An Outbreak of Sensationalism

By Christine Gorman

Most people think that fear should have no place in the cool, reasoned realm of medicine. But its presence, strengthened by prejudice and denial, has whipsawed the public response to AIDS -- from early dismissal to doomsday and back again -- ever since the epidemic began seven years ago. Last week, in a sensationalistic book guaranteed to punch panic buttons across the nation, Sex Therapists Dr. William Masters and Virginia Johnson triggered an uproar in the scientific community. Contrary to accepted wisdom and to all that is so far known by medicine, they claim the "AIDS virus is now running rampant in the heterosexual community" and can be transmitted through casual contact. Says Masters: "We are sounding an important warning. A lot of people think we are not in a serious situation. We think we are."

Together with Co-Author Dr. Robert Kolodny, who directed the research for Crisis: Heterosexual Behavior in the Age of AIDS (Grove Press), the first couple of sex treatment charge the government with "benevolent deception" in downplaying the extent and nature of the epidemic. Among their assertions:

-- At least 3 million Americans, twice the official estimate, are infected with the AIDS virus.

-- The risk of catching AIDS from a transfusion is seven times as great as that admitted by blood banks.

-- The AIDS virus -- theoretically at least -- can be transmitted via mosquito bites, French kissing, toilet seats -- and by sliding into second base (if, by chance, an infected player has bled onto it).

Reaction from AIDS experts has ranged from "drivel" to "hogwash." U.S. Surgeon General C. Everett Koop promptly called the work "irresponsible" and accused Masters and Johnson of "scare tactics." "There are no scientific data to support these alarming statements," warned Dr. Stephen Joseph, New York City's health commissioner. "They pile their statements, each holding a thin layer of established fact, on top of one another like slices of bologna." Many criticized the trio for first publishing their findings in a mass-market book, which was excerpted last week in Newsweek, instead of in a scientific journal where their data would have been carefully scrutinized. A Chicago Tribune editorial blasted the "panic-peddling book," and the New York Times decried its "false alarms about AIDS." Callers seeking clarification jammed AIDS hot lines. Fumed Epidemiologist Andrew Moss of the University of California at San Francisco: "This is the AIDS equivalent of shouting 'Fire!' in a crowded theater."

Crucial to the argument set forth in Crisis is the authors' contention that at least 3 million Americans are infected with the AIDS virus. Masters and his associates arrived at that figure by a fairly straightforward calculation: if there are 50 to 100 symptomless carriers of the AIDS virus for every case of actual disease, as was first noted in 1985, and there were 45,000 cases of AIDS in the U.S. in late 1987, then one would now expect about 3,375,000 people (75 X 45,000) to be infected with the virus.

Simple as it is, the arithmetic is also dead wrong. When the epidemic first got under way, there were few cases of AIDS and the virus was spreading among a largely uninfected gay population; thus the ratio of carriers to cases was high, explains James Curran, director of the AIDS program at the federal Centers for Disease Control (CDC) in Atlanta. Today, thanks to a widespread education campaign and safer sex, the rate of new infection among gays has dropped dramatically. But naturally the number of infected people who fall ill continues to rise. As a result, among gays, the ratio of carriers to cases is now 20 to 1. Says Curran: "As the epidemic ages, the ratio will get smaller."

For their study, the sex therapists recruited 800 people from churches, colleges and singles bars in New York City, Atlanta, St. Louis and Los Angeles. They found that only 1 of 400 people who had been monogamous for the past five years tested positive for AIDS antibodies. However, 6% of the group that reported at least six sex partners a year were infected. Masters, Johnson and Kolodny admit that their results "cannot be easily generalized" because those studied were not representative of the population at large. Despite this disclaimer, they conclude, "the AIDS virus has certainly established a beachhead in the ranks of heterosexuals, and . . . the rate of spread among heterosexuals will now begin to escalate at a frightening pace."

While there has not yet been a national study of the general prevalence of the virus, no large-scale studies support the Crisis contention. To the contrary. Since 1985 the Department of Defense has tested nearly 4 million military personnel and found a stable .15% rate of infection. About .2% of the 8.8 million blood donors screened each year by the American Red Cross are infected. "AIDS is making some encroachments into the heterosexual community," says Dr. Douglas Dieterich of New York University Medical Center. "But it is grossly exaggerated to claim that it is running rampant."

Similarly, the sex therapists argue that the chance of catching an AIDS infection from donated blood is not 1 in 40,000, as the blood-bank industry now claims, but 1 in 5,418. They derive that figure from the highly inflated statistic of 3 million AIDS virus carriers. Even then, they do not allow for the fact that 80% of the nation's 18.8 million blood units come from repeat donors, who have a much lower rate of infection.

The most misleading of the authors' assertions, however, fall in the chapter titled "Can You Catch AIDS from a Toilet Seat?" They accurately report that the risk of infection from a source other than sex, contaminated needles, blood or the womb is practically nil. But they proceed to describe in vivid detail how it might be "theoretically possible" to contract AIDS from, among other things, contact lenses, a salad in a restaurant or instruments in a doctor's office. The farfetched examples are so memorable that the caveats are quickly forgotten. Worse, the therapists call for mandatory AIDS tests of all pregnant women, hospital patients between the ages of 15 and 60, convicted prostitutes and marriage-license applicants. Health officials have repeatedly said that such tests are not medically or economically worthwhile and risk driving the disease underground.

In their defense, the Crisis trio argue that it is up to the medical community to prove them wrong. As a practical matter, however, scientists cannot prove that something will never happen. Even so, in a dozen studies conducted on some 500 people living with AIDS-infected relatives, not a single case of casual transmission has occurred, even though they shared toothbrushes, toilets, cups, plates, toys and bed linens. "They've created a straw man," says CDC's Curran. "Let them prove that it is true."

The current furor, says Bernie Zilbergeld, an Oakland psychologist and longtime critic of Masters and Johnson, stems from what he terms their "chronic inability to be precise." For example, he asks, how do they know that their 400 nonmonogamous study subjects were not bisexuals or IV drug abusers? Epidemiologists long ago learned that people often admit to risky behavior only after they have been told they test positive. Yet Masters and Johnson did not extensively question their subjects about high-risk behavior.

"They could have done a great service by concentrating on present-day sexual habits rather than the epidemiology of AIDS," says New York's Joseph. "We need in-depth, scientifically obtained knowledge about sexual behavior these days." Studies have consistently shown that heterosexuals at high risk and their partners frequently resist practicing safer sex even though they know the consequences. Research by Masters and Johnson in their own area of expertise, he argues, could have produced effective ways to motivate the recalcitrant.

For now, the danger is that the furor will divert attention and resources from the real heterosexual epidemic -- the one raging in the inner city among IV drug abusers, their sexual partners and children. The alarmist prophecies promoted in Crisis may discredit ongoing efforts to control the disease. "This plants the seeds of distrust in a group that the public should be able to look to for answers," argues Mervyn Silverman, former San Francisco public health director. Crying wolf, as Masters and Johnson have done, is no way to fight an epidemic.

With reporting by Scott Brown/Los Angeles and Joyce Leviton/Atlanta