AIDS; WORDS FROM THE FRONT By Bryan Ellison
Spin Dec. 1993
Since 1949, the Epidemic Intelligence Service has infiltrated hospitals, health departments, and newspaper offices around the world. Bryan Ellison exposes how this elite, semi-secret wing of the Centers for Disease Control and Prevention has managed to stifle debate about everything from swine flu to AIDS.
At 1600 Clifton Road in Atlanta, Georgia, the mammoth brick towers of the centers for Disease Control and Prevention sprawl across clean manicured lawns. This is the Pentagon of government health - a $2 billion military prevention agency that monitors broken limbs and illness, and evangelizes on everything from malaria pills to gun control. Tucked into the midst of this labyrinth is the hub of a little known but extremely powerful network of health professionals. Think of its as the CIA of health care: the Epidemic Intelligence Service (EIS).
Although few people know of its existence, the resources of the EIS and its reach into public life are extensive. Nearly 2,000 EIS trainees occupy key positions in national and international health care. Former United States Surgeon General William H. Stewart is a member, as are two other assistant Surgeon Generals. Jonathan Mann and Michael Merson, past and present heads, respectively, of the World Health Organization's global AIDS Program, both trained with the EIS. Universities, health departments, private practices, dentist offices, veterinary hospitals, and insurance and pharmaceutical companies are all stocked with members. Others work within tax-exempt foundations, including the Ford, Rockefeller, and Joseph Kennedy Foundations and the Rand Corporation, helping direct the spending of trust funds on medical and other projects.
Even reporters who cover health-related organizations and medical breakthroughs have graduated from the EIS program. The New York Time's chief medical correspondent, Lawrence Altman, is a member, as is Bruce Dan, former ABC News medical editor and former senior editor of the prestigious Journal of the American Medical Association. Marvin Turck, the editor at the University of Washington'' Journal of Infectious Diseases, joined EIS in 1960.
All have undergone six weeks of intensive epidemiological training, and then served for two years, on CDC salary, in state and local health departments around the country. Many worked in the CDC itself. After completing their field experience, EIS alumni are free to pursue any career they desire. But all understand the implicit agreement that they function as a permanent reserve for the CDC, gathering information about potential epidemics and reporting it back to headquarters.
Taken at face value, the wide pool of EIS graduates would seem no more ominous than a clique of university alumni. But the EIS's mandate is broad and its potential powers daunting. In a declared emergency, this uniformed branch of the Armed Services has the authority to suspend many individual rights. In peacetime, the EIS can control what we know about illnesses and when we know it. So far, it has taken the public to the brink of hysteria over illnesses from swine flu to AIDS.
EIS was the brainchild of public health expert Alexander Langmuir. In 1949, the CDC was interested in expanding beyond its mandate for malaria control, but needed justification. It tapped Langmuir from his teaching position at the Johns Hopkins University School of Hygiene and Public Health. Langmuir's arrival was a coup for the CDC - he possessed a security clearance as one of the few scientific advisers to the Defence Department's biological and chemical warfare program. The Cold War was raging at that time, and civil defence ranked high in government priorities.
Langmuir proposed that the CDC build a comprehensive surveillance system of trained individuals in all sectors of public and private life to detect the earliest signs of a biological warfare attack. "In the event of war the [EIS members] could be returned to active duty with the Public Health Service and assigned to strategic areas to fulfil the functions for which they were trained," said Langmuir. Federal officials responded with millions of dollars, and the first class entered in July 1951. The symbol of the EIS reflected its focus on activism instead of scientific research - pair of shoes worn through with holes.
But biological warfare never struck, and the EIS has justified its existence over the years by adapting its mandate to include civil medical emergencies. Langmuir himself noted that the warfare infrastructure could be used to control any natural epidemic, using quarantine measures, mass immunizations, and other emergency techniques.
This country experiences more than 1,000 clustered outbreaks of disease each year - roughly one every eight hours - including colds, flu, hepatitis, and numerous noninfectious conditions, all running their course and disappearing, and often eluding scientific explanation. The EIS, it was reasoned, could detect most of those clusters as soon as they popped up, and in its military style treat selected outbreaks as emergencies on the assumption they were contagious. And today, the EIS's role is so broad as to include any "epidemic," including those of violence; for example, EIS officers were called to monitor the L.A. riots following the Rodney King verdict and to examine injuries after the World Trade Center bombing in 1993.
But it's the annual outbreak of influenza virus - the flu - that has fuelled the EIS's most engaging battles, ironically with dire consequences to public health on occasion. In the spring of 1957, news reached the U.S. that the flu was devastating nations of the Far East. The CDC rang the alarm of an imminent and devastating epidemic, and Congress responded by providing money to allow the agency to crash-produce a vaccine, which nevertheless arrived too late. In the end, the mild flu disappeared quite spontaneously, leaving behind none of the predicted destruction. Some public-health experts even questioned whether the hype-up scare may have only stimulated vaccine sales.
