A huge amount of progress in the biological and medical sciences is trumpeted in the media on a regular basis, especially in pursuits like the Human Genome project. So where are the much-needed breakthroughs in AIDS research? Cohen provides a heap of answers in this detailed history of the scientific, personal and political struggles in this desperately important field.

The biology is vividly explained, as in this description:

"HIV is an arsonist that targets firehouses: it selectively infects and destroys the immune system cells that are most critical in clearing the body of a viral infection." (p.47)

The book is indexed and includes a glossary and a handy list of acronyms. As well as striving to disentangle the technicalities of immunology, Cohen also tries to explain the different approaches to science in this area. He makes what seems to me an ad hoc distinction between reductionists and empiricists, the former being those aiming at basic research, the latter trying to find out what works. In the usual parlance, however, reductionists would tend to be empiricists, and vice versa.

"Basic research…did not aim to develop something useful, but rather to increase understanding." (p.178)

In the footnote to this sentence, Cohen confesses, somewhat surprisingly, that he first read this distinction between use and understanding in a book published in 1997 which traces the dichotomy back to the ancient Greeks. Yet he writes for Science magazine. Be all this as it may, the distinct approaches to research have been part of the bedevilment in moving towards solutions to the plague, in the context of the lack of any overall coordination of the global effort to find a vaccine.

In the Prologue, he notes the bleak fact that "one in every three adults who live in Botswana is infected with HIV", and concludes by saying that "if one in three adults in the United States were infected by HIV, I am confident that… a critical rethinking of the scientific community’s battle plan already would have happened."

In the Epilogue, he advocates what he calls the March of Dollars, such that,

"[the] research community… does everything possible to remove obstacles, organizes itself, logically uses animal models, fills research gaps, takes appropriate risks, and fully exploits promising leads. The March of Dimes [in 1937] directed just such an effort in the search for a polio vaccine."

The reader may find this book heavy going, densely populated as it is with endless meetings and wrangles between researchers, activists and bureaucrats, although Cohen has boiled his 150 notebooks down into very professional prose. However, his attempts to bring to life the gallery of characters he deals with are confined, bizarrely enough, to noting their hair (during one stretch of the book, about every ten pages). Hence we have Zagury’s eyebrows, Hu’s hair, Bolognesi’s baldness, Desrosier’s moustache, Koff’s beard, Burke’s crop, Gallo’s crinkle, Stott’s beard, and Esparza’s broom. Perhaps I shouldn’t mention all this, but perhaps Cohen shouldn’t have bothered putting it in to begin with. Unfortunately, this is what science journalism is often like. On the whole, I would prefer more diagrams (there are none here) and less verbiage, but it has to be said that this book goes a long way to explaining why we have a long way to go.