Damned Heretics

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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.

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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blog, insofar as it seems to believe both in science and the importance of intellectual imagination, uncompromised by out of date emotions such as the impulse toward conventional religious beliefs, national aggression as a part of patriotism, and so on.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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Nation blogger rejects Harpers/Farber out of hand

Amid the mud slinging, a key point

Harpers Publishes AIDS Denialist shrieks a Nation blogger, carried by Yahoo News today (March 2 Fri).

All the standard prejudicial cliches are played – Duesberg’s theory is “discredited”, Farber a “well known denialist”, etc. – with a promised 50 point rebuttal of Farber’s “errors” to be provided by South Africa’s Treatment Action Campaign as soon as prepared, and reproducing the classic knee-jerk responses by HealthGAP and Gregg Gonsalves (from POZ) that indicate it was unnecessary for the authors to read more than a few words of the 10,000 or so word Farber article before dashing off a reply.

In all this, not one valid point relevant to whether Farber is right or not in her scientific and medical practice complaints. Clearly the motivation is something else other than checking the essay for its validity.

On the other hand, supportive comments also started flowing almost immediately.

Some of the comments really reflect the visceral contentiousness of this topic as described in the article. According to my read, Duesberg is not saying that HIV and AIDS are unrelated, but only that the classic scientific criteria for the demonstration of causality have not been met. Should there indeed be in excess of 4,000 documented cases of AIDS in patients who are HIV- as claimed, it would surely seem reason enough to revisit the science and at least ask “why?”. In any case, as a health professional and medical science writer for the past 20 years, I thought the article was both balanced and thought provoking. My subscription to the Atlantic was tossed long ago. I’ll be reading Harper’s as long as I’m alive and they’re still publishing.

The interesting aspect of the comment stream, which is growing fast at the Nation, is the frequent mention of the writers being persuaded by the fact that the “drugs work”.

And based on my amateur study of the field, I wouldn’t even be totally shocked if it turned out that HIV is highly correlated with AIDS but is not directly causally connected (last I checked, the causal mechanism has never been discovered).

However, overwhelming field and lab evidence suggests that the anti-retroviral (ARV) cocktails work. Maybe we don’t understand exactly how HIV causes AIDS, but the ARV drugs work. We know this. Thabo Mbeki provided us with one of the world’s most persuasive, most tragic field experiments when he denied ARV drugs to his HIV-infected citizens, after being convinced by Farber and Duesberg, then was forced by internal and international pressure to begrudgingly provide them, with corresponding life-saving results (somewhat mitigated by alleged governmental tail-dragging).

This is clearly the one major claim which acts as the chief pillar of support of the current HIV?AIDS ideology at this lower level of informed discussion.

We will post here shortly on the explanation for antiretrovirals “working” even if HIV has nothing to do with causing immune deficiency.

(show)

The Nation

COMMENTS (152)

The latest issue of Harper’s Magazine contains a stunning 15-page article by well-known AIDS denialist Celia Farber (formerly of Spin magazine) that extensively repeats UC Berkeley virologist Peter Duesberg’s discredited theory that HIV does not cause AIDS. Among the claims that Duesberg makes (and Farber recounts approvingly) are:

AIDS is actually a “chemical syndrome, caused by accumulated toxins from heavy drug use.”

“Many cases of AIDS are the consequence of heavy drug use, both recreational (poppers, cocaine, methamphetamines, etc.) and medical (AZT, etc.)”

“HIV is a harmless passenger virus that infects a small percentage of the population and is spread primarily from mother to child, though at a relatively low rate.”

“75 percent of AIDS cases in the West can be attributed to drug toxicity. If toxic AIDS therapies were discontinued…thousands of lives could be saved virtually overnight.”

“AIDS in Africa is best understood as an umbrella term for a number of old diseases, formerly known by other names, that currently do not command high rates of international aid. The money spent on anti-retroviral drugs would be better spent on sanitation and improving access to safe drinking water.”

The best rebuttals to Duesberg’s hypothesis are here (AIDS Treatment News 2000: AIDS Denialists: How to Respond)

AIDS Denialists: How to Respond

AIDS TREATMENT NEWS Issue #342, May 5, 2000

John S. James

For over ten years self-styled “AIDS dissidents” have said that HIV does not cause AIDS, that AIDS is not a contagious disease, that HIV is a harmless retrovirus (some say, instead, that HIV does not exist), that AIDS treatments are poisons which themselves cause the disease, and that the AIDS epidemic is a huge medical fraud promoted by corrupt pharmaceutical companies, scientists, and doctors. This movement has learned to appeal to very different agendas; and along with heavy doses of misinformation it weaves some accurate facts and emotional, social, and political truths. It has hidden funding, celebrity endorsements, and corporate journalists who can get its views publicized in mass media as news. It does not conduct medical research nor take care of patients, but has more than a decade of experience in learning how to debate and look credible.

Our concern is not the ideas–we agree that all sorts of ideas should be explored and debated–but rather the direct translation of casual speculation and debating points into the medical care of patients with life-threatening illness, which is strongly encouraged by many of the “dissidents.”

In the U.S., where AIDS treatments usually have been accessible to patients who need them, this movement has made noise for many years, but has found only a tiny constituency of believers who will put their lives at risk by rejecting all medical advice in favor of the rhetoric and debate. But recently it has been revitalized by tapping into other agendas in developing countries, where people have been told that they are going to die and have no chance of treatment, because the drugs have been priced far beyond their reach (by U.S. and international government policies to protect the interests of major corporations, as well as by corporate greed). The “dissidents” (we believe a better term is “AIDS denialists”) have found a new audience among leaders and publics who are understandingly suspicious of a Western- dominated, heavily corporate mainstream which pursues its own profit above all else, and offers millions of people around the world nothing but death.

These issues will be prominent in the next few weeks, through the XIII International AIDS Conference in Durban, South Africa, July 9-14, 2000. This conference, by far the largest in the world, happens only once every two years; this is the first meeting in a developing country. And South Africa is the only country in the world where the AIDS denialists have ever been recognized by a head of state (see “South Africa ‘AIDS Dissident’ Dispute: Time to Stop and Think,” AIDS TREATMENT NEWS #340, April 7, 2000).

