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?

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-AID...

"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

It's too bad that you're replying to a comment on a deeply researched book (And the Band Played On) with a link to a shallow and slanted retrospective justification for lack of leadership.

The original book criticizes then-president Reagan, but also the media (specifically including the NYT) and elements of the medical establishment.

It also gets into controversies within the gay establishment, such as whether to make a fuss about the problem (which could attract attention and lead to "outing" of people), and whether to close bathhouses as health risks.

MRC is hardly an unbiased source of information. Their news group's stated goal is to be the "Leader in Documenting, Exposing and Neutralizing Liberal Media Bias."

From the wikipedia page:

Journalist Brian Montopoli of Columbia Journalism Review in 2005 labeled MRC "just one part of a wider movement by the far right to demonize corporate media" rather than "make the media better." Additionally, Montpoli wrote that "false equivalence is at the very root of MRC’s beliefs."

1 - nothing you said disproves my statements; that reagan had the word "aids" dragged from his lips during a press conference does nothing to change his record of disregard, contempt, and disregard of a crisis because he and his donors disapproved of gay people; nor does it change the fact that he didn't voluntarily mention it until 1987

2 - nor does a record of funding disprove reagan's intentional oversight; by 1992 aids was the #1 cause of death for US men ages 25-44 [1] and by 1994 the #1 cause of death for all americans age 25-44 [1]; the funding was wildly insufficient to mount a proper response. And were it not for reagan's homophobia and bigotry, a more vigorous response could reasonably have saved many more lives

3 - while it is true that federal policy doesn't hinge exclusively on what the president says, nice attempt to change the goals. The point was not that the federal government and medical establishment -- despite reagan -- did both their job and their moral duty, but that he intentionally hampered the response. I repeat: it's indisputable that if a disease affecting, well, reagan supporters had killed 20 thousand americans it would have garned a much more vigorous response, one which could be triggered and pushed by the president himself. For example, see the improvement in response under Clinton. I'm sure it's just a coincidence that AIDS was a priority under a president who isn't a homophobe.

4 - brent bozell is a proud homophobe; what a surprise that he manages to find supposed evidence -- though you shouldn't believe a thing he says without consulting a primary source -- finding that reagan didn't intentionally fail a group of americans reagan despised

[1] http://aids.gov/hiv-aids-basics/hiv-aids-101/aids-timeline/

edit because i forgot the link

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/

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

To quote Reagan's biographer: "Reagan's response to this epidemic was halting and ineffective."

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.

It's important to remember that AZT (the first effective anti-retroviral treatment for HIV) was invented in the 60s as part of cancer research. It wasn't until the mid-80s that HIV researchers started testing it.

In other words, it's not as if the drug was invented in response to the AIDS crisis. Once the NIH/NCI made AIDS research a priority, it was a rather straightforward matter to start testing known anti-retroviral drugs. One can reasonably argue that if the government had made HIV research a priority in the late 70s and early 80s, the effective treatments would have been found before the epidemic exploded (for example, contrast to SARS or bird flu, where the index patients are chased down and isolated, and immunological research begins before there are even tens of thousands of patients.)

Was HIV even identified in the late 1970s and early 80s though? I thought it was identified as a consequence of looking at the causes of the AIDS epidemic.

The virus was discovered in 1983, but knowledge of the "gay cancer" was around in the late 70s. I shouldn't have said "HIV research" there, but rather, "AIDS research". The medical world's interest in AIDS was pretty limited until it started to break out of the marginalized populations of gay men and drug users.

Ah, OK, makes sense. That's when it was realized that it was not exclusively "GRID" (Gay-related Immune Disorder) and that it was transmitted by virus.

It's been a while since I've read the book but "And the Band Played On" paints a pretty sad picture about all the missed opportunities to save lives in the early years of the epidemic, due to (admittedly complicated) politics. And not just among politicians and government agencies, but among medical doctors and researchers and leaders of the gay community. You can feel rage and frustration coming through the pages--and it's an incredibly heartbreaking book as you see many of the main personalities involved in the fight against AIDS succumb to it themselves. Including the author himself.

http://en.wikipedia.org/wiki/And_the_Band_Played_On#Subject

That's specific to the early years though, pre-Rock Hudson. Obviously a lot's changed since then.

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_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-holoc...

Of course, SARS was 30 years later...

To get some perspective, 1981 was as close to 2013 as it was to 1949.

Edit: Yes, I meant 2013, thanks. Point being: I remember the mid (not early) 80's and it SEEMS so recent and modern but it's as far removed from our life today as 1950's life was then.

This made me feel really old, so I checked your math:

  2003 1981 - p
  22
  1981 1949 - p
  32

I think you mean 2013.

Note that HIV/AIDS wasn't altogether distant from Reagan personally: the Reagan's were friends of Rock Hudson, who died of AIDS-related complications in 1985.

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.

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.

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.

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.

Didn't the early stages occur in Africa?

I guess I should say the early stages of the response.