Langmuir dipped into the new funds from that heralded debacle and expanded the EIS. By 1976, the EIS network had become so widespread that it could detect even the tiniest outbreaks of illness. When five soldiers caught a flu that January, the alarm bells sounded again. This time the disease was nicknamed "swine flu," based on the speculation that pigs served as the reservoir for the virus. President Ford and Congress panicked, throwing vast new sums of money into another flu vaccine. Then came an unexpected wrinkle: The program stalled when insurers discovered that the vaccine itself could produce extraordinary side effects, ranging from severe fevers and malaise to paralysis and death.
Now the EIS network sprang into action. Except for the five soldiers, no flu epidemic could be found, and the EIS was placed on full alert to detect any outbreak. Unless Congress could be convinced the danger was real, the vaccine program would end. As described by Gordon Thomas and Max Morgan-Witts in their book Anatomy of an Epidemic, the large Auditorium A, located in CDC headquarters in Atlanta, became the command center - called the "war room." Set up especially for this occasion, it contained "banks of telephones, teleprinters, and computers, the hardware for an unprecedented monitoring system which, to work, also required a typing pool, photocopy machines, and doctors sitting at rows of desks in the center of the room." Experts worked around the clock, week after week, chasing down every rumour of flu outbreaks.
A cluster of pneumonia cases suddenly appeared in Philadelphia, days after American Legion members had returned home from their July convention. On Monday morning, August 2, after receiving word of this outbreak, personnel in the CDC's swine-flu war room established contact with Jim Beecham, a brand new EIS officer on assignment in the Philadelphia health department. The CDC could not directly intervene in the situation without an invitation, and Beecham helped arrange one immediately. Within hours three EIS officers flew down to Philadelphia. They were joined within days by dozens of CDC experts.
When the CDC personnel arrived, pre-positioned EIS members such as Beecham and top health adviser Robert Sharrar stopped obeying local authorities and began following orders from the incoming CDC team. The CDC began fomenting wild rumours that this "Legionnaire's disease" was the beginning of the swine flu epidemic. The media proved cooperative; the New York Times assigned none other than Lawrence Altman, an EIS alumnus, to cover the story.
With nationwide hysteria rapidly developing, Congress suddenly changed its mind and approved the swine flu vaccine. Some 50 million Americans were inoculated over the next several months, ultimately producing at least 1,000 cases of severe nerve damage and paralysis, dozens of deaths, and nearly $100 million in liability claims. Meanwhile, within days of the legislative approval, the EIS team finally acknowledged the pneumonia was not related to swine flu, but the announcement came too late.
The swine flu never showed up, and the fiasco nearly destroyed the CDC's reputation. But the EIS executed damage control by blaming Legionnaire's disease on a newly isolated bacterium. In reality, the stricken Legionnaires had been elderly men, several with kidney transplants, who had become extraordinarily drunk at the convention - all classic risk factors for pneumonia. Such minor disease outbreaks are relatively common, though rarely fall into the public spotlight. But the CDC had succeeded in scaring the nation about a harmless bacterium, one found in plumbing of almost any building.
The CDC needed another crisis epidemic to revive its heroic image and expand its mandate. In 1981, the White House was considering cutting the CDC budget by 23 percent. AIDS appeared not a moment too soon, in the same year.
EIS officer Wayne Shandera, on active assignment in the Los Angeles health department, received a call from Michael Gottlieb, a young immunologist at the UCLA Medical Center. Four patients had pneumocystis carinii pneumonia and serious immune deficiencies. Shandera had already heard a report of a fifth such case. One or two cases usually meant nothing; five seemed more plausible as an outbreak. And all five men were young homosexuals, a coincidence which could possibly indicate a sexual link. These five cases were the official start of what later came to be known as the acquired immune deficiency syndrome (AIDS) epidemic.
Shandera forwarded the data to his unofficial bosses at the CDC. According to Randy Shilts in his book And the Band Played On, James Curran, the CDC official who saw the report, wrote "Hot stuff. Hot stuff" across the top and rushed it into publication. New reports were trickling in of dying male homosexuals, most of whom also suffered from a rare skin cancer known as Kaposi's Sarcoma and Opportunistic Infections (KSOI) Task Force to manage the investigation, loaded with such EIS members as Harold Jaffe and Mary Guinan.
Virtually all of the first 50 cases admitted to using poppers, the liquid nitrite drug widely popular among homosexual men for its aphrodisiac properties. Scientists had not studied the long-term effects of this inhaled drug, but its chemical structure was known for its severe toxicity and ability to cause cancer. Nevertheless, a cursory study comparing popper use in disease-free gays with those with AIDS led the EIS to rule out poppers as the culprit.
The Task Force then mobilized the EIS network to define sexually linked clusters of cases and to prove the syndrome had "spread" beyond homosexual men. Clusters were not hard to find, since the AIDS cases were extremely promiscuous men with hundreds or thousands of sexual encounters, and at least one instance of sexual contact with another AIDS case. EIS officers such as David Auerbach, assigned to the Los Angeles County Department of Public Health, interviewed these men and confirmed the prediction. Meanwhile, following the model of hepatitis-B transmission, EIS agents hunted down every heroin addict and blood transfusion recipient, including hemophiliacs, with conditions vaguely resembling the immune deficiencies in homosexuals. EIS personnel scoured hospitals and monitored local health departments for patients, and within months found a small handful of heroin users with opportunistic infections. EIS member Bruce Evatt and Dale Lawrence tracked down a hemophiliac in Colorado, dying primarily of internal bleeding, who also happened to have pneumonia. EIS agent Harry Haverkos travelled to Florida and Haiti to find impoverished Haitians with opportunistic tuberculosis. Instantly the heroin addicts, the hemophiliac, and the Haitian were all relabeled as AIDS cases, and the CDC trumpeted the news that AIDS had "spread" outside the homosexual community.
