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Massive Washington drug trial meet is unanimous – HIV, nevirapine OK, Harper’s not

We return from the heart of darkness, having seen the light, courtesy of Tony Fauci


The morning session at the HIV Prevention Trials Network Annual meeting at the $309 a night Marriott Wardman Park Hotel in Washington began with a bounteous breakfast buffet including unlimited fresh orange juice, scrambled eggs, sausages of two kinds and long and perfectly done slices of bacon, meeting the highest standard of English country house weekends of the past century.

We ate as much bacon as we reasonably could, in honor of the hapless victims of AIDS around the world and the public spirit of many of them in agreeing to participate for very small reward ($10 or $20, we were told, is typical) in testing revolting drugs which may help stave off the depredations of a retrovirus which is entirely to blame for their ailments, according to every single person present at this meeting, for which no fewer than 861 people had signed up.

Bleary from a unsuccessful fight to find anything but trash on the 27 inch tv in our room last night, this morning we simply sat down beside two Thai girls at the nearest table. Destiny, however, took a hand. A friendly woman sitting at the same table proved to be administering the very pilot study that had Myron Cohen exploding with enthusiasm yesterday afternoon.

She informed us of the answer to the puzzle that had challenged us since. She explained how the “statisticians” had allowed them to launch a study which would detect the effects of nevirapine on the transfer of HIV positivity from man to woman or vice versa, even though this mostly (after initial infection) occurs at such a low rate that for all practical purposes it can be ignored as nil.

This was the last point in the day when pure logic ruled, as it turned out, and it was interesting to explore it with her. We have to say we are still not quite sure if the study design makes sense in principle. In case you can and wish to comment, we explain our difficulty in a hidden section which will emerge if you click (show):

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The conundrum is as follows: if Nancy Padian, Gisselquist and numerous other mainstream reasearchers agree that on the whole it would take heterosexual discordant couples (one HIV positive, one negative) one thousand couplings on average to effect one transfer of HIV positivity, how could a dose of nevirapine or anything at all make any discernible improvement in this almost negligible rate?

(The rate is even lower, one thousand to ten thousand, according to the slide by Myron Cohen yesterday, endorsed by other speakers in the meeting, which noted that after the acute phase, during the lengthy period of dormant virus before actual AIDS breaks out ten to twenty years after, the chances of transferring the cirus heterosexually were 1/1000 to 1/10,000, as shown in a slide which we will reproduce here)

The brunette beauty told us that “the statisticians” had worked out how to do the study. Apparently there would be about 4000 men and women roped into this trial, and that the expected maximum total of successful transfers of the positive virus antibody status in five years would be “88”. If there were more than 88 the trial would be halted, she said, since it would be clear that nevirapine was not working to inhibit the rate.

How does that work? we enquired. You mean, if it takes ten years for the average couple, at the rather generous level of two bouts a week, to transfer HIV positive status to the other, then if you have 2000 couples, you can expect many more events? And therefore if there is any improvement with nevirapine, you will be able to see it (assuming there is a control group, which has often been missing from NIAIDS trials, according to the Harpers piece)?

Yes, she agreed. But unfortunately the first talk had started, and she had to excuse herself with advice to look at their web site and see what the statisticians had explained.

We must say we couldn’t immediately decide whether their approach made sense or not. Perhaps readers can advise.

If ten men take ten hours to paint a house, then twenty men would take five hours, sure. But if ten men can eat lunch in half an hour, twenty men can’t eat lunch in fifteen minutes. Which principle applies to this study?

Is the principle of a faster paint job applicable to the statistics of HIV transfer? Assuming that HIV is transferred through sex at all, which seems questionable (the 1 in 1000 Padian found seems to have been raised from zero during the trial by a somewhat circuitous and apparently invalid logic) especially since the lower end estimate on the slide yesterday from Myron Cohen showed 1/10,000? (We reproduce the chart in black and white for clarity here)

Unless we are mistaken, the average couple would be corpses in their graves before their number came up. At the lower, once a week copulation rate that is the normal assumption of researchers, that rate would be 50 copulations a year, or 500 in ten years, so 10,000 would take a couple 200 years. So the bottom line would be that the average couple would take 20 to 200 years to transfer HIV.

The approach suggested by the statisticians, the lady explained, was simply to use this figure to project how many events would occur in a group of 2000 discordant couples. Since the typical couple will take 20 to 200 years, and the events occur at random, anywhere from immediately for an unlucky couple to forty years for a lucky one, a five year study of 2000 couples should produce about one quarter ie 50 to 500 transfers of HIV.

In other words, if one couple takes an average of 20 years to transfer, then two thousand couples all copulating simultaneously will produce more such events in a shorter time. Presumably if the curve is flat there will be 50 to 500 in five years, more or less. So where does this mere “88” come from? Apparently the statisticians have chosen the 1 in 10,000 bouts average rate of transfer.

This is an interesting fact, that heterosexuals can find very comforting even if they believe in the dangers of HIV. Apparently anyone’s chances of contracting HIV in sex from another person of the opposite sex in a single bout is a very low 1/10,000, not 1/1000, according to the assumptions of the statisticians.

