1 00:00:00,440 --> 00:00:03,000 Speaker 1: Hey, this is Leon Napok. I'm the host of Fiasco, 2 00:00:03,240 --> 00:00:05,640 Speaker 1: but you may also know me from the podcasts Slowburn, 3 00:00:05,840 --> 00:00:09,240 Speaker 1: Think Twice, Michael Jackson, and Backfired the Vaping Wars. I'm 4 00:00:09,280 --> 00:00:11,880 Speaker 1: excited to be sharing with you the next season of Backfired, 5 00:00:12,000 --> 00:00:15,960 Speaker 1: titled Attention Deficit, which is now available exclusively on Audible. 6 00:00:16,800 --> 00:00:20,280 Speaker 1: Backfired is a podcast about the business of unintended consequences. 7 00:00:20,840 --> 00:00:23,119 Speaker 1: In the first season, my co host ri L Pardess 8 00:00:23,200 --> 00:00:25,480 Speaker 1: and I dove deep into the world of vaping and 9 00:00:25,520 --> 00:00:28,440 Speaker 1: how the well intentioned quest for a safer cigarette went awry. 10 00:00:28,960 --> 00:00:32,879 Speaker 1: Now we're tackling ADHD and how the push to destigmatize 11 00:00:32,880 --> 00:00:35,879 Speaker 1: this hard to define childhood diagnosis has led to an 12 00:00:35,920 --> 00:00:38,720 Speaker 1: explosion of stimulant use in kids as well as adults. 13 00:00:39,000 --> 00:00:41,560 Speaker 1: It's a story about the promise of psychiatry to fix 14 00:00:41,640 --> 00:00:44,640 Speaker 1: our brains and the power of the pharmaceutical industry to 15 00:00:44,680 --> 00:00:47,600 Speaker 1: shape how we and our doctors think about what's wrong 16 00:00:47,640 --> 00:00:50,239 Speaker 1: with us. To hear both seasons of Backfired, go to 17 00:00:50,240 --> 00:00:53,600 Speaker 1: audible dot com slash Backfired and start a free trial 18 00:00:54,040 --> 00:00:59,640 Speaker 1: that's audible dot com slash backfired. Previously on Fiasco. 19 00:01:00,720 --> 00:01:04,680 Speaker 2: My main job was to try and develop drugs that 20 00:01:04,760 --> 00:01:07,000 Speaker 2: could treat this devastating disease. 21 00:01:07,520 --> 00:01:10,959 Speaker 3: The FDA announced today it would formerly streamline it's drug 22 00:01:10,959 --> 00:01:12,000 Speaker 3: approval process. 23 00:01:12,200 --> 00:01:15,000 Speaker 4: This thing of hoping for like a magic bullet, that 24 00:01:15,120 --> 00:01:16,840 Speaker 4: you know, we would all be activists for two or 25 00:01:16,840 --> 00:01:19,040 Speaker 4: three years, and then the cure would come, the vaccine 26 00:01:19,040 --> 00:01:20,480 Speaker 4: would come, and we would all go back to our 27 00:01:20,520 --> 00:01:22,119 Speaker 4: lives wasn't going to happen. 28 00:01:22,400 --> 00:01:32,800 Speaker 5: People need medication now, ten years from now, they'll be dead. 29 00:01:33,440 --> 00:01:36,679 Speaker 1: When the virus that causes AIDS was isolated in nineteen 30 00:01:36,760 --> 00:01:39,520 Speaker 1: eighty three, it looked kind of like a time bomb. 31 00:01:40,520 --> 00:01:43,720 Speaker 1: HIV could eat away at someone's immune system for months 32 00:01:43,840 --> 00:01:48,760 Speaker 1: or years before they experienced any serious symptoms. Then one day, 33 00:01:49,240 --> 00:01:53,760 Speaker 1: pretty much any infection could become fatal. In nineteen eighty seven, 34 00:01:54,200 --> 00:01:57,600 Speaker 1: a young chemist at the pharmaceutical company Murk came up 35 00:01:57,640 --> 00:02:01,040 Speaker 1: with an idea for how to disable the bomb. His 36 00:02:01,200 --> 00:02:02,600 Speaker 1: name was Irving Siegel. 37 00:02:03,320 --> 00:02:06,920 Speaker 6: What Siegel took on was really an impossible task. No 38 00:02:07,160 --> 00:02:11,200 Speaker 6: pharmaceutical scientist had ever really taken on such a challenge 39 00:02:11,200 --> 00:02:11,480 Speaker 6: as this. 40 00:02:12,639 --> 00:02:15,000 Speaker 1: David France is the author of the book How to 41 00:02:15,040 --> 00:02:18,240 Speaker 1: Survive a Plague and the director of the documentary film 42 00:02:18,280 --> 00:02:21,640 Speaker 1: by the same name. During the height of the epidemic 43 00:02:22,080 --> 00:02:24,560 Speaker 1: France was an activist and a journalist who covered the 44 00:02:24,600 --> 00:02:28,120 Speaker 1: search for AIDS treatments. He says that after the release 45 00:02:28,160 --> 00:02:32,520 Speaker 1: of the first AIDS drug, AZT, many drug companies scrambled 46 00:02:32,520 --> 00:02:33,639 Speaker 1: to produce knockoffs. 47 00:02:34,320 --> 00:02:37,720 Speaker 6: When AZT had come out in eighty seven, it immediately 48 00:02:37,800 --> 00:02:41,880 Speaker 6: proved that there was a massive and very of financially 49 00:02:41,919 --> 00:02:46,000 Speaker 6: rewarding market for drug companies to exploit. 50 00:02:46,840 --> 00:02:50,440 Speaker 1: But as you've heard, AZT was not a miracle drug. 51 00:02:51,080 --> 00:02:54,120 Speaker 1: Even when AZT seemed to make someone better at first, 52 00:02:54,760 --> 00:02:58,600 Speaker 1: the virus rapidly mutated inside their body, which meant that 53 00:02:58,639 --> 00:03:03,960 Speaker 1: eventually almost everyone who took it still developed AIDS. Irving Seagull, 54 00:03:04,200 --> 00:03:07,360 Speaker 1: the scientist at MERK, was convinced he could build something 55 00:03:07,400 --> 00:03:11,160 Speaker 1: better than AZT, a new class of drug that would 56 00:03:11,160 --> 00:03:13,840 Speaker 1: attack HIV in a totally different way. 57 00:03:14,360 --> 00:03:18,760 Speaker 6: Irving Siegel, he was young, he was charismatic. He pulled 58 00:03:18,800 --> 00:03:23,679 Speaker 6: together a team of very excited researchers, and the very 59 00:03:23,680 --> 00:03:27,160 Speaker 6: first thing that he focused on was a very novel approach. 60 00:03:27,240 --> 00:03:29,240 Speaker 6: No one else was taking it, and that was an 61 00:03:29,240 --> 00:03:32,440 Speaker 6: approach to look at protease inhibitors. 62 00:03:35,960 --> 00:03:41,080 Speaker 1: Maybe you've heard that phrase before protease inhibitors. I definitely had, 63 00:03:41,280 --> 00:03:43,480 Speaker 1: but I also did not know what a protease was 64 00:03:43,880 --> 00:03:47,240 Speaker 1: or what it meant to inhibit it. So as I've learned, 65 00:03:47,760 --> 00:03:51,120 Speaker 1: the HIV one protease is an enzyme that plays a 66 00:03:51,160 --> 00:03:54,280 Speaker 1: critical role in allowing the virus to replicate in the body. 67 00:03:55,040 --> 00:03:58,960 Speaker 1: Siegel believed that the key to treating HIV was stopping 68 00:03:59,000 --> 00:04:02,840 Speaker 1: the protease from doing its job. After getting some initial 69 00:04:02,880 --> 00:04:05,480 Speaker 1: buy in from the higher ups at MERK, Siegel and 70 00:04:05,520 --> 00:04:08,840 Speaker 1: his colleague Nancy Cole started working on it, and just 71 00:04:08,880 --> 00:04:11,800 Speaker 1: a few months later they completed a paper reporting a 72 00:04:11,840 --> 00:04:17,080 Speaker 1: promising result. By inhibiting the HIV protease, it was possible 73 00:04:17,160 --> 00:04:20,159 Speaker 1: to stop the virus from replicating, at least in the 74 00:04:20,200 --> 00:04:24,479 Speaker 1: confines of a lab experiment. The quick turnaround was typical 75 00:04:24,480 --> 00:04:27,640 Speaker 1: of Siegel. His wife Catherine told me he was someone 76 00:04:27,640 --> 00:04:29,600 Speaker 1: who took the stairs two steps at a time when 77 00:04:29,600 --> 00:04:32,480 Speaker 1: he came into work, and was often moving so fast 78 00:04:32,520 --> 00:04:34,560 Speaker 1: that he would forget to button his shirts all the way. 79 00:04:34,920 --> 00:04:36,920 Speaker 2: Can remember very clearly saying to myself, I have to 80 00:04:37,000 --> 00:04:39,240 Speaker 2: keep up with this guy, because he's just he did. 81 00:04:39,279 --> 00:04:42,160 Speaker 2: That's how rapidly he moved, That's how rapidly his brain 82 00:04:42,240 --> 00:04:42,719 Speaker 2: worked too. 83 00:04:43,480 --> 00:04:46,840 Speaker 1: Emilio Emini is a virologist who worked with Siegel as 84 00:04:46,880 --> 00:04:49,839 Speaker 1: the head of Murk's efforts on HIV. He was a 85 00:04:49,839 --> 00:04:52,640 Speaker 1: co author on that first paper about the HIV protease. 86 00:04:53,160 --> 00:04:54,880 Speaker 2: So you can imagine, you know, a very you know, 87 00:04:55,040 --> 00:04:58,800 Speaker 2: thin individual who is constantly moving and whose brain is 88 00:04:58,839 --> 00:05:01,280 Speaker 2: constantly functioning, absolutely extraordinary. 