Damned Heretics

Condemned by the established, but very often right

I am Nicolaus Copernicus, and I approve of this blog

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

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

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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blog, insofar as it seems to believe both in science and the importance of intellectual imagination, uncompromised by out of date emotions such as the impulse toward conventional religious beliefs, national aggression as a part of patriotism, and so on.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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Why not give AIDS drugs to everyone? Jon Cohen’s bright idea

Andrew Sullivan cheers: he’s never met an AIDS drug he didn’t like

A column yesterday (Sun Jan 22) by Jon Cohen in the NY Times magazine achieved a new record in the level of absurdity proposed in HIV?AIDS, a field which already has more inconsistencies and irrationalities and scientific superstitions per square inch of publication than any other scientific study in history.

Jon Cohen is a Science writer and ex-Talk magazine scribe, who published a history of the AIDS non-vaccine five years ago, Shots in the Dark: The Wayward Search for an AIDS Vaccine, a book which apparently managed to overlook the biggest and most obvious reason for that failure (the fact that HIV is described by the scientific literature as acting as an effective anti-HIV vaccine already). He says that what we need to stop HIV?AIDS is really quite simple.

In Idea Lab: Protect or Disinhibit?, he suggests giving AIDS drugs to everybody.

Of course, researchers have made progress in treating patients who already have H.I.V., developing powerful drug cocktails that can stave off disease. But when it comes to preventing the virus’s spread, success is spotty. One of the few effective interventions involves the use of anti-H.I.V. drugs to keep a mother from infecting her baby. And an underappreciated facet to this story has far-reaching implications: both mothers and their uninfected babies receive the drugs.

If anti-H.I.V. drugs can help uninfected babies dodge the virus, might the same approach work for uninfected adults? Could the sexually active take antiretrovirals to avoid contracting H.I.V. in the first place? Intrigued by the prospects, some gay men already have experimented with what’s known as “pre-exposure prophylaxis” or PrEP: a recent survey conducted by the U.S. Centers for Disease Control and Prevention at gay-pride events in four U.S. cities found that 7 percent of those interviewed said they had tried it.

A half-dozen studies are now under way that will determine whether these men are onto something.

(here is the whole piece

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The New York Times

January 22, 2006

Idea Lab

Protect or Disinhibit?

By JON COHEN

At the end of every year, the Joint United Nations Program on H.I.V./AIDS releases an update on the epidemic. In keeping with tradition, the news for 2005 remained grim: an estimated 4.9 million people were infected with H.I.V. during the year – up from 4.6 million in 2003.

Of course, researchers have made progress in treating patients who already have H.I.V., developing powerful drug cocktails that can stave off disease. But when it comes to preventing the virus’s spread, success is spotty. One of the few effective interventions involves the use of anti-H.I.V. drugs to keep a mother from infecting her baby. And an underappreciated facet to this story has far-reaching implications: both mothers and their uninfected babies receive the drugs.

If anti-H.I.V. drugs can help uninfected babies dodge the virus, might the same approach work for uninfected adults? Could the sexually active take antiretrovirals to avoid contracting H.I.V. in the first place? Intrigued by the prospects, some gay men already have experimented with what’s known as “pre-exposure prophylaxis” or PrEP: a recent survey conducted by the U.S. Centers for Disease Control and Prevention at gay-pride events in four U.S. cities found that 7 percent of those interviewed said they had tried it.

A half-dozen studies are now under way that will determine whether these men are onto something. The trials all focus on tenofovir (marketed under the brand name Viread), a drug that appears safer than the other AIDS medications on the market. Placebo-controlled trials are enrolling 5,000 people on four continents who are in high-risk groups, including gay and bisexual men, sex workers and injecting drug users. All told, the experiments will cost more than $40 million, which is being paid for by the C.D.C. and the National Institutes of Health, as well as the Bill and Melinda Gates Foundation.

