Thirty years ago today, the CDC's Morbidity and Mortality Weekly Report published a report of five young men with Pneumocystis carinii pneumonia who were treated at three different hospitals in Los Angeles, California. The authors observed that all five patients had no known common contacts, but had in common the fact that they "reported having frequent homosexual contact with various partners" and using inhalant drugs. An accompanying editorial note explained:
Pneumocystis pneumonia in the United States is almost exclusively limited to severely immunosuppressed patients (1). The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual. The fact that these patients were all homosexuals suggests an association between some aspect of a homosexual lifestyle or disease acquired through sexual contact and Pneumocystis pneumonia in this population.
... All the above observations suggest the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocystosis and candidiasis. Although the role of CMV infection in the pathogenesis of pneumocystosis remains unknown, the possibility of P. carinii infection must be carefully considered in a differential diagnosis for previously healthy homosexual males with dyspnea and pneumonia.
The disease identified in this report turned out to be AIDS, and we still haven't conquered it. Donald Abrams and Paul Volberding, two of the first doctors to study the disease, told NPR's Jacki Lyden this morning what it was like to be tackling this alarming medical puzzle:
Dr. ABRAMS: For me, this was my community. I'm a gay man in San Francisco. I also was 31 at the time. These were my friends, and these were my colleagues and it was impossible to leave work. Because when I got home, people called and said, hey, can you come over and look at this spot or can you feel this swollen gland or what's going on with my partner? And it was really intense but we both lived through toxic shock syndrome and Legionnaires disease during our medical training and I think we thought that...
Dr. VOLBERDING: This would go away and (unintelligible)...
Dr. ABRAMS: Yeah, we'd solve it and it would be the same. And little did we think that we'd still be talking about this 30 years from now as a devastating illness.
The world has made a great deal of progress against AIDS, although the benefits of the medical advances are very unevenly distributed around the world. Healthcare providers, researchers, activists, drug companies, and policymakers have done incredible work. It can be hard to remember how terrifying and controversial HIV - or "gay-related immunodeficiency diseases" (GRID), as it was known earlier - was in the US when it first emerged.
A few years ago, the San Francisco Chronicle republished some of the early articles about the disease by Randy Shilts, a Chronicle journalist who went on to write And the Band Played On.
In "The Story in the Closet," Shilts writes:
BY ANYBODY'S standards, more than 12,000 Americans dead or dying from a disease nobody even heard of just four years ago is a giant news story. Still, outside San Francisco, the subject has evaded the kind of thorough coverage any comparable threat to the public health would engender.
The reason for the lack of coverage is not hard to fathom: The groups most victimized by acquired immune deficiency syndrome are not exactly an honor roll of America's favorite minorities.
The speed and sophistication of technology and information-sharing have increased dramatically over the past three decades. Have our tolerance and ability to care about members of groups other than our own improved, too?
Update, 6/6: Over at her Superbug blog, Maryn McKenna has three excerpts (here, here, here) about the early days of AIDS from her book Beating Back the Devil, a fascinating look at the "disease detectives" of CDC's Epidemic Intelligence Service.
AIDS kills a fraction of the numbers of people killed by cars, handguns, alcohol, tobacco, or even appalling fast-food every year.
It seems our society tolerates a hell of a lot of self-inflicted health problems and our ability to care about them is limited by our species' ability to think "it'll happen to somebody else, not me".
Yes, Vince, itâs this crazy thing called, âfreedom.â See, freedom can be dangerous because the universe is not Nerf-World, but since that is mankindâs preferred state of being (as opposed to living like a caged animal), we tolerate it. Of course, itâs not libertine â we have plenty of prohibitions and regulations to mitigate the worst of it â but on balance, we like it that way.
Vince, you're right that people's fear of a different hazards isn't purely based on the number of people killed per year - although if it hadn't been for the public-health response to AIDS, it could've overtaken some of the more mundane hazards as a cause of death.
I think the response to AIDS is warranted, and many governments (ours included) have also been putting a lot of effort into reducing car crashes and deaths attributable to lifestyle factors. Unlike libertarians, I'm glad to see these efforts. While we still have a long way to go in reducing car crashes and cardiovascular deaths, reductions in these areas have also been some of the notable public health achievements of the last century.
Shilts' The Band Played On is an awesome chronicle of the unfolding epidemic. Liz, thanks for refreshing my memory about Shilts compelling reporting.