In Search of Solidarity

An Interview With Radical AIDS Doctor Alan Berkman, Physician and Firebrand

What I knew about Alan Berkman, M.D. was that he was the Medical Director of Highbridge-Woodycrest, a residence in the Bronx for individuals and families with AIDS. It's one of the oldest residences for people with AIDS and offers a comprehensive, holistic approach to medicine and treatment, which goes beyond just feeding people pills. With the focus on the individual, Highbridge-Woodycrest has created a system of complementary services that range from substance use and nutrition to therapies such as acupuncture, herbology, shiatsu and reflexology in addition to high-tech Western medicine. It's an institution rooted in a philosophy of empowerment and personal integrity. A good place served by a dedicated doctor.

I also knew that Berkman had created something called Health GAP (Global Access Project), an organization that works to change international patent and intellectual property laws that otherwise bar drug companies from creating cheaper versions of anti-HIV medications in poorer countries. I understood that this AIDS doctor was an international activist committed to providing affordable treatment to the millions dying abroad.

What I didn't know about Alan Berkman was that he was also a lesson in '60s consciousness and militant radical politics and has lived a multi-faceted life quilted together by the sometimes contradictory themes of health, prison, and the need to stand up for what you believe.

A Radical From the Suburbs

Alan Berkman grew up in Middletown, New York, in a conservative climate. Though he came from a fiery line of politically active relatives, Berkman did not discover politics until he entered Cornell University in 1963, where he was quickly initiated into the political currents of both the Civil Rights and the Anti-Vietnam War movements.

From Cornell, Berkman headed to Columbia Medical School in New York, where the intensity of social action against the war and political consciousness around race was peaking. Berkman and his classmates organized and staged protests demanding everything from affirmative action at the medical school to making Presbyterian Hospital more accountable to the community. Berkman also applied his political ideals to the healthcare system and for the next ten years worked in community medicine in the South Bronx and Lower East Side. The doctor also treated prisoners in the Attica uprisings in 1971 and in 1974 came to the aid of Native Americans at Wounded Knee.

Somewhere along the way, the path of the liberal doctor turned into the mission of a revolutionary with medical skills. In the 1970s, Berkman openly supported militant groups like the Black Liberation Army and Weather Underground. In 1981, members of these groups had a shoot-out with police in Nyack, New York after robbing an armored car. Two policemen and a Brinks guard were killed, and one member of the group was shot but managed to escape. Subsequently, Berkman was charged by the FBI with treating her gunshot wound and not notifying the authorities.

After serving a year in prison for refusing to testify, he was indicted as an accessory after the fact and was released on bail. He failed to appear in court and spent more than two years as a fugitive.

After his arrest in 1985, he was charged and convicted of additional felonies resulting from his time underground. Berkman spent the next eight years in maximum-security prisons, including more than four years in solitary confinement. He twice had bouts of Hodgkin's Disease and his effort to get adequate medical care was covered by The New York Times and featured on "60 Minutes." His written testimony about healthcare in the federal prison system was used by a Congressional subcommittee in formulating reforms of Bureau of Prisons policies and practices.

He was released in 1992. Since then he has concentrated his time between researching homeless, mentally ill individuals; overseeing the medical staff at Highbridge-Woodycrest; being a post-graduate fellow at the HIV Center for Clinical and Behavioral Studies; working with Health GAP; and battling cancer. I spoke with Dr. Berkman in his office at HighBridge-Woodycrest.

How would you characterize your childhood?

[It was] a very uneventful childhood, marked only by being somewhat different because I was Jewish in a town that didn't have a lot of Jews. Occasionally, especially still in the '50s among some of my Italian friends ... being Jewish was still somewhat problematic. So we used to fight about that.

Fight verbally?

And physically! [laughter]

You were not shy about fighting.

No, no I wasn't. I came from a Jewish family that was more of the fighter side -- where you had to stand up for yourself. My grandfather was a guerilla fighter in Poland. He led a Jewish group. When there were pogroms that attacked Jewish villages, his group retaliated. He wound up fleeing Poland with a murder charge or two on his head. There was definitely a strain in my family where you had to stand up for yourself and what you thought.

Were your parents like that as well?

My father had very clear principles and he was normally a very law-abiding person, [though] after he got out of the Army after WWII, he smuggled guns to Israel.

You went to Medical School right after Cornell. Did you see going to Medical School as part of your political track or was your political involvement separate?

I did become increasingly politically involved, but ... up until my senior year I saw them as somewhat separate tracks.

