And the AIDS Epidemic

In this book you'll discover:

■ that the Centers for Disease Control ordered AIDS researchers not to
notify the contacts of AIDS patients that they had been exposed to the
AIDS virus.

■ that CDC officials gave approval to CDC employees to give incorrect

and misleading information under oath to a federal administrative law
judge.

■ that the chief sex educator for Florida's Dade County AIDS division, who
was supposed to be teaching students how to protect themselves from
AIDS, continued to participate in anal sex in public places until he
eventually died of AIDS.

■ that even if a cure or vaccine were ever found for AIDS, the mere
existence of a cure or a vaccine does not guarantee that the disease will
be either controlled or eradicated.

■ that the Centers for Disease Control and the Public Health authorities
have admitted that they have the capability of controlling the AIDS
epidemic, but have chosen not to for political reasons.

■ that syphilis has been transmitted through intact skin and former
Surgeon General Koop has said that "AIDS will probably be transmitted
in the same manner as...syphilis"

■ that officials of the Centers for Disease Control obstructed the investiga-
tion of possible mosquito transmission in Belle Glade, Florida, a swamp
area where there were almost three times as many AIDS cases as
anywhere else in the U.S.

Gus G. Sermos, former Public Health Advisor and

AIDS Researcher at the Centers for Disease
Control, explains in this book that the "negligence,
incompetence, arrogance and complete lack of
leadership" in the AIDS epidemic by the Public
Health authorities and the Centers for Disease
Control have caused the American citizens to
become nothing more than "unconsenting guinea
pigs" in an epidemic that may become the worst
the world has ever known.
In days of yore, the bearer of grim tidings forfeited his life. In
1985, that dutiful servant sometimes is banished. That's what's
happened to Gus Sermos. He's the Federal expert who labored
for 2 1/2 years with scant assistance and considerable resistance
from the state to document the burgeoning epidemic of acquired
immune-deficiency syndrome (AIDS) in Florida...
Editorial
THE MIAMI HERALD
December 7,1985

"A few years ago, the state recognized that AIDS was becoming a
problem and asked the CDC to send someone to help," said Gary
Clarke, deputy director of the health program office in the
Department of Health and Rehabilitative Services (HRS).

The CDC sent Gus Sermos. At a time when AIDS was a

"relatively unknown, minor kind of anomaly in the medical
journals," Sermos helped persuade health officials that it was "a
dangerous disease that should be reported," Clarke said ... "He
did a super job for us."
From a story by
Mary Carmen Cupito
Staff Writer
ST. PETERSBURG TIMES
December 6,1985

"Sermos has been a good man," said Prather. "He did

outstanding work."
E. Charlton Prather, M.D.
Florida Department of Health and Rehabilitative Services
From a story by Vern Williams
THE MIAMI NEWS
December 4,1985

"We feel that Gus has done a tremendous job ... When he started,
there was nothing."
David Collie
Senior Public Health Advisor
Centers for Disease Control
From a story by
Steve Sternberg
THE MIAMI HERALD
 ACKNOWLEDGEMENTS

First, I want to thank my vivacious wife, Patt, for her

support and encouragement. Also, I want to thank the
members of my family for their sustaining assistance.
Professional banishment can turn even the mildest
season into a brutal Siberian winter.

Next, I thank Mark Whiteside, M.D. for reviewing

the final draft of the manuscript.

My appreciation also goes out to Roberta F. Fox,

Attorney-At-Law in Miami, for her valuable legal
counsel in my time of need.

Finally, my thanks is extended to my friends inside

the Centers for Disease Control. Their comments
have let me know that my observations are right on
target.

July 22,1988
Tavemier, Florida
 Contents

RAFAEL .............................................................................. 1

THE DO-NOTHING POLICY............................................. 5

SIGNIFICANT PREVALENCE ........................................19

DEADLY POKER.............................................................33

HUMPTY-DUMPTY'S PEOPLE .....................................53

TRUST vs. SURVIVAL .....................................................69

BASIC EPIDEMIOLOGY ..................................................73

BASIC DISEASE SURVEILLANCE ........................97

TUSKEGEE REVISITED...............................................109
 RAFAEL 1

1
Rafael

The stench wrapped itself around me like a filthy, wet

blanket as soon as I reached the area outside of his room. I
was only about three feet away from the open doorway to
Rafael's room at Miami's Jackson Memorial Hospital when
his doctor rounded the corner at the hallway intersection
and quickly motioned with his right arm for me to come
over to him.
"Glad you could visit us this afternoon," he said.
"How's Rafael," I asked him.
"Let's just say he's squirting his brains out," he told me
nonchalantly.
There was nothing else to say, so we walked into
Rafael's room together. The putrid odor came from the bed
where he lay. He had been diagnosed as having the
Acquired Immune Deficiency Syndrome (AIDS) almost
three weeks ago— during the first week of July 1983. Since
then, his already-slim body had sprayed out thirty pounds
of fluid.
Rafael nervously glanced in our direction, groaned, and
suddenly clutched at his gurgling abdomen with both
hands. He arched his back as we approached the bed. The
2 DOCTORS OF DECEIT

uncontrollable whoosh of bowel-water sounded like a

high-pressure firehouse bursting under his sheet.
Except for a few instantaneous quivers, he remained
rigid for fifteen or twenty seconds before he relaxed and
sagged back down again. His right leg was raised, his bent
knee clearly outlined under the thin sheet. The part of the
sheet between his legs looked like someone had just fired a
load of steaming, watery-brown, Double-00 buckshot at it.
Rafael was a very sick man. Or as his doctor preferred to
phrase it in the medical record, he "was not doing very
well."
Earlier in the week I had reviewed his medical chart; he
was suffering from Cryptosporidiosis - a parasitic
infection which principally affects the intestinal tract. His
symptoms were obvious: explosive, watery diarrhea,
vomiting, and severe abdominal pain. In addition to his
intestinal problems, he suffered from Pneumocystis carinii
pneumonia, an opportunistic lung infection common to
AIDS patients and other persons with impaired immune
systems.
The doctor introduced me to him, then said he needed to
see another patient down the hall. After he left the room, I
told Rafael I was glad to meet him. Fear of the unknown
made me extremely cautious regarding any physical contact
with an AIDS patient; the cause of the disease had not yet
been discovered.
Even though it was a stupid question, I asked him how
he was doing and if the new medication had helped him
feel any better. He said the medicine had not helped him as
far as he could tell. Then he brightened up and smiled. He
stared at me a moment before he said anything else.
 RAFAEL 3

"But my weekend in Key West relaxed me a lot," he

added gleefully.
"When did you go to Key West?" I asked.
"Last weekend. But I checked back into the hospital on
Monday morning."
"How did you get out of here? Did you have the
doctor's permission?"
"Oh yes. I was really feeling low, very depressed last
week. The doctor thought it would boost my spirits if I got
out to visit my friends for the weekend. We partied all
Saturday and Sunday, but I got so weak early Monday
morning I had to come back then...one of my friends drove
me back. I couldn't even sit up; I had to lay in the back
seat of his car. I puked and my ass leaked...I thought I was
going to die before I got here."
"Did you have sex with anyone while you were with
your friends in Key West?"
"Yes," he said. "That's what made my weekend there so
satisfying. I got screwed twenty times I bet. I thought it
might be my last fling for awhile...I didn't want to waste
any time."

Rafael gave me the answers I needed to complete his

AIDS case report. As I turned to leave, a young man about
twenty-five years old came quietly into the room. He
walked over to Rafael, leaned down and kissed him
delicately on the cheek. They whispered to each other for a
few moments and then he turned to face me. He introduced
himself to me as one of Rafael's lovers. I asked him if he
was aware of the cause of his lover's illness. He told me in
a calm, resigned tone of voice that he knew Rafael had
4 DOCTORS OF DECEIT

AIDS.
He gave me his name, address, and telephone number
when I asked how I could contact him if it became
necessary to do so. I explained that I might need to speak
with him in the near future to check up on his health or give
him some important, health related information. I told him
very little was known about AIDS and that he should not
have sex with Rafael anymore — or anyone else until after
he saw his doctor for a physical examination. I also advised
him not to donate blood anywhere. Then I waved good-bye
to Rafael, left the room, and returned to my cubicle in the
Dade County Health Department — two blocks to the west,
on Fourteenth Street.
Rafael's Key West fling would have to last him forever.
He suffered from more explosive, bowel-twisting diarrhea
the next day, went into cardiac arrest and died.
The Do-Nothing Policy 5

2
The Do-Nothing Policy

Historical facts can, and often do, turn out to be

slippery. In general, many historical facts are based on
official versions of individual reports or opinions, any or all
of which may be either misleading or completely false.
Most versions of historical events have been so smoothly
polished that nothing remains of the rough edges which
actually helped shape and define the event.
If it is ever written, the "official" history of the AIDS
epidemic in the United States will be slipperier, and more
difficult to grasp, than a gallon of spilled mercury on a
polished gymnasium floor.
One reason is because no single government official has
made an independent decision regarding our national
response to the epidemic. All of the group decisions and
discussions insure that no one is responsible for any single
aspect — be it failure or success - of the management of the
epidemic.
Another reason the history of this epidemic will be hard
to grasp is because many of our national and state health
officials will do anything and everything possible to shift
the blame to "someone else" for the impending public
6 DOCTORS OF DECEIT

health catastrophe.

"The general point about AIDS is that everyone should

have done something sooner... we all tended to
underestimate the problem. We all - CDC [Centers for
Disease Control], scientists and the media — should have
paid more attention to this sooner."

Those are the revealing thoughts of Dr. James Curran of

the Centers for Disease Control's AIDS program. They
appeared in an article by Andrea Rock in the November
1987 MONEY magazine. Dr. Curran's words serve as an
excellent example of the Public Health Service's newly
developing "share the responsibility for the AIDS
epidemic" mentality.
Individual witnesses to an event, or incident, are
important because the truth of an event is not only made up
of the facts of the event itself, but also includes the
feelings, attitudes, and motivations of the participants and
the onlookers. In reality, these unwritten, "non-factual"
ingredients are often the most significant part of any
historical record.
This writing is neither dispassionate nor unbiased. I am
a witness; this is my testimony. This account represents
some of what I saw and heard. It reflects my own feelings
and attitudes as well as my interpretation of the feelings
and attitudes and motivations of the people I dealt with.
None of us grew up in the vacuum of total objectivity.
We have all been conditioned by the values and moral
structures of our time and place. One goal of this book is to
make a small part of the history of the AIDS epidemic in
The Do-Nothing Policy 7
America much less slippery.

Dr. Richard Morgan, Director of the Dade County

Health Department, called me to his office the day after
Rafael died. He wanted to talk about my recent activities
and he asked me to bring him up to date on how the AIDS
surveillance (case reporting) program was working. He was
my direct supervisor in Dade County. The day I arrived in
Miami he had made me promise to always keep him
informed of my activities in "his" county.
By this time, late July 1983, I had been working in
Florida for a month so there were several major issues for
us to discuss. After brushing over some of the bureaucratic
niceties he asked me if I had completed any of the AIDS
case reports on recently diagnosed patients. (Rafael had
been my first "live" patient. All of the other AIDS patients
had been — up until that time ~ introduced to me via their
death certificates, autopsy reports, and medical records.) I
briefed Dr. Morgan about Rafael and his circumstances.
Dr. Morgan asked if I had ever received any specific
instructions, from either Dr. John Witte at the Florida
Department of Health and Rehabilitative Services (HRS) in
Tallahassee or my Federal supervisor at the Centers for
Disease Control (CDC) in Atlanta, regarding the follow-up
of sexual contacts to the AIDS patients I interviewed. I told
him the subject of contact tracing (follow-up of sex
partners) had never come up in any of my conversations
with either Dr. Witte or my CDC supervisor, Mr. Larry
Zyla.

From the frown on his face and his long stare out the
window, it was easy to see he was surprised, perplexed, and
8 DOCTORS OF DECEIT

apparently displeased that neither my state nor federal

supervisor had ever brought up the fundamental subject of
contact tracing with me. When he brought his thoughts
back into the room, he said he was pleased I had advised
Rafael's lover to seek medical evaluation and that I had
also cautioned him against donating blood.
Then Dr. Morgan got up from his chair, leaned over his
desk and bluntly stated, "It is our responsibility and
obligation to notify people who have been in sexual contact
with an AIDS patient."
He believed they should have an opportunity to seek
medical advice and he was convinced we must advise them
not to donate blood. He went on to say it was the least we
could do for the sex partners in particular, and the "public
health" in general.
We both knew from training and experience that
notifying people personally was far more effective than
either "blanket" or "shotgun" information and notification
programs. He believed we owed it to them and that our
failure to do all we could possibly do to notify the sex
partners of the AIDS patients would be highly
irresponsible.
As the director of the health department in Dade
County, Dr. Morgan was well aware of the Venereal
Disease Control Program, its purpose, and how it operated.
He understood that the essence of any effective venereal
disease control system was vigorous, methodical contact
tracing.
For clarification it may be helpful to mention that
Venereal Disease (VD) and Sexually Transmitted Disease
(STD) are for the most part interchangeable terms.
The Do-Nothing Policy 9
Nowadays, however, the term Sexually Transmissable
Diseases is more often used because it gives us a more
accurate way to describe these diseases. The word
"transmissable" more clearly points out the actual scope of
these diseases because it signifies that even though these
diseases are transmitted almost exclusively by sexual
contact, they are also capable of being spread by
non-sexual or unhygienic means.
In a typical venereal disease control program, sex
contacts (partners) to newly diagnosed venereal patients are
located, if possible, by the caseworker. Then the
caseworker refers the sex partner into the clinic for medical
examination, evaluation, and treatment. This standard
operating procedure halts, or at least slows down, the
spread of infectious diseases such as syphilis and
gonorrhea.
Dr. Morgan's belief in our responsibility to the sex
contacts of AIDS patients in particular and to the "public
health" in general was unshakable. Additionally, he told me
he had consulted with Morton Laitner, the attorney for the
Dade County Health Department.
According to Dr. Morgan, Mr. Laitner advised him that,
in addition to our public health responsibility, he (Laitner)
believed we had also incurred the legal, and ethical,
r es p ons i bi l i t y to do all we could do to prevent the
transmission of this deadly disease to a patient's sex partner
of partners.
(Several days later I asked Mr. Laitner about his
viewpoint because I wanted to know exactly what legal or
ethical opinion he held and what he based it on. Laitner told
me that he simply believed it was inappropriate for us to
10 DOCTORS OF DECEIT
■

collect sex partner information from patients with AIDS, or

other infectious diseases, and then not use that information
to try to keep other people from becoming infected. In
other words, he clearly pointed out to me, if we, the public
health authorities, obtain information — from someone with
an infectious disease - about his sex partners, we become
obligated to at least make an effort to interrupt the
spreading of the disease. If we do nothing, we have
effectively turned the sex partners into nothing more than
involuntary, uninformed research subjects.)
Dr. Morgan sent a memorandum to me in order to
clarify his official position. He said he wanted his
instructions in writing in case "anything came up" in the
future.

His memorandum was dated July 28, 1983. It stated:

It shall be the policy of Dade County Health

Department that Gus Sermos, Public Health Advisor,
upon contacting a suspected AIDS case, shall request
the names, addresses, and the telephone numbers of any
contacts (sexual partners) with the AIDS case.

Said information shall be recorded in the case report. If

the contact has not obtained knowledge from the AIDS
case, a letter or telephone call shall be made by the
Public Health Advisor to advise the individual of the
alleged contact.

During the telephone conversation, the contact shall be

advised to have a physical examination for clinical
The Do-Nothing Policy 11
manifestations of AIDS. If telephone contact is not
possible, the following language shall be placed in a
letter addressed to the contact: Please contact my office
as soon as possible. I have some important information
relating to your health.

Further, all contacts shall be advised that they should

not be blood donors.

Within a few days of receiving Dr. Morgan's

memorandum regarding my duties for notifying the sexual
partners of AIDS patients of their exposure to someone
with a deadly disease, I called my supervisors in
Tallahassee and Atlanta to tell them about my new orders
from Dr. Morgan in Miami.
First, I called Dr. John Witte in his Tallahassee office.
He was the medical director of the Health Program Office
which is part of Florida's massive Department of Health
and Rehabilitative Services (HRS). He was in charge of
Florida's AIDS program. I was responsible to Dr. Witte for
my statewide activities because the Centers for Disease
Control (CDC) had assigned me to him. Witte had recently
retired from the CDC. He and the CDC jointly decided to
station me in Miami at the Dade County Health
Department. I told him of my meeting with Dr. Morgan and
read the memorandum to him over the telephone. He
casually told me to ignore the instructions I had received
from Dr. Morgan.
Immediately after speaking with Dr. Witte, I called
Larry Zyla, my CDC supervisor, in Atlanta, Georgia. He
told me not to get involved in contact tracing or contact
12 DOCTORS OF DECEIT

notification. I will never forget his closing remark.

Seemingly bored with the whole matter, he simply said,
"We don't have anything to offer the contacts."
After hanging up the telephone, all I could figure out
was that Zyla's statement reflected the opinions and
instructions he had received from his superiors at the CDC.
He would not have jumped out on that limb all by himself.
His saying that we had nothing to offer the contacts was
one of the first great deceptions spawned by our misguided
public health authorities in regard to the growing AIDS
epidemic.

Here are several of the greatest advantages for active

contact tracing and notification:

1) Since no cure is yet available for AIDS virus

infection, the most that public health officials can do, in
addition to "educating" the public, is to attempt to reduce
the number of people who may be exposed to the virus.
Notifying people who may not be aware that they have
been exposed to the virus may keep others from being
exposed and subsequently infected.

2) In some situations the patients are disinterested, or

even hostile, towards their sex or drug-using partners.
Thus, they may never notify them of their exposure to the
virus.

