The Daily Agenda for Friday, December 6

Jim Burroway

December 6th, 2013

Telstra Tower on Black Mountain, Canberra, ACT

Same-Sex Marriage Arrives Down Under: Canberra, Australian Capital Territory. Beginning today — Saturday, December 7 if you’re in Australia, where Canberra is sixteen hours ahead of New York and nineteen hours ahead of California — same-sex couples will be able to enter into a same-sex marriage. Which, to be clear, is nothing at all like marriage. No, siree. It’s completely different. Because in Australia, plain old marriage is a Federal issue, not a state or territorial one as it is in the U.S. But since the Federal government has refused to take up marriage equality, the government of Australian Capital Territory, which is the seat of the nation’s capital city of Canberra, devised a territory-only solution called “same-sex marriage,” which because it was not defined according to the Federal government’s definition as marriage, it is therefore, by definition, not marriage but “same-sex marriage.” At least that’s the argument that “same-sex marriage” supporters are putting forth before Australia’s High Court earlier this week.

But because the High Court won’t rule on those arguments until December 12, there is, at minimum, a five day window in which same-sex couples can get same-sex married. The pro-equality group Australian Marriage Equality — they may need to re-think their name for the time being — says that at least twenty couples are prepared to same-sex marry this weekend, with at least two couples doing so right after midnight. AME also says that “Telstra Tower on Black Mountain will black out at 11.59pm this evening and then turn back on at 12am lit in sequential rainbow colours to mark the first same-sex weddings which take place at 12.01am.”

Events This Weekend: Mad Bear, Madrid, Spain; Holly Folly, Provincetown, MA.

An overcrowded ward at Wisconsin’s Mendota State Hospital, 1947.

Wisconsin Sheriffs Call For Indeterminate Sentences for Gay People: 1944. The annual convention of the Wisconsin Sheriffs Association, meeting at Milwaukee’s Schroeder Hotel, passed several resolutions, including one endorsing a bill proposed by the Wisconsin Police Chiefs Association which would mandate medical treatment and indeterminate sentences for gay people, among other sexual offenders, who were charged with disorderly conduct. The problem, apparently, was that the current law only carried light fines and minimal jail sentences.

What the Wisconsin Sheriffs Association was asking for was what would become known as a “sexual psychopath law.” Through much of the 1930s and 1940s, American newspapers found sensational stories in gruesome murders, often of young children, which reporters and authorities attributed to “deviates,” whether there was any evidence linking gay people to the crimes or not. Those newspaper headlines feed the belief that sexual lawlessness was growing across the country. Michigan was the first state to pass a sexual psychopath law in 1935 which required a judge to determine anyone convicted of a sex crime to determine whether that person was “psychopathic, or a sex degenerate, or a sex pervert.” If so found, the judge was to order the defendant to a state mental hospital until the defendant “ceased to be a menace to the public safety because of said mental condition.” How mental health officials were supposed to make that kind of a judgment, the law didn’t say.

By 1967, twenty six state and the District of Columbia had passed similar laws. Wisconsin’s sexual psychopath law, enacted in 1947, gave broad powers to the local sheriff to place a suspect in detention without a hearing and without a conviction. That law was replaced in 1951 with the Sexual Deviate Act, which required the individual to be convicted of a crime first. In 1954, it was noted that of 22 individuals who were being indefinitely committed under the law, thirteen had been convicted of sodomy. Wisconsin’s Sexual Deviate Act was finally repealed in 1980.

American Medical Association Opposes Gay Cures: 1994. The AMA’s governing House of Delegates adopted a revised policy paper calling for an end to efforts to change sexual orientation. The old position paper titled, “Health Care Needs of the Homosexual Population,” which had been adopted in 1981, had read, that “some homosexual groups maintain, contrary to the bulk of scientific evidence, that preferential or exclusive homosexuality can never be changed, these people may be discouraged form seeking adequate psychiatric consultation. What is more important is that this myth may also be accepted by homosexuals.”

