Would earlier (or more) funding on AIDS research have significantly reduced U.S. deat

Great Debates
#1

I actually hope to get a serious answer to this question, and would have posted in GQ but I figured it’d come here quick enough. And maybe by starting here, we’ll avoid an uglier place.

There are a few threads afoot about Reagan, and a few people are voicing the opinion that Mr. Reagan was clearly an evil man as he denied and delayed spending money to find a cure for AIDS. I question this on a few levels.

A quick disclaimer: The below is my personal recollection and understanding of things. I have no cites or real facts to back me up. I’m happy to be proven wrong (or right for that matter). Further, I am not anti-gay and I believe AIDS spending was and is very important. Also, I’ve had friends who’ve been taken by the disease. Now…

As I recall, when AIDS was first discovered, there was a lot of fear, but not a lot of death. It was along the lines of Sars, that it was horrible and everybody wanted to avoid it, but in the scope of things, the deaths were in the hundreds or maybe even thousands, but nothing like the sorts of numbers cancer racks up for example. As I recall,for a few reasons, the actual deaths were often signficantly overstated. My recollection was that long before significant numbers of people were dying (or even known to be infected), Reagan had already invested a great deal of money towards it’s cure.

Further, my recollection of events is that the huge drop in the death rate was directly attributable to changes in behaviour, not in medical advances. My understanding is that by the time serious medical advances came along, the infection rate had already been dramatically lowered. Also, my recollection is that the behavioural risks that led to AIDS were well-known by the public from the very beginning, so that this wasn’t any sort of secret that the government could’ve exposed by spending money earlier.

So, I ask, hopefully on a purely factual basis: If funding for AIDS had’ve been delivered more promptly, would there have been significantly fewer deaths? And I’ll also ask the question in a considerably more caustic format: If Ronand Reagan had never delivered a dime of the billions that he committed for AIDS research, would there be significantly more deaths?

By the way, I specifically put the “U.S.” in the title. I understand the very severe situation in Africa, and understand and agree that earlier funding perhaps could’ve made a difference there. But I suspect those around here critical of Mr. Reagan’s AIDS policies are referring specifically to U.S. deaths, and mainly to U.S. deaths in the past.

Thank you.

#2

AIDS is not a highly contagious disease. It’s also a virus. No varus, to date, has been cured. Or put another way, pouring money into finding a cure is money down a rat hole. A simple change in sexual practices combined with a vacination (much cheaper to fund) would have significantly changed the course of the desease.

#3

And I’ve complete forgotten how to spell or use a spellchecker.

#4

I understand that, in the beginning, it was difficult to tie the behaviour to the disease because lack of funding prevented the kind of medical effort from the CDC and others that would have clearly established it. There was great resistance to the idea that it was a sexual and blood-borne disease, and the paltry funding did nothing to help change that. The gay community hated the idea that the overly sexualized part of their big-city culture was responsible for spreading it; the Red Cross and the blood banks refused to believe it was blood-borne and that their supplies were tainted, and that they could be spreading it as well. Their constant objection was “you’ve got no proof”, and without adequate funding, proof was difficult to find.

It was eventually demonstrating these things that brought about the radical shift in behaviours (i.e., closing the gay bathhouses and condom education programs) that made the difference. I’m going largely from memory of the movie based on the book by Randy Shilts about the AIDS epidemic.

#5

I think we are in agreement of the events but I don’t think money would have solved it because of the state of medical knowledge at the time. We still can’t cure a virus and we have completely mapped the human genome. Pouring money into it in the 80’s would not have helped (if a cure was the goal). I’m not sure if the medical community realized the futility of a viral cure or not but there was a definite shift in fund allocation toward the extension of life versus an actual cure.

From a political standpoint, there is a finite amount money to invest in research and there are a lot of health issues to fund. More people die from the stupidity of smoking than the stupidity of unprotected sex.

#6

And said, there’s a lot of demand for an AIDS cure, by virtue of this disease being such a hot topic. As Magiver pointed out though, it’s not highly contagious, and pouring money into findin a cure is like dumping it into a rat hole.

Too bad too, since this disease is almost 100% preventable.

