The Coming Plague (121 page)
Authors: Laurie Garrett
37
M. Carl, D. L. Blakey, D. P. Francis, and J. E. Maynard, “Interruption of Hepatitis B Transmission by Modification of a Gynaecologist's Surgical Technique,”
Lancet
I, 8274 (1982): 731â33.
Lancet
I, 8274 (1982): 731â33.
38
W. L. Heyward, T. R. Bender, A. P. Lanier, et al., “Serological Markers of Hepatitis B Virus and Alpha-fetoprotein Levels Preceding Primary Hepatocellular Carcinoma in Alaskan Eskimos,”
Lancet
II, 8304 (1982): 889â91.
Lancet
II, 8304 (1982): 889â91.
39
N. E. Reiner. F. N. Judson, W. W. Bond, et al., “Asymptomatic Rectal Mucosal Lesions and Hepatitis B Surface Antigen at Sites of Sexual Contact in Homosexual Men with Persistent Hepatitis B Virus Infection,”
Annals of Internal Medicine
96 (1982): 170â73.
Annals of Internal Medicine
96 (1982): 170â73.
40
According to CDC statistics amassed by Dr. Miriam Alter, the more easily transmitted hepatitis A dominated all reported cases of the liver disease until 1983, when it was surpassed by hepatitis B. The increase was largely in gay Caucasian males. Between 1966 and 1983, hepatitis A rates declined, as surely as B rates escalated.
41
R. H. Purcell, “The Viral Hepatitides,”
Hospital Practice
, July 1978: 51â63.
Hospital Practice
, July 1978: 51â63.
42
M. Robertson, “Joining the War Against Hepatitis B,”
San Francisco Chronicle
, February 5, 1982: A24.
San Francisco Chronicle
, February 5, 1982: A24.
43
Laws governing drug paraphernalia and possession vary widely around the world and from state to state within a country. In Amsterdam, for example, it is legal to purchase both the narcotic drugs and sterile equipment for injection. In the United States narcotics use is governed at both the state and federal levels. In general, the commerce or business end of narcoticsâimport, transport, and distributionâfalls under federal law, while the consumer endâuse and possessionâis under state law. The exceptions relate to quantities, with federal jurisdiction coming into play where the amount of drugs in one's possession is large. A cogent review of the complexities of U.S. narcotics laws can be found in L. Gostin. “The Interconnected Epidemics of Drug Dependency and AIDS,”
Harvard Civil Rights-Civil Liberties Law Review
26 (1991): 114â84.
Harvard Civil Rights-Civil Liberties Law Review
26 (1991): 114â84.
44
In 1975,
Newsday
and reporters Les Payne, Knut Royce, and Bob Greene won the Pulitzer Prize for their series of reports tracing the deaths of suburban Long Island, New York, residents back through international crime networks all the way to the poppy fields of Turkey. The series was republished as a book:
The Heroin Trail
(New York: Holt. Rinehart and Winston, 1974). The author has drawn liberally from their work in describing heroin distribution during the 1970s.
Newsday
and reporters Les Payne, Knut Royce, and Bob Greene won the Pulitzer Prize for their series of reports tracing the deaths of suburban Long Island, New York, residents back through international crime networks all the way to the poppy fields of Turkey. The series was republished as a book:
The Heroin Trail
(New York: Holt. Rinehart and Winston, 1974). The author has drawn liberally from their work in describing heroin distribution during the 1970s.
45
Heroin was first marketed internationally by the Bayer Chemical Company of Germany, which sold the compound in 1898 as a cough suppressant. By 1906 the product had become so popular that the American Medical Association officially recommended its use as a painkiller.
But by 1924 some 200,000 Americans and an unknown number of Europeans were cough syrup addicts. That year the U.S. Congress outlawed further importation of the Bayer cough syrup and all other heroin-containing products.
The second international heroin marketing effort came on the heels of World War II, reaching the lucrative urban centers of Europe and North America during the 1950s. From its outset, the second heroin marketing efforts, which was entirely illegal, was run by well-established, traditional organized crime elements in each country.
