Comment On the Presidential Commission

It has been widely reported that the Presidential Commission on the HIV Epidemic has greatly improved after
getting off to a bad start. We agree with this assessment. The current chairman, retired admiral James D. Watkins, is very good at running this kind of commission, and has approached the task without preconceptions. Typical commissions write reports which mostly gather dust; the HIV commission has already implemented public-policy improvements even before its report is written.
Recently the Commission held three days of hearings on AIDS treatment development in New York, February 18-20; see our testimony above. Although these hearings were open to the public--as is everything this Commission does--surprisingly few people attended. The auditorium had seats for 700 people but only once was it even half full.
We cannot review the three days in this short space, but here are some impressions of the highlights.
The NIH (National Institutes of Health) scientists who testified looked almost entirely at long-term projects. The
slogan of the day was that there is no quick fix. They asked for "bricks and mortar"--more laboratory facilities--as well as
money to train more PhDs and postdoctoral researchers. They also asked for more independence for scientists to choose their own projects, instead of merely fulfilling preconceived research contracts as they have all too often had to do in the past. NIH wants more than year-to-year spending authority, so that administrators could make balanced long-term plans, and it wants permission to award grants faster to scientists.
We strongly support these requests to strengthen the often-neglected infrastructure of U.S. medical research. But
we question the excessive control of old-boy networks and the resulting narrow focus on AZT-type drugs or long-term solutions only. This problem is less the fault of the scientists than of the pervasive lack of national mobilization to save the lives of those who are already ill. Scientists today depend so heavily on access to money, equipment, permissions, and prestige journals that they can only study what others approve. Even within their own fields they must follow national policy, seldom lead it.
The FDA (Food and Drug Administration) also wants more money, to be able to evaluate the greater numbers of AIDS drugs which increased research funding will produce. The FDA, like the NIH, usually insists on time frames too long to be useful to those now ill.
The Commission avoided asking pointed questions, and considerable self-congratulation, aggrandizement, and fluff
crept into the testimony. There seems to have been a deliberate policy of keeping the witnesses comfortable so they
could say more than if they had been on the defensive. The NIH, the FDA, and the alternative-treatment movement all got a good reception and left happy. Perhaps the Commission decided that there isn't time now to reform the agencies, that a better way to fight the epidemic is to mobilize existing forces by giving them what they need to operate.