Dr. Susan Buchbinder, head of the H.I.V. research section at the San Francisco Department of Public Health, runs one of those trials, known as Project T. Buchbinder says she initially had “big reservations” about the research, because she worried about what psychologists call “behavioral disinhibition”: what if fear of H.I.V. declined in people who took the drug, and they then skipped using condoms or increased their number of sex partners? “It’s scary as an investigator, as a public-health official and as a person who has worked with the community for many years to think

about doing something that could paradoxically make the epidemic worse rather than better,” she says.

Buchbinder decided to conduct Project T because tenofovir PrEP had worked well in research monkeys and because she’d heard the anecdotes about underground use, including a cocktail known in street slang as “the 3V’s”: Viread, Viagra and Valium. If the intervention worked, she reasoned, then researchers could confront the problem of behavioral disinhibition head-on with education campaigns, much as they do with condom promotion efforts that simultaneously encourage monogamy or even abstinence. And if tenofovir PrEP fails to stop H.I.V. transmission or causes serious side effects, then people urgently needed that information too. (In part because the prospect of harming a healthy person raises formidable liability issues for Gilead Sciences, tenofovir’s manufacturer, the company says it has no interest in marketing the drug as a prophylaxis, even if trials prove that it works.)

Optimistic mathematical models show that if tenofovir PrEP is effective 90 percent of the time and is used by 90 percent of the people who are at highest risk of becoming infected, it could cut new H.I.V. infections in a community by more than 80 percent in a few years. That is, if behavioral disinhibition does not undo the benefits.

Dr. Marcus Conant, a San Francisco clinician who has specialized in AIDS since the start of the epidemic, has high hopes that tenofovir PrEP will work wonders. Indeed, he already prescribes it to a half-dozen select patients. “With my patients, it’s not even ethical for me to wait for the science,” Conant says. “I can identify those patients who I know are at extremely high risk. Should I wait for the scientific evidence to prove that it doesn’t work before I give it to someone where it may work?”

Even if it works spectacularly well, tenofovir PrEP will not substitute for an AIDS vaccine, the holy grail of prevention research. With a vaccine, a few shots can train an immune system to ward off a disease for decades. But tenofovir PrEP would work only if people take the drug repeatedly. Then again, no AIDS vaccine is on the near horizon. Tenofovir PrEP, in contrast, could prove its worth by 2008.

Jon Cohen is a correspondent for Science magazine and the author of “Shots in the Dark: The Wayward Search for an AIDS Vaccine.”

* Copyright 2006The New York Times Company

Actor/ political scientist/ editor/ talking head/ conservative/ gay blogger Andrew Sullivan, who as noted earlier, in his unquestioning, arts/ liberal/ political pundit based unalloyed faith in the HIV?AIDS medical authorities, returned this year to popping HAART regimen pills to revive his supposedly declining imnmune system, thinks this is a fine idea.

Daily Dish Sunday, January 22, 2006

Drugs And Negs

22 Jan 2006 02:21 pm

In the current HIV prevention discussion, this idea is well worth airing and perhaps pursuing: Why not put all HIV-negative men on a simple anti-retroviral regimen as a prophylaxis, rather than as a treatment? In any single case, the likelihood of possible transmission drops (because the drugs kill off the virus before it can take hold of a new immune system). The big studies being done will help confirm whether there are collective behavioral adjustments that undermine the effort to reduce transmission. My own view is that gay men, if the studies pan out, could and perhaps should embark on a proactive campaign to get as many sexually active men as possible on meds. It’s a way for HIV-negative men to do something which is not simply defensive in nature, and make decisions about their health in a moment outside the inevitable irrationality of a sexual encounter. We’re used to taking pills after we’ve become sick. Why not take them before – as a prevention technique? Even a mild decline in transmission could drastically alter the dynamic of the epidemic – for the better. Next up: involve vulnerable African-American women in the same discussion.