3) Active contact tracing, especially in areas where

there are low levels of AIDS virus in the population (low
sero-prevalence areas), may be particularly effective in
The Do-Nothing Policy 13
identifying and notifying those persons who have no idea
that they have been exposed to the virus. In particular, we
must be concerned about women in their childbearing years
who may unknowingly be sex partners or needle-sharing
partners with infected individuals.

4) Public health personnel, through their contact

tracing efforts for other sexually transmissible diseases,
have experience and a good track record in maintaining
confidentiality and in notifying and counseling sex
contacts.

5) Active contact tracing provides direct counseling to

persons who may be difficult to reach via traditional
education programs. Obviously, this type of counseling is
extremely important in preventing the spread of the AIDS
virus.

6) Public health officials are able to maintain the

"original" patient's confidentiality because they do not give
out the name of the index (original) patient to the person
being notified. Patients who notify their sex contacts reveal
their own identity in the process. Therefore, many infected
persons are uncomfortable if they are expected to notify
their own contacts.

7) It is much easier to control the quality of the

counseling message when trained health professionals
notify the sex contacts.

It was a mile-high lie to announce, as a matter of public

14 DOCTORS OF DECEIT

health policy, that we had nothing to offer the sexual

contracts of AIDS infected individuals. By doing nothing,
the CDC established the implicit premise that it was
acceptable to simply allow the AIDS virus to spread,
unchecked, throughout our society.
Even before the advent of the AIDS antibody test, there
were people who would willingly have altered their sexual
activities if they had been informed that a sex partner of
theirs had developed AIDS.
Several months later, in the autumn of 1983, a vivid
example of the stagnation and misdirection that was
weakening our public health's disease intervention system
took place.
Early one afternoon I received a telephone call from a
doctor in Coral Gables. He said he needed help regarding a
recently diagnosed AIDS patient of his.
During the call, he described the AIDS patient as a
bisexual male in his mid-thirties. The patient was a
highly-paid professional with a wife and two children, ages
three and five.
The problem the doctor needed help with was that the
patient did not want his wife to ever find out he had AIDS
and, as a consequence, he refused to take any precautions
(use condoms, abstain from sex) with her. The patient had
insisted that the doctor never divulge his diseased condition
to his wife. Since the doctor did not want to risk being sued
for violating the patient's confidentiality, he had already
decided not to inform the endangered wife.
Later in the afternoon the patient was due in for an
appointment. The doctor asked if I would come to his
office to meet the patient. He hoped I could sway the
The Do-Nothing Policy 15
patient's decision and convince him to take some
precau t i o n s for his wife's sake.
At my knock, the doctor opened his private, outside
door. Once we were settled in his office he re-explained the
situation. He strongly urged me to do or say anything I
could think of to influence his patient to take precautions
during sex with his wife. He felt he had done all he could to
encourage the patient to respond to common sense and
familial consideration. I told him I would do all I could to
alter his patient's mind-set.
A few minutes later a nurse escorted the patient into the
office where we sat waiting. Eagerly, the doctor introduced
me to him as "the man from the health department." The
patient was nervous and perspiring heavily. Even though he
already knew the doctor had asked him to meet with
someone one from the health department, I repeated to him
who I was and why I was there to see him.
Together we reviewed the basics of what disease
specialists understood about the AIDS epidemic up to that
date. Also, I mentioned to the patient our knowledge of a
situation in the adjoining county (Broward) in which an
infected husband gave his wife AIDS via sexual
intercourse. He listened attentively while we reviewed the
options open to him; he could either use condoms or
abstain from engaging in sex with his wife.
"I can't start wearing a rubber when my wife and I have
sex," he blurted out to us.
"She'll think something is wrong with me...and if I quit
having sex with her, she'll know for sure something's
wrong."

No one said a word for at least a minute. What was

16 DOCTORS OF DECEIT

there to say? The guy appeared to be intelligent and

alert...and perfectly willing to risk, or sacrifice, his wife's
life (and maybe even his children's lives) to keep his
diseased condition a secret.
Leaning back further in his chair, the doctor remained
silent. Finally, I leaned forward and in a deliberate
monotone asked the patient: "Don't you understand the
situation? Something is very wrong with you. You have a
disease that is probably going to end your life in the near
future. Do you want your wife to die too? Are you willing
to risk her health even if we aren't sure she will get this
disease from you? If she does become infected because of
your carelessness, who will keep the children when she is
too weak to help herself? What if you both die? Who will
take care of your young children?"
I paused for a moment, then continued. "And your male
lover, the one you meet on Key Biscayne two or three times
a week. What about him? Maybe he infected you. Or, if he
did not give you AIDS, maybe you will infect him in the
time you have left to live. Can't you even consider him?"
"I can't risk a divorce, it would cost me everything I
have," he said, as he got up from his chair. As he walked to
the door, he turned and told us, "I'll think about what
you've told me. I need time." He shut the door and
vanished into the glare of the afternoon sun.
"I can't afford to spend time involved in a lawsuit
because I tried to do the right thing," the doctor said as he
closed the patient's folder and threw it into the wooden tray
on the right side of his desk.
He was caught in a bind. If he told the patient's wife she
may be in danger of catching a deadly disease, she could
The Do-Nothing Policy 17

have easily figured out what happened.

A doctor or a sexually transmitted disease caseworker,
for example, can always begin his litany to a sex partner
with the canned phrase, "Someone you have had sex with
has an infectious disease." In many instances his statement
will not reveal who the infected sex partner is.
However, if the person the doctor, or caseworker, is
talking to has only had one sex partner (in the applicable
time period) it does not take him long, about one-tenth of a
second, to guess who is being referred to. Unless the wife
(in this case) had another lover the situation would become
extremely messy.
I promised him I would take care of the situation with
maximum discretion if he wanted me to speak to the
patient's wife. We both wanted to do something to protect
her from being infected. For all we knew, she may already
have been infected anyway.
There was nothing I could do to officially assist the
doctor in regard to the patient's wife. My superiors had
clarified their "do-nothing" positions earlier. However, I
was w i l l i n g to act as the doctor's representative if he so
chose. He called me the following week to say, "forget it."
"Their fate's on the wind, there is nothing more I plan
to recommend or do." The doctor thanked me for trying to
help him, then he hesitated for a moment. I thought he was
hanging up.
"I wanted you to know," he continued, "I think our
health service is making a grave mistake. I feel like I sent a
Kamikaze pilot out on a mission: I know he's going to
crash... just don't know when...or how many he'll take with
him on the way down."
18 DOCTORS OF DECEIT

The doctor went on to explain his feeling of complete

helplessness. As he drew his conclusions, I sympathized
with him. His final summation was that even if we could
not stop the Kamikaze pilots from "crashing," perhaps we
could cut down on the number of people they took with
them.

A copy of his death certificate arrived in the morning

mail in early 1984. The bisexual male had been ashes
("cremains" is the appropriate mortuary term) for two
weeks. When, out of curiosity, I checked up on his family,
a friend of theirs told me the wife and children moved to
California after the funeral.
Significant Prevalence 19

3
Significant Prevalence

At the time Dr. Morgan sent me the memorandum in

July 1983, approximately 110 people had been diagnosed
with AIDS in Florida. The number of diagnosed AIDS
cases in the entire United States then was about 1500 cases.
Five years later, Florida had 5,000 AIDS cases and the
United States had over 70,000 reported AIDS cases.
In an article dated December 8, 1987, THE MIAMI
HERALD reported that Dr. E. C. Prather (intimates call
him "Skeeter") of Florida's Department of Health and
Rehabilitatives Services (HRS) told the State Senate Select
Committee on AIDS, on December 7th, that by 1991 there
would be at least 32,000 AIDS cases in Florida.
(Current estimates by our federal health officials
indicate that there will have been 285,000 AIDS cases
diagnosed in the United States by 1991; 365,000 AIDS
cases by 1992; and 450,000 AIDS cases by 1993.)
The article in the Herald goes on to say: "Florida hopes
to launch a statewide AIDS notification program next year
(1988) to inform people who may have been exposed to the
deadly virus." According to the article, the state will need
to hire sixty (60) people for their notification program.
20 DOCTORS OF DECEIT

Five years later...five years after Dr. Morgan sent his

memorandum...five long, deadly years after federal and
state health officials decided to ignore common-sense
public health practices...five years and over 5,000 bodies
later in Florida...five years and 70,000 bodies later in
America. Why?

Sex partner notification, if it is ever implemented on a

state-by-state basis, will be a direct reversal of the idiotic
policy announced by our "expert" federal health authorities
in the early days of the AIDS epidemic. Back then the
health officials said they decided against contact tracing
because there was no treatment to offer either the sex
contacts or the patients themselves. There is still no
available treatment.
Another reason the public health authorities gave for
standing idly by while the epidemic gathered momentum
was that it would cost too much to have caseworkers
perform contact tracing duties. Financial costs have not
decreased; they have increased in geometric proportions.
What circumstances have caused this possible change in
public health recommendations? Disease control policies
may slowly be corrected to deal with the reality that the
virus is now widespread. Like molten, creeping lava, the
virus has been allowed to penetrate deeper into our
population.
Have you ever watched the news reports from Hawaii
that showed how the civil defense authorities were handling
the massive outpourings of lava during the volcanic
eruptions? They could not stop the lava, but they could -
and they did -- evacuate persons who were in the line of
Significant Prevalence 21
danger. That is exactly what a sex partner notification
program can do, it can alert persons to the fact that they are,
or have been, in "dangerous territory."
Thus, it appears that after five years of complete
neglect, the guardians of public health have decided to
attempt to intervene in the transmission of this disease.

A person does not have to be a Harvard-trained medical

doctor to realize it would have been much less expensive,
in both lives and dollars, and a thousand times more
effective to have begun this type of contact tracing and
notification program at least as early as 1983.
It is not necessary for a person to have been educated as
an epidemiologist at Johns Hopkins University to
understand that a small group of disease caseworkers could
have started this program by interviewing hundreds of
AIDS patients then (1983) instead of thousands or tens of
thousands of patients now. No, it would not have solved all
of the problems related to the relentless spreading of the
AIDS virus, but it would have given us a five-year
headstart.
If contact tracing is worth starting at this late date, it
certainly would have been a worthwhile effort five long
years ago. This tracing of sex contacts could have been
undertaken in every state.

Trained infectious disease caseworkers work in every

state of this nation. They are always available for medical
emergencies and other high-priority disease intervention
assignments.
In fact, the Centers for Disease Control (CDC)
22 DOCTORS OF DECEIT

maintains a regular contingent of its own Public Health

Advisors in most, if not all, states. These health advisors
are always available for instant assignment to any location
where a special public health need is identified.
For example, when the Mariel Cubans arrived in this
country in the spring of 1980, the CDC sent its own health
advisors and doctors to the "intake centers" in Florida and
Arkansas. The CDC called me on a Friday afternoon in
early May (1980) and ordered me to report to Eglin Air
Force Base (near Fort Walton Beach, Florida) the next day.
All of the health advisors were assigned to those intake
locations to assist in the processing of the new arrivals. We
were there to help test the Cubans for infectious diseases
(syphilis, tuberculosis, etc.) and to provide medical
treatment if necessary.
(It is now known that 4 out of a survey group of 990
Mariel Cubans were carrying the AIDS virus when they
entered this country in 1980.)
Essentially, we had been assigned to those sites to
intervene in the transmission of disease: to prevent the
infected persons from passing infectious diseases to each
other and to the citizens already in our country who would
eventually be exposed to these "newly arrived" Marielitos.
Another example of how rapidly and massively the
CDC can respond to a public health crisis comes to mind.
In 1981 the rate of penicillin-resistant gonorrhea
(Penicillinase Producing Neiserria Gonorrhea - PPNG)
increased enormously in the Los Angeles area. For a period
of at least eight months the CDC assigned health advisors
to Los Angeles for the express purpose of performing
contact tracing and sex partner notification casework.
Significant Prevalence 23
During this time, the CDC sent eight to ten health
advisors each month to the Los Angeles metropolitan area
from all parts of the United States to assist in this important
disease intervention activity. My orders came for this
assignment in July 1981. I spent the entire month of August
1981 in the Los Angeles metropolitan area performing
basic venereal disease intervention casework.
Money for that disease crisis seemed to be no problem;
we all were furnished with government automobiles, daily
living expenses, and overtime pay.
Recently (June 6. 1988) USA TODAY reported in its
"News From Every State" section that, "Federal health
workers will be sent to Southern California this summer to
combat the rise in syphilis. Los Angeles rate: 55.6 cases per
100,000 people, up from 24.3 cases per 100,000 in '85 -- 4
times USA rate."
Our public health system can respond to whatever crisis
it chooses. What struck me as particularly strange way back
in 1983 were the pitiful, mournful wailings of our suddenly
ignorant, financially bereft, public health officials who had
no plans, and supposedly no available funds, to mount a
response to the AIDS epidemic.
Almost all state health departments, no matter how
much they roar about "state's rights," are merely extensions
of the federal health bureaucracy. Therefore, when the
federal leadership takes a particular posture on an issue, the
state health departments follow along blindly. Like
dependent chickens, they never want their beaks to wander
very far from the federal feed bag.
Federal grants and cooperative agreements for disease
prevention and control programs are granted to the states
24 DOCTORS OF DECEIT

via the Centers for Disease Control.

Since the CDC administers the financial or "personnel
in lieu of money" grants, they have a powerful coercive
force at their disposal - money and staff. Wise state
officials know that grant monies can either be delivered
with a smile, or withheld with a grimace. No play, no pay.

Few state health leaders have the courage, the political

support, or even the desire to establish an independent,
state policy. Besides, it is so easy, so effortless, for them to
model their own positions on guidelines and policies that
the federal authorities have already prepared.
Plus, and a BIG PLUS at that, if any legal, medical or
ethical entanglements ever develop concerning a particular
program or policy, the state health authorities, with clasped,
sweaty hands and sad, spaniel eyes, will declare to the court
of inquiry: "We were only following federal guidelines,
your Honor. We are in no conceivable way responsible for
this tragedy."
Why so many bodies after seven years of the AIDS
epidemic in America? Why so many bodies in Florida five
years after the memorandum from Dr. Morgan in Dade
County?

Stephen King, M.D. served for several years in the early

1980's as Florida's State Health Officer. Actually, he was a
federal employee assigned to Florida out of the regional
office in Atlanta. (When he left Florida in 1985, he returned
to the Atlanta regional office.) On June 12, 1985, Dr. King
sent a memorandum to Jerry Hill. (I do not know who Jerry
Hill was or is, nor did I know his position.) Listen to Dr.
Significant Prevalence 25
King as he describes the position of Florida's State Health
Department (HRS) and you will begin to understand why
there are going to be thousands and hundreds of thousands
of corpses to bury or cremate in the coming years. The
following two pages of his memorandum address AIDS
policy issues:

Memo to PDPC
June 12,1985
Page Two

ISSUE 9
How should HRS handle sex contacts of AIDS cases?

BACKGROUND
...What obligation does HRS have in notifying the
partners of known cases and others thought to be
infectious?

CURRENT PRACTICE
Current practice holds that information held by HRS is
confidential and often anonymous. Contrary to the rest
of the STD (Sexually Transmitted Disease) program,
case management is not done. If it were, there would
need to be permission given for follow-up of sexual
contacts, etc.

STRATEGY
Ultimately, the Department will have to become
aggressive in its efforts of control. The current
emphasis on confidentiality/anonymity is because of
26 DOCTORS OF DECEIT
our efforts to protect the blood supply. As that issue
becomes less critical, the case-work will be very similar
to other STD's and should become a part of an
expanded STD program.

Page Three
ISSUE 10
Control of Spread

BACKGROUND
For a variety of reasons, governmental efforts have
centered on protection of the blood supply and
somewhat less on surveillance. However, enough is
known of the natural history of the disease that
effective efforts of control are possible. Perhaps the
major reason for this delay is that public opinion
consists mostly of fear and anger with blame being
placed on current target groups. Most legislators would
agree that allocation of scarce resources to help these
target groups would be unpopular compared to
protection of the blood supply, for instance.

STRATEGY
Continued community education and consultation will
hopefully heighten the awareness of the general
population. It is believed that extension of significant
prevalence will also "heighten awareness." As part of
the community education, it will be necessary to make
sure as many as possible will understand that with
increased surveillance and screening, along with
increased capacity of STD (Sexually Transmitted
Disease) case management and appropriate quarantine,
Significant Prevalence 27
risk can be reduced.

RECOMMENDED POSITION FOR THE

DEPARTMENT (HRS)
HRS should prepare for a likely groundswell of public
opinion for HRS to "do something." We should be in a
position to report positively.

This memorandum is a paper jungle of bureaucratic

violence. Dr. King's words reflect the complete disintegration
of our public health system and its guiding philosophy ~ to
safeguard health and to save lives. It clearly illustrates that
our public health officials have, in fact, advertently or
inadvertently, encouraged the spread of the AIDS
epidemic, rather than do everything in their power to halt
its spread. Ironically, they have helped create the epidemic
we now expect them to control.
Dr. King tells us in Issue no. 9 that information held by
HRS is confidential and often anonymous. No kidding.
Every state protects the confidentiality of information given
to venereal disease (STD) case workers by the infected
people they interview. And all states protect that
information vigorously. In fact, communicable disease
patient/sex partner information is among the most secure,
best protected information maintained by a state.
In my five years of venereal disease casework in five
states, I can only recall one incident in which a staff
member violated a patient's confidentiality. The worker
was immediately fired.