All this seems to be logical, and is a standard approach in HIV?AIDS research, we believe, but somehow one still wonders if there is any sense in it at all. Surely such a fantastically low rate of transfer for an individual couple probably reflects the reality that HIV just does not transfer in heterosexual sex at all, and nevirapine or any other factor is therefore going to make no difference whatsoever, except for producing illnmess and even death for some, if the critics are right.

Of course, the fact that condoms could certainly achieve the desired result without any nasty medication whatsoever is not relevant, because this is not permitted to be mentioned by the granting agency, the federal government.

That was the last time we examined anything with a critical eye today, it turned out. For having demolished as much bacon and orange juice as possible on behalf of the trial participants unable to attend this meeting, we joined the 861 listeners in the main hall presentations, and from that moment on we found ourselves increasingly unscientific in mood, as we were caught up in the group spirit.

By the end of the day, in fact, we had seen the light. Suddenly there was no need to criticize at all. Right in front of our eyes was the best evidence that HIV medication research was on the right track, and that anyone who was going to criticize was simply an outsider who hadn’t got the message.

This overwhelming evidence included:

1) The vivacious and warm personae of the participants, who seemed so much more content and agreeable than complaining HIV critics, one has to say, and who set an extremely good example for the populations of underdeveloped countries to follow. If belief in HIV had conferred such vibrant health and energy on the 861 people gathered in this meeting, surely it would bring the same blessing to the people of Africa and Asia.

2) The extraordinary cohesion and sense of mission shared by all. There was not a single doubter or skeptical mind in the bunch, as far as we could tell. This was enormous team spirit, equal or perhaps even greater than a school of fish, all swimming in unison in the same direction. The effect was overwhelming. The latest science has revealed that the mirror neurons in one’s brain tend to bring one’s mind in line with another human being as one observes them in action. We found it impossible not to empathize with 861 people in close proximity who have the same idea all at once.

3) The inspiring positive spirit of the HTPN and DAIDS leaders, including at least three with enormous charisma and oratorical talent, who we found could stir even a skeptical outsider with a sense of mission and accomplishment as we all moved forward together into the future where thanks to advanced science and sophisticated drugs the entire world will be able to live with HIV/AIDS, if not actually avoiding HIV altogether.

Such exceptional orators included Myron Cohen, Jonathan Kagan and the celebrated Anthony Fauci, whose sense of mission, vigor and confidence in the future imbued us as well as everyone else listening to them. In fact, we suggested to all three that perhaps we should name them “Heroes of AIDS” in a magazine piece, but unexpectedly Anthony Fauci, after three seconds reflection, declined.

4) The powerful arguments advanced to this reporter to the effect that any doubts in the relevance of HIV medication to AIDS were as absurd as Holocaust denial, and probably the moral equivalent. “Come and see for yourself!” cried at least two busy researchers with massive trials ongoing on the Dark Continent. One tall African-American active in Zambia told me that I would see how they brought in ailing AIDS victims so weak they had to be wheeled in barrows. Three months later, the anti HIV regimen had them returning to their villages.

5) The level of organization and authority reflected in the slides presented, with their perfectly worked out diagrams, arrows, columns, tables and lists, jargon, acronyms, and labels, showed everything labeled, named, ordered, computed and Powerpointed and explained clearly and logically (we assume, since the slides often slid by too quickly for real inspection). Nothing is more convincing and authoritative than a scheme mapped out and charted in clear order, we found.

6) Clear agendas. All Friday morning one agenda after another was presented and explained, in slide after slide – the currently very popular microbicides research agenda, the pediatric research agenda, the antiretroviral, behavioral, substance use and STD control research agenda. In fact, it could be said that nowhere had the public monies been more intensively applied than in this effort to map a future research agenda, which had so clearly achieved its goals. One could have nothing less than complete confidence in all these agendas, whatever their underlying rationale.

Questioning any agenda so thoroughly mapped would be like questioning the course of a tightly disciplined, immaculately maintained ship – a Navy ship, say, with clean uniforms (in fact there was one officer of the CDC present in full gold banded cuffs and medals, of whom we took this snapshot) and all sailors at their posts, steaming ahead to do battle, guns polished and loaded and course steady. As an observer on the bridge you would never dream of challenging the competence of the captain, even if the prow was aiming at a stone harbor wall dead ahead.

7) Keeping their own house in order. Nothing instils confidence in an operation than keeping its own house in order, as we say. One half hour presentation, by the proud designer of a new DAIDS computer reference system, explained how it would allow everyone applying for a trial grant to check at any moment, day or night, the precise position the application had reached in winding its way through the bureaucracy. This admirable order of priorities in the concerns of all involved won appreciative applause.

8) The tremendous presentation by the NIAIDS director. The week long session ended on a high note as Anthony Fauci, looking extremely dapper in a nicely tailored dark grey suit with subtle color threading, reassured his troops that funding might have leveled off from its previous 45 degree ascent, but they shouldn’t feel depressed. He had found a slide from the early years of the plague in which he predicted that funding would be tight, but as it turned out it was only just beginning its steep climb. The same thing might happen again, he suggested, and meanwhile he personally would make sure that the number of trials they were administering didn’t drop too far.

