1980/81 - CDC is monitoring the health status of America. They do kind of interesting things. They take of really important problems, like measuring how many people are dying and etc., etc. I read a paper once in the CDC Morbitiy Mortality Report where the center for disease control recommended that all coke machine designs be changed. What they had noticed was the following: 2 people had been killed by coke machines. Their mechanism by killing is, somebody had put their dollar in a coke machine and the coke machine didn't give them a coke. Sometimes you take a shot at the coke machine. What I'm telling you is under 2 sets of circumstances the coke machine took a shot back. The CDC thought we can prevent all of this by making coke machines in the shape of a pyramid. Supposedly it is hard to tip over a pyramid.
They are not only important in tapping numbers and doing epidemiology, but they are the repository for Orphan drugs within our country. What I mean by an Orphan drug is, a drug against a rare disease, an orphan disease if you will. There is some arbitary cut off, lets say under 200,000 people get the disease then that disease is rare enough in our society that your pharmacist probably isn't going to want to keep this on the shelf. Because if it's a rare disease it's going to sit on the shelf and nobodys going to take it and it's going to go bad. Therefore, the CDC is like a big drug store and if you get a disease and there is a cure for it, and there aren't many cure for Orphan diseases, because if you were a pharmecutical company and there are diseases that impact a large number of people and there are diseases which impact a small number of people, which one are going to be working on? The big ones. I know they do both, but they don't like doing both.
Early in the history of AIDS epidemic, for example, people didn't want to work on AIDS, the pharmectutical companies, because there was'nt enough people who had it. We will certainly come back to that question.
There is a disease called Pneumocystis Carnii peumonia. It was not prevelant in our population. There was a drug to treated called Pentamadine. It was indeed stored in the Center for Disease Control. What happened is, if I went to my doctor and he gave me a diagnosis of pentamadine, then the doctor would call up CDC and I would get my pentamadine. There was a woman working for the CDC and she was monitoring the release of pentamadine. This was the background noise going on. There were cases of immunosuppressed people, it was going along, and in a specific month she noticed that there were 27 cases; I'm making up the number. She realized that this is too many. In that first initial 27 cases she wrote a note to her boss saying there is a problem and we better start being conerned. People only get PCP when they are immunosuppressed. The immunosuppresion could come from getting a kidney transplant or having somthing like that, but she said too many.
As a result of these early cases, in 1981 epidemiologist from the Center for Disease Control went out and interviewed these patients who were getting the pentamadine. The epidemiological profile that jumped out from those first 27 patients must have been incredibly frightening to these epidemiologists because, when they were asked about the numbers of sexual partners that they had, these individuals were on the permiscous end of the life style. It was not unusual for these men, they were gay, to have a thousand partners a year.
The profile that came out of this was, gay young men who had large number of sexual partners. The immediate profile that came out of this establishes a stagmitization that goes on with this disease. The first group to be impacted by this disease in America was the gay population. They were undergoing a sexual revolution in the 1970's, equivalent to the heterosexual revolution that went on in the 1960s. There were bath houses were there was enomerous sex going on at such incredible rate.
There was a patient that was referred to as patient 0, and out of something like the first hundred cases of AIDS which were indeed discovered by this particular process, he had slept with 48 of them. He was a stewart on an airline and so he would go into a town and pick up someone and the disease spread by this. The thing that I'm trying to point out now is, from an early epidemiological profile, what came out of this was a lifestyle. This was a historical accident and we lived with the consequences of that historical accident.
I'm going to try and emphasize that things that happened back then still impact on this because it is still believed that this is a gay disease? Yes, by a lot of people. And it is still predominantly within the gay population in America. However, the ratio of men to women who are HIV infected in the world is about 1:1. Therefore there is a realy important lesson here. This is not a gay disease. As a result of a historical accident it got into the gay population in America and it spread. It spread within that population and is gradually leaking into the heterosexual population in our society, but globally that is not true. These epidemiologists, mode of transmission, it was clearly indicated early by people like Etandez Gus that this was a sexually transmitted disease and very early during the history of this epidemic. I strongly recommend that if you don't want to read a book at least look at the HBO movie, The Band Played On. You will see that these epidemiologists were busting their hump, if you will, and in the first year or two they had elaborated that this was a sexually transmitted disease, that it was blood-born, that it could be transmitted by transfusions, that it could be transmitted from mothers to babies. It is kind of interesting because over a short period of time, under two years, this little group of nerdy scientists had elaborated the modes of transmission.
