Damned Heretics

Condemned by the established, but very often right

I am Nicolaus Copernicus, and I approve of this blog

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Qualified outsiders and maverick insiders are often right about the need to replace received wisdom in science and society, as the history of the Nobel prize shows. This blog exists to back the best of them in their uphill assault on the massively entrenched edifice of resistance to and prejudice against reviewing, let alone revising, ruling ideas. In support of such qualified dissenters and courageous heretics we search for scientific paradigms and other established beliefs which may be maintained only by the power and politics of the status quo, comparing them with academic research and the published experimental and investigative record.

We especially defend and support the funding of honest, accomplished, independent minded and often heroic scientists, inventors and other original thinkers and their right to free speech and publication against the censorship, mudslinging, false arguments, ad hominem propaganda, overwhelming crowd prejudice and internal science politics of the paradigm wars of cancer, AIDS, evolution, global warming, cosmology, particle physics, macroeconomics, health and medicine, diet and nutrition.

HONOR ROLL OF SCIENTIFIC TRUTHSEEKERS

Henry Bauer, Peter Breggin , Harvey Bialy, Giordano Bruno, Erwin Chargaff, Nicolaus Copernicus, Francis Crick, Paul Crutzen, Marie Curie, Rebecca Culshaw, Freeman Dyson, Peter Duesberg, Albert Einstein, Richard Feynman, John Fewster, Galileo Galilei, Alec Gordon, James Hansen, Edward Jenner, Benjamin Jesty, Michio Kaku, Adrian Kent, Ernst Krebs, Thomas Kuhn, Serge Lang, John Lauritsen, Mark Leggett, Richard Lindzen, Lynn Margulis, Barbara McClintock, George Miklos, Marco Mamone Capria, Peter Medawar, Kary Mullis, Linus Pauling, Eric Penrose, Max Planck, Rainer Plaga, David Rasnick, Sherwood Rowland, Carl Sagan, Otto Rossler, Fred Singer, Thomas Szasz, Alfred Wegener, Edward O. Wilson, James Watson.
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Many people would die rather than think – in fact, they do so. – Bertrand Russell.

Skepticism is dangerous. That’s exactly its function, in my view. It is the business of skepticism to be dangerous. And that’s why there is a great reluctance to teach it in schools. That’s why you don’t find a general fluency in skepticism in the media. On the other hand, how will we negotiate a very perilous future if we don’t have the elementary intellectual tools to ask searching questions of those nominally in charge, especially in a democracy? – Carl Sagan (The Burden of Skepticism, keynote address to CSICOP Annual Conference, Pasadena, April 3/4, 1982).

It is really important to underscore that everything we’re talking about tonight could be utter nonsense. – Brian Greene (NYU panel on Hidden Dimensions June 5 2010, World Science Festival)

I am Albert Einstein, and I heartily approve of this blog, insofar as it seems to believe both in science and the importance of intellectual imagination, uncompromised by out of date emotions such as the impulse toward conventional religious beliefs, national aggression as a part of patriotism, and so on.   As I once remarked, the further the spiritual evolution of mankind advances, the more certain it seems to me that the path to genuine religiosity does not lie through the fear of life, and the fear of death, and blind faith, but through striving after rational knowledge.   Certainly the application of the impulse toward blind faith in science whereby authority is treated as some kind of church is to be deplored.  As I have also said, the only thing ever interfered with my learning was my education. My name as you already perceive without a doubt is George Bernard Shaw, and I certainly approve of this blog, in that its guiding spirit appears to be blasphemous in regard to the High Church doctrines of science, and it flouts the censorship of the powers that be, and as I have famously remarked, all great truths begin as blasphemy, and the first duty of the truthteller is to fight censorship, and while I notice that its seriousness of purpose is often alleviated by a satirical irony which sometimes borders on the facetious, this is all to the good, for as I have also famously remarked, if you wish to be a dissenter, make certain that you frame your ideas in jest, otherwise they will seek to kill you.  My own method was always to take the utmost trouble to find the right thing to say, and then to say it with the utmost levity. (Photo by Alfred Eisenstaedt for Life magazine) One should as a rule respect public opinion in so far as is necessary to avoid starvation and to keep out of prison, but anything that goes beyond this is voluntary submission to an unnecessary tyranny, and is likely to interfere with happiness in all kinds of ways. – Bertrand Russell, Conquest of Happiness (1930) ch. 9

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Larry Altman’s Guide to AIDS Conferences


25 years of mental inertia on parade

Does the HIV meme ever leave?

Now we have the Toronto AIDS conference upon us. Dissenters must feel enormous conflict as they contemplate this monstrosity. On the one hand, the biggest and best target audience in the HIV∫AIDS world, assembled right on their doorstep, and easily accessible from New York, San Francisco, San Diego, Alberta and other locations of key dissenters, especially Toronto, where CBC-associated Colman Jones has been operating for years.

But on the other, the sheer size of this planetary sized snowball of nonscience is forbidding, to say the least. What hope have sense and reason, those frail levers of the individual mind, of moving this mountain? This great agglomeration of communal fantasy will gather 45,000 believers, all told, if all the 20,000 public tickets are sold at the $20 million event. They will include great names in celebrity and politics, including the world’s greatest disease philanthropist, Bill Gates, who will give the opening address, having just handed over another half billion to the Global AIDS, TB and Malaria Fund, Bill Clinton, co-chair of the International AIDS Trust with Nelson Mandela, the Canadian Health Minister Tony Clement and even Elton John will turn up, so they say. Alicia Keys will perform Sunday night.

