an AMA rundown of the paper:

“These findings represent a major departure from the notion that plasma HIV RNA level is a reliable predictor of rate of CD4 cell loss in HIV infection and challenge the concept that the magnitude of viral replication (at least as reflected by plasma levels) is the main determinant of the speed of CD4 cell loss at the individual level. The clinical implications are that in the majority of cases, an individual patient’s plasma HIV RNA level at the time of presentation for clinical care cannot predict, to a significant extent, the rate of CD4 cell decline that he or she will experience over the subsequent years and is therefore of limited clinical value in shaping the decision to initiate antiretroviral therapy,” the researchers write.

(JAMA. 2006;296:1498-1506.)….

“The second and potentially more exciting implication of the findings of Rodriguez et al is that future improvements in the treatment of HIV infection and AIDS may result from improved understanding of the 90 percent of CD4 cell depletion that remains enigmatic,” they write. “A better understanding of the immunologic and genetic factors that drive HIV-associated CD4 cell loss may translate to novel therapeutic approaches that could favorably shift the pathogen-host balance.

So 90 per cent of CD 4 depletion is not driven by HIV? But… but… Dr. Fauci, come to our rescue here. We were under the impression that HIV caused AIDS by depleting CD4 cells. You told the audience that when you appeared in New York with Mathilde Krim and Larry Kramer at the New School to celebrate “AIDS after 25 Years”. Help us here.

Did Dr Fauci censor himself on HIV∫AIDS flaws?

Why was this paper not flagged at NIAID before it could be published? The answer to that question also seems enigmatic. Maybe it was because Dr Fauci thought there might be something in our previous nomination on his behalf for recognition from Stockholm (Dr Fauci finds solution to AIDS – it’s HIV; NAR nominates him for Nobel) on the grounds that he had discovered that HIV actually increased CD4+8 proliferation, and therefore was an antidote to itself.

Readers may note that at the bottom of that post is a Comment by Robert Houston which points out that Dr Fauci himself in a review of HIV∫AIDS quoted from a paper he himself forwarded to the National Academy of Sciences that showed that a huge rise in HIV load of 5,560% resulted in a negligible change in CD4 count of -6%, at the same time as boosting CD8 count 20%.

Is it possible that Dr Fauci is aware of the fact that HIV load has no great influence on CD4 count, and even wrote about it for the information of the medical community, on the basis of a paper he forwarded to the National Academy, and somehow forgot to tell government officials, health workers and the public?

Surely it would be too cynical to imagine that the director of NIAID would censor himself in this way, after censoring the media for twenty two years?

Surely a public servant of the well paid and important kind that Dr Fauci is would never withhold information from members of the public who pay his salary who might then be misled into taking drugs with horrendous side effects for no good reason?

Surely a public servant of the stature of Dr Fauci would not freely acknowledge a flaw in the paradigm which has brought so much funding to his institution among colleagues, and yet somehow neglect to tell the public?

If he did, then it behooves us to wonder just how flawed does Dr Fauci think the HIV∫AIDS paradigm really is. Are there other flaws which he has quietly recognized in chats and talks to his peers in the medical policy fraternity, but has omitted to acknowledge in public?

It already seems clear that his answer to Robert Houston at the “AIDS after 25 Years” panel on how HIV killed CD4 cells was misleading. He repeated the same old claims that there was direct killing and indirect killing which have not only been revealed as specious by mainstream papers which he must have read himself, but he knew himself from his own review and paper that HIV load has very little to do with CD4 count changes.

So today’s revelation in JAMA is nothing new to him, and we don’t really expect him to help us to understand it. Dr Fauci’s policy on informing the public seems to be this: however many reasons there are to doubt that HIV is “the virus that causes AIDS”, it is important not to undermine public confidence by acknowledging them in public.

But it is fine to talk and write about them among colleagues.

We wonder what all the haplessly gullible gays now staggering about with wrecked and ugly bodies, and the ghosts of their dead, will have to say about it when they finally come to their senses?

Maybe they will take up Larry Kramer on his suggestion for a latter day Nuremburg Trial, and put Dr Anthony Fauci in the dock.

AMA rundown:

Libraries

Medical News

Keywords

HIV, CD4 CELLS, IMMUNE RESPONSE

Contact Information

Available for logged-in reporters only

Description

Preliminary research indicates that the initial HIV RNA level in untreated HIV-infected patients appears to have little value in predicting the rate of CD4 cell count decrease, potentially limiting its clinical value concerning the decision of when to begin antiretroviral therapy for an individual, according to a study in the September 27 issue of JAMA.

Newswise — Preliminary research indicates that the initial HIV RNA level in untreated HIV-infected patients appears to have little value in predicting the rate of CD4 cell count decrease, potentially limiting its clinical value concerning the decision of when to begin antiretroviral therapy for an individual, according to a study in the September 27 issue of JAMA.

Depletion of CD4 cells is a characteristic of progressive human immunodeficiency virus (HIV) disease and a powerful predictor of the short-term risk of progression to AIDS, according to background information in the article. Blood levels of HIV are also thought to predict HIV disease progression risk. In addition to their role as predictors of the clinical outcomes of HIV infection, CD4 cell count and plasma HIV RNA level are commonly used as markers of the success of highly active antiretroviral therapy (HAART). Until this study was completed, however, the degree to which blood levels of HIV could predict the rate of CD4 cell loss in HIV-infected individuals with similar demographic characteristics to those seen in clinical practice was unclear.

To address this question, Benigno Rodríguez, M.D., of Case Western Reserve University, Cleveland, and colleagues conducted a study to estimate the extent to which presenting blood levels of HIV can account for or “explain” the rate at which CD4 cells are depleted among an untreated HIV-infected population of patients including women and ethnic minorities. The study included repeated analyses of 2 multicenter groups, with observations beginning in May 1984 and ending in August 2004. Analyses were conducted between August 2004 and March 2006. The participants included antiretroviral treatment–naïve, chronically HIV-infected persons (n = 1,289 and n = 1,512 for each of the 2 groups) who were untreated during the observation period (6 months or greater) and with at least 1 HIV RNA level and 2 CD4 cell counts available. Approximately 35 percent were nonwhite, and 35 percent had risk factors other than male-to-male sexual contact.

The researchers found that only a small proportion of the rate at which CD4 cells are lost (only 4 percent – 6 percent) in a given individual patient could be explained by presenting plasma HIV RNA level, suggesting that in chronic untreated HIV infection over 90 percent of the determinants of CD4 cell decline are not reflected in the amount of virus in blood at the time of initial medical evaluation.

“Our findings confirm previous observations that the magnitude of HIV viremia [the presence of a virus in the blood stream], as defined by broad categories of presenting HIV RNA level, is associated with the rate of CD4 cell loss and extend this observation to patient populations comprising both men and women. Despite this association, however, only a small proportion of the interindividual variability in the rate of CD4 cell decline can be explained by plasma HIV RNA level, even after accounting for the effect of measurement error,” the authors write.

“These findings represent a major departure from the notion that plasma HIV RNA level is a reliable predictor of rate of CD4 cell loss in HIV infection and challenge the concept that the magnitude of viral replication (at least as reflected by plasma levels) is the main determinant of the speed of CD4 cell loss at the individual level. The clinical implications are that in the majority of cases, an individual patient’s plasma HIV RNA level at the time of presentation for clinical care cannot predict, to a significant extent, the rate of CD4 cell decline that he or she will experience over the subsequent years and is therefore of limited clinical value in shaping the decision to initiate antiretroviral therapy,” the researchers write.

(JAMA. 2006;296:1498-1506. Available pre-embargo to the media at http://www.jamamedia.org.)

“The second and potentially more exciting implication of the findings of Rodriguez et al is that future improvements in the treatment of HIV infection and AIDS may result from improved understanding of the 90 percent of CD4 cell depletion that remains enigmatic,” they write. “A better understanding of the immunologic and genetic factors that drive HIV-associated CD4 cell loss may translate to novel therapeutic approaches that could favorably shift the pathogen-host balance.

Editor’s Note: This work was supported in part by the Case Western Reserve University Center for AIDS Research and NIH grants. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Explaining, Predicting, and Treating HIV-Associated CD4 Loss – After 25 Years Still a Puzzle

In an accompanying editorial, W. Keith Henry, M.D., of the University of Minnesota, Minneapolis; Pablo Tebas, M.D., of the University of Pennsylvania, Philadelphia; and H. Clifford Lane, M.D., of the National Institute of Allergy and Infectious Diseases, Bethesda, Md., discuss the findings concerning HIV RNA levels and CD4 cell loss.

“The study by Rodriguez et al may have several important clinical implications. The first and more straightforward is that baseline measurements of viral load alone should have less of a role in driving decisions on when to start antiretroviral therapy for an individual patient; these initial viral load levels cannot predict how rapidly the disease will progress. … The seemingly useful practice of combining a CD4 cell count and plasma HIV RNA levels to assess an individual patient’s prognosis for AIDS progression or response to highly active antiretroviral therapy needs reexamination.”

“The second and potentially more exciting implication of the findings of Rodriguez et al is that future improvements in the treatment of HIV infection and AIDS may result from improved understanding of the 90 percent of CD4 cell depletion that remains enigmatic,” they write. “A better understanding of the immunologic and genetic factors that drive HIV-associated CD4 cell loss may translate to novel therapeutic approaches that could favorably shift the pathogen-host balance. … Discovering and developing therapies that target key nonviral factors has the potential over the decades ahead to build on the success of antiretroviral therapy and expand access to sustainable effective therapy.”

(JAMA. 2006;296:1523-1525. Available pre-embargo to the media at http://www.jamamedia.org.)

Editor’s Note: Please see the editorial for financial disclosures, funding and support, etc.

HIV measurement is questioned

CLEVELAND`, Ohio, Sept. 26 (UPI) — Preliminary U.S. research indicates the HIV RNA level in untreated HIV-infected patients has little value in predicting the rate of CD4 cell count decrease.

Researchers say that potentially limits HIV RNA’s clinical value concerning the decision of when to begin antiretroviral therapy.

Until the new study was completed, the degree to which HIV blood levels could predict the rate of CD4 cell loss was unclear.

To address the question, Dr. Benigno Rodríguez of Case Western Reserve University and colleagues conducted a study to estimate the extent to which presenting blood levels of HIV can account for the rate at which CD4 cells are depleted among an untreated HIV-infected population of patients.

The researchers found only a small proportion of the rate at which CD4 cells are lost could be explained by plasma HIV RNA level, suggesting more than 90 percent of the determinants of CD4 cell decline are not reflected in the amount of virus in blood.

The research appears in the current issue of the Journal of the American Medical Association.

UPDATE: Nick Bennett Replies on his site Viral load paradigm shift? Not really.

