There are people who believe that everything scientists and doctors think they know about HIV is wrong. They include scientists, doctors, journalists, activists, HIV-positive people, and people with AIDS. Orthodox researchers take offense at what they perceive as the callous propagation of irresponsible views by these skeptics, dissidents, or (to their most passionate critics) “deniers” of HIV.
The line between a loony skeptic and a reputable dissenter may be blurry. One of the HIV skeptics won the Nobel Prize in Chemistry for developing a key technology used in HIV testing. It was one of the most important biomedical discoveries of the 20th century. One of the HIV skeptics believes he may have been abducted by aliens who spoke to him in the form of a glowing raccoon. These are the same person.
In January, I watched “House of Numbers,” a documentary about the AIDS causation controversy that toured the film festival circuit last year and is playing serially at theaters in a small number of cities. After the opening- night screening that I saw in Portland, Oregon, director Brent Leung held a question-and-answer session.
Leung isn’t a typical HIV-AIDS dissenter. He doesn’t claim to be better educated about AIDS than any other nonscientist who has researched AIDS. He says his film was meant to raise questions that aren’t being talked about enough, and that it succeeded in doing so, even for the director himself. He doesn’t accept the label “denialist,” not only because he thinks it’s unnecessarily emotional and unkind — intended, of course, to evoke Holocaust denialism — but because he puts himself forward (when discussing the film, if not when narrating it) as a searcher and an HIV agnostic, without definite beliefs.
The aspect of AIDS reappraisal most important to him is what he says are the many problems with HIV testing, a grievance not without merit. The camera follows him through the pro- cess of being tested for HIV in South Africa. This, and the interviews with Luc Montagnier and his co-laureate, famous for their AIDS research, may be the two most important parts of the film. Skeptics other than Leung talk about confusing testing standards, but
There’s no question that conditions other than HIV infection can lead to something that looks a lot like AIDS.
he shows them in living color. He asks questions of a woman who interviews him about his risk factors (“Tell me about your sex life!”) and another who processes his test and determines the results. What they say does not summon all HIV testing into question, but it could lead to legitimate questions about the tests and about the practice of medicine.
“House of Numbers” is a good over- view of recurring themes in the skep- tics’ books. Last year, I read two of the most recent contributions to the skeptical literature: one by Barbara Culshaw, a mathematical biologist whose back- ground is in modeling HIV epidemiology; the other by Henry Bauer, a retired professor of chemistry at Virginia Tech.
As skeptical books go, Culshaw’s “Science Sold Out” isn’t bad. Culshaw describes how her work in HIV epidemiology led her to question received wisdom about HIV, then surveys the objections other dissidents have raised. She packs a useful overview of the skeptics’ arguments into fewer than 100 pages.
The thing is, “as skeptical books go,” isn’t saying much. In content, structure, and prose style, “Science Sold Out” is like a lengthy blog post. It is in good company: several skeptics present themselves like the kid who just discovered cold fusion in his science fair project and has to show you right now. Gary Null’s “AIDS: A Second Opinion” (2001) is unfocused. Celia Farber’s “Serious Adverse Events” (2006) is courageous journalism and engaging reading, but it’s unpolished and leaves the reader wanting a more thorough understand- ing of AIDS science to justify her ear- nest tone. Peter Duesberg’s touchstone “Inventing the AIDS Virus” (1996), while thorough, is in places overly simplistic or too anecdotal, straining the reader’s impression of his intellectual honesty. Harvey Bialy’s science-heavy biography of Duesberg (“Oncogenes, Aneuploidy, and AIDS,” 2004) is a little sloppy and unapologetically cheerlead- ing, and has some of the same weak- nesses as Duesberg’s book.
This is the biggest point on which Bauer’s book shines. “The Origin, Persistence, and Failings of HIV/AIDS Theory” is the first of the skeptic books I have read in which not only is the science, as far as I can tell, reasonably sound, but the book is of high quality. It is well-written in a professional style, well-edited, documented with copious references, and follows a clear narrative progression through a wide-ranging discussion. The skeptics have badly needed a book that reads like a scientist’s work, not like a screed banged out in a few weeks by a cranky lab technician or a strung-out antiestablishment reporter. They finally have that book.
The first part reads like a mystery. Bauer asks questions about what he says are inconsistencies in the HIV theory, then proposes a hypothesis that would explain them. His work is clearly the product of rational analysis by a scientific mind — something that is beyond the ken of many of the researchers disgorged from institutions of higher learning and into the HIV research machine. You’d have to be an expert in retroviruses or already have a dogmatic set of beliefs about HIV not to come away from this book with more questions than you’d had before.
The second part is about the progress of science (with nods to Thomas Kuhn and Karl Popper); the third is a scientific and political history of AIDS. I expected these parts to sound like filler, but they didn’t. They’re much less technical than the beginning of the book, but Bauer is equally comfortable, and equally convincing, in discussing data or in discussing scientific principles.