For some reason the Canadian Prime Minister Stephen Harper is unable to participate owing to pressing business elsewhere, but this doesn’t seem to be the result of being tipped off that the whole thing is a giant mistake, predicated on a false reading of the scientific literature. That’s about as likely as the vision of Thabo Mbeki mentioning his realistic view of HIV∫AIDS to George W. Bush at the White House on Thursday, when our President cut short his vacation to hear what he had to say.

The crowd is so thoughtless that even mainstream scientists of any accomplishment no longer bother to turn up to this circus, according to Larry Altman, who gave us a reassuring rundown of what to expect in the Tuesday Science Section of the New York Times, the newspaper of record in HIV∫AIDS.

So comfortably conventional was Altman’s piece that despite close examination we could not detect one single glimmer of independent thought in the entire lengthy exercise, which covered Larry’s attendance at 13 of the 15 World AIDS Conferences that have taken place since 1985. Larry’s account did not veer from the conventional wisdom in any respect, however wide the gap between the scientific literature and what he was saying. It is now quite clear that the medical correspondent of the New York Times is nothing less than the propaganda partner of Dr Anthony Fauci, head of NIAID.

For what his deft rundown reveals is that even at the tippy top of the ladder, media reporters have been coopted for years into becoming the chief cheerleaders for the paradigm. In fact, Altman’s account is that of an activist, who gets “sad and angry” when he meets with an African leader who rejects the news he brings.

What precisely does Larry Altman get paid for?

This is the question that came to mind as one ploughed through this homily. Is not Altman meant to be an independent reporter, independently assessing what he is told by scientists? Is it not reasonable to expect independent thought from the mind of a senior medical correspondent of the paper of record when he tackles a disputed field where lives of millions are at stake?

Let’s deconstruct what Larry has learned after twenty years tracking AIDS with the HIV∫AIDS meme firmly entrenched in his brain. Has the meme now finally paralyzed all movement in his neural networks? It looks dangerously close to doing so, if it hasn’t already.

August 8, 2006

The Doctor’s World

Talking About AIDS, With All the World Watching

By LAWRENCE K. ALTMAN, M.D.

Perhaps we have a clue straight away in the title A Doctor’s World. Apparently Larry is a doc, an MD – not a scientist, educated at Tuft and trained at the University of Washington, and then the CDC, and now teaching at NYU. If so, then by nature he is not in any position to challenge science, since he is well trained to absorb established knowledge in medicine, not to question. He is more like an auto mechanic learning a manual. He has been learning, and teaching, the manual of AIDS for twenty years. But why does he not read the mainstream literature?

The 16th International AIDS Conference opens in Toronto on Sunday a huge arena for many groups to share the now huge body of knowledge.

Indeed, the manual is now huge, it is too long to allow any independent thought whatsoever.

I have attended all but two of the conferences since 1985, and I have watched the meetings change, reflecting one of history’s worst pandemics.

Larry, we understand. With barely time to read all the press releases and attend the press conferences and catch one or two people in the corridors in 13 Conferences, and with access to all the key people and covering the medical story throughout the year, in twenty two years you have never had time to think about whether the pandemic made any sense, or notice that for a decade the mainstream literature has been saying that the global pandemic is based on a false assumption, that “HIV positive status” is sufficiently infectious.

They have also have played a major role in lowering the price of antiretroviral drugs in poor countries.

Larry, are you an activist or a reporter? Activists may have continually made the mistake of assuming that all new drugs are good, but what excuse has an MD and CDC graduate got for not examining this assumption? This is the man on whom the Times and its readers are relying for an accurate and balanced report on the most politically charged and commercially profitable area of HIV?AIDS. Has he ignored Harper’s March issue, or read it and dismissed it – if so on what grounds?

In the last six years, the conference has been held in South Africa and Thailand… to give scientists in modern laboratories and hospitals their first view of the challenges in delivering antiretroviral therapy in developing countries, where a vast majority of the world’s H.I.V. infected people live.

But has what you and they ‘see” been interpreted through distorting lenses? Is it not better that they first read the literature thoroughly, so that they have a more sophisticated interpretation of what seems obvious in front of their eyes? Is this not the difference between “anecdotal” and “scientific” evidence?

In 1988 The mainstay of therapy then was AZT, which cost about $8,000 a year. Additional drugs were needed to treat the many and often fatal opportunistic infections that developed when the number of a patient’s CD-4 immune cells fell too low.

And why were additional drugs needed? AZT was a drug that was abandoned after it was discovered and tested as too damaging to the patient, even as it killed cancers. Before the dose was reduced, it evidently killed a lot of people earlier (2-3 years) than they were expected to die of the Virus (10-20 years). By some estimates 300,000 patients were lost to AZT, a catastrophe which is the crux of the new book, Wrongful Death, by Stephen Davis. Maybe, Dr Altman, you should read it, if this enormous debacle hasn’t yet triggered some skepticism in your mind?

King Carl XVI Gustaf of Sweden attended the conference in Stockholm. Former presidents, including Bill Clinton and Nelson Mandela of South Africa, have attended. Both have said they wished they had done more to prevent AIDS when they were in office.

