The AIDS Guerrillas : ACCEPTABLE RISKS, <i> By Jonathan Kwitny (Poseidon: $24; 384 pp.)</i>

Much as discrepancies of class cause crime and riots, discrepancies of knowledge also cause social unrest. A case in point is modern medicine: As it becomes more and more inaccessible to the general public, we can see a form of revolt, an uprising in which the masses, starved by ignorance if not by famine, attempt to take back what they have lost to their internists: the control of their health and well-being.

When anarchists as subversive as grandmothers start smuggling experimental drugs across the Mexican border in their Winnebagos in a last-ditch effort to save the lives of their AIDS-stricken grandsons, and when a New York group of gay activists starts distributing bootleg batches of alpha interferon by placing it on communion wafers for purposes of ingestibility, evidence would seem to suggest that we are witnessing a silent revolution, a revolt of the people, not against the tyranny of its rulers, but that of its druggists and doctors.

A major contribution to the vast literature on AIDS, “Acceptable Risks” is by far the best and most complete history that has been published to date of the pharmaceutical underground that has arisen to circumvent the sluggish procedures of bureaucracies like the Food and Drug Administration, whose resourcefulness in protecting consumers from untested products has become, in the most literal sense of the word, lethally effective. Jonathan Kwitny’s riveting book challenges the blind faith we place in the medical status quo and questions our most basic assumptions about the competence of governmental officials in looking after our best interests and functioning as the final arbiters in life-and-death issues of what we can and cannot take to heal ourselves.

Using novelistic techniques that at times come perilously close to those of pulp fiction, Kwitny organizes this harsh indictment of federal AIDS policy around two deservedly radiographic portraits of Jim Corti and Martin Delaney, a nurse and a corporate communications consultant respectively, who, working independently of each other, became the cunning strategists of an international drug-trafficking scheme. When their lovers became sick with AIDS, they were quickly swept up in an undercover smuggling ring that imported into the United States unapproved yet promising AIDS treatments available on foreign markets.

If Delaney is the driving intellectual force behind this vast conspiracy, Corti operates on a grass-roots level as a diabolically ingenious black marketeer, a jet-setting AIDS folk hero who crisscrosses the globe like a roaming bandit, amassing huge quantities of medical contraband that he immediately dumps at cost on eager American markets. Driving a mini-bus that came to be known among his customers as the “Virus Van,” Korti began his romantic career as the legendary kingpin of his own private drug cartel by looting the pharmacies in Tijuana for anti-viral drugs, an activity that soon led him to China, where he succeeded in acquiring the controversial medicine Compound Q by bribing lecherous young Maoists with pornographic tapes of “Debbie Does Dallas.”

While Korti was abroad hammering out deals with pharmaceutical companies and scavenging around Europe for the latest drug treatments, Delaney was operating on the home front, lobbying furiously against the entrenched medical interests of an unwieldy health- care system that had established an incestuous alliance with big business. Exhibiting a real genius for influencing even the most conservative public officials, he helped make experimental drugs available to AIDS patients long before the FDA, bogged down in red tape as well as in its own internal squabbles, could make the iron-clad case for their safety and effectiveness which, up until recently, federal policy had required before the commercial release of a product on American markets.

When Delaney wasn’t exposing the fraud of profiteers who played upon the hopes of the terminally ill with kitchen potions ranging from coffee enemas to urine injections, he was fighting tooth and nail to force the FDA to reform the sadistic procedures with which its researchers selected subjects for clinical trials. His heroic struggles resulted in a whole series of unprecedented changes in an antiquated drug-approval process that once allowed thousands to die by depriving them of medicine that showed promise, if not what is referred to in governmental bureaucratese as “statistically significant efficacy.”

Kwitny’s account of the medical gridlock that has paralyzed Washington during the Bush and Reagan Administrations provides a bleak picture of the indecisiveness and passivity of federal officials, whom many gay activists have described as the bureaucratic instruments of nothing less than a Republican thanatocracy. Although Corti and Delaney dismiss ridiculous charges of premeditated genocide, they do show that, under the circumstances, traditional medical safeguards against the reckless use of untested products are not only counterproductive but also impossible to enforce.

Experiments conducted under the auspices of prominent AIDS researchers like Paul Volberding, whom Kwitny describes as an unscrupulous careerist, have been undercut by the desperation of sick people whose first priority is to survive rather than to offer themselves up as self-immolating martyrs to that most inhuman of scientific requirements, the incontrovertible determination of a treatment’s “statistically significant efficacy.” Sick lovers have been known to impair the value of the data collected in experimental studies by sharing drugs with each other when only one of them meets the criteria for acceptance into a medical trial. Participants in other clinical studies have sabotaged the test results by pooling the medicine they are given and then divvying it out among themselves in order to cut down on the chances that they are receiving a placebo. The book makes a compelling plea for the rationality and common sense that have been so strikingly absent from the federal response to an epidemic that is revolutionizing our attitudes toward the compassionate use of potentially dangerous drugs.

While “Acceptable Risks” provides such a thorough and cogent history of an extraordinary chapter in the politics of medicine that it should be required reading for any health official, the book does have one weakness that raises important questions about the representation of the epidemic for the American public, even if it doesn’t reflect negatively on the uncompromising integrity of these two ferocious opponents of governmental ineptitude. Kwitny’s important new study belongs to a genre that was invented for a mass-market readership, a form of journalism that caters to those whose tolerance for straightforward reportorial narrative is minimal--the literary equivalent of TV docudrama, a tendentious and often candidly propagandistic investigative report that employs all the techniques of fiction to express its author’s righteous indignation.

At times, “Acceptable Risks” masquerades as novel, using such rhetorical devices as deceptively verbatim recreations of dialogue, brooding evocations of atmosphere, and manipulative attempts to introduce plot and suspense into episodes whose relation to each other is in reality only chronological. On the one hand, in regard to the coverage of AIDS, such fictional strategies have the advantage of forcing recalcitrant readers, whose prejudices might otherwise interfere with their ability to empathize with the hideous misfortunes of high-risk groups, to conjure up visual images of suffering that will almost inescapably compel them to share in the author’s outrage. On the other hand, the AIDS epidemic in itself has produced such staggeringly implausible stories that the last thing the representation of the disease needs is for a journalist as accomplished as Kwitny to graft onto the spectacularly theatrical nature of this crisis the rhetorical embellishments of fiction.