Even if you haven’t troubled to read the scientific literature before misleading the public, and thus still have no idea that HIV?AIDS is the most questioned ruling hypothesis on earth, endlessly exploded by a leading retroviral scientist at exhaustive length in top journals, not to mention eviscerated in more than sixteen books and many articles and web sites by all manner of specialists and science writers and laymen who have made a close study of the topic, this has to be the oddest proposal that has come along for some time.

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“This is his bare hint of the elephant in the room, the vast dirty secret which is hidden by denial by the hapless patients of HIV?AIDS in this country, and their supposed rescuers

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For the immediate problem it suggests is, of course, side effects. Cohen recognizes this drawback by talking of a new drug which is supposed to have fewer side effects than the norm for HAART drugs, the standard regimen which gave Larry Kramer a liver transplant and is wont to render your appearance rather unpleasant with fatty deposits in the wrong places, before eventually killing you off.

The trials all focus on tenofovir (marketed under the brand name Viread), a drug that appears safer than the other AIDS medications on the market. Placebo-controlled trials are enrolling 5,000 people on four continents who are in high-risk groups, including gay and bisexual men, sex workers and injecting drug users. All told, the experiments will cost more than $40 million, which is being paid for by the C.D.C. and the National Institutes of Health, as well as the Bill and Melinda Gates Foundation.

In other words, the side effects of this “safe” drug remain to be seen. But there is one hint that tells us already what they are likely to be. The company which makes the drug says it has no interest in extending their beneficial influence to people without any sign of HIV,

And if tenofovir PrEP fails to stop H.I.V. transmission or causes serious side effects, then people urgently needed that information too. (In part because the prospect of harming a healthy person raises formidable liability issues for Gilead Sciences, tenofovir’s manufacturer, the company says it has no interest in marketing the drug as a prophylaxis, even if trials prove that it works.)

This doesn’t stop Cohen, of course, who believes that handing the stuff out in the gay community might cut new HIV infections by more than 80 percent, if it works “90 per cent of the time”. All this is based on “mathematical models, ie is nothing but speculation.

Optimistic mathematical models show that if tenofovir PrEP is effective 90 percent of the time and is used by 90 percent of the people who are at highest risk of becoming infected, it could cut new H.I.V. infections in a community by more than 80 percent in a few years. That is, if behavioral disinhibition does not undo the benefits.

What he means by the last sentence is that if it works and people feel they are protected against catching HIV, then they will get up to even more mischief, sexually speaking. This is the concern of his source for the idea, the chief of San Francisco city AIDS research:

Dr. Susan Buchbinder, head of the H.I.V. research section at the San Francisco Department of Public Health, runs one of those trials, known as Project T. Buchbinder says she initially had “big reservations” about the research, because she worried about what psychologists call “behavioral disinhibition”: what if fear of H.I.V. declined in people who took the drug, and they then skipped using condoms or increased their number of sex partners? “It’s scary as an investigator, as a public-health official and as a person who has worked with the community for many years to think about doing something that could paradoxically make the epidemic worse rather than better,” she says.

Is it research and thought, or media/Beltway babble?

If this is the usual quality of logic brought to bear on the epidemic by the chief city researcher at the ground zero of the US AIDS epidemic, one can only say that the continuing confusion about HIV?AIDS and the flourishing survival of an apparently baseless paradigm in the medical community is no mystery.

That is to say, if the premise is that the drug does protect against infection, why would it expand the epidemic if those protected against carrying HIV escalate their sexual antics? What Ms Buchbinder has to fear would be the expansion of hospital admissions for side effects, one would think, not new HIV positives.

But the bottom line is that the lack of sense and logic which permeates the minds of HIV?AIDS activists seems to have no limits whatsoever, even among professional commentators on the topic who have been around it for years.

This is probably because in paradoxical manner they do have sense and logic, in that their entire brainpower seems to be taken over by an effort to spin the consequences of the HIV=AIDS premise they are given by authority, and once having accepted that without question, they happily construct what are really quite logical extrapolations of the premise, and when they run into inconsistencies, they either overlook them or reinterpret them to accord with the sacrosanct premise.

