Dean's World

Defending the liberal tradition in history, science, and philosophy.

Scientific Dissenters

I am known for being highly critical of conspiracy theories. And yet, I also tend to be open to unorthodox views. Some people probably see that as two mutually exclusive tendencies, but they aren't. The reason I don't believe most conspiracy theories is because I'm a believer in Occam's Razor (all things being equal, the simplest explanation tends to be correct), and conspiracies almost universally require many, many people acting in coordinated fashion--and then for all of them to keep their mouths shut. In my experience, human beings just aren't organized or disciplined or trustworthy enough to pull off most conspiracy theories.

By comparison, being open to an unorthodox viewpoint requires merely open-mindedness and a willingness to give more credence to data than opinion. It's really not all that complicated, but some people find this baffling.

I mention all of by way of introducing the fact that I one of the odder things I believe is that HIV may not cause AIDS.

I am not certain of this. But I have sufficient doubts that were I to turn up HIV positive I'd refuse to take any medications for it unless and until certain very specific symptoms appeared (Kaposi's sarcoma and dramatic drop in t-cell count, basically). Even then, you'd have to put a gun to my head to get me to take any combination of medications that included a drug called AZT.

I also have a strong suspicion that most people in Africa diagnosed with AIDS are actually dying of malaria--because their governments get more international aide money for fighting AIDS than they do for fighting malaria, even though malaria kills millions.

That's a rather dizzying set of suspicions, I know. However, some very smart people besides me think many of the same things.

I also have a suspicion, by the way, that Oncogenes, Aneuploidy and AIDS: A Scientific Life & Times of Peter H. Duesberg may well be the book of the year for people interested in the life sciences.

I mentioned that I generally take a very dim view of conspiracy theories. But bureaucratic screwups, petty politicking, and general human credulousness? These are universal in all human endeavors--including science, I'm afraid.

Posted by Dean | Permalink | Technorati Trackbacks
Mrs. du Toit (www):
It's not a mutually exclusive concept at all. You can apply Occam's Razor in this case by doing this:

"In Africa, all things being equal, the simplest and easiest explanation IS a conspiracy by government if funding and fraud are involved."

Fraud and extortion are much more rare in The West and we tend to think of as bad or sinful. This is not the case in other parts of the world.
12.28.2004 11:24am
annika (mail) (www):
Isn't Deusberg the only scientist who holds that particular view of HIV though? And wouldn't that cause his theories to run afoul of Occam's razor. i'd heard (but don't know if it's true) that he once said he'd be willing to be injected with HIV, but never actually went through with it.
12.28.2004 12:11pm
Jay Solo (mail) (www):
I think there are others, but anyone with these beliefs or suspicions tends to stay quiet. The establishment comes down on HIV/AIDS dissenters, be they scientists, politicians, or anyone, perhaps harder and more viciously than I have ever seen with anything else.

I first learned that there was any dissent from SF author James P. Hogan, a favorite of mine, and one I trust as a rational mind. If he suggests there may be something going on, I'm going to give it consideration.
12.28.2004 12:56pm
caltechgirl (www):
Dean, my friend, I hate to say this, but I'm pretty sure you're barking up the wrong tree. I appreciate your viewpoint on scientific "truths". I think you're absolutely right to question some of this, but the thing is, I think you're pursuing the wrong field. Sure there are a hell of a lot of things we don't know about cancer and viruses, and granted, we do seem to spend a hell of a lot of money on stuff that will never lead to a cure. But if mutations don't cause cancer, how come my friends have mice that grow tumors, the same tumors starting at the same age, that grow the same way and all that's wrong with them is a genetic mutation?

Part of the reason that we know so little about cancer is that everyone has for 20 years focused on the genetic aspects of the disease because it's such an obvious answer, but there are any number of downstream events such as RNA translation and protein folding that could contribute to uncontrolled growth. Very few are actually lookign at those things because they are more difficult to study.

As far as AIDS is concerned, we know that HIV causes AIDS. Period. HIV destroys the immune system one cell at a time. AIDS is what happens when your immune system is dead. AZT is an awful drug, but so are chemo drugs. Which one kills you first?
12.28.2004 1:02pm
JDS (mail):
I read alot about this several years ago, and haven't thought about it much since, but I've always kept it at the back of my mind. I'm not necessarily sold on the idea, but after reading about it again, it seems to me that Deusberg's risk behavior-AIDS relationship actually seems to be a simpler explanation than the HIV-AIDS relationship. In my mind, it actually might explain certain phenomena better. It certainly explains why AIDS never turned out to be the epidemic that it was predicted to be.
12.28.2004 1:02pm
caltechgirl (www):
Also, just wanted to add that the person who wrote the article you linked to (George Gabor Miklos) knows his stuff and just wrote a great article in Nature Neuroscience on gene chip analysis and how it fails to live up to its potential.
12.28.2004 1:04pm
Phelps (www):
Actually, I hold the same belief, and it is based 100% in the scientific method and pathology theory. Here's the basics:

* Many people test positive for HIV antibodies that never contract AIDS

* A small number of people have AIDS (since it is a syndrome and they have sufficient symptoms) but test negative for both HIV and HIV antibodies

These two things together (with much more weight given to the second fact) tell me that AIDS is not -- without completely rewriting everything we know about germs -- caused by HIV. Is there a correlation? Absolutely. But correlation is not always causation. There is also a very, very strong correlation between AIDS and drug use, and it isn't beyond reason to chalk up the last little bit to people refusing to cop to drug use because of the illegality. It is convenient to tie this to blood transfer in IV drug users, but then we start bumping into the fact that the correlations are just as strong between IV drug users and people who practice promiscious sex.
12.28.2004 1:49pm
Brain Fertilizer (mail) (www):
Dean,
I've been biding my time to post pretty much the same thing.
Here are some realities that fly in the face of conventional wisdom regarding HIV/AIDS:
1) The symptoms that result in an AIDS diagnosis in Africa are significantly different from those in the US
2) the only way to test for AIDS at this point is by testing for antibodies. Get that? If the bodies immune system is broken down, how can the immune system be producing antibodies against it?
3) "HIV causes AIDS" was an extremely rapid conclusion compared to typical bio-science processes. The issue of AIDS was always significantly socio-political, rather than purely medical like, say, diabetes (which is also gradually being politicized from the obesity angle).
4) Once the conclusion was made, the socio-political environment stifled all other research into the issue by the simple expedient that anyone who offered any view other than "HIV causes AIDS" doesn't get funding.

So the preponderance of evidence supports the idea that HIV causes AIDS. But since any investigation into the matter was cut off at the knees, there was no chance for a competing theory to be researched.
One theory I'd heard was that the homosexual male AIDS was simply the breakdown of an over-taxed immune system shocked by prophylactic doses of anti-biotics (designed to pre-emptively kill gonorrhea, syphillis, and other STDs), but that doesn't really explain the intravenous drug user incidence of AIDS. Still, the idea that HIV is merely another non-malignant marker of AIDS should not be so quickly dismissed. Is the reason we can't find a cure for AIDs simply that we are looking in the wrong direction?

My source for these is an essay by James P. Hogan. I won't be able to cite it completely until I get home from work.
12.28.2004 1:53pm
Chris Lansdown (mail) (www):
Caltechgirl,

I have no dog at all in this fight (I have no notion of whether HIV causes AIDS, so I trust the general wisdom that it does unless I have a good reason not to), but do you really think that just asserting something boldly ("X is true. Period.") is going to affect a skeptic's belief in the slightest?
12.28.2004 1:54pm
Wince and Nod (mail) (www):
Chris,

I've tried it myself, and seen it tried many times, yet emphatic assertion has a very low success ratio.

Umm, like zero, in my experience.

Yours,
Wince
12.28.2004 2:00pm
maor (mail):
Dean,
Do you buy Duesberg's theory that drug use is what causes AIDS? Because a few posts ago, drugs were illegal only because of financial interests etc.
(Not that there's anything wrong with conflicting ideas. That's what keeping an open mind is all about. But I'm curious.)



Anyway, what gave AIDS to all those French hemophiliacs in the mid-80's?
It would be nice to hear that that didn't exactly happen.
12.28.2004 2:04pm
caltechgirl (www):
Not trying to change minds here. Just pointing out that they're wrong.

As for testing for HIV, that is done by PCR which amplifies the virus DNA out of the host background. Has ZERO to do with antibodies or any other immune system function for that matter. Even Duesberg agrees on that point.

As for Duesberg, I wrote a pretty thorough debunking of him here
12.28.2004 2:14pm
Dean Esmay (www):
Connie: Oh, corruption doesn't really fall into "Conspiracy Theory" thinking so far as I'm concerned, especially not the kind of corruption you're talking about.
12.28.2004 2:15pm
James Owens (mail):
Duesberg's article is dated 1993. I would suspect that if it held any water, we would have heard something by now. It makes for an interesting read - certainly, but seems more a well thought out plot for a fiction novel than anything holding any real scientific value.
12.28.2004 2:26pm
Dean Esmay (www):
Guys: You all kind of disappoint me, only because you apparently didn't even skim the very first link I provided, which lists literally dozens of top scientists who strongly question the HIV-AIDS hypothesis.

If you don't want to follow the link, how can we have this discussion without my repeating myself?

