1. Theo Smart, "This Side of Despair," QW, 13 September 1992, 44.

2. Jayne Garrison, "Experts Glum as New Drugs for AIDS Flop," San Francisco Examiner, 2 February 1992, A-1.

3. Jayne Garrison, "Activists Despondent and the Movement Is Splintering," San Francisco Examiner, 2 February 1992, A-10.

4. Garrison, "Experts Glum as New Drugs for AIDS Flop." Arguably, activists were too quick to dismiss the class of non-nucleoside reverse transcriptase inhibitors, since some of them, such as nevirapine, would later attract attention when used in higher doses or in combination with other drugs. In this sense, activist impatience risked contributing to the discrediting of some drugs, just as activist enthusiasm magnified the credibility of others. See Smart, "This Side of Despair."

5. Delaney's rebuttal took the form of a letter to the editor of the Examiner, reprinted in "No Room for Hope?" PI Perspectives, April 1992.

6. John S. James, "Tat Inhibitor Trials Canceled; Business Reasons Cited," AIDS Treatment News, 17 May 1991.

7. John S. James, "Tat Inhibitor Update," AIDS Treatment News, 3 January 1992.

8. This letter was printed in Ronald A. Baker, "Epidemic of Mistrust: Hoffman-LaRoche and the Treatment Activist Community," BETA, March 1993.

9. Martin Delaney, "The TAT Offensive," Advocate, 9 March 1993, 35.

10. John S. James, "AIDS Treatments 1992/1993: Where Are We Now?" AIDS Treatment News, 1 January 1993.

11. Lawrence K. Altman, "At AIDS Talks, Reality Weighs Down Hope," New York Times, 26 July 1992, A-1.

12. Gregg Gonsalves and Mark Harrington, "AIDS Research at the NIH: A Critical Review. Part I: Summary" (Treatment Action Group, New York, 1992, photocopy).

13. Gregg Gonsalves, interview by author, tape recording, New York City, 28 April 1994.

14. Gonsalves and Harrington, "AIDS Research at the NIH," 1, 12-13.

15. Ibid., 7.

16. Jon Cohen, "Reorganization Plan Draws Fire at NIH," Science 259 (5 February 1993): 753-754.

17. John Lauritsen, Poison by Prescription: The AZT Story (New York: Asklepios, 1990), 121; "Pimping for AZT," New York Native, 8 October 1990, 4.

18. Michael Broder, "Wellcome Gives $1 Mil to Community Research," QW, 12 July 1992, 16, 19.

19. Robert Massa, "Drug Money: Should Activists Take Donations from Pharmaceuticals?" Village Voice, 23 June 1992, 18.

20. From the leaflet "Time & Lives Are Running Out!!!" (San Francisco: ACT UP/Underground, 1992, photocopy); for a discussion see Michael C. Botkin, "The 1992 Scabbies," Bay Area Reporter, 21 January 1993, 18.

21. Gina Kolata, "After 5 Years of Use, Doubt Still Clouds Leading AIDS Drug," New York Times, 2 June 1992, C-3.

22. One study sometimes cited as demonstrating that AZT prolongs life, in fact—by its own account—failed to distinguish between the benefits of AZT and the benefits of "other aspects of care associated with zidovudine [AZT] therapy," such as PCP prophylaxis, in the group studied. See Richard D. Moore et al., "Zidovudine and the Natural History of the Acquired Immuno-deficiency Syndrome," New England Journal of Medicine 324 (16 May 1991): 1412-1416.

23. See Mark D. Smith, "Zidovudine: Does It Work for Everyone?" Journal of the American Medical Association 266 (20 November 1991): 2750-2751 (editorial).

24. D. Cotton and D. Weinberg, "Survey Results: Treatment Decisions in HIV Care," AIDS Clinical Care 4 (1991): 85-91.

25. Jean-Pierre Aboulker and Ann Marie Swart, "Preliminary Analysis of the Concorde Trial," Lancet 341 (3 April 1993): 889-890 (letter to the editor).

