>>
>>New York Native
>>September 9, 1996
>>Reprinted with permission.
>>
>>
>>Dr. Sandra Mengele
>>--------------------
>>Will San Francisco turn into Auschwitz Il?
>>
>>By Neenyah Ostrom
>>
>>The debate over how, when, and whether to administer the toxic new anti-HIV
>>protease inhibitor "cocktails" continues to grow; it has now escalated to
the
>>point that some public health officials are calling for "Directly Observed
>>Therapy" to force "AIDS" patients to take the drugs or presumably-as is the
>>case in tuberculosis "Directly Observed Therapy"-be jailed until "cured."
>>
>>In San Francisco, the city's Health Director Sandra Hernandez is advocating
>>not only "Directly Observed Therapy" (DOT) for individuals taking protease
>>inhibitors but also identification of every HIV-positive individual and
>>mandatory reporting of cases to facilitate the implementation of DOT.
>>
>>While advocating widespread (and potentially coercive) administration of
the
>>new "cocktails" (which include protease inhibitors and AZT or one of its
>>analogs), San Francisco's Health Department Director appears to be
>>disregarding the numerous deleterious effects of these drugs, including
>>episodes of hemorrhaging in hemophiliacs; increased peripheral neuropathy
>>(pain in the limbs, usually the legs); development of incredibly painful
>>kidney stones; potentially deadly interactions with common drugs such as
>>antihistamines, and many others.
>>
>>ACT UP/San Francisco has strenuously protested Hernandez's support of these
>>coercive policies.
>>
>>On Tuesday, August 20, ACT UP/SF protestors invaded the monthly meeting of
>>the city's health commission to challenge Hernandez's "AIDS prevention
>>proposal" that would force San Francisco's HIV-infected individuals to take
>>the experimental drug cocktails.
>>
>>The action followed publication of an article in the San Francisco Bay
Times
>>by Terry Beswick in which Hernandez described her "AIDS" prevention
proposal.
>>Beswick's July 11 article was titled "Treatment Combinations Herald a New
>>Era: People Living With AIDS Hope, While Officials Worry."
>>
>>Beswick enthusiastically described the reported success of the new protease
>>inhibitor cocktails, commenting that "an irrepressible sense of excitement
is
>>spreading like wildfire as those who are taking the new drugs witness a
>>dramatic change in their own lives."
>>
>>Beswick also interviewed San Francisco Department of Public Health Director
>>Hernandez, M.D., who views these new combinations of toxic drugs (toxicity
is
>>a subject not addressed by Beswick) as having potential for "AIDS
prevention"
>>efforts.
>>
>>"I think that strictly from a drug therapeutic perspective...the data that
we
>>have seen is a phenomenal breakthrough," Hernandez told Beswick. "I think
it
>>holds a huge promise."
>>
>>Beswick added, "And while the new drug combos offer individuals the
>>possibility of controlling their infection and living longer, Dr. Hernandez
>>and others believe there is a great potential for curtailing the further
>>spread of the HIV epidemic itself."
>>
>>Hernandez appears to visualize combining behavior control therapy, if
>>possible, with protease inhibitor cocktails to reduce the spread of HIV.
>>
>>"If you assume that we make no further impacts on behavioral change to try
to
>>prevent new HIV infections and transmission, then these protease inhibitors
>>potentially-in that they reduce viral load so dramatically- could have an
>>impact on new HIV infections," Hernandez told the Bay Times. "That is, for
>>that individual who may not be practicing safe sex all of the time, if they
>>are taking protease inhibitors regularly in combination with other
>>antiretroviral therapy, then presumably, their infectiousness would also be
>>somewhat decreased."
>>
>>Hernandez goes so far as to suggest that protease inhibitors should be used
>>as "morning after" pills to prevent new infections.
>>
>>"You can potentially eliminate new infections if you got people started on
>>protease inhibitors plus one or two other drugs," Hernandez told the Bay
>>Times.
>>
>>Beswick added, "The problem is how to identify non-health care workers who
>>have been exposed to the virus through sexual or needle sharing
situations."
>>
>>While recommending that people who might have been exposed to HIV begin
>>therapy with protease inhibitors immediately after the suspected exposure
and
>>continue the therapy for an indeterminate period of time, Hernandez also
made
>>the point that once a person begins taking these drug cocktails, he or she
>>can be considered to be a public health threat if the therapy is
>>discontinued.
>>
>>"It is a double-edged sword," Hernandez told Beswick. "The real dilemma is
>>how do you get a message out there that sort of says 'taking one protease
>>inhibitor a day is probably worse than taking no protease inhibitors at
all.'
