THE GOOD DOCTOR

He's been in on the AIDS battle since the beginning, but it's the feds
Donald Abrams fights when it comes to scoring marijuana

Dr. Donald Abrams won't say the word "joint." After what he's been through
in his attempts to acquire marijuana from the feds for his research, it's
hard to blame him if his incessant use of the term "marijuana cigarette"
makes him sound like a fifth-grade health class teacher struggling to
explain the dangers of reefer madness.

"I do that on purpose," Abrams confesses. "I have to stay away from coming
across like an advocate."

Abrams is an oncologist with the University of California at San Francisco.
He is also co-director (with Dr. Igor Grant) of the Center for Medicinal
Cannabis Research (CMCR), which is based in San Diego. Of late, Abrams has
been in the news often concerning his seemingly Sisyphean efforts to
acquire marijuana through proper federal channels to conduct groundbreaking
experiments on how marijuana may affect AIDS and cancer patients.

All the publicity makes it easy to forget that Abrams is not some Johnny
Pot Seed Come Lately, pimping some trendy area of research just to grab
some ink. The truth is that there's not a doctor in the world with more
experience dealing with those with AIDS and HIV, because Abrams was there
from the very beginning. With doctors Paul Volberding and the late
Constance Wofsy, Abrams established San Francisco General Hospital's old
Ward 86, now known as the Positive Health Center. The year was 1983, two
years after what was then called only the "gay cancer" began cutting its
scythe of horror across the nation.

While he may be more well-known these days for his struggles to do research
with marijuana, Abrams is hardly some Timothy Leary. Abrams wants in on the
fight, not to drop out of anything.

The good doctor, soft-spoken, well-groomed and exuding an exceptional calm,
sits in his office in General two floors below the AIDS ward. For a
nationally renowned scientist, his office contains not a hint of pretension
or inflated ego. As he speaks, he also clearly is eager to get upstairs to
his patients, walking the same hallways he's trod for two decades.

Abrams is also a a founder of the Community Consortium, a San Francisco
community-based HIV clinical trials group. He has always kept a close eye
on what substances - licit or illicit - his patients were using in their
private battles with AIDS. He has always used his observations, along with
the input of consortium participants, as one means of attempting to direct
scientific experiments to legitimize or debunk some of the "home remedies"
AIDS patients have been using since the initial outbreak of the disease.

It didn't take Sherlock Holmes to notice that many people were using
marijuana for a number of reasons, most significantly as a means to fight
off the "AIDS wasting syndrome" that has caused many sufferers to become
skeletal from lack of appetite. People were also using marijuana to combat
the nausea associated with several AIDS medicines, and for pain relief.

Yet, as Abrams would discover, shaping a legitimate experiment was one
thing, getting the weed to conduct the study was quite another. The
science, quite simply, was in danger of being permanently lost in the
politics swamping the potential benefits of medical marijuana.

"It was unbelievable, the number of OCatch-22's' I found myself coming up
against," Abrams says calmly. "People would tell me in the beginning about
these government conspiracies determined to prevent any positive news about
marijuana from reaching the public and I would think they were goofy. But
after a while, I confess I found myself shaking my head and wondering what
was going on."

The main obstacle Abrams encountered involved the classification of
marijuana by the federal government as a Schedule 1 drug - right up there
in severity with the likes of heroin and LSD. Government supplies of
marijuana for any scientific use were all filtered through the National
Institute on Drug Abuse. What the powers wanted were studies that, at least
potentially, were focused on how bad the evil weed was for any fool dumb
enough to use it.

What this meant for Abrams, of course, was that his pleas for marijuana to
be used to prove such potentially positive results as pain relief or weight
gain among AIDS and/or cancer patients were consistently falling on deaf ears.

"I was reminded many times that the organization was called the National
Institute on Drug Abuse, not for Drug Abuse," Abrams says with a laugh.

It was in 1992 that Abrams first petitioned the government for some
marijuana to be used for his work. It took five years, and several
reworkings of his proposals, for Abrams to finally get government approval
to receive marijuana - the first federal approval for medical marijuana
research in 15 years. To get his hands on the weed, Abrams had to go
through the back door.

