The Coming Plague (52 page)
Authors: Laurie Garrett
Reagan appointees throughout the federal public health structure reflected the administration's concern for extremely conservative interpretations of health policy. Vociferous abortion opponent Dr. C. Everett Koop was named Surgeon General. Assistant Secretary Brandt was a “states' rights” advocate who believed that most sensitive health issuesâsuch as venereal disease preventionâwere best handled locally, rather than at the federal level. For Health and Human Services Secretary, Reagan chose a mainstream Republican, Dr. Richard Schweiker. And Schweiker's Deputy Secretary was Dr. Robert Windom, an ultraconservative Florida physician whose
Ask Dr
.
Bob
radio talk show, wildly popular in conservative circles, had positioned him as a leading celebrity fund raiser for the 1980 Reagan campaign. CDC director Foege, a close ally of former President Jimmy Carter, would soon be replaced by James Mason, a Mormon physician strongly supported by the conservative senator from Utah, Orrin Hatch.
Ask Dr
.
Bob
radio talk show, wildly popular in conservative circles, had positioned him as a leading celebrity fund raiser for the 1980 Reagan campaign. CDC director Foege, a close ally of former President Jimmy Carter, would soon be replaced by James Mason, a Mormon physician strongly supported by the conservative senator from Utah, Orrin Hatch.
Inside the White House, Reagan surrounded himself with domestic policy advisers who considered even Schweiker and Brandt too liberal: Jack Svahn, Gary Bauer, Nancy Risque, Carl Anderson, Bob Sweet, and Becky Dunlap. These powerful six had their political roots in extremely conservative religious and policy groups.
As Koop would later describe it: “The Reagan revolution brought into positions of power and influence Americans whose politics and personal beliefs predisposed them to antipathy toward the homosexual community.”
23
So sensitive was the GRID situation in the eyes of the White House that, far from ignoring the epidemic (as has been alleged by many critics), key insiders sought almost from the beginning of the Reagan era to hold all federal actions on the matter under tight, centralized control. Koop, for example, though he was the Surgeon General and, therefore, logically the spokesperson for federal epidemic control, was flatly forbidden to make any public pronouncements about the new disease. More than five years would pass before Koop's gag would be untied. A CDC budget outline and description of funding needs, written in response to congressional inquiry, was blocked by Secretary Schweiker's office, and Democrats had to threaten congressional subpoena action to obtain the report in late 1982. Similarly, officials such as the NIH's Wyngaarden, the CDC's Mason, and HHS's Brandt knew they were expected to clear all potentially controversial comments
on the topic with the Domestic Policy Council inside the White House.
24
23
So sensitive was the GRID situation in the eyes of the White House that, far from ignoring the epidemic (as has been alleged by many critics), key insiders sought almost from the beginning of the Reagan era to hold all federal actions on the matter under tight, centralized control. Koop, for example, though he was the Surgeon General and, therefore, logically the spokesperson for federal epidemic control, was flatly forbidden to make any public pronouncements about the new disease. More than five years would pass before Koop's gag would be untied. A CDC budget outline and description of funding needs, written in response to congressional inquiry, was blocked by Secretary Schweiker's office, and Democrats had to threaten congressional subpoena action to obtain the report in late 1982. Similarly, officials such as the NIH's Wyngaarden, the CDC's Mason, and HHS's Brandt knew they were expected to clear all potentially controversial comments
on the topic with the Domestic Policy Council inside the White House.
24
With time, some of Reagan's appointees would surprise observers at both ends of the political spectrum with their independence of thought and action. But there was no visible abundance of it inside the Reagan administration in 1982.
Not surprisingly, David Sencer's letter to Wyngaarden didn't result in the prompt action he and Mayor Koch had expected. It would be more than three months before the NIH would issue its first Request for Applications on GRID research (on August 13, 1982), and a full year before the selection and granting process would be completed. Checks for the first formal research grants to basic scientists wouldn't be cut until May 1, 1983.
25
25
Researchers on the front lines warned that precious time was being lost, and the disease was spreading. But the NIH officially deflected most interest in GRID back to the CDC. In response to Sencer's urgent plea, Wyngaarden suggested the New York City Health Commissioner wait a year, for the NIH's next annual grant round. When an internal NIH report, signed by the director of the National Cancer Institute, urgently recommended creation of an emergency joint NIH/CDC task force to study the mysterious disease, Wyngaarden responded coolly: “While NIH does not bear a direct responsibility for controlling the outbreak, it is apparent that an epidemic of this sort may offer significant scientific opportunities ⦠. I hope that NIH will not fail to capitalize on any opportunity to contribute ⦠.”
26
26
At the annual meeting of the American Public Health Association during the summer of 1982, the group's president, Dr. Stanley Matek, charged that the CDC was forced to stoop to “robbing Peter to pay Paul ⦠Peter is currently the money for venereal disease and other vital public health problems.”
By that time the CDC had spent just under $1 million for some thirteen months of GRID research.