The models we have available and the words we use to describe a phenomenon shape our thinking about it. Bauer refers throughout his book to “F(HIV),” by which he means “the frequency of positive HIV tests” (p. 5) rather than “the number of people who are HIV positive.” He refuses to grant the premise that a virus that we can call HIV is actually detected by “HIV” tests. His terminology makes his argument straightforward by keeping the terms of discussion clear. Such epistemological rigor is a sign of a careful thinker and a good scientist, and is not the norm in science journalism in the mainstream press.
It’s not widely known that there is an HIV-skeptic movement at all, but it’s even less widely known is that it is not monolithic. Worse, among those who know about HIV skepticism, there’s an unfortunate tendency to view the dis- agreement in black-and-white terms: either HIV is a dangerous virus that, if contracted, always leads to AIDS and eventual death; or else HIV is harmless. But it doesn’t take much investigation to discover that important truths may lie between these stereotyped extremes.
There’s no question that conditions other than HIV infection can lead to something that looks a lot like AIDS. The skeptics regard this as important information and at least the beginning of an important discussion. Even grant- ing that HIV exists and (with or without cofactors) usually leads to development of immunodeficiency, AIDS is a hodgepodge of symptoms rather than a well-defined disease. This is not to say people with AIDS aren’t really sick, but that just because two sick people are said to have the same disease doesn’t mean that they do.
There are other conditions for which “disease” is a less than ideal metaphor, and about which it is more socially acceptable to say so than with AIDS. Alcoholism, attention deficit disorder, and homosexuality are examples. Anybody who shows up at a meet- ing and says he is an addict is considered an addict. Any child who doesn’t like to sit still in a desk for eight hours is a candidate for being fed Adderall. Homosexuality stopped being a disease one day in 1973, when a resolution got a sufficient number of votes at a meeting of the American Psychiatric Association. Within a generation, mental-health practitioners went from believing almost uniformly that homosexuality was an illness to believing almost uniformly that gay people are healthy. As a gay man, I’m happy about the change, but I acknowledge that it was political, not scientific — as was the decision to declare homosexuality an illness in the first place. Considering the widespread perception of AIDS as a disease limited to a few populations, gay men among them, the terms of the AIDS causation debate are uncomfortably homologous to those of the prior controversy about homosexuality. AIDS is at least as much a political definition as a medical one.
The skeptics point out that HIV was not exactly determined to be the cause of AIDS by careful research and exchange of ideas in peer-reviewed journals. Increasingly vocal gay activists were lobbying the Reagan administration to take AIDS more seriously, so in 1984, Reagan’s Health and Human Services secretary hastily convened a press conference and announced that “the probable cause of AIDS has been found.” Probable. Standing next to her at the podium was Robert Gallo, the scientist whose name would appear on four papers published in Science the same year that are still cited as establishing HIV’s causal role in AIDS. They are suggestive but not conclusive for such a strong claim. That year, only 3.4% of citations of one of those papers implied or stated that it conclusively established that HIV causes AIDS. Two years later, that percentage had risen to 62.0%, though little had happened to bolster the claims of the paper on its own merits (see Steven Epstein, “Impure Science.” University of California Press, 1996, 82–87). “HIV causes AIDS” was repeated often enough and became more and more the conventional wisdom.
Duesberg, the best known dissenter, argues that AIDS is attributable mostly to antiretroviral and recreational drugs. He believes long-term drug abuse gives some people AIDS, and toxic drugs used to treat HIV actually cause or worsen AIDS symptoms. To some extent, he is correct. Abusing drugs can make you sick, and the list of side effects of AIDS drugs is sickeningly long. The question is whether the entirety of AIDS, or only a portion of it, can be explained by the use of drugs.
Other skeptics, notably the “Perth Group” led by Eleni Papadopulos- Eleopulos, deny that HIV has been proven to exist at all. Bauer falls closest to this view. Leung’s professed HIV agnosticism notwithstanding, so, I think, does he.
A third view receives little attention and is virtually unknown except to specialists and skeptics — astonishingly so, because it is hardly exclusive to skep- tics. It is the view of the most important part, and arguably the most respected part, of the HIV-AIDS establishment. This view is that HIV, without cofactors (such as other pathogens, illness, or malnutrition), is relatively unlikely or unable to lead to development of AIDS.
The most visible exponent of this view is Luc Montagnier, the man who discovered HIV, for which he was awarded the 2008 Nobel Prize in Physiology or Medicine. Montagnier’s French research team and Bob Gallo’s American team both claimed to have discovered the virus. Although it is generally accepted that Montagnier’s team beat Gallo’s to the punch, and that carelessness or malfeasance marred the work of Gallo’s lab, Gallo remains a giant in the HIV research establishment. So it’s worth noting that he, too, has acknowledged the role of cofactors. He writes in his book “Virus Hunting” (1991) that a family of viruses he discovered, the HTLVs, “are the only known specific co- factors for AIDS” (248, emphasis his). In “Virus,” Montagnier’s book on HIV for a lay audience, he briefly argues against Duesberg and calls him dangerous. But this is at the end of an entire chapter
At least some of the inter- views were done under false pretenses. In the end, does it matter?
about the improbability that all AIDS cases are caused by HIV alone. Thus, even the man who discovered the virus is on record doubting what dissenters call the “HIV=AIDS=Death” model. He has not backed down from this view.
