Dean's World

I posted on this subject yesterday and it sparked a storm of controversy. Much of it didn't surprise me. There has long been a group of researchers (as well as political activists and professional journalists) who believe primary cause of AIDS is not HIV. Most of them are considered nutcases, hotheads, or homophobes. I've seen it many, many times.

On the other hand I'm used to being ridiculed for holding unconventional views. So such accusations don't scare me away. Nor do they hurt my feelings when they're levelled at me. But it does make me wonder: what drives people's characterizations of the HIV skeptics as dangerous, sinister, or insane?

Well, it's a philosophical question and one with no easy answer. I'm not casting aspersions. Maybe I am one of the dangerous crazies. Like I said, my feelings aren't hurt if people think so.

However, the firestorm of discussion left me feeling that I needed to say more. Then I decided I should say a lot more.

If you're going to respond I merely ask that, before you start peppering me, you take the time to read some sources first. I want you to note of these sources that all but one are written by people with doctorates in fields directly related to the subject at hand, most of them tenured at major universities, and most of them with numerous publications in peer-reviewed journals under their belt. Indeed, you can look up papers most of them have written in Medline. So if you're going to express your (quite proper) skepticism, I would suggest that you express what assertions you are skeptical of, rather than simply sneer at those researchers--or me, for that matter.

I first became deeply interested in the subject of AIDS in the very early 1990s, when I read And the Band Played On by Randy Shilts, still considered the definitive history of how the AIDS epidemic began and how it was treated in the scientific, public health, and political arenas. Shilts himself was a gay journalist who eventually died of the epidemic. Although his book was a little politically charged at times, it was absolutely merciless toward everybody involved. He included a detailed accounting of how two different researchers, Robert Gallo and Luc Montagnier, independently claimed to have discovered the virus that caused AIDS. Shilts gave a lot more detail on Gallo and Gallo's methods, but one thing that struck me was Shilts' descriptions of how Gallo came to "discover" the virus: he never clearly explained how Gallo had demonstrated that the virus was the cause of AIDS.

It almost seemed like, because Montagnier announced the virus at the same time, everybody just assumed this meant there was independent corroboration. Shilts didn't say that, but from his descriptions it sounded weird: "I have a virus here, I think it's AIDS, the other guy says so too." Then the world watched while Gallo and Montagnier squabbled over who "really" discovered it first, everybody sort of assuming that since they'd both "discovered" it that they'd both demonstrated that it caused AIDS.

I assumed that this was all because Shilts was not very good at science journalism. Perhaps he hadn't bothered to document the hard-nosed scientists who got down to brass tacks and did double-blind testing. Still, it was striking: as Shilts portrayed it, it seemed that Gallo had isolated this virus in the lab, had thought it caused cancer but couldn't prove it and didn't really know what it was, then decided that it might cause AIDS--and simply proposed that to the world. When the other guy popped his head up, Gallo seemed to assume that Montagnier had vindicated his view, and the two of them began to fight over who got credit for "discovering" it first. Shilts also described how, publicly at least, Gallo had a habit of behaving like a pompous, self-important ass, but managed to make himself a multimillionaire selling kits to test for the antibody to the virus in humans (not the virus itself, just the antibody to it).

Anyway, the whole book was gripping and informative reading. I might want to quibble with some of Shilts' points, but to this day I doubt if a better history of the early days of this or any modern epidemic could be written.

Keeping an interest in the subject (I have long had friends in the gay community) I often read literature on AIDS. I was bemused when I discovered, in the early 1990s, that a few in the gay community were beginning to talk about how some homophobic, fag-hating right-wingers were questioning whether HIV caused AIDS. Some of that criticism seemed on-target, since some right-wing publications like The American Spectator were giving favorable mention of researchers who questioned whether HIV caused AIDS. But a few mainstream journalists were also giving these researchers some cautious press--and meanwhile, their critics were livid. I ran across so many negative ad hominem attacks on any researcher or journalist who would question whether HIV caused AIDS I was taken aback.

Science isn't supposed to work that way. If someone, especially a qualified person, questions a hypothesis, you don't attack them. You ask whether they're asking intelligent, reasonable, well-informed questions. If they dissent, you respect their right to dissent and at most question whether their dissent has any rational basis. You don't attack their motives unless you've got strong evidence for it.

Yet instead what I was often reading was the most apoplectically purple prose I'd ever seen pointed at a working scientist. There were some fierce denunciations from pundits and government officials, too. The most incendiary criticsm was centered on one man: A tenured Berkeley biologist and member of the National Academy of Sciences named Peter Duesberg.