Then, February 1967, Kwame Ture [originally known as Stokely Carmichael] came to Cornell as part of a tour that the Student Non-Violent Coordinating Committee was doing. [Before this] there had been a process for me of gradually and increasingly questioning the basic legitimacy of what the U.S. government was doing both in Vietnam and vis-à-vis Black civil rights. But it was hearing him speak that I felt on a very visceral level, in my heart, that I had a different sense of what it would feel like growing up Black in the United States as opposed to having grown up White. I found it a very disturbing, moving experience. All of a sudden I thought, there's more than one reality here.

And if there was a more complex reality going on -- if not two different realities -- which one was I going to identify with? Was I going to continue to just follow this track of a young, white man who's interested in being a doctor and sort of go along that way and hopefully be a nice doctor? Or was I going to change my life to take into account that there was a profound social injustice. Was I going to be in solidarity with people that were suffering from this social injustice? Or was I just going to go my own way? If I really thought Vietnam was genocidal on the part of the U.S. government and if I really thought that it was important to be in solidarity with human rights for Black people and other peoples who were discriminated against by this system, then I had to do something about it.

So, by the time I got to New York and Columbia [Medical School] in 1967 I was primed for putting [politics and medical school] together.

Many have described you as an anti-imperialist. Is that how you would describe your activism?

I think that's a fair label. That also included work with the community and demands around the healthcare system. I always tried to integrate what it meant to have a radical perspective about healthcare and how that needed to be delivered and what it meant to be responsive to the community.

I made a particular point of studying people like Che Guevara, who was a doctor and whose theory was that the world would be transformed by countries achieving their independence and carving out their own, presumably, socialist path. That was certainly my general, overarching feeling ... that we were going to recreate the world on a more egalitarian basis. That we were going to get rid of social oppression. I think we had a gut feeling that we would know when we'd achieved justice because it would feel better.

Increasingly I had a more overall perspective and I began to meet people from the Puerto Rican Independence Movement and students from Africa that were involved with African liberation struggles and it felt like there was a brotherhood/sisterhood of people around the world uprising.

Did your philosophy change?

I think [my philosophy] has gone through different periods, in part based on what was happening in the world. Even within the anti-War movement in that period of time I also found myself more drawn to Weathermen -- although I wasn't a member -- which was a more radical faction. That was in part out of my sense that you had to figure out concrete things to do when you talk about being in solidarity -- and that doesn't mean violent things necessarily. It's very easy to be a radical in the U.S. just by talking radically or by peacefully protesting and whether or not it's effective never seems to be the issue.

One of the things about politics and medicine is that the challenge is to come up with concrete things to do to try to ameliorate the problem you're trying to solve. I think we looked for different approaches to try to stop what was going on. So, even at that point, when we stopped just having peaceful protests and sometimes had more militant marches directed against the Justice Department or didn't passively get beaten and arrested by the police but ran away or fought back, I think that was part of me throughout that whole time. But it always depended on what the issues were. Contrary to what government prosecutors would say, I had no great attraction to violence per se.

It sounds like the same thing was applied as when you weren't afraid to fight the kids who were making anti-Semitic remarks.

Right. And I guess I always thought it was important to put your money where your mouth was. ... The U.S. government was using our tax money to kill hundreds of thousands of Vietnamese and that it didn't matter who voted for what -- it didn't seem to stop.

It always seemed strange to me that we're in a country that has the military power to reach out anywhere in the world and inflict its will on other people [but] the only way one can really intervene is by waiting for the opposition party whether it's the Democrats or the Republicans to win the majority and decide that they'll vote to stop it. It seemed always like a short-sighted and very American-oriented type of politics. And a very safe type of radical politics.

So the obvious irony of a doctor affiliated with groups willing to use violence didn't cause a conflict for you?

No, though in retrospect perhaps they should have more. In the Che Guevara model, [I was] bringing medical skills and also a political engagement ... which isn't the same as saying I think some of those actions were a good idea.

Without getting into what I did or didn't do -- because some of [what you read] was the prosecution's position -- I definitely was affiliated with this network of people that did all those things. What lead to [the incident described in the Times article] was the fact that I was charged with treating somebody who had been shot in the course of a shoot-out with the police and did not turn her into the police.

While you were on trial, you were diagnosed with Hodgkin's Disease, how did that come about?

I noticed a lump under my arm and when it didn't get better over a number of weeks, I went to the doctor. The doctor couldn't feel it. He wasn't a competent doctor and many prison doctors are not. Although I was a very high security prisoner and was treated very badly, they also knew that I had a lawyer and friends and supporters. So, when I demanded that I get medical care, they did get a surgeon to come in and she thought it needed to be taken out. When it was taken out I was diagnosed with Hodgkin's Disease.

