AIDS TREATMENT NEWS #157, August 21, 1992
Excerpts from Talk by Martin Delaney

Martin Delaney: "Some of you may remember that I came before you last year at this dinner to raise the question of, 'So what?' I urged you then to think through and plan the practical outcome of each and every experiment you conduct. I saw a lot of discomfort and squirming in the audience that night along with many puzzled faces which wondered whether I understood that research needs to be creative and open-ended, that science can't be ordered or directed like some business project. My point was to raise the question of balance and to remind you that we were in the middle of an epidemic, not a course in graduate school. Tonight, I suspect I will invoke a bit more squirming and discomfort, not because I'm here to say you're doing a bad job, but because I want to raise the possibility that there may be ways to do a better job if you try.

"In this last year, and especially at Amsterdam and in the last few days of this conference, an enormous number of new leads, insights, and opportunities have been uncovered. A wealth of new scientific ground has been covered since last year, but I somehow fear that we are no closer to achieving the goal of a cure for AIDS. The question which disturbs me is, 'Who is connecting the dots?' Who's reading the whole book, and not just their own chapters? Who's taking responsibility for the big picture and making sure that all these new leads and insights will be followed up? Who is taking steps to avoid duplication of efforts in the sea of research? ...I wonder also whose responsibility it will be, after we leave here this week, to make sure that all the key questions raised here will be pursued and answered in a logical, step-by-step fashion...Who, indeed, is in charge around here? I'm deeply afraid, however, that the answer to this question is, 'Everyone and no one.'

"From where I have stood for the last several years, not as your enemy but often as your critic, it doesn't look like there is any kind of a battle plan directing this effort. And if we truly want to believe that we are engaged in a war against AIDS, there most certainly ought to be. As a complete outsider and a military strategist, Dr. Luttwak [Edward N. Luttwak, Center for Strategic & International Studies, who spoke to the meeting before Delaney] came here and in a few moments recognized that we really aren't fighting a war against AIDS. He knows what a war looks like. And this isn't one, however much we try to pretend it is. A war begins with a plan, an orchestration of resources and a prioritization of long and short term objectives. Dr. Luttwak suggests you might need more first hand intelligence -- information from the front, or clinical battle lines. I say that won't make much sense until there's a headquarters and a command structure to report it to. And a chain of command through which the orders could flow, orchestrating the achievement of objectives....

"I'm not suggesting that someone should take over and begin telling all of you what to do. But I am saying that currently, you simply don't have a plan, you don't have objectives. In a way, it's fair to say you don't even have a clue. And that's simply no way to achieve a goal, let alone win a war. As I said last year, it's not a dictatorship we need, but a different balance. We needn't proceed from no plan -- the current scenario -- to total regimentation. We can, however, seek a greater sense of direction, some form of planning and prioritization and managed interaction, than we have now...

Another point is how much the different sciences have to learn from each other and how much could be gained if you learned to communicate with each other. How much better would things be if you learned a language less arcane than the one you chose, one which allowed you to get your own messages out more clearly and which would allow you to hear so much more from the front lines of clinical observation ...We are waiting for you to cure a disease, not write another paper in Science.... You must understand the goals before you: to minimize suffering and pain, to keep people alive with a reasonable quality of life, to cure a disease -- and in the process, make a giant leap against all human diseases. It has been striking at this conference to see the universality of your work. Even though you may work in the name of AIDS or cancer, you are working and learning to direct the forces of life itself. What enormous payoffs for humanity lie at the end of this rainbow? And won't we get there sooner if we remain focused on clear, sharp goals rather than wading in the endless circular pools of academic pursuit?

"Now I must acknowledge that as much as we appreciate the things you have already accomplished, the failure to accomplish more is palpable in the country today. We see it in the funding cuts imposed on you by Congress, a situation in which our liberal Democratic Congress this month voted to cut AIDS research spending below the paltry levels proposed by our right wing Republican President. Surely, something is wrong with this picture. We see it in the growing fight for resources between groups fighting different diseases. These are symptoms of the discontent and impatience bubbling to the surface. Those of you squirming out there may think I just don't understand your situation, but I suspect I understand the obstacles you face far more so than the public at large, and more so than the Congress which writes your paychecks. And however little patience you hear in my voice, far less is felt by the people who are dying of this disease and don't understand why things can't move any faster. Perhaps it is not fair of us to expect miracles from you, but neither should we settle for anything less than your very best effort. And you cannot possibly be at your best when you work without a plan, without an overall design or sense of direction, and no command structure or organization. I would rightly be thrown out of my job at a small foundation for acting in this manner -- yet somehow you've come to accept it in your world, with all the weighty problems you hope to solve. You cannot possibly be at your best when each of you doesn't know what the others are doing and why, or when your views are blinded by how you feel about each other, rather than the quality of the insights presented.

"I ask not that you work harder, but smarter. I call upon you to initiate new levels of collaboration and engage in some big picture thinking. I ask that you begin to work together by designing a plan, one that maximizes the enormous gifts each of you has to offer while orchestrating the players together in a symphony of science. As human beings, you need not and should not settle for less from yourselves. I urge you to begin this planning process yourselves, because if you don't the day is coming when it will be imposed upon you by outsiders who may not understand your needs or concerns. But I'm equally convinced that with a plan, a good plan of your own making, you will find real synergy in your efforts and show the world what a war on AIDS really looks like."

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