Re: The Age of AIDS

1

Everything is so simple looking throught that retrospectoscope. The reality is that, even after 23 years, and billions of dollars in research funding, there is still no cure for AIDS. The most effective cure then is still the most effective cure today: prevention.

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And there would have been a lot of AIDS deaths prevented if research had earlier established the cause as HIV. Sheesh.

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Everything is so simple looking throught that retrospectoscope

But aren't the people in the PBS transcript at least purporting to talk about what they knew at the time? Maybe you have reason to think differently.

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Actually, I think Heckler is looking through the retrospectoscope and refusing to acknowledge that her actions had bad consequences.

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5

Yes, even with all of the money poured into it, there still is no cure for AIDS, but getting money sooner might have meant a test for HIV sooner, which could have been combined with prevention efforts to slow the spread or a test for donated blood sooner that could have saved the lives of many hemophiliacs. It also might have meant the discovery of more effective treatments sooner. To say that more money at the beginning of the epidemic wouldn't have helped speed up the timeline when you've got your scientists saying they had no funding to travel to international conferences and had to steal lab supplies seems ridiculous.

But aren't the people in the PBS transcript at least purporting to talk about what they knew at the time?

In this case, they were asking her for her opinion looking back. It would be one thing if at the time she didn't think that more money would have helped, but she still doesn't think it would have.

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Or what Weiner said.

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Also, this timeline on the history of AIDS in NYC was really good. And I'll earn my own special place in hell by pointing this part of it out:

October 25, 1985
Against Koch's recommendation, New York State urges local health officials
to padlock gay baths and sex clubs. A month later the Mine Shaft is
shuttered, followed by Plato's Retreat, a straight swingers' club.

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8

In 1982, I was doing research on a SCIDS project in LA. It wasn't until much later that we found out that many of the patients whose blood samples we were working with, in fact, were HIV+. What was apparent to most of us, even at that time, was that there was a constellation of symptoms among a subset of the population, that didn't all fit a single picture or syndrome. Research funding was directed, as it always is when new avenues of research open up, from other, well-funded areas. In our case, funding for SCIDS was used for early AIDS research. In other cases, cancer funding was used for what appeared to be a newly emerging Kaposi's sarcoma, and so forth.

The timing of new funding for AIDs and the concommitant time course of the epidemic can only be idealistically matched when looking back. I don't buy the implication, for instance, that there was an overt suppression of additional funding because this was, primarily, a disease of homosexuals.

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9

I was referring to the scientists who said they needed more funding, and whom Yamamoto described as looking through the retroscope (unless it is we who are looking through it) as talking about what they knew at the time.

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10

"scientists saying they had no funding to travel to international conferences and had to steal lab supplies seems ridiculous."

That's a matter of course. Breastcancer is my research area now and there is never enough funding.

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11

Stealing lab supplies? Do you take this as hyperbole or common course in the industry?

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Research funding was directed, as it always is when new avenues of research open up, from other, well-funded areas. In our case, funding for SCIDS was used for early AIDS research. In other cases, cancer funding was used for what appeared to be a newly emerging Kaposi's sarcoma, and so forth.

Sounds like it all worked out for the best, then.

I don't buy the implication, for instance, that there was an overt suppression of additional funding because this was, primarily, a disease of homosexuals.

Why in the world not? Haven't you noticed the kinds of funding this administration is suppressing?

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Sharing of resources in collaborative efforts is what one might call stealing to make a polemic point. Afterall, it's illegal under NIH rules.

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14

I'm sure AIDS isn't the only disease where money is/was tight and people were pilfering supplies from other labs and having trouble paying for travel. Still, the cavalier attitude with which she dismissed those problems just really got to me. I wish you could have seen the way she said it, with no care in the world or acknowledgement in her tone that the lack of funding might have caused some harm.

It's one thing to acknowledge that the funding wasn't there because that's not where the budget priorities were and that's a shame but we did a pretty good job with what we had and another entirely to deny there was a problem or say that extra funding wouldn't have helped.

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15

Breastcancer is my research area now and there is never enough funding.

So if a congressional subcommittee asked the secretary of HHS if there was enough funding, you'd want him to say, "No," right? Do you think Heckler was right to say "In the AIDS situation, I really don't think there is another dollar that would make a difference because the attempt is all-out to find an answer" then?

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Is the disagreement here about Heckler's attitude, or about what would have been reasonable behavior on the part of CDC at the time?

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17

It depends on the admiral's stance on Heckler's attitude is.

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18

It depends on what the admiral's stance on Heckler's attitude is.

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My problem is less with what the CDC/Heckler did at the time than the attitude that she wouldn't have done more or asked for more funding had she known then what we know now.

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20

I still don't get it.

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21

Cripes. 20 to 17-18.

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I also think that her attitude now is an indicator that she was likely to have neglected the problem then. That is, not having looked at the funding proposals etc., and knowing that she's now taking a la-di-da attitude toward having presided over one of the worst infectious disease crises since at least the Spanish influenza, I'm inclined to believe that she probably didn't do a good job at the time either.

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23

Through the retrospective glass, it seems she should acknowledge that she was wrong, and more funding would indeed have helped.

But at the time, it might not have been an evidently crazy decision to deny funding; it wasn't clear how big the problem was, how fast it was spreading, and there's never been a science grant proposal that's asked for less money.