Fauci’s confidence was fortifying, and we felt quite reassured that the whole effort to test the effect of rather unpleasant drugs on the world’s ailing poor was unlikely to slow down noticeably.

In fact, we took the opportunity to ask him about his reaction to the new Harpers article, by Celia Farber, mentioned earlier, which calls into question the entire scientific quality and even the rationale of the 20 year effort to combat HIV?AIDS that Fauci has led with such success in the eyes of the world and the White House.

Unlike every other major figure in the NIAIDS and out of it that I had asked yesterday and this morning, Fauci, however, informed me that he hadn’t yet read it. By sheer coincidence, however, his talk had contained a spirited defense of the HIVNET nevirapine trial in Uganda which Farber had revealed was a complete mess, according to its embarrassing initial internal reviews.

Fauci had repeated the endorsements of the Institute of Medicine and other defenders of the study, who had claimed that despite the failures of controls and other flaws pointed out by critics, the final result, as rewritten by the responsible official in NIAIDS, was that nevirapine was an effective drug and should be funded with large chunks of the $15 billion in AIDS aid promised by President Bush.

Apparently this section of the speech was not in any way designed as a response to Harpers, then, but Fauci was interested to hear that it applied. When I mentioned that he hadn’t replied to the second half of the Harpers piece, however, he asked me what I meant. I told him it contained a fine summary of Peter Duesberg’s activities and critique of HIV. “Oh, that’s all been dealt with on our web site!”, he said dismissively.

Ed Tramont, Director of the Division of AIDS (DAIDS) of the NIAID (National Institute of Allergy and Infectious Diseases, NIH) and others, who all admitted to having read the Harpers piece, seemed to think there was no cause to take it seriously either. His reason, he said, was that as soon as he saw Peter Duesberg mentioned in it, he knew he didn’t have to take it seriously. (However, having discovered that we took Duesberg’s reviews seriously as scientific literature, peer reviewed in the best journals, he rushed to tell Tony Fauci that we believed in Duesberg’s critique.)

With the single exception of one key bureaucrat at DAIDS, who when asked his reaction to the Harpers piece looked miserable, and said “I just do my job”, noone seemed to feel that it deserved taking seriously. “They can write anything they like but it doesn’t make it right!” said a female John Hopkins scientist. Those willing to discuss the topic – and there were several of these – insisted that the drugs, including nevirapine, worked very well, and any time I wanted to visit Africa I could confirm this for myself. Their very real conviction was apparent, even in private conversations.

But one thing was noticeable. No one was able to explain how Peter Duesberg had been able to publish continuously over two decades complete scientific eviscerations of the HIV claim in some of the most reputable peer-reviewed journals in the world, where the referees included the greatest experts in the field, often extremely wary of his cause and anxious to prevent publication but evidently unable to prove what he said was factually wrong.

The only answer to both Peter Duesberg and Celia Farber seemed to be as the brunette scientist from John Hopkins put it, “They can publish what they like but it doesn’t mean it’s right!’ Fauci’s “Go to my web site!”, and the testimony of African trial administrators (one from Harvard, no less) that if one didn’t believe the drugs were valuable, “come to Africa and see for yourself.”

Immersed in today’s clubby experience, however, that seemed good enough. Power and money certainly provided a more attractive form of truth than tiresome and remote scientific journals that no one important needs to take seriously.

After Tony Fauci had presented several networking awards to a handful of hard working trial administrators, the meeting broke up and closed lunch sessions planning the future of trials took place.

But we had already learned enough, and full of enthusiasm for the marvelous example of these lively servants of a great cause, which they had so powerfully reassured us was the right one, we returned on the train to New York with what we had sought from the horse’s mouth – replies from the mouths of the biggest horses in the business to the best written and most tightly edited and checked challenge to HIV research and ideology to be published in mainstream journalism for two decades.

15 Responses to “Massive Washington drug trial meet is unanimous – HIV, nevirapine OK, Harper’s not”

  1. Richard Jefferys Says:

    “the best written and most tightly edited and checked challenge to HIV research and ideology to be published in mainstream journalism for two decades.”If you believe this, you have not read a single piece of scientific literature regarding the pathogenesis of HIV for over ten years. Neither, apparently, have you read any immunology since – among the same old tired falsehoods trotted out by Farber – is the saw about antibodies always preventing disease. Herpes zoster causes shingles in the presence of herpes zoster-specific antibodies.Herpes simplex can cause outbreaks in the presence of HSV-specific antibodies. Hepatitis B &C can cause liver disease in the presence of hepatitis B or C-specific antibodies.Dengue virus can cause WORSE disease if antibodies are present (antibody-mediated enhancment). Want to ask that esteemed journalist, Celia Farber about this?