The tendency of celebrities and politicains to cloak themselves in virtue by unwittingly supporting the paradigm in this field against review is a propaganda success for its promoters, but is all the more reason to ensure that the factual basis for their concern and attention should be gotten very, very straight.

The Toronto conference will be the third held in Canada. Prime Minister Brian Mulroney opened the 1989 meeting in Montreal, but his successor, Jean Chrétien, did not appear at the Vancouver meeting in 1996. The current prime minister, Stephen Harper, has not accepted an invitation to appear in Toronto, disappointing the organizers. But as Dr. Helene D. Gayle, the president of the International AIDS Society, an independent professional group that is chief organizer of the meeting, said, “AIDS conferences can sometimes be hard on politicians.”

Maybe Harper has been talking to Mbeki? But more important, is it not the professional duty of Altman as the Times guide to the field to note the interlocking career paths of key players in the arena? Gayle, who has just moved from the Gates Foundation, was at the CDC for years, as noted in an earlier post.

The conferences have also had their more startling moments. In a speech at the Durban conference in 2000, President Thabo Mbeki of South Africa refused to acknowledge H.I.V. as the cause of AIDS. Minutes later, he walked out of a televised forum as Nkosi Johnson, 11, spoke of being born with H.I.V. He wished, he said, that the government would “start giving AZT to pregnant H.I.V. mothers to help stop the virus being passed on to their babies.”

What precisely was it that told Larry Altman not to take Thabo Mbeki’s response seriously, and proceed to investigate what lay behind Thabo Mbeki’s judgement? Did Larry ever do a lengthy, respectful interview with Mbeki, then or later? Why not? We can’t find one listed at the Times. Would he not have jumped at the chance to do one with Tony Blair, if he had shown such a reaction? Mbeki is a world leader of stature, involved in top international negotiations in G8, for example, and leading peace initiatives in Africa and elsewhere. Why doesn’t he rate?

In 1996 in Vancouver, the audience cheered after a grandmother told the conference: “How did I get infected? The answer is very simple: It just doesn’t matter.”

Really? Does the AIDS meme paralyze all thought in Larry’s brain? Wouldn’t this have triggered some faint response in your mind? Do grandmothers usually serve as VD vectors?

There was a growing understanding that the AIDS virus, which had yet to be named H.I.V., had been spreading silently for at least a decade before the disease was first detected in 1981.

Silently stealing over minds everywhere, the AIDS meme…but Larry, all the evidence is that the “AIDS virus” spreads only with the maximum of effort, and not in the general population, and this has been the case from the beginning. And the evidence from the CDC’s estimates of prevalence in the US (roughly 1 million for the duration, once the artificial changes due to altering assumptions are removed) is that it has not spread at all. In fact, evidence from the testing of Army recruits suggests that not only has it not spread among the general population but that its prevalence is probably twenty times less than the CDC estimate.

Dr Altman, you are writing fiction and passing it off as fact, according to the mainstream literature.

At the time, there were no effective antiretroviral drugs. Some doctors were shunning AIDS patients. Hospital workers left meal trays at patients’ doors. Many people feared that they might become infected from casual contact despite epidemiologic evidence to the contrary.

And now they fear they might be infected through heterosexual sex, despite all evidence to the contrary. Larry, read the literature, where this question has been discussed for years, how exactly is HIV spreading in Africa and Asia if the largest studies show it cannot be transmitted between man and woman?

The cases in the United States, then fewer than 10,000, were mostly among gay men, intravenous drug users and hemophiliacs. But the totals were doubling every six months. In one presentation, Dr. Peter Piot, a researcher who is now the executive director of the United Nations AIDS program, reported a cluster of heterosexual cases in Africa. But few knew how wildly the disease was spreading there.

No inkling yet that this may not have happened? No inkling yet that the whole case for this wild spread has fallen apart, and that it was merely a wild expansion of estimates, which took conventional disease and placed it under a new umbrella, “AIDS”?

Activists proclaimed “No test is best” because of the stigma linked to the disease and the lack of effective therapy. Now the federal government wants all Americans to be tested.

Tested and then given dangerous drugs for a virtually non infectious agent for a disease which the literature shows is caused by toxic substances, including the very drugs they will administer – according to the unrefuted reviews in the literature of the mainstream studies in that literature?

Maybe the activists are saving the world from mass HIV testing and mass ARV taking, since the latest theory demands that ARVs should best be given “within a few days” of infection. So if the Feds do succeed in getting us all tested, then at least one million people will have to suffer the side effects of ARVs on the dubious basis of counteracting HIV, which has been demonstrated to be efficiently overcome by a normal immune response.

Conceivably, it might be argued that with HIV “spreading” silently no one can be tested in time to catch the “first few days” unless everybody is given HAART prophylactically. The ‘market’ would then expand to the entire US population, and then to the world.

By 1988, when the meeting was held in Stockholm, there were more discouraging findings for H.I.V. patients: a vast proportion would develop full-spectrum AIDS within a decade of being infected, countering earlier suppositions that a relatively small percent would be struck down by its debilitating complications.

Did this not correlate with AZT, later reduced drastically in dosage since even HIV∫AIDS scientists could see it was killing people in three years or less, when the Virus was supposed to kill them only in ten to twenty years, a supposed benefit never explained?

