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BOOK REV IEWS

Book Reviews manufactured with the French virus. In March 1987, after
considerable controversy and negotiations, President Ronald
Reagan and French Prime Minister Jacques Chirac signed
an agreement that the Department of Health and Human
SCIENCE FICTIONS: A SCIENTIFIC MYSTERY, Services and the Institut Pasteur would share the patent
A MASSIVE COVER-UP, AND THE DARK LEGACY rights to the blood test for AIDS. The dispute, however, was
OF ROBERT GALLO far from settled.
By John Crewdson. 670 pp., illustrated. Boston, Little, Brown, 2002. In the preface to his book, Crewdson states, “This is not
$27.95. ISBN 0-316-13476-7. a book about AIDS. Nor is it really about science. It is a book
about how scientists behave when the stakes are high, and
the stakes were never higher than the search for the cause

A NOBEL prize has yet to be awarded for the discovery
of the human immunodeficiency virus (HIV) or for the
blood test to detect antibodies to the virus. Although the ac-
of AIDS.” The account, however, is about both Crewdson
and Gallo. Although Crewdson writes about himself and
the Tribune in the third person, much of the information in
tual reasons are not known, it is widely speculated that the his book would never have become public if he had instead
Nobel committee for medicine wants to stay away from the devoted more than 10 years of his life to something else.
harsh battle over credit for the discovery between Robert In January 1990, soon after the Tribune article was pub-
Gallo of the National Cancer Institute and Luc Montagnier lished, the Office of Scientific Integrity at the National In-
of the Institut Pasteur in Paris. stitutes of Health opened an inquiry into Gallo’s AIDS re-
Gallo is one of the most famous scientists in the world, search. Gallo’s actions were tentatively found to “warrant
although he is in the spotlight less frequently now than a significant censure,” but the office’s findings were then sub-
decade ago. John Crewdson is an investigative reporter who stantially revised. Subsequently, the Office of Research In-
works for the Chicago Tribune. Crewdson has written a very tegrity in the Department of Health and Human Services
critical book about Gallo’s role in the discovery of HIV. In replaced the Office of Scientific Integrity. In February 1992,
November 1989, the Tribune published a detailed account the Office of Research Integrity found Gallo guilty of scien-
of the discovery written by Crewdson. He has continued to tific misconduct for “falsely reporting that LAV had not been
pursue the story, and this book is the result. transmitted to a permanently growing cell line.”
According to Crewdson, Gallo not only falsely claimed In November 1993, a review board reversed a related
that he was the first to isolate HIV and to develop the HIV- finding of misconduct against Mikulas Popovic, a virologist
antibody test, but also denigrated and obfuscated the role working in Gallo’s laboratory, because it concluded that the
of Montagnier and his colleagues at the Institut Pasteur. burden of proof had not been met. Days later, the Office of
Gallo’s “discovery” was based on a sample of HIV supplied Research Integrity withdrew its determination that Gallo
by Montagnier. (At the time, the French virus was known as had committed scientific misconduct. In July 1994, the De-
lymphadenopathy-associated virus, or LAV.) Either Gallo’s partment of Health and Human Services agreed to provide
laboratory deliberately used the LAV sample without cred- the French with additional millions of dollars in patent roy-
iting the French investigators, or the French sample acciden- alties and acknowledged that “a virus provided by Institut
tally contaminated other viral cultures in Gallo’s laboratory. Pasteur was used by National Institutes of Health scientists
The AIDS epidemic is usually dated to June 1981, when who invented the American HIV test kit in 1984.” Crewd-
a report entitled “Pneumocystis Pneumonia — Los Angeles” son writes that the Chicago Tribune “had set the day’s events
appeared in the Morbidity and Mortality Weekly Report. It in motion five years before.”
described five homosexual men with what soon came to be The strength of this book is the richly detailed account of
known as the acquired immunodeficiency syndrome and was the discovery of HIV and the many people who were part
followed by many similar reports. Both Gallo’s laboratory of this process. Crewdson, however, would have increased
and Montagnier’s laboratory tried to isolate and culture the number of potential readers if he had written a shorter
the AIDS virus. Crewdson details these efforts, including book that more cogently presented the evidence to support
the samples of the virus that Montagnier provided to Gallo his views. There are 540 pages of text, plus a timeline, a glos-
in 1983. sary, a list of dramatis personae, and about 80 pages of “in-
In April 1984, Margaret Heckler, secretary of the Depart- formational” notes. And there is more — notes about ci-
ment of Health and Human Services, announced at a press tations and the text of various U.S. government documents
conference that Gallo had discovered the virus that causes that Crewdson obtained under the Freedom of Informa-
AIDS and had developed a test to detect antibodies against tion Act. These, however, are available only on the World
the virus in blood. Montagnier and his colleagues were not Wide Web.
