As I come to the 630th and last page of this book, it is 4:47 a.m. Even though I already know this long story well, even though in my professional life I have cared for AIDS patients and fought virtually all the public health policy battles Shilts outlines, I am left with an emptiness. There must be a 631st page, I think; there must be more. The Reagan Administration that we overwhelmingly asked to govern us until January 1989 could not have been as calculating, as politically cold-blooded, as portrayed.
Randy Shilts in his chronological voyage into the AIDS epidemic has done the best job thus far of cataloguing the fear and the denial that have accompanied the intrusion of the human immunodeficiency virus into American life. Shilts on AIDS exceeds Woodward and Bernstein on Watergate: They show up, so to speak, only after the break-in; he is there from the very start. I know at least half the people mentioned in this book, and Shilts has interviewed all the right ones. I have been in the many of the places he describes--notably San Francisco General Hospital, where I spent 2 1/2 years--and he captures their mood. He interprets key events properly. He identifies heroes and villains correctly.
Few of us, for instance, knew about the courage of Dr. Edgar Engleman, medical director of the Blood Bank of the Stanford University Medical Center, who defied conventional wisdom and began testing the blood donated to Stanford long before testing of the blood supply was suggested or mandated by federal health officials. It takes guts to defy the medical establishment and to risk ridicule from colleagues. No one has yet counted the number of lives Engleman's courage saved, but we have counted and continue to count the number of victims the lack of foresight by others has produced.
I have not seen a more accurate description than Shilts' of the budgetary politics on Capitol Hill, the inexcusable delay and subterfuge that continue to cost us so catastrophically in dollars and in lives. Brilliant and dedicated public health physicians are repeatedly caught lying to the Congress to protect a lovable President who is reluctant to return the love that he has received. The picture of a White House staff and a President unwilling to listen to their own health experts, unwilling to demonstrate compassion for the citizens the disease has devastated and unwilling to allocate the dollars necessary to avoid offending the moral minority is creatively intertwined with the human stories of men and women willing to give, in some cases until death, of their compassion, intellect, political savvy and leadership.
Throughout the book, the point is clearly made that few are making the point. Until the death of Rock Hudson in 1985, Shilts documents, AIDS coverage was sporadic and frequently lackluster in all newspapers whose names do not include the words San Francisco or Chronicle. The evidence is clear enough, although since Shilts worked for the Chronicle, his praise of that newspaper weakens his case.
His case is also weakened by the fact that he is little short of arrogant about medical research in areas other than the one that most concerns him. In comparing AIDS spending at the National Institutes of Health to spending on Legionnaire's Disease, for example, he states: "By NIH budget calculations, the life of a gay man was worth about one quarter of that of a member of the American Legion," turning an otherwise important point into an irrational oversimplification based more on anger than on reporting or analysis. In comparing inaction on AIDS to action on the Tylenol poisonings of 1982 Shilts makes it clear that although he has been on the battlefield, he has never been in uniform.
Decision making in public health is exceptionally difficult, the more so when the public is afraid and the media are interested. We are a society that expects instant medical gratification; when we can't get it, when we can't cure, we deny and we blame. The need to protect against the serious threat of Tylenol laced with cyanide and the opportunity to cure patients infected with Legionella, the organism causing Legionnaire's Disease, using a few dollars worth of the inexpensive antibiotic erythromycin, were substantially different from the struggle against AIDS.