In roughly the same amount of timeâor lessâthe CDC had spent $9 million in pursuit of the cause of death of twenty-nine Legionnaires in 1976â77; more than $1 million on Ebola hemorrhagic fever investigations in Central Africa; at least $135 million on Swine Flu investigation and vaccine development. By the end of 1982, Brandt would defend the Reagan administration by pointing out that between June 1981 and December 1982 a total of 5.5 million federal government dollars were dedicated to the GRID effort, dispensed to the CDC, NIH, and Food and Drug Administration.
This would not appease critics.
“There is no doubt in my mind that if the disease had appeared among Americans of Norwegian descent or among tennis players, rather than gay men, the response of the government and medical community would be different,” charged powerful Democratic Party member Congressman Henry
Waxman of California. “I want to be especially blunt about the political aspect of Kaposi's sarcoma. This horrible disease afflicts members of one of the nation's most stigmatized and discriminated against minorities. The victims are not typical mainstream Americans. They are gays mainly from New York, Los Angeles, and San Francisco. Legionnaires' Disease hit a group of predominantly white, heterosexual, middle-aged members of the American Legion. The respectability of the victims brought them a degree of attention and funding for research and treatment far greater than that which has been made available so far to the victims of Kaposi's sarcoma. I want to emphasize the contrast between the âmore popular' Legionnaires' Diseaseâwhich affected fewer people and proved less likely to be fatalâand Kaposi's sarcoma. What society judged was not the severity of the disease but the social acceptability of the individuals afflicted with it.”
27
Waxman of California. “I want to be especially blunt about the political aspect of Kaposi's sarcoma. This horrible disease afflicts members of one of the nation's most stigmatized and discriminated against minorities. The victims are not typical mainstream Americans. They are gays mainly from New York, Los Angeles, and San Francisco. Legionnaires' Disease hit a group of predominantly white, heterosexual, middle-aged members of the American Legion. The respectability of the victims brought them a degree of attention and funding for research and treatment far greater than that which has been made available so far to the victims of Kaposi's sarcoma. I want to emphasize the contrast between the âmore popular' Legionnaires' Diseaseâwhich affected fewer people and proved less likely to be fatalâand Kaposi's sarcoma. What society judged was not the severity of the disease but the social acceptability of the individuals afflicted with it.”
27
With more than 500 diagnosed GRID cases in America, an apparent death rate of 50 percent, and no sign the epidemic would spontaneously abate, the mysterious ailment had become thoroughly politicized. Battle lines were drawn. Public health scientists and physicians were forcedâagainst the basic natures of mostâto choose sides. With time the situation would only worsen, antagonisms would heighten.
Swine Flu and Legionnaires' Disease had certainly been politicized epidemics, but scientists working on the front lines had, for the most part, been shielded from the squabbles and allowed to pursue their investigations. And they never lacked sufficient resources. If GRID had been, for example, a lethal contamination of a commercial food product, there would have been no question of the CDC's public health mandate: order a recall of the product, issue high-profile public warnings, and identify and disinfect the source of the contamination.
But what constituted proper health action in 1982 for GRID?
Curran and Jaffe felt a key part of their job was to warn the gay community. In public forums in New York, San Francisco, and Los Angeles the CDC scientists labeled GRID “an epidemic unprecedented in the history of American medicine” and urged gay Americans to shake themselves out of a state of collective denial. Curran would point to Bill Darrow's data showing that the more sexually active a man was, the greater his risk of contracting GRID.
Meanwhile, Darrow had for months been using the standard sociology techniques he had applied to other disease problems during his twenty-one years with the CDC, to try to disprove etiologic roles for “poppers,” “fisting,” and other environmental factors, and prove that GRID was caused by an infectious agent. He searched for an irrefutable infectious link between people who had the disease.
A crucial clue came on March 6, 1982, when the Los Angeles Department of Health got a phone call from a gay man who had previously been interviewed by CDC investigators, as had dozens of GRID victims, mostly
in California and New York. The man called from an L.A. hospital, where his lover had just succumbed to GRID.
in California and New York. The man called from an L.A. hospital, where his lover had just succumbed to GRID.
“There are two other guys here in the hospital with the disease right now, and I know they had sex with my lover,” the man said.
The call was referred to Dr. David Auerbach, an EIS trainee for the CDC, based in Los Angeles. Auerbach met with the informant hours later, and heard a sexual saga that began in October 1979, when five previously unacquainted gay couples shared a table at a benefit banquet.
28
28
The informant and his boyfriend, like the other four couples, had a long-standing but nonmonogamous relationship.
During the summer of 1980 one of the couples threw a backyard barbecue party, inviting a pair they had met at the benefit, who brought with them a gay prostitute. That night all five men had sex with one another. Sometime later, the informant's lover had sex with a member of the barbecue crowd.
Two months later, two members of the barbecue quintet contracted
Pneumocystis
pneumonia. A few weeks earlier the informant's lover had discovered Kaposi's sarcoma splotches on his skin.