Wednesday, September 27, 2006

Viral load paradigm shift? Not really.

An interesting study came out recently (I managed to get a copy of the article from one of the authors) on the predictive value of viral load. It’s well known (at least among those who bother to read and understand the literature) that those people with higher viral loads tend to progress faster, as was shown by John Mellors back in the mid 1990s using the large Multicenter AIDS cohort study (MACS).

This study took things one step further. They replicated the original findings of Mellors by showing again that viral load roughly predicted how fast AIDS occurred in another large cohort composed of people from 3 seperate study sites. For example, in this new paper people with viral loads less than 500 had an average loss of CD4 cells of 20 per year whereas those with viral loads over 40,000 had an average loss of 78 a year (with a smooth change for values inbetween). Basically this data proved that viral load was a reasonable predictor of rate of progression! They compared this analysis with the original MACS cohort and it looks practically identical!

But then they tried to look at the individual rate of progression of each member of the cohort. Unsurprisingly they found that the rough-and-ready estimates of progression rate within a subgroup varied from one individual to another. When they ran complex statistical analysis on the effects of viral load on THIS data they found that only about 5-6% of the inter-individual variation can be explained by the initial viral load. In another words, while viral load predicts that you WILL lose CD4 count, and you can give an AVERAGE loss of CD4 cells per year based on that count, you can’t say for sure what the ACTUAL loss will be for any one person very accurately.

Well, duh. Nothing amazing there.

Now, what’s sad about this whole thing is that is appears as if the dissident websites have jumped all over the mass-media coverage of this without bothering to read the paper. They are assuming that this somehow negates the usefullness of viral load measurements. Ironically if a paper showing that viral load predicted 100% of the CD4 T cell loss (an impossible thing) relied on complex statistical analysis I’m sure they wouldn’t accept it with anything like the same level of naivity!

This is nothing new – we’ve known for years that various other factors can play into AIDS progression, from nutritional status to immune makeup, depression, and viral genetics. We’ve known for years that overall T cell losses include uninfected as well as infected cells, that immune hyperactivation leads to apoptosis but a lack of renewal – both things that are only indirectly due to HIV infection, but not direct cell killing. What we haven’t done before is put a number on anything – to say roughly HOW much influence these things can have on an individual level.

It should also be noted that this should lay to rest any idea that mainstream science is simply laying back and accepting the current paradigm without question. If that were the case, why was this large, comprehensive, complex study performed? Is it because that when dissidents say that scientists ARE sitting back on the current paradigm they are…*gasp*…lying??! And, SHOCK HORROR, this was supported by an NIH grant, the very same NIH that the dissidents are trying to claim is horribly corrupt and under the thumb of pharmaceutical sponsors!

Ahh, is that the sound of cherries being picked?

Anyhow, I will quote from the paper:

“Our findings confirm previous observations that the magnitude of HIV viremia, as defined by broad categories of presenting HIV RNA level, is associated with the rate of CD4 cell loss and

extend this observation to patient populations comprising both men and women.”

In other words, viral load predicts rate of progression to AIDS.

If the dissidents are trying to twist this paper to say anything else, they are managing a feat of astonishing deception. Is there more to the story? Of course! No-one, except the dissidents, is saying anything else. They also state that “In humans, the predictive value of immune activation level on HIV disease course, independent of plasma HIV RNA levels, can be demonstrated even when measured during early infection”, which goes back to what I said above.

And I refer the reader to my older post on HIV pathogenesis.

It should also be mentioned that viral load isn’t used as a clinical criteria for starting treatment unless the load is very high and the CD4 counts are equivocal. Viral load is almost exclusively used for monitoring response to therapy on the individual level, so inter-individual variability isn’t an issue anyway.

This result is very important in that it highlights the need to investigate other factors important in triggering or controlling rate of progression to AIDS, but it won’t really change the current paradigm in terms of understanding AIDS pathogenesis, nor will it change current treatment guidelines, because neither depends on the idea that HIV viral load is the be-all and end-all of AIDS.

Except of course, that it is in the minds of the dissidents.

Which is (one reason) why they’re wrong.

posted by Bennett at 11:18 PM

0 Comments:

Comment: Bravo, Bennett, for defending the paradigm against what looked like a nasty finding judging from the first reports. Now we too have the actual paper in hand, we can see that the point Dr Bennett makes is perfectly correct, this was a paper dealing with variations between individual experiences, not with the overall correlation between the two measures of HIV and CD4 for all the patients in the study. Naturally there can be many other factors accounting for variations in individual experience, as there are many reasons for contracting AIDS symptoms, and reasons for vulnerability.

But he entirely overlooks the thrust of the paper, which demonstrates that the authors are unable to discern what those causes of variation might be. They explored the possibilities that sex, risk factor and/or presenting HIV RNA stratum might be the answer and found nothing that could predict the rate of CD4 loss. In fact, Bennett’s reassurance that everything is fine in HIV∫AIDS la la land is merely the same old reflex denial of the big black headline over the AMA comment by W. Keith Henry, which is that “Explaining, Predicting and Treating HIV-Associated CD4 Cell Loss (is) After 25 Years Still a Puzzle.

Henry et al note that the report “challenges the notion that, at the individual level, a limited number of HIV measurements over a short period of time provide meaningful prognostic information regarding the rate of CD4 cell decline and by extension the risk of opportunistic infections.” Of course, if the medical fraternity would take off their NIAID provided glasses with “HIV is behind everything” etched onto them they would have known this in the first place. If they bothered to read their own literature (or this blog) or even think clearly they would know that it is just as likely that CD4 counts are lower at rest and higher when activated, than vice versa, as Dr Fauci has recently touched on in his extensive review. Moreover, the level of active virus in the blood of patients without AIDS symptoms in the long “latent period” is utterly negligible. It is hard to conceive it has anything at all to do with changes in CD4 count, compared with myriad other influences on the immune system.

The result of the study is in fact utterly predictable, and the only surprise it holds is for those who imagine that the simple minded mechanism of HIV causing AIDS imagined in the first place over two decades ago – HIV killing CD4 cells dirctly – is still part of the paradigm. This includes Dr Fauci, it appears, who doesn’t read his own medical literature according to his public statement at the New School on the ways HIV kills CD4 cells, which repeated this now outmoded idea, as well as the cell suicide theory of “indirect killing”, when both are rejected by his top theoretical thinker Zvi Grossman, who has retreated to the conclusion that how it all happens is a “conundrum”.

What is really the study’s only novel usefulness is its demonstration yet again that no one has any idea how HIV can possibly govern the loss of CD4 cells that is held to be cause of AIDS, and that the obvious alternative – that HIV is merely an opportunistic infection, and rather than governing CD4 count, it is CD4 count that governs the rise and fall of HIV viral load, as CD4 numbers are affected by other factors – the poisons and other assaults that may bring on AIDS symptoms.

It puts yet another nail in the coffin of a paradigm that has never been able to demonstrate its central premise.

Institute slams FDA on drug safety

September 23rd, 2006


Musical chair leadership has left agency in disarray

How about AIDS? Maybe IOM should look at NIAID too?

Hot news two days in a row in the Times: the FDA is on the hot seat, accused of dereliction of duty and letting unsafe drugs onto the market in a damning report it paid the Institute of Medicine $3 million for, following the Merck arthritis drug Vioxx debacle. In this case, the FDA bureaucrats have been poorly rewarded for their patronage, since the IOM has roasted them, demonstrating the problems are systemic.

The report’s conclusions are often damning. It describes the Food and Drug Administration as rife with internal squabbles and hobbled by underfinancing, poor management and outdated regulations.

“Every organization has its share of dysfunctions, unhappy staff members and internal disputes,” the report said. But panel members said that they were deeply concerned about the agency’s “organizational health” and its ability to ensure the safety of the nation’s drug supply.

Gardiner Harris’ story Study Condemns F.D.A.’s Handling of Drug Safety has been moved from the Business Section of the Times yesterday to the front page top right and expanded today (Sat Sep 23), so it is unlikely to be missed by anyone important in Washington or New York City.

The New York Times

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September 23, 2006

Study Condemns F.D.A.’s Handling of Drug Safety

By GARDINER HARRIS

WASHINGTON, Sept. 22 — The nation’s system for ensuring the safety of medicines needs major changes, advertising of new drugs should be restricted, and consumers should be wary of drugs that have only recently been approved, according to a long-anticipated study of drug safety.

The report by the Institute of Medicine, part of the National Academy of Sciences, is likely to intensify a debate about the safety of the nation’s drug supply and the adequacy of the government’s oversight. The debate heated up in September 2004 when Merck withdrew its popular arthritis drug Vioxx after studies showed that it doubled the risks of heart attacks.

Several senators have already proposed significant changes, some of which the report seems to endorse.

The report’s conclusions are often damning. It describes the Food and Drug Administration as rife with internal squabbles and hobbled by underfinancing, poor management and outdated regulations.

“Every organization has its share of dysfunctions, unhappy staff members and internal disputes,” the report said. But panel members said that they were deeply concerned about the agency’s “organizational health” and its ability to ensure the safety of the nation’s drug supply.

The report made these recommendations, most of which would require Congressional authorization:

¶Newly approved drugs should display a black triangle on their labels for two years to warn consumers that their safety is more uncertain than that of older drugs.

¶Drug advertisements should be restricted during this initial period.

¶The F.D.A. should be given the authority to issue fines, injunctions and withdrawals when drug makers fail — as they often do — to complete required safety studies.

¶The F.D.A. should thoroughly review the safety of drugs at least once every five years.

¶The F.D.A. commissioner should be appointed to a six-year term.

¶Drug makers should be required to post publicly the results of nearly all human drug trials.

In a telephone conference with reporters on Friday, top F.D.A. officials struck an awkward balance between thanking the institute for its work and defending their own leadership. They said they needed to study the report before deciding which of its recommendations to endorse.

“While considerable work has been done over the past two years to improve our approach to drug safety, work still needs to be done,” said Dr. Andrew C. von Eschenbach, the acting commissioner of the agency and the nominee for commissioner.

An internal e-mail message sent Friday to agency staff members by Dr. Sandra L. Kweder, deputy director of the Office of New Drugs, was blunter, bemoaning the report’s criticism of what it described as the agency’s dysfunctional culture.

“It is a long, inflammatory section of the report that will certainly generate the most public attention and hit our people hard,” Dr. Kweder wrote, according to a copy provided to The New York Times.

Agency critics were elated.

“The new report validates what the watchdog community has been saying for the last two years,” said Senator Charles E. Grassley, Republican of Iowa, who as chairman of the Senate Finance Committee has overseen investigations into drug safety problems. “Problems are systemic, and solutions must reflect a new mind-set by the agency leadership.”

