AIDS Crisis Calls for 'Firm Leadership and Direction'

Q: The AIDS report is a major example of IOM’s increased visibility. Its recommendations have been widely disseminated. Are you happy with the response it’s gotten from policymakers? THIER: The response from the research community has been pretty reasonable. The major concern is that we pointed out that education is our only major intervention until therapies and vaccines are developed, but the amount of activity relating to education has been very modest. We also were concerned that if you conceptualize AIDS only in the medical model, without seeing the social and international implications, it would be very hard to get a sound national response. We also pointed to the need for some kind of a coordinating mechanism. We’re facing a rather serious problem in which the numbers at the moment don’t reflect what’s coming at us, and where, if we act, we could do something to trim off a rapid growth in the illness. If we don’t act, we risk allowing it to spread to people who don’t have to get it. We were trying to see that we didn’t have different groups going off in different directions. If everybody is freelancing and there is no ccordination, we could have major gaps in our strategy. We had in mind a presidential commission, but we didn’t have in mind that there would be any ideological litmus test for membership. We thought it would be primarily a technical membership. We wanted people who understood each of the specific areas and who were so distinguished in their fields that they would influence by moral suasion as well as by their positions. I don’t see this as a partisan issue. What we need is firm leadership and direction. The need for a coordinating, oversight function that was obvious a year ago is even more obvious now. Q: Are things going better here in the world? THIER: France is taking a very crisp set of steps. Whether you agree with every step is not the question; they have a national program, they have a strategy that’s clearly enunciated, they are moving forward and you know where they are. Britain is moving in that direction and so is Switzerland. And we, who have the largest population at risk of the industrialized countries and the largest number of cases, are making the least response. Q: Could people in the scientific community do more to urge the administration to move faster on this? THIER: It’s important to be careful that the scientific community doesn’t overstep its expertise. The scientific community is quite as capable of politicizing itself as any other group. It is certainly entitled to its political views, but it has no political expertise beyond any other group. What the scientific community ought to do is sure that it is organized, sharing information, asking the questions that ensure the structure and support and personnel and information sharing are as good as they can be—that we’re not missing opportunities, not bogging down in competition. I think the questions raised by the virus itself, by the immunology, by the dementia, pose many biological and clinical research questions that in themselves represent foundations for inquiry. Q: You’re talking about basic research that might well have applications in a lot of areas besides AIDS. THIER: Yes. And I’m talking about being careful that we don’t target everything at AIDS and take it out of basic research. Because if we do, the kinds of insights that came out of oncovirus research and allowed us to nail the AIDS virus might not occur. Putting all the money into AIDS, unless it includes continued support of fundamental immunology, biology and molecular biology, could be a long-range mistake. I don’t see that happening at the moment, so that message seems to be getting across.

AIDS Crisis Calls for 'Firm Leadership and Direction'

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