pleased. In May 1985, the U.S. Patent and Trademark Office Although making supplemental material, such as govern-
awarded the American patent for the AIDS blood test to ment documents, available on the Web is helpful, relegating
Gallo and the Department of Health and Human Services. citations to the Web is a bad idea. If citations are important
The French patent application, which had been filed 17 enough to include in a book, they belong with the text.
months earlier, was still pending. What provisions are there to keep them on the Web indef-
In December 1985, the Institut Pasteur sued the Depart- initely? A compromise would have been to include a CD-
ment of Health and Human Services, contending that the ROM with the book. Whether “e-references” will become
French were the first to discover the AIDS virus and to de- commonplace in publishing is, however, a subject for anoth-
velop the antibody test and that the American test was being er article.

N Engl J Med, Vol. 347, No. 10 · September 5, 2002 · www.nejm.org · 771

The New England Journal of Medicine
Downloaded from nejm.org on September 22, 2012. For personal use only. No other uses without permission.
Copyright © 2002 Massachusetts Medical Society. All rights reserved.

and the pros. including how poor adherence can fuel the emergence of drug resistance and how it can be overcome through the formulation of timed-release capsules of combinations of THE HUMAN IMMUNODEFICIENCY VIRUS: drugs. Although source-poor settings. the book is useful both to have benefited greatly from redrawing: too many are oc- infectious-disease physicians and to research scientists. Thirty references including good reviews would probably imens involving combinations of drugs that inhibit reverse be more helpful than 322 outdated ones. $75. before the ultimate answers about HIV were scant discussion of delivering efficacious treatment in re- known. for a small fee. with a particular emphasis on drugs and compounds that inhibit dependently of the others. Overall. Academic medical pub. Emini. and the blocking of crucial host-cell functions. reader can therefore gain a rounded view of the science that The book contains black-and-white figures. Current treatment to provide in a textbook. N. Vpu. pol. some books on HIV medicine. none of them more recent than 1998. into monochrome figures was a poor solution. The pic. Of course. It is difficult to judge just how much detail and attribution pects for the development of a vaccine. from the authors. this book provides a comprehensive account of ics will continue to pose a problem. and Vif ). ing of its molecular biology has led to successful drug reg. envelope–receptor interactions. on my shelf and. management of opportunistic infections is not addressed at tively researched account but rather that many of Crewd. a topic that has featured prominently in recent HIV–AIDS conferences.J. The one chapter that includes refer. ulatory functions (Tat and Rev) and accessory functions ters obsolescent. the book is written of which are more nuanced and sympathetic to Gallo. syndrome or AIDS dementia. The editor states that each of the chapters in the book is designed to be as complete as possible and may be read in- T HIS book addresses our knowledge about replication of the human immunodeficiency virus (HIV). Gallo was working under intense pressure. But coverage of these topics can be found in other text- son’s conclusions are open to other interpretations. ISBN 0-691-00454-4. could be updated annually. it features nine au- grase. Copyright © 2002 Massachusetts Medical Society. Princeton. including inte. 347. AND THERAPY ance mutations. anti-HIV drugs and potential drugs and targets. immunity to HIV infection. but the pages of text are followed by as many Institut Pasteur first isolated HIV. ment of HIV infection repeats much that has come before. I shall keep it that. only when we reach the chapters on novel ences from 2001 might be praiseworthy. and there is only cursory mention of he could have acted much differently over the