>>What you potentially have out there is highly resistant strains of HIV that
>>may be resistant to both AZT and the protease inhibitors, and you've got
>>nothing in your armamentarium to fight it."
>>
>>Hernandez has a plan to prevent the problem of "mutant" HIV strains from
>>emerging: the instigation of "Directly Observed Therapy," following the
>>tuberculosis model, as the Bay Times reported:
>>
>>Dr. Hernandez says that she is plan,ning an aggressive educational campaign
>>directed at local physicians, and has also directed her staff to develop a
>>comprehensive report on the public health implications of protease
inhibitors
>>immediately after the Vancouver conference.
>>
>>Furthermore, she believes that it may be necessary to consider adopting the
>>tuberculosis model of Directly Observed Therapy (DOT), in which health care
>>workers ensure that patients take the complete dose of their medications,
on
>>time and as prescribed. DOT has been shown to be the most effective means
of
>>treating tuberculosis as well as thwarting the emergence of
>>multidrug-resistant strains of the bacterial infection.
>>
>>Beswick didn't tell his readers that tuberculosis patients who do not
comply
>>with DOT are jailed for an indefinite period, until they are considered to
be
>>"cured"-a concept that is still undefined, and some believe unachievable,
for
>>"AIDS."
>>
>>Is the Health Department Director in San Francisco planning to jail
>>HIV-positive people who refuse to take protease inhibitor cocktails?
>>
>>According to ACT UP/SF, the Directly Observed Therapy (DOT) plan outlined
by
>>Hernandez "would mandate by law that all HIV-positive San Franciscans show
up
>>at a designated health clinic to consume state prescribed AIDS drugs in the
>>presence of a public health official. If the patient misses a scheduled
>>dosing or refuses to take the pills, he or she would be jailed and forced
to
>>comply. Hernandez admitted in the [Bay Times] article that in order for DOT
>>to work 'you would have to track everybody and [the patient's HIV status]
>>would have to be reportable as tuberculosis is.' "
>>
>>ACT UP/SF attended the Health Commission meeting and, when it was underway,
>>stood in unison, blew whistles, scattered fake death certificates accusing
>>Hernandez of mass murder, and chanted, "DOT's A Bitter Pill To Force-Feed
>>Toxic Drugs That Kill," according to the organization.
>>
>>Other ACT UP/SF supporters climbed on the Health Commission panel's
>>conference table and unfurled a banner decorated with a skull and
crossbones
>>and the words "Poisons Don't Prevent AIDS."
>>
>>A statement of demands was presented to Hernandez. The Health Commission
>>meeting was delayed about 20 minutes, but ACT UP/SF members left before
>>authorities arrived, the organization reported, and there were no arrests.
>>
>>"As a Latino gay man, I am outraged that Dr. Hernandez would propose
forcing
>>anyone to take dangerous compounds that cause severe side effects that harm
>>the immune system and that can kill if mixed with everyday drugs like
>>Seldane," said activist Ronnie Burk. "We know that these drug pushers don't
>>have a scientific leg to stand on when promoting fascist schemes like DOT.
>>It's obvious that health officials, not people with HIV, are San
Francisco's
>>real public health menaces."
>>
>>In addition to protesting Hernandez's su~ested coercive policies regarding
>>toxic drugs of unproven effcacy, ACT UP/SF members also questioned the
>>usefulness of "viral load" testing as a barometer of an individual's
health.
>>
>>An ACT UP/SF document quoted an article by "AIDS" researcher Tim Peto
>>published in the May 1996 Journal of Antimicrobial Chemotherapy that
>>enumerated some of the problems inherent in "viral load" testing.
>>
>>"The disadvantages of [viral load] assays are fundamental," Peto wrote,
>>according to ACT UP/SF. "First, it is unclear whether circulating plasma
>>viral products (RNA, viral protein, or intact virions) all give internally
>>consistent results. Second, it is unclear whether plasma viral load is the
>>main reason of HIV disease activity. Third. the quantitative relationship
>>between changes in viral load and drug efficacy is completely unknown.
>>Finally, the relationship between drug efficacy and changes in viral load
may
>>differ between different classes of drugs. At present, there is no
convincing
>>evidence that current surrogate markers can be reliably used to predict the
>>clinical eff'cacy of new treatments...."
>>
>>"AIDS activists" in San Francisco are particularly upset about Hernandez's
>>proposals, since, as protester Antonia Crane pointed out, "San Francisco is
>>viewed as a model of how the rest of the nation should respond to AIDS.