And all the while you knew what was going on ...

Oh I did, I mean, I think I'd be dead if I hadn't been a doctor.

Now your health is poor, you are in the prison system, you are perhaps more experienced than the doctors treating you, how was it to be advocating for yourself at that point? That seems like a super-human feat.

It was very difficult. But I was driven by the fact that I wanted to stay alive. I think most prisoners that are very sick want to stay alive. I used a combination of advocating forcefully, all the diplomacy I could muster, with the goal in mind of trying to keep myself alive under very dire circumstances. When you're in prison, your care is under the general supervision of people who don't much care if you live or die and that's a very hard reality. You feel like your most basic right to life is in the hands of people who don't care about you. [But] doctors had to look at me and see themselves because most doctors are white men! [Laughs] Though counter-point to that was that I was a high security prisoner, so I was shackled to the bed all the time, I got treated worse than most prisoners did around most things because of the political context I was involved with. The FBI was very angry with me and this idea that I had helped the Black Liberation Army people ...

You scared the hell out of them.

Well, yeah, on some little level.

It was an incredibly difficult and painful situation. At a later time, I was literally paralyzed for several months as a result of a bad reaction to one of the chemotherapy drugs and I would still be shackled to the bed -- even though I was paralyzed and couldn't move.

While you were in prison ACT UP was organizing and people were starting to understand what was going on with HIV. Were you aware of this? At what point did you start to get involved with HIV?

While I was in prison in Philadelphia in 1986, after I had been treated for cancer, they finally took me out of the segregation unit and put me on the high security general population unit. A young Puerto Rican [man] came in and was down from me and across the tier. He was very thin, coughed a lot and sweated a lot. I had been reading about AIDS at that point and could put into perspective some of the patients I had on the Lower East Side who died with big lymph nodes and wasting and stuff. This young man started to have seizures and we had to bang on our bars to get the guards to come one night to take him out. He never came back. We subsequently learned that he died in the hospital with PCP. I think that was the first time in the prison that I saw a clear case of HIV. I worked with some other prisoners to set up a prisoner's council to begin to do some peer education in the prison.

That was fairly early for HIV peer education work.

Yes, I think a lot of political people who were in prisons started some of the earliest peer education programs all over the country. The most successful one being ACE in Bedford [Hills Correctional Facility], started by Kathy Boudin and Judy Clark, both of whom had been caught in the aftermath of the Brink's robbery. A lot of us took our organizing skills and concerns to HIV.

Do you find having been in prison helpful in working with people here, at Highbridge-Woodycrest?

I think I understand how people experience this as an institution. We're a nice institution, but we have rules, so I understand that. When I came out of prison, I reacted to everything through a personal prism of whether I felt respected or not. I would lose my temper about things that seemed very small. I remember in an earlier job, the administrator moved the furniture in my office and I got very angry. Because she had done it without talking to me about it and it was disrespectful. I found myself angry about being made to wait in line. Everybody else had to wait too, it wasn't personal, it wasn't that I had "Ex Con" written on my forehead, but I realized that it brought an emotional flashback to being de-personalized in prison, to being just a number. It made me think about the fact that people have difficulty waiting here. It's very easy for those of us who are middle class to say, "Well I've got to wait when I go to my doctor too! Why can't other people wait?" It's actually a different emotional wait for some people. So I think it gives me insights into a number of levels.

How does working in Highbridge-Woodycrest fulfill your professional and political needs?

I was always interested in community medicine and what we're able to do here is the one-stop shopping that everyone talks about. And we do it in this beautiful building. I think the architecture of this building conveys a message to people that they matter ... that's a very important thing. A lot of people here have spent their lives in projects and welfare offices and prisons and city hospital emergency rooms where you're supplied the bare minimum that gets by as being human. I wanted to be here -- in a place where we had the capacity to take care of people in an environment where people could heal, not just physically, but emotionally.

A lot of people here decided that they wanted to kick their drug habit. That if they were going to accomplish something with their lives, they wanted to re-create themselves ... it was very moving, on a human level, the existential issue of who am I? And what can I do with my life? To be around people who had re-created themselves and said, "OK, I'm going to take advantage of these last few months of my life to die clean." Not everybody, and I'm not saying that dying clean is the biggest goal in the world, but it was interesting to me how many people would struggle to do that. It was just a very interesting experience about the capacity of human beings to change. And so many of the men here could have been in prison with me. And in prison there's the assumption that people can't change and people should be de-humanized and brutalized. And you get a lot more violence and brutality in response to that. Here, you could take the same people, put them in a humane environment, surround them with a community that cares about them and says that they're worth caring about, and people will respond in a whole different way.

