FROM THE DIVISION CHIEF’S meeting, Kevin went straight to a conference room above the library. He was glad to find only twenty people inside. He had faced larger hostile groups and not just AIDS activists, also those on the other side who demanded exclusion of HIV-infected children from public schools or mandatory HIV screening of anyone applying for a government job.
Kevin recognized many of the men from previous meetings. He had even established some rapport with a few of them. His temper was under control until he saw the moderator was Rebecca Wolman.
“Wonderful,” he seethed through clenched teeth.
Rebecca looked at her watch and said, “Can we start, now that Dr. Bartholomew is here?”
The room hushed. All the attendees crossed their arms.
“We asked for this meeting,” she said, “because it’s been three months since the AZT trial was stopped—terminated because an independent data and safety monitoring board concluded it would be unethical to deprive the people on placebo from receiving a life-prolonging medication. We’ve read about how kind Burroughs Wellcome is being, how accommodating the FDA has suddenly become, how nicely they’re working together to make AZT available to all those poor, suffering AIDS patients.”
She raised her voice and lowered her pitch like an alto launching into an aria.
“But it’s been three months, and nothing has happened. Ten people with AIDS are dying every day in this country!”
“What the fuck is going on?” she yelled at Kevin, “And what are you doing about it?”
Her audience pounded their fists on the table.
“AZT. Now!” they chanted. “AZT. Now!”
Unruffled, Kevin held up a hand.
“If we’re going to have a dialogue, you have to let me talk too.”
They kept on chanting.
“Or I’m leaving.”
He took two steps toward the door. There was quiet.
How infantile, he thought.
Being as conciliatory as he could, Kevin said, “Can I give you some information about the trial that hasn’t been in the press?”
Taking their cynical expressions as acquiescence, he distributed copies of his handout. He explained the study’s limitations—its short duration before all those who were assigned to get placebo were switched to AZT, the restrictive entry criteria which made generalizing results to other AIDS patients problematic. He also described the severe anemia, nausea, and muscle damage that occurred much more frequently in those who had received AZT during the randomized phase of the trial.
He was tempted to mention Marco’s situation as a personal example of where the harm would exceed the benefit. Then he recalled Gwen telling him that when dealing with angry people who perceive they have less power than you—whether patients, employees, or activists—it doesn’t help to bring up your own personal issues. They won’t be sympathetic.
“I really do get it. People with AIDS are dying,” Kevin concluded, “and for some of them, AZT is likely to improve survival and quality of life in the short term. But I worry that wide release of the drug before definitive studies are done could turn out to be a terrible mistake. What if the outcome of taking the drug for longer than a few months is worse than taking nothing?”
“That’s right,” Rebecca retorted. “We don’t know what the long term safety of AZT is, but it’s clearly an immediate stay of execution for anyone who’s had Pneumocystis. Burroughs Wellcome promised to make AZT available in October. It’s going to be January at the earliest, if then.”
“That’s out of my control, Rebecca.”
“You were an investigator in the trial. If you publicly put pressure on the company, if you accuse them in front of TV cameras and say delaying distribution of AZT is genocide, they’ll have to respond. It will disgrace them in a way we can’t.”
“Rebecca, I collaborated with BW scientists in designing the trial. I am not going to make an accusation like that. Anyway, BW can’t do this alone, certainly not until the FDA gives them a green light. And the FDA is greasing the wheels for AZT approval to happen at warp speed. There has never been a drug for any disease that will get out to dying people this fast and on the basis of such little evidence.
“You’re also ignoring safety. The company and the FDA have to work out how to monitor the toxicity of long-term treatment with AZT. If people start dropping dead from toxicity, compassionate-use distribution will look like a greedy marketing ploy by the company and negligence by the FDA. And that would have a deadening effect on development of new drugs. Try to see the bigger picture.”
“Kevin, the bigger picture is that this is a holocaust. You’re a fucking stooge for a Nazi pharmaceutical company. We’re done here.”
As the group got up to leave, Kevin wanted to scream. My lover is dying of AIDS. What gives you the moral authority to demonize me?
Just thinking those words was enough catharsis for him to stay focused on salvaging the meeting. As the men gathered their coats and umbrellas, Kevin saw that underneath the anger, they were dispirited.
“Rebecca,” he projected in his most basso voice, “Is this how you want to end things? What have you gained here?”
That caught their attention. Everyone stopped. They looked back and forth between the antagonists.
“Our mission at City Hospital is to give the best treatment to people with AIDS. Yours is to empower them. Shouldn’t we be working together? Wouldn’t that be the best thing for folks who have this disease?”
Kevin slowly looked around the room, systematically making eye contact with each person. Some were weighing his proposal. The others were already nodding in agreement.
Rebecca, not oblivious to the fact that she was quickly becoming a minority of one, said, “OK. We can talk about that.”
Kevin offered his hand. The men clapped as she shook it.