#7

It sure is. Just stop having sex with anybody-you have no guarantee that your significant other is 100% faithful, do you? Avoid going to the hospital-accidents with needles and badly screened donated blood is always a possibility. Never walk barefoot anywhere-who knows what you might step on accidently.
Did I miss anything?

#8

Course there were all those people that died from getting bit by a skeeter that had previously bitten a gay dude. The internment camps solved that problem. And IIRC, everyone, even chicks, started wearing condoms at all times back in 82. Most swore of sex completely, cuz everyone already knew that you could get AIDS from the straight stuff too. Nah, spending money on research and public education wouldn’t have saved anyone. Just look at what a disaster penicillin and the other antibiotics are. Three generations on, and the darn things have quit working; plus children who would have died without the drugs have raised poorly-immune children of their own. What a disaster ! It’s almost as if increasing medical knowledge increases the opportunities for people to die in awful ways. Once AIDS appeared, we should have gotten the message and slunk back into our caves. Shivering in fear, our ignorance would have kept us safer.

#9

Course there were all those people that died from getting bit by a skeeter that had previously bitten a gay dude. The internment camps solved that problem. And IIRC, everyone, even chicks, started wearing condoms at all times back in 82. Most swore of sex completely, cuz everyone already knew that you could get AIDS from the straight stuff too. Nah, spending money on research and public education wouldn’t have saved anyone. Just look at what a disaster penicillin and the other antibiotics are. Three generations on, and the darn things have quit working; plus children who would have died without the drugs have raised poorly-immune children of their own. What a disaster ! It’s almost as if increasing medical knowledge increases the opportunities for people to die in awful ways. Once AIDS appeared, we should have gotten the message and slunk back into our caves. Shivering in fear, our ignorance would have kept us safer.

#10

That’s not even a good rant.

You completely missed the logic. Penicillin and similar drugs work against bacterium. Nothing (again that is NOTHING) has ever been developed to cure a virus. We have developed inoculations against viruses, but not a cure. It’s not like the research money was sitting on a shelf . These funds are finite and have to be spent according to medical need. We could have spent more on AIDS. But the money would have to be taken from other health research funds. Which funds should those be?

A lot of money was and is being spent on AIDS. It is hardly a national crisis that requires it to be investigated above all other diseases. It is certainly the easiest disease to avoid. Don’t boink someone without protection and don’t share needles. Even a Florida voter can understand those instructions. And yet millions of dollars were spent (mostly in Gay venues) to drive this point home.

#11

When was it that they finally determined how AIDS was transmitted? 1983? Knock a year or two off of that and combine it with some serious educational efforts–the kind that Reagan didn’t want to fund–and yeah, I think you’ve got a pretty good chance at really knocking down the number of persons infected by HIV.

#12

Magiver, I’m not arguing events, I’m arguing that a lack of funding prevented the kind of basic knowledge of the disease that allowed for policy changes to make a dent. In 1982, they were still trying to isolate AIDS; finding a cure was years in the future. When the CDC went to the Red Cross and said “you’re spreading AIDS with tainted blood”, the Red Cross said “You don’t even know how the disease spreads, so how can you blame us?”

And while finding a cure is a lost cause, finding treatments over the years has done a hell of a lot to extend the lives of people with HIV.

Money thrown at AIDS early on would have gone towards nailing down the nature of AIDS, and would have gone far towards making the public policy changes and social changes necessary to save lives, at a much earlier time.

#13

Which is exactly why it is so very important to quickly determine the modes of transmission of new virii, the risk factors, and engage in a public education campaign to encourage people to change unsafe behaviors. If you never get the disease, you can’t die from it.

Of course, some risky behaviors aren’t bleedingly obvious without the benefit of 20/20 hindsight:

If we’d worked at it harder, we could have known this sooner, and saved more people. You may call that a waste of money. I don’t.

#14

It is difficult to play this game, really. The OP is exactly right about the HIV infection rates decreasing before the etiology was even firmly tied down. This is largely attributed to the decline of the 1970s bathhouse culture. I am not an expert in the epidemiology of the disease by any means, but I think the evidence of this is reasonably sound.

