By Arturo Casadevall and Ferric C. Fang
As young doctors in the 1980s, we witnessed the devastation of the AIDS epidemic. In those early years, patients died within months of diagnosis, often in agony, suffering headaches, diarrhea, shortness of breath and even blindness. Yet medical science fought back—first identifying the virus, then developing a diagnostic test and coming up with treatments. By 1996, highly effective therapy was available. While much work remains, in particular the development of an HIV vaccine, the response to AIDS stands as a success story in the history of medicine.
At a time when federal funding for medical research faces deep cuts, it’s important to remember especially one key part of this story—the part that took place well before AIDS was ever discovered in people. The fact is, progress against AIDS did not come from maximizing therapeutic options that were available in 1985. HIV-infected patients did not do better because they were given clean bed sheets, better social care or drugs already available at the time. The breakthroughs came in the form of new medicines that grew out of fundamental research carried out decades earlier.
Back in the 1960s and ‘70s, scientists studied retroviruses that caused cancer in animals, but weren’t associated with human disease. They discovered that these viruses produce a long protein and that, for the viruses to successfully replicate in cells, this protein needs to be cut into smaller pieces by an enzyme known as a protease. The researchers figured out that interfering with the protease kills the virus. And AIDS researchers in the 1980s and ‘90s built on this knowledge to create extremely effective antiviral drugs known as protease inhibitors.
Today, retroviruses are known to cause not only AIDS but also adult T-cell leukemia/lymphoma and several other diseases. Incidentally, this avenue of research also led to drugs that can cure hepatitis C. The whole experience demonstrates how curiosity-driven basic research of no apparent significance to people can transform human health in unexpected ways.
That kind of basic science is under siege—and has been since even before President Donald Trump began calling for drastic cuts to medical research. At the end of the George W. Bush administration, the National Institutes of Health started to demand evidence that the research it funds have “significance” to human health—some indication that it will improve “scientific knowledge, technical capability, and/or clinical practice.” Yet as the AIDS story demonstrates, the significance of research may be evident only in retrospect.
Humanity has never needed science more than it does today, as it confronts existential threats from environmental degradation, population growth, new infectious diseases, climate change, antibiotic resistance and a failing green revolution —to name a few. Tackling these problems will require generous and consistent investment in all sorts of basic science, whether or not it has any practical application that’s obvious today.