As we go on to this particular thing, I'm going to talk about a professor by the name of Michael Gottlieb and the reason why I'm talking about him is basically for two reasons; he was at UCLA so the history of AIDS was definetly impacted by UCLA as an institution. Michael Gottlieb was a young faculty member, basically a post-doctorate fellow in the UCLA School of Medicine. In order to succeed in an academic environment you have to have certain personality flaws. You must be aggressive, you must put all other kinds of things away, because early in your career you give up a lot to become successful so you don't have to do much later.
Michael Gottlieb was a young clinical fellow in UCLA School of Medicine. He heard about this disease. There were people coming to the hospital at UCLA who were immunosuprressed who had PCP, and he wanted all of them to be given to him. He was very concerned with #1 is this a problem in our society, and #2 establishing his reputation in the field of medicine.
Michael Gottlieb wrote the first description of this disease in the Weekly Morbility/Mortality Report. He described that these patients were immunosuppressed and that the basis for their immunosuppression was by a decrease in their T4 lymphocyte count. We will talk about T4 lymphocyte later. He showed that this was an immunosuppressive disease. He also did an amazing thing. He asked for a whole bunch of money to study this disease. His superiors either didn't think he was right or they didn't like him, or probably a combination of both. They denied him this money. He went above his bosses heads. He went to the regions and state legislations and said, "were are going to have a problem, because there is this disease that is sexually transmitted which is ever-expanding." This action made his bosses angry, his superiors in the medical school.
Michael Gottlieb was denied tenuer in medical school on the basis of him not doing anything of academic significance. This is kind of an irony because, as long as we remember the AIDS epidemic he will be remembered for doing something important. I bring him up because he now establishes a clinical correlates of this particular thing. What I like you to realize is, I'm trying to take away this, what I consider misperception that people were not doing anything. People were doing things.
What happens in 1983? I bring this up for the following reason. Here is an agency called the Center for Disease Control. Here is another agency called the National Institutes of Health (NIH). The CDC hires basically applied scientists. The NIH is our federal government's agency to carry out basic research. What I mean by basic research is research at the cutting edge of the envelope. Like all human interactions there is a hierarchy. Applied scientists are thought to be lower than basic scientist, and this is particularly true if you are a basic scientists.
People at the CDC were really involved in elaborating the initial mechanisms for transmission and were very concerned about the AIDS epidemic. The people at NIH were at the beginning of this epidemic indifferent to this disease. It did not impact enough people and people at the NIH said, "not our problem." If you were in the AIDS community at that time, you did not call NIH, you called the NIH not interested in homosexuals. That was the attitude because the power structure said this is not a significant enough problem for us to work on. We are working on cancer and the really important questions, they are not really important.
In 1983, a many by the name of Anthony Fauci wrote a paper in the JAMA in which he implied, never really said but he implied, that HIV could be casually transmitted. If there is any paper we would love to take out of the medical literature that had an impact at that particular time, it's that paper because the communication system in our society, newspaper and television, really ignored the epidemic at the beginning but they emphasized this paper because they read it and said, "here is an important guy who said it might be casually transmitted." We can trace that fear directly back to this particular person. I want to say right now that there is absolutely no evidence that HIV is casually transmitted or will ever have the potential to be casually transmitted. When you ask people if there is a possibility that this virus could mutate and it could indeed become transmitted by saliva? As a scientist we always have to say yes that is possible. But as a scientist I can also tell you that casual transmission doesn't happen so that was a misconception.
One of the things that does happen in a very interesting sequence of events. There is another person, Bob Gallo who also works at the NIH, a person in this business. When I'm talking about this business again I'm talking about a professional scientist who brings all the personality flaws to this business. He is not a very nice guy. Bob Gallo was the first person to show that a human cancer was caused by a retrovirus. In essence, does Koch's postulates and demonstrates that a virus called HTLV-1 (human lymphotrophic virus) cause the disease called Cessaries cancer in human beings, and he becomes incredibly important in the field of retroviral research.