26. Tim Kingston, "The Concorde AZT Trial: Does It Fly?" San Francisco Bay Times, 22 April 1993, 6-7.

27. J. Lange, "Antiretroviral Treatment," Session PS-03-2, IX International Conference on AIDS, Berlin, 8 June 1993.

28. John S. James, "AZT, Early Intervention, and the Concorde Controversy," AIDS Treatment News, 23 April 1993.

29. Kingston, "Concorde AZT Trial."

30. David Gold, "The Concorde Study," Treatment Issues, May 1993; Lawrence K. Altman, "New Study Questions Use of AZT in Early Treatment of AIDS Virus," New York Times, 1 April 1993, A-1.

31. Kingston, "Concorde AZT Trial."

32. "After Concorde," Treatment Issues, May 1993 (editorial).

33. Larry Kramer, "AZT Is Shit," Advocate, 18 May 1993, 80 (editorial).

34. Kingston, "Concorde AZT Trial."

35. Linda Marsa, "Toxic Hope: Widely Embraced, the AIDS Drug is Now Under Heavy Fire," Los Angeles Times, 20 June 1993, 14.

36. Charles R. Caulfield, "AZT: People or Profits?" San Francisco Sentinel, 8 April 1993, 1, 19-20.

37. Quoted in Caulfield, "AZT: People or Profits?" 20.

38. Neville Hodgkinson, "New Realism Puts the Brake on HIV Bandwagon," Sunday Times (London), 9 May 1993, Features section.

39. Neville Hodgkinson, "How Giant Drug Firm Funds the Aids Lobby," Sunday Times (London), 30 May 1993, Home News section; "GAG Claims Doctors Are Killing Babies," Capital Gay, 4 June 1993, 9.

40. See the statement by Marcus Conant in Kingston, "Concorde AZT Trial"; and see ACT UP/Golden Gate Treatment Issues Committee, "ACT UP/ Golden Gate Responds to AZT Criticism," San Francisco Sentinel, 15 April 1993, 14 (op-ed).

41. Kim Painter, "Despite Questions, Experts Still Back AZT," USA Today, 5 April 1993, 6D.

42. Altman, "New Study Questions Use of AZT."

43. "After Concorde," Treatment Issues, May 1993 (editorial).

44. James, "AZT, Early Intervention, and the Concorde Controversy."

45. See Anastasios Tsiatis, "Intent-to-Treat Analysis," Journal of Acquired Immune Deficiency Syndromes 3, suppl. 2 (1990): S120-S123.

46. Kingston, "Concorde AZT Trial"; see also the statement by Burroughs Wellcome in David Gold, "The Concorde Study," Treatment Issues, May 1993.

47. James, "AZT, Early Intervention, and the Concorde Controversy."

48. Kramer, "AZT Is Shit."

49. Lawrence K. Altman, "The Doctor's World: AIDS Study Casts Doubt on Value of Hastened Drug Approval in U.S.," New York Times, 6 April 1993, C-3.

50. "After Concorde."

51. Jon Cohen, "AIDS Research: The Mood Is Uncertain," Science 260 (28 May 1993): 1254-1265, quotes from 1254.

52. A. S. Fauci, "Pathogenesis of HIV Infection" (paper presented at Plenary Session 01, IX International Conference on AIDS, Berlin, 7 June 1993); J. Levy, "Mechanisms of Pathogenesis and Long-Term Survival with HIV/AIDS" (paper presented at Plenary Session 05, IX International Conference on AIDS, Berlin, 9 June 1993). Another perspective was presented by Montagnier in back-to-back presentations on 10 June 1993: "HIV, Cofactors and AIDS," Session OP-03-1; and "Report of the EEC Group: Mechanisms of CD4+ Lymphocyte Depletion," Session OP-03-2.

53. Jay A. Levy, "Pathogenesis of Human Immunodeficiency Virus Infection," Microbiological Reviews 57 (March 1993): 183-289.

54. Quoted in Dave Gilden, "Groping toward a New Understanding," San Francisco Bay Times, 17 June 1993, 14-15. McKean died of HIV-related causes in 1994.

55. Robin A. Weiss, "How Does HIV Cause AIDS?" Science 260 (28 May 1993): 1273-1279.

56. R. Gallo, "Perpectives for the Future Control of AIDS," Session OP-01-1, IX International Conference on AIDS, Berlin, 8 June 1993.