How to Answer

For years most AIDS doctors and scientists have seen the denialists as a lunatic fringe best ignored in hopes that it would go away. They did not want to bring it more attention, or spend their time rehashing issues that were settled years ago in the scientific community. And few of them were prepared for this debate–for while they have spent their time treating patients or conducting medical research, the other side has spent years doing nothing but debating, learning what goes over and what does not in various forums, and learning how to use the Internet, where anything can be made to look credible.

Many now agree that refusing to answer is a mistake. AIDS professionals and activists often forget that the world looks different to people who do not have the same access they do.

We have had long conversations with sincere, intelligent people, including patients and journalists, who had clearly been influenced by the denialists and who told us that we were the first person they had ever found who would talk to them to defend the “mainstream” view. Their doctors would not discuss it, nor would any researchers they asked. Most people do not have the background or training to judge a technical scientific argument themselves; instead, they look at how they are being treated. When one side will not give them the time of day on the issue while the other is always available, they may believe those they can talk to, without hearing any other view.

While some researchers and activists have answered the denialists (for Web links, see http://www.niaid.nih.gov/spotlight/hiv00/default.htm), it has long been difficult for patients to find understandable and effective written answers to some of their claims.

So if one does answer the denialists’ arguments, what form should the answers take? We have discussed this with a number of activists, and there is clearly an emerging consensus:

(1) The denialist position consists of about 5 to 10 major points (depending on how you count them–we list 7 below), which are repeated again and again. Each must be addressed separately, with separate flyers or brochures which healthcare and service professionals can give to clients to address their individual concerns.

(2) The back-and-forth debate format is not especially useful here, because it tends to turn on technical points, asking readers to make their own decisions on the scientific merits of the issue, which most people are not prepared to do. A better format is to explain what the denialists are saying, then show with two or three examples that their arguments are not credible–that the assertions on which they ask others to base life-and-death decisions usually leave out far more compelling information than they include.

Most importantly, we need to explain what is really going on in treatment and research–the human story as well as the medical/scientific one, a reality more interesting than the stick-figure ideologies of the denialists. Here we should avoid the argumentative style of trying to score points against the other side. Instead, follow the truth wherever it may lead; when there is truth in the denialist case, by all means acknowledge it.

(3) Eventually we will need an in-depth, well-referenced document explaining the issues to healthcare and AIDS service professionals, and also to patients and anyone else who wants this detailed information. (For an example of what part of this document might look like, see the article by Bruce Mirken which we published in our last issue, “Answering the AIDS Denialists: CD4 (T-Cell) Counts, and Viral Load,” AIDS TREATMENT NEWS #341, April 21, 2000. This article addresses one of the seven or so major denialist assertions, which we list below. The other six articles still need to be written.)

(4) From this in-depth document can come the flyers, brochures, videos, Web sites, and other media.

Seven Deadly Deceptions

Here is our list of the major denialist arguments. As noted above, the problem is not unorthodox ideas, but their immediate translation into personal medical advice, usually to tell patients to reject all medical care for HIV or AIDS, as well as suggesting that safer sex and other infection- control precautions can be ignored. So for each of the seven points, we include the corresponding action item. We are continually amazed at how casually sheer speculation gets translated into life-and-death decisions.

* HIV is harmless (or does not exist), and AIDS is not contagious–so sexual and other precautions are unnecessary.

* The HIV test is unreliable–so don’t get tested.

* AIDS drugs are poisons, pushed by doctors corrupted by the pharmaceutical industry–so don’t take any of them, no matter what your doctor says–or don’t go to a doctor at all, especially if you feel well.

* Viral load and CD4 tests are useless–so don’t use them.

* AIDS deaths would have gone down anyway, even without new treatments–so you don’t need medical care.

* AIDS is over, or never existed, or only affected small risk groups–so there is no important need for medical research on AIDS or HIV, or for AIDS services.

* The free speech of dissenters has been suppressed–so you can’t believe anything you hear.

Note: We omitted the idea that AIDS was created in a government laboratory to kill African Americans, gay people, or others. This conspiracy theory is widespread in some communities, but usually does not urge people to reject medical care, or safer sex or other precautions against infection.

Note on “Denialists” vs. “Dissidents”

Some of these medical ideologists are upset with the term “AIDS denialists”; they prefer “AIDS dissidents,” which suggests parallels with such historic examples as anti- totalitarian dissidents, or Galileo.

We use “denialists” because it is more specific and descriptive. There can be many kinds of AIDS dissent. But the denialists regularly deny that precautions against infection are necessary, deny that HIV testing is appropriate, deny that any approved treatments should be used (or CD4 or viral load tests to monitor disease progression), deny that treatment saves lives, and often deny that AIDS is a real epidemic, or even a real medical condition.

The problem is not ideas, but the organized efforts to practice bizarre medicine, telling people with a major illness to reject care entirely. Denialists have convinced pregnant women or mothers of HIV-positive children to reject treatment universally recommended by their doctors–then harvested publicity from court cases which result. In the U.S. and other countries where treatment is available, they have found few who will sacrifice their own lives; but now they are going to South Africa and elsewhere in the developing world, seeking to deny medical care to people who will have little or no voice in the decision, while also impeding public-health campaigns to slow the spread of HIV infection.

The issue here is not freedom to express ideas; no one is stopping that. The issue is destructiveness by a handful of professional or semi-professional denialists whose ideas and behavior have failed to win them the respect they want.

The AIDS denialist movement will be remembered if it can do serious damage to worldwide efforts to control the pandemic. Otherwise it will be largely forgotten, like similar movements during other epidemics in the past.

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Copyright © 2000 – AIDS Treatment News.

, here (Jon Cohen – five pieces from 1994 on The Controversy over HIV and AIDS)

The Controversy over HIV and AIDS

The contention of a small number of so-called “dissenters” that HIV is not the cause of AIDS has recently received international attention, thanks to South African President Thabo Mbeki’s public questioning of the scientific evidence linking the virus to the disease. In 1994, Science correspondent Jon Cohen conducted a thorough examination of the arguments of the leading dissident, virologist Peter Duesberg. Science is making those articles available free of change in view of the serious public health implications of this debate.