The drug industry, through its trade organization, reacted warily. “Though there is always room for improvements, it would be a mistake to accept the notion that the F.D.A. drug safety system is seriously flawed,” said Caroline Loew, senior vice president of the Pharmaceutical Research and Manufacturers of America.

The Institute of Medicine is a nonprofit organization created by Congress to advise the federal government on health issues. The report was issued by the Committee on the Assessment of the United States Drug Safety System, led by Sheila P. Burke, deputy secretary and chief operating officer of the Smithsonian Institution.

The report described fierce disagreements between those who approve drugs and those who study their effects after approval, disputes that repeated F.D.A. efforts have not resolved. Indeed, managers’ failure to address such disagreements competently “has played an important role in damaging the credibility” of the agency, it said.

Critics of the food and drug agency have long been divided into two warring camps. Some say the agency fails to approve life-saving medicines quickly enough, while others say that it is so intent on rapid approvals that it fails to ensure the safety of the drugs.

The institute’s report champions the latter view by calling for greater caution. It suggests that one of the agency’s biggest problems is a deal struck in 1992 between Congress and the drug industry in which drug makers agreed to pay millions in fees to speed reviews. This deal has increased pressures on drug reviewers to act quickly, and it has limited “the ability of reviewers to examine safety signals as thoroughly as they might like,” the report said.

“Some also have serious concerns that the regulator has been ‘captured’ by industry it regulates, that the agency is less willing to use the regulatory authority at its disposal,” the report said, criticizing the agency’s regulatory tools as “all-or-nothing.”

“The agency needs a more nuanced set of tools to signal uncertainties, to reduce advertising that drives rapid uptake of new drugs, or to compel additional studies in the actual patient populations who take the drug after its approval,” it said.

The pharmaceutical industry is likely to fight at least some of the proposals, said Charlie Cook, a Washington political analyst.

“One should never underestimate the influence of the drug industry,” Mr. Cook said. “But I would think that at least the outlines of many of these recommendations would have a decent chance of getting through Congress.”

Senators Michael B. Enzi, Republican of Wyoming and chairman of the Health, Education, Labor and Pensions Committee, and Edward M. Kennedy of Massachusetts, the ranking Democrat on the committee, have jointly proposed a bill that would undertake at least some of the changes advocated by the report.

Another bill, sponsored by Senator Grassley and Senator Christopher J. Dodd, Democrat of Connecticut, offers similar proposals.

There is little chance that Congress will act on any of these proposals before next year, when it must reauthorize the 1992 financing deal with the drug industry. Negotiations between the drug industry and agency about the parameters of that deal are already under way.

Despite its fierce criticisms, the report may bolster the confirmation prospects of Dr. von Eschenbach. A Senate committee approved his nomination on Wednesday, but two Republican senators have vowed to block it.

Over the past 10 years, no commissioner has served more than two years, though the term is open-ended. The report deplored this “lack of stable leadership.”

“Without stable leadership strongly and visibly committed to drug safety, all other efforts to improve the effectiveness of the agency or position it effectively for the future will be seriously, if not fatally, compromised,” the report states.

It recommends that the commissioner be nominated for a six-year term, but such a change may not solve the problem of early exits. President Bush has nominated two past commissioners. The first left for another job within the administration; the second left amid accusations of financial improprieties.

The report recommends that Michael O. Leavitt, the secretary of health and human services, appoint an independent board to advise the commissioner “to implement and sustain the changes necessary to transform” the agency’s culture.

It rejects suggestions by Mr. Grassley and others that the F.D.A. create a center for drug safety to monitor drugs after approval.

“Achieving a balanced approach to the assessment of risks and benefits would be greatly complicated, or even compromised, if two separate organizations were working in isolation from one another,” the report concludes.

The F.D.A. asked the Institute of Medicine to review its drug safety system shortly after the Vioxx withdrawal in 2004, and the agency has agreed to pay $3 million for the study.

The original had this nice paragraph in it, subsequently cut but only to expand the point and drive it home:

Couched in formal language and careful footnotes, the report’s boring exterior belies an incendiary heart. With each page, it paints a devastating picture of a dysfunctional agency that is unable to ensure the safety of the nation’s drug supply.

Also it appears that Gardiner has now come into possession of a frantic email from one of the FDA’s cats in the hot seat, responding to the report.

An internal e-mail message sent Friday to agency staff members by Dr. Sandra L. Kweder, deputy director of the Office of New Drugs, was blunter, bemoaning the report’s criticism of what it described as the agency’s dysfunctional culture.

“It is a long, inflammatory section of the report that will certainly generate the most public attention and hit our people hard,” Dr. Kweder wrote, according to a copy provided to The New York Times.

One of the arrangements which has made the FDA and the industry it is meant to watch all too cosy is a deal from 1992 where the drug companies pay millions to hurry their permits through:

…one of the agency’s biggest problems is a deal struck in 1992 between Congress and the drug industry in which drug makers agreed to pay millions in fees to speed reviews. This deal has increased pressures on drug reviewers to act quickly, and it has limited “the ability of reviewers to examine safety signals as thoroughly as they might like,” the report said.

Nice understatement, very discreet. This rather blatant fee setup is under review right now but nothing is likely to be done until next year. Here are the main recommendations of the report on ways to tighten up the reins, which the industry lobbyists now have six months to undermine:

¶Newly approved drugs should display a black triangle on their labels for two years to warn consumers that their safety is more uncertain than that of older drugs.

¶Drug advertisements should be restricted during this initial period.

¶The F.D.A. should be given the authority to issue fines, injunctions and withdrawals when drug makers fail — as they often do — to complete required safety studies.

¶The F.D.A. should thoroughly review the safety of drugs at least once every five years.

¶The F.D.A. commissioner should be appointed to a six-year term.

¶Drug makers should be required to post publicly the results of nearly all human drug trials.

The one we like best is this one: “¶The F.D.A. should thoroughly review the safety of drugs at least once every five years.” Yes, sir. Maybe whenever our federal watchdog shapes up again and gets its bite back it will do more than give the HIV∫AIDS drug companies a free pass, as it has for twenty years, riding on the scientifically blind gay activist support for untested drugs and itself blindly willing despite all signs of trouble to go along with clinical trials that have not once included a placebo controlled, ARV free group.

Or has the FDA now abandoned all oversight to the NIAID, which as Harper’s glaringly exposed in Celia Farber’s stunning article in March this year Out of Control: AIDS and the corruption of medical scienceis in bed with the drug companies with the lights out?

Drugs are key to HIV∫AIDS’ heart of worms

Certainly someone should reexamine the regulatory performance with regard to HIV∫AIDS drugs, whoever retains any responsibility in this regard, since now more than one study indicates that ARV drugs kill at least half the AIDS patients who die in the first year of medication with HAART, instead of rescuing them from sickness and death.

In fact, the atrocious performance of the drugs in AIDS is the key to exposing the clay feet of the paradigm, as Harper’s intimated and we will demonstrate in our next post.

Given that it is the NIAID who bears the responsibility for the way ARV trials have been conducted, and even for rewriting and even reversing their results, as Harper’s reported, maybe the FDA could redeem itself by spending the money for a review and calling on Celia Farber as a highly paid expert consultant, since she has amassed a pile of damning material in this regard, and still hasn’t been paid properly for her twenty years of public service in this regard. NIAID off-and-on employee Harvey Fishbein could also be a consultant, if Dr Fauci can be persuaded to let him.

Come on guys, pay the IOM another $3 million for an independent study on that topic, if you are still on speaking terms after this, which we hope you are. After all, the IOM report was exceedingly polite about your talents:

The Committee believes the staff of the Food and Drug Administration, and of the Center for Drug Evaluation and Research in particular, to be a dedicated and talented group of public servants who currently lack the organization and resources to address all of the challenges before them and perform their crucial role of advancing and protecting public health in an increasing complex environment. We believe that the Congress needs to ensure that the Center for Drug Evaluation and Research is given the authority and assets (human, financial, technological, etc.) it requires. The Center’s leaders have to be prepared to address the underlying cultural problems that divide and impair the optimal functioning of Center staff and effectively use the existing and new authorities and resources to achieve the Center’s public health and regulatory mission.

Sooner or later, the abysmal state of HIV∫AIDS medication, which is a can of worms which cannot be hidden away in the technical literature forever, and which itself reveals the horrendous truth behind the scenes in this disgraceful chapter in US science and medicine, will be brought to light. So why not cover yourselves with glory and do it now?

Oh, you would prefer not to grasp the nettle just now, thank you? We understand.

Well, NAR stands ready to shoulder the burden. Next post coming up, and we’ll make it a brief summary of the report that the Institute of Medicine would do if only NIAID director Anthony Fauci was not staring them down and waving the bureaucratic equivalent of a baseball bat.

Here is where the text of the report The Future of Drug Safety: Promoting and Protecting the Health of the Public can be read on line.

Here’s a good quote, straight from the introduction, emphasizing how important it is to the drug industry itself that public confidence in the safety of drugs should be high:

Almost every morning’s newspaper and each evening’s television newscasts include a new and more disturbing episode of pharmacological crisis and medical mayhem in the United States” (Markel, 2005). “. . .

The FDA has become synonymous with drug safety. In a sense, `FDA approved’ is the brand that the entire $216 billion U.S. drug market is founded upon. Dilute the confidence of the public in the agency, and many billions of dollars in current and potential sales vanish overnight. That’s exactly what’s happening right now in the wake of the biggest drug withdrawal ever” (Herper, 2005).

The recent highly-publicized controversies surrounding the safety of some drugs have contributed to a public perception that the drug safety system is in crisis. It seems fair to say that this perception has created an opportunity for a thorough evaluation of the U.S. drug safety system.

News media coverage and congressional examination of the Center for Drug Evaluation and Research’s (CDER) handling of safety concerns have raised questions about the review and approval process and whether it has become so accelerated that adequate attention may not be given to safety, and about the completeness and timeliness of risk communication to the public.

Questions also surfaced about the independence of the scientific expertise relied on by Food and Drug Administration (FDA) (i.e., conflict of interest on the its advisory committees) and about the possibility of undue industry influence related to CDER’s increasing dependence on Prescription Drug User Fee Act (PDUFA) funding.

Test everybody – CDC’s answer to AIDS apathy

September 21st, 2006


If it comes, it might have interesting consequences

Test everybody! Find out if you or I are positive! This is the brave idea whose time has come, according to the CDC and one of its admirers, A. David Paltiel, a health policy expert at the Yale University School of Medicine.

“I think it’s an incredible advance. I think it’s courageous on the part of the CDC,” said A. David Paltiel, a health policy expert at the Yale University School of Medicine.

So down the slippery marketing slope we go with the CDC to the bottom at last, which we welcome with two cheers.