years. not least because few chapters cite references accessory. persuad. In the mainly by North Americans for North Americans. his leg. although there is much detail on drug-resist- BIOLOGY. Another topic I would like to have seen covered is the problem of poor adherence by patients to today’s drug reg- ROBERT STEINBROOK. tion strategies. The last three chapters cover nonpharmaceutical preven. Vpr. pages of references.org The New England Journal of Medicine Downloaded from nejm. M. In the 19 years since virologists at the and succinct. providing annual updates should not be too onerous a duty. Vol. therapeutic targets in HIV-1 are they subdivided into reg- ly that its delayed delivery was what rendered the other chap.uk 772 · N Engl J Med. the introductory chapter lumps together all HIV test of time. 2012. There is early 1980s. but it is more like. with publication in a textbook in mind. whereas others already seem dated at the time proteins encoded by genes other than gag. Contrary to the blurb on the ture is not flattering. editing for consistency would also have been helpful.D.. This book is not a general textbook on HIV and AIDS.nejm. auxiliary genes. . The creation of timely textbooks in rapidly (Nef. The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne Crewdson has put Gallo under the microscope. the detailed understand. The clinical judgment correct? The issue is not the facts in this exhaus. developing fields like HIV and AIDS or functional genom. The second chapter on their mechanisms of action are addressed in detail in this the genetics of HIV-1 stands out as the only one not written book. has portrayed it. on the wasting r. structure and biology of HIV type 1 (HIV-1) is masterly tional drug design. 10 · September 5. all. and env as of publication. it does not cover epidemiology. cluded with various shades of gray in places where hatching Is it realistic to produce an up-to-date textbook on HIV would have been clearer. imens. since this chapter transcription early in the infection cycle and inhibit protein was not intended to be an account of the historical devel- cleavage late in HIV-particle formation. Some of these chapters will stand the instance..weiss@ucl. thors from one laboratory and absurdly cites their research tions. A little more ing several of the best investigators in the field to write au. To what extent is Crewdson’s harsh book’s flyleaf. accessory-gene func. to prevent mother-to-child transmission. No. no doubt. Indeed. coverage Princeton University Press. This approach is successful. which would lies behind drug efficacy. a crucially important aspect of the benefit of anti-HIV drugs acy is unlikely to be as mendacious and dark as Crewdson — namely.D. University College London There is relatively little on the pathogenesis of HIV other London W1T 4JF. United Kingdom than immune deficiency — for instance.ac. al- though there could be better cross-referencing. illustrated. The grants. WEISS. but if they teach their subject. For thoritative chapters. Thus. 2002. For personal use only. The introductory chapter on the of HIV infection exemplifies the practical outcome of ra. PH. and the long chapter on the interface between the pathogenesis and treat- it. as if it were the proceedings of a conference. 2002 · www. will occasionally lift it down for such an undertaking would require an ongoing commitment reference over the next two to three years. coverage of the dynamics of drug resistance Edited by Emilio A. in relation to viral fitness is lacking — particularly. IMMUNOLOGY. All rights reserved.org on September 22. as are the prospects for other targets. of the transmission of drug-resistant HIV. based on lishers should give more thought to electronic publications what was known as of the end of the 1990s. No other uses without permission. Simply converting color figures and AIDS? Emilio Emini has made a brave attempt. ROBIN A. whereas the chapter on HIV genetics calls them published after 1999. Furthermore. These drugs and opment of HIV and AIDS discovery. 544 pp.

