Shots in the Dark by Jon Cohen, W. W. Norton, 拢21.95, ISBN 0393050270
鈥淢Y fellow Americans, if the 21st century is to be the century of biology, let us make an AIDS vaccine its first great triumph.鈥� Bill Clinton鈥檚 impassioned plea to the American people in 1997 is credited with putting new life and vigour into the stagnant field of HIV vaccine research. But his speech came a good nine years after the date set by the US Department of Health and Human Services to introduce a testable vaccine. What had gone wrong?
Jon Cohen鈥檚 highly critical account of the conduct of the HIV research community over the past decade may shock readers unfamiliar with the ways of scientific research. If you believe, or even merely hope, that science advances untainted by personal ambition or political gain, you鈥檒l be deeply disturbed by the painfully slow progress chronicled in Shots in the Dark. It鈥檚 unsettling enough for those of us who already appreciate that the apparent objectivity of scientific theory is profoundly influenced at every level by individual bias or personal beliefs-and even further, by wider social and political pressures.
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A well-respected science journalist, Cohen originally planned to describe a year in the search for an AIDS vaccine. But as researchers were soon to discover, developing a vaccine would take far more than a year, so Cohen took another tack. Still optimistic, he decided to focus on how the first effective HIV vaccine emerged from the laboratory into the marketplace. Several years after he began writing Shots in the Dark, Cohen came to appreciate that he was in for a marathon. And as we know all too well, the hope of an AIDS vaccine has yet to be realised.
At the core of his book lies disappointment. Everyone involved, from politicians to scientists, has failed, he says. They did not cooperate to tackle one of the greatest health threats faced by humanity.
So what does Cohen want? He calls for a unified effort that combines basic research with applied research programmes. We also need large-scale primate studies with clear end-points to evaluate different vaccination strategies in head-to-head comparisons.
The imposing figure of the virologist Jonas Salk strides through this book. 鈥淭here must be a better way,鈥� said Salk when the search for a polio vaccine began. This quote becomes Cohen鈥檚 mantra: if the search for an HIV vaccine had prompted a similar response to the 1950s campaign for a polio vaccine, then we might be in sight of our goal by now.
Salk is more vividly painted than all the other players in the quest for an AIDS vaccine. Wayne Koff, scientific director of the International AIDS Vaccine Initiative, appears as a man with 鈥渁 firebrand鈥檚 heart disguised by the nerdy beard-and-glasses look he favoured鈥�. Jim Scott, a key figure in the British HIV research programme, is a 鈥済ood-natured hobbit of a man鈥�.
Cohen鈥檚 strong US-centred approach ignores European iniatives to coordinate AIDS vaccine research. But overall this is an excellent book, carefully researched and enjoyable to read. If the narrative is confusing at times-lurching from one small step forward to describing an outbreak of hostilities among researchers or acrimonious exchanges between the scientific community and the pharmaceuticals industry-then this only reflects the erratic progress of most scientific endeavour. Anyone involved in resolving the tensions between basic and applied research to answer a fundamental scientific question will find much in Shot in the Dark to take to heart. His most important message is that this story is far from over.