Continuum (Vol 4 No 6)
HIV, AZT, big science & clinical failure
By MARTIN J. WALKER
Martin J. Walker was chairman of the Steering Committee on AZT Malpractice (SCAM) and the AZT on Trial Conference, London 1993.
The ruling ideas are nothing more than the ideal expression of the dominant material relationships. -Marx and Engels (1942)
The imagination which could produce obstacles to scientific progress became for Gaston Bachelard (1884-1962) a harbinger of a person’s ‘secret being’ and inner destiny provoking ‘a leap towards a new life’. Miller (1994)
AZT both reflected and reinforced the basic paradigm within which almost all AIDS research was to take place. Nussbaum (1990)
In April 1984, Robert Gallo told America that he had found the ‘probable’ cause of AIDS in ‘a virus’ later called the Human Immunodeficiency Virus (HIV). Since that time, those who have dissented from orthodoxy have been trying to understand how within two years the general consensual acceptance of Gallo’s hypothesis – which came to be that an HIV was the sole cause of a number of AIDS-defining illnesses – was transformed into a universal scientific tenet . Gallo’s idea, which has never been scientifically proven, even survived the opinions of Luc Montagnier, one of France’s most eminent virologists who is now credited with having discovered HIV in 1983 and who in l991 stated that HIV alone was insufficient to cause AIDS.
Because Gallo and his disciples are virologists, much of the debate about consensus and hegemony in AIDS science has focused on scientists and scientific institutions (Bernstein, Duesberg, Eleopulos, Hodgkinson, Lauritsen, Schiff). Some gay writers have looked tentatively at the role which gay men themselves and gay culture in general has played in reinforcing the HIV=AIDS=DEATH construct. Few commentators however, have focused on the crucial role which the production and marketing of AZT, the first drug licensed as anti-retroviral, played in reinforcing Gallo’s idea.
AZT specifically, and ongoing work by scientists on attempts at anti-viral therapies generally, confirmed in both the public and scientific mind, that a HIV was the sole cause of AIDS. AZT was marketed as the cure for a viral condition and, lay thinking went, scientists would not have invented an anti-viral cure if the illness was not caused by a virus. AZT may well have been the first drug in history which defined the illness it was meant to treat, rather than the other way around.
AZT has proved a remarkably persistent poison in the pantheon of orthodox medicine. Between 1987 and 1992, crucial years in the development of research into the causes of what many have accepted as AIDS, AZT was the sole drug licensed for the treatment of a HIV in people who had AIDS diagnoses. In 1992, ddl and ddC were trialled against AZT controls and were later prescribed only in conjunction with it. In 1993, the delayed publication of the Concorde trial results showed conclusively that asymptomatic antibody-positive individuals who took AZT, died more quickly and in greater number than those simply affected by AIDS-defining illnesses. Following these results, the drug went out of fashion as a mono-therapy. Wellcome, its scientists, and public relations staff however, worked hard to rehabilitate the drug and in large part succeeded in burying the implications of the Concorde Trial results.
Today, ten years after licensing, AZT is still used as a gold standard by scientists and doctors who believe an HIV is the sole cause of the AIDS-defining complex of illnesses. As the progenitor of other apparently anti-viral drugs and circular proof that ‘HIV causes AIDS’, AZT has had immense tantric, but no clinical value. This article looks back at the part which AZT played in transforming Gallo’s theoretical assertion – that an HIV was the sole cause of AIDS – into an apparently indisputable scientific and material reality.
The production and marketing of commodities creates certain realities and ‘truths’ which are often far more persistent than the scientific assumptions upon which the commodities themselves are based.
In the process of producing and marketing AZT, the Wellcome Foundation set in chain a powerfully persuasive machine which created information, culture and social relations with one purpose, to sell the drug. This network had a life force which would have continued to drive it forward, even if it had occurred that the drug quickly killed everyone who took it.
The production and marketing of AZT can best be viewed within the context of the global pharmaceutical industry in general and the Wellcome Foundation in particular*. The world pharmaceutical industry is worth £130 billion. Over the last ten years the industry has been characterised by high growth and high profits.
Throughout the eighties and nineties, the pharmaceutical industry has been in a state of transition. Mergers, takeovers, the buying up of smaller companies and the divestment of unprofitable productive sections, has left a few large companies jostling for position.
Takeovers and mergers represent one response to a crisis of profitability in the industry, a crisis which has been brought about by cut backs in public health spending in Europe and America and spiralling research and development budgets. This integration into larger global corporations has occurred also because many pharmaceutical companies have been extending their reach into different levels of health care, into hospital management, corporate employee health schemes and cradle to grave health care planning.
The development of a single medicine from initial conception to the market place is said to entail an average investment of between £200 million and £500 million. Other major costs include contribution to the administration costs of licensing and the cost of mistakes, dropped development and recalled drugs.
In the mid 1980s, the Wellcome Foundation was outside the top ten ranking world pharmaceutical companies. These rankings are, however, based upon turnover and more generally, money spent on research and development. In other respects the Wellcome Foundation was a hugely powerful organisation.
Outwardly its success was due to a few market leading drugs. Zovirax the anti-herpes virus drug, had been Wellcome’s top seller for a decade. The company also held the patents on a number of antibiotics and anti- bacterials, especially Septrin, and had, in the past produced whooping cough vaccine. Wellcome’s major problem throughout the ’70s and early ’80s, was that its ethos was too academic and its production tended to be unfocused. The company produced animal health products as well as organo-phosphate pesticide.
