* In order to reflect the values necessary to end the AIDS crisis, the Project takes its inspiration from the work of Nobel laureate Barbara McClintock, a research geneticist who, without advanced technology and bucking the then-prevailing orthodoxy, discovered a revolutionary premise underlying DNA replication. Though her findings were shunned by her colleagues, she continued her work. It was only years later, after the discovery by others of the structure of DNA, that her work was finally acknowledged. Her approach - intense commitment and a focus on divergence rather than the norm - is a model for AIDS research
Due to years of grassroots pressure from AIDS activists nationwide, President
Clinton, in his campaign for the White House, promised to implement a "Manhattan
Project for AIDS". The Manhattan Project was a multibilliondollar crash
program at the Presidential level in World War II to develop an atomic bomb.
Based on the premise that such a concept was possible, it proved the premise
and produced the product. If such skills and resources could be assembled
for the purposes of destruction, surely AIDS, and its accompanying devastation,
deserves a similar allout effort. A project designed to cure AIDS is essential
for a sound global future: economically, culturally and most crucial ethically.
A number of proposals for such a project have been put forward. Unfortunately, none of these plans fundamentally questions the relationship between pharmaceutical companies and the slow pace of AIDS research, or the research establishment's refusal to study diverse theories of pathogenesis. And none provides real power rather than merely an advisory role for people with HIV and AIDS of diverse communities in the running of the project.
Any new initiative on federal AIDS research must be based on a comprehensive critique of the current system. After 11 years and several billion dollars of spending, NIH has a track record on AIDS that parrots some of the worst aspects of the National Cancer Institute's (NCI) "War on Cancer". That program (much longerrunning and more generouslyfunded) has resulted in:
1. an "early detection" model with a minimum of available treatments;
2. an emphasis on the development of toxic, debilitating and expensive chemical therapies (individual and combination) of limited efficacy;
3. claims of "survival" when a patient lives two years after diagnosis.
The NCI remains unable to detail a coherent model for the pathogenesis
of the disease and has come up with frightfully few effective longterm cancer
therapies, yet has systematically neglected (and sometimes attacked) promising
experimental treatments not sponsored by large pharmaceutical companies.
Like NCI, the NIH's AIDS programs are becoming selfperpetuating research machines which contribute only marginally at best to uncovering effective treatments, while gobbling billions in tax monies. Among the reasons for this:
Priorities in both basic and clinical research are inordinately influenced
by the interests of major pharmaceutical companies. Research directions
are thought of in terms of drug outcomes, rather than understanding an illness
in a way which could lead to a broad range of effective treatments. Government
research priorities become tied to corporate profit interests primarily
through direct and indirect conflicts of interests by members of NIH policy-making
committees and rankandfile Principal Investigators (PIs), via either consulting
fees or stock ownership.
Other channels of influence are campaign contributions to, or lobbying of, Congresspeople who control the NIH budget. University programs are influenced by the widespread grants and endowments bestowed upon them by drug companies, as well as by personal financial ties of research faculty to those companies.
The result of this entrenched system is a research agenda both public and private skewed towards drugs likely to receive FDA approval (or occasionally, for which a Congressional sponsor can be found), a closedloop process favoring companies rich enough to afford the huge expenses required. Thus, promising treatments are ignored or rejected because:
1. they are backed by small companies with inadequate funds to navigate the exhaustive FDA approval process; or
2. they are unpatentable (or already on the market for other purposes), making
FDA approval uneconomical to the sponsors.
3. they threaten the markets for alreadyapproved or indevelopment products of large companies;
As a result, over 100 treatments (including drugs, vitamins, herbs and nocost health practices) not backed by large pharmaceutical companies have been reported through medical literature and/or clinical experience to improve the health of people with HIV or AIDS to some degree, yet virtually none has had a largescale clinical study which could either show its ineffectiveness or move it ahead towards broad recognition and, where relevant, FDA approval.
Furthermore, the corporate focus on profits promotes the development of treatments which are extremely expensive and require indefinite use. When these are the primary treatments investigated by NIH, the mentality created is one of accepting a few more years of life of dubious quality, rather than a striving for a cure. In fact, a therapy from outside the major companies which shows curative promise is viewed as a competitive threat, often provoking moves in academic or government circles to discredit it.
Understanding pathogenesis the origin and development of disease is the
key to finding cures. Through every level of the current AIDS research system,
a very narrow band of pathogenesis theories are promoted and wellfunded.
All posit HIV as the unquestioned necessary and sufficient cause of AIDS,
and examine only a few possible biological mechanisms by which the virus
could cause immune system damage. Some theories consider viral cofactors
(such as cytomegalovirus and various herpes viruses) as "initiators"
or "promoters" of HIV's action.
