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I'm currently reading And The Band Played On which is a detailed account of the rise of the AIDS epidemic and how it was ignored and mishandled back in the 80s.

I'm currently reading And The Band Played On which is a detailed account of the rise of the AIDS epidemic and how it was ignored and mishandled back in the 80s. Definitely check it out if this subject interests you.

tptacek 13y ago
Curious: if we call t_0 1981, the Kaposi's Sarcoma article, and t_x 1996, the advent of HAART, and consider (t_x - t_0) "the AIDS epidemic" --- ignoring the ongoing epidemics in Sub-Saharan African and India, which are enormous problems but somewhat orthogonal to the problem described by your book --- what comparably lethal disease in human history was more effectively addressed by the medical establishment? How can we quantify the mishandling of AIDS in the 1980s?
- cdcox 13y ago
  It's not a direct comparison, but consider the handling of Ebola, where due to simple epidemiological interventions spread has basically been localized and stopped and no outbreak has killed more than 1000 people. Or consider the regular emergence of new flu strains which are far more contagious and are quickly and effectively contained. Though that comparison isn't great because we have a lot of knowledge when it comes to dealing with the flu. My impression is (and I have not studied this) the failure in the HIV epidemic (pandemic?) wasn't a failure to develop drugs, it was a failure to perform basic epidemiological interventions to learn about and slow the progress of the disease.
  - tptacek 13y ago
    In a sense this is a way of saying that in epidemiology, the failures are noisy and successes are silent, so comparing large epidemics across history might be misleading.
  - brazzy 13y ago
    the comparison makes no sense because the diseases are radically different. Ebola kills so quickly and is so infectious that it is self-limiting: patients die before they can spread it very far. Whereas AIDS patients can spread the disease for years, though it is as weakly infectious as as contagious disease can be.
- pqqqqq 13y ago
  Just to give you an idea, the FDA didn't start screening its blood until 1985 after several documented cases where patients received AIDS from blood transfusions. http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/ http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/ Reagan has been criticized for his complete non-response to AIDS as well. He mentioned it in passing in 1985, and didn't actually address the issue until 1987. Since AIDS mostly affected homosexuals and drug users, AIDS wasn't exactly a high priority for the Reagan administration in light of the Religious Right's massive power at the time. The popular rhetoric of the era was more akin to "AIDS is God's punishment for homosexuality" than compassion. http://www.nytimes.com/2004/06/09/politics/09policy.html http://www.nytimes.com/2004/06/09/politics/09policy.html To quote Reagan's biographer: "Reagan's response to this epidemic was halting and ineffective."
  - tptacek 13y ago
    I believe that AIDS wasn't a high priority for Reagan, but from my vantage point it looks like HIV is an instance of an enormously complicated biological challenge being addressed with extraordinary effectiveness and rapidity by the medical establishment. I take your point (and the sibling commenter's point) about the epidemiologic response to AIDS; I may be over-fixated on the research and development side of the issue.
    - pqqqqq 13y ago
      What about SARS back in 2003? China first observed SARS in Nov 2002 but didn't report it until February 2003. The responsible virus was identified by April 2003 and the whole disease contained by July. http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_%28SARS%29 http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndro... I'm not an epidemiologist so I can't compare the relative complexity of the SARS virus to HIV. But I'm skeptical that HIV presented a massive and insurmountable biologic challenge compared to other viruses. I also encourage you to look into the epidemiological and sociological aspects of AIDS. It's horrifying, and it colors my above skepticism. The gay community referred to AIDS as a holocaust back in the early 80s, and I would encourage you to read this article at your leisure to see why: http://www.nytimes.com/1988/10/23/books/l-aids-and-the-holocaust-156488.html http://www.nytimes.com/1988/10/23/books/l-aids-and-the-holoc...
