PENGUIN BOOKS COOD I NTLNTI O S An award-winning wr|ter, Bruce Nussbaum served in the Ieace Corps írom 1967 to 1969. GOOD INTENTIONS How Big Business and the Medical Establishment Are Corrupting the Fight Against AIDS Br uce Nussbaum I L N C U I N B O O KS PENGUIN BOOKS Published by the Penguin Group Viking Penguin, a division of Penguin Books USA Inc .. Thatis whatis atstake inthe bitterbattlebetween Sam Broderand David Barry. Lverytimethey came down with a leveror one oltheirkids got sick, they thoaght it was AI DS. 7 C 0 0 D I N T E NT I 0 N S Broder`s ¨boys," his two brilliant lab assistants, stack by him. ¨Look, are yo a serioas aboat this drag or what:" Broder de- manded. He knew Ni ts aya had in- vented the on|y q aick test íor anti-AIDS drags. Ashewashghtingthegoodhghtwith Wellcomein haleigh, Broder's boystriedto keepthemselvesbasyinthelabbacki n Bethesda, Naryland. Broder,cha·ged ap withenormo as enth asiasm, championing a drag he believed i n, a drag tested in his lab, drivingheadlongagainsttheíorcesoíinertia. Inthe past, Broder'shghtshadbeenagainstgovernmentbarea acracy. Nowhewas 8 The Choice Is AZT ap againstperhapsa more poweríal opponent, a private company. Batwhenitcametoscientihc crasades, Sam Broderhad shown a knack íor winning. Nobodywas incontrol, noonepersonhe.d thereinson íanding, no onehada .ockoncareeradvancement. Oíall the scientists who were to become we..known in the eighties hghting AI DS,itwas Sam Broderwhoseíacewoa.dappearinmorenewspa- perstories,moremagazineprohles,andmore TYspotsthananyother.Currently senior wr|ter at Business Week, he is a|so the author oí The World After Oil: The Shifting Axis of Power and Wealth. Their hght reveals an ugly truth about America's medical system. They were handling live A| DS viras witho at the proper containment laci|ities, and no one knew how contagioas the viras was. The three woald start work at the crack oídawn, stop when the rest came in, and pick ap |ate at night j ast to prevent the other sta Bers írom being exposed to the live viras. ¨Becaase iíyoa're not gonna be serioas, iíyoa're not gonna go a|lo atwiththisdrag, I' mgonnatellyoasomething. I íBarry and Wel|come didn'tcomeacross,theywo aldbeírozenoatíorgood. He wo a.d cometo be theverysymbo.oíthegreat progress oíscienceagainst themonsterdisease. Andhewoa.ddoitbyrammingthroagh 9 C 0 0 D I N T E N T | 0 N S a -econd·rate, mediocre drag called AZT, the hr-t and only billion-dollar AI DSdrag. The N| H didn`t pat oat a dime íor that tria|, even thoagh I persona||y asked, said Barry. Yet credit can go to bolster reputations, advance careers, and win Nobel Irizes, oritcan be usedjust as well to rationalize prodigious prohts made o6terminally ill people. He walked intotheirweird headqaarters that looked likesome i nterga|actic space station and coníronted David Barry, the head science honcho. It was al spaces, big money, and instit ational no-man's- lands. With hisoverwhe enth asiasm and his killer instinct íor the appropriate phrase that woa.d destroy his adversaries in meetings, Broder c at his way to the scientihc heights. Penguin Books Ltd, 27 Wrights Lane, London W8 5TZ, England Penguin Books Australia Ltd, Ringwood. Bat Sam Broderneeded that scienti6c credit too, íor something j ast as important. As he |eít, wa|king into the dark winter night, Sam Broder wss sti|| visib|y íario as. ¨They a|ways seethemse|ves as being mach more important in the scheme oíthings than they rea||y are." | ast |ookat whowason theíront pageoíthe Wall Street Joural and the Whington Post when AZT was ío and to work against A| DS, said Barry. Batwho orga· ni :edthetria|: Whopaidforit: We||comescientists, notthegovernment`s. Sare Sam had been a great champion oí AZT inside the íedera| barea acracy, Barry acknow|edged. 5 C00D |NTE NTI0NS Sowheredid the New York Times getitsversionoleventssurrounding AZT: It had to be Broderand hiscronies. ¨Sam Broder`s stamp is on everything." I lthe currency olmedical science is credit, then he who writes the history ol discovery apportions that credit. Nitch Nits aya, Broder's1apanesepostdocwiththebesthandsi nany |abanywhere,|iked Compoand S. It wasn't the hrst drag to work in Nits aya's assay. Ittookc|oattogetadragthroaghthatdamnb areaa- cracy they call the IDA. So on Narch l, Broder Bew downto haleigh, North Carolina, totalk to the gays at Barro aghs Wellcome Company who had sent Compoand S to hislab. Whi .e hiscolleagaeswerestillhghtingthe olddiseases, stroke and cancer,hesaw ear.y on that AI DS was the new írontieríorscience, or at scientihc research. Barro aghs We||comeand David Barrymightneedthecredit íor AZTto s apport theirc|aimtobigprohts. Barry thoaght he knew who was behind the editoria| attacks and he said so. The Times was repeating, virt aa||y word íor word, Broder`s version oí the history oí AZT`s deve|opment. Yerycoo||y, Barryobservedhowstrange itwasthatthose gays ap atthe NCIwerea|waystryingtohogthecredit.¨Iirstitwashobert Ca||o who insisted he discovered the AI DS viras, even tho agh I and everyonee|se | knowbe|ievethe Irenchgottoithrst." Nowitwas Broder with AZT.¨Naybeit`sbeca asegovernmentscientistsmake|essmoneythan scientistswhoworkíorprivateind astrythattheyíee|theneedíorsomach credit," said Barry. Bat the brata| trath is that Broder had been the third scientist Barroaghs We||comehadsent AZTtoíortesting,notthehrst. He mere|yconfrmed that AZT was activeagainst AI DS in thetesttabe.¨Someonee|se,at Dake University,sawinvitroactivityhrst," said Barry. ¨You can easily get the impression that we were an innocent bystander in the development ol AZT," he said. It cost big money, mi||ions, to test a drag on h andredsoíh amans. Yoang,ambitioas scientiststend to íol the money trai .. Broderwasto become thecons ammate eighties AI DS scientist. He wrapped the moral argency oí an epidemicaroand hisownambitionand rode ittothetopoíthe hi .l.