89 00:05:02,040 --> 00:05:05,279 Speaker 1: By December of nineteen eighty eight, Siegel and his team 90 00:05:05,360 --> 00:05:08,520 Speaker 1: were on the cusp of a major advance, producing the 91 00:05:08,560 --> 00:05:12,120 Speaker 1: first three D image of the protease. After more than 92 00:05:12,120 --> 00:05:15,200 Speaker 1: a year of intensive work, they finally had a clear 93 00:05:15,320 --> 00:05:22,520 Speaker 1: understanding of its unique cellular structure. Emilio Emini sometimes compares 94 00:05:22,600 --> 00:05:28,160 Speaker 1: the HIV protease to a pac man, introducing it has 95 00:05:28,160 --> 00:05:30,720 Speaker 1: a wedge like mouth which it uses to chomp down 96 00:05:30,800 --> 00:05:39,200 Speaker 1: on HIV proteins and slice them into smaller pieces. These 97 00:05:39,240 --> 00:05:45,719 Speaker 1: smaller pieces then spawn new HIV proteins throughout the body. Siegel, Emini, 98 00:05:45,800 --> 00:05:48,560 Speaker 1: and their colleagues at MURK wanted to jam the pac 99 00:05:48,640 --> 00:05:52,680 Speaker 1: man's mouth and render it incapable of doing any chomping 100 00:05:52,800 --> 00:05:59,440 Speaker 1: or slicing. They believed that once this happened, the virus 101 00:05:59,480 --> 00:06:00,800 Speaker 1: would stop replicating. 102 00:06:01,360 --> 00:06:05,480 Speaker 2: So if the protease is not functional, or if it's 103 00:06:05,520 --> 00:06:10,120 Speaker 2: rendered non functional and cannot perform this cutting activity, then 104 00:06:10,400 --> 00:06:14,920 Speaker 2: the viral proteins that are produced won't be assembled into 105 00:06:15,040 --> 00:06:18,919 Speaker 2: new viral particles right, and therefore the viral infection cycle 106 00:06:19,160 --> 00:06:19,920 Speaker 2: is terminated. 107 00:06:23,680 --> 00:06:26,320 Speaker 1: The three D image of the protease gave Segel and 108 00:06:26,360 --> 00:06:29,720 Speaker 1: his colleagues a precise map of the enzyme, showing them 109 00:06:29,760 --> 00:06:32,920 Speaker 1: where exactly they had to jam it. Now they could 110 00:06:32,920 --> 00:06:36,120 Speaker 1: move on to the next step developing a drug, a 111 00:06:36,120 --> 00:06:40,359 Speaker 1: protease inhibitor that could be digested by human beings. Siegel 112 00:06:40,520 --> 00:06:44,160 Speaker 1: was confident that it could be done, but then shortly 113 00:06:44,200 --> 00:06:47,480 Speaker 1: before Christmas, Siegel had to travel to London to deliver 114 00:06:47,600 --> 00:06:51,599 Speaker 1: a long scheduled lecture. After three days away from his lab, 115 00:06:51,800 --> 00:06:54,800 Speaker 1: he was eager to get back, so at the last 116 00:06:54,839 --> 00:07:00,239 Speaker 1: minute he decided to change his flight to a red eye. 117 00:07:00,400 --> 00:07:03,200 Speaker 1: Pan Am flight one oh three left London on the 118 00:07:03,279 --> 00:07:06,560 Speaker 1: night of December twenty first, nineteen eighty eight. Less than 119 00:07:06,600 --> 00:07:10,760 Speaker 1: an hour after takeoff, the plane exploded over Lockerby, Scotland, 120 00:07:11,240 --> 00:07:12,760 Speaker 1: killing everyone on board. 121 00:07:13,480 --> 00:07:16,280 Speaker 7: Just after seven this evening, a jumbo jet crashed onto 122 00:07:16,360 --> 00:07:19,120 Speaker 7: the town of locker Bit in the Scottish borders. It 123 00:07:19,160 --> 00:07:21,440 Speaker 7: was a Pan American Boeing seven four seventh. 124 00:07:21,920 --> 00:07:24,480 Speaker 2: I remember very clearly where I was when I got 125 00:07:24,480 --> 00:07:26,960 Speaker 2: the news. I was at home. Actually it was right 126 00:07:27,000 --> 00:07:29,640 Speaker 2: before Christmas. It was right before Christmas in nineteen eighty eight. 127 00:07:29,840 --> 00:07:32,240 Speaker 7: We now know there were two hundred and forty four 128 00:07:32,280 --> 00:07:34,160 Speaker 7: people on board, including three children. 129 00:07:34,680 --> 00:07:37,560 Speaker 1: Irving Seagull was just thirty five years old when he 130 00:07:37,640 --> 00:07:39,040 Speaker 1: died in the locker be bombing. 131 00:07:39,520 --> 00:07:42,360 Speaker 2: It was absolutely devastating, as you can imagine. It was 132 00:07:42,400 --> 00:07:45,840 Speaker 2: devastating for what we were doing collectively, was devastating for 133 00:07:45,920 --> 00:07:48,680 Speaker 2: the science. It was devastating for the whole field. But 134 00:07:48,720 --> 00:07:51,440 Speaker 2: more importantly, it was devastating personally for Irving and for 135 00:07:51,520 --> 00:07:52,080 Speaker 2: his family. 136 00:07:53,200 --> 00:07:56,520 Speaker 1: Seagull's vision of a protease inhibitor would eventually lead to 137 00:07:56,560 --> 00:07:59,840 Speaker 1: a massive paradigm shift in AIDS treatment as part of 138 00:07:59,880 --> 00:08:03,200 Speaker 1: the so called triple cocktail. It would unlock the first 139 00:08:03,280 --> 00:08:07,280 Speaker 1: effective therapy for HIV and AIDS, and it would finally 140 00:08:07,320 --> 00:08:10,200 Speaker 1: make it possible for people who had the disease to survive. 141 00:08:11,360 --> 00:08:14,440 Speaker 1: But none of that would happen until nineteen ninety six, 142 00:08:15,440 --> 00:08:19,360 Speaker 1: nine years after Segel first saw promise in the HIV protease, 143 00:08:20,080 --> 00:08:23,160 Speaker 1: and fifteen years after the first cases of AIDS were 144 00:08:23,160 --> 00:08:31,920 Speaker 1: observed in America. It's impossible to say whether an effective 145 00:08:31,960 --> 00:08:35,160 Speaker 1: treatment might have come sooner if Irving Siegel hadn't changed 146 00:08:35,160 --> 00:08:38,880 Speaker 1: his flight from London. What's clear enough is that his 147 00:08:39,000 --> 00:08:42,880 Speaker 1: death was a major setback, one of many in science's 148 00:08:42,920 --> 00:08:49,480 Speaker 1: long and grueling campaign against AIDS. I'm Leon Napak from 149 00:08:49,520 --> 00:08:53,800 Speaker 1: Audible Originals and Prologue projects. This is fiasco. 150 00:08:54,840 --> 00:08:58,400 Speaker 3: Typically, the stronger the drug, the faster HIV adapts to 151 00:08:58,480 --> 00:08:58,880 Speaker 3: resist it. 152 00:08:59,120 --> 00:09:01,000 Speaker 4: It seemed that everything we had done up to that 153 00:09:01,080 --> 00:09:02,480 Speaker 4: point hadn't been enough. 154 00:09:02,600 --> 00:09:05,640 Speaker 8: Researchers say a new class of drugs are working. 155 00:09:05,720 --> 00:09:09,040 Speaker 9: Where once there was only desperation, there is now genuine hope. 156 00:09:09,160 --> 00:09:12,000 Speaker 10: I'm looking falling through a future, the Lazarus effect that 157 00:09:12,040 --> 00:09:14,679 Speaker 10: people described it felt like a miracle. 158 00:09:17,640 --> 00:09:20,720 Speaker 1: In this episode, the darkest days of the AIDS crisis 159 00:09:20,720 --> 00:09:24,560 Speaker 1: in America followed at long last by a glimpse of light. 160 00:09:32,400 --> 00:09:36,840 Speaker 1: By the nineteen nineties, HIV had spread all over the globe. 161 00:09:37,080 --> 00:09:39,720 Speaker 11: Fourteen million people in the world are now HIV positive. 162 00:09:39,720 --> 00:09:41,800 Speaker 11: The number grows dramatically every year. 163 00:09:41,760 --> 00:09:44,199 Speaker 1: And affected just about every demographic. 164 00:09:44,520 --> 00:09:48,040 Speaker 11: Still, no cure still no vaccine to prevent it. 165 00:09:48,640 --> 00:09:51,720 Speaker 1: In the US, cases among women and people of color 166 00:09:51,840 --> 00:09:55,440 Speaker 1: were climbing at a particularly alarming rate, and as the 167 00:09:55,480 --> 00:09:58,320 Speaker 1: time bomb went off and more and more people, the 168 00:09:58,360 --> 00:09:59,720 Speaker 1: death totals were rising. 169 00:10:00,000 --> 00:10:03,360 Speaker 3: Every year in this country, four hundred thousand have gotten AIDS, 170 00:10:03,760 --> 00:10:05,720 Speaker 3: two hundred and forty thousand have died. 171 00:10:05,880 --> 00:10:08,360 Speaker 2: Whatever we've been doing has not been enough. 172 00:10:08,559 --> 00:10:11,360 Speaker 6: It wasn't until we hit nineteen ninety three and nineteen 173 00:10:11,440 --> 00:10:15,080 Speaker 6: ninety four and nineteen ninety five that the body counts 174 00:10:15,120 --> 00:10:16,439 Speaker 6: became extreme. 175 00:10:16,880 --> 00:10:18,800 Speaker 1: David France again, these were. 176 00:10:18,760 --> 00:10:23,880 Speaker 6: Mass dying events each year. Forty three thousand Americans died 177 00:10:23,920 --> 00:10:28,040 Speaker 6: in nineteen ninety three, fifty thousand Americans in nineteen ninety four. 178 00:10:28,640 --> 00:10:31,480 Speaker 6: So we entered a period of real despair. 179 00:10:34,000 --> 00:10:37,400 Speaker 1: For many AIDS activists, the tragedy wasn't just about how 180 00:10:37,440 --> 00:10:40,679 Speaker 1: many people were dying during this period. It was also 181 00:10:40,720 --> 00:10:43,160 Speaker 1: that many of the dead had been leaders in the movement. 182 00:10:43,800 --> 00:10:46,600 Speaker 6: Nineteen ninety three opened with the death of Bob Ravski, 183 00:10:46,880 --> 00:10:50,360 Speaker 6: who was a key member of Act UP, one of 184 00:10:50,400 --> 00:10:53,040 Speaker 6: its kind of poet warriors. 