Apparently, Dr. King brings up the anonymity issue as

28 DOCTORS OF DECEIT
an effort to sidetrack attention. STD casework is rarely
easy. There is usually so much information from the
"original" patients that a caseworker has all the work he
can possibly handle anyway. There is rarely, if ever,
enough staff in an STD clinic to follow-up on the sex
partners of all of the patients. 1 never knew anyone who
went "to the field" to locate a contact based on "phoned in"
or anonymous information.
It is usually the responsibility of the individual
caseworker to obtain permission to follow-up the sexual
contacts of patients with venereal disease. If the patient
does not want you to pursue his sex contacts, he will not
tell you who they are under any circumstances. An essential
aspect of STD casework is to induce patients to give you
the information you need to intervene in the transmission of
their particular infectious disease.
When, you may wonder, did Dr. King think the
Department would "ultimately" have to become aggressive
in its efforts of control? Perhaps he thought 3000 people
with AIDS in Florida would spur his State Health
Department into action. Or maybe he thought 10,000
persons needed to be diagnosed with AIDS before the
guardians of public health mounted their offensive.
Our health authorities will only become aggressive at
attempting to control the AIDS epidemic when the body
count and the dollar count exceeds the political and
budgetary thresholds of pain that can be tolerated by state
and federal elected officials.
He is right; the casework will be very similar to other
STD program work. And, it will certainly be an
e-x-p-a-n-d-e-d operation. The only difference is that all of
Significant Prevalence 29
the patients will die. And everybody they infected as they
careened down the paths to their graves will die the same
horrible death.
Dr. King calls attention to the "protection of the blood
supply" in issues no. 9 and no. 10. It certainly puzzles me
how doing nothing offered greater security to the already
contaminated blood supply. From my experience, the
protection of the blood supply always took second place to
the guarantees of complete anonymity that the blood banks
promised to their donors.
Down in issue no. 10 he admits effective efforts of
control are possible. Then he goes on to say public opinion
consists of fear, anger, and blame placed on the target
groups: homosexuals and intravenous drug users. In other
words, let the homosexuals and the intravenous-drug users
die.
Dr. King's opinion is that when public opinion deems
the homosexuals and intravenous-drug users "worthy" of
saving, the state's health department will swing its public
health machinery into life-saving action.
Evidently he also believes good public health measures
are instituted by the elected officials. Now that the burden
is tightly strapped on the backs of the legislators, they will
have the opportunity to rationalize to you, their
constituents, why they presently need millions of dollars at
the state level and billions of dollars at the national level to
fight the AIDS epidemic.
Dr. King goes on to say the general population will
have its "awareness heightened" with the extension of
significant prevalence. Cows and hogs have their
"awareness heightened" when the farmer pulls up to the
30 DOCTORS OF DECEIT

front door of the slaughter house.

What he means is that when there are thousands of
AIDS cases being diagnosed each year, you, the general
population, will become concerned. On a more basic level,
"significant prevalence" means thousands of people dead
and thousands more dying. "Significant prevalence" is what
bowed our nation out of Vietnam. Our soldiers discovered
"significant prevalence" in the German concentration
camps at the end of World War II.

According to his memo, your growing concern (fright)

will enable the HRS case management teams to begin
managing the epidemic. Then their program efficiency will
reduce the risk of your contracting the AIDS virus.
Finally, we are told HRS should prepare for a
groundswell of public opinion. Imagine, people will
actually expect their State Health Department to do
something about the rapidly growing AIDS epidemic.
By wanting to be in a position to report positively, he
essentially means that HRS better be able to gloss over
their failure to act in the past. In bureaucratic parlance he is
saying they had better be able to "cover their asses" with
paper, lies, medical hocus-pocus, blue smoke and mirrors,
or any other available device.
Next they will tell you of their grandiose proposals for
controlling AIDS and protecting the public health in the
coming years.
The derelict, deluded public health mentality exhibited
in Dr. King's memorandum represents the rampant medical
and political cross-breeding common to public health
officials all over this country. This incestuous mating of
Significant Prevalence 31
medicine and politics has given birth to a deformed,
spastic, remorseless, public health monster that can neither
sustain itself nor save you.
The irony of his memorandum is that Dr. King
seemingly writes it from the viewpoint of an uninvolved
third party. His words sound like they are coming from the
mouth of an innocent bystander rather than the lips of the
State Health Director.
From their lackadaisical, negligent attitudes it appears
that many of our state and federal health officials went to
the "Calvin Coolidge" School of Public Health. President
Coolidge said if he saw ten troubles coming down the road
at him, he would not take any action because nine of those
ten troubles would run off the road and into a ditch before
they got to him. He said he would deal with the tenth
trouble "when it got to him."
The AIDS epidemic is not going to run off of the road.
This voracious consumer of humanity is going to thunder
right down the middle of Main Street.
Deadly Poker 33

4
Deadly Poker

Several years ago a professional poker player was being

interviewed after he had just won the National Poker
Playing Championship in Las Vegas, Nevada. The
television announcer asked him what he thought the secret
was to being a first-rate poker player.
The new champion answered the announcer's question
without hesitation. He said. "Whenever you sit down at a
table to play poker, the first thing you should do is to look
around the table at the other players to see if you can spot
who the sucker is. If you can't tell WHO the sucker is, you
better get up and leave the table because YOU are the
sucker."

Since June 1981, when the Acquired Immune

Deficiency Syndrome (AIDS) was first officially
recognized by our public health authorities at the Centers
for Disease Control, we have all been played for suckers by
the very government institutions that are charged with
safeguarding our collective health and welfare.
Since the AIDS epidemic began, the Department of
Health and Human Services (HHS), the Public Health
34 DOCTORS OF DECEIT

Service (PHS), the Centers for Disease Control (CDC), and

their counterparts at many of the state health departments
throughout the country have been betting our own lives
against us in a deadly game of public health poker. It is
time to take a closer "look around the table" at these other
players.
The public health experts and authorities at these
agencies, particularly those officials at the Public Health
Service and the Centers for Disease Control, have been
entrusted with the enormous responsibility of combating
the rapidly growing AIDS epidemic. Tragically, they have
failed us. Their blatant dereliction of duty is turning the
AIDS epidemic into the greatest public health catastrophe
in this nation's history.
Safeguarding the public's health by preventing the
spread of disease is one of the fundamental objectives of
the Public Health Service. The primary mission of the
Centers for Disease Control, a subordinate agency of the
Public Health Service, is to prevent the spread of infectious
diseases in our human population.
The most effective method of preventing an infectious
(communicable, contagious) disease from spreading
through a population is to interrupt its transmission - to
stop it from being transmitted by interfering with the path
(blood, body fluids, etc.) it uses to pass from one person to
another person.
Put simply, in controlling or preventing diseases that are
transmitted from person to person, the rational objective is
to reduce the number of infected individuals in the
population while, at the same time, minimizing their
contact with members of the non-infected population.
Deadly Poker 35
Obviously, the only reason the number of AIDS patients
is being reduced is because the disease kills them — not
because medical treatment cures them. Since there is no
known cure for AIDS, infected people cannot be cured or
rendered non-infectious. Thus, if there is no method to
render persons non-infectious once they have become
infected, a disease control program must concentrate on
keeping those individuals from becoming infected in the
first place.

No substantial effort has yet been undertaken by the

Public Health Service or the Centers for Disease Control to
actually minimize the contact of infected persons with
members of the non-infected population.

Instead of acting quickly, decisively and effectively to

safeguard our health, the doctors at the Public Health
Service and the Centers for Disease Control have sacrificed
traditional, scientific methods and classical, common-sense
disease prevention and control practices to the tarbaby of
political expediency.
The AIDS epidemic has been dealt with as if it were
strictly a "gay rights" issue. More recently, the runaway
locomotive of "civil liberties" or "civil rights" has derailed
the implementation of appropriate disease intervention
measures.

Liberty and security are the two most important

society-stabilizing counterweights which government must
always try to keep in balance. When, for example, you are
insecure because you believe your welfare is threatened by
36 DOCTORS OF DECEIT
disease epidemics, crime, or civil unrest, you are usually
willing to sacrifice some of your freedoms or liberties in
order to gain more security.
For example, passengers flying on scheduled airline
flights are searched for metallic objects or other dangerous
articles prior to boarding the aircraft. In essence, the
passengers have waived their constitutional rights against
illegal "search and seizure" so that their flight might be
more secure from a hijacking or other act of violence.
You have a constitutional right (Article IV of the Bill of
Rights) to refuse being searched before taking a flight, but
you do not have a constitutional right to fly on that
airplane. When you submit to the search you are trading a
portion of your civil liberty for an additional measure of
security.

In the last century and the first part of this century, laws
existed in almost every state that prohibited people from
spitting in public places. Legislatures and city councils
enacted those laws to help prevent the spread of
tuberculosis; not because spitting was an unbecoming habit
of the lower class. In this comparison, the public health or
"the commonwealth" was considered to be of greater
importance than preserving a person's right to spit
anywhere he chose. Another small liberty was traded for a
measure of additional "public health" security.
A few years ago we celebrated the 200th anniversary of
our United States Constitution. It was a year of great
celebrations regarding our Founding Fathers and their
wisdom. It appears though that we, as citizens, are
demanding more than our Constitution can deliver.
Deadly Poker 37

On one hand, we want complete security; we insist that

our government take care of our needs. On the other hand,
we demand freedoms which approach absolute liberty. Are
we asking too much of our Constitution, our politicians,
and our courts? How does the AIDS epidemic fit into the
balance of liberty versus security?
The Declaration of Independence of July 4, 1776,
declares that among our unalienable Rights are, "Life,
Liberty, and the pursuit of Happiness." The authors of this
historic Declaration borrowed and amended the phrase
from John Locke, the English philosopher whose essay
"Concerning Civil Government" proclaims that man has a
natural right to "life, health, liberty and possessions."
Notice the order of our "rights." Life is first, then
liberty (Locke put health before liberty.) Last in this basic
grouping of rights is the pursuit of Happiness and (Locke)
possessions. It appears obvious the writers of our
Declaration, and John Locke, were aware that a person
must have "life" before he could have liberty. And that a
person must have life and liberty before he could "pursue
Happiness" or have possessions. The writers apparently all
understood and accepted the idea that a citizen's rights
exist in a specific order of occurrence. We cannot have
liberty or pursue happiness if we are already dead.
Going as far back as the 13th century, we can see that
the great medical theologian and philosopher, St. Thomas
Aquinas, maintained a similar view. In his Summa
Theologiae, Aquinas wrote of human values and "being" in
general. His writing states that the moral order is modeled
according to a triple order of original stimuli: "that of
preserving being, that of propagating it, and that of
38 DOCTORS OF DECEIT

progressing socially, culturally, and morally."

Evidently, Aquinas, Locke, and the authors of our
Declaration of Independence, held the same, or at least
similar views. They all knew you had to live before you
could possess any rights. As Aquinas said so well: you
must live before you can create a new generation; you must
be capable of producing another generation or else there
can be no social, cultural, or moral progress. Life comes
first. Death and the dead lay claim to no rights.
Our public health system was originally created to
improve and protect the medical well-being of our entire
national population. Now, instead of protecting the
noninfected population from disease, the primary goal of
our public health leaders is to maintain the civil rights,
political health, and public relations welfare of the
diseased.

Tremendous political pressure, exerted by homosexual

groups and other concerned or involved individuals from
all parts of the country, has severely undercut an evidently
weak, already staggering public health system. Like one of
those old buildings the demolition experts take down with
strategically placed dynamite charges, our basic public
health structure has collapsed in a cloud of bureaucratic
dust.
Should we blame the homosexuals for our faltering
health system? Of course not.
Homosexuals, prostitutes, intravenous-drug users, and
other persons infected with the AIDS virus are not
duty-bound to uphold our public health statutes. They are
not paid with tax dollars to protect our health and
Deadly Poker 39

well-being.
As strange as it may seem, the homosexuals have acted
as if they had an overpowering, sub-conscious death wish.
Their vehement repudiation of standard public health and
disease control measures has guaranteed that thousands
more of them will die the horrible death AIDS confers on
its victims.
Sex partner notification/contact tracing programs and
AIDS virus antibody testing programs seem to be the
disease intervention measures that homosexuals fear the
most. They believe they will be discriminated against if
their confidentiality is not totally protected.
Here is a brief aside - On a beautiful day in early 1985
my wife and I packed our two boys, lunch, and assorted
teach equipment into my Blazer for a mid-afternoon trip to
our favorite beach on Key Biscayne. We parked, unloaded
the boys, bags, cooler, and floats and headed down the
sandy path which meanders through a thicket of seagrape
trees as it leads to the beach. We were approximately 30
feet down the path, paying close attention to the boys, when
we almost stumbled over what appeared to be two huge
sand-coated lizards. As we adjusted our eyes to the
speckled mixture of sunlight and shade, we were so
surprised we weren't sure how to react. As I recall, my first
instinct was to burst out laughing at the ridiculousness of
what was happening right there in front of us. Then it
seems I was offended, more at the location of the action
than the action itself.
There - just four or five feet to the right of the path -
were two naked, sand-encrusted men writhing on the
ground. Bugger and buggee were so enraptured with each
40 DOCTORS OF DECEIT

other that they didn't notice us for several seconds. (In the
meantime we'd grabbed the boys, picked them up, and
pulled their heads into our shoulders to mask their lines of
sight.) Amid the grunts and groans and rasping, scraping
sounds that go along with frantic anal intercourse on sandy,
leaf-strewn ground, we took a few steps before looking
down again at the two men. At that moment the man on the
bottom looked up at me.
What a surprise for both of us! He was Roger Hope, the
sex education instructor for the Dade County Health
Department. Roger stared at me for several seconds, but his
partner apparently became miffed at his inattentiveness, so
he started thrusting with even more gusto than before.
Roger then put his head down and they went furiously back
to their previous engagement. My wife and I quickly paced
the remaining distance to the freedom of the sunlight before
we released our boys and pointed them at the water.
I recounted this story because it seemed so absolutely
crazy to me that a person I was acquainted with at work,
and who was Dade County's primary sex educator, would
be so totally indiscreet, so willing to engage in what had
already been established as the "highest" high-risk
behavior. Roger Hope was one of those persons who went
wild if he thought someone's confidentiality might be
violated by the public health system that employed him. All
I can guess is that he didn't consider anal intercourse in a
public place to be a threat to his confidentiality - or to
anyone else's sense of appropriate public behavior. A few
weeks later Roger told me that he wasn't ashamed of his
gay lifestyle. My only comment to him was to tell him his
actions didn't constitute a lifestyle, they described a
Deadly Poker 41

deathstyle.
Later in 1985 Roger Hope was diagnosed with AIDS.
He died in 1986. His sandy sex partner died from AIDS in
1987.

Ever since the AIDS epidemic became a focal point of

news and events in this country, anyone who disagreed
with the homosexual's demands for total confidentiality has
been called homophobe — one who hates homosexuals. As
it will ultimately turn out, the supreme homophobes will be
seen to have been the homosexuals themselves and their
collaborators, the public health authorities.
Confidentiality is a hollow, two-toned battle cry. For
example, when people are reduced to numbers instead of
names, they achieve maximum dehumanization. In the Nazi
concentration camps the Jews became tatooed numbers;
their human identity was eradicated.
As my work in the AIDS epidemic continued, and the
numbers of cases increased, I noticed that when I discussed
a particular AIDS patient with a CDC colleague in Atlanta,
he saw a number at the same time that I saw a person. A
certain sensitivity is lost when a system loads numbers and
digits into a computer rather than bodies into a grave.

A long time ago, I stood at the edge of a swamp in north

Florida. About twenty-five yards away, four ducks paddled
along in the slow, black water. With absolutely no hint of
any other activity, one of the ducks vanished straight down
into a silent, black swirl. There had not been time for the
duck to go qua--, much less a full quack. It seemed that the
other ducks never noticed the disappearance, untroubled,
42 DOCTORS OF DECEIT

they kept padding idly along.

An alligator had pulled the duck beneath the surface.
And, as alligators like to do, stuffed the carcass into some
muddy hole to ripen for a future meal.
AIDS patients have vanished just as unnoticed and
unreported as that duck. That is an example of absolute
confidentiality. I doubt the duck ever knew what got him. I
know some of the AIDS patients never knew what pulled
them down into the grave.
During the entire time I worked for the CDC's AIDS
program, I consistently heard it said by people opposed to
contact tracing and antibody testing that if names were ever
"collected" by disease caseworkers, laboratories, etc., it
would endanger the patients and their sex partners.
This hidden danger was supposed to exist because the
Central Intelligence Agency (CIA), Federal Bureau of
Investigation (FBI), or some other clandestine group or evil
organization, could collect the names and take some sort of
retaliatory action against the involved individuals.
That fear is now, and was then, a waste of time and
energy. Because if any of those so-called "dangerous" or
"clandestine" organizations had ever decided, for whatever
reason, to discriminate or retaliate in some fashion against
homosexuals, all they needed to do was to review either
current or old Sexually Transmitted Disease Clinic records.
Those records contain codes for "homosexual" patients
and/or blocks of detailed information which specifies
same-sex (male to male) sexual contacts. In other words, if
any plot had ever been hatched to discriminate against
homosexuals on a wholesale basis, ample information
already was available in easily retrieved files.
Deadly Poker 43
Another example of this pervasive demand for secrecy
happened to me in Tallahassee in the spring of 1985. I had
flown up from Miami to assist in the making of public
service announcements which would be distributed to
television stations in Florida. With funding from the Public
Health Service, the State of Florida had set up an AIDS
Hotline which would operate from a "secret" suburban
location in the Tallahassee area.
All other AIDS Information Networks or Hotlines I had
been involved in were organized and managed by gay
males or females. This Hotline was no different. When the
time came for me and another Florida health official to go
to the Hotline location to film the announcements, we were
both handed blindfolds by the driver of the car that had
been sent to pick us up.
As we sat down in the car, the driver told us it was a
requirement that all visitors to the Hotline location wear
blindfolds to prevent any possible retaliation from
gay-bashers or homophobes. I asked him where his
blindfold was. He said he had been "cleared" by the
supervisor to know the location of the Hotline office. I was
tired of these stupid, one-act, "confidentiality" soap operas
so I told the guy that we had funded the operation in the
fi rst place, hired the staff in the second place, and we were
not going to ride through the streets of Tallahassee like
kidnapped CIA agents in Beirut.
He really got upset and fell back on his multiple rights
to confidentiality. Finally, I convinced him that their
security measures were indeed infantile if in fact someone
wanted to do them harm. So he agreed to drive us to the
Hotline location if we would agree to "not look where we
44 DOCTORS OF DECEIT

were going."
This obsession with confidentiality and secrecy can, and
will, turn out to be a major stumbling block to research and
disease prevention. The often stated assertion that
homosexuals will "go underground," if complete secrecy is
not guaranteed, is for the most part false and misleading.
Even the Surgeon General, C. Everett Koop, has helped
spread the deceptive idea. In the book, YOU CAN DO
SOMETHING ABOUT AIDS, he declares:
"When a community or a state requires reporting of
those infected with the AIDS virus to public health
authorities in order to trace sexual and intravenous drug
contacts — as is the practice in other sexually transmitted
diseases - those infected with the AIDS virus will go
underground out of the mainstream of health care and
education."
If an infected person goes "underground" in order to
avoid any encounter with medical facilities, it will only be
a matter of time before that person surfaces again in either
a hospital, clinic, or Medical Examiner's autopsy room.