Duesberg is top on the list only becuase he was the first and loudest and most stubborn scientist on the matter. You now also have to contend with Dr. Robert Root-Bernstein, who held a MacArthur Prize fellowship from 1981 to 1986 and is associate professor of physiology at Michigan State University. You also have to contend with the Perth Group, headed by Dr. Eleni Papadopulos-Eleopulos, professor of medical physics at Royal Perth Hospital, a teaching hospital at the University of Western Australia, and Dr. Valendar Turner, professor of emergency medicine at University of Western Australia who's part of the same group. You also have to contend with Dr. Gordon Stewart is professor emeritus of public health at Glasgow University, and a former WHO adviser on AIDS.

You must contend with the late Dr. Alfred Hässig, (1921-1999) who was professor emeritus in immunology at the University of Bern, Director of the Swiss Red Cross Transfusion Service, and President of the Board of Trustees of the International Society of Blood Transfusion. With colleagues he formed the Study Group for Nutrition and Immunity, a Swiss research group that doesn't believe that HIV causes AIDS either.

You must contend with Dr. Heinz Ludwig Sänger, Emeritus Professor of Molecular Biology and Virology at the Max-Planck-Institutes for Biochemy in München.

You have to contend with Dr. Harvey Bialey, scholar in residence and coordinator at the Institute of Biotechnology, UNAM, in Mexico and a former Editor-at-Large for Nature Biotechnology and Research Editor of Bio/Technology.

You must also contend with the board of directors for the Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis.

You have to contend with all of these people too.

Please look carefully at the links I have provided before commenting further. It will make things much easier.
12.28.2004 2:30pm
caltechgirl (www):
None of these guys is current. Yes there are some Nobel people (Kary Mullis is the least respected laureate I know of) and some MacArthur winners, but that was years ago, and all of these folks seem to suffer from tenure syndrome and/or emeritus syndrome. Their stuff is just not as current as others are. As for that last link, the VAST majority of those folks have no listed university affiliation, and probably know jack about AIDS and HIV. One name I was looking for, David Baltimore, a well-known retroviral researcher, nobel laureate, and president of Caltech, is noticeably absent from the list, along with any other names I recognize as top academic scientists.

I could get on that list and look suitably impressive too, "Caltech Girl, PhD, UNC Chapel Hill, NC, USA"; but it means nothing.

And what do these guys have to do with AIDS?:

# Celia Farber, Writer, Gear Magazine

# Russell Schoch, Editor, California Monthly; Berkeley

# Tom Bethell, Washington (DC) Correspondent of The American Spectator

# Charles Geshekter, PhD African History; Prof., Cal. State Univ.; Chico, CA

# Mark Craddock PhD, Mathematics; Lecturer, Univ. of Sydney

# John Lauritsen, Market Researcher/Analyst (ret.); Author; Journalist, Cape Cod, MA

Their affiliations give no clue as to how they would be expected to have ANY AIDS expertise, yet they are members of this Board of Directors you cited.

Still not buying it.
12.28.2004 2:42pm
maor (mail):
Dean,
Do you realise how many scientists there are in the world?
BTW, I did read the link. He demands a high level of proof that HIV is the cause (OK by me), but practically no proof that drugs are the cause (just esentially "It coulda been the drugs!"). But I guess he can't show that drugs are the cause because he isn't getting enough funding!

It's perfectly logical that not all HIV-infected people get AIDS. No virus defeats the immune system 100% of the time.
12.28.2004 2:47pm
Dean Esmay (www):
Caltechgirl: You have my respect, but Chris is right: telling me that HIV causes AIDS, period, doesn't really get anywhere with me. Indeed, whenever a scientist makes such a definitive statement, I have to wonder.

I can't tell you how many researchers and nutritionists and MDs in the 1990s were telling me that low-carb diets are "dangerous and ineffective, period." And how many said that low-fat diets reduce heart disease, period. Or what a dim view I take of scientists who say "human being are causing cataclysmic global warming, period." ;-)

Annika: So far as I know, while Duesberg is far from alone now in questioning whether HIV causes AIDS or even questioning whether HIV exists at all (a shocking and growing number now back him on both of those), he does seem so far as I know to be the only one who believes that drugs and unprotected sex are the primary cause of AIDS. I've looked at his reasoning and I find it rational if not entirely convincing. I find Occam's Razor easy to apply here: is it a virus that no one has ever been able to find in the human bloodstream (HIV testing kits only test for the antibody to the virus, not the virus itself) and that acts in a way that no other retrovirus has ever been shown to act, or is it gay men and female prostitutes having frequent unprotected anal sex with thousands of partners while heavily using poppers, cocaine, speed, booze, pot, heroine, etc. destroying their immune systems?

And why do we now have people who've been HIV+ for more than 20 years and are still fit and healthy? We are supposed to believe that not only does this virus which can't actually be found in patients causes it, but that it can stay dormant for decades. Where does Occam's Razor slice on this?

I'm not saying Duesberg is correct, since other researchers who question the HIV hypothesis have other ideas. Most of them credit Duesberg, however, for probably being right on the big question: whether HIV has been proven to cause AIDS.

Phelps: Yeah. To get around the AIDS patients who were HIV negative they first named it something different: "Idiopathic Cytopathic Lymphoma III" if I recall correctly. I believe they now just say that the tests for HIV aren't reliable, which I find rather mind-boggling since that means the HIV hypothesis has never fully satisfied Koch's postulates.

Maor: As I said, I find Duesberg's theory rational if not convincing. But medicinal pot is not the same thing as what Duesberg's talking about at all. His belief is that frequent unprotected sex, coupled with heavy use of amyl nitrate ("poppers"), cocaine, heroin, and many other drugs besides all combines to destroy the immune system.

I'm not convinced that he's correct in that. I am convinced that he's been treated extraordinarily badly by the scientific establishment, most especially those who receive lots of government grant money to study HIV.

Whatever your opinion on the matter, one thing you cannot say is that all the scientists who question the matter of HIV causing AIDS are crackpots. Many of them are very smart people, highly qualified in the field.
12.28.2004 2:49pm
Dean Esmay (www):
Caltechgirl: Yes, many on the last list are journalists or non-scientists. But many are scientists.

As for whether any of them are current: you mean a lot of them are not current, or none of them are? Didn't you just speak well of George Gabor Miklos? And is Harvey Bialy really just suffering from Emeritus Syndrome?

Maor: I do realize how many scientists there are. I also realize that consensus isn't the only thing that makes for good science. The consensus view in science has been blown to smithereens by dissenters several times in my lifetime. If you believe the dissenters in this case are wrong, that's fine. I merely note that you cannot dismiss them as a bunch of flakes and crackpots. Wrong, possibly. Nutjobs? No.

Regarding drugs causing AIDS: That's his hypothesis. He's published some research on it but has been thwarted in finding funding for more. This is not unusual and does not make him wrong. Wrong he may be, but it disturbs me deeply that his requests for funding were completely rejected even in the very earliest days when he was still working with guys like Gallo.

I've read his book, Inventing the AIDS Virus, which is a rather massive tome. It contains a lot of history that matches perfectly with everything I've read about the early days of AIDS research in such books as And The Band Played On by the late Randy Shilts (dynamite book by the way).

The more important lesson here is not that Duesberg is correct, but that once Gallo and Montaigne declared that they'd discovered the cause of AIDS, ALL government funding (ALL OF IT) went to studying HIV, and anyone who wanted money to study AIDS had to study HIV pretty much from 1984 onward.

Tell me: Is Harvey Bialy a crackpot?
12.28.2004 3:06pm
Catch 22:
I agree with caltechgirl. If Dean's World were science and Dean the scientist, I would say Dr. Frankenstein needs a call or maybe Al Franken.

And as any fool knows aids was exacerbated by Reagan in the 80's.
12.28.2004 3:10pm
ILNative (mail):
My question is sorta-kinda related to this topic, and it's been bothering me for a while.

All over our media are pleas to "stop the epidemic" of AIDS in Africa. We hear of the millions that are HIV-positive and the millions that are dying of AIDS, and something. must. be. done. NOW.

Um, okay. But what do we do?

Really, what? My cousin and his wife were medical missionaries in Uganda, teaching native doctors how to treat AIDS along with AIDS prevention. Their biggest obstacle was the culture -- women and children are considered property in many parts of Uganda, so the more women you have and the more children you have, the richer you are. Do we really think they're going to embrace the condom? And if we did stress the importance of safe sex and monogamy, wouldn't we be accused of forcing OUR culture on them?

Of course, the argument could be made that any culture that treats women and children as property NEEDS to be forced out, a la the Taliban, so I may be arguing in circles here.

I'm not being sarcastic, really. I just don't understand what the "Stop the Epidemic!" people want us, as Americans, to do. Other than talk and have concerts, of course.
12.28.2004 3:13pm
Dean Esmay (www):
ILNative: They're trying to do it by mass distribution of AZT (and mostly just AZT) and by distributing condoms and education.

The fact of the matter is that malaria kills more people than AIDS does, but it doesn't receive the same attention--and there's good reason to suspect that a lot of AIDS cases in Africa are really just malaria, but the various health agencies are reporting them as AIDS because they get more money if they do.

Now why is that, do you suppose?
12.28.2004 3:25pm
Dean Esmay (www):
I missed this:

As for testing for HIV, that is done by PCR which amplifies the virus DNA out of the host background. Has ZERO to do with antibodies or any other immune system function for that matter. Even Duesberg agrees on that point.

This is news to me. You're saying that current testing actually locates HIV in AIDS patients?
12.28.2004 3:34pm
caltechgirl (www):
Yes it does. In fact if you read Duesberg's website he cites Kary Mullis as the founder of the technology used to test for AIDS and one of his supporters.