In about 1983 there was some indications that retroviruses may be important in this disease. Therefore, Bob Gallo started putting some people on this project and so they did start working on this. However an interesting sequence of events occurs. I'm going to spend a little bit of time talking about this, the controversy that surrounds the discovery of the causative agent of this disease. I want to spend time talking about this to point out how science is done, what scientists are like, and again I'm making generalizations that are not 100% sure. Science is driven often times by competition instead of cooperation. As a scientist to come in second place means you have lost.
In 1983 in a journal called Science Luc Montagnier published a paper in which he isolated or he characterized a retrovirus that he called LAV (Lymphadonopathy virus). He argued quite well that this was the causative agent of AIDS. When you publish a paper in any peer reviewed scientific journal in the world that paper is sent out for review. Montagnier sends it to Science and asks them to publish this, Science sends it out to three people to read and they make a determination whether it is good enough. One of the people that it was sent to was one of the worlds most eminent retrovirologist, and that was Bob Gallo. Bob Gallo read this paper and said this can't be true because if anybody is going to find that a retrovirus causes AIDS it's going to be me.
Scientific papers are written so there is a body of a scientific paper and an abstract of the paper. It turns out that Bob Gallo wrote the abstract of this paper as a part of his reveiwing processes and send it back. In the abstract of this paper it said might cause the disease. In the body of the paper, written by Luc Montagnier, it said it causes the disease. Therefore, it was publsihed as a kind of mixed message. The paper was published and there was a great interest around the world, but not so much interest in America. When I say not so much interest is a kind of lie. People at CDC very much wanted to work on LAV. And the power structure in American science said that Bob Gallo was more important than the people at the CDC.
Nine months later Bob Gallo publishes a paper, as a matter of fact 3 papers, same journal called Science. In that particular series of articles Bob Gallo claims that he found the cause of AIDS, and it is not LAV it's HTLV-3; because he found another virus in between. The scientific community now claims Bob Gallo found it, therefore it must be true. The secretary of health and human services announced that within 2 years we will have a vaccine. Bob Gallo applies for a patent for AIDS test to the American patent agencies. Nine months before that Luc Montagnier had applied for a patent. Until this day Luc Montagnier's patent have not been awarded. This test is a money making operation. What I am telling is that the AIDS test could have been available 9 months earlier, except that the american government along with Bob Gallo did not want the French to get precedents. This is tragic because it points out a problem with competition vs. cooperation because it means than anybody who got HIV infected by a blood transfusion during that time period could have been prevented. This is a national disgrace because this thing goes on and on and on.
During the time period from 1983 to basically today there has been so much controversy between who discovered the virus. French government was suing the American government. They wanted 1/2 of the mone. Ronald Reagan and the president of France actually got together and said we will split the money. They split it on the basis of the following: It was determined that the virus, LAV that Luc Montagnier isolated, was virtually identical to that virus that Bob Gallo isolated. When you say they are identical with each other, I want to make the following point. HIV exists in multiple and multiple strains. You will find out that it's probably one of the most mutable organism that we ever discovered. It has a high mutation rate. Therefore, indeed if I look at each individual patient they are infected with a different virus. If I looked at my virus and your viruses, they would be genetically different but what I'm telling you is that the two viruses that were isolated in those two laboratories were the closest viruses ever characterized in the history of HIV. What makes it interesting is the following.
When Luc Montagnier found the virus he sent it to Bob Gallo, as all scientists are obliged to do. If I find something important and someone writes and said I want to study it, I have to send it to them. I don't necessarily want to because they now become a competitor. But Bob Gallo had this virus in his lab and he isolated exactly the same virus that Luc Montagnier had sent him.
Bob Gallo claimed that the other virus contaminated his culture and it happened by chance. There has been all kinds of suits going on for this particular thing for the longest time, and whenever there are suits there are attorneys. An attorney found in a post-doctorale notebook a picture of the virus. Under that picture it said virus given by Luc Montagnier. That picture was the picture that was published in the scientific paper that Bob Gallo wrote. And under that it said here is the new virus we found. The interesting thing that happens is that Bob Gallo and Luc Montagnier have had this ongoing controversy as to who discovered this virus.