57. M. Seligmann, "The Concorde Trial: First Results," Session WS-B24-5, IX International Conference on AIDS, Berlin, 10 June 1993; M. Seligmann, "Report of the Coordinating Committee of the Concorde Trial," Session OP-01-2, IX International Conference on AIDS, Berlin, 8 June 1993.

58. Delaney's comments are from a press conference and a Project Inform "Town Meeting," both held on June 9, 1993 (author's field notes).

59. M. A. Fischl, "Combination Therapy: Now and the Future" (paper presented at Harvard AIDS Institute—AIDS Clinical Research Symposium, Berlin, 8 June 1993).

60. From the press release "Effectiveness of AZT/ddC Combination Depends on Pretreatment Immune Cell Count," News from NIAID, 7 June 1993.

61. From the press release "The Effectiveness of AZT Alone, ddC Alone or AZT/ddC Combination Is Similar Overall for Patients with Advanced HIV Disease," News from NIAID, 10 June 1993. My thanks to Jon Cohen, AIDS reporter for Science, for this anecdote.

62. M. Fischl, "The Safety and Efficacy of Zidovudine (ZDV) and Zalcitabine (ddC) or ddC Alone versus ZDV," Session WS-B25-1, IX International Conference on AIDS, Berlin, 10 June 1993.

63. Author's field notes, Session WS-B25-1; Robert Massa, "Two Steps Back," Village Voice, 22 June 1993.

64. "When to Start Antiretroviral Treatment: Research Issues," Session ME-13, IX International Conference on AIDS," Berlin, 10 June 1993. Quotes that follow are from author's field notes.

65. As Montini and Slobin noted in a study of NIH Consensus Development Conferences that try to create "standards of care," practitioners and researchers confront different work environments and pressures, and their expectations are shaped accordingly. Typically, practicing physicians have a "desire for certainty," while researchers (even those who also see patients) may have a much higher "tolerance for uncertainty." See Theresa Montini and Kathleen Slobin, "Tensions Between Good Science and Good Practice: Lagging Behind and Leapfrogging Ahead Along the Cancer Continuum," Research in the Sociology of Health Care 9 (1991): 127-140, quote from 130. On the professional socialization that teaches doctors to manage uncertainty, see Renée C. Fox, "Training for Uncertainty," in Phil Brown, ed., Perspectives in Medical Sociology (Prospect Heights, Ill.: Waveland Press, 1992), 450-459. For a dissenting view arguing that doctors are trained to suppress and deny uncertainty, see Jay Katz, The Silent World of Doctor and Patient (New York: Free Press, 1984), chapter 7.

66. Lawrence K. Altman, "Experts Change Guides to Using Drugs for H.I.V.," New York Times, 27 June 1993, A-1, A-10.

67. Lawrence K. Altman, "The Doctor's World: Government Panel on H.I.V. Finds the Prospect for Treatment Bleak," New York Times, 29 June 1993, C-3.

68. David A. Cooper et al., "Zidovudine in Persons with Asymptomatic HIV Infection and CD4 + Cell Counts Greater than 400 Per Cubic Millimeter," New England Journal of Medicine 329 (29 July 1993): 297-303.

69. John B. Bartlett, "Zidovudine Now or Later?" New England Journal of Medicine 329 (29 July 1993): 351-352 (editorial).

70. Natalie Angier, "Australian Study Says AZT Slows Progression toward Full-Blown AIDS," New York Times, 29 July 1993, A-9.

71. Paul Volberding, interview by author, tape recording, San Francisco, 7 July 1994.

72. P. A. Volberding et al., "The Duration of Zidovudine Benefit in Persons with Asymptomatic HIV Infection: Prolonged Evaluation of Protocol 019 of the AIDS Clinical Trials Group," Journal of the American Medical Association 272 (10 August 1994): 437-442.

73. Centers for Disease Control and Prevention, "Zidovudine for the Prevention of HIV Transmission from Mother to Infant," Journal of the American Medical Association 271 (25 May 1994): 1567-1570.

