Shots in the Dark: The Wayward Search for the AIDS Vaccine

Dear James,

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I was a graduate student at the University of Chicago and a fledgling reporter when AIDS appeared on the journalistic radar scope in the early 1980s. It was called GRIDS by the time I noticed it (Gay-Related Immune Deficiency Syndrome), and no one knew what the hell was causing it. You would see these cryptic wire stories about a mysterious malady that stripped away the immune system, causing strong young people to wither and die as though in time lapse photograph, ending up like '40s-era corpses from the death camps. Eventually, you saw these dying young men on the bus in the morning, their foreheads glistening with sweat on cool days, their shirt collars several sizes too big. I was a science reporter at the Chicago Sun-Times during mid-1980s when science honed in on HIV as the cause. I remember thinking at my desk: "We have got you now, Mr. Virus. We will corner your ass with our all American brains and blast you out of existence, just the way we did all those baddies before you." How little I knew. The Wall Street Journal announced on Feb. 22, 2001, that Merck has "initiated small human trials of a new experimental HIV vaccine that is a spark of hope among AIDS scientists." That we have only a "spark of hope" and have yet to mount a massive vaccine trial this far along bespeaks an extraordinary failure of science--and more. With 40 million people infected worldwide, this also qualifies as a moral failure of biblical proportions.

Cohen takes a cooler approach, arguing (on page 137):

A major reason the AIDS vaccine community failed to organize itself and conduct an ambitious, definitive experiment ... is that the NIH provided an illusion of organization and leadership ... [and] did not like to direct research. Rather, it believed that science was best moved forward by individual researchers submitting proposals for funding, which their peers would then evaluate.

Cohen argues that this led to a scattershot system in which experimental conditions varied so widely from lab to lab that no meaningful comparisons were necessary and potentially fruitful avenues of study were ignored. While research went nowhere, Cohen continues, the high-profile leaders from the National Institutes of Health promoted the sense that "science had attacked the AIDS vaccine problem as vigorously as possible." Cohen is critical of Anthony Fauci, who headed both the National Institutes of Allergy and Infectious Diseases, which received the bulk of the AIDS money from the National Institutes of Health, as well as NIH's Office of AIDS Research, which putatively coordinated research at nearly two-dozen different institutes. Cohen shows that Fauci and the government "exuded competence and confidence'' but actually had a tenuous hold on the research all along. Cohen's main point is that the AIDS project required hyper-directed, independent research projects like the March of Dimes, which began to win the battle against polio in the 1950s. Sponsored by private money (literally dimes mailed in from around the country), Jonas Salk and his Dimes people were free of government timidity, uninhibited by all the log-rolling and meddling that went on in Congress during the early days of the AIDS crisis. (They were also free of modern-day strictures governing human experiments--but that is another story.) Cohen's assertion that a March of Dimes for AIDS would have made more progress more quickly is undoubtedly true. But the polio effort was sustained by a national consensus--that the disease needed to be wiped out and wiped out quickly. AIDS has yet to generate such a consensus--more than 20 years after the first cases were discovered. As one researcher told Cohen: "The polio foundation was put together because Roosevelt had a couple of paralyzed legs--they didn't know much more than that." But with AIDS, "we come in and say 'This question [is] unanswered, this question is unanswered, gee, that's a good question unanswered.' And it goes on year after year." This lack of urgency stems from the fact that AIDS victims in the United States have been mainly homosexuals, drug users, and their lovers up to now. Unlike polio sufferers, who were stricken through casual contact, AIDS sufferers were stricken through deliberate behaviors, making this the most widely stigmatized disease in history.

Shots in the Dark does a spectacular job of reporting the science of the AIDS debacle and showing how the National Institutes of Health allowed the research effort to stampede in 100 directions at once. The book lays out the avarice, ego, indifference, and palm-greasing in Congress that brought us to this dismal pass. But in focusing so tightly on the politics and science, Cohen pays too little attention the moral dimension of what has happened here. To wit: The search for a vaccine failed to gather steam because the victims of this disease were judged less worthy of national compassion than were the victims of polio in the mid-20^th century. I see this as the source of the delay. Do you?

Sincerely,
Brent Staples

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This week, our critics tackle Jon Cohen's Shots in the Dark: The Wayward Search for the AIDS Vaccine. (Click here to buy it and here for an explanation of our format.)

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