Cruel in its manifestation, fiendishly enigmatic in its pathogenesis, AIDS marches on relentlessly. Already 360,000 cases have been diagnosed in this country alone; 220,000 people have died. Worse is sure to come soon. It is about 10 years since the disease was first identified. With its stealthy years-long latency, that means thousands infected by the HIV virus in the mid-1980s, before they learned how to protect themselves, will soon start to develop symptoms and die. Despite massive research, the tiny virus has outwitted the best scientific minds. Little progress has been made in finding a cure or vaccine.
The time has come for new thinking, new approaches. A lucid and logical framework for the future comes now from Bernard N. Fields of the Harvard Medical School. In a paper in the British journal Nature, he argues that AIDS is far more complex than anyone imagined and calls for a broadening of research and a return to basic science.
In other words, valuable time has been lost in following narrow hunches for an easy cure, some magic bullet. "The real challenge," he writes, "is to put aside politics and the illusion of easy answers so that we can concentrate on studies that offer a real possibility of working." He adds: "In our zeal to control AIDS, we have invested enormous resources in the search for drugs and vaccines. This may have been reasonable 10 years ago, but is no longer."
Wise words, but politically difficult. A huge medical, corporate, bureaucratic and political infrastructure is committed to testing new remedies and vaccines. Even as Dr. Fields' words were published, the National Institute of Allergy and Infectious Diseases appeared, reluctantly, to be ready to spend tens of millions of dollars on human tests of two vaccines even though laboratory tests showed they had no effect on HIV viruses isolated from infected people.
In their legitimate outrage over the federal government's shameful slowness to act on AIDS during the last decade, activists forced quick approval of unproven drugs. As a result, the drug AZT was widely prescribed to delay the onset of disease in infected people who had not yet developed symptoms. Only later did further studies show it was useful only in people with advanced disease.
AIDS has dashed hopes that it could be controlled as polio was. That devastating epidemic too was caused by a virus. Once it was identified, a vaccine could be developed. Alas, as Fields notes, the HIV virus is far more complex, unpredictable and nefarious. Fields calls for expanded research in related areas (such as on other infectious agents), on basic study of the early events of HIV infection and on the so-called opportunistic infections that often fell AIDS patients. "AIDS is a novel disease requiring new paradigms and a new conceptual framework," he argues. "We must give serendipity (and reasoned scientific redirection) a chance to join the war on AIDS."
His notions are embraced by many AIDS experts, including Dr. Mervyn F. Silverman, president of the American Foundation for AIDS Research, and Dr. William Paul, new director of the Office of AIDS Research at the National Institutes of Health. Some activist groups, such as the New York ACT UP organization, continue to focus on a speedy cure and support a bill in Congress that would set up a focused research program outside of the NIH. But other AIDS groups, though divided, have begun to see that such narrow approaches have so far proved counterproductive. We need a new beginning on AIDS.