[Greenberg is an American journalist, critic, and editor and publisher of Science and Government Report, a newsletter that analyzes American politics, particularly as related to science and health issues. In the following review, he offers praise for And the Band Played On.]

When the files and memoirs become available, all long wars are revealed to have been badly fought. It could not be otherwise with the AIDS epidemic, given the disease's stealthy spread, the outcast populations it initially struck and its scientific intractability. Most important, however, was a horrific coincidence: the simultaneous arrival in the United States in 1981 of an uncompassionate, overtly homophobic presidency and a mysterious, fatal affliction transmitted mainly through the sex practices of male homosexuals. The ingredients for calamity were abundant, and the forces opposing them turned out to be feeble.

The begrudging response to AIDS by the world's greatest scientific and medical power is copiously reported and analyzed in And the Band Played On, a remarkable narrative by Randy Shilts, a San Francisco Chronicle reporter who's been on the AIDS beat from the beginning. Organized in chronological, datelined sections starting with the belatedly recognized hints of AIDS in medical data collected in the mid-1970s, it ranges worldwide, detailing public and private events, sometimes day by day. The story of the epidemic is recounted through the experiences of obscure and well-known patients, the few physicians and researchers who futilely tried to sound early alarms, their political allies and opponents, from San Francisco City Hall to Congress, and the scurrilous scientific infighting that long delayed reliable identification of the AIDS virus.

Shilts occasionally dwells on trivialities; he favors overly florid passages and grants excessive credence to unsupported gossip. But this is otherwise a solid journalistic performance, sure to be a durable study of the AIDS debacle.

Of particular importance is his account of the press's indifference to the early stages of the epidemic, when journalistic alarms might have aroused political attention and freed urgently needed money for basic epidemiology and other fundamentals of disease control. Shilts notes that AIDS, first reported in the medical literature in June 1981 and excitedly discussed in widening scientific circles from then on, merited only six articles in The New York Times in the following eighteen months, none on page one. The focus of coverage, then and even in today's glut of press attention, was on episodes and dangers of heterosexual spread. In August 1982, when carefully supported warnings about AIDS were regularly coming from even conservative scientific quarters, Dan Rather earnestly reported, "Federal health officials consider it an epidemic. Yet you rarely hear a thing about it." The broadcaster to millions, in full command of choosing what to broadcast, did not explain the neglect. However, he added, "At first it seemed to strike only one segment of the population. Now, Barry Peterson tells us, this is no longer the case." Peterson concluded his performance by noting, "But there is almost no money being spent so far." What was being spent, Shilts relates, had either been raised privately or was in Federal accounts that the White House had marked for severe reductions.

There is also a skillful account of the blood banking industry's last-ditch battle against antibody screening, a battle that was waged long after the transmission routes of AIDS had been clearly identified. This story is one of the lesser-known villainies in the egregious history of AIDS, but Shilts weaves it into the chronology, noting that the bumbling Health and Human Services Secretary, Margaret Heckler, delivered assurances that the nation's blood supply was safe long before protective screening was instituted.

At the emotional center of Shilts's account is the devastated gay community of San Francisco. He displays affection for its proud, aggressive style of gay liberation, but also anger and dismay at its prolonged, suicidal unwillingness to alter the sexual behavior that was clearly accelerating the spread of the disease. The battles of the bathhouses constitute a tragic episode in denial and self-delusion, and Shilts tells it all.

But the main story here, the one that is more thoroughly documented by Shilts than by any other reporter, is the aloof and ignorant meanness that the Reagan White House brought to the AIDS crisis. The attitude continues to this day; it manifests itself in presidential silence about AIDS-afflicted children—though Reagan is ever ready to plead for a spare organ for a child dying of a socially respectable disease. A conservative judiciary is routinely taken to be the twenty-first-century legacy of this Administration. But, given the precious time that Reagan squandered in confronting AIDS—even long after his own biomedical advisers proclaimed a calamity in the making—he may well have assured himself an inglorious, enduring place in an unlikely quarter: medical history. Money for AIDS research and education has finally increased to respectable levels, but this has been done at the initiative of Congress and over the resistance of the White House.