One cheer is for the possibility that more than several superrich and savvy guys’ son or daughter is bound to be positive and then he may pay for a wholesale frontal attack on the NIAID media censorship battlement around the paradigm, or at least a court challenge to the HIV testers to produce an isolated virus, as Martin Kessler suggests in Comments.

The other loud cheer is for the possibility that everybody’s mother and grandmother will prove positive too, just as Dr Harvey Bialy, author and incendiary revolutionary leader of the HIV/AIDS insurgents at the top level of the debate, suspects, as we laid out in our earlier post Ask Mama – a typically novel Bialy initiative, which explained why this research should be done forthwith, by anyone heterosexual who is HIV+ – test your mother and your grandmother immediately, for positively dramatic results.

Federal health officials Thursday recommended regular, routine testing for the AIDS virus for all Americans ages 13 to 64, saying an HIV test should be as common as a cholesterol check.

The U.S. Centers for Disease Control and Prevention guidelines are aimed at preventing the further spread of the disease and getting needed care for an estimated 250,000 Americans who don’t yet know they have it.

“We simply must improve early diagnosis,” said CDC Director Dr. Julie Gerberding.

Nearly half of new HIV infections are discovered when doctors are trying to diagnose a patient who has already grown sick with an HIV-related illness, CDC officials said.

“By identifying people earlier through a screening program, we’ll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others,” said Dr. Timothy Mastro, acting director of the CDC’s division of HIV/AIDS prevention…

The recommendation, if fully implemented, could mean testing for to 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States.

200 million tests at $15 each, that would be $3 billion.

So is CDC Director Dr. Julie Gerberding (pic) planning an exit to some grateful drug company? Such a thought would never come up in responsible circles. But it is the duty of blogs to mention the unmentionable.

PS: For third loud cheer, see Hank Barnes’ Comment below.

For ref here’s the item, first signalled by McKiernan in Comments today: CDC Backs HIV Test for All Between 13-64

SF Gate Return to regular view

CDC Backs HIV Test for All Between 13-64

– By MIKE STOBBE, AP Medical Writer

Thursday, September 21, 2006

(09-21) 18:20 PDT ATLANTA (AP) —

Federal health officials Thursday recommended regular, routine testing for the AIDS virus for all Americans ages 13 to 64, saying an HIV test should be as common as a cholesterol check.

The U.S. Centers for Disease Control and Prevention guidelines are aimed at preventing the further spread of the disease and getting needed care for an estimated 250,000 Americans who don’t yet know they have it.

“We simply must improve early diagnosis,” said CDC Director Dr. Julie Gerberding.

Nearly half of new HIV infections are discovered when doctors are trying to diagnose a patient who has already grown sick with an HIV-related illness, CDC officials said.

“By identifying people earlier through a screening program, we’ll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others,” said Dr. Timothy Mastro, acting director of the CDC’s division of HIV/AIDS prevention.

Although some groups raised concerns, the announcement was mostly embraced by health policy experts, doctors and patient advocates.

“I think it’s an incredible advance. I think it’s courageous on the part of the CDC,” said A. David Paltiel, a health policy expert at the Yale University School of Medicine.

The recommendations aren’t legally binding, but they influence what doctors do and what health insurance programs cover.

However, some doctors’ groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counseling and revising consent procedures.

Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians.

“Are doctors going to do it? Probably not,” Fields said.

But the recommendations were endorsed by the American Medical Association, which urged doctors to comply. The CDC said it’s difficult to predict how many doctors will.

Previously, the CDC recommended routine testing for those at high-risk for catching the virus, such as intravenous drug users and gay men, and for hospitals and certain other institutions serving areas where HIV is common. It also recommended testing for all pregnant women.

Under the new guidelines, patients would be tested for the AIDS virus as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical.

The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.

Consent for the test would be covered in a clinic or hospital’s standard care consent form. Patients would be allowed to decline the testing. The CDC’s guidelines say no one should be tested without their knowledge.

An American Civil Liberties Union official protested the CDC’s idea of dealing with HIV on standard consent forms, and the agency’s de-emphasis of pre-test counseling.

“By eliminating these safeguards, what they’re calling ‘routine testing’ will in practice be mandatory testing,” said Rose Saxe, a staff attorney with the ACLU AIDS Project.

The cost of the new policy is not clear. A standard HIV test can cost between $2.50 and $8, public health experts say.

New rapid tests cost about $15. If an initial result is positive, confirmatory tests can cost another $50 or more. Treatment for HIV can cost more than $10,000 a year.

WellPoint, the Indianapolis company that owns 14 Blue Cross and Blue Shield plans across the country, has not yet taken a position on the CDC guidelines.

It also hasn’t estimated what it will cost to expand HIV testing for its 34 million members, but it traditionally covers tests recommended by the CDC, said WellPoint spokeswoman Shannon Troughton.

The recommendation, if fully implemented, could mean testing for to 100 to 200 million Americans, said Ron Spair, chief financial officer of Pennsylvania-based OraSure Technologies, one of three companies that sell rapid-result HIV tests in the United States.

The other companies are MedMira Inc. and Trinity Biotech. Standard HIV tests are done through both public health labs and private and commercial labs.

“This certainly expands the rapid HIV testing market,” Spair said.

Identifying more HIV patients will place an added burden on public health programs that pay for such care, some of which are facing potential cuts under a proposal before Congress. But more diagnoses may help win bolstered funding, said John Peebles, an assistant branch chief over HIV programs at the North Carolina Department of Health and Human Resources.

“If you don’t know what you need, you can’t make the argument for resources,” Peebles said.

The CDC has been working on the guidelines for about three years, and got input from more than 100 groups, including doctors’ associations and HIV patient support groups.

___

On the Net:

Centers for Disease Control and Prevention:

www.cdc.gov/mmwr

URL: Test everybody

©2006 Associated Press

NAR wins Clinton’s ear for a moment

September 21st, 2006


Exchange in MOMA establishes Bill is no puppet of NIAID

His actively critical position same as Jim Watson’s: the drugs work don’t they?

Always willing to plunge into the fray on behalf of our faithful readers, we followed the master plan announced on NAR yesterday and a) attended the showing of “Pills, Profits and Protest: Chronicle of the Global AIDS Movement” at CUNY and b) won the ear of President Clinton for a moment, which, even though we were surrounded by a press of rival admirers clamoring for the blessing of his attention, succeeded in prompting a remarkable exchange on the dread topic of the Virus and its powers.

At CUNY, the little publicised event attracted about thirty people, almost all women, to this showing of an hour long video by co-directors Ann-christine d’Adesky, Shanti Avirgan and Ann Rossetti on the successes of virtuously motivated activists in Brasil and elsewhere in winning access to damaging drugs at a cheaper price than before.

Afterwards there was a panel consisting of Shanti Avirgan (pic, right – click photos twice to make much larger), who is with the Department of Anthropology at New York University, Shirley Lindenbaum (left) a bright and fluently appreciative academic professor from the Anthropology department of CUNY and Jennifer Klot of the HIV/AIDS Program, Social Science Research Council, a lady well versed in the intellectual extrapolations of AIDS activist politics. The predictable theme of the comment was congratulations all round for the tireless efforts of all in this cause, particularly women, tied to their concern for domestic violence, and the need to pursue the same objective tirelessly in places the film had not treated, like Eastern Europe and Thailand. Brasil came in for particular honor for its early move to make the drugs available to all.

Two facts were of special interest to us: a) the expert anthropologists had neglected to consider the anthropology of medicine and science, and had no idea at all that the human motivations and behavior of medical and scientific authorities might be the same old game as that of the drug companies, who came in for universal suspicion and condemnation for their desire for profits for their shareholders. They could understand that drug companies might be motivated by profit but that doctors and scientists might be motivated by self interest to cut corners or worse as a permanent tendency of their respective tribes seemed to be beyond their consideration. Perhaps it was too far away from the ivory tower to be noticed.

But secondly and more importantly b) there was present a classic example of the drug taking patient who by his very existence seems to contradict the fears of the dissenters in HIVXAIDS, since he had been taking, he claimed, more than the normal amount of HAART drugs for over ten years at the behest of his doctor who favored an aggressive level of treatment. According to his friends present, who included the academics who had mounted the show, he had been in hospital and at death’s door, and the arrival of HAART had saved him. Now he appeared full of vigor and full cheeked, saying he had suffered fat displacement in the past but that the phase had passed and he now felt as full of energy as he ever had.

All we can say in line with the fears of the AIDS critics is that we once again had that familiar sense that he reeked of germs, which we fancy we detect through smell and through a sensation in the back of our nose and throat, admittedly a subjective response, but frequent when we have enountered AIDS patients over the years. But in behavior our new friend was confident, energized and happy to credit the drugs with keeping him alive and well.

We will fill out the above report later and follow up on both aspects with further checking.

Extraordinary exchange with Clinton

It was bearing that anecdotal, contradictory evidence of the man’s vigor in mind anew that we then dropped in on the party at MOMA, to see if by chance we could somehow connect with either Clinton and Gates, and get them to take us seriously enough to give us the name of a staff member to send information to as to what is really going on behind the scenes in HIVXAIDS, and what the literature actually tells us about the viability of the paradigm.

Sampling the barbecued rib and the tuna at a table in the thick of the crowd we chatted to an FT reporter about our purpose, and to our surprise – perhaps in a spirit of devilish experimentation at no cost to himself – he encouraged us to do it. So armed with this unexpected support from a fellow Englishman, we plunged into the scrum of assiduous supplicants surrounding Clinton nearby and succeeded in winning his attention and broaching the topic.

“Mr President”, we said, we have “something very important to tell you, and would like to have an email address or the name of one of your staff to send it to, and be sure you get it!” “Really?” said the great man – indeed he is great in stature, seemingly about six foot six – “What is it about?” So we told him: it was about President Mbeki being right in what he had told him about HIV/AIDS. And to our amazement, he was hooked by the issue. Instead of physically slipping away from the idea like a startled fish, which is the way of almost all politicians and political players in this game that we have encountered in public, he actually addressed the topic.

At first, he had the predictable reflex response that no, he had fully considered the alternative, and was convinced there was nothing in it, because it was simply too clear that those who took the anti-HIV drugs did so much better than those who did not. For some reason on some basis, however, which we will fill in later from our notes of the exact words used, he didn’t lose interest so we continued the exchange by telling him that we thought he was misled, that there was every reason to think that Mbeki was right and that we would send him something on it. One thing he did say – he was convinced that the drug trials were rotten. Could he have been reading Harper’s?

