Monday, May 31, 2010

The Reagan Administration Meets the AIDS Pandemic…

…and allies itself with the virus, rather than politically unpalatable science. From Level 4: Virus Hunters of the CDC, by J.B. McCormick, M.D., S.F. Fisher-Hoch, M.D., with Leslie Ann Horvitz, pp. 174-177; McCormick is writing:

Two very important discoveries began to emerge from our investigation. For one thing, we were recording far more cases of AIDS in women than we were used to seeing in the United States or Europe, where the disease was still striking gay men in disproportionate numbers. For another, we were also beginning to see a direct correlation between the number of sexual partners and the rate of infection. This was a finding similar to what physicians had observed among the gay men in San Francisco early in the AIDS epidemic. While we recognized that this was a disease spread by sexual transmission, the shock for us was that, in Zaire, it was almost entirely due to “normal” heterosexual intercourse. But that didn’t mean that there was no homosexual transmission. It was just that our investigation revealed that it was relatively rare among men living in Kinshasa. The same situation appears to be true of most of Africa. Certainly, there was no organized or visible gay community in Zaire, as there is in the West. On the other hand, compared to the West, heterosexual contacts in Africa are frequent, and relatively free of social constraints—at least for the men.

Our findings in Kinshasa were supported by similar investigations throughout Africa, notably in Rwanda. The world now had to face an uncomfortable, frightening reality. We thought about the ramifications of our discovery and discussed them at length. There was every reason to believe that, having found heterosexually transmitted AIDS in Kinshasa, we were likely to find it everywhere else in the world. Until this moment, especially in the United States, AIDS was linked almost exclusively to gays and drug addicts and other marginalized groups such as Haitians. It wasn’t something that was supposed to affect “mainstream” people.

In 1984, our team and a Belgian team in Rwanda, led by Van der Peer, published our conclusions in The Lancet, the venerable British medical journal. These articles would change the way that people looked at the disease. After reviewing the situation in Africa, we then posed a question: “Will this be the face of AIDS in the West within the next decade?”

To some at the time, the very question was itself blasphemous. But we know today, for many countries in the West, the answer is yes. In 1996, AIDS is now the primary cause of death in women between the ages of 25 and 40.

In my report to the director of the CDC, I suggested that AIDS was endemic in Zaire, and that it may have been present since the mid 1970s. I based my conclusions on accounts by physicians who had seen a number of undiagnosed cases of weight loss and diarrhea, invariably resulting in death over at least ten years. Although they’d attributed the cause to TB, it seemed in retrospect that the cause of death was probably AIDS related. In what was the most controversial part of the report, I went on to characterize the disease as one that was spread by heterosexual contact in Zaire, adding that there was no evidence that homosexuality or drug abuse had played a significant role in its transmission. I recommended that the CDC undertake a long-term collaboration with the Ministry of Health of Zaire to establish a system of surveillance for the disease in that country. Finally, I called for the WHO to convene a workshop on the problem to be held either in Kinshasa or Brazzaville, in the neighboring Congo. These recommendations were subsequently accepted.

I returned to Atlanta on November 8 and immediately reported to my chief, Gary Noble, and to the director of the Center for Infectious Diseases, Walter Dowdle. After listening to what I had to say, they both agreed that I should meet with Bill Foege, director of the CDC. This was the year that Dr. Foege had announced his departure as head of the agency, and because his successor, James Mason, happened to be visiting CDC that day, he was invited to sit in on the meeting. In addition, we were joined by Jim Curran, director of the HIV/AIDS Division, and Fred Murphy, director of the Division of Viral Diseases. Serendipity had brought together in one place and time many of the major players in AIDS who were associated with the CDC.

Bill Foege had lived and worked in Africa, so right away he recognized just how grave a situation we were confronting. He decided that we should put in a call to Dr. Edward Brandt, U.S. assistant secretary for health. I was put on the speaker phone with him. I did not know who he was—other than that he was a Ronald Reagan appointee—and I had no idea how he might respond. I began by describing our data and went on to outline our major conclusions. I tried to spell out everything as simply and as clearly as possible.

There followed a long silence on the other end.

Brandt began by saying that I must have got it all wrong.

“There must be another explanation for your findings. Have you considered other vectors, like mosquitoes?”

Mosquitoes were obviously easier for him to talk about than sex.

“I don’t think that the evidence supports that, sir,” I said. “So far, we’ve found very little disease in children. And children get just as many mosquito bites as adults—probably more. That’s why they suffer so much from malaria. And if AIDS were transmitted by mosquitoes, we wouldn’t have seen the sort of random [sic] pattern of distribution of the disease in the population that we did. When you look at malaria, you can see see a random pattern. We all know anyone can get malaria; it just depends on who gets bitten. But what we saw with this disease were definite chains of infection as well as clustering around sexual contacts. There were hardly any cases with children or with old people.”

My explanation, as well-reasoned as I thought it was, failed to sway Brandt. He seemed bent on coming up with another theory; just so long as it would let heterosexual intercourse off the hook. Our discussion went on like this for about twenty minutes. But nothing I could say seemed to make an impression on him. I was stunned by the depth of disbelief—or, rather, denial—on the Washington end of the line. Certainly, everyone sitting in the room with me understood the compelling nature of the evidence and realized that it was imperative that we take action.

Evidently, the conclusion the administration had reached was very different. This was the Reagan era. If AIDS was going to have an explanation, it seemed then it would have to be politically and socially more acceptable than what we had to offer. Voters were not going to like our message. They rested easier easier with the notion of a “gay plague,” as the disease was called when it first became known to the general public. There was a self-satisfied, ugly moralism about that notion. What we proposed to tell them is that AIDS was a plague all right, but that no one was immune.

By steadfastly refusing to acknowledge the dimensions of the AIDS crisis, the Reagan administration made itself an ally of the virus. It would take another year before Washington’s policy would begin to change, with the appointment of C. Everett Koop as surgeon general. Koop, a political conservative with a strong sense of right and wrong, was a great physician and objective scientist. He refused to contaminate public health with ideology.

As George W. Bush might have said at the time, “Brandtie, you’re doing a heck of a job.”

Further, consider: After the meeting described above the Reagan administration knew that HIV/AIDS could kill not just the members of groups it hated or despised, but the people it considered “normal” … and it did nothing, rather than deal with a fact that would not play well with its base – a group that it now knew was no more immune to HIV/AIDS than any other people. So, not even protecting the lives of its political base was more important to the administration than securing its votes.

1 comment:

  1. Alison in Indiana8:17 PM CDT

    WOW, thanks for posting this. It puts some conspiracy theories to shame, doesn't it.