While few here think of the pharmaceutical mission as one
of a "Nanny State", perhaps it should be seen as such,
especially when, for years, many doctors were refusing to
treat HIV patients who wouldn't take the "life-saving"
antivirals for the purpose of delaying the onset of AIDS.

Now we know that those drugs never delayed the
onset of anything (see IAS standard of care below),
what the HIV doctor/ HIV patient has become is nothing
short of a nanny state.

Thus, we MUST view the PharmApologists as our Nannies.

Perhaps Tucker Carlson has some rare insights
(that is, for his right-wing-challenged brain)
about seatbelts and the Nanny state:

Taking on the 'Nanny' state (Tucker Carlson)

December 15, 2005 9:09 a.m. ET
http://www.msnbc.msn.com/id/10284169/#051215a

Of all the crackpot things I've said in public over the
years, nothing has elicited more hate mail than the time I
came out against seatbelts. It was about five years ago, and
I was giving a ride to a reporter from People magazine. We
were crossing Capitol Hill in my elderly Volvo when she
remarked upon the fact I was violating the law by not
wearing my seatbelt. That's right, I said, and launched into
a lecture about the tyranny of the nanny state. I can't
remember if I actually quoted Patrick Henry. I do remember I
got pretty hot. She put it in her magazine.

Within hours of publication I had dozens of calls and
e-mails from angry, self-righteous strangers demanding to
know how I dared - dared! -- say something unkind about
seatbelts. They save lives! Are you against saving lives?
Are you for traffic deaths? You monster!

I'm not against saving lives, of course, or even against
seatbelts. I wore mine once, in a snowstorm in Connecticut
in 1988. In the end I didn't crash, so the seatbelt didn't
work. Plus it wrinkled my shirt. I haven't made the same
mistake again.

But enough about me. The point is not that seatbelts are bad
or that I don't care for them, but that seatbelt laws are
insulting to the American spirit. Should the state really
protect competent adults from themselves? And if so, what's
the message of punishing someone for ignoring his own
safety? Protect yourself or we'll kill you?

Seatbelt laws are ludicrous and infuriating, exactly the
sort of thoughtless, petty harassment that got Sam Adams so
worked up. Unfortunately, 230 years later, no one seems to
care.

12/14: The Situation's Tucker Carlson speaks to a man on a
mission to make seatbelts optional.

Kenneth Prazak has spent two years and $2,000 fighting a $25
ticket for not wearing a seatbelt.   Except for Kenneth
Prazak. Kenneth Prazak cares. The 53-year-old Illinois man
spent two years and more than $2,000 fighting a $25 seatbelt
violation. Prazak wasn't speeding or driving recklessly or
endangering the lives of other motorists when he was pulled
over. As he put it, "I was just minding my own business
driving down the road." In the end, members of the jury
didn't care. They ruled against him. Yet in the process of
fighting his lost cause, Prazak made a stirring case for
personal freedom.

Kenneth Prazak was a guest on the show Wednesay, and there's
no doubt in my mind that a lot of viewers will hate him.
Many others will write him off as a crank. They have a
point. By conventional standards, Prazak is a crank.
Ordinary people would rather suffer indignities at the hands
of the state than be considered weird by their friends. But
every generation raises up individuals willing to think for
themselves, people who've decided they're not going to pay
the tea tax, who've had it with sitting at the rear of the
bus. Society doesn't always welcome people like this; they
tend to be difficult. But history usually rewards them.

So mock Kenneth Prazak if you will. But before you do, see
if you can argue with the reasoning of his closing argument:
"The real issue here is, who owns your life? Is it yours or
is it government's?" His conclusion: "If government makes my
choice for me, I am no longer free."

Melodramatic? Sure it is. But that doesn't mean it's not
true. Keep in mind, small laws add up to big tyrannies.

========== Early ARV Treatment = NO BENEFIT

After years of promoting "early ARV" treatment as "life-saving",
the pharma shills on this newsgroup are STILL biting their
tongues over the July 2004 revision of the HIV Standard
of Care as published in JAMA:

  "For less severely compromised individuals  (ie, asymptomatic
   individuals with CD4 cell counts > 200/microL), there are no
  definitive data from prospective, randomized controlled
  studies to determine when antiretroviral therapy is associated
  with a survival benefit."

My favorite parts are the disclosures about the outrageous
conflicts of interest by the doctors who have been misleading
about HIV treatment since the first AZT studies.