In the early ’80s, Wellcome started to rationalise, cutting back on staff, shedding some of its unfocused production and developing a more professional, less academic approach to marketing. By the mid-80s the company had moved into all the contemporary buzz-word areas – cell biology research, life science and genetic engineering – and it was eager to find another ‘modern’ market-leading drug.
In his 1935 will, Sir Henry Wellcome left clear instructions that the profits from the Wellcome Foundation were to be invested in the non-profit-making philanthropic Wellcome Trust. By the mid 1980s this Trust was one of Europe’s biggest medical research funders.
The Trust was linked with the other major European Medical Research Trusts and consequently, Wellcome-connected scientists staffed many of the university departments and regulatory bodies across the world.
Because the Wellcome Foundation was founded by a Briton and an American, William Burroughs, it joined that small coterie of very powerful government and non-governmental organisations which could call themselves Anglo-American. From the early part of the century a special relationship has existed between Britain and America which has meant that various organisations of the American state, together with the country’s largest philanthropic trusts and foundations, its transnational corporations, and its scientific and medical professional bodies, have all been interlocked with their British counterparts.
The Rockefeller Foundation, America’s largest Trust, which pioneered scientific medicine at the turn of the century, often had British representatives on its board, as did the Carnegie Foundation. The Rockefeller Foundation and the Rockefeller Institute financed British hospitals, British universities and British scientific and social research.
Rockefeller Institute work with the Wellcome Foundation and later the Wellcome Trust had gone on since the early days of a British and American presence in Africa, China and South East Asia. Following the second ‘world war’, the Wellcome Trust which was almost bankrupt relied upon American financial support to get back on its feet. By the end of the 1950s, Rockefeller interests and those of Wellcome covered many overlapping areas.
The power and influence of the Rockefeller Foundation in the years between the ‘world wars’ and up until the late 1960s was considerable. Not only did the empire influence and manipulate many of America’s biggest corporations but it also had influence within the CIA, the FBI and all the most powerful institutions of the US government, from the State Department to the NIH.
The Rockefeller empire set up numerous organisations in America, Europe and Britain, to engineer the social and political direction of these countries.
They also set up international organisations which would work towards balancing the world foreign policy and political economy; the first of these, the American Round Table, published the Foreign Affairs Journal and was related to the British Institute of International Affairs. This transatlantic policy organisation was added to, in the fifties, with the Bilderberg Group, and in 1974 the Trilateral Commission (Britain, America and Japan).
The senior executives of multinational corporations that attended Bilderberg and Trilateral Commission meetings, could rub shoulders with officials from the State Department, British Ministers of Defence, Japanese Government officials and heads of the most powerful financial institutions in the world. Three out of the last four presidents of the United States have been Rhodes Scholars and Trilateral members.
The reality of the influence held and exercised by the Trilateral Commission, has been obscured by smoke screens thrown across their activities by participants. Despite this, a number of generalisations can be made; first the Trilateral Commission has discussed every important world economic and political crisis, whether concerning oil or population growth, usually years before they occurred. Secondly this group provided the world’s most powerful people with a ready-made network of world political strategy and industrial influence. The Trilateral Commission was throughout the nineteen seventies and eighties the policy think tank of the developed world.
Throughout the nineteen eighties, the Wellcome Foundation and the Wellcome Trust both participated in the Trilateral Commission. At this time, the Wellcome Foundation had forty main subsidiaries worldwide. Their largest subsidiary and major profit earning company was the US-based Burroughs Wellcome. Wellcome was sending medical support and aid to the dissenting parties in the eastern bloc countries and breaching the Japanese market with an expanding new plant.
AZT ORPHANED AT A YOUNG AGE
AZT was not designed as a drug to combat an HIV. It was developed, from a herring and salmon sperm extract, by Jerome Horowitz in 1964 for the National Cancer Institute (NCI). As cancer chemotherapy, it was designed to destroy dividing cells which were producing tumours. AZT was, however, indiscriminately cytotoxic. It could kill any dividing cells by interfering with the reproduction of DNA.
After development of AZT was dropped it became an ‘orphan drug’, one with no pharmaceutical company parent to rear it and it languished, on the shelves of the National Institutes of Health. The decision to test AZT in 1985 for anti-viral properties was not due to farsightedness or any sixth sense – in 1985 and 1986, inside NIH research establishments everything which came to hand was being tested for antiviral qualities.
AZT was sent to Burroughs Wellcome where Dave Barry, head of research, suggested that AZT should be sent to an investigator to be tested for anti-retroviral qualities. The commissioned report was positive. Wellcome then put the drug in the hands of Sam Broder, head of the National Cancer Institute (NCI) – part of the National Institutes of Health (NIH). Since 1984, Broder had been Clinical Director of the NCI Special Task Force on AIDS.
Burroughs Wellcome had two good reasons for giving the drug to Sam Broder – first Robert Gallo worked at the NCI and secondly, Wellcome knew that Broder would see the drug through the regulatory hoops. With Wellcome apparently playing a back seat role, the drug became the official cure for AIDS, promoted by the US government. To help Broder work AZT through the regulatory process, and to secure their ownership of the drug, Burroughs Wellcome gave the NCI $55,000 in 1985 and $25,000 in 1986.
Research and development, including trials, for new drugs can take up to twelve years. With the help of the NIH, Wellcome managed to carry out this work for AZT in eighteen months. In 1986, a twelve centre trial study began to test AZT for effectivity in AIDS cases. This was the first time that the drug had been used on human beings.
