Newsday - June 2, 1988
Laurie Garrett. Newsday Staff Correspondent

The panel said that little progress has been made since it issued an initial study two years ago in which it also attacked federal anti-AIDS efforts and called for the spending of $1 billion a year for research and an additional $1 billion annually for education.

The latest report calls for anti-AIDS spending of more than $3 billion per year. This year, the federal government will spend $951 million on all AIDS-related programs. Next year, spending will rise to $1.3 billion.

The panel called for massive increases in federal spending on drug abuse programs and urged that the definition of AIDS be broadened to include all individuals now infected with the HIV virus, the cause of AIDS.

If the panel's recommended definition of AIDS were to be followed, the number of individuals counted as AIDS cases would jump from about 63,000 to about 1 million in the United States. The move would be controversial because it would mean that people without noticeable symptoms would be in the same category as those near death, and exacerbate the difficulty in keeping government records of the epidemic.

Speaking on behalf of the academy, Theodore Cooper, chairman of the board of the Upjohn Company, said it is obvious the White House and Capitol Hill have their eyes on Moscow and other political issues at the moment, and that the recommended increased spending will not be well received in most political quarters. "We are well aware of the political realities," said Cooper, "and that this is an election year. But we would be remiss if we didn't call it as we see it."

According to the academy, America has problems on three critical fronts in the war on AIDS: development of drugs for treatment, creation of a vaccine against the virus, and public education.

Cooper said much important, basic research has been done on AIDS, particularly in virology, but "we have not yet been able to apply this new knowledge to development of an effective vaccine or drug therapy. It seems that the more we know, the more complex the picture becomes," said Cooper.

The academy warned that scientists should not try to take shortcuts in vaccine and drug research, rushing into human vaccine trials before completing tests in animals, or trying to overly streamline the drugtesting system. In particular, the academy condemned efforts to test anti-AIDS drugs without using standard pharmaceutical controls, such as placebos. This position is opposed by many gay organizations, which say it is cruel to not give people potentially life-extending drugs.

The harshest words from the academy concerned public education. While praising recent efforts by Surgeon General C. Everett Koop, the academy concluded overall, "that the federal response has been too uneven. Where direction has been reasonable, the lack of forceful policymaking may have done little harm. But where public policy has been clearly inadequate...the nation has suffered from the absence of strong federal leadership."

In addition to public education, the panel cited the lack of consistent federal policy from one agency to another. For example, the Department of Defense feels it is unsafe to allow HIV-infected individuals to fly airplanes, while the Public Health Service says mere infection has no effect on job performance.

They also cited a lack of coordination in research between government agencies, as well as problems between the public and private sector.

Spokesmen for the White House and Public Health Service declined to comment on the report.

Most inadequate, said the academy, is government response to intravenous drug abusers. "It is a crime, a positive crime, that there are waiting lists for drug programs," declared Institute of Medicine President Samuel Thier. He conceded it is difficult to reach and educate drug abusers. But, he said, New York City has waiting lists of six months for methadone treatment at the moment, indicating some addicts are aware of AIDS, want to stop endangering themselves through drug use, but are "being tragically ignored by the lack of adequate federal and state programs."

Academy representative Robin Weiss said all federal drug abuse programs should be beefed up, and "spending of around $1.5 billion a year would not be unreasonable." Current federal spending in the area is less than $100 million.

In addition to calling for increased spending on drug abuse programs, the academy said research spending, currently running around $635 million, should increase to $1 billion a year. And public education of groups other than drug users and clinical programs should receive "substantial funds." While reluctant to give a precise number yesterday, the academy said it now feels more than the $1 billion it recommended two years ago would be needed for public education.

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