The Bay Area Reporter - Thursday, May 28, 1999
Phillip Alden, ACT UP/Golden Gate Writers Pool

Another man is stumbling down the block and is stopped by the police. They almost arrest him for public intoxication.

A third man, under treatment for depression and anxiety, suddenly finds his anxiety level rising even though he has taken his medication at the usual time. This same man falls into a depressive state and treats those around him like garbage for over a week.

These three men share two things in common; the first is that they all are living with HIV/AIDS, and the second is that they recently went on Sustiva, an antiviral drug made by DuPont Pharmaceuticals.

Ryan (not his real name) wrote a letter to DuPont asking for any information they may have regarding psychotropic side effects of Sustiva. DuPont failed to respond to his letter.

"I wasn't looking to sue DuPont or anything like that," he says. "I just wanted to know what was causing these terrible emotional problems. They didn't even have the decency to send me a form letter."

Ryan, and the other two men in this story, are victims of serious psychotropic side-effects caused by Sustiva. Ryan had to double the amount of anti-anxiety medication he was on, and increase the dosage of his anti-depressant.

"It's bad enough that living with AIDS has its own terrible emotional cost," Ryan says, "now the drugs are [messing] with our minds as well as our bodies."

A Bay Area doctor who wished to remain anonymous told this reporter that he has seen a significant number of his patients experience serious psychological side effects from Sustiva. A representative from DuPont, one of the guys who frequent doctor's offices to push product, told this doctor that there is "growing anecdotal evidence" that Sustiva can cause serious psychotropic side-effects.

As with all drugs, there are two factors at play here. The first is that Sustiva can cause an otherwise emotionally healthy person to suddenly need anti-depressants or other types of psychotropic medications. The second factor is that Sustiva can reduce the efficacy of some psychotropic medications, which means that people have to increase their dosages.

There are three ways a drug can affect the body:

1. The drug is well tolerated and does, or does not do, exactly what it is supposed to do.

2. The patient will experience side effects. Some of these side effects may be well tolerated. These side effects are usually documented during the human trial phase of the drug's development and appear as warnings on the fact sheet accompanying the drug.

3. The drug causes an adverse drug reaction (ADR). An ADR may not be picked up in the human trial.

Drugs prescribed by your doctor can be as dangerous as illegal street drugs. Human trials catch some ADRs, but a drug's safety and efficacy is really determined over time. This means that all of us are guinea pigs for the pharmaceutical companies. If a drug has not been on the open market for a number of years, it's still risky.

There is sufficient data on drugs like aspirin and penicillin because they have been on the market for decades, but a drug that has only been on the market for a few years is not necessarily safe.

Doctors rely on the drug companies for information about a new drug. This means that salespeople from the drug companies are their main source of information. Salespeople tell doctors what their drugs do. Doctors are usually very busy, and many may take the salesperson's word at face value.

It's important to understand that doctors don't necessarily know the efficacy or the safety profile of drugs they prescribe. They know a lot, by virtue of their training and intimate knowledge of their patients, but they can be almost as ignorant as the patient when prescribing a new drug.

AIDS patients have a difficult row to hoe. As activists, they demanded the Food and Drug Administration "fast-track" approval for anti-AIDS drugs. They know that they are guinea pigs. In the desperate war against the disease, they are willing to take chances with new and very toxic drugs.

People who are not suffering from a life-threatening or chronic condition should take special care when asking their doctor about a new drug. Viagra has killed a number of people because of adverse drug interactions, especially in combination with nitrates. Doctors are hesitant to refuse a patient's request for a new drug. If doctor A is unwilling to give you the prescription you saw on television, doctor B will happily prescribe it for you. Both doctors and patients are aware of this, hence reluctance on the doctor's part to refuse a patient's prescription request.

Many doctors and their family members are wary of all drugs, and they avoid taking any kind of pill if there is another option. Their behavior should be model for us all. Not all drugs are bad, but it only takes one pill to change an ailment to a life-threatening situation.
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Always watch for outdated information. This article first appeared in 1999. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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