Talking Shop in the Medical Field: The Unfolding of A Strange New Disease

by Mahin Hassibi

Medical specialists in different fields complain about insurance companies or the Medicare rates; otherwise “talking shop” only occurs when a new disease appears. That’s how it was in December1981 when my oncologist-friend asked me if I had seen the New England Journal of Medicine. She said there was the unusual report of a rare form of pneumonia that, until then, had appeared only in patients after heavy chemotherapy. The new cases were all men: homosexual, heroin addicts and the rest were Haitians. We agreed that the information was not complete and the report was indeed strange.

That evening I happened to talk to a Haitian colleague and mentioned the report. She was a skeptic about bias in reporting and became immediately incensed. She said she had two women friends, heterosexual, who had died in a Washington, D.C. hospital with the unexplained diagnosis of deficiency in their immune systems. Yes, indeed, they were Haitian. Maybe, she said, there is a new agent of destruction concocted somewhere to get rid of some undesirable group. Had we not read about the Tuskegee experiments? We kept the speculation going for a while, but no conclusion could be drawn.

The next time that I talked with my oncologist-friend, she asked what I thought about the unusual diagnosis of Kaposi Sarcoma, a new report in medical journals. Why should same-sex relations cause rare skin cancer? A researcher had found some connection between the use of amyl nitrate (used by some gay men as an enhancer of sexual pleasure) and Kaposi. But what explained the causative factor for Haitians?

Before long, the varied symptoms were replaced by a common underlying pathology and a scientific name: “acquired immune deficiency syndrome,” AIDS. Around the same time, hemophiliacs came to replace Haitians as the third “H” in the groups most affected — homosexuals, heroin users, hemophiliacs. This meant one way of getting the disease was through injection of blood products used to treat hemophilia.

The mass media created a panic, informing the public of every opinion, rumor or hypothesis. But the sense of panic was not limited to the general public. Some doctors refused to see patients with AIDS; hospital staff did not want to care for them. Some patients went without food because no one would feed them if they could not take the tray left near the door of their room.

Almost overnight, everybody knew somebody who was sick. The volunteer high school student who came to tutor the children on the pediatrics ward; the young black child psychiatrist who resigned to “write a book ” and was found dead in a hotel room in Hawaii where he had gone to commit suicide; the colleague who was trying to convince me to buy his condo because he wanted to move out of the city. They were all dead and in such a short time. Some were known to be gay, others far from it.

A media psychiatrist was going on lecture circuit, saying that heterosexuals were immune to the disease because he had not seen women with AIDS among his acquaintances. Then in 1983 the French identified the virus causing the disease — human immunodeficiency virus, HIV. But why did the virus choose to attack gay man? How was it transmitted? Doctors began reasoning by analogy and devising ways to eliminate or reduce the possibility of transmission. Cases soon appeared of women infected by husbands and HIV-positive babies were born to them. By 1985, the first test for AIDS was approved by the FDA. The disease of a few men at the beginning of the eighties became the killer of many men, women and children worldwide.

During the past quarter of century our knowledge has increased, but not all behaviors are based on knowledge. In South Africa, the government is still looking for some agent other than HIV and treating patients with unproven medications. In the west, many ignore necessary precautions for preventing a sexually transmittable disease; others remain uneasy when it comes to testing pregnant women to prevent the birth of ill children. My Haitian friend was right in observing that black females were also infected. It now appears that HIV infection is the 4th cause of death among black women in the U.S.

Aspects of AIDS remain puzzling, such as the very small likelihood of transmission from infected women to men, as opposed to the high percentage of women infected by HIV-positive men. And medicine has lost much of its optimism regarding infectious diseases: AIDS now looks like other diseases that are here to stay.

Mahin Hassibi is a Professor of Clinical Psychiatry (Ret.) at New York Medical College.


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