From the fetid squalor of Belle Glade, Florida, to the

buggery-filled bathhouses of San Francisco, California, our
public health experts have consistently deceived us with
lies and elastic facts about the AIDS epidemic and the
danger it represents to our health.
From the polluted blood supplies of Los Angeles to the
addict-occupied tenements of New York City, the truth
about the modes of transmission of the AIDS virus - now
named the Human Immunodeficiency Virus (HIV) - has
been continually obscured by the medical leaders at the
Deadly Poker 45
Public Health Service and the Centers for Disease Control.
These doctors are traitors to their profession. They have
converted our system of public health into a quagmire of
public death.

Here is an example of an elastic fact. On the "Good

Morning America" television program of July 31,1987, the
Surgeon General of the United States, Dr. C. Everett Koop
was discussing AIDS with four teenagers. One of the
teenagers asked Dr. Koop how long the AIDS virus can
live outside the human body.
"Fortunately, Andrew," Dr. Koop answered, "this virus
is one that does not live well outside the body. It's a very
friable (fragile) virus. If it were tough, we'd have a much
bigger problem on our hands."
Notice that Surgeon General Koop did not say the virus
could not live outside the body; he said that it did not live
"well" outside of the human body. It is a shame that
Andrew, the teenager, did not think fast enough to ask Dr.
Koop how the virus, if it is so fragile, survives being frozen
in the blood it contaminates. Or how did four out of eight
women in Australia become infected with the virus after
being artificially inseminated with previously frozen
semen?
Viruses, unlike bacteria for example, "come to life"
when they find lodging in living cells. Although viruses can
be destroyed by the intense heat of sterilizing ovens
(autoclaves), or with various chemical germicides, they do
not necessarily die when they are deprived of nutriment.
They merely become inert In the inert state, viruses are
able to survive indefinitely; in body tissues, in the
46 DOCTORS OF DECEIT

environment...probably even in outer space.

Here is an example of an outright lie: In August 1986,
my former supervisor, Mr. Larry Zyla, who was (is) a
Senior Public Health Advisor in the CDC's AIDS program,
testified under oath before a federal administrative law
judge in Atlanta, Georgia.
Mr. Zyla said that by the end of December 1985, the
Centers for Disease Control had solved all of the
No-Identified-Risk (NIR) AIDS cases in the United States.
No Identified Risk cases are AIDS cases in which no risk
factor (intravenous drug usage, homosexual activity, blood
transfusion, etc.) is found that could explain how the
patient contracted AIDS.
I told the judge that Mr. Zyla was absolutely wrong,
that it was IMPOSSIBLE for the CDC to have solved all of
those cases. The judge showed no interest in my rebuttal of
Zyla's false statement. Zyla works for Drs. James Curran
and Harold Jaffe, both highly placed officials in the
HIV/AIDS Division of the CDC; he had their complete
approval to make such an incorrect assertion.

A factor which compounds these gross deceptions is the

willingness and the unbridled capability of the leadership at
these agencies to smother or destroy the credibility, and
career, of anyone who disagrees with, or questions, their
epidemiologic (factors dealing with disease incidence,
occurrence, and control) findings or the policies and
guidelines that result from those findings.
For example, the Human Immunodeficiency Virus
(HIV) is reported to be the cause of AIDS. Dr. Robert
Gallo of the National Institutes of Health identified HIV as
Deadly Poker 47

the cause of AIDS. To be fair, it must be mentioned that

there are other researchers who strongly disagree with Dr.
Gallo's, and the CDC's, declaration that HIV causes AIDS.
As reported in Jack Anderson's column of February 9,
1988, Dr. Peter Duesberg of the University of California at
Berkeley, believes that AIDS may in fact not be caused by
HIV. Dr. Duesberg studied the virus in Gallo's laboratory
and he concluded it did not meet the standard criteria for an
agent which induces disease. "Robert Gallo doesn't support
any alternative views," Dr. Duesberg is quoted as saying in
the column.
Dr. Duesberg's situation was the focal point of a brief
article in the Wall Street Journal of February 26, 1988.
Katie Leishman, a freelance writer who has written several
excellent AIDS articles, describes Dr. Duesberg as one of
the world's foremost authorities on retroviruses (the AIDS
virus is a retrovirus) and she adds that he is a member of
the National Academy of Sciences.
It has been several years since he outlined his ideas
about AIDS not being caused by the AIDS virus. In that
time many of our leading AIDS researchers have refused to
rebut Dr. Duesberg in press forums or at the requests of
universities.
Ms. Leishman reports that Dr. Frank Lilly, chairman of
the department of genetics at Albert Einstein College of
Medicine stated to Dr. Duesberg at a meeting of the
Presidential AIDS Commission that "You may be right.
There is a slight possibility that HIV [the AIDS virus] does
not cause AIDS. The evidence to date is in fact
circumstantial."
It is certainly conceivable that one reason our public
48 DOCTORS OF DECEIT

health authorities have limped down the road to organizing

an AIDS prevention program, is because they themselves
may harbor private doubts as to the actual cause of AIDS.
If that is the situation, then any prevention effort based on
the AIDS virus scenario would be worthless.
According to Ms. Leishman, another commission
member, Dr. William Walsh, scolded Dr. Duesberg by
saying he should confine his opinions to professional
circles. Dr. Walsh added: "Don't confuse the public. Don't
confuse the poor people suffering from the disease."

When I read Dr. Walsh's words, I could almost hear the

crunching sounds of heavy boots hitting the deathcamp
pavement in the midnight hours, forty-five years ago. I
easily visualized a scene dominated by obedient, efficient
German officers coaxing the cowering, confused Jews to
undress and line up for their showers. "Clean clothes and
hot food after you've showered," said the Nazi guard in the
long leather coat. The Jews were never confused again:
their shower consisted of a lethal dose of Zyclon B gas and
a trip to the crematory.

Dr. Duesberg's opinions represent two problems to the

official AIDS "authorities." One problem is that he clearly
demonstrates the inadequacy of molecular biology to
explain how the AIDS virus (HIV) actually causes disease
in a living host.
The second problem is that Dr. Duesberg's hypothesis
has forced his detractors to defend their theories and to
admit the shortcomings in their knowledge.
Deadly Poker 49
To a medical bureaucrat, confusion is dangerous
because it means that whoever is "confused" does not
accept or understand the idea or theory which is being
advanced as "the official, unified theory."
If you are part of the general public, your confusion
results, according to the experts, from the fact that you are
not an expert. Therefore, once you have been given the
facts your confused state of mind will dissolve.
Confused people are also susceptible to panic. And
panic is to be avoided at all costs as far as our health
officials are concerned. I remember reading an interview
with Dr. Robert Gallo. The interview took place in the
spring of 1985 and was published in either SCIENCE
DIGEST or SCIENCE 85.
Dr. Gallo was asked what he would do if he concluded
that the AIDS virus was going to kill a large part of the
American population. He answered that he would not
inform the public of his conclusion because the information
would cause panic. And that there was no use causing such
panic if nothing could be done to stop the virus.
When our public health authorities shut out of their
minds ideas which do not fit in with their official theories,
our entire research system self-destructs. Instead of
research and discovery, our health authorities concentrate
on controlling theories, groping through the darkness, and
hoping for a favorable outcome... the grope and hope
syndrome.
Another problem arises which indicates the "you can't
have it both ways" dilemma of the CDC's postion. In 1985
it was reported by the CDC that somewhere between 7 and
20 percent of the persons infected with the AIDS virus
50 DOCTORS OF DECEIT

would go on to develop "full-blown" or "frank" AIDS and

expire from the disease. The problem with that scenario is
this: if the AIDS virus causes AIDS all by itself, why
would the other persons (about 85 percent) survive the
infection of HIV? Other factors, co-factors, would of
necessity have to play a role in who lived and who died.
Currently, it is accepted that approximately 60% of the
AIDS patients die within 18 months of diagnosis and
upwards of 90% die within three years of being diagnosed
as having AIDS.
Co-factors are factors other than the basic causative
agent of a disease which increase the chances that a person
will develop the specifc disease. For example, co-factors
may play the decisive role in who is and who is not
overwhelmed and destroyed by a particular disease causing
organism. Prior infections of syphilis, tuberculosis.
Epstein-Barr virus, or cytomegalovirus may increase the
rapidity with which the AIDS virus destroys its host. Or the
presence of other microorganisms may predispose a person
to self-destruct much more quickly than would normally be
expected.
Obviously, the CDC's experts were speaking
prematurely, or else they were lying. It appears now that
fully 90 to 100 percent of the people infected by the virus
will sicken and die within ten years. Evidently neither
Gallo nor the CDC researchers want to even consider
publicly at least, the interaction of other "factors" in the
inexorable march of AIDS through our nation.
Several years ago when Drs. Caroline Macleod and
Mark Whiteside were studying the possibility of co-factors
playing a role in AIDS transmission and host susceptibility,
Deadly Poker 51
they were hooted at by CDC and State of Florida health
officials. Drs. Whiteside and Macleod also investigated the
possibility that mosquitoes may be a mechanical vector for
transmission of the AIDS virus.
Dr. Harold Jaffe of the CDC's AIDS Branch told me in
the spring of 1985 that soon they were going to do a study
in Belle Glade and that they would prove that neither
mosquitoes nor the environment had anything to do with
the spreading of the AIDS virus. Even if you are not a
scientist, it is easy to see the flaw in announcing the results
of a study before it begins. This is an example of the
painstaking "research" the federal AIDS experts are being
praised for.
The state and federal health authorities called the two
doctors, Macleod and Whiteside, rogues and amateurs.
Anybody who proposed an idea for research or discussion
which disagreed with or deviated from the "official
position" was immediately ridiculed and branded as a
non-expert.
In fact, one of my many supervisors, David Collie, of
the CDC's AIDS Program, stated to an administrative law
judge in August 1986 that the final act on my part which
resulted in my transfer from Florida was my mentioning of
co-factors in an interview with a reporter, Steve Sternberg,
from THE MIAMI HERALD (The HERALD published the
article on November 10,1985).

What still seems so perplexing is that my statement to

Mr. Sternberg did not concern the AIDS epidemic at all; it
was in response to his questions about the Multiple
Sclerosis (MS)"outbreak" in Key West. Mr Collie said I
52 DOCTORS OF DECEIT
"wasn't qualified to discuss Multiple Sclerosis or co-factors.
Strangely enough, Florida's State Health Department has
asked me to help them investigate the epidemic of Multiple
Sclerosis in Key West.

Ironically, a disease investigator's qualifications diminish

the more he probes into forbidden, or restricted, territory.
Our inflexible public health authorities are basing their
whole AIDS "program" on the assumption that the AIDS
virus (HIV) is in fact the cause of AIDS. What will they
say if it turns out that the AIDS virus is merely a co-factor
for AIDS rather than the singular causative agent?
Perhaps our trusted public health officials are as
confused as a bird dog with a nose full of red pepper. Or
even worse, maybe they are nothing more than careless
flagmen, waving the unwary and the misinformed over the
precipice into oblivion.
Humpty-Dumpty's People 53

5
Humpty-Dumpty's People

In Lewis Carroll's THROUGH THE LOOKING

GLASS Humpty Dumpty says, "Whenever I use a word, it
means just what I choose it to mean -- neither more nor
less.
Our public health authorities have become masters of
verbal trickery. They twist and distort words and phrases to
the point where new, inbred definitions suck the life out of
long-held public health concepts and philosophies.
Almost daily they beguile us with bulletins, stagger us
with statistics, and baffle us with recommendations that tell
us how we can save ourselves from the ravages of the
AIDS virus. Many of these recommendations are based on
ignorance instead of information, on hopes rather than
facts.
Clear, logical thinking and common sense are drowned
in the ocean of conflicting facts and confusing opinions
bestowed on us by our public health experts at the Public
Health Service and the Centers for Disease Control.
Apparently, the doctors in Atlanta and Washington never
learned that the razor-sharp, double-edged sword of
information and education cuts in two directions.
54 DOCTORS OF DECEIT

The "natural history" of the AIDS epidemic has yet to

be defined. That is because we have not observed the
epidemic long enough. What will be happening in five
years? In ten years? In twenty years?
Many difficulties confront our attempts to identify and
understand the course the epidemic will take in the coming
years. Transmission patterns may either shift to new groups
or expand in the already identified "risk groups."
Current evidence, for example, tells us AIDS may be
more widely spread in the future through heterosexual
activity. If this scenario comes to pass, it is reasonable to
believe sexually active teenagers may one day constitute a
new risk group for contracting, and spreading, the AIDS
virus.
Additionally, we have only been able to analyze and
interpret the information derived from the "reported" AIDS
cases. Thousands of AIDS cases have never even been
diagnosed, much less reported, to our health authorities.
To this day we still do not know the origin of the AIDS
virus. Certainly, the virus did not spontaneously generate
itself. We still do not know how widely the virus has spred
across America.
Scientists are uncertain how many people infected with
the AIDS virus will go on to develop the full spectrum of
disease and ultimately die from the consequences of AIDS
virus infection. Regardless of what the scientists will admit
all evidence indicates that least 90 to 100 percent of the
people infected with the AIDS virus will ultimately die
from it.
Humpty-Dumpty's People 55
Perhaps most importantly, we do not know or
understand all of the potential, or actual, routes of
transmission of the AIDS virus. According to the Centers
for Disease Control (CDC) there are only three ways for a
person to become infected with the AIDS virus: blood
contamination, via transfusion or intravenous drug usage;
sexual contact; and by being born to an infected mother.
This contention by the CDC is an oversimplification of
how the virus may be transmitted.
For example, the CDC and the Surgeon General state
that a person acquires the AIDS virus during sexual contact
with an infected person's blood, semen, or possibly vaginal
secretions. Then, they say the virus enters a person's blood
stream through the rectum, vagina, or penis.
However, on page 14 of the SURGEON GENERAL'S
REPORT ON ACQUIRED IMMUNE DEFICIENCY
SYNDROME he declares: 'Tn the future AIDS will
probably increase and spread among people who are not
homosexual or intravenous drug abusers in the same
manner as other sexually transmitted diseases like syphilis
and gonorrhea."
His statement is an oversimplification and a distortion
of how syphilis and gonorrhea are transmitted from person
to person. It is a contradiction to his earlier statement. If the
virus is in fact spread in the same way as syphilis and
gonorrhea, it does not have to enter the bloodstream
through the vagina, rectum, or penis.
Here are three specific instances when syphilis and
gonorrhea were transmitted at (to) a body site other than the
rectum, vagina, or penis. I investigated these cases during
my assignment in Texas.
56 DOCTORS OF DECEIT

1) A woman came into the Houston venereal disease

clinic with a typical, primary syphilis chancre (sore
between her breasts. The nurse took a sample of the fluid
(exudate) from the sore. We examined it by looking at it
through a specially equipped microscope called a
"darkfield" microscope.
Most of this fluid is made up of "sera," a blood
component without red blood cells in it. The best, most
accurate, method of diagnosing early syphilis is to use the
darkfield microscope because you can see the bacteria
called spirochetes (Treponema pallidum, a spirochete), that
cause syphilis. This type of diagnosis is qualitative: either
you see the spirochetes (darkfield positive), or you don't
(darkfield negative).
We identified the syphilis-causing spirochetes. The
diagnosis was made; the woman had primary syphilis. She
was given the required penicillin injections. During the
interview with her, she told me she had recently "had sex"
with a man, but that she would not let him engage in
vaginal sex with her. She let him "rub" his penis between
her breasts until he ejaculated.
It is commonly accepted knowledge that the primary
syphilis sore appears at the site where the bacteria enter the
body. We located her sex partner. He recalled having a sore
on his penis. The sore had since healed. He was given
medical treatment also and interviewed for his other sex
contacts.