Burroughs We..come, sloreigndrugcompsny,wssste s.inghisdiscov- ery,hes sid. Broder be|ieved that Barro aghs We||come needed to grab a|| the credit íor AZT to e ·p|ain the drag`s $I 0, 000-a-year price tag, practica||y the highesteveron a drag. 5 mi||ion peop|e iníected with the AI DS viras i n the United States a|one, Broderknewthat AZTco a|dbecomethemostprohtab|edraginthehistory oí pharmace atica|s. Brodera|soknewwhowasbehindthismoveto stea| hiscredit. David Barry, Barroaghs We| |come's vice presidentoíresearch, was the rea| ca| - prit. Lach andeverytime the newspapertook We||cometo task íorcharg- ingtoo maehíor AZT, itwroteaspecihcversionoíthehistoryoíthedrag. thi book is sold subject to the condition that it shall not, by way of trade or otherwise. His lour-door Honds, psrked in lrontol ssignthst re sd, DIRECOR, NCI, wss sdycoveredintwo inches ol white. He'drisked his .ile, snd olhiswile snd chi .dren, by h snd the de sd .y virus, whi .e they were sbout ¨ ols sle lsci .ities." Itwss nothing .essthsn sthelt olcredit,hes sid. They h sven'tto.d theiri nvestors there s.history olthediscovery ol the drug. ¨It is their po to denigr ste snd nu.the contributions ol others," he s sid. B C 0 0 D I N T E N T | 0 N S Broder knew why Barro aghs We||come was rewriting history. Whoevercontro||ed the o Bcia| history oíAZT appor- tioned the credit íor its deve|opment. 0atside his omce at the Barroaghs We||come headq aarters in the gent|y ro||ing green hi| |s oí ha|eigh, orth Caro|ina, the temperatare neared eighty. Thiswasthesecondb|ast bythe Times editoria|boardinten daysandthethirdtimeina sing|eyear thepaperoírecordhadaccased Barro aghs We||comeoíprohteering. o otherprivate company inthe historyoítheco antry had ever come ander that kind oíattack by the Tmes. A26N88 199 362.1 '9697'920973-dc20 9-1054 Printed in the United States of America Designed by Laura Hough Except in the nited States of America. Outside, srsre Nsry.sndsnowcoveredthecsmpusolthe Nstions. I nstitutesol He s.th,the nstion's top srch center. The drug wss AZT snd the disesse wss AI DS, but whst Broder wss suggestingcou.d chsnge the wsy drugs lorc sncer, A.zheimer` -, hesrt dis· e sse, tr snsp.snts~verthing in medicine~get or otherwise circulated without the publisher's prior consent in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser. 0íten the tone oívoice,thehesitations,thepausesinconversationaremoreimportantthan the act aal words. |nthegrandtraditionoíjoarnalism,qaoteshavebeenchangedtosave the angrammatical írom themselves. Myagent, Lsther Newberg, at ICM, was bri||iant in teaming the two olus up. Thankstootomyparents, Henryand Sy|via Nussbaum,whobrought the New York Times home every Sunday when I was a kid. XVI Bruce Nussbaum May 1990 PART ONE BEHI ND THE SCENES: DRUG REALPOLI TI K Thescientists st in his o Bce r sgingon into the co.d night. I lhe wss right, this wss goingto be one olthe gre stest s :snds.s ever to hitmedics.science.
The omces oíCongressmen Henry Waxman (D.-Ca|ií.) and Theodore Weiss (D.-N. Themeaslesepidemicnowsweepingthecountry isaconseq aenceoítheiractions. |tisman-made,ca asedbycatbacksmade in the early eighties. The rear-gaard action led by Waxman, Weiss, and Weicker to save what they co ald is a moving drama. Thehandredsoíhoars oíinterviews were transcribed personally into a computer. He a|so reminded me, a lewyears back, that I appearedto enjoy writing a bit more than editing. I wishtothank Ann Codo B, myeditorat At|antic Month|y Iress,lor heradviceinshapingthe narrativestory,i nhigh|ightingthegoodstu Bandcu||ingthebad. Broder cocked his he sd to the right, bre sthed deep.y, gsthered up ste sm, snd p .unged on with the smszing sccus stion.
The Road to Hell Is Paved with Good Intentions Contents Introduction xiii Part One 1 Behind the Scenes: Drug Realpolitik .. There were other so arces who req aested anonymity becaase they wereinpoliticallyv alnerablepositionsatthe N| H,the IDA,andelsewhere. Thesemen played keyrolesin deíendingthenation's healthsystemagainsttheravagesoíheaganadministration catbacks. The general pablic has noideahow closethatsystemcameto beingdestroyed bynearsightedideologaes. Beebe, a proíessional linguist, taught me that people don't talk the waythey write. I wou|d |ike to thank Stephen Shepard, editor·in·chiel ol Business Week, who was more than generous in providing a |eave to do this book. Hewore smustsche, wor.d thst Ssm Broderwss ssophisticstedmsn,morethsnjust s bench nerd.