Product Description
In 1984 Health and Human Services Secretary Margaret Heckler announced that an AIDS vaccine would be ready for testing in two years. Since then, nearly 60 million persons worldwide have been infected by the human immunodeficiency virus (HIV), and only one vaccine, containing the gp120 surface protein of the virus, has made it to a large-scale, phase three efficacy field trial. This text explains the reasons for this intolerably slow progress, despite the great advances that have been made in biotechnology, genetics and immunology.

CUSTOMER REVIEWS (Average Customer Rating: 4.5 based on 5 reviews)

Impressive

The book is nothing short of a fantastic account of the events which have shaped policy and prejudice of the AIDS anatomy and policy. At first the chapter all about Saul was wierd. Wondering where is the author leading me, and the chapter on the companies in it for PURE profit, and not creating ANYTHING worth publising. And of course you can't leave out the workings of a beaurocratic government (HA)! I had to drop the book after about 3/4 through it just because it started to write/read like a history book - which is why it gets four stars instead of five. As far as content and points of view (unbiased) it was GREAT and would recommend to anyone interested in POLICY of governments, companies, public view, and history of expirments shaping the AIDS vaccine (or should I say cure since there will never be a true "vaccine").
September 10, 2005

Now for the bad news

Reviewers of Jon Cohen's Shots in the Dark have uniformly praised his insight and investigation into the world of HIV/AIDS research. His careful accounting has exposed weaknesses of the American national biomedical research endeavor led by the National Institutes of Health (NIH).

Few if any reviewers have commented on the veracity of his conclusion. HIV/AIDS research is a political hot potato.

But one thing that should be obvious to most readers is that two decades of trying to model HIV with a different disease in a species not normally infected with the experimental disease, has been an abject, costly, and misleading failure. Cohen's response is a strident call for more, much much more, of the same.

Human immunodeficiency virus is a retrovirus that causes disease only in humans. It is a species-specific disease. Chimpanzees infected with HIV display very mild transient symptoms. Nothing regarding HIV infection in humans or in the treatment of AIDS has been a result of the use of chimpanzees. This has been acknowledged by leading primate researchers such as Dr. Thomas Insel, past director of the Yerkes National Primate Research Center at Emory University and now director of the National Institute of Mental Health.

Sooty mangabeys, an African monkey, are natural carriers of a disease called simian immunodeficiency virus (SIV). In spite of the similar name, HIV and SIV are caused by different viruses. When macaques, an Asian genus of monkey, are infected with a serially-passaged SIV, they become terminally ill. They develop chronic nosebleeds, diarrhea, and anorexia as they progress to morbidity.

This fact was discovered when the poor husbandry methods of the nation's NIH monkey labs inadvertently allowed the wide-spread infection of macaques with SIV. The disease was identified when primate researchers read about the symptoms of HIV. Always on the lookout for a new moneymaking animal model, the primate research community quickly claimed that the newly discovered disease would be a productive model of HIV.

Many hundreds of millions of dollars later, they are still asking the American taxpayer to be patient and to give them more money to kill many more monkeys.

In light of the fact that everything known about AIDS and how to treat the disease has been a direct result of human cell studies, clinical studies, and epidemiological research, it is difficult to understand why Cohen still stands with the monkey researchers and urges more money be shoveled into this black hole of proven failure. The only answer I can imagine is that he is just enamored with anything that looks like science.

Readers unfamiliar with the history of the failure of the monkey and chimpanzee models are likely to come away from Shots in the Dark with a very wrong-headed idea of how we ought to be spending our finite resources to stop this pandemic. To this extent, the book is dangerous and likely to have negative consequences if decision makers take Cohen's recommendations to heart.

In spite of this, as a historical accounting, I found the book to worthwhile.

July 08, 2005

An excellent, readable overview of vaccine research

Jon Cohen is probably the most knowledgable journalist on the topic of HIV vaccines and has been following developments in this area for over a decade. He's had unparalleled access to people working in the field and it shows in this well organized history of the search for an HIV vaccine. I used to work in this area of research and, although there are issues where I have quibbled with the author, I can think of no better introduction to the field and the key issues that have shaped it. Cohen has been uniquely able to maintain the trust and respect of key people working in the field, while also raising important social and scientific issues. The result is a thoughtful, relatively thorough chronology that is also readable and concise. At a more personal level, the book brought back many forgotten controversies and issues that formed the background for almost a decade of my own work. The writing is that vivid, while also maintaining a high standard of scientific journalism.
December 19, 2002

They themselves are the experiment

Buy this book, read it, and pass it on to a friend. In short, make it infections, as it is one of the best hopes for `enlightened' men to capture the future.

