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Editorial

Gordon Nary
The International Association of Physicians in AIDS Care

February 1997

Michael Waldholz's feature on David Ho in the December 18 Wall Street Journal was totally eclipsed by Time's Man of theYear profile of the Aaron Diamond AIDS Center chief in its December 30 issue. The Waldholz report on Ho and his hypothesis that aggressive antiviral therapy initiated shortly after HIV infection may eradicate the virus from the body detailed some accusations against Ho that were not adequately answered. These unanswered criticisms may have left the impression that the charges had substance, and that's unfortunate.

When I read of rival researchers' complaining that Ho has somehow monopolized media attention at their expense, I wondered why such a distinguished publication would print such tabloid nonsense.

There are at least four reasons why Ho gets so much media attention:

(1) He often has something new and exciting to say;

(2) he is accessible to the media and many of his detractors aren't;

(3) he has a gift for clear description of often complex issues and in explaining his findings with common-sense metaphors; and

(4) he brings a much-needed optimism in the weltschmerz of AIDS.

I found Waldholz's statement that "while other scientists typically wait to discuss their work after publishing the results in scholarly journals, Dr. Ho has grabbed headlines by making claims at scientific conferences months before publishing the results in scientific journals" inaccurate and misleading. Scientific meetings are the primary venue for the presentation of new data, often before publication. AIDS and other infectious disease meetings have always been the venues for the latest news in clinical management of HIV disease. Ho's presentation of data at these meetings is no different in practice from the presentation of other data by thousands of other investigators.

The article also questioned the ethics of asking a patient doing well on antiviral combinations to stop therapy. There are ethical questions about many and possibly most clinical trials. But in this case, it's the wrong ethical question.

There should be no doubt about the risks of stopping antiviral therapy in this trial. The risks are well delineated to the patient, including the opportunity to resume therapy if the virus remanifests. The real ethical question is how patients balance their own ethical obligations to others with HIV/AIDS with their obligations to themselves and to those who love and depend on them. Those of us who benefit from research on others with the same disease have an increased obligation to participate in trials that could benefit others. Unfortunately, too many of us participate in trials only as long as they benefit us. That is the major ethical problem with most trials.

One activist moaned that Ho's experiment "will falsely raise hopes."Hope is a feeling that what one desires may happen. Most of us who have HIV, love someone with HIV, and/or have dedicated our lives to meeting the scientific, clinical, political, and social challenges of the pandemic have been sustained by hope. And Ho and his colleagues who have pioneered the advances in combination antiviral therapy have revitalized that hope. There is no false hope-only false hype.

©1997, Medical Publications Corporation




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