  2. truthseeker Says:

    Richard, you fasten on an error that I noticed too, and you are right, it wasn’t fact checked in that respect very well at all. I imagine it was just a slip. There are others, however, and you are right to note them.What I wrote stands, otherwise, I believe. If you have specific points of disagreement, other than this trivial error, point them out. General fulminating is merely the naive-on-the Web syndrome, as far as I am concerned. This blog tries to maintain print standards.I will say one thing, though. You reveal a certain disdain for the work of Peter Duesberg, but are you his equal or superior? Nobelist Walter Gilbert used to use his work as a teaching tool in his graduate classes at Harvard, in tribute to the precision of his writing. Duesberg would have won the Nobel, in the opinion of many, if he hadn’t run into political problems by speaking up when he believed the new HIV paradigm had no scientific content.Are you standing by the implication of your comments here that you believe yourself to be the equal or superior of Duesberg? If not, why would you think that his arguments are so weak that you can see through them but his peer reviewers could not? I ask merely for information, since I thought your contribution was respectable, if not on the level of Duesberg’s papers. Have you read his 2003 Biosciences paper? If so, what points do you think are incorrect?This blog is pseudonymous only to avoid the problems noted, and any email is replied to. Please don’t post off topic, if possible, thanks.Truthseeker.

  3. Richard Jefferys Says:

    “You reveal a certain disdain for the work of Peter Duesberg, but are you his equal or superior?”I have no idea what this even means, let alone what it has to do with the matter at hand. Superior in some eugenic sense? I’m not a scientist so if you’re referring to whatever highly subjective pecking order it is that has the Nobel at the pinnacle, I’m nowhere near that. And it is irrelevant; even a Nobel prize does not confer infallability upon the winner. Peter Duesberg could win a Nobel prize and be crowned Queen of England and he’d still be wrong about HIV. As for peer review, it is not an arbiter of a theory’s validity. If you choose to believe that it is, I would point out the fact that far more papers on the science and immunology of HIV infection – including plenty of original research, involving real people – have been published in peer-reviewed journals than reviews and hypotheses (completely free of original data) from Dr. Duesberg. Or are you saying that the peers that reviewed Peter’s articles were “superior” to the peers that reviewed the others? As for Biosciences, this is a quarterly Journal published by the Indian Academy of Sciences with a readership of ~2,100 and an Impact Factor of 0.657 as of 2002. I in no way intend to denigrate Indian science when I say that these are not numbers that would cause Biosciences to be considered a leading journal (there are many such boutique journals around the world). I look at the title: “The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition” and think, well, the immunological features of HIV infection are unique, reproducible and bear no relation to the immunological defects of malnourishment – which respond almost immediately to feeding – or drug abuse. The strongest predictor of progression to AIDS is the level of immune activation but recreational drugs, anti-viral chemotherapy and malnutrition don’t cause immune activation. Mmmm. Do I really need to read this paper? Scanning through it against my better judgement, I can see that it poses a bunch of specious “predictions” and then gleefully goes about demonstrating that they haven’t been met. Puerile and ridiculous. There’s no discussion of HIV immunology and the understanding of disease pathogenesis as it stood in 2003, no citing of data showing that malnutrition, recreational drugs or antivirals cause the immunological peturbations seen in HIV infection (not surprisingly – there isn’t any). It is transparently clear that you are unaware of all of this, which makes me wonder why you think it is appropriate for you to wander around the PTN meeting with a surfeit of smug stupidity, belittling people that you are in NO position to belittle.

  4. Chris Scheuermann Says:

    I would just like to say a few things. One, immunology is, in the grand scheme of things, a fledgling science, in and of itself. So don’t be so ready to herald a few cited works as the holy grail of HIV pathogenesis. Remember the history of this “syndrome”. HIV is cytotoxic, it kills like a truck…well, actually no it isn’t and no it doesn’t. HIV is cytotoxic, (but since it only infects a rather pathetic amount of T-cells…) HIV indirectly kills cells that it doesn’t infect. UH, ok, sure. Well, no, not really. Then our Lord and Savior David HO came out with what must have been the most ludicrous mathmatical model for disease progression ever. At the rate that HIV was said to be “furiously replicating”, it should have killed in a matter of months. But, at least we put otherwise healthy people on the most toxic drugs ever manufactured. (But, at least I can feel confident that my wellbeing is furiously guarded by those wonderful pharma’s who consistently hold to Good Clinical Practice. and would never endanger anyone with fraudulently trialed medications1) NOPE!!! Wait, they do that too. So, now we have papers that posit immune activation. Could be interesting. However, I would caution a few things. For one thing, this is not new. This theory, much like HIV initiating an auto-immune response has been thrown around before. Of course It only took them twenty plus years to posit something other than cytotoxicity…though they still won’t admit it. But, be carefull about lauding the latest advancements in “HIV pathogenesis” without realizing that, as history repeats itself, that Idea will be dead in a couple of years, and HIV will do something else miraculous, though they still won’t be able to prove it. Just remember that not too many scientists are willing to disprove that which they are heavily funded to prove. I would also point out that many of the alternative theories for AIDS that are suggested by those you would term denialist, are denied the funding to test their hypotheses. It is convenient for you to say you can’t find any such studies when you know full well the monolithic/corporate pseudo-science that exists in this country. It is very easy to be in your position…you are the majority. You have all at your disposal. There are billions of dollars backing you up. As Kary Mullis has said, and I paraphrase, “HIV can be made really interesting if you throw billions of dollars at it!” The monolithic nature of AIDS should anger you more than anything else. If this is truly a “plague” of sorts, then I would want every hypothesis tested. Again, there is no alternative AIDS research being done, because there is no money given for it. Just sit back to a couple of minutes and wonder…WHAT IF YOU ARE WRONG? WHAT IF THEY ARE ALL WRONG? It has happened before. Many believe it is happening again. You have to at least consider it.