Volume 266 – 9 December 1994

PDF of Full Text

The Duesberg Phenomenon

Jon Cohen

PDF of Full Text

Duesberg and Critics Agree: Hemophilia is the Best Test

Jon Cohen

PDF of Full Text

Fulfilling Koch’s Postulates

Jon Cohen

PDF of Full Text

The Epidemic in Thailand

Jon Cohen

PDF of Full Text

Could Drugs, Rather Than a Virus, be the Cause of AIDS?

Jon Cohen

and here (

Answering the AIDS Denialists: CD4 (T-Cell) Counts, and Viral Load, AIDS TREATMENT NEWS Issue #341, April 21, 2000, Bruce Mirken

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Answering the AIDS Denialists: CD4 (T-Cell) Counts, and Viral Load

AIDS TREATMENT NEWS Issue #341, April 21, 2000

Bruce Mirken

The self-styled “AIDS dissidents,” groups and individuals advocating the view that HIV does not cause AIDS, and often urging people with HIV to reject medical care, have raised their profile in recent months, ratcheting up their advocacy in the U.S. and attempting to influence the health policies of foreign governments. Although these forces sometimes accept the need to treat opportunistic infections, most reject the vast majority of conventional HIV/AIDS treatment, especially use of drugs to combat HIV. This article is part of a series in which AIDS TREATMENT NEWS examines key arguments put forth by the “dissidents”–perhaps more accurately termed “AIDS denialists,” because most deny that AIDS is a genuine epidemic and many deny that the term “AIDS” even describes a real medical condition.

The AIDS denialist movement is not unified (for example, some groups say that HIV is a harmless virus, while others say HIV does not exist), so the summary here of some of their arguments is necessarily only a sketch. More detailed descriptions can be found in the references listed below.

Answering Denialist Views on CD4 (T-Cell) Tests

One consistent thread running through the denialist literature is the assertion that AIDS medicine has made a serious mistake by relying on laboratory markers such as CD4 cell counts, and viral load as measured by techniques such as polymerase chain reaction (PCR). These markers are criticized as unreliable at best and a devious effort to hide the failure of HIV/AIDS science at worst. One recently-formed group, ACT UP Hollywood (not connected with long-standing ACT UP chapters in New York, Philadelphia and elsewhere), argues that “all HIV and viral load tests as well as T-cell counts need to be banned immediately because they are useless indicators of a person’s health.”(1)

The arguments against use of CD4 center around two broad issues. One is the natural variability in CD4 counts, which can be lower than average for reasons not related to AIDS.(2,3) The other is whether or not CD4 numbers actually correlate with clinical prognosis. In her book WHAT IF EVERYTHING YOU THOUGHT YOU KNEW ABOUT AIDS WAS WRONG?, Christine Maggiore, founder of Los Angeles-based Alive and Well AIDS Alternatives, writes, “A number of studies found in the biomedical literature show that low T cell counts do not correlate with compromised immunity, and that normal ranges for T cells in HIV negative persons can vary from 300 to 2,000.”(3) Some denialists cite the famous Concorde study of early versus deferred use of AZT monotherapy–in which an AZT-induced boost in CD4 counts did not translate to improved survival–as proof that, as one writer put it, “there was absolutely no correlation between CD4 T-cell counts and clinical health.”(4)

The denialist argument appears to be built upon a narrow and highly selective reading of the data. For example one of the sources Maggiore cites as proof for the above statement that low CD4 counts can occur without HIV, a Transfusion Safety Study Group report at the 9th International AIDS Conference, specifically notes that HIV-negative individuals with two or more CD4 counts below 300 were rare, and that both those with known and unknown causes of immune suppression “differ from the retrovirus immunodeficiency pattern” in a number of key parameters, including CD4 percentage and CD4/CD8 ratio.(5)

In other words, transient low CD4 counts seen in other circumstances do not equal AIDS and bear little resemblance to what is typically seen in HIV-infected individuals. What the denialists regularly ignore is that while unusually low CD4 counts can occur for a variety of reasons, numerous large, long-term cohort studies have demonstrated a distinct pattern associated with HIV infection: A statistically significant CD4 decline commonly begins around the time of seroconversion and gradually becomes more severe over time, eventually leading to increased susceptibility to opportunistic infections. This has been observed in cohorts of gay men, transfusion recipients and hemophiliacs. In these cohorts a decline in CD4 count has been consistently and strongly associated with the development of AIDS-defining illnesses.(6)

Also neglected in denialist discussions of CD4 is the large body of evidence associating specific opportunistic infections with lowered CD4 counts. For example, in the Pulmonary Complications of HIV Study, an 1,182-person cohort, 79 percent of cases of pneumocystis carinii pneumonia (PCP) occurred in individuals with CD4 counts below 100 and 95 percent occurred in patients whose CD4 count was below 200.(7) The Multicenter AIDS Cohort Study (MACS) has also reported a “greatly increased risk” of PCP when CD4 counts drop below 200.(8) Numerous other studies have found similar associations between lowered CD4 counts and increased risk of PCP and other opportunistic infections.(6,9,10) Such findings formed the basis for long-standing recommendations regarding opportunistic infection prophylaxis (using drugs to prevent these infections). Other research relevant to this discussion is covered in the section on viral load, below.

