First Policy Statements Create Optimism AIDS Panel Will Achieve Sound Strategy

When the presidential AIDS commission was created last summer, it was immediately dismissed by many in the public health community and elsewhere as a political gesture by the Reagan Administration that would do little, if anything, about the deadly and burgeoning epidemic.

Last week, that view changed dramatically.

The first policy statements of the commission chairman, Adm. James D. Watkins, dealing with drug abuse, health care and research--which are expected to be approved by the full panel Thursday--were so ambitious that they took virtually everyone by surprise. One congressional source involved in AIDS legislation momentarily considered issuing a press release containing only one word: “Hurrah.”

Personality Conflicts

To be sure, the commission has yet to tackle the more controversial issues of AIDS education, discrimination and testing. Still, the group--initially torn by personality conflicts and ideological differences, and the abrupt resignations of its first chairman and vice chairman--now has begun to inspire optimism that a broad and thoughtful strategy for combatting AIDS in the United States finally will emerge.

“There is no question the commission was on the rocks,” Watkins, former chief of naval operations, said in an interview. Watkins took over the panel in October when its first chairman, Dr. W. Eugene Mayberry, and his hand-picked vice chairman, Dr. Woodrow A. Myers Jr., both quit.

“I thought I had the leadership to pull things together,” Watkins added. “I thought I could do it if I had a chance.”

200 Hours of Testimony

During the last four months, the commission has heard 350 public witnesses in 200 hours of testimony. At the end of this initial phase, Watkins called for a 10-year, $20-billion program to ensure that all intravenous drug abusers could receive “treatment on demand” for their addiction and urged reforms in health care and in basic AIDS research and drug development.

Many attribute the commission’s turnaround to his strong influence, as well as to the addition of its two replacement commissioners, Kristine Gebbie, chief health officer for the state of Oregon, and Dr. Beny J. Primm, a specialist in drug abuse, both of whom are highly regarded for their AIDS expertise.

“Kris and Beny are great, and if these are the kind of recommendations we can continue to expect, then I see the commission doing exactly what the mandate called for,” said Myers, who complained in October that the commission’s atmosphere was too divisive for him to remain.

“Things change and situations change,” Myers said. “At the time I made my decision, I made it on the evidence that was available.”

‘Weird Direction’

Gebbie said that because she arrived late to the commission, she was not sure whether “the potential (for constructive work) was already there” or whether the commission “was headed in a weird direction and the shock value of having two people quit forced everyone to turn around.”

Gebbie made it clear when she agreed to join that she would not serve on a commission that promoted policies she considered dangerous or unwise. “But I also think some assumptions were made about the people on the commission because of how they got there,” she said. “Many people harbor suspicions about the Reagan Administration. There was a mind-set that any commission appointed out of this White House would be inadequate.”

Some critics, pleased as they are with the first series of recommendations, still believe that it took the White House far too long to act.

Earlier Recommendations

“They (commission members) are coming up with the recommendations that the public health experts have already given us,” said Rep. Henry A. Waxman (D-Los Angeles), chairman of the House Energy and Commerce subcommittee on health.

“They now recognize we need more funding for drug abuse programs and research. I hope they will come around to the recommendations on testing and confidentiality that the public health experts have already urged upon us. At best, if they do this, we can only say we lost precious time,” he said.

It is still difficult to predict, however, how commission members will respond in the more sensitive areas they will be addressing in the coming months--issues such as AIDS education, testing for AIDS antibodies, discrimination and confidentiality.

Mandatory Testing

The Administration favors widespread routine testing--and mandatory testing in certain situations--a position contrary to that of leading public health experts. And among the panel members are some who, at the time they were appointed, were known to hold views at odds with the medical, scientific and public health Establishment in the areas of testing, transmission and confidentiality.

“As we move through those issues, we will see a much harder test of the commission,” Gebbie said. “I think you will probably see much more tension. I sense that quite a few commissioners know very little about basic public health measures. We seem to be starting from different viewpoints. Where we’ll end up, I don’t know.”

Watkins sees himself as a “consensus builder” on the commission and said he believes that this first set of recommendations “will help in a large measure to allay fears that we are a do-nothing commission.”

‘Learned So Much’

He added: “We are living with this 24 hours a day. Many commissioners know their professional reputations are on the line. When we started, we didn’t know anything. We were a bit naive on the subject. We weren’t in a position to come down on any issues. All the commissioners have learned so much in the past four months.”

As commissioners, he said, “you have to be tough on the system, the bureaucracy, yet you also have to be compassionate to the human side of it. I hope we don’t get totally caught up in the fiscal demands or in potentially controversial issues. I’ve always tried to remember that, at the end of each of these discussions and issues, is a person with AIDS--a person who needs help.”

Watkins, in some of his public statements, already has offered a clue to his thinking on some of the tougher issues that face the commission--and his views seem to be consistent with that of most public health officials.

‘Best Tool We Have’

“In the absence of a cure, then public distribution of information and education is the best tool we have to fight the spread of AIDS,” he said Monday in a speech before the National Press Club.

In answer to a question after his speech, he said that he favors “an environment which encourages 100% voluntary testing with all of the counseling that goes along with it” and protections of confidentiality.