To be honest, whenever anyone is that nasty about a man, I want to know more about him. It's an instinct I have always had. I was always curious about the guy, and I even sent him some email asking him whether he really thought that HIV wasn't caused by AIDS, and if he really believed that AZT, the drug most prescribed to fight AIDS, was poisonous. I got a very terse response from him, basically to the affirmative but not much more than that.

Still, I was intrigued. This man was a scientist. He was a tenured professor with major awards and serious peer-reviewed work on his resume. He was once considered absolutely brilliant. Indeed, he was one of the primary researchers responsible for proving to the scientific world that there existed an obscure kind of virus called a "retrovirus." Without his work we might not even know there was such a thing--and HIV is a retrovirus. This man was a member of the National Academy of Sciences, and he had nothing to sell. No snake oil, no alternative remedies, nothing. He offered only dissent from the reigning hypothesis, and an alternative hypothesis.

It appeared to me that he was dangerous all right. Because if he was correct, the therapies being used to treat many AIDS patients was quite possibly killing them.

He wasn't the only dissenter on HIV, but he was definitely the most unwavering, and the one who really raised people's ire. Still, there were other researchers who agreed with some of what he said. This was 10-15 years ago that I was finding all this out, and only a few years after HIV was announced as the cause of AIDS.

Still, eventually I sort of lost interest. Most of the world didn't seem to be taking these people seriously, and everybody, absolutely everybody, was taking the HIV hypothesis seriously. Eventually I just forgot about it. Until one day to my shock I discovered that ACT-UP, the notorious gay rights organization that had all but forced local, state, and Federal government agencies to recognize that the AIDS threat was real, had come out against the drug AZT, saying it was killing people, and that some of its members were openly questioning whether HIV was the real cause of AIDS.

Now these guys had always had a a reputation for being inflammatory and sometimes flakey, but no one could question their sincerity or call them a bunch of fag-bashers.

Finally, in the late 1990s, a book came out called Inventing The AIDS Virus by Dr. Peter H. Duesberg. I read it within days of its release. It was no easy read, but it was a tour-de-force. It was a detailed history of the research that led up to the announcement to the world that HIV caused AIDS. It matched everything that had been written in And The Band Played On, but with more detail. It was here that I also learned that Duesberg was once a close associate of Robert Gallo's.

Most damning, his description of how both Gallo and Montagnier had "discovered the AIDS virus" matched Shilts' perfectly: they had the virus in the lab already, weren't sure what it did, Gallo proposed that it was AIDS and Mongagnier announced he'd found the same virus--and suddenly the world embraced them both.

Duesberg detailed several studies that were done to "confirm" this hypothesis, all of them obviously very sloppy and none of them properly double-blinded. He then went on and on and on in dizzying detail about why he believed the entire hypothesis was nonsense from day one, and listing all the problems he saw. He also detailed his own alternative hypotheses about the cause of AIDS. He was careful in his reasoning and provided much data. I wasn't sure that he was right, but I was pretty sure of one thing:

Either Peter Duesberg was a monstrous liar or, by the mid-1990s at least, no one had ever demonstrated with any scientific rigor that HIV caused AIDS--and people had only come to believe it by a combination of well-meaning panic to stop a horrible disease, bureaucratic bumbling, petty politicking, and greed. No there was no conspiracy, but there was certainly a massive interlocking of government SNAFUs, scientists with huge conflicts of interest, a breakdown of the peer review process, and people in charge of that process who now had vested personal interests in maintaining the status quo.

Or: Duesberg was full of it. There really didn't seem much alternative explanation. The man was too careful, too meticulous, and provided too much documentation. He had to be taken seriously, if only to prove him wrong.

Or so I thought.

Instead, there seemed a virtual press blackout on the book. Most of the reviews in the mainstream press were short, snotty, and condescending. It was clear that they weren't interested in arguing with Duesberg, and when they didn't sniff at him like rancid garbage they ridiculed him, and mocked anyone who wanted to take him seriously.

I began to feel like I was either wildly paranoid or this was a dizzyingly frightening look at just how the confluence of billions of dollars of government money, journalistic laziness and incompetence, and petty politicking had polluted medical science, science reporting, and public health policy.

I didn't know what to think. But I did know that Duesberg had done his homework, and he still had no conflict of interest. Yes, he was selling this book, this one book. But he had no nostrums to offer, no special programs to sell. He just had two big things to say: 1) HIV can't possibly cause AIDS, and the national and international health agencies' definitions of what made up AIDS were a mishmash of incoherent mumbo-jumbo, and 2) AZT and some other treatments for AIDS were almost certainly ineffective and appeared to be incredibly dangerous. He also had his own carefully-explained and documented hypotheses, which he was unable to find funding to continue researching.