Regarding the effect of treatment-induced increases in CD4 on clinical prognosis, the small increases seen in Concorde indeed did not correlate with improved long-term outcome. But numerous other studies do show a strong correlation with lowered risk of AIDS-defining opportunistic infections or death, particularly with larger, HAART-induced CD4 increases. In the U.S.-government trial ACTG 320 (which compared AZT plus 3TC vs. AZT plus 3TC plus indinavir [Crixivan(R)]), the indinavir group had a mean CD4 increase roughly three times that of the AZT/3TC only group, and half as many AIDS- defining events.(11) In a meta-analysis (combined analysis) of seven (mostly pre-HAART) antiretroviral studies, researchers found that “having either a reduction in HIV-1 RNA level or an increase in CD4+ lymphocyte count, or both, was associated with a delay in clinical disease progression.”(12) Overall, a large body of evidence involving both treated and untreated patients shows a clear correlation between low or declining CD4 counts and increased risk of opportunistic infections or death.(13,14)

The denialist view of CD4 counts is used to call into question the 1993 revision of the CDC’s AIDS case definition, which added a CD4 count of 200 or lower as an AIDS-defining condition. In Maggiore’s words, it “allows HIV-positives with no symptoms or illness to be diagnosed with AIDS. Since 1993, more than half of all newly diagnosed AIDS cases are counted among people who are not sick.”(3) The mass of evidence showing that HIV-infected individuals with CD4 counts below 200 are at overwhelmingly increased risk for life-threatening infections is simply ignored.

And on Viral Load

Maggiore states in her book that “low levels of viral load have not been correlated with good health, with absence of illness or high T-cell counts, while high viral loads do not correspond with low T-cells or sickness.”(3) In a recent newspaper column she also complains that viral load tests are not FDA-approved for diagnosis of HIV infection, and notes, “Viral loads are found in people who test HIV-negative.”(15) Denialist objection to viral load testing is bolstered by the fact that Kary Mullis, who won a Nobel prize for developing the basic technique of PCR, is a supporter of their cause and has questioned the use of his technique to quantify virus.(3)

In a 1996 article published in the denialist journal REAPPRAISING AIDS, authors Christine Johnson and Paul Philpott demonstrate their scorn for viral load measurements in the title of their discussion, “Viral Load of Crap.” Focusing on the 1995 Ho and Shaw NATURE papers on viral dynamics, they write:

“Ho and Shaw’s technique looks for HIV RNA, the genetic material found in the viral core. They assume that since each HIV contains two HIV RNAs, there must be one HIV for every two HIV RNAs they count. But the large amount of HIV RNA they report is found only after sending blood samples through polymerase chain reactions (PCR). PCR is the ‘DNA fingerprinting’ technology which takes tiny numbers of genetic molecules (RNA or DNA) and turns them into huge quantities.” What these tests find, they argue, is meaningless: “Some of these are HIVs that have been neutralized by antibodies, some are defective HIVs (those that did not form correctly) and some are free-floating HIV RNA. Though none of these entities has any pathological capacity, the viral load technique confuses them with whole, infectious virus, the only kind that has any biological significance.”(16)

This essay is typical of the denialist analysis of viral load, illustrating both its strengths and weaknesses. Like much of the movement’s literature, they discuss only PCR and not the other technologies used to quantify viral load, mistakenly stating that Ho used PCR when in fact he used bDNA (branched DNA)–a different process marketed by a different company.(17,18)

Philpott and Johnson effectively lay out the theoretical reasons why PCR-based viral load tests might produce a misleading result. Indeed, company researchers and the FDA have acknowledged potential causes of error and variation in viral load results, and a potential margin of error in these assays of roughly threefold.(18,19) Thus, when the FDA approved the Roche Amplicor HIV-1 Monitor (a PCR-based assay), it required the labeling to indicate that the test can accurately detect a three-fold or greater change in HIV RNA for patients with a viral load of 1000 copies or greater and a six-fold or greater change for patients whose viral load is below 1000.(19) (Although Maggiore is correct in saying that the FDA has not approved PCR for diagnosing HIV infection, she neglects to mention that the agency did approve it “to assess patient prognosis… or to monitor the effect of antiviral therapy”).

Strikingly, Philpott and Johnson stick entirely to theory and do not address the key question of whether or not viral load measurements predict the likelihood of disease progression or death in the real world. A very large body of evidence indicates they do, some of which was available prior to their dismissal of the tests as a “Viral Load of Crap.” The mass of confirming data–from ongoing cohort studies as well as antiretroviral trials–that has accumulated since then is rarely acknowledged in denialist writings.

Beginning in 1995 John Mellors and colleagues published a series of articles detailing MACS cohort data showing a strong correlation between baseline viral load and subsequent disease progression.20,21,22 Using stored blood samples from patients’ early study visits, Mellors examined the rates of AIDS-defining events and deaths in relation to viral load levels measured using bDNA. In a 1604-patient sample, only 0.9 percent of those whose baseline viral load was 500 copies or lower died of AIDS within six years, while 69.5 percent of those whose viral load was greater than 30,000 copies died. “Plasma viral load was the single best predictor of outcome,” Mellors wrote, “followed by CD4+ lymphocyte counts [T-cell counts] and neopterin levels, beta2-microglobulin levels, and thrush or fever. We observed a strong association between viral load and the subsequent rate of decline in CD4+ lymphocyte counts.”(22)

Similarly strong associations between viral load levels and clinical outcome have been reported in numerous other cohort studies, including the 1170-patient EuroSIDA cohort(23) and the Multicenter Hemophilia Cohort Study,(24) among others. In the hemophilia cohort, “each log(10) increase in baseline viral load was associated with a five-fold increase in risk for AIDS-related illness during the first six months of follow-up.” The predictive value of viral load was independent of that of CD4 count.

One particularly interesting study looked at viral load in gay men in the Baltimore MACS cohort and injection drug users in the Baltimore “AIDS Link to Intravenous Experiences” (ALIVE) cohort. Rather than measuring plasma HIV-RNA in the usual way, using PCR or bDNA, this study looked at cell- associated infectious viral load using the quantitative microculture assay. This method “quantifies the biologically functional and infectious cell-associated HIV-1 by measuring the amount of HIV infected cells capable of infecting donor cells from an uninfected person in culture.”(25) Looking at the risk of AIDS-defining infections, non-AIDS-defining bacterial infections, and death, the researchers found that “higher levels of infectious viral load were significantly related to increased hazards for all three outcomes,” with little difference between the gay men and the intravenous drug users. After adjusting for CD4 level and numerous other factors, viral load was strongly predictive of risk of progression to AIDS.

