HOW AIDS ACTIVISTS CHALLENGED AMERICA

A memoir recalls the struggle to liberate AIDS drugs from an obstructionist federal agency—and the “quislings” in the gay activist movement.

Driscoll recounts the period from 1988 to 1996 when he and other gay activists fought to get the Food and Drug Administration to expedite approval of new AIDS drugs, especially the revolutionary protease-inhibitor cocktails. In the author’s telling, it’s a disturbing story of a risk-averse bureaucracy delaying lifesaving medical innovation. The FDA insisted that approval of AIDS drugs required huge, expensive, multiyear efficacy studies to see if they substantially prolonged life. Activists countered that those standards should be relaxed for a fatal disease with no good treatment, and that quicker testing for safety and performance metrics—like reduction of viral load—was sufficient. (Driscoll and his allies won the battle and were proven right in 1996 when the expedited approval of protease inhibitors dramatically reduced death tolls.) The work is also an epic of political intrigue and infighting in the gay community. The author and his allies, mostly based in San Francisco, departed from activist orthodoxy to work pragmatically with pharmaceutical companies and Republican politicians, including Vice President Dan Quayle, to push reform of the FDA approval process. They were opposed by left-wing gay activists in New York who, Driscoll contends, were in lock step with the Democratic establishment and its FDA clients and therefore resisted measures to speed up drug approval. The upshot was a divisive contest over policy and turf, in which the author weathered public vitriol and private threats from pro-FDA activists and attempts to expel him from the AIDS-activism organization ACT UP.

Driscoll pulls no punches in castigating his opponents of decades past. He calls the FDA “the Fascist Drug Agency,” and decries it as a quagmire of “regulatory featherbedding, dysfunction and corruption,” thanks to then-FDA Commissioner David Kessler’s “love of bureaucratic power.” The author goes on to denounce the New York activist crowd for a level of corruption that brought to mind the Hollywood noir Chinatown. In a lengthy appendix, ACT UP founder Larry Kramer emerges as an erratic figure with a “cyclopean” fixation on corporate greed. Personal wounds also get opened, as in a digression on Driscoll’s Ph.D. adviser, whom he describes as a malevolent homophobe. This acid-etched commentary is twined into a memoir that’s lucid and cogent in chunks but has a disorganized, repetitive structure that jumbles together science, reprints of articles, and political wrangling. At his best, the author offers a shrewd, engrossing primer on effective activism as he recollects how he coordinated street protests, punchy PR, and backroom lobbying. In one masterful maneuver, he got Quayle’s aides to summon FDA officials to the vice presidential office and confront them with anguished AIDS patients desperate for new drugs. Driscoll is also affecting when he recalls the loss of friends and loved ones. (“It was terrible to watch those bright, talented, kind, beautiful young men wilt and die, sometimes slowly, but often in only a few months or weeks. You were laughing, planning, and sharing ideas with them one week; a month later you were attending their memorial service.”) These quiet, heartfelt passages give a sense of the tragic stakes driving all the byzantine power plays.

A rambling, rancorous but often gripping account of a crucial chapter in the war against AIDS.