Seven of 22 the members of The Presidential Advisory Council on HIV/AIDS have now resigned. This was one of those public displays of moral exhibitionism to which we've become accustomed: They announced their rationale in a Newsweek op-ed, writingthat they can no longer be effective under a "president who simply does not care."
Their alleged main grievance was proposed cuts for HIV/AIDS funding in President Trump's proposed budget. The actual amount of those cuts is irrelevant, in that such proposals are essentially generalized recommendations. The real complaint is the very thought that previously sacrosanct funding should be considered for reduction at all.
Yet however, it wouldn't be nearly enough.
To understand why, you need to understand just how much it already gets--and how much more than any other disease, proportionate to the number of people afflicted.
Let's start with the Ryan White HIV/AIDS Program. It currently doles out about $2.3 billion annually to about three-fourths of the estimated 1.1 million Americans living with HIV/AIDS--beyond what private insurance, Medicaid, Medicare, and Social Security disability already provide. A testament to the power of a tiny but powerful lobby: There's nothing like it for any other disease--cancer, heart disease, you name it.
Under Ryan White, people with HIV get a host of benefits that have no relation to HIV-- free medicine, hospital visits, hospitalization, and other health care for separate conditions. It covers dental care, delivered meals, and everything but first-class seats to Bermuda. Little wonder that despite such massive funding, activists claim it's "stretched to the limits" in some states. So we've got to spend even more. And Congress must be cowed into continually re-authorizing the legislation.
Not that Ryan White is the only vehicle. For example, those with HIV/AIDS also get about $330 million annually from the Housing Opportunities for Persons with HIV/AIDS program.
And that's just the federal money spent on those living with the disease. It's in the realm of federal research funding for new HIV/AIDS treatments that the disparity between the treatment of that affliction and all the others is most striking.
DISTORTED PRIORITIES IN MEDICAL RESEARCH
First, you should know that in the U.S. and other advanced countries, HIV has gone from "fatal" to "controllable." Just two words: "Magic Johnson." Diagnosed HIV-positive years ago, today he's probably healthier than you are. But some people do fall between the cracks: The Centers for Disease Control and Prevention (CDC) says 6,721 Americans died of AIDS in 2014.
The cancer line item in the National Institutes of Health (NIH) published research budget is just over double that for HIV/AIDS at $6.33 billion against $3 billion. But cancer will afflict about 1.7 million Americans this year and kill about 600,000--almost 100 times the number of AIDS deaths. Unfortunately, a direct research expenditure comparison is impossible since some of that $3 billion doesn't actually go for HIV/AIDS research, but rather to help patients in other ways. Yes, it's yet another supplement to Ryan White. But meanwhile, there's a separate line item of $5.25 billion for infectious disease research, of which some goes to HIV/AIDS medical research.
Nevertheless, looking strictly at the HIV/AIDS and cancer line items, HIV/AIDS spending is 21.43 times more than cancer spending per patient--and a stunning 42.33 times more per death.
Further, HIV diagnoses are declining while those for cancer are growing. In the U.S., HIV diagnoses have decreased by about a fifth since 2004, while those for cancer continue to increase as the population grows and will soon overtake heart disease as the leading U.S. cause of death.
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Meanwhile some common forms of cancer remain a death sentence. About 54,000 Americans will contract pancreatic cancer this year, of whom 80% will be dead next year--regardless of how early they were diagnosed. Within five years, almost all will be dead. HIV/AIDS gets 25 times the research funding as pancreatic cancer.
Yet actually cancer spending compares favorably with many other deadly diseases.
"Diabetes kills more Americans each year than breast cancer and HIV/AIDS combined with no sign that these odds are improving," stated the American Diabetes Association in a 2015 press release. "Twice as many Americans have diabetes as have cancer and diabetes is 20 times more prevalent than HIV/AIDS." Further, the number and percentage of Americans with diabetes has been soaring, the obesity epidemic being responsible for most of this. HIV/AIDS receives just shy of 5,000 times more per diagnosis than diabetes. And diabetes research funding is slated to decline next year!
Alzheimer's research spending has almost doubled in recent years, but per diagnosis HIV/AIDS still gets about 40 times as much. And as the population ages, Alzheimer's numbers will soar. And what's special about Alzheimer's is the tremendous cost to society. Total payments for health care, long-term care, and hospice for people with Alzheimer's disease and other dementias are projected to increase from a massive $259 billion in 2017 to more than $1 trillion in 2050 (in 2017 dollars). Do we want to find truly effective treatments? Or introduce Soylent Green?
How about the developing world? HIV infections there have plummeted by 33% since 1991. But diarrhea kills 2,195 children every day--more than AIDS, malaria, and measles combined.
SO WHY NOT JUST SPEND MORE ON EVERYTHING?
Once you know the numbers, the spending disparity seems palpably unfair. And so it is. But it's worse than that: Funneling such disproportionate amounts to HIV/AIDS research is actually harmful to those suffering from other diseases.
That's because the world of medical research is, to a sizable extent, a zero-sum game. Yes, we can say, "Why not just tremendously increase overall medical research spending?" And we have over time. But it's not that simple. There are only so many qualified researchers, so many labs, and so on. Funding plays a large role in how those resources are used, and vastly out-of-whack spending in one area draws those resources away from the others. Ultimately no matter how much you enlarge the "pie," you're starving victims of other diseases as long as HIV/AIDS retains its privileged status.
To make these points--to argue against high HIV/AIDs spending in any way--is, of course, to be accused of "homophobia" Certainly that charge awaits you if you suggest that, while we're setting priorities for allocating limited resources among a host of diseases, at least some weight might be given to whether an affliction is related to personal behavioral choices.
Yet it's no more "homophobic" to note that lifestyle choices can decrease or increase HIV/AIDS risk than it's "phobic" to say lifestyle influences the risk of contracting or dying from other diseases, such as obesity and (type II or adult onset) diabetes. Even the gay publication POZ admits that overwhelmingly the major risk factors for contracting HIV are just two activities: unprotected anal sex and sharing intravenous drug paraphernalia. (They don't say anal sex with gay men, but those are the people likely to be carrying the virus. You can't get the disease from someone who doesn't have it.)
That's a stark contrast to some diseases where there is simply nothing you can do. My best friend in my current country just died of bile duct cancer only a month after falling ill and literally two days after receiving a diagnosis. It's rather bizarre to learn you've been leaving "Get well soon!" messages for a corpse. There are no controllable risk factors for bile duct cancer.
At any rate, with the now-tiny number of U.S. AIDS deaths, even gay males are more likely to die of virtually any lethal disease than of HIV infection. The disproportionate spending on HIV/AIDS is unfair to everyone--except lobbyists.
I've written on AIDS for over 30 years, and I remember when activists rightly claimed to have been discriminated against. It's now every bit as immoral that they demand massive discrimination in their favor. And it's killing us.
Michael Fumento is an attorney, freelance writer, and author of five books including The Myth of Heterosexual AIDS: How a Tragedy Has Been Distorted by The Media and Partisan Politics (1990).
