Dean's World

Heh - I assume Michael was joking. ;)

Dean, absolutely right to put the baby first. Congratulations (a bit early, I suppose), and good luck with everything!

Go tend the herd, Dean.

Everyone else, here's a Borders coupon for 25% off if you want to pick up either Bialy's or Duesberg's books. I think I will - if my car starts after work.

I have been pondering this debate since Dean brought it up, so I'm glad that it's still simmering. Mind you, I'm not the paranoid type: I don't think there's a conspiracy. I'm just familiar with the history of science, and know about revolutionary theories and how they often overthrow the status quo. Maybe this is one - or maybe not. Either way the subject deserves more scrutiny, and I'm glad Dean is fanning the fires here.

I've been trying to think of an analogy that would illuminate how we've gotten "here" if Duesberg et al are right.

Imagine you were a doctor who knew little about lung cancer - say 100 years ago. Then imagine that someone diagnoses it, and all of a sudden we have thousands and thousands of cases of it being reported.

Statistically, we would go from 0 cases to thousands in a relatively short period of time. You could project a trend based on the increasing number of cases being diagnosed that would lead you to believe that you are in the midst of this cancer epidemic.

As for the origin of the epidemic, some would posit a virus that is burning through the population. Others might suggest that cigarette smoking might have something to do with it, and that the epidemic could be eliminated with a change in lifestyle.

However, virus supporters could point out that some people who don't smoke have lung cancer, and many who do don't have it. They may also be able to show a virus or pathogen that is common across many - but not all - lung cancer patients, and assume that this pathogen is responsible for the cancer.

The "smoking" proponents (? - for lack of a better term) could suggest that these cases are "outlayers", due to the effects of second hand smoking, or haven't smoked long enough to develop cancer.

Dunno if this is helpful but thought I'd share it anyway.

Dean, wasn't there a serious question whether the CDC data was reliable? I seemed to recal seeing comments from some folks who held that position.

Found the source:

HIV Prevalence in the United States, 2000
P. L. Fleming, R. H. Byers, P. A. Sweeney, D. Daniels, J. M. Karon, and R. S. Janssen
CDC, Atlanta, GA

Link: http://www.retroconference.org/2002/Abstract/13996.htm

Abstract is as follows:

Background: As of 1992, back-calculation methods estimated greater than 1 million cumulative HIV infections, incidence of greater than 40,000 per year, HIV prevalence of 650,000-900,000. Since HAART in 1996, deaths declined and persons with HIV/AIDS survived longer. In 1998, the HIV prevalence estimate was 800,000-900,000. Estimates of national prevalence, proportion diagnosed and needing care help establishing priorities and funding for HIV care.

Methods: National surveillance data through June 2001 were adjusted for reporting delays. We adjusted 1998 HIV prevalence estimates by the difference between AIDS incidence and deaths in 1999-2000. A Poisson regression model estimated prevalent diagnosed HIV cases from AIDS cases in 25 HIV reporting states. Predicted HIV cases were compared to observed HIV cases; the best fitting model was applied to AIDS data to estimate prevalent diagnosed HIV cases in the United States. The proportions with no reported CD4 count after HIV diagnosis from 12 states with lab-based reporting of HIV and CD4 tests were applied to prevalence estimates to approximate lack of care/treatment.

Results: During 1999 and 2000, respectively, AIDS incidence was 40,800 and 40,200 and AIDS deaths were 17,200 and 15,300. Assuming stable HIV incidence, the number of persons living with HIV/AIDS increased about 50,000 and prevalence increased to 850,000-950,000. This prevalence range, plus 450,000 observed deaths, suggests cumulative HIV incidence is 1.3-1.4 million. In 2000, there were 340,000 prevalent AIDS cases. States reporting HIV (not AIDS) cases had an estimated 130,000 prevalent HIV (not AIDS) cases. Our model estimated that 330,000 persons were diagnosed with HIV (not AIDS) nationwide in 2000; about 670,000 persons have been diagnosed with HIV/AIDS. The proportion who know their status is 670,000/850,000 to 670,000/950,000 (about 75%). Of 340,000 persons with AIDS, an estimated 7% had no reported CD4 count as of June 2001. Of 330,000 persons with HIV (not AIDS), an estimated 61% had no reported CD4 count. Thus, of 670,000 persons diagnosed with HIV/AIDS, about one-third may not be receiving ongoing care. Together with 180,000-280,000 undiagnosed persons, about 400,000-500,000 HIV-infected persons (i.e. 42-59% of 850,000-950,000 infected persons) may be un-tested, un-treated, or both.