(Overhead - The Chronology of AIDS Research pg. 86)
In a journal called Nature, which is one of the most eminent journals in the world, an interesting scenario happened. This is a commentary which means, in a scientific journal when we used the word commentary it means that it has never been examined for peer review and accuracy. The scientific community was so angry with Luc Montagnier and Bob Gallo that they decided to let the two scientists settle their differences on their own behind closed doors. The driving force in putting them behind closed doors was Jonas Sulk who recently died. It turns out that not only he was important in polio but important in history of the epidemic. Thus, Bob Gallo and Luc Montagnier wrote this amazing paper, a compromise between Bob Gallo and Luc Montagnier. These two could not even decide on what to call the virus, LAV or HTLV-3. If they picked one name over the other, the person who made up the name would get precedent. Therefore, they had to compromise and now we have the name HIV; HIV is the compromise between these two peoples egos.
Bob Gallo in his whole laboratory for the last 10 years have been under investigation by the office of scientific integrity and the office of scientific research. With the new Republican regime in office all the problems have dissapeared. Bob Gallo, flat out, stole the virus from Luc Montagnier. Today by any standards Luc Montagnier and Bob Gallo are the most eminent retrovirologists in the world. Bob Gallo publishes a paper on AIDS research every 4 days. He was 100's of post-doctorale fellows. He has done a lot of important things.
One has to think when we do have large scientific problems, does cooperation or competition make things go faster? I think you can make an argument for both. When he initially found this particular thing, he grew HIV in a steady culture, and he actually lied, he did not do that. In the papers he wrote that I isolated a new cell line to grow this particular virus. That implied that if Iwas working on HIV in my lab I had to get cells from Bob Gallo to grow the virus. So you have a secret that I need to get from you. This is what he wrote in the paper. We wrote to him and said can you tell us the secret? We got a letter back saying, "well I'm not sure you guys are sophisticated enought to work on this because you might hurt yourself, you might get infected." It turns out with closer scrutiny, he lied in the paper. The cell line that he grew it on was a cell line called HUT, which was available from time zero in the American Tissue Culture Bank. He flat out lied because he didn't want people to get to his level of doing research. This is a competitive business and so it becomes interesting.
The whole idea of AIDS testing, if you have read anything about France and the history of AIDS epidemic in France, one of the things that happened in France is because of this inter-relationship between the tests the French people did not want to use the American test; they were pissed. The administors of health were writting notes back and forth saying "we refuse to use the american tests and we are trying to get ours back in order." Because of this time period 400 people are going to become infected. The french people read these notes and they got pissed and they took those people who were lower level ministers and trialed them for poisioning the blood supply and through them in jail for 4 years. A scientist spent 4 years in jail for poisoning the blood supply. He was released and they said that was not enough, and so they trialed him for something else and through him back in jail.
1985, because of the discovery of the virus, the causative agent, a test becomes available. That test becomes an important component for the following reason. Up until this point we had a disease called AIDS. We did not know about the asymptomatic phase because when people were not expressing symptoms we didn't know that they were infected. But with the development of the HIV test we could now go back and characterize the clinical course of the disease. AIDS indeed was an end of a chronic infection where there was an asymptomatic phase and we could go and find those people. Secondly, we could indeed screen every pint of blood that was donated in America for the presence or abscence of antibodies against the virus. If it was positive you would not give it to people. This was really important. In 1985 it was estimated that 1 out of 400 pints of blood in the city of San Fransisco was contaminated with the HIV virus. And, an average cardiac bypass operation requires 20 pints of blood. If you divide 20 into 400 that means that if you went into the hospital for a bypass in the city of San Fransisco, in 1985, you had 1 out of 20 chance of becoming infected. This became elliminated as a mode of transmission as soon we got the test.
In 1985-1986 the first drug against HIV infection was approved by the FDA, and it was a drug called AZT. AZT is by no means a cure all. It may not even be a very good drug, but I want to point that if the epidemic starts in 1980 and the first drug was released in 1985 that is not bad. When you realize that the average time between testing and approval for an FDA drug is somewhere between 10 and 12 years. AZT was initially used or tested as a cure for cancer. Therefore a large fraction of the tolerant studies were already done. We found out that it had a little or no impact on cancer, but Burls Welkim took this on and got it FDA approved. The way we test drugs and release them sets up another controversy. Burls Welkim, because this drug was an orphan drug and they were given rights over this drug could charge exclusive rights over this drug and could charge whatever they wanted. Early during this disease people were charged $15-20,000 a year for that drug.
