Roger Spottiswoode’s film And the Band Played On, based on the book of the same name by Randy Shilts, is a tremendous drama that touches on many distinct issues that were present at the time of the discovery of the AIDS virus, as well as the curious resistance medical and disease experts experienced from affected populations, the government and even other medical professionals. Chiefly following a team of researchers at the CDC, led by Don Francis (Matthew Modine) and William Darrow (Richard Masur), the film follows the attempts of this organization and others to track the spread of the disease, discover exactly what it is and how it is being transmitted, and find ways to do something about it. Throughout the film, issues of medical and professional dominance, the responsibility of the public and medical establishments in dealing with the spread of AIDS, the apathy of the public towards the crisis, and conflicts between prevention and curing of major diseases.
There are several major themes throughout the film, most of them revolving around the nature of homosexuality and its impact on the way people treat the disease. Because this mysterious illness was occurring mostly among homosexuals at the time – a population that was barely recognized and tolerated in much of America in the 70s and 80s – the AIDS issue became inextricably tied with gay issues. To that end, as the government and other communities ignored the gay issue, so too did they ignore the AIDS issue. Furthermore, the need for many gay men to stay closeted made it even harder for researchers to track the disease, as people would have to keep their sex lives secret or express it in numerous dangerous ways (such as in public bathhouses). It became easy at first for the general public (and the Reagan administration) to not worry about it, as it was only happening to an undesirable population of the nation anyway; it is only after prominent figures begin to receive AIDS diagnoses and the numbers spread far wider than anticipated that any progress is made.
Another significant theme throughout the film is the push and pull between medical and bureaucratic dominance – the workers at the CDC encounter significant resistance from the federal government, who refuses to substantially fund research into the disease because the numbers sound too big, and are seemingly not cost-effective. The only real breakthroughs begin to come when important figures who have contracted AIDS (like Richard Gere’s choreographer character) start funding the CDC and other initiatives independently, organizations resorting to taking private money because public funding will not be found.
Even within the medical community, professional jealousy and ambition causes rifts and strained relationships between people who should be working on the disease, as Dr. Gallo (Alan Alda) does the best he can to ensure that he takes full credit for the discovery of the true AIDS retrovirus that the French scientists at the Pasteur lab actually discovered. By showing this conflict of medical dominance and professional dominance, the film demonstrates the conflict of interest the medical community will have in perpetuating itself at the expense of time, money and lives; spending so much time stonewalling important research for the sake of one’s personal pride is just one of many subjective stonewalls Francis and his team encounter throughout the film. And the Band Played On takes a decidedly sympathetic stance to the hard-working CDC officials who are working to investigate this disease and help to stop its spread, encountering significant barriers from a variety of places (which the film then ideologically opposes). First and foremost, the film explicitly blames Reagan and the Reagan administration for being apathetic and not caring about the AIDS crisis; the film is interspersed with newsreel footage comparing the blind optimism of the Reagan era to the harsh realities of AIDS-era America in the 80s. One particularly chilling juxtaposition comes when reporters talk of reduced budgets in all manner of government departments (including health care), only to cut to Reagan excitedly reporting that the Department of Defense is the only department whose budget increased that year.
He is greeted with thunderous applause, the film cutting to the Secretary of Defense, to show just how out of touch and disgusting these actions are. Reagan’s silence on the AIDS issue is well-documented, as it took him far too long to bring up the issue even after the federal government knew about it (Perez and Dionisopolous, 2009). To that end, it was clear that public health did not believe it had the responsibility for controlling the spread of AIDS, leaving it to an underfunded and stonewalled medical establishment. I believe that the most important point raised throughout And the Band Played On is the frustration and fury that should be felt at the establishment’s inability to do anything about the spread of the AIDS virus. Organizations such as the blood industry, the federal government, and even the gay community prevent sensible efforts from the CDC crew and Francis to stop the spread of AIDS, often for no good reason other than frugality. When the owner of the San Francisco bathhouse is called out for keeping his business open despite knowing the risks his clients are put in, he responds, “We're all in this for one thing: money. I make'em when the guys come in. You doctors, you make'em when they go out.” The capitalistic nature of all the industries involved takes a vested interest in people staying sick so they might capitalize on the problem.
