From David Rasnick...

**********The Reappraising-AIDS Discussion List**********

Wow. Put words in people's mouth, eh?

I think you're lying about these numbers. You make this claim with no
support whatsoever.

Kelly Jon Landis wrote:

"Richard and All,

One might reverse the question you asked of Alex. If 'ART's are so
"life-saving" why are a quarter million Americans diagnosed as "HIV
positive" or with "AIDS" who are eligible for such 'treatment'
according to T-Cell Counts and PCR "Viral Load" clinical markers,
choosing not to take them?"

You're misrepresenting the data to support your views.

Nowhere does the IOM state the number of people they estimate to not be
receiving HAART who may "need" it are not receiving it because they're
"choosing not to take them.":The whole point of the IOM report is "to
develop a framework for a system of public financing and delivery of
HIV care capable of meeting the current and future challenges of the
HIV/AIDS epidemic." It's a modeling exercise, Bruce Shackman, who I
know, was one of the reviewers.

The IOM list upfront some of the factors reported to be associated with
non-receipt of ARVs:

By income
odds ratio (OR) of getting ARV if < $25,000
0.60

By insurance status
OR getting ARV if uninsured 0.74
OR getting ARV if Medicaid alone 0.83
OR getting ARV if Medicare-other 0.82
OR getting ARV if HMO insurance 0.90

- These associations offer zero support for your statements, unless
you're arguing that having an income of less than $25,000 a year and
being uninsured make you more likely to agree with Kelly Jon Landis's
views on antiretrovirals.

Here is some more verbiage from the IOM:

"HAART Use Deficit

The estimates are based on an initial finding that there are 950,000
individuals living with HIV and that 670,000 individuals are aware of
their HIV status, of whom 25 percent (167,500) are uninsured and 50
percent (335,000) are insured through a program financed with public
dollars (Table A-2). Among those individuals who are aware that they
are infected, we estimate that 69 percent (463,069) are in need of
combination antiretroviral therapy and that slightly fewer than half in
need of HAART (230,000 individuals) receive antiretroviral medications,
leaving a deficit in HAART use of 233,069 for this cohort. We believe
that an additional 82,000 individuals who are infected but unaware of
their HIV status are also in need of HAART."

- So it's an estimate of CD4 T cell count distribution among the
estimated 670,000 people that are aware of their HIV status which leads
them to estimate that 463,069 people are "in need" of HAART.

So how do they estimate HAART usage among these 463,069 people? The
information is as follows:

"Estimates of the current prevalence of HAART use are drawn from a
number of sources. Studies of HIV-infected populations (AIDS and HIV
non-AIDS) in New York State and in three metropolitan areas used local
data sources (HIV/AIDS surveillance, lab reporting, Medicaid and AIDS
Drug Assistance Program [ADAP] billing claims) from 2001 in a framework
endorsed by the Health Resources and Services Administration HRSA) to
estimate participation in HIV care (Kahn, 2002). Studies of Medicaid
and ADAP populations were conducted for 1998 in four heavily
HIV-affected states (Kahn et al., 2002). Additional older estimates
provide nationally representative data of individuals in care (Bozzette
et al., 1998) and individuals in private and public HIV specialty
clinics (Moorman et al., 1998; Palella et al., 1998). Based on these
data, we estimated that 230,000 individuals are on HAART, including 40
percent of those with a nadir CD4 count between 50 and 199. To
determine the association of HAART use with income level and insurance
status used data from HCSUS (Andersen et al., 2000). Though this data
is from 1996, somewhat more recent nationwide data (from 1997- 1998)
and analyses of data from the state and local levels suggest the
persistence of income and insurance effects found by Andersen et al.
(Bhattacharya et al., 2003; Goldman et al., 2003; Kahn, 2002; Kahn et
al., 2002; Goldman et al., 2001; Hsu et al., 2001). Low-income
individuals (family income < $25,000) were less likely to be on HAART
(odds ratio [OR] = 0.6). The odds of being on HAART also varied by
insurance status, from 0.74 among those with no insurance, to 0.83
among Medicaid recipients, to 0.90 among those with health maintenance
organization (HMO) insurance (reference group is those with private
fee-for-service insurance) (Andersen et al., 2000).