The Montreal conference in 1989 made me sad — and angry — when President Kenneth D. Kaunda of Zambia delivered an apology for his indifference to the epidemic, saying he had lost a son to AIDS in 1986.

A year earlier, denying my request to interview Mr. Kaunda about AIDS in the Zambian capital, Lusaka, his press secretary scolded me for going to Africa to report on an American disease. The president had more important things to do, the aide said.

Sad and angry – what are you, Dr. Altman, an activist or a reporter?

At the meeting, Mr. Kaunda pleaded with governments to support scientists to find a cure for AIDS, saying failure would turn the epidemic into “a soft nuclear bomb on human life.” But in the years of Mr. Kaunda’s silence, hundreds of thousands of Africans had become infected.

How responsible were you, Dr Altman, for selling this story? How had these thousands of Africans become infected, now we know they weren’t infected sexually?

Organizers moved the 1992 conference to Amsterdam from Boston to protest the new United States’ policy of denying visas to H.I.V.-infected people. Since 1990, no conference has been held in the United States.

Superstitious even by the rules of the paradigm. But nothing compared with the vile injustices forced on mothers who must give their children AZT or lose their custody. David Crowe has pointed to the scandal of a recent case in an August 7 letter to the Globe and Mail, which Dr Altman should read, if he wishes to ponder the consequences of blind faith in the current science.

The Berlin conference in 1993 was my dreariest. The epidemic was worsening, and the outlook for major scientific advances seemed bleak. A European study, presented at the meeting, showed that AZT alone did little good over the long term.

Well, well. And why was that a surprise for you, if you were familiar with its toxicity, as advertised on its label? And have you covered the possibility that protease inhibitors and HAART are following exactly the same pattern? See Lancet last week, where HAART was revealed as not yet having improved the death rate one iota in ten years.

For years, scientists said they had learned more about the AIDS virus than about any other microbe. But skeptics were numerous because therapeutic advances were few.

Skeptics are more numerous than that, since no good justification for the theory that HIV was the correct target was offered then or since, with all evidence was against it and no explanation for it.

Then, in 1996, reports at the Vancouver conference showed that a combination of new antiretroviral drugs, called protease inhibitors, and older ones could successfully treat AIDS, extending the lives of many people. Some patients got up from their deathbeds to live more normal lives in what seemed like Lazarus.

Otherwise known as HAART, based on a theory of David Ho that even his colleagues soon laughed at, and which has produced horrendous side effects and no reprieve from death since, see Lancet last week (Vol 368 Aug 5, 2006 p 427). Does nothing arouse your curiosity, Dr Altman? Does nothing vibrate your antennae? Since 1996, what has happened? Have deaths declined? Are there not other reasons for the initial benefits that the narrative of HIV∫AIDS claims prove that HIV is the correct target of HAART?

If Coca-Cola could deliver its product in Africa, an AIDS expert said in Vancouver, then the world could deliver AIDS drugs to poor countries. The drug cocktails, which cost about $20,000 a year, reduced the amount of H.I.V. detectable in the blood and increased the number of T cells, a crucial component of the immune system. The startling turnarounds in patients confirmed, in their own way, the causal role of H.I.V. in AIDS and refuted claims to the contrary.

Right. The initial improvement, often quite striking in seriously declining patients in Africa, which is the only “proof” offered now of the “Virus which causes AIDS” phrase which is part of the Times stylebook now. The current argument is that HAART cocktails produce immediate turnarounds in patients, therefore they must be directed at the right target. This supposedly refutes myriad arguments to the contrary, otherwise unanswered in the literature. But eventually, side effects, and death at the same rate as before. Some turnaround, Dr Altman. Is your curiosity not aroused as to whether there might be some other interpretation of the magical initial effect? Should you not cover the issue, constantly raised even by patients, as to whether they really do feel better for long?

Exuberant leaders talked about curing AIDS by ridding the body of H.I.V. Later, experiments showed that a cure remained beyond reach because the virus found hiding places in the body to escape the drugs.

So now drugs have to be taken forever. Based on keeping the presence of the virus as negligible as it would be anyway with a functioning immune system, which is then burdened by the drugs, which eventually cause what the virus is then blamed for, decline and death. Meanwhile, those who do not take drugs flourish with a normal immune system until some other threat overtakes them.

That year, as the treatments began to emerge, the United Nations created its AIDS program. In the years since, its director, Dr. Piot, has stressed that the political will of top world leaders is necessary to turn the epidemic around.

At the Geneva conference in 1998, the first country-by-country estimates of H.I.V. infections and AIDS deaths underscored the devastating impact of the epidemic in the developing world.

Did overall deaths rise? At least check that, Larry. Were populations decimated? Have predictions of disease and death proved out, except where “life saving” drugs have been added to the burden of poverty, hunger and malnutrition, and their associated conventional diseases? Or have populations expanded, sometimes by huge numbers (in sub Saharan Africa, for example) that make a nonsense out of claims that HIV has brought illness and death that will decimate whole societies. Look at the population statistics, Dr Altman, before retailing all these claims without examination.

And enthusiasm about promising reports of effective treatments was dampened by the recognition of unexpected complications. In the case of the drug cocktails, it was lipodystrophy, a side effect of protease inhibitors that causes fat to disappear from some areas of the body and redistribute in other areas, changing the body’s shape in peculiar ways.

