The Broad Benefits of AIDS Research
The question may be curious or hostile, but it’s increasingly being asked: Are we spending too much money on AIDS research relative to other diseases?
On the surface, this question seems reasonable. In reality, it’s useless. That this question is part of the AIDS debate and the inspiration for an emerging AIDS funding backlash is potentially tragic.
The responsibility--the fault--for this rests squarely with the biomedical research community and AIDS activist groups. They have done a truly lousy job of articulating the extraordinarily broad range of medical breakthroughs and benefits that AIDS research can yield. Instead, they have consistently opted to position AIDS in the policy arena purely as a “special interest” disease requiring extraordinary measures and an equally extraordinary budget.
No one can rationally argue that combating AIDS doesn’t require extraordinary efforts. But as AIDS-related research consumes a rising portion of the federal biomedical budget, it’s increasingly clear that we need to aggressively explore the impact of this research beyond AIDS. Although AIDS and its HIV virus is an infuriatingly elusive and deadly disease, it is not something wholly separate and distinct from other diseases.
The biomedical research establishment must start viewing AIDS research as more of a gateway into the nature of viruses, the immune system and molecular biology. AIDS activists must start building up coalitions with other segments of the disease research community--and not just building up budgets.
“The constituents and advocates in HIV research are just now starting to realize the more global aspects of HIV research,” says Dr. Anthony Fauci, who runs the nation’s war on AIDS as director of the National Institute for Allergy and Infectious Diseases. “We’ve reached the point that we’re not going to be able to say, ‘We need more for AIDS’ and get more; we have to be able to show other benefits.”
Although Fauci has personally pointed to spinoff benefits of HIV research, he acknowledges that the research community has been so consumed in AIDS research itself that there have been few formal efforts to transfer AIDS-gleaned insights to other fields. An Office of Technology Assessment survey published earlier this year confirmed the obvious: Researchers believed that there would be significant spinoffs from AIDS research. Unfortunately, there’s consistently been a “take it for granted” and “by the way” quality to the discussion of spinoffs.
“AIDS is such a lightning rod,” says Fauci. “Spinoffs get lost in the commotion and smoke of all the controversy.”
But it is Fauci’s responsibility--and the responsibility of the AIDS activist community--to see that they do not. It is in no one’s interest to narrowly define the impact of AIDS research.
The Nixon Administration’s War on Cancer failed to generate a “cure” for cancer; instead, it spawned the knowledge infrastructure of molecular biology that made biotechnology possible and put us in the position to begin to deal with diseases such as AIDS.
The fact is that diseases are not all tucked away in neat, discrete compartments. Fundamental structures and interactions make medical research more interdisciplinary today than at any other time in history. Precisely because we are investing so much into AIDS research, we must take every step possible to make sure that the results have as far-reaching an impact as possible.
“Virus research in general has become completely dominated by HIV,” says David Baltimore, the Nobel Prize-winning molecular biologist who is president of Rockefeller University. The research “has given us a much more precise understanding of viral interactions with cells. . . . The one area where it may drive technology is in drug design and vaccine design.”
What’s more, Baltimore says, the research is “almost certain to tell us that there are types of genetic controls in normal cells that we have never imagined.”
“We still have a lot of spadework to do in basic research,” Fauci says. “We have to understand a lot more: the expression of the viral gene and the interaction with the cellular gene function.”
That kind of basic research has the broadest possible implications. It’s like learning how to read: Once you can read a short story, learning to read poetry or novels is less of a challenge. Fundamental insights into the HIV virus and the immune system should be directly transferable to insights into other diseases. Fauci argues that AIDS research can’t help but offer insights into degenerative diseases such as multiple sclerosis and auto-immune diseases like lupus. The opportunistic infections that attack people with AIDS also attack people who aren’t infected with the HIV virus.
The point is simple: AIDS has become the engine for critical biomedical research in this country. The issue isn’t, “Are we spending too much on AIDS research?” We could ask that of any budget for any serious disease, be it lung cancer or Alzheimer’s. It is, “Are we getting the maximum return for the maximum number of people?”
As Dr. Leroy Hood, the Bowles Professor of Biology at Caltech and director of the National Science Foundation’s Science and Technology Center in Biotechnology, says: “If we’re going to spend this much money on AIDS research, the mission should be a very broad one.” Hood and other researchers want to see AIDS money set aside for developing new technologies to enhance viral diagnostics and intervention.
None of this should reduce the primary focus on AIDS. On the contrary, a flow of spinoffs should consolidate this society’s willingness to commit resources. Fortunately, even the most radical segments of the AIDS activist community are beginning to understand that it can acquire more resources to fight AIDS less by stressing the uniqueness of the disease than the insights it offers for all.
“The real bottom line is that we’re going to have to make common cause with those other (disease lobbying) groups to enhance all of the biomedical budget,” asserts Mark Harrington, a member of the treatment and data committee of the AIDS Coalition to Unleash Power (ACT-UP).
“The need to institutionalize the AIDS research process and transfer it to other efforts is clear,” says Jean McGuire, who runs the AIDS Action Council in Washington. “It is a necessary part of building support.”
People who challenge the level of AIDS research funding should appreciate that an investment in AIDS research isn’t an investment in a special interest group but an investment in the public health.
It’s time for the National Institutes of Health, Congress, the Administration and AIDS activists to aggressively encourage a wide array of research spinoffs to reinforce that.