The association between viral load (measured using bDNA or PCR) and clinical progression has been seen consistently in HIV treatment trials, including the meta-analysis of seven studies discussed above,(12) in which “each 10-fold decrease in HIV-1 RNA was associated with a 51 percent reduction in progression risk.” In both the pivotal trial of ritonavir(26) and ACTG 320,(11) patients randomly assigned to the protease inhibitor arm showed significantly better suppression of viral load and significantly reduced AIDS-defining events.

After reviewing the available data, including numerous studies not listed here, the expert panel convened by the Department of Health and Human Services to determine HIV treatment guidelines recommended using both CD4 and viral load in conjunction with the clinical condition of the patient to guide therapeutic decision-making. The panel noted, “Multiple analyses in over 5,000 patients who participated in approximately 18 trials with viral load monitoring showed a statistically significant dose-response type association between decreases in plasma viremia and improved clinical outcome.”(27)

Discussion of this data is notably absent even in current denialist literature. Maggiore’s recent column,(15) for example, cites one article from 1993(28)–very early in the development of these assays–as “studies showing that viral load test results do not correlate with illness, with wellness, with T-cell counts or even the finding of virus by co-culture.” This is at best a dubious interpretation of this study, and Maggiore fails to discuss any of the more recent evidence showing precisely the opposite. Evidence cited of viral loads found in HIV-negative people turns out to be a handful of anomalous cases, several of which involve false- negative antibody tests in people who clearly had AIDS.(29)

Evaluating the Evidence

No lab test or surrogate marker is perfect. All have innate limitations, natural variation, and a chance of error, and as a result HIV/AIDS researchers and treatment activists alike have cautioned that physicians must always remember they are treating patients, not lab values.

The limitations of CD4 and viral load tests, both real and theoretical, have been exhaustively described by the denialists. But their declarations that these tests are meaningless are based on a skewed, highly selective reading of the data that simply omits anything which might contradict their views. The overwhelming preponderance of evidence strongly indicates that both CD4 and viral load measurements can provide useful and important information that doctors and patients can use to evaluate progress and make treatment decisions.

For More Information

Many of the denialist Web sites and books are accessible through the references below.

Unfortunately, the medical mainstream has usually not bothered to answer these views–so persons with sincere questions have heard only one side. This is changing. Meanwhile, the U.S. National Institute of Allergy and Infectious Diseases has prepared a page of links to publications with evidence that HIV causes AIDS, http://www.niaid.nih.gov/spotlight/hiv00/default.htm . Also, see http://www.aegis.org/topics/aids_debate.html .

References

1. ACT UP Hollywood home page, http://www.outspoken.org/actuphollywood/index.html

2. Strausberg, John. THE AIDS HERETICS. New York Press. March 9, 2000; 13: 10.

3. Maggiore, Christine. WHAT IF EVERYTHING YOU THOUGHT YOU KNEW ABOUT AIDS WAS WRONG (4th Edition, 2000). American Foundation for AIDS Alternatives, Studio City, California.

4. Conlan, Mark Gabrish. Interview: John Lauritsen. ZENGER’S. April 1997.

5. Mosley, James. Idiopathic CD4+ Lymphocytopenia: Other Lymphocyte Changes. IX International Conference on AIDS, Berlin, 1993, abstract #WS-A25-5.

6. Stein, Daniel S, Korvick, Joyce A. and Vermund, Sten H. CD4+ Lymphocyte Cell Enumeration for Prediction of Clinical Course of Human Immunodeficiency Virus Disease, a Review. JOURNAL OF INFECTIOUS DISEASES, 1992; 165: 352-363.

7. Stansell, J.D., and others. Predictors of Pneumocystis carinii pneumonia in HIV-infected persons. Pulmonary Complications of AIDS Study Group. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. January 1997; 155:1, 60-66.

8. Phair, J., and others. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. NEW ENGLAND JOURNAL OF MEDICINE. January 1990; 322:3, 161-165.

9. Nightingale, SD, and others. Incidence of Mycobacterium avium-intracellulare complex bacteremia in human immunodeficiency virus-positive patients. JOURNAL OF INFECTIOUS DISEASES. June 1992; 165: 6, 1082-1085.

10. Spaide, R.F., Gaissinger, A., and Podhorzer, J.R. Risk factors for cotton-wool spots and for cytomegalovirus retinitis in patients with human immunodeficiency virus infection OPHTHALMOLOGY. December 1995; 102:12, 1860-1864.

11. Hammer, S., and others. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic milliliter or less. NEW ENGLAND JOURNAL OF MEDICINE. 1997; 337: 725-733.

12. Marschner, I. C., and others. Use of Changes in Plasma Levels of Human Immunodeficiency Virus Type 1 RNA to Assess the Clinical Benefit of Antiretroviral Therapy. JOURNAL OF INFECTIOUS DISEASES. 1998; 177: 40-47.

13. Smith, D.K., and others. Causes and rates of death among HIV-infected women 1993-1998: The contribution of illicit drug use and suboptimal HAART use. 7th Conference on Retroviruses and Opportunistic Infections, San Francisco, January 30-February 2, 2000, abstract #682.

14. O’Brien, William A., and others. Changes in plasma HIV RNA level and CD4+ lymphocyte counts predict both response to antiretroviral therapy and therapeutic failure. ANNALS OF INTERNAL MEDICINE. 1997; 126: 939-945.

15. Maggiore, Christine, Questioning AIDS, Q & A. MAGNUS. March/April, 2000.

16. Johnson, Christine and Philpott, Paul. Viral Load of Crap. REAPPRAISING AIDS. October, 1996.

17. Ho, D.D., and others. Rapid turnover of plasma virions and CD4 lymphocytes in HIV-1 infection. NATURE. January 12, 1995; 373: 123-126.

18. Todd, J. Performance Characteristics for the quantitation of plasma HIV-1 RNA using the branched DNA signal amplification technology. JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES AND HUMAN RETROVIROLOGY. 1995; 10: supplement 2, S35-44.

