I'm confused about why your proof requirements are so specific.  Why is, for example, this study, which found that more active types of ARVs increased the life expectancy of those with HIV, not good enough?

Logically, if the increased ARVs increased life expectancy, those drugs help, regardless of whether the old ones did or not.  So even though that study is a comparison of two treatment regimens, the fact that one works better than the other means it works better than nothing as well.

Q: What do you think of western civilization? Gandhi: I think it would be a good idea.

I explained, in detail, my objections to the study you linked to - please re-read my post on that topic.  If you can't understand how decreasing drug toxicity could be an alternate explanation for the results I don't know how to explain it to you.

" So even though that study is a comparison of two treatment regimens, the fact that one works better than the other means it works better than nothing as well."

Only if one of those regimens has first been compared to a placebo or the previous standard of care.  In the case of ARVs - this has never occurred.

Life expectancy on drugs > life expectancy without.  I'm not sure what else you need.

Q: What do you think of western civilization? Gandhi: I think it would be a good idea.

If you think that's what that study says, you are mistaken.

No, I'm not.

"CONCLUSIONS: The recent declines in morbidity and mortality due to AIDS are attributable to the use of more intensive antiretroviral therapies."

Q: What do you think of western civilization? Gandhi: I think it would be a good idea.

"CONCLUSIONS: The recent declines in morbidity and mortality due to AIDS are attributable to the use of more intensive antiretroviral therapies."

Sure as far as it goes this statement may be correct.  Newer drugs do appear to kill fewer people than high dose AZT.

Are "more intensive" ARVs less toxic than high dose AZT.  Yes.  Was drug toxicity controlled for in this surveillance report?  No.  Does the study support the conclusion that drug efficacy and drug efficacy alone resulted in lower mortality?  No.

So you've just magically decided these drugs kill people based on what?  I mean, any drug is going to have side-effects, but I'd love to see evidence that these drugs are going to kill people faster than HIV will.  Moreover, and this is something you've suspiciously failed to address, people with HIV on those drugs have a greater life expectancy than people with HIV who are on no drugs whatsoever.

Q: What do you think of western civilization? Gandhi: I think it would be a good idea.

"So you've just magically decided these drugs kill people based on what?  "

AZT kills people.  It was a failed chemotherapy drug.  I leave you to google the life threatening side effects of more modern ARVs.  They are toxic drugs.  Toxic side effects kill people.

"I mean, any drug is going to have side-effects, but I'd love to see evidence that these drugs are going to kill people faster than HIV will"

You've got it backwards.  You don't assume that the drugs will save lives and then demand evidence that they don't.

" Moreover, and this is something you've suspiciously failed to address, people with HIV on those drugs have a greater life expectancy than people with HIV who are on no drugs whatsoever."

The study that you link to is not evidence of that.  I am more than willing to evaluate such evidence from properly controlled, double blinded clinical trials.

AZT kills people.

So does water, plus its 100% addicting. Have you heard about the undeground networks the UN/government/illuminati have been building underneath our very nation? There is probably water in your home right now!

It was a failed chemotherapy drug.  I leave you to google the life threatening side effects of more modern ARVs.  They are toxic drugs.  Toxic side effects kill people.

HIV has an effect: Death. Drugs have side effects. It's a risk v. benefit calculation. Who gives AZT to somebody not infected or exposed to HIV? Same thing can be said about a bunch of other medications given to kids --- I'll wager that without the drugs I took as a kid to get reduce my then chronic asthma I would not be alive today. Of course, they had bad side effects and at least one could have killed me but thats why it is a risk/benefits thing coupled with intensive monitoring.

Bottles and cans just clap your hands just clap your hands

"So does water, plus its 100% addicting. Have you heard about the undeground networks the UN/government/illuminati have been building underneath our very nation? There is probably water in your home right now!"

What the hell?  If anything I have said has lead you to believe I am some sort of conspiracy theorist, please point it out and I will correct your mistaken understanding.

"HIV has an effect: Death. Drugs have side effects. It's a risk v. benefit calculation."

Yes, and how does one determine if the risk outweighs the benefit?  Controlled clinical trials.  Do you have some sort of anti-science opposition to properly controlled, double-blinded clinical trials of new medications?  Do you know of some sort of alternative way to scientifically demonstrate their efficacy?

You still have failed to address the evidence, from the study I linked, that people live longer on those meds than on nothing.  

If that's not enough, here's another.  Quoting: "Where available, highly active antiretroviral therapy has resulted in significant decreases in HIV-associated morbidity and mortality."  The same study says that development of highly-active retrovirals reduced HIV mortality by 80%, and raises life expectancy from 9-11 years upon diagnosis of HIV to more than 20.

So, I have provided more than ample evidence that retrovirals increase life expectancy on the whole.  I now defy you to show me evidence that they do not.  On what are you basing this belief of yours?