These Phase II trials were terminated prematurely, after a period of only nine months when it was found that while only one of the AZT-taking group had died there were 19 deaths in the placebo group. Many theories have been put forward since, as to why this might have happened. The trial was so badly organised that no follow-up information was recorded on any of the trial subjects, making it impossible to see what might have happened in the longer term.
In 1992, John Lauritsen, an American researcher and writer, obtained documents, under the Freedom of Information Act, from the US Food and Drug Administration (FDA). These documents, although heavily censored, revealed that the trials had become unblinded, with trial subjects crossing between groups; that serious adverse reactions to the drug had gone unreported, including 19 cases of anaemia requiring life-saving transfusions, and that trial records had been altered to reflect better results for the drug. The trial was so chaotic at its Boston centre that in January 1987, the FDA was forced to hold a special meeting to decide whether or not to allow through the data from this and two other centres – which it did.
After almost four years of licensed use, it was accepted that AZT had a 1,000 times higher toxicity than had been quoted by Burroughs Wellcome in the Data Sheet Compendium or cited in the Physicians Desk Reference in 1986. At an end cost of £10,000 per patient per year, Wellcome attempted to keep the dosage as high as possible. By 1993, however, dosages per day had been reduced by most doctors from 1,200 mg to 500mg.
In 1990, Wellcome managed to open an expanding market when they got the FDA to license the use of AZT for healthy individuals who tested antibody positive. It was only a short step from this decision to the free dispensing of AZT as a prophylactic – for example for doctors or nurses who had received needle stick injuries.
TRANSFORMATION OF AN IDEA INTO REALITY
In December 1986, three months after the US Phase II trials had been halted Wellcome began submitting a 4,500 page dossier on AZT produced by its Beckenham laboratories to the world’s regulatory bodies. Wellcome’s Beckenham laboratories produced a 4,500 page dossier on AZT for submission to regulatory authorities. These dossiers, whatever their country of destination, were produced in English without translation.
In May 1987, the drug was licensed by the British regulatory authority.
America followed Britain in licensing and by the middle of 1987, AZT was licensed for use in 15 different countries. By November 1987, within a year of the only trial being aborted, AZT was licensed in 35 countries. Between 1983 and 1987, during the first flushes of the development and licensing of AZT, Wellcome’s turnover almost doubled from £674 million to £1132 million.
To give the marketing bandwagon maximum publicity, Wellcome organised the biggest world-wide media campaign that had ever been carried out by a drug company. The idea was that if Wellcome could sell to governments in bulk, the fine tuning of AZT marketing could be left to in-place networks of doctors and scientists in those countries. Licensing hearings in European countries were preceded and followed by symposia, geared to attracting maximum press coverage. In September 1987, a symposium was held in Paris to launch AZT. One hundred and eighty doctors and journalists attended an all expenses paid meeting at the Hotel Sofitel, at Sevres. Similar symposia followed licensing in other European countries.
In the autumn of 1987, there were symposia in Naples, organised to cover the African continent, and in Ecuador, giving television coverage to the Caribbean and Latin America. Wellcome chose the Naples conference, ‘AIDS and associated cancers in Africa’ to launch the ‘new generation’ of AIDS testing kits. Both these conferences were organised in conjunction with Wellcome by Abbott Laboratories, one of the leading drug companies in the Rockefeller portfolio.
Wherever the AZT caravan stopped, it presented physicians from important metropolitan centres like London and New York. These market pitches were paid for in every last detail by Wellcome, Burroughs Wellcome or one of the other drug companies which made up the Wellcome cartel group.
In December 1989 the marketing circus went to Brazilia. Wellcome had established laboratories in Brazila, in partnership with ICI. Doctors attended from all over Latin America. The guest of honour was the Brazilian minister of health, Dr Guerra. Other guests were Dr David Hawkins from St.Stephen’s Hospital, London, and Dr Tom Lissauer from St Mary’s in Paddington, London. Professor Paul Griffiths, from the Royal Free Hospital in Hampstead, London, and Dr Brian Gazzard, from the Westminster Hospital, London, all gave accounts of the beneficial treatment of HIV patients with AZT.
Dr Guerra renewed his country’s commitment to fight the spread of AIDS. In its in-house journal, Wellcome expressed its pleasure at the Brazilian government’s commitment: “Dr Guerra also reaffirmed publicly at the time, his intention to allocate US$130 million for the management of AIDS, with a substantial part of that to be spent on the purchase of Retrovir (AZT).” By March 1988, Wellcome had patent applications pending in 40 countries.
Within two years of its aborted licensing trials, with the scientific establishment no nearer to proving any actual link between an HIV and AIDS, with no relevant data available about serious adverse reactions, long term effects or comparisons with non-drug-treated subjects, Dr Jonathan Mann who had been Director of the WHO Global Programme on AIDS could say that “the only drug to prove effective (against AIDS) so far was Wellcome’s Zidovudine (AZT)”.
A LICENCE TO KILL
One possible reason why, despite trials being held in America, AZT was first licensed in Britain might have been that Wellcome had greater control over the Medicines Control Agency than they did over the FDA. In Britain all matters to do with the licensing and marketing of medicines are regulated by the Medicines Control Agency. This agency which became an independent self-financing organisation under the Next Step programme in 1989, had previously been a part of the Department of Health.
The most important Committee which comes under the guidance of the MCA is the Medicines Commission. This Committee advises the Minister for Health on matters relating to medicines. Another, the Committee on the Safety of Medicines grants product licenses.