In 1961 the Mafia distributors who controlled the U.S. heroin trade created increased consumer demand and profits by manufacturing a false drug panic. Heroin was deliberately held off the market,
causing tens of thousands of addicts, most of them then living in New York City and nearby cities such as Newark, to experience the physical pangs of withdrawal. Once the desired pressure had been exerted, the wholesalers released drugs diluted still further, setting the standard of 90 to 95 percent dilution that would remain in place for years. To maintain the high to which they had become accustomed, addicts had to purchase more heroin. On the other hand, the diluted formulation seemed less threatening to potential new consumers.
causing tens of thousands of addicts, most of them then living in New York City and nearby cities such as Newark, to experience the physical pangs of withdrawal. Once the desired pressure had been exerted, the wholesalers released drugs diluted still further, setting the standard of 90 to 95 percent dilution that would remain in place for years. To maintain the high to which they had become accustomed, addicts had to purchase more heroin. On the other hand, the diluted formulation seemed less threatening to potential new consumers.
46
Meanwhile, there was one city on the planet in which nearly pure heroin crystals could be purchased relatively cheaply at the retail level: Saigon. The heroin was of such strength that the thousands of U.S. soldiers stationed in the city who indulged in the drug refrained from injecting the substance because they obtained a powerful high from merely smoking the Saigon product.
The congressional Subcommittee on Public Health heard testimony that at least 12,000 returning GIs were severely addicted and in need of detoxification and treatment. A U.S. medical officers' survey put that figure higher, estimating that 25,000 to 37,000 GIs had become heroin addicts during the Vietnam War. See “The Drug Abuse Problem in Vietnam,”
Report to the Office of the Provost Marshal,
U.S. Military Assistance Command Vietnam, 1971; and
New York Time
s, May 16, 1971: A16.
Report to the Office of the Provost Marshal,
U.S. Military Assistance Command Vietnam, 1971; and
New York Time
s, May 16, 1971: A16.
In 1975 the U.S. government spent $360 million on drug treatment and prevention programs, and $320 million on law enforcement aimed at narcotics control. By 1980 those figures had shifted to $410 million for treatment and prevention, half a billion dollars for law enforcement. By 1989 those figures would have soared to $1.2 billion for treatment and prevention efforts and $2.66 billion for law enforcement. Institute of Medicine,
Treating Drug Problems
, Vol. 1 (Washington, D.C.: National Academy of Sciences, 1990).
Treating Drug Problems
, Vol. 1 (Washington, D.C.: National Academy of Sciences, 1990).
47
New Jersey Department of Health, “Statistical Perspectives on Drug Abuse Treatment in New Jersey, 1985,” CN 362, Office of Data Analysis and Epidemiology, Trenton, NJ, 1986.
48
C. E. Cherubin, “Infectious Disease Problems of Narcotic Addicts,”
Archives of Internal Medicine
128 (1971): 309â13.
Archives of Internal Medicine
128 (1971): 309â13.
49
D. P. Levine and J. D. Sobel,
Infections in Intravenous Drug Abusers
(Oxford, Eng.: Oxford University Press, 1991).
Infections in Intravenous Drug Abusers
(Oxford, Eng.: Oxford University Press, 1991).
50
Ibid.
51
E. Drouhet, B. Dupont, C. Lapresle, and P. Ravisse, “Nouvelle Pathologie: Candidose Folliculaire et Nodulaire avec les Localisations Ostéo-Articulaires et Oculaires au Cours des Septicemies
à Candida albicans
chez les Héroïn Omanes, Mono et Polythérapic Antifongue,”
Bulletin de la Société Française Mycologique Médecin
10 (1981): 179â83.
à Candida albicans
chez les Héroïn Omanes, Mono et Polythérapic Antifongue,”
Bulletin de la Société Française Mycologique Médecin
10 (1981): 179â83.
52
J. Mills and D. Drew, “
Serratia marcescens
Endocarditis: A Regional Illness Associated with Intravenous Drug Abuse,”
Annals of Internal Medicine
84 (1976): 29â35.
Serratia marcescens
Endocarditis: A Regional Illness Associated with Intravenous Drug Abuse,”
Annals of Internal Medicine
84 (1976): 29â35.