Since the feds didn't want to hear anything potentially good about
marijuana, Abrams devised an ingenious - and ultimately successful -
methodology for gaining approval. He offered up a study on the potential
negative interaction between marijuana and protease inhibitors, the
antiviral drugs that, taken in combination with others, have helped
HIV-infected

patients retain healthy immune systems.

"I have to give credit to ACT UP San Francisco for sparking the idea,"
Abrams says generously, as the group has not always been a supporter of
Abrams, lumping him in with every other physician they perceive as
over-medicating AIDS patients. "I was attending a meeting when someone from
the group expressed their concern about the possible consequences of people
smoking marijuana and taking protease inhibitors," recalls Abrams. "I don't
know what their context was, they don't like any drugs at all, but to me, a
lightbulb went off. I rushed home afterward and looked in the textbooks.
Sure enough, I discovered that protease inhibitors and cannabinoids are
metabolized by the same pathway. I knew I was onto something."

The meeting was in 1997. By 1998, Abrams finally had his much-needed drug,
as well as a supply of Marinol, a pill containing THC, the active
ingredient in marijuana. He released the results of the study last year.

He and his group found no negative interaction between marijuana and
protease inhibitors, "and while we were at it, we also took a peek at such
things as weight gain and increased appetite" in the patients, Abrams says
with a smile. Sure enough, AIDS patients who smoked marijuana gained an
average of 7.7 pounds during the 21-day, inpatient study. Those taking
Marinol put on 7 pounds on average while the unlucky placebo-taking
subjects still managed to gain a 2.9 pounds on average.

"We knew from college that marijuana increased the appetite, and we also
knew people were using it out in the community to maintain their appetites,
so it was good to have some scientific evidence to back up what many
doctors were already seeing for years in their patients who were using
marijuana," says Abrams. "It shouldn't have taken so long to get to this
point, but I try very hard to separate the politics from the science. My
job is to help people."

Helping people is always what Abrams has desired. He has always wanted to
be a doctor, "since I found out I couldn't be a tree," he says rather
enigmatically. Yet if Abrams had known what lay ahead, he may have, at the
very least, considered another career.

In July of 1981 Abrams, now 51, was a young doctor, a cancer specialist
heading for Seattle to do bone marrow transplants at the Fred Hutchinson
Cancer Research Center. It was part of his fellowship for the University of
California at San Francisco. Fellowships follow residencies, so Abrams
would soon be in the position of deciding the specifics of his career path.

As such matters are often decided, his career, in a sense, chose him. On
his way to SFO, he happened to flip on the radio. What he heard shaped his
future, and continues to influence even millions of people to this day.

"I heard a brief snippet of a news report that said there was an epidemic
of cancer in gay men," Abrams remembers vividly two decades later. "Being a
gay man, that sort of startled me. Being someone studying to be a cancer
specialist, I was intensely curious. I had only caught the tail end of the
story, so I spent the rest of the trip to the airport flipping through the
dial, but I couldn't find anything more about this supposed Oepidemic.'

"I arrived in Seattle and spent the first day of my month-long rotation
cornering people in what little spare time I had, asking if they had heard
anything about this Ogay cancer.' They all thought I was some sort of
loon," Abrams says, laughing. "Nobody knew a thing about it. That's the way
it was in the beginning."

THE BEGINNING

It's hard to believe it has been 20 years since AIDS hit the public
consciousness, although it would take a bit longer to acquire its formal
name. That's because no one knew what was happening, other than the fact
that people (at the time almost exclusively gay and bisexual men) were
dying indescribably horrible deaths at a mind-boggling rate.

Those who were in San Francisco 20 years ago will never forget the
devastation, the visual evidence of impending death haunting the streets as
once vivacious men became little more than barely moving skeletons, covered
with lesions, staring out at the world with the sunken, terrified eyes
reminiscent of WWII concentration camp prisoners.

Donald Abrams will never forget "the beginning." Some people hide from such
ugliness, some leap in and help through their tears. Losing friends, losing
lovers, losing staggering numbers of patients - Abrams uses the seared
images of loss as part of his motivation to continue. He is one of the
world's most respected physicians involved in both bedside patient care and
research toward ... well, toward whatever helps.

By August of 1981, Abrams had returned to San Francisco.