Shilts's account shows that the nation's early warning system for disease—practicing physicians in collaboration with the Federal Centers for Disease Control—functioned well in recognizing that a vicious, unknown pathogen was suddenly on the loose. The ability to find and counter these menaces had previously brought renown to the C.D.C. for such feats as its swift identification of the organisms that killed American Legionnaires in Philadelphia a decade before. The difference with AIDS, however, was that the first known victims were homosexuals, many conspicuously defiant about their sexual life style. Next came another pariah group, needle-sharing intravenous drug users. They were unreachable by scientific evidence or reasoned pleas, while the politically well-organized gay communities initially reviled the AIDS data as a homophobic invention designed to erode their hard-won liberation.

The combination of defiant gays and indifferent addicts might have been enough to extinguish the weak public health instincts of the newly installed Reagan Administration. But Shilts fails to give proper weight to another element: the fiscal austerity of the new Administration, which was on high alert against the budget-busting ingenuity of the Federal biomedical research establishment. The great performer in this annual feat was the National Institutes of Health, which had regularly eluded White House budget control by quietly collaborating with socalled disease-of-the-month lobbies that played on Congressional heartstrings.

In September 1981, three months after the C.D.C. published the first reports of AIDS-related pneumocystis carinii pneumonia, the National Cancer Institute, the biggest and most public-relations-minded part of the multi-billion-dollar N.I.H. complex, held a conference to stake out jurisdiction over what later came to be identified as AIDS. Without any sense of urgency, it was there decided to send out invitations to apply for research funds.

The Cancer Institute, fighting its own battles with budget director David Stockman, then relegated the AIDS problem to its leisurely review process for grant applications. This meant that virtually no research funds went out for nearly two years. Could N.I.H. have moved faster? To think so is to confuse a science department with a fire department. N.I.H., more like a cluster of university graduate institutions than a politically responsive Federal agency, has long cultivated careful deliberation in awarding its bountiful budget. Bedazzled by fears of disease and promises of cures, Congress has obligingly enriched N.I.H. and shielded it from the White House. When AIDS came along, N.I.H. had the money and independence, and a long tradition of dedication to science rather than sickness. What it lacked was a crusading spirit to get after AIDS. The necessary passion was present in the Centers for Disease Control, but that organization lacked the money. With a budget one-tenth the size of N.I.H.'s, the C.D.C. was forced to rob syphilis-control programs to chase after AIDS. And, on orders from the White House, C.D.C.'s managers assured a bewildered Congress that the funds on hand were sufficient for the task.

Meanwhile, most top-flight researchers—well supported by cancer money and deep into their own projects—shunned the AIDS problem, many of them thinking it would blow over quickly, like Legionnaires' disease, and therefore wasn's worth a detour in career plans. One exception, of course, was the Cancer Institute's Robert Gallo, who stands widely accused of filching the Pasteur Institute's AIDS research in his pursuit of the Nobel Prize. Second-string scientists, though eager for money, failed to meet the Cancer Institute's strict standards for its prestigious grants. What was lacking was enough political fire to ignite the complacent biomedical establishment. And the indifference of the press in the early years was largely responsible for the absence of that political fire.

Would the lost years have made the difference between a horrible but limited epidemic and a worldwide catastrophe? There's no certain answer, especially since it is now known that AIDS was incubating for many years, perhaps over a decade, before the first cases were identified. What's cooking out there now is unknown, as are the prospects for ingenious developments in research. It is clear that a simple lack of funds in those early years prevented the research that should have underpinned the long-term strategy of public education, experimental treatments and vaccine development.

Shilts states toward the end of this huge, commendable work that

everbody agreed that the baths should have been closed sooner; they agreed health education should have been more direct and more timely. And everybody also agreed blood banks should have tested blood sooner, and that a search for the AIDS virus should have started sooner, and that scientists should have laid aside their petty intrigues. Everybody subsequently agreed that the news media should have offered better coverage to the epidemic much earlier, and that the federal government should have done much, much more. By the time everyone agreed to all this, however, it was too late.