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“It really is a marvel of modern society how one can accumulate every imprimatur of authority in one’s field – in this case, writing about AIDS, for the most part – and work for every bunch of editors in the top magazine strata, and not have one grain of sense or ability to question the assumptions of conventional wisdom.”

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This is in accordance with modern brain research, which is the subject of the next post here unless another outrage to common sense demands deconstruction first.

In the end, however, thinking based on faulty premises has to stop, and it seems clear that it has ground to a halt in both Cohen and Sullivan. The net result is that you get conclusions like this one with which Cohen finishes his column:

Even if it works spectacularly well, tenofovir PrEP will not substitute for an AIDS vaccine, the holy grail of prevention research. With a vaccine, a few shots can train an immune system to ward off a disease for decades. But tenofovir PrEP would work only if people take the drug repeatedly. Then again, no AIDS vaccine is on the near horizon. Tenofovir PrEP, in contrast, could prove its worth by 2008.

Why, pray, would one not be happy with this delightful drug if it works as hoped? Why would one need a vaccine? Would it not in effect be a vaccine, one with the additional advantage of not making everyone HIV positive, which a vaccine which bred antibodies against HIV would do – since the HIV test is for HIV antibodies, not HIV, which can hardly be found in any HIV patients without strenuous artificial measures? A population where everybody is HIV positive, which is what a vaccine promises, is hardly what we need.

The answer, of course, to why one wouldn’t want this darn drug as an easy prophylactic lies in the dreaded side effects. This of course is what is implied by Cohen’s fleeting mention of the fact that “tenofovir PrEP would work only if people take the drug repeatedly.”

The elephant behind the AIDS curtain

This is his bare hint of the elephant in the room, the vast dirty secret which is hidden by denial by the hapless patients of HIV?AIDS in this country, and their supposed rescuers, the drug companies and their human delivery system of officials, doctors, nurses and science-illiterate science writers and blogger/talking heads who won’t mention the elephant even as they grope in the dark and find its shape unmistakably there.

In this Alice in Wonderland landscape where bad science joins hands with denial, the emotions of hope and optimism can shine like a sun on a landscape without the shadows of reality. Thus we have a prominent AIDS doctor already handing out this stuff to “select patients”.

Dr. Marcus Conant, a San Francisco clinician who has specialized in AIDS since the start of the epidemic, has high hopes that tenofovir PrEP will work wonders. Indeed, he already prescribes it to a half-dozen select patients. “With my patients, it’s not even ethical for me to wait for the science,” Conant says. “I can identify those patients who I know are at extremely high risk. Should I wait for the scientific evidence to prove that it doesn’t work before I give it to someone where it may work?”

This then is the end result of the train of logic that results from the HIV?AIDS paradigm, that these privileged patients, in good health and not even HIV positive, will consider themselves lucky to join the HIV positive group whose main suffering is caused by the drugs they take, which eventually lead to death, according to all the critiques of the paradigm.

All one can hope is that the new drug will not have the same unpleasant effects as the old, which will perhaps give these unfortunate souls more time to browse the literature of dissent in this area and perhaps grow to understand just how much science argues against the paradigm, and perhaps wean themselves from this baby bottle ideology, which now aims to expand its circle of depredation even more widely in the population, at least among gays.

As long as the likes of Andrew Sullivan and Jon Cohen assume the mantle of thought leaders in this arena, and fail to fulfil their first duty as pundits and go to the original source ie the scientific literature of the review of the claim, as well as of the claim, this route to enlightenment on the part of their followers seems to be unlikely to be followed, however.

Jon Cohen’s performance seems to be even more disgraceful than that of Sullivan, of course, since Cohen at least claims to be a student of science. Sullivan in AIDS is now just a nattering nabob of underinformed Beltway blather, which is par for the course for busy professional media pundits. Just look at Sullivan’s bio, to see how impossible it is that he could find much time to go to a library, even on the Internet. He must barely have time to change clothes between his appearances on television, his visits to the centers of night life, and his computer.

