Renilde Loeckx. Cold War Triangle: How Scientists in East and West Tamed HIV. Leuven: Leuven University Press, 2017. 192 pp. $29.50 (paper), ISBN 978-946270113-7.
Reviewed by Dora Vargha (University of Exeter)
Published on H-Diplo (February, 2019)
Commissioned by Seth Offenbach (Bronx Community College, The City University of New York)
Renilde Loeckx’s Cold War Triangle tells the story of an international scientific collaboration across the iron curtain that led to the development of HIV blockbuster drugs such as Viread and Truvada. It is as much a story of Cold War collaboration among scientists, as a story of collaboration between scientific institutions and pharmaceutical companies. In her introduction, Loeckx, a former ambassador of Belgium, sets out to bridge diplomacy and science to tell the story of Antonín Holy and Erik Le Clercq: the collaboration of a Czechoslovak and Belgian scientist with the American pharmaceutical company Gilead Sciences. As Loeckx writes, the book is “about the human face of science, how scientists from three different cultures collaborated to create the complex drugs that saved millions of lives” (p. 15).
The book is part of a growing academic field that focuses on East-West collaboration and interaction in medicine, science, and technology during the Cold War. The historiography of Cold War medicine, science, and technology is still dominated by American and Western narratives; thus, new works on collaborative scientific research in the Cold War and an important Cold War perspective on the history of HIV are very warmly welcome indeed—even if this is one with clear shortcomings.
After a very brief overview of the history of microbes, vaccines, and virology, Loeckx starts her story with the Cold War politics of penicillin that propelled the fusion of private pharmaceutical research with academic research in Belgium. The Belgian domestic production of penicillin culminated in the joint establishment of the Rega Institute by the Catholic University of Leuven and RIT (Recherches et Industries Thérapeutiques). Piet De Somer, one of the main protagonists of the book and Erik De Clercq’s mentor and boss was instrumental in creating the institute, as a partner in the company and a professor at the university. The production of polio vaccines made RIT and the Institute a financial success.
The book then shifts to the East, first to the Soviet Union and Lysenkoism, then to Czechoslovakia and the Institute for Organic Chemistry and Biochemistry (IOCB), describing the roles of Frantisek Sorm and Otto Wichterle (inventor of the soft contact lens) in its establishment. Loeckx describes the growing engagement with Western researchers and companies, with Carl Djerassi’s agreement with the American company Syntex and Prague researchers as a case in point. Unfortunately, the work does not examine why or how such collaborations were sanctioned by the state, what the collaborations consisted of, or when the agreement was signed.
We meet the book’s heroes, Antonín Holy and Erik De Clecq in chapter 3, where we learn about Holy’s path into biochemistry and how he met the Belgian De Clercq in Göttingen, during Holy’s postdoctoral stay in 1964. De Clercq was set by his parents to become a doctor from an early age, was mostly drawn to chemistry, and was persuaded by De Somer to join his laboratory in 1966. Chapter 4 examines how collaboration grew between the East and West prior to the Soviet invasion of Czechoslovakia in 1968, which cut short many of the attempts at the scientific collaboration. Loeckx shows that 1968 had very much to do with Holy becoming a central player in IOCB, after Sorm became unwanted politically by the post-Prague Spring government.
De Clercq and Holy’s collaboration rested on Holy sending potentially antiviral compounds to Leuven for testing, while De Clercq sent reagents to Prague, which Holy had limited access to due to lack of resources. The collaboration eventually ended in the patenting of DHPA, an antiviral compound that had the potential to be developed into a pharmaceutical, and which the two scientists patented before publishing their results in Science. In discussing the various collaborations of De Clercq, involving a multitude of actors of various nationalities and professional status, Loeckx misses a wonderful opportunity to critically engage with how scientific “discoveries” are claimed and patented, and how power relations, gender, status, and the conventions in scientific knowledge production play into the process.
Instead of a triangle, what seems to emerge from the pages of the book is the intricate global network of scientific collaboration and exchange. The story has many more sides to it than the three mentioned in the title and final chapters: the Californian start-up, the Rega Institute of KU Leuven in Belgium, and the Institute of Organic Chemistry and Biochemistry in Czechoslovakia (and later the Czech Republic). Instead, Loeckx paints a picture that is more akin to a convoluted spider’s web, connecting not only Belgian, American, and Czechoslovak scientists, but also Japanese, British, East and West German, Swiss, Polish, French, Dutch, and Canadian ones as well. In this sense, the book delivers far more than its promise: a much more exciting look into the global scientific network at large in the Cold War years and beyond.