This is a massive journalistic endeavor for a single man to mount, set against the hurdles of the decidedly clubby world of big-money medicine and ten-plus years of the Byzantine complexities of many different scientific disciplines, not one. Its factual, story-to-tell approach, is a breath of fresh air in a miasma of empty government panel reports, obtuse scientific ramblings, sensationalist hardcopy, and necessarily overstated activist rancor. For those who take time with it, it works its way, not "into your face", but slowly into your heart.

For the less passionate, however, it is not clear, that this book, stoutly rendered by Cohen and W.W.Norton, carries its burden of proof, in all cases. Where are the numbers? We read that vaccine research persistently remained at 10% of the overall NAIAD budget, but, W.W., a data table would have been nice. The same with the grant evaluation-success rates and total project funding(s), and other small things here and there. But these points hardly sacrifice the whole. The broader picture and point to be made is overwhelmingly clear: Physician, help thyself! Alternatively, one might call it, "When bad things happen to really, really smart people."

This realization builds from page to page with almost every conflict and with almost every story of pursuit recounted. **The "endless frontier" of medicine-man-directed-science has not been expansive enough to include the basic, fundamental lessons of process science, risk bearing and decision making under uncertainty, strategic planning, and public relations.** It is no accident that Jonas Salk's last recounted wish is for "better ways", and the attentive reader will find similar hints or cries for help from other scientists as well.

Since 1981, it is a time for *war*, man against microbe. These scientists seem to miss the lessons of the *harsh*, *daily* reality that THEY AND THEIR ETHOS *ARE* THE EXPERIMENT!

This is true, notwithstanding, of course, of the great "Nobel prize experiment", that perniciously hangs like a collaboration-distracting "mirror, mirror" amid the lab-rats. At other times, the profession also seems oddly self-aware, as the paucity of those interested in putting themselves in harm's way of such a dashing "experiment" is laid bare, for example, while the directorship for the new NIH Vaccine Center goes unwanted.

Now, in 2001, the field seems blood red and who will say which fault belongs to whom? Who could fault the NIH, who, after all, have only the power to subsidize? Who could fault the politicians, who thought the scientists had it "under control (at least contained, ahem!) and adequately funded"? Who could continue to fault the system, when incremental changes have been made? Finally, what Prince will come at the end to say, "And I, for winking at your discords too, have lost a brace of kinsman?"

Yet the notion that Cohen suggests, that, after twenty years, "the world is watching", does nothing but turn up the heat on a pot with the same ingredients. One cannot look into Dr. Fauci's or Dr. Baltimore's eyes, for instance, and think that these researchers, these captains, are utterly bankrupt, immoral egoists or that they have deaf ears, deaf ears to the 60 million that may die one of the most miserable deaths possible, surrender (insofar as the human mind could even comprehend the magnitude of such a loss).

To be fair - and hopeful -, the medical profession, has let itself open to study and critique, far, far more than others. Yet, more chanticleer cries will repeat the past, for what may be needed now are truly better ways, diversity of thought, competence in management, and sufficiency in funding - the hard work, not the low-hanging fruit; settling in for the long-run; in short, the next 20 years.

The Buddhists believe that a single man can change the world. This reviewer hopes that others who read this book also have vigor enough to take a trumpet to Washington, not to wake anyone up, but like Joseph on the way to Jericho, truly a March of D-times.
July 10, 2001

Search for an AIDS vaccine

Jon Cohen has written an absolutely masterful history of the search for an Aids vaccine. His book poses all the right questions. He explores all the political and scientific issues that have affected this long journey to a vaccine. His research is exhaustive and the book is well documented. It reads as the very best kind of scientific adventure tale. It is the best account that I have read about this disease and the people who have tried to unravel its mysteries.
February 08, 2001

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