Cohen on the other hand has been a Science reporter for years, and although we appreciate that his dogged propagandizing for the bureaucratic and lab heroes of HIV?AIDS has led to trips to India and Beijing, a book contract and other perks, we really think that professionalism alone demands that he of all reporters should go back to the science and think and read for himelf before writing any more on the topic.

But of course this is a suggestion which is unlikely to be realized. A man whose reputation and fees hinge on the dangers of the “nasty virus” as he calls it is hardly in a position to reassess what amounts to his life’s work.

It really is a marvel of modern society how one can accumulate every imprimatur of authority in one’s field – in this case, writing about AIDS, for the most part – and work for every bunch of editors in the top magazine strata, and not have one grain of sense or ability to question the assumptions of conventional wisdom.

Jon Cohen is a writer for Science, the prestigious international weekly journal of the American Association for the Advancement of Science (AAAS). He has covered biomedicine, specializing in vaccines, for the past fifteen years. Cohen began writing for Science in 1990, becoming one of the world’s leading AIDS reporters. In 1998, Cohen received a Sloan Foundation grant to complete Shots in the Dark: The Wayward Search for an AIDS Vaccine, which was published by W.W. Norton in January 2001. In addition to reporting on a wide range of scientific and medical topics for Science from many locales around the world, Cohen has done in-depth, investigative stores about the National Institutes of Health, tobacco industry funding of science, defense against bioweapons, the troubled vaccine industry, credit battles, the genomics revolution, and the science press itself. He also has written for the Atlantic Monthly, the New Yorker, the New York Times, the Washington Post, Slate, Smithsonian, Talk, Discover, the New Republic, Surfer, and other publications. His 1997 Science article about the rise and fall of an AIDS research program in the former Zaire won the international health reporting award from the Pan American Health Organization. From 1986 to 1990 he was senior editor at the City Paper in Washington, D.C. He earned a B.A. in 1981 from the University of California, San Diego, where he majored in science writing. Cohen lives in Cardiff-by-the-Sea, California, with his wife, a TV documentary producer, and their two children.

Andrew Sullivan’s bio offers the same paradoxical evidence that one can attend Magdalen and Harvard, push one’s way into the top job of a major East Coast political weekly, and achieve enormous success in media as a writer for every big name in the book, and have absolutely no idea what is going on in the field of HIV?AIDS, where your very own health is at stake.

But of course, the solution to the paradox is clear. No one on the inside of the media looking in ever has much of a clue as to what is really going on, except in their own little world. To do that, you have to be on the outside looking in, and around.

But then, why do those who are members of the club seem to speak with so much canny insight and informed knowledge? That is because everyone on the inside says the same thing, so their words are constantly confirmed by each other. They are, in effect, the priests of an information religion.

As anyone who lives long enough knows, the only reliable source of knowledge is an independent mind and an independent bank account. Alas, these are increasingly rare in our modern hyper-organized and materially driven society, and they rarely gain access to power and influence.

Let’s hope the one development that promised to counter this trend, the Web, continues to resist being coopted.

Long live the independent blog, especially in science.

For confirmation of this theory of how membership of the club corrupts the mind, we offer as sufficient evidence this essentially fantastic view of the world of AIDS as seen through the eyes of Jon Cohen:

As a long-time correspondent for the journal Science and a leading authority on the global AIDS epidemic, Cohen has traveled the world documenting the human toll of AIDS and the social and medical research being marshaled against it. But he hadn’t seen anything as dire as Tambaram since his travels in the AIDS-ravaged lands of sub-Saharan Africa.

“Tambaram is how my mind’s eye imagines the Black Plague: long rows of filled beds with dying people,” he said in a recent interview. “The clinicians were fantastic: smart, humane, and generous. But this is a nasty virus, and it still takes a lot of money and know-how to keep HIV at bay. As the doctors there stressed to me, they’re doing the best they can. I could see that. It’s just that the best they can offer right now isn’t enough.”