This
>>intolerable proposal will ruin the lives of PWAs across the country,
>>especially in rural, conservative areas."
>>
>>ACT UP/SF emphasized that their campaign to stop "AIDS" patients from being
>>coerced into taking toxic and unproven therapies has only just begun.
>>
>>Meanwhile, computer bulletin boards like sci.med.aids are teeming with
>>reports of painful adverse reactions to protease inhibitors and "cocktails"
>>that include protease inhibitors and AZT or a related drug.
>>
>>One patient wrote that Norvir [a protease inhibitor] is his "last hope,"
even
>>though he's experienced nausea and diarrhea while taking the drug. He added
>>that "the most debilitating side effect is severe leg cramps. Anyone have
any
>>experience with these cramps and how to alleviate them?"
>>
>>Another patient reports experiencing "slight nausea, slight numbness in
both
>>hands, lack of appetite, unsettled GI tract (not diarrhea) with
intermittent
>>sharp pains, increased pain sensitivity, fatigue, mild depression,
headache,
>>and hot flashes.... Running, working out, and playing tennis have always
been
>>very important to me. But, given how I feel now, there is no way I could do
>>any of them...."
>>
>>A medical professional asked, "Anyone hearing accounts of existing
neuropathy
>>[pain] being aggravated by Crixivan [a protease inhibitor]? I have a client
>>who can't decide if his increased pain is in his head or really in his legs
>>due to starting Crix six weeks ago."
>>
>>Another very painful side effect appears to be kidney stones/crystals. A
>>patient on Crixivan reported to sci.med.aids, "I woke up with intense pain
in
>>the kidney region which kept getting worse. The drug insert listed this as
>>one of the possible reactions experienced by a small percent of patients. I
>>called my MD at 5 a.m. to ask if it was, in fact, a reaction to Crixivan
and
>>he blew me off saying he never heard of it!! (I've since given him a piece
of
>>my mind!) After what seemed a painful eternity, the stone passed (I could
see
>>the pencil point-sized stone).... Have I said the pain is incredible.
Another
>>friend just experienced this same reaction and went to the E.R., not
knowing
>>what the hell was going on!"
>>
>>Additionally, the Food and Drug Administration issued an advisory to
>>healthcare providers on July 16 noting that the agency had received 15 case
>>reports of "spontaneous bleeding episodes in HIV positive patients with
>>hemophilia who were being treated with HIV protease inhibitors at the time
of
>>the event."
>>
>>What are these drugs actually doing to the bodies of "AIDS" patients?
>>
>>And to what lengths will public health officials go to force patients to
take
>>these toxic chemicals? Will "Directly Observed Therapy" become the norm for
>>"AIDS" patients throughout the entire country?
>>
>>And will that result in "AIDS" patients being jailed, like TB patients, if
>>they refuse to take their medication?
>>
>>Unlike tuberculosis, there is no point at which an "AIDS" patient is
>>considered to be cured. Speculation about patients being incarcerated for
>>life in what amounts to concentration camps has generally been labeled as
>>irresponsible and paranoid; now, however, are those fears about to be
>>realized? 
>>
>>==========
>>
>>(Side box)
>>
>>Adverse Reaction
>>---------------
>>
>>Roche's Invirase
>>
>>Body as a whole: Allergic reaction, chest pain, edema, fever, intoxication,
>>parasites external, retrosternal pain, shivering, wasting syndrome, weight
>>decrease.
>>
>>Cardiovascular: Cyanosis, heart murmur, heart valve disorder, hypertension,
>>hypotension, syncope, vein distended.
>>
>>Endocrine/Metabolic: Dehydration, dry eye syndrome, hyperglycemia, weight
>>increase, xerophihalmia.
>>
>>Gastrointestinal: Cheilitis, constipation, dysphagia, eructation, feces
>>blood-stained, feces discolored, gastralgia, gastritis, gastrointestinal
>>inflammation, gingivitis, glossitis, hemorrhage rectum, hemorrhoids,
>>hepatomegaly, melena, pain pelvic, painful defecation, pancreatitis,
parotic
>>disorder, salivary glands disorder, stomatitis, tooth disorder, vomiting.
>>
>>Hematologic: Anemia, microhemorrhages, pancytopenia, splenomegaly,
>>thrombocytopenia.
>>
>>Musculoskeletal: Arthralgia, arthritis, back pain, cramps muscle,
>>musculoskeletal disorders, stiffness, tissue changes, trauma.
