Monday, March 20, 2006

Harper's gets hornswaggled

Poor Africans mercilessly exploited by pharmaceutical companies: this byline is a dream for some health journalists. Breaking that kind of story appeals to self-interest and altruism: it can promote your own career, and it places you are on the side of the angels, protecting the vulnerable by speaking truth to power. As long as the story, of course, holds water.

In this month’s Harper’s Magazine, Celia Farber has published a damning indictment of AIDS drug testing practices by pharmaceutical companies in the United States and Africa. (An edited version of the article is available here.) Farber’s main accusations are (a) that one of the study drugs (nevirapine) of an DAIDS/NIH clinical trial on the prevention of mother-to-child transmission of HIV caused the death of Joyce Ann Hafford by liver toxicity, although the true cause of death was obscured and never told to her family and (b) the dangers of liver toxicity with the use of nevirapine were already long known. The policy of using nevirapine with HIV positive pregnant women is based on HIVNET 012, a deeply flawed (according to Farber) DAIDS/NIH study conducted in Uganda back in 1997. Farber basically argues that the regulatory, scientific and ethical problems of the HIVNET 012 trial were overlooked in order to profile nevirapine as a safe, effective and cheap way to reduce mother-to-child transmission in Africa. Voices in the NIH who questioned the methods and results of HIVNET 012 were silenced or sidelined. By the time the use of the drug was implemented (particularly in the developing world) too much was at stake: the reputation of the NIH for one thing, and the profits being made by the drug’s manufacturer (Boehringer) for another.

Farber, in fact, aligns herself with those who believe that nevirapine is not an effective HIV prevention drug, and that the risks outweigh the benefits. This line of thinking takes her on a whole other tack: that AIDS research in general is not about helping patients, but merely a way of serving the interests of the powerful. She tries to rehabilitate the reputation of Dr. Peter Duesberg, well-known for his view that HIV does not cause AIDS, that AIDS drugs themselves are behind (what are called) cases of AIDS, and that if toxic AIDS therapies were discontinued, thousands of lives would be saved overnight. For Farber, the bottom line is that the ‘AIDS industry’ – represented by pharmaceutical companies, health agencies and activist groups – promote the production and consumption of dangerous drugs to fight a syndrome that may well not exist. She’s been doing this sort of thing for awhile.

Reaction to Farber’s article has been swift. The Treatment Action Campaign in South Africa has issued a statement citing 56 errors (of various types) in Farber’s piece. In Slate, Jon Cohen uses the article as an example of ‘pharmanoia’, the pathological mistrust of all things pharmaceutical. (Is there a brand name drug for that? Never mind.) Perhaps the best comment is that of Pulitzer Prize-winner Laurie Garrett: “Harper's got hornswaggled. They thought they had a scoop, but it was tired old BS dredged up from the bad old days.”