Wednesday, January 13, 2010

'And the Band Played On: Politics, People, and the AIDS Epidemic'

This book review first appeared in The Washington Times on Wednesday, November 18, 1987.  A slightly different version was published in the New York City Tribune on Wednesday, November 25, 1987.

BOOK REVIEW / Richard Sincere
Uncertain war against a deadly virus

And the Band Played On: Politics, People, and the AIDS Epidemic
By Randy Shilts
St. Martin’s Press
$24.95, 630 pages

Considering the age of most victims of Acquired Immune Deficiency Syndrome, the only possible analogy is with war — a generation decimated, felled not by bullets but by an insidious virus.

AIDS was a political hot potato even before the disease had a name. In “And the Band Played On: Politics, People, and the AIDS Epidemic,” a gripping account of the known history of the virus, veteran journalist Randy Shilts demonstrates how political interest groups fumbled with the issue. Whether this led to the needless deaths of some 21,000 people by 1987 remains to be proven. It is clear, however, that playing politics with human lives can be devastating.

More than any number of back- alley pummelings, the AIDS epidemic has made palpable the deep-seated American animosity toward homosexuals. The evidence is in the response to the epidemic:

In the early ‘80s the National Institutes of Health spent $36,100 of research money per Toxic Shock fatality (it was no longer a mystery disease by then) and $34,841 per Legionnaire’s fatality. In contrast, it spent $3,225 per AIDS death in fiscal 1981 and $8,991 in fiscal 1982.

As a University of California dean remarked early in the epidemic, “at least with AIDS, a lot of undesirable people will be eliminated.”

This blatant bigotry was matched by more subtle remarks. When pressed about AIDS research, former Secretary of Health and Human Services Margaret Heckler noted her concern that it would break out into the “general population” — as though gay men, drug addicts, and poor blacks and Hispanics were an alien population or from another planet.

By May 1987, when President Reagan made his first public speech about AIDS, 36,058 Americans had been diagnosed as having the disease, 20,849 had died and between 1 million and 2 million had been infected. The United States is today the only Western industrialized democracy without a coordinated program to combat AIDS.

It is far too easy to parcel out blame during a crisis. Only historical perspective will verify the accuracy of the charges. Few actors in the AIDS drama escape Mr. Shilts’ scrutiny. He identifies heroes, villains and victims.

The heroes include playwright Larry Kramer and political activist Bill Kraus, who early warned of the dangers of promiscuous behavior and who were ostracized b’ their colleagues for their efforts. They also include the tireless researchers at the national Centers for Disease Control, the Pasteur Institute in Paris and various hospitals around the country.

The political heroes were Democratic Rep. Phillip Burton of California, Republican Sen. Orrin G. Hatch of Utah, Surgeon General C. Everett Koop and Health and Human Services Assistant Secretary for Health Edward Brandt. As Mr. Shilts writes, these men took the commonsense approach “that attentiveness to the AIDS issue was not determined by whether one was liberal or conservative but by whether one did or didn’t care about the public health.”

Sadly, the villains outnumbered the heroes. Government officials head the list: HHS Secretary Margaret M. Heckler and her spokesmen insisted that AIDS researchers had all the money they needed, even as scientists were sending her detailed memoranda outlining the specific shortfalls in funds, equipment and personnel amounting to tens of millions of dollars; Mr. Shilts presents a convincing case that Mrs. Heckler and the administration lied to the Congress, the press and the public about AIDS research.

Likewise he documents that New York Mayor Edward Koch, his health commissioner David Sencer and Gov. Mario Cuomo refused to support AIDS research or treatment for more than five years into the epidemic, though New York City had more than half the AIDS cases. They, too, lied to the public about their concern, he writes.

The media, particularly the TV networks and the prestige press, deserve even more censure. They simply refused to cover the crisis unless it involved someone other than homosexuals. The big papers ignored shocking reports from the Centers for Disease Control, the Government Accounting Office and the Congressional Research Service. Besides the gay press, only the San Francisco Chronicle covered the epidemic in any depth.

Other villains were the bathhouse owners and paranoid gay political leaders who felt that promiscuous sex was a right to be vigorously defended. Blood banks would not acknowledge the danger AIDS posed to the blood supply. The infamous “Patient Zero,” a French-Canadian flight attendant, was linked with many early AIDS cases, yet continued to have sex with unwitting partners well after he had been diagnosed. And his irresponsible behavior was not unique.

More ambiguous is the case of Dr. Robert Gallo, credited for discovering the AIDS virus, which he dubbed HTLV-III. In this account Dr. Gallo is portrayed as childish and egotistical, refusing to cooperate with fellow scientists and setting back the search for a cure, treatment and a vaccine. The book also says there is substantial evidence that he might not have discovered the AIDS virus at all, but took his specimens from the French researchers who actually did.

The list of victims grows each day and includes Rock Hudson, Liberace, Michael Bennett, Perry Ellis, Willi Smith, Stewart McKinney, Terry Dolan, Roy Cohn and Michel Foucault. Regrettably, Bill Kraus, who fought for AIDS funding and against sexual promiscuity succumbed in early 1986.

Mr. Shilts makes no recommendations and offers no conclusions, but several can be inferred. One is that al if the AIDS crisis demonstrates anything, it is the need for a substantial public health emergency fund. AIDS caught everyone by surprise — scientists, doctors, public officials — and it can happen again. Research scientists and physicians should not have to fight tooth and nail for basic equipment in the early stages of a medical crisis. The Capitol Hill appropriations process must respond expeditiously or see thousands die.

The current government response shows no sign of improvement. The conflict between the stolid pragmatism of Surgeon General Koop and the naivete of Education Secretary William Bennett, whose solution seems to extend no further than advocating chastity, continues. And the petty squabbling within the Presidential AIDS Commission promises to destroy that body before its work begins. The band still plays on.

Richard Sincere Jr. is a Washington-based policy analyst and writer.

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