What prompted you to start Health Gap?

In 1998 I spent some time in South Africa as a consultant through the Columbia School of Public Health, looking primarily at their mental hospitals. I began to get a sense of the scope of the epidemic and the human tragedy that was evolving and also realized that in addition to the patients in the mental hospitals, members of the staff were dying from AIDS.

I had that in my heart and mind when I went to the 12th International Conference in Geneva. The slogan was "bridging the gap." The gap referred to the chasm between the resources -- particularly treatment resources -- [between] the wealthy and the poor countries. I think that many, many people there were frustrated that these very involved and wonderful people from all over the world came together, but absolutely no program for bridging the gap was developed. And, in fact, there was quite a bit of criticism about the fact that every time an activist, doctor or research scientist from one of the poorer countries would speak, many people from the developed countries would get up and leave. They thought it had no relevance to people from the wealthier countries. It was quite obvious and very frustrating.

My wife -- who's also an AIDS doctor -- and I then went to visit friends in Germany and visited Dachau, the concentration camp. It was a very moving experience for me to recall the fact that the German people let this happen. And the world let genocide happen. So, I was sitting on this train going from Berlin to Paris ... and had the pictures [in my mind] of Africa and the pictures of the drug companies feting the doctors on Lake Geneva and having big parties in the hotels and thinking about the issue of not just letting this happen. The mass dying that was going on in Africa was not the same as the Holocaust, but the reality was that it was mass death and it was increasingly preventable. Treatable, at least.

So I drew up a strategy paper that argued that we could win real victories around treatment issues. Treatment was key. Not that other issues weren't important. But treatment offered people in Africa hope. You can offer people condoms from today until tomorrow -- and we need to -- you can offer people rules of everything they shouldn't do -- and we need to -- but the reality is that social mobilization, especially in countries like South Africa where there is massive dying going on -- apathy sets in. In the face of massive death, most people don't mobilize, in fact, most people get very quiet, hoping that somehow it will pass over them. It's a traumatic response to a horrible trauma. Treatment says you can do something for yourself, for your child, for your loved ones, that there's a way out of this suffering. That's why the treatment access has been so incredibly important. The other thing about treatment access is you really save lives.

The pharmaceutical companies have the highest profit margin of any industry group in the U.S. The way that they get to do that is through patent law -- having a government granted monopoly that stops other companies from producing it much, much more cheaply. So they love it and want to extend it; 17 years isn't enough, they want 20 years. The drug companies in the U.S. got the World Trade Organization to say that patents should be for 20 years internationally. So actually, we impose on the poor countries of the world, patent laws that are even more restrictive than the ones we have here.

You have an industry that says that they do all the research, they produce the new drugs. That's a generalization that hides the fact that a lot of the basic research into drugs, particularly AIDS drugs, was done by NIH [the National Institutes of Health], then licensed out for clinical trial testing to the big drug companies. Most of the drugs were developed with tax payer money through NIH, then just for testing, were given to the big drug companies and then given patents by the U.S. government to have total control over these medications.

We should also point out that with all of this "research" that they supposedly do, they haven't bothered to research coming up with a new TB or malaria drug that effects so many millions of people in the world in the last 30 years. Most research goes into looking for things like a cure for baldness, another Viagra, female hormones that probably do more harm than good for most women [and] the marketing that takes up more than 23 percent of the entire budget of the big drug companies. The generalization that patents protect research is one of those generalizations that, when you challenge it, it disguises more than it reveals.

What are the actions that Health GAP takes?

Our focus was to change U.S. trade policy first and to get to them to stop pressuring countries not to either produce or import AIDS drugs. Health GAP brought a whole number of individuals together -- most of whom had a lot of experience around AIDS activism. The first thing we did was disrupt Al Gore's campaign and pointed out that Al Gore was the point person for the Clinton Administration in bilateral negotiations with South Africa and that he had been pressuring South Africa not to produce or import drugs to treat HIV under this law they had passed in 1997. We created enough pressure and good press work that the Clinton Administration began to back down.

[Health GAP] posed the moral issue of the fact that ... abstract property rights were more important than confronting this enormous epidemic. To say that [protecting patents] is so sacrosanct that people should die by the millions, THAT was the moral issue that we posed. We made it so that government officials and even the drug company officials didn't feel comfortable saying "Well that's just impossible, people are going to die. The drugs are too expensive, there's just nothing we can do about it."

Gillian Murphy, M.P.H. is a freelance writer, consultant, and frequent contributor to Body Positive_._