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24

Heckler said something at the time which, when I heard it, just floored me. It's in Shilts' book "The Band Played On", but I can' t find it with Google.

It went something like "We're watching very closely to see if it spreads from [the pool of people it's now confined to]". The implication was pretty clear that for her the problem would become an important public health problem only when it spread outside the gay community. The Reagan administration's whole AIDS policy seemed predicated on avoiding the bad PR that faggots bring with them.

My negative reaction to Heckler's pronouncement was pretty automatic, but I was a knee-jerk liberal working in a hospital. .

I wasn't really very gay-friendly then, either. A little before then, a gay friend and a gay acquaintance had migrated to SF, basically to be part of the group sex scene, which they believed was liberating and cutting-edge, and as I understood what it was they were going for I was quite repelled. But I didn't want them to die.

It may be that Heckler realizes that she got in too deep for a few pious words today to have any meaning.

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25

There's no cure for diabetes now either, but there's an effective treatment. Same for AIDS. That argument is a non-starter.

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26

It may be that Heckler realizes that she got in too deep for a few pious words today to have any meaning.

I understand the impulse to work out some such explanation, to grant everyone some level of moral imagination and awareness. I do it a lot myself, but "shameless meanness" is probably just as plausible an explanation.

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27

it wasn't clear how big the problem was

Is that really true? My impression was that the deadliness of AIDS was evident straightaway. It's a question of the rapidity of mortality rather than how many people it affects, isn't it? Just as there haven't been that many bird flu victims, but it's still treated differently in public health terms than other diseases.

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28

If not rapidity, number of deaths to number of infections.

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29

It quickly became known that the disease was spreading very fast, and to begin with it was 100% fatal. The question was always whether it would spread outside the gay community.

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30

There's a telling example that Larry Kramer uses in The Normal Heart, about the massive media coverage and serious attention by health professionals that was being given to (if I'm remembering correctly) some defective bottles of aspirin that had to be recalled. I think the death toll was less than ten people, if that.

And at the same time, hundreds had already died from what would become known as AIDS, which had already been identified as its own mysterious syndrome at that point, but there was still an almost total media blackout for the disease.

Larry Kramer's sort of an agitprop guy, though, so the anecdote should probably be taken with a grain of salt.

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31

It's a question of the rapidity of mortality rather than how many people it affects, isn't it?

I think it's more rapidity of transmission and threat to the general populace. If bird flu were very deadly, but for some magical handwavy reason could only be contracted by a small percentage of people, it wouldn't receive nearly the attention it does. And the dollars tend to follow first the size of the population, and then the noisiest. Rare fatal genetic disorders have even a harder time, because they're not infectious.

And I'm not sure if before the discovery of HIV and the transmission vector it was realized it was could be a general health threat, especially with the syndrome presenting in different ways. It might have looked like, for a while, a problem of one subculture that had no definable cause and didn't look like it could spread. (What-iffing aside, I suspect though, that garden-variety prejudice was in play. If it's a disease of gays and drug-users it's low political cost.)

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32

It might have looked like, for a while, a problem of one subculture that had no definable cause and didn't look like it could spread.

If I recall correctly, weren't Haitians an identifiable risk group from very early on? That (a geographically, rather than behaviorally, defined risk group) seems as if it should have been a tip-off that we were looking at a contagious disease from the outset.

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33

I do remember, in the late eighties, a rather unpleasant debate among activists about whether to stress the degree to which it might spread to the general population as a way of increasing public awareness, funding, seriousness, etc. Nobody really knew, but the pattern had by then emerged that male homosexual sex and iv drug use had transmission rates, in the American context, very much higher than other groups. There was already the issue of whether the apparently different transmission patterns of sub-Saharan Africa would eventually appear here. I was a follow-the-facts guy, but I understood the desperation and determination.

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34

If the small subculture vulnerable to AIDS had been overweight white males older than 60 (by my guess, 5-10% of the population), I think that the response would have been more prompt.

When this was happening it was pretty unmistakable, if you weren't either a rabid homophobe or a Reagan loyalist. As soon as it was established that risk was increased by certain bad behaviors, for a lot of people the problem became unimportant. That was the context of all the other discussion about what to do.

There really didn't seem to be a widespread awareness that if the faggots (with their bad habits) all died, that would be a very bad thing.

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35

weren't Haitians an identifiable risk group from very early on

Yeah, they were part of the "4 Hs": homosexuals, heroin users, Haitians, and hemophiliacs. They're still considered high-risk. One of my friends isn't allowed to donate blood because she did Peace Corps in Haiti.

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36

Yeah, they were part of the "4 Hs": homosexuals, heroin users, Haitians, and hemophiliacs.

Confusion over this led to an 85% decrease in the number of sheep raised by rural high-school students in the late 80s.

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37

Nice.

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38

But the argument I would still make is that the attention should have been focussed on the behaviors most likely to lead to transmission, even while acknowledging that the risks might be more general, and that everyone might be at risk.

I was close to the members of a theater troupe that went to schools with a safe-sex message in those days. I think they did a pretty good job never mentioning homosexuality per se, but suggesting the behaviors which put you at most risk and what to do about them.

