Top San Francisco Health Official Urges Faster Drug Trials

San Francisco's Director of Health, David Werdegar, M.D., M.P.H., departed from his prepared testimony to the
Presidential Commission on the Human Immunodeficiency Virus Epidemic to call for much faster clinical trials of drugs to reduce illness and death from HIV infection, at hearings on March 25 in San Francisco.

The oral testimony, on the fourth of six recommendations to the Commission, was as follows:

"I believe in greatly accelerated clinical trials. When you look at our projections to 1993 you can see that the clock
is ticking. The current national cooperative drug trial system is cumbersome and unduly long; it just won't produce the
results fast enough.

"And there are other approaches. We could do community- based trials in high-prevalence areas. We'd be perfectly happy to do it here in San Francisco under Health Department auspices. We can get clinical trials, large scale, with
controls, going tomorrow. The current clinical trials, I'm afraid, are just leaden-footed."

The prepared text reads as follows:

"Greatly accelerated clinical trials of potentially useful drugs to reduce the morbidity and mortality of HIV infection.
The national cooperative drug trial approach is unduly long and cumbersome. It should be supplemented by speedier mechanisms. As our own projections show only too well, time is of the essence.

"Community-based trials in high prevalence areas is one such approach. The Health Department in San Francisco, for example, would welcome the opportunity to conduct large scale clinical trials locally, utilizing the San Francisco General Hospital, the Public Health Hospital, community hospitals and practitioners, and the University of California Health Science Center. These could get under way promptly."

The other five recommendations concerned a comprehensive national plan; Federal block grants for education, prevention, and treatment, directly to the health departments of cities seriously affected by the AIDS epidemic; financial incentives for the development and support of long-term care services; continued support of anonymous and confidential testing programs; and legislation to prevent discrimination in jobs, housing, and health insurance.

We find the research recommendation particularly noteworthy, as it is one of the very few times that any government official has broken with the official line that we're moving as fast as we can, Science can't be rushed, there is no faster way--and too bad about those now infected.

Dr. Werdegar's statement also hints that the central issue in treatment research is NOT financial. What we need most--quick, practical trials which could be integrated with ongoing patient care--would cost relatively little, much less than the ineffectual research programs now in place, and far, far less than the cost of care of perhaps hundreds of thousands of cases of unnecessary terminal illness.

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