The best lack all conviction,
while the worst
Are full of passionate intensity.
-- from "The Second Coming"
by William Butler Yeats
After the November 1994 elections, the most rabidly conservative members of the United States House of Representatives began to carry out a long-standing vendetta against people with HIV. From California Representative Robert Dornan's attempts to boot HIV+ military personnel out of the armed services to mandatory HIV testing provisions included in the reauthorization of the Ryan White Care Act, a small noxious band of House Republicans have decided to forego what is best for the public health and what is equitable and just in order to pursue their holy war against us. These Republicans have been most successful in the research arena where, unlike in the AIDS care, prevention and civil rights areas, there are only a few advocates working to stop them. For over a year now, TAG and other AIDS research activists, along with leading scientists, have been trying to thwart the mean-spirited and politically opportunistic attacks on AIDS research.
The assault on AIDS research is being led in the U.S. House of Representatives by Louisiana Representative Bob Livingston, chairman of the Appropriations Committee, and an ordinarily more moderate Republican and ardent supporter of biomedical research, John Porter of Illinois, chairman of the Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. In July of 1995, Representative Porter, for the first time in the history of the epidemic, revoked designated AIDS spending at the National Institutes of Health (NIH) and stripped the NIH AIDS budget away from the NIH's Office of AIDS Research (OAR) in the House's fiscal year (FY) 1996 spending bill.
TAGline readers will know that in 1993, TAG pushed for the strengthening of the OAR, in order to give our nation's AIDS program central coordination and leadership. Mr. Porter's move to rescind the fiduciary authority of the OAR and to return research dollars once designated for AIDS--now unmarked--directly back to the institutes was an unvarnished attempt to gut the 1993 reforms in the NIH's AIDS research program. In addition to the House leadership's animosity towards AIDS research, Mr. Porter's attacks on the OAR were clearly inspired by the still-vigorous back-channel opposition to the Office by NIH institute directors, especially Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and the deposed, former director of the OAR. For the institute directors this was [as goes the present day's structural colloquialism] "all about power and control." The OAR, with a mandate to lead our nation's AIDS research program stretching across the borders of their 24 individual institutes, centers and divisions, was a threat to their autonomy. The powers of the new OAR represented a kind of federalism at the NIH which ran counter to the political culture at NIH--a political culture which more closely resembled the British Commonwealth's collection of independent countries under a mostly powerless, ruling monarch.
Despite the support of literally hundreds of scientists--including three Nobel Prize winners--and the efforts of all the national AIDS organizations, we were unable to turn back the attacks on AIDS research in FY 1996. Why did we lose? The key reason for our defeat was Mr. Porter's intransigence on the issue. Mr. Porter's animosity to the OAR remained unabated throughout the FY 96 appropriations cycle. Valiant attempts by California Representative Nancy Pelosi to restore the NIH AIDS budget to the OAR were beaten back by Mr. Porter at every turn. While the Senate did not follow the House's lead and did include a single, consolidated NIH AIDS research budget for the OAR in its version of the FY '96 spending bill, Senators Arlen Specter and Mark Hatfield were, in the end, willing to cede to Mr. Porter's designs on AIDS research.
Another key reason for our defeat was the lack of support by the Clinton Administration. White House officials, including the President, issued a torrent of kind words of support for the OAR. However, in a clear case of the tail wagging the dog, the NIH institute directors were calling all the shots on Capitol Hill. NIH Director Harold Varmus also sat noticeably quiet all year, speaking in support of the OAR in Congressional testimony, but refusing to use his clout with Congress to rescue the OAR. Some of the blame for our loss of designated AIDS funding at the NIH and a consolidated NIH AIDS research budget also falls on our own community. Relatively few resources are directed by national AIDS organizations into research advocacy, and research is too often at the bottom of the list of issues of concern in a hefty legislative agenda.
So what happens now? As I write this, the House is set to mark-up its FY 97 NIH budget; we are fighting to restore a consolidated NIH AIDS research budget to the OAR once again. Mr. Porter is in a weaker political position than he was last year and we may just succeed. We have enlisted the help of the Chicago AIDS Foundation which has mobilized to assist us on Mr. Porter's home turf. The NIH AIDS Program Evaluation Working Group report on the NIH AIDS research program released this spring included a call for a strong OAR, belying Mr. Porter's contention that his actions last year were "what the scientists want[ed]." If we lose in the FY 97 House mark-up of the NIH budget, the battle will continue in the Senate and throughout House-Senate conference negotiations on a final spending bill. It's going to be a long, hot summer.