Q: What do you think of western civilization? Gandhi: I think it would be a good idea.

"You still have failed to address the evidence, from the study I linked, that people live longer on those meds than on nothing."

No, I've addressed it again and again, and I quoted, in detail, from that study.  Let me do so again:

" The proportion of patients for whom any antiretroviral therapy was prescribed increased, from 72 percent of patients in 1994 to 95 percent by June 1997, with marked increases in the prescription of combination regimens (from 25 percent in 1994 to 94 percent by June 1997)."

So the number of people on drugs went from 72% to 95% - and at the same time there was a marked shift from the older therapy (AZT) to combination therapies - 25% to 94%.  Again here this is not a controlled clinical trial, so whatever you want to take from this mess - it cannot prove anything scientifically, about all it can do is suggest avenues for further study.  But I don't understand why you are fixated on the increase from 72% to 95%, instead of the increase from 25% to 94%.  This surveillance report cannot falsify the hypothesis that combination therapies, using lower doses of AZT, and newer, less toxic drugs, were simply less toxic than previous therapies.  The decrease in mortality could be solely due to the increased usage of less toxic treatment regimes, from 25% to 94%.

Your other link is more of the same.  It's not a controlled clinical trial.  You seem not to understand the need for controlled clinical trials when seeking evidence for drug efficacy.  I don't really know how to explain this to you.

"So, I have provided more than ample evidence that retrovirals increase life expectancy on the whole.  I now defy you to show me evidence that they do not."

No you haven't.  Please provide a link to a long term, placebo controlled, double blinded study that demonstrates decrease morbidity/mortality in AIDS patients as the result administration of a specific ARV.  This is the sort of proof required by science.

"On what are you basing this belief of yours?"

You are the believer, I am the agnostic.

You are not the first person to claim that properly controlled clinical trials are unethical.  But, until such studies are conducted you do not know whether or not such drugs cause more harm than good.  Not conducting such studies is unethical.  Continuing to administer these drugs in the absence of such evidence is unethical.

Oh my gentle Jesus. You're advocating withholding treatment from HIV+ people for the purposes of "science?" Really? No ethics board will approve that. That'll make Tuskegee and Willow Brook look like a picnic.

The first ARVs should have been compared to placebo plus standard of care at the time for whatever OIs arose.  Those studies were not conducted.  The one that comes closest was the Concorde study, which was ended early, compared early AZT to late AZT ( a kinda placebo), and in which the blind was compromised by the massive adverse side effects of the drug.  Everybody, doctors and patients knew who was on what drug.  

I'm not familiar with the study, but it is common in medicine to halt a study early if a drug shows great promise and switch the placebo folks over to it. It's the ethical way to do it otherwise you're watching people die while you potentially hold their salvation in your hands. I doubt you'd find a physician who is enough of a monster to do what you are proposing.

Since this time every new drug has been compared to previous drugs, and tested against surrogate markers, usually over a short period of time.  There are no long term placebo controlled double blinded studies of any of these drugs.  Until there are, you simply cannot make the claim that these drugs saves lives over the long term.  There is no scientific evidence to back you.  Attempting to gather that evidence is not insane, it is not unethical - it is required by science.

OK. Pehaps you'd like to volunteer for the experiments proposed by nightlily and be a part of the Koch's postulates study? After you come down with HIV you can refuse treatment and we can compare you to a regular person who takes ARVs. All in the name of science, right?

♫You's a superstar boy, why you still up in the hood?♫

"Oh my gentle Jesus. You're advocating withholding treatment from HIV+ people for the purposes of "science?" Really? No ethics board will approve that. That'll make Tuskegee and Willow Brook look like a picnic."

No, I am advocating that these drugs be subject to proper clinical trials, like every other drug.  Such a clinical trial should include a placebo arm which uses a placebo and otherwise treats patients with the pre-ARV standard of care for opportunistic infections.  Until such a study is conducted, there is no basis to claim that ARVs save lives over the long term, there is no basis to claim that you are not doing more harm than good.  You seem to operate with a world view that accepts that ARVs are known good, and withholding them is evil.  There is no science to support that belief.

I will offer this one caveat - these drugs are remarkably cytotoxic - they kill cells.  They kill fungus, bacteria, and host cells.  As such they are powerful broad spectrum antibiotics/antifungals.  The existing body of studies supports this as there are short term positive effects of taking these drugs.  But most studies are just that, short term.  And these drugs aren't used over the short term, you are supposed to take them for the rest of your life, during which time the toxic side effects of killing your own cells may catch up with you.  

But I will admit that existing studies do possibly support the short term use of these drugs to knock out particularly bad opportunisitc infections if more conventional treatments are not effective.  But that's not the way we use these drugs.  