>>
>>Neurological: Ataxia, bowel movements frequent, confusion, convulsions,
>>dysarthia, dysesthesia, heart rate disorder, hyperesthesia, hyperreflexia,
>>hyporeflexia, mouth dry, numbness face, pain facial, paresis,
poliomyelitis,
>>progressive multifocal leukoencephalopathy, spasms, tremor.
>>
>>Psychological: Agitation, amnesia, anxiety, depression, dream excessive,
>>euphoria, hallucination, insomnia, intellectual ability reduced,
>>irritability, lethargy, libido disorder, overdose effect, psychotic
disorder,
>>somnolence, speech disorder.
>>
>>Reproductive System: Prostate enlarged, vaginal discharge.
>>
>>Resistance Mechanism: Abscess, angina tonsillaris, candidiasis, hepatitis,
>>herpes simplex, herpes zoster, infection bacterial, infection mycotic,
>>infection staphylococcal, influenza, lymphadenopathy, tumor.
>>
>>Respiratory: Bronchitis, cough, dyspnea, epistaxis, hemoptysis, laryngitis,
>>pharyngitis, pneumonia, respiratory disorder, rhinitis, sinusitis, upper
>>respiratory tract infection.
>>
>>Skin and Appendages: Acne, dermatitis, dermatitis seborrheic, eczema,
>>erythema, folliculitis, furonculosis, hair changes, hot flushes,
>>photosensitivity reaction, pigment changes skin, rash maculopapular, skin
>>disorder, skin nodule, skin ulceration, sweating increased, urticaria,
>>verruca, xeroderma.
>>
>>Special Senses: Blepharitis, earache, ear pressure, eye irritation, hearing
>>decreased, otitis, taste alteration, tinnitus, visual disturbance.
>>
>>Urinary system: Micturition disorder, urinary tract infection.
>>
>>---------------
>>
>>Merck's Crixivan
>>
>>Body as a whole/Site unspecified: Abdominal distention, chest pain, chills,
>>fever, flank pain, flu-like illness, fungal infection, malaise, pain,
>>syncope.
>>
>>Cardiovascular System: Cardiovascular disorder, palpitation.
>>
>>Digestive System: Acid regurgitation, anorexia, aphthous stomatitis,
>>cheilitis, cholecystitis, cholestasis, constipation, dry motuh, dyspepsia,
>>eructation, flatulence, gastritis, gingivitis, glossodynia, gingival
>>hemorrhage, increased appetite, infectious gastroenteritis, jaundice, liver
>>cirrhosis.
>>
>>Hemic and Lymphatic System: Anemia, lymphadenopathy, spleen disorder.
>>
>>Metabolic/National/Immune: Food allergy.
>>
>>Musculoskeletal System: Arthralgia, back pain, leg pain, myalgia, muscle
>>cramps, muscle weakness, musculoskeletal pain, shoulder, stiffness.
>>
>>Nervous system and Psychiatric: Agitation, anxiety, anxiety disorder,
>>bruxism, decreased mental acuity, depression, dizziness, dream abnormality,
>>dysesthesia, excitement, fasciculation, hypesthesia, nervousness,
neuralgia,
>>neurotic disorder, paresthesia, peripheral neuropathy, sleep disorder,
>>somnolence, tremor, vertigo.
>>
>>Respiratory System: Cough, dyspnea, halitosis, pharyngeal hyperemia,
>>pharyngitis, pneumonia, rales/rhonchi, respiratory failure, sinus disorder,
>>sinusitis, upper respiratory infection.
>>
>>Skin and Skin Appendage: Body odor, contact dermatitis, dermatitis, dry
skin,
>>flushing, folliculitis, herpes simplex, herpes zoster, night sweats,
>>pruritus, seborrhea, skin disorder, skin infection, sweating, urticaria.
>>
>>Special Senses: Accommodation disorder, blurred vision, eye pain, eye
>>swelling, orbital edema, taste disorder.
>>
>>Urogenital System: Dysuria, hematuria, hydronephrosis, nocturia,
premenstrual
>>syndrome, proteinuria, renal colic, urinary frequency, urinary tract
>>infection, urine abnormality, urine sediment abnormality, urolithiasis.
>>
>>Sources: Merck and Hoffman-LaRoche package inserts for Crixivan and
Invirase.
>>
The above information was supplied by Dr. Linda Thompson
>Attorney at Law >Chairman, American Justice Federation
>Internet:  lindat@iquest.net
>
>
And from >>Date: Fri, 27 Sep 1996 07:52:15 -0400
>>From: ACTUPSF@aol.com
>>Subject: Dr. Sandra Mengele's AIDS plan
>