The explicit link between capitalism and the healthcare industry implicates doctors as well, focusing on the profits they incur when they have more sick people to treat as opposed to spending more money early for preventative medicine. When Francis wishes to propose a $37 million “Phase Two” for AIDS education and outreach, Jim Curran (Saul Rubinek) notes that it’s too big a number for the government to approve. Francis replies that it is “cheap” compared to the billions they will be spending down the line if they do nothing now. This point cuts to the heart of the AIDS epidemic as presented in the film; no one cares enough to spend the money, as it does not seem like “their problem” yet. Currently, health resources are unfairly distributed towards curative instead of preventative measures, as this is one way to keep the cycle of illness going (“Medical Dominance”).
The importance of this focus on money over public safety (and the film’s resistance to that position) is summarized neatly in the climactic scene in which AIDS is named. After some of the blood industry’s blood for transfusions is found to be contaminated with AIDS, blood industry officials note that the cost to test their existing blood supply for the virus is too much for the relatively small numbers of AIDS sufferers from the transfusions, to which Francis replies, “How many people have to die to make it cost-efficient for you people to do something about it?” The unconscionable nature of the politics of commerce overriding the basic medical needs of the public is the most important point the film makes, and is arguably the thesis statement behind why investigation into the AIDS virus received such resistance.
One intriguing modern example (even foreshadowed in the film itself) is the recent Ebola outbreak, in which populations refused to believe that they have Ebola, and doctors failed to even diagnose the virus correctly (Stern, 2014). Like AIDS, Ebola is a virus very few in the culture it affects most understands, and is inextricably tied to their culture. Healthcare delivery and research into the Ebola virus is also performed in a similar manner to AIDS patients in the film; in And the Band Played On, the gay residents of San Francisco are resistant to the medical professionals in their field advocating for changes in their lifestyle (e.g. going to bathhouses) to prevent the spread of the disease. Meanwhile, in West Africa, Ebola sufferers and entire African villages are refusing to report their symptoms to medical professionals due to a sense of cultural paranoia at what they might do (Stern, 2014). Both African Ebola sufferers and gay AIDS sufferers lament their social or cultural identities being associated with the disease, which is an issue also touched upon within the film.
In addition to that, there are still substantial hurdles in the healthcare delivery system of preventative medicine, with much more medical funding and resources going to primary care facilities than is proportional, with most health care resources going to 1% of the population that is in hospital care (“Medical Dominance”). In Canada itself, we will soon be running into substantially higher health care expenditures given the rising of population age and lower numbers of working Canadians (MacDonald-Dupuis, 2013). Currently, Canada is the fifth most expensive country in the OECD for spending money on health care, pointing to substantial inequalities in health care delivery – much of this is on curative rather than preventative care (MacDonald-Dupuis, 2013). This points to the examples in the film of entrenched public and private medical industries being unwilling to change policies, even when money would be saved in the long run by spending more on preventative care now.
And the Band Played On discusses many of these issues and more in great detail, pointing out how deeply-entrenched homophobia, the conflict between medical professionals over credit and dominance, and an apathetic public government and civilian population made the spread of AIDS even worse than it could have been. The film clearly advocates for medical dominance, giving them the resources they need to get things done; however, the complex sociopolitical situation that is explored in the film cannot be so easily addressed with such simple answers. Much like with modern issues of the Ebola outbreak and inefficiencies in the Canadian health care system, dramatic changes need to be made to make our health care outcomes more positive.
References
MacDonald-Dupuis, N. (2013). The problem with Canada’s unsustainable health system.”
Huffington Post. Retrieved from. http://www.huffingtonpost.ca/natasha-macdonalddupuis/the-future-of-canadian-healthcare_b_4429892.html.
“Medical dominance.” (n.d.) HLSC 2802.
Perez, T. L., & Dionisopoulos, G. N. (1995). Presidential silence, C. Everett Koop, and the surgeon general's report on AIDS. Communication Studies, 46(1-2), 18-33.
Shilts, R. (1987). And the Band Played On: Politics People and the AIDS Epidemic. St. Martin’s Press.
Spottiswoode, R. (dir.) (2003). And the Band Played On. Perf. Matthew Modine, Ian McKellen. HBO Films.
Stern, J.E. (October 2014). Hell in the hot zone. Vanity Fair. Retrieved from http://www.vanityfair.com/politics/2014/10/ebola-virus-epidemic-containment.
