Declaring that Maryland's health system has failed the poor, physicians at Johns Hopkins Hospital said yesterday that poverty and discrimination have placed the life-extending drug AZT beyond the reach of half of Maryland's AIDS patients.
Their comments preceded today's publication of a study that documents how patients who were sufficiently plugged into Maryland's health-care system to get the drug enjoyed dramatic benefits from AZT treatment.
More than half of the people who took AZT lived two years past the date of their diagnosis, the study found, while only a quarter of the patients who didn't take the drug survived that long.
Additionally, doctors said patients taking AZT spent less time in the hospital, felt better during their illness and continued working longer. But less than half of blacks, women and intravenous drug users ever got the drug -- leading to shorter survival times for those patients.
All three groups shared one feature, scientists said: They are more likely to be poor. "Our data show that the system has failed," Dr. Richard Chaisson, director of AIDS patient care at Johns Hopkins, said yesterday.
"The larger answer is reforming the health-care system so it's a system based on need rather than ability to pay."
The study, based on records of the 1,028 AIDS patients diagnosed between January 1983 and June 1989, was conducted by researchers at the Johns Hopkins School of Medicine and the Maryland Department of Health and Mental Hygiene. Those patients include 714 who were diagnosed after April 1987 -- when AZT first went on the market. The study appears in today's New England Journal of Medicine.
Researchers said the study was the most comprehensive look at AZT's benefits to date because it was based on an entire population of AIDS patients -- not simply patients who volunteered for a clinical trial.
The information was gleaned from a database kept by the state health department. Among the study's findings:
* Thirty-five percent of men lived two years past their diagnosis, compared with 28 percent of women. More than half the men got AZT, while one-third of the women did.
* Forty-two percent of non-Hispanic whites survived two years, compared with 30 percent of minorities. Sixty-three percent of the white patients got AZT, while 43 percent of minorities did.
Dr. Richard D. Moore, assistant professor of medicine at Hopkins, said AZT worked equally well for all the demographic groups -- but those steeped in poverty and drug use were unlikely to get the drug.
In some ways, the scientists said, poor people with AIDS face the same barriers to health care as they do with other chronic diseases.
Many doctors, they said, are simply loath to accept Medicaid patients because of low reimbursement rates. A Baltimore doctor who sees a Medicaid patient in his office typically gets $10. A doctor who sees a patient with a private medical plan receives $60 to $70.
But AIDS poses additional barriers, Dr. Chaisson said. Many NTC doctors simply do not want to treat AIDS patients because they fear contracting the disease, lack knowledge about managing the disease or feel uncomfortable having intravenous drug users as patients, he said.
"Whether it's a social barrier or an economic barrier, many physicians do not like to treat these patients," Dr. Chaisson said.
He added, however, that the patients present some problems that are not of the doctors' making. Many do not keep appointments, comply with treatment, seek care to begin with or know where to find it, he said.
Eventually, poor people who never received AZT or other helpful drugs show up desperately ill in the emergency room -- long after doctors can make a significant difference in their survival time.