Learning From HIV

Summing Up the Lessons From Five Years of Science Reporting

Eric Davidson has spent most of his long career studying the genetic "switches" that turn genes on and off. It is laborious, painstaking work, which may be one reason Davidson has become a gruff man who doesn't suffer fools. When I called him a few years back to ask him about evolutionary genetics, he barked, "Why does The Village Voice want to know about that? When I think of the Voice, I think of a cross between The Daily Mail and The Daily Worker."

I burst out laughing, which allowed me to evade answering his question. I didn't really know why the Voice would be interested in science. Nevertheless, Davidson ended up spending hours responding to my naive, often downright ignorant questions. The more I learned from him and the hundreds of other scientists I've interviewed in my five years at the Voice, the more it became clear why an alternative paper that publishes activist journalism should want to know about biology. Quite simply, it is changing everything.

Most fundamentally, it is changing our perception and definition of ourselves. In the popular press, we have a gene for this and a gene for that. In its crudest form, pop biology defines a human being as a chemical-reaction chamber with no unconscious and no emotion that cannot be calibrated into biochemical balance. That's why, when someone is acting strangely, people are now apt to joke, "Did you forget your medication?"

Davidson's work demolishes one pillar of this notion, the idea that we have a gene for this or that, in some one-to-one correspondence. It's much more like music. Yes, Mozart and Beethoven used the same notes, but how they arranged them is what matters. Similarly, if genes are turned on at different times, or in the context of different sets of genes, the results can be dramatically different. Humans and chimpanzees, for example, share more than 98 percent of their DNA. The real difference between the species probably lies not in the 2 percent that diverges, but in how the 98 percent that is the same gets orchestrated. As Davidson told me, it's not what the genes are, but "how the genes are used."

So, too, with science itself: How societies use—or misuse—science is what matters. Here in the U.S., biology is becoming synonymous with pharmacology. That's largely because the pharmaceutical industry—the most profitable industry in America—funds more and more research, and lobbies the government to direct more of its vast research budget to test-tube science that will make it easier to find new drugs, not toward social science that will never lead to a product. Of course, molecular biology has provided near miraculous treatments for ailments as diverse as depression and AIDS. But the idea that biology is only about cells and test tubes obscures the rest of human experience, such as culture and politics. The word biology, after all, comes from the ancient words for life and logic. It is the logic of life.

What can emerge from looking at biology outside the test tube? A study in the prestigious Archives of General Psychiatry compared the mental health of Mexican immigrants to that of third-generation Mexican Americans. Despite having much less money and access to health care, the recent immigrants had one half the mental-health problems of their richer, more assimilated counterparts. William Vega, the Berkeley researcher who conducted the study, notes that marriage rates and other family ties were stronger among the recent immigrants. "There's an exchange," he says. "You get material benefits, but you're trading off emotional support and nurturance." Such "affluenza," as other researchers have dubbed this problem, can be tranquilized by medication but not cured by it.

I spent most of last year reporting on AIDS in sub-Saharan Africa, where the majority of people survive on less than two dollars a day. Whatever their mental health, their physical health is appalling. The tremendous advances in understanding HIV and in creating treatments are quite simply worthless to most infected Africans. The reason has nothing to do with virololgy or immunology. As the anguished Ugandan doctor Peter Mugyenyi put it to me, "The medicines are where the problem is not, and the problem is where the medicines are not. The reason this cannot be put right is economics."

And politics. Many African doctors do not tell their HIV patients that AIDS drugs exist, fearing that it would amount to psychological torture. But activists rightly condemn such paternalism. After all, if people don't even know that treatment exists, they will not fight for it. More than perhaps anything in recent memory, the expensive AIDS drugs have spotlighted the horrendous inequities between the first and third worlds. The more people realize that they are dying as much from a lack of money to buy drugs as from HIV itself, the greater the chance that outrage will swell into a political movement that just might narrow, at least a little, the gap between rich and poor.

And so we come full circle. We need politics to make drugs available, but we need drugs to drive the politics. This, Professor Davidson, is why the Voice wants to know about science: It wants to know what is actual, what is possible, and what we can dare to hope for.

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