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HIV and the Blood Supply: An Analysis of Crisis Decisionmaking
Criticism of the CDC's Data and Motives
Participants in the Atlanta meeting and others in key decisionmaking roles expressed reservations about the validity of the CDC data, as they did not believe the CDC to be a credible source of information regarding AIDS (Donohue, Gallo interviews). Some perceived the CDC's urgency regarding AIDS as a self-serving strategy to ensure its (CDC's) survival. A January 26, 1983, interoffice memo of the American Red Cross stated:
CDC is likely to continue to play up AIDS—it has long been noted that CDC increasingly needs a major epidemic to justify its existence … especially in light of Federal funding cuts … AIDS probably played some positive role in CDC's successful battle with OMB to fund a new $15,000,000 virology lab. This CDC perspective is also obvious from the general "marketing nature" of the January 4, 1983 … meeting. … We can not depend on CDC to provide scientific, objective, unbiased leadership on the topic. … Because CDC will continue to push for more action from the blood banking community, the public will believe there is a scientific basis and means for eliminating gays. … To the extent the industry (ARC/CCBC/AABB) sticks together against CDC, it will appear to some segments of the public at least that we have a self interest which is in conflict with the public interest, unless we can clearly demonstrate that CDC is wrong [Cumming 1983].
In particular, as stated earlier, blood bank physicians questioned the validity of the CDC data on the correlation of anti-HBc to AIDS cases among a cohort of homosexual who attended an STD clinic.
Erroneous assumptions about the incubation period and the mortality rate for AIDS led to widely differing, inaccurate projections of the outcome of more vigorous donor screening. Some of the key decisionmakers relied upon their knowledge of the epidemiology of other viral disease to guide them in developing prevention and control measures. For example, it was believed that the incubation period for AIDS was one year, and at the maximum, two to three years (FDA, BPAC 1983b). A minority of persons proposed that AIDS was caused by a disease agent that had a much longer incubation period. In August 1982 Medical World News published a theory that AIDS was caused by a retrovirus; in 1982 Edgar Engleman, M.D., also proposed that AIDS was caused by a retrovirus (Engleman, Gallo interviews). The U.S. surveillance systems were ill-equipped to identify diseases with a long incubation period such as AIDS. Although 90 percent of AIDS cases were identified, it was difficult to identify those who were HIV infected but did not have AIDS (Francis interview).