Out of the Labs, Into the Limelight-and No Magical Cure Up their Sleeves : AIDS: Painstaking research will be too late for many. But medicine is not a political science easily moved by hype.
Like its predecessors in Montreal and Stockholm, the Sixth International Conference on AIDS in San Francisco was as much media event as scientific meeting--perhaps more of the former than the latter.
This is not to say that the conference was totally lacking in scientific merit. With a bulging catalogue of abstracts that matches in size the telephone directories of many cities, there were data and conclusions derived from data aplenty. Nothing in the way of news about a definitive cure for HIV infection or a vaccine on the immediate horizon, but if someone is in possession of either of those two items, he or she is far more likely to publish it in a high-profile scientific journal than to present it at a meeting, even one as large and prestigious as the AIDS Conference. This approach is not unique in the world of scientific research.
What is unique to the AIDS Conference is its high profile in the press and among the public. Conventions of biomedical specialists even larger than AIDS Conference VI often steal in and out of town unbeknown to the citizenry. A handful of reporters may attend, hoping to glean a tidbit or two that can be passed on to the news consumer hungry for such information.
By contrast, the AIDS Conference receives intense scrutiny and its presentations are analyzed in sometimes excruciating detail on TV, the radio and in the print media. It comes complete with media stars, at least a few of whom appear to relish the attention. Robert Gallo, Luc Montagnier and Anthony Fauci may soon be household names. I challenge the reader to name one researcher in the fields of Alzheimer’s disease or stroke, two public-health problems of arguably far greater magnitude than AIDS.
The AIDS Conference is also unique in the annals of medical conferences, insofar as individuals with the disease under investigation and discussion have a major impact on the scientific sessions--to the point where they seem capable of disrupting them and thus altering the agenda to satisfy their needs. But why? And to what end?
The answer seems straightforward. AIDS-related research is perceived as moving at a snail’s pace, a pace that must seem ever so hopelessly inadequate to someone whose immune system is on the verge of crumbling and who has only a few months or years in which to benefit from a “miracle” cure. Hanging over the AIDS Conference was the perception that new anti-HIV drugs are not being developed rapidly enough, or that better drugs than AZT exist but are not being approved for release and general use with due haste.
Never before in recent history has a medical problem been attacked with such ferocity and resources by both the scientific community and private government agencies. True, both the interest and the funding came late. As Randy Shilts points out scathingly in his book “And the Band Played On,” the National Institutes of Health missed the boat at the onset of the epidemic. Yet it now is at least attempting to make up for lost time with huge HIV-related programs.
Rapid progress is certain to yield results that will, alas, come too late for many with the disease. Of course, the same could be said about work related to any other illness.
The public must be made aware that, in a time of fiscal constraint and intense competition for research dollars, the price of gaining a more complete understanding of AIDS is a marked slowdown in work on other diseases. Put simply, some less than stellar AIDS projects gain funding at the expense of excellent non-AIDS research, which must be abandoned. Who, in the long run, benefits from this?
As for the paucity of new medications, there can be no greater danger for the HIV-infected population or at-risk individuals than that inadequately tested drugs come to be used in therapeutic or prophylactic situations. Large-scale, painstaking clinical trials remain the only way to establish the usefulness of new agents and (more important) their possible toxicity and undesired side effects. Again, there is a need for time, a commodity in short supply to someone who harbors the AIDS virus.
It is thus natural that emotions and tempers become strained during a meeting such as the one just ended. Cooler heads and dispassionate spirits must prevail, but will they?
As the hype on AIDS Conference VI mercifully fades, stay tuned for AIDS Conference VII in Florence next summer. The coverage will, if past is prologue, be even more intense. Unless, that is, a cure or vaccine materializes in the meantime--something that even those who work tirelessly in the field would be thrilled to witness.