It wasn't just spite that made some people actually hope that there would be widespread heterosexual aids in those days. The desire not to be singled-out, as it were by fate, and the suspicion a cure would rapidly appear then, even if wrong-headed and naive, seem only human to me.

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39

It might have looked like, for a while, a problem of one subculture that had no definable cause and didn't look like it could spread.

I don't understand why the scientific community would have treated it this way, even if the political community could afford such blinders. Knowing that a disease has high mortality and inexplicable (if relatively categorizable) incidence is right about the time you want to freak the fuck out. And sort of related to 33, no once could have known that this disease was not poised to spread to the general population. It was clearly not a heritable disease; the high mortality + unknown origins would have made this a general health threat (at least among the scientific community).

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39 - In And the Band Played On and other things I've read/seen about the history of AIDS, the scientific community was always portrayed as dealing with the problem head-on. All of the blinders and obstacles were always imposed by the politicians.

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41

It quickly became known that the disease was spreading very fast, and to begin with it was 100% fatal.

We know that, now, (about mortality rates), but, given the lengthy incubation period between infection and symptoms and the multi-year long disease progression, it wasn't at all clear, at the inception of the US epidemic, that the mortality rate was 100%.

Also, HAART therapy is not a cure. It gives, on average, about a 6 year survival benefit.

History already has demonstrated that a massive infusion of money is necessary but is not sufficient to cure a disease. Heckler may be lined up against a wall for her attitude but she can't be faulted on the facts. There is no causative line that can be drawn between her attitude, actual funding of research, and AIDS deaths, without taking some seriously convoluted dance steps. There is a much more direct connection between education, social stigma, SES, risk-taking in younger people, and the spread of AIDS. I mean, after all these years, prevalence in the US is rising.

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42

"Heckler may be lined up against a wall for her attitude but she can't be faulted on the facts."

What does this mean? It makes no sense to me. I guess if you're saying that when she let it be known that she wasn't worried much about a lot of faggots dying, that had no actual effect on the faggot death rate, then we can say that it was just a nuance of attitude with no real-world consequence.

I wouldn't really call that "mere", though.

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43

"The budget was completely out of control" was true, but Republicans have this thing of letting the budget get completely out of control, and then using that as an excuse to cut spending they don't like. The fraudulence of this position was not as clear then as it is now, of course.

As I understand, the Reagan administration dragged their feet for a year or two, maybe three, on funding AIDS research. I can't believe that this was entirely inconsequential.

Unlike breast cancer, AIDS then was an emergent disease, and thus should have received extra attention. (Breast cancer spending has been there for decades, with mixed results). It's also a contagious disease, as breast cancer is not, and deserved special attention for that reason too.

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44

It's just that the real world consequences have not been sufficiently established. It doesn't matter if you make it sound all faggot-hating conspiracy-like. AIDS is caused by HIV, not by faggot haters (or God for those so inclined). The absence of a cure, even today, 23 years after the discovery of HIV, is not intentional.

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45

Heckler did not know the things we know now. The fact that a cure was not found does not mean that she should not have started looking for a cure immediately. Nobody knew that.

You've reversed the argument. At the point when Heckler made her decision, she should have made the opposite decision, even though that may not have done any good. Supposing that you are right, which I haven't conceded, she still was wrong.

Your attempt at satirizing my position is bullshit, as is your rationality.

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46

The absence of a cure, even today, 23 years after the discovery of HIV, is not intentional.

I don't think anyone said it was. But, as per 2, lots of lives could have been saved even without a cure's being discovered. As I understand, the history behind the country's sluggish response to AIDS in terms of prevention is very complicated; but Heckler's callous attitude may be part of it.

(Also, since God has been mentioned, anyone who says AIDS is punishment from God can fuck right off.)

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47

I think the belief that more resources would have led to a cure was always questionable as a sure thing. And I think a lot of magic thinking was and is involved on this question.

On the other hand, I do think the Reagan administration was slow to respond, and the reasons had to do with their prejudices.

They didn't know. Had a vaccine been found, then the several-years difference foot-dragging would have caused many deaths through negligence. As it is, the effect of the negligence is not so clear.

For the last twenty years, education, prevention, and chipping away at the mortality curve have been the thing, and the backsliding has been discouraging.

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48

We all have some powerful emotional reasons for wanting to fund our pet diseases. I know I have mine. I apologize.

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49

My 48 to John Emerson at 45.

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50

I think that the default SOP should have been to put resources in research immediately. That judgement is not dependent on hindsight.

Quite the opposite -- if Yamamoto is correct, doing the right thing wouldn't have helped, but they still should have done it, because they didn't know that. If the victims hadn't been faggots, I suspect that SOP would have been followed.

In the same way, if a doctor withholds care, he's wrong even if it eventually turns out (as he didn't know) that the disease was incurable.

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51

God and the Fight Against AIDS

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52

AIDS is not my pet disease. I am and always have been very low risk. Politically, I thought that the Reagan administration's position was vicious, even if it did no actual harm (which I do not admit).

Six years is actually quite a nice amount of time to postpone death.

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53

I read the transcript and it seemed that for the first two years after AIDS was defined as a syndrome, no one was certain where to look, and the researching groups were trying to find connections between the populations that had the disease. HIV was found after about two years (1983), and that's about the point where the scientists had enough evidence to go to the blood banks and raise hell.