74. Rae Trewartha, "AZT, Perinatal Transmission: Unanswered Questions," AIDS Treatment News, 16 September 1994.

75. Ronald Bayer, "Ethical Challenges Posed by Zidovudine Treatment to Reduce Vertical Transmission of HIV," New England Journal of Medicine 331 (3 November 1994): 1223-1225 (editorial).

76. Concorde Coordinating Committee, "Concorde: MRC/ANRS Randomised Double-Blind Controlled Trial of Immediate and Deferred Zidovudine in Symptom-Free HIV Infection," Lancet 343 (9 April 1994): 871-881.

77. Quoted in "Burroughs Wellcome Responds to Publication of Concorde Study," New York Native, 2 May 1994, 12.

78. Paul Cotton, "Use of Antiretroviral Drugs in HIV Disease Declines Following Preliminary Results from Concorde Trial," Journal of the American Medical Association 271 (16 February 1994): 487.

79. Deborah Cotton, interview by author, tape recording, Boston, 25 October 1994.

80. Douglas Richman, interview by author, tape recording, San Diego, 1 June 1994.

81. Margaret A. Fischl et al., "Combination and Monotherapy with Zidovudine and Zalcitabine in Patients with Advanced HIV Disease," Annals of Internal Medicine 122 (1 January 1995), 24-32, esp. 25.

82. Stephen Lagakos, interview by author, tape recording, Boston, 27 October 1994. In the published report, the authors themselves noted that "caution should be used when interpreting subgroup analysis because subgroup analyses may produce spurious results." The researchers supplemented the subgroup analysis with a "trend analysis, which used pretreatment CD4 cell counts as a continuous variable" and which, therefore, did not "suffer from the same limitations" (Fischl et al., "Combination and Monotherapy with Zidovudine and Zalcitabine," 27, 30).

83. Susan Ellenberg, interview by author, tape recording, Rockville, Md., 25 April 1994.

84. Fischl et al., "Combination and Monotherapy with Zidovudine and Zalcitabine," 30.

85. Lagakos, interview.

86. Martin Hirsch, interview by author, tape recording, Boston, 25 October 1994.

87. Ibid.

88. Fischl et al., "Combination and Monotherapy with Zidovudine and Zalcitabine," 30.

89. Richman, interview.

90. Mark Harrington, "The Crisis in Clinical AIDS Research" (Treatment Action Group, New York, 1 December 1993, photocopy), 13-14, 16.

91. See Evelleen Richards, Vitamin C and Cancer: Medicine or Politics? (New York: St. Martin's, 1991).

92. Edward A. Wyatt, "Rushing to Judgment," Barron's, 15 August 1994, 23.

93. Christine Gorman, "Let's Not Be Too Hasty: Activists Who Once Clamored for Speedier Approval of AIDS Drugs Now Favor a More Deliberate Approach," Time, 19 September 1994, 71.

94. John S. James, "BARRON'S: 'Do We Have Too Many Drugs for AIDS?'" AIDS Treatment News, 19 August 1994.

95. David Feigal, interview by author, tape recording, Rockville, Md., 1 November 1994.

96. Kessler has provided an overview of his position on rapid approval of AIDS drugs in: David A. Kessler and Karyn L. Feiden, "Faster Evaluation of Vital Drugs," Scientific American, March 1995, 48-54.

97. Derek Link, interview by author, tape recording, New York City, 28 April 1994.

98. Gina Kolata, "Debate Reopens on AIDS Drug Access," New York Times, 12 September 1994, A-16.

99. Anthony Fauci, interview by author, tape recording, Bethesda, Md., 31 October 1994.

100. David D. Ho et al., "Rapid Turnover of Plasma Virions and CD4 Lymphocytes in HIV-1 Infection," Nature 373 (12 January 1995): 123-126; Xiping Wei et al., "Viral Dynamics in Human Immunodeficiency Virus Type 1 Infection," Nature 373 (12 January 1995): 117-122.

101. Gina Kolata, "New AIDS Finding on Why Drugs Fail," New York Times, 12 January 1995, A-1.

102. Lagakos, interview.

103. "With Good Intentions, Overzealous Researchers May Be Setting the Stage for Yet Another Colossal Failure," TAGline, January 1995, 5.