A striking element in the book is the extent to which scientific research, pharmaceutical production, and European and American military were intertwined in the 1980s and 1990s in HIV research. The most prominent representation of this is Donald Rumsfeld, who keeps popping up on the pages of the book as the not-so-invisible hand that occasionally makes things happen. Another key player is NATO, which, for reasons mostly unexplained and unanalyzed in the book, funds lavish virology meetings in Tuscan villas.
Despite the wide-ranging tracing of networks and vivid portrayals of scientific work, the narrative remains slightly lopsided. We learn a lot of details about the Western side of affairs, and very little of the Eastern part of the story. This is unfortunate, since it gives way to stereotypical and crude representations of science—and life—in Eastern Europe during the Cold War, and to some inaccuracies. In a book about Belgian-Czechoslovak collaboration among virologists and a section dedicated to the discussion of polio vaccines, one would expect Loeckx to acknowledge the important work of Czechoslovak virologists in live polio vaccine development and the elimination of polio there in the early 1960s, which preceded the Belgian success story by quite a number of years.
Though a well-written and -researched work, Loeckx has no formal training as a historian, which might explain some of the omissions, lack of critical analysis, and a somewhat unbalanced narrative. Still, historians certainly do not have exclusive rights to writing histories and Loeckx’s friendship with De Clerq means that she is well positioned to explore the history of the collaboration. The author traveled to the Czech Republic, Poland, France, and the United States to collect material, most likely via interviews. At least this is what can be inferred from the acknowledgements, as there are no lists, dates, or references for the interviews or other unpublished sources in the endnotes. Furthermore, Loeckx acknowledges her journalist partner for his guidance and assistance in writing the piece, and the book conforms to more journalistic standards, which eschew the rigorous citations and bibliographies common in academic works. Thus, it is perhaps unfair to expect the book to deliver a thorough historical analysis of such a complex story.
However, in this case, this is very unfortunate indeed. The narrative outlined misses a wealth of opportunities for enrichment, posing questions, and pushing the book beyond telling a good story. Embedding the work within rich historiographies on drug development, scientific collaboration, Cold War politics and diplomacy, and the history of pharmaceutical companies’ entanglement in scientific research would have helped situate the complex narrative and provide starting points for critical analysis. While she engages some works in the secondary literature, a bit more attention to historical context have helped. For instance, Loeckx lets the end of the Cold War go unnoticed and unremarked upon in a book that is centered on the Cold War itself.
The book can certainly serve as a springboard for further historical investigation of this fascinating story. However, without any references to specific personal narratives, conversations, letters, conflicts, memories, et cetera, and with no indication where most of the book’s information comes from (apart from highlighting the help of a number of protagonists in the acknowledgements), it is very difficult, if not impossible to cite, corroborate, or challenge the book’s key claims. The colorful stories definitely make for a most enjoyable read and serve as wonderful anchors for historical context, but we don’t know what these episodes are based on. Who recounted them? When? Where might have the author learned about them? Moreover, Loeckx rarely goes beyond full acceptance of what her sources say, and because sources are not cited, it is often unclear if a particular assessment and interpretation is her own or that of someone she interviewed. As a clear example of the difficulty in crossing disciplines, the book’s journalistic flair and liberty in not quoting or even alluding to any unpublished sources and the lack of critical engagement with them will make most historians cringe.
Even more disturbing is Loeckx’s portrayal of women—or lack thereof. We often find out, in passing, that it was female assistants who trained the central actor scientists in laboratory practices that proved key to their research, or it was the female assistants who actually did the work the male scientists were credited for. Despite their crucial role, most of these assistants go unnamed in the narrative, their names only appearing in endnotes, while male protagonists appear with their full names in the body of the text. Bela Novakova, the assistant who apparently taught everything Holy knew about biochemistry is named only in the album and endnotes, while the so-called “mother of the laboratory,” who instructs Rudi Pauwels in preparing the cells for AIDS research, is not named at all (p. 104). Anita Van Lierde, the assistant who actually made the discovery of BVDU’s antiviral effect also remains unnamed in the main text. Writing women out of the history of science in this manner is inexcusable for any historical work, especially one published in 2018.
