Of lions, crocodiles and baboons

SAN FRANCISCO — SAN FRANCISCO -- It is after hours and the AIDS clinic at San Francisco General Hospital is almost empty. Just one patient remains, confused and emaciated, waiting for a ride home.

Steven Deeks, who works here, stops to help the man he calls "Dallas" with one of the smaller indignities of this disease. The doctor calls again for a cab to come to an address the drivers may know too well and avoid too often.


For three years, Dr. Deeks has kept a name and address book of 100 AIDS patients. Sixty have died and half the remaining 40 have moved on to late-stage disease. Just today, the 33-year-old doctor tells me, a patient his own age, a man just beginning his professional career, came in exhibiting the terrible, unmistakable first symptoms of AIDS-related dementia.

Working as he does, among patients with advanced disease, Dr. Deeks is not ashamed to describe himself as frustrated or even "a little" desperate. "In an epidemic," he says calmly, "things can't always be done in a conservative manner."


So it is no wonder that the doctor took a risk. Last month, he became part of the most highly publicized -- indeed sensationalized -- AIDS research in memory. He performed a baboon bone-marrow transplant to see if cells from an animal that does not get HIV could boost the deteriorating immune system of a human with the disease. And, he said, "I had no qualms."

If Dr. Deeks' desire to try something was understandable, so surely was Jeff Getty's desire. Mr. Getty advocated for this experiment, pushed for FDA approval, and volunteered to be the subject.

After all, Dr. Christiaan Barnard might have been writing about Getty when he described the state of mind of his first heart transplant patient this way:

"If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water, convinced you have a chance to swim to the other side when you would never accept such odds if there were no lion."

With the lion of AIDS chasing Mr. Getty, the 38-year-old who told me to call him an AIDS "activist" and not a victim, was determined "not to just lie down and die." If nothing else, he would devote his body to search for a cure.

Now, little more than a month and innumerable banana jokes since the transplant, Dr. Deeks doesn't yet know whether the baboon cells have had any effect. But Mr. Getty has become a star of print and video in a controversy that labels him either a hero or a threat to humanity.

Mr. Getty has become as well the poster boy in an ethical debate about front-line medicine. What risks should medicine take for what chance of cure? What are the costs and benefits of research in a disease that has seen so many hopes raised and dashed?

Mr. Getty's claim to heroism comes from his role in the quest for the cure. But the threat in this xeno-transplant from baboon to man is that another devastating disease could "jump" from one species to another -- as AIDS itself did. It's the fear that a transplant recipient's body could be the perfect halfway house.


The likelihood that Jeff Getty would provide such a halfway house is virtually nil. The Food and Drug Administration approved this procedure for one man, one baboon.

Public health danger

It's easy to monitor a study of one. But you do not have to be a screenwriter to script the next scene with 50 clinics, 20 baboons, 1,000 patients -- an impossible tracking job and a public health danger that, in a worst-case scenario, could outrank AIDS.

As ethicist Art Caplan at the University of Pennsylvania says, the baboon transplant "would be bad if it failed. It would be worse if it worked."

Optimistic researchers talk about a temporary boost to the immune system, not a cure for AIDS. It may be unpopular to put price tags on health care -- or on life -- but are we ready to pay some $200,000 or more for a "boost" when the federal Centers for Disease Control estimate there are between 750,000 and 1.2 million Americans with AIDS or HIV? Where would the hundreds of billions come from? And at the cost of pursuing what other avenues of AIDS research?

Every researcher holds some candle of promise, if only the elusive hope that "we will learn something." But the social risks and costs of baboon bone-marrow transplants are far too great for too small a promise, too vague a hope.


Here, in the busiest AIDS clinic in America, keenly aware of the devastation of this disease, it is possible to admire the bravery of an AIDS activist and the humanity of his doctor, and still believe they are going down the wrong path.

Even a society being chased by the lion of AIDS may have more to fear from the crocodiles in the river.

Ellen Goodman writes a syndicated column.