Would the extra money have made a difference in that two year window? Hard to say. The scientists seem to think so.

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54

While recognizing that we don't have a cure, I guess I don't see why starting more intensive research a couple of years earlier wouldn't have led to drastic life improvements in AIDS patients a couple of years earlier. Is that even what's being argued? Or is the argument about what course of action the facts known to the government supported?

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55

We all have some powerful emotional reasons for wanting to fund our pet diseases. I know I have mine.

Boy, talk about a bad faith argument. Shame on you.

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56

In the same way, if a doctor withholds care, he's wrong even if it eventually turns out (as he didn't know) that the disease was incurable.

This is right, on the face of it, but this example doesn't apply. There was no care to withhold. That's my point. Money for research=/cure. And, in fact, as per my anecdote above, there was money for research, the complaint seems to be that there wasn't enough.

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57

Deep breath, everybody. Let's all try to be nice(ish).

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58

I can see an argument that research takes time and thought, and that you have to have some idea of what you're dealing with before you can even "throw money at it"

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59

I guess I don't see why starting more intensive research a couple of years earlier wouldn't have led to drastic life improvements in AIDS patients a couple of years earlier.

Because the bottlenecks to launching a new area of research are not limited to funding. It takes a lot of time and effort to set up new projects and they always begin small, requiring less funding in the beginning. Pilot projects are almost exclusively born from existing research projects and grants. In practical terms, an excess of money would suffer from the same problems that are apparent in the California stem cell funding; waste, inefficiency, cronyism, and mediocrity.

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60

Ah, #58.

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61

I did not say research = care. That was an analogy; you were supposed to be able to fill in the blanks. I think that rational, normal SOP would have been to put any new fatal infectious disease on the front burner, in the same way that normal rational SOP for MDs is to treat every patient.

As I understand, this didn't happen; Heckler as much as said so, when she talked about budget constraints (along with making her other comments).

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62

I think that rational, normal SOP would have been to put any new fatal infectious disease on the front burner...

I disagree. It depends entirely on the potential scope of the disease. The impact of AIDS was not immediately apparent.

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63

You have to remember that the early victims who died of AIDS were being treated or died from comorbid conditions. It wasn't until much later that people put the constellation of symptoms under one umbrella syndrome.

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64

I'm pretty sure I was in third grade (1985) when I first learned about AIDS. One of my friends, whose mother was the science teacher at elementary school, explained it as a disease that you got when you shared blood with other people. This was the day after we'd all become "blood brothers," like Tom Sawyer, so we all cried and were very afraid we'd die.

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65

I remember about a two-three year period when people, including scientists, were making a lot of noise about AIDS and the Reagan administration appeared to be stonewalling. Am I to understand that during this period there was never any real political problem, and that all the right things were being done, and that the people making the noise were being unreasonable (or perhaps, lobbying for their pet disease)?

This is not my understanding at all, but with the information I have now I'm not able to argue beyond what I've done already. You seem to have a confirmed and rather polemical opinion on the subject, but a lot of it is on a "trust me" basis at this point.

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66

63: Much later? AIDS was understood as a syndrome in 1982.

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67

I remember the after-school specials about kids with AIDS and this is hazy, but some sort of basketball-related injury with blood on the court maybe and everyone worried. And by the time eighth grade sex ed came around, we had the sense that AIDS was as common as all the other STDs and that everyone would be dying of AIDS when they had sex.

Caution is a good thing, but I really think that we went weirdly overboard in our school sex ed classes. Learned none of the practicals like condoms, just about diseases. I guess diseases are safe territory -- talking about pregnancy is weird, but talking about cri du chat and chromosomal disorders, well, that's the okay part of pregnancy.

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68

How did that whole business about Fauci vs. The Pasteur Institute (not a court case, a controversy) fit into it? Did that hold up the identification of HIV and its acceptance?

It seems to me that so much, even epidemiological studies, which are very useful in identifying patterns and behaviors, depend on some basic knowledge.

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69

It's probably worth pointing out that while AIDS was defined as a syndrome in 1981, a 'syndrome' doesn't mean much more than 'here's a list of common symptoms which keep appearing, and seem to be related, but we don't know how, exactly.' Getting to the point where they realized that all of the young men wandering into hospitals with rare pneumoniae (s?) were afflicted by the same underlying problem took some time, but calling it AIDS didn't suggest a clear research path. (Which, indeed, might be cause for more funding, not less, but does go against the idea that the CDC understood AIDS in 1981 and wouldn't fund a cure.)

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70

As I remember, past a certain point the patient advocates and the scientists were on one side, and the Reagan administration was on the other.

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71

More money sooner--- even with all the inefficiencies Yamamoto talks about (and really then, why does he/she even go to work, or is breast cancer research bottle-neck free? Sheesh!) anyway, more money sooner, it seems to me, conceivably would have yielded the cocktail sooner and that, trust me, would have been a lovely thing. Besides, warblogger Sully has been able to strut his stuff for years thanks to the cocktail!

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72

Much later? AIDS was understood as a syndrome in 1982.

The jump from chimps is thought to have been in the 1930's. The first US cases date to 1977.

Then, what Cala says in #69.