In 1991 another drug called DDI. 1992 we are still hunting for a cure, we are hunting for vaccines. If we talk about this epidemic and I now show you an outline of my generic epidemic, we certainly went through the unknown phases pretty fast. We know the causative agents, we know all kinds of mechanisms of spread. Therefore, this is different than the tylenol scare because we are not at the end, even if the end really exists. One of the things I want to try and convince you of, when it comes to my scientific collegues I think on a whole the scientific community has responded to this epidemic pretty well.
(Overhead - A Comparison of Other Epidemics pg. 85)
I'm going to look at plague polio and AIDS. I'm going to talk about the first kinds of things or the first documented epidemic, isolation of the agent that causes it, and first therapy. When we go back in the plague and you read in medical literature the first outbreak of plague was 560 AD; this is according to the medical literature. The agent that caused that disease was discovered in 1894. This is a long time. When you compare that to AIDS, 1981 to 1984, we did not do bad. It took us only 3 years to find the cause. I am being unfair in a certain fashion because the status of scientific technology in 560 AD was not as nearly sophisticated as ours. But if you compare the time period between when polio was first described and when the agent was found that caused it I'm not only trying to make an argument that we have not done too bad with respect to the AIDS epidemic but what allowes these numbers to decrease. Why did it take that many years to find the cause of the plague and 3 years to find the cause of AIDS? My answer is that we as a society dedicate a certain amount of money and the technology that derives from that money to carry out basic research. We are expanding ever more the envelope of our knowledge. It is going to be my contention that we spend something like $14 billion every year on biomedical research and that that money is really well spent because the stuff that may seem really stupid ultimately can end up to have really important benefits in life. I am not only proud of my scientific collegues with respect to how they responded to the AIDS epidemic, but to the normal progress of human knowledge. If I can tell you that when I was born we thought proteins were the genetic material and we found out that DNA is the genetic material in 1940's and what it looked like in 1950's and retroviruses are here, that has been really important in the history of this epidemic.
6/28/95 3rd Hour - Historical Perspective
(Overhead - Political Time Line pg. 85)
I have given a description of the history of the epidemic from a scientific perspective. When I started the lecture what I said is what I want you to think about is, were we ready? What I mean now, I am now talking about particularly the way science is done in America. If you look at the Center for Disease Control and you talk about the NIH, if you are unhappy about the way things are working then you should go out and say maybe we need to restructure the whole picture and get different things. But my perspective is I'm really happy the way the CDC responded to this epidemic and I'm with the NIH, and maybe I want Bob Gallo working at a university instead of NIH, but I don't want to throw away the system because I don't think I know a better system yet.
Now I want to talk a little about the politics, or the socio-political history of the epidemics; the players and their roles. In 1980-1981 an interesting happens, that is when the epidemic starts and Ronald Reagan gets elected as the president. One of the things that we have to talk about is the role of our political leaders in responding to crisis. Clearly I think that the AIDS epidemic was a crisis and Ronal Reagan responded to that crisis. Here is my cartoon representation of the way that I think he responded to the epidemic. You don't have to agree with me but I think he had his head up his butt. When I say that look at what I mean. The AIDS epidemic starts and clearly at the beginning it was probably small. His scientific advisors were probably giving him information saying there is a potential health problem in our society. Ronal Reagan never mentioned the word AIDS in any public utterance until about 1986.
In 1986 or 87 the only reason why he did talk about AIDS was because one of his friends got the disease and died from it, and that was Rock Hudson. As a consequence he was almost forced to talk about it. One of the things that I will forever hold against Reagan is his lack of leadership with respect to the AIDS epidemic. In my opinion he should have talked about it, he should have made people aware of it, and would it have impacted on the course of the epidemic at all? I don't' know. I think even Reagan realizes he may have made a mistake because after he was no longer president he actually came on television and said in an ad that he had really made a mistake about the AIDS epidemic and he really felts sorry for the children who had AIDS. This may say something about him because again he is talking about the innocent victims of this epidemic and he is ignoring the major constituency.