Hideous side effects but sold to patients as worth the sacrifice to avoid the unproven depredations of the invisible Virus.

The Durban meeting, in 2000, was the first international AIDS conference held in a country with such widespread poverty. Speakers directly attributed the magnitude of the epidemic to the failure to advocate protective measure and to provide effective treatments to vast populations in Africa and elsewhere.

And you put on the spectacles they gave you to wear, rather than use your own?

A session was scheduled to announce what organizers thought would be favorable research findings: that a spermicide, nonoxynol-9, could be an effective microbicide against H.I.V. A microbicide, any substance that kills germs, can be formulated as a cream, gel, film or suppository. But the plenary session became a surprising disappointment: the product had failed.

And is now the subject of heavily funded research, to support the defense of women in under developed countries against their abusive men who will not wear condoms, and thus infect them from visits to prostitutes, although studies show that women infect men at a rate of 1 in 9000.

In Barcelona in 2002, Dr. Bernhard Schwartlander, a W.H.O. epidemiologist, provided the outline of what has become the agency’s efforts to treat millions of people. Though the plan has failed to meet its target, health officials say it has fundamentally changed attitudes about what can be done in poor countries.

What can be done in poor countries is deliver Western drugs and persuade the otherwise uninformed population that they need to take them, rather than the medicines normally prescribed for their ailments, you mean? Do you not have some responsibility as a prominent reporter and opinion maker to check out the questions surrounding the basis of this policy, as far as you reasonably can?

The last conference, in 2004, was held in Bangkok to focus attention on AIDS in Asia. Yet the Thai government had to cancel a summit meeting of 10 invited heads of state at the conference because only President Yoweri Museveni of Uganda accepted.

Is it at all possible that heads of state, like some domestic critics, might finally feel in their intuitive political bones that something is out of whack with the HIV∫AIDS story, as Mbeki has signaled, though they don’t quite know what it is?

This year in Toronto, to accommodate the disparate interests of the 24,000 participants, the sessions will cover a wide range of topics. Over six days, the presenters are to deliver 4,500 reports — and hundreds more in satellite meetings before and after the main event.

As an index of the busywork that the paradigm has generated, this is truly impressive. Alas, if the basic premise is inaccurate, it is also a demonstration that in modern science, failure to examine the premise critically does not prevent the expansion of research to infinite size if funding is available.

A few major advances have been announced at the international meetings over the years, but most gains have been incremental, as is true for meetings in other fields.

Does it not appear that research in this field has been unusually unfruitful, given that the advances at the fundamental level amount to disproving almost all early speculation about the modus operandi of the Virus, as well as finding no way of accounting for its supposed lethality after two decades, and no cure yet discovered, and with a vaccine now said possibly never to be achieved?

For these and other reasons, a number of leading scientists have stopped attending, choosing to present their findings elsewhere…some supporters complain that the quality of the scientific presentations has declined at recent conferences. Recognizing that criticism, Dr. Gayle, the president of the international society, said that the organizers had focused on strengthening the meeting’s scientific component.

But will they include any scientific review of the basic assumption, or will they and Dr Altman continue to ignore the unanswered review papers of Duesberg et al as if they didn’t exist? Don’t bother to answer. After all, no one involved would benefit from any revision, especially those paying for the show.

The conferences have come to attract a wide array of institutional sponsors and commercial exhibitors, who together are paying about half the $20 million cost of the Toronto conference, about the amount for similar meetings.

The spirit is in the opposite direction: implementing current belief as globally as possible:

Scientists have come far in the 25-year history of AIDS. Some infected patients now need to take only one pill a day. Only a few years ago, many regimens involved a dozen or so pills, taken several times a day. But scientists and political leaders still have much further to go. In the decade since the drug cocktails were introduced, 20 million people have become infected, underscoring that the need to build a system to deliver effective health care is as urgent and essential a need as lowering the cost of antiretroviral drugs.

That is why “Time to Deliver” is the theme for the Toronto conference. So many lives — and so much money — is now at stake, organizers say, that everyone involved in fighting the AIDS pandemic must be held accountable.

Thanks very much for the rundown, Larry. Now just one question: when you say, everyone must be held accountable, does that include the medical correspondent from the Times?

Talking About AIDS, With All the World Watching:

(show)

August 8, 2006

The Doctor’s World

Talking About AIDS, With All the World Watching

By LAWRENCE K. ALTMAN, M.D.

The 16th International AIDS Conference opens in Toronto on Sunday and will vastly differ from the first meeting, in Atlanta in 1985, four years after AIDS was discovered.

What began as a relatively small forum for 2,200 scientists to share their embryonic knowledge has evolved into a huge arena for many groups, including patients infected with H.I.V., their advocates, social workers, economists, lawyers and policy makers to share the now huge body of knowledge.

I have attended all but two of the conferences since 1985, and I have watched the meetings change, reflecting one of history’s worst pandemics. In some cases, they have helped shape the response to the epidemic, influencing attitudes, politics, policy and treatment. They have also have played a major role in lowering the price of antiretroviral drugs in poor countries.