From 1985 to the end of 1989, one of the most prominent members of the Medicines Commission, advising the Minister for Health on AIDS treatments, was Professor Trevor Jones (presently head of the Association of British Pharmaceutical Industries), the Director of Research and Development at the Wellcome Foundation. Especially in relation to AZT, Jones was perhaps the most important executive officer in the whole of the Wellcome complex.
Besides Professor Jones, out of a total Committee of twenty five, no less than five other members of the 1989 Medicines Commission had interests in or connections with Wellcome.
AZT was fast-tracked through the British licensing system after a period of only eight months of research and development. The technical deliberations which took place within the Committee on the Safety of Medicines are secret so we are unlikely to find out how the decision to license AZT was taken.
We can however say that no other purportedly anti-viral drug which followed AZT was given that same fast-track opportunity.
The greatest marketing advantage which any company producing a treatment for an illness can have is control over the diagnosis of that illness. This principle has always been central to the arguments against quackery in medicine. The ethical question is clear – an unscrupulous charlatan could with one hand, conjure up equipment that diagnosed a terrible disease and with the other sell the patient the cure! In the early days of AIDS, Wellcome had a monopoly franchise on HIV testing kits which were produced by their subsidiary company Wellcome Diagnostics.
In August 1984, Wellcome was approached by Dr Robin Weiss, the executive Director of the Institute of Cancer Research (ICR) – a postgraduate Institute, part of London University and counterpart to the American NCI where Gallo held the patent rights on testing kits. In the past, the Institute had received the majority of its funding from the Medical Research Council (MRC) but this had been gradually overtaken by funding from industry.
Dr Weiss offered Wellcome his ideas about diagnostic testing kits and then went into business with Wellcome producing the kits. In 1985, it was estimated that the British market for diagnostic kits was worth between £3 million and £4 million; worldwide, the market was assessed at a value of £180 million. Wellcozyme HIV Monoclonal, the second generation AIDS testing kit, was launched by Wellcome in autumn 1987, at a Naples symposium.
Medical equipment does not have to have the same rigorous regulatory proving as pharmaceuticals. There are no clinical trials and no peer review. Wellcome’s production of HIV antibody testing kits was a marketing scandal of immense proportion, for Wellcome knew that ultimately they would be able to sell AZT to almost every individual that they had diagnosed as HIV antibody positive. Even if an HIV were the main cause of AIDS and even if AZT were even partially effective, the fact that one pharmaceutical company had control over the diagnosis and treatment of a major illness was ethically wrong. If an HIV was not the cause of AIDS, or even if the testing kits measured a higher volume of cases than there were – if AZT was totally ineffective – then this was an ethical disaster waiting to happen.
THE TRIALS OF AZT
The traditional form of evaluating research has been peer review, followed by publication in a few established and meritorious journals. This system of gate-keeping clearly had its drawbacks because it meant that orthodoxy retained control not only over standards of research, but inevitably over content. The peer review system attempted to act as a centralised clearing house for research while keeping a continuous if nominal check on standards.
Today, there are no universal standards for the evaluation of non- license application drug trials. Commercial and industrial interests have helped launch a large number of vested interest journals which print the research work which they have funded. Drug trials are overseen primarily by research staff working for the producer company and even the investigators are often supported by the company or work in units which rely for future funding from the company concerned.
For the first five years of AZT’s life, Wellcome controlled almost all the known AIDS cases in Europe and America by drawing them into trials. In November 1987, eight months after licensing in the US, Dr Trevor Jones declared in a press release that they soon anticipated clinical studies to involve 6,000 patients, aside from 5,000 patients who were already using the treatment. Nussbaum (1990) reported that in 1988, practically 80% of the patient slots in the NIAID’s AIDS clinical trial group were for AZT trials.
By 1992, Dr Jones was able to tell the press that 4,000 separate studies had now been carried out which demonstrated the benefits of AZT.
PRAYING FOR A PLAGUE
In 1990, when AZT had been licensed for three years, Wellcome got market analysts BdZ (Barclays de Zoete Wedd) to report on the prospects and risks to the marketing and production of AZT. According to BdZ, the FDA decision to licence AZT for asymptomatic antibody positive subjects, that year, had stabilised the market.
BdZ defined the factors which might destabilise the market position of AZT as:
* The sudden obsolescence of AZT with the discovery of a cure for AIDS.
* Any publicity about debilitating toxicity.
* Any publicity about questionable efficacy.
* The possible rapid approval for competitor drugs.
* A decline in the projected AIDS epidemic.
These points speak volumes about the political economy of medicine in developed countries. To recoup its initial capital investment and secure a long market life for AZT on the basis of the BdZ report, Wellcome had to hope that; no cure for AIDS was discovered; there was no criticism of AZT; there was no fast-track approval of any other drug; reports of the (heterosexual) spread of AIDS continued. In the world of big business only the scent of scandal separates marketing theory from marketing practice.
Wellcome, or agents on their behalf, carried out all five of these strategies between 1988 and 1993 during which time AZT remained unchallenged.
AZT: AN AIDS DEFINING DRUG part 2 (Continuum Vol 5 No 1)
AZT: A seller’s market
by Martin Walker
By the end of their term in office the last British Conservative government had become the ‘government of sleaze’. To the public, ‘sleaze’ had come to be symbolised by brown paper envelopes filled with money for questions, given to MPs as payment for lobbying ministers.