- snowwrestler 13y ago
  I don't have the exact citations at hand, but I believe a key difference with AIDS is that professional epidemiologists themselves are of the opinion that the early stages of the AIDS epidemic were mishandled, primarily due to lack of funds and/or power by the Reagan administration.
  - pbhjpbhj 13y ago
    Didn't the early stages occur in Africa?
    - snowwrestler 13y ago
      I guess I should say the early stages of the response.
- x0x0 13y ago
  There is a difference between effectively managed by the medical establishment and what Reagan / america did in the 80s. I'm at work and I don't have sources readily available, but my understanding is that many older gay people (those still alive) hate reagan and republicans specifically because they slow rolled the response to hiv. Much of America's response wasn't really pushed until the Clinton administration. So how much of the below is the legitimate difficulty of rapidly responding to a new disease is arguable, but I don't think anyone can make a real case that if a new disease had appeared in the 80s that affected straight white men that it wouldn't have gotten a much more vigorous response from the reagan administration/fda/etc. At bare minimum, by the first time reagan mentioned aids publicly, 20,849 Americans had died from it [1]. How he squared his conscience with not mentioning aids until twenty thousand americans had died is amazing. A brief history mostly off the top of my head 1 - reagan didn't care at all about aids until an actor friend of his died of it; 2 - the strong perception within the fda was that reagan didn't care about aids / didn't want anything done about it; 3 - reagan allowed his staff to delete a mention of ryan white from a speech; 4 - reagan didn't mention aids publicly until mid 1987 Writing in the Washington Post in late 1985, Rep. Henry Waxman, D-Los Angeles, stated: "It is surprising that the president could remain silent as 6,000 Americans died, that he could fail to acknowledge the epidemic's existence. Perhaps his staff felt he had to, since many of his New Right supporters have raised money by campaigning against homosexuals." [1] 5 - act-up, amongst others, fought with the fda about not just glacial drug approval processes, but also the fda denying access to experimental therapies even to patients without other therapeutic options; 6 - I don't remember this as well, but I believe hiv patients also had to fight the fda for early-ending of clinical trials, because they were insisting that people taking placebos should basically die So some of this is similar to why many gay people of the right age hate Ed Koch, but an aggressive intervention by the reagan administration might have saved many lives. [1] http://www.sfgate.com/opinion/openforum/article/Reagan-s-AIDS-Legacy-Silence-equals-death-2751030.php http://www.sfgate.com/opinion/openforum/article/Reagan-s-AID...
  - newbie12 13y ago
    "The real Reagan record on AIDS is different. AIDS funding skyrocketed in the 1980s, almost doubling each year from 1983 - when the media started blaring headlines - from $44 million to $103 million, $205 million, $508 million, $922 million, and then $1.6 billion in 1988. Reagan's secretary of Health and Human Services in 1983, Margaret Heckler, declared AIDS her department's "number one priority." While the House of Representatives was Democrat-dominated throughout the 1980s, which Democrats would quickly explain was the source of that skyrocketing AIDS funding, Reagan clearly signed the spending bills that funded the war on AIDS. It's also wrong that Reagan didn't utter the word "AIDS" until 1987. Any reporter who bothered to check facts would find that Reagan discussed AIDS funding in a 1985 press conference, just for starters. But let's turn that around on the rest of Washington. Does that mean no reporter asked Reagan about AIDS in the 1984 presidential debates? And that every interview President Reagan granted to a national or local media outlet failed to solicit Reagan's opinions on AIDS until 1985? Using this phony-baloney spin line - that federal policy hinges exclusively on the presidential bully pulpit - is an exercise in liberal hyperbole over hard data." http://www.mrc.org/bozells-column/new-myths-reagans-record http://www.mrc.org/bozells-column/new-myths-reagans-record