In the last six years, the conference has been held in South Africa and Thailand. This was done in part to give scientists in modern laboratories and hospitals their first view of the challenges in delivering antiretroviral therapy in developing countries, where a vast majority of the world’s H.I.V. infected people live. These two conferences also helped doctors in developing countries get up to speed on AIDS and encouraged scientists to conduct research on AIDS problems peculiar to their geographic area.

Many AIDS experts point to the last decade as the beginning of efforts to narrow the gap between rich and poor countries in providing fairer distribution of treatment and care for H.I.V.-infected people. But the efforts started earlier. In 1988 at the Stockholm conference, I heard discussions about ways that people in poor countries might be given access to the same care and drugs as patients in rich ones. The mainstay of therapy then was AZT, which cost about $8,000 a year. Additional drugs were needed to treat the many and often fatal opportunistic infections that developed when the number of a patient’s CD-4 immune cells fell too low.

Besides the scientists, patients and advocates, heads of state and royalty have also attended some of the conferences.

King Carl XVI Gustaf of Sweden attended the conference in Stockholm. Former presidents, including Bill Clinton and Nelson Mandela of South Africa, have attended. Both have said they wished they had done more to prevent AIDS when they were in office.

The Toronto conference will be the third held in Canada. Prime Minister Brian Mulroney opened the 1989 meeting in Montreal, but his successor, Jean Chrétien, did not appear at the Vancouver meeting in 1996. The current prime minister, Stephen Harper, has not accepted an invitation to appear in Toronto, disappointing the organizers.

But as Dr. Helene D. Gayle, the president of the International AIDS Society, an independent professional group that is chief organizer of the meeting, said, “AIDS conferences can sometimes be hard on politicians.”

In Barcelona in 2002, demonstrators drowned out a talk by Tommy G. Thompson, the secretary of health and human services in President Bush’s first term. In San Francisco in 1990, protesters prevented Dr. Louis Sullivan, the secretary of health and human services under the first President Bush, from delivering a closing speech.

The conferences have also had their more startling moments.

In a speech at the Durban conference in 2000, President Thabo Mbeki of South Africa refused to acknowledge H.I.V. as the cause of AIDS. Minutes later, he walked out of a televised forum as Nkosi Johnson, 11, spoke of being born with H.I.V. He wished, he said, that the government would “start giving AZT to pregnant H.I.V. mothers to help stop the virus being passed on to their babies.”

In a K.G.B. disinformation campaign in 1986, a Soviet official told the conference in Paris that H.I.V. had been genetically engineered and that it had escaped from a government laboratory in the United States.

In 1996 in Vancouver, the audience cheered after a grandmother told the conference: “How did I get infected? The answer is very simple: It just doesn’t matter.”

The sessions at the first conference, in 1985, filled only a few rooms in a convention center in Atlanta. There was a growing understanding that the AIDS virus, which had yet to be named H.I.V., had been spreading silently for at least a decade before the disease was first detected in 1981.

At the time, there were no effective antiretroviral drugs. Some doctors were shunning AIDS patients. Hospital workers left meal trays at patients’ doors. Many people feared that they might become infected from casual contact despite epidemiologic evidence to the contrary.

The cases in the United States, then fewer than 10,000, were mostly among gay men, intravenous drug users and hemophiliacs. But the totals were doubling every six months. In one presentation, Dr. Peter Piot, a researcher who is now the executive director of the United Nations AIDS program, reported a cluster of heterosexual cases in Africa. But few knew how wildly the disease was spreading there.

A new H.I.V. test was about to be approved to protect the blood supply, but there was intense debate over its use in testing people. Activists proclaimed “No test is best” because of the stigma linked to the disease and the lack of effective therapy. Now the federal government wants all Americans to be tested.

Dr. Kevin M. De Cock, who now directs the World Health Organization’s H.I.V./AIDS program, recalled the audience’s silence at that first conference as pathologists described brain damage from the virus.

“The realization was sinking in that you were going to see dementia and terrible neurological disease,” Dr. De Cock said, and “everything we were learning about AIDS in those days was, This is worse than we thought.”

Two years later, on the eve of the 1987 conference in Washington, President Ronald Reagan gave his first speech on AIDS. At that conference, demonstrators protesting the slow drug approval process claimed that they were being denied potentially lifesaving treatments as scientists conducted lengthy clinical trials.

Dr. Jonathan Mann, then the leader of World Health Organization’s AIDS program, said the global epidemic had entered a stage in which prejudice about race, religion, social class and nationality was spreading as fast as the virus.

At the conference’s end, the mood was restrained, but there was real optimism that the widespread problems were not so awesome as to be beyond control.

By 1988, when the meeting was held in Stockholm, there were more discouraging findings for H.I.V. patients: a vast proportion would develop full-spectrum AIDS within a decade of being infected, countering earlier suppositions that a relatively small percent would be struck down by its debilitating complications.

The Montreal conference in 1989 made me sad — and angry — when President Kenneth D. Kaunda of Zambia delivered an apology for his indifference to the epidemic, saying he had lost a son to AIDS in 1986.

A year earlier, denying my request to interview Mr. Kaunda about AIDS in the Zambian capital, Lusaka, his press secretary scolded me for going to Africa to report on an American disease. The president had more important things to do, the aide said.

At the meeting, Mr. Kaunda pleaded with governments to support scientists to find a cure for AIDS, saying failure would turn the epidemic into “a soft nuclear bomb on human life.” But in the years of Mr. Kaunda’s silence, hundreds of thousands of Africans had become infected.

