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Left Field by Patricia Nell Warren

As 2006 draws to a close, it was eight years ago when I first started writing for A&U Magazine. In 1998 many Americans couldn’t have located Iraq on the map. We had a balanced budget, cheaper gas, more people working, and our country enjoyed significant respect by other nations. On the 1998 AIDS scene, the Clinton administration (remember Clinton?) was still fiercely resisting activists over the issue of needle exchange programs. AZT was still being pushed for prevention of mother-child transmission. Lipodystrophy was just beginning to be discussed. Many people were predicting a heterosexual AIDS epidemic and spiraling global AIDS deaths. In 1998 World AIDS Day estimated thirty million in the world living with AIDS. Organizers asked people to do significant practical things: practice safer sex, talk to a friend with AIDS, make an effort to get educated.

Since that time, earthquake changes have jarred the United States and the world—everything from Y2K to 9/11. Today we have big new things that weren’t around in 1998: the U.S. Patriot Act, an awesome budget deficit, the loss of our global respect. The AIDS statistics haven’t spiraled as high as predicted. Today World AIDS Day tells us that forty million around the world are living with AIDS. (The official UNAIDS/WHO estimate is 39.5). AIDS Day recommendations are a bit pro forma. People were simply told to wear a red ribbon, talk to people, get involved in events.

Yes, many things have changed in our world. But one thing hasn’t changed in the AIDS establishment. They still insist that AIDS research is 100 percent dependable and true, and can be relied on absolutely. More than any other area of medical research, AIDS research has constructed vast castle walls of rhetoric around itself.

Yet the subject that occupied so many of my columns over the last eight years—corporate and academic corruption as it affects drugs and treatments—was already glimmering faintly on the radar screen in 1984, though not many people were paying attention to it. In 1984, New England Journal of Medicine became the first research publication to require that its authors disclose their conflicts of interest as a condition of publication. Not till 2000 did NEJM publish their landmark article, “Is Academic Medicine for Sale?” As the magazine’s editors ruefully admitted later, “Although we came to this issue early, no one could have foreseen at the time just how ubiquitous and manifold such financial associations would become.”

NEJM’s rueful statement is clearly a candidate for understatement of the year. More and more revelations about the corruption and conflicts of interest infesting large areas of corporate and academic medical research are hitting the headlines almost—it seems—weekly. Dozens of drugs, notably antidepressants, stand revealed as being more dangerous than we were told—because clinical-trial data was falsely reported. Antidepressants have gotten the highest visibility because so many millions of people today, even children, are directed to use them by government and medicine. The possibility of some AIDS research being similarly corrupted seems not to bother many Americans—they’re not directly put at risk by HIV transmission, or at least they believe they’re not at risk. Yet AIDS research has had its ugly revelations and its headlines—they reached clear into the ranks of the National Institutes of Health, when NIH researcher Jonathan Fishbein, director of the Office of Policy in Clinical Research Operations, blew the whistle on the department’s misconduct of a key AIDS drug study. AIDS research has been jarred by other scandals, as I reported in my recent column “Meltdown II” [March 2006].

As the year ends, I still don’t see any high-profile scientists or corporate executives going to trial or prison for life-threatening and criminal actions that affected the safety of legal drugs. It seems that the U.S. would rather cram its prisons with low-profile offenders who do illegal things with illegal drugs.

As 2007 looms ahead, the anti-corruption activists talk more and more about global corruption as well—the kind that keeps safe and affordable treatments away from people in other countries needing them. But in the U.S. I have a sense of the AIDS establishment waiting for the other shoe to drop. Some of them have to know that, sooner or later, the Big One will hit the news…meaning the scandal that will finally put vast cracks in those walls of rhetoric. As for the long-suffering people out there who are hoping for treatments with fewer drastic side effects, or for a vaccine that is effective and safe and protects a wide range of people, we can only hope that the New Year holds some good news for them.

The Other Shoe