185 00:10:52,920 --> 00:10:55,320 Speaker 12: Questions, what does a decent society do with people who 186 00:10:55,440 --> 00:10:58,160 Speaker 12: hurt themselves because they're human? Who smoke too much, we 187 00:10:58,280 --> 00:11:00,800 Speaker 12: too much, you drive carelessly, who don't have safe sex? 188 00:11:00,960 --> 00:11:02,760 Speaker 12: And the answer, I think the answer is at a 189 00:11:02,800 --> 00:11:05,520 Speaker 12: decent society does not put people out to pastor and 190 00:11:05,600 --> 00:11:07,640 Speaker 12: let them die because they've done a human thing. 191 00:11:08,440 --> 00:11:12,520 Speaker 6: His death was a trauma for the movement and the community, 192 00:11:13,120 --> 00:11:15,880 Speaker 6: and then by the end of the year, Michael Callen died. 193 00:11:16,640 --> 00:11:19,720 Speaker 1: You met Michael Callen in our second episode. He was 194 00:11:19,720 --> 00:11:22,679 Speaker 1: the singer, an early AIDS activist who spearheaded a safe 195 00:11:22,679 --> 00:11:25,880 Speaker 1: sex campaign in New York and helped create a Bill 196 00:11:25,880 --> 00:11:27,400 Speaker 1: of Rights for people with AIDS. 197 00:11:28,160 --> 00:11:30,760 Speaker 13: It's hard to believe Michael Callen is no longer with us. 198 00:11:31,240 --> 00:11:33,800 Speaker 13: For more than a decade, he made beautiful music and 199 00:11:33,880 --> 00:11:37,280 Speaker 13: worked tirelessly to improve the quality of life for people 200 00:11:37,320 --> 00:11:40,120 Speaker 13: with AIDS, all the while fighting the disease himself. 201 00:11:40,400 --> 00:11:40,719 Speaker 10: We won. 202 00:11:40,800 --> 00:11:43,520 Speaker 6: Michael Callen was the author of a book on surviving 203 00:11:43,679 --> 00:11:47,880 Speaker 6: HIV and if the guy who was a self proclaimed 204 00:11:48,000 --> 00:11:54,040 Speaker 6: long term survivor couldn't survive, then it seemed we were 205 00:11:54,120 --> 00:11:55,000 Speaker 6: all lost. 206 00:11:55,320 --> 00:11:57,480 Speaker 14: I realized that some people could look at my life 207 00:11:57,520 --> 00:12:00,520 Speaker 14: and say, oh, it was so sad when he died 208 00:12:00,559 --> 00:12:03,800 Speaker 14: of AIDS, And isn't that tragic? But what I want 209 00:12:03,880 --> 00:12:07,560 Speaker 14: to come through is that even after all the pain 210 00:12:07,720 --> 00:12:11,560 Speaker 14: and all the torture, and even having AIDS, I can 211 00:12:11,600 --> 00:12:15,160 Speaker 14: honestly say being gay is the greatest gift I was 212 00:12:15,240 --> 00:12:17,679 Speaker 14: ever given. I wouldn't change it. 213 00:12:17,679 --> 00:12:27,800 Speaker 2: For the worlds. 214 00:12:27,600 --> 00:12:31,080 Speaker 1: Amid all of this death, more and more activists started 215 00:12:31,080 --> 00:12:34,840 Speaker 1: to burn out Garantz. Frankie Ruda, who had joined Act 216 00:12:34,920 --> 00:12:37,400 Speaker 1: Up as a teenager in the late eighties, was one 217 00:12:37,440 --> 00:12:37,960 Speaker 1: of them. 218 00:12:38,120 --> 00:12:41,040 Speaker 10: I think people have just had a lot of unprocessed 219 00:12:41,040 --> 00:12:43,040 Speaker 10: grief and we're just really like unraveling. 220 00:12:43,160 --> 00:12:47,439 Speaker 1: Honestly, Like many in the movement, Frankie Ruda was exhausted 221 00:12:47,480 --> 00:12:50,920 Speaker 1: by the lack of progress on medical treatment and by 222 00:12:50,960 --> 00:12:52,959 Speaker 1: infighting among her fellow activists. 223 00:12:54,040 --> 00:12:58,280 Speaker 10: All activist organizations have kind of a half life. They 224 00:12:58,679 --> 00:13:02,360 Speaker 10: burst onto the scene, they're incredibly viral, and then they 225 00:13:02,400 --> 00:13:04,000 Speaker 10: start to sort of change. 226 00:13:04,520 --> 00:13:07,280 Speaker 1: The changes Act UP was going through might have been 227 00:13:07,320 --> 00:13:11,000 Speaker 1: easier to take if Frankie Ruda wasn't also losing friends 228 00:13:11,000 --> 00:13:12,960 Speaker 1: to AIDS on a routine basis. 229 00:13:13,440 --> 00:13:16,240 Speaker 10: A lot of people had been infected around the same 230 00:13:16,240 --> 00:13:19,520 Speaker 10: period of time, and there was a sense amongst a 231 00:13:19,559 --> 00:13:22,520 Speaker 10: lot of people that they were not getting out of 232 00:13:22,520 --> 00:13:27,480 Speaker 10: this alive. Some people were very pessimistic about whether or 233 00:13:27,480 --> 00:13:31,839 Speaker 10: not they were going to see the end of the pandemic. 234 00:13:33,400 --> 00:13:36,520 Speaker 1: The sense of despair deepened in June of nineteen ninety 235 00:13:36,559 --> 00:13:41,240 Speaker 1: three when scientists made a crushing announcement about AZT at 236 00:13:41,240 --> 00:13:43,760 Speaker 1: the International AIDS Conference in Berlin. 237 00:13:43,920 --> 00:13:47,480 Speaker 11: Discouraging news Today about the effectiveness in some cases of AZT. 238 00:13:48,040 --> 00:13:51,400 Speaker 1: French and British researchers had conducted the largest study ever 239 00:13:51,480 --> 00:13:55,439 Speaker 1: on AZT. Their conclusion was that in the long term 240 00:13:55,559 --> 00:13:57,959 Speaker 1: the drug simply did not work well. 241 00:13:58,000 --> 00:14:02,040 Speaker 4: The T yes it was, there no significant benefit in 242 00:14:02,160 --> 00:14:05,120 Speaker 4: terms of survival or profession to AIDS. 243 00:14:05,559 --> 00:14:08,560 Speaker 3: Reading from slides on a big overhead screen, the head 244 00:14:08,559 --> 00:14:11,880 Speaker 3: of the European study told the delegates patients inspected with 245 00:14:12,120 --> 00:14:15,800 Speaker 3: HIV who take AZT before they develop symptoms of AIDS 246 00:14:16,200 --> 00:14:18,800 Speaker 3: are no better off than patients who take it after 247 00:14:18,840 --> 00:14:20,080 Speaker 3: they come down with the disease. 248 00:14:20,520 --> 00:14:24,360 Speaker 1: The limits of AZT were already well known, but according 249 00:14:24,440 --> 00:14:27,440 Speaker 1: to the new study, the drug didn't extend life for 250 00:14:27,520 --> 00:14:31,800 Speaker 1: people with AIDS by a single day. In fact, patients 251 00:14:31,800 --> 00:14:36,120 Speaker 1: in the placebo group actually lived a little longer. After 252 00:14:36,160 --> 00:14:39,440 Speaker 1: the conference, the Washington Post described it as the most 253 00:14:39,440 --> 00:14:44,320 Speaker 1: depressing moment in aid's treatment history. Mark Harrington, the act 254 00:14:44,440 --> 00:14:47,040 Speaker 1: UP member you first met in our previous episode, was 255 00:14:47,080 --> 00:14:49,560 Speaker 1: in Berlin at the time of the AZT announcement. 256 00:14:50,480 --> 00:14:52,600 Speaker 4: I think at that point it was pretty universally felt 257 00:14:52,600 --> 00:14:54,920 Speaker 4: that we were all doomed and anybody that had HIV 258 00:14:55,040 --> 00:14:58,440 Speaker 4: was going to die. We're not going to be changing 259 00:14:58,480 --> 00:15:01,840 Speaker 4: the field fast enough to to save our lives or 260 00:15:01,880 --> 00:15:03,680 Speaker 4: the lives of most of our friends that had HIV 261 00:15:03,800 --> 00:15:05,760 Speaker 4: and most of the other millions and millions of people 262 00:15:05,800 --> 00:15:09,000 Speaker 4: that had HIV. So it seemed that everything we had 263 00:15:09,040 --> 00:15:11,080 Speaker 4: done up to that point hadn't been enough. 264 00:15:11,880 --> 00:15:15,320 Speaker 1: Three weeks after the conference in Berlin, a group of 265 00:15:15,360 --> 00:15:20,840 Speaker 1: AIDS activists channeled their sorrow into a protest in Washington, Free. 266 00:15:20,640 --> 00:15:24,000 Speaker 3: The deaths of years we are taking any harm. 267 00:15:24,960 --> 00:15:27,440 Speaker 1: It was a new kind of protest known as a 268 00:15:27,440 --> 00:15:28,400 Speaker 1: political funeral. 269 00:15:29,040 --> 00:15:32,560 Speaker 6: It got to the point where the community started this 270 00:15:32,800 --> 00:15:38,280 Speaker 6: campaign to show our deaths, to show what AIDS looked like, 271 00:15:38,640 --> 00:15:41,000 Speaker 6: and the most dramatic way that that happened was through 272 00:15:41,280 --> 00:15:47,040 Speaker 6: political funerals, in which the corpses of the fallen comrades 273 00:15:47,560 --> 00:15:52,080 Speaker 6: were taken out into the streets and displayed in these 274 00:15:52,440 --> 00:16:00,200 Speaker 6: these really heartbreaking expressions of anger and rage. 275 00:16:00,440 --> 00:16:03,480 Speaker 1: The point of political funerals was to force an awareness 276 00:16:03,520 --> 00:16:05,960 Speaker 1: of the death toll from AIDS onto those who might 277 00:16:06,040 --> 00:16:10,400 Speaker 1: otherwise find it easy to look away. Mark Harrington says 278 00:16:10,440 --> 00:16:13,840 Speaker 1: that activists didn't want AIDS to be a private epidemic. 