Enjoy!

susie
____

In the 7/14/04 JAMA article titled "Treatment for Adult HIV Infection:

2004 Recommendations of the International AIDS Society-USA Panel,"
Yeni et al. state:

"Randomized clinical trials have demonstrated a survival benefit
with the use of antiretroviral therapy by patients with severe
immunodeficiency. For less severely compromised individuals
(ie, asymptomatic individuals with CD4 cell counts > 200/microL),
there are no definitive data from prospective, randomized controlled
studies to determine when antiretroviral therapy is associated with a
survival benefit. In the absence of such data, the decision to
initiate therapy should be made based on survival and disease
progression information obtained from observational studies, the
consequences of moderate degrees of immune deficiency, and the
long-term safety of antiretroviral drugs."

---------------------------------

JAMA.2004 Jul 14;292:251-265.

Treatment for Adult HIV Infection

2004 Recommendations of the International AIDS Society-USA Panel

Patrick G. Yeni, MD; Scott M. Hammer, MD; Martin S. Hirsch,
MD; Michael S. Saag, MD; Mauro Schechter, MD, PhD; Charles
C. J. Carpenter, MD; Margaret A. Fischl, MD; Jose M. Gatell,
MD, PhD; Brian G. Gazzard, MA, MD; Donna M. Jacobsen, BS;
David A. Katzenstein, MD; Julio S. G. Montaner, MD; Douglas
D. Richman, MD; Robert T. Schooley, MD; Melanie A. Thompson,
MD; Stefano Vella, MD; Paul A. Volberding, MD

Abstract: Context  Substantial changes in the field of human
immunodeficiency virus (HIV) treatment have occurred in the last 2
years, prompting revision of the guidelines for antiretroviral
management of adults with established HIV infection.

Objective  To update recommendations for physicians who provide HIV
care regarding when to start antiretroviral therapy, what drugs to
start with, when to change drug regimens, and what drug regimens to
switch to after therapy fails.

Data Sources  Evidence was identified and reviewed by a 16-member
noncompensated panel of physicians with expertise in HIV-related basic
science and clinical research, antiretroviral therapy, and HIV patient
care. The panel was designed to have broad US and international
representation for areas with adequate access to antiretroviral
management.

Study Selection  Evidence considered included published basic science,
clinical research, and epidemiological data (identified by experts in
the field or extracted through MEDLINE searches using terms relevant
to  antiretroviral therapy) and abstracts from HIV-oriented scientific
conferences between July 2002 and May 2004.

Data Extraction  Data were reviewed to identify any information that
might change previous guidelines. Based on panel discussion,
guidelines were drafted by a writing committee and discussed by the panel
until consensus was reached.

Data Synthesis  Four antiretroviral drugs recently have been made
available and have broadened the options for initial and subsequent
regimens. New data allow more definitive recommendations for specific
drugs or regimens to include or avoid, particularly with regard to
initial therapy. Recommendations are rated according to 7 evidence
categories, ranging from I (data from prospective randomized clinical
trials) to VII (expert opinion of the panel).

Conclusion  Further insights into the roles of drug toxic effects,
drug resistance, and pharmacological interactions have resulted in
additional guidance for strategic approaches to antiretroviral
management.

Author Affiliations: Department of Infectious Diseases,
Hospital Bichat-Claude Bernard, X. Bichat Medical School,
Paris, France (Dr Yeni); Department of Medicine, Columbia
University College of Physicians and Surgeons, New York, NY
(Dr Hammer); Department of Immunology and Infectious
Diseases, Harvard Medical School, Boston, Mass (Dr Hirsch);
Department of Medicine, University of Alabama, Birmingham
(Dr Saag); Department of Preventive Medicine, Universidade
Federal do Rio de Janeiro, Rio de Janeiro, Brasil (Dr
Schechter); Department of Biomedicine, Brown University
School of Medicine, Providence, RI (Dr Carpenter);
Department of Medicine, University of Miami School of
Medicine, Miami, Fla (Dr Fischl); Department of Medicine,
University of Barcelona, Barcelona, Spain (Dr Gatell);
Department of HIV Medicine, Chelsea and Westminster
Hospital, London, England (Dr Gazzard); International AIDS
Society-USA, San Francisco, Calif (Ms Jacobsen); Department
of Medicine, Stanford University Medical Center, Stanford,
Calif (Dr Katzenstein); Department of Medicine, University
of British Columbia, Vancouver (Dr Montaner); Departments of
Pathology and Medicine, University of California and San
Diego VA Healthcare System, San Diego (Dr Richman);
Department of Medicine, University of Colorado School of
Medicine, Denver (Dr Schooley); AIDS Research Consortium of
Atlanta, Ga (Dr Thompson); Istituto Superiore di Sanità,
Rome, Italy (Dr Vella); Department of Medicine, University
of California and San Francisco Veterans Affairs Medical
Center, San Francisco (Dr Volberding).

