Chapter Forty-One
“Dr. Bjond, you're a cell biologist?”
“Yes, I am.”
“And a former professor at the University of Wisconsin’s School of Medicine?”
“Yes.”
“And also a former member of the medical research team at Stanford University’s School of Medicine?”
“Correct.”
“And in addition to being a published author, you at one time developed an experimental tissue transplantation technique?”
“Along with my colleague, Dr. Schultz, yes.”
“And in the mid 1990’s, you did a study of a disease called Kaposi's Sarcoma, or KS?”
“Yes, I did.”
“Before we get to your findings, please tell us: What exactly is KS?”
“That's actually a more confusing question than you might imagine, Mr. Baker. Originally, Kaposi's Sarcoma was defined as red-purple or blue-brown cancerous lesions, or spots on the skin and other organs, mainly on the lower extremities, the legs – most commonly found in older men of Russian-Jewish, Italian and African descent, living around the Mediterranean Sea.”
Baker looks confused, but of course, he’s not. He just realizes that everyone else is, or should be. He unveils some enlarged pictures of KS lesions on an easel positioned where both the Judge and the jury could see. “Are these pictures of KS?”
“Yes, it definitely looks like it from here.”
“So, what does this disease have to do with young, sick, homosexual American men?”
“Nothing, really. That’s the confusion. Today we recognize basically three completely separate kinds of Kaposi's Sarcoma. The first is what I just described, the classical kind – the cancer that Mediterranean men get. Then there's a type that is called iatrogenic KS, meaning caused by the drugs administered in certain kinds of transplant surgery. And then there's the kind of KS that became the hallmark of the disease called AIDS.”
“But all of these are cancers?”
“Well, that's another good question. My research discovered that, no, at least the kind of KS seen in AIDS patients is not a cancer. It looks a lot like the cancerous tumors found in the other kinds of KS, but it's not.”
“Why not?”
“Well, for one thing, it disappears before the AIDS victim dies. No cancer does that.”
“So what is the AIDS-kind of KS?”
“It appears to be a drug reaction.”
“To what drug?”
“Nitrites, commonly called poppers.”
“It's not the result of an HIV infection?”
“Definitely not.” Dr. Bjond looks over at Dr. Gallo, seated at the defense table. “Even Dr. Gallo himself, in 1994, acknowledged that KS could not be caused by HIV. Besides, from the very beginning there were many gay men with KS who were HIV-negative and did not have any immune deficiency.”
“So this kind of KS has nothing to do with AIDS?”
“I didn't say that. No, that's not true. What is true is that is has nothing to do with the virus called HIV.”
“All right, Dr. Bjond, why don't I just let you explain….”
“First you have to understand that there is a very strong link between the use of poppers and KS. For example, the rise of KS among gay men directly parallels the rise in the use of poppers. And conversely, when the use of poppers has declined from time to time – from FDA restrictions or bad publicity – so has the incidence of KS. There is very little KS reported outside the gay male population, and very little use of poppers outside the gay male population. Even in early studies, the use of amyl nitrite was found to be common in every single case of KS. Twice as many white gay men use poppers compared to black gay men, and twice as many white gay men get KS compared to black gay men. The highest concentrations of KS lesions are found on the face, nose, and chest – also the most exposed portions of the body to a chemical being inhaled. Do you want me to go on?”
Baker looks at the jury and sees that they have gotten the point. “No, thank you. I think you've made the point that there is a high probability that the KS we have always associated with AIDS is caused by the use of nitrite inhalants, correct?”
“Correct.”
“So why didn't heart patients using amyl nitrite for years before nitroglycerine get KS?”
“A couple of reasons. First, their use was very infrequent and very low dose. And secondly, the new lines of nitrites developed for the gay community – butyl nitrite, isobutyl nitrite, and such – were refined and far more potent.”
“So KS was the result of poppers destroying the immune system.”
“No, I didn't say that, either, and it's a very interesting phenomenon. KS is actually the result of a taxed immune system trying to further enhance its immune effectiveness, not an immune deficiency.”
Baker knows that everybody in the courtroom would be totally lost at this point, and had he not had this explained to him several times over the past year, he would be lost himself.
“All right, Dr. Bjond, you’ll have to explain that slowly for all of us.”
“Well, as Dr. Gallo himself said in 1994, KS appears before the onset of AIDS. Think of it this way: Your body tries to give you warnings when you're doing something that might damage it. You get sore muscles to tell you to stop exercising. You get indigestion to tell you to stop eating. You get a rash to tell you to stay away from things you’re allergic to. The most likely explanation of KS is that it is like an allergic reaction to the nitrite inhalants, where the body is telling you stop sniffing that stuff or more severe danger is on the way.”
“An allergic reaction?”
“Not exactly, but somewhat like that. A taxed immune system can increase its activity by using an additional resource…cells that normally line the blood vessels begin to divide and their progeny acquire a different fate by becoming disease-fighting macrophage cells. This cellular transformation is visibly evident as discolored lesions beneath the skin. This transformation process represents the effort of an already stressed body in fighting the adverse effects of this toxic chemical.”
“But what if you don't listen to your body? What if you don't pay attention to these warning signs and keep…popping?”
“Then eventually the nitrites will destroy your immune system and you will develop immune deficiency.”
“Acquired immune deficiency?”
“Yes.”
“Where your immune system cannot fight off diseases?”
“Yes.”
“And if you then get sick, say, with one of the opportunistic diseases?”
“You then have Acquired Immune Deficiency Syndrome.”
“AIDS?”
“Yes.”
“An opportunistic disease, like Pneumocystis carinii pneumonia - PCP?”
“Well...”
Baker wheels around to look at Bjond. He had expected a simple Yes to that question. Instead, he is now very worried he has just opened up a can of worms. Had they never asked Bjond about PCP? Where is he going with this? Shit, did I blow it? Can I just move on? But he knows he can’t walk away from that answer, leaving the jury to wonder and perhaps risk Crawley finally deciding to cross-examine and destroy everything else Bjond had said. Very hesitantly, Baker asks, “Well, what?”
“I hate to be so technical, but PCP is another interesting case. It's been called an opportunistic disease by the CDC, and we assumed it took hold because of decreased immune function. But there's a lot of argument against that, too.”
I still don’t know where this is going, but, “Go on…”
“Virtually all lung infections are bacterial, and it makes sense that a bacterial infection could develop if the immune system were dysfunctional. But PCP is a fungal infection whose infective 'opportunity' is not immune-related at all, but arises from tissue oxygenation problems caused by nitrite inhalant abuse. We're back to poppers most likely causing PCP as well as KS.”
Baker breathes a big sigh of relief. It had all worked out all
right. In fact, much more than ‘all right.’
“Just a few more questions, Dr. Bjond. You said that KS was not a cancer?”
“That's correct.”
“So you wouldn't want to treat it with a cancer treatment, like chemotherapy?”
“No, you wouldn't.”
“Would you give a patient with the AIDS-kind of KS a drug designed to kill cancer cells?”
“There would be no point in that.”
“Would you give a patient with KS a drug to suppress the immune system?”
“That's the last thing you would want to do – the kiss of death, if you will.”
“If you gave a patient with KS this kind of drug – one, like AZT, that kills not only cancer cells but vital T cells of the immune system as well, what would happen, do you think?”
“You'd probably kill the patient.”
“Thank you, Dr. Bjond.”
Wrongful Death: The AIDS Trial Page 52