Conclusions: HIV prevalence is likely to increase less than 3% per year if current trends continue. The proportion of infected persons who know their status is increasing; three-quarters have been diagnosed, but a large proportion may not be in ongoing care.

Just more info for the discussion.

**All "greater than or less than signs" were eliminated and replaced with the terms "greater than" or "less than" by me...b/c of the html issues.

Also, from the CDC's MMWR (Morbidity and Mortality Weekly Report) Vol 50, No 21, 06/01/2001 (PDF here) (emphasis mine):

The first research on effective behavior interventions to reduce transmission of HIV among sex partners and injection drug users began in the early 1980s. Behavior interventions, including school-based programs, peer-to-peer interventions, strategies that limit needle sharing, strategies that use parent-to-child communication, client-centered counseling, and personalized risk-reduction strategies, are effective in promoting healthy behaviors that are protective for HIV (8).

PHS released guidelines in 1994 and 1995 for routinely counseling and voluntarily testing pregnant women for HIV and for offering zidovudine to infected women and their infants (9). Since this intervention, mother-to-child HIV transmission rates have decreased dramatically. During 1985--1999, AIDS cases among children declined 81%.

As a result of these and other HIV prevention efforts and increases in societal awareness of and response to the AIDS epidemic, new infections in the United States, which had risen rapidly to a peak of 150,000 per year in the mid-1980s, declined to an estimated 40,000 per year since 1992. With the advent of highly active antiretroviral therapy in the mid-1990s, the number of new AIDS cases and deaths declined dramatically and then stabilized in the United States and several other industrialized nations.

Here is the data from the CDC annual surveillance reports cited above. Reports include totals for U.S. and its possessions (including Guam, Puerto Rico, Virgin Islands, and Pacific Islands).

Early surveillance reports (pre-1993) either did not track non-AIDS HIV infections or did not distinguish between AIDS and non-AIDS HIV infections.

Column data: Cumulative Diagnosed with AIDS

1982: 000,452
1983: 003,064
1984: 007,699
1985: 015,948
1986: 029,003
1987: 049,743
1988: 082,764
1989: 117,781
1990: 161,073
1991: 206,392
1992: 253,448

* Table 12 of the 1992 report contains a summary of cases reported/deaths per year 1981-1992


Column data: Cumulative Diagnosed with (HIV only . AIDS only . HIV or AIDS) ... Currently Living with (HIV only . AIDS only . HIV or AIDS)

1993: 055,649 . 361,364 . 0,417,013 ... 051,439 . 137,529 . 188,968
1994: 069,330 . 441,528 . 0,510,858 ... 063,219 . 167,818 . 231,037
1995: 077,302 . 513,486 . 0,590,788 ... 070,413 . 190,775 . 261,188
1996: 083,802 . 581,429 . 0,665,231 ... 076,664 . 216,769 . 293,433
1997: 092,107 . 641,086 . 0,733,193 ... 084,414 . 247,571 . 331,985
1998: 106,575 . 688,200 . 0,794,775 ... 097,962 . 274,624 . 372,586
1999: 122,507 . 733,374 . 0,855,881 ... 113,167 . 299,944 . 412,471
2000: 138,011 . 774,467 . 0,912,478 ... 127,286 . 322,865 . 450,151
2001: 174,026 . 816,149 . 0,990,175 ... 161,976 . 344,178 . 506,154
2002: 199,759 . 859,000 . 1,058,759 ... 144,129 . 384,906 . 529,035
2003: 221,065 . 929,985 . 1,151,050 ... 174,639 . 405,926 . 580,565

* Numbers in the 2002 and 2003 reports are noted as estimates


I don't think these data match the HIV graph in question.

By "throwing out" I mean using...lol. "throwing out" seems to imply that 1 million would be wrong.

Shad,

One more thing, it's probably not fair to compare HIV numbers from the CDC with AIDS numbers from the CDC without taking into account that the CDC only got it's HIV data from 33 states--while it got AIDS data from 50 states.

This doesn't change the HIV numbers (i.e. we still can't find the data for the straight line), but we probably shouldn't compare totals of HIV to totals of AIDS without taking that into account. Trends, yes...totals, no.

That last comment was hasty. The truth is we don't know WHERE he got his numbers at all.

That's because the graph is based on estimates of 1 million, while the data presented here is of known cases. Known cases increase as more people are tested over the years.

