Good Intentions: How Big Business and the Medical Establishment Are Corrupting the Fight Against AIDS.

• Author: Cohen, Jon

Good Intentions: How Big Business and the Medical Establishment Are Corrupting the Fight Against AIDS Good Intentions: How Big Business and the Medical Establishment Are Corrupting the Fight Against AIDS. Bruce Nussbaum. Atlantic Monthly Press, $19.95. In critiquing the medical-industrial complex and the orthodox old-boy AIDS network, Good Intentions adds to the history of AIDS, bringing to life the people who shepherded the drug AZT from laboratory to patient. Nussbaum thoroughly records their smelly backroom deals, bureaucratic botchings, conflicts of interest, and peccadillos. He also chastises the powers-that-be for ignoring (and deep-sixing) drugs other than AZT and toasts the researchers and people infected with the AIDS virus who bucked the system and started their own community-based drug trial programs. And Nussbaum's business writing seems largely on the mark, which is to be expected from a veteran BusinessWeek hand. He convincingly shows how the Food and Drug Administration (FDA) favors pharmaceutical giants like Burroughs Wellcome over underfunded startup companies that have interesting products but can't afford the regulatory process. The way Burroughs's David Barry sailed AZT through the regulatory doldrums of the FDA, his old employer, is a classic it's-who-you-know tale. Yet Nussbaum undermines his credibility with error after error, sullying the genuine facts in the book.

The biggest hoot comes early on. "It is a polite finction that scientists at the NIH [National Institutes of Health] and the drug companies work for the public health," Nussbaum posits. "They really work for credit and cash." As Nussbaum himself might say in the flabbergasted voice he maintains throughout Good Intentions: Shocking.

While NIH scientists should always put the public good above their own gain, since when are drug companies held to that standard? Burroughs Wellcome's original $10,000-a-year asking price for AZT was offensively high, but so are the price tags on plenty of other drugs (cyclosporin, which prevents the rejection of transplanted tissue, costs $13,000 a year). The fact is, in the U.S., health care is a for-big-profit industry. Nussbaum doesn't analyze whether this is good or bad, opting to attach the symptoms rather than the disease.

Three pages later, Nussbaum gets his medical history wrong. "In the fifties," he claims, "it was polio that received the big government research bucks." Not so. In the fifties, as Jane S. Smith details...