279 00:16:14,680 --> 00:16:18,840 Speaker 4: We wanted the American people to see the cost, to 280 00:16:18,920 --> 00:16:22,360 Speaker 4: see the lives that were being lost, and to be 281 00:16:22,440 --> 00:16:25,440 Speaker 4: made aware by us putting it into their faces that 282 00:16:26,360 --> 00:16:29,040 Speaker 4: the people that were dying were loved and were valued 283 00:16:29,640 --> 00:16:32,920 Speaker 4: members of our society. And so this was a sign 284 00:16:33,160 --> 00:16:39,760 Speaker 4: of desperation, of despair, but also a beautiful sign of solidarity. 285 00:16:40,680 --> 00:16:43,040 Speaker 1: It was the summer of nineteen ninety three when an 286 00:16:43,080 --> 00:16:45,880 Speaker 1: act UP member with AIDS named Tim Bailey took a 287 00:16:45,920 --> 00:16:49,760 Speaker 1: turn for the worse. As he lay dying, Bailey told 288 00:16:49,760 --> 00:16:52,160 Speaker 1: his friends that he wanted his body thrown over the 289 00:16:52,160 --> 00:16:55,120 Speaker 1: White House gate. It would be a nod to an 290 00:16:55,120 --> 00:16:58,480 Speaker 1: act UP protest held the previous year when more than 291 00:16:58,480 --> 00:17:01,240 Speaker 1: a dozen activists poured out the ashes of their loved 292 00:17:01,240 --> 00:17:02,880 Speaker 1: ones onto the White House lawn. 293 00:17:03,360 --> 00:17:06,719 Speaker 5: And we're here today to bring home to George Brush 294 00:17:07,400 --> 00:17:10,000 Speaker 5: the results of this murders in action. 295 00:17:11,200 --> 00:17:14,640 Speaker 1: Tim Bailey's idea to have people throw his actual body 296 00:17:14,720 --> 00:17:17,560 Speaker 1: onto the lawn was a little more extreme, and his 297 00:17:17,640 --> 00:17:21,280 Speaker 1: friends demurred, but they promised him they would do something 298 00:17:21,400 --> 00:17:22,720 Speaker 1: in front of the White House. 299 00:17:27,680 --> 00:17:31,399 Speaker 5: True Love. 300 00:17:33,160 --> 00:17:36,640 Speaker 1: On July first, nineteen ninety three, a few days after 301 00:17:36,720 --> 00:17:40,160 Speaker 1: Bailey died, his friends drove his body from a funeral 302 00:17:40,200 --> 00:17:42,320 Speaker 1: home in New Jersey to Washington, d C. 303 00:17:43,240 --> 00:17:46,280 Speaker 6: This was carried out like a military operation. They rented 304 00:17:46,320 --> 00:17:49,560 Speaker 6: a van and they called upon Act Up members around 305 00:17:49,560 --> 00:17:51,120 Speaker 6: the country to meet them in Washington. 306 00:17:52,160 --> 00:17:54,720 Speaker 1: The plan was to meet up at the Capital reflecting pool, 307 00:17:55,080 --> 00:17:59,000 Speaker 1: then marched down Pennsylvania Avenue in a procession, But by 308 00:17:59,040 --> 00:18:01,720 Speaker 1: the time the activist van pulled into a parking lot 309 00:18:01,800 --> 00:18:05,960 Speaker 1: near the Capitol, the authorities were already there. Some were 310 00:18:05,960 --> 00:18:06,840 Speaker 1: wearing riot gear. 311 00:18:07,000 --> 00:18:10,080 Speaker 10: This is this is the last whistles, It's in the will. 312 00:18:10,440 --> 00:18:13,080 Speaker 2: There are legal permits, there are family members here. 313 00:18:13,440 --> 00:18:17,320 Speaker 5: You're going to You're going to interfere with a funeral 314 00:18:17,400 --> 00:18:19,000 Speaker 5: procession in front of. 315 00:18:18,960 --> 00:18:19,800 Speaker 15: All this press. 316 00:18:19,960 --> 00:18:25,680 Speaker 6: It was a showdown of remarkable tension and anger. There 317 00:18:25,760 --> 00:18:30,080 Speaker 6: was rage and tears coming from the protesters, who felt 318 00:18:30,160 --> 00:18:32,840 Speaker 6: that they owed it to Tim Bailey to be able 319 00:18:32,880 --> 00:18:38,479 Speaker 6: to accomplish what he had asked for and yet they 320 00:18:38,480 --> 00:18:39,240 Speaker 6: were being blocked. 321 00:18:50,520 --> 00:18:53,520 Speaker 1: According to one witness, a federal agent at one point 322 00:18:53,560 --> 00:18:56,800 Speaker 1: reached into the van holding Bailey's casket and snatched the 323 00:18:56,880 --> 00:19:01,200 Speaker 1: keys from the driver. Activists surrounded van and sat down 324 00:19:01,280 --> 00:19:04,720 Speaker 1: so it couldn't be driven away. After a tense standoff 325 00:19:04,720 --> 00:19:08,120 Speaker 1: that lasted several hours, they flung open the back doors 326 00:19:08,240 --> 00:19:09,720 Speaker 1: and forced the casket. 327 00:19:09,359 --> 00:19:16,560 Speaker 6: Out, But the pushback from this phalanx of police officers 328 00:19:16,920 --> 00:19:20,560 Speaker 6: was such that the whole casket nearly fell over and 329 00:19:20,640 --> 00:19:29,000 Speaker 6: nearly emptied itself in the parking lot. Everything you wanted 330 00:19:28,960 --> 00:19:31,760 Speaker 6: to do, and now you're fucking hell. 331 00:19:32,600 --> 00:19:36,560 Speaker 1: You have to god damn more. Eventually, the activists regained 332 00:19:36,560 --> 00:19:39,480 Speaker 1: control of Bailey's casket and managed to get it back 333 00:19:39,520 --> 00:19:42,600 Speaker 1: into the van. The police then surrounded the van and 334 00:19:42,760 --> 00:19:45,600 Speaker 1: escorted it onto the highway back towards New Jersey. 335 00:19:46,160 --> 00:19:51,399 Speaker 6: The escort lasted into Maryland to Baltimore, and Tim's body 336 00:19:51,440 --> 00:19:54,560 Speaker 6: was returned ultimately to the funeral home and he was 337 00:19:54,600 --> 00:19:57,600 Speaker 6: given a regular burial after that. 338 00:20:04,960 --> 00:20:09,160 Speaker 1: By nineteen ninety three, activists weren't the only ones losing hope. 339 00:20:09,920 --> 00:20:12,920 Speaker 1: Scientists were also beginning to doubt whether an effective treatment 340 00:20:12,960 --> 00:20:17,760 Speaker 1: for HIV was possible AZT like drugs had proven ineffective, 341 00:20:18,359 --> 00:20:21,399 Speaker 1: and while MIRK was putting its energy behind protease inhibitors, 342 00:20:21,880 --> 00:20:25,720 Speaker 1: there was no guarantee that those would work either. Here 343 00:20:25,800 --> 00:20:30,960 Speaker 1: again is Emilio Emini, the virologist who ran Merk's HIV efforts. 344 00:20:31,359 --> 00:20:34,720 Speaker 2: What was in everyone's back of everyone's mind was, well, 345 00:20:35,080 --> 00:20:38,320 Speaker 2: maybe every single drug we develop against this virus, or 346 00:20:38,359 --> 00:20:40,760 Speaker 2: even an inhibit of the protease, maybe the virus can 347 00:20:40,840 --> 00:20:44,160 Speaker 2: very quickly defeat it by simply becoming resistant quickly. 348 00:20:44,880 --> 00:20:47,959 Speaker 1: Thanks to Irving Siegel and his colleagues, MIRK had been 349 00:20:48,000 --> 00:20:52,240 Speaker 1: early on protease research, but in the years after Siegel's death, 350 00:20:52,640 --> 00:20:56,360 Speaker 1: progress had been slow. It wasn't just because Siegel wasn't 351 00:20:56,359 --> 00:20:59,200 Speaker 1: there to help. Everyone I spoke to said his team 352 00:20:59,240 --> 00:21:03,200 Speaker 1: continued working on protease inhibitors with the same urgency as before. 353 00:21:04,040 --> 00:21:06,199 Speaker 1: It was just that making a functional drug out of 354 00:21:06,200 --> 00:21:10,400 Speaker 1: Siegel's idea was extremely hard. Here's David Franz again. 355 00:21:11,119 --> 00:21:17,200 Speaker 6: It was the most complex pharmaceutical production ever undertaken. To 356 00:21:17,320 --> 00:21:24,200 Speaker 6: create this molecule took fourteen painstaking steps, each one very 357 00:21:24,240 --> 00:21:27,640 Speaker 6: time consuming. Each one depended on the one before it. 358 00:21:27,720 --> 00:21:31,720 Speaker 6: The idea that this would work was certainly far from 359 00:21:32,080 --> 00:21:32,879 Speaker 6: but reliable. 360 00:21:34,040 --> 00:21:36,520 Speaker 1: The drug that Merk was working on would eventually be 361 00:21:36,600 --> 00:21:40,480 Speaker 1: called krick Savan. The scientist in charge of producing it 362 00:21:40,560 --> 00:21:43,600 Speaker 1: happened to also be a chef, and in an interview 363 00:21:43,640 --> 00:21:47,160 Speaker 1: with the Philadelphia Inquirer, he explained that making krick savan 364 00:21:47,400 --> 00:21:49,800 Speaker 1: was like cooking an intricate, multi course meal for a 365 00:21:49,840 --> 00:21:53,160 Speaker 1: thousand people. If you wrote the recipe for krick savan, 366 00:21:53,280 --> 00:21:57,240 Speaker 1: he said, each of the fourteen steps would cover sixty pages. 367 00:22:00,600 --> 00:22:04,119 Speaker 1: The effort seemed to be paying off. Kricks Evan worked 368 00:22:04,160 --> 00:22:07,960 Speaker 1: extremely well in lab trials, so well that, according to 369 00:22:08,040 --> 00:22:11,840 Speaker 1: David France, the team at Merk did something pretty unusual. 370 00:22:12,280 --> 00:22:16,840 Speaker 6: As Merk and the HIV team were getting more and 371 00:22:16,880 --> 00:22:20,560 Speaker 6: more excited about kricks evan from what they saw in laboratories, 372 00:22:21,040 --> 00:22:24,760 Speaker 6: they wanted to push the thing into human trials very quickly, 373 00:22:25,160 --> 00:22:28,880 Speaker 6: and they had such faith that it would work that 374 00:22:29,640 --> 00:22:34,120 Speaker 6: they did something that is not done in pharmaceutical research. 