Cohen is back in Asia now, joining thousands of health workers, researchers, activists and journalists for the 15th International AIDS Conference in Bangkok, which runs from 11-16 July. The theme of the conference is “Access for All,” but in a remarkable series of stories over the past nine months, Cohen has made clear that while there’s been great progress, the goal of proper care for all of those in Asia who are HIV-positive or suffering from AIDS remains far off. AAAS and Science will distribute thousands of reprints of his stories at the conference, without charge.

“There are an estimated 40 million HIV-infected people in the world,” Cohen said in the interview. “It depends on which equation you use to calculate which of those people need drugs now, but it’s a pitifully small number who are actually receiving them.”

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Science Correspondent Jon Cohen Sees Perils, Promise in the Fight Against AIDS

Jon Cohen with Sun Fuli in Beijing

Jon Cohen with Sun Fuli in Beijing

[You can see a slide show and a photo essay that accompany Jon Cohen’s stories on AIDS in Asia. Read the full set of stories here.]

Jon Cohen arrived at the old Tambaram hospital in Chennai, India, on a Saturday morning last winter and saw sights that he hadn’t seen before in Asia. There were five AIDS wards, each with three dozen beds, and each of them filled to capacity. In the past year, he was told, the staff had treated 10,000 patients.

As a long-time correspondent for the journal Science and a leading authority on the global AIDS epidemic, Cohen has traveled the world documenting the human toll of AIDS and the social and medical research being marshaled against it. But he hadn’t seen anything as dire as Tambaram since his travels in the AIDS-ravaged lands of sub-Saharan Africa.

“Tambaram is how my mind’s eye imagines the Black Plague: long rows of filled beds with dying people,” he said in a recent interview. “The clinicians were fantastic: smart, humane, and generous. But this is a nasty virus, and it still takes a lot of money and know-how to keep HIV at bay. As the doctors there stressed to me, they’re doing the best they can. I could see that. It’s just that the best they can offer right now isn’t enough.”

Cohen is back in Asia now, joining thousands of health workers, researchers, activists and journalists for the 15th International AIDS Conference in Bangkok, which runs from 11-16 July. The theme of the conference is “Access for All,” but in a remarkable series of stories over the past nine months, Cohen has made clear that while there’s been great progress, the goal of proper care for all of those in Asia who are HIV-positive or suffering from AIDS remains far off. AAAS and Science will distribute thousands of reprints of his stories at the conference, without charge.

“There are an estimated 40 million HIV-infected people in the world,” Cohen said in the interview. “It depends on which equation you use to calculate which of those people need drugs now, but it’s a pitifully small number who are actually receiving them.”

[See the full interview with Jon Cohen here.]

As the Bangkok conference nears, Cohen sees a world divided into rich nations and poor nations. The rich nations are refining their treatment programs, learning how best to use drugs to combat the virus, and pushing for a vaccine. But in the poor nations, and this includes the nations of Asia, “there aren’t a lot of options for treatment,” he says. “The big challenge is to get treatment to people, and there is a massive scale-up underway right now. But as of today, very, very few HIV-infected people in the world who are poor receive drugs or have access to drugs even though the price has plummeted.”

For years, Cohen says, most of the nations of Asia had been reticent about dealing with the spread of the infection among their people. That’s partly a function of denial, he suggests, a response shared by the United States as AIDS hit its stride there in the 1980s, and partly from the fact that the disease is relatively new to places like China. But in the past year, he’s seen a change.

“There have been very dramatic commitments from …India, China and Thailand to treat the people most in need,” he explains. “I also think that India and China are more forthrightly dealing with their epidemics than they were a few years ago. They’re acknowledging the scale and they’re also starting to deliver services. But almost every country, and I would include the United States here, is fighting this virus with one hand tied behind its back because of political agendas. That hasn’t changed much. It’s changing, but it’s glacial, it’s excruciating to watch…. The virus just doesn’t wait for anyone-it doesn’t care. It doesn’t play politics. It doesn’t have a brain. It doesn’t have morals. None of that matters to HIV. It just wants to copy itself and spread, that’s all it wants to do.”