I consulted two retrovirologists on Duesberg. One told me point blank that Duesberg was just plain wrong--but could not tell me why he was wrong. He did say that there was some real sloppiness in HIV research, but insisted HIV was definitely the cause of AIDS. Peculiarly, when I asked him about AZT, his eyes suddenly widened and he actually looked a bit frightened. "That's a really fucked-up drug," he said. But he said that scientific politics made it impossible for a lot of researchers to admit that.

Another retrovirologist I consulted (this was years ago, you'll just have to take my word that these conversations happened) told me he was also certain Duesberg was wrong. AIDS was caused by HIV, period. But he did agree that Duesberg had been treated badly, and that the research on HIV in the beginning had been very sloppy. He said Duesberg should be credited for making retrovirologists be more rigorous, but Duesberg was too temperamental and made problems for himself. Curiously, this retrovirologist also could not tell me why exactly he believed HIV caused AIDS--his answers were vague and when I drilled him, he terminated the conversation.

For a long time I kept quiet about all this. I rarely talked about it much . There seemed no point. It just made people think I was crazy when I said anything about it. Clearly I wasn't going to change anyone's mind, and maybe I just wasn't smart enough to understand the research I had read or the answers to the questions I'd asked. Maybe Duesberg and the other AIDS researchers who questioned the HIV hypotheseis were just off on some wild goosechase. Maybe I was just paranoid and overreaching my own intellectual horizons.

Then, very recently, this book was released: Oncogenes, Aneuploidy, and AIDS: A Scientific Life and Times of Peter H. Duesberg. It shot to the top of my wish list the moment I saw it. If you read the Amazon reviews they're interesting. But far more interesting is the review of the same book which was published in the peer-reviewed scientific journal Nature Biotechnology, a companion publication of Nature. Nature is one of the most respected scientific journals in the world. You have to subscribe to read their articles online, but a reprint was published on Peter Duesberg's own site: Iconoclast to the Max.

I suggest you read that review, and look at it carefully. It was written by one George L. Gabor Miklos, PhD. You can see a list of Miklos' scientific publications right here.

Now I'm going to repeat this link because I want you to read it before you comment to me. Iconoclast to the Max

Miklos is just another flake, is he?

In our earlier conversation on this here on Dean's World, a couple of highly intelligent, well-credentialed scientists took me to task for bringing this stuff out on my weblog. They said I was endangering people's health and damaging my credibility, especially because I said I suspected that the HIV critics were right and that I thought AZT was so dangerous I'd personally never take it.

I won't call my critics out because I respect them and I'm not trying to pick fights with them. But in response to their queries, and their suggestion that none of the AIDS dissenters I talked about were really qualified or should be taken seriously, I wrote to Miklos, and to several other researchers whose names I found in Medline.

I heard back from Dr. Miklos this morning. I had told him that some of my readers were taking me to task, and that I wanted to ask him whether he had merely found the book on Duesberg entertaining and thought-provoking--or if he honestly believed that Duesberg was correct and that HIV is not the proximate cause of AIDS. Some of what he wrote in response was personal/confidential, but here is his word-for-word answer, with only those personal items excised (all emphasis his, not mine):

Bottom line; Duesberg is correct on both counts...on the basis of DATA...not hysteria. Your readers can be as angry as they like, but they should save their anger until after they have evaluated clinical DATA...and then they should direct their anger at their own medical profession.

The scientific data do not support the hypothesis that the HIV virus causes AIDS. If you have Kaposi sarcoma and you have antibodies to the HIV virus, the CDC says you have AIDS...by definition! If you are diagnosed with Kaposi sarcoma and you don't have antibodies to HIV, then you don't have AIDS...you have Kaposi sarcoma!....go figure!

Tell me Dean, if you are diagnosed with blue ears and you have antibodies to the HIV virus, the CDC would say that you have AIDS....if you don't have antibodies to the HIV virus you would have blue ear disease....what a joke. Your own CDC essentially defines any disease where you have antibodies to HIV in your system as AIDS. If you have malaria and and you have antibodies to the HIV virus, the CDC would you have AIDS...by definition! So AIDS equals malaria...this is clinically stupid.

You ought to ask your readers."What is AIDS?"...DEFINE IT!

Background,

I am a senior scientist/business person in the international biotechnology area. I have the luxuries of both being retired, and not being "in the system"....I don't depend on government grants and hence can evaluate data without fear or favor which is what I do for my clients.The entire AIDS and cancer areas are a mess. All current hypotheses are plainly incorrect, inadequate or in many cases absolutely falsifiable on the basis of existing data....this is all that Duesberg is pointing out. I don't defend him ad hominem...I defend the critical evaluation of data.