375 00:22:34,800 --> 00:22:39,240 Speaker 1: Typically, after successful lab trials, pharma companies test their drugs 376 00:22:39,320 --> 00:22:42,400 Speaker 1: on healthy animals to make sure the drugs aren't toxic 377 00:22:42,600 --> 00:22:46,640 Speaker 1: and can be absorbed into the bloodstream. According to France's reporting, 378 00:22:47,240 --> 00:22:48,840 Speaker 1: Merk skipped the animal trial. 379 00:22:49,480 --> 00:22:52,919 Speaker 6: Sort of What they did instead was they tested it 380 00:22:52,960 --> 00:22:58,000 Speaker 6: among the scientists. They took it themselves, and so they 381 00:22:58,040 --> 00:23:02,480 Speaker 6: knew that it was safe because they all survived the 382 00:23:02,520 --> 00:23:06,640 Speaker 6: exposure to it. And it's something that has often joked 383 00:23:06,640 --> 00:23:09,280 Speaker 6: about in the pharmaceutical world as a big chimp study, 384 00:23:09,440 --> 00:23:12,200 Speaker 6: in which the big chimp is the scientist himself. 385 00:23:14,640 --> 00:23:18,040 Speaker 1: We asked Emilio Amini about the big chimp trial. He 386 00:23:18,160 --> 00:23:24,240 Speaker 1: declined to comment. I told you a bit ago about 387 00:23:24,240 --> 00:23:28,040 Speaker 1: the devastating AZT announcement in Berlin. It was about six 388 00:23:28,080 --> 00:23:30,600 Speaker 1: months later that Merk ran a trial of krick Savan 389 00:23:30,720 --> 00:23:33,160 Speaker 1: and a group of people who were all HIV positive. 390 00:23:33,960 --> 00:23:38,360 Speaker 1: A week into the study, each patient's viral load fell dramatically. 391 00:23:39,240 --> 00:23:42,760 Speaker 1: Krick Savan appeared to work, at least in the short run. 392 00:23:43,440 --> 00:23:46,719 Speaker 2: What we initially saw was that there was in fact, 393 00:23:47,119 --> 00:23:51,240 Speaker 2: very clear and rapid decline a virus load in those individuals. 394 00:23:51,440 --> 00:23:53,159 Speaker 2: And this was the first time that was seen with 395 00:23:53,200 --> 00:23:56,840 Speaker 2: any drug, you know, for HIV. So it gave us 396 00:23:56,880 --> 00:23:58,280 Speaker 2: a sort of a glimmer of hope that you know, 397 00:23:58,320 --> 00:24:01,399 Speaker 2: we have, you know, something potentially useful here, right, you know, 398 00:24:01,440 --> 00:24:03,920 Speaker 2: we felt, well, maybe there's something special about the proteuse. 399 00:24:03,920 --> 00:24:07,160 Speaker 2: Maybe there's something special that the virus cannot rapidly become 400 00:24:07,200 --> 00:24:12,320 Speaker 2: resistant to this class of drugs, and so we were encouraged. 401 00:24:12,960 --> 00:24:15,960 Speaker 1: The question was would the virus find a way to 402 00:24:16,040 --> 00:24:19,760 Speaker 1: mutate around the drug like it had with AZT. The 403 00:24:19,800 --> 00:24:22,639 Speaker 1: researchers at MERK were optimistic enough that they had shared 404 00:24:22,640 --> 00:24:28,160 Speaker 1: their preliminary results with other AIDS researchers, but soon their 405 00:24:28,200 --> 00:24:34,359 Speaker 1: hopes were dashed. Once again, HIV had mutated and effectively 406 00:24:34,440 --> 00:24:36,159 Speaker 1: become resistant to the new drug. 407 00:24:38,280 --> 00:24:40,919 Speaker 2: So if if we go back to the pac man analogy, 408 00:24:41,119 --> 00:24:46,080 Speaker 2: and you consider the protease inhibitor has been a something 409 00:24:46,119 --> 00:24:48,200 Speaker 2: a ball of rock, whatever you want to call it, 410 00:24:48,359 --> 00:24:50,199 Speaker 2: that gets in the mouth of the pac mand so 411 00:24:50,280 --> 00:24:52,480 Speaker 2: that the pac man can no longer, you know, close 412 00:24:52,600 --> 00:24:55,119 Speaker 2: its mouth and chump up the viral proteins. What the 413 00:24:55,200 --> 00:24:59,439 Speaker 2: mutation does is that the mutation alters the structure of 414 00:24:59,480 --> 00:25:03,680 Speaker 2: the pac man mouth just ever so slightly, but ald 415 00:25:03,840 --> 00:25:09,399 Speaker 2: is it enough so that the inhibitor can't bind into 416 00:25:09,480 --> 00:25:10,520 Speaker 2: that mouth anymore. 417 00:25:12,920 --> 00:25:13,359 Speaker 12: The one. 418 00:25:15,560 --> 00:25:18,440 Speaker 1: Just to make sure you got that, the mutation occurred 419 00:25:18,560 --> 00:25:22,360 Speaker 1: right in the pac man's mouth. Now, the protease inhibitor 420 00:25:22,359 --> 00:25:25,840 Speaker 1: that Murk had spent years developing and fine tuning didn't 421 00:25:25,880 --> 00:25:29,920 Speaker 1: fit properly, and so the pac man the protease went 422 00:25:30,040 --> 00:25:34,120 Speaker 1: right back to chomping and slicing HIV proteins and enabling 423 00:25:34,119 --> 00:25:39,639 Speaker 1: them to replicate in patient's bodies. HIV was rebounding in 424 00:25:39,720 --> 00:25:44,040 Speaker 1: Murk's study participants, and it was happening extremely fast. By 425 00:25:44,040 --> 00:25:45,639 Speaker 1: that time, we had a good feel for this. 426 00:25:45,680 --> 00:25:48,000 Speaker 2: We already knew that what we were looking at here 427 00:25:48,080 --> 00:25:49,000 Speaker 2: was resistant selection. 428 00:25:49,359 --> 00:25:49,960 Speaker 1: It was harder. 429 00:25:50,000 --> 00:25:52,280 Speaker 2: It was harder for the virus to become resistant against 430 00:25:52,320 --> 00:25:54,720 Speaker 2: the protease inhibitor, but it wasn't that hard. 431 00:25:55,640 --> 00:26:00,000 Speaker 1: HIV was the ultimate Darwinian nightmare. It seemed to evolve 432 00:26:00,200 --> 00:26:04,040 Speaker 1: around every obstacle put in its path. After years of 433 00:26:04,080 --> 00:26:07,760 Speaker 1: effort and hundreds of millions of dollars spent, Merk's new 434 00:26:07,840 --> 00:26:10,440 Speaker 1: drug appeared to be meeting the fate of every other 435 00:26:10,680 --> 00:26:17,560 Speaker 1: HIV treatment. The disappointment of krick Savan didn't mean that 436 00:26:17,640 --> 00:26:21,000 Speaker 1: protease inhibitors in general would never work, or that a 437 00:26:21,040 --> 00:26:24,880 Speaker 1: different drug based on the same idea wouldn't produce different results. 438 00:26:26,040 --> 00:26:29,880 Speaker 1: In fact, in the early nineties, several pharmaceutical companies other 439 00:26:29,920 --> 00:26:33,159 Speaker 1: than Merk were attempting to develop their own protease inhibitors. 440 00:26:34,080 --> 00:26:37,159 Speaker 1: In May of nineteen ninety four, a company called Hoffman 441 00:26:37,240 --> 00:26:40,320 Speaker 1: Laroche became the first of Mrk's rivals to put a 442 00:26:40,320 --> 00:26:42,440 Speaker 1: protease inhibitor in front of the FDA. 443 00:26:42,960 --> 00:26:46,760 Speaker 11: But new drug called the most important advance since AZT. 444 00:26:47,119 --> 00:26:49,639 Speaker 1: The drug was called sequineverr. 445 00:26:49,240 --> 00:26:52,560 Speaker 11: Sha quivnaire, the first of a new generation of AIDS 446 00:26:52,600 --> 00:26:53,600 Speaker 11: fighting drugs. 447 00:26:53,760 --> 00:26:58,040 Speaker 1: Hoffman Laroche was asking the FDA for accelerated approval, which 448 00:26:58,080 --> 00:27:01,400 Speaker 1: was exciting news for AIDS activists patients across the country. 449 00:27:02,320 --> 00:27:05,920 Speaker 1: Merk's protease inhibitor hadn't panned out, but maybe Hoffman the 450 00:27:06,000 --> 00:27:08,359 Speaker 1: Rosch's version would turn out to be the real deal. 451 00:27:08,920 --> 00:27:12,000 Speaker 3: Researchers caution against too much optimism, but it is the 452 00:27:12,040 --> 00:27:15,280 Speaker 3: most powerful weapon yet developed against the AIDS virus. 453 00:27:15,640 --> 00:27:19,000 Speaker 1: There was, however, a surprising hitch in the company's plan 454 00:27:19,160 --> 00:27:23,760 Speaker 1: to get sequinevere to market quickly. A small but influential 455 00:27:23,840 --> 00:27:29,959 Speaker 1: group of former act UP members was standing in the way. 456 00:27:30,920 --> 00:27:34,840 Speaker 1: They called themselves the Treatment Action Group or TAG for short. 457 00:27:36,000 --> 00:27:39,400 Speaker 1: TAG included many of the science oriented activists from act UP, 458 00:27:39,760 --> 00:27:44,119 Speaker 1: including Mark Harrington. As you heard in our previous episode, 459 00:27:44,240 --> 00:27:46,640 Speaker 1: Harrington and some of his colleagues had split off from 460 00:27:46,640 --> 00:27:49,080 Speaker 1: act UP, in part because they wanted to work with 461 00:27:49,160 --> 00:27:54,040 Speaker 1: government officials, not just antagonize them. By nineteen ninety four, 462 00:27:54,600 --> 00:27:57,840 Speaker 1: TAG was in regular contact with the FDA, and one 463 00:27:57,880 --> 00:28:01,160 Speaker 1: of its members served on the Agencies of FI Advisory Board. 