What caused the change in those Asian countries? The factors vary from place to place, he says, but one element is common: Fear. The countries fear the impact on their economies. They fear international disapproval of the sort China faced last year over its failure to respond in a timely and forthright way to the SARS outbreak. And increasingly, he says, they fear the dire impact on their people.

“Think about it—in Asia, who really drives the epidemic?” Cohen asks. “Well, it’s driven by sex workers and mostly by their clients—that’s what really drives it. And so it’s easy for people to be moralistic and to say, ‘You got yourself into this—who cares?’ Countries come realize then, that, first of all, sex workers and clients are part of the population. They’re people too. And much as you might want to marginalize them, they have children, they have spouses, and those people often become infected often having done nothing that any moralist would say is wrong. In India, there’s a saying that a woman’s greatest HIV risk factor is getting married. Women are largely monogamous there. Many, many women have become infected after their husbands went to sex workers. Countries just start to accept that they can’t just put this disease in a corner and say, ‘This is something that happens to bad people.’

There is a window of opportunity open right now in much of Asia, he says. And while it gradually is closing, there remains time to save thousands of lives with effective intervention.

“Once you get to a certain level of spread, like South Africa, where you have 20 percent of the adults infected, you can’t base your prevention program around targeting those 20 percent of the people,” he says. “It’s just too large a group. But if you only have, as is the case in China now, somewhere around a million infected people, you can target those people for prevention care. You can target high-risk groups, like injecting drug users and sex workers, and really make a huge difference in preventing a widespread epidemic. That’s where Asia sits right now.”

Cohen has been covering HIV and AIDS since 1989. He has reported extensively for Science, and his 2001 book “Shots in the Dark: The Wayward Search for an AIDS Vaccine” (W.W. Norton & Company, 2001) won the National Association of Science Writers’ Science-in-Society award. His latest book, “Coming to Term: Mysteries, Myths and the Latest Science of Miscarriage” is slated for release by Houghton Mifflin in January. What’s striking, in an interview with Cohen, is not only his knowledge and eloquence, but his balance. He has seen the worst of the AIDS epidemic in places like Tambaram and sub-Saharan Africa, he has seen how politics at times cripples the fight against the disease, and yet his perspective retains strong elements of compassion and hope.

“The greatest cause for optimism is that the virus [in Asia] hasn’t spread that far yet. So there’s a terrific chance to use the new treatment programs to encourage people to receive tests,” he says. “If you can offer drugs, there’s more likely people will receive a test, because there’s something you can do for them.

“And then…on the edge of research, there are some really interesting possibilities. Research equals optimism, to me—that’s the whole idea.

“When I work in large AIDS wards, it of course depresses me—and I would have deep suspicions about anyone who didn’t feel saddened by the helplessness—but I also feel like, on some level, we are helping. When I go sailing and I’m piloting a boat, the motion of the sea doesn’t make me ill. It’s the same sort of feeling when I’m at work in a depressing situation: While I’m doing my job, it blunts the dizzying sensation of meeting many, many people in one place who I know only have weeks or days to live. I’m also buoyed by the wisdom that comes with great suffering, and I meet people everywhere who impress me with how well they handle the crises of life with AIDS.”

The journal Science, published by AAAS, has the largest paid circulation of any peer-reviewed general science journal in the world, with an estimated total readership of one million. AAAS, founded in 1848, is the world’s largest general scientific society, serving some 10 million people through 262 affiliated societies and academies of science. The non-profit association is open to all and fulfills its mission to “advance science and serve society” through initiatives in science policy, international programs, science education and more.

