WORDS FROM THE FRONT
Spin Dec. 1993
1949, the Epidemic Intelligence Service has infiltrated hospitals,
health departments, and newspaper offices around the world. Bryan
Ellison exposes how this elite, semi-secret wing of the Centers
for Disease Control and Prevention has managed to stifle debate
about everything from swine flu to AIDS.
At 1600 Clifton
Road in Atlanta, Georgia, the mammoth brick towers of the centers
for Disease Control and Prevention sprawl across clean manicured
lawns. This is the Pentagon of government health - a $2 billion
military prevention agency that monitors broken limbs and illness,
and evangelizes on everything from malaria pills to gun control.
Tucked into the midst of this labyrinth is the hub of a little known
but extremely powerful network of health professionals. Think of
its as the CIA of health care: the Epidemic Intelligence Service
people know of its existence, the resources of the EIS and its reach
into public life are extensive. Nearly 2,000 EIS trainees occupy
key positions in national and international health care. Former
United States Surgeon General William H. Stewart is a member, as
are two other assistant Surgeon Generals. Jonathan Mann and Michael
Merson, past and present heads, respectively, of the World Health
Organization's global AIDS Program, both trained with the EIS. Universities,
health departments, private practices, dentist offices, veterinary
hospitals, and insurance and pharmaceutical companies are all stocked
with members. Others work within tax-exempt foundations, including
the Ford, Rockefeller, and Joseph Kennedy Foundations and the Rand
Corporation, helping direct the spending of trust funds on medical
and other projects.
who cover health-related organizations and medical breakthroughs
have graduated from the EIS program. The New York Time's chief medical
correspondent, Lawrence Altman, is a member, as is Bruce Dan, former
ABC News medical editor and former senior editor of the prestigious
Journal of the American Medical Association. Marvin Turck, the editor
at the University of Washington'' Journal of Infectious Diseases,
joined EIS in 1960.
All have undergone
six weeks of intensive epidemiological training, and then served
for two years, on CDC salary, in state and local health departments
around the country. Many worked in the CDC itself. After completing
their field experience, EIS alumni are free to pursue any career
they desire. But all understand the implicit agreement that they
function as a permanent reserve for the CDC, gathering information
about potential epidemics and reporting it back to headquarters.
Taken at face
value, the wide pool of EIS graduates would seem no more ominous
than a clique of university alumni. But the EIS's mandate is broad
and its potential powers daunting. In a declared emergency, this
uniformed branch of the Armed Services has the authority to suspend
many individual rights. In peacetime, the EIS can control what we
know about illnesses and when we know it. So far, it has taken the
public to the brink of hysteria over illnesses from swine flu to
EIS was the
brainchild of public health expert Alexander Langmuir. In 1949,
the CDC was interested in expanding beyond its mandate for malaria
control, but needed justification. It tapped Langmuir from his teaching
position at the Johns Hopkins University School of Hygiene and Public
Health. Langmuir's arrival was a coup for the CDC - he possessed
a security clearance as one of the few scientific advisers to the
Defence Department's biological and chemical warfare program. The
Cold War was raging at that time, and civil defence ranked high
in government priorities.
that the CDC build a comprehensive surveillance system of trained
individuals in all sectors of public and private life to detect
the earliest signs of a biological warfare attack. "In the
event of war the [EIS members] could be returned to active duty
with the Public Health Service and assigned to strategic areas to
fulfil the functions for which they were trained," said Langmuir.
Federal officials responded with millions of dollars, and the first
class entered in July 1951. The symbol of the EIS reflected its
focus on activism instead of scientific research - pair of shoes
worn through with holes.
warfare never struck, and the EIS has justified its existence over
the years by adapting its mandate to include civil medical emergencies.