===================================================
Financial disclosures of AIDS researchers - 7/14/04 JAMA

JAMA, July 14, 2004 Vol 292, No. 2 251-265

Treatment for Adult 2004 Recommendations International AIDS Society-
USA Panel

Patrick G. Yeni, MD
Scott M. Hammer, MD
Martin S. Hirsch, MD
Michael S. Saag, MD
Mauro Schechter, MD, PhD
Charles C. J. Carpenter, MD
Margaret A. Fischl, MD
Jose M. Gatell, MD, PhD
Brian G. Gazzard, MA, MD
Donna M. Jacobsen, BS
David A. Katzenstein, MD
Julio S. G. Montaner, MD
Douglas D. Richman, MD
Robert T. Schooley, MD
Melanie A. Thompson, MD
Stefano Vella, MD
Paul A. Volberding, MD
Patrick G. Yeni, MD

Dr Yeni has received research grants for site investigator
from GlaxoSmithKline, Bristol- Myers Squibb, Boehringer
Ingelheim, Roche, Tibotec/Virco, and Gilead.

Dr Yeni has received honoraria for advisory positions and lecture
sponsorships from Abbott Laboratories, Bristol-Myers Squibb,
Boehringer Ingelheim, Roche, Tibotec/Virco, and Merck Sharp
and Dohme.

Scott M. Hammer, MD

Dr Hammer has received research grants for site investigator from
Roche, GlaxoSmithKline, and Merck.

Dr Hammer has been a consultant for Bristol-Myers
Squibb, GlaxoSmithKline, Merck, Shionogi, Pfizer, Boehringer
Ingelheim, Shire, Gilead, and Tibotec/ Virco.

Martin S. Hirsch, MD

Dr Hirsch has received research support from Takeda.

Dr Hirsch has been a consultant for Schering Plough, GlaxoSmithKline,
and Bristol-Myers Squibb.

Michael S. Saag, MD

Dr Saag has received research support from Abbott Laboratories,
Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Ortho
Biotech/Johnson&Johnson, Pfizer/Agouron, and Hoffmann- LaRoche.

Dr Saag has been a consultant for Abbott Laboratories, Boeringer
Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline,
OrthoBiotech/Johnson & Johnson, Pfizer/Agouron, Roche,
Schering-Plough, Shire Pharmaceutical, TherapyEdge, Tibotec/ Virco,
Trimeria, Vertex, and ViroLogic.

Dr Saag has received honoraria for positions on the speakers
bureau for Abbott Laboratories, Boeringer Ingelheim, Bristol-Myers
Squibb, Gilead Sciences, GlaxoSmithKline, OrthoBiotech,
Johnson & Johnson, Pfizer, Agouron, Roche, Schering-Plough,
Shire Pharmaceutical, TherapyEdge, Tibotec/Virco, Trimeria,
Vertex, and ViroLogic.

Margaret A. Fischl, MD

Dr Fischl has received research grants from Abbott Laboratories,
Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, and
Ortho Biotech.

Dr Fischl has received honoraria for continuing medical education
programs from GlaxoSmithKline.

Dr Fischl has served as an advisor for Agouron Pharmaceuticals and
GlaxoSmithKline.

Brian G. Gazzard, MA, MD

Dr Gazzard has received research grants from Abbott Laboratories,
Boehringer Ingelheim, Pfizer, GlaxoSmithKline, Bristol-Myers Squibb,
and Johnson &Johnson.

Julio S. G. Montaner, MD

Dr Montaner has received grants from Abbott Laboratories,
Agouron Pharmaceuticals, Shire Biochemical, Boehringer
Ingelheim, Bristol-Myers Squibb, DuPont Pharma, Gilead
Sciences, GlaxoSmithKline, Roche, Kucera Pharmaceutical,
Merck Frosst Laboratories, Pharmacia & Upjohn, and Trimeris.