Organizers moved the 1992 conference to Amsterdam from Boston to protest the new United States’ policy of denying visas to H.I.V.-infected people. Since 1990, no conference has been held in the United States.

In Amsterdam, researchers presented a study showing that young American doctors were more reluctant to care for AIDS patients than comparable groups of doctors in Canada and France.

The Berlin conference in 1993 was my dreariest. The epidemic was worsening, and the outlook for major scientific advances seemed bleak. A European study, presented at the meeting, showed that AZT alone did little good over the long term.

For years, scientists said they had learned more about the AIDS virus than about any other microbe. But skeptics were numerous because therapeutic advances were few.

Then, in 1996, reports at the Vancouver conference showed that a combination of new antiretroviral drugs, called protease inhibitors, and older ones could successfully treat AIDS, extending the lives of many people. Some patients got up from their deathbeds to live more normal lives in what seemed like Lazarus.

If Coca-Cola could deliver its product in Africa, an AIDS expert said in Vancouver, then the world could deliver AIDS drugs to poor countries. The drug cocktails, which cost about $20,000 a year, reduced the amount of H.I.V. detectable in the blood and increased the number of T cells, a crucial component of the immune system. The startling turnarounds in patients confirmed, in their own way, the causal role of H.I.V. in AIDS and refuted claims to the contrary.

Exuberant leaders talked about curing AIDS by ridding the body of H.I.V. Later, experiments showed that a cure remained beyond reach because the virus found hiding places in the body to escape the drugs.

That year, as the treatments began to emerge, the United Nations created its AIDS program. In the years since, its director, Dr. Piot, has stressed that the political will of top world leaders is necessary to turn the epidemic around.

At the Geneva conference in 1998, the first country-by-country estimates of H.I.V. infections and AIDS deaths underscored the devastating impact of the epidemic in the developing world.

And enthusiasm about promising reports of effective treatments was dampened by the recognition of unexpected complications. In the case of the drug cocktails, it was lipodystrophy, a side effect of protease inhibitors that causes fat to disappear from some areas of the body and redistribute in other areas, changing the body’s shape in peculiar ways.

The Durban meeting, in 2000, was the first international AIDS conference held in a country with such widespread poverty. Speakers directly attributed the magnitude of the epidemic to the failure to advocate protective measure and to provide effective treatments to vast populations in Africa and elsewhere.

A session was scheduled to announce what organizers thought would be favorable research findings: that a spermicide, nonoxynol-9, could be an effective microbicide against H.I.V. A microbicide, any substance that kills germs, can be formulated as a cream, gel, film or suppository. But the plenary session became a surprising disappointment: the product had failed.

In Barcelona in 2002, Dr. Bernhard Schwartlander, a W.H.O. epidemiologist, provided the outline of what has become the agency’s efforts to treat millions of people. Though the plan has failed to meet its target, health officials say it has fundamentally changed attitudes about what can be done in poor countries.

The last conference, in 2004, was held in Bangkok to focus attention on AIDS in Asia. Yet the Thai government had to cancel a summit meeting of 10 invited heads of state at the conference because only President Yoweri Museveni of Uganda accepted.

This year in Toronto, to accommodate the disparate interests of the 24,000 participants, the sessions will cover a wide range of topics. Over six days, the presenters are to deliver 4,500 reports —and hundreds more in satellite meetings before and after the main event.

As in previous years, noisy protests are likely to punctuate the conference, adding to a circuslike atmosphere and making it seem more like a convention and social gathering than a scientific meeting.

The AIDS conferences are not intended to set agendas or to pass resolutions — like conferences on the environment, for example — or even to reach a consensus on how to fight the disease. A few major advances have been announced at the international meetings over the years, but most gains have been incremental, as is true for meetings in other fields.

For these and other reasons, a number of leading scientists have stopped attending, choosing to present their findings elsewhere. The United States is paying for about 175 people — government employees and representatives of nongovernmental agencies — to attend.

Some scientists continue to go wherever the conferences are held to attend refresher courses, learn of new findings and listen to reports from disciplines to which they are rarely exposed.

These scientists say they believe the activism and diversity of the participants are critical to keeping AIDS in the news. Still, some supporters complain that the quality of the scientific presentations has declined at recent conferences.

Recognizing that criticism, Dr. Gayle, the president of the international society, said that the organizers had focused on strengthening the meeting’s scientific component.

For journalists and participants, the conferences are challenging. A participant can listen only to a small fraction of the presentations, and at best has time to digest the material. All too often, presentations that a participant wants to hear are scheduled a few minutes apart in different areas of vast convention halls. Also, the race between meeting rooms is often interrupted by chance encounters with other participants who want to stop and talk.

The conferences have come to attract a wide array of institutional sponsors and commercial exhibitors, who together are paying about half the $20 million cost of the Toronto conference, about the amount for similar meetings. The other half of the cost comes from registration fees that range from $150 to $995, depending on the participant’s country. (Those from poor countries pay the least, and some receive scholarships.)

Scientists have come far in the 25-year history of AIDS. Some infected patients now need to take only one pill a day. Only a few years ago, many regimens involved a dozen or so pills, taken several times a day.