There are also antibody tests. In fact the quick test that they do in the public health offices is an antibody test. That's why they're so quick. Immunohistochemistry takes anywhere from 20 minutes to a few hours to overnight, depending on the procedure.

Patients who take the antibody test are usually in reasonably good health and are early in their disease course.

However, they usually refer patients who test positive via the antibody test for a more definitive PCR test that translates the retroviral RNA and amplifies the DNA. The result is then run out on a gel. If you have a band in the right (or wrong, depending on how you look at it) place, you have the HIV virus.

You can even tell who gave you the virus if the transmission was recent enough, by running a restriction analysis (similar to what they use in a paternity test) and comparing the genetic profiles of the virus samples from different people.
12.28.2004 3:53pm
caltechgirl (www):
Here's the quote on PCR testing from Duesberg's webpage:
" Kary Mullis won the 1993 Nobel Prize in Chemistry for his invention of the polymerase chain reaction technique for detecting DNA. This is the technique used to search for fragments of HIV in AIDS patients."
12.28.2004 3:57pm
Dani:
I side completely and utterly with Caltech girl on this subject. Furthermore, Dean, I think you are doing a great many people a huge disservice by posting your thoughts on this matter. I think it's irresponsible, and dangerous because people read you and think you're a pretty smart guy.

I am no HIV researcher but I remember when it first came out. Duesberg's theory was hatched then, and just because he doesn't want to update his thinking it his problem, not mine. He still wants to blame the victim for leading a lifestyle that "stresses the immune system." That was the thinking then, you know. Blame the gays. Poke these "researchers" hard enough and I wonder how many come up homophobic.

Two labs simultaneously identified HIV- one in France and one in the US. At that time I was in medical school. I remember the various theories evolving and followed the articles closely, because my very life depended on it.

Caltech Girl is right- who are these guys? Don't be dazzled by their titles or the fancy-sounding groups they're in. Not a one of them heads any repectable organization- certainly very few are virologists. And an ER doctor? Root-Bernstein is an emeritus professor in physiology? A lawyer? What the hell has that got to do with viral studies? Oh yeah- and the swiss researcher who ran the Red Cross and got Lord knows how many people infected via blood transfusion (before it could be reliably diagnosed in the blood supply)- as if he has no conflict of interest in stating it's not viral. Maybe his attitude about viruses slowed up the implementation of blood testing in Switzerland, who knows.
Personally, I think Duesberg is pissed that Gallo was THE guy that found the cause, and he never got over it.

Just for fun I did a Lexis/Nexis and Medline search for both Papadopolus and Hassig and got no hits on either. As far as I can tell, NONE of these dissenters has done ANY original research on HIV. They just sit around and criticize what has been done. To call them "scientific" is a real stretch, Dean.

Phelps, your statements do nothing to change my opinion. Do many people with HIV not have AIDS (yet)? Sure- and how many of those are taking antiretrovirals? MANY, MANY people get sublinical infections of viral diseases- chickenpox, herpes, you name it. But they've got the virus, they just never got sick. Yet, we all accept those are virally transmitted illnesses. ALso, it's B cells that make antibodies, not T cells, so you can have lots of antibodies around with low T4 counts.

As for those who have AIDS without HIV, there are lots of little viruses out there that we aren't aware of. My own dear husband got suppressed T4 counts and candidal esophagitits- both markers for AIDS. But he tested HIV negative, the symptoms went away, his T4 count came up and he's fine. We'll never know what little viruses wreaked havoc with our lives for a few frightening weeks. (He was a phlebotomist in SF before we realized HIV was blood-borne- so we had plenty of reason to worry).

Also Aids is different in Africa because they've always had a much higher incidence of things such as Kaposi's sarcoma. And there are different viral strains, as well. We also look for different symptoms between women and men, before diagnosing HIV.

So anyway Dean, on this issue I am very, very disappointed. It would be one thing to say "What do you all think about this topic" but to throw your own opinion behind it is a real loss, for everyone.
12.28.2004 4:03pm
Brain Fertilizer (mail) (www):
Okay, we have a little bit of a controversy here.
Caltech girl says, without citation, that:
As for testing for HIV, that is done by PCR which amplifies the virus DNA out of the host background. Has ZERO to do with antibodies or any other immune system function for that matter. Even Duesberg agrees on that point.


It sounds pretty credible, however, and made me feel kind of stupid for asserting that the HIV test was based on antibodies...until Dean came back and repeated what I said about the HIV test.

So I did a bit o' Googling. Every article but one described HIV testing as being antibody- or antigen-based. The only article on the first page that described the PCR method to the exclusion of antibody-based testing was this article, and it even describes the method as "new" as of June 2004. So despite her assertion, antibody testing has been the only standard until just recently, and is still the main method used worldwide.

Or am I missing something?
12.28.2004 4:11pm
Brain Fertilizer (mail) (www):
...and the discussion moved as I was researching and dealt with that controversy as I was posting.

Oh, well.
12.28.2004 4:15pm
Dani:
Antibody testing is done first, because it's cheap. If it's positive, or borderline, it's sent off for PCR.
12.28.2004 4:18pm
caltechgirl (www):
PCR testing of HIV has been done for many many years. Here's an article from 1996 describing the procedure:
Rapid, non-radioactive detection of virus infection by polymerase chain reaction.

Evans MJ, Edwards-Spring Y, Povinelli D, Wendt A, Harvey R, Rittenhous-Diakun K, Riepenhoff-Talty M.
Clin Diagn Virol. 1996 Aug;6(2-3):163-74.

A simple Medline Search (pubmed.org) would have served you better, as Medline searches biomedical journals back to the 70s.

Furthermore, PCR has been used to test viral load for many years, as referenced here:
Guidelines for using antiretroviral agents among HIV-infected adults and adolescents.

Dybul M, Fauci AS, Bartlett JG, Kaplan JE, Pau AK; Panel on Clinical Practices for Treatment of HIV.
Ann Intern Med. 2002 Sep 3;137(5 Pt 2):381-433.
12.28.2004 4:19pm
Chris Lansdown (mail) (www):
Dani,

I'm curious: what do you think are the horrible results that will come about from Dean posting this?
12.28.2004 4:26pm
Chris Lansdown (mail) (www):
Caltechgirl,

Just a curious question: has HIV been sequenced yet? If memory serves, smallpox has, but I'm not familiar with how many diseases have been sequenced.
12.28.2004 4:29pm
Chris Lansdown (mail) (www):
Caltechgirl,

by the way, does the HIV test specifically detect HIV, or only reverse transcriptase (or something associated with the reverse transcriptase)? It wasn't clear from what you said.
12.28.2004 4:33pm
Brain Fertilizer (mail) (www):
PCR has been used for years, yes, but only in conjunction with antibody testing, from the articles I read. From what I understand, it is "new" to use it to the exclusion of antibody testing.
...which still begs the question: if the body is producing antibodies to the virus, how can it be called a failure of the immune system?
12.28.2004 4:34pm
Dani:
Dean is a voice of reason in the wilderness of idiocy 99% of the time. Just as many people chose not to click on his links, some won't bother to read this thread. Like I said, if people want to debate this, fine. But, for him to say he wouldn't take drugs "until he got Kaposi's" is pure suicide, sorry.

IMHO all this thread has done is either:

a. Damage Dean's credibility or

b. given someone with HIV another reasonable source to back up his own deluded thinking about why he shouldn't take antiretrovirals.

Chris, there are thousands of people out there lurking, reading whatever pops up with "HIV" on the search engine. I do worry about the harm this could cause. I think bloggers need to be responsible.
12.28.2004 4:34pm
caltechgirl (www):
the HIV1 protein is sequenced, but there is much genetic variation. Certain parts of the sequence are more conserved than others. Here's the protein code:
meakwsknsi ggwpqvreri rqtppaaegv gavsqdldkh gavtsshmnn adsvwlraqe eedevgfpvr pqvplrpmty kgafdlsffl kekggldgli yskkrqeild lwvyhtqgff
pdwhnytpgp giryplcfgw cfklvpvdtr eveedtkeen ncllhpmsqh gledeerevl kwqfdsalar thiarelrpe yykec

each letter represents an amino acid.
This sequence comes from a sample from Vietnam.
Hope the link works.
12.28.2004 4:37pm
Brain Fertilizer (mail) (www):
Caltech Girl,
What is your PhD in, again?
12.28.2004 4:42pm
caltechgirl (www):
The immune system eats foreign molecules, simply. B cells produce antibodies that latch on to foreign molecules so that they can be recognized by the T cells. T cells eat the bad guys, removing the threat. That's a kindergarten explanation, but essentially the main story. The immune system fails when it can't do it's job of protecting the body by eating invaders. When there are no T cells, the body can't remove attackers. HIV kills T cells.

As far as what they test for, I believe that the standard PCR actually looks for the message that encodes the protein coat of the virus, rather than the reverse transcriptase that allows HIV to reproduce itself using the host's cellular machinery, but either sequence would be unique to HIV and would detect the presence of the virus
12.28.2004 4:43pm
Brain Fertilizer (mail) (www):
Caltechgirl,
Nice job on providing the protein chain. That answers quite a few questions I was trying to pose.
12.28.2004 4:44pm
Monomer:
"And why do we now have people who've been HIV+ for more than 20 years and are still fit and healthy? We are supposed to believe that not only does this virus which can't actually be found in patients causes it, but that it can stay dormant for decades. Where does Occam's Razor slice on this?"

