Injections of Hope

Carla Spartos's stimulating article "Injecting Big Brother" [July 18] helped enhance the perception that addiction is both a disease and a significant public-health issue. However, her report, based partly on my article "Immunization for Prevention and Treatment of Cocaine Abuse: Legal and Ethical Implications," in the journal Drug and Alcohol Dependence, may give premature hope to the community of cocaine-addicted individuals. Furthermore, I believe that it significantly simplified, overstated, and even misrepresented some of my views.

Spartos implied that an end to cocaine addiction "would come at the hands of pharmaceutical companies and biotech labs, which are about to unleash the ultimate weapon—the antidrug vaccine." However, it will be years before a vaccine will be available. The required FDA studies will not be completed until well into this decade. Spartos also stated that "Cohen argues everyone should get the shots." In contrast, my goal was to present a panoply of viewpoints and engage in ethical analysis. I emphasized that "while it might be more satisfying to the reader were I to provide firm 'truths,' such an absolutist approach would be inappropriate." Specifically addressing the question of universal immunization, I wrote:

"In view of the [potential benefits of universal immunization], why not institute universal mandatory immunization once a cocaine vaccine is available? There is ample legal support for the state's application of police power when necessary to act in the interests of public health. However, just because society has this power does not mean that such an approach is ethically justified. . . . In any case, there are certainly a number of persuasive reasons not to initiate mandatory immunization with a cocaine vaccine."

I hope that this communication will help those addressing the scientific and ethical problems inherent in dealing with substance abuse.

Peter J. Cohen, M.D., J.D.
Adjunct Professor of Law
Georgetown University Law Center
Washington, D.C.

TB or Not TB?

Pertinent aspects of AIDS in Africa were overlooked in the interesting article by Mark Schoofs in your July 11 issue ["Proof Positive: How Science Has Demonstrated That HIV Causes AIDS"].

According to The Sunday Times of London (May 24, 1994), scientists from Harvard University and the University of Kinshasa in Zaire found "evidence that HIV tests may be triggered by other factors, such as leprosy and tuberculosis," producing high rates of false positive results in Africa. The major confirmatory test, called the Western Blot, was determined to be "equally unreliable."

Thus, in African studies that, according to Mr. Schoofs, found "the antibody tests are accurate more than 98 percent of the time," the confirmatory tests may simply have given similarly excessive positive results.

This issue is quite significant, because if false positive results for HIV occur in those who have contracted other pathogens, such as for leprosy and TB, then such persons obviously would be prone to a higher death rate. Thus, mortality results for HIV-positive Africans in the studies described by Mr. Schoofs cannot specify or prove HIV as the cause.

Mr. Schoofs also reports that African patients who can afford HIV drugs get better. It is known, however, that HIV drug combinations have an effect against some opportunistic infections, as do less expensive antibiotics. Moreover, the socioeconomic bias imposed by drug costs means that Africans who get HIV drugs also may have better food, water, and sanitation.

Robert Houston

Mark Schoofs replies: Like tests for many diseases, the HIV test occasionally cross-reacts with other microbes. This is one reason Ugandan researchers have been continuously verifying that it is accurate in their setting. They compare the antibody test against many HIV tests, not just the Western Blot. Further corroboration comes from people in Ugandan studies who have TB but not HIV; Houston's hypothesis predicts that they would test HIV-positive, but they consistently test HIV-negative. About the HIV drugs: Except in very rare cases, they do not act directly on other pathogens. They work by blocking HIV and giving the immune system a chance to recover. Finally, there are many middle-class Africans with HIV who have decent food and water but who die of AIDS because they cannot afford the drugs or because they spend down their assets and are forced to stop taking them.

Leaning on Lenny

Richard Goldstein's July 18 article, "Celebrity Bigots," was excellent. It pains me to hear the current crop of air personalities cite Lenny Bruce as an influence. Bruce took on the powerful, but he delivered penetrating zingers with a quality of gentleness to devastating effect. The tone of Imus and Schlessinger is viciousness and abuse.

John Navin, DJ
Jones Radio Network
Denver, Colorado

Not Easy Being Greenberg

Loved Andrew Hearst's article on Jamie Greenberg's public-access TV show, Media Shower ["One Man's Machines," July 25]. Hearst captured the essence of Greenberg's unique brand of humor. Such shows are essential to overstimulated, emotionally saturated New Yorkers. Greenberg has an underground appeal that allows our burnt-out psyches to sit back and be utterly bemused.

Lisa Piergrossi

Baby Shower

Mainlining Musto is a guilty pleasure that hurts so good! He's a Stoli martini with an absinthe chaser and a Häagen-Dazs heart. Every column is an arcane little adventure unto itself, and to read several online at once is like reading Proust on Prozac at least! If Charles Dickens and Armistead Maupin had a baby, that baby would be Musto.

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