What David Rasnick learned at the Gordon Conference:Cocktails Don’t Help PatientsThe first instance occurred during the question period of a lecture he gave on treating early HIV infection. He and Ho have been treating a cohort of 20 patients for close to a year with protease inhibitor/AZT cocktails. The study is on-going and no results have been published, so Markowitz was discussing preliminary data. According to him, most of the subjects already had AIDS symptoms at the start of the experimental therapy-including five who’d previously been hospitalized-although a few had no history of symptoms. Once the therapy began, HIV "viral load" for each patient dropped below the level of detection and has stayed that way, Markowitz said. He considered this an indication that the therapy was a good one. But did eliminating viral load make the patients healthier? Markowitz had nothing to say about this during his lecture. Surely if the patients had gotten better when their HIV viral load went down, Markowitz would have bragged about it. But the subject didn’t come up until I raised it in the question period. How are we doing? I asked. "Some are healthy enough to work," he said happily. The implication was that were it not for the cocktails, these patients would not be healthy enough to work, but I suspected this was not the case. Markowitz’s smile vanished when I asked, During the 11 months on therapy, when their viral loads were undetectable, did your patients do better, stay the same, or do worse? He didn’t say a word. It was an embarrassing moment for the audience. I interrupted the uncomfortable silence by restating the question. Your patients should be doing better, right? Again Markowitz was speechless. He either didn’t know how his patients had done over the course of therapy (which is very unlikely) or they were not doing well-despite having HIV "viral loads" of zero. During this revealing silence the lecture was ended by the announcement of a coffee break. I left with one of my curiosities satisfied: the press accounts of miracles attributed to cocktail therapy-the fabled "Lazarus effect"-weren’t showing up in scientific studies.
 TORONTO |