I think caltechgirl has covered the answers to these questions and assertions. I'm only responding to the dormancy phenomenon, noting that many infectious diseases can remain dormant - hepatitis B, TB, and herpes come immediately to mind, though there is a spectrum as to what dormancy means.
12.28.2004 4:45pm
caltechgirl (www):
I don't have my PhD yet, but it will be in Neurobiology. (May '05)
12.28.2004 4:46pm
Dani:
Brain fertilizer-
The virus particles kill off the T-cells faster than the antibodies can be made. So T-cell mediated immunity, such as prevention of fungal infections and some forms of cancer, is compromised. Whereas B-cell immunity- bacterial and most viral infections- is mostly intact.

Tcells actually go out and kill off the "baddies". B cells make antibodies to do the work.

This is why AIDS patients get such odd illnesses, not run of the mill pneumonia or other more common infections. Part of the immune system functions, the other part doesn't.
12.28.2004 4:47pm
Chris Lansdown (mail) (www):
Caltechgirl,

Interesting, but what is the HIV1 protein? (wikipedia didn't seem to turn up anything on a cursory search.)

Anyhow, I thought that there were more retroviruses than just HIV — just searching for reverse transcriptase would only turn up the presence of a retrovirus, not HIV specifically (unless each retroviruses's reverse transcriptase were substantially different).

Incidentally, I've heard that the highly mutagenic nature of HIV might be partially responsible for longer life-spans: the virus does better with living hosts and so there's an evolutionary pressure against lethality. Do you know if there's anything to this idea (I gather that it's fairly well established in a general sense — that diseases often reduce in lethality over time since lethality is rarely as good a strategy as co-existance, but I'm curious about this case)?
12.28.2004 5:09pm
Chris Lansdown (mail) (www):
Dani,

I won't argue that bloggers should be responsible about what they write, just as people should always be responsible about what they say.

That being said, while you're criticizing Dean for posting while being wrong, I don't see how your prescribed action could be derived from a general principle. If we give Dean the credit of believing that he is correct, how can we have acted otherwise?

That is, if he made a mistake and could tell that it was a mistake before posting, surely he wouldn't have posted. But if he couldn't tell that it was a mistake, what criteria could he have used to avoid posting and still be willing to be the voice of reason amid a sea of idiocy (to use a colorful metaphore) on other topics?
12.28.2004 5:18pm
caltechgirl (www):
Each RT is going to be slightly different genetically. Certain portions of the RT gene are more highly conserved than others, so if you were amplifying the region that was more specific for HIV, you would know what you have. That's one reason why I suspect the standard PCR test is for the protein coat.

As to viral survival, since infection will almost always lead to viral death with the death of the host, survival of the virus is predicated on transmission. If the host knows he/she is sick, transmission will not happen or will at least be decreased. That's why HIV takes such a strong hold over the body before symptoms come on. The evolutionary pressure is on increasing longevity before symptoms appear in this case.

I believe HIV-1 is the virion, the protein coat that assists with entry into the host cell, otherwise it wouldn't work in the experiments reported in this article:

Studies of ebola virus glycoprotein-mediated entry and fusion by using pseudotyped human immunodeficiency virus type 1 virions: involvement of cytoskeletal proteins and enhancement by tumor necrosis factor alpha.
Yonezawa A, Cavrois M, Greene WC. J Virol. 2005 Jan;79(2):918-26.
12.28.2004 5:21pm
Phelps (www):
Dani said:


As for those who have AIDS without HIV, there are lots of little viruses out there that we aren't aware of.


So... you agree with me that AIDS isn't caused by HIV? This isn't a nuanced question -- AIDS either is or isn't caused by HIV. I understand that if HIV caused AIDS, some people could fight off HIV and never develop AIDS, but that fails to account for the AIDS cases that never show any indications of an HIV infection.

Science isn't about appeals to authority. I don't care who is saying what -- I only care about what is being said that is right and reasoned. Hypothesis predict things that are tested.

Hypothesis: HIV causes AIDS.
Prediction: Everyone with AIDS will have been infected with HIV.
Experiment: Failed.

That is the death of a hypothesis.
12.28.2004 5:25pm
caltechgirl (www):
Nope. Wrong. The hypothesis Phelps stated predicts that HIV leads to AIDS, not that AIDS is caused by HIV. The correct prediction for that hypothesis is that everyone with HIV will develop AIDS.

Why is it that you seem to be ignoring Dani's point that AIDS symptoms may also be caused by other things? In fact the full blown spectrum disorder that we usually call AIDS may actually be caused by any number of diseases and perhaps some drugs. It's just that when we catch it early, everything but HIV infection is usually easier to treat.

No one is arguing that HIV is the sole cause of AIDS, but just because every single AIDS case can't be tied to HIV doesn't mean that there are no cases of AIDS for which HIV is the cause.
12.28.2004 5:42pm
Brain Fertilizer (mail) (www):
Yeah, I was beginning to realize that "deficiency" doesn't necessarily mean "instantaneous total breakdown".
But thanks for confirming that for me.

In any case, I'm still with Dean that too much of the science of HIV and AIDS has been consensus-based, in that the conclusion was made too quickly (long before PCR testing, according to the article Caltech Girl cited) on more of a socio-political basis than scientific, and ever since that decision was made you simply don't get funding if you don't toe the line on "HIV causes AIDS".
Based on everything I've read, here and elsewhere, I still think one of the reasons we haven't made more progress against HIV/AIDS is that our focus is too narrow. While HIV might indeed cause AIDS, the level of proof is insufficient to conclude that beyond any doubt.

For instance, I remember being told by my mom that if I put too much sugar on my cereal, I would get sugar diabetes. In my teens, science had determined that was ridiculous, sugar consumption did not cause diabetes. And now, the current scientific evidence indicates that flooding your blood stream with refined sugar does indeed raise the likelihood of diabetes because the pancreas can fail if overtaxed.
Now, I think it can be safely said that no one factor determines that you will get diabetes, but rather a combination of factors. What if the same is true for AIDS? It makes sense that an overtaxed immune system might lose its ability to distinguish "friend" from "foe" and begin attacking itself, particularly if HIV is a benign marker virus that is too weak to survive in a body with a healthy immune system.
What if AIDS is actually something that affects someone who is exposed to high levels of antibiotics or foreign proteins (both of which would tax an immune system)?

I do agree that questioning the assumption that HIV causes AIDS is harmful if people use that as a reason to not use sensible precautions, such as when the President of South Africa embraced the notion as an excuse to not promote condoms and abstinence in his country.
But from a research angle, I don't see how expanding the research to other scientifically-sound theories could hurt. Serendipitous results from just such research makes the money spent worthwhile. Research is never a bad thing (making sure blind alleys really are blind).
12.28.2004 5:46pm
Dani:
Sorry Phelps, I misspoke. I meant those that APPEAR to have AIDS, like my husband. Such as people who have Kaposi's sarcoma or PCP without being HIV positive. These things arise spontaneously, as well. Remember, it's not AIDS that kills these people, it's usually the specific infection.

However, since no one is given the diagnosis of AIDS without being first diagnosed with the virus, by definition everyone who has AIDS has HIV. It's part of the diagnostic criteria.
12.28.2004 6:04pm
Dean Esmay (www):
I've gotten used to having my credibility questioned. I get it all the time: my doubts about human-caused catastrophic global warming, my belief that low-carb diets are not dangerous, my belief that Bjorn Lomberg should be taken seriously, that Julian Simon and Gregg Easterbrooke should be taken seriously, and so on.

I went through a long period of being an advocate for low-carb diets. During that time period I had licensed nutritionists and medical doctors thundering abuse on my head, telling me I was irresponsible, giving people advice that was going to ruin their health, that I was a lunatic, an extremist, a fringe nutjob, and so on. Meanwhile, I was talking to other doctors and researchers who were outside the mainstream who were questioning all of that dogma.

Now we know: low-fat diets do not reduce mortality. Low-carb diets do not destroy your liver, do not destroy your kidneys, do not cause you merely to lose water weight, do not cause muscle loss, and so on. They work, and they are not particularly dangerous.

I see the same phenomenon at work here: I am "irresponsible" -- in what way? By noting what I personally would never do, and what other scientists out of the mainstream say?

Every one of the scientists who's questioned the HIV hypothesis has faced this accusation. All of them: they're being irresponsible, they're a threat to public health, they're going to kill people, they're outside the mainstream and should be banished from public discourse.

Well I'm sorry, but: My guiding philosophy is that people are in charge of their own health care, not doctors, and that doctors are there to give advice, not orders. The responsibility for anyone's health is ultimately their own, not doctors and not public health officials. These people should be listened to and taken seriously but they are not Gods--and when they react with thundering denunciation at being rigorously questioned, I'm sorry, but my antannae begin to quiver.

Furthermore, keeping information away from people because it might be dangerous to them is not a mentality I have ever had much regard for.

If you want to call me a lunatic, fine. But my credibility? I tell you what my thinking is and why I think it. You decide for yourself what you think of my intellectual integrity or rigor. I'm not leading any worldwide crusade here. I'm telling you what my thinking is (I'm highly skeptical of the HIV-AIDS hypothesis) and showing you other people who are working scientists who are even more skeptical than I am.

I'm just a guy in my pajamas. You decide how important that is. ;-)
12.28.2004 6:17pm
Dani:
Brain Fertilizer-
Yeah, it'd be great if these "scientists" were actually doing research. I'm totally with you on that. But my point is THEY AREN'T. They are pontificating about this and that without doing any research. They're not doing any work to check for other things. No publishing. No original research. Just a whole lot of theories that they have not even attempted to prove. It's the difference between inductive reasoning and deductive reasoning. If you don't bak up the former by performing the latter, you don't have squat.

