Medical Progress -- Live! On CNN!

By Charles P. Alexander

AIDS patients who tuned in last Thursday to Cable News Network and several other TV news shows had reason to feel excited. Reporting live from Atlanta Hospital, a CNN correspondent described an operation in progress aimed at ridding a 37-year-old man, identified only as "Tony," of AIDS by heating his blood to 108 degrees F. Heightening the drama was the presence on camera of Carl Crawford, 33, an AIDS patient who had received the same treatment four months ago and whose symptoms had apparently disappeared.

But there were some warning signals to alert the wary. First, results from the experimental procedure, performed by Drs. William Logan and Kenneth Alonso, had not yet been reviewed by other professionals or published in any medical journal. Crawford and Tony were the only patients who had ever undergone the blood-heating treatment. That is not a large enough group to draw any conclusions, and it is too soon to tell whether Tony will get better or worse. Finally, as CNN duly reported, Atlanta Hospital is on the verge of being shut down by the state of Georgia unless the facility can refute charges (unrelated to the Logan-Alonso experiment) that patients there have received poor care.

What is a TV viewer, particularly one who has AIDS, to make of this story? Is the treatment a miracle cure? Or is it a mirage that cruelly raises the hopes of AIDS sufferers -- the medical equivalent of cold fusion? No one, and certainly not journalists, can know the answers. The case illustrates the press's growing lack of restraint in medical coverage, especially where AIDS is concerned. CNN called the treatment "experimental and controversial," but by leading off newscasts with the story and cutting to the hospital for frequent live reports, the network was in effect trumpeting the blood-heating procedure as a major development. That outraged many medical experts. "This is turning a life-and-death issue into a media circus. Frankly, it makes me sick to my stomach," said Dr. Bernard Bihari, a New York City physician who has conducted trials of experimental AIDS drugs.

The work done by Logan, a retired heart surgeon, and Alonso, a professor of pathology at Atlanta's Morehouse Medical School, started as an effort to treat Kaposi's sarcoma, a cancer common in AIDS patients that produces severe skin lesions. The doctors thought that heating a patient's blood might combat the cancer and possibly even kill the AIDS virus. During the procedure, called hyperthermia, blood is drawn from a vein in the groin, heated in a water bath and continuously recirculated into the body. In little more than an hour, the body's temperature reaches 108 degrees F, and it is kept there for an additional two hours. Crawford came through the operation with no ill effects, as did Tony -- so far. Logan and Alonso were careful not to call their treatment a cure for AIDS. Said Logan at a press conference: "It may not be the total answer. We're not expecting that really."

But last month Alonso thought the treatment was worth mentioning to WXIA-TV, Atlanta's NBC and CNN affiliate, which carried the story on May 25. Five days later, CNN broke the news nationally. Since then, it has been reported, sometimes skeptically, on local TV news shows around the U.S. and in such newspapers as the Boston Globe, the San Francisco Chronicle and the Los Angeles Times.

Only a few months ago, according to Crawford and his doctors, his body was covered with Kaposi's sarcoma lesions, but after the hyperthermia treatment, the sores vanished. Moreover, the doctors claim that his blood tests negative for the AIDS virus. In one of the early CNN reports, Crawford praised his "wonderful doctors. They can't say I'm cured, of course, you know, but I feel that I am cured. I really do."

It is possible that Crawford was in fact helped by the treatment. Or it could be that he experienced an unexplained remission, perhaps aided by his new hopeful attitude. That is known as the placebo effect, and it has been observed in patients with many kinds of diseases, including AIDS. Dr. Sharilyn Stanley, an AIDS researcher at the National Institutes of Health, expressed doubts that hyperthermia could work. She cited studies showing that the AIDS virus can survive at temperatures up to 133 degrees F. Even if the virus has somehow been eradicated from Crawford's blood, it could still be in his bone marrow or other tissue and may re-emerge.

The motives of Logan, Alonso and Atlanta Hospital are open to question. The small private institution has lined up three or four more AIDS patients for the treatment and plans to charge them $30,000 each. (The doctors have set up a foundation to subsidize patients who cannot pay the full amount.) But Logan and Alonso will have to find another place to work unless the hospital can thwart the move to revoke its license to operate. The state is investigating two recent deaths in the operating room.

CNN defends its coverage of the blood-heating experiment. Said Steve Haworth, director of public relations: "We are making it very clear in our coverage how unproven ((the procedure)) is . . . We made it clear that only the patient himself was calling it a cure." Asked if the frequent live reporting from the hospital tended to hype the story, Haworth replied, "It depends on what is going on. We had no other breaking story during the day."

On the air, the network noted that Tony had learned about the operation because of CNN's reporting. His treatment came soon after Janet Adkins committed suicide using a machine publicized on the Donahue show. If people are relying on TV to help them make life-and-death medical decisions, they are asking for big trouble.

With reporting by Tom Curry/Atlanta and Andrew Purvis/New York