19. Food and Drug Administration, letter to Roche Molecular Systems, March 2, 1999.

20. Mellors, J., and others. Quantitation of HIV-1 RNA in plasma predicts outcome after seroconversion. ANNALS OF INTERNAL MEDICINE. 1995; 122: 573-579.

21. Mellors, J., and others. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. SCIENCE. May 24, 1996; 272: 1167-1170.

22. Mellors, J., and others. Plasma viral load and CD4+ lymphocytes as prognostic markers in HIV-1 infection. ANNALS OF INTERNAL MEDICINE. 1997; 126: 946-954.

23. Miller, V., and others. Association of viral load, CD4 cell count, and treatment with clinical progression in HIV patients with very low CD4 cell counts: The EuroSIDA cohort. 7th Conference on Retroviruses and Opportunistic Infections, San Francisco, January 30-February 2, 2000, abstract #454.

24. Engels, E., and others. Plasma HIV-1 viral load in patients with hemophilia and late-stage HIV disease: A measure of current immune suppression. ANNALS OF INTERNAL MEDICINE. 1999; 131:256-264.

25. Lyles, C.M., and others. Cell-associated infectious HIV-1 load as a predictor of clinical progression and survival among HIV-1 infected injection drug users and homosexual men. EUROPEAN JOURNAL OF EPIDEMIOLOGY. 1999, 15:99-108.

26. Cameron, D.W., and others. Randomized placebo-controlled trial of ritonavir in advanced HIV-1 disease. THE LANCET. February 21, 1998; 321: 543-549.

27. Panel on Clinical Practices for Treatment of HIV Infection. GUIDELINES FOR THE USE OF ANTIRETROVIRAL AGENTS IN HIV-INFECTED ADULTS AND ADOLESCENTS. January 28, 2000. (This document is available at http://www.hivatis.org .)

28. Piatak, M, and others. High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR. SCIENCE. March 1993; 259: 1749-1753.

29. Sullivan, P.S., and others. Persistently negative HIV-1 antibody enzyme immunoassay results for patients with HIV-1 infection and AIDS: serologic, clinical and virologic results. Seronegative AIDS Clinical Study Group. AIDS. January 1999; 12:1, 89-96.

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Over at Slate science writer Jon Cohen has a piece examining the wave of “pharmanoia” afflicting mass media.

Pharmanoia

Coming to a clinical trial near you.

By Jon Cohen

Posted Tuesday, Feb. 21, 2006, at 3:00 PM ET

In July 2004, AIDS activists trashed a Gilead Sciences exhibit booth at the international AIDS conference in Bangkok, Thailand, because of a proposed study of the company’s drug tenofovir. The trial sought to assess whether tenofovir, arguably the safest AIDS drug on the market and already approved by the Food and Drug Administration, could prevent infection if given in daily doses. The proposed subjects were volunteer HIV-negative Cambodian sex workers. No matter. AIDS advocates objected because they thought the company was taking advantage of a vulnerable population and failing to offer the women medication if they became infected. Helping to lead the “zap” was ACT UP Paris, which splashed fake blood on the Gilead booth, hung a large banner that read “Closed Due to Death,” and plastered the walls with signs that said “Sex Workers Infected by Gilead” and “Gilead Prefers Us HIV+.”

The protest against Gilead is one example of pharmanoia, the extreme distrust of drug research and development that’s sweeping the world. As Joep Lange, head of the International AIDS Society at the time of the Bangkok meeting recently wrote, the protest was based on “uninformed demagogy” and threatened to derail “arguably the most important studies for those at high risk of acquiring HIV infection around the globe.” When Cambodian President Hun Sen pulled the plug on the study a month after the protest, he added his own uninformed demagogy to the fracas.

To be sure, major drug companies and the battalions of academic researchers on their payrolls deserve intense scrutiny. And they have received it, in this story in Bloomberg News about questionable clinical trials in Miami and in these stories in the New York Times about a defective heart device, which were honored this week by the George Polk journalism awards. Also justifiably unsparing is the Washington Post’s 2000 series “The Body Hunters,” which critically examined Pfizer’s experiments with Trovan on Nigerian children who had meningococcal meningitis, and the recent hammering of Merck for its decision not to report heart problems in trials of Vioxx. But as Big Pharma becomes the new Big Tobacco, some critics wildly exaggerate—see Celia Farber’s article on AIDS and the corruption of medical science in the March issue of Harper’s—turning shades of moral gray into black.

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Consider other recent narratives that involve AIDS and the testing of drugs on humans. In John le Carré’s The Constant Gardener and the movie based on it, a big drug company and its affiliates cover up the toxicities of an experimental tuberculosis drug that they’re testing on Kenyan AIDS patients. They then murder the people who try to expose their wrongdoing. Le Carré writes in an author’s note: “by comparison with reality, my story was as tame as a holiday postcard.” In fact, the plot is so over the top, it’s a hoot. In January, the Toronto Globe and Mail, Canada’s leading daily, ran an article titled “Sex Slaves for Science?” featuring Salome Simon, a woman described as “a medical guinea pig” who participated in a long-running Canadian program that’s hunting for clues to develop an AIDS vaccine. Simon volunteered for the study. She can leave it at any time. And the researchers provide her with free medical care, as well as counseling about how to avoid infection. (Read more about this study.) Here are two other examples of drug R & D criticism run amok.

By overplaying unproved but sensational misdeeds, Big Pharma’s watchdogs obscure serious ones—like the inane lawsuit that 39 drug makers filed against the South African government in 1998 to block it from making generic versions of anti-HIV drugs. The scattershot approach also draws attention away from a critical and increasingly complicated issue that AIDS has pushed to the fore: What do researchers owe people who volunteer to test new medicines and devices?

There’s a fundamental rule of thumb for the ethics of conducting human biomedical studies: Don’t behave like a Nazi. It was the cruel and deadly Nazi experiments on concentration-camp prisoners that led to the 1947 Nuremberg Code, which spelled out 10 core principles for human experiments. These include the requirement that research subjects must freely join a study with full knowledge of the risks and that researchers must make every effort to minimize unnecessary mental or physical suffering. After the Nuremberg Code came several, more specific canons—the Declaration of Helsinki, guidelines from the Council for International Organizations of Medical Sciences, and the Belmont Report—that together spell out the international ethical tenets for human research.