In addition, in real science, especially in dealing with living systems, one cannot ever "prove" anything. You can only rule other things out as causation. That is what has been done with HIV and every other disease. It's what we call the "null hypothesis"- that is you predict that HIV will have nothing to do with AIDS. You do your tests. You find you are wrong.
This is repeated over and over, until the overwhelming evidence is that it must be the cause. No one has been able to rule out HIV as the cause of AIDS, nor have they ruled anything else in. So there you have it.

Not being able to "prove" evolution is what the creationists take to the bank every time, because they don't understand science itself.
12.28.2004 6:19pm
Dani:
Whatever, Dean. If you can sleep alright at night, great for you.
12.28.2004 6:21pm
Dean Esmay (www):
One of the primary arguments by the HIV critics is that a whole host of diseases are inappropriately diagnosed in AIDS, so that the simple presence of the HIV antibody coupled with practically ANY autoimmune disorder is likely to be diagnosed as AIDS.

Meanwhile, we still have people who've been HIV-antibody positive for decades now who are in robust health despite taking no treatment what-so-ever.

We also have people who exhibit all the classic symptoms of AIDS--Kaposi's sarcoma, dropped t-cell counts, eventual death by pneumonia--who are HIV negative.

These facts are not in dispute by anyone that I'm aware of in the field.

It's interesting to hear that PCR is now being used to find HIV itself in patients. It's very new information to me. I'd be curious to know more about this.
12.28.2004 6:22pm
Brain Fertilizer (mail) (www):
But at least part of the reason that research isn't being done on other causes of AIDS is because they can't get funding.

It's circular logic:
This is the only accepted valid hypothesis. Why? Because no other hypotheses have any valid evidence. Why? Because they aren't doing research. Why? Because there is only one accepted valid hypothesis.

When research funding is predicated on the assumption that the only valid hypothesis is that HIV causes AIDS, you aren't going to end up with any information that says anything differently. Particularly when there are such strong socio-political pressures to stick with a conclusion that was reached for socio-political reasons in the first place.

Less than five years from the first diagnosis of the syndrome to a conclusion of the definitive causation so waterproof as being beyond further research? You've got to be kidding me.
12.28.2004 6:33pm
Brain Fertilizer (mail) (www):
Man, I really wish we could get Galileo in on this discussion...
12.28.2004 6:35pm
Catch 22:
So would you be wearing rubber gloves in a medical setting ? Or would you rely on your theories ?

"My guiding philosophy is that people are in charge of their own health care, not doctors, and that doctors are there to give advice, not orders. The responsibility for anyone's health is ultimately their own, not doctors and not public health officials."

In what medical facilities is that protocol practiced ?

Would medical liability exclude such lawsuits
based on your guidelines ?
12.28.2004 6:40pm
Brain Fertilizer (mail) (www):
So turn it around, Catch 22:
You always do everything your doctor tells you? You never ask questions to understand the thought process behind your treatment? You feel your doctor always takes the time to completely and thoroughly understand your situation before making a diagnosis? You think going for a second opinion is a waste of time, money, and resources? You think that doing some research on your symptoms before you visit your doctor is unnecessary?

I think Dean's approach is a good one. I use it myself. As a result, I've never had a single one of the Military Hospital horror stories happen to me or my family. Being an active patient absolutely improves your treatment and hastens your recovery.
12.28.2004 6:46pm
Dean Esmay (www):
Yes, I can sleep just fine at night.

By the way, the accusation that those who question the HIV-AIDS hypothesis are homophobes is also old hat. Everyone who questions it gets that too.

Yes, and I'm aware that Kary Mullis invented the PCR. I'm also aware that Peter Duesberg won his greatest fame in the field of retrovirology as he was either the first or one of the first (I forget which) to actual demonstrate that such a beast existed.

The fact that Gallo and Montaigne both simultaneously discovered on what came to be labeled labeld HIV and now simply "The AIDS virus" and that they had a huge fight over it. Randy Shilts goes into that at some length in his book, as does Duesberg (his history is on-target if nothing else).

But there was and remains a lot of criticisms of their findings--including the stubborn insistence of a lot of researchers that these guys never actually published anything that satisfied Koch's postulates.

Meanwhile, both Gallo and Montaigne, but especially Gallo, have been shown to have HUGE conflicts of interest. Not least of which is that Gallo made himself a multimillionaire several times over selling those HIV-antibody tests, all in the 1980s and before PCR testing was even done.

Science can either stand up to rigorous questioning or not. My larger point is that treating those who question a hypothesis as lunatics, crackpots, and incompetents usually doesn't do much for me. Show me why they're wrong--and that you've at least researched it enough yourself to recognize where the dissenters are coming from.

The fact that the dissenters don't get published in journals like Science and Nature is certainly no surprise. Dissenters in most fields don't get published in them. Furthermore, it remains that those who question the reigning paradigm on HIV simply don't get funded--almost all the money is government funding, and only research on HIV gets any money. Which creates a rather frustrating Catch-22 situation for anyone who questions whether HIV is the primary cause of AIDS.

And the drug companies (who are not evil, by the way) have their own conflict of interest: they can't make money selling pills that fight HIV by funding research into alternative hypotheses that question whether HIV is the proximate cause of AIDS.

From my perspective, it's disturbing whenever someone questions a reigning paradigm is subject to accusations about their personal integrity. I don't mind my own being questioned--I'm used to it by now--but it disturbs me when working scientists with respectable careers are destroyed because they insist on dissenting. Perhaps there's no way around it, but it still disturbs me.

Yes, Duesberg's work on AIDS is out of date. He's given up. This means he's a secret homophobe and deserves to be abused as a lunatic? He's apparently doing cancer research that's receiving favorable reviews now. He hasn't stopped his HIV dissent though.
12.28.2004 6:47pm
Dean Esmay (www):
So would you be wearing rubber gloves in a medical setting ? Or would you rely on your theories ?

I would wear rubber gloves, and rely on my own theories, thank you.

There are two kinds of doctors in my experience: those who like me as a patient and those who hate me. The ones who hate me are the ones who don't like me asking difficult questions or consulting literature on my own. Those who like me enjoy having a patient who takes responsibility for his own care.

In what medical facilities is that protocol practiced ?

It should be practiced in most of them.

It is practiced in my household.

Would medical liability exclude such lawsuits
based on your guidelines?


I would certainly like to see tort laws changed to put more responsibility onto patients for making their own decisions, if that's what you're asking. A lot of what's wrong with medical liability is because it's based on the assumption that Doctors are all-knowing Gods. This is bad for both doctors and patients in my view.
12.28.2004 6:50pm
Dean Esmay (www):
I dropped a note to George L. Gabor Miklos, and am searching for Harvey Bialy's email address.

You guys got any questions you want me to ask either of them?
12.28.2004 7:04pm
Dean Esmay (www):
Oh, I guess I have to correct something above. I didn't look closely enough. Apparently Duesberg has funding for some of his AIDS research now, and published in the Journal of Bioscence in 2003. You can read his paper and related commentary right here.

Is the Journal of Bioscience a junk journal? I know there are junk journals out there.
12.28.2004 7:20pm
ATM (mail):
It is possible for someone to have AIDS like symptoms that does not have a HIV etiology. AIDS is caused by dysfunction and death of certain types of cells including T cells and macrophages, but perhaps not solely limited ot them. Any cause that could elicit the same dysfunction could cause an AIDS like disease. For example, another virus is thought to be one possible cause of Non-HIV AIDS. But that does not mean that HIV is not the cause of AIDS in many individuals nor does it mean that the vast majority of acquired immune deficiency cases are not caused by HIV. Likewise it is possible for a person to be HIV positive yet have some level of resistance to HIV that prevents or delays onset of symtomatic disease. For example it is known that there chemokine receptors that are required along with the T cell CD4 receptor for mediating HIV entry into the T cell. Having mutations in one or more of the alleles of the genes that code for these HIV coreceptors can prevent or reduce the frequency of entry of the virus into the T cells, and thus eventually killing the T cell. There are populations that have mutations in both alleles of CC5 receptor, which leads to strong resistance to HIV infection and AIDS development. Alternatively, a person may be infected with an HIV variant that has mutations that don't allow efficient infection of T cells, but allows infections of other cell types. The individual would have an HIV infection, but may not develop AIDS unless the virus mutates. It is sufficient to say that not enough is known about HIV biology to predict/explain the reaction of any given individual to any given set and doses of HIV variants.
12.28.2004 7:20pm
Dean Esmay (www):
Oh, er, sorry, the related commentaries are here and also here.

By the way, if people want to further discuss this with me, I would appreciate it if it not be referred to as "my" theories, as if I'm just some dork who's made all this stuff up on his own.

If you don't find Duesberg or any of the other researchers who question the HIV-AIDS hypothesis credible, fine. But these are their theories, not mine. I'm just an idiot who takes them seriously.
12.28.2004 7:24pm
Dani:
The Journal of Bioscience is not listed in Medline. This paper also does not represent orignal research, it's just a VERY long rehash of Duesbergs beliefs.
12.28.2004 7:54pm
Catch 22:
The latter comments address my concerns. There is a distinction between theory and practice. And as one who wears rubber gloves that function points out the reality of the medical setting.

It isn't just theory. If it were, anything brought up by any observer is valid and worthy of consideration. But a Doctor has to make decisions based on a common standard of care that mandates certain criteria of treatment or else he or she is medically liable both financially and with respect to the standard of care under which they hold their state medical license. This does not preclude listening to patient opinion and options.