"By then (fellow AIDS pioneer) Paul Volberding had just completed his
fellowship at UCSF and become the first full-time oncologist at San
Francisco General hospital. I was still a fellow and fellows are supposed
to get laboratory experience. Paul knew that I was gay and he also knew
that I wasn't too keen on laboratory work per se - I've always been more
interested in being with the patients, I think that's what I do best.

"In any case," Abrams continues, "Paul told me he had just seen his first
case of gay cancer at S.F. General and thought I should become involved. So
in August I began doing my lab work with Harold Varmus, who of course went
on to win the Nobel Prize (in 1989 with J. Michael Bishop for their work on
cancer-causing genes). Their lab was a retro virology lab."

Abrams found himself in the center of the storm, in exactly the right spot
to acquire information because AIDS, or more accurately, HIV, is a
retrovirus. It involves the flow of genetic material. Let the doctor
explain it:

"Normally the flow of genetic information follows this sequence: DNA makes
a piece of RNA, which makes protein, which puts the cell together," a
patient Abrams offers. "A retrovirus is a single piece of RNA, which then
gets into the cell that it infects. From here it goes into the

genetic material of the cell and uses a special enzyme to copy itself into
a piece of DNA. So it goes against the flow of nature - RNA making a piece
of DNA that then inserts itself into the gene of the cell that it infects."

Super simplified, DNA (deoxyribonucleicacid) forms the pattern of the
genetic code, unique to each individual. RNA (ribonucleic acid) serves as
the messenger for the genetic code. When the messenger starts dictating to
the boss - fundamentally changing things in the case of AIDS - all hell, as
we all have learned, breaks loose.

In 1981, no one knew the "gay cancer" was caused by a virus, much less a
retrovirus. Abrams' work in Varmus' retrovirus lab, and his previous
experience as a hematologist with Kaiser Hospital in 1989, proved to make
him a perfect choice to join Volberding and Wofsy (a specialist in
infectious diseases) in launching the nation's first program dedicated to
fighting the epidemic.

In 1983, the trio treated San Francisco's most severely ill patients in
Ward 86. It was in 1984 that the HIV virus was identified, and Abrams and
his colleagues have never stopped conducting clinical studies on how best
to defeat the disease, as well as help find ways for their patients to
continue with fulfilling, complete lives.

By 1984, Donald Abrams had the largest AIDS patient load of any doctor in
San Francisco, which means that it was quite likely he had the largest load
of any doctor in the world. Perhaps someone in New York saw more death -
though it matters little when one is seeing death on such a massive scale.

SPIRITUAL CONNECTION

In the 20 years of AIDS, nearly 19,000 San Franciscans have lost their
lives to the disease. Worldwide, the death toll has surpassed the 20
million mark attributed to the Spanish influenza of 1918.

Of course, numbers are cold and distant, especially in such quantity. To
think that every statistic is in reality a human being, with family
members, lovers, co-workers - it's almost too painful to get the mind
around. Abrams has experienced the dying of others from all angles,
professional and personal.

"From the years 1985 through 1989, the four men I had serial monogamous
relationships with are all dead now," he says quietly, his eyes looking off
into the distance, into the past. He speaks of one loss in particular, one
death that shaped his life.

"In 1989 my lover, Mark Henry, died. When we got together, I knew he had
HIV and that he was sick, but we were together for almost four years," says
Abrams. "Losing Mark gave me a tremendous understanding of what my
patients, their lovers and their families were going through. Mark was the
one I was in the hospice with when he died. His death was a very important
part of my education and my growth."

Here Abrams pauses for a heartbeat or two.

"And it took its toll," he concludes with a sigh.

Hospitals and clinics are jammed with excellent, well-meaning doctors of
all stripes who found, after a time in the trenches, that working with AIDS
cases was too emotionally draining. Moving on to other areas of focus could
never be construed as an uncaring decision - for many the decision is
paramount to maintaining some sort of emotional equilibrium.

After all, there is only so much death and dying a man can witness. Then,
if you're like Abrams, you might start looking toward the heavens.