The epidemiology also directly led to the knowledge that HIV was mostly transmitted sexually, and led to a big push for safe sex in the gay community in the early 1980s. This further decreased the infection rate in the gay community. I think the epidemiology was tied down pretty quickly – before HIV was even identified IIRC in 1983 it was called GRID (gay-related immune deficiency), and it was highly suspected that it was a sexually transmitted virus.

But, the rates of AIDS deaths of HIV positive people never came down until 1996. AZT monotherapy really didn’t do much in staving off the disease, and we had to wait until 1996 for the first protease inhibitors and HAART to come along, which really dealt HIV a wallop. The development of these drugs depended on a lot of things outside of the AIDS field, including molecular modeling and better pharmacological fabrication techniques.

Pouring money into the AIDS field may have helped us understand the structure of the gag protease, which was a key part in protease inhibitor design. But I can’t see it speeding up the development of the therapy. Where it almost definitely would have helped is in diagnosis. The first AIDS tests were horribly unreliable. We could not screen patients accurately, and even worse, we could not screen donated blood and platelets accurately. This led to hundreds of needless infections in hemophiliacs and people getting infected blood by transfusion. Much of the early work on a disease comes in accurate diagnostic tools and developing treatment is often secondary to this. Identifying infected people is half of the battle with HIV: proper diagnostic tools were key in the lifestyle modification efforts which successfully reduced incidence dramatically in the mid-to-late 1980s. If we could have moved beyond the first generation ELISAs to Western blots, PCR assays, and more sophisticated immune assays earlier, we could have probably saved hundreds. This was not waiting on advances in computational biology or materials science, and nearly definitely could have been sped up considerably.

Lastly, it is true that we have never “cured” a virus. Many viruses don’t need “curing” and vaccines have been quite effective for others. Some are still a bitch (HepC comes to mind). HIV has opened a door for us, though: the first chronic virus which is now manageable with chemical antiviral therapy. Similar drugs are in regular usage for different viruses like influenza. These were developed to use the same strategies of the HIV antivirals. This is not like we are throwing money into a bottomless pit here in search of an unattainable cure – much of this research applies beyond the HIV field and helps us understand and treat other diseases. It has broadened our knowledge of our own immune system. We have developed new vaccine strategies which have not yet worked on HIV but may work on other viruses. It has strengthened the ties between epidemiologists, public health and social workers, community activists, and the medical profession. It has given us insight on viral lifecycles and novel gene regulation. It has given us molecular tools which apply in many fields.

The ease of avoidance of a disease or its affected demographic is no reason not to work on a virus or complain about its level of funding. Just remember that lung cancer and heart disease are also largely avoidable, and nobody is arguing that we shouldn’t be funding research into those diseases.

#15

I don’t know who “they” are but I thought it was pretty obvious how it was transmitted. Identified, no. Transmitted, yes. When I found out it was a virus I knew what lay ahead. My personal swag in the 80’s was a death toll of 5%. Maybe a little high but definitely possible.

I thought it was 1980 when I first saw mention of it (was doing some research last year and remember seeing an article on it). Your estimate of 1983 is correct.

Yes, you can blame Reagan for not spending money on ad campaigns early on. But that was already a hot button item in the Gay Community before the discovery of the actual virus. You can’t say the word didn’t get out. Why it was ignored is a debate unto itself. Probably the same reason people ignore anti-drug messages. What affect a national AD campaign would have I honestly couldn’t say. I’ve never been able to understand human nature in the face of obvious facts.

#16

It is difficult to play this game, really. The OP is exactly right about the HIV infection rates decreasing before the etiology was even firmly tied down. This is largely attributed to the decline of the 1970s bathhouse culture. I am not an expert in the epidemiology of the disease by any means, but I think the evidence of this is reasonably sound.

The epidemiology also directly led to the knowledge that HIV was mostly transmitted sexually, and led to a big push for safe sex in the gay community in the early 1980s. This further decreased the infection rate in the gay community. I think the epidemiology was tied down pretty quickly – before HIV was even identified IIRC in 1983 it was called GRID (gay-related immune deficiency), and it was highly suspected that it was a sexually transmitted virus.

