From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: HIV does not cause aids & AZT *will* kill you
Date: 05 Feb 1997
Newsgroups: misc.health.aids

In <5d90op$oe2$1@news.cybernex.net> dirk@inet.net (D.) writes:

>Read the *package insert*:
>
>(or the recent Physician's Desk Reference)
>
>AZT causes AIDS


  The package insert does not say that AZT causes AIDS.  It says merely
that some side effects of AZT can be difficult to distinguish from the
pathology of HIV.  It says difficult, not impossible.  And it does not
say that these problems are AIDS-defining ones.  For example, both AZT
and HIV may cause weakness, malaise, and (indirectly) even nausea.
Sometimes thrombocytopenia (none of which is "AIDS").  How do you tell
which problem is due to which agent?  Clinically it's usually not
difficult.  You simply stop the AZT for a while.  If AZT was the
problem, the symptoms promptly go away (an exception is muscle
weakness, which takes longer to resolve).  Problems caused by the
underlying HIV infection, however, continue unabated, and not
infrequently get worse.

   Drug holidays are used all the time in medicine-- indeed are a
cardinal feature of good medical care, and not just in the case of HIV.
The Nagels concluded that their doctor was an idiot for not taking
their daughter off AZT for a bit to see if her symptoms improved, and
(unfortunately) they are probably correct.  But that doesn't mean that
most experienced AIDS clinicians are that dumb.  I assure you, they
aren't.  Nor are patients.

   Let me tell you a fact of clinical medicine which is
underappreciated: it is a universal human instinct to want to stop all
food intake, and particularly all medication intake, when illness
strikes.  Most doctors find their patients do this, even when they
clearly should not (my own patients, for instance, are apt to stop all
their pills, even their antihypertensives, then they get the flu!)  The
idea that there are large numbers of HIV patients out there taking all
thier pills, even when they are being poisoned by them, is incredible
nonsense.  People just do not work that way.  Nearly everyone who is
ill with HIV has tried to stop all medications at least once, I have no
doubt, and promptly found that this was NOT the answer.

   If there are people out there taking complicated regimes of
antivirals, then it's surely not because they are doing it in response
to some lab number, or surrogate marker that comes from some theory.
ROFL!  People who suggest this know NOTHING about the reality of
medical care.  Just TRY to get most people to follow that complicated a
regime for high blood pressure when there are side effects, for
instance.  IT DOES NOT WORK.  YOUR PATIENTS WILL NOT DO IT.  If there
are people with AIDS on complicated regimes of side-effect producing
antivirals, it is because these make them feel better (overall) on a
nearly day to day basis, the way insulin shots help diabetics.  Believe
it.

                                         Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: HIV does not cause aids & AZT *will* kill you
Date: 06 Feb 1997
Newsgroups: misc.health.aids

In <32F956B2.6ECE@mail.earthlink.net> Wally Boulton
<wallyb@mail.earthlink.net> writes:
>
>Steven B. Harris wrote:
>
>> If there are people out there taking complicated regimes of antivirals,
>> then it's surely not because they are doing it in response to some lab
>> number, or surrogate marker that comes from some theory. ROFL! People
>> who suggest this know NOTHING about the reality of medical care. Just
>> TRY to get most people to follow that complicated a regime for high
>> blood pressure when there are side effects, for instance. IT DOES NOT
>> WORK. YOUR PATIENTS WILL NOT DO IT. If there are people with AIDS on
>> complicated regimes of side-effect producing antivirals, it is because
>> these make them feel better (overall) on a nearly day to day basis, the
>> way insulin shots help diabetics. Believe it.
>
>
>Dr. Harris,
>
>I'm not picking any bones with you, but my middle name ought to be
>"Compliance."  Your last statement hits home, although I also do not
>care to take a chance on developing resistance when there are so few
>alternatives available.  What if I fail on the rest of them?  And
>besides, Norvir is easy to take (for me), as are the rest of my regimen
>-- some once a day, in the morning with breakfast, some twice a day
>(with breakfast and then with dinner.)
>
>Just thought I'd give you a grin.  (Please don't flame me for this -- I
>wasn't criticizing, just being anecdotal.)
>
>My best,
>
>Wally Boulton (wallyb@earthlink.net)



   I forget if you said that you'd been other than asymptomatic before.

    Yes, there are a few people who will do complicated drug regimens
with NO symptom history, only for the sake of prevention.  But they are
rare.  My hat's off to them.  In general, the public will not.

   There is also a subset of people with very good compliance because
of some really nasty problem IN THE PAST.  One study found that
compliance with anti-rejection meds for renal tranplant, for instance,
was 100%.  NOBODY who's been on dialysis wants to go back.

                                    Steve Harris, M.D.