2) In another case a woman came to the Houston clinic

with a primary syphilis sore on her left wrist. A specimen
of the "sera" was taken from the sore, examined under the
Humpty-Dumpty's People 57

darkfield microscope, and found to be teeming with the

syphilis-causing spirochetes. She was treated with
penicillin and interviewed.
She said she had not wanted to have vaginal sex or
rectal sex with her boyfriend so she had masturbated him
several times. Evidently he had a syphilis chancre on his
penis at that time. And the disease was transmitted to the
woman by entering her body through the skin on her wrist.
Several days later we located the boyfriend. He was
infected with syphilis, treated, and interviewed. He too
remembered having a "cut" or sore on his penis for about a
week during the time he let his girlfriend masturbate him.
These cases show that syphilis can be routinely
transmitted without the bacteria having to enter the body
through the rectum, vagina, or penis. In fact, these two
examples clearly illustrate that the spirochetes were able to
enter the patients' bodies at locations—a chest and a
wrist--other than the typically vulnerable mucosal
membranes.
There is no doubt that the genital ulcers (penile ulcers in
the above two examples) are capable of spreading syphilis.
Can they also spread the AIDS virus? Of course they can.
The virus is in the blood. "Sera" is a blood component and
it is discharged through syphilitic sores.
In a press release dated October 5, 1987, the United
Press International (UPI), quotes Dr. Willard Cates. He is
the Director of the CDC's Division of Sexually Transmitted
Diseases. He said: "The genital ulcers caused by syphilis
appear to facilitate spread of the AIDS virus because the
sores serve as a portal of entry and egress for the virus."
58 DOCTORS OF DECEIT

In a case involving gonorrhea, a three-year-old girl was

brought to the clinic by her mother. Her right eye was
swollen and had a white discharge dripping from it. She
was examined by the clinic physician, a specimen of the
discharge was taken and tested. The girl was diagnosed as
having gonococci conjunctivitis (gonorrhea of the mucosal
membrane surrounding the eye.)
During the interview with the girl and her mother, we
discovered that the mother's boyfriend was staying at her
house. We are always alert to the possibility of child abuse
in cases like this. I went to the house, brought the boyfriend
back to the clinic, and interviewed him.
Yes, he said, he had noticed a frothy, yellowish
discharge from his penis. No, he swore, he had never
touched the little girl with his penis. The clinic physician
examined him, found that he had gonorrhea (the
confirmation test came back several days later), and treated
him.
In summary, the clinic physician and I concluded that
the boyfriend had apparently been careless in matters of
hygiene. He must have touched her with his
discharge-contaminated fingers or hands and passed the
infection to her. No, we did not "prove" that she acquired
the infection in her eye in that manner, but it was our best
explanation of how she became infected with gonococcal
conjunctivitis.
Gonorrhea is spread by the exudates (discharges) from
the mucous membranes of infected persons. Can the AIDS
virus be transmitted from person to person in this manner
also? Again, the Surgeon General says in his report that
AIDS will "probably" be spread in the same way as other
 Humpty-Dumpty's People 59
sexually transmitted diseases such as syphilis and
gonorrhea.

On May 31, 1987 President Ronald Reagan finally gave

as his thoughts on the epidemic. In his call for expanded
testing of people for the antibody to the AIDS virus, he
said: "AIDS is surreptitiously spreading throughout the
population, and yet we have no accurate measure of its
scope. It is time we knew exactly what we are facing."

Are you willing to bet your life or the lives of your

loved ones that our medical geniuses will soon develop a
cure for AIDS virus infection? Or a vaccine which will
prevent you from becoming infected with the AIDS virus?
If you are, you may be in for a surprise.
Syphilis, gonorrhea, and tuberculosis are infectious
diseases that have been treatable and curable for at least
four decades. Yet those diseases are still being diagnosed
every day of the week in our country.
Surprisingly, those diseases are not being reported in
declining numbers, as you might expect, but in increasing
numbers. The mere existence of a cure or a vaccine for a
particular disease does not mean that the disease will be
either controlled or eradicated.
For example, a headline in the January 29, 1988 edition
of USA TODAY reads, "U.S. syphilis rate highest since
1950." According to the article, syphilis cases rose 30
percent in 1987, to their highest level since 1950. Dr.
Robert Rolfs of the CDC is quoted in the article as saying,
"With all of the talk about AIDS prevention in the past four
or five years, most of us thought there would be a
decrease.
60 DOCTORS OF DECEIT
The increase in the sexually transmitted disease, coming
after four years of decline, is disappointing."
The article reports that in 1950 the syphilis rate was
16.4 cases per 100,000 people. In 1987 the rate was 14.7
per 100,000. In that year, the total number of syphilis cases
was 35,398 in this country.
After 38 years of syphilis control programs, information
and education, curative treatments, and massive federal
funding to pay for it all, we still are fighting, and losing, the
battle against an "old" disease.

The Centers for Disease Control does not really control

disease, but it has mastered the fine art of controlling
information about disease. Dominion over the data does not
necessarily mean that the CDC has an unimpaired
unencumbered perspective on public health requirements
and practices.
In regard to AIDS for example, a small cadre of
"experts" at the CDC define which disease characteristics
will or will not be described as AIDS related. They draw
their own conclusions from the information they gather
about the epidemic. And then they decide what action, if
any, they will take to control the epidemic.
For a quick comparison, can you imagine the legal
swamp we would all be swallowed up in if the Federal
Bureau of Investigation (FBI) enacted its own laws,
enforced those laws, served as judge and jury at the trials of
the lawbreakers it had arrested for violating those laws, and
ran the prisons that held the newly-convicted criminals?
The "legal system" described in that scenario would make
about as much sense to our constitutional form of
Humpty-Dumpty's People 61
government as the CDC's AIDS Program makes to our
longstanding system of public health policies and
procedures.

Additionally, it is of great importance to remember that

the AIDS cases acknowledged by the CDC only represent
the numbers of individuals who have developed the AIDS
virus-related infections and diseases. Currently, the number
of people who are carrying the virus is estimated at
between 1 and 5 million. Except for information purposes,
testing people for the virus is still an "unacceptable"
approach to gauging the extent of the virus in our
population.
Dr. James Mason is the current Director of the Centers
for Disease Control. Reputedly, he is a specialist in matters
regarding public health and policies affecting our
nationwide public health programs. Comments he made to
Interviewer Barbara Reynolds of USA Today (December 7,
1987) provide clear evidence of the irresponsible, unethical
attitudes which pervade our public health management.
"Testing for AIDS" was the topic of the interview. The
first question put to Dr. Mason concerned the CDC's
planned 30 million dollar, 30-city study of how much the
AIDS virus has spread. For USA Today, the interviewer
asked: "Will the results be confidential?"
Dr. Mason replied: "Since we don't even know the
names of the people, there's no confidentiality involved.
It's anonymous. In this process, when a person turns out to
be positive in our laboratory, there's no way we can go
back and notify them."
The interviewer next asked him: "Isn't that wasted
62 DOCTORS OF DECEIT

research, since lives could be saved if people knew they

were carrying AIDS?"
Dr. Mason replied: "If we hadn't been doing this
survey, a person wouldn't have found out anyway because
he didn't go to one of those settings to be tested for AIDS.
If he went to be tested for AIDS, he would have found out.
But he went for some other purpose, and his blood sample
was randomly chosen, so he hasn't lost. We've gone to
ethicists and review boards, and they have to weigh what is
the public-health need for this information, and what is the
potential harm to the individual."
No matter how you interpret them, Dr. Mason's
remarks represent a bizarre, deranged attitude for someone
who is one of the chief public health officials in this
country. Here are some points to consider:

1) Dr. Mason seems to believe that the CDC is a

research institution which, as a sideline, dabbles in saving
lives by preventing the transmission of infectious disease
He is pleased that there is no way for the health authorities
to go back and notify persons of their "infected" status.

2) He says that a person would not have found out he

was infected with the AIDS virus anyway, because he did
not go to one of the "settings" to be tested for AIDS.

How would you react to your doctor if, when you went
to see him for a sore throat, he gave you a prescription, and
sent you home. Then, three months later, you notice a large
painful lump on your back. You call the doctor for an
appointment and go to his office for an examination.
 Humpty-Dumpty's People 63
As he looks at your back, he says to you, "This is
serious, the cancer is growing faster than I thought
possible. It wasn't nearly this big when I saw it three
months ago."
Bewildered by his comment, you ask the doctor, "What
do you mean by saying you saw it three months ago?"
"Oh," he sighs, "it was just a tiny spot then."
"But doctor," you say, "you didn't tell me anything
about a spot on my back when I came here before."
"Look," he scoldingly announces to you, "you came to
my office because of a sore throat. You never asked me to
check you for any other signs or symptoms of disease. Now
that you've come for my advice about your cancer, I'll
refer you to a specialist."
The above scenario is as ridiculous as Dr. Mason's
irresponsible assertion that the CDC has no obligation to
inform you of a disease condition they discovered via their
testing for the AIDS virus.
3) It doesn't matter how many ethicists and review
boards Dr. Mason and the CDC went to. This type of study
is anti-public health and anti-life. The ethicists he consulted
must have fled Nazi Germany in 1945, before they could be
questioned, as potential witnesses or defendants, for the
upcoming Nuremberg Trials.

4) Dr. Mason goes on to say that the ethicists have to

weigh the potential harm to the individual - the person
who is found to be infected.

Death is the only potential harm to the individual. If the

64 DOCTORS OF DECEIT

people involved in this human experimentation were

notified of their AIDS virus infection, they could seek
immediate medical counseling and probably extend their
chances for a longer life. Also, they could be advised of
"safe-sex" behavior. And as an additional precaution the
infected persons could be advised NOT to donate blood.

What if the Federal Aviation Administration (FAA)

ordered all of the air traffic controllers in airport towers
across the country to only report airplane crashes and not to
worry about monitoring the airplanes landing or taking off
at their particular airport. The idiocy of such an order
would, in fact, cause more airplane crashes than normally
occur because the pilots would have to coordinate among
themselves their own take-off and landing patterns. But, at
least the FAA officials (similar to the officials at the CDC)
could say to the bereaved survivors that they indeed had a
great crash-reporting system. They could then point with
pride to their policy of not interfering with the pilots' rights
to fly in any direction they chose.
Rather than just monitoring the diagnoses and deaths of
persons who have met the CDC's definition of AIDS, the
CDC could have and should have been monitoring the
carriers of the AIDS virus. But no, to do that would have
required a knowledge of basic public health principles and
the willingness to provide leadership. Contact between
infected and non-infected individuals has not been
minimized; it has been maximized.
"It has been clear for some time that the real epidemic
starts when you become infected with HIV" (Human
Immunodeficiency Virus), said Dr. William Haseltine of
Humpty-Dumpty's People 65

Harvard's School of Public Health. Haseltine's statement,

as recorded in The New Federalist of January 22, 1988,
underscores one of the gross deceptions of the CDC. While
officials at the CDC have used the reports of persons with
manifested symptoms (opportunistic infections related to
AIDS virus infection) to describe the epidemic, the "real
epidemic" has not been dealt with. As an epidemic, AIDS
must be defined as the number of persons infected, and
therefore infectious, not just the "top" of the epidemic we
see reflected in the "cases reported" figures.
Dr. Margaret Fischl, who is the director of the AIDS
Program at the University of Miami School of Medicine
was also quoted in The New Federalist. She stated: "The
CDC definition of AIDS should never be used clinically. It
makes no sense. These are all patients who need the
attention of physicians. They need tests and treatment,
Having seen more than 2,000 patients with the illness, it
drives me crazy to have people tell me it's not AIDS if it
doesn't fit a CDC description."
During the two and one half years I worked in Florida
on AIDS case research, I spent many hours with Dr. Fischl
in her office at Jackson Memorial Hospital. Her volume of
work with AIDS patients is indicated by the fact that she
was the largest single source of reported AIDS cases in the
State of Florida. I never did fully understand the CDC's
nasty, oblique attitude towards her.
When we were on the way to see her one day in July
1985, Dr. Harold Jaffe of the CDC's AIDS Program told
me that he did not trust her...that I should keep an eye on
her. Apparently, Dr. Jaffe and several of the other CDC
66 DOCTORS OF DECEIT

doctors felt uncomfortable with her because she did not

acquiesce to their every utterance.
I do remember her telling me of the sporadic arguments
between her and the CDC AIDS physicians regarding
whose names would be listed, and in what order the names
would appear, on the research articles they collaborated on.
Also, medical research competition being fierce, it
appeared that Drs. Jaffe and Curran (James Curran is the
head of the CDC's AIDS Program) were concerned that Dr.
Fischl would "withhold" the most interesting cases for her
own personal research.
There is an adage heard frequently in government work
that says, "No good deed should go unpunished." Thinking
about Dr. Fischl, and her extensive AIDS research and
casework, reminded me of an incident which illustrates the
application of the adage by Florida's top health officials.
At one of the many meetings I attended in Tallahassee, I
was seated in an office with Dr. James Howell, then Deputy
Secretary for Florida's Department of Health and
Rehabilitative Services (HRS), and Dr. John Witte of
HRS's Health Program Office.
The telephone rang, Dr. Howell picked it up, listened
for a few minutes, then said an emphatic NO. Dr. Howell
looked at Dr. Witte and I, then said the governor's office
had called to find out what he and HRS thought about a bill
that had been approved by the legislature for $250,000 to
be used for AIDS research. The research funds had been
applied for by Drs. Margaret Fischl, Nancy Klimas, and
Mary Ann Fletcher of the University of Miami Medical
School. Each of these doctors are established, respected
researchers.
Humpty-Dumpty's People 67

Dr. Howell commented that he told "them" that he and

HRS did not want the governor, Bob Graham, to sign the
bill because "we can't have people going around us." He
went on to say that neither he, Dr. Stephen King, nor Dr.
Witte "knew anything about the request for research money
until recently" and that "we have to be informed as a matter
of protocol." As you can see, the $250,000. which was
desperately needed for AIDS research was denied by state
health authorities because they had "not been informed."
Obviously, protocol is far more important to health
officials than seeing to it that research goes forward against
a new disease with an apparent fatality rate of 100 percent.
This attitude is typical of many of the health authorities to
whom you have entrusted your welfare.
At this writing, Dr. Howell is the director of the Palm
Beach County Health Department. He and Dr. Fischl serve
together on the Governor's AIDS Task Force.

Dr. Jonathan Mann, director of the World Health

Organization's Special Program on AIDS was quoted in the
June 1987 issue of Reader's Digest as saying: "AIDS
poses
an unprecedented health problem, so it will require
unprecedented solutions." Dr. Mann is wrong. The
solutions for the AIDS epidemic have precedence. The only
unprecedented aspect of the AIDS epidemic is the inability
and unwillingness of our stumbling public health officials
to deal with the epidemic according to the basic principles
of disease intervention.

Victor Hugo, the French poet and novelist (1802-1885),

said, "Great blunders are often made, like large ropes, of a
68 DOCTORS OF DECEIT

multitude of fibers." One fact will become much more

evident as time passes: we will see that the continued
expansion of this voracious epidemic was amplified by a
multitude of deadly blunders on the part of our national
health authorities.
Negligence, incompetence, arrogance, and a complete
lack of responsible leadership are additional ingredients
which have fostered the spread of the AIDS virus in our
country.
At present, the labyrinthine bureaucracies of the Public
Health Service and the Centers for Disease Control offer a
safe harbor for our deceitful, irresponsible federal health
officials.
Eventually, the time will arrive - too many bodies, too
much money, and your demands to know "what went
wrong" and "who's to blame" will make it happen — when
they are tweezered out of their protective holes and
enclaves. Then, as they stand squinting in the sunlight of
responsibility and accountability, they will be forced to
explain their tragic failure.
Trust vs. Survival 69

6
Trust vs. Survival

Survival is the most basic function of any organism.

Your instinct to survive - that gut-gripping, deep-seated
demand your brain subconsciously makes on you in the
presence of danger — will almost always overpower all
other considerations as you go about your daily life. To
survive is to prevail, to continue existing.
In our modem American society we all depend, more
than ever before, on other people, organizations, and
institutions to provide us with the food, products, and
services we need to live. Additionally, we count on our
system of federal, state and local government to provide a
certain amount of stability to our existence.
Trust is one of the most frequently used survival tools
you have available. Think about it for a moment and you
will realize how much other people's actions affect your
continued health and welfare.
When you board an airplane you take it for granted the
person sitting in the cockpit knows how to fly. It is not
standard procedure for an airline captain to show the
passengers his pilot's license as they board the aircraft. We
assume the pilot is licensed and certified to fly that
70 DOCTORS OF DECEIT
particular aircraft. You assume, the pilot also assumes, the
mechanics have maintained the aircraft according to the
required maintenance procedures.
When you drive, as you accelerate your car through an
intersection, you trust that the other drivers will obey the
traffic laws and stop at their red light. Going one step
further, you assume that the traffic signal is functioning
properly - a green signal showing on all four sides of the
traffic light would obviously be a hazard to your safety.
When a doctor tells you that you are afflicted with a
certain disease, or that your condition requires a specific
surgical procedure, you may have to go beyond the realm
of trust. Faith in his judgement and confidence in his
medical ability will be major factors in whether or not you
accept his medical recommendations.
The practice of medicine is not pure science; it also
involves a high degree of art. In many circumstances,
doctors do not make strictly scientific decisions. Their
ethics, moral values, and sensitivity to your specific
situation all play an important role in the treatment or
surgery they recommend for you.
Oftentimes, after recommending surgery or medication
for a patient's particular medical problem, the doctor will
encourage the patient to seek a second opinion from
another doctor. There is certainly nothing bizarre or out of
the ordinary about a patient's wanting a second opinion
regarding his condition from another doctor.
But, what if you had no one else to go to for a second
opinion? You would have to hope your doctor was right or
you would have to forgo your doctor's recommendations.
In any event, the lack of an available second opinion can
Trust vs. Survival 71

put you in a dangerous situation.

Can you imagine for a moment how violated and
betrayed you would feel if you found out your own doctor
had been lying to you for years about the disease from
which you suffer? Perhaps he lied when he said he knew
"things" he could not possibly have known. Or perhaps he
lied about what he knew and intentionally misrepresented
facts to you. Regardless of whether he lied to you out of
ignorance or out of duplicity, the damage to you would be
irrevocable.