464 00:28:02,359 --> 00:28:06,200 Speaker 1: As the FDA considered the possibility of early approval for sequinivere, 465 00:28:06,760 --> 00:28:09,720 Speaker 1: the activists in TAG made it known that they were 466 00:28:09,760 --> 00:28:14,440 Speaker 1: against it. I asked Harrington to explain their thinking. So 467 00:28:14,560 --> 00:28:17,800 Speaker 1: TAG opposed fast tracking the drug, and I think as 468 00:28:17,840 --> 00:28:20,480 Speaker 1: we tell our listeners about that, that their first instinct 469 00:28:20,480 --> 00:28:22,360 Speaker 1: will be to say, wait a second. I thought these 470 00:28:22,359 --> 00:28:24,240 Speaker 1: guys wanted to fast trike the drugs. 471 00:28:24,280 --> 00:28:26,440 Speaker 4: What happened Berlin happened. 472 00:28:26,880 --> 00:28:29,639 Speaker 1: After the conference in Berlin, where it was revealed just 473 00:28:29,720 --> 00:28:33,399 Speaker 1: how much of a failure AZT was. Harrington had come 474 00:28:33,440 --> 00:28:37,360 Speaker 1: to view the drug as a cautionary tale. Years earlier, 475 00:28:37,600 --> 00:28:40,120 Speaker 1: AZT had been fast tracked and given the benefit of 476 00:28:40,160 --> 00:28:44,160 Speaker 1: the doubt. Now the pitfalls of moving too fast were 477 00:28:44,200 --> 00:28:45,000 Speaker 1: all too clear. 478 00:28:45,760 --> 00:28:48,160 Speaker 4: We recognized that some of the things that we'd done 479 00:28:48,200 --> 00:28:52,160 Speaker 4: to change clinical trials had led to false answers that 480 00:28:52,320 --> 00:28:56,000 Speaker 4: weren't accurate. We found out that the fast tracking for 481 00:28:56,080 --> 00:28:58,840 Speaker 4: drugs resulted in some drugs that didn't work being released 482 00:28:58,840 --> 00:28:59,480 Speaker 4: onto the market. 483 00:29:00,080 --> 00:29:02,560 Speaker 1: Harrington felt that he and his fellow activists had been 484 00:29:02,640 --> 00:29:06,200 Speaker 1: naive for years. They had agitated for drugs to be 485 00:29:06,280 --> 00:29:09,640 Speaker 1: released as quickly as possible to people with AIDS on 486 00:29:09,720 --> 00:29:13,240 Speaker 1: the theory that anything was better than nothing, and. 487 00:29:13,240 --> 00:29:16,120 Speaker 4: We had gotten a scientist in the regulators to also 488 00:29:16,160 --> 00:29:19,719 Speaker 4: be naive. But everyone was tired of all the deaths 489 00:29:19,840 --> 00:29:22,560 Speaker 4: and all the sick people and the lack of hope. 490 00:29:22,640 --> 00:29:25,000 Speaker 4: Everyone wanted these drugs to work, but just wishing. 491 00:29:24,720 --> 00:29:30,239 Speaker 1: Doesn't make it so sequinevere. The protease inhibitor developed by 492 00:29:30,280 --> 00:29:33,600 Speaker 1: Merk's rival Hoff and Laroche struck the members of TAG 493 00:29:33,680 --> 00:29:37,440 Speaker 1: as yet another source of false hope. Among other things, 494 00:29:37,720 --> 00:29:40,400 Speaker 1: Harrington was alarmed by the way Hoff and Laroche had 495 00:29:40,440 --> 00:29:41,600 Speaker 1: conducted its trials. 496 00:29:42,360 --> 00:29:44,760 Speaker 4: They did a little study in fewer than three hundred people, 497 00:29:45,560 --> 00:29:48,560 Speaker 4: and in summer of ninety four they wanted to FDA 498 00:29:48,600 --> 00:29:52,520 Speaker 4: to give it accelerated approval, and we said, no, this 499 00:29:52,600 --> 00:29:54,600 Speaker 4: is three hundred people. You want to do the first 500 00:29:54,640 --> 00:29:57,560 Speaker 4: of a new generation of AIDS drugs with a shitty 501 00:29:57,600 --> 00:30:00,680 Speaker 4: inadequate sample size. That's far too load to tell us 502 00:30:00,680 --> 00:30:02,720 Speaker 4: even if there's a side effects, let alone whether the 503 00:30:02,840 --> 00:30:07,120 Speaker 4: drug works, and you need to redraw your whole clinical 504 00:30:07,160 --> 00:30:08,560 Speaker 4: development plan from scratch. 505 00:30:09,240 --> 00:30:13,600 Speaker 1: From tag's perspective, if sequinavere were approved hastily, it had 506 00:30:13,600 --> 00:30:16,760 Speaker 1: a good chance of dominating the market for protease inhibitors. 507 00:30:17,480 --> 00:30:20,120 Speaker 1: That was what had happened with AZT after the FDA 508 00:30:20,360 --> 00:30:23,440 Speaker 1: fast tracked approval of that drug back in nineteen eighty seven. 509 00:30:24,280 --> 00:30:26,080 Speaker 1: David Franz explains. 510 00:30:26,400 --> 00:30:30,200 Speaker 6: They did not want an AZT like scenario to take place. 511 00:30:30,600 --> 00:30:35,160 Speaker 6: If sequinavere was probably the least promising of the protease inhibitors, 512 00:30:35,560 --> 00:30:38,320 Speaker 6: and yet if it had gotten to market before anybody else, 513 00:30:38,680 --> 00:30:42,640 Speaker 6: they worried that it would you take all the oxygen 514 00:30:42,680 --> 00:30:46,120 Speaker 6: out of the air for the other developed compounds. 515 00:30:47,120 --> 00:30:50,000 Speaker 1: TAG demanded that Hoffman Laroche go back to the drawing 516 00:30:50,000 --> 00:30:54,800 Speaker 1: board and dramatically expand the trial size for sequinavier. They 517 00:30:54,840 --> 00:31:00,000 Speaker 1: proposed eighteen thousand participants, a sixtyfold increase from the original study. 518 00:31:01,160 --> 00:31:05,280 Speaker 1: Hoffman Laroche executives weren't exactly pleased to hear this, and 519 00:31:05,400 --> 00:31:08,480 Speaker 1: to gin up support for their fast track application, they 520 00:31:08,560 --> 00:31:11,800 Speaker 1: faxed tag's proposal to a bunch of other AIDS activist 521 00:31:11,800 --> 00:31:16,160 Speaker 1: groups across the country. When those activists learned about tag's opposition, 522 00:31:16,840 --> 00:31:18,240 Speaker 1: many of them were outraged. 523 00:31:19,000 --> 00:31:22,000 Speaker 6: When TAG went their own way, they stepped on a 524 00:31:22,000 --> 00:31:24,400 Speaker 6: lot of feet. In fact, they stepped on just about 525 00:31:24,440 --> 00:31:27,680 Speaker 6: every foot in the movement. AIDS activists had never before 526 00:31:27,720 --> 00:31:30,520 Speaker 6: this point tried to slow down a drug to market, 527 00:31:31,440 --> 00:31:36,280 Speaker 6: and it created an amazing shit storm in the activist community. 528 00:31:37,200 --> 00:31:40,640 Speaker 1: Dozens of AIDS groups signed a statement registering their disagreement 529 00:31:40,640 --> 00:31:44,280 Speaker 1: with TAG over sequinivir, but TAG by this point had 530 00:31:44,280 --> 00:31:47,120 Speaker 1: built up a lot of sway with the FDA, and 531 00:31:47,200 --> 00:31:49,560 Speaker 1: Hoffman Laroche's application was rejected. 532 00:31:50,760 --> 00:31:55,600 Speaker 4: The controversy was fast and furious between libertarian activists who 533 00:31:55,640 --> 00:31:57,680 Speaker 4: really thought people should just take anything they want, and 534 00:31:57,720 --> 00:32:00,600 Speaker 4: then kind of more rigorous activists who thought we needed 535 00:32:00,600 --> 00:32:03,120 Speaker 4: better data before approving drugs that were going to be 536 00:32:03,160 --> 00:32:05,920 Speaker 4: taken by hundreds of thousands of Americans and millions of 537 00:32:06,400 --> 00:32:09,400 Speaker 4: people around the world. People from the community were yelling 538 00:32:09,440 --> 00:32:12,280 Speaker 4: at each other and calling each other killers and murderers 539 00:32:12,480 --> 00:32:13,040 Speaker 4: and so on. 540 00:32:13,840 --> 00:32:16,200 Speaker 1: TAG made it clear that they were not just singling 541 00:32:16,240 --> 00:32:20,080 Speaker 1: out Hoffman Laroche. They wanted every drug company working on 542 00:32:20,120 --> 00:32:24,080 Speaker 1: protease inhibitors to take their time to run large, rigorous 543 00:32:24,120 --> 00:32:28,920 Speaker 1: trials that would yield rich, clean data. Other activists stuck 544 00:32:28,960 --> 00:32:31,720 Speaker 1: with what they had been saying for years, and people 545 00:32:31,720 --> 00:32:43,120 Speaker 1: with AIDS didn't have time to wait. Back at Murk, 546 00:32:43,400 --> 00:32:46,480 Speaker 1: Emilio Emini and his colleagues were continuing to track the 547 00:32:46,520 --> 00:32:50,400 Speaker 1: participants of their protease inhibitor trial. Remember, they had seen 548 00:32:50,440 --> 00:32:53,000 Speaker 1: their virus levels plummet in the first week of using 549 00:32:53,040 --> 00:32:56,680 Speaker 1: crick savan, and then like clockwork, the numbers had shot 550 00:32:56,720 --> 00:33:00,000 Speaker 1: back up in all of them, all of them except 551 00:33:00,360 --> 00:33:08,640 Speaker 1: one patient, number one hundred and forty two. For some reason, 552 00:33:09,000 --> 00:33:13,440 Speaker 1: that patient's viral load remained nearly undetectable, not just at 553 00:33:13,480 --> 00:33:15,520 Speaker 1: first but for months afterwards. 