But scientists and political leaders still have much further to go. In the decade since the drug cocktails were introduced, 20 million people have become infected, underscoring that the need to build a system to deliver effective health care is as urgent and essential a need as lowering the cost of antiretroviral drugs.

That is why “Time to Deliver” is the theme for the Toronto conference. So many lives — and so much money — is now at stake, organizers say, that everyone involved in fighting the AIDS pandemic must be held accountable.

406 Responses to “Larry Altman’s Guide to AIDS Conferences”

  1. Truthseeker Says:

    Where is that Chris Noble post? It should be contradicted.

    More interesting is the Good Math Bad math blog comment and thread Pathetic Statistics from HIV/AIDS Denialists that Tara points to which trashes our replies to Chris Noble as up the creek. Unfortunately the way it is expressed is so preoccupied with calling us moronic that it is hard to deconstruct, but it will be done.

    The basic point is that Duesberg is said to be wrong and statistically naive to have said “Thus, all positive teenagers would have had to achieve an absurd 1000 contacts with a positive partner, or an even more absurd 250,000 sexual contacts with random Americans to acquire HIV by sexual transmission.”

    The blogger, Mark C. Chu-Carroll, self-described as “a Computer Scientist working as a researcher in a corporate lab. My professional interests run towards how to build programming languages and tools that allow groups of people to work together to build large software systems.”, writes:

    While I was on vacation, I got some email from Chris Noble pointing me towards a discussion with some thoroughly innumerate HIV-AIDS denialists. It’s really quite shocking what passes for a reasonable argument among true believers.

    The initial stupid statement is from one of Duesberg’s papers, AIDS Acquired by Drug Consumption and Other Noncontagious Risk Factors, and it’s quite a whopper. During a discussion of the infection rates shown by HIV tests of military recruits, he says:

    (a) “AIDS tests” from applicants to the U.S. Army and the U.S. Job Corps indicate that between 0.03% (Burke et al.,1990) and 0.3% (St Louis et al.,1991) of the 17- to 19-year-old applicants are HIV-infected but healthy. Since there are about 90 million Americans under the age of 20, there must be between 27,000 and 270,000(0.03%-0.3% of 90 million) HIV carriers. In Central Africa there are even more, since 1-2% of healthy children are HIV-positive (Quinn et al.,1986).

    Most, if not all, of these adolescents must have acquired HIV from perinatal infection for the following reasons: sexual transmission of HIV depends on an average of 1000 sexual contacts, and only 1 in 250 Americans carries HIV (Table 1). Thus, all positive teenagers would have had to achieve an absurd 1000 contacts with a positive partner, or an even more absurd 250,000 sexual contacts with random Americans to acquire HIV by sexual transmission. It follows that probably all of the healthy adolescent HIV carriers were perinatally infected, as for example the 22-year-old Kimberly Bergalis (Section 3.5.16).”

    Computer Scientist Mark continues: “Now, I would think that anyone who reads an allegedly scientific paper like this would be capable of seeing the spectacular stupidity in this quotation. But for the sake of pedantry, I’ll explain it using small words.”

    It seems worth deconstructing this in a special post, so we’ll do that as best we can.

    We know better than to argue with professional statisticians when it comes to probability! If Chris Noble had confirmed that he was an university teacher in the field, we would have stepped more cautiously. But to be honest we thought he wasn’t, judging from his posts.

  2. Michael Says:

    The post by Chris Noble claiming censorship was at the Aetiology site under the Rebecca Culshaw thread.

    It can be accessed by clicking on this link.

    I would hope the administrator of NAR will himself post the correction of supposed censorship.

  3. Chris Noble Says:

    I certainly have been getting a message informing me that my IP has been banned from commenting.

    If this is due to a computer glitch then I apologise for assuming that this was due to AL banning me.

  4. Truthseeker Says:

    Chris, you can rest assured that NAR will not ban you, since you have raised a very interesting (to us) simple puzzle in Duesberg’s statistical formulation which doesn’t seem to have been fully solved, and as far as we are concerned that wins you lifetime posting rights on this blog.

  5. Chris Noble Says:

    As my last post did indeed come through my IP is obviously not currently banned.

    Is AL the only administrator for NAR?

    …Duesberg’s statistical formulation which doesn’t seem to have been fully solved…

    Just what is that isn’t resolved?

    I’ll attempt just once more to illustrate the mathematical fallacy at the heart of Duesberg’s argument.

    If the probability of winning the lottery is 1 in a million then indeed you would expect that on average for every winning ticket another 999,999 non-winning tickets will have been sold. Duesberg’s argument assumes that these 999,999 non-winning tickets must have been bought by the same person that bought the winning ticket and that nobody else bought any tickets at all.

    Likewise if we accept Duesberg’s figures then on average for every random heterosexual contact where HIV is transmitted we would expect 249,999 where no transmission occurred. Duesberg’s argument assumes that the 744 HIV+ 17-19 year old military recruits must of each had on average 250,000 random heterosexual contacts and that the remaining 2,812,441 HIV- 17-19 year old military recruits had each had exactly zero heterosexual contacts.

    Just what would resolve the issue for you?

  6. Truthseeker Says:

    Just what would resolve the issue for you?

    Chris, the issue has been moved to the comment thread of a new post, following, Duesberg’s math incorrect, say bloggers, which deals with the topic.

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