In looking to pursue its marketing strategy for AZT inside the British parliament, Wellcome used two devices: first the science lobby and scientific institutions and secondly a small all-party parliamentary campaigning group, the All Party Parliamentary Group on AIDS (APGOA), which had until 1987 been more or less dormant.
In October 1988, just as Wellcome and the Medical Research Council were beginning the Concorde trials, the APGOA received sudden and quite substantial funding. This funding came in part from the Wellcome Foundation which in 1988 gave around £10,000. In later years, as well as the Wellcome donation, CRUSAID, a charity funded by Wellcome and responsible for distributing money to grass roots groups supporting people suffering from AIDS-associated illnesses, gave money to APGOA. Other contributors to APGOA were Roche and the London International Group, whose subsidiary, the London Rubber Company, produces condoms.
In November 1988, APGOA began regular publication of the Parliamentary AIDS Digest, a forty- or fifty-page journal published four or five times a year.
The group funded two research workers who worked within parliament producing the Digest.
From the time that Wellcome began sponsoring the APGOA, doctors who wrote for the Digest and those who attended the all-party meetings were, in the main, doctors involved in the Concorde trials or another of Wellcome’s grant-receiving projects.
From 1989 onwards, Wellcome had an input to government which was even more influential than contact with MPs in the House. In July 1989, Sir Alfred Shepperd, who was at the time Chairman of Burroughs Wellcome and who had been Chairman of the Wellcome Foundation up to 1985, was a member of the Advisory Council on Science and Technology (ACST). This body advises the government and the civil service on matters of science. Its meetings are attended by the chief scientific adviser to the Cabinet Office and departmental chief scientists and scientific advisers. Also on this committee in the late 1980s was Professor Roy Anderson, who at that time headed the department of Pure and Applied Biology at London’s Imperial College of Science, Technology and Medicine. He was also a Wellcome Trustee. As a trustee he was one of a handful of powerful men who controlled the Wellcome funding empire. Throughout the time of his term of office with the ACST Professor Anderson was one of the most vociferous proselytisers for AZT.
SCIENCE AND INDUSTRY
In America it was the National Institutes of Health that controlled all the research around ‘HIV and AIDS’, ensuring that scientists kept to the beaten track. Research into ‘HIV’ was allowed but not into AIDS; research was allowed into anti-viral pharmaceuticals but not into natural health care for immune system disorders.
In Britain AIDS research funding and its direction were controlled by the Medical Research Council (MRC). The MRC was originally set up with a number of other Research Councils, so that government money could be equitably allocated to government-prioritised medical research projects.
Although scientific research had always had some identity of interest with industry, it was not until after the second world war that the dichotomy between the interests of citizens and those of industry began to be manifest. This dichotomy became evident in a number of different ways; with the advent of crop spraying with pesticides for example.
From its inception, the MRC was superficially independent of industry. In the 1950s, the organisation made various forays into such areas as the effects of chemicals on health. By the 1970s, the MRC was constrained from any independent research by its links with industry.
By the 1980s, things had become much worse and as the government increasingly cut back on research funding their place was taken by industrial companies in partnership agreements, and the Wellcome Trust.
By the late Eighties and the era of AZT marketing, the MRC was the dog of an institution being wagged mercilessly by its pharmaceutical tail.
The results of many of these publicly supported projects were never published by the MRC. A clause in the research protocol ensured that Wellcome, or another company, had use of the research results before, or even instead of, the MRC.
In the Concorde Trial protocols, Wellcome managed to negotiate a clause of just this kind and consequently Wellcome were able to suspend the trial results while they organised damage limitation. During the waiting time, a number of Wellcome directors cashed in their own shares in the company.
When the results were finally published they were written in ‘scientese’ which obscured their easy understanding.
A review of the MRC Committee on AIDS (MRCCoA), at the time when AZT was on the agenda, opens a window onto the intricate machinery of scientific vested interests that industry has created over the years. The individuals or their specific vested interests are not as important as the process which is involved; individuals and their interests change but the process continues.
In the mid eighties, MRCCoA consisted of a Chairman and eight members. The Chairman was Lord Jellicoe, who was also, at the time of Concorde, Chairman of the MRC itself. Lord Jellicoe was leader of the House of Lords from 1970-73 and during his time in the Lords he has been a member of the All Party Group for the Chemical Industry. At the time of Concorde he was also Vice Chairman of the All Party Parliamentary Group on AIDS. From 1978 to 1983 he was Chairman of the Board of Directors of Tate and Lyle, Britain’s biggest sugar company. In 1993, he was Chairman of Booker Tate, the confectionery conglomerate. From 1985 to 1990 he was on the Board of the Davy Corporation, a company which makes plant for the pharmaceutical and food processing industries. Lord Jellicoe is also involved with Rockefeller interests through a Directorship of Morgan Crucible.
Sir Austin Bide, a member of MRCCoA from 1987 to 1990, was the chief executive of the drug company Glaxo from 1973 to 1980 and then became the first Chairman of the Board and in 1985 their honorary President. Sir Austin has been Chairman of the anti-socialist Adam Smith Institute since 1986 and from 1974 to 1985 he was a member of the Council of the CBI.
An interest in the promotion of processed food is the one thing which stands out in the career of Sir David Crouch, a member of MRCCoA in the late eighties and Conservative MP for Canterbury from 1966 to 1987. He was a member of the Society of the Chemical Industry and Chairman of the All Party Group for the chemical industry for almost twenty years from 1970 to 1987. He was a director of the pharmaceutical company Pfizer from 1966 to 1987.
