Too often, public health has been sacrificed to progressivism.
The first time I came across Anthony Fauci’s name was in the mid-1990s while reading journalist Randy Shilts’ searing book And the Band Played On (1987), which is widely considered the definitive history of the early years of the AIDS epidemic. One of the book’s central themes is the failure of the left-wing public health and political establishments to be honest about who was at risk for AIDS and how it was spread—because, at the time, telling the truth meant violating leftist political pieties. This failure occurred even though infection with the virus at the time meant almost certain death.
COVID-19 and AIDS are very different diseases. Still, there are eerie echoes of the destructive political bias that contributed to our AIDS failures, both in public health policy and in the activist community’s response to the COVID-19 pandemic.
Today Shilts, who would later die of the disease he chronicled, is viewed as a hero; at the time, he was spat on in the street and called a traitor or sexual fascist by many others in the gay community. Like many skeptics of establishment policy on COVID-19 today, those who dissented from the “approved” views about AIDS were treated brutally by the public at large. Of course, COVID-19 and AIDS are very different diseases. Still, there are eerie echoes of the destructive political bias that contributed to our AIDS failures, both in public health policy and in the activist community’s response to the COVID-19 pandemic.
Anthony Fauci is only a minor player in Shilts’ account, but the book details one key incident during which Fauci publicly implied, in a prominent editorial in the Journal of the American Medical Association, that there could be casual household transmission of HIV—an assertion contrary to all of the best science being done at the time. When the (inevitable) blowback from his colleagues and peers came, he accused the media and laypeople of “not understanding the language of science.” Even as a young scientist, Fauci had already become an expert in the D.C. sport of political deflection and denial. Fauci’s sloppiness led to months of AIDS hysteria where the public worried about entirely implausible casual transmission pathways.
Meanwhile, the left-wing politics of the public health community writ large meant they were unwilling to discuss the actual risks associated with virus transmission. Shilts’ provocative name for expert, activist, and media circumlocution around the truth of transmission was “AIDSspeak."
Today, I’d argue we suffer from “COVIDspeak,” and many of the same problems apply. (In contrast to AIDSspeak, however, it seems that the left and public health establishment are now more politically interested in causing hysteria than they are in tamping it down.) Rather than forthrightly discussing the risks (which are significant for old and sick people, almost nonexistent for children, minor for those under 50), and adjusting behavioral recommendations and guidelines accordingly, health authorities have pushed for policies like elementary school lockdowns and mass quarantines of the healthy Americans, in the face of all reasonable evidence or any serious attempts to weigh costs and benefits.
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Coronavirus testing.[/caption]
A REFUSAL TO SPEAK CLEARLY ABOUT RISKS AND THOSE AT RISK
In the early days of the AIDS epidemic, public health officials in New York and San Francisco (at the time the two epicenters of the disease) refused, for political reasons, to take several lifesaving steps that would have them run afoul of the powerful gay activist lobby in those cities. These activists wanted to be free of stigmatization of the rampantly promiscuous behavior that was ubiquitous in those communities at that time. Shilts writes that “people died while gay community leaders played politics with the disease, putting political dogma ahead of the preservation of human life.”
Kramer was attacked viciously by his community, and dismissed as prudish by the left-wing gay establishment. Kramer’s pleas, meanwhile, went ignored by public health officials.
People like AIDS ‘hero’ Larry Kramer, founder of arguably the two most important early AIDS awareness organizations (The Gay Men’s Health Crisis and ACT UP), had sharply criticized the promiscuity and resultant rampant disease-spreading in the gay community in the 1970s. Kramer was attacked viciously by his community, and dismissed as prudish by the left-wing gay establishment. Kramer’s pleas, meanwhile, went ignored by public health officials.
National public health leaders were often no better than their counterparts in New York and San Francisco. Even from the first public reports of AIDS in the CDC’s Morbidity and Mortality’s Weekly Reports, the public health authorities intentionally buried the mortality rate on an inside page, and dropped any mention of homosexuality or the gay community from the article’s title. Frankly discussing the behaviors and demographic characteristics that heightened risk was an absolute taboo.
Nowhere was the damage from the activist and public health community’s left-wing orientation more obvious than with respect to the issue of “bathhouses.” Even when, as Shilts writes, a noted AIDS activist approached the director of the Office of Gay and Lesbian Health in the San Francisco Department of Health to encourage closing “bathhouses” (which were a ubiquitous feature of the gay community in those days, which were not really bathhouses, but gathering spots for men desiring multiple casual sexual contacts in one night) the director demurred. They voiced concern that this could be “manipulated to fuel an anti-gay backlash.”
Not only would bathhouses not be closed, but gay activists and many public health leaders also would not even mention the promiscuity and sexual culture that occurred in these spaces. A left-wing view of morality and political expediency took prominence over public safety. “The politically correct line, emerging from a handful of ‘AIDS activists,’ maintained that talking about the gay community’s prodigious promiscuity was part of a ‘blame-the-victim mentality,’” Shilts noted.