If I am asking, were we politically ready for this disease?, one way to respond to that would be by saying well maybe we should not have a president. I don't think the system is at fault here, I think we deserve who we elect and if we elect people like Ronald Reagan well that is who we live with.
I now want to give you another scenario. I want to go back 4 years earlier. At that time Jimmy Carter and Gerald Ford are running for president, and Jimmy Carter won the election. Later when Gerald Ford was running for president a set of interesting events occured. The people at the CDC came to president Ford and said that we think there is going to be an epidemic of influenza in America. We have isolated from a soldier at Fort Detrick Maryland the same strain of virus that caused the Spanish flu in 1918. Remember that I talked to you about the Spanish flu at that time period and somewhere between 10-20 million people died of that epidemic. Gerald Ford's scientific advisors came by and said we think this might happen again. Political advisors came in and said, "President Ford, if indeed you have been given scientific advice that there is an epidemic coming and you do nothing about it your chances of being elected are diminished if America finds out about it." From my perspective, Gerald Ford now does exactly the right thing. Gerald Ford, with all of his flaws, he mounted one of the world's greatest public health efforts ever. He put out a mandate from the presidential office that said by next year I want the pharmecutical industry in America to have enough vaccines against the Spanish flu to vaccinate every human being in America. He said, I want enough vaccines against this thing so that every American can be vaccinated. The people in the pharmecutical industry mounted an incredible campaign. That requires a lot of vaccines, and you make vaccine by growing the virus on chickens and do an incredible amount of work. And the pharmecutical company followed the president's mandate and they were prepared to vaccinate every single person against the Spanish flu.
I want to talk about another kwirk of history that happens during this time period. The people who insure the pharmecutical industry got wind of what was happening and they said, 1 year is not enough time to develop a vaccine. And, if there is going to be any problem with the vaccine since the president is making you do this, who should cover any potential liabilities? They said we are not going to do it. It is quite interesting that the American government capitulated and said, we will cover any potential liablilites. That was the monumental step and a precedent in the American government because generally when you try and sue governments you don't even get a chance. This sets an amazing precedents now and we will talk about it later because, in the relationship between the Food and Drug Administration and the pharmecutical company, the pharmecutical industry carries the liability for any potential litigation. Here was an exception and one can only project what's going to happen because yours and my tax dollors are still paying for the litigation that is going on. There was enough vaccine to vaccinate every person in America against this particular disease and people lined up to get vaccinated against this disease, and a strang kork of faith happens. More people died from this vaccine than ever got the Spanish flu. Realize what I just said and I'm making a scenario to make a point. Just by waiting in line someone is bound to die. This epidemic never came. Gerald Ford was given advised by a scientific advisor saying something might happen, get ready, and the epidemic never came. Hence, Gerald Ford never won the election.
Four years later Reagan is elected president. Ronald Reagan was elected president on a political platform that said we like the streamline government. One of the things that Ronald Reagan presumably wanted to get rid of was the involvement of federal government in health care related matters. When I say that what does that imply about agencies like Center for Disease Control? That they might dissapear and go away with the beurocracy. In health care related matters then falls to the state level. Now this is a mandate. If you think about Reagan's mandate that was part of it, and now some nerdy people walk up to Ronald Reagan and say, "guess what president? We are predicting an epidemic." Ronald Reagan looks at them and said, "aren't you the same guys that told Gerald Ford that there was going to be an epidemic, and weren't you wrong?" According to the Bohman perspective, again please make up your own mind, Ronald Reagan made the decision to ignore that information and to use a precedent of Gerald Ford to say weren't you guys wrong? People who are potentially going to lose their job might bring up something to say there is going to be a problem and let us stay around for a little while longer. In my opinion Ronald Reagan made an error because he ignored that information. This time the epidemic did come. Thus, maybe there is a political component involved here. Maybe it is a combination of his homophobia and his conservative politics, and etc. etc. I don't know, but I think it is important to keep in mind that when we talk about politics and science that there are black and white issues. Scientists are screaming for money for all kinds of causes to the politicians and politicians have to decide how to partition that money. Often times with einsight we say they made a mistake and maybe Reagan did.