Langmuir himself noted that the warfare infrastructure could be
used to control any natural epidemic, using quarantine measures,
mass immunizations, and other emergency techniques.
experiences more than 1,000 clustered outbreaks of disease each
year - roughly one every eight hours - including colds, flu, hepatitis,
and numerous noninfectious conditions, all running their course
and disappearing, and often eluding scientific explanation. The
EIS, it was reasoned, could detect most of those clusters as soon
as they popped up, and in its military style treat selected outbreaks
as emergencies on the assumption they were contagious. And today,
the EIS's role is so broad as to include any "epidemic,"
including those of violence; for example, EIS officers were called
to monitor the L.A. riots following the Rodney King verdict and
to examine injuries after the World Trade Center bombing in 1993.
But it's the
annual outbreak of influenza virus - the flu - that has fuelled
the EIS's most engaging battles, ironically with dire consequences
to public health on occasion. In the spring of 1957, news reached
the U.S. that the flu was devastating nations of the Far East. The
CDC rang the alarm of an imminent and devastating epidemic, and
Congress responded by providing money to allow the agency to crash-produce
a vaccine, which nevertheless arrived too late. In the end, the
mild flu disappeared quite spontaneously, leaving behind none of
the predicted destruction. Some public-health experts even questioned
whether the hype-up scare may have only stimulated vaccine sales.
into the new funds from that heralded debacle and expanded the EIS.
By 1976, the EIS network had become so widespread that it could
detect even the tiniest outbreaks of illness. When five soldiers
caught a flu that January, the alarm bells sounded again. This time
the disease was nicknamed "swine flu," based on the speculation
that pigs served as the reservoir for the virus. President Ford
and Congress panicked, throwing vast new sums of money into another
flu vaccine. Then came an unexpected wrinkle: The program stalled
when insurers discovered that the vaccine itself could produce extraordinary
side effects, ranging from severe fevers and malaise to paralysis
Now the EIS
network sprang into action. Except for the five soldiers, no flu
epidemic could be found, and the EIS was placed on full alert to
detect any outbreak. Unless Congress could be convinced the danger
was real, the vaccine program would end. As described by Gordon
Thomas and Max Morgan-Witts in their book Anatomy of an Epidemic,
the large Auditorium A, located in CDC headquarters in Atlanta,
became the command center - called the "war room." Set
up especially for this occasion, it contained "banks of telephones,
teleprinters, and computers, the hardware for an unprecedented monitoring
system which, to work, also required a typing pool, photocopy machines,
and doctors sitting at rows of desks in the center of the room."
Experts worked around the clock, week after week, chasing down every
rumour of flu outbreaks.
A cluster of
pneumonia cases suddenly appeared in Philadelphia, days after American
Legion members had returned home from their July convention. On
Monday morning, August 2, after receiving word of this outbreak,
personnel in the CDC's swine-flu war room established contact with
Jim Beecham, a brand new EIS officer on assignment in the Philadelphia
health department. The CDC could not directly intervene in the situation
without an invitation, and Beecham helped arrange one immediately.
Within hours three EIS officers flew down to Philadelphia. They
were joined within days by dozens of CDC experts.
When the CDC
personnel arrived, pre-positioned EIS members such as Beecham and
top health adviser Robert Sharrar stopped obeying local authorities
and began following orders from the incoming CDC team. The CDC began
fomenting wild rumours that this "Legionnaire's disease"
was the beginning of the swine flu epidemic. The media proved cooperative;
the New York Times assigned none other than Lawrence Altman, an
EIS alumnus, to cover the story.
hysteria rapidly developing, Congress suddenly changed its mind
and approved the swine flu vaccine. Some 50 million Americans were
inoculated over the next several months, ultimately producing at
least 1,000 cases of severe nerve damage and paralysis, dozens of
deaths, and nearly $100 million in liability claims. Meanwhile,
within days of the legislative approval, the EIS team finally acknowledged
the pneumonia was not related to swine flu, but the announcement
came too late.
The swine flu
never showed up, and the fiasco nearly destroyed the CDC's reputation.