It's still pretty naive to make something of the estimates which are clearly based on little information, and made only because it's something the CDC is supposed to do (you can't control new diseases without making estimates). I'm surprised veteran scientists based a claim on these estimates as I'm sure they know how little regard journals have for arguments based on crude round number estimates with no error bars.
Their mathematical analysis, with no consideration of latency, medication or how much changing incidence affects prevalence was also surprisingly simplistic.

For what it's worth, I have made an update to my analysis of the AIDS/HIV charts to reflect an extremely good point raised by David Crowe.

In short, David argues that the growth of total AIDS cases should be exponential instead of linear. In my response I argue that although the curve looks linear, close analysis implies that it is actually the beginning portion of an exponential growth curve, but we will need several more decades worth of data to be sure. Read the update for full details.

Maor -

I am not disputing that it is likely the CDC has at some point provided estimates regarding HIV or AIDS incidence and prevalence in addition to actual reported numbers. They likely have provided many different estimates at different times using different models and different sets of assumptions.

What I continue to dispute is whether the data shown in the HIV graph came from any of the CDC sources that the paper cited. We can guess and speculate as to where these numbers came from all day long, but we should not have to do so. These data were represented as numbers coming directly from the CDC, so damning on their own that they could serve as dispositive proof that HIV could not possibly be the cause of AIDS.

We need to know if these data are estimates. We need to know the basis for these estimates. We need to know what models were used to arrive at them. We need to know how reliable these estimates were represented to be by whomever made them. We need to know if they have been contradicted or superseded by other estimates. We need to know if these data came from some other source than the CDC.

To summarize, I would like to directly examine for myself the CDC source which states that HIV prevalence (or even incidence) held constant at 1,000,000 persons within the U.S. from 1985 until 1995, at which point it dropped to 900,000 persons and then held constant at 900,000 persons through the year 2000.

Also, thank you to everyone so far who is keeping the conversation focused on the topic at hand, rather than veering off into another general discussion free-for-all.

We will entertain questions from commenters to this article who wish to address the data presented and its implications. You are free to question the data or its implications—not the presenter, and not issues outside of the data presented here.

You may ask questions related to other HIV issues in other threads, which you'll find attached to the numbered links below.

"What I continue to dispute is whether the data shown in the HIV graph came from any of the CDC sources that the paper cited."

I found a CDC estimate of 1 million from a 1985 CDC report by an internet search (haven't been able to find it again). I don't know if it's the same report as is referenced, although I don't see how that matters.

"We need to know if these data are estimates."

Definitely estimates. The phrase was "an estimated 1 million". Even the latest figures of 900,000 are estimates, based on an estimate of roughly 200,000 undetected HIV+ cases. For the 1985 estimate, almost all HIV+ cases were as yet undetected.

"To summarize, I would like to directly examine for myself the CDC source which states that HIV prevalence (or even incidence) held constant at 1,000,000 persons within the U.S. from 1985 until 1995, at which point it dropped to 900,000 persons and then held constant at 900,000 persons through the year 2000."

Ain't no such thing.

"We need to know how reliable these estimates were represented to be by whomever made them."

Not very. Ironically, Duesberg and Bialy seem to be the first to place any significant faith in the accuracy of these CDC estimates!

Maor -

Definitely estimates. The phrase was "an estimated 1 million".

I'm not finding that characterization anywhere in the Duesberg paper (link provided above). From what I see, the data are used in two places in that paper. The first place is in the graph on page 4 of the PDF, which was previously mentioned. The second place is at the top of page 9 of the PDF where the prediction of “AIDS spreads by infection” of HIV is addressed with this:

But, contrary to the spread of AIDS, there is no “spread” of HIV in the US. In the US HIV infections have remained constant at 1 million from 1985 (29) until now (30), (see also The Durban Declaration and figure 1b). By contrast, AIDS has increased from 1981 until 1992 and has declined ever since (figure 1a).

References given are (29) (Curran et al 1985) and (30) (Centers for Disease Control and Prevention 2001). The Durban Declaration contains no CDC incidence/prevalence numbers, and "figure 1b" is the HIV graph on page 4.

I do not see any indication in Duesberg's paper that the CDC data being presented are estimates or projections of any kind.

Again, my argument is not with you, Maor; I agree with you that these data are estimates. I just want to examine the source that they were taken from. I do not think it too much to ask that a serious paper published in a medical journal use identifiable and defensible sources of data.

Jenks: Seriously, you need to cut it out. Your sarcasm adds nothing to the discussion, and seriously distorts some researchers who, just because you don't agree with them, don't warrant your scorn.