One of the things that is going to happen is, I'm going to come back to the region 1981-1983 when we talk about money. One of the questions I definitely want to deal with is, how much money should our government be spending on AIDS research, what is appropriate? But before I do that I want to go off and talk about a couple of other people who I think are important in the history of the AIDS epidemic.
Rock Hudson was a reluctant component to the history of the AIDS epidemic because he did not want to be involved at all from what I've read about. But did he change the course of this epidemic? If you look at 1981-1986 and you plot interest in the epidemic, you will find that interest in the epidemic follows a plot something like this. There was certainly papers written about it, they were on back pages, it was called the gay plague and nobody was interested. There were no television programs about it and we did not hear about it on the news. At this point, where Rock Hudson reluctantly announces that he has AIDS and was indeed gay, if you plot interest in the epidemic it goes like this; newspaper articles, television programs, movies. He forever changed that particular point and we owe him a great deal of gratitude for them. He did not want people to know he was gay. The film indurstry spend large amounts of money protecting him. He was certainly an important person.
There was another important person. His name is C. Everett Koop. A more improbable hero in the AIDS epidemic is hard to imagine. C. Everett Koop was to the right of Ronal Reagan and his politics. He was politically conservative and he brought all of that baggage with him to the office of Surgeon General. When he was indeed appointed to the office of surgeon general, the liberal politicians and congress said, "we can't possibly have this guy as surgeon general because he is too conservative." When C. Everett Koop became the surgeon general he put all of his political beliefs aside and he raised his ideals, if you will, to his political office. He stated many times that he thought all of America is his political constituency or his constituency in the office of surgeon general. As surgeon general he did an amazing thing. He had a brochure sent to every household in America. In this particular brochure he talks about condoms, he talks about how HIV is transmitted, he talks about everything that the people in the conservative wing of his party didn't want him to talk about. This brochure was sent to every household in America in 1987.
One of the things that is quite interesting about this brochure, I want to say that I'm really happy that he sent this brochure out but the question I want to ask is, if the epidemic started in 1981 why did it take 6 years, because did we know this before that? Yes. Therefore, we can slap him on the wrist for the delay but we can pad him on the shoulder for doing it at all. In a biography on television he said the following, when he came to Washington he was politically naive, he would have not known how to do this. But as longer he was in Washington the more sophisticated he became. When he brought this pamphlet to the cabinet meeting, he had this brochure printed on blue and gold paper. He handed out a copy of this and it looked like it must have cost a fortune to print it. He told them what was inside the pamphlet and he has enough of them to sent to every household. He fooled them and implied that he had spent $10 on every brochure and the people in the cabinet meeting said, "if you spent that much money you have to send them because we are not storing them." This is an amazing brochure because it indeed was the first attempt to educate the populas of America about the dangers implicit in the AIDS epidemic.
There are other people that are important in this epidemic, and they are people like Ryan White. Ryan White was a young boy who became infected with this disease and he became the spokesperson for this disease. He is now dead, but he was on the cover of every magazine. When you read about him and realized that he was kicked out of school and his family was forced to move from various place, and he became friends with Elton John and really became the spokesperson for this disease. At the age of 12 he showed more maturity than most of the politicans who talk about this disease. Here is a young man who knew he was going to die from this disease. He brought a lot of class and dignity in to this.
Magic Johnson is also an important person in this epidemic. The point that I'm going to make is that what happens. When Magic Johnson announced that he was HIV positive you could plot number of HIV tests done in Los Angeles, number of condoms sold in Los Angeles, interest in AIDS epidemic, some kind of generalization. The point in when Magic Johnson announced he was HIV positive is that an interest spiked, and it stayed up for about 2 weeks. After 2 weeks apathy sets in and that peak comes back down. However he did make that contribution. I don't necessarily hold Magic Johnson as a hero in this epidemic, but he increased awareness. If you talk about Arthur Ashe he was another celebrity and does indeed interest increase. I am being fesicious when I say maybe we need a celebrity to die every couple of weeks.
more to come soon...
Edited by David Melamed, David@DocMelamed.com