What was significant in all this was the fact that our President emeritus averred he had indeed looked into the issue very carefully, and had come to his own conclusions about it. In fact, we renewed the interchange for a moment after he had moved on by gripping him on the arm and telling him appreciatively that “at least you are a thinking politician, well done!” This got him to turn back to us yet again and assure us enthusiastically that indeed he had studied it carefully himself and not simply taken the advice of a staff member. Surely this is a remarkable statement by someone who is also the consummate politician – Clinton’s Rhodes scholar mind is as alive as ever and he is in the prime of life. No wonder he is moving mountains with his global causes.

Clinton then moved on to engage other much more distinguished greeters and we stood there for a minute contemplating him in admiration too – surely there is no man of his political stature who has combined such genuine charisma with a Rhodes scholar level of mental attention to ideas taken by all too many people as beyond their ken, curtained off in the “science” department, and here he was literally in the rosy pink of good health, emanating vibrancy and the joy of purposeful existence from every pore.

Change the constitution!

No wonder the pretty women flocked around wideyed with their digital cameras, and the personable and sleek suited men were anxious to shake his hand. Later, at the nearby Papillon Bistro Bar where the press were corralled, a tall reporter standing next to me as Clinton came downstairs and halted in the entrance area, once again surrounded by and intensely engaged with one supporter after another, exclaimed that it was a very great shame for this country that this man is prevented from running again for an office that he could now fill with so much more experience and skill than anyone else around.

And indeed, this live Clinton encounter showed us what television and the press cannot – that this is a man of almost heroic distinction in a group of dimensions – personality, political skill, celebrity flair, intellectual alertness and address, and applied idealism in the cause of human need on a global scale – probably not matched by any other in memory, at least in our experience of encountering public figures in person.

The excitement and full bodied distinction of the Clinton Global Initiative event, of the presidents of corporations and countries who have flocked to participate in his event and his cause, and the quality and energy of the personnel who now man his organization, were all immediately apparent to the visitor, and they all clearly stem from the physical charisma and eternally attentive mind of an extraordinary man.

If anything will ever change in HIVXAIDS, it is clearly most likely if Clinton can be persuaded to review the matter again in the light of what the literature actually says, and not what he believes it says. So we intend to send him a letter outlining why he should do so, just as soon as the event is over. For today, we return to see if we can buttonhole Jimmy Carter or Bill Gates with equal success, however unlikely that may be, since Gates has in fact apparently decamped.

Unreality with Clinton at the Sheraton

September 20th, 2006


Powerbroker summit heralds billions for poor, suffering – we hope

But will anyone listen to the only literate politician?

(President Bill Clinton presented a Certificate of Commitment from the Clinton Global Initiative (CGI) to recognize the Unitus-ACCION Alliance for India on Saturday, September 17, 2005 in New York City. Unitus vice chair Elizabeth Funk and board member Steven Funk accepted the certificate on behalf of Unitus)

Bill is busy as master of ceremonies again at his Clinton Global Initiative bash at the Sheraton today thru Friday, handing out certificates of commitment, waffling and cheerleading strictly along the lines of mainstream wisdom, gathering plaudits and admirers and generally adding his showbiz flair to his post-Presidency race for chief global do gooder, in which Jimmy Carter now seems reduced to an also ran because he does the same thing with much less fanfare and business savvy.

Here’s an admiring Fortune article from a couple of weeks ago if you can stand it – well, it’s not too sycophantic:

Bill Gates has the money. But no one motivates people and moves mountains like Bill Clinton. He’s even got Rupert Murdoch onboard. A look at how the former President has borrowed from the business world to fight HIV/AIDS in Africa and other scourges…

Clinton says he spends more than half his time on the foundation, and he’s trying to get to the point where that’s all he does. “I don’t see how we could have exploded this any faster and had more impact that we have,” he says. “We started with me, a handful of people, and $10 million in debt.” When asked if he has any fear of failure, he says, simply, “No.” Then he offers a line that you might hear from a motivational speaker. “If you try enough things and are ambitious enough, you’re going to fail at some. The thrill of this is trying to do it.”

Fortune Magazine: The Power of Philanthropy

Fortune Magazine

Date: September 7, 2006

Bethany McLean

Bill Gates has the money. But no one motivates people and moves mountains like Bill Clinton. He’s even got Rupert Murdoch onboard. A look at how the former President has borrowed from the business world to fight HIV/AIDS in Africa and other scourges.

(Fortune Magazine) — When the black SUV crested the hill and stopped near a cluster of low buildings in the desolate Rwandan village of Rwinkwavu, a crowd of people cheered and the cameras started to roll. Showtime. Paul Kagame, the tall, cave-chested President of Rwanda, alighted from the driver’s seat, and Bill Clinton, thinner than he used to be and ruddy in a brightly checked shirt, emerged from the passenger’s side.

They were there to visit a hospital that treats people with HIV/AIDS, and Clinton was … still Clinton. The former President was midway through a nine-day, seven-country African sprint meant to showcase the work of his William J. Clinton Foundation: conferring with the American ambassador to Chad at 5 A.M. on a runway in N’Djamena; talking politics with reporters in a Johannesburg hotel until his eyes, which these days have deep-black half-moons under them, were bleary; celebrating Nelson Mandela’s 88th birthday; launching a development initiative in Malawi with President Bingu Wa Mutharika; and visiting a clinic with Bill and Melinda Gates in Lesotho, where Clinton was knighted last year.

Soon it would be on to Ethiopia, Nigeria, and Liberia, but now he was in Rwinkwavu, making the rounds with Dr. Paul Farmer – a hero in the world of medicine for his work treating AIDS patients in Haiti. Last year Clinton persuaded Farmer and his Boston-based organization, Partners in Health (PIH), to bring their methods to Rwanda.This hospital was the result, and now it was time to show it off.

What seemed like half the village followed Clinton and Farmer from room to room, along with the obligatory horde of reporters and some very zealous Rwandan security guards. “Make sure you meet this guy,” said Clinton, gesturing toward an embarrassed Farmer. “You’ll be able to say you shook the hand of the guy who won the Nobel Peace Prize.” The group made its way to a ward where mothers and their sick children were huddled three to a bed; Clinton tried to make a connection with them. A bit later, outside, he effortlessly changed tone, joking with a young woman: “I’ll let you be President if you’ll let me be 20 years old again. No one would take that trade.”

As the crowd swirled around him, one petite American woman in a simple black suit chose to stay out of the spotlight. Beth Collins spent 17 years in the corporate world-director at Walt Disney Theatrical Productions, vice president at Universal Pictures, CFO of Talk Media – before giving up the business life in 2004 to become the Clinton Foundation’s Rwanda country director. Now 45, she says she had always felt the call of service but made the decision to answer it (and take a humongous pay cut) only when she came across a book about the genocide in Rwanda – and realized that because she’d been traveling the world nonstop for Disney (Charts), she didn’t even know there had been a genocide in Rwanda. A colleague put her in touch with Clinton, who has always regretted that he didn’t do more as President to stop the genocide. Collins says she never had a moment’s doubt about swapping one life for another.

And so, with the support of the Rwandan government, she and Farmer came to Rwinkwavu and set about rebuilding the dilapidated clinic, a onetime Belgian colonial hospital built to service a tin mine. In 1994, the year that an estimated 800,000 Tutsis were slaughtered by Hutu militia, the hospital was abandoned and became a place where people hid and were killed. Now, thanks to funding from Clinton, Unicef, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria, it is a hospital again, with a small, clean white room stacked with lifesaving antiretroviral drugs (ARVs) that hold AIDS at bay.

In 2004, Collins helped the government place Rwanda’s first orders for those drugs. Roughly 1,700 Rwandans receive ARVs through the program, which trains regular people to deliver and administer meds. “I’ve never loved a job more than this one,” Collins says. “Now I can use my business experience to really do something.”

The un-funded foundation

Welcome to the world of the Clinton Foundation – which, it should be said at the outset, is not a foundation at all in the traditional sense, because it has no money of its own. What it does have, of course, is Bill Clinton and all he brings with him: what Dr. Richard Feachem, executive director of the Global Fund, calls his “personal bully pulpit”; what Bob Carson, outgoing chairman of the American Heart Association, calls his “mind-boggling convening power”; what Doug Band, who began as Clinton’s personal aide in the White House and now carries the title of counselor, calls his “ability to motivate people and move mountains.”

The people he motivates are an odd but potent mix of longtime allies and FOBs, doctors and activists, and executives ranging from the unknown and enormously dedicated (Beth Collins) to the high-profile and frankly improbable (longtime nemesis Rupert Murdoch, who is bankrolling a global-warming initiative).

“We take a lot of cues from the business world,” says Clinton, who these days can sound more like a CEO than a politician. “We have very entrepreneurial people and a very entrepreneurial process. We identify a problem, we analyze it, and we move.” Much of his staff comes from business, and he says using business practices “allows us to do a lot with relatively small resources.”

Overseas assignments don’t come with a car and driver or first-class airfare. “Your job satisfaction is not my main concern,” policy chairman Ira Magaziner, an FOB for almost 40 years, likes to tell the staff. “You can sit in coach for ten hours.” The foundation’s 2006 budget is just $30 million; next year it will roughly double.

The Bill and Melinda Gates Foundation, by contrast, has a $30 billion endowment. “Yeah, I’d like to have his money,” says Clinton of Gates. “But I think our way adds value. It’s kind of a pain to always ask for financing, but perhaps it forces you to look closely.” “We have a culture of getting s**t done. It is very empowering and very unforgiving,” says Anil Soni, a former McKinsey consultant who is now COO of Clinton’s HIV/AIDS initiative. “Ira and Clinton will say, ‘People are going to die tomorrow if we don’t do this.’ And it’s true.”

The foundation doesn’t have a clearly defined hierarchy or a detailed business plan. Its tentacles sprout from need, opportunity, and passion rather than design. “We don’t have committees, we don’t have processes,” says foundation CEO Bruce Lindsey, who has been with Clinton since Arkansas. “If a decision needs to be made, we make it. If we can help, we help now, not tomorrow.”

The foundation operates a bit like a management consulting firm – burrowing into and improving the work of larger organizations – albeit one that is out to rescue the world from the dark threats of poverty, AIDS, climate change, and childhood obesity. “The scale and ambition were startling,” says Mala Gaonkar, a hedge fund manager at Lone Pine Capital who gives money to Clinton. “I’m an analytical person.The foundation is very good at saying, ‘Here are the outcomes, here are the metrics, here’s how we’ve done.’ “

Since we’re talking about Bill Clinton, you’ll also hear criticisms. His foundation is just a way to keep the cameras and the crowds coming. He’s just doing it to help his wife. He overpromises and underdelivers. He grabs credit for the work of others. He’s searching for redemption. There’s probably some truth to all of them.

Certainly nobody soaks up the spotlight like Clinton – of course he got together with Madonna to discuss what they might do to save Malawi. And inevitably, all the showmanship can make you wonder about the substance. But to criticize is also to acknowledge that the bar is higher for Clinton than for anyone else. Instead of joining corporate boards, he’s attacking many of the world’s most intractable problems.

