San Francisco Chronicle - Wednesday, August 2, 1989
Randy Shilts, National Correspondent

Although an array of doctors and local officials said cities hit hard by AIDS face soaring health-care costs, Dr. James Mason, assistant secretary for health of the U.S. Department of Health and Human Services, said the government will focus its AIDS efforts on prevention programs and laboratory research, not patient care.

Mason's statements marked the first clear enunciation of Bush administration policy on the pressing issue of who will pay the growing medical bill for AIDS.

"I'm not deprecating the need for patient care, but if I acquiesce for my budget going to finance care and treatment, I know there will be less for biomedical research and prevention," he said during testimony at a congressional hearing.

"To spend money on care and not on prevention or on finding anti-viral treatments would be penny wise but pound foolish," said Mason, the acting surgeon general until a replacement is named for C. Everet Koop, who retired.

Mason's remarks, to the House Governmental Affairs Subcommittee on Intergovernmental Operations, came after two days of testimony about the harrowing financial impact AIDS is having on the cities hardest hit. Although the federal government finances most of the laboratory research and prevention programs, local governments have borne the brunt of the costs for providing medical care for AIDS patients.

In San Francisco, the network of volunteers, community groups and municipal services that has long served as an international model for AIDS care is "under severe stress," said Dr. Paul Volberding, director of AIDS Activities at San Francisco General Hospital.

The renowned AIDS clinic at San Francisco General, he testified, has been operating at capacity for two years and is about to be overwhelmed. With city funds severely restricted, the hospital needs federal grants to begin the training of new doctors and staff to handle recent increases in AIDS cases. HIV-INFECTED PEOPLE

Adding to the patient-care burden, Volberding said, are the growing numbers of HIV-infected people who have taken the AIDS antibody test in recent months to monitor their immune systems and take advantage of breakthroughs in early HIV treatments.

"We know these patients are coming our way, but we don't have the resources to handle them," Volberding said.

In earlier testimony, Pat Christen, acting director of the San Francisco AIDS Foundation, noted that the federal government this year is providing only 27 percent of the $89 million that San Francisco is spending for AIDS care. To afford local AIDS costs, which are expected to reach $377 million by 1992, the city must receive substantial federal aid, Christen said.

The San Francisco model of AIDS care "is a marvelous model - and it is crumbling," Christen said. ". . . Cities like San Francisco, New York, Newark and other epicenters of this disease need to be considered "natural disaster areas' and be eligible for the type of emergency funding we would afford a drought in Kansas, an oil spill in Alaska or a flood in Texas."

Dr. Nicholas Rango, director of the New York State AIDS Institute, said the lack of federal funds for AIDS care is "a recipe for disaster" that has created a "fragmented and inadequate delivery system." "How Bad Does It Have to Get?'

"We have absurdly danced around this most critical issue," added Dr. David Smith of Parkland Memorial Hospital in Dallas. "We have provided for everything but a place to send AIDS patients for the day-to-day management of their health problems."

Representative Ted Weiss, D-N.Y., the subcommittee chairman, criticized the reluctance of the Bush administration to help city governments cope with AIDS. "How bad does it have to get before the federal government takes action?" he asked.

Congressional Democrats also closely questioned administration officials on plans to provide early treatment for HIV-infected people before they contract one of the deadly diseases that characterize an AIDS diagnosis.

Dr. Anthony Fauci, associate director of the National Institutes of Health for AIDS research, said studies of drugs that may ward off the immunological devastation of the AIDS virus have "the highest priority" because "it makes sense to focus on early intervention."

But Mason of HHS said, "Very little money is included in (the next fiscal year's) budget for early intervention." PELOSI "VERY DISCOURAGED'

When reminded by Democratic Representative Nancy Pelosi of San Francisco that Mason said earlier in the hearing that the government has a "moral obligation" to provide the life-saving treatments that are now available for HIV-infected people, Mason retorted, "I think we do have a moral obligation, but I'm not sure where we're going to get (the money)."

Pelosi said the statement left her "very discouraged."

In other testimony, Dr. Frank Young, commissioner of the Food and Drug Administration, said he expected the FDA to consider, within two weeks, a move to give access to a promising new AIDS drug.

Young said the manufacturer of the drug, ddI, is expected to ask for permission to make the compound more widely available by mid-August. The FDA would act on the application within 30 days of receiving it, Young said.

Broader release of a second drug, Foscarnet, used to treat AIDS-related blindness, probably will be approved next month.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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