The AIDS epidemic has spotlighted the ethics of clinical research like no disease in history. Early on, AIDS activists demanded a voice in drug R & D; today they sit on influential panels that help governments set research guidelines and evaluate the worth of HIV-fighting drugs. AIDS also brings ethics to the forefront because it preys on ostracized groups—sex workers, gay men, minorities, drug users, migrants. And when powerful but expensive anti-HIV drug cocktails became available, the developed world was forced to recognize that patents and profits were standing in the way of reaching the vast majority of the HIV infected.

Should researchers conducting a study that aims to prevent HIV infection be required to provide anti-HIV drugs to participants who become infected during the trial, for reasons that have nothing to do with it? No official guidelines address this difficult question, which was central to the protests surrounding the abandoned study in Cambodia. In a sophisticated exchange between two bioethicists a few years ago, one, Ruth Macklin of Albert Einstein College of Medicine, argued that researchers have this “moral obligation.” The other, Charles Weijer of the University of Western Ontario, countered that in “moral theory, causation is a necessary condition of compensatory claims.” In other words, the researchers had no obligation to provide treatment unless their trial caused the infection.

Weijer also argued that providing anti-HIV drugs to subjects was an “undue inducement” because it might lead poor people to volunteer. There is “something strange about this worry,” wrote Ezekiel Emanuel, the chief bioethicist at NIH, in the Lancet last July. “No person would become HIV positive just to get antiretroviral drugs,” Emanuel and his co-authors reasoned. If someone joins a trial because of the offer of anti-HIV drugs, they concluded, then the inducement is not undue.

Last May, an unusual meeting of activists, researchers, and bioethicists convened at the Bill and Melinda Gates Foundation to hash out the questions raised by the protest over the Cambodia trial. The group’s report, “Building Collaboration to Advance HIV Prevention,” wisely asserts that providing anti-HIV drugs to people who become infected during a prevention trial “is steadily becoming a question of logistics and implementation rather than a hot topic of ethical debate.” This has major implications for ongoing tenofovir pre-exposure prophylaxis experiments, as well as trials of AIDS vaccines and topical gels and creams known as microbicides. Indeed, as the report notes, several large sponsors of AIDS vaccine trials now have promised to help make sure that people infected during studies receive the medicines.

The ethical canons haven’t changed. But as the price of anti-HIV drugs has plummeted from $15,000 per person a year to a few hundred dollars, major international efforts are under way to bring these medicines to poor people. In essence, increased access to drugs revealed that the ethical quandary came down to cost, not right or wrong.

Researchers from wealthy countries typically provide research subjects in poor ones better health care. They also train colleagues and bring medical equipment that remains in use long after studies end. But there are financial and practical limits to what they can offer. No ethical manifesto, however, spells out precisely how much is enough. The unstated message of “Building Collaboration” is that researchers and communities that participate in clinical studies have to negotiate this bottom line.

AIDS has ushered in an ethos in which more and more people, especially in desperately poor countries, want to know what’s in it for them to participate in a clinical trial. They want some say in establishing what researchers call the risk/benefit ratio. These are reasonable demands. But pharmanoia makes them harder to hear.

Related in SlateAmanda Schaffer describes microbicides, a new method of AIDS prevention for women. Carl Elliott and Trudo Lemmens attack for-profit ethical reviews of clinical trials. Jim Fallows, Brent Staples, and Jon Cohen discuss Cohen’s book, Shots in the Dark: The Wayward Search for an AIDS Vaccine.

Jon Cohen writes for Science magazine. You can reach him at joncohen45@hotmail.com.

Slate

As Cohen and others point out, conspiracy theories like Duesberg’s warp and exploit some of the best political interventions made by AIDS activists: that patients should be engaged with their medical diagnosis and treatment, that clinical drug trials should be grounded in sound ethical practices, that the emphasis on virology has circumvented immunological approaches to AIDS and that attention to the effects of poverty, malnutrition and other diseases is vital to preventing and treating AIDS.

It’s a shame that a magazine as well respected as Harper’s has shirked its duty to report on these issues and instead published Farber’s article. South Africa’s Treatment Action Campaign has put together a comprehensive rebuttal of Farber’s article documenting over 50 errors. I’ll post links to it just as soon as it is made public. In the meantime, I post here a statement from HealthGAP and a letter to Harper’s from Gregg Gonsalves of GMHC.

HealthGAP: “Harper’s Magazine has stooped to new lows in publishing a lengthy article that rehashes old distortions by a writer who does not believe that HIV causes AIDS. Harper’s should immediately publicly retract this article, and devote the same space to an accurate piece of news about the global AIDS crisis. We are very concerned that this inaccurate article will be used to fuel government inaction outside the US, where some heads of state, such as the South African President and the Minister of Health, have invoked AIDS denialist rhetoric rather than prioritizing antiretoviral treatment access for the 800 South Africans with HIV who are dying unnecessarily each day.”

Gregg Gonsalves: “Dear Editors, I have been a long-time Harper’s Magazine reader. I am sorry that the March 2006 issue is the very last that I will read.

With Celia Farber’s article “Out of Control, AIDS and the Corruption of Medical Science,” your magazine has managed to destroy its 156 year-old reputation in 15 pages.

Farber is a well-known AIDS denialist and publishing her work is akin to giving the folks at the Discovery Institute a place to expound upon the “science” of intelligent design, Charles Davenport a venue to educate us about the racial inferiority of the Negro or Lyndon LaRouche a platform to warn us about aliens, bio-duplication, and nudity.

If Harpers was some fringe publication or supermarket tabloid then we could all laugh at Farber’s weird conspiracy theories and pseudo-science. The sad thing is that unlike the hoaxes perpetuated on the New Republic by Stephen Glass several years ago, Ms. Farber’s reputation as a crank is widespread. Thus, it seems that your editors, after careful research and despite the overwhelming evidence to the contrary, decided that Ms. Farber was a serious journalist with a real story to be told.