Oct. and there is a nice progression from basic and translational science to clinical medicine. however. This book will be an extremely useful and important ad- py for HIV-1 infection. other atypical mycobac- teria are not. It nicely Lately. who gave so much to the field of AIDS re- decades.tju. month. 2002 · www. It will also be extremely useful for fellows in clinical infectious disease as they enter and proceed through training. 27–30. For personal use only. Notices submitted for publication should contain a mailing address and vestigate HIV-1 infection as well as for other infectious-dis.. Jennifer Hoy. London. but the editors and the authors do a very solid job of making N OTICES this book readable and useful for clinical scientists who in. or fax (215) 598-3637. has begun to take on the further research. ME 04070-0190.com. No. who are interested in clinical HIV-1 infection. phone number of a contact person or department. and certainly the past five or six years. The past two One highlight of this book is the moving and appropri- ate dedication to Drs. It will serve physicians unable to publish all notices received. I would like The International COX-2 Study Group is accepting abstracts for its to have seen more information on the developing immune. tients with profoundly decreased CD4+ counts who do not have a response to HAART. es in the guidelines for the use of this type of therapy. Scarborough. ond edition of this textbook clearly hits the mark. The listings can be viewed who treat patients with HIV-1 infection in academic medical in their entirety or searched by location. Terr. ISBN 1-901865-28-2. although Mycobacterium avi- um complex is thoroughly covered. the field has matured.j. based therapeutic approaches to HIV-1 infection. Dec. In addition. Finally. 842 Durham Rd. or fusion inhibitors and chemokine-receptor antagonists are fax (207) 883-1527. Contact Paula K. another new class of antiretroviral agents.O. or call (877) 275-6462.org. summarizes what we now understand and what still requires at least in the developed world. We regret we are ease specialists and general internists. 10 · September 5. Vol.org).nejm. or see http:// tients with subclinical infections. 2012. Foundation for Blood Research. M.. It is difficult to cover this immense topic in its entirety. M E D ICA L GROUP M A NAGE M E NT ASSOCIAT ION sion of viral resistance. 30.. www. outpatient disease. 347. A textbook on this topic could be out of date HIV-1–infected patient is still a moving target. roger. or key word. I T is difficult to think of a topic in biomedicine about which it is harder to write a textbook than human immu- nodeficiency virus type 1 (HIV-1) and AIDS. There will surely be some chang. they will constitute Mills. Haddow. centers or private practice. markable changes in state-of-the-art diagnosis of and thera. 2002. illustrated. reasons.org · 773 The New England Journal of Medicine Downloaded from nejm. All rights reserved. Finally. P. It is likely that it will remain Philadelphia. Edited by Suzanne Crowe. or e-mail phaddow@fbr. 630 pp. As Box 190. Contact Scientific Frontiers.it. or kin-2 to increase the levels of CD4+ T lymphocytes in pa. with HIV-1 infection live longer and more productive and healthy lives because of antiretroviral therapy. A more complete discussion of the The “76th Annual Conference” will be held in Las Vegas. e-mail cpatrono@unich.fbr. Copyright © 2002 Massachusetts Medical Society. Notices also appear on the Journal’s Web site (http://www. town. POMERANTZ. Oct.nejm..org. search before their untimely deaths in an airplane accident.” to be held in Rome. such as dition to the libraries of physicians and medical scientists highly active antiretroviral therapy (HAART).mgma. E. NOTIC ES MANAGEMENT OF THE HIV-INFECTED PATIENT tic armamentarium over the next few years. N Engl J Med. as well as against opportunistic in- fections and AIDS-related tumors. Care of the olutionary. Any book that attempts to cover such a wide body of C A L L F O R A B ST R AC T S information will have some faults or omissions. Englewood. the second edition of this excellent textbook ap. No other uses without permission. including 13–15. plete and progress logically. HIV-1 infection. Martin Dunitz. which occurs after the initiation of HAART in pa. The 22nd annual course will be offered in Scarborough. Contact Medical Group Management Association. PA 19107 an up-to-date and useful resource for some time to come. . Some advances in the field. aspects of a chronic. A full chapter on viral resistance would help clinicians understand this complex topic. “Fifth International Workshop on COX-2. www. its sequelae. There is also a chapter on how treatment methods may differ in the developing world. Deadline for submission is Sept. Jonathan Mann and Mary Lou Clem- ents-Mann. issues such as organ transplantation in HIV-1–infected persons will have to be addressed. P REGNA NCY M ULT IP LE M A RKE R SCRE E NING SH OR T CO U R S E The chapters on antiretroviral treatment are quite com. but the sec- before it even comes to print. New- structured treatment interruptions and the use of interleu. there will be important changes in the therapeu. or call (215) 598-3600. 27– various presentations of the immune reconstitution syn. For these ROGER J. are stabilizing.edu The editors have enlisted a diverse group of authors to re- view the diagnosis and treatment of HIV-1 infection and Book Reviews Copyright © 2002 Massachusetts Medical Society. PA 18940. Thomas Jefferson University pears at an opportune moment.pomerantz@mail. have seen re. 20. and John ful integrase inhibitors can be developed. CO 80112. cussion of the interactions between HIV-1 and hepatitis C virus would be useful. If clinically use- Second edition. as patients $190. have been rev. Suite 200. More coverage of salvage therapy would complement the discus. 104 Inverness drome. Me. and a more detailed dis. or call (207) 883-4131. treat- ments against the virus.org on September 22. or see http:// developed.D. Each chapter is well thought out.