He is not going for the quick hits; he’s going where others haven’t. And he agrees that the bar should be set high: “I believe a lot should be expected of me because I was given an astonishing life.” He also says he has opportunities now that he didn’t have as President. “The raw power [of the presidency] can be way oversold. There are limits to it.”

Unique as it is, the Clinton Foundation also stands for something larger than itself. “I am trying to do this in a way that will inspire other people,” he says. “I hope the way we do things will become more the norm.” Like the Gates Foundation and Robin Hood, the Clinton Foundation is part of a new turn in philanthropy, in which the lines between not-for-profits, politics, and business tend to blur. In this hardheaded philanthropic world, outcomes matter more than intentions, influence isn’t measured in dollars alone, and you hear buzzwords like “scalability,” “sustainability,” and “measurability” all the time. As Clinton says, “It’s nice to be goodhearted, but in the end that’s nothing more than self-indulgence.”

AIDS initiative

On Aug. 14, more than 24,000 people from 160 countries gathered in Toronto for the biennial International AIDS Conference. In a cavernous convention center, attendees waited for hours to cram into a room the size of several football fields to hear Bill Clinton and Bill Gates talk about their work on HIV/AIDS. Where Gates discussed his long-term search for an AIDS vaccine, Clinton described a more immediate goal. “What I wanted to do was to stop people from dying,” he said. “I thought we could do something no one else was doing, and so I did it as best I could.”

The Clinton HIV/AIDS Initiative (CHAI, for short) is illustrative of the foundation’s work for its businesslike approach, its fearlessness, and its knack for promotion. CHAI’s model-act like a for-hire blue-chip consultant and attempt to change the structure of a market rather than just dole out money – has become a blueprint for the foundation as a whole. CHAI employs 491 of the foundation’s roughly 570 employees, about half of them volunteers. It’s also where the whole enterprise got its start.

When Clinton left office, he didn’t have a master plan. There were only a handful of people working on raising money to build his library and a lot of requests. “Every board, every bank, every hedge fund wanted him,” says Band. “But he is not a corporate animal. He’s a public servant.” After leaving office some $10 million in debt, in the past five years Clinton has made over $30 million giving speeches and more than $10 million as an advance for his book, My Life; a deal with businessman Ron Burkle could yield him tens of millions more.

In 2002, Clinton went to Barcelona for that year’s International AIDS Conference, and Dr. Denzel Douglas, the Prime Minister of St. Kitts and Nevis, told him, “We need your help.” Douglas said that if the destruction being wrought by AIDS wasn’t stopped, any other effort to alleviate poverty would be useless. “I didn’t have a clue what I was agreeing to,” Clinton said in Toronto. “We had a total of 12 people in Harlem, and we couldn’t even answer the mail.”

The problem is immense. In sub-Saharan Africa, where perhaps 70% of the world’s infected people live, in some countries more than 20% of the adult population is HIV-positive. The health-care infrastructure is minimal to nonexistent in many places, and annual incomes are less than $200 a year. As recently as the late 1990s, the prevailing attitude toward the explosion of HIV/AIDS was that it was basically hopeless.

Antiretrovirals cost upwards of $10,000 a year. The multinational pharmaceutical companies that owned the patents on these drugs were reluctant to lower their prices. “For the first 20 years of the known epidemic, from 1981 to 2001, we did very little,” says Feachem, head of the Global Fund. “We denied, we minimized, we grossly underfunded.” As President, Clinton admits, he defended for too long the patents of Big Pharma companies against cheap competition from generics. But he rejects widespread criticism of his administration’s HIV/AIDS efforts, arguing that he was stymied by the GOP-controlled Congress. “I think I did do a good job,” he says.

The dismal global picture had begun to change well before 2002, when Clinton got involved. No one in the deeply politicized global AIDS community will ever agree on the impact of any given initiative, but certain things indisputably happened.

In no particular order: Activists, particularly Nobel Prize-winning Doctors Without Borders, began to protest the high price of drugs. Indian generic-drug makers, led by Cipla, began to make cheaper generic ARVs. The major pharmaceutical companies agreed to provide their drugs at what they say is no profit to the poorest of countries. In 2001 the Global Fund was started, and its billions provided major purchasing power. In January 2003, George W. Bush announced that the U.S. would commit $15 billion over five years to “turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.”

Clinton decided to take on the price of ARVs and dispatched his longtime aide Magaziner to look at the problem. By 2002 the most common ARV, the three-in-one pill that patients took twice a day, was being sold for as little as $250 to $500 per person per year, and for much more in some places. Magaziner thought that was all “outrageously expensive.”

Magaziner and Clinton were Rhodes Scholars together. A former management consultant, Magaziner became a key architect of Hillarycare, and after that blew up, he pretty much disappeared from public view. But these days he seems to be everywhere. With his intense eyes and rumpled olive-green suits, and usually fresh from a 20-hour flight in coach, he has something of the mad scientist about him. “He’s not a charmer and not a politician, but he’s the genius,” says Basil Stamos, a doctor whose family helps fund the foundation.

Magaziner called in a network of volunteers, some of them donated by McKinsey, and had them dissect the supply chain for ARVs. “There are a lot of little things that come naturally to someone with a business background,” says Magaziner. As it turns out, much of the cost of the drug is the raw materials. He first went to Big Pharma to discuss how they could reduce their costs, but he says they weren’t interested. (“Ira came to see us to offer to help us work through our supply chain,” says one pharmaceutical executive. “We had already scrubbed the numbers. We understand our supply chain.”) So Magaziner turned to India.

Generic-drug makers like Cipla were already starting to crack Big Pharma’s monopoly. Magaziner’s team got all the suppliers to agree to lower their prices to the point where they would lose money in the first year. They did so in part because CHAI guaranteed them certain volumes. In late 2003, CHAI announced that it would make the most common AIDS drug available for less than $140 a year via agreements with four generic-drug companies.

In Toronto, Clinton described CHAI’s accomplishment this way: “Four years ago, first-line generics cost about $500 a person a year. So we set out to organize a drug market to shift it from a high-margin, low-volume, uncertain payment process to a low-margin, high-volume, certain payment process…. We were able to lower the price to just under $140 a person a year.” He also said that over 400,000 people in almost 60 countries are now getting ARVs under his foundation’s agreements. The foundation has also negotiated price reductions for pediatric drugs and HIV tests.

Within the global AIDS community, however, there are often complaints that headline numbers and press releases present too rosy a view. The Clinton Foundation is not immune to this criticism. At a meeting of generic-drug makers in 2005, discussion turned to Clinton. “He is a very good talker,” said Cipla CEO Dr. Yusuf Hamied, according to a transcript. It’s true that the $140-a-year price comes with a long list of conditions that weren’t included in CHAI’s press release, and that the 400,000 figure includes patients whose drugs-and doctors-are paid for by others. (CHAI doesn’t break out the number of people whose drugs it actually pays for.)

When Clinton says, “We reduced the price from $500,” that’s a royal we-it includes the contributions of drugmakers like Cipla and groups like the Global Fund. In response to such criticism, the Clinton Foundation provided Fortune with a spreadsheet showing that between 2003 and the present, it arranged for the purchase of $72 million worth of ARVs, at an average price of less than $140 for the most common three-in-one combination. Nor does that number tell the whole story. As Cipla’s Dr. Hamied puts it, “Clinton has played a major role in giving companies like Cipla credibility, for which I will always be grateful.”

Other key players agree. “Our folks have gone out and looked very closely,” says Joe Cerrell, director of global health advocacy at the Gates Foundation. “There’s no question that the work and the accomplishments have been dramatic.” The Gates Foundation has already given Clinton $750,000 and is evaluating two more grants. “We’re fundamental believers in the model,” says Cerrell.

You’ll also hear that the publicity Clinton generates is disproportionate to the size of his work and obscures the contributions of others-although this may be inevitable, given who he is, and may do more good than harm, since he aims the spotlight on such worthy causes. In Toronto, Stephen Lewis, the UN special envoy for HIV/AIDS in Africa, recounted how he went to Magaziner “almost begging him to intervene” in Lesotho, a tiny, landlocked kingdom that is surrounded by South Africa and has one of the highest rates of HIV/AIDS. “Within one month-I repeat, within one month-the Clinton Foundation had signed a memorandum of understanding with the Ministry of Health,” said Lewis, contrasting CHAI’s urgency with other organizations that moved “with supernatural acceleration from inertia to paralysis.”

Sir Bill

In addition to funneling low-cost ARVs to Lesotho, the foundation has helped pay for the refurbishment of a pediatric clinic near Maseru, the capital. In gratitude, King Letsie III last year dubbed Clinton a Knight Commander of the Most Courteous Order of Lesotho. In July the Maseru airport – which can be used only during daylight because the landing strip has no lights – was festooned with banners for Clinton’s arrival.

What you wouldn’t know from all the hubbub is that others are working in Lesotho too. For instance, back in 1999, Bristol-Myers Squibb (Charts) announced it would donate $100 million over five years to five African countries, including Lesotho. In December 2005, BMS, along with the Baylor College of Medicine, opened a pediatric clinic that’s also in Maseru.

When the Secret Service did their advance work in Lesotho before Clinton’s visit, they chose the BMS-Baylor clinic as the place to have doctors on standby if Clinton should fall sick. “No one has star power like Clinton,” says Dr. Mark Kline, president of the Baylor International Pediatric AIDS Initiative. “But the casual observer might be led to believe that no one else is doing anything, and that may draw resources away from others. They’re doing great stuff, but they’re one of a number of groups that are doing great stuff.”

In Toronto, Clinton also announced that his goal was “universal access [to ARVs] by the end of the decade.” It is almost impossible to comprehend the enormity of that goal – the billions that would be needed to pay for drugs, delivery, training, and infrastructure. In one small instance, Dr. William Bicknell, a professor at Boston University who also works in Lesotho, calculates that Lesotho will be able to treat up to 45,000 people a year with the roughly $9 million it is expected to have available. But upwards of a quarter-million people in Lesotho will need treatment by decade’s end.

That Clinton would even say “universal access” may hint at his messianic streak, but it’s also a measure of how much things have changed in a very short time. “There was anger and recrimination,” says Feachem. “Now there is hope and ambition.” Everyone agrees that what has made the difference is access to treatment. Old prejudices, such as the notion that poor people couldn’t be trusted to take their pills regularly, have been proven false. As Clinton said in Toronto, “They’ll live if you give them the tools to live.” But even Clinton acknowledges that treatment alone will never be enough. “I think it will be a rocky road until we have a vaccine or a cure,” he told the crowd in Toronto.