But, the rates of AIDS deaths of HIV positive people never came down until 1996. AZT monotherapy really didn’t do much in staving off the disease, and we had to wait until 1996 for the first protease inhibitors and HAART to come along, which really dealt HIV a wallop. The development of these drugs depended on a lot of things outside of the AIDS field, including molecular modeling and better pharmacological fabrication techniques.

Pouring money into the AIDS field may have helped us understand the structure of the gag protease, which was a key part in protease inhibitor design. But I can’t see it speeding up the development of the therapy. Where it almost definitely would have helped is in diagnosis. The first AIDS tests were horribly unreliable. We could not screen patients accurately, and even worse, we could not screen donated blood and platelets accurately. This led to hundreds of needless infections in hemophiliacs and people getting infected blood by transfusion. Much of the early work on a disease comes in accurate diagnostic tools and developing treatment is often secondary to this. Identifying infected people is half of the battle with HIV: proper diagnostic tools were key in the lifestyle modification efforts which successfully reduced incidence dramatically in the mid-to-late 1980s. If we could have moved beyond the first generation ELISAs to Western blots, PCR assays, and more sophisticated immune assays earlier, we could have probably saved hundreds. This was not waiting on advances in computational biology or materials science, and nearly definitely could have been sped up considerably.

Lastly, it is true that we have never “cured” a virus. Many viruses don’t need “curing” and vaccines have been quite effective for others. Some are still a bitch (HepC comes to mind). HIV has opened a door for us, though: the first chronic virus which is now manageable with chemical antiviral therapy. Similar drugs are in regular usage for different viruses like influenza. These were developed to use the same strategies of the HIV antivirals. This is not like we are throwing money into a bottomless pit here in search of an unattainable cure – much of this research applies beyond the HIV field and helps us understand and treat other diseases. It has broadened our knowledge of our own immune system. We have developed new vaccine strategies which have not yet worked on HIV but may work on other viruses. It has strengthened the ties between epidemiologists, public health and social workers, community activists, and the medical profession. It has given us insight on viral lifecycles and novel gene regulation. It has given us molecular tools which apply in many fields.

The ease of avoidance of a disease or its affected demographic is no reason not to work on a virus or complain about its level of funding. Just remember that lung cancer and heart disease are also largely avoidable, and nobody is arguing that we shouldn’t be funding research into those diseases.

#17

edwino
I agree with everything you said that didn’t go over my head. My point, poorly stated, is that I believe the research needed in the 80’s required a higher level of technology (which has now arrived). Nothing short of a “Manhattan Project” would have helped cure the disease.

My hope for the future lies in the recent ability to decode genes. I see this as a first step into an area of knowledge that will grow exponentially in my lifetime.

#18

Magiver,

Just to nitpick, knowing the entire human genome has very little implication on disease treatment currently. There are dozens of steps in between, and hundreds of unknowns which need to be researched. There is no computational technique to assay what a gene is doing: this must be done experimentally, and this takes lots of money. The Human (and other) Genome Project gives us a lot of data to ease the research, but the sequencing raises thousands more questions than it answers.

We are also (probably) decades away from realistic gene-based treatment. Certainly there is hope for the future there, but there is a ton of work to be done in order to get us there, and new therapies need to be developed in the mean time.

My main point is that the diagnostic techniques developed have not depended on new technologies, they have only depended on more research. So increased funding probably would have sped up better diagnostic tools, and this would have reduced the number of deaths, probably considerably.

#19

Oh yeah - it’s all Reagan’s fault that all those people in the 80s got AIDS from walking barefoot.
:rolleyes:

Come on, Czarcasm - usually you don’t say things this silly.

Regards,
Shodan

#20

I don’t know if increased funding would have created better diagnostic tools, but it might have shortened the discovery period. AIDS was around long before it hit the Gay community but it lacked the needed incrediants to make it a large scale problem (transportation and human behavior). It exploded almost overnight around the planet. I would have to get a CDC wonk’s opininion, but I think they took it pretty seriously when there were some dots to connect.