53
Bacterial subtypes 29/52/80/95 in Detroit; 29/77/83A/85 in Boston. See L. R. Crane, D. P. Levine, M. J. Zervos, and G. Cummings, “Bacteremia in Narcotic Addicts at the Detroit Medical Center: I. Microbiology, Epidemiology, Risk Factors, and Empiric Therapy,”
Review of Infectious
Diseases
8 (1986): 364â73; and D. E. Craven, A. I. Rixinger, T. A. Goularte, and W. R. McCabe, “Methicillin-Resistant
Staphylococcus aureus
Bacteremia Linked to Intravenous Drug Abusers Using a âShooting Gallery,'”
American Journal of Medicine
80 (1986): 770â76.
Review of Infectious
Diseases
8 (1986): 364â73; and D. E. Craven, A. I. Rixinger, T. A. Goularte, and W. R. McCabe, “Methicillin-Resistant
Staphylococcus aureus
Bacteremia Linked to Intravenous Drug Abusers Using a âShooting Gallery,'”
American Journal of Medicine
80 (1986): 770â76.
54
L. B. Reichman, C. P. Felton, and J. R. Edsall, “Drug Dependence: A Possible New Risk Factor for Tuberculosis Disease,”
Annals of Internal Medicine
139 (1979): 337â39.
Annals of Internal Medicine
139 (1979): 337â39.
55
The exceptions, of course, were the middle- and upper-class cocaine addicts. By 1985 a multimillion-dollar industry for treatment of such individuals would flourish worldwide. One would even bear the imprimatur of the wife of a former U.S. President, Betty Ford.
11. Hatari
1
Centers for Disease Control,
“Pneumocystis
PneumoniaâLos Angeles,”
Morbidity and Mortality Weekly Report
30 (1981): 250â52.
“Pneumocystis
PneumoniaâLos Angeles,”
Morbidity and Mortality Weekly Report
30 (1981): 250â52.
2
Centers for Disease Control, “Kaposi's Sarcoma and
Pneumocystis
Pneumonia Among Homosexual MenâNew York City and California,”
Morbidity and Mortality Weekly Report
30 (1981): 305â8.
Pneumocystis
Pneumonia Among Homosexual MenâNew York City and California,”
Morbidity and Mortality Weekly Report
30 (1981): 305â8.
3
The often-cited first popularly published account of these cases was written by Lawrence Altman: “Cancer Outbreak in Homosexuals,”
New York Times
, July 3, 1981: 20. In point of fact, the first published account of a mysterious new ailment in the gay community was authored by Dr. Lawrence Mass and appeared on May 18, 1981, in the
New York Native
.
New York Times
, July 3, 1981: 20. In point of fact, the first published account of a mysterious new ailment in the gay community was authored by Dr. Lawrence Mass and appeared on May 18, 1981, in the
New York Native
.
4
Many details of the first days of the AIDS epidemic, particularly in the United States, can be found in D. Black,
The Plague Years
(New York: Simon & Schuster, 1986); S. Connor and S. Kingman,
The Search for the Virus
(London: Penguin, 1988); M. Daly, “AIDS Anxiety,”
New York
, June 20,
1983: 23â29; L. Kramer,
The Normal Heart
(New York: New American Library, 1985); R. Shilts,
And the Band Played On
(New York: St. Martin's Press, 1987); and F. P. Siegal and M. Siegal,
AIDS: The Medical Mystery
(New York: Grove Press, 1983).
The Plague Years
(New York: Simon & Schuster, 1986); S. Connor and S. Kingman,
The Search for the Virus
(London: Penguin, 1988); M. Daly, “AIDS Anxiety,”
New York
, June 20,
1983: 23â29; L. Kramer,
The Normal Heart
(New York: New American Library, 1985); R. Shilts,
And the Band Played On
(New York: St. Martin's Press, 1987); and F. P. Siegal and M. Siegal,
AIDS: The Medical Mystery
(New York: Grove Press, 1983).
5
By 1990 the CDC's budget was $1 billion. The nearly fourfold increase was largely related to AIDS surveillance, state health department support for HIV work, and AIDS education campaigns.
6
S. E. Follansbee, D. F. Busch, C. B. Wofsy, et al., “An Outbreak of
Pneumocystis carinii
Pneumonia in Homosexual Men,”
Annals of Internal Medicine
96 (1982): 705â13.
Pneumocystis carinii
Pneumonia in Homosexual Men,”
Annals of Internal Medicine
96 (1982): 705â13.
7
S. K. Dritz, “Medical Aspects of Homosexuality,”
New England Journal of Medicine
302 (1980): 463â64.