The HIV connection took some convincing. Really, not until the middle of '84 were most people convinced of HIV as the causative agent of AIDS. I was at UCLA at that time and by the end of that year, multiple investigators had switched to full-time AIDS research there.

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73

Yes, but no one's complaining about lack of funding for AIDS research in the 1940s, or even in the 1970s. People are complaining about those years in the early and mid 80s when the existence of the problem was known but the federal government was holding back. You seem to believe that this never happened, and that funding levels were unexceptionable throughout the 80s -- no more money should have been devoted to AIDS research than was. This is a minority opinion, which makes it interesting, but I don't see much of anything to support it with, which makes it dull.

Have you got anything you could point me to in support of your position?

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74

No, LizardBreath, I'm saying that there is no evidence that Heckler's attitude or actions led to excess AIDS deaths.

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75

I'd be interested in evidence that AIDS research was never underfunded and that at the time she made the decisions she made, she was making the right decisions.

For another comparison, if someone refuses to send out a rescue party to an accident, that's wrong, whether or not it later turns out that the people were all dead already.

You're putting too much weight on your ex post facto allegation, which may or may not be true, that it turned out not to have made any difference.

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76

I don't think so, John Emerson. While an increase in basic research funding yields more results in the long run, specific results are not, necessarily, a guaranteed payoff from specific funding.

The smoking-lung cancer connection provides a classic example for this. It's known that smoking causes lung cancer in a stochastic sense but it's not possible to say that a particular person's lung cancer was caused by smoking. greater tropical storms.

The field of molecular biology matured during the 80's and early 90's, and basic research in one area led to results in another. The proteases inhibitors developed for the treatment of AIDS couldn't have been developed in 1981 because the background for that science wasn't there yet.

When there is a fixed biomedical research dollar to spend, taking away from lab A to give to lab B would not change the overall progress in basic research, research of the type that laid the groundwork for the practical progress we are seeing for AIDS today.


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77

This is still mostly assertion and philosophical generalities.

You have never given us any information about what actually happened in the early Reagan administration, and what you have said about anything is all "trust me", without documentation. But we don't know who you are.

And I understand you to be saying that when a distinctly new contagious disease arises, no funds should be shifted to the study of the new disease. This makes no sense at all, since in addition to being a new and unknown threat, an unstudied new disease would presumably be more profitable scientifically than one which has already been beaten into the ground with studies. I am also unconvinced that an earlier start wouldn't have been helpful, and you've given no evidence at all that it wouldn't have. Just personal philosophy.

I'm calling bullshit. I think that I've been dealing with a lawyer's case (not a good thing to my eye) which may have been intended to provoke. You've obviously argued it before, and your argument has got its strong points and weak points, but every point you've made has been selected with an eye to supporting the conclusion you started with.

If I studied up on the case I suspect that I'd find more weak spots in your relentless argument than I have so far. I have other fish to fry, and I doubt that I'll do that, so I will now really should retire.

Unfogged prides itself on civil argument, and I've honored the local customs on this, but I'm startled by the feebleness of the response here to Yamamoto.

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78

We're all arguing about feminism in the other thread. This guy hasn't been all that interesting.

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79

I have the distinct impression that this subject is far afield for most of the commenters here and, from the comment above, simply outside of their interest areas. That's fine. Please do study this before presuming a lack of knowledge in others.

And, sheesh. The presumption that I'm a "guy"...

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80

If you're insulted by errors, you'd probably do better with a more gendered pseudonym.

In any case, you haven't said anything beyond wafting in with some completely unsupported generalities. If you have anything concrete to say, you might be able to get a conversation going. Not with what you've been posting.

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81

Not offended. Surprised that the error tipped this way instead of another, in light of the other thread. That's all.

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82

We are complex and multifaceted.

Seriously, if you're interested in my thought process, I assumed Yamamoto was a reference to the WWII admiral, and that someone using the name of a man as a pseudonym was a man. Neither is a necessarily valid step, and my conclusion was wrong, but that's what I was thinking.

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83

We are complex and multifaceted.

Truly.

I shy away from gendered handles because I'm afraid that something clearly feminine will land me in less than neutral territory. (That when people don't respond, it's my gender rather than my "totally unsupported generalities" or something like that.) As I recently returned from Japan, I picked a common Japanese surname, and also a sure google hit so that a search wouldn't instantly yield all my embarrassing postings. It was probably misleading in that the famous Yamamoto was all male and warlike. But even as "Paper Plate" I was assumed male elsewhere.

Oh well, it's a farce, being gender-free on the internet.

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84

I think I know what Yamamoto's saying, and it seems to be this.

We'll assume that by 'needless preventable deaths', af first, we mean the people who contracted AIDS while researchers were trying to figure out what caused it. And the claim is that more money during those years (mid-1981 to 1983) would have lead to a faster discovery of HIV, and thus a faster wakeup call, which according to the PBS documentary went like this a) oh, shit, it's a retrovirus b) this can definitely be in the blood supply c) oh double shit, it doesn't cause symptoms right away and so the patient can transmit it d) condoms & needle exchanges.

In this early stage of research, I'm not sure that the CDCs response is a) to throw all known resources at a new problem, nor b) whether additional funding would have significantly sped up the discovery. Not all the AIDS funding goes to the researchers who theorized about the retrovirus, and surely many of them would have been barking up the wrong trees. Perhaps many of them would have hit on it sooner, but as I understand (vaguely, from science friends), new fields of research tend to attract people in tangentially related fields -- there's not going to be an AIDS expert when they're not sure what the syndrome is.