The biomedical research establishment bought the line and scrambled to find a virus. Scientists first turned to their familiar microbes; Epstein-Barr virus and cytomegalovirus, both known for many years through herpes virus research, were each blamed by different factions.
But the fate of AIDS research was sealed almost from the beginning. Donald Francis, an EIS member since 1971 who had gained notoriety for implementing heavy-handed public health tactics when working for the World Health Organization in the third world, had by 1981 risen to a high position within the CDC's Hepatitis Laboratories Division. He had also earned a graduate degree studying feline retroviruses.
Within just 11 days after the first report of AIDS cases appeared in June 1981, Francis placed a telephone call to Myron Essex, his former research supervisor at Harvard University. With no evidence whatsoever to back up his claims, Francis insisted that the new syndrome must be caused by a retrovirus - with a long latency period between infection and disease. Only five AIDS patients officially existed, yet Francis had already mapped out the entire future of the disease.
Francis doggedly pushed his view whenever anyone would lend him an ear, and even when no one would. "This is the epidemic of the century, and every qualified person should want to have a piece of the action," he would later say in a speech at the CDC.
Within a year, KSOI Task Force head James Curran was echoing the Francis hypothesis, as were other key CDC staffers. Working with Essex, Francis lobbied their close colleague, Robert Gallo, a well-funded retrovirus scientist at the National Institutes of Health (NIH), to search for an AIDS virus. Robert Biggar, another EIS member at the NIH, helped mobilize the huge federal institute behind the retrovirus hunt.
In 1983, the French scientist, Luc Montagnier, discovered a new retrovirus, since named the human immunodeficiency virus (HIV), and Gallo claimed "co-discovery" one year later. When Gallo held a press conference to announce the virus, the event set the HIV hypothesis in stone as official federal dogma. Donald Francis and his fellow EIS agents had triumphed, though remaining out of the spotlight.
With the EIS's help, the CDC and the federal government have managed to inflate fear of AIDS into a global paranoia, thereby feeding the machine that keeps scores of EIS graduates in business - writing, researching, analyzing, and otherwise cashing in on the AIDS "epidemic." Even when dissent scientists manage to create an opening for honest debate about AIDS, the EIS has masterfully exercised damage control, learning to squelch embarrassing new twists that threaten the prevailing dogma. In July of 1992, during the Eight International Conference on AIDS in Amsterdam, Newsweek suddenly published an article by reporter Geoffrey Cowley on several HIV-negative AIDS cases. Researchers at the AIDS conference interpreted the article as a political green light, and began pouring forth dozens of reports of previously unmentioned AIDS patients without HIV, from both the United States and Europe. The situation began reeling out of control, re-opening the question of whether HIV is the true cause of AIDS. Anthony Fauci, director of AIDS Research at the NIH, and James Curran of the CDC raced to Amsterdam on Air Force Two to take charge. The best they could do on the spot was to listen to the reports, promising to resolve the situation.
Three weeks later, the CDC sponsored a special meeting at its Atlanta headquarters. The scientists reporting HIV-free AIDS cases were invited, as was Cowley, the Newsweek reporter. The unexplained AIDS cases were relabeled idiopathic CD4+ lymphocytopenia, or ICL - so as to break any connection between these cases and AIDS. That was enough for Cowley. Since then, he has not reported on AIDS cases without HIV, or even ICL.
Information about these same HIV-free AIDS cases had been available to the media long before the public episode, but had continually been censored. Lawrence Altman, the EIS member who had become the head medical writer for the New York Times, admitted to Science magazine that he knew of cases for several months but did not break the story because he didn't think it was his paper's place to announce something the CDC was not confident enough of to publish. The Times, of course, has long cultivated an image of publishing "all the news that's fit to print."
The era of infectious diseases in the industrialized world, the age when most people died of tuberculosis, malaria, yellow fever, or polio, ended long ago. But the EIS, a relic of the past, has grown ever larger in its membership and influence. Its clandestine methods and near invisibility have allowed the CDC to virtually manufacture epidemics, and to make the whole process appear spontaneous. Now, as AIDS and the EIS moves into the '90s, some members are beginning to privately mourn the fat days of the mid- to late '80s, when AIDS research dollars flowed most freely from government coffers. Once again, the EIS may soon be forced to justify its existence to Congress in order to finance its ambitious program of centralized public health surveillance. Cloaked in science, the EIS's agenda threatens to expand public health controls over private beliefs and life-styles. Healthy suggestions are one thing; exploiting hysteria to impose emergency powers is quite another. *