New England Journal of Medicine
302 (1980): 463â64.
8
Centers for Disease Control, “Acquired Immune Deficiency Syndrome (AIDS): Precautions for Clinical and Laboratory Staffs,”
Morbidity and Mortality Weekly Report
31 (1982): 577â80.
Morbidity and Mortality Weekly Report
31 (1982): 577â80.
9
Larry Kramer, Joseph Sonnabend, Michael Callen, and Richard Berkowitz penned dire warnings to the gay community that appeared in the
New York Native
, then the city's leading gay newspaper. Sadly, the most outspoken leaders of the gay community at the time, and the
Native
itself, roundly denounced Kramer and Callen. The pair were reviled as homosexuals filled with self-loathing; antisex gays who wanted their fellow travelers to return to the quiet, closeted days before Stonewall. Kramer, in particular, was called everything from a homophobe to a hateful fearmonger. The campaign against Callen would start slowly, but would snowball until, in 1983, false rumors would spread that the gay activist was secretly a Christian fundamentalist, working for the Reverend Sun Myung Moon.
New York Native
, then the city's leading gay newspaper. Sadly, the most outspoken leaders of the gay community at the time, and the
Native
itself, roundly denounced Kramer and Callen. The pair were reviled as homosexuals filled with self-loathing; antisex gays who wanted their fellow travelers to return to the quiet, closeted days before Stonewall. Kramer, in particular, was called everything from a homophobe to a hateful fearmonger. The campaign against Callen would start slowly, but would snowball until, in 1983, false rumors would spread that the gay activist was secretly a Christian fundamentalist, working for the Reverend Sun Myung Moon.
10
K. B. Hymes, J. B. Greene, A. Marcus, et al., “Kaposi's Sarcoma in Homosexual Men: A Report of Eight Cases,”
Lancet
II (1981): 598â600.
Lancet
II (1981): 598â600.
11
M. S. Gottlieb, R. Schroff, H. M. Schanker, et al., “
Pneumocystis carinii
Pneumonia and Mucosal Candidiasis in Previously Healthy Homosexual Men: Evidence of a New Acquired Cellular Immunodeficiency,”
New England Journal of Medicine
305 (1981): 1425â31; H. Masur, M. A. Michelis, J. B. Greene, et al., “An Outbreak of Community Acquired
Pneumocystis carinii
Pneumonia: Initial Manifestation of Cellular Immune Dysfunction,”
New England Jonrnal of Medicine
305 (1981): 1431â38; and F. P. Siegal, C. Lopez, G. S. Hammer, et al., “Severe Acquired Immunodeficiency in Male Homosexuals, Manifested by Chronic Perianal Ulcerative Herpes Simplex Lesions,”
New England Journal of Medicine
305 (1981): 1439â44.
Pneumocystis carinii
Pneumonia and Mucosal Candidiasis in Previously Healthy Homosexual Men: Evidence of a New Acquired Cellular Immunodeficiency,”
New England Journal of Medicine
305 (1981): 1425â31; H. Masur, M. A. Michelis, J. B. Greene, et al., “An Outbreak of Community Acquired
Pneumocystis carinii
Pneumonia: Initial Manifestation of Cellular Immune Dysfunction,”
New England Jonrnal of Medicine
305 (1981): 1431â38; and F. P. Siegal, C. Lopez, G. S. Hammer, et al., “Severe Acquired Immunodeficiency in Male Homosexuals, Manifested by Chronic Perianal Ulcerative Herpes Simplex Lesions,”
New England Journal of Medicine
305 (1981): 1439â44.
12
W. L. Drew, L. Mintz, R. C. Miner, et al., “Prevalence of Cytomegalovirus Infection in Homosexual Men,”
Journal of Infectiouis Diseases
143 (1981): 188â92.
Journal of Infectiouis Diseases
143 (1981): 188â92.
13
H. Masur, M. A. Michelis, J. B. Greene, et al., “An Outbreak of Community-Acquired
Pneumocystis carinii
Pneumonia,”
New England Journal of Medicine
305 (1981): 1431â38.
Pneumocystis carinii
Pneumonia,”
New England Journal of Medicine
305 (1981): 1431â38.