Sir David’s real interests, however, were in public relations; since 1964 he was chairman of David Crouch & Co, marketing and PR consultants, whose clients include Beechams. He was also a director of two other leading PR firms in the field of processed food marketing: Burson Marsteller Ltd, of which he was a director from 1972 to 1983, handle many of the large processed food and pharmaceutical accounts, including an account for Wellcome. In 1989, Sir David was a director of Kingsway Rowland the company which handled aspects of the PR account of AZT for Wellcome.
Of the scientists on the MRCCoA, Dr Joseph W.G. Smith is an interesting individual. Recently a Director of the Public Health Laboratory Service, in the 1970s he was head of bacteriology at the Wellcome research laboratories.
The most important of the MRC AIDS subcommittees throughout the time of Wellcome’s Concorde trials was the AIDS Therapeutic Trials Committee. This committee was responsible for selecting and overseeing all government and industry sponsored trials into AIDS and HIV at the time Wellcome received its license for AZT. At least five members of this committee, the only committee in the country which could, during the late eighties, have furthered competitive research and drug development, had received funding through the Wellcome Trust.
The monopolisation and infiltration of ‘independent’ research facilities by commercial and industrial interests, represented, well before privatisation, a considerable shift in the control of public money. As happened at the Ministry of Agriculture, Fisheries and Food, over the years the base of both research and regulation which had always been in the industry, began to manifest an everyday policy which was against the interests of consumers. How, for example, could the MRC ever be involved in independent research into health and chemicals, chemicals and food, chemicals and cancer, when its committees are dominated by chemical company interests?
THE MEDICAL PROFESSION
Since the middle of the last century, first serving the new industrial bourgeoisie and later the working class as well, the general practitioner became the mainstay of the National Health Service. Until the 1960s, many general practitioners had a reputation for independence of mind. Over the last thirty years this independence has been eroded on the one hand by the drug marketing and the introduction of centralised high technology centres of scientific medical excellence and on the other hand by ongoing fiscal crisis.
From the beginning, Wellcome marketed AZT as a complex, high flying and very expensive drug. One of the advantages of this was that Wellcome did not have to depend upon general practitioners to dispense the drug. The ordinary doctor was, in fact, a serious problem for Wellcome as they entered the field of AIDS. What if general practitioners were to find other ways of treating HIV antibody positive patients? Wellcome set out to educate general practitioners to the enormous dangers of HIV and AIDS, ensuring that most general practitioners were so afraid of the highly contagious nature of the ‘disease’, that they quickly passed patients on to the hospitals. To reinforce this and strike further discipline into doctors, the General Medical Council ruled that it would be a disciplinary offence for general doctors to treat AIDS patients.
In 1987, the year that AZT was licensed, the British Medical Association (BMA), the professional trade union for doctors and an organisation which had substantial links with Wellcome, set up the BMA Foundation for AIDS. In March 1988, Wellcome gave a covenant to the Foundation, a sum of £36,000 annually for four years, totalling £144,000. This meant that at the very heart of the British medical profession, Wellcome had control of the information flow on AIDS.
In 1988, Wellcome helped fund a £150,000 educational package for GPs about HIV and AIDS. The package contained three videos. It was expected that Wellcome representatives, together with reps from Calmic, one of Wellcome’s hygiene product companies, would show the videos and promote the free package in all 11,000 surgeries in Britain.
The Chairman of the BMA Foundation for AIDS was Dr John Marks who was also at that time Chairman of the Council of the BMA. Dr John Marks is the brother of Professor Vincent Marks, a leading member of a group which at that time was called the Campaign Against Health Fraud and later changed its name to HealthWatch. Professor Vincent Marks, with two of his colleagues at Surrey University, was also the recipient of a Medical Research Council grant of almost £120,000 to research ‘monoclonal antibodies to HIV’. Wellcome’s testing kits depended upon the efficient production of such monoclonal antibodies.
Another trustee of the BMA Foundation on AIDS was Dr Brian Gazzard, at that time, consultant physician at Westminster and St. Stephen’s Hospital. Dr Gazzard had appeared on Wellcome’s sales caravans and was also at the time one of the Concorde trial doctors. Dr Gazzard had also worked on research funded by the Wellcome Trust into so-called HIV, at the London School of Hygiene and Tropical Medicine.
THE VOLUNTARY SECTOR ORGANISATIONS
The 1968 Medicines Act makes it a criminal offence to advertise medical treatments directly to patients (vulnerably ill people). However, the sale of AZT directly to individuals who had tested ‘HIV antibody’ positive – using a Wellcome-produced testing kit – was from the beginning the cornerstone of Wellcome’s marketing strategy.
Those who suffered AIDS-associated illnesses or who had been diagnosed ‘HIV antibody’ positive, mainly gay men, were an unknown factor. Pharmaceutical companies had no real experience of dealing with large, youthful, cultural identity groups.
The greatest potential for drug pushing was to be found in the plethora of self-help organisations which were springing up throughout the country.
Here at these focal locations, not only gay men gathered but specifically those who had tested ‘HIV antibody’ positive.
Wellcome set out to buy up all the self-help groups which had contact with gay men who tested ‘HIV antibody’ positive in Britain and America. Where they were unable to fund them directly, they gave grants for journals, papers and magazines or for specific projects. There were no overt strings attached to such money but recipients had to adhere to the medical model of AIDS and act as conduits by which off-the-street gay men concerned about their health could be funnelled into the charnel houses of chemotherapy.