When the director of San Francisco’s public health office finally issued orders to close the bathhouses, in October 1984, it was three and a half years after the first AIDS cases were reported. (Far too late for thousands of those infected in the meantime.) True, there had been previous orders for education about AIDS transmission to take place in bathhouses, but even these guidelines were not enforced. While the public health community refused to comment on why these were sites of high risk, many in the gay community insisted that the bathhouses were the appropriate places for AIDS education—an act that reminded one dissident gay activist Shilts features of “telling people to stay in a burning building so they can learn about fire safety.”
In June of 1983, one month after the Reagan Administration called AIDS their “number one priority” in public health, the Second National AIDS Forum at the 5th National Lesbian and Gay Health Conference convened in Denver, Colorado. Despite thousands infected across America, the forum’s public policy committee voted to “oppose any legislative attempts to restrict sexual activities or to close private clubs or bathhouses.” Instead, the focus was entirely on establishing politically correct language: "We condemn attempts to label us as 'victims,' a term which implies defeat, and we are only occasionally 'patients,' a term which implies passivity, helplessness, and dependence upon the care of others. We are 'People With AIDS.'"
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Dianne Feinstein.[/caption]
POLITICIZING SCIENTIFIC AMBIGUITY DURING THE AIDS EPIDEMIC
Then (as now), scientific uncertainty was manipulated for purely political ends. As Shilts observed, “‘Scientists don’t really know’ … In gay AIDSspeak, that meant that scientists couldn’t prove AIDS was spread by sex, so people shouldn’t take measures to protect themselves.” At the other end of the spectrum, among heterosexuals, Shilts noted that this meant that scientists couldn’t prove that AIDS was not spread by casual contagion, therefore people should take any measure possible to protect themselves and society. Both versions of this story “were rooted in the same language of paranoia,” Shilts writes. ”[O]ne political and the other medical, although they implied drastically different solutions.”
“‘Scientists don’t really know’ … In gay AIDSspeak, that meant that scientists couldn’t prove AIDS was spread by sex, so people shouldn’t take measures to protect themselves.”
Anthony Fauci is not the only player from the AIDS drama whose name resonates from the 1980s to our current COVID-19 crisis. During the AIDS crisis, New York Governor Mario Cuomo, father of current Governor Andrew Cuomo, told gay community leaders in May 1983 that he would not move against the bathhouses—even after almost 1,500 AIDS cases had already been diagnosed. Cuomo (who had run a homophobic campaign for Governor against closeted NYC mayor Ed Koch) was never taken to task for his failure on AIDS. Instead, much like his son whose record on coronavirus has been arguably the worst of any state governor, Cuomo senior is being hailed as an “AIDS hero” in a typical piece of revisionist history published (perhaps appropriately) by the official U.S. government website on HIV.
Meanwhile, San Francisco then-mayor Dianne Feinstein, (now California’s Senior Senator), also avoided public commentary on bathhouses until April 1984 (three years after the epidemic began ravaging her city). And even then, the comments didn’t come until she was cornered during a visit to New York City by the San Francisco Chronicle’s political editor. “My own opinion is that if this was a heterosexual problem, they would have been closed already,” she finally conceded—all but explicitly acknowledging that she knew the correct public health outcome, but had been too cowardly to act on it.
Over and over again, elected representatives prioritized appearances of political correctness over the lives of Americans. This culture of political propriety affected public health authorities, too, with equally disastrous outcomes, such as with blood donations. In 1982, scientists began to discover compelling evidence that AIDS could be spread through the transfusion of tainted blood. Tennis legend Arthur Ashe and legendary Science Fiction writer Isaac Asimov were among the many who would ultimately die from this mode of transmission. Because excluding blood donations from gays (a very high-risk group) offended the gay community, however, gay men continued to give blood—many of whom were infected with HIV. As Shilts details, leaders in the gay community lobbied the Red Cross against screening policies; once prohibitions were instituted, one prominent and celebrated gay leader encouraged gays to lie about their sexual orientation to donate. The CDC would eventually estimate that more than 12,000 people were infected with the AIDS virus this way, and mandatory screening and testing protocols were not put in place until 1985. The vast majority of those infected would die.
And yet, activist voices in the gay community could only respond to the blood donation crisis in the language of civil rights and paranoia. Shilts quotes one gay rights group opposed to blood screening as declaring, “Stigmatizing the blood of an already disenfranchised segment of society may permit homophobic and racist forces to accomplish in the name of ‘science’ what they thus far have been unable to fully accomplish politically.”