Those who stay find their own ways of coping. Abrams, quite literally, did
start looking skyward. In 1994, he began a new relationship with his
current partner, Clint Werner. Along with using his talents as a
macrobiotic chef to eliminate red meat, sugar and dairy products from
Abrams' diet, Werner introduced Abrams to a wondrous new hobby. The couple
travels the world to experience the physical and spiritual beauty that
accompanies a total solar eclipse. For Abrams, it has been a near-magic tonic.

It was evident in his manner how viewing an eclipse revitalizes Abrams, as
he had just returned from an eclipse journey to Africa, expecting to view
the event in Zimbabwe but ending up watching in Zambia, as the first Z
country couldn't get the infrastructure together to handle the congregating
herds. Although Abrams describes Zambia as "50 to 100 times" less developed
than Zimbabwe, which he further figured was "50 to 100 times" less
developed than South Africa, where he had attended an AIDS conference, the
relatively harsh conditions did not have a negative impact on his experience.

"This was my sixth total eclipse and there is nothing like it in nature,"
Abrams fairly rhapsodizes. "When I first started seeing solar eclipses (in
1994) it was in a different era of HIV, when more patients were still dying
rather unpleasant deaths.

"It is the most amazing natural phenomenon. It brought home to me that
there must be some bigger power up there that's sort of in charge," Abrams
says in his understated manner. "It was a spiritual experience and now
every time I see one it sort of refreshes my spirituality, it gives me more
faith that perhaps there is some method to all this madness that is the
world as we know it."

There is total darkness, the essential life force is seemingly snuffed.
Blackness, night in the middle of the day. Animals, people even today, can
panic and think all is doomed. Then, miraculously, all is restored. Light
returns, life is saved.

Much like what Abrams and his colleagues are trying to facilitate as they
keep pushing to bring the world out from under the immense cloud that is
the AIDS epidemic.

"I hadn't even thought of eclipses in such literal terms, made that
connection," Abrams smiles reflectively, "but that's good, that may be a
part of my attraction, my spiritual connection to what is at its core a
quite predictable scientific event. I like that."

Abrams needs all the inner strength he can muster. For example and
ironically, given the care he takes to steer clear of the politics and
concentrate on the science and the patients, the New England Journal of
Medicine recently declined to print the results of Abrams' much-heralded
study on marijuana and protease inhibitors. Their reasoning? It sounded too
much to them as though he were advocating medical marijuana.

"It took us two years to do the study, five years to get the marijuana for
it. They had the nerve to suggest that I submit it as a 400-word letter to
the editor," said an obviously peeved Abrams. "I felt that as a severe
disappointment, that one of the two reviewers basically said that our
manuscript, which I think was deeply scientific, sounded like an advocacy
piece. I'll just reformat it and submit it to yet another journal, but I
feel that in this case, they were just incorrect. It's amazing the number
of walls that keep popping up."

Still, Abrams' perseverance, along with other factors such as a new
Democratic governor of California and work by state Sen. John Vasconcellos
(D- San Jose) to establish guidelines for enforcement of Proposition 215,
the state's medical marijuana initiative, have apparently paid off for the doc.

Earlier this year, the state agreed to fund four studies - three to be
conducted by researchers at Abrams' CMCR, to look at whether marijuana can
relieve symptoms and pain associated with AIDS and multiple sclerosis.
Abrams himself will be responsible for one of two studies on whether
smoking marijuana helps relieve nerve pain associated with HIV, as current
drugs have proved ineffective at easing the pain, research has shown.

Another study would examine whether smoking marijuana affects spasticity, a
multiple sclerosis symptom which causes pain, spasms and loss of function.
The fourth study would look at the effects of marijuana smoking on driving
ability.

In any case, federal approval for the marijuana supply is expected,
finally, to happen swiftly, thanks to more streamlined interaction between
various national agencies.

"I think it's groundbreaking and I'm frankly relieved that finally we
scientists can look at cannabis as a possible therapeutic rather than being
limited to searching only for its possible ill effects," says Abrams. "I
think we're at the beginning of a new era."

By the by, the next total eclipse will also cross southern Africa, ending
as a sunset in Australia.

"I've never seen an eclipsing sun setting," says Abrams dreamily. "Thirty
seconds - that's how long it will last, just 30 seconds. But I think it
might be an experience too hard to pass up. I think I might be going to
Australia."