104. "With Its First Protease Trial Completed, Roche Races to FDA with Lukewarm Results, Activists Cry 'Foul,'" TAGline, July 1994, 1.

105. Robert Trautman, "AIDS Group Urges Wider Use of Experimental Drug," Reuters, 27 October 1994.

106. John S. James, "'Access' and 'Answers': FDA Antiviral Advisory Meeting, September 12-13," AIDS Treatment News, 16 September 1994.

107. G'dali Braverman, interview by author, tape recording, San Francisco, 17 December 1993.

108. Brenda Lein, interview by author, tape recording, San Francisco, 18 December 1993.

109. Peter Staley, "The Responsibilities of Empowerment" (paper presented at "Until There Is a Cure, VI" Conference, Palmetto, Fla., 2 December 1994, photocopy). This was the keynote address, distributed by Treatment Action Group in New York.

110. Harrington, "Crisis in Clinical AIDS Research," 11-12.

111. David Barr, interview by author, tape recording, New York City, 28 April 1994.

112. Tim Kingston, "Coppola's Kids: Leading AIDS Researchers Gather at Project Inform Think Tank in Napa," San Francisco Bay Times, 28 January 1993, 6-7.

113. Gregg Gonsalves, "Basic Research on HIV Infection: A Report from the Front" (Treatment Action Group, New York, 1993, photocopy), 1-2.

114. Ibid., 4, 5.

115. Quoted in Simon Watney, "Dutch Dating," QW, 9 August 1992, 44, 45, 67.

116. Donald Abrams, interview by author, tape recording, San Francisco, 16 December 1993.

117. Gina Kolata, "Scientists Say U.S. Research on AIDS Needs Redirection," New York Times, 12 May 1994, A-12.

118. Bernard N. Fields, "AIDS: Time to Turn to Basic Science," Nature 369 (12 May 1994): 95-96.

119. Kolata, "Scientists Say U.S. Research on AIDS Needs Redirection." On William Paul's appointment, see Jon Cohen, "New AIDS Chief Takes Charge," Science 263 (11 March 1994): 1364-1366.

120. Andrew Pollack, "Meeting Lays Bare the Abyss between AIDS and Its Cure," New York Times, 12 August 1994, A-1.

121. Julio S. G. Montaner and Martin T. Schechter, "Time for Realism over HIV Infection," Lancet 344 (20 August 1994): 535.

122. Andrew Pollack, "U.S. Official to Shift Funds toward Basic AIDS Research," New York Times, 10 August 1994, A-6.

123. The transcript of this presentation was published in William E. Paul, "A Turning Point in AIDS Research: Building on Firmer Foundations," Vital Speeches 60 (September 1994): 709-712.

124. Martin Delaney, "The Evolution of Community-Based Research," Session PS-02-3, IX International Conference on AIDS, Berlin, 8 June 1993.

125. Fauci, interview.

126. Link, interview.

127. Lein, interview.

128. Robert Gallo, interview by author, tape recording, Bethesda, Md., 3 November 1994.

129. The term "pollination" was suggested to me by Michael Botkin, interview by author, tape recording, San Francisco, 16 December 1993.

130. Gallo, interview.

131. Link, interview.

132. Ho, Neumann et al., "Rapid Turnover of Plasma Virions"; Wei, Ghosh et al., "Viral Dynamics." On the persistence of imagery of warfare in discourses about the immune system, see Emily Martin, Flexible Bodies: Tracking Immunity in American Culture—From the Days of Polio to the Age of AIDS (Boston: Beacon Press, 1994).

133. David D. Ho, "Time to Hit HIV, Early and Hard," New England Journal of Medicine 333 (17 August 1995): 450-451.

134. Marlene Cimons, "New Strategies Fuel Optimism in AIDS Fight," Los Angeles Times, 20 February 1995, A-1.

135. John S. James, "3TC Plus AZT: Important Treatment Advance?" AIDS Treatment News, 12 December 1994.

136. "Like the Wings of Icarus, Treatment Hype Sweeps Its Prey Upward to the Heavens, Then Plucks Them Down Into Icey [sic] Waters," TAGline, February 1995, 1, 3, 5.