It's certainly possible that in the 'what is this?' stage, we could have poured more money into research and still not discover the link any faster than the 18 months it took. It's very hard to say, especially because it wasfunded (i.e., we're not arguing where the CDC said no funds but one where scientists said, not enough.) And so saying that Halleck definitely caused X amount of infections by not funding early research doesn't seem to hold up.

Now, that said, I think after HIV is discovered, the lack of funding and federal stonewalling isn't excusable. But it took time for all the scientists to get on the same page, and in that early part it's hard to say what funding would have done.

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Yamamoto should get off his/her "they made assumptions about my gender when they are supposed to all be so enlightened" schtick and look at comment 71. Next, the notion that there was not stonewalling and withholding of resources at the beginning on the part of the Reagan admin is ludicrous. I remember. I was there. Besides, were ACTUP and Queer Nation just making it all up? Come on. And really, the lack of resources meant less work was done and this surely-- and I am repeating myself--- but it appears I must!--- slowed the appearance of various drugs that have since then improved the lives of many people who are living with HIV. Face it. They did not like the gay and they did some things they shouldn't have. The delays were real and there was an at times spoken assertion that the gays brought this on themselves. Again, I heard it. And now according to your logic some questions: Are there too many labs working on breast cancer now? Is all this attention maybe even slowing the arrival of the cure? Sounds outrageous don't you think? I know I do.

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I will add too that it is very convenient for Y to talk about what good this thing would do or that thing would do given how fast labs work and all the rest. But I say no to that. This is sophistry to avoid the moral issue of official attitudes towards citizens who were sick. "Well, it didn't matter anyway in the end that there was not that much money put in..." Lord. No no no. That is not the issue. I need much better than that; becuase a) we don't know for a fact that it did not matter and b) in the end that's not the issue--- the issue is what the government was not willing to do. But hey in this new brave age of ours governments have all kinds of explanations they come up with and apologists who can phrase it all so as to throw sand in the eyes of the credulous. So funny. This is about the 80s but it has a real now feel.

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This is sophistry to avoid the moral issue of official attitudes towards citizens who were sick. "Well, it didn't matter anyway in the end that there was not that much money put in..." Lord. No no no. That is not the issue. I need much better than that; becuase a) we don't know for a fact that it did not matter and b) in the end that's not the issue--- the issue is what the government was not willing to do.

May I say both (a) you betcha, and (b) thank you for restoring Emerson's faith in Unfogged.

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Cala, in the early stage of any study, most funding is wasted. As Henry Ford said, "I didn't have ten thousand unsuccessful experiments. I discovered ten thousand things that didn't work". The possibility of "failure" is part of the definition of experimentation; you don't sit around and wait until you're sure what the right thing to do is.

"After HIV was discovered....." Early research was directed toward discovering HIV.

We have only Yamamoto's claim so far that the research was properly funded. That's what's at issue. It's a factual question, and a lot of people at the time thought that it wasn't. And as I've said, my argument does not require proof that earlier funding would have saved any lives. (This question may have been relevant to LB's original post). Yamamoto is slipping in an ex-post-facto simple-minded utilitarianism into the argument. "It wouldn't have made any difference anyway" is often an invalid argument.

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I'm not quite sure exactly what Yamamoto is arguing. But 76 seems to totally miss the point of Emerson's 75, which was that even if more funding wouldn't have saved any lives, underfunding AIDS research was a morally very poor decision. Because they had no way of knowing that more funding wouldn't have saved any lives. That's just expanding on Mark's 86b, and Emerson's 88: "It wouldn't have made any difference anyway" is often an invalid argument.

Also, this: When there is a fixed biomedical research dollar to spend
doesn't describe the situation. The Reagan administration made a decision to cut biomedical research funding after pushing through tax cuts that blew up the deficit. Heckler praises this 'fiscal restraint'. She should be saying, "You know, since there was a very scary epidemic starting, maybe this wasn't the best time to slash funding for biomedical research."

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My argument was mostly against Tia's 2 and similar sentiments: charging that Y amount of lives could have been saved if X more dollars had been spent because HIV would have been found Z times faster I think is the weakest of arguments against the Reagan administration's failure to fund it. (It's also a sentiment that bothers me about research in general, i.e., 'they' must be holding back the cure for cancer because we've spent so much money on it. There's just not a mappable function from dollars spent to cure attained, other than 'lots' of money is better than 'little' money.)

It's also, for what it's worth, not an argument that the CDC did everything it could.

Stronger arguments: the scientists at the time argued that the research wasn't funded properly, and that not funding the research stemmed from discrimination against gays, and we know that from, well, public statements.

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We have only Yamamoto's claim so far that the research was properly funded.

Those are your words, J. Emerson, not mine. I made no such claim.

Cala get's it in 84. I am guessing Cala has some science background.

With hind sight it's very easy to say that this research avenue or that public health measure would have been best pursued because 20 years later we see results in that area.

It should be obvious to everyone that a free condom campaign would have been incredibly effective.

