AIDS Decade in Review (cont.)

Ms. Seele: This is Pernessa Seele. I think that when we look at the global issue of HIV and drugs, and you talk about 1 billion by 2002 -- people infected, and most of those people being in undeveloped countries -- here in this country we are having a conversation about the option to take the drugs. The epidemic is -- in other countries they don't even have options to take the drugs, because there are no drugs, because taking drugs is really directly linked to your economic status. And so, when we look at the epidemic today, what are we going to do about the world and AIDS and people just don't have drugs. So I think -- the epidemic has gotten to a place where we have to look at so many issues in terms of -- in this country to get proper drugs that people can take and be effective -- at the same time, deal with the pharmaceutical companies to make these drugs available where anybody can take them in Africa. The census in Africa and India and third would countries -- unfortunately, they're not even at a place to say, you know, "these are the harsh." They are like "we don't even have drugs."

Mr. Kramer: It's interesting that it's not a campaign issue, that nobody is asking Gore or Bush what they would do about getting drugs that American taxpayers have basically financed into the hands at a reasonable price of the rest of the world. I mean, it's just an unconscionable greed.

Ms. Seele: That's exactly what it is, greed.

Mr. Kramer: It's murder. It's murder. We are murdering the rest of the world. We paid for these drugs to be developed and we have to pay through the nose for them ourselves.

Dr. Marlink: If I could interject -- this is Marlink again. The cost is a huge issue, and then the issues, as Pernessa was saying, even go beyond that in that both -- the basics needed in many places are from basic laboratory diagnostics, to treatment of opportunistic infections, to prevention of opportunistic infections, to basic nutrition, to care of the dying, or analgesics or pain medicines -- on and on. Those can be worked on and those also have their costs. But the other parts are also infrastructure -- we use that term too often, but that usually boils down to training, money, and structures -- both physical and administrative structures, that are long term, and it's not a quick fix and it's not until --

Mr. Kramer: That's why I think it's so important that if we're going to be the guinea pigs for these drugs for the rest of the world, which we're more than willing to be, somehow we have got to find a way to make these drugs cheaper and simpler while we test them to see if they're safe so they can then b sent overseas. That's basic. We've learned a lot from these drugs, but what we're learning now is that what we have to send overseas is, quite frankly, so awful that we can't send them overseas.

Dr. Marlink: Right. It's almost regardless of the cost, they're not usable in most settings.

Mr. Kramer: They're not usable, exactly. And the other thing that nobody pays any attention to is that we simply do not have any data -- sufficient data -- to know which of these drugs works and in which combination. The drug company makes the drug, unleashes it on the world, goes on to merrily develop another poison without continuing to test the stuff that's out there. There is no database that is worth anything. We've had a terribly difficult time trying to get this project called Treatment Data Project -- Rodger McFarlane -- off the ground which, quite frankly, we were wooed by WebMD, they announced it publicly to the world that they were going to put this database online so that we could all enter our own data into a secure web site and we would have hundreds of thousands of people around the world plugging in their own data so we would know which combinations were working and what the side effects were. It's a wonderful idea and it's taken us two years of WebMD not answering our phone calls after having announced to the world that they were going to do it. I hope this will get to the eyes of somebody at WebMD, who'll just finally say, "come on, guys, keep your promise here." We need this database.

Dr. Marlink: That was the usefulness of the idea, and also the fact that that database does not exist anywhere --

Mr. Kramer: Anywhere. Anywhere.

Dr. Marlink: -- is a national crime.

Mr. Kramer: We're finding out, for instance, that 50 percent of people who take certain drugs die from liver disease rather than AIDS, because the drugs are so harsh on the liver. That would turn up in a database a lot faster than any other way.

Event Moderator: I'm going to interrupt you guys for a second to get to some of the questions that are coming in right now from the audience. Let's take a look at this one. It says: We've seen AIDS pass through the Reagan Administration, then Bush, and onto Clinton. Any comments on how the current Clinton Administration has fared in addressing the epidemic?

Mr. Kramer: He's as worse and just as bad as all the rest. I mean, the politics of this disease are so awful that -- you know, Clinton said all the right things. He didn't do any better than -- than certainly -- don't get me started; I hate them all.

Dr. Marlink: I think that when AIDS has taught all of us and -- it teaches us many things. One thing it does teach us is that leadership is required, and leadership is not necessarily who the leaders are. Leadership may not be the popular choice -- the person taking the unpopular choice, and really going down the path that --

Mr. Kramer: That's well said, Rick.

Dr. Marlink: -- is less traveled, and may take courage. Politics, by their nature, selects the people that are going to say what the majority want to hear rather than perhaps lead us.

Mr. Kramer: Did you read that article in The Times today about George Bush and the death penalty in Texas?


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