We defined HAART need based on HIV disease stage. All those with AIDS
"need" HAART. Although there are many legitimate reasons not to
provide HAART when someone has AIDS, and many patients may decline
HAART, clinical guidelines suggest offering and using HAART. Among
those with HIV disease with a CD4 count of 200 to 350 (often
symptomatic), we assume that half need HAART, consistent with the
guidelines' suggestion for flexibility in this range. For those even
earlier in disease, we define need as the small percentage estimated to
be currently using HAART, which at that stage is not recommended (DHHS,
2003)."

Before I go into the cites, I note that the report authors do state
here - wihout a cite though - that "many patients may decline HAART."
This is actually the strongest support for your argument that the
report has to offer. In terms of the numbers which you have come to
believe indicate that there 233,000 such people, all of the same mind
as you, these are derived from the cites. The most important being the
Kahn study from 2002:

Public Health Rep. 2002 May-Jun;117(3):252-62; discussion 231-2.

Access to and use of HIV antiretroviral therapy: variation by
race/ethnicity in two public insurance programs in the U.S.

Kahn JG, Zhang X, Cross LT, Palacio H, Birkhead GS, Morin SF.

Institute for Health Policy Studies, University of California-San
Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118,
USA. jgkahn@itsa.ucsf.edu

OBJECTIVES: To examine access to and use of HIV highly active
antiretroviral therapy (HAART) by race/ethnicity in Medicaid and the
AIDS Drug Assistance Program (ADAP) in 1998 in four states. METHODS:
The authors analyzed reimbursement claims and AIDS surveillance data in
California, Florida, New York, and Texas. Study subjects were
identified using diagnostic or medication codes specific to HIV. The
race/ethnicity of program enrollees was compared to representation in
the HIV epidemic to examine access. Claims for antiretroviral (ARV) use
were compared to U.S. Public Health Service treatment guidelines to
assess HAART use. RESULTS: The authors identified 151,000 HIV-infected
individuals in these two programs in the four states. Evidence of AIDS
or symptomatic HIV was present in 78%-88% of enrollees in Medicaid,
versus 31%-48% in ADAP. African Americans participated in Medicaid
10%-53% above and in ADAP 17%-31% below representation in the epidemic.
Non-Latino whites exhibited the opposite pattern, being in Medicaid
5%-38% below and in ADAP 9%-65% above epidemic representation. Latinos
participated more in ADAP (7%-31%), except in New York. HAART use over
90 days (July-September) ranged from 38% to 76% by program and state.
Differences by race/ethnicity were inconsistent and small: African
Americans had lower HAART use by 6%-14% in California and Florida
Medicaid, and Latinos had higher HAART use by 2%-11% in ADAP and in
Texas Medicaid. CONCLUSIONS: African Americans were more likely to
access HIV drugs through Medicaid than through ADAP, which may reflect
differences in program eligibility criteria as well as care seeking
later in HIV disease. Differences in the use of HAART by race/ethnicity
within state programs were small.

- The key phrase here is "HAART use over 90 days (July-September)
ranged from 38% to 76% by program and state." The year they are talking
about it is 1998. It is based on these numbers that the IOM estimated
how many people are or are not on therapy. They also used data from the
HCSUS study (Bozzette et al) which is a sample of ~2,500 people whose
antiretroviral usage was assessed in December 1996.

The full text of the Kahn paper is available online at:
http://www.publichealthreports.org/userfiles/117_3/117252.pdf

The discussion includes a long list of caveats to the data, and notes
that no specific information CD4 counts or viral load were available.

