Great Moments in Epidemiology
By David Henderson
In his 1987 book on the AIDS crisis, And the Band Played On, Randy Shilts has a section on a press release put out by the American Medical Association on May 6, 1983. Because of copyright issues, I won’t reproduce all 3 pages of Shilts’s treatment of the issue. Instead I’ll quote the press release in full and then quote selectively from Shilts’s discussion.
AMA News Release
For Release Friday, May 6, 1983
EVIDENCE SUGGESTS HOUSEHOLD CONTACT MAY TRANSMIT AIDS
Chicago—Evidence suggesting that Acquired Immune Deficiency Syndrome (AIDS) can be transmitted by routine household contact is presented in this week’s Journal of the American Medical Association.
James Oleske, MD, MPH, and colleagues report eight cases of otherwise unexplained immune deficiency syndrome among children from the Newark, N.J., metropolitan area born into families with recognized risks for AIDS.
“Four of these children have died,” the authors report. “Our experience suggests that children living in high-risk households are susceptible to AIDS and that sexual contact, drug abuse or exposure to blood products is not necessary for disease transmission.”
Commenting on the study in an accompanying editorial, Anthony S. Fauci, MD, of the National Institutes of Health, points out, “We are witnessing at the present time the evolution of a new disease process of unknown etiology with a mortality of at least 50 percent and possibly as high as 75 percent to 100 percent with a doubling of the number of patients afflicted every six months.”
At first the disease appeared to be confined only to male homosexuals, he adds. Then it became clear that IV drug users also were susceptible, and after that the disease was found among Haitians and hemophiliacs, the latter apparently exposed through transfusion of blood products.
“The finding of AIDS in infants and children who are household contacts of patients with AIDS or persons with risks for AIDS has enormous implications with regard to ultimate transmissibility of this syndrome,” Fauci says. “If routine close contact can spread the disease, AIDS takes on an entirely new dimension,” he adds.
“Given the fact that incubation period for adults is believed to be longer than one year, the full impact of the syndrome among sexual contacts and recipients of potentially infective transfusions is uncertain at present. If we add to this the possibility that nonsexual, non-blood-borne transmission is possible, the scope of the syndrome may be enormous.”
Shilts then writes:
Arye Rubinstein was astounded that Anthony Fauci could be so stupid as to say that household contact might have anything to do with spreading AIDS. Rubinstein had never been a great admirer of New Jersey’s Dr. Oleske; they had antithetical views of AIDS in children. To Rubinstein, the mode of transmission was fairly obvious and fit quite well with existing epidemiological data on AIDS. The mother obviously infected the child in her womb. The fetus and parent shared blood as surely as an intravenous drug user, hemophiliac, or blood transfusion recipient. The fact that none of the infants in Oleske’s study were over one year old reinforced this notion. In order to interpret this data to mean that “routine household contact” might spread AIDS, an entirely new paradigm for AIDS transmission was needed. Rubinstein’s paper explained it all very easily, though the Journal of the American Medical Associationseemed more enamored with Oleske’s specious analysis. In fact, the journal editor at first returned Rubinstein’s paper with the section on intrauterine transmission crossed out. The paragraphs had only appeared because Rubinstein had insisted that they be retained.
What was Fauci’s problem?
Upon investigation, Rubinstein learned that Anthony Fauci had not bothered to read his paper [I presume Shilts means Rubinstein’s paper] before writing the editorial. Instead, he just read Oleske’s conclusions and started running off at the mouth.
Shilts goes on to point out that Fauci blamed the hysterical media for taking his comments “out of context.” After all, Fauci had used the word “if.” Fauci argued that the chief villain was the AMA’s press office.
Even the New York Times reported the Associated Press version.
Shilts then writes:
Moreover, the report created a lasting impression on the public that would raise the hysteria level around AIDS for years to come. Scientists just aren’t sure how AIDS is spread, the thinking went. Because of the long incubation period, possible transmission routes existed that might not reveal themselves until later—until it was too late. Anthony Fauci had said as much in his ill-considered editorial.
All the ways to get AIDS were established by then , and scientists, at least at the CDC, understood precisely how AIDS had spread.
But the damage was done.