AIDS TREATMENT NEWS Issue #306, November 6, 1998
John S. James

* $110 million was budgeted to fight the AIDS epidemic in African-American communities, and to reduce racial and ethnic disparities in AIDS programs.

* The Ryan White programs received a $261.4 million increase- -including a $175.5 million dollar increase for ADAP, the need projected by the ADAP Working Group (before the current moves to increase drug prices, however).

* AIDS research at the U.S. National Institutes of Health was increased by $184.9 million; overall NIH funding for medical research was increased by at least as large a proportion.

* Substance abuse prevention and treatment was increased by $297 million.

* AIDS prevention was increased by $32.9 million, which includes $10 million for HIV screening of newborns.

Comment

The success of AIDS funding in this Congress was due to several lucky conditions, not all of which will be repeated. The federal government had an unexpected surplus, our legislative advocates were in place, and they could call on the community for grassroots support. But also, this Congress was heavily distracted by other affairs, and with money on its hands, threw it at a lot of things and went home. It would be a serious mistake to count on good fortune in the future. Instead we need to broaden our focus, and work more with other health constituencies.

On non-funding issues, AIDS-related legislation was mostly negative or mixed. Congress not only prohibited Federal funding of needle exchange for an additional year, it also included language which threatens Federal funding for any organization which conducts needle exchange, even with private dollars. And it prohibited the local Washington D.C. government from funding needle exchange there.

On another issue, the Senate confirmed the new FDA commissioner, Jane Henney. According to BIOCENTURY EXTRA (October 22), she was confirmed moments before the Senate adjourned, and only after she had promised in writing not to seek a manufacturer of RU-486, (the "abortion pill" which may also be useful in treating breast cancer and other diseases).

Also in its last-minute rush, Congress passed a law to federally regulate content of the Internet, to prevent pornography from reaching children. We do not yet know if it could threaten AIDS prevention information.

Medical Marijuana

On medical marijuana, Congress passed a compromise resolution requiring the FDA to report in 90 days on efforts to have marijuana considered for approval as a prescription drug. This is progress, and the original resolution was much worse, as it would have put Congress on record as opposing medical marijuana entirely.

But we are concerned that the FDA is not set up to consider this issue well. The FDA institutionally favors chemical entities over plant parts, and drug approval typically requires studies taking years and costing millions of dollars--a largely pointless exercise when trying to measure subjective relief. Who will produce such data for marijuana? What is needed instead is flexibility now in letting patients find the relief that works for them--while researchers isolate and develop the (probably non-psychoactive) cannabis ingredients which are now suspected of providing much of the medical benefit of the plant. Eventually these will be developed as conventional new drugs, and in rich countries at least the need for medical marijuana will largely go away.

The outgoing Congress had other ideas. It nullified in advance the November 3 Washington D.C. vote on medical marijuana, by forbidding the city's local government from spending any money to count the votes or certify the result; the ballots had already been printed, however, and we have heard that the votes will be counted automatically, although the election result cannot become law. Congress also authorized money to biologically engineer a fungus to destroy marijuana plants.

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