The full text of the HCSUS papers are also online e.g.
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1089126&blobtype=pdf

Because they used a survey approach they asked questions like this:

My Health Is Doctor's Top Concern
Agrees completely 1,381
Agrees mostly 864
Agrees somewhat 354
Agrees a little/not at all 177

- Unless you're arguing that most of these people's doctors also agreed
with your views on ARVs, then I don't see any support for your claims
here either. This study was a probability sample, so they extrapolate
that there might be 13,688 nationally that would fall into the category
of agreeing with their doctor a little or not at all. I wouldn't argue
that this is an insignificant number and it does very likely say
something about medical practice in the US, but it in no way suggests
that these individuals are denialists.

So, the IOM estimates may indeed be correct in suggesting that there
are significant numbers of people who meet indicators for HAART that
are not receiving it; however there is zero evidence that a significant
number of these people are not receiving HAART because they agree with
Kelly Jon Landis - just the opposite.

Kelly if there are 231,000 people in the US who hold your views on ARV. How
do you explain the simple fact that they make no appearance on any of the
many internet web and chat sites that you denialists operate. After all here
we are 20 plus years into the existence of those forums and they still seem
to be occupied by only a few hundred folks at the most. The number of active
dissidents has remained remarkably stable over the years.

Wouldn't it be logical to assume that if the 231,000 people you claim to be
anti ARV made that choice because they believe the dissident position. Then
the web traffic on dissident websites would indicate much greater bandwidth
usage then they have shown since their inception. Additionally if only 1% of
those folks were active on the dissident forums that would be 2,310 active
posters which has never been seen on any of your forums and you have
admitted so more then once when challenged about the so called vast numbers
of the dissident movement.

If there were 231,000 people in the US who choose to refuse ARV because they
do not believe in HIV or do not believe in the effectiveness of ARV we would
surly see more then the measly half a dozen whack jobs like your self here
on MHA.

The sad truth about the inadequate use of ARV in the US is much more about
race, income, homelessness, drug addiction, apathy, stigma, bigotry, denial,
and the broken nature of the US health care system. To see the truth of this
just read the studies in the New England Journal of Medicine that have been
published over the last decade that deal with the differences of medical
care between African Americans, and Women in comparison to White Males.

Gary Stein

<snip>

It is also worth pointing out that Rath initially tried to sue Health-e
news for defamation after they published this and other articles.

He has since withdrawn all defamation cases against the various media
agencies.

You can't sue somebody for telling the truth.

Chris Noble

told the vitamins would be adequate to fight any life-threatening
infections."

That's nothing.  I'm aware of thousands of people who have died, after
having been told they had a deadly viral disease and that they could fight
the virus with AZT.

"Rath protocol has not been approved".

Approved by whom??  Self-appointed experts, who can't tell a virus from a
tapeworm?
Read Dr. Rath's book.  It really makes sense.

How about some controlled studies?
About ARV's were already know a few things.  They are not effective,
longterm, and they destroy liver and kidneys.  Does Kariem live in a glass
house?  I think so.  So he should not throw stones.

Just because you make this claim doesn't make it true, does it.

And the Court rejected a central claim of Rath's and yet he persists
in spreading that lie.

Denialists love a good lie!

        George M. Carter

The Rath statement is a flat-out lie Alex, what it does is use the fact
that the court document has to reference Rath's defamatory accusations
as a way to quote the court quoting Rath!! The court found no truth to
the accusations, because there isn't any.

I read Rath's propaganda piece. If you want to know what the judgement
of the court was then read the court judgement.

http://www.tac.org.za/Documents/RathCases/JudgmentTACvRath-20060303.pdf

Why doesn't Rath put the original document on his website?

Chris Noble

Any information I need on the ubject (which doesn't actually mean a lot) I
get from reputable sources. I certainly do not need a charlatan like Rath to
inform and 'educate' me!

Now there's an interestig statement. I would be very interested as well.