Jackie Byrd
And the Band Played On – Public Health, Politics and Passivity
The title of the book – a reference to the band that continued to play aboard the sinking Titanic – serves as the most concise summary of the book itself. Reporting on AIDS full-time for the San Francisco Chronicle in 1982 and 1983 enabled Randy Shilts to produce a work of journalism that covers every facet of the early years of the epidemic. The author makes his own opinion known only in the prologue; however, the key players (and the key spectators, in this case) share their own thoughts and opinions through a chronological account beginning in 1976. The escalating death toll coupled with the rampant inaction only serves to justify the author’s sense of outrage to the reader. The first years of the AIDS epidemic – the years in which interventions could have saved the most lives – were marked not by major interventions, but by the complete failure to treat the situation as a crisis. Shilts systematically exposes the quarrels (or lack thereof) that dominated the media, politics, the scientific world and the rest of the world.
In his prologue, Shilts condemns the inaction of the administration, scientists, public health authorities, gay community leaders and the media. The strong rhetoric he uses in repeating “people died” while each of these arenas bickered over issues paling in comparison to the reality of the situation is justified by the facts presented throughout the text. While Shilts has understandably come to his own opinions after recreating the first eleven years of the epidemic in such accurate and thorough detail, the power of the book’s thesis is not in a concise opinion shared by the author, but it in the conclusion any reasonable person can draw from the evidence. It is over the course of the book, that the reader comes to understand the magnitude of the failures and small successes of each of the four contributors to the travesty.
The facts are presented in chronological order over the course of an eleven year span and substantiated by carefully documented interviews with the men and women quoted as well as reviews of publicly available government reports. Much like a scientific thriller, Shilts shifts among San Francisco, New York, Denmark, Atlanta, Bethesda, and Paris. Each geographic location has its own focus, whether scientific, social, political or public health. However, as the years pass by in each location, the professionals of every discipline interviewed all begin to demonstrate or display disbelief at a lack of concern for the medical threat of the epidemic.
The Reagan Administration is portrayed as the most passive, and perhaps ignorant, of the five major players presented. According to this account, members of the Reagan stuck to the party line; though this less-personal characterization is perhaps due to an inability to obtain interviews with Secretary Heckler, Reagan, and Reagan’s advisors. By taking the reader to scientific facilities and research universities in the United States and France, Shilts exposes the prestige jockeying and bureaucratic politics that impeded collaborative and even functional, scientific research efforts. He presents not just the underlying issue, but the primary scientist – Dr. Gallo at the NIH – as well as a financial analysis of the NIH’s true AIDS funding. As recounted by the researchers in France, these distorted priorities resulted in competition rather than collaboration. This contrast serves to further highlight the overarching failure of the U.S. at the time. France viewed AIDS as an American problem and didn’t dedicate much time or funding to it; on the other hand the U.S. wouldn’t even view it as a problem at all and left scientists scrambling for resources.
To avoid casting all scientists or politicians as inactive, he takes great care in his meticulous research and reporting to highlight those who took a stand. Shilts contrasts the consequences of Dr. Gallo’s ambition with the compassion exhibited by clinical researchers like Dr. Gottlieb, who drew attention to their discoveries in the quickest way they could. In a similar way, he presents the readers with political aide Bill Kraus and Senator Orin Hatch, one of the few of his party who believed health to be a non-partisan issue. He continues this attempt to tell the story of not just the cowards, but the courageous in every city and discipline.
To present the AIDS epidemic in its historical context, Shilts introduces the reader to the San Francisco bathhouse scene and an array of people on each side of the bathhouse closure debate that evolved only once it was clear a disease was killing homosexual men. While the politicians were trying to make public health a policy issue, the public health officials were acting like politicians. The failure of the public health commissioners to act in the interest of the public health is the judgment of the author; however, it a sentiment voiced by other public health workers, a former sex club owner, and Mayor Diane Feinstein.
Shilts, a member of the media himself, holds the media to a high standard, as public guardian. Without knowing the historical context, one might assume the minimal coverage homosexual AIDS stories received in the media was a result of little public interest in health stories. However, this quantified low level of coverage compared to the measurably higher amount of coverage received by stories of heterosexuals and children with AIDS suggests otherwise. The most incriminating piece of evidence of the media’s role in passively allowing the public indifference (even among the communities the most at risk) was the sudden obsessive interest that arose when Rock Hudson was suspected to have the illness they had ignored among gay men for years.
Assertions are not made about a group’s opinions or failures; key members of each group supply the timeline of the events and their frustrations. By exploring each arena in which the issue of AID plays out, he presents an extensive compilation of evidence with which the reader can come to his or her conclusions. However, the escalating death toll statistics interspersed amidst the tales of indifference and misrepresentation of the issues certainly serve to ensure any reasonably educated reader does not miss the unavoidable conclusion. “By the time America paid attention to the disease, it was too late to do anything about it” (xxi). Even in writing this book, Shilts could do little to stop the spread of the epidemic. He could merely pass on the small successes and massive failures that marked the early years of an epidemic that will affect the nation and the world indefinitely.
The title of the book ultimately highlights the timelessness of the underlying issue. People are remarkably skilled at remaining indifferent to a crisis affecting others. Whether a natural disaster abroad or an outbreak of the flu; we see the passivity of mankind today. AIDS flourished in the U.S. because the necessary coalition of agencies and individuals could not form. There are elements to the story that are dated: the media outlets ignoring it were not part of a 24/7 news cycle, Rock Hudson is not a household name any longer, and some might say the stigma of homosexuality has disappeared if not diminished. Those differences aside, the underlying attitudes of the media, scientists, potential victims, and politicians were no different than the attitudes many of these parties have today. It is not just a historical account; it is current affairs, and it could be the future. Randy Shilts serves as a witness to this tale of widespread indifference hoping to prevent it from happening again, “to any people, anywhere” (xxiii).
The author had himself tested for HIV while writing And the Band Played On; however, he waited until the last page was written to get the results. He did not want to compromise the integrity of his reporting. The test was positive; Randy Shilts died of AIDS in 1994. His death serves to drive his point home even harder – though his thesis and his death, and the deaths of countless other Americans, could have been avoided if people cared and acted when it mattered. Every public health professional should read this tale to familiarize themselves with the struggles they will face in making people care enough to change behavior.
