To the Editor:
In “Are We Spending Too Much on AIDS?” [October 1990], Michael Fumento misses a crucial distinction. AIDS differs from cancer or TB inasmuch as it is a new disease; cancer and TB have been with us for centuries. The allocation of resources Mr. Fumento deplores was decided when the cost and trajectory of AIDS were unforeseeable. Planners knew only that AIDS was—as it remains—incurable and fatal. Although, within the United States, it was afflicting only certain groups, elsewhere it was ravaging whole populations.
Considerable doubt reigned—and some persists—as to the modes and risks of contagion. Clearly AIDS is transmitted during sex, an activity in which many of us are likely to engage. Although the government often squanders money, it would under the circumstances have been uncommonly short-sighted to stint on funding for research.
Funding remains necessary. Because, as Mr. Fumento acknowledges, AIDS (unlike cancer) can largely be prevented by modified behavior, it makes sense to inform the vulnerable. Since teenagers (especially disadvantaged ones) are more likely than their elders to be promiscuous, they are the obvious target of this effort.
Mr. Fumento’s examples of wasteful spending, while lamentable, are hardly as egregious as boondoggles in defense or the savings-and-loan industry. No one would dispute that government should be induced to spend more carefully, but that is a separate question, of process, not principle.
Mr. Fumento raises another issue. He seems to suggest that because AIDS is not a sufficiently grave problem within our borders, we should not exert ourselves unduly to discover a cure and/or vaccine. But the health of human beings is a matter of international concern. Surely it is beyond argument that the extraordinary medical and scientific expertise of the United States should be available to all humanity (obviously I am referring to prevention and cure, not to CAT scans), and particularly to poorer peoples tormented by illnesses they cannot prevent or treat. The United States still has a role to play in improving the lot of underdeveloped nations. Research into diseases such as AIDS is the least controversial and most humane way to play it.
Mark Shapiro
Englewood, New Jersey
_____________
To the Editor:
. . . Michael Fumento clearly blames those who have pressured the government to spend more money on AIDS research. He says they have forgotten about cancer and heart disease and practically accuses them of criminal negligence in their singleminded pursuit of a cure for AIDS. But Mr. Fumento is pretty singleminded himself. He has his own agenda and conveniently leaves out anything that does not forward his own cause. He writes, “modification of . . . behavior could in theory reduce future AIDS cases virtually to zero.” Mr. Fumento does not connect the drop in estimates of AIDS patients that he reports to the millions of dollars that have been spent on AIDS education. If he did, he would be forced to admit that money spent on AIDS education over the past few years is among the best spent money in the history of the Public Health Service.
Mr. Fumento makes the point that cancer and heart disease kill many more people than AIDS. But while he makes it quite clear that AIDS is related to life-style, he does not balance the scales by mentioning the small fact that the major cause of both these diseases is smoking. It is unfair directly to compare research costs across various diseases. Research in cancer and heart disease has been going on for most of the century, while AIDS research did not begin until a few years ago. As in business, there are much higher start-up costs involved.
One last detail for Mr. Fumento to ponder when conducting his next AIDS research cost-benefit-opportunity-lost analysis: should we consider AIDS in the rest of the world, or should we, in the United States, worry only about taking care of ourselves?
David Bornstein
New York City
_____________
To the Editor:
Michael Fumento wants a “compassionate society [to] allocate funds and research . . . where they can do the most good for the greatest number of people.”
Like those with AIDS, the greatest number of people have self-induced diseases. Secretary of Health and Human Services Louis W. Sullivan recently wrote,
It cannot be overemphasized that the top ten causes of premature death in our nation are significantly influenced by personal behavior and lifestyle choices. . . . Better control of fewer than ten risk factors—such as poor diet, lack of prenatal care, infrequent exercise, the use of tobacco, alcohol, and other drug abuse, and failure to use seat belts—could prevent between 40 percent and 70 percent of all premature deaths, a third of all cases of acute disability, and two-thirds of all cases of chronic disability.