The grant funding of self-help groups in the field of AIDS, by vested interest organisations, is perhaps one of the greatest scandals of AIDS medicine. By bombarding newly tested gay men with partial information about AZT and other so-called anti-viral drugs, Wellcome had found a way round the Medicines Act and the perfect way to construct a drugs market. Wellcome adopted a strategy which has been known within politics for hundreds of years. Wellcome didn’t need General Practitioners to sell AZT, they mounted their beach heads in the bourgeois sectors of the gay community and developed a colonial class which administered the medical model for them.
The use of self-help organisations was and still is a systematic marketing strategy, and while it is important to list the groups which received drug company money, it is more important to understand the strategy which Wellcome used.
Sally joined an organisation called Positive Life (PL) which had been set up by people who were HIV antibody positive. PL had been set up for five years by the time Sally joined in 1991.
Soon after starting work, Sally was asked to write a number of articles about AZT. Sally was nervous about writing the articles because she felt the need to be critical but responsible and she was worried she might upset people by suggesting AZT was toxic.
Not long after her first article came out she was contacted by the head of the Health Education Authority AIDS programme who suggested that her article might contain inaccuracies. She was insistent that Sally should have lunch with her. When Sally went to lunch she found that a media relations manager from Wellcome’s Public Relations Department was also there.
The conversation over lunch centred upon Wellcome’s relationship with voluntary sector organisations and the problems of marketing AZT. Not long after the lunch, the coordinator of PL received a phone call from a public relations company informing them that Wellcome wanted to fund their organisation. PL did not accept the money.
Wellcome did not always have to make such direct advances to groups. From an early stage they managed to gain influence on the committees and boards of the major fund-dispensing bodies which acted as gate-keepers for voluntary sector funding. These strategically placed individuals, on the board, for example, of CRUSAID, an organisation which in the early nineteen nineties was controlling in excess of £4 million in funding, made sure that funds were channelled only to organisations which believed in the use of anti-viral drugs.
BIG SCIENCE RIDING OFF INTO THE BLACK HOLE
Much dissent especially in politics is based upon an intuitive and heart-felt sense of right and wrong; arguments take place around moral or ethical issues which are often impossible to prove. In AIDS, the principal orthodox proposition – that a Human Immunodeficiency Virus is the cause of AIDS – appeared to be based upon a scientific truth.
While it appears at first that only the idea of Gallo’s retrovirus and its transmission has shaped our perception of AIDS and its social relations, it is more complex than this. Gallo and Gallo’s idea are themselves a product of the social and commercial relations which exist inside science and the production of scientific knowledge.
Had Gallo presented his theory thirty years ago in a reputable scientific journal, rather than at a fin de sciècle press conference in Washington, his proposal would have been tested by his peers. A focused and centralised authority which had responsibility for evaluating scientific knowledge would have made a judgment, its clinical basis would have been replicated and a dialectical process would hopefully have forged the truth. As it was, there was no proving, no dialectical process, no clinical proof and no biological proof, no peer review, no open public critique. Gallo’s idea was passed down in tablets of stone and ‘HIV’ was found guilty without any kind of trial or search for the truth. Science by absolute decree of the idea.
This is not how science has been practiced nor how truth has been arrived at over the last two centuries.
Karl Marx was the first important European philosopher to refute Hegal’s contention that ideas themselves shape material reality; rather Marx insisted, social attitude and concepts are created by material reality; especially the material reality of contemporary production. Marx went on to posit a whole system, in which ideas are tested against material reality, where a continual struggle, a dialectical process, takes place between man and the natural world. This is how the creation of the material world has been understood for the last hundred years and it is how we now understand the processes of human production, whether of ideology or of scientific knowledge.
Gallo, of course, did not personally create this whole condition of science, with its thousands of aspiring scientists, its universal commercial subsidy, its proliferation of research journals and its incestuous intimacy between government and laboratory. But come the hour, cometh the man and Gallo and his idea were the perfect product of the productive relations within twentieth century science. In the first instance, the condition of science in the developed world – the relationships within science, the authority of science and its institutions – ensured the passage of the Gallo’s idea into a material reality.
Duesberg (1996) analyses this position. At first, when he describes the evolution of the virology industry in the United States throughout the 1980s, it reads a little like sour grapes. But what he is in fact analysing at the beginning of his book, are the conditions and relations, especially in the field of virology, which produce contemporary scientific knowledge.
Given these relations and the structure of this kind of science, Duesberg points out that it was inevitable that the conclusion was reached that ‘AIDS’ was caused by a virus.
While Gallo’s ‘idea’ that a retrovirus is the cause of AIDS was a product of contemporary science, its reproduction and transmission in turn has been a consequence of the social, economic and political relations which exist today within both science and the medicine industry. For it was not simply the idea generated by Gallo, but a fluid series of material relations, which themselves have become an industry.
First there was the epidemiological approach, then the cell biology approach to research, the discounting of empirical qualitative research, then the pharmaceutical production of AZT. Then there was the long-standing relationship between the drug companies and doctors, between doctors and patients. Then there was the relationship between the drug companies and those who suffered from illnesses associated as AIDS. There was also the relationship between professional medicine and patients and the culture of the gay community itself. Between all these sets of relations, there developed relations, attitudes, views, which were initially based upon the production, distribution and exchange of drugs. These basic social relations around medical production were cemented together by the media, by fear of illness and a plethora of cultural and psychological networks.