"I'm not familiar with the study, but it is common in medicine to halt a study early if a drug shows great promise and switch the placebo folks over to it."

The study was a mess.  It was unblinded by side effects and patients started sharing medication as well.  Also, comparing late therapy to early therapy is no kind of placebo.  The very design of the study indicates the political pressures that were being brought to bear at the time.  Even though AZT was the first drug of it's kind and had never been proven effective, people were still convinced it would be unethical to withhold the new "miracle drug" for too long.

"OK. Pehaps you'd like to volunteer for the experiments proposed by nightlily and be a part of the Koch's postulates study? After you come down with HIV you can refuse treatment and we can compare you to a regular person who takes ARVs. All in the name of science, right?"

Do you imagine this to be some sort of rebuttal to my argument that double blinded, placebo controlled clinical trials are required to demonstrate drug efficacy?  If in the future I develop a fatal disease, I will be more than happy to enter a properly controlled clinical trial of a new drug.  Perhaps I will get the drug, perhaps not - either way I'll probably get excellent care, and whatever my personal outcome my involvement in the trial will help determine whether or not the drug is effective.

What I cannot get through my head is why there is this bizarre a priori assumption that all new drugs are good. Until the clinical trials are conducted, we don't know if the drug is good or bad, and it could be very bad.  So, being in the placebo arm of a study of such a drug could be a blessing.

And honestly, stop harping on Tuskegee.  Was Tuskegee a double blinded, placebo controlled clinical trial?

What I cannot get through my head is why there is this bizarre a priori assumption that all new drugs are good. Until the clinical trials are conducted, we don't know if the drug is good or bad, and it could be very bad.  So, being in the placebo arm of a study of such a drug could be a blessing.

But hasn't AIDS mortality dropped rapidly since the introduction of the medication? Isn't the "Death rates among 1,255 test subjects dropped from 29% per year to 9% per year when patients got anti-retrovirals" a comparison between no medication and medication, showing a very significant change? Even without double-blind medical tests, I'd say that says a lot about whether the drugs have a positive effect.

To what alternative factors do you attribute the fall in AIDS mortality? It seems to be a bit strong for a placebo effect, and infection rates did not show a similar drop. How is this success not a proof for the medications effectiveness?

Higher T-cell counts when using antiretrovirals are totally from the placebo effect. And there's no other way to assess the effectiveness of a drug except for double-blind studies. They can't be assessed in vitro.

You want to tell me that an increase in median survival time after AIDS outbreak from 9 month to 4 - 12 years (numbers taken from here: http://en.wikipedia.org/wiki/Aids#Antiviral_therapy) is a placebo effect?

That would be quite some positive thinking, there.

I think it's because what doesn't kill you only makes you stronger. The weak died in 9 months, leaving only the strong to skew the statistics.

"Higher T-cell counts when using antiretrovirals are totally from the placebo effect." (Emphasis added.)

You know this how? I hadn't realised you were into Christian Science.

Do Republicans send out mass mailers explaining to their base why science sucks, except when it says what they already believe?

You just got trolled bro.

In fact they should rename Ken to "Hadou-Ken" because he's downright fierce.

Do you mean that nothing Ken says can be taken at face value? Does that include his claims to be from New Jersey, his claims to be married, his claims to have visited Korea, and his self-contradictory statements about his political beliefs? If not, how can you tell when he means what he says and when he doesn't? Maybe it doesn't matter?

Do you figure that about Alf as well? His affinity for UFOs, cryptozoology, and conspiracy theories, his general alienation, his racialist animus, was that all crap too?

Fierce? If nothing he says counts for anything, "waste of time" seems more descriptive.  

...his claims to have visited Korea...

Lived (post 13). WAY different from "visited", eh, Mr. Clinton? I guess you needed to second Goro. Fine. I'll take it from there.

I've visited Canada.

You never had sex with that woman either.

The Canadian one? No.

"But hasn't AIDS mortality dropped rapidly since the introduction of the medication? Isn't the "Death rates among 1,255 test subjects dropped from 29% per year to 9% per year when patients got anti-retrovirals" a comparison between no medication and medication, showing a very significant change? Even without double-blind medical tests, I'd say that says a lot about whether the drugs have a positive effect."

The 29% per year was in the high dose AZT era.  AZT was a failed chemotherapeutic agent.  It was too toxic.  Too toxic to be taken briefly to attempt to knock out cancer.  And then in the AIDS era we have AIDS patients taking it continually.  The rapid drop in mortality corresponds to the advent of protease inhibitors and combination therapies that drastically reduced or eliminated the dose of AZT (as the study notes in the portion I quoted).

So what you are saying is that we have no numbers about AIDS mortality when it is untreated, e.g from the 80s when the illness was just newly discovered?