Meanwhile, what remain virtually ignored by mainstream researchers are such alternative theories as autoimmunity (the idea that AIDS results from the immune system turning on itself) or such proposed cofactors as nonviral infections (bacterial, fungal, parasitic or mycoplasmic), side effects of medicinal drugs, nutritional deficiencies, environmental toxins or psychological stress. Shunned completely are those suggesting that HIV may not play a causative role.
Contrary to the claims of mainstream scientists, this set of priorities is not, in most cases, the result of either inadequate credentials by the "dissidents" (many have distinguished backgrounds) or a lack of sound scientific bases for their theories (many have written wellresearched papers, although some are unpublished or appear in obscure journals). Rather, the nearexclusive focus on viral causes, particularly new viruses, is a byproduct of both pharmaceutical company domination of AIDS research and academic research "trends" of what is deemed the "new frontier" of scientific knowledge (a determination heavily influenced by the former).
Since the 1980s, antiviral drugs particularly those developed by genetic engineering have become the medical industry's "hot commodities" (as antibiotics were in the 1950s and 60s) because they involve the highest technology (thus justifying the expensive corporate staff and facilities) and offer high profit margins. In addition, academic and government researchers are pressured to seek recognition through publishing and winning grants (both controlled by a "peer review process" in which a small elite sets trends for favored scientific fields).
The result of these factors is stark: scientific work on AIDS, whether basic science or drug development, which could lead to a new antiviral, gains funding and prestige in academic and NIH research circles. In contrast, any theories which significantly differ from those propounded by "leading" (i.e., wellconnected) researchers are scorned and funding for investigating them is often rejected. This creates a climate which influences many researchers to steer clear of all but the safest, most conventional approaches. Some with theories outside the mainstream continue to pursue their work with extremely limited funds and no (or only obscure) publishable outlets for their information, guaranteeing a longer than necessary research schedule and the absence of their approaches and findings from the thinking of others in the field.
The NIH's AIDS research projects are funded through an uncoordinated
and competitive system of investigatorinitiated research, leaving vital
areas unexplored. Within the NIH and in the private sector, many researchers
remain compartmentalized within their university, agency or company or even
a department thereof and do not communicate, much less collaborate, with
colleagues working on identical problems. This is especially true in terms
of crossdisciplinary contact (e.g., virologists rarely speak to immunologists
or nutritionists). An inordinate emphasis in both public and private agencies
on secrecy and gloryseeking discourages researchers from challenging this
isolation. Further, the location of AIDS research in 21 separate NIH institutes
and centers has prevented a concerted, comprehensive and multidisciplinary
approach to understanding and thus treating this disease.
The newly enhanced powers of the NIH Office of AIDS Research will help somewhat in reducing the most obvious inefficiencies and in highlighting, through the construction of a "strategic plan", some areas of neglected research. But the absence of a single unified research project (rather than separate programs coordinated by one office) and the lack of a multidisciplinary approach will prevent that strategic plan from being complete or from being implemented quickly.
Furthermore, while coordination and multidisciplinary teamwork (rather than competition and isolated research efforts) would do much to advance our knowledge, these are not the only problems with the current research effort. The NCI is more coordinated bureaucratically and financially than the AIDS programs, yet has not fared any better in its cancer research.
An "oldboynetwork" of researchers, most working for either
large pharmaceutical companies, major universities or private research institutions,
gets the lionsshare of the funds. Due to the structure of academic institutions
and the requirements for career advancement, many academicallybased researchers
(regardless of their good intentions) submit proposals aimed more at enhancing
their institution's prestige, facilities or budgets than at creatively probing
for solutions to this urgent crisis.
One outcome of this system is the waste produced by university research departments receiving multiple grants, each including indirect (overhead) costs. Some grants provide greater overhead than substantive research funds. Another outcome is that a single researcher can be the Principal Investigator (PI) on numerous grants (17 in the case of one prominent AIDS researcher). Regardless of a PI's individual skill or reputation, one person cannot possibly attend to the research content of these projects in any concerted or creative way. This is a factory model of research, reaping large amounts of overhead for one institution and pushing out more of the same product rather than taking new paths.
For all these reasons, it is imperative that Congress immediately enact an intensive AIDS research initiative to cast a broad net which will unravel the pathogenesis and lead to the cures for this disease. The same government that could find the resources to set up a unified command and transport, feed and shelter 400,000 troops to wage a war in the Persian Gulf can certainly quickly create a powerful, wellfunded project to pursue a lifegiving struggle to end the suffering and deaths from AIDS.