Currently, in the United States, we are in just such a

situation concerning the AIDS epidemic. There is no one
else to go to for a second opinion. The official "group-think"
of the Centers for Disease Control and the Public Health
Service represents the only acceptable opinion in circulation
in this country.
Do you trust the health officials at these two agencies?
Do you think they would ever lie to you? Do you believe
your federal and state health officials have done everything
in their power to impede the spread of AIDS in our
country? Are you willing to bet your life on what Surgeon
General C. Everett Koop says about the AIDS epidemic in
America?
An almost unbelievable fact is that no serious effort has
been made, or is being made, to avert a rapidly expanding
epidemic which has the potential to erode our basic social,
legal, and medical structures. Endless committee meetings,
conferences, talks, and commissions, create the false
impression that our state and federal agencies are doing
something to halt the spread of this lethal disease.
72 DOCTORS OF DECEIT

In our private life, only a madman would remain

impassive in the face of such a powerful threat to his
survival or the survival of his family. It appears the
strongest of all our instincts, the instinct for survival, has
ceased to motivate us to take any action or voice any
opinions to our elected officials. Most people share the
fantasy that their health authorities have undertaken the
actions necessary to control the epidemic. The managers
(there are no leaders) of the Public Health Service and the
Centers for Disease Control are lost in the wilderness of
incompetence, deceit, and political expedience.

Are you prepared to resolve all of the conflicting

opinions in favor of your own continued existence?
Basic Epidemiology 73

7
Basic Epidemiology

John Snow's classic studies of the cholera epidemics in

London, England in the mid-1800's are excellent examples
of attempts to not only discover the cause of a disease, but
to prevent its recurrence.
Snow did not know what caused cholera; nor did he
know how to cure someone of the disease. What Snow
believed, and subsequently proved, was that a disease can
be prevented from infecting people even if no cure exists
and no one knows its cause.
Unlike many of our state and federal health officials of
the 1980's, Snow did not whine and moan that nothing can
be done because there is no cure, no treatment, and no
vaccine. He went into the streets and took action.

In 1848, Snow conducted his first study when a cholera

epidemic broke out in the Golden Square area of London.
First, he gathered information about where the cholera
patients lived and worked. Second, he took a map of the
area and put a dot on it to signify where each of the stricken
people lived. Water was suspected of being a source of
infection, so he also showed the locations of the water
74 DOCTORS OF DECEIT

pumps in that section of the city.

Because many of the cholera cases were grouped
around the Broad Street pump, he focused his attention on
this water supply as the most likely source of the disease.
Next, to confirm his theory that the water from the
Broad Street pump was the source of the epidemic, he
gathered information from the cholera patients about where
they obtained their drinking water. His tedious review
showed that drinking the water from the Broad Street pump
proved to be the one common factor among the cholera
patients.
By simply removing the handle from the pump, Snow
effectively shut down the epidemic.
Had Snow attempted to shut down the pump by today's
retarded health standards, the national health authorities
would no doubt have named a commission ~ best defined
as a bureaucrat's orgasm — to study the water supply
situation and issue a report within one year.

During the cholera epidemic of 1854, Snow again

proved his worth. He studied the numbers of cases
according to the water supply districts they lived in. His
continuing investigation showed that the water intake of
one particular company was located near a major source of
contamination. To solve the problem, the water company
moved their intake pipe away from the contaminated area.
As a result of his two epidemiologic studies, Snow,
working without knowledge of the existence of
microorganisms, proved two important hypotheses:

1) He showed disease can be prevented even if its

Basic Epidemiology 75

cause is unknown and there is no treatment or cure for it;

2) He discovered water can serve as a vehicle for
transmitting cholera.

Although John Snow believed in the existence of

microorganisms — and that they caused cholera ~ his
concept was not accepted until the "germ theory" was
confirmed by the labors of Robert Koch and Louis Pasteur
during the years 1860-1890.
As a result of the research of Koch and Pasteur, the
emphasis shifted from environmental factors to bacteria as
the direct cause of many diseases.
Epidemiology is the study of the occurrence of disease
in human populations. An epidemiologist is a person who
studies the distribution (how many people are infected;
their age, race, sex, etc.) and the determining factors (what
causes it, how it is spread, etc.) of disease in human
populations.
The term comes from the Greek words: EPI-, meaning
on or upon; DEMOS, meaning people; and LOGOS,
meaning the study of. Epidemiology had its beginning with
the studies of the disease epidemics such as smallpox,
cholera, and bubonic plague. All of these diseases were
characterized by high death rates.
As this "science" has advanced and grown, it has now
reached the point where it is applied to the study of disease in
its broadest sense. For example, we now speak of the
epidemiology of cancer, heart disease, measles, hypertension,
accidents, or even victims (called victimology).
Each "disease" is composed of the same elements:
1) the disease determinants;
76 DOCTORS OF DECEIT

2) the human population in which the disease occurs;

3) the distribution of the particular disease in that
population.

After studying the distribution and determining factors

of a disease, the epidemiologist is then able to apply
scientifically accepted principles and methods to the
control and prevention of the disease.
Obviously, problems arise if, for whatever reason, the
standard disease control measures are not applied or they
are applied too late.

Frequently, the capability of our medical system to cure

diseases can create another type of prevention and control
problem. When curative treatments are available, it is easy
for the emphasis to shift from prevention and control to
merely curing the infected persons as they come to the
attention of the health authorities. This "lazy" type of
program survives very well unless a disease, like AIDS,
comes along to upset its lethargic operation.
Syphilis and gonorrhea are two good examples. Since
both of these sexually transmissible diseases (STD's) are
curable, it is often much less expensive, in terms of
manpower and dollars, for health departments to
concentrate more on curing the newly infected patients,
than it is for the health departments to prevent those same
patients from becoming infected in the first place.
The political dynamics of disease prevention and
control rise and fall like the ocean's tide during a full
moon. For example, if in an STD clinic operation the
caseworkers are successful in their prevention efforts, the
Basic Epidemiology 77

number of new cases being diagnosed will decrease. In

other words, their disease intervention activit y will enable
them to find the sex partners of infected patients and have
those partners preventively treated before their infections
complete their incubation periods and show up as new
cases of either syphilis or gonorrhea.
However, success has its own drawbacks. If the number
of diagnosed cases in a geographic area decline due to the
efficiency of the disease control activities, it is likely that
program directors will shift a percentage of the disease
control funding to other areas with higher numbers of
reported cases.
On the other hand, if a clinic is understaffed or managed
inefficiently, the rate of newly diagnosed cases will rise.
This increase will usually be due to the decision,
inadvertent or not, for a disease program to concentrate on
curing the new cases instead of preventing the cases from
developing. Thus, the unsuccessful prevention program will
be given more money. In effect, that program is rewarded
for its failure.
In any event, disease control and prevention statistics
are extremely susceptible to manipulation. Statistics and
information about AIDS cases are being massaged by the
finest medical masseurs your federal tax money can buy.
For example, in late 1984, two Florida doctors reported
to me that each of them had just diagnosed a female nurse
as having AIDS. Both of the nurses had been exposed to
blood from patients they encountered in the performance of
their duties.
Since neither the doctors nor I could "prove" that either
of the nurses had come in contact with AIDS virus infected
78 DOCTORS OF DECEIT

blood, the two cases were not acknowledged as significant

by my supervisors at the Centers for Disease Control.
I mentioned these two cases to nurses at meetings in
Florida so that the nurses would at least be aware that there
were some unresolved AIDS cases involving their
colleagues. Generally, the only comments were that the two
infected nurses had probably used intravenous drugs or had
engaged in sex with infected partners.
Neither of those allegations or innuendoes regarding
drug use or sexual activity with infected partners were ever
shown to be true. It was not until 1987 that the CDC
released information regarding three other health care
workers who had become infected via their professional
activities.

Many years ago, General Lewis "Chesty" Puller of the

U.S. Marine Corps said the path to hell is paved with the
bones of Second Lieutenants who forgot to post their
security. He was referring to the slaughter that could befall
a platoon if no guards were posted while the platoon was
halted or camped.
If General Puller had been in the Public Health Service
of the 1980's he would have changed his wording to read:
The path to hell is paved with the skeletons of public health
doctors who forgot their epidemiology.

Understanding the basics or the "how-to's" of studying

a disease process in a group of people is actually not as
complicated as many experts would have you believe. You
do not have to be a medical doctor. You do not need to
have a college degree; you only need to be able to gather
 Basic Epidemiology 79

information, think, and draw conclusions from your

thoughts.
In addition to the suffering and death, one of the great
horrors of the AIDS epidemic in this country is that
thousands, perhaps millions, of competent, rational people
have completely surrendered their power of reason to the
"AIDS experts" in our federal government.
James Wilson, one of the Founding Fathers of our
nation wrote about the fate of citizens that surrender their
power of reason. In his essay on natural law he stated:

...some nations that have been supposed stupid and

barbarous by nature, have, upon fuller acquaintance with
their history, been found to have been rendered barbarous
and depraved by institutions. When, by the power of some
leading members, erroneous laws are once established, and
it has become the interest of subordinate tyrants to support
a corrupt system; errour and inequity become sacred. Under
such a system, the multitude are fettered by the prejudices
of education, and awed by the dread of power, from the
free expression of their reason.

Doctors and other public health professionals are not

especially imbued with divine, supernatural, or esoteric
insights that go beyond the conceptions of the average
citizen. They are essentially well-trained technicians, with a
language all their own — like lawyers or airline pilots. Once
you can penetrate the jargon barrier you are able to think
your way through to viable, rational conclusions.
Our medical authorities claim to possess a special
understanding of disease control information that is beyond
80 DOCTORS OF DECEIT

the grasp of even the most intelligent outsider.

Arrogance, or pride taken to its most destructive
extreme (the Greeks called it "hubris"), causes a high rate
of failure among experts and authorities of all professions.
Try to tell an airline pilot that his aircraft's wings are
covered with too much ice. He will most likely tell you to
mind your own business...that he is the Captain. When he
attempts to take off and crashes, he is killed, but so are you
and everyone else on board. But he was in charge, was he
not? He was the expert.
Doctors, in most instances, can get away with saying
anything, especially about medical facts and issues,
because they are "doctors." Who can argue with them? If
you try to bring up a point of contention, you will be told
that the doctor knows...that he is a medical expert.
Obviously, it is not advisable to try to argue about
neurosurgery with a neurosurgeon, unless you are also a
neurosurgeon. But public health issues can be grasped
rapidly if you will just focus on common sense and not be
awed by the education of the doctor-expert.

Another thought you need to keep in mind about the

AIDS epidemic is that none of the medical experts can save
your life if you develop the disease. In June of 1987
newspapers reported that approximately 6500 physicians
and other health professionals attended the national AIDS
meeting in Washington, D.C.
All of those doctors could come to your bedside as you
waste away with AIDS, but none of them acting
individually nor all of them acting in concert would be able
to save you from dying as a result of the ravages of the
Basic Epidemiology 81
AIDS virus and its related infections.
The purpose of this chapter is to put information about
the AIDS epidemic in perspective by mixing it in with
general disease control terms and concepts.

Epidemiology has evolved to its current status as our

knowledge of the physical world has increased over the
centuries. The men listed below made significant
contributions to the study of disease and its cause.

HIPPOCRATES -- A Greek physician, he was the first

person to attempt to explain disease from a rational, rather
than a supernatural, standpoint. He also began to associate
diseases with environmental factors.

FRACASTORO - A 16th century Italian, he believed

that microscopic infectious agents caused disease. He also
recognized three modes of disease transmission:
person-to-person; at a distance, through the air; and by
intermediate objects such as personal articles (called
fomites.)

JENNER — An English physician, he experimented by

inoculating persons with material containing cowpox
viruses. His analysis of the results paved the way toward
the acceptance of cowpox vaccine as a reliable method of
immunizing people against smallpox.

Each of these scientists worked without knowing of the

existence of microorganisms. They recognized the
importance of the relationships between the host (the
82 DOCTORS OF DECEIT

infected person) and the environment in which he lived.

Their tools: logic and common-sense.

AGENT, HOST, AND ENVIRONMENT

The basic approach to learning all you can about a

disease — AIDS in this case ~ is to look at the interaction
of the host (man), the agent that causes the disease (the
AIDS virus), and the environment.

HOST FACTORS

Host factors are made up of a wide variety of individual

characteristics. Examples include:

Age Marital Status

Sex Socioeconomic Status
Lifestyle Disease History
Nutrition Ethnic Grouping
Heredity

All of the preceding host factors, and others, are

extremely important. They affect a person's risk of
exposure to a source of infection and, perhaps equally
important, they affect a person's resistance or susceptibility
to infection and disease.
Think of your body as if it were a fort. In most
situations a disease causing agent that comes in contact
with you is repelled by your skin. The mucous membranes
of your nose, throat, genitalia, anus, or your eyes offer a
great deal of protection against intrusions into your body.
Basic Epidemiology 83
In your respiratory tract the tiny hairs, called cilia,
constantly move invasive particles and other "trash" up to
your mouth so you can expel them. Coughing gives you the
ability to get germs out of your respiratory tract.
Your resistance to disease is increased to its greatest
extent by specific acquired immunity, which may be
obtained either naturally or artificially. Natural mechanisms
of acquiring immunity to a disease involve the formation of
protective antibodies. You would actively acquire these
antibodies by actually experiencing an infection yourself.
Protective antibodies are also acquired passively by means
of transplacental transfer from mother to fetus.
Artificial means for acquiring immunity involve the
administration of either vaccines or toxoids, or of antitoxins
or immune serum globulin.

Factors which will increase your susceptibility to

become ill include pre-existing sickness, malnutrition, and
an artificially depressed immune system which can result
from the various medications used to treat other diseases.
Now the AIDS epidemic is upon us. Yes, your body
produces antibodies to the AIDS virus. But they do not
destroy the virus. They are non-neutralizing antibodies.
Therefore, antibodies to the AIDS virus do not neutralize,
or destroy it
You must protect your "fort" from becoming infected
with the AIDS virus. Many of us have probably been
exposed to the virus, but we were not infected ~ hopefully
- because it did not penetrate our skin or our mucous
membranes.
84 DOCTORS OF DECEIT
AGENT FACTORS

Diseases are caused by a large number of causative

(etiologic) agents. There are biological agents, chemical
agents, and physical agents. Examples of each follow:

Biological Agents - viruses, fungi, bacteria, protozoa,

and rickettsia.

Chemical Agents — food additives, industrial chemicals,

pesticides, and pharmacologics.

Physical Agents — light, heat, noise, vibration, and

ionizing radiation.

ENVIRONMENTAL FACTORS

As we learn more about disease it becomes increasingly

clear that the agent, host, and environmental factors relate
to each other in a variety of combinations to produce
disease in humans. Some of these environmental factors are
listed as follows:

Water Housing Conditions

Milk Pollutants
Food Weather
Plants

Disease investigators must be aware of these

interrelated factors regarding the host, the agent, and the
environment.
Basic Epidemiology 85
THE INFECTIOUS DISEASE PROCESS

Infectious disease results from the relationship of the

agent (pathogen), the host, and the environment The six
components which make up this process are called "the
chain of infection." Knowledge of these six factors is
crucial if you want to identify how you can protect yourself
via the appropriate prevention or control measures:

1) Causative (infectious) agent.

2) Reservoir of the agent.
3) Portal of exit of the agent from its host.
4) Mode of transmission of the agent to a new host
5) Portal of entry into the new host
6) Host susceptibility.

The causative agent of AIDS is now called the Human

Immunodeficiency Virus (HIV).

RESERVOIRS OF THE AGENT

Human beings are the reservoir of the AIDS virus. It

lives and multiplies inside us.
In general, the reservoir of an infectious disease agent is
defined as the normal habitat in which the agent lives,
grows, and multiplies. We are the habitat for the AIDS
virus.

Once a person is infected with the AIDS virus, he or she

is infected for life and infectious for life.
Being infectious for life means just what it says.
86 DOCTORS OF DECEIT

Someone who is infected with the AIDS virus is able to

transmit the virus as long as he lives.

Carriers of the virus can be divided into three groups:

1) Those persons who have already developed one or
more of the opportunistic infections that besiege and kill
AIDS patients;
2) Persons who have noticeable signs or symptoms of
disease, but who have not been diagnosed with any of the
specific opportunistic diseases are described as having the
AIDS Related complex (ARC);
3) Individuals who carry the virus but have exhibited
no symptoms of infection.

Any of these carriers may transmit the virus to other

people.
However, from the standpoint of spreading AIDS, the
carriers who show no signs or symptoms of disease are the
most dangerous. These individuals are particularly
dangerous because they, as well as their intimate contacts,
or sex partners, are totally unaware of the presence of their
infection. Consequently, they take no special precautions to
prevent spreading the virus to other people.
Additionally, plants, soil, and water in the environment
are reservoirs of infection for a wide variety of diseases.
Many of these diseases are not normally life-threatening to
humans. But to a person without a competent immune
system, these infections are voracious, opportunistic
diseases.
Basic Epidemiology 87
PORTALS OF EXIT OF THE AGENT FROM THE HOST

The portal of exit is commonly referred to as the path

by which an infectious agent leaves its host. The portals of
exit listed here are the ones we associate with human
reservoirs of infection.

Respiratory tract: This portal of exit is common to many

diseases such as influenza, tuberculosis, and the common
cold. Diseases caused by infectious agents using this portal
of exit are among the most difficult to control.

Genito-urinary tract: Diseases such as AIDS, syphilis,

and gonorrhea are spread via this portal.