But by 1994, the AMA became convinced that the growing evidence showed that whatever disturbance gay people may have felt about their sexual orientation “is due more to a sense of alienation in an unaccepting environment” and called for “nonjudgmental recognition of sexual orientation by physicians.” The AMA also said that “aversion therapy” — which involved showing a gay man, for example, nude pictures of men and shocking them with a jolt of electricity — “is no longer recommended for gay men and lesbians.” It went on: “Through psychotherapy, gay men and lesbians can become comfortable with their sexual orientation and understand the social responses to it.” The new policy paper was adopted without dissent.

FDA Approves First Protease Inhibitor for Treating AIDS: 1995. The Food and Drug Administration gave its approval for Saquinavir(marketed as Invirase), the first protease inhibitor for treating AIDS. This approval was notable for two reasons. First, the FDA gave its approval only 97 days after receiving the application for approval, which was in marked contrast to the years that it would have taken under the normal drug approval process. But after several high profile protests (see, for example, Oct 11), the FDA changed its process for approving drugs for treating HIV/AIDS to allow for a significantly accelerated schedule. But the most important aspect of this approval was that Invirase would prove to be the third part of what would soon become a three-drug cocktail which, for the first time since 1981, gave people with AIDS hope for a reprieve from what had been assumed to be a death sentence.

The first component of that three-drug cocktail, azidothymidine (AZT, marketed as Retrovir), was first approved in 1987. AZT was a nucleoside analog reverse transcriptase inhibitor (or “nuke”), which blocked a particular enzyme associated with HIV. It was virtually the only means for fighting the disease for almost a decade, but it’s effectiveness was sorely limited. In November of 1995, the FDA approved another “nuke”, Lamivudine (3TC, or Epivir) which gave doctors a second option for when patients became unresponsive to AZT. But when taken together, AZT and 3TC seemed to offer an additional “punch” for many people than they experienced when taking the drugs individually. When protease inhibitors became available and were used in combination with AZT and 3TC, doctors soon discovered that these this combination therapy reduced the amount of HIV swimming around in patients’ blood by about 99 percent. In early 1996, two more protease  inhibitors, Ritonavir (marketed as Norvir) and Indinavir (marketed as Crixivan), joined Invirase on the market, giving doctors more ingredients to choose from for what would be known as the “AIDS cocktail,” or Highly Active Anti-Retroviral Therapy (HAART).

Researchers had previously seen too many supposedly promising treatments quickly proved to be ineffective before to get their hopes up too high now. Early reports of a possible breakthrough in 1996 were tentative, but the results soon proved unmistakable. When 3TC joined AZT in 1995 as a viable treatment, there was a noticeable plateau in the number of deaths due to AIDS. But in 1996 when the three-drug cocktail became available, the number of deaths due to AIDS would see its first drop since the epidemic began. And it wasn’t a slight drop either. It was a 20% improvement from the year before. People at death’s door began coming back from the abyss. For some who had prepared to die, finding that they were living again presented an entirely new set of challenges. The emotional whipsaw, dubbed “the Lazarus Syndrome” made restarting a life (including an education, careers, or simply a place to live) that had been systematically dismantled through disease, disability and stigma just one more challenge to surmount while still dealing with the anxiety of wondering whether this combination would soon fail as all of the other treatments had done before.

The three-drug cocktail, which became known as Highly Active Antiretroviral Therapy (HAART), wasn’t a cure, but the breakthrough was undeniable. Further improvements in HAART resulted in more effective combinations and dosages which made adherence much simpler. HAART would eventually transform AIDS from a terminal disease to a chronic disease, albeit still a very serious one. More recent research shows that, thanks to HAART, people with AIDS can now expect a nearnormal lifespan. And yet, HAART’s side effects can take a brutal toll on the body, and its cost — ranging from $10,000 to $15,00 a year for a single patient — makes life-prolonging medications a severe financial strain for anyone without insurance or governmental assistance. All of which makes finding a cure still as important as ever.

If you know of something that belongs on the Agenda, please send it here. Don’t forget to include the basics: who, what, when, where, and URL (if available).

As always, please consider this your open thread for the day.


December 6th, 2013

I was working at a health care consulting firm in the early 90s and some of our clients were working on protease inhibitors. We, quite simply, couldn’t believe the data we were getting from pharma manufacturers on the effectiveness of these new drugs and the cocktail. It really did seem too good to be true.

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