THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Friday, October 11, 1996 TAG: 9610110012
SECTION: FRONT PAGE: A15 EDITION: FINAL
TYPE: Opinion
SOURCE: KEITH MONROE
LENGTH: 87 lines
We're at war, taking millions of casualties and the enemy is alien invaders. No, I haven't overdosed on Dark Skies. I simply attended a briefing by two leaders in a life-and-death struggle. The enemies are bacterial and viral agents, and the men doing the briefing were experts in this theater of war.
Dr. Robert Gallo, co-discoverer of the HIV virus, and Dr. John Gill Bartlett, chief of the Johns Hopkins division of infectious diseases, brought news from the front to a conclave of editorial writers in Baltimore last week. It was no place for hypochondriacs.
Men like Gallo and Bartlett are fighting a remarkable high-tech war, but the foes are various and implacable. They can shift shapes and they never surrender. Bartlett points out that 30 years ago his field was a backwater. It was thought that all infectious diseases had been identified and were on their way to defeat. That turned out to be hubris on a grand scale.
Well-known microbes - cholera, hepatitis, malaria - kill more than a million people a year - each. New infectious agents constantly swim into our ken. Bartlett suggests that if in 1980 an attempt to predict looming threats had been made, it would have missed most of the news of the past 15 years.
Since 1980 we've learned that bacterial agents cause gastric ulcers, Lyme disease and hemorrhagic fever, that infectious diseases play a part in hundreds of thousands of cases of gastric, liver and cervical cancer. An infectious agent may play a role in arthritis and there's evidence of another in 35 percent to 75 percent of cases involving coronary-artery plaque. In 1980, no one had heard of T-cell leukemia, HIV, hantavirus and several varieties of herpes now known to cause serious illnesses.
Battles are being won. Bartlett cites the eradication of smallpox. Polio has been eliminated from the Northern Hemisphere and may vanish from the face of Earth by 2000. Other candidates for elimination or suppression are mumps, rubella, tetanus and hepatitis.
Bartlett calls development of the hepatitis B vaccine a milestone. There are 300,000 cases and 5,000 deaths annually due to the virus. The CDC recommended universal vaccination in 1991. But there's been less action than hepatitis B warrants because, like AIDS, it's a slow-motion disease that can take up to four decades to cause liver cancer or cirrhosis.
Some fights can be won by old-fashioned hand-to-hand combat. Bartlett cites the remarkable achievement of a public-health official in Baltimore who himself had become infected with TB. He made combat against it a personal crusade. By aggressive action among high-risk populations, Baltimore went from being the No. 1 American city in cases of TB to No. 28.
Other victories result from more sophisticated science. In May 1993 an alert doctor was struck by an unusual death and drew it to the attention of researchers. By the end of June, less than six weeks later, a new infectious agent - hantavirus - had been identified.
And then there's AIDS. Gallo is one of its leading foes. He describes his job as ``trying to outfox'' the retrovirus and reports that the epidemiological picture is not good. ``AIDS is a heterosexual disease worldwide and is becoming more so in the United States.'' Furthermore, strains once unique to Africa have made their way to India and appear to be much more easily transmitted heterosexually. ``They aren't here yet, but they could get here and worsen the epidemic,'' Gallo says.
On the therapeutic front, the news is better. Bartlett cites the effectiveness of AZT against AIDS as a major event of the past decade. By demonstrating a drug could prolong the lives of AIDS sufferers, it set off a stampede to develop new ones.
Drug therapies can slow the disease, but they have side effects and are expensive. Some of Gallo's research focuses on so-called ``natural'' or biological means to block infection. It's spurred by the discovery that 1 percent of whites have a receptor mutation that appears to make infection impossible and 15 percent have a lesser mutation making infection difficult.
These are impressive men engaged in a noble struggle. They have some concerns about the way the war is being prosecuted. Bartlett thinks we need new ways to assess costs and benefits. For example, treating AIDS with the latest drugs can cost $10,000 to $12,000 a year. Treating all patients in the United States would cost $3 billion to $6 billion.
Some say that's a poor investment. Bartlett points out that if you calculate cost per year of life preserved, AIDS treatment costs $18,000. A lot. But mammograms cost $30,000 per year of life preserved and coronary bypass surgery costs more than $100,000. Neither is considered cost prohibitive.
Gallo says government research was the only game in the 1950s and 1960s, but it has been decentralized to universities, cancer centers and drug labs. He approves. But both men worry that cuts in government funding for the National Institutes of Health for even two or three years would result in serious setbacks in ongoing battles. When you're in the middle of a war, disarmament makes no sense. Gallo's shorthand: ``No money. Cures never. More money. Cures sooner.'' MEMO: Mr. Monroe is editor of the editorial page of The Virginian-Pilot. by CNB