  5. truthseeker Says:

    “You reveal a certain disdain for the work of Peter Duesberg, but are you his equal or superior?”

    -I have no idea what this even means, let alone what it has to do with the matter at hand.

    I am referring to your assumption that your feelings are a more accurate lens that the mind and scientific experience of Duesberg. By your own admission, it seems, they are not.

    -I’m not a scientist so if you’re referring to whatever highly subjective pecking order it is that has the Nobel at the pinnacle, I’m nowhere near that.

    Well, then I would hope you would at least grant Duesberg’s work the respect it deserves.

    -And it is irrelevant; even a Nobel prize does not confer infallibility upon the winner. Peter Duesberg could win a Nobel prize and be crowned Queen of England and he’d still be wrong about HIV.

    Very true, if you mean he could be wrong about HIV despite being a Nobelist and Queen of England to boot. But we were not saying that he was automatically right if he is respected, just that if the scientific world of his peers respects him you should respect him too, at least until you have actually read what he wrote and found out the flaws to your satisfaction.

    -As for peer review, it is not an arbiter of a theory’s validity.

    Very true, as HIV?AIDS demonstrates rather clearly.

    -If you choose to believe that it is, I would point out the fact that far more papers on the science and immunology of HIV infection – including plenty of original research, involving real people – have been published in peer-reviewed journals than reviews and hypotheses (completely free of original data) from Dr. Duesberg. Or are you saying that the peers that reviewed Peter’s articles were “superior” to the peers that reviewed the others?

    Very true, a point which I was going to make in some future post, pointing to the eternal truth that the same points can so often be made on both sides of an argument. Yes, peer review has backed the articles on both sides of this issue, but the point I was making was that the peer review Duesberg ran into was hostile and determined to find flaws, and could not, which in and of itself suggests the quality of his work, if you do not wish to read it for yourself, and the peer review that passed on the claims of the paradigm supporters is more of the back scratching kind, as in the Korean case of Hwang recently, not very intent on finding flaws.

    This suggests that Duesberg’s work is precisely as distinguished as Gilbert found it to be, a fact you could confirm by reading it properly, which you apparently prefer not to do, even though someone as intelligent as yourself should enjoy reading such fine work, if you can get past your prejudice.

    – As for Biosciences, this is a quarterly Journal published by the Indian Academy of Sciences with a readership of 2,100 and an Impact Factor of 0.657 as of 2002. I in no way intend to denigrate Indian science when I say that these are not numbers that would cause Biosciences to be considered a leading journal (there are many such boutique journals around the world).

    But as the case of HIV and AIDS shows, quality and truth in science or science journals has little relation to size of readership, or popularity, since science is not a democracy, and the performance of Science and Nature in the field of AIDS has shown this, which is not really surprising, since their performance reflects the qualities of those who run them, and they are not superhuman by any means, and have shown great human failings, especially in the case of Maddox.

    Personally I respect the intellect of many Indians enormously and can well believe that the 2100 readers of Bioscience are a very high quality audience, and their peer reviewers the equal of those in the rest of the world, and possibly even superior, if you are comparing them with those in the US, such as Fauci, who was one of Duesberg’s reviewers, who was unable to demonstrate any factual flaw in Duesberg’s paper for the Proceedings and whose review was merely to give his own opinions. If you put Fauci and Duesberg on a par scientifically or intellectually you have not read the work of both of them, and you certainly have not met them in person.

    – I look at the title: “The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition” and think, well, the immunological features of HIV infection are unique, reproducible and bear no relation to the immunological defects of malnourishment – which respond almost immediately to feeding – or drug abuse.

    Well, the impact of HIV infection on the immune system is precisely what is at issue, with Duesberg saying it has no provable repercussions beyond the initial generation of antibodies and the subsequent disappearance of the virus to negligible levels, which is exactly what conventional medicine would expect. Thus the immunological features of HIV infection are not unique, but standard, and would be perfectly reproducible if HIV was injected into humans, and are not involved in the effect of malnutrition or drugs, whose effects are held to be due to HIV instead of being seen for what they are, the expected effects of malnutrition and drugs.

    – The strongest predictor of progression to AIDS is the level of immune activation but recreational drugs, anti-viral chemotherapy and malnutrition don’t cause immune activation. Mmmm. Do I really need to read this paper? Scanning through it against my better judgement, I can see that it poses a bunch of specious “predictions” and then gleefully goes about demonstrating that they haven’t been met. Puerile and ridiculous. There’s no discussion of HIV immunology and the understanding of disease pathogenesis as it stood in 2003, no citing of data showing that malnutrition, recreational drugs or antivirals cause the immunological perturbations seen in HIV infection (not surprisingly – there isn’t any).