But the EIS executed damage control by blaming Legionnaire's disease
on a newly isolated bacterium. In reality, the stricken Legionnaires
had been elderly men, several with kidney transplants, who had become
extraordinarily drunk at the convention - all classic risk factors
for pneumonia. Such minor disease outbreaks are relatively common,
though rarely fall into the public spotlight. But the CDC had succeeded
in scaring the nation about a harmless bacterium, one found in plumbing
of almost any building.
The CDC needed
another crisis epidemic to revive its heroic image and expand its
mandate. In 1981, the White House was considering cutting the CDC
budget by 23 percent. AIDS appeared not a moment too soon, in the
Wayne Shandera, on active assignment in the Los Angeles health department,
received a call from Michael Gottlieb, a young immunologist at the
UCLA Medical Center. Four patients had pneumocystis carinii pneumonia
and serious immune deficiencies. Shandera had already heard a report
of a fifth such case. One or two cases usually meant nothing; five
seemed more plausible as an outbreak. And all five men were young
homosexuals, a coincidence which could possibly indicate a sexual
link. These five cases were the official start of what later came
to be known as the acquired immune deficiency syndrome (AIDS) epidemic.
the data to his unofficial bosses at the CDC. According to Randy
Shilts in his book And the Band Played On, James Curran, the CDC
official who saw the report, wrote "Hot stuff. Hot stuff"
across the top and rushed it into publication. New reports were
trickling in of dying male homosexuals, most of whom also suffered
from a rare skin cancer known as Kaposi's Sarcoma and Opportunistic
Infections (KSOI) Task Force to manage the investigation, loaded
with such EIS members as Harold Jaffe and Mary Guinan.
of the first 50 cases admitted to using poppers, the liquid nitrite
drug widely popular among homosexual men for its aphrodisiac properties.
Scientists had not studied the long-term effects of this inhaled
drug, but its chemical structure was known for its severe toxicity
and ability to cause cancer. Nevertheless, a cursory study comparing
popper use in disease-free gays with those with AIDS led the EIS
to rule out poppers as the culprit.
The Task Force
then mobilized the EIS network to define sexually linked clusters
of cases and to prove the syndrome had "spread" beyond
homosexual men. Clusters were not hard to find, since the AIDS cases
were extremely promiscuous men with hundreds or thousands of sexual
encounters, and at least one instance of sexual contact with another
AIDS case. EIS officers such as David Auerbach, assigned to the
Los Angeles County Department of Public Health, interviewed these
men and confirmed the prediction. Meanwhile, following the model
of hepatitis-B transmission, EIS agents hunted down every heroin
addict and blood transfusion recipient, including hemophiliacs,
with conditions vaguely resembling the immune deficiencies in homosexuals.
EIS personnel scoured hospitals and monitored local health departments
for patients, and within months found a small handful of heroin
users with opportunistic infections. EIS member Bruce Evatt and
Dale Lawrence tracked down a hemophiliac in Colorado, dying primarily
of internal bleeding, who also happened to have pneumonia. EIS agent
Harry Haverkos travelled to Florida and Haiti to find impoverished
Haitians with opportunistic tuberculosis. Instantly the heroin addicts,
the hemophiliac, and the Haitian were all relabeled as AIDS cases,
and the CDC trumpeted the news that AIDS had "spread"
outside the homosexual community.
research establishment bought the line and scrambled to find a virus.
Scientists first turned to their familiar microbes; Epstein-Barr
virus and cytomegalovirus, both known for many years through herpes
virus research, were each blamed by different factions.
But the fate
of AIDS research was sealed almost from the beginning. Donald Francis,
an EIS member since 1971 who had gained notoriety for implementing
heavy-handed public health tactics when working for the World Health
Organization in the third world, had by 1981 risen to a high position
within the CDC's Hepatitis Laboratories Division. He had also earned
a graduate degree studying feline retroviruses.