At a small dinner party last year in London, a dapper, goateed Scottish entrepreneur named Sir Tom Hunter found himself seated next to Clinton. Hunter, who sold his sneaker empire for $500 million in 1998 and is now the richest man in Scotland, soon found himself in Africa. After late-night discussions about the intertwined nature of the forces that make poverty such an intractable problem-Does health care help people who don’t have clean water? Does clean water help someone who is starving?-the two decided to launch an integrated development program in Rwanda and Malawi. The goal of the Clinton-Hunter Development Initiative, or CHDI, which even Clinton admits is “pretty brassy,” is to double per capita income within ten years. Hunter is committing $100 million over a decade; Clinton is lending his name and the manpower. Already, Magaziner has had people out riding the trucks that distribute fertilizer in order to figure out how best to reduce the cost, just as they did with ARVs. “Clinton speeds things up,” says Hunter. “We don’t have to wait to see if someone takes our call. Our goal is to take the dependency out,” he adds. “We absolutely want to put ourselves out of business.”

In addition to his physicians, saints, and Scottish entrepreneurs, Clinton also has his Wall Street supporters, including money management firm Sterling Stamos. Sterling Stamos, which manages over $3 billion, is set up so that 10% of the general partners’ profits go to charity. Chris Stamos, a partner in the firm, says he decided to commit money to Clinton when, along with Tom Hunter, he accompanied Clinton to Africa. The defining moment came in Rwanda, when a local reporter asked Clinton about his administration’s failures during the 1994 genocide. “It didn’t happen under my administration,” Clinton replied. “It happened under me.”

“It was so unpolitical,” says Stamos.

Just a few weeks after Clinton returned from his 2006 trip to Africa, he was at a press conference-yes, another one-in Los Angeles. Accompanied by British Prime Minister Tony Blair, he announced his latest initiative: an attempt to tackle global warming by working with the world’s 20 largest cities to help them reduce emissions and buy energy-friendly products such as efficient lighting more cheaply. The $3 million in funding is coming from three donors: Anson Beard (one of the retired Morgan Stanley executives who played a role in ousting CEO Phil Purcell), Barbra Streisand-and Rupert Murdoch. “I’m quite sure it’s the only time that Rupert Murdoch and Barbra Streisand have done anything together!” says Clinton. Few have been tougher on the Clintons than Murdoch’s New York Post, but recently the camps have been cozying up; Murdoch even hosted a fundraiser for Hillary. Murdoch “has the same right to his opinions that I have to mine,” says Clinton. “It would be hypocritical of me if I weren’t willing to work with people who have opinions different than mine.” He laughs. “It was said of me when I was governor that I’d never remember who I’m supposed to hate one day to the next.”

What with global warming and the worldwide HIV/AIDS pandemic, you might think Clinton has his hands full. Then you meet Bob Harrison, a former Goldman Sachs partner who now spends most of his days in a cramped room in Clinton’s Harlem office. The little space is dominated by a giant posterboard that says ALLIANCE FOR A HEALTHIER GENERATION. After Clinton’s quadruple-bypass surgery in the fall of 2004, the American Heart Association called to see if he’d do a public-service announcement. Clinton responded that he wanted to do something that had measurable results, and in May 2005 his foundation and the AHA announced the alliance, which has as its grand goal stopping the increasing prevalence of childhood obesity by 2010. It’s a personal issue for Clinton-he battled his weight as a child, and his ongoing struggles with diet have been exhaustively chronicled-but it is more than that. Childhood obesity could cause this generation of Americans to be the first in history with a shorter life expectancy than their parents. The economic consequences are staggering.

Like most of Clinton’s projects, the alliance is both immensely ambitious and embryonic. This spring Clinton held-surprise!-a press conference to announce a deal he had struck with the beverage industry to limit the amount of sugar and calories in drinks sold in schools. Harrison is now negotiating a similar deal with snack-food makers, and other parts of the plan, such as helping health-care providers better treat obesity, are underway. “This is as intense and urgent as almost any period of time at Goldman Sachs,” says Harrison, who worked for the John Kerry campaign after leaving the firm. He does not take a salary.

Clinton’s beverage deal has already come under fire from a wide range of activists, lawyers, and academics, who say he simply swiped the groundwork laid by a grass-roots movement, and that he has been used as a handy public relations tool by soda companies desperate to avoid the very real threat of litigation. When you look closely at the agreement, it’s all voluntary. States such as Connecticut have passed legislation that goes further. “Industry went looking for someone like Clinton to make it look like they were doing something good, when in reality they were being forced into it,” says Kelly Brownell, the director of the Rudd Center for Food Policy and Obesity at Yale who was recently named one of Time’s 100 most influential people for his work on childhood obesity. “I’m not surprised that Bill Clinton would do something to grab the spotlight,” says Michelle Simon, the founder of the Center for Informed Food Choices.

The deal with the soda companies showcases another key tenet of the Clinton Foundation-its determination to work with, not against, industry. “The foundation’s approach is to be very conscious of economic realities. We’re not trying to put anyone out of business or even do damage,” says Harrison. Says Clinton: “I never ask any business to lose money. What we need most in AIDS, in climate change, in health care, is for them to reexamine the premises on which they operate.” He cites Wal-Mart’s move to a greener business model as a key example of doing well by doing good. The alliance’s work may help test the limits of that old saw.

Everyone who works for the Clinton Foundation insists that “no” is part of the vocabulary-after six months of research, for instance, they decided they didn’t have the resources at this particular time to fix the world’s water and sanitation problems. But you can’t help wondering about their level of self-awareness when Band says, with apparent sincerity, “We believe we’ll have way more impact if we focus on a few things specifically rather than a lot of things broadly.” They seem to be spread thin, but from their perspective, maybe they’re being incredibly selective. Band, with his ever buzzing BlackBerry, a letter from Mandela on his desk, and an e-mail from Spielberg in his in-box, says that the foundation receives 5,000 pieces of mail a week, 20% of them requests for help. “If it’s a malady the body can have, they’ve come to us,” says foundation CEO Lindsey.

If it all sounds a bit grandiose, could it be any other way? As Lindsey says, “It’s the nature of the beast. We work for a man who sees big problems and wants to tackle them.”

On a Thursday in late August, Clinton’s Harlem office is a frenzy of activity. People are streaming in and out of the conference room, where a gigantic purple orchid blooms against the Manhattan skyline. Clinton is in the house, and a string of events are in full swing to celebrate his 60th birthday, which began on the day itself, Aug. 19, and will conclude with a private Rolling Stones concert fundraiser in October. Today Clinton’s staff threw him a surprise party, and Bono sent a singing telegram delivered by famed Irish tenor Ronan Tynan, who sang what amounted to a history of the Irish in America. Clinton teared up. (No, he isn’t Irish.)

Clinton’s office is an oasis of calm. Lining the windowsills and covering the walls are framed memorabilia and photographs. It seems more like a museum than a working office, and indeed, Clinton isn’t there often. He travels roughly half the year, and when he’s in New York State he works mostly out of Chappaqua, spending one day a week in the Harlem office.

Clinton’s health problems in the fall of 2004 don’t seem to have slowed him down. He looked exhausted in the wake of his surgery but now appears fit-and remains absurdly active. In addition to the foundation, there’s the Bush-Clinton Katrina fund, his work as the UN’s special envoy for tsunami relief, and-oh, yes-politics. It is an election year, after all, so his calendar includes time for campaigning. “I knew I would want to help as much as I could,” Clinton says. And then there are the things that just pop up, like today’s meeting with a Make-A-Wish child whose wish was to meet Clinton. (“He’s so smart,” says Clinton. “He’s read all the books I have.”) He also finds the time to read four or five books a week. On the trip to Africa, he talked constantly about Robert Wright’s Nonzero. (“It contradicts people’s sense of themselves to have to share the future with the other,” Clinton said. “But there is no conceivable alternative.”) Of course, he also golfs, although he says, “If I played more than once a week, I’d get bored.”

Clinton says he spends more than half his time on the foundation, and he’s trying to get to the point where that’s all he does. “I don’t see how we could have exploded this any faster and had more impact that we have,” he says. “We started with me, a handful of people, and $10 million in debt.” When asked if he has any fear of failure, he says, simply, “No.” Then he offers a line that you might hear from a motivational speaker. “If you try enough things and are ambitious enough, you’re going to fail at some. The thrill of this is trying to do it.” He insists that his foundation is not an attempt to atone for past sins or compensate for lost power. “I promised myself when I left the presidency that I would not spend one day sitting and moping and wishing I was still President,” he says. He repeats a variation of this a little too often for it to be believable, though, and while he’ll discourse on the limits of presidential power, he also recounts a telling anecdote. Someone recently asked him if he thought he would wind up doing more good as a former President than he did as President. “Only if I live a long time!” he said.

In truth, no explanation of Bill Clinton’s motives can do them justice. Is he trying to help Hillary by generating goodwill and building support among both Republicans and Democrats? He’ll deny that Hillary needs any help. He is sensitive to charges that he didn’t put a stamp on his time as President, and he acknowledges a few failures-about Rwanda, he says, “I do think I have a debt there, and I don’t think it can ever be fully discharged.” But if he has any sense of mission not accomplished, he won’t admit to it.

Clinton casts his motivations in moral and religious terms-and frequently mentions his own mortality. In a speech a year ago, he said, “It will benefit us economically if we do this. But we need a little humility here. If we really have our religious teachings grounded, well, we will do this because it’s the right thing to do.” He also said, “I’ve reached an age now where it doesn’t matter whatever happens to me. I just don’t want anybody to die before their time anymore.” In Harlem, he picked up a picture of himself and Hillary back in Arkansas. “I was only 39 then, and I didn’t look it,” he said. “I didn’t look my age until I was 45, and then it all went to hell.” He’s been saying things like this since 1996 or so, when he seemed to realize that his graying-now white-hair lent him a gravitas he’d lacked. But after quadruple-bypass surgery, who can say he hasn’t earned it now?

Flying through African skies after a long day in Malawi, Clinton went on another extended monologue about his motivations. “Always in my life, I’ve had a consuming interest in people, politics, and policy. I’m out of politics now except for whatever use I am to Hillary. But I’m not out of people and policy. My primary motivation is that I love this stuff.” For the people in Malawi, he said, there was but one choice: to work to live. “That’s the way 99% of people in human history have lived. If you’re in that narrow class who can live to work, you are privileged not just now, but in any single moment that ever existed.” He added, “If you can do something that makes a difference, you have a moral obligation. But it’s not a burden, it’s a joy. I think those are my motives,” he concluded. “But who can really know?”