    The specious predictions are the ones Duesberg repeats from the Durban Declaration enumeration of the beliefs of HIV?AIDS ideology, as I recall. There are 14 or so major points Duesberg enumerates from this ideology which conflict with standard science and each other. Perhaps you would care to explain how they are consistent after all. If you can’t, then you will have to revise your views for they are all lynchpins of the HIV paradigm.

    – It is transparently clear that you are unaware of all of this, which makes me wonder why you think it is appropriate for you to wander around the PTN meeting with a surfeit of smug stupidity, belittling people that you are in NO position to belittle.

    I have no idea what this even means, let alone what it has to do with the matter at hand. Apparently you are the one who belittles the ones you disagree with (“puerile and ridiculous”) in debate (“belittling people that you are in NO position to belittle” – what does this mean by the way? That I am too insignificant to belittle Tony Fauci? But surely in the intellectual universe I am allowed to think myself superior to Fauci, if he really does as he professes believe in HIV=AIDS, despite supposedly having read Peter Duesberg’s critiques, unlike yourself).

    Besides, when did I belittle anyone? As I recall, I paid only the most lavish compliments to Anthony Fauci as the most inspiring and fortifying leader, whose words filled me with new conviction that he would lead us forward into a bright future where HIV?AIDS would be something we will all be able to live with.

    I certainly never belittled you, Richard, did I? Did I accuse you of “smug stupidity”? As an intelligent defender of the faith, I value your contribution enormously, with the small exception of your belittling me, Duesberg or anybody else.

    I hope I have your permission to have corrected your spelling mistakes, though.

  6. Dean Esmay Says:

    I find it a little odd that somsone who claims not to be a scientist can make broad sweeping statements about what someone else either does or does not understand about a specific specialty area of science.

  7. Richard Jefferys Says:

    The tone of your piece – a self congratulatory celebration of your rectitude versus the purported ignorance and foolishness of the assembled researchers – speaks for itself, and I feel no need to apologize for the fact that it makes me angry. And my sweeping statements and assumptions about the knowledge of human immunology and HIV pathogenesis of the author of this site are based on what it contains. The comments above provide little evidence that my assumptions are incorrect:”Well, the impact of HIV infection on the immune system is precisely what is at issue, with Duesberg saying it has no provable repercussions beyond the initial generation of antibodies and the subsequent disappearance of the virus to negligible levels, which is exactly what conventional medicine would expect. Thus the immunological features of HIV infection are not unique, but standard”This in no way addresses the unique immunological features of HIV infection: persistent activation, naive T cell depletion and memory T cell dysfunction, which are demonstrably NOT the “expected effects of malnutrition and drugs.” Look at the literature. If my sweeping statemements are in fact doing a disservice to your knowldege of human immunology and HIV pathogenesis, then please demonstrate as much.

  8. Richard Jefferys Says:

    If Duesberg says that HIV infection “has no provable repercussions beyond the initial generation of antibodies” how does he explain that there is actually a continued generation of antibodies in response to mutations in the HIV envelope protein, continued accumulation of HIV-specific memory CD8 T cell responses over the course of disease and persistent immune activation which correlates with the slow but steady erosion of the naive CD4 and CD8 T cell pools?

  9. truthseeker Says:

    All we need is respect.Unless someone objects I am going to remove some of this ad hominem nonsense, which is the kind of thing this blog is designed to avoid. The Web provides plenty of soap boxes which can provide the temporary illusion that small men are taller than they are, even though the illusion usually doesn’t survive more than a few posts anyway. We just don’t need emotionalism to distract from what is a confused topic at the best of times, one in which it is very hard for most of us to find our way and see more than one side of the argument. Especially since this kind of emotional distraction is one of the weapons used by the paradigm protectors in HIV?AIDS to avoid clear illumination of their weaknesses.The one thing we need to do to discuss any topic profitably is to restrain the petty shafts and arrows of disdain which we oh-so-intelligent humans are apparently built by nature to let fly at the mere sight of someone who thinks differently from the way we do, at least on the Web and in email, which for some pyschological reason seems to encourage this kind of thing (do we automatically rate someone who has fewer body signals on display when they communicate as someone we may freely attack, perhaps because they do not show our own tribal signals ? How does this work?) The screen seems to let all immature and adolescent elements in our makeup off the leash, unless we are lucky enough to have been educated in a decent university among intelligent people who know that it is a mark of breeding and enlightenment to treat anyone willing to debate with us with respect.As noted below, all informed and thoughtful comments welcome but there is a proviso that we treat everyone debating this vexed issue with respect in what we say, however much better informed and cleverer we may privately think ourselves.The reason for this is simply that nothing sane or productive gets done while people are pissing on each other.