Anyway, it ought to be Harvey Bialy and Peter Duesberg who refute your readers.

I am simply an idependent scientific judge and I stand by my glowing review.

Dr. Miklos forwarded me a copy of a responding comment to his glowing review which was published in a subsequent issue of Nature Biotechnology (Vol 22 No. 9, pp. 1077-1078), and his own response, as well as the response of the editors. The responder attacked Duesberg as full of it. Miklos accused Duesberg's critics of not bothering to look at the data and of dodging the issues, while the Nature editorial staff struck a defensive but neutral pose. I'd reprint it all but I can't seem to copy or paste from the PDF.

I understand the tendency to be skeptical. But at this point, I'm no longer willing to be pat on the head or told to shut up. I stand by what I've said before: I have a strong suspicion that HIV doesn't cause AIDS, and in any case if I were HIV+ you probably couldn't get me to take AZT if you put a gun to my head.

I also have some emails from other AIDS researchers (people working at medical colleges) who are happy to tell me why they may disagree with Duesberg on some points but are very much with him on the notion that HIV can't possibly cause AIDS and that drugs like AZT are snake oil. Would any of you like me to ask them some questions? I now have email addresses for Bialy and Duesberg as well. Do you think they're worth talking to? Do any of you have anything you want me to drill them on?

Either way, for the "skeptics of the HIV skeptics" I have a few blunt questions:

Is Miklos nuts? Is Duesberg nuts? Are these people all incompetents? (I mean all of them, scroll down, there's more than Duesberg listed there.) Was South African President Thabo Mbeki really entirely wrong to refuse to toe the line on AIDS? And are these professional journalists who allege widespread intimidation and censorship all a bunch of flakes and losers who should be silenced because they are threats to public health?

Am I a threat to public health?

On that last one, I'll say okay, but too bad. I'm a threat who wears pajamas and has nothing to lose--and I damn well want some answers. Because here's my truth: In the last 15 years, I have never met anyone who could give me straight, no-nonsense answers to the toughest questions on AIDS.

For example: is it true that the best anyone has ever been able to establish with HIV is correlation--that AIDS sufferers are HIV Positive? But is it also not true that the list of possible symptoms for AIDS is extremely long, and has grown to include such diverse things as Herpes, Toxoplasmosis, cervical cancer, tuberculosis, and yeast infections? All basically under the theory that if you have HIV it's destroying your immune system, and therefore you are susceptible to a huge list infectious disease or some autoimmune disorders?

If so, are there any rigorously defined standards for an AIDS diagnosis besides "patient is HIV+ and has any one of the following long list of conditions?"

Is it not true that, while in the early 1990s almost no one in the medical community would admit it, we now know that there are people who have been HIV-positive for many years (at this point, some for over 20 years) who are in robust health and take no medication for it whatsoever? If so, and if you were presented with a patient who's been HIV+ but healthy for decades and then came down with cervical cancer, would you feel that an AIDS diagnosis and a prescription for an AIDS cocktail was justified? Why exactly? Are there any tests you'd perform beyond the HIV test and the already-established tests for cervical cancer before drawing that conclusion? If so what are they, and what results would you look for?

As far back as the late 1980s there were diagnosed AIDS patients who were taking anti-HIV medications like AZT, and then stopped despite doctor's objections. Some of them are still alive right now and are willing to talk. Has anyone bothered to fund research to study these people?

Is it not true that some of the AIDS "cocktail" drugs are in fact quite dangerous, and might well kill a healthy patient?

Given everything now theorized about decades-long dormancy periods and the possibilities some grant that a patient might be an AIDS "carrier" but personally immune, is it medically possible that a patient might be HIV+ and have some AIDS symptoms and not have AIDS? Are there any rigorous diagnostic standards for telling one type of patient from the other? If so, what are they?

Is it not true that there have in the past been people who came down with the entire original list of AIDS symptoms from the early 1980s (Kaposi's Sarcoma, diarrhea and vomiting, drop in t-cell count, rapid weight loss, and eventual death by a specific type of pneumonia), but were HIV negative and therefore diagnosed as having an "idiopathic" condition? Even though they looked exactly like all the gay men who died of AIDS in the 1980s? Do you think that people who find this suspicious are being irrational?

Finally: am I a threat to public health for asking these questions? Why?

* Update * I realized this morning that I had repeatedly misspelled Dr. Miklos' last name, and failed to include a citation for the second article in Nature Biotechnology. That's been corrected. Apologies to Dr. Miklos.--Dean