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An Epidemic for Our Time : HISTORY OF AIDS; Emergence and Origin of a Modern Pandemic By Mirko D. Grmek (Princeton University Press: $29.95; 279 pp.) : : GOOD INTENTIONS By Bruce Nussbaum (Atlantic Monthly Press: $19.95, 360 pp.) : SURVIVING AIDS By Michael Callen (HarperCollins: $18.95; 243 pp.)

November 04, 1990|Laurie Garrett | Garrett, currently a medical writer for Newsday, has covered AIDS since the outset of the epidemic in the United States, Africa and Europe

That AIDS is the most politically charged disease of the 20th Century is obvious: No other ailment has been the focus of a United Nations General Assembly session, a special summit of most of the planet's ministers of health, massive demonstrations and disruption of trading on the New York Stock Exchange.

And so it is that these three books undoubtedly will be welcomed by some, denounced by others. Those who praise Grmek's effort probably will hold the other two in disdain; the reverse also is true.

Grmek, a Yugoslavian-born physician and historian who heads the Sorbonne's school of graduate studies, received widespread acclaim last year when it his book released in France. The translators are to be congratulated for their speedy and wonderfully readable efforts--America needed this book posthaste.

Probably because he is not working in the politically charged American AIDS environment, Grmek has succeeded in writing what may well by the best AIDS book released to date. By assiduously avoiding the use of emphasizing devices such as modifying adjectives, italics, exclamation points and personality characterizations, Grmek has written a book that is at once neutral in tone and bold in assertion.

Step by detailed step, Grmek takes the reader down paths of scientific and historic logic, presenting explanations for the origin of AIDS; the differences among African, European and American patterns of the disease's spread; why France should be credited for discovery of the human immuno-deficieny virus (HIV), and why HIV must be accepted as the cause of the disease.

HIV, Grmek asserts, undoubtedly is the cause of AIDS and has been on the planet in its current lethal form for about 150 years. It has undergone at least two waves of human epidemics, Grmek writes, one originating in Africa, the other in America, and "in the second phase of the current epidemic the whole world has essentially been infected by (the spreading of) the American strains. Before the emergence of AIDS in American homosexuals, the African strains of AIDS were introduced into Europe on several occasions, that gave rise only to sporadic cases."

Even those who disagree with his conclusions will find Grmek's research compelling and his positions difficult to dispute.

Such cannot be said of Nussbaum's attempt to expose widespread fraud, corruption, conflictofinterest and incompetence in the American biomedical establishment's war on AIDS. That the system is long overdue for overhaul has become accepted dogma in scientific, government and activist circles. And AIDS-patient advocates have been instrumental in reshaping this system in profound ways that already have affected not only AIDS research but also cancer treatment and the entire function of the Food and Drug Administration. These elements all were in place, the characters colorful, for a compelling and important book.

Unfortunately, the caliber of "Good Intentions" is best summarized by its title. Nussbaum, a Business Week reporter, clearly wrote the book too quickly, and based his analysis on the views of a handful of New York City AIDS activists.

Nussbaum's writing seethes, fumes and rages. The "bad guys" are the leading AIDS researchers at the National Institutes of Health, the FDA, America's universities and Burroughs Wellcome, manufacturer of the only currently licensed AIDS treatment, AZT. To these individuals, Nussbaum assigns only malevolent intentions: greed, fame, patient-abuse, theft, competition, fraud and duplicity. AIDS activists, particularly members of the New York chapter of ACT UP, are described as heroic, brilliant, uncompromising, courageous and consistently capable of achieving historic firsts in medicine.

The dichotomy is not only incorrect, it also is a gross disservice to people who have dedicated years of their lives to this disease. Even individuals described in glowing terms by Nussbaum, such as San Francisco AIDS activist Martin Delaney and New York physician Joseph Sonnabend, have attacked the inaccuracies and injudicious portrayals in this book. Delaney has gone further, expressing fear that the book's critique of the NIH might provide ammunition to members of congress currently seeking to cut the national AIDS research budget.

Michael Callen, who features prominently and heroically in Nussbaum's book, has written his own AIDS epistle, making similar assertions about the biomedical establishment. Fortunately, that is not his focus. The author, who has had AIDS for at least nine years, provides a service to people with AIDS by challenging the notion that the disease is universally fatal.

There are other survivors--individuals who have lived three or more years since developing full AIDS--and Callen details available data on American cases. Fourteen survivors discuss with Callen why they believe they have survived while so many of their friends have fallen. Some took AZT, some found religion, a few are into holistic medicine and megavitamins and several have latched onto New Age ideology as a path to longevity. All have rejected the notion that death is an inevitable outcome of their ailment.

The book ultimately falls short, in my opinion, precisely because it is not a product of the very science that Callen eschews. The reader has no idea how representative these 14 individuals may be of AIDS survivors as a whole, and it is impossible to draw a sound conclusion about which--if any--approach may be a key to outliving the AIDS virus.

BOOKMARK: For an excerpt from "Surviving AIDS," see the Opinion section, Page 2.

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