Get over it man, you're a med student, and it doesn't make you smarter or better informed than anyone here on this matter. It doesn't. Stop with the sneering. Remember something that an old physician once told me: if you graduate as a full-fledged MD, half of what you will learn in med school will turn out to be wrong by the time you retire--you just don't know which 50% it will be so you have to learn it all. It is also a damn sure certainty that you will sooner or later be embarassed as a physician. Have at least a little humility while you're still a student, m'kay? I have had the experience at least three times in my life of outguessing a physician who was treating me. If you think this never happens, you're mistaken.

Humility first. You aren't God, and neither are your instructors.

Everybody else: The most important epidemiological data goes to the number of HIV infected individuals found in the US population. Shad's first set of offered data gives us nothing, since it truly IS an apples-and-oranges comparison: Shad is attempting to conflate actual persons who can be identified by a physician as being HIV+ with what's found in epidemiological data about the entire population. The numbers we have presented here are the total number of HIV+ persons found through testing in the blood supply, members of the military, and reports from hospitals and etc. That number appears not to have changed much in 20 years.

The only thing under discussion is the number of persons with HIV running around their system found in the US population. Despite claims that this is an "apples and oranges" discussion, it is not. If HIV infections found in the general US population have remained relatively static while AIDS cases have increased and decreased, this is important epidemiological data, for it throws the claim that HIV is an infectious disease that leads to AIDS into sharp relief--and claims of how latency periods and bad early reporting can explain it all away should subject to much scrutiny.

Others in this discussion have already made horribly ridiculous assumptions--such as that the introduction of protease inhibitors (which did not occur until 1996) could explain the sudden dropoff in new AIDS cases that started in 1992. Others have tried to explain it away with the education programs on safe-sex--which would miss the fact that during the same time period, other STDs increased in their prevalence.

You guys need to stop acting as if this is a bunch of idiots who are positing conspiracy theories and stupidity. It really is not that easy.

More later.

Well, I already said good-bye on the other thread, but now I have to at least point out that most of the sarcasm is in response to a certain extremely caustic and difficult person who was propped up here as some kind of authority only to make a complete fool of himself. So don't assume that you have the whole book on me. If snide comments don't add to the discussion, I have to ask, what at all does Bialy add?

Dean,
We're not positing a conspiracy. We're positing that Duesberg and Bialy are making a mountain out of a molehill by taking speculative estimates and passing them off as reliably accurate data. Something they have accused their critics of doing.

The excuse that the decline in AIDS incidence began before protease inhibitors is weakened significantly by the fact that it began after AZT. This doesn't prove that AZT did it, but the failure to even consider the possibility was poor analysis.

Maor,
AZT was put as monotherapy in 1985 (patented in march)
After the Concord trial (publied in 1993), the dose of AZT monotherapy falls from 1500 mg to 300-600 mg.
In 1996, 3TC was added. Chemical studies demonstrates that AZT decreases the plasma amounts of 3TC. I think that it is chemically obvious that 3TC reacts with AZT in a oxidoreduction reaction.
The previous dates agree with the slope changes in the second graph.
And explain me why the Ruengpung study says that :

Our results preliminary suggested that infected infants who were perinatally exposed to ZDV may have a more rapid early disease progression with unfavorable viral manifestations than those without exposure to antiretroviral drug

They have seen experimentally that AZT allows a more rapid early progression of AIDS. How do you not can see that ?

Mr. Esmay,

First, let me just thank you for breezily dismissing out of hand the efforts by various people to inject actual data from cited sources, without actually refuting any of the data presented. It's enlightening to see how little respect you show for the time and energy people spent to actually do a little research on the scientific topic at hand, and to share the results of that research with others in a clear manner with referenced sources which can be independently verified.



Second, let me address a few of the statements you have made, both to me specifically in your last comment and to your audience in general in the original post here.

Apparently part of the confusion stems from mislabeling: the "incidence" of HIV would have been more clearly labeled as the total number of HIV-infected individuals found in the population. It's that level, which has remained fairly stable over a 20 year period, which most starkly draws the entire question of an infectious epidemic into sharp relief. That's CDC data—data they don't make easy to find, mind you. (original post)

Please share the actual, specific CDC source of these numbers with the rest of us so that we may examine it for ourselves.

I've got an open challenge: who can find me any year between 1985 and now in which the total number of HIV+ persons in the U.S. did not number between 800,000 and 1,000,000? I tried and couldn't (original post)

Please see my first comment on this thread. Also see Jeremy's comment on the abstract placing the low-end estimate at 650,000. Additionally, see jfr's comment using yet another source placing prevalence as low as 470,000. Finally, see one of my later comments where I extract the relevant data from each of the annual CDC surveys from 1982 through 2003 (none of which place the total number of HIV+ persons in the range you cite).

