- The Washington Times - Thursday, November 28, 2002

In "Extraordinary Popular Delusions and the Madness of Crowds," Charles MacKay described times throughout history when people simultaneously deluded themselves, such as Holland's 17th century tulip craze. Of course, delusions have caused more than just monetary loss, as evidenced by the Salem witch hunts; under a seemingly rational system of "trials," people were irrationally put to death.
This World AIDS Day, it is time to recognize that our nation's approach to disease prevention is as riddled with ulterior motives as a banker's buy rating on an Internet stock. Around the world, millions have lost their lives relying on the misguided advice of governments to practice "safe sex" and use condoms to avoid AIDS. Unfortunately, just as financial institutions led domestic and foreign investors astray with convincing rationalizations for buying overvalued stocks in the 1990s, nations throughout the world mimic our half-measured, conflict-ridden approach to AIDS and other disease prevention.
Certainly, abstinence and condom use have reduced the spread of AIDS. But, using condoms "consistently and properly" to prevent the spread of AIDS, as the U.S. Centers for Disease Control and Prevention recommend, is putting a buy rating on an overvalued security device.
CDC's advice is nothing more than a "don't ask don't tell" approach to AIDS: Don't worry about your or your partner's HIV infection status, just use condoms and play Russian roulette with your life. In studies where one partner was infected and condoms were used, the infection rate was roughly 15 percent and this was in a situation where both partners were "consistent and proper" because they were aware one partner was infected. The reality is that love-making is not typically "consistent and proper," especially in the absence of knowledge of a partner's infection. More important, most people would not choose to willingly pursue a sexual relationship with an HIV-infected partner.
Clearly, it is delusional to continue recommending condom use without also strongly encouraging knowledge of HIV infection status. With testing, if you are infected, you can seek treatment; if you know your partner is infected, you can take appropriate steps. There is a common denominator in all delusional systems, namely the failure of checks and balances to operate properly. In a recent series of articles on the Internet bubble, The Washington Post observed: "If any of these groups [regulators, financial firms, media] had acted the way they were supposed to and blown the whistle, it is likely the bubble would never have grown so big or perhaps never developed at all. But it is in the very nature of a bubble that the lapses are simultaneous and widespread."
For years, the government has given lip service to prevention, deluding the public while allowing its AIDS prevention approach to be dictated by interest groups. Just as investment banks' recommendations lulled investors into a false sense of security, individuals have become complacent about the risks of getting AIDS while using condoms.
Historically, AIDS activists have opposed testing, fearing the effect on their social lives. Drug makers prefer to sell more profitable drug therapies. And, hospitals, clinical labs, physician groups, and existing HIV testing facilities, such as those funded by the CDC, support testing by health care professionals, but oppose easy to use rapid home tests. These players have lobbied successfully against home testing. This self-interest and a failure of responsible parties to blow the whistle, have resulted in the absence of a strong testing agenda and a tragic loss of life.
I have witnessed first-hand the government's health-care conflicts. A company I founded and later sold to Johnson & Johnson (J&J;) developed the first home AIDS test. We called it a "home access" test because, although a specimen was collected at home, it was mailed back to a lab for testing and results and counseling were available by phone. We chose this approach because of strong interest-group pressure against a conventional home test (opponents claimed "counseling" was essential despite data showing the vast majority of people tested in health care settings receive no counseling), reasoning that it was a first step toward approval of a conventional home test.
In 1997, we submitted clinical data to FDA demonstrating the test was safe and results were identical to lab tests. However, based on "the input of advisory groups and interested parties," the FDA refused to review the application. After five years of lawsuits, the FDA finally proposed to settle and lift its ban and review the data.
Publicly, the CDC supported home-access HIV testing, speaking in its favor at an FDA panel meeting. Privately, after the meeting, the CDC wrote a confidential memo to FDA and senior staff at the Department of Heath and Human Services urging the test not be approved based on concern that too many people would use it, find out they were HIV positive, that would "overburden the already overburdened health care system." Eventually, the FDA approved the test. Shortly afterward J&J;, which provides test kits to clinical laboratories, closed the company (although it controlled valuable patents, including access to conventional home-testing technology, J&J; showed no interest in selling the business).
Americans should be concerned that many of the same public health officials, who have shown they care more about appeasing special interests than the public's health, are now formulating our nation's approaches to potential terrorist threats such as smallpox and anthrax. Many among those who listened to government's "safe sex with condoms" campaign needlessly became infected with HIV and lost their lives.
President Bush fought hard to be able to hold federal homeland security workers accountable. It is time to hold those in charge of developing and executing our nation's flawed health-care policies accountable and stop deluding ourselves that they have our best interests at heart.

Elliott J. Millenson was founder and CEO of Direct Access Diagnostics, which developed the nation's first home-access AIDS test. He is now a private investor in Far Hills, NJ.

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