July 14, 2004
Jackie Judd: Jon Cohen of Science Magazine welcome back, day three.
Jon Cohen: Glad to be back.
Jackie Judd: The news of the day today was the speech by the U.S. Drug Czar Ambassador Randall Tobias; you were in the arena when he spoke, what stood out to you?
Jon Cohen: Well, for one thing there weren't that many activists compared to the past where you would see 1,000, 2,000 activists in a room doing a demonstration like that; there were 3, 4 dozen people doing this protest. It went on for 20 minutes or so ...
Jackie Judd: It was choreographed too, they were allotted a certain amount of time and the deal was then they would sit down and let him speak; right?
Jon Cohen: That's right; that's not new; these have been choreographed in the past, but typically in an action like this there have been more people in this choreographed event. So it stood out to me first of all that it was kind of an anemic activist event compared to what I have seen in the past at these conferences. And I think it's indicative of where the epidemic has moved and how the activist community has very different agendas now than they did 10 years ago when there were no good drugs available; and everybody wanted new drugs, and they were angry that there were no good drugs. Everyone, there was no factionalism.
Jackie Judd: And now people are picking their item?
Jon Cohen: Their item, their country's agenda, I mean in Thailand you have the drug users doing an activist march today about their concerns with their government; you have the South African people speaking this morning's Zackie Achmat about nevirapine for mother-to-child transmission being taken off the registry or not taken off the registry. I mean, that's their battle; that's not the world's battle.
Jackie Judd: The Tobias speech, you and I both watched it. I came away hearing something slightly different than what stuck you to you. What I heard was a forceful defense of the President's PEPFAR Program, the Emergency Funding for AIDS Program; what did you hear?
Jon Cohen: I heard what you heard, but in addition to that I heard the loudest apology I have heard from the Bush Administration about the behavior of the past of the United States Government. And I have a copy of the text of his speech here. And he said, I believe any fair-minded person looking at history of the response over the last 20 years would conclude that the world was far to slow to take up this fight with the focus it deserves. But then he turns the corner and says, when I say the world I mean in particular the developed world including the United States; that's an apology. And he goes on to say we in the developed world displayed ignorance or even apathy about the global dimensions and intricacies of the AIDS crisis. I haven't heard an apology like that before about the past behavior of the United States.
Jackie Judd: And what do you think the political calculus of that was?
Jon Cohen: Well to turn to the next sentence which is, but we are doing the right thing now, you know. That's the political calculus, and the other obvious thing to me is, you know here we are in the land of elephants. There were big elephants in the corner; there were things that didn't come out in his speech that are political hot potatoes.
Jackie Judd: Which is why they weren't in his speech ...
Jon Cohen: Which is why they weren't in his speech. Well he discussed Viet Nam which is a new PEPFAR country, and he didn't say that they were going to offer needle exchange.
Jackie Judd: Because the Administration is on the record opposed to it.
Jon Cohen: The Administration is on the record opposed to it, well that's an elephant in the corner. It would be, I think, more forthright to say, we opposed needle exchange for these reasons and we don't think that's the way to help Viet Nam. Say it, you know. There's also another huge elephant in the corner which is the big debate at this conference of why is the U.S. spending so much more on PEPFAR than it is devoting to the Global Fund and what's the logic that says that is the best way to use all that money. And they really didn't address why that is the best way to spend all that money.
Jackie Judd: Let's talk about science. This conference is after all, supposed to be about science ...
Jon Cohen: It's a relief for me to get away from the politics.
Jackie Judd: And I know you like to wander the halls and see what's out there; what struck you today?
Jon Cohen: I, you know, once again, I just came; I am just walking in here from a great session, very cool stuff. And I was sitting next to a really great AIDS researcher who just goes, whoa, you know. It's a little complicated, but bear with me.
Jackie Judd: You make it simple for us.
Jon Cohen: I'll try. When you get infected with HIV, the virus that is in you ... there are a bunch of different HIV's in you and they compete with each other and the strongest strain wins, basically. Each infected person has tons of strains of HIV in them, but one strain dominates, it's Darwin and it's evolution. Then you put drugs in, well drugs come into the body and now the viruses and the drug are hitting each other, right. The drug is here hitting the virus down like this; what does the virus do? Well the virus moves, it mutates, so that the drug can't hit it anymore, all right. But when the virus moves like that it is not as strong of a virus as it used to be, and there was a finding a few years ago that people who failed on therapy, meaning that their virus jumped back up, actually didn't see their immune system decline for some time. Why? Because they had a weaker virus in there that wasn't as fit in a Darwinian sense.
So a very clever researcher today described a study where they had a group of 50 patients who didn't want to do treatment anymore because they had all failed, they were for whatever reasons tired of doing treatment. So they took one drug that no one in their right mind would ever give as a single agent as a monotherapy, you would never give 3TC as a monotherapy, if you did that, you would develop resistance to that drug more quickly than any other AIDS drug. But they reasoned ... these people already have resistance to that drug and that resistance is making the virus less fit, so let's give half the people that drug all by itself; nothing else ...
Jackie Judd: And what did it show?
Jon Cohen: What it showed is that the people who took that one drug did better over time than the people who took nothing; that it looks as though it kept the virus in that weaker Darwinian state, which is just a wild concept.
Jackie Judd: What would you have expected to happen ...
Jon Cohen: Well ...
Jackie Judd: ... or what would the researchers have expected to happen?
Jon Cohen: Well I think the minute that researchers heard the design in the experiment they said, why didn't I think of that. I think they would have expected the outcome but nobody had done the experiment. I mean what is this world where you have 20 drugs to treat a disease? It is a marathon relay race where you are handing the baton off, and the baton is the drugs that you are taking; that's the baton. Because what happens is you exhaust the drugs you are taking because of mutations. We are constantly looking for new batons; well who would have thought that this could be a baton. That's why I am so wowed about it; I think it's very cool. Will it matter to a lot of people, we don't know yet. This has to be proven in a much, much larger study.
Jackie Judd: Right. You mentioned 50 people were involved.
Jon Cohen: Not a lot of people.
Jackie Judd: So what happens to that kind of science in this place; does somebody look at it, say that's interesting, here's some money, do a larger study.
Jon Cohen: That's one of the beauties of these big conferences. You have people from every country in the world who are hearing this stuff, these are planting seeds. That's what these little studies do; they plant seeds. Other people have to put water on those seeds, and it's so diverse here, you have no idea. It's like journalism, you have no idea where the words land, you know. We have no idea who is out there; we don't know, you know and that's the beauty of it to me.
Jackie Judd: I want to wrap up with one correction from yesterday.
Jon Cohen: Yeah, yeah, I made a mistake. I am moving too fast sometimes, I said 14,000 people a day are dying. I was wrong as Ambassador Tobias pointed out in his speech, it's 8,000 people a day, and I am embarrassed and I apologize for that, but I need more sleep and more food and I ...
Jackie Judd: We are on a very different time zone over here.
Jon Cohen: We are, yeah.
Jackie Judd: Jon Cohen, thanks, I'll talk to you tomorrow.
Jon Cohen: Thanks so much Jackie.
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