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Coronavirus testing.[/caption]
SCAREMONGERING AS A FUNDRAISING SCHEME
For those of us old enough to remember the early days of AIDS, we can also recall when the tide from little-to-no information shifted to an era of scaremongering in the name of public health. In a panic, people were worried that if the truth was known about the actual risk categories, both in terms of who and how, there would be less action. This was an understandable feeling from a political standpoint, but it flew in the face of science.
[M]iddle-class white heterosexuals were intentionally targeted by a propaganda campaign that greatly exaggerated their personal risk, in the hopes that it would push them to support dramatically increased funding for AIDS research and treatment.
Shilts and his allies were not the only ones at the time who called out the left and public health establishments for their lies and hypocrisy. In 1987 journalist and conservative think-tanker Michael Fumento attempted to blow the whistle on the left’s AIDS hysteria. That hysteria was fueled by the media, such as the New York Times (which published headlines such as “Aids may dwarf the plague”); celebrities such as Oprah Winfrey (who declared that one in five heterosexuals could be dead from AIDS in the next three years); and the political establishment (Reagan’s HHS claimed that the epidemic could be worse than the black death). Fumento exposed these statements from celebrities and public health leadership as totally ungrounded. Instead, they were talking points pushed by powerful left-wing lobbies.
Why they pushed this narrative was especially interesting. Fumento showed that middle-class white heterosexuals were intentionally targeted by a propaganda campaign that greatly exaggerated their personal risk, in the hopes that it would push them to support dramatically increased funding for AIDS research and treatment. It’s similar to how we see low-risk businesses and schoolchildren terrorized today because we have not developed sufficiently robust policies to protect the actual high-risk elderly and ill.
Larry Kramer would write about this in his famous March 1983 essay, “1,112 and Counting.” With his usual unsparing honesty, Kramer wrote, “There have been no confirmed cases of AIDS in straight, white, non-intravenous-drug-using, middle-class Americans.” Even today, AIDS in America remains overwhelmingly an issue prominent in the gay community ( 69%), and among IV drug users (7%). Meanwhile, white, non-IV-drug-using heterosexuals account for just 3-4% of overall AIDS cases. Nonetheless, countless articles were written to convince white heterosexuals that they were at substantial risk.
Public health and sound science was sacrificed for fear-mongering and politics—then, as it is today.
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Gene Wilder in Young Frankenstein. "Trust the science."[/caption]
THE EXPERT CLASS IS NOT DESERVING OF BLIND DEFERENCE
Countless other themes from the AIDS crisis translate onto the COVID-19 pandemic today. For instance, while contract tracing is much beloved by the left now, the left hated it during the AIDS epidemic. Shilts recounts that when one leading physician focused on contract tracing of AIDS patients in a similar way that was done for syphilis patients, he was stymied by local officials concerned about “civil rights” and “privacy.”
Don’t “trust the science” or the scientists—trust the scientific method of skepticism and rigorous empirical testing of hypotheses.
Lethal policies were also explicitly justified by their political implications. At the 1983 National AIDS Forum, organizers released a statement that “We should never forget that we live in a homophobic society, or that homophobia is the major threat to our health.” The language used by the forum was almost identical to that which would be used by thousands of “public health” officials who justified the COVID-19 exposure risk posed by the George Floyd protests during the height of the pandemic—and all in the name of racism being a public health crisis. (In fact, a vanishingly small part of the public health establishment had the courage to condemn the George Floyd protests on public health grounds.)
None of the aforementioned suggests that we should ignore public health authorities outright, of course. While there is a reasonable and lively debate to be had about its level of severity, there is little doubt that COVID-19 is a serious disease, one that we have a wide societal interest in protecting people from, particularly those in high-risk groups. Moreover, there are many, many public health officials who are really trying to get it right, and some may be doing a good job of minimizing their political biases.
But, as history shows, the expert class (particularly the wealthy, liberal expert class) is not deserving of public deference, especially if their opinion is grounded, not in science, but personal and political preferences. As their history with how they handled the AIDS epidemic demonstrates, this particular group, which accounts for a majority within the public health community, often falls back on reflexive leftism rather than scientific evidence when confronted with a major crisis.
Contra nearly every Democrat in office right now, we can’t just blindly “follow the science,” of which epidemiology and public health is just one branch. As Brit Hume wrote, in response to Joe Biden’s claim that he would listen to scientists in determining his COVID-19 policy: “Which Scientists: Mental health doctors, pediatricians, economists? Or just epidemiologists? Their advice is all about fighting the disease but not about the collateral damage from doing so, which falls outside their expertise. Listening only to them has had serious consequences.”
Don’t “trust the science” or the scientists—trust the scientific method of skepticism and rigorous empirical testing of hypotheses. And don’t put your faith in anyone who doesn’t talk in a serious way about both the costs and benefits of public health interventions. The AIDS epidemic teaches us that the organized left, as embodied in the public health establishment, cannot be trusted to be disinterested arbiters of truth, even when it was necessary to save themselves.