137. Stephen D. Moore, "Wellcome Advises Shareholders to Accept $15.15 Billion Takeover Offer from Glaxo," Wall Street Journal, 8 March 1995, A-3.

138. Rick Loftus and David Gold, "Protease Inhibitors: Where Are They Now?" GMHC Treatment Issues, January 1995.

139. "AIDS Activists Seek Speedy Access to Protease Drugs," Nature 374 (2 March 1995): 4.

140. Diane Naughton, "Drug Lotteries Raise Questions: Some Experts Say System of Distribution May Be Unfair," Washington Post, 26 September 1995, Z-14.

141. Loftus and Gold, "Protease Inhibitors."

142. Claire O'Brien, "HIV Integrase Structure Catalyzes Drug Search," Science 266 (23 December 1994): 1946.

143. Warren E. Leary, "Experts Press for Fast Action on AIDS Drug," New York Times, 8 November 1995.

144. Philip J. Hilts, "Acting with Unusual Speed, Drug Agency Approves New AIDS Treatment," New York Times, 2 March 1996, 7; Philip J. Hilts, "With Record Speed, F.D.A. Approves a New AIDS Drug," New York Times, 15 March 1996, A-9.

145. Lawrence K. Altman, "A New AIDS Drug Yielding Optimism as Well as Caution," New York Times, 2 February 1996, A-1.

146. Daniel Hoth, interview by author, tape recording, Foster City, Calif., 11 July and 19 October 1994.

147. Jon Cohen, "Bringing AZT to Poor Countries," Science 269 (4 August 1995): 624-625.

148. Mark Barnes, "Treatment's High Cost," New York Times, 28 November 1995, A-14 (letter to the editor).

149. Richard Preston, The Hot Zone (New York: Anchor Books, 1994). For a more sober treatment, see Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance (New York: Farrar, Straus and Giroux, 1994).

150. Lawrence K. Altman, "AIDS Is Now the Leading Killer of Americans from 25 to 44," New York Times, 31 January 1995, B-8; "First 500,000 AIDS Cases—United States, 1995," Morbidity and Mortality Weekly Report 44 (24 November 1995): 849-853.

151. See Elizabeth Fee and Daniel M. Fox, eds., AIDS: The Making of a Chronic Disease (Berkeley: Univ. of California Press, 1992).

152. See H. P. Kitschelt, "Political Opportunity Structures and Political Protest: Anti-Nuclear Movements in Four Democracies," British Journal of Political Science 16 (January 1986): 57-85.

153. "Clinton Administration Names AIDS Panel to Speed Drug Search," New York Times, 7 February 1994, A-9.

154. Hoth, interview.

155. Jon Cohen, "AIDS Task Force Fizzles Out," Science 271 (26 January 1996): 438.

156. "15 Drug Firms Announce Alliance on AIDS Research," Los Angeles Times, 20 April 1993, D-2.

157. David R. Olmos, "The Cost of a Cure," Los Angeles Times, 2 March 1994, B-5.

158. Garance Franke-Ruta, interview by author, tape recording, New York City, 29 April 1994.

159. Braverman, interview.

160. Moisés Agosto, interview by author, tape recording, New York City, 26 April 1994.

161. Link, interview.

162. See Eric L. Hirsch, "Sacrifice for the Cause: Group Processes, Recruitment, and Commitment in a Student Social Movement," American Sociological Review 55 (April 1990): 243-254.

163. Sarah Schulman, My American History: Lesbian and Gay Life During the Reagan/Bush Years (New York: Routledge, 1994), 12.

164. Mark Harrington, interview by author, tape recording, New York City, 29 April 1994.

165. See Scott A. Hunt, Robert D. Benford, and David A. Snow, "Identity Fields: Framing Processes and the Social Construction of Movement Identities," in New Social Movements: From Ideology to Identity, ed. Enrique Laraña, Hank Johnston, and Joseph R. Gusfield (Philadelphia: Temple Univ. Press, 1994), 185-208.

166. Chris Bull, "No News Is Bad News," The Advocate, 13 July 1993, 24-27.

167. Franke-Ruta, interview.

168. Kolata, "Scientists Say U.S. Research on AIDS Needs Redirection."