tptacek 13y ago

Curious: if we call t_0 1981, the Kaposi's Sarcoma article, and t_x 1996, the advent of HAART, and consider (t_x - t_0) "the AIDS epidemic" --- ignoring the ongoing epidemics in Sub-Saharan African and India, which are enormous problems but somewhat orthogonal to the problem described by your book --- what comparably lethal disease in human history was more effectively addressed by the medical establishment? How can we quantify the mishandling of AIDS in the 1980s?

cdcox 13y ago
It's not a direct comparison, but consider the handling of Ebola, where due to simple epidemiological interventions spread has basically been localized and stopped and no outbreak has killed more than 1000 people. Or consider the regular emergence of new flu strains which are far more contagious and are quickly and effectively contained. Though that comparison isn't great because we have a lot of knowledge when it comes to dealing with the flu. My impression is (and I have not studied this) the failure in the HIV epidemic (pandemic?) wasn't a failure to develop drugs, it was a failure to perform basic epidemiological interventions to learn about and slow the progress of the disease.
- tptacek 13y ago
  In a sense this is a way of saying that in epidemiology, the failures are noisy and successes are silent, so comparing large epidemics across history might be misleading.
- brazzy 13y ago
  the comparison makes no sense because the diseases are radically different. Ebola kills so quickly and is so infectious that it is self-limiting: patients die before they can spread it very far. Whereas AIDS patients can spread the disease for years, though it is as weakly infectious as as contagious disease can be.
pqqqqq 13y ago
Just to give you an idea, the FDA didn't start screening its blood until 1985 after several documented cases where patients received AIDS from blood transfusions. http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/ http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/ Reagan has been criticized for his complete non-response to AIDS as well. He mentioned it in passing in 1985, and didn't actually address the issue until 1987. Since AIDS mostly affected homosexuals and drug users, AIDS wasn't exactly a high priority for the Reagan administration in light of the Religious Right's massive power at the time. The popular rhetoric of the era was more akin to "AIDS is God's punishment for homosexuality" than compassion. http://www.nytimes.com/2004/06/09/politics/09policy.html http://www.nytimes.com/2004/06/09/politics/09policy.html To quote Reagan's biographer: "Reagan's response to this epidemic was halting and ineffective."
- tptacek 13y ago
  I believe that AIDS wasn't a high priority for Reagan, but from my vantage point it looks like HIV is an instance of an enormously complicated biological challenge being addressed with extraordinary effectiveness and rapidity by the medical establishment. I take your point (and the sibling commenter's point) about the epidemiologic response to AIDS; I may be over-fixated on the research and development side of the issue.
  - pqqqqq 13y ago
    What about SARS back in 2003? China first observed SARS in Nov 2002 but didn't report it until February 2003. The responsible virus was identified by April 2003 and the whole disease contained by July. http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_%28SARS%29 http://en.wikipedia.org/wiki/Severe_acute_respiratory_syndro... I'm not an epidemiologist so I can't compare the relative complexity of the SARS virus to HIV. But I'm skeptical that HIV presented a massive and insurmountable biologic challenge compared to other viruses. I also encourage you to look into the epidemiological and sociological aspects of AIDS. It's horrifying, and it colors my above skepticism. The gay community referred to AIDS as a holocaust back in the early 80s, and I would encourage you to read this article at your leisure to see why: http://www.nytimes.com/1988/10/23/books/l-aids-and-the-holocaust-156488.html http://www.nytimes.com/1988/10/23/books/l-aids-and-the-holoc...
snowwrestler 13y ago
I don't have the exact citations at hand, but I believe a key difference with AIDS is that professional epidemiologists themselves are of the opinion that the early stages of the AIDS epidemic were mishandled, primarily due to lack of funds and/or power by the Reagan administration.
- pbhjpbhj 13y ago
  Didn't the early stages occur in Africa?
  - snowwrestler 13y ago
    I guess I should say the early stages of the response.
x0x0 13y ago
There is a difference between effectively managed by the medical establishment and what Reagan / america did in the 80s. I'm at work and I don't have sources readily available, but my understanding is that many older gay people (those still alive) hate reagan and republicans specifically because they slow rolled the response to hiv. Much of America's response wasn't really pushed until the Clinton administration. So how much of the below is the legitimate difficulty of rapidly responding to a new disease is arguable, but I don't think anyone can make a real case that if a new disease had appeared in the 80s that affected straight white men that it wouldn't have gotten a much more vigorous response from the reagan administration/fda/etc. At bare minimum, by the first time reagan mentioned aids publicly, 20,849 Americans had died from it [1]. How he squared his conscience with not mentioning aids until twenty thousand americans had died is amazing. A brief history mostly off the top of my head 1 - reagan didn't care at all about aids until an actor friend of his died of it; 2 - the strong perception within the fda was that reagan didn't care about aids / didn't want anything done about it; 3 - reagan allowed his staff to delete a mention of ryan white from a speech; 4 - reagan didn't mention aids publicly until mid 1987 Writing in the Washington Post in late 1985, Rep. Henry Waxman, D-Los Angeles, stated: "It is surprising that the president could remain silent as 6,000 Americans died, that he could fail to acknowledge the epidemic's existence. Perhaps his staff felt he had to, since many of his New Right supporters have raised money by campaigning against homosexuals." [1] 5 - act-up, amongst others, fought with the fda about not just glacial drug approval processes, but also the fda denying access to experimental therapies even to patients without other therapeutic options; 6 - I don't remember this as well, but I believe hiv patients also had to fight the fda for early-ending of clinical trials, because they were insisting that people taking placebos should basically die So some of this is similar to why many gay people of the right age hate Ed Koch, but an aggressive intervention by the reagan administration might have saved many lives. [1] http://www.sfgate.com/opinion/openforum/article/Reagan-s-AIDS-Legacy-Silence-equals-death-2751030.php http://www.sfgate.com/opinion/openforum/article/Reagan-s-AID...
- newbie12 13y ago
  "The real Reagan record on AIDS is different. AIDS funding skyrocketed in the 1980s, almost doubling each year from 1983 - when the media started blaring headlines - from $44 million to $103 million, $205 million, $508 million, $922 million, and then $1.6 billion in 1988. Reagan's secretary of Health and Human Services in 1983, Margaret Heckler, declared AIDS her department's "number one priority." While the House of Representatives was Democrat-dominated throughout the 1980s, which Democrats would quickly explain was the source of that skyrocketing AIDS funding, Reagan clearly signed the spending bills that funded the war on AIDS. It's also wrong that Reagan didn't utter the word "AIDS" until 1987. Any reporter who bothered to check facts would find that Reagan discussed AIDS funding in a 1985 press conference, just for starters. But let's turn that around on the rest of Washington. Does that mean no reporter asked Reagan about AIDS in the 1984 presidential debates? And that every interview President Reagan granted to a national or local media outlet failed to solicit Reagan's opinions on AIDS until 1985? Using this phony-baloney spin line - that federal policy hinges exclusively on the presidential bully pulpit - is an exercise in liberal hyperbole over hard data." http://www.mrc.org/bozells-column/new-myths-reagans-record http://www.mrc.org/bozells-column/new-myths-reagans-record