Mr. Fumento mentions cervical cancer as a worthy object of expenditure. Cervical cancer appears to be a sexually-transmitted disease caused by a virus. Virgins don’t get it. Risk factors are early age at first intercourse, sex with many partners, and sex with uncircumcised men. All these factors are subject to behavioral control, including, one would expect, the consistent use of condoms.
Why should those who assume such risks expect society to bail them out when they get sick or injured? Wouldn’t it be fairer to restrict scarce research funds to some of the other illnesses Mr. Fumento mentions, like Alzheimer’s and breast cancer, which are not self-induced? Or to others in that category, like leukemia, rheumatoid arthritis, multiple sclerosis, glaucoma, juvenile diabetes? And the list goes on.
Robert Carlen, M.D.
Sayville, New York
_____________
Michael Fumento writes:
Both Mark Shapiro and David Bornstein advocate higher funding for AIDS on the basis of its being a newer disease. Mr. Bornstein cites the factor of start-up costs as in a business, while Mr. Shapiro leaves his observation as res ipsa loquitur. But what if there were a new disease found that resulted in, say, a large increase in bunions in the general population? Should this bunion pathogen suddenly jump onto the top of the research heap simply because it is new? Clearly, looking at the impact of a disease—severity, numbers of victims, costs to society—is the only rational way of allocating funds. The analogy to a business is a false one, for businesses have to purchase equipment, inventory, land, buildings, licenses, etc. But as I pointed out in my article, AIDS research has essentially just taken over from other areas of research—much to the detriment of the victims of those diseases.
Mr. Shapiro is wrong about teenagers: they have lower levels of AIDS cases and infections per capita than any other sexually active risk group because, as my book The Myth of Heterosexual AIDS points out, the main risk factor for heterosexual acquisition of AIDS is not promiscuity but contact with intravenous drug abusers. Heterosexual teenagers appear to have relatively little such contact.
Mr. Shapiro is also wrong when he says that “no one would dispute that government should be induced to spend more carefully. . . .”A new book, The AIDS Disaster, argues that waste in AIDS spending should be completely ignored in the name of the greater cause, and in any case this is exactly what has happened. The reporters who are busily filing story number 10,387 on Pentagon or S & L waste simply refuse to go after the thorny question of AIDS spending.
I did not connect the drop in the estimates of AIDS patients to AIDS education because there is no connection. As I documented in my book, new HIV infections in cities around the country peaked and declined several years before the federal government or any other public body spent a penny on AIDS education.
AIDS infection is related almost exclusively to life-style. While smokers greatly increase their risk of heart disease and cancer, the statement that the major cause of heart disease and cancer is smoking is unsubstantiated.
Finally, as to the rest of the world, my arguments are much the same. Do Messrs. Shapiro and Bornstein think that a cure for AIDS found in the U.S. will benefit the rest of the world but treatments for cancer, heart disease, diabetes, and Alzheimer’s won’t? By robbing these illnesses of funds and researchers, we hurt not only Americans but people of every nation. The U.S. does have an obligation to the world, and part of that obligation is to allocate our researchers—the world’s finest—on an equitable basis and without regard to squeaky wheels.
The problem with Robert Carlen’s suggestion is evident in his letter. More and more, diseases are being linked to behaviors of some sort, but at the same time it is rarely the case that these illnesses occur only in the presence of specific behaviors. That is, there is a clear link between smoking and lung and heart disease, but no one can say whether a person with lung cancer or a diseased heart might not have developed the disease anyway. Cervical cancer is an example of this. Yes, the papilloma virus which causes genital warts has been linked to this type of cancer and promiscuous women are likely to get these warts. But most cervical cancers appear to occur in the absence of papilloma and the only reason no virgins (or very few) get cervical cancer is that by the time one reaches the age where these cancers are occurring, there are almost no virgins left.
One cause of death and injury that is always linked to specific behavior is automobile accidents. Would Dr. Carlen therefore suggest that we should conduct no research on how to prevent automobile accidents?