554 00:33:16,160 --> 00:33:20,120 Speaker 2: And that one patient, for reasons that to this day 555 00:33:20,440 --> 00:33:25,000 Speaker 2: are never never been really understood, that one patient, the 556 00:33:25,080 --> 00:33:28,640 Speaker 2: virus level came down but never came back up again. 557 00:33:30,640 --> 00:33:31,640 Speaker 3: And this was. 558 00:33:31,640 --> 00:33:34,720 Speaker 2: The first time any patient, as far as we knew, 559 00:33:35,360 --> 00:33:38,680 Speaker 2: that had been treated with an HIV inhibitor, had actually 560 00:33:38,720 --> 00:33:43,440 Speaker 2: demonstrated the ability for prolonged virus suppression. And we kept 561 00:33:43,440 --> 00:33:47,120 Speaker 2: following that patient and never came back up, and just 562 00:33:47,160 --> 00:33:47,720 Speaker 2: stayed down. 563 00:33:48,480 --> 00:33:51,120 Speaker 1: Amini and his colleagues didn't just write this off as 564 00:33:51,120 --> 00:33:55,240 Speaker 1: an anomaly. The data was real, and patient one hundred 565 00:33:55,240 --> 00:33:58,520 Speaker 1: and forty two wasn't some kind of superhuman And. 566 00:33:58,440 --> 00:34:01,640 Speaker 2: What we said to ourselves was, well, the fact that 567 00:34:01,720 --> 00:34:05,040 Speaker 2: it happened in one patient doesn't tell us that, you know, 568 00:34:05,080 --> 00:34:06,800 Speaker 2: we have a high probability that we're going to be 569 00:34:06,840 --> 00:34:08,840 Speaker 2: able to do this, you know and everybody. But you 570 00:34:08,880 --> 00:34:10,759 Speaker 2: know what it does tell us. It tells us for 571 00:34:10,800 --> 00:34:14,440 Speaker 2: the first time that it's actually possible to do it. 572 00:34:16,280 --> 00:34:19,719 Speaker 1: Patient one hundred and forty two became Mrk's north star. 573 00:34:20,560 --> 00:34:23,560 Speaker 2: In fact, various members of the team had mouse pads 574 00:34:23,640 --> 00:34:26,040 Speaker 2: actually made up that actually showed the virus load in 575 00:34:26,080 --> 00:34:29,120 Speaker 2: this one individual. It was a way of saying to ourselves, look, 576 00:34:29,120 --> 00:34:31,719 Speaker 2: we actually did it. Now what we now need to 577 00:34:31,719 --> 00:34:33,520 Speaker 2: figure out is how do we do it in everybody. 578 00:34:38,080 --> 00:34:41,320 Speaker 1: Emini and his colleagues followed their small phase one study 579 00:34:41,400 --> 00:34:43,919 Speaker 1: with a much bigger Phase two trial that would track 580 00:34:44,000 --> 00:34:47,799 Speaker 1: thousands of subjects over many months. Even just producing enough 581 00:34:47,880 --> 00:34:50,200 Speaker 1: drugs for a study that big was a challenge. 582 00:34:50,680 --> 00:34:53,520 Speaker 2: The process of making the drug was not trivial. It 583 00:34:53,560 --> 00:34:57,680 Speaker 2: would require the establishment of literally a brand new chemical 584 00:34:57,719 --> 00:35:02,839 Speaker 2: manufacturing facility. One of the steps was an extreme exotherm, 585 00:35:02,960 --> 00:35:04,480 Speaker 2: which is a way of saying that it was an 586 00:35:04,480 --> 00:35:06,360 Speaker 2: explosive step that if you didn't do it carefully, it 587 00:35:06,360 --> 00:35:08,080 Speaker 2: would blow up your factory literally. 588 00:35:08,560 --> 00:35:11,759 Speaker 1: While the trial got underway, Amini and his colleagues began 589 00:35:11,840 --> 00:35:15,960 Speaker 1: testing out different doses of cricksivan on patients. They also 590 00:35:16,160 --> 00:35:19,480 Speaker 1: tested the drug in combination with other kinds of drugs, 591 00:35:19,800 --> 00:35:24,680 Speaker 1: including AZT. That was a relatively new idea meant to 592 00:35:24,719 --> 00:35:28,640 Speaker 1: address HIV's ability to rapidly mutate around pretty much every 593 00:35:28,719 --> 00:35:30,600 Speaker 1: drug researchers had thrown at it. 594 00:35:31,120 --> 00:35:34,360 Speaker 6: A thought occurred to scientists, and it was simultaneously in 595 00:35:34,440 --> 00:35:38,799 Speaker 6: multiple labs that it's simply a matter of math that 596 00:35:39,600 --> 00:35:45,080 Speaker 6: two drugs is better at preventing the virus from mutating 597 00:35:45,120 --> 00:35:47,080 Speaker 6: in ways that will escape the drug treatment. 598 00:35:47,760 --> 00:35:50,440 Speaker 1: Emilio Emini was one of the scientists who'd helped make 599 00:35:50,480 --> 00:35:54,560 Speaker 1: this discovery. It's so called combination therapy was more effective 600 00:35:54,600 --> 00:35:59,040 Speaker 1: than using a single drug. Before protease inhibitors were developed, 601 00:35:59,280 --> 00:36:01,560 Speaker 1: there had only been in two classes of drugs to 602 00:36:01,640 --> 00:36:05,359 Speaker 1: try in combination with each other, AZT and one other. 603 00:36:06,400 --> 00:36:10,680 Speaker 1: Now there were three each one would attack HIV in 604 00:36:10,719 --> 00:36:14,239 Speaker 1: its own way and essentially back the virus into a 605 00:36:14,320 --> 00:36:18,000 Speaker 1: corner until it could no longer mutate its way out. 606 00:36:18,719 --> 00:36:21,280 Speaker 6: People wanted to try a third drug and to see 607 00:36:21,640 --> 00:36:25,360 Speaker 6: if attacking the HIV virus in three different ways would 608 00:36:25,400 --> 00:36:29,880 Speaker 6: indeed flummix the HIV to the point of being able 609 00:36:29,920 --> 00:36:32,800 Speaker 6: to actually produce lasting results. 610 00:36:33,560 --> 00:36:36,680 Speaker 1: A group of patients were given cricksavan along with AZT 611 00:36:37,000 --> 00:36:41,719 Speaker 1: and the other drug. The early results were remarkable, and 612 00:36:41,760 --> 00:36:44,759 Speaker 1: by the end of nineteen ninety five, Amini and his 613 00:36:44,880 --> 00:36:47,760 Speaker 1: colleagues at MURK were ready to tell the world about 614 00:36:47,760 --> 00:36:50,480 Speaker 1: what they were seeing. 615 00:36:52,880 --> 00:36:55,279 Speaker 8: There's a major new reason for hope in the fight 616 00:36:55,320 --> 00:36:58,880 Speaker 8: against age. Tonight, researchers at an age conference in Washington 617 00:36:58,960 --> 00:37:01,440 Speaker 8: say a new class of drugs were working. 618 00:37:01,719 --> 00:37:05,880 Speaker 1: On January thirtieth, nineteen ninety six, Amini was in Washington, 619 00:37:05,960 --> 00:37:09,440 Speaker 1: d c. To address the annual Conference on Retroviruses and 620 00:37:09,520 --> 00:37:14,120 Speaker 1: Opportunistic Infections. There, he delivered some major news. 621 00:37:14,400 --> 00:37:16,839 Speaker 9: Studies presented at the conference show that over a six 622 00:37:16,880 --> 00:37:20,000 Speaker 9: month period, the drug sharply reduced the level of virus 623 00:37:20,000 --> 00:37:23,200 Speaker 9: in the body. Also, over a six month period, people 624 00:37:23,239 --> 00:37:25,960 Speaker 9: taking the drugs died at half the rate of people 625 00:37:26,040 --> 00:37:27,160 Speaker 9: not taking the drugs. 626 00:37:27,480 --> 00:37:30,279 Speaker 1: Crick Savan, combined with the two other drugs, had made 627 00:37:30,520 --> 00:37:35,160 Speaker 1: HIV undetectable in most patients, and the effect didn't appear 628 00:37:35,200 --> 00:37:38,120 Speaker 1: to be temporary. At the time of the conference, it 629 00:37:38,160 --> 00:37:42,400 Speaker 1: had persisted for six whole months. Audience members gasped at 630 00:37:42,440 --> 00:37:46,160 Speaker 1: the data. For the first time since the AIDS epidemic began, 631 00:37:46,760 --> 00:37:50,480 Speaker 1: a treatment was having a lasting impact. The three drug 632 00:37:50,520 --> 00:37:54,800 Speaker 1: combination was working. After all those years of disappointment. AZT 633 00:37:55,120 --> 00:37:57,759 Speaker 1: did end up being part of an effective therapy, but 634 00:37:57,800 --> 00:38:00,960 Speaker 1: the development of proteus inhibitors had made the crucial difference. 635 00:38:02,120 --> 00:38:05,560 Speaker 1: By March, crick Savan and two other protease inhibitors have 636 00:38:05,680 --> 00:38:09,320 Speaker 1: been approved by the FDA. They were the fastest approved 637 00:38:09,360 --> 00:38:11,160 Speaker 1: drugs in the agency's history. 638 00:38:11,760 --> 00:38:13,920 Speaker 2: I'd be lying if I didn't say it wasn't emotionally 639 00:38:13,960 --> 00:38:18,040 Speaker 2: and personally very satisfying. And what was most gratifying was 640 00:38:18,080 --> 00:38:20,440 Speaker 2: not just looking at the virus load. But it was 641 00:38:20,520 --> 00:38:23,239 Speaker 2: clear that as soon as the drugs became available and 642 00:38:23,320 --> 00:38:26,239 Speaker 2: started to be used appropriately as a combination from the 643 00:38:26,320 --> 00:38:29,960 Speaker 2: very beginning, that the impact it was having on progression 644 00:38:29,960 --> 00:38:31,359 Speaker 2: to as was us extraordinary. 645 00:38:35,400 --> 00:38:38,759 Speaker 1: The three drug combination became known as the Triple Cocktail. 