14
W. W. Darrow, D. Barrett, K. Jay, et al., “The Gay Report on Sexually Transmitted Diseases,”
American Journal of Public Health
71 (1981): 1004â11.
American Journal of Public Health
71 (1981): 1004â11.
15
Gottlieb, Schroff, Schanker, et al. (1981), op. cit.
16
Siegal and Siegal (1983), op. cit.
17
W. Rozenbaum, J. P. Coulaid, A. G. Saimot, et al., “Multiple Opportunistic Infection in a Male Homosexual in France,”
Lancet
I (1982): 572â73.
Lancet
I (1982): 572â73.
18
Most budgetary information outlined in this chapter was drawn, unless noted otherwise, from U.S. Congress, Committee on Government Operations, “Federal Response to AIDS” (Washington, D.C.: Government Printing Office, November 30, 1983); and U.S. House of Representatives, Hearings Before a Subcommittee of the Committee on Government Operations, “Federal Response to AIDS,” August 2, 1983.
19
No laboratory funds were specifically earmarked for the group, though lab research is generally the most expensive component of any scientific investigation.
20
Original members included Drs. Willy Rozenbaum, Jacques Leibowitch, Serge Kernbaum, Jean-Claude Gluckman, David Klatzmann, Odile Picard, and Charles Mayaud, as well as Claude Villalonga and Jean-Baptiste Brunet. For a detailed description of French anti-AIDS efforts, see M. D. Grmek,
History of AIDS: Emergence and Origin of a Modern Pandemic
(Princeton, NJ: Princeton University Press, 1990).
History of AIDS: Emergence and Origin of a Modern Pandemic
(Princeton, NJ: Princeton University Press, 1990).
21
A. R. Moss, P. Bacchetti, M. Gorman, et al., “AIDS in the âGay' Areas of San Francisco,”
Lancet
I (1983): 923â24.
Lancet
I (1983): 923â24.
22
A good synopsis of the early San Francisco Cohort findings can be found in the CDC's
Morbidity and Mortality Weekly Report
34 (1985): 573â75, entitled “Update: Acquired Immunodeficiency Syndrome in the San Francisco Cohort Study, 1978â1985.”
Morbidity and Mortality Weekly Report
34 (1985): 573â75, entitled “Update: Acquired Immunodeficiency Syndrome in the San Francisco Cohort Study, 1978â1985.”
23
In his revealing book,
Koop: The Memories of a Family Physician
(New York: Random House, 1991), former Surgeon General C. Everett Koop described in detail his struggles over AIDS. He asserted, “Within the politics of AIDS lay one enduring, central conflict: AIDS pitted the politics of the gay revolution of the seventies against the politics of the Reagan revolution of the eighties.”
Koop: The Memories of a Family Physician
(New York: Random House, 1991), former Surgeon General C. Everett Koop described in detail his struggles over AIDS. He asserted, “Within the politics of AIDS lay one enduring, central conflict: AIDS pitted the politics of the gay revolution of the seventies against the politics of the Reagan revolution of the eighties.”
24
E. N. Brandt, “Implications of the Acquired Immunodeficiency Syndrome for Health Policy,”
Annals of Internal Medicine
103 (1985): 771â73.
Annals of Internal Medicine
103 (1985): 771â73.
25
According to the U.S. Public Health Service, AIDS-related actual spending in FY 1982 and 1983 broke down as follows:
| (In thousands) | ||
|---|---|---|
| Agency | FY 1982 | FY 1983 |
| ADAMHA (Alcohol, Drug Abuse, and Mental Health Administration) | $ 0 | $ 516 |
| CDC (Centers for Disease Control) | $2,050 | 6,202 |
| FDA (Food and Drug Administration) | 150 | 350 |
| NIH (National Institutes of Health): | ||
| NCI (Natâl Cancer Institute) | 2,400 | 9,790 |
| NHLBI (Nat'l Heart, Lung and Blood Institute) | 5 | 1,202 |
| NIDR (Natâl Institute of Dental Research) | 25 | 25 |
| NINCDS (Nat'l Institute of Neurological, Coronary Disease and Stroke) | 31 | 684 |
| NIAID (Natâl Institute of Allergy and Infectious Diseases) | 297 | 9,223 |
| NEI (Nat'l Eye Institute) | 33 | 45 |
| DRR (Department of Research Resources) | 564 | 699 |
| National Institutes of Health Totals | $3,355 | $21,668 |
| Grand Total Public Health Service Spending | $5,555 | $28,736 |
26
Memorandum, Dr. James Wyngaarden, Director, National Institutes of Health, to Board of Institute Directors, July 13, 1982.