In practice, medical care presumes and demands responsibility. Medical opinion offered to a non-professional audience presupposes that the author might offer opinions and options that are responsible and well founded and not based solely on non mainstream scientists who support those views. In my view theory and opinion carries no such responsibility.

My first comment above could definitely be viewed as snarky and demeaning, so I hereby retract that statement.
12.28.2004 8:19pm
Dean Esmay (www):
In perusing Duesberg's 2003 paper, it does indeed look like it's mostly a broad overview of what he published in Inventing the AIDS Virus with updates to note data since then.

Presumably, with limited funding and whatever facilities he's got available at Berkeley, all Duesberg (or, really, any of the dissidents) can afford is probably epidemeological studies--and of course those are useful but limited. I'd like to see more done to study AIDS patients who cease taking chemotherapy; as he and his fellows note, there are a striking number of anecdotal reports of patients who ceased taking AZT and other coctail medications and report still being in good health years after terminating treatment--which all by itself should at least call into question whether some doctors are premature in putting their patients on such medications. (The most high-profile example is Magic Johnson, but there are many others, some of them now active in AIDS advocacy groups like ACT-UP.)
12.28.2004 8:42pm
Dave00 (mail) (www):
Koch's Postulates

1. The specific organism should be shown to be present in all cases of animals suffering from a specific disease but shold not be found in healthy animals.

2. The specific microorganism should be isolated from the diseased animal and grown in pure culture on artificial laboratory media.

3. This freshly isolated microorganism, when inoculated into a healthy laboratory animal, should cause the same disease seen in the original animal.

4. The microorganism should be reisolated in pure culture from the experimental infection.

Correct me if I'm wrong but Koch's Postulates seems to be specific to bacterial infections (microorganisms) and virus are not microorganisms, therefore Koch's Postulates would not apply.
12.28.2004 9:44pm
mariner:
About 20 years ago, a lone nutjob postulated that most duodenal ulcers were caused by a bacterium. But EVERYBODY knew ulcers are caused by excessive stomach acid. And drug companies were making BILLIONS of dollars each year on fancy antacids (Like Tagamet).

So the doctor was hounded out of the country.

He moved to Australia, and continued his research. Denied funding for research, he eventually resorted to injecting himself repeatedly with bacteria, and curing the resulting ulcers with standard courses of low-cost antibiotics.

Now everybody knows that most ulcers are caused by Heliobacter pylori.

I'm amazed at how many supposedly intelligent people continue to be wowed by "consensus science".
12.28.2004 10:03pm
Dani:
Yes mariner, that would be why "consensus science", i.e. expert opinion, ranks third (last) in terms of strength of evidence in support of a medical theory. It is considered "Level C".
Next is Level B "Limited or inconsistent scientific evidence." At the top is Level A "Good and consistent scientific evidence." The latter category generally requires verified doublinded studies. That is where we are with most recommended HIV/AIDS treatments.
12.28.2004 10:39pm
Dean Esmay (www):
Dave00: Well some HIV researchers are now claiming that Koch's postulates have in fact been met by the HIV researchers. Which would tell me that at least some take the notion seriously.

Much of this discussion, including things Dani, Caltechgirl, and other sare saying, actually points to the criticisms central to most who question the HIV-AIDS hypothesis. ActuallY Caltechgirl herself said something telling: she said, "No one is arguing that HIV is the sole cause of AIDS, but just because every single AIDS case can't be tied to HIV doesn't mean that there are no cases of AIDS for which HIV is the cause."

That "No one is arguing that HIV is the sole cause of AIDS," at least ten years ago, likely would have resulted in her being treated like a heretic. Now, it appears that a growing number of AIDS researchers are at least able speculate that there are multiple co-factors involved--which is what some of the HIV-critics were saying all along (not Duesberg, but some of the others I've cited). If she were a retrovirologist, it could have been a career-ender if the wrong people heard her say it and she did not instantly retract it.

The critics also charge that what Dani said here:

"However, since no one is given the diagnosis of AIDS without being first diagnosed with the virus, by definition everyone who has AIDS has HIV. It's part of the diagnostic criteria."

...is exactly what's wrong with the HIV-AIDS hypothesis. Have all the symptoms of AIDS but no HIV? You don't have AIDS and aren't treated like you do. Have HIV and have only one of literally dozens of conditions? You are diagnosed with AIDS and treated like you have it. Even being HIV-positive and having cervical cancer can get you that AIDS diagnosis (or could the last time I looked).

To some of us that doesn't look like medicine. It looks like sloppy reasoning. If you can have HIV for decades and not have AIDS, what is the justification for saying that HIV is causing any particular symptom you have? And if you have a list of symptoms EXACTLY matching that of all those gay men in San Francisco and New York who died between 1980 and 1984, but no HIV, what is your justification for saying they don't have AIDS but simply have some non-specific malady?

But by the way, it was difficult to get anyone to even admit that you could have HIV and not develop AIDS as much as 10 years ago. Now that we've got HIV+ people on record as being 20-years symptom free, most are now (grudgingly) admitting that HIV doesn't always result in AIDS--that it can either stay dormant for decades or that maybe somehow some people have developed a natural immunity by some as-yet unknown mechanism.

But if a person might have such immunity, then once again: what is the justification for asserting that an HIV+ person has AIDS if he only has one or two of a list of dozens of possible symptoms? Could this not be an "HIV immune" person who's just developed another malady by coincidence? What's the justification for putting them on the cocktail?

And what are we to make of these people who say they were put on the cocktail, felt ill, stopped taking it despite the hysterical warnings of their doctors, and now report feeling better and being symptom-free? They're just all lunatics? More importantly, should they be ignored or should they be studied? Becuase right now, everything I've read (may have missed it somewhere, you let me know if I have), no one has undertaken a study of such people, despite the fact that they are increasingly common--groups like ACT-UP have been telling gay people with HIV to stay away from AZT and the rest of the cocktails for years now, and there are hundreds of people at least who've taken their advice and are walking around alive.

I can already tell you what the typical response to that is: "AIDS is a complicated and difficult to understand and unpredictable syndrome that requires a high degree of knowledge to diagnose." And more blather about my lack of credentials to even ask these nettlesome questions.

Somehow we are able to diagnose people by the millions of people in Africa based solely on the fact that they are HIV-antibody positive. Including a lot of people who, apparently, get their diagnosis solely because they test positive on those cheap HIV-antibody tests and exhibit symptoms of dysentary or malaria.

It remains that an AIDS diagnosis pays better than a malaria or dysentery diagnosis in most of Africa. Why is this, and doesn't anyone think there may be a conflict of interest there? Even if AIDS is a raging crisis in Africa, we already known malaria kills you every bit as dead and wipes out people by the millions every freaking year. Why are we creating this obvious conflict of interest for the hospitals and public health officials in those countries?

The usual response to all of these questions is to question the integrity or intelligence of those who raise the questions.
12.28.2004 10:42pm
Dean Esmay (www):
Do we actually have double-blind studies on people who go on amu of the particular cocktails vs. those who take no medication? The last I looked (it's been a few years) it was still considered unethical to even use a control group of HIV+ people who took no medications.
12.28.2004 10:47pm
Dean Esmay (www):
Mariner: Yes, the story of how Barry Marshall (along with Robin Warren) proved that most ulcers are caused by bacteria when no one would listen to them is rather inspiring---and instructive, since no one would pay them any attention for quite some time.

A similar story from the late 19th century was the researchers who went for years claiming that beriberi was not caused by any infectious agent but was rather a vitamin deficiency. They were mocked and ridiculed, sometimes quite cruelly--but eventually were vindicated. Beriberi is now universally acknowledged to be a thaimin deficiency (I'm pretty sure it's thaimin) and to have no infectious cause at all.

We seem to think we're much smarter than people were back then and that our own scientific establishment would never treat a researcher shabbily just for being a dissenter.

Some have asked why Duesberg, if he's so sure he's right, won't inject himself with HIV. He's said for a long time that it would be a useless stunt--and now that we finally (finally!) admit that not everyone with HIV will contract AIDS, he's been vindicated on that score. If he were HIV+ and never got AIDS, all the critics would say he hasn't gotten it YET, and we'd have to wait at least 20 years before anyone would even grudgingly accept that maybe he was never going to contract it.
12.29.2004 12:20am
Dean Esmay (www):
...that is, assuming that they didn't just say his case was anecdotal and he probably had that mysterious natural immunity that some are theorized to have.
12.29.2004 12:28am
Monomer:
Brainfertilizer: "And now, the current scientific evidence indicates that flooding your blood stream with refined sugar does indeed raise the likelihood of diabetes because the pancreas can fail if overtaxed."

This is a sort of commonsense theory which I believe is basically wrong. I think most diabetes is due to insulin resistence, not a deficient pancreas, though the latter is possible. Even really fat people are usually less than a year ahead of the rest of us in terms of overall food consumption.

Also, I am unaware as to how antibiotics would tax the immune system. I'm only pointing these things out because there seems to be a lot of not so true truths going around in the well read leity.

Look out for the next Michael Moore hit upon medicine, or those who would be the Michael Moore of Medicine.
12.29.2004 4:30am
Dean Esmay (www):
It's actually not a bad hypothesis but it's difficult to falsify. We can say with fair confidence that both the amount of refined carbohydrate and fat in our diets, as well as overall caloric intake, is unusually high. This has to stress both our insulin and glucagon responses. We also live a lot longer these days, which you would expect to play a role. We certainly know that girls are undergoing menarche at much earlier ages these days, which appears to be due to diet and other lifestyle factors but is likely to play a role in this as well.