Alimentary tract: The mouth can be involved in the

transmission of such diseases as AIDS, syphilis, and
gonorrhea. From the other end of this tract, sometimes
referred to as the "nether throat," various enteric (intestinal)
diseases like hepatitis A, typhoid, dysentery, and cholera
are spread. Obviously, body fluids, or wastes, coming from
this portal (the anus) should be considered infectious.

Skin: Disease causing agents often exit through the skin

via superficial lesions or deep punctures or wounds.
Syphilis, in the primary and secondary stages is a disease
spread this way. This "through the skin" (percutaneous)
mechanism also involves escape - or entry - as a result of
bites of insects or by objects such as needles. The AIDS
virus, present in blood or body fluids, can leave or enter the
body through breaks or cuts in the skin.
88 DOCTORS OF DECEIT

Transplacental transmission: Usually, the placenta is an

effective barrier for the fetus against maternal infections.
However, this protection is not completely effective against
the agents that cause some diseases such as AIDS, syphilis,
hepatitis B, rubella, and toxoplasmosis.

MODES OF TRANSMISSION OF THE AGENT TO THE

NEW HOST

It is essential for the disease causing agent to be

transmitted from an infected person to a non-infected
person for the disease to spread. How the infectious agent
is spread - its mode of transmission - can be classified as
either direct transmission or indirect transmission.

Direct transmission means the infectious agent is

immediately transmitted to a new host via direct contact or
droplet spread. The role of person to person contact can be
illustrated by the spread of venereal diseases (syphilis,
gonorrhea) and enteric (intestinal) diseases (cholera,
hepatitis A).

Direct contact with soil, for example, may cause a

person to develop any one of several fungal (mycotic)
diseases. Some of the AIDS patients I interviewed were
still working in their gardens or orchards after they had
been diagnosed with AIDS. In every case these particular
patients rapidly developed the fungal infections that
hastened their deaths.
Regarding droplet spread, infectious aerosols are
produced by talking, coughing, and sneezing. These
 Basic Epidemiology 89
infectious aerosols may transmit infections to susceptible
people within a distance of approximately three feet. Many
respiratory diseases are spread in this manner.

Indirect transmission of an infectious agent may be

accomplished via animate (living) or inanimate (non-living)
mechanisms.
Animate disease transmission mechanisms involve
vectors such as fleas, ticks, and mosquitoes. Infectious
agents are able to be transmitted through purely mechanical
means or the agent may be transmitted subsequent to its
growth and multiplication in the vector (the flea, tick, or
mosquito) itself.
Inanimate mechanisms of disease transmission involve
the spread of the disease by means of the air or "vehicles."
Vehicles consist of any substances, including objects
(hypodermic needles), food, milk, water, or biological
products, by means of which an infectious agent is
transported and introduced into the portal of entry of a host.
In mid-1984 I witnessed what I consider to be a
textbook example of potential disease transmission with a
doctor's gloves serving as the "vehicle." I had gone over to
the University of Miami Medical School to set up a
meeting with a nurse who worked in the branch of the
school that trains dental hygienists.
While I waited for her, I stood near the front office by a
window which looked out onto the training floor where
twelve to fourteen dental chairs were located. Each chair
had a patient sitting in it who was being worked on by a
student hygienist. From the side of the training room I saw
a woman go up to the first chair to review the work of the
90 DOCTORS OF DECEIT

student. Then after several minutes she moved on to the

next chair.
After watching her for about ten minutes I knew
something wasn't right. I scrutinized her movements more
closely. Then I noticed what was wrong. As she went from
patient to patient, putting her fingers in their mouths and
running her fingers all over their teeth and gums, she never
changed her gloves or even washed her gloved hands. I
couldn't believe it. There I was - in a medical training
environment, in an area under the supervision of a doctor,
in the Age of AIDS (whose cause had just been discovered
months earlier) - witnessing one of the most careless,
reckless acts I could imagine. My own thoughts were "If
these are the "professionals" at the medical school, what in
the hell is going on out in the dental offices?"
Later that afternoon I called Dr. Harold Jaffe at the
CDC in Atlanta and told him what I had seen and asked for
his advice on whether or not we (I) should say anything
about this to anyone at the dental school. I mentioned to
him that several Haitians were being treated there and that
one of the nurses had stated to me that she knew of two or
three gay men with AIDS who had had their teeth cleaned
at the school. Dr. Jaffe told me there was nothing we could
do; that we definitely cannot interfere with the dental
school because we have no authority to do so.

The inanimate airborne mechanisms resulting in

indirect transmission involve respiratory droplet nuclei
(dried residue of a droplet) and dust. As in the case of
tuberculosis and other respiratory diseases, aerosols which
are produced may result in the formation of particles that
Basic Epidemiology 91
contain one or more infectious organisms.
These disease carrying particles may stay suspended in
the air and remain infectious for varying lengths of time.
Such particles are particularly dangerous since they are of
such small size that they are drawn easily into the lungs of
a new host.

Air also serves to spread disease bearing particles of

varying sizes that arise (by shaking or blowing) from
contaminated items like floors, clothing, bedding. Disease
causing (etiological) agents present in the soil are also
distributed through the air.

PORTALS OF ENTRY INTO THE HOST

In many situations, an infectious organism uses the

same portal of entry into your body that it used to escape
from its "old" home, or habitat. In respiratory diseases,
influenza and tuberculosis for example, the respiratory tract
serves as the portal of escape from the source of the
infection and as the entry point into the new host.
Blood transfusion-related AIDS cases represent a good
example of direct exit and entry of the AIDS virus. The
virus is transferred from the bloodstream of the infected
person directly into the bloodstream of the new host.
Obviously, blood from an AIDS infected person can
transmit the virus without having to enter into the
bloodstream of another person. Blood from an infected
person can transmit the virus if it enters the body of another
person through cuts, scratches, or abrasions.
92 DOCTORS OF DECEIT
-■

EPIDEMIOLOGIC VARIABLES

The methods and techniques of studying how a disease

is spread are designed to detect a causal association
between a disease and a characteristic of the person who
has the disease, or a factor in his (the infected person's)
environment. Since neither groups of people nor then-
living surroundings are identical at different times and
places, these important variables are called "epidemiologic
variables."
These environmental and population variables should
be carefully studied since they can help us: 1) determine the
individuals and populations at the greatest risk of acquiring
a particular disease. 2) find out what organism, or agent,
causes the disease. 3) predict what course the disease will
take as the future unfolds.
For the purpose of understanding and analyzing disease
information it is useful to organize the information
according to time, person, and place.

Time—refers both to the period during which the

individual cases of the disease being studied were exposed
to the source of the infection and the time period during
which sickness occurred.

Person—refers to the characteristics (age, race, sex, etc.)

of the individuals who were exposed and who contracted
the infection or disease being investigated.

Place—refers to the factors, features, and conditions

which existed in or described the environment (milieu)
Basic Epidemiology 93

where the disease occurred.

It is from an honest analysis of the risks (risk-factors)

associated with these specific variables of time, person, and
place that we are able to develop and test hypotheses
concerning: what agent causes the disease; where the agent
comes from, where it lives; how the agent is transmitted.
One particular characteristic of a person or his
environment may put that person at an increased risk of
acquiring a specific infection or disease. However, several
identifiable characteristics of time, person, or place usually
must act together to produce an infection or disease in a
person.
What happens if the people you trust and count on to
study the spread of diseases and epidemics lie to you? What
happens when public health officials decide they do not
want to find out all they can about the agent, host, and
environmental factors we have reviewed together here?
Bodies and money are what happen. More people become
infected; more people die; and the costs of the AIDS
epidemic continue to accelerate.
It was during the First International Symposium on
AIDS, held in Atlanta, Georgia in April 1985, that I
became fully aware of the subversion of our public health
system.
Dr. James Curran, director of the AIDS program at the
Centers for Disease Control, came up to me in the crowded
hallway of the World Congress Center and asked, "What's
all this bullshit about Belle Glade?"
He was referring to the fact that the case rate there was
the highest in the country and that two doctors, Caroline
94 DOCTORS OF DECEIT

Macleod and Mark Whiteside, were investigating the

possibility of mosquitoes and environmental factors playing
a role in the transmission of the AIDS virus.
I told Dr. Curran there was no "bullshit" regarding the
Belle Glade situation...that there were at least two and
probably three times as many cases of AIDS in that area
than had been reported, but that it was almost impossible to
get them (the patients) diagnosed because of a lack of
available medical facilities. He just shook his head, turned,
and wandered off into the crowd.
Out of the crowd, about three hours later, appeared Dr.
John Witte of Florida's Department of Health and
Rehabilitative Services. Dr. Witte was then in charge of
Florida's AIDS Program. He came over to me and said I
should not go to Belle Glade anymore... that it was "too
politically sensitive" and "too hot an issue."
Again, another distressed face came at me from the
depths of the crowd. This time, about an hour after I had
seen Dr. Witte, Dr. Bill Bigler (he reported to Witte) came
over to me at a railing near one of the escalators. He asked
if I had seen "the boss." He was referring to Dr. Witte. I
told him yes.
Dr. Bigler then asked me, "Did he tell you about Belle
Glade?"
"Yes, he said not to go there anymore." I told Dr.
Bigler.
"Good," he said. "I just wanted to make sure you got
the message."
The next day I saw my federal supervisor, Larry Zyla. I
related to him what Drs. Curran, Witte, and Bigler had said
to me the day before regarding Belle Glade. I do not need a
Basic Epidemiology 95
tape recorder to remember his response.
He blew a puff of smoke in the air and grunted, "I don't
give a shit."
Their decision to abandon Belle Glade offended me
because I knew they were selling out to some other interest,
be it political or economic, or otherwise. Belle Glade is the
essence of a huge tropical laboratory, located right here in
the United States.
What an opportunity—now lost—to study a major,
deadly epidemic in a tropical setting of squalid living
conditions, swarms of mosquitoes, malnutrition, and an
influx of "out of the country" laborers. These are only some
of the "time, person, and place" factors that could possibly
have increased our knowledge about AIDS and its patterns
of transmission.
Basic Disease Surveillance 97

8
Basic Disease Surveillance

Disease surveillance (reporting) refers to the continuous

vigil over the occurrence and distribution of a disease and
the particular events or conditions which increase the risk
of the disease being transmitted to other persons.
To be of value, a disease surveillance program must be
a consistent, methodical process. If a disease reporting
program is handicapped by inaccurate or insufficient
information, the conclusions drawn from the data will be as
tainted as the fruit from a poisonous tree. This information
garnering process consists of four major functions:

1) Collection of relevant data for a specified

population and geographic area;
2) Consolidation of the gathered data into meaningful
arrangements or groupings;
3) Analysis and interpretation of the data;
4) Regular dissemination of the information and an
analysis of "what it means" to directors, managers, and
workers in disease control programs. This information
should also be made available to the general public.
98 DOCTORS OF DECEIT

Collecting information regarding a disease is rarely

easy. In fact, gathering disease information is almost
always difficult because it is a time-consuming,
labor-intensive undertaking. However, there are health
officials who believe that all a disease surveillance program
requires is that a health department employee be available,
near a telephone, waiting to receive calls from a nurse or
doctor who want to report that a particular disease has been
diagnosed at his/her hospital or clinic.
Then, if no calls come in reporting a disease, the official
opinion is that there was no disease to be reported.
In other situations — AIDS, other sexually transmissible
diseases, and tuberculosis are examples — a written case
report is the required method of reporting the diagnosis of a
disease, regardless of where the disease was diagnosed.

The arrival of the AIDS epidemic has created many new

challenges - or obstacles - to anyone who has attempted to
collect information about it as it grew. Some of these
challenges are due to lack of knowledge about the disease
itself. However, many of the roadblocks to gathering
information about the AIDS epidemic have been caused by
either mistrust or strife between medical professionals and
local, state, or federal health officials.
I spent two and one half years investigating and
cataloging over 800 AIDS cases. My first taste of the
non-scientific problems I would encounter happened when
I called on Dr. Wade Parks at his office near Jackson
Memorial Hospital in Miami. Dr. Parks had diagnosed
many of the pediatric AIDS cases in Miami at that time.
The only description I had received of Dr. Parks was from
Basic Disease Surveillance 99

Dr. John Witte. He told me that Dr. Parks was "an angry
young man who wasn't young anymore."
Dr. Parks greeted me at the door to his office that
morning of July 11, 1983. We sat and talked for 10 or 15
minutes. I told him my assignment in Florida was to collect
AIDS case data and that I hoped he would give me
information on the children he diagnosed with AIDS so I
could, in turn, pass it along to the state health department
office in Tallahassee and to the CDC in Atlanta.
He did not appear to be comfortable with my request for
his confidential patient information. He told me in very
specific terms that he knew the people I worked for and
that he did not trust them. Then he pulled himself forward
in his chair, looked me directly in the eye, and declared
with his deep, booming voice, "I won't report any cases to
you because the people you work for are all whores."

There are 10 major sources or types of information

which are relevant and valuable to any disease surveillance
program. They are:

1) Mortality (death) reports or certificates. Death

certificates, if they are accurate and reflect the actual cause
of a person's death, are a valuable tool to use in studying
diseases. Recently, however, it was reported that a
comparison of death certificates and hospital medical
records points out "discrepancies" in 30 percent of the
officially reported causes of deaths. Obviously, this large
discrepancy has an adverse impact on the reliability of
mortality information.
The AIDS epidemic has expanded these incorrectly
100 DOCTORS OF DECEIT

listed causes of death because doctors, in some cases, have

preferred to conceal the true cause of the patient's death. In
other situations, the doctors were not aware of the actual
cause of death because specific diagnostic tests were never
performed.

2) Morbidity (disease) reports. With increasing

frequency, these reports are withheld because the doctors or
hospitals want to maintain the total confidentiality of the
patient. Fear of discrimination against the patient is the
most often cited reason for not reporting the diagnosis of
AIDS.
Many doctors believe that the cause of death will
ultimately be discovered in the hospital or morgue.
Therefore, they decline to report the AIDS diagnosis to the
health authorities while the patient is alive and subject to
the possibility of being discriminated against.

3) Epidemic reports.

4) Laboratory utilization reports (results of blood tests,

pathology reports, etc.).

5) Reports of epidemic investigations.

6) Reports of individual case investigations.

7) Special surveys (hospital admissions, disease

registers, tumor registers, blood specimen surveys, autopsy
reports).
Basic Disease Surveillance 101

8) Information on "reservoirs" of the infection and

vectors (carriers of the disease).

9) Demographic (population) data.

10) Environmental data.

The ultimate objective of any worthwhile disease

surveillance program is to determine the extent a disease
has spread into a given population and to assess the risk of
the disease's continued transmission. This knowledge is
vital if control measures for the disease being studied are
ever going to be applied effectively and efficiently.
Disease surveillance information must, therefore, be as
complete and current as possible if it is to realistically
portray the number of people with the disease and the way
the disease is distributed throughout a given population.
Sometimes, disease surveillance is conducted even
though standard control measures (cures, treatments,
vaccines) are not yet available. In such a circumstance, this
information is collected in anticipation of the development
of effective disease control and prevention measures. There
are two principal reasons for performing disease
surveillance even when there is no cure or treatment for a
disease.
First, disease surveillance is conducted by state and
federal health authorities to increase knowledge of the
reservoir of the infection (who has the disease), of the
infectious agent (what causes the disease), and modes of
transmission (how the disease is being spread). This
knowledge gives the public health authorities the facts they
102 DOCTORS OF DECEIT

need to set priorities so that appropriate control measures

can be rapidly implemented when they become available or
practicable.
For example, if a state's health officials incorrectly
believe there are only 100 people with AIDS in their state,
when the real number of diagnosed or undiagnosed AIDS
cases is actually over 500, their budgetary and personnel
planning for a disease control program will be severely
flawed.
Also, a disease control program must be able to assess
the effect - success or failure - of the control measures
once they actually are implemented. In other words, if a
state health department does not have an accurate idea of
how many AIDS cases are in the state now, it will be
nothing more than dartboard guesswork as to whether the
control program is succeeding or failing.

In order to accomplish the main objective of disease

surveillance activity (determining the extent of the
infections and the risk of the disease's transmission), it is a
standard requirement that individuals who are responsible
for disease investigation programs perform certain tasks.
These individuals must:

1) Describe each person having an infection by name,

age, race, sex, address, occupation, and the time of the
onset of symptom(s).

2) Determine, if possible, the source of the infection

and mode of transmission of the infectious agent in each
individual case.
 Basic Disease Surveillance 103

3) Identify persons who were exposed to the infection

(these persons are called "susceptibles") because the
infection may have been transmitted to them.

4) Specify the frequency of occurrence of the

infection (disease) in the particular population groups
which have been found to be "at risk" for acquiring the
disease.

5) Identify the population groupings that are currently

experiencing, or that might experience, an increased
frequency of the disease.

6) After the above tasks are completed, or as progress

is being made toward its completion, it is essential that the
disease investigator prepare and distribute current
surveillance reports to the persons who are participating in
the disease prevention and control activities.

Each state's disease (morbidity) reporting system is

based upon rules and regulations which have been adopted
by that state's health department (board of health). Its
authority to make and issue health regulations is derived
from specific legislation enacted by the state's legislature.
In some states the legislative act defines most, if not all,
of the disease reporting requirements. Any change in those
reporting requirements would necessitate another act by the
state's legislature.
More commonly, however, enabling legislation confers
upon the state health department the authority to establish
and modify, if necessary, the disease reporting regulations.
104 DOCTORS OF DECEIT

Individual disease reports are almost always considered

to be confidential and, therefore, they are not available for
public review.
Characteristically, disease reporting guidelines and
regulations specify which diseases or disease-related
conditions are reportable, who is responsible for the report
itself, what information is required for each case of the
disease reported, what manner or mechanism of reporting is
needed, and to whom information is to be reported. The
regulations also specify the various preventive (protective)
measures to be taken in the event of the occurrence of
particular diseases.