Having attended similar meetings eg Davos before we view their power to change things with a jaundiced eye but there is something invigorating about Clinton’s bonhomie, and the powerbrokers of the world are here. He seems sure to “make a difference”, although given his record so far on HIV∫AIDS he will likely add to that problem rather than solve it.

In Toronto, Clinton also announced that his goal was “universal access [to ARVs] by the end of the decade.” It is almost impossible to comprehend the enormity of that goal – the billions that would be needed to pay for drugs, delivery, training, and infrastructure. In one small instance, Dr. William Bicknell, a professor at Boston University who also works in Lesotho, calculates that Lesotho will be able to treat up to 45,000 people a year with the roughly $9 million it is expected to have available. But upwards of a quarter-million people in Lesotho will need treatment by decade’s end.

The proceedings can be viewed from your desk in Cuernavaca or Kuala Lumpur by going to Clinton Global Initiative and watching it streamed in a live webcast from a link on that page.

After angling for a word with Clinton, Gates or Buffett at today’s event we are toying with the idea of visiting CUNY this evening for tips on how an activist might jump on board tomorrow and hijack this ship, since the Anthropology department is running a film, Pills, Prophets, Protests, on the antics of protesters agitating for their beloved pills:

Pills Profit Protest

18 September 2006

Don’t miss a screening of Pills Profit Protest: Chronicle of the Global AIDS Movement, a film by Center for Religion and Media Fellow Shanti Avigran, with Anne-christine d’Adesky and Ann T. Rossetti, at the CUNY Gradute Center this Wednesday, September 20, from 6:30 to 8:00 pm. Pills Profit Protest documents the battle for access to HIV treatment by depicting the struggle between the marginalized and the powerful and is an essential commentary on one of the largest global crises we face today. The screening will be followed by a panel discussion with filmmaker Shanti Avigran, Shirley Lindenbaum (Department of Anthropology, CUNY Graduate Center), and Jennifer Klot (HIV/AIDS Program, Social Science Research Council).

But probably after exposure to this insanity we will be forever discouraged from associating with activists of any type, and let the good ship HIV∫AIDS/Clinton/Buffett/Bono/NIAID sail on unperturbed.

The chances of getting any of these key citizens or their staff to look at the medical literature or even its more popular exposition in books and on the Web and related commentary in NAR seems minimal in an age where video streaming seems so much more exciting and relevant.

The man they might listen to – but don’t

And of course, the one politician on the world stage who has shown the intellectual capacity and fortitude to look behind the scenes in the matter of global HIV∫AIDS is not likely to be asked to contribute.

After all, we have all just heard anew from the Los Angeles Times on the subject of “Dr Beetroot” – Her Ideas on AIDS Are Called Bad Medicine – along the following lines. First, how Mbeki’s capacity for independent investigation and judgement has now blighted his reputation irrevocably:

In the late 1990s, Mbeki warned of the toxicity and harmful side effects of antiretroviral treatments, and in 2000 he questioned the link between the human immunodeficiency virus and AIDS. He has never publicly disavowed those views, although government spokesman Themba Maseko said this month that the government thought HIV caused AIDS.

“I don’t think he understands how much it has damaged his presidency,” said William Gumede, the author of a biography critical of Mbeki. “Even his closest allies, if you speak to them, don’t see it.”

Other observers think that the more pressure from activists and international experts, the less likely Mbeki is to dismiss Tshabalala-Msimang because he finds it difficult to admit he was wrong about AIDS.

“I think there’s a certain degree of vanity here,” said political analyst Tom Lodge, a former political science professor at the University of the Witwatersrand in Johannesburg. “He’s like a lot of politicians: He really finds it difficult to say, ‘Look guys, I made a mistake.’ “

Not much here to encourage other politicians to follow his example.

Then we have the authoritative opinion of a UN envoy and a comedian in the matter:

With 600 to 800 people dying of AIDS in South Africa daily, (UN envoy Stephen) Lewis said the government had much to atone for, but added, “I’m of the opinion that they can never achieve redemption.”

Cape Town comedian Peter-Dirk Uys, known for his scathing stage show, “Foreign AIDS,” has gone even further, calling his country’s antiretroviral program “the new apartheid” because so many poor people are dying of acquired immune deficiency syndrome from a lack of drugs…

Finally we are told in effect that Dr Manto Tshabalala-Msimang’s opinion is completely uninformed by the medical literature and merely a matter of being a loyal partner of Thabo Mbeki’s, having fought in the trenches with him in the early days.

Political analyst Lodge said Tshabalala-Msimang held conventional views on HIV and AIDS before she was named health minister, but she had since echoed Mbeki’s opinions, adding her spin about garlic, lemons and beets as a treatment for AIDS.

“In the case of the president, who likes to think independently of experts and who often is in quite an isolated position intellectually, it is possible to see — and it’s also possible to regret — where he has ended up,” Lodge said.

“It’s in some ways all the more unforgivable in her case because, unlike the president, she has a conventional medical training. She is going against the conventions and the professional protocols of her own background.”

What does one call a world where the reporter for a respectable newspaper believes X, reports as authoritative the beliefs in X of a UN envoy and a comedian, confirms the beliefs in X of the most powerful individual financial movers and shakers in the world, and all of them feel free to ignore and even despise the views of the one global player who has actually checked the medical literature, the one source of authority in medicine and science that all must defer to, which says Y is true, not X?

Instead, they choose to follow the authority of a director of NIAID, Dr. Anthony Fauci, who is incapable, as he showed recently in a panel in New York, of getting straight what that literature says about the simplest issue in HIV∫AIDS, how the Virus supposedly causes damage to the immune system, and when asked from the audience by Robert Houston to explain, proceeds to state propositions now contradicted by the mainstream HIV∫AIDS literature, let alone the review critiques of Peter Duesberg which are now twenty years old and as viable and unaswerable as ever.

What does one say about a world which rejects black Thabo Mbeki’s views in favor of white Anthony Fauci’s?:

Her Ideas on AIDS Are Called Bad Medicine

South Africa’s health chief favors a treatment of beets, lemons and garlic over proven drugs. The president resists calls to fire her.

By Robyn Dixon, Times Staff Writer

September 19, 2006

JOHANNESBURG, South Africa — The United Nations special envoy for AIDS has likened her to the “lunatic fringe,” while a well-known comedian derides her as the “angel of death.”

She is South Africa’s top health official and one of the most important front-line fighters against AIDS in a country beset by an epidemic. But Health Minister Manto Tshabalala-Msimang has been widely criticized for questioning the effectiveness of antiretroviral drugs to combat AIDS, advocating instead a treatment using beets, lemons, garlic and sweet potatoes.

She has been criticized in international forums, and dozens of global health experts recently called for her to be fired. But South African President Thabo Mbeki has remained steadfast. Some analysts suggest he is being loyal to a longtime political ally, others say he is satisfied with her performance because her views are similar to his own.

In the late 1990s, Mbeki warned of the toxicity and harmful side effects of antiretroviral treatments, and in 2000 he questioned the link between the human immunodeficiency virus and AIDS. He has never publicly disavowed those views, although government spokesman Themba Maseko said this month that the government thought HIV caused AIDS.

“I don’t think he understands how much it has damaged his presidency,” said William Gumede, the author of a biography critical of Mbeki. “Even his closest allies, if you speak to them, don’t see it.”

Other observers think that the more pressure from activists and international experts, the less likely Mbeki is to dismiss Tshabalala-Msimang because he finds it difficult to admit he was wrong about AIDS.

“I think there’s a certain degree of vanity here,” said political analyst Tom Lodge, a former political science professor at the University of the Witwatersrand in Johannesburg. “He’s like a lot of politicians: He really finds it difficult to say, ‘Look guys, I made a mistake.’ “

This month, Mbeki ignored a call for Tshabalala-Msimang’s dismissal from 81 international AIDS experts, including David Baltimore, who won a Nobel Prize, and Robert Gallo, who developed the first blood test for HIV and identified the virus as the cause of AIDS.

In a letter to Mbeki, they called for an end to South Africa’s “disastrous, pseudoscientific policies,” saying the health minister was an embarrassment.

At the International AIDS Conference in Toronto last month, U.N. envoy Stephen Lewis described the South African government’s approach as “wrong, immoral, indefensible.”

“It is the only country in Africa,” he said, “whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state.”

With 600 to 800 people dying of AIDS in South Africa daily, Lewis said the government had much to atone for, but added, “I’m of the opinion that they can never achieve redemption.”

Cape Town comedian Peter-Dirk Uys, known for his scathing stage show, “Foreign AIDS,” has gone even further, calling his country’s antiretroviral program “the new apartheid” because so many poor people are dying of acquired immune deficiency syndrome from a lack of drugs.

In South Africa, 5.5 million people are infected with HIV, second only to India. The government estimates it treats 140,000 South Africans with antiretroviral medicines. Of those, 40,000 are funded through the President’s Emergency Plan for AIDS Relief, an initiative started by President Bush.

Gumede said Mbeki did not want to fire Tshabalala-Msimang under pressure, but noted that her power had been curbed when the government set up a committee of ministers this month to oversee the AIDS treatment plan.

“Mbeki is very sensitive,” he said. “If he feels one of his loyal supporters or loyal allies is under siege, it’s real unlikely that he will fire such a person.”

Mbeki and Tshabalala-Msimang have been friends since the early 1960s, when they and other students went into exile. Mbeki is also close to the health minister’s husband, Mendi Msimang, treasurer of the ruling African National Congress and the ANC’s London representative when Mbeki was in exile in Britain during apartheid.

Mark Gevisser, author of a forthcoming biography on Mbeki, said the president had been asked why he appointed Tshabalala-Msimang health minister. Mbeki reportedly pointed to a photo of himself, Tshabalala-Msimang and other young exiles and said: “She’s been with us from the start, and she’s a doctor. She could have gone into private practice; she could have left the movement, but she has stayed with us.”

Gevisser said trust was a key factor.

“It’s history that the two of them as youngsters went into exile together, and that’s significant, but not as significant as the fact that he feels that she’s someone that he can completely trust,” he said. “I would imagine that there’s a deep, enduring bond and a sense of loyalty, and a sense of, ‘We were with each other in the trenches, so I can trust this person absolutely.’ That becomes a measure, as much as a minister’s competency in a portfolio.”

Political analyst Lodge said Tshabalala-Msimang held conventional views on HIV and AIDS before she was named health minister, but she had since echoed Mbeki’s opinions, adding her spin about garlic, lemons and beets as a treatment for AIDS.

“In the case of the president, who likes to think independently of experts and who often is in quite an isolated position intellectually, it is possible to see — and it’s also possible to regret — where he has ended up,” Lodge said.

“It’s in some ways all the more unforgivable in her case because, unlike the president, she has a conventional medical training. She is going against the conventions and the professional protocols of her own background.”

*

robyn.dixon@latimes.com


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