27
G. Bosker, “Gays and CancerâBlaming the Victims?”
In These Times,
August 25âSeptember 7, 1982: 2.
In These Times,
August 25âSeptember 7, 1982: 2.
28
The events are described in D. M. Auerbach, W. W. Darrow, H. W. Jaffe, and J. W. Curran, “Cluster of Cases of the Acquired Immune Deficiency Syndrome,”
American Journal of Medicine
76 (1984): 487â92; W. W. Darrow, “AIDS: Socioepidemiologic Responses to an Epidemic,” in R. Ulak and W. F. Skinner, eds.,
AIDS and the Social Science: Common Threads
(Lexington: University Press of Kentucky, 1991), 82â99; and Centers for Disease Control, “A Cluster of Kaposi's Sarcoma and
Pneumocystis carinii
Pneumonia Among Homosexual Male Residents of Los Angeles and Orange Counties, California,”
Morbidity and Mortality Weekly Report
31 (1982): 305â7.
American Journal of Medicine
76 (1984): 487â92; W. W. Darrow, “AIDS: Socioepidemiologic Responses to an Epidemic,” in R. Ulak and W. F. Skinner, eds.,
AIDS and the Social Science: Common Threads
(Lexington: University Press of Kentucky, 1991), 82â99; and Centers for Disease Control, “A Cluster of Kaposi's Sarcoma and
Pneumocystis carinii
Pneumonia Among Homosexual Male Residents of Los Angeles and Orange Counties, California,”
Morbidity and Mortality Weekly Report
31 (1982): 305â7.
29
R. Shilts, “Patient Zero: The Man Who Brought the AIDS Epidemic to California,”
California,
October 1987: 96â99, 149â60; and R. M. Henig,
A Dancing Matrix
(New York: Alfred A. Knopf, 1993).
California,
October 1987: 96â99, 149â60; and R. M. Henig,
A Dancing Matrix
(New York: Alfred A. Knopf, 1993).
30
The early AIDS gay clusters looked like this:
Sources: D. M. Auerbach, W. W. Darrow, H. W. Jaffe, and J. W. Curran, “Clusters of Cases of the Acquired Immune Deficiency Syndrome,”
American Journal of Medicine
76 (1984): 487â92; W. W. Darrow, “AIDS: Socioepidemiologic Responses to an Epidemic,” in R. Ulack and W. F. Skinner, eds.,
AIDS and the Social Sciences
(Lexington: University Press of Kentucky, 1991), 82â99; and W. W. Darrow, M. E. Gorman, and B. P. Glick, “The Social Origins of AIDS: Social Change, Sexual Behavior, and Disease Trends,” in D. A. Feldman and T. M. Johnson, eds.,
The Social Dimensions
of
AIDS: Method and Theory
(New York: Praeger, 1986), 95â107.
American Journal of Medicine
76 (1984): 487â92; W. W. Darrow, “AIDS: Socioepidemiologic Responses to an Epidemic,” in R. Ulack and W. F. Skinner, eds.,
AIDS and the Social Sciences
(Lexington: University Press of Kentucky, 1991), 82â99; and W. W. Darrow, M. E. Gorman, and B. P. Glick, “The Social Origins of AIDS: Social Change, Sexual Behavior, and Disease Trends,” in D. A. Feldman and T. M. Johnson, eds.,
The Social Dimensions
of
AIDS: Method and Theory
(New York: Praeger, 1986), 95â107.
31
In Auerbach, Darrow, Jaffe, and Curran (1984), op. cit., the question of latency was depicted as follows:
32
L. Corey, “The Diagnosis and Treatment of Genital Herpes,”
Journal of the American Medical Association
248 (1982): 1041â49.
Journal of the American Medical Association
248 (1982): 1041â49.
33
Centers for Disease Control, “Update on Kaposi's Sarcoma and Opportunistic Infections in Previously Healthy People in the United States,”
Morbidity and Mortality Weekly Report
3 (1982): 294â301.
Morbidity and Mortality Weekly Report
3 (1982): 294â301.
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