  10. Richard Jefferys Says:

    Fair enough. And yes, humans have evolved to communicate using visual cues, auditory cues and language. Cut out the first two and it’s not surprising that we can get a bit lost. But also the debate is kind of doomed. Perhaps because of my anger, but probably even without it, I am a “paradigm protector.” Duesberg’s paper calls the Durban Declaration something like “the most definitive edition of the HIV/AIDS hypothesis” – what is that exactly? Was there ever a definitive edition of the herpes zoster/chickenpox-shingles hypothesis? And Duesberg’s 17 predictions are not from the Durban Declaration (which has seven bullet points), they’re what he thinks the predictions SHOULD be with a smattering of selective quotes from the Durban Declaration thrown in there. The people you are citing in support of your beliefs are simply running amok in an artificial construct of their own making. There have never been homogenous views about HIV in the scientific community, Jonathan Sprent and Don Mosier both published immediate (and, it turned out, very prescient) rebuttals in Nature to the Ho/Wei papers that posited such a big role for cytopathicity. Nobel winning immunologist Rolf Zinkernagel has never even characterized HIV as a cytopathic virus. Does this mean that HIV doesn’t cause AIDS? No, it does not. This view of people that accept the fact that HIV causes AIDS as one big monolithic grouping is ridiculous and bears no relationship to reality; Duesberg and his ilk need to pretend otherwise because without this false construct their ideas would never gain any traction. I was at a community-based AIDS organization in New York City from 93 to 2000, spanning years both before and after effective treatments were available. We had ~3,000 members, several hundred of which we were in touch with regularly. I know from direct experience what was happening to people (including plenty who never trusted antiretrovirals enough to ever take them, particularly in the monotherapy era), so – to follow up on Chris’s question – I don’t spend any time wondering if Duesberg is correct because his theories – and those expounded on this website in what I will politely refer to as a disagreeable tone – are completely incompatible with my life experience.

  11. truthseeker Says:

    Something in the software may have erased this message, so we had to add it back later. – Editor.

  12. Richard Jefferys Says:

    “As far as I know, they have only four points to account for this, and I think it should be the subject of a separate post, since I want to quote your comment in it to display it better, if I may.”You may not, although I suppose if you insist I won’t be able to do much about it. I was providing comments about your articles, not comments for inclusion in them. Your repeated return to the idea that Duesberg’s points are legitimate suggests that this discussion is going to just go round and around. Let me have one more try at explaining what I mean: Duesberg’s “predictions” are made up by…Peter Duesberg. Who decides cytopathicity is crucial to the “HIV-AIDS hypothesis”? Peter Duesberg. Who decides it should be esay to culture HIV from people with AIDS? Peter Duesberg. On and on. This all “must” be true for HIV to equal AIDS. I cannot stress enough that this is total rubbish. It is very easy to come up with specious predictions and then show they’re not met; it is a parlor game, not science. This is why no one wants to publish his writings. Your question as to why Duesberg persists with it is an interesting one; I think he was a retrovirologist when the virus was first identified in humans, why would he want to insist that it does not cause disease in the face of the evidence? I have no idea, although I have some largely evidence-free suspicions as I think I already said.

  13. truthseeker Says:

    No, I don’t insist.

    Sorry to say it, Richard, but clearly you do not respect the people and the material you are criticizing, including even your own, it seems, since you don’t wish me to quote it, so how is it possible to continue an exchange with you which will be of interest to any onlooker?

    “Total rubbish” is simply not the kind of phrase to use about the points made by Peter Duesberg in the leading journals of science which have been vetted by senior peer reviewers unable to find factual flaws, let alone reject them as “total rubbish”, which they would have been only too glad to do if they could.

    You seem by your own admission to know too little about the whole affair to make such dismissive remarks, since you do not even know whether Duesberg was a retrovirologist when Montagnier discovered HIV in patient blood. Not only was he aworking with retroviruses but he had achieved enough to be named California Scientist of the Year, soon (in 1986) to be admitted to the National Academy at a very young age, and be talked of as a candidate for the Nobel prize for his cancer work (letter in Nature).

    You don’t seem to understand that you are dismissing out of hand one of the best scientists alive, one of the finest intellects of his scientific generation and one of the most accomplished even in the face of severe funding handicaps produced by the kind of prejudice you are showing.

    I speak as someone who has interviewed for publication a large number of the most distinguished names in a variety of scientific and other fields, so I am reasonably familiar with the prevailing standards. I can assure you that any time you do not immediately understand Peter Duesberg’s point you had best assume that it is valid, and you will discover it to be so when you do understand it.

    Of course his points are legitimate. Even the two you quote indicate that you are not aware of how the debate has progressed. The kind of adjustments you refer to are the adjustments of those who cannot answer objections without shifting the goalposts, as they say.

    If you don’t respect the points made by those you think are wrong, or the people who make them, then your assertions will just reduce to insulting them, which is what has happened. You have to respect an argument to make an effective counter argument.

