re: In response to Nicholas Bennett 25 August 2004
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Pennee Atkinson,
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Re: re: In response to Nicholas Bennett

Nicholas Bennett said:

”The paper you use refers to entirely different classes of antiviral drugs.

As with all pharmaceuticals, the drugs work in different ways. You cannot expect an HIV protease inhibitor to act against a herpes thymidine kinase, any more than you can expect a beta-blocker to lower cholesterol.”

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If you do a GOOGLE search for Viracept you will be inundated with information about treating “HIV” with Viracept. Yet if you did the same search but took out the HIV, and put in “Herpes” you would be innundated with ads encouraging you to ask your doctor about Viracept for Herpes. (I do not suggest doing this unless you have anti-spyware on your computer).

So Viracept is an anti-HIV drug and an "off-label" treatment approved for Herpes as well. Do you have any evidence that would exclude Viracept as a treatment for Herpes except the fact that it is not listed as such in the PDR?

It is much more profitable for a drug company to make a new drug than to spend the money getting an old drug approved for a different illness. And the reason for that is simple – drugs loose their patent protection after some years and that is when the profits for that drug start to go downhill. Once the patent is lost all sorts of companies could make generic Viracept. So the company produces Viracept for “HIV” and “something new” for Herpes. That way you have two patented drugs on the market. When the first runs out you still have the second and you are rushing to get the next one. Many of these drugs are not that different at all in their mechanism. That is why they are listed by class – like, “antiviral” though that label certainly does not include all the mechanisms of the drug. For example, Inderal is, as you say, a beta blocker used to treat heart problems and is improper for use as a cholesterol lowering drug, yet is routinely given to musicians to stop their shaky hands before a performance. Drug companies also make money by creating 'new' pathways of delivering the drug, (a patch for example, instead of tablet or capsule), and thus getting a new patent.

It is not, “basic immunology” as you state, it is “basic marketing”. Though they are not mutually exclusive. You cannot ignore the fact that drug companies are business and their main goal is to make money. This is especially true if they are publicly held because a drop in revenues is often compounded by a drop in share holdings.

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Nicholas Bennett also said:

“I'm afraid it's rather too simplistic to put all antivirals in the same basket, when by their very nature they have to be extraordinarily specific to target a virus above healthy uninfected cells. Viruses are parasites and unlike bacteria use a great deal of the host cellular machinery. This is why virus infections are generally poorly treated by drugs. Suggesting that anti-herpes medications are the same as anti-HIV drugs because they are both "antivirals" is an extraordinary show of ignorance. You may as well say that a tree is the same as a grass because they're both "plants"!”

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I’m afraid it’s rather ludicrous to put all antivirals into their own individual baskets. There are over 80 drugs marketed for “HIV” now and 83 in the making.(3) If these drugs were so specific I would think one or two would suffice. (Then again, as I stated previously, money is a driving force here that cannot be understated). And if you want to try and say the pharmaceutical companies need to make new drugs to keep up with the fantastic mutations of that super-bug “HIV” then I would think the pharmaceutical companies would be able to place the new and specific genetic codes on their label. And come to think of it, why don't the "HIV" tests come in semi-annual batches, like the flu vaccines? Why don't we have "HIV-7" or "HIV-8, 9, 10" by this time?!

And your "very specific anti-HIV" drug AZT was first developed as a cancer drug and is now being brought back to use in colon cancer drug trials.(1) Also, AZT cannot possibly have the "anti-HIV" specific effect that is claimed for it anyway because it is not significantly triphosphorylated by the body. (2)

Most interns and many doctors do not prescribe drugs for “off label” use because they are new and inexperienced or afraid of malpractice complaints and lawsuits. I suggest to you, the young doctor Bennett, that you forgo verbose attempts at “educating the ignorant” by regurgitating textbook medicine and make some attempts at thinking outside the book (or box).

1. Cancer Invest. 1995;13(5):464-9. Related Articles, Links: Phase I trial of high-dose infused zidovudine combined with leucovorin plus fluorouracil. Beitz JG, Damowski JW, Cummings FJ, Browne MJ, Clark JW, Bigley JW, Weitberg AB.

2. Current Medical Research and Opinion Vol. 15: Supplement, 1999 A Critical Analysis of the Pharmacology of AZT and its Use in AIDS Eleni Papadopulos-Eleopulos (1), Valendar F. Turner (2), John M. Papadimitriou (3), David Causer (4), Helman Alphonso (5) and Todd Miller (6)

3. Stock Focus Promising AIDS Drugs, Promising Profits Lynn Cook, 04.07.04, 8:30 AM ET http://www.forbes.com/strategies/2004/04/07/cz_lc_0407sf.html

Competing interests: None declared