I actually agree with Mark in his a) above, "we don't know for a fact that it did not matter ". He's exactly right and it's what I've been saying in my posts above. I don't make the claim that funding was ideal and that nothing could have been changed. I simply call bullshit on the idea that we knew then that simply spending more money on research would have changed the time course of the epidemic and its aftermath. We just don't know and we can't know.

Just as an aside, HIV was discovered in France, with research funding that was miniscule compared to the United States.

On Mark's b), yes, the government should do more, especially world-wide. But the government is not responsible for the AIDS epidemic. The HIV is. There are more AIDS deaths in the US now than there were at any time during the 80's. And world-wide, millions of people are dying of AIDS. The problem is far worse than it was in the 80's. Besides research support, massive public health measures are necessary.


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I simply call bullshit on the idea that we knew then that simply spending more money on research would have changed the time course of the epidemic and its aftermath. We just don't know and we can't know.

You do see that this is irrelevant to any moral evaluation of Heckler?

And "we can't know" is really a quite weak statement. Other things being equal, doesn't properly funding research tend to be more effective? In which case we have reason to believe that more funding could have led to discovering the virus sooner, which could have led (perhaps) to a more effective public health campaign. (And I don't think anyone disagrees with you that a free condom campaign would have and still would be effective; one of our beefs with Reagan's ideological heirs is that they're obstructing this sort of thing, too.)

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With hind sight it's very easy to say that this research avenue or that public health measure would have been best pursued because 20 years later we see results in that area.

You're the one relying on hindsight. AIDS proved to be a tricky and difficult problem without a quick answer, but Heckler had no way of knowing that. She gambled that she could get away with doing nothing much (taking no initiative at all, except cutting research spending across the board for unrelated reasons). She may have won her gamble (I'm not admitting that, it's just your assertion) but the gamble was wrong (and for the wrong reasons -- tax-cutting ideology and bigotry). At the time she made the decision she had no way of knowing whether she would be killing people or not.

The comparison with long-term gambling on NOLA levees comes to mind, or the O-ring gambles in the space program. They got away with those gamnbles for a long time.

For all your seeming rationality, you haven't documented anything and you seem to ignore all inconvenient points. I first wondered whether you were a stealth homophobic troll, but now I wonder whether you suffer from Aspergers or something. Because you seem to have your own interpretation of what the (very narrow) main point of the thread is, which hardly relates at all to what other people are talking about.

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93 was me.

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My read was 'troll' in the sense of here primarily to start a fight rather than communicate, but I wouldn't necessarily make any guesses about actual beliefs Y holds.

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I first wondered whether you were a stealth homophobic troll, but now I wonder whether you suffer from Aspergers or something...

Oh, jesus. That's sweet.


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Thought you'd like it, Yamamoto. You have a very peculiar, droidish persona, and a medical explanation would make things fall into place.

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98

Yamamoto: I'm going to say this because I wish someone had said it to me. Please take these responses in good humor, and try to respond as if you had merely been misunderstood. In a surprising number of cases it may actually be true.

When you see so much cleverness, and what looks like subtlety, it can be hard not to feel all comments are directed pointedly and knowingly at you, that you've been read as carefully as you thought you were reading and writing, that everyone has read everything upthread, where you may have carefully said what you are not saying. Think of yourself as being at a party, where someone may have heard a part of some heated reply of yours, taken it for everything you have to say and mean, and lit into you accordingly.

I wouldn't like you to go away repulsed by these responses. I see where you commented in another thread a while ago. Good. One of the rewards of hanging in there is that after a while you can build up good will. Some regulars here have been repelled or banned at one time or another. Get to know us, and it will get easier.

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Some regulars here have been repelled or banned at one time or another.

Lies! IDP is banned!

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I Don't Pay is banned!

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101

And Tia is pwned!

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One of the rewards of hanging in there is that after a while you can build up good will.

For example, I'm unrelentingly obnoxious, yet tolerated.

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Yeah, if you troll long enough, they'll ask you to blog.

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98: Unless Y's a Bush Republican, in which case she has to fight it out with Ideal and baa. THERE CAN BE ONLY TWO.

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104 - We don't have any female Republicans, do we? There's a void looking to be filled.

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She has three kids. The void's been filled at least a few times. (Too much?)

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Some regulars here have been repelled or banned at one time or another

Quite true.

One of the rewards of hanging in there is that after a while you can build up good will.

Very true. Even if you disagree with the views held by most of the people here. baa is, for example, beloved here even though he often challenges what passes for the conventional wisdom here.

THERE CAN BE ONLY TWO

Typical Democrats, always imposing quotas. I guess baa and I are tolerated on the affrimative action for conservatives program.

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108

affrimative action for conservatives program.

No, you come in under the quota for those whose spelling will send Wolfson into an amusing tizzy. We'd let you stay even if you converted.

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affrimative action for conservatives

Uh, Ideal, we'll do a lot of things for you around here--give you advice, host games, cure cancer--but some services are not provided.

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No, you come in under the quota for those whose spelling will send Wolfson into an amusing tizzy.

OK. However, the one time I tried to make claims regarding my inability to spell, I was slapped down rather vigorously. But yes, I also fill a position in the affirmative action for the illiterate program. Thanks for mentioning it.

We'd let you stay even if you converted. But if Hell has frozen over, with the Internet still work?

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It will be powered by flying pigs.

