Making sense of an epidemic

Epidemics provoke sober analysis and hysterical fantasy. Both can already be discerned in responses to the Zika outbreaks currently provoking anxiety around the world. A good time, perhaps to reflect on the history of AIDS as both the writers discussed here did, one to rather better effect than the other.

This review drew a response, incidentally, from the author of the second book. Neville Hodgkinson, for it was he, more or less said that a) my university salary at the time was funded by the Wellcome Trust. The Wellcome Trust endowment cam originally from a drug company. Ergo, I was a source not to be trusted on a question like the origins of HIV infection. Which, I reckon, gives another indication of the quality of his thought…  

If few things reveal more about how a society really works than the threat of a new epidemic, few academic tasks can be more daunting than following what is revealed while it is still happening. The serious contemporary historian always faces two problems endemic to the discipline, but amplified. One is the sheer volume of material, while the other is preserving enough detachment to avoid “heroes, villains and conspiracies”, as Virginia Berridge puts it. When the project is a contemporary history of Aids, these two obstacles must be even more formidable. The potential sources are limitless: thousands of scientific papers, uncounted newspaper stories, hundreds of committees and advisory groups, letters, minutes, newsletters, health education leaflets, TV advertisements. The issues posed by the disease are, and remain, deeply contentious.

It is a pleasure, then, to see Berridge tackling them so well in her policy history, Aids in the UK. Her book is coolly written, impressively (but not, as it could so easily be, overwhelmingly) detailed, and judicious throughout. She weaves together the strands of science, medicine, policy and culture in a richly worked account of the Aids years in Britain which will interest anyone who wants to reflect on the Aids experience.

If a single theme stands out among many, it is the way old experiences and established institutional habits condition responses to a novel health threat. Attitudes to earlier epidemics, and especially to more familiar sexually transmitted diseases, were obviously important, as were the authority of scientific advice, and the building of what Berridge identifies as two policy communities, first among gay men and their self-help groups, then among clinicians and scientists. Both had significant influence on government policy at the peak of concern over the disease, in 1986-87, when the best epidemiological evidence indicated that there was a real risk of a nationwide epidemic. The quasi-wartime spirit which gripped Government then, with civil servants comparing the threat to that of nuclear war, is one of the more remarkable episodes in the Thatcher years, and an instructively uncharacteristic one. Whitehall, Berridge indicates, defended a traditional liberal view of how to contain and treat the disease, in the face of much more illiberal sentiment from outside.

Thus, where we might have had compulsory screening, and associated punitive measures, we got education – through both mass media and local efforts – and research. And both were backed with real money. Berridge calculates that total government spending on Aids rose from Pounds 1-2 million in 1986 to over Pounds 200 million by 1991.

It is still hard to judge how much of this was contingent. Berridge’s analysis is not focused on personalities, although she does emphasise the importance at this time of four key figures – the chief medical officer, the permanent secretary at the Department of Health, the then minister Norman Fowler and the chairman of the cabinet committee on Aids, the deputy prime minister William Whitelaw – all working in concert. But this was only one alliance among many, in constellations which shifted in complex ways as the disease, and the effort to deal with it, evolved. It is charting these shifting constellations which Berridge is especially good at, and as she does so, she disposes of the possibility of any single, simple story about Aids policy in Britain.

A history without heroes and villains, though, can still have winners and losers. Some of the losers in a medical story are obvious, in this case those who have died, those still living with the disease, and those who have been told they are HIV positive. The winners, as the book makes clear, have been interestingly diverse. In some senses, they include surviving gay men, both because of a new sense of community in adversity, and because it has become easier to talk about male homosexuality and sexual practice. There are several professional and policy groups whose position has been enhanced by the disease, including public health workers, counsellors, specialists in genito-urinary medicine, and the Medical Research Council. Traditional habits of doing political business in Britain also received a boost. Berridge certainly emphasises repeatedly the extent to which the “Aids crisis” of 1986-87 evoked a consensual, “one nation” response even from a government identified with the New Right. The mass media, more ambiguously, saw its political importance underlined and its influence on the definition of Aids issues fiercely debated.

One of those debates, about the merits of the scientists’ story about Aids, is aired in Neville Hodgkinson’s book. Hodgkinson, of course, is not a historian, though his story overlaps with Berridge’s at many points. He is the former medical and science correspondent of the Sunday Times, who now offers a long work developing his critique of the mainstream scientific position on Aids. Heroes and villains are here aplenty, but the main heroes appear to be the Californian virologist Peter Duesberg and Hodgkinson himself. His repetitive and self-regarding book is an extended exercise in history as self-vindication, seemingly reproducing every article he ever wrote on the subject, and every letter he ever received in reply.

The result is a frustrating book for anyone except instinctive contrarians. Hodgkinson’s position has moved further from the orthodox over the past few years. He advances four main scientific propositions: HIV is not the cause of Aids; serological tests for HIV are useless in any case because they yield inconsistent results, and most positives are false positives; the anti-viral drug AZT kills more patients than it cures; and, finally, HIV probably does not exist in nature, but is a laboratory artefact.

In each case, there are a few scientists, and rather more Aids activists, who support the proposition, and thousands who believe it is completely wrong. Hodgkinson says several times that the latter are largely well-intentioned, but his approach belies this. They are all made to appear as defenders of vested interests, in share prices, grants or reputations, or as too timid to step out of line.

This style leaves one in little better position to assess the merits of Hodgkinson’s claims at the end of the book than at the beginning. Aside from its relentless one-sidedness, it is a failure as a popular science book. Nowhere, for example, is there any attempt at a clear explanation of the outlines of the immune system, or of how HIV is supposed to act on it. This omission means that all those researchers who persist in believing that this is what matters about Aids appear either gullible or malign.

What Hodgkinson does establish is no more than one could show about any poorly understood disease: that research is full of anomalies, and one can always argue about their significance; that individual patients’ careers are very complex, and no single factor – virus, gene or germ – explains everything about any condition; that there is, as yet, no convincing treatment for Aids. He also, perhaps, demonstrates that one or two of the heterodox scientists, especially Duesberg, have been ill-served by peer review when it comes to assessing grant proposals. Disagreeing with their views ought not to mean that their research is frozen out entirely.

But Hodgkinson comes nowhere near offering convincing reasons for believing that the HIV hypothesis, as we might still call it, is not the best hope for advancing our understanding of the disease. Nor does he offer a book whose tone persuades one he is in any state to think clearly about Aids in all its manifestations. For that, the reader returns, with relief, to Berridge. (1996)

Virginia Berridge. AIDS in the UK: The making of policy 1981-1994. OUP, 1996.

Neville Hodgkinson. Aids: The Failure of Contemporary Science. Fourth Estate, 1996.



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