261. "Blood Simple," National Review, (February 20, 1995), pp.48-50.
Gay activists were discomfited when Newt Gingrich extended a helping hand to people at risk from AIDS, writing to White House Chief of Staff Leon Panetta to complain that they are prevented from using an HIV Home Collection Kit. The kit allows anyone who wishes to find out whether they are HIV-infected, by mailing in some blood on number-coded cards and calling anonymously for the results. Paul Weyrich, National Chairman for the Coalitions for America, spoke up for the release of the kit, adding that he feels "uncomfortable" talking about the whole subject because "of the manner in which this deadly disease can be contracted" but feels that because "this has clearly become a public health issue affecting millions of Americans, some of whom are innocent victims of this deadly virus" the kit should be approved forthwith. And William Mellor III, President of the Conservative Institute for Justice, threatened to bring a lawsuit to gain the release of the kit. They were joined during a recent press conference by a young woman who tearfully explained that she would not be destined to die from AIDS if the kit had been available to her. Quite a line-up. But why?
The real target, of Newt et al., is the FDA which has been blocking the new product for a mere--seven years. There have been frequent complaints about the FDA being hostile to business, excessively bureaucratic, and so on. I must admit that when I first became involved in trying to get the kit approved I did not share all these sentiments. I thought that they were mainly a reflection of general anti-government attitudes, that the FDA was one of the few government agencies that has considerable merit. Although excessively cautious, it did save us from calamities, such as the terrible birth defects caused by the sedative Thalidomide in the early 1960s in Europe. I began to realize that much less wholesome considerations than public health drive the FDA when I read that it blocked the approval of two very simple devices that are in the public interest, without any comprehensible explanation: a device used to detect breast cancer (the "Sensor Pad"). Withholding of the HIV Home Collection Kit completed my conversion.
I came to support the kit not out of interest for market efficiency, but out of moral concerns. Examining the balance between the common good and individual rights, I argued that anyone who is HIV infected--whether that person got the disease from a blood transfusion, from a spouse, needle exchange, or "bad behavior"--has a moral commitment to inform others. The reasoning is simple: No cure or vaccine for HIV is in sight and the only way to prevent the horrible disease from spreading is for those who are carriers to notify all previous contacts that they must change their behavior and warn all prospective contacts. All this requires that persons who are likely to be infected be tested so they can discharge their moral obligations. The kit directly serves this purpose.
Several gay leaders have come up with a plethora of reasons why they are not so obligated. They argue that there is an incubation period during which even if the person is a carrier, the antibody will not appear when tested; hence, everyone should always act as if everyone is infected. But this is like saying that because you are always told to fasten your seat belt, a pilot need not warn you when the airplane is about to make a crash landing. Most humans do not always act wisely and, as the Bible says, you should not place a hole in front of a blind person. When you see a fellow human being approaching a fatal trap, warning is one's basic social responsibility.
Enter the HIV Home Collection Kit. It is radically different from most things that the FDA reviews. It is not a drug whose chemical attributes and effects citizens have a hard time grasping; it is not a complex compound whose safety must be extensively tested. It is not even a home-test kit, say like a home pregnancy test. It is a simple device that collects some blood at home, and after it is mailed to a lab it is subjected to the same medical tests that blood collected in the doctor's office is. Indeed, practically all the objections raised during a FDA hearing about the kit were fallacious on the face of it, reflecting political opposition.
Michael Savage, Chair of the National Alliance of Lesbian and Gay Health Clinics, argued that merely printing the kit's instructions in Spanish and offering bilingual counselors will "not provide adequate and serious care sensitive to the diverse needs of Hispanic and Spanish speaking individuals in the United States." At best, this is none of FDA's business.
Dr. Merlyn Sayers argued that "it is not known to what extent testing will increase among individuals practicing low-risk behavior, basically simply expanding testing among the worried well' as opposed to reaching those at true risk." Heightened fear of dying has dire consequences; even if the kit would only lay to rest these fears, it would be well worth the price.
And, from the believe-it-or-not category, Christopher Portelli, the National Coordinator of the Gay Health Clinic Alliance, argued that the kit should be banned because someone may use it to force someone else to be tested, let's say a parent may force the lancet into their child, or an employer compels an employee. Disregarding the rather far fetched nature of these speculative objections, Portelli seems unaware that there are quite a few laws on the books against assault and battery which such an act constitute.
One objection was raised that, at first, seems to have merit. Marion Brown, a counselor at the Whitman-Walker Clinic, maintained that persons may commit suicide, or at least have nervous breakdowns, if they find out over the phone that they tested positive. Only if they would go to the doctor's office would they receive the result coupled with the necessary counseling. Surveys conducted by the Center for Disease Control and Prevention show that 32% of those tested by pre-kit, existing methods obtain their results by phone or mail. And 85% of those who test positive receive no counseling whatsoever! Moreover, today's rushed doctors are neither particularly keen on nor trained to provide the kind of counseling the gay community would like to see.
Last but not least, there is a question of one's basic liberty. If persons choose to be tested completely anonymously, by not going to a doctor's office, where people talk, records are kept, information is fed into insurance companies' computers, they should be free to make this choice. They should be enabled to mail in a sample with an anonymous identification number and call for an answer. This is what the kit achieves.
Paul Weyrich and others believe that the gay community really objects to the kit because it would cause gay clinics to lose federal dollars. A gay leader explained to me that the kit is a device of those who want to stigmatize and isolate gays. No evidence was presented in support of either theory. But it matters little. Whether the objections to the kit are driven by financial motives, paranoia, or humanitarianism, they disregard the basic matrix of facts and values involved: There is no way to stop an HIV carrier from infecting others if he engages in certain actions. To prevent contagion requires that persons know if they are infected, which the kit helps establish. Since HIV infection is deadly, preventing people from using the kit is morally indefensible.