A plea not to "sex up" the data on toxicities 18 July 2003
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Peter J Flegg,
Consultant Physician
Blackpool Victoria Hospital, UK, FY3 8NR

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Re: A plea not to "sex up" the data on toxicities

I would like to respond to Christopher Tylerís last letter (15 July). To try and clarify the rapidly-degenerating debate about drug toxicities, I will try to summarise the current state of play regarding HIV drugs in a single sentence: With respect to therapy with the presently available antiretroviral drugs, there is clear evidence that in asymptomatic HIV infection the balance of the risk/benefit equation is in favour of no treatment (or a deferral of treatment), while in symptomatic/advanced HIV infection the balance of the risk/benefit equation strongly favours treatment.

The dissident correspondents have produced no evidence to the contrary, only repetitive arguments around the admittedly important and serious issue of drug toxicity. Unless there is further new evidence concerning toxicities of current drugs, or new drugs with lesser toxicity or greater efficacy, the equation will remain balanced where it currently is. A shift in any direction represents scientific progress, and not therapeutic nihilism.

Secondly, may I make a plea for HIV dissidents who are corresponding on this forum to do several things.

Be precise with your language. Call a trial fraudulent when and only when you have evidence for a fraud having been committed (and not merely reciting a litany of trial violations and CRF errors "cut and pasted" from a dissident web site). To do otherwise is libel.

Describe a drug as "eating away the lining of the intestines" only if you have evidence it does so (quoting nausea and vomiting as recognised side effects will not suffice, and nor will references to an article from the HIV dissident Perth Group claiming to "predict untoward effects on many tissues" either).

Claim a drug causes "the agonising death of many thousands" only if you have evidence it has done so, not just evidence that the drug has toxicities (and if you have such evidence, please give us the references for the study that demonstrated this). If your evidence is sound, let it stand up and be judged on its own merits, not "sexed up" to try and convince people that there is more than meets the eye.

Donít try to imply that zidovudine is more toxic than it is because a supply of azidothymidine from Sigma Chemicals in the late 1980s, intended for non-medical laboratory use, comes in a bottle with a skull and cross-bones on the side. (this tale is a regular dissident attempt to mislead the unwary). For example, another chemical also comes with a similar toxic label, complete with skull and cross bones, accompanied by the following advice: Toxic if swallowed. After contact with skin, wash immediately with plenty of water. In case of accident or if you feel unwell, seek medical advice immediately (show the label where possible). The chemical in question: Acetylsalicylic acid (aspirin). God knows what a chemical supplier might deign to put on the label of a bottle of phosphoric acid, and I have just consumed several cans of the diluted stuff to try and get through the current heat wave!

Please try to update yourselves with current recommendations for HIV therapy. No one puts asymptomatic patients who have no evidence of significant immunodeficiency onto therapy. Either you are ignorant of what is the current strategy, or you are deliberately trying to mislead others into thinking that this is the case, when it is not.

Competing interests:   Attendance at drug company-sponsored meetings