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It is man's most relentless battle: the struggle against infectious disease
Drugs, vaccines, disease and the machinations of the pharmaceutical industry have replaced the Bomb as the popular source of global anxiety. Earlier this year there was John le Carré's novel, The Constant Gardener, which flayed the multinational drugs companies - known collectively as Big Pharma - for their cynical use of Third-World populations as testing grounds for their products. And now we have a rash of earnest exposés of the terrors of the human and viral world order. The primary reason for this is, I think, Aids and the ensuing realisation that the spectacular medical triumphs of the past century are not as conclusive as we thought. Crucially, the hubristic conviction of some scientists in the 1960s that infectious disease would soon be a thing of the past has proved to be absurdly wrong. Aids in Africa is now raging as fiercely and catastrophically as any medieval plague, tuberculosis is on the increase, antibiotic-resistant bacteria are spreading in hospitals and, most topically, foot and mouth has demonstrated how easily a phenomenally infectious virus can transform politics and society in an instant. The lesson is that, however far our technology takes us, we remain embedded in nature and that billions of years of bacterial and viral evolution are not to be overthrown by a few decades of human ingenuity. Our own DNA, it now transpires, contains in its chemical alphabet evidence of primordial viruses. Infection is the way of the world or, to put it more definitively, a non-infectious world could not be this one. These three books are all, in different ways, responses to this dawning awareness of a truth which, for a while, was concealed from us by our medical success. The best and most soberly responsible of the three is Jon Cohen's Shots in the Dark. This is a formidably researched (there are 50 pages of notes) story with an unhappy ending. After almost two decades of research we still do not have an effective vaccine against Aids in spite of the fact that, in the first burst of scientific confidence that followed the identification of the HIV virus in the mid-1980s, a vaccine was promised within two or three years. This is, in part, because HIV is a singularly tricky customer. It mutates rapidly, it does not occur in animals in anything like the same form as it does in humans, and its avoidance of the immune system is ingenious in the extreme. But it is also, according to Cohen, because of multiple failings within the research community. At one level, these have occurred because the victims of Aids have always tended to be politically marginal. Gay anal sex and intravenous drug use do not sit easily in any manifesto. Furthermore, as safe sex and potent anti-viral drugs cocktails kept the death rates in the West far below the worst initial projections, the urgency of the issue declined. Most outrageous of all, dead Africans also do not sit high on the political or financial agendas of the developed nations. This, as Cohen acknowledges, has now changed thanks, in part, to the Aids Conference in Durban last summer at which Edwin Cameron, an HIV-positive South African high court justice, and Nelson Mandela gave the kind of speeches that fire even the most closed consciences. But the more important point Cohen makes - precisely because it is not yet one that has been widely acknowledged - is that science itself has been at fault. He contrasts the research into an Aids vaccine with that for a polio vaccine in the 1950s. Then Albert Sabin and, especially, Jonas Salk adopted a strictly empirical approach. Their priority was efficacy, not knowledge. Salk did not care how a vaccine worked, as long as it worked. As a result, he concentrated directly on the problem at hand with the tools available. The result was the defeat of polio - for the moment. In contrast, a reductionist or, more correctly, a rationalist approach has been used in pursuit of an Aids vaccine. Scientists have worked with the conviction that only by learning as much as possible about the virus and its activities can it be defeated. Reasonable as this may sound, it means that many scientists who are nominally researching a vaccine are, in fact, doing pure science - all very well in its place, but not here where millions are dying. Cohen's account of this curious intellectual heresy is salutary, thorough and alarming. Nicholas Regush's The Virus Within is a good deal less persuasive. Written in what has become the breathless and irritating standard style for American accounts of scientific innovation, it tries and fails to alarm us even more. The story is about a virus - HHV-6 - which almost everybody has and which, therefore, has not generally been regarded as an interesting object of research. Some scientists, however, have become convinced that it is involved in a range of diseases including multiple sclerosis, chronic fatigue syndrome and, most controversially, Aids. Plainly, since most people do not have these conditions, the virus is normally benign. The theory is that it is activated by particular conditions - in the case of Aids, for example, by anal sex, drug use, or the damage to the immune system inflicted by poverty and disease in Africa. This would suggest that the HIV researchers are aiming at the wrong target. That may simply be a trigger for the real killer, HHV-6. Lay people can only read and wonder, although perhaps, in the light of Regush's style, it is best just to wonder. But one thing should be said. If everybody or almost everybody has HHV-6 then it cannot be the cause of any of these diseases, just as if everybody smoked, cigarettes would not be the cause of lung cancer. Other factors must be at work. To argue otherwise about something that seems to be a normal part of our bodies is like saying having eyes causes blindness. But I don't suppose logic is the issue here. Prescription Games is a populist, professional attack on Big Pharma. Jeffrey Robinson's penchant for one-line paragraphs, often without verbs, will put off the sensitive, but, otherwise, it is a competent job, providing all the necessary evidence for reasonable people to feel uneasy about the global drugs companies. But it is a polemic, so it lacks a fair assessment of the opposing case. Certainly we hear of decent Big Pharma bosses, but we do not hear the full justification of their activities. And what, after all, is the alternative? |