11 days after the first report of AIDS cases appeared in June 1981,
Francis placed a telephone call to Myron Essex, his former research
supervisor at Harvard University. With no evidence whatsoever to
back up his claims, Francis insisted that the new syndrome must
be caused by a retrovirus - with a long latency period between infection
and disease. Only five AIDS patients officially existed, yet Francis
had already mapped out the entire future of the disease.
pushed his view whenever anyone would lend him an ear, and even
when no one would. "This is the epidemic of the century, and
every qualified person should want to have a piece of the action,"
he would later say in a speech at the CDC.
Within a year,
KSOI Task Force head James Curran was echoing the Francis hypothesis,
as were other key CDC staffers. Working with Essex, Francis lobbied
their close colleague, Robert Gallo, a well-funded retrovirus scientist
at the National Institutes of Health (NIH), to search for an AIDS
virus. Robert Biggar, another EIS member at the NIH, helped mobilize
the huge federal institute behind the retrovirus hunt.
In 1983, the
French scientist, Luc Montagnier, discovered a new retrovirus, since
named the human immunodeficiency virus (HIV), and Gallo claimed
"co-discovery" one year later. When Gallo held a press
conference to announce the virus, the event set the HIV hypothesis
in stone as official federal dogma. Donald Francis and his fellow
EIS agents had triumphed, though remaining out of the spotlight.
With the EIS's
help, the CDC and the federal government have managed to inflate
fear of AIDS into a global paranoia, thereby feeding the machine
that keeps scores of EIS graduates in business - writing, researching,
analyzing, and otherwise cashing in on the AIDS "epidemic."
Even when dissent scientists manage to create an opening for honest
debate about AIDS, the EIS has masterfully exercised damage control,
learning to squelch embarrassing new twists that threaten the prevailing
dogma. In July of 1992, during the Eight International Conference
on AIDS in Amsterdam, Newsweek suddenly published an article by
reporter Geoffrey Cowley on several HIV-negative AIDS cases. Researchers
at the AIDS conference interpreted the article as a political green
light, and began pouring forth dozens of reports of previously unmentioned
AIDS patients without HIV, from both the United States and Europe.
The situation began reeling out of control, re-opening the question
of whether HIV is the true cause of AIDS. Anthony Fauci, director
of AIDS Research at the NIH, and James Curran of the CDC raced to
Amsterdam on Air Force Two to take charge. The best they could do
on the spot was to listen to the reports, promising to resolve the
later, the CDC sponsored a special meeting at its Atlanta headquarters.
The scientists reporting HIV-free AIDS cases were invited, as was
Cowley, the Newsweek reporter. The unexplained AIDS cases were relabeled
idiopathic CD4+ lymphocytopenia, or ICL - so as to break any connection
between these cases and AIDS. That was enough for Cowley. Since
then, he has not reported on AIDS cases without HIV, or even ICL.
about these same HIV-free AIDS cases had been available to the media
long before the public episode, but had continually been censored.
Lawrence Altman, the EIS member who had become the head medical
writer for the New York Times, admitted to Science magazine that
he knew of cases for several months but did not break the story
because he didn't think it was his paper's place to announce something
the CDC was not confident enough of to publish. The Times, of course,
has long cultivated an image of publishing "all the news that's
fit to print."
The era of
infectious diseases in the industrialized world, the age when most
people died of tuberculosis, malaria, yellow fever, or polio, ended
long ago. But the EIS, a relic of the past, has grown ever larger
in its membership and influence. Its clandestine methods and near
invisibility have allowed the CDC to virtually manufacture epidemics,
and to make the whole process appear spontaneous. Now, as AIDS and
the EIS moves into the '90s, some members are beginning to privately
mourn the fat days of the mid- to late '80s, when AIDS research
dollars flowed most freely from government coffers. Once again,
the EIS may soon be forced to justify its existence to Congress
in order to finance its ambitious program of centralized public
health surveillance. Cloaked in science, the EIS's agenda threatens
to expand public health controls over private beliefs and life-styles.
Healthy suggestions are one thing; exploiting hysteria to impose
emergency powers is quite another. *