The persistent clamour which surrounded the production of AZT and the very material reality of its production, left most people no alternative but to believe that the scientific community had first found the cause of AIDS and then with persistent logic and science found a cure for it. This construct was, however, a fantasy wish-fulfilment created by scientists who wanted to be seen able to respond effectively to what some of their number were already describing as a world plague.
The fact that people were ill with greater frequency and died more quickly when they took AZT, did not affect the the public perception that users of AZT got better, or lived longer lives of better quality than people who unfortunately did not have access to the drug. From a very early stage, the great, mysterious and very male-oriented adventure of science began to depart from the real record of absolute clinical failure of so-called antiviral remedies. This total failure was in part disguised by the increasing understanding of doctors, and their ability to treat the individual infections and other illnesses which made up the spectrum of AIDS.
Wellcome’s strategy of hegemony, brilliantly orchestrated, was highly successful. In 1992, five years after AZT was licensed, the 44.7 tonnes of AZT produced that year returned Wellcome over £250 million profit. The profits for the following year were even higher.
Over the last few years, AIDS science, which has as its only aim the production of magic-bullet drugs, has moved further and further away from the conditions of people’s living illnesses. The mad scramble of science to understand the intricacies of ‘HIV’ has given new meaning to the old axiom, ‘The operation was successful but the patient died’. AIDS scientists are now openly declaring that clinical end-points are no measure of the success of their work. To protect their authority, they have created an impenetrable wall around themselves, and within this wall its practitioners discuss mutual ideas which over the years have come to develop their own inner logic.
To people knowledgeable about AIDS but beyond the pale of orthodoxy, it appears as if AIDS scientists are slipping deeper into some kind of group psychosis. Apparently considered statements by scientists take on the meaning and form of mantras or cultish utterances which are nonsensical to those outside AIDS science. Such statements as: ‘If antivirals don’t work it’s because the virus is very intelligent and keeps mutating’; or ‘Non-infectious HIV is pathogenic’ or ‘Protease inhibitors mean AIDS is over’.
At some point early on in the bang of big AIDS science and its widening galaxy of abstract theorising it became impossible to readdress fundamental ideas. At issue in this reluctance was not only the plausibility of science and the authority of individual scientists but the continuing production and the profitability of anti-viral drugs. AZT was undoubtedly one of the factors which pushed the handcart of early AIDS speculation over the hill, and transformed it into the juggernaut of premature consensus.
If any doubt did begin to creep like cracks through the cultural hegemony created around AZT, at the end of the Concorde trials, these cracks were quickly filled by the culture of pharmaceutical influence which stood ready with the cocktail of combination therapy. The ‘combo’ approach which after all still had AZT as its central support, quickly came to be reflected upon with gothic disbelief but even then, science and medicine was saved at the last minute by protease inhibitors. These miracle drugs, despite the fact that they had been trialed for only two years will, it was said, give all those who are ‘HIV antibody’ positive, a happy and contented old age. The grim deception of that view is already apparent.
We are all in awe of science, especially medical science for it appears inarguable. What science does, is, and what science says can happen, scientists make happen. Like the stone masons and architects of the seventeenth century, scientists are constructing the everyday reality within which contemporary society lives.
When we look closely at the science of AIDS, and particularly at Gallo’s hypothesis, we realise quite quickly that we are not dealing with scientific truth in the normal sense of the expression. The idea that an HIV is the cause of AIDS-associated illnesses, is just that – an idea – there is, even now, no evidence but only supposition to support it.
This idea, however, has achieved a materiality of considerable proportion, and it has spurned an industry. An understanding of how this happened is important – important because in understanding it, we understand not only how knowledge is reproduced in our society, but also how power is mediated.
Without this information we can not know how to dissent. We have to have this intimate understanding of the way in which the power relations of orthodoxy shape the world in order that we can resist it.
We do not believe power resides in slogans and our dissent does not become real when we say ‘HIV is not the cause of AIDS’. Nor does our dissent become real if we simply argue the opposing scientific perspective. We have to dissent with who we are, with our acts; this is why the intimate knowledge of the orthodoxy’s power is important to us. To oppose them we must behave differently, resist their social and institutional relations and the way in which they produce and make material knowledge.
People have to empower themselves, in every area where industry and capitalist production have taken over the basic functions and interchanges of everyday life. People have to fight back by finding themselves and a better way of treating themselves.
(Parts I & II) Burkett, E. (1995) The Gravest Show on Earth. Houghton Miflin, New York.
Duesberg, P. (1996) Inventing the AIDS Virus. Regnery, Washington.
Hodgkinson, N. (1996) AIDS: The Failure of Contemporary Science. Fourth Estate, London.
Kennedy, I. (1983) The Unmasking of Medicine. Sutton, Surrey: Paladin.
Schiff, M. (1996) The Memory of Water. Thorsons, London.
Lauritsen, J. (1993) The AIDS War. Asklepios, New York.
Lauritsen, J. & Young, I. (1997) The AIDS Cult : Essays on the Gay Health Crisis. Asklepios, Provincetown.
Marks, K. and Engls, F. (1942) The German Ideology. Laurence and Wishart edition, London.
Miller, J. (1994) The Passion of Michel Foucault. Flamingo, London.
Nussbaum, B. (1990) Good Intentions. Atlantic Monthly Press, New York.
Papadopulos-Eleopulos, E. (1993) Is a positive Western blot proof of HIV infection? Bio/technology vol. 11.
Root-Bernstein, R. (1993) Rethinking AIDS. Free Press, New York.
Walker, M.J. (1993) Dirty Medicine: Science, Big Business and the Assault on Natural Health Care. Slingshot, London.