Book Review

Science Fictions: A Scientific Mystery, a Massive Cover-up, and the Dark Legacy of Robert Gallo

N Engl J Med 2002; 347:771-772September 5, 2002

Article

Science Fictions: A Scientific Mystery, a Massive Cover-up, and the Dark Legacy of Robert Gallo
By John Crewdson. 670 pp., illustrated. Boston, Little, Brown, 2002. $27.95. ISBN: 0-316-13476-7

A Nobel prize has yet to be awarded for the discovery of the human immunodeficiency virus (HIV) or for the blood test to detect antibodies to the virus. Although the actual reasons are not known, it is widely speculated that the Nobel committee for medicine wants to stay away from the harsh battle over credit for the discovery between Robert Gallo of the National Cancer Institute and Luc Montagnier of the Institut Pasteur in Paris.

Gallo is one of the most famous scientists in the world, although he is in the spotlight less frequently now than a decade ago. John Crewdson is an investigative reporter who works for the Chicago Tribune. Crewdson has written a very critical book about Gallo's role in the discovery of HIV. In November 1989, the Tribune published a detailed account of the discovery written by Crewdson. He has continued to pursue the story, and this book is the result.

According to Crewdson, Gallo not only falsely claimed that he was the first to isolate HIV and to develop the HIV-antibody test, but also denigrated and obfuscated the role of Montagnier and his colleagues at the Institut Pasteur. Gallo's “discovery” was based on a sample of HIV supplied by Montagnier. (At the time, the French virus was known as lymphadenopathy-associated virus, or LAV.) Either Gallo's laboratory deliberately used the LAV sample without crediting the French investigators, or the French sample accidentally contaminated other viral cultures in Gallo's laboratory.

The AIDS epidemic is usually dated to June 1981, when a report entitled “Pneumocystis Pneumonia — Los Angeles” appeared in the Morbidity and Mortality Weekly Report. It described five homosexual men with what soon came to be known as the acquired immunodeficiency syndrome and was followed by many similar reports. Both Gallo's laboratory and Montagnier's laboratory tried to isolate and culture the AIDS virus. Crewdson details these efforts, including the samples of the virus that Montagnier provided to Gallo in 1983.

In April 1984, Margaret Heckler, secretary of the Department of Health and Human Services, announced at a press conference that Gallo had discovered the virus that causes AIDS and had developed a test to detect antibodies against the virus in blood. Montagnier and his colleagues were not pleased. In May 1985, the U.S. Patent and Trademark Office awarded the American patent for the AIDS blood test to Gallo and the Department of Health and Human Services. The French patent application, which had been filed 17 months earlier, was still pending.

In December 1985, the Institut Pasteur sued the Department of Health and Human Services, contending that the French were the first to discover the AIDS virus and to develop the antibody test and that the American test was being manufactured with the French virus. In March 1987, after considerable controversy and negotiations, President Ronald Reagan and French Prime Minister Jacques Chirac signed an agreement that the Department of Health and Human Services and the Institut Pasteur would share the patent rights to the blood test for AIDS. The dispute, however, was far from settled.

In the preface to his book, Crewdson states, “This is not a book about AIDS. Nor is it really about science. It is a book about how scientists behave when the stakes are high, and the stakes were never higher than the search for the cause of AIDS.” The account, however, is about both Crewdson and Gallo. Although Crewdson writes about himself and the Tribune in the third person, much of the information in his book would never have become public if he had instead devoted more than 10 years of his life to something else.

In January 1990, soon after the Tribune article was published, the Office of Scientific Integrity at the National Institutes of Health opened an inquiry into Gallo's AIDS research. Gallo's actions were tentatively found to “warrant significant censure,” but the office's findings were then substantially revised. Subsequently, the Office of Research Integrity in the Department of Health and Human Services replaced the Office of Scientific Integrity. In February 1992, the Office of Research Integrity found Gallo guilty of scientific misconduct for “falsely reporting that LAV had not been transmitted to a permanently growing cell line.”

In November 1993, a review board reversed a related finding of misconduct against Mikulas Popovic, a virologist working in Gallo's laboratory, because it concluded that the burden of proof had not been met. Days later, the Office of Research Integrity withdrew its determination that Gallo had committed scientific misconduct. In July 1994, the Department of Health and Human Services agreed to provide the French with additional millions of dollars in patent royalties and acknowledged that “a virus provided by Institut Pasteur was used by National Institutes of Health scientists who invented the American HIV test kit in 1984.” Crewdson writes that the Chicago Tribune “had set the day's events in motion five years before.”

The strength of this book is the richly detailed account of the discovery of HIV and the many people who were part of this process. Crewdson, however, would have increased the number of potential readers if he had written a shorter book that more cogently presented the evidence to support his views. There are 540 pages of text, plus a timeline, a glossary, a list of dramatis personae, and about 80 pages of “informational” notes. And there is more — notes about citations and the text of various U.S. government documents that Crewdson obtained under the Freedom of Information Act. These, however, are available only on the World Wide Web.

Although making supplemental material, such as government documents, available on the Web is helpful, relegating citations to the Web is a bad idea. If citations are important enough to include in a book, they belong with the text. What provisions are there to keep them on the Web indefinitely? A compromise would have been to include a CD-ROM with the book. Whether “e-references” will become commonplace in publishing is, however, a subject for another article.

Crewdson has put Gallo under the microscope. The picture is not flattering. To what extent is Crewdson's harsh judgment correct? The issue is not the facts in this exhaustively researched account but rather that many of Crewdson's conclusions are open to other interpretations, some of which are more nuanced and sympathetic to Gallo. In the early 1980s, before the ultimate answers about HIV were known, Gallo was working under intense pressure. Although he could have acted much differently over the years, his legacy is unlikely to be as mendacious and dark as Crewdson has portrayed it.

Robert Steinbrook, M.D.