Pneumocystis
pneumonia. A few weeks earlier the informant's lover had discovered Kaposi's sarcoma splotches on his skin.
The three men died on October 6, 1981; February 6, 1982; and March 6, 1982.
“Six-six-six, you get it?” the informant asked. “Six-six-six!”
Moved by the biblically ominous coincidence of sixes, the man had called the Health Department.
Auerbach telephoned Darrow in Atlanta, who took the next flight to Los Angeles.
For several high-paced days Auerbach and Darrow crisscrossed Los Angeles and Orange counties, interviewing the eight surviving GRID patients of the nineteen cases diagnosed in the two counties prior to April 1982. To gain information on the eleven who had died, the CDC investigators sought out family members, ex-lovers, and friends. Many refused to cooperate, but within two weeks the scientists had solid information sexually linking nine of the men.
By April 7, Darrow and Auerbach had established that two members of the barbecue party group had in 1979 and 1980 had sex with two other Los Angeles GRID casesâindividuals who hadn't yet been linked in any way to the rest of the group.
As they crisscrossed Los Angeles that spring day, something eerie happened. Two unacquainted men with GRID independently mentioned a handsome French-Canadian flight attendant with whom they had had sex. The coincidence was striking.
The CDC investigators were further “astounded,” they said, when “on the same day the companion of a third case in Los Angeles said that his roommate had had sexual contacts with two friends of this same out-of-California [Canadian] case.”
Though Darrow and Auerbach went to great lengths to protect the confidentiality
of the men they interviewed during the 1981â82 investigation, even destroying all photographs and identifying material, somebody close to the inquiry leaked the Canadian's name to San
Francisco Chronicle
reporter Randy Shilts.
of the men they interviewed during the 1981â82 investigation, even destroying all photographs and identifying material, somebody close to the inquiry leaked the Canadian's name to San
Francisco Chronicle
reporter Randy Shilts.
And Gaetan Dugas would be, after his demise, vilified and crucified, mistakenly named as the man who personally spread GRID around North America.
29
In 1985 Dugas's photograph would hang in the STD clinic in Lusaka University Teaching Hospital in Zambia, captioned: “The Man Who Started the Epidemic.” Because four of their Los Angeles GRID cases named Dugas as their sexual partner, the CDC investigators designated the Canadian as “Patient Zero.” This would later be mistakenly interpreted as indicative of a primary, causative role for Dugas.
29
In 1985 Dugas's photograph would hang in the STD clinic in Lusaka University Teaching Hospital in Zambia, captioned: “The Man Who Started the Epidemic.” Because four of their Los Angeles GRID cases named Dugas as their sexual partner, the CDC investigators designated the Canadian as “Patient Zero.” This would later be mistakenly interpreted as indicative of a primary, causative role for Dugas.
Darrow flew the following day to New York City to interview Dugas, the man's physician, Alvin Friedman-Kien, having agreed to introduce the two when Gaetan came in for a checkup.
Darrow was struck by Dugas's candor and swagger. Though Dugas had a few Kaposi's lesions, he seemed unconcerned. He said he felt fine. And he anticipated sexual encounters in the dozens of cities he was scheduled to fly into over coming weeks.
Dugas matter-of-factly laid out his sexual/disease history for Darrow. By late 1978âDarrow's study periodâDugas was averaging 250 encounters a year. Between December 1978 and April 1982, Dugas guessed, he'd had sex with about 750 men. He estimated that his lifetime total of sex partners, since he became active in 1972, exceeded 2,500.
During that time Dugas had suffered ailments that weren't diagnosed as GRID until July 1981. In 1979 his lymph nodes swelled appreciably and he felt as if he had a severe case of the flu. A few months later he came down with
Pneumocystis
pneumonia and was hospitalized in Canada. By early 1981 Dugas had Kaposi's sarcoma, and in July 1981 he came under the care of dermatologist Friedman-Kien.
Pneumocystis
pneumonia and was hospitalized in Canada. By early 1981 Dugas had Kaposi's sarcoma, and in July 1981 he came under the care of dermatologist Friedman-Kien.
The CDC's Mary Guinan had interviewed Dugas during the summer of 1981, and his story was already in the agency's files when Darrow asked Dugas to list as many of his sex partners as he could remember. Dugas had never learned the names of most of his bathhouse partners. But he was able to confirm those four Darrow and Auerbach had discovered in Los Angeles, and add sixty-eight more, including four New Yorkers whose cases then led Darrow to a cluster of men who partied on Fire Island during the summers of 1979 and 1980.
Other books
Fabulous Five 022 - Melanie's Valentine by Betsy Haynes
Do-Over by Niki Burnham
Liverpool Love Song by Anne Baker
Autumn Glory and Other Stories by Barbara Metzger
Half Life by Hal Clement
Azazeel by Ziedan, Youssef
The Book of Goodbyes by Jillian Weise
Roger Ailes: Off Camera by Zev Chafets
The Advocate's Conviction by Teresa Burrell
The Witch of Eye by Mari Griffith