  14. truthseeker Says:

    Special note: The software has screwed up my post of 11.26 pm last night, so I insert it here for reference:Carry on talking reasonably like that Richard and I shall be half persuaded by what you say :-) There is something about anger at another viewpoint which devalues the speaker (how does that work?) and something about quiet resignation which catches us more persuasively, even though both may be saying exactly the same thing, ie the other point of view is trash.For one thing, I think you make the best point of all, the one thing that seems to be a paradox for the HIV challengers (amid dozens that are problematical for the paradigm chamoions) and that is, as Jim Watson said to me, “the drugs work, don’t they?” You speak from your own experience with numbers of people.Although in principle all hands on individual experience can be dismissed scientifically as anecdotal, I hear enough people say time and time again that they have seen people get better on drugs with their own eyes, to feel that this is the chief difficulty that HIV critics have to surmount. Even though, on balance, as I say, in my reading they have little else against them.Why are there so many reports that HAART drugs make people feel better, and seem to defeat ailments which were quite crippling before their use? I believe they have four points to account for this, but I think it should be the subject of a separate post, since I want to quote your comment in it to display it better, if I may.As to them running amok in a fantasy of their own making, I believe that the core of the dispute focuses clearly on the inconsistencies which are claimed to support HIV, whatever you want to make of the Durban declaration, which in and of itself was an absurd and revealing statement of faith in answer to scientific objections, you must agree. Science is not a matter of counting votes, or of the number declaring faith, but of reason applied to evidence. Individuals with good minds have often been right in challenging conventional wisdowm, as Nobel prizes typically attest. I find the easiest way to make friends with an accomplished scientist is to ask him or her what kind of trouble he or she had in the beginning with his or her new idea, which afterwards made their reputation.Given that you deal in both reaon and evidence and on that basis are the kind of scientific defender of the HIV ideology we respect – though your expertise seems to have you concentrating on the trees rather than seeing the wood, in my humble opinion – we are certain you will agree with that.But whether or not you agree that Duesberg is ahead of you in scientific expertise and study of every aspect of this problem – after all, who had greater incentive to do that study? – you have to admit that it implies something amiss if after twenty years he is able to point out the same gaps and inconsistencies as he was two decades ago. And the possibility that he is a misguided crackpot is ruled out by his credentials, which have recently receieved a great boost from his much respected if not admired cancer work. For what its worth, he is obviously much brighter than his opponents on paper, which you can check for yourself, and in person, which you could probably check for yourself if you truly had a good point you wanted to check with him. I think you have to recognize that there is a problem here, and only review (which is all Harpers is asking) can resolve the biggest paradox, which is that the critique is live and well among large numbers of serious minds who have been given every incentive to stop objecting and change their minds.There is hardly any view which is more unpopular and suspect that this view that HIV is not the answer to what causes AIDS. Every financial and social incentive has been applied for years to shut the view up. There are many people like me who would be delighted if there was good reason to switch, which is part of the point I facetiously made in depicting the HIV PTN meet as having all the characteristics of a cult.I honestly think you have to face the possibility that like so many people your belief influenced what you experienced, rather than experience informed your belief. At the very minimum this is one way that the inconsistency of our opposing beliefs in AIDS could be reconciled.Evidently the people at HIVPTN felt the same way when they urged me to “come to Africa and see for yourself”, but that would also be explained by self deception, wouldn’t it? On the other hand what cannot be explained by self deception is the long list of impossibilities that Duesberg listed in his Biosciences paper, which weigh in the balance very heavily against the one that the HIV challengers have to answer, though you seem to think they are all specious.The other thing that you have to explain to your own satisfaction is the attitudes of the top HIV enthusiasts who have seen fit all these years to avoid debate rather than happily engage in it, which is what decent scientists who genuinely believe that they have the right idea would normally do.Why couldn’t Gallo reply to the Duesberg papers in the Proceedings, as he promised? Why couldn’t Montagnier write a reply to Dueberg in another venue as he promised? Why did Maddox feel that Duesberg lost the right of reply in Nature? Why did Duesberg lose all support for his own research? Why would no one support his funding to explore his objections to HIV, and now NCI will not fund his evidently very promising cancer ideas? Why did a certain scientist invite Duesberg to the opera and produce from his coat pocket an announcement for Duesberg to sign to the effect that he was wrong after all? Is any of that likely or necessary if you have the winning hand?Do you really smell only flowers, and not the rat?

  15. Jensen Says:

    I don’t know if this is too late for an answer, but I was extremely intrigued by the proposed trial to show if Nevirapine would lessen the rate of sexual HIV transmissions in heterosexuals.

    For the suggested number of ‘successful transmissions’ (as Truthseeker puts it, no doubt caught up in the general atmosphere of trial optimism) in 4000 people over 5 years to be a reliable measure, it seems to me the researchers would have to make sure:

    1. That those people don’t engage in any other risk behaviour during those 5 years (doable but rather boring)

    2. That they engage only in ‘heterosexual forms’ of sex since 4000 sodomists presumably would be at greater risk than 4000 missionaries (doable but rather boring)

    3. That they average a prescribed number of couplings in those 5 years (doable but rather boring)

    4. In case this is a couple study as the description suggests, that they remain faithful both in the sense that they are not allowed to break up, or at least required to replace the old with a new discordant partner, and in the sense that they cannot engage in promiscuous behaviour, since it would heighten the risk of contracting diseases like gonorrhea, which are said to facilitate the transmission of HIV. (doable but rather boring)

    5. That a specified number of them (corresponding to the control group) consent to having regular sex with an HIV infected person. (extremely risky, not romantic – legal?)

    6.That all consent to being experimented upon with a toxic drug. (extremely risky)

    My question is this: Where will the researchers ever find thousands of test subjects with such a peculiar mix of conventional virtues and appetite for risky behaviour?

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