646 00:38:39,480 --> 00:38:41,880 Speaker 1: It came with difficult side effects at a huge price 647 00:38:41,960 --> 00:38:46,799 Speaker 1: tag upwards of fifteen thousand dollars a year. Still, many 648 00:38:46,840 --> 00:38:49,320 Speaker 1: people were able to obtain it through their health insurance 649 00:38:49,800 --> 00:38:54,240 Speaker 1: or through the federally funded AIDS Drug Assistance program. That summer, 650 00:38:54,560 --> 00:38:58,160 Speaker 1: Mark Harrington began taking the Triple Cocktail and experienced an 651 00:38:58,160 --> 00:39:00,120 Speaker 1: almost immediate change. 652 00:39:00,239 --> 00:39:03,239 Speaker 4: My fire load went from over two hundred thousand to 653 00:39:03,360 --> 00:39:09,479 Speaker 4: nothing over the next three months, and it's been either 654 00:39:09,600 --> 00:39:12,200 Speaker 4: very low or undetectable in the twenty five years since. 655 00:39:13,000 --> 00:39:14,760 Speaker 4: And none of us could really believe it at first. 656 00:39:14,920 --> 00:39:17,320 Speaker 4: It was too good to be true, But the truth 657 00:39:17,560 --> 00:39:20,960 Speaker 4: was that these drugs really did stop the progression of HIV. 658 00:39:21,640 --> 00:39:24,920 Speaker 9: Nobody is proclaiming a cure for AIDS yet, but based 659 00:39:24,960 --> 00:39:27,720 Speaker 9: on the results with a new drug combination, many people 660 00:39:27,719 --> 00:39:30,680 Speaker 9: are starting to believe it may soon be a possibility. 661 00:39:31,400 --> 00:39:35,279 Speaker 1: Harrington's friend and fellow activist Garantz. Frankie Ruda had joined 662 00:39:35,320 --> 00:39:37,680 Speaker 1: the movement at the tail end of the Reagan administration. 663 00:39:38,680 --> 00:39:41,440 Speaker 1: By nineteen ninety six, she had scaled back her involvement 664 00:39:41,560 --> 00:39:44,040 Speaker 1: and had enrolled in college hoping to become a doctor. 665 00:39:44,760 --> 00:39:47,000 Speaker 1: She still remembers where she was when she heard the 666 00:39:47,040 --> 00:39:48,480 Speaker 1: triple cocktail was working. 667 00:39:49,080 --> 00:39:50,720 Speaker 10: I was in New York that summer, and I remember 668 00:39:50,760 --> 00:39:53,440 Speaker 10: talking to folks and sort of getting the news and 669 00:39:53,880 --> 00:39:56,719 Speaker 10: just like being in this elevator to this crappy little 670 00:39:56,760 --> 00:39:59,280 Speaker 10: apartment I was sharing with some friends in college. 671 00:40:00,200 --> 00:40:00,359 Speaker 2: Like. 672 00:40:02,920 --> 00:40:05,920 Speaker 10: Feeling like, even though I knew it was the work 673 00:40:05,960 --> 00:40:11,799 Speaker 10: of men and science, it felt like some grand act 674 00:40:11,840 --> 00:40:18,720 Speaker 10: of mercy made manifest. And I think the Lazarus effect 675 00:40:18,760 --> 00:40:21,920 Speaker 10: that people described for these medications on people sort of 676 00:40:21,960 --> 00:40:25,279 Speaker 10: coming off their deathbeds and coming back to life gives 677 00:40:25,280 --> 00:40:28,040 Speaker 10: you a sense also that even the scientists and the 678 00:40:28,200 --> 00:40:32,920 Speaker 10: doctors had to take a recourse in biblical and religious 679 00:40:33,000 --> 00:40:37,880 Speaker 10: language to describe what happened, because it felt like a miracle. 680 00:40:38,719 --> 00:40:42,120 Speaker 9: Where once there was only desperation, there is now genuine hope. 681 00:40:42,400 --> 00:40:46,920 Speaker 13: Started getting weight, and little lakers and pains and problems 682 00:40:46,920 --> 00:40:49,879 Speaker 13: that I had in my body started resolving, and sort 683 00:40:49,880 --> 00:40:51,680 Speaker 13: of like everything went back to normal. 684 00:40:51,960 --> 00:40:54,480 Speaker 15: And now I feel that I have a great potential 685 00:40:54,560 --> 00:40:59,359 Speaker 15: to live a much longer lifespan than was originally fought 686 00:40:59,360 --> 00:41:02,000 Speaker 15: when I was diagnosed in nineteen eighty seven, and I 687 00:41:02,040 --> 00:41:03,120 Speaker 15: look forward. 688 00:41:02,760 --> 00:41:06,440 Speaker 3: To being here for my daughter's graduation next year from college. 689 00:41:06,560 --> 00:41:08,799 Speaker 1: I have a fourteen month old grand. 690 00:41:08,520 --> 00:41:11,840 Speaker 2: Baby that I you know, so I'm looking forward to 691 00:41:11,880 --> 00:41:12,480 Speaker 2: a future. 692 00:41:13,280 --> 00:41:17,720 Speaker 1: The opportunistic infections disappeared, a ma seated people began gaining 693 00:41:17,760 --> 00:41:21,600 Speaker 1: weight again. The so called AIDS wards in America's hospitals 694 00:41:21,680 --> 00:41:23,480 Speaker 1: emptied out and closed down. 695 00:41:23,960 --> 00:41:26,280 Speaker 9: In New York City, which has the most AIDS cases 696 00:41:26,280 --> 00:41:29,160 Speaker 9: in the country, the death rate from AIDS dropped almost 697 00:41:29,239 --> 00:41:32,200 Speaker 9: half from nineteen to day last January to eleven a 698 00:41:32,280 --> 00:41:36,000 Speaker 9: day in July. Across the country, hospitals are seeing fewer 699 00:41:36,040 --> 00:41:38,600 Speaker 9: AIDS patients and fewer deaths. 700 00:41:38,880 --> 00:41:41,680 Speaker 4: When I found out that they were working for me, 701 00:41:42,320 --> 00:41:44,080 Speaker 4: and they were also working for other people that had 702 00:41:44,080 --> 00:41:54,000 Speaker 4: started them, I could exhale, you know, I could say, okay, okay, 703 00:41:54,040 --> 00:41:57,120 Speaker 4: we can move on now. We have got to this point. 704 00:41:57,680 --> 00:42:01,600 Speaker 9: Nineteen ninety six was a watershed year in AIDS. 705 00:42:01,640 --> 00:42:05,200 Speaker 13: It was the first year, the first time that treatment 706 00:42:05,440 --> 00:42:07,680 Speaker 13: actually outpaced the virus. 707 00:42:07,600 --> 00:42:09,800 Speaker 4: And the first time in fifteen years of the pandemic, 708 00:42:10,560 --> 00:42:13,200 Speaker 4: we had something that we could offer to anybody with 709 00:42:13,360 --> 00:42:16,839 Speaker 4: HIV or AIDS that could keep them healthy if they 710 00:42:16,840 --> 00:42:19,359 Speaker 4: had HIV OR, that could reverse their AIDS and save 711 00:42:19,400 --> 00:42:23,839 Speaker 4: their life if they had AIDS, and that was truly unbelievable, 712 00:42:23,840 --> 00:42:24,720 Speaker 4: and yet it was true. 713 00:42:26,520 --> 00:42:29,680 Speaker 1: With that, a new era in the history of AIDS began. 714 00:42:30,600 --> 00:42:55,200 Speaker 1: But the nightmare wasn't over yet, not even close. On 715 00:42:55,360 --> 00:43:00,000 Speaker 1: next week's season finale, why the HIV AIDS epidemic persists 716 00:43:00,400 --> 00:43:03,719 Speaker 1: after the development of the Triple Cocktail, and why it 717 00:43:03,760 --> 00:43:05,680 Speaker 1: continues to this day. 718 00:43:06,239 --> 00:43:10,560 Speaker 13: Anytime you're talking about sex and drugs, it's a moral 719 00:43:10,640 --> 00:43:13,600 Speaker 13: issue rather than a public health issue. 720 00:43:14,680 --> 00:43:19,080 Speaker 1: Fiasco is presented by Audible Originals and Prologue Projects. The 721 00:43:19,120 --> 00:43:22,560 Speaker 1: show is produced by Andrew Parsons, Sam Graham Felsen, Madelin 722 00:43:22,600 --> 00:43:27,239 Speaker 1: kaplan Ula Cualpa, and me Leon Nafock. Our researcher is 723 00:43:27,280 --> 00:43:31,719 Speaker 1: Francis Carr. Editorial support from Jessica Miller and Norah waswas 724 00:43:32,520 --> 00:43:37,000 Speaker 1: archival research by Michelle Sullivan. This season's music is composed 725 00:43:37,000 --> 00:43:41,040 Speaker 1: by Edith Mudge. Additional music by Nick Silvester of God Mode, 726 00:43:41,160 --> 00:43:44,680 Speaker 1: Joel Saint, Julian and Dan English, Noah Hect and Joe Valley. 727 00:43:45,440 --> 00:43:49,359 Speaker 1: Our theme song is by Spatial Relations. Our credits song 728 00:43:49,400 --> 00:43:53,920 Speaker 1: this week is Philosophers by Peter Sandberg. Music licensing courtesy 729 00:43:53,960 --> 00:43:57,720 Speaker 1: of Anthony Roman audio mixed by Erica Wong with additional 730 00:43:57,760 --> 00:44:01,640 Speaker 1: support from Selina Rabbe. Our artwork is designed by Teddy 731 00:44:01,680 --> 00:44:05,760 Speaker 1: Blanks at Chips and Y. David Blum is the editor 732 00:44:05,800 --> 00:44:08,960 Speaker 1: in chief of Audible Originals. Mike Charzak is the vice 733 00:44:09,000 --> 00:44:12,640 Speaker 1: president of Audible Studios. Zach Ross is head of acquisition 734 00:44:12,680 --> 00:44:17,200 Speaker 1: and development for Audible. Thanks to Peter Yasse, Nancy Cole, 735 00:44:17,360 --> 00:44:21,320 Speaker 1: Elliott Siegel, and Catherine Siegel. Thanks to you for listening. 736 00:44:22,000 --> 00:44:24,520 Speaker 1: Come back next week for the final episode of our season.