Dr Montaner has received honoraria for speaking from Abbott
Laboratories, Agouron Pharmaceuticals, Shire Biochemical,
Boehringer Ingelheim, Bristol-Myers Squibb, DuPont Pharma,
Gilead Sciences, GlaxoSmithKline, Hoffmann-La Roche, Kucera
Pharmaceutical, Merck Frosst Laboratories, Pharmacia &
Upjohn, and Trimeris Inc.

Dr Montaner holds 2 US patents, one regarding use of nevirapine
and another regarding pharmacological applications of mitochondrial
DNA assays. Dr Montaner has 2 patent applications that are
pending, one regarding pharmacological applications of
mitochondrial DNA assays and another regarding sepsis.

Robert T. Schooley, MD

Dr Schooley has received grants from GlaxoSmithKline,
Bristol-Myers Squibb, Merck, and Tibotec/Virco.

Dr Schooley has been a consultant for Abbott
Laboratories, Pfizer, Hoffmann-LaRoche, GlaxoSmithKline,
BristolMyers Squibb, Merck, Vertex, ViroLogic, and
Tibotec/Virco.

Melanie A. Thompson, MD

Dr Thompson has received grants from Abbott Laboratories, Agouron/
Pfizer Pharmaceuticals, Boeringer Ingelheim, Bristol-Myers
Squibb, Chiron Corporation, GlaxoSmithKline, Gilead
Sciences, Merck Research Laboratories, Oxo-Chemie, Roche,
Serono, Theratechnologies, Triangle Pharmaceuticals,
Trimeris, and VaxGen.

Dr Thompson has been a consultant for Abbott
Laboratories, Agouron/Pfizer Pharmaceuticals,
GlaxoSmithKline, Gilead Sciences, Serono, and Triangle
Pharmaceuticals.

Dr Thompson has received honoraria for lecture sponsorships and
continuing medical education from Abbott Laboratories,
Agouron/ Pfizer Pharmaceuticals, Boeringer Ingleheim,
Bristol-Myers Squibb, GlaxoSmithKline, Gilead Sciences, Roche,
Serono, Triangle Pharmaceuticals, and Trimeris.

Mauro Schechter, MD, PhD

Dr Schechter has received honoraria from Abbott Laboratories,
Bristol-Myers Squibb, GlaxoSmithKline, Merck, and Roche.

Dr Schechter has been a consultant for Abbott Laboratories,
BristolMyers Squibb, GlaxoSmithKline, Merck, and Roche.

Jose M. Gatell, MD, PhD

Dr Gatell has served in advisory positions for Roche, Bristol-Myers
Squibb, Merck Sharp and Dohme, GlaxoSmithKline, Gilead,
Boehringer Ingelheim, Abbott Laboratories, Tibotec/ Virco.

Brian G. Gazzard, MA, MD

Dr Gazzard has received lectureship fees from Abbott Laboratories,
Boehringer Ingelheim, Pfizer, GlaxoSmithKline, Bristol-Myers Squibb,
and Johnson & Johnson.

David A. Katzenstein, MD

Dr Katzenstein has held advisory positions at Boehringer Ingelheim,
Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Merck,
ViroLogic, Visible Genetics, and the Doris Duke Charitable Trust.

Dr Katzenstein holds a US patent for polymerase chain reaction
assays monitoring antiviral therapy and making therapeutic
decisions in the treatment of AIDS.

Stefano Vella, MD

Dr Vella has received lecture sponsorship for
satellite symposia and continuing medical education programs
from Merck, Agouron, Gilead, Boehringer Ingelheim, and
Roche.

Paul A. Volberding, MD

Dr Volberding has received honoraria from Gilead,
Bristol-Myers Squibb, GlaxoSmithKline, and Boehringer
Ingelheim.

Dr Volberding has been a consultant for Pfizer, Bristol-Myers
Squibb, and Shire.

Douglas D. Richman, MD

Dr Richman has been a consultant for Abbott Laboratories,
Bristol-Myers Squibb, Chiron, Gilead, GlaxoSmithKline,
Merck, Novirio, Pfizer, Roche, Takeda, Triangle, and
ViroLogic.

Corresponding Author: Patrick G. Yeni, MD, Hospital Bichat-Claude
Bernard, 46 Rue Henri-Huchard, 75877 Paris Cedex 18, France
(Patrick.Yeni@Bch .Ap-Hop-Paris.Fr).