— Edward W. Lempinen

6 July 2004

4 Responses to “Why not give AIDS drugs to everyone? Jon Cohen’s bright idea”

  1. Darin Brown Says:

    >>> Dr. Marcus Conant, a San Francisco clinician who has specialized in AIDS since the start of the epidemic, has high hopes that tenofovir PrEP will work wonders. Indeed, he already prescribes it to a half-dozen select patients. “With my patients, it’s not even ethical for me to wait for the science,” Conant says. “I can identify those patients who I know are at extremely high risk. Should I wait for the scientific evidence to prove that it doesn’t work before I give it to someone where it may work?”

    Ummm…YES! This is the usual “shoot first; ask questions later” mindset of HIV/AIDS, both in terms of publication of scientific “advances” as well as pharmaceutical distribution. The “imminent” and “urgent” threat of HIV has always been used as an excuse to dodge the traditional avenues of peer review, open discussion of new research findings, and administration of new medical therapies.

    The ultimate paradox of Cohen/Sullivan’s idea is that if taken to its logical conclusion, it would require literally *everyone* in the world to go on the drugs. After all, doesn’t Cohen explicitly compare this prophylaxis to an HIV vaccine? Presumably, he would expect everyone to go on a vaccine, if he felt it were developed (no matter how paradoxical that idea is to begin with). So, why does he seem to promote this new drug prophylaxis only to “those at high risk” (read: gays, blacks, Africans)? If it really works, why not give it to everyone?

    Of course, Cohen can’t do this. The general population is not going to buy into the idea of every citizen and human being of the world being pumped full of ARVs for the rest of their lives. But this forces Cohen into another corner. By promoting that the drugs should only be given as prophylaxis to “those at high risk”, he is basically acknowledging the fact that HIV is *not* a threat to “everyone”, that the virus *does* discriminate along cultural and behavioural fault lines.

    It’s amazing to think what kind of mental contortions Cohen must be going through to balance all the internal contradictions and paradoxes he holds in his mind.

  2. Truthseeker Says:

    “The “imminent” and “urgent” threat of HIV has always been used as an excuse to dodge the traditional avenues of peer review, open discussion of new research findings, and administration of new medical therapies. ”

    Well pointed out, Darin. Sometimes one forgets that the entire literature in AIDS and all its research has pretty much got a free pass for twenty years, through dodging of this kind. Everyone is “too busy saving lives” to worry about whether what they are doing makes sense, even if it kills.

    Alas, the assembled structure of frequently absurd rationalizations which has resulted is fully protected from the gaze of the believer such as Cohen by a certain property of the human brain which recent neuroscience has thrown much light on, about which we intend to post soon.

    That is, the natural tendency of the left brain hemisphere to protect any belief which it has adopted from conflicting data input by flipping the data as it comes into the brain, rather than adapting the belief.

    So according to this research with brain damaged patients Cohen is merely exhibiting the common behavior of the bulk of humanity, who are not inclined to think very hard if they can help it. He is entirely unaware of the trick his own brain is playing on him.

  3. reffa Says:

    Regarding the dangers of the bird flu mutating as the 1919 flu did please see my website http://www.cancerfraudbadbiotech.com the Gold 2006 section. Here is a discussion on a special genetic tag on the AIDS virus that if it interacts with the bird flu could TAG for DEATH 70% of mankind. Also discussed is WW1 and mutagens such as mustard gas. Flu is an evolutionary messenger and as such the environment controls and directs overpopulated species which have not responded to other natural controls,i.e., famine etc and have continued out of control . Dr.James Lovelock (GAIA theory ) has commented on my theory. Noam Chomsky said it may be of phenomenal importance to mankind. US Surgeon General has regretted my treatment. I have dealt with Dr.Duesberg in the 90s and he wasn’t brave enough to help me with my academic black listing . Can we avoid disaster? Yes. Will we? Given how badly I’ve beeen treated, and how slow we are to react (see Pfizer CEO McKinnell’s failure) I doubt it.Thank you. E.A.Greenhalgh

  4. Truthseeker Says:

    Thank you for your support, Pat :-)

    [Refers to justifiably immoderate post provoked by spam for soccer bets site posted above, now deleted – Ed.]

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