E-DRUG: Ethics of AIDS Drug Trials

[srahmad@essential.org]

E-DRUG: Ethics Of AIDS Drug Trials In Ivory Coast, 
       Thailand Stir Controversy by James Robinson 
--------------------------------------------------

WASHINGTON, Feb 9 (AFP) - Were women in the Ivory Coast and Thailand 
were used as guinea pigs in an AIDS drug trial? This question has
become the unexpected focus of efforts to derail President Bill 
Clinton's nomination for the top US doctor. 

Conservative Republicans are hoping the US Senate next week will 
reject Clinton's nomination of David Satcher as the next 
surgeon-general of the United States, a powerless but symbolic post 
considered a "bully pulpit" on public health concerns. 

"You don't make laboratory rats out of people," said Satcher's chief
opponent, Senator John Ashcroft, a darling of conservative Republicans 
and a possible presidential contender. 

"We should have real reservations about a surgeon general whose regard 
for Third World populations allows him to use your tax dollars to have 
lower standards in conducting medical research on people overseas than 
the standards he would use in the United States of America," Ashcroft 
said. 

As director of the US Centers for Disease Control and Prevention in 
Atlanta, Georgia, Satcher oversaw a research study in which the AIDS 
drug AZT was given to pregnant mothers to determine if it prevented 
transmission of the HIV virus to their children. 

Because giving AZT intravenously was considered too impractical and
expensive for the patients in the trial, the study looked at the 
effectiveness of lower dosages of the drug taken orally. 

However, to make a comparison, a control group of women received a
placebo drug or sugar pill -- meaning they got no AIDS medication. 

"You never use a placebo when an effective treatment is known," 
Ashcroft said, adding that "control groups are required to receive the 
best current treatment, not the local one ... (and) you don't do in a 
Third World country what you could not do in your own country." 

Republicans also fault Satcher for not opposing so-called 
"partial-birth" late-term abortions and for favoring needle exchange 
programs designed to combat HIV infection. 

But Satcher's supporters say Ashcroft and others are distorting the 
AIDS trial in an effort to smear the nominee. And one Republican 
senator has come to Satcher's defense in the AIDS drug trial debate. 

Senator Bill Frist, a respected surgeon, said the drug trial in Africa 
was requested by African officials through the World Health Organization 
and was designed to take into consideration local conditions. 

For example, "We do not know today whether AZT interacts in some way
with a background of malaria," Frist said. 

"And you have to have a placebo control trial because the population 
there is not the population in the United States of America or in France 
or in England or wherever these past trials have been conducted," said 
Frist, who recently returned from a trip to Africa, where he inquired 
about the trials. 

Politics has plagued the surgeon-general position before in recent 
years. Clinton's first person in the post, Joycelyn Elders, was forced to 
resign in 1994 after suggesting school children be taught about 
masturbation. 

                         Copyright AFP 1998. All rights reserved. 

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