In addition to the specific diseases or conditions which

have been deemed reportable within a given state, health
department regulations usually point out two other
situations that would require reporting:

1) The occurrence of any outbreak or unusually high

prevalence of any disease - the AIDS epidemic meets this
criterion.

2) The occurrence of any unusual disease of

epidemiologic significance - the AIDS epidemic meets this
criterion too.

Provisions are also included in most state health

regulations to immediately add to the list of reportable
diseases any disease that becomes important from the
public health standpoint. The specific information required
for each case of a reportable disease can usually be revised
Basic Disease Surveillance 105
under similar circumstances.
Reporting diagnosed (known) or suspected cases of a
reportable disease is generally considered to be the
obligation of the following persons:

1) Physicians, dentists, nurses, medical examiners,

and other health practitioners;

2) Administrators of hospitals, clinics, schools,

nurseries, and nursing homes;

3) Any other individuals knowing of, or suspecting,

the existence of a reportable disease or infection.

Laboratory directors are commonly expected and

required to report the results of diagnostic tests which
furnish evidence of a reportable disease. This evidence
includes, but is not limited to, isolations and identifications
of infectious agents and reactive or elevated serologic titers
(blood tests). These laboratory reports are not considered to
take the place of physicians' reports of infectious disease.
The particular requirements for the reporting of a
specific disease depend greatly on the priority assigned to
the disease by state and federal health officials. For
example, sexually transmissible diseases and tuberculosis
are traditionally considered to be "high priority" diseases as
far as reporting, treatment, and intervention programs are
concerned. In most states, these infectious diseases are
supposed to be reported to the health authorities as soon as
they are diagnosed, using report forms that are different
from those routinely used for other reportable diseases.
106 DOCTORS OF DECEIT

Traditionally, people with infectious diseases are

reported to the public health authorities for several reasons:

1) As a humanitarian gesture, it is necessary to treat,

or cure, an infected individual to ease his pain and
suffering.

2) It is necessary to cure, treat, or at least counsel, a

person with an infectious disease to lessen the chance that
the disease will be spread to another person or persons.

3) From the financial standpoint, it makes responsible,

budgetary sense to cure, treat, or counsel infected persons
as early as possible in the disease's cycle. If this medical
intervention is not provided, extraordinary treatment and
financial measures will have to be taken at a later date.

In the autumn of 1985, a medical examiner in south

Florida told me he had learned that approximately 40
persons (I believe the exact number was 41) had received
bone grafts from a man who had tested positively as having
antibodies to the AIDS virus.
The man had died in an accident; results of the positive
AIDS antibody blood test were not known until after his
death and after the bone had been removed from his body.
Upon finding out about this extraordinary happening, I
called Dr. Harold Jaffe at the CDC's AIDS branch. I
wanted his guidance as to how we should approach this
situation. In my mind, this set of circumstances merited our
monitoring of the recipients of the bone from the deceased
man.
Basic Disease Surveillance 107

Dr. Jaffe instructed me to drop the matter. He said there

was nothing we could do to alleviate the situation.
From the standpoint of our duty to conduct surveillance
of the AIDS epidemic, I felt we at least should notify the
individual physicians of the bone recipients so that they, in
turn, might be better prepared to vigilantly monitor their
patient's health status over the coming years.

How many other similar incidents have taken place

across America? No one knows.
When these bone recipients themselves begin to
develop the signs and symptoms of AIDS, will their doctors
be surprised to find out their patient's have contracted
AIDS? Will their doctors even make the correct diagnosis?
What about the risk to the sex partners of the bone
recipients? Has our public health system neglected all
considerations for their welfare?
Tuskegee Revisited 109

9
Tuskegee Revisited

The Centers for Disease Control (CDC) was originally

established in 1946 as the Communicable Disease Center.
It was based in Atlanta, Georgia.
A young institution, the CDC is the direct descendant of
a World War II agency which was called Malaria Control
in War Areas (MCWA). An emergency organization, the
MCWA had its headquarters in Atlanta primarily because,
at that time, malaria was endemic (widespread) in the
southeastern United States.
Before its disbanding at the end of World War II, the
Malaria Control in War Areas agency had assumed
responsibility for the control of murine typhus fever, a
disease transmitted by the bites of infected rodents' fleas.
Additionally, the MCWA had set up a training program
for the laboratory diagnosis of several tropical, parasitic
infections to which returning American servicemen had
been exposed while overseas. Unknown to the MCWA
personnel at that time, some of the tropical, parasitic
infections they studied would be voraciously consuming
AIDS patients forty years later.
Built around the nucleus of the Malaria Control in War
110 DOCTORS OF DECEIT

Areas' disease control specialists, the new Communicable

Disease Center was intended to be a "center of excellence."
Professional and technical personnel were added as the
years passed. These crucial personnel additions increased
the CDC's scientific competence and allowed it to expand
its training and demonstration programs.
As it grew, the CDC used these growing resources to
address an ever-widening range of health problems. Then
in 1970, the name changed from Communicable Disease
Center to Center for Disease Control.
In 1973, the CDC became an agency within the U.S.
Public Health Service. Now its role expanded to include: 1)
the prevention of unnecessary morbidity (illness) and
mortality (death); and 2) the enhancement of the health of
the American people. Since 1980 the CDC has been
re-organized as the Centers for Disease Control. Today the
mission of the CDC, its very reason for existence, includes:

* Prevention and control of infectious and chronic

diseases.
* Prevention of disease, disability and death associated
with environmental hazards.
* Prevention of occupational diseases and accidents.
* Promotion of health through education and information.
* Support of local, national, and international prevention
efforts in epidemiology, disease surveillance, laboratory
science, and training.

Our United States Congress funds the Centers for

Disease Control with taxpayers' dollars. Ask yourself a few
questions. Is the CDC really preventing unnecessary illness
Tuskegee Revisited 111
and death? Is AIDS an "unnecessary" illness and death?
Has the CDC enhanced the health of the American
people? If you think so, do you think it is possible they may
now "lose" all of the lives they "saved" in the past forty
years by their total failure to deal with the AIDS epidemic
as they would have dealt with any other killer epidemic?

Before the AIDS epidemic slammed into the snoozing

CDC like a runaway, midnight freight train, it would have
been possible, but very difficult to successfully show the
CDC had failed to accomplish one of its missions.
Obviously, no government agency is 100% effective.
However, there is a Grand Canyon of difference in an
agency being 100% effective and an agency that says it
must re-invent the "wheel" of our public health system in
order for it to respond to a challenge such as the AIDS
epidemic.
Never before has there been a "Syphilis Czar" or a
"Tuberculosis Czar." Why is it now considered necessary
(as proposed by the President's AIDS Commission) to
create the grand position of AIDS Czar?
Trade-offs are customary practices in most, if not all,
bureaucracies. Money is shifted from program to program
in budgetary shell games. Sweetheart funding deals are
made to friends of the organization. In fact, the basic kinds
of "slippage" described above are usually given little more
than passing attention by auditors, program administrators,
or congressional budget committees.
However, when an agency such as the CDC fails to
perform its traditional role in disease intervention and
repudiates established public health policies, we must
112 DOCTORS OF DECEIT

assume that some major event, or breakdown, has occurred.

Indeed, a breakdown of our public health system has
occurred. It appears that the Centers for Diseases Control
inherited from its sire, the Public Health Service, a
defective "gene."
Thus, the CDC came into the ethical scientific world
with a crippling birth defect. That birth defect came to be
known as the Tuskegee Syphilis Study.

The Tuskegee Syphilis Study was one of several

investigations which was taking place in the 1930's with
the ultimate goal of venereal disease control in the United
States. Starting in 1926, the United States Public Health
Service (USPHS) became actively involved in venereal
disease control work.

Later, in 1929, the USPHS agreed to participate in a

cooperative demonstration study with the Julius Rosenwald
Fund and the state and local health departments in six
southern states: Virginia (Albermarle County); Mississippi
(Bolivar County); North Carolina (Pitt County); Tennessee
(Tipton County); Georgia (Glynn County); and Alabama
(Macon County). The objective of these demonstrations
was to study the control of venereal disease.
These syphilis control demonstrations were performed
from 1930 to 1932. In Macon County, Alabama, the
prevalence of syphilis was very high: 35%. The population
of Macon County at that time was 82% Black.

In 1932, when the Public Health Service began a

substantial effort toward the control and treatment of
Tuskegee Revisited 113

syphilis, many facts were still unknown regarding the latent

stages of the disease, its "natural" course, and the
epidemiology of late and latent syphilis. The Public Health
Service wanted to know more about syphilis and its late
manifestations so the decision was made to do a study.
Evidently, there is no protocol which documents the
original intent of the study. Furthermore, none of the
interviews with participants in the study or any of the
medical "literature" searches provide any evidence that a
written protocol ever existed.
Centered in Macon County, Alabama, the Tuskegee
Syphilis Study was a research effort which examined the
effect of untreated syphilis in approximately 400 Black
males who were the subjects (guinea pigs). No evidence
was ever presented that indicates the participants in the
study, the 400 Black males, were adequately informed
about the nature of the experiment.
From the beginning of the study until 1972, the U.S.
Public Health Service held to its continuing policy of
withholding treatment for syphilis from the infected
subjects. It was common medical knowledge, even before
the study began, that untreated syphilitic infection caused
disability and premature death.
As late as 1969, a technical and medical advisory panel
convened by the U.S. Public Health Service, recommended
that the participants surviving at that time, should not be
given appropriate medical treatment. By October 1972, it
was estimated that 125 of the participants were still living.
At this time, 1972, their health status was unknown.
Members of the Tuskegee Syphilis Study Ad Hoc
Advisory Panel, which met in twelve sessions during 1972
114 DOCTORS OF DECEIT

and 1973, offered many opinions and conclusions from

their review of the Tuskegee Study. Their complete
findings are published in the Final Report of the
Tuskegee Syphilis Study Hoc Advisory Panel.

Here are some selected excerpts from their Final

Report. Their observations and conclusions are as
important today as they were in 1972-1973 because they
give us not only a rearview mirror to the past, but an insight
into what attitudes or actions may have been "carried
forward" by our public health authorities since 1973 and a
predictive view into what may lay ahead.
Jay Katz, M.D., a Professor (Adjunct) of Law and
Psychiatry at the Yale Law School and a member of the
Panel, wrote: "There is ample evidence in the records
available to us (the Panel) that the consent to participation
was not obtained from the Tuskegee Syphilis Study
subjects, but that instead, they were exploited, manipulated
and deceived."
Dr. Katz continues. He quotes one of the senior
investigators of the study who wrote in 1936 that since "a
considerable portion of the infected Negro population
remained untreated during the entire course of syphilis...an
unusual opportunity (arose) to study the untreated syphilitic
patient from the beginning of the disease to the death of the
infected person."
Dr. Katz observes, "Throughout, the investigators seem
to have confused the study with an 'experiment in nature'."
In its discussion as to whether or not existing policies to
protect the rights of patients participating in health research
are adequate and effective (in 1973), the Panel wrote: "Our
Tuskegee Revisited 115
response to this charge, embodied in this report, should not
be viewed simply as a reaction to a single, ethically
objectionable research project. For the Tuskegee Syphilis
Study, despite its widespread publicity was not an isolated
phenomenon...
"Our initial determination that the protection of human
research subjects is a current and widespread problem
should not be surprising...in the past decade the press has
publicized and debated a number of experiments which
raised ethical questions: for example, the injection of
cancer cells into aged patients at the Jewish Chronic
Disease Hospital in Brooklyn, (and) the deliberate infection
of mentally retarded children with hepatitis at
Willowbrook...
With so many dramatic projects coming to the attention
of the general public, more must lie beneath the surface."

I included this brief review of the Tuskegee Study

because it provides us with additional perspective on the
AIDS epidemic of the 1980's.
The most crucial lesson derived from the Tuskegee
Study is that for forty years the public health authorities in
this country used misinformed, unconsenting citizens as
human guinea pigs in a research project.
Now, we are all unconsenting guinea pigs in a study
that encompasses a scale which dwarfs the Tuskegee Study.
At the end of World War II, our government, through
the Nuremburg Military Tribunal, tried German physicians
for crimes against humanity. Testimony at their trials by
official representatives of the American Medical
Association clearly suggested that research like the
116 DOCTORS OF DECEIT

Tuskegee Syphilis Study would have been intolerable in

this country or anywhere in the civilized world. Yet, the
Tuskegee Study was continued after the Nuremburg
findings and the so-called Nuremburg Code had been
widely circulated in the medical community.
Moreover, the Study was not even reviewed in 1966
after the Surgeon General had set forth his guidelines
regarding the ethical conduct of research.
The Public Health Service review committee was
concerned with possible adverse criticism by 1969, but they
were reassured by the observation that "if we established
good liaison with the local medical society, there would be
no need to answer criticism."
Their tricks and facades are coming at us from out of
the past like tidal waves. That is the situation today in
regard to the AIDS epidemic. There is no need to answer
criticism because the public health officials feel certain
they can forever subdue any and all disagreement through
their "peer review" system.
As the world's past experience with the highly-educated
Germans showed during the NAZI era, education is not
automatically synonymous with ethical wisdom.
If more of us were aware of our recent public health
history we could exclaim with Horatio, the ancient writer,
that "There needs no ghost...come from the grave / To tell
us this."

One of the most valid reasons for studying history is

that events which happened in the past not only formed the
present, but that they offer an insight into what can lie
ahead for a society. Events of the past are inextricably
Tuskegee Revisited 117
linked to actions in the future.
The officials of the Public Health Service and the
Centers for Disease Control did not halt the Tuskegee
Study because they decided it was an inappropriate
research project, they finally ordered that it be terminated
because of the adverse publicity. There was no shame or
remorse on the part of the "ruling" public health authorities
in 1973, they simply could not tolerate the damage it was
doing to their public relations machine.
Now, with the AIDS epidemic upon our land, it
becomes increasingly clear that our public health officials
are essentially standing by and half-heartedly recording the
path of the epidemic as it careens its way across the
continent.
One reason I became so completely involved in tracing
people that had died from AIDS was that common sense
told me we needed to know where the virus had been if we
ever hoped to predict its future path.

On the way to Jackson Memorial Hospital one day in

July 1985, I had been explaining to Dr. Harold Jaffe of the
CDC's AIDS Branch how two pathologists at Jackson (Drs.
Kory and Goulds) had performed tedious research on tissue
specimens in their laboratory. Through their efforts, the two
doctors had found evidence that 36 people, previously
undiagnosed as having AIDS, had in fact, died from AIDS
virus infection. Dr. Jaffe seemed unimpressed. He said we
did not need to pursue that type of research because "we
already knew where the disease was coming from."
In no conceivable way could we then or now know
exactly where the disease is "coming from". Look at it this
118 DOCTORS OF DECEIT
way, if we knew precisely where the disease was coming
from we could stop it from progressing along its natural
path.

Dr. Jaffe's comment on that July day in 1985 amplified

a similar incident that occurred in late 1984. On November
30, 1984, I was in Atlanta at the CDC headquarters for
training classes. I went to one of the laboratories where
AIDS research was being conducted and while I toured the
area I met Dr. Cy Cabradilla. He told me he had been
performing tests on tissues from AIDS patients but that he
was in need of some more tissue from deceased AIDS
patients. He asked me if I could obtain some additional
tissue specimens from a pathologist or medical examiner in
Florida. I told him I felt sure I could find the tissues he
wanted because I had developed a close relationship with
several Florida medical examiners.
Later that day, my CDC supervisor, Larry Zyla told me
to forget getting any specimens for Dr. Cabradilla. Zyla
went on to say that "El Supremo" (a name Zyla sometimes
used to refer to Dr. James Curran) said that he (Cabradilla)
did not need any more tissue...that he had enough.
Several weeks later I spoke with Dr. Cabradilla via
telephone. He asked me if I had been able to get the
specimens he wanted; I told him no, that I had been
instructed not to obtain the tissues. Dr. Cabradilla did not
sound too surprised and the matter was closed.
After two years of tracking the disease all over Florida,
it finally became vividly clear that we were still doing
almost nothing to slow down the spread of the AIDS virus.
Basically, I began to feel like I was doing nothing more
Tuskegee Revisited 119
than fulfilling the role of an official graves registration
clerk.
It has been said that the public health officials have
"allowed" the AIDS epidemic to continue spreading. It
appears that they have actually encouraged its spread
through their dereliction and negligence.
A company of firemen in a large city could never even
hope to defend their negligence if, after the city burned
down, they told the mayor, "We wanted to see how far it
was going to spread before we turned on the water.
Besides, we didn't want people to panic. And we know that
if people saw us turning on the water, they would be afraid
that the fire was going to get out of control."
The logic in the previous scenario is obviously
ridiculous, but it is no more ridiculous than the reaction of
our health experts to the AIDS epidemic. Fire fighting is
very similar to disease prevention in that no one ever
knows in advance what is going to turn out to be a disaster.

In future years, the AIDS epidemic will be looked back

on and studied from every conceivable angle by scientists,
public health professionals, teachers, students, politicians,
and the clergy. It will stand as the exemplification of what
happens when federal and state health authorities fail to
implement, for whatever reason, the standard, time tested
disease intervention measures.
All during the time I spent traveling across Florida in
constant pursuit of AIDS case information, I carried a small
notebook with these words written on the front page: In
nature there are neither rewards, nor punishments; only
consequences.
120 DOCTORS OF DECEIT
Unlike John Snow in England in the 1850's, our health
experts of the super-scientific, high-technology 1980's
failed to take the handle off of the pump.
122
■'
DOCTORS OF DECEIT

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