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Sure, we'd just have to switch it over to aviato-porcine power.

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Damn. I am pwned.

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101/113 -- Damn, you guys, get a room...

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Should work faster, what with all the cooling the frozen Hell-ice will provide.

I think I count as the token female Republican. I'm registered as a Republican in my home state (because they asked me at the DMV and I didn't know and they said 'what are your parents?') and a Democrat in this state, which meant on election day I got phone recordings from both parties enjoining me to vote. I'm pretty sure I could vote in both locations, too.

I vote Democrat, though, except for the time I voted Green. So I'm not a good token.

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But Tia's not that way inclined!

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This is funny, and I don't know where to link it.

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115: That's by far the best kind of Republican, except for the Green part.

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The Green was a vote for alderman. It doesn't really count.

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Pick this one, Ogged. You'll want to look for houses on N. Elliot, though, not S. Elliott.

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Wrong thread, Apo.

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Dammit. And for a totally lame comment, too.

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117: I thought this Yglesias post discussing what it means that the President of this country can show up in Iraq without informing its leadership means about the current status of Iraq. It's sort of an obvious point, but I hadn't thought of it.

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[slot this in at comment 97 or so-- in NZ-- I have been asleep]
Basta already! Cui bono!! Cui bono!! For whom would it be a benefit? I will tell you for whom. Heckler. Heckler is grasping at an unproven assumption that extra money would not have helped so she may avoid a serious charge of (and I phrase it gently and avoid mentioning motivation [and dance right on the line of preterition (praeteritio for Ben) here]) “You were in charge of health and you wantonly disregarded the health of citizens.” If she had been in enlightened and non-homophobic administration the benefit of the doubt perhaps could be hers for the taking. But instead we are asked to take this notion as proven fact and allow it to be the key means whereby she can prevail in the court of public opinion and, I guess, live with herself. Heaven knows it is all she’s got. In any case, she asks for the benefit of one doubt too far! Furthermore, Y is an enabler for some bad revisionist history. But this sort of thing is often a problem with scientists/doctors. They think it is all biological and “scientifical” and they therefore unconsciously hold positions that will not withstand moral scrutiny. I remember speaking with (or rather banging my head against wall) with someone in the sciences once who could not see that there may be some moral dimensions for the search for a/the gay gene. I think we need to think about what we may really be talking about when we may think we are just addressing the acquisition of knowledge or the ins and outs of procedure and allocations. (De hac re dixi, I think-- I think it’s been troll feeding time for some time now.)

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There's a reason this is the official Sausagely fan-site: the man is like unto a god in his capacity to state the apparently non-obvious obvious. I liked this, on the minimum wage, as well:

In regard to the minimum wage debate, I'm getting a little tired of appeals to "Economics 101" (or Social Analysis 10, as the case may be) as a conversation-stopper in political debate. After all, there's a reason they offer more economics classes and you don't get your degree after taking just one. A lot of introductory physics classes don't deal with relativity or quantum mechanics, which doesn't make quantum mechanics wrong; it makes introductory physics an oversimplification of complicated reality designed to provide a foundation for further learning.

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Can we make a distinction between Heckler, whom I don't remember very well and Koop, whom I seem to remember had a very obvious humanitarian interest and was portrayed as standing somewhat outside the administration about this?

I would separate the questions of mobilization from effective scientific response, although I admit they are related, and a political "czar" for that kind of thing, or perhaps allowing the head of the NIH to lead, could speed things up quite a bit.

I mean that FDR's response to the Depression may have been, and probably was, largely ineffective economically, but very significant morally. He also modeled what it means to take suffering seriously.
That is leadership, and it wasn't there.

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127

I remain unhappy with Yamamoto's insistence on focussing all attention on the one issue he/she cared to talk about ("Did Heckler actually kill anybody?"), while raising other irrelevant, distracting questions (about monkey transmission in the 30s, the importance of prevention, whether he/she is a guy, etc.) His/her main points were almost entirely assertions, with no attempt at documentation, and I still am not satisfied that she/he has made his/her case even in the limited sense.

I do not share, and scarcelky understand, the Unfogged wish to keep pet Republicans. It may have made some sense twelve years ago, before the Gingrich / Delay / Bush rampages.

However, I am the odd man out here on that question.

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(or Social Analysis 10, as the case may be)

Sausagely went to Harvard?

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127: See my 95. I pretty much agree with your assessment.

And without the Republicans here, who would we berate?

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128 - Oh! Weiner: speaking of universities with which you have been affiliated, it was brought to my attention last weekend that the mascot of your current institution is the "Red Raider". That's the gayest thing I've ever heard.

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For some reason we've been granted permission to use Yosemite Sam as our mascot.

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A little long and lean for Sam, who is the very image of a troll — I mean the real ones.

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So many mean comments. Ouch! And, Sniff!

Check this story. "It is accepted that works may not be displayed in the way that the artist might have intended."


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Just a little more: Reading some Seneca the Younger today. This delightful exchange between two characters in his "Hercules Gone Mad" (lines 1237-1238) is tangentially relatable to the main topic of this benighted thread:
Quis nomen usquam sceleris errori addidit? / Saepe error ingens sceleris obtinuit locum. ["Who is so bold to call an error 'crime?'" "A major error often ranks as crime."]

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