Apart from Angela Merkel’s brief appearance, the issue of gender inequality in science is rarely addressed, and if so, only as an Eastern European phenomenon. This representation is exacerbated by unexplained remarks such as “Shugar sent bright Polish researchers to the Rega institute; it didn’t hurt that they were female” (p. 66). (Loeckx leaves it at that; it is unclear what she means by this). Describing why the outdoor swimming pool became the main attraction at one of the scientific meetings, Loeckz comments, “after all, dainty ladies swimming topless was not something these scientists were used to seeing everyday” (p. 114). While not conforming to academic standards of referencing primary sources can be explained by the genre and background of the author, the problematic portrayal of women is harder to explain.
In the end, the book tells a fascinating story and gives a glimpse into the making of scientific discoveries, the rush for patents in research, and collaborative work during hostile political situations. It is mostly an enjoyable read, albeit skewed towards Western protagonists, and will surely enrich our understanding of the multitude of actors involved in HIV research and global scientific production. At the same time, the book remains a triumphalist narrative in which male hero scientists work together with a well-meaning pharmaceutical company, as the book ends in unfettered high praise for Gilead, a top-ten global pharmaceutical company—which has recently been accused of withholding a safer HIV drug to exploit existing patents and thus maximize profits. While the scientific feat of the protagonists and the importance of blockbuster drugs such as Truvada in the global management of HIV are certainly to be acknowledged and lauded, some critical analysis of gender, HIV politics, patenting scientific results, and the global pharma market in this book would take it a long way.
. Riikka Nisonen-Trnka, “Science with a Human Face: The Activity of the Czechoslovak Scientists František Šorm and Otto Wichterle during the Cold War” (PhD diss., University of Tampere, 2012); Bradley Matthys Moore, “For the People's Health: Ideology, Medical Authority and Hygienic Science in Communist Czechoslovakia,” Social History of Medicine 27, no. 1 (2014): 122-43, https://doi.org/10.1093/shm/hkt073; Lily M. Hoffman, “Professional Autonomy Reconsidered: The Case of Czech Medicine under State Socialism,” Comparative Studies in Society and History 39, no. 2 (April 1997): 346-72; Dora Vargha, “Between East and West: Polio Vaccination across the Iron Curtain in Cold War Hungary,” Bulletin of the History of Medicine 88, no. 2 (2014): 319-43.
. See for instance D. Slonim et al., “History of Poliomyelitis in the Czech Republic—Part III,” Central European Journal of Public Health 3, no. 3 (1995): 124-26; Karel Žáček et al., “Mass Oral (Sabin) Poliomyelitis Vaccination. Virological and Serological Surveillance in Czechoslovakia, 1958-59 and 1960,” British Medical Journal 1, no. 5285 (April 21, 1962): 1091-98; Vilem Skovranek, “Present State of Poliomyelitis after Nation Wide Vaccination with Live (Oral) Vaccine in Czechoslovakia,” in Programs of Vaccination, encephalitis and meningitis in enteroviral infections, virological and clinical problems. VIIth symposium of the European Association Against Poliomyelitis, ed. H.C.A. Lassen (Oxford: Europ. Assoc. Poliomyelitis and Allied Diseases, 1962); and Dora Vargha, “Vaccination and the Communist State: Polio in Eastern Europe,” in The Politics of Vaccination: A Global History, ed. Stuart Blume, Christine Holmberg, and Paul Greenough, Social Histories of Medicine (Manchester: University of Manchester Press, 2017).
. Ged Kenslea, “Gilead Lawsuits: California HIV Patients File Class Action and Personal Injury Cases over Key HIV Drug,” Aids Healthcare Foundation website, May 9, 2018, https://www.aidshealth.org/2018/05/gilead-lawsuits-california-hiv-patients-file-class-action-and-personal-injury-cases-over-key-hiv-drug/.
Dora Vargha is lecturer at the Department of History and the Wellcome Centre for Cultures and Environments of Health at the University of Exeter. Her research focuses on the history of medicine, science and technology in the Cold War era.
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