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1996-07-08
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From the Radio Free Michigan archives
ftp://141.209.3.26/pub/patriot
If you have any other files you'd like to contribute, e-mail them to
bj496@Cleveland.Freenet.Edu.
------------------------------------------------
THE WALL STREET JOURNAL THURSDAY, DECEMBER 2, 1993
Good (Hidden) News About the AIDS Epidemic
By Robert S. Root-Bernstein
Statistics of any kind are difficult to interpret, and AIDS
statistics are no exception. Indeed, the latest statistics
released by the Centers for Disease Control are so odd as
to be virtually indecipherable. One begins to suspect the
difficulties have been introduced on purpose.
On Oct. 30, the CDC released a report contending that AIDS
has become the top killer of U.S. males age 25 to 44, and
the fourth leading killer of women in the same age
group-statistics that received wide currency in the lead-up
to World AIDS Day yesterday. Although the report states clearly
that part of the reason for the sudden upsurge in AIDS cases
is due to a new expanded definition that went into effect
a year ago, it nonetheless presents the data so that the
implications of this change are far from obvious.
Between January and September of 1992, 60,656 people were
diagnosed with AIDS and reported to the CDC. Between January
and September of this year, 85,526 new AIDS patients were
reported to the CDC, an increase of 41% from the year-earlier
period. One's first impression is that the epidemic continues
to worsen.
The CDC report immediately cautions that the huge increase
in new AIDS cases does not mean that AIDS is mushrooming.
Most of the increase, it says, is due to changes in the
definition of AIDS that vastly expanded the diagnostic criteria
at the beginning of this year. These definitional changes
were predicted to more than double the number of reported
cases and, indeed, the number of cases reported under the
new definition account for more than half of all those reported
so far this year.
Interestingly, though, no one seems to have noticed that
if the number of cases diagnosed under the new definition
was to be more than twice the number found under the old
definition, and AIDS has continued to grow at the same rate
as before, then the total number of AIDS cases reported this
year should be not 41% higher than for the same period last
year but more than 100% higher. Why the discrepancy?
Even odder, CDC officials claim that when the new
definitional bias is taken into account, AIDS is only
increasing about 3% to 5% a year, as it has been since 1990.
The definitional changes simply allowed many people who were
going to get AIDS someday (according to the old definition)
to be diagnosed (and treated) sooner. That is good for people
with AIDS, but what does it do to our ability to track the
course of the epidemic?
The CDC itself admits that over half of the new cases
reported this year are due to the new definition: 48,915 of
the 85,526. In other words, only 36,611 of the AIDS cases
reported so far this year would have qualified as AIDS cases
according to the old definition. That is 20,045 fewer AIDS
patients in 1993 than the 60,656 diagnosed during the same
nine months in 1992. This is a drop of 33%, not an increase
of 3% to 5%.
So, are AIDS cases increasing steadily at 3% to 5% a year,
as the CDC claims without any apparent justification - or
are they decreasing drastically by some 30%? If all the people
who have been diagnosed as having AIDS according to the new
definition would eventually have been diagnosed as having
AIDS according to the old definition a fact the CDC itself
admits- then is it not possible to see the current glut of
large numbers as a form of artificial inflation designed to
impress the CDC's clients just at a time when, in fact, the
AIDS epidemic may have peaked and be on its way down?
The crucial information is the number of people who would
have been diagnosed with AIDS according to the new definition
had it been in place in 1992, or 1990, or even 1985. These
data do not, and can never, exist.
Even worse, this is not the first time that the definition
of AIDS has been altered to increase the number of diagnoses.
The definition change implemented in 1985 increased the number
of AIDS diagnoses about 2% a year over the 1984 definition;
the 1987 change increased new diagnoses 30% to 40% a year;
and now the new changes more than double the number. Anyone
simply plotting AIDS statistics provided by the CDC year by
year will be terribly misled by the resulting graph for the
simple reason that the numbers represent apples one year;
apples and oranges another; apples, oranges and bananas a
few years later; and so forth.
As James O. Mason, assistant secretary of health and human
services, told the Los Angeles Times in 1991 when the latest
alterations were proposed, changing definitions "messes up
the baseline for comparison from past to future" and "will
make the interpretation of trends in incidence and
characteristics of cases more difficult." Perhaps that is
the point.
Perhaps the CDC does not want anyone to recognize what some
statisticians and actuaries have been predicting for several
years now; that AIDS peaked sometime between 1989 and 1992
in the U.S. and is on its way down. Indeed, according to one
of the best validated principles of epidemiology- Farr's law-
the epidemic should proceed at the same rate that it arose.
Think of it: Perhaps those people who were most susceptible
to AIDS have already contracted the disease and it will remain
within high risk groups, as the National Research council
report predicted last year. Or even better, maybe safer sex
campaigns, clean needle exchanges and better health care are
having their effects. Is it really so unthinkable that there
is good news on the AIDS front that we cannot face it when
it appears?
The upshot of this lesson is a simple one. The CDC is
comparing apples with apples and oranges. That it can get
away with such sleights of hand only goes to show how really
deeply innumeracy runs in this society; innumeracy so pervasive
that not even our science reporters, our AIDS activists and
our researchers seem to notice. Or is it worse, even, than
not noticing. Have we reached the stage in AIDS advocacy that
we will mislead in order to succeed?
Mr. Root-Bernstein is a professor of physiology at Michigan
State University. He is the author of "Rethinking AIDS", Free
Press.
------------------------------------------------
(This file was found elsewhere on the Internet and uploaded to the
Radio Free Michigan site by the archive maintainer.
Protection of
Individual Rights and Liberties. E-mail bj496@Cleveland.Freenet.Edu)