Tragic choice, controversy, and public decision-making :the case in France of random selection of AIDS patientsfor treatment (“Lot-Drawing”)
Protease inhibitors, the first drugs to bring about real remission in AIDS, were first developed in 1996. Between the time they were proven effective and the time they became accessible to all AIDS patients in France, the available quantity of protease inhibitors was far from sufficient to satisfy the need. In response to this temporary “tragic choice” situation, the Conseil National du Sida [National AIDS council] proposed that the drugs be distributed by lots ; i.e., through random selection of patients (from pre-established lists). The following is a monographic study of the genesis of that situation, the controversy caused by the recommendation to proceed by lot-drawing, and the consequences of that controversy. Its objectives are twofold : 1) to propose a model for analyzing controversies by studying how media coverage interacted with a specific collective action ; 2) to show the ongoing relations within the particular network of actors –pharmaceutical companies, clinicians, AIDS patient advocacy groups, and public agencies and authorities– involved in getting anti-HIV treatments onto the market in France.