How many different numbers, posted by how many different people, using how many different sources, do you require before you accept that this challenge has been met?

Shad's first set of offered data gives us nothing, since it truly IS an apples-and-oranges comparison: (thread comment)

The data I presented in my first comment on this thread was a quick response to the challenge in your original post to find any year with HIV prevalence outside your 800,000 - 1,000,000 range. I picked an official CDC survey report from the middle of the list (on their hard to find "HIV/AIDS Surveillance Reports" webpage), opened it up, and shared some numbers from it disputing your claim.

Shad is attempting to conflate actual persons who can be identified by a physician as being HIV+ with what's found in epidemiological data about the entire population.(thread comment)

I am not conflating anything. I am presenting the data which Deusberg and Bialy have cited as their sources.

In this comment I list all sources cited by Duesberg in his paper. None of them contained the data that he used. In this comment I have extracted the relevant data from the CDC annual surveys, which Bialy cited as his source for the graphs in FALSIFYING THE UNFALSIFIABLE HYPOTHESIS. That is all.

Do not blame me because this data does not say what you want it to say, and because it does not match the data in the graphs they use. In each of my comments, I have stated that I cannot find any source which provides the data that Duesberg and Bialy cited, and have asked for it to be provided.

The numbers we have presented here are the total number of HIV+ persons found through testing in the blood supply, members of the military, and reports from hospitals and etc. That number appears not to have changed much in 20 years.(thread comment)

The data you have presented here have no verifiable source. You have repeatedly claimed that these numbers came from the CDC, but you refuse to cite any specific source. These numbers do not match any CDC data set spanning 1985 through 2000 that anyone else has been able to find.



Finally, let me ask one more time in the interests of elevating this discussion above demagoguery and publicity stunts and into the realm of respectable, informed debate:

PLEASE SHARE THE ACTUAL, SPECIFIC CDC SOURCE FOR THESE NUMBERS WITH THE REST OF US SO THAT WE MAY EXAMINE IT FOR OURSELVES.

Thank you.

Instead of responding to a rather simple request in this thread from two days ago which asked them to demonstrate that the data they are touting actually came from the CDC as they claim, Mr. Esmay and Mr. Bialy have decided to invest their time and energy in a different thread, manufacturing multiple accounts with which to hurl rhetorical feces at anyone foolish enough to try to engage them in a rational conversation.

Best of luck to those of you who choose to continue participation in the farcical Jerry Springer/Ricki Lake form of scientific "debate" encouraged on this blog. I'm done.

Response to Shad and Chris Noble:

Agree, let's stick to the subject at hand.

During our phone conversation the other night, Harvey designated me as the "Starburst Kid" to emphasize a point imbedded in the graph that has everyone so exercized. Can the "novel" accesory genes found in HIV sequences add up to an "AIDS" gene? This point is specifically addressed on page 151 of Harvey's book where Duesberg is quoted: "HIV is a conventional retrovirus, without an AIDS gene." Additionally, ARGUMENTS are presented which reveal Duesberg's expertise outside the area of "acutely transforming" retroviruses. Is there a response? Well ... yes. Gallo and Fauci essay in Harrison's Principles, "In reality, the function of these genes (nef, vif, and vpu are poorly understood and their in vivo relevance is unclear." And, an astounding admission, "there are mutants of rev and tat that not only are nonfunctional but ACTUALLY INTERFERE with normal rev and tat function and INHIBIT VIRUS EXPRESSION." (emphasis added).

Imagine that, a mutating virus that can interfere with itself. Maybe that's why there can be an incidence/prevalence "equilibrium" in the complex of vertical and rare horizontal transmissions of retroviruses and retrovirus-like elements in primates. A direct measure of "incidence" may not be possible.

We've answered the questions if you look at all posts. Answer ours.

Richard Bennett wrote:. Dean and Bialy (and Bialy's various sock puppet personae) assert that the number of HIV+ people in the US has been stable ever since 1985. They're said this over and over, and their argument absolutely depends on that assertion being true.

Actually their argument depends on HIV prevalence and incidence being stable before 1985. With a median time to AIDS of 10 years you need to know the HIV incidence not prevalence decades before 1985 in order to be able to calculate the expected number of AIDS cases. Duesberg extrapolates the 1 million figure backwards in time 200 years. Amazingly this extrapolation produces absolutely no uncertainties.

Chris