Book Review

AIDS and Contemporary History

AIDS: The Winter War

N Engl J Med 1994; 330:1025-1026April 7, 1994

Article

AIDS and Contemporary History
(Cambridge History of Medicine.) Edited by Virginia Berridge and Philip Strong. 284 pp. New York, Cambridge University Press, 1993. $54.95. ISBN: 0-521-41477-6

AIDS: The Winter War
By Arthur D. Kahn. 236 pp. Philadelphia, Temple University Press, 1993. $27.95. ISBN: 1-55639-018-4

For some, the concept of contemporary history is not only an oxymoron, but also a dangerous mistake. A history of the present cannot possibly be based on the perspective provided by the passage of years or a thorough examination of archival material. According to this view, the very immediacy of the urge to chronicle the present guarantees that the effort will fall victim to the distorting influence of contemporary politics. Despite such difficulties, historians in increasing numbers have been lured into applying their craft to the understanding of the recent past, and even the present. A desire to be relevant, to serve the interests of those confronting an uncertain and difficult set of choices, to bolster the partisan claims of those locked in conflict, to foreclose the possibility of history's repeating itself -- “first as tragedy, then as farce” -- has motivated different historians, and sometimes the same historians at different moments. In no other context are the promise and the limitation of contemporary history more obvious than the context of the AIDS epidemic.

As Virginia Berridge emphasizes in her thoughtful introduction to AIDS and Contemporary History, the first contribution of historians after recognizing that a new viral epidemic had taken hold was to place the shock of the new into a historical context. What lessons could be learned from the past? Although it was not their exclusive focus, the first wave of historical analyses was often driven by concern about the balance that ought to prevail between liberty and state control in the face of an epidemic disease. Berridge cites Roy Porter, the noted British historian of medicine, whose lesson to us is clear: “History says no to the policeman's response to AIDS.” In an earlier book, AIDS: The Burdens of History, edited by Elizabeth Fee and Daniel M. Fox (Berkeley: University of California Press, 1988), the central focus was on the lessons of history.

Berridge notes that in the most recent phase AIDS itself has become the subject of careful historical analysis. Here the focus is typically on conflict in policy and policy development. At their best, such efforts seek to underscore the continuities and discontinuities between AIDS policy and medical and social policy more broadly conceived.

In AIDS and Contemporary History, Berridge and Strong provide us with a collection of essays drawn largely from a 1990 conference. The book is divided into two broad sections. The first seeks to place AIDS in context by examining its “prehistory.” Particularly noteworthy are chapters on the regulation of sexuality, the role of public health physicians, and the history of the Wassermann test. Each chapter seeks, more or less explicitly, to set the stage for AIDS by describing the evolution of public policies in realms that would later bear on AIDS. In a striking reflection of ideological breadth, an essay on the response to hepatitis B suggests that excessive concern for humanitarian interests subverted the effective application of public health principles and resulted in a missed opportunity to develop interventions that might have “immobilized the AIDS blitzkrieg” before it began.

The second part of this very interesting book looks explicitly at AIDS policy, with particularly good contributions on drug policy in Britain, needle-exchange programs in New York, and macro-level policy in France.

What marks this book, which has the inevitable limitations of any collection of loosely related essays, is the skill with which almost all the essays have been researched and the attention to detail as well as to broader themes. In short, it is a successful example of what contemporary history can provide.

If AIDS and Contemporary History is noteworthy, that cannot be said of another recent example of contemporary history, Arthur D. Kahn's AIDS: The Winter War. Kahn, a classicist, might have been expected to prepare a history that bears the marks of the grand tradition of careful scholarship. Sadly, that is not the case. The book contains two sections connected only by the theme that AIDS activism has profoundly affected the response to the epidemic.

In the first half, Kahn covers the well-trod terrain of activism and efforts to confront the research and regulatory arms of the drug establishment. To focus his discussion, Kahn tells of efforts to obtain AL 721 (a mixture including 70 percent neutral glycerides, 20 percent phosphatidylcholine, and 10 percent phosphatidylethanolamine, extracted from egg yolks). It is an odd choice of subject, since enthusiasm for this substance among its former proponents has waned. (That itself might have suggested an account of how desperation, venality, and a challenge to scientific rigidity have all come into play in the struggle for an answer to AIDS.) In this case, passionate efforts were expended over a substance with no apparent long-term benefit. Kahn's poorly crafted tale contains none of the bitter irony that such an account should provide.

The second part is no better. Here the author tells the story of the Presidential Commission on the Human Immunodeficiency Virus Epidemic, appointed by Ronald Reagan. Saved from catastrophe by Admiral James Watkins, the commission ultimately issued a widely applauded and largely ignored report in mid-1988. Kahn's account might have been a probing piece of contemporary history, attentive to textual critique and institutional and policy analysis, but the results are lackluster. Long, undigested quotations from interviews neither inform nor illuminate. The narrative line is a jumble.

In a world in which social-science research on medical issues too often entails arid and repetitious quantitative studies, contemporary history offers the possibility of rich and careful descriptive analyses that open up deeper understandings of the relation between medicine, science, ethics, politics, and the law. The promise of contemporary history is fulfilled in Berridge and Strong's AIDS and Contemporary History; in Kahn's AIDS: The Winter War there is only disappointment.

Ronald Bayer, Ph.D.
Columbia University School of Public Health, New York, NY 10032