I'm shuddering to think what the likes of Moore will do in looking at the medical community. Just look at how guys like Ralph Nader talk and you'll have some idea. Evil drug companies, incompetent and heartless hospitals, greedy doctors, vicious and cruel insurance companies--oh but of course a few good and saintly people in the field to make it look "balanced." Brrrrr!
12.29.2004 4:41am
maor (mail):
Dean,
Modern nutrition is one of the weakest branches of biology, because you can't directly experiment much on humans and long term statistical studies are either extraordinarily expensive or unreliable. I don't take any claims too seriously unless there's a good biochemical explanation (i.e. Vitamins are necessary for important, specific, known functions, therefore a lack of vitamins would be expected to be a bad thing). I wouldn't want all of biology judged by the field of nutrition.

One common thing is to say that carbohydrates are "good" and sugar is "bad". Try getting a detailed biochemical explanation. When pointed out that sugar is a carbohydrate, it is then common to say that sugar raises blood glucose levels more quickly than other carbohydrates. All the studies I've seen contradict this. (The professor of my nutrition course, a real health nut, said that I made a good point. He never bothered to come up with an answer.) It also said that sugar tends to be "refined". If you say that flour also tends to be refined, then you are told "Well, that's also bad. I meant unrefined carbohydrates are good".

Now, when someone says that studies show 50% of HIV-infected people already having AIDS, maybe they did the study all wrong and this isn't true, but jeepers, 50% (and growing)! I don't wonder why they THINK HIV causes AIDS. I'm not sure why people are so confident about whatever nutritional theories they have, though. It seems like an inborn human trait.
12.29.2004 6:09am
Dean Esmay (www):
I would agree that modern nutrition is a very weak branch of science.

The problem is that I suspect that HIV research is a similarly weak branch, and that because of the political and financial nature of it, it's become corrupt and difficult to trust.

Indeed, the more I dig the harder a time I have finding support for much of what's said here; Pubmed searches are turning up current publications by people like Root-Bernstein and Rasnick, and these people are qualified in their fields. These people also disagree with each other on some things but are unified on the weakness of HIV as a description for AIDS. Just for starters here's the Pubmed search on Root-Bernsetin:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?SUBMIT=y

The guy's all over the place--and he's been one of the dissidents for a long, long time, for while he believes HIV plays a role he's long been adamant that it cannot be the sole cause, and he was considered a crackpot and a lunatic for years.

Guys like Rasnick--quite qualified by the way, Rasnick actually designs protease inhibitors for a living and you'll find him in Pubmed--are saying flat out that the research showing HIV correlation with AIDS is weak as hell, and that only a select few with a great deal of personal financial motive s, and who also have a great deal of control over whose research gets funded, are defending the reigning paradigm.

My question remains: why are these dissidents automatically assumed to be clueless boobs and unqualified nutjobs and angry soreheads simply because they question the reigning paradigm? Why are these often people who were winning all sorts of awards and fellowships and considered huge bright stars in their fields suddenly toppled from grace simply becuase they insist that the anti-AIDS drugs are dangerous and that the HIV-AIDS hypothesis has serious flaws?

Why is it that it wasn't until the mid-1990s that anyone would even admit that maybe you could be HIV+ and not develop AIDS? Why is it that some people still act shocked when you point this out?

I could point to more, but I feel like it would be unfair to just shotgun-blast a bunch of stuff out at once. But it really disturbs the Hell out of me that people just feel free to ascribe invidious motives to these guys. Dani says peer-reviewed, double-blind studies have been done showing that HIV causes AIDS. Okay. Name them. And then explain HOW EXACTLY a diagnosis for AIDS is reached that is not based on a logical tautology. You can tell me how a malignant melanoma is diagnosed without invoking a tautology. Can you do it with AIDS?

KS + dropped T-cells + HIV = AIDS
KS + dropped T-cells - HIV = Not-AIDS

Why? What is the diagnostic criterion?

Cervical cancer + HIV = AIDS
Cervical cancer - HIV = Not-AIDS

Why? What is the diagnostic criterion?

This is elementary science. If you're reduced to telling me that I'm too ill-informed and not qualified to understand a straight answer to my question, fine, but don't expect me to simply take you on faith becuase I won't. I can understand a cancer diagnosis explanation just fine. I can understand a malaria diagnosis explanation just fine. I can understand hyperlipoproteinemia and all its various permutations and its possible risk factors just fine. But I can't understand what justifies an AIDS diagnosis and what doesn't besides, "If HIV is present and there is an autoimmune problem it is AIDS?" What kind of logic is that? Because that appears to be the working definition if you look at most of the literature.

David Rasnick has offered to inject himself with HIV if another researcher would agree to take an anti-HIV cocktail on a daily basis to see who dies first. Why has no one taken him up on it? The man designs protease inhibitors for a living and you WILL find his name in Pubmed. (He's also got some pretty withering critiques of the "viral load" measures of HIV using the PCR by the way, and he's no moron.)

Again it's not fair to blast too many questions at once, but let me just ask this one question:

We have had only 20 years of research on this disease. Why does 100% of all funding go to studying and fighting AIDS, and 0% go to any alternative hypothesis on the disease? Again, there are a large and growing number of people who are now HIV+ and refusing chemotherapy. Why isn't anyone studying them? They are easy to find and they are growing in number. Can you honestly say you are POSITIVE they're all gonna die because of their choice, and that there is NO value in doing ANY study on them?
12.29.2004 6:56am
Rosemary Esmay (www):
Crap. I said: "Why does 100% of all funding go to studying and fighting AIDS, and 0% go to any alternative hypothesis on the disease?" but that should be "Why does 100% of all funding go to studying and fighting HIV, and 0% go to any alternative hypothesis on the disease?"

We spend billions. Is even 1% of it worth studying the possibility that this hypothesis may have flaws?

Where's the falsibility here?
12.29.2004 8:15am
Rosemary Esmay (www):
That last comment was Dean not me. :-)
12.29.2004 8:58am
maor (mail):
"David Rasnick has offered to inject himself with HIV if another researcher would agree to take an anti-HIV cocktail on a daily basis to see who dies first. Why has no one taken him up on it?"

Because duels went out of fashion a couple centuries ago.
Also, very few people like science THAT much.


As to:
KS + dropped T-cells + HIV = AIDS
KS + dropped T-cells - HIV = Not-AIDS

This makes a lot of sense if you have outside evidence that HIV causes KS + dropped T-cells. It helps you decide how to treat the problem. You wouldn't give protease inhibitors to someone with KS but no HIV.
(I will not comment on whether this outside evidence really exists, but obviously most doctors assume it does.)
12.29.2004 12:08pm
Brain Fertilizer (mail) (www):
Um, the "diabetes" reference was just supposed to be an example of how science needs time to test out assumptions and how any given current trend of assumptions can be overturned by more information, and then the new conclusions can be overturned by even more information in favor of the original assumptions. It was not intended to be a definitive look into the onset of diabetes.

The point is, "being convinced" is not the same as "knowing". I get suspicious when anyone says science has proven anything. I will agree wholeheartedly that the preponderance of current evidence supports the idea that HIV causes AIDS...but I still agree with Dean that it may well be because we aren't looking at enough data.
At one time, the preponderance of evidence really did indicate that our state of health was determined by a balance of "humours", right? But rigorous investigation of all possibilities resulted in the better-but-still-incomplete understanding we have now.

I get even more suspicious when the requirement to being "credible" is whether or not you accept the current opinion.
12.29.2004 12:35pm
maor (mail):
"At one time, the preponderance of evidence really did indicate that our state of health was determined by a balance of "humours", right?"

I think that was more of a model which was never tested because science hadn't really been invented yet.
I gotta agree with you about science not really proving stuff. All that philosophical stuff about "scientific proof" isn't relevant all that much outside of physics.
12.29.2004 1:21pm
silvermine (mail) (www):
I'm glad you're interested in scientific stuff, but the past month or so, you're beginning to convince me that you've just fallen off the apple cart. ;)

Sure -- some people have HIV and don't develop AIDS. That happens with just about every virus. People who carry a virus and don't develop symptoms are great for distributing the virus.

In addition, many viruses (and bacteria, in a few cases) find a way to go dormant in the body, are not detectable in the blood, and come back later to bite you in the ass. A very common example is chicken pox. It takes it's DNA and inserts it into your own DNA. That's what all retroviruses, including HIV, do. As you make new cells, they'll all have that viral DNA in them. Later, decades down the road, something happens (I don't know what it is in the case of shingles or HIV, but every biology student studies another retrovirus in which we know exactly what happens -- bacteriophage Lambda), and the cell starts to make mRNA from that DNA and virus replication begins. In the case of chicken pox, you end up with shingles. Same virus, multiple diseases.

You come up with some excellent questions, and interesting hypotheses, but I would certianly like to see you delve deeper into the science invloved, instad of taking the word of various "experts". Learn why people think it's possible for people to have HIV and not get AIDS, instead of just declaring that some reason that obviously AIDS can't be caused by HIV. Because it's no proof at all.
12.29.2004 2:19pm
Sigivald (mail):
Remember, guys, that "S" in "AIDS" stands for <a rel="nofollow" href="http://cancerweb.ncl.ac.uk/cgi-bin/omd?query=syndrome" > syndrome </a>.

And a syndrome is just a set of symptoms thought to have a single cause. (Once we're <i>sure</i> there's a single cause, it's a disease, not a syndrome, as I understand the term's useage.)