If you choose to report falsehoods as truths when it comes to HIV/AIDS, how can I trust the veracity of the rest of what appears in your pages?

Yours truly,

Gregg Gonsalves

COMMENTS

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Same Harper’s just got “linked” a lot for their “Impeach Bush” editorial?

Posted by MASK 03/02/2006 @ 4:14pm | ignore this person

Speaking of crackpot journalism, does Carlin Romano still contribute to the Nation? Here’s a line or two from an atrocious Islamophobic article he wrote in the Philadelphia Inquirer, citing gay neoconservative Bruce Bawer favorably:

According to Bawer, liberals in Europe, even more than their American counterparts, want to believe that most Muslim immigrants share Western middle-class goals: a safe place to live, opportunities for their children, and the like. That accounts, Bawer argues, for the odd mix in their attitudes to Muslims: joy in the “multiculturalism” that makes their previously homogeneous societies more “colorful,” and a nativist desire to keep Muslims in their place as exotica.

Bawer asserts that the reality – confirmed for him by the resistance of European Muslims to assimilation, and the marked presence in their communities of honor killings, homophobia, polygamy, marital rape, forced marriage, and intolerance of democracy and pluralism – is that European Muslim leaders, with demographics on their side, still harbor the millennial hope of taking power in Europe, and see the European attitude as both weak and hostile. It is “political correctness,” Bawer writes, that has “gotten Europe into its current mess.”

Of course, Marc Cooper writes things just as embarrassing on his own blog.

Methinks the Nation Magazine should clean up its own act first.

Posted by LPROYECT 03/02/2006 @ 4:51pm | ignore this person

Great point, LPROYECT.

uh, what?

Posted by TJBEHRENS1 03/02/2006 @ 5:00pm | ignore this person

“Many cases of AIDS are the consequence of heavy drug use, both recreational (poppers, cocaine, methamphetamines, etc.) and medical (AZT, etc.)”

So one more reason that people should not do drugs.

I can now teach my children that on top of all the other bad things that can and will happen to you if you start doing drugs, that if they start doing drugs they can be more susceptible to contracting aids.

Just say no…

Todd

Posted by OKSPORTSGUY 03/02/2006 @ 5:09pm | ignore this person

Awesome!! Now I can go back to unprotected sex!!!

Posted by PCR 03/02/2006 @ 5:21pm | ignore this person

Some of the comments really reflect the visceral contentiousness of this topic as described in the article. According to my read, Duesberg is not saying that HIV and AIDS are unrelated, but only that the classic scientific criteria for the demonstration of causality have not been met. Should there indeed be in excess of 4,000 documented cases of AIDS in patients who are HIV- as claimed, it would surely seem reason enough to revisit the science and at least ask “why?”. In any case, as a health professional and medical science writer for the past 20 years, I thought the article was both balanced and thought provoking. My subscription to the Atlantic was tossed long ago. I’ll be reading Harper’s as long as I’m alive and they’re still publishing.

Posted by IGNATIOUST 03/02/2006 @ 5:28pm | ignore this person

I am always sympathetic to skeptics and contrarians, so I was curious to read Celia Farber’s HIV articles.

In 1987, when I subscribed to Spin.

Since then, HIV denialism has been pretty thoroughly debunked. Whereas these questions were usefully provocative in 1987, they are much less useful twenty years later. Now they much more closely resemble IDers or global warming dissidents: fringe scientists who ignore the overwhelming evidence contradicting their hypotheses.

I studied a social science, and I am sympathetic to some of Farber’s critiques, such as the sociological phenomenon of scientists protecting their income streams and positions, at the expense of unbiased critical inquiry. Like I said, that made me open-mindedly consider her critiques in the 80s. And based on my amateur study of the field, I wouldn’t even be totally shocked if it turned out that HIV is highly correlated with AIDS but is not directly causally connected (last I checked, the causal mechanism has never been discovered).

However, overwhelming field and lab evidence suggests that the anti-retroviral (ARV) cocktails work. Maybe we don’t understand exactly how HIV causes AIDS, but the ARV drugs work. We know this. Thabo Mbeki provided us with one of the world’s most persuasive, most tragic field experiments when he denied ARV drugs to his HIV-infected citizens, after being convinced by Farber and Duesberg, then was forced by internal and international pressure to begrudgingly provide them, with corresponding life-saving results (somewhat mitigated by alleged governmental tail-dragging).

It would have made sense for Harper’s to publish this in 1987 or even 1997, but not in 2006. Or at least not without also publishing rebuttals indicating just how contrary to overwhelming scientific evidence and consensus this position is.

Posted by LEFTBEHINDS 03/02/2006 @ 5:40pm | ignore this person

Ignatioust-

I hadn’t read your reply before writing my reply.

Yes, I absolutely agree that the cases of AIDS without HIV are the strongest argument for a research program investigating this issue. My understanding is that that science is in fact underway.

I should say that I haven’t read the full Harper’s article, just excerpts here and elsewhere (as well as almost all of Farber’s other work on this, which is extensive and repetitive). Maybe this article is more balanced than Farber usually is.

Posted by LEFTBEHINDS 03/02/2006 @ 5:45pm | ignore this person

Even if you have 4,000 people who appear to have the syndrome without the virus, all that should indicate is that there can also be other causitive factors producing a syndrome similar to what the virus produces. After all, the symptoms of a cold can be from a cold virus – or from some other cause entirely. Yet cold viruses do clearly cause colds.

The telling fact would be the people with the virus who never develop the syndrome. It’s been determined that they all share a genetic uniqueness, are all of European ancestry, and that the rare gene was selected for in the European population because it also protected against the Black Death. Everyone without that rare gene who harbors the virus develops AIDS within a decade. I’m not in medicine, but to not accept that as fact, excuse me, buggers belief.

Posted by UNNATIONAL 03/02/2006 @ 6:17pm | ignore this person

Read all of the comments and post a reply.

OLDER

NEWER >> Liar, Liar, Pants on Fire

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