Aids: Getting More Than Its Share?

By Charles Krauthammer

Last month a thousand demonstrators camped outside the National Institutes of Health near Washington and with a talented display of street theater protested governmental and scientific neglect of AIDS. If not the angriest demonstration Washington has seen in a long time, it was certainly the most misdirected. The idea that American government or American society has been inattentive or unresponsive to AIDS is quite simply absurd. Consider:

Treatment. Congress is about to do something extremely rare: allocate money specifically for the treatment of one disease. The Senate voted $2.9 billion, the House $4 billion over five years for treating AIDS. And only AIDS. When Senator Malcolm Wallop introduced an amendment allowing rural districts with few AIDS patients to spend the money on other diseases, the amendment was voted down, 2 to 1.

Research. Except for cancer, AIDS now receives more Government research money than any other illness in America. AIDS gets $1.2 billion to $1.3 billion. Heart disease, for example, receives about half as much, $700 billion. The AIDS research allocation is not just huge, it is hugely disproportionate. AIDS has killed 83,000 Americans in nine years. Heart disease kills that many every six weeks.

Testing. Under pressure from AIDS activists, the FDA has radically changed its regulations for testing new drugs. The Administration has proposed "parallel track" legislation that would make drugs available to certain patients before the usual testing process is complete. Nothing wrong with this. But this exception is for AIDS patients only -- a fact that hardly supports the thesis that government is holding back an AIDS cure or discriminating against AIDS patients.

The suffering caused by AIDS is enormous. Sufferers deserve compassion, and their disease deserves scientific inquiry. But AIDS has got far more. AIDS has become the most privileged disease in America. Why? Mainly because its victims are young, in many cases creative and famous. Their deaths are therefore particularly poignant and public. And because one of the two groups that AIDS disproportionately affects (gay men) is highly organized. This combination of conspicuousness and constituency has allowed AIDS activists to get more research funding, more treatment money and looser drug-testing restrictions than any comparable disease.

Nothing wrong with that. The system for allocating research and treatment money in American medicine is archaic, chaotic and almost random anyway. Under the "Disease of the Month Club" syndrome, any disease that has in some way affected a Congressman or some relation gets special treatment. There is rough justice in this method of allocation because after a while Congressmen and their kin get to experience most of the medical tragedies that life has to offer. At the end of the day, therefore, funds tend to get allocated in a fairly proportionate way.

AIDS is now riding a crest of public support, won in the rough and tumble of politics. All perfectly legitimate, and a tribute to the passion and commitment of AIDS activists. But that passion turns to mere stridency when they take to the streets to protest that a homophobic society has been ungenerous and stinting in its response to the tragedy of AIDS. In fact, American society is giving overwhelming and indeed disproportionate attention and resources to the fight.

At first the homosexual community was disoriented and defensive in reaction to AIDS. In the quite understandable attempt to get public support, it fixed on a strategy of claiming that AIDS was everyone's problem. Since we were all potential sufferers -- anyone can get AIDS, went the slogan -- society as an act of self-protection should go all out for cure and care.

This campaign was initially successful. But then it ran into an obstacle. It wasn't true. AIDS is not everyone's problem. It is extremely difficult to get AIDS. It requires the carrying out of specific and quite intentional acts. Nine out of ten people with AIDS have got it through homosexual sex and/or intravenous drug use. The NIH demonstrators, therefore, now appeal less to solidarity than to guilt: every person who dies is more blood on the hands of a society unwilling to give every dollar demanded for a cure.

But society has blood on its hands every time it refuses to give every dollar demanded by the cancer lobby, the heart disease lobby, the diabetes lobby. So now a different tack: the claim that the AIDS epidemic is, of course, not an act of government but an act of God -- and government has not done enough to help its helpless victims.

In fact, AIDS is far less an act of God than is, say, cancer or diabetes. Apart from a small number of relentlessly exploited Ryan White-like exceptions, the overwhelming majority of sufferers get AIDS through some voluntary action: sex or drug abuse. You don't get AIDS the way you used to get TB, by having someone on the trolley cough in your face. You don't get it the way you get, say, brain cancer, which is through some act of God that we don't understand at all.

AIDS is in the class of diseases whose origins we understand quite well. It is behaviorally induced and behaviorally preventable. In that sense it is in the same moral class as lung cancer, the majority of whose victims get it through voluntary behavior well known to be highly dangerous. For lung cancer the behavior is smoking; for AIDS, unsafe sex (not, it might be noted, homosexuality) and IV drug use.

As a society we do not refuse either to treat or research lung cancer simply because its sufferers brought it on themselves. But we would find it somewhat perverse and distasteful if lung cancer sufferers began demonstrating wildly, blaming society and government for their problems, and demanding that they be first in line for a cure.

Many people contracted AIDS before its causes became known, about six years ago. For them it is truly an act of God. For the rest (as the word has gone out, an ever increasing percentage), it is an act of man. They, of course, deserve our care and treatment. But it is hard to see from where they derive the claim to be first in line -- ahead of those dying of leukemia and breast cancer and stroke -- for the resources and compassion of a nation.