And since we know plenty of micro-organisms can infect someone <i>and</i> by asymptomatic (Typhoid Mary, anyone? HPV, which only causes warts in some subset of infectees?), I see no particular problem with "HIV causes AIDS, but not everyone with HIV ends up with AIDS", especially when we explicitly expand "AIDS" to "some threshold number of symptoms, perhaps weighted, in the definitive list of symptoms that we call, as a whole, AIDS".
12.29.2004 2:27pm
Sigivald (mail):
(PS. This comment mangler really ruins HTML, even HTML you put in with its own tools.)
12.29.2004 2:28pm
silvermine (mail) (www):
Duesberg's J. Biosci. article actually doesn't even say he doesn't think HIV causes AIDS. He thinks it takes HIV and other factors.

(That's what "necessary but not sufficient" means.)

In the editorial, he says:
"‘Despite its spectacular birthday the HIV-AIDS hypothesis has remained entirely unproductive to this date:
There is as yet no anti-HIV-AIDS vaccine, no effective prevention and not a single AIDS patient has ever been cured – the hallmarks of a flawed hypothesis.’"

So, I guess he thinks herpes isn't caused by the herpes virus either. ;) Oh, wait -- that's another retrovirus! Oh, and I guess the chickenpox virus doesn't cause chicken pox. It does have a vaccine, but it isn't 100%.

How does he think we are supposed to extract inserted DNA from cells? Retroviruses are tough to cure.

"That "No one is arguing that HIV is the sole cause of AIDS," at least ten years ago, likely would have resulted in her being treated like a heretic."

Well, it all depends on what you mean. I mean, chicken pox isn't caused just by the virus. You also have to be susceptible to it, and contract the disease. Like I said above, it's perfectly possible to just be a carrier, and pass it on to people without ever getting it. Same for oodles of other viruses. There's always more than just the virus. For example, you also have to have a receptor for whatever evil little proteins it has to manipulate your body. That's why many diseases can't cross species, and why some people are "natually immune" to one or more diseases.

"And what are we to make of these people who say they were put on the cocktail, felt ill, stopped taking it despite the hysterical warnings of their doctors, and now report feeling better and being symptom-free? They're just all lunatics? More importantly, should they be ignored or should they be studied? Becuase right now, everything I've read (may have missed it somewhere, you let me know if I have), no one has undertaken a study of such people, despite the fact that they are increasingly common"

Actually, I seem to recall reading a lot about people who seem to be naturally immune being researched because they could help point us in the right direction for a vaccine. However, I also think I recall that they are generally only immune to one strain, not all.

Of course, I will agree that AIDS does get a rather large porportion of money and that it would be more cost-effective to spend it on malaria and other diseases that do more damage instead. Or, just a crazy idea, let's spray for it like we should be doing, because the chemicals that kill mosquitos are far less dangerous that the diseases that mosquitos carry.
12.29.2004 2:54pm
Phelps (www):
I think Chicken Pox is a terrific analogy -- in that you have zero cases of someone with shingles that did not have a chicken pox infection. That is not the case with AIDS.
12.29.2004 4:04pm
silvermine (mail) (www):
No... There are many diseases with different causes with similar symptoms.

The symptoms of shingles include massive amounts of nerve pain. Other diseases also have massive amounts of nerve pain. Only the ones caused by the chickenpox virus are shingles. The others are something else.

Same for AIDS. Other diseases may have similar symptoms, especially since AIDS is an immune-system problem, and people get many secondary infections due to it. Their symptoms are exactly the same as many other diseases, because they have those diseases too. So the symptoms of pneumonia, for example, can be caused by a simple infection of various pneumonia-causing viruses AND bacteria, or it can be those agents plus HIV.

But that doesn't mean HIV does not have an effect.

Just because different diseases have the same symptoms is not proof that some of those diseases don't exist. I can't tell you how many cold-like diseases I've gotten from my son this year (yay daycare germs!). They're certianly different little organisms, but they cause similar symptoms.

People usually don't notice the initial infection, because the symptoms are similar to a cold, and the body fights off most of the infection pretty quickly. The DNA is already inserted into cells, and the virus goes into a "dormant" state that is asymptomatic. Like other retroviruses, it then reactivates, and causes nasty problems, most of which are secondary infections due to immune system suppression.

So yeah, you can have a lot of symptoms of AIDS and not have HIV -- because you either have a cold, or because you have an infection that is also a common secondary infection with HIV.

Just like the symptoms in me for a regular old cold virus and for hand, foot, and mouth were virtually identical. That doesn't mean I'm going to say that the hand, foot, and mouth virus isn't making me sick. It just makes me sick in a way that is reminicent of a cold.

(Okay, not exactly the same. It was like a cold with the most freaking awful sore throat ever. But I wouldn't have suspected I had anything other than a cold if it weren't for the fact that my son had a rash all over his hands, feet, and mouth. ;) )
12.29.2004 4:32pm
Dean Esmay (www):
Guys: I find it fascinating that some of you are willing to agree with me on my Kyoto protocol skepticism even though I'm not a climatologist, but you're willing to kind of sneer at me when I expess HIV skepticism.

You may want to ask yourself why that is. The basis of my skepticism is the same in both cases.

Except that my skepticism on HIV is based more than on logic--it's based on having direct correspondence with, as well as having read very very deeply, on the subject of HIV and AIDS.

The simple fact of the matter is that there is a large and growing number of qualified doctors and scientists who are openly questioning the idea that HIV causes AIDS. Now I note that some of you have questions, and that's fine. But if you have a genuinely inquiring mind you really ought to, you know, say, "Hmm, I'm skeptical, what's your basis for your skepticism?"

I'll post more on this today.
12.30.2004 12:32am
maor (mail):
I believe in global warming but I'm a Kyoto skepticist.
I believe HIV causes AIDS but I'm an AZT skepticist.
If you said you were a "global warming skepticist", that would be a better analogy.
12.30.2004 6:03am
Dean Esmay (www):
There is substantial evidence that there is global warming.

There is in my view insufficient evidence that humans are causing it, or that it is catastrophic, to justify trillions of dollars in expenditures on it. There are better uses for such expenditures, and the problem is likely to be self-correcting if it exists at all.

On HIV: I am skeptical of whether it really causes AIDS, but grant that it might. If it does, I am skeptical that it is the sole cause. In any case, I suspect there's a good chance that a lot of people diagnosed with AIDS don't have it, and shouldn't be taking any AIDS medication.

And I believe the science on this has become incredibly sloppy and tautological and that too many people in the field are afraid to admit this.
12.30.2004 6:27am
Michael Demmons (mail) (www):
we still have people who've been HIV-antibody positive for decades now who are in robust health despite taking no treatment what-so-ever.


We also have people who've smoked for decades who've never developed lung cancer. Therefore, I am highly suspicious that smoking causes lung cancer.
1.3.2005 11:07am
Dean Esmay (www):
We also have people who've smoked for decades who've never developed lung cancer. Therefore, I am highly suspicious that smoking causes lung cancer.

Yes. That's quite true. Now: do we put smokers on chemotherapy to prevent them from getting lung cancer?

Also, we had literally decades of study before we were willing to say definitively that smoking caused lung cancer. Doctors threw out literally hundreds of thousands of suspected polio viruses before they felt confident that they'd identified the polio virus. Far, far, far less research was done before it was declared to the world that they'd identified the AIDS virus—despite the fact that some people with all the classic, original set of AIDS symptoms didn't have it.

You're aware that every person alive has countless viruses running around in his system at any given time, right?

There are now support groups in several major cities for HIV+ people who choose to forego chemotherapy (i.e. AIDS cocktails). No one's studying them to find out why most of them aren't sick.

Would you at least agree with me that a person with HIV but is otherwise healthy should think twice before taking a daily handful of reverse transcriptase and protease inhibitors which haven't even undergone the normal FDA-required testing for most new drugs?
1.3.2005 11:29am
Michael Demmons (mail) (www):
You're aware that every person alive has countless viruses running around in his system at any given time, right
Fucking great, Dean. As if my hypochondria wasn't BAD ENOUGH!!!!

Excuse me. I have bugs on me! :-)
1.4.2005 8:39am
Michael Demmons (mail) (www):
As for your last question, of course I would agree that they probably should not. But that's mostly because I don't trust the FDA as far as I can throw them. On the other hand, I do respect people who offer themselves up as guinea pigs to test out these medications. I really do.

But then, I would also agree that the best AIDS medicine is prevention, and that almost everyone who gets it - at least via sexual fluids - does so because they are idiots. However, that's not what we were discussing, was it?

Anyway, I'm not commenting because I necessarily disagree with you - although I generally do on this issue - but rather I eas commenting on a gap in logic. Because x does not appear in y does not mean that y does not cause x. And honestly, I don't know enough about the disease's cause to argue a point either way. The only thing I know for sure about HIV and AIDS is that it is a fairly easily preventable disease.
1.4.2005 8:47am
Dean Esmay (www):
Michael: I am agreed with all of that, except I will take exception to this:

But then, I would also agree that the best AIDS medicine is prevention, and that almost everyone who gets it - at least via sexual fluids - does so because they are idiots.

"Everyone" is too big a word, and "idiots" is probably the right word much of the time but not all the time.

But I try to be cautious in my phrasing. Certainly we would both agree with this: anyone who is engaged in regular anal sex with multiple anonymous partners and is casually using recreational narcotics is engaging in incredibly self-destructive behavior.

I'll even go further: even if you're using condoms, regularly engaging in sex, pa