Montagnier believes that bacteria called mycoplasmas may help HIV cause immunodeficiency. He has speculated that sexual liberation and an increase in multiple partnerships among certain homosexual populations in Western countries led to the spread of a family of mycoplasmas . . . from a rectointestinal localization to a genital one, and then to systemic blood infections. Such infections would have gone unnoticed, being easily tolerated, if not for the unexpected arrival of HIV, which was endemic in Africa. (“Virus,” 176)
This is the most surprising single fact one encounters when investigating the AIDS causation controversy: the belief of important mainstream researchers is not that “HIV causes AIDS” but some- thing more like “HIV has something to do with causing AIDS.” These researchers don’t often get asked useful questions. When they do, they may not want to answer. And when they answer, we don’t like to think about the implications of their answers, so we simply don’t.
To that end, Leung’s film is invaluable. He managed to interview all the heavies of the HIV research establishment, and I look forward to getting the DVD (available in June 2010), which he says will have some of the hundreds of hours of footage that didn’t make the film. I was surprised that he got some of
those fellows on tape at all. I wouldn’t expect Bob Gallo, for instance, to sit down with a young filmmaker sympathetic to the dissidents. At the Q&A after the film in January, I asked how the interviews came to be. The “in” was Martin Delaney, a significant figure in AIDS activism. Leung and Delaney were on friendly terms, and Delaney agreed to be interviewed. Gallo, as I expected, had originally declined to be interviewed for the documentary; but Delaney, a friend of Gallo’s, got him to sit for an interview after all. Thence, a domino effect brought other big names who didn’t want their voices left out.
Some of the scientists say things in the film that will surprise most people, and many of them now say that these things were “taken out of context.” Isn’t that always the way? Delaney died before the film was released, so he can’t be asked whether it is what Leung told him it would be or whether he regretted facilitating interviews with “respectable” AIDS scientists. It seems likely that at least some of the inter- views were done under false pretenses — that Leung knew he was making an essentially pro-dissenter documentary but portrayed it as an uncontroversial documentary about the sociology of AIDS. Leung denies this, and in the end, does it matter? Suppose he did interview the scientists without telling them what kind of documentary he was filming, then cherry-picked quotations. Using the footage to put words in their mouths would be a problem; but if he’s only showing them saying things they wish they hadn’t said, so much the better. That is in the best tradition of investigative journalism.
I suspect there is some of both. Don Francis is shown saying, “Gallo said he had all these viruses, and it was a lie.” The implication is that Francis, who previously worked in Gallo’s lab, is endorsing the idea that HIV hasn’t been properly isolated and may not be a real virus. He was likely talking about the controversy over who discovered the virus, saying that Montagnier’s French team beat Gallo’s American team. On the other hand, Montagnier is shown saying, “We can be exposed to HIV many times without being chronically infected. Our immune system will get rid of the virus within a few weeks, if you have a good immune system.”
That should astonish people who have accepted conventional ideas about HIV as propagated by doctors, STD counsel- ors, and the like; but the remark is quite in character for Montagnier. There is no reason to suppose its meaning is mis- represented, and in fact we know it was not: Leung has released four minutes of footage, from which the quotation was drawn, in which Montagnier explains that HIV transmission can be decreased by making impoverished people healthier and thus more able to fight off HIV.
Authorities whom no one would label dissenters agree that, relative to most diseases, it’s difficult to get AIDS, and not only for the reason Montagnier gives. Estimates range from hundreds to even thousands of unprotected sexual contacts with an infected person that, on average, are necessary for a person to become positive. Use condoms correctly and the risk is exceedingly low. If you do become positive, Montagnier says you have a good chance of fighting HIV off, just as you fight off a cold after a couple of weeks (indeed, HIV can cause symptoms like the common cold in the acute phase a few weeks after infection). And then, if you don’t fight it off, it may be years before you become ill, or decades, or you may never become ill, and we don’t know why. It’s still a very bad idea to be careless about HIV. Even one chance in a thousand isn’t one you want to take when the consequence
If Leung is showing them saying things they wish they hadn’t said, so much the better.
is AIDS, and many factors in specific cases can raise or lower these general figures by orders of magnitude. But this is hardly the model of AIDS we’ve been given by health authorities. Leung’s film and the skeptics’ books are among the few places you might discover this.
Not all those called dissidents comprise a separate camp from the main- stream. Some are more a bridge between disparate parts of it. I wondered for years whether I were the only person to see this; the skeptics themselves do not often mention it. At the Q&A, Leung said something similar: he doesn’t think of “House of Numbers” as a dissident film, because all he did was put scientists in front of a camera and show what they’re saying, and how damaging some of the orthodox AIDS scientists’ own positions are to conventional ideas about HIV and AIDS. “You can take out the controversial people,” he said, “and you still have a damning documentary.” He’s right: less interest- ing than what the dissidents in the film say is what the orthodox AIDS experts say, and it’s nothing they haven’t been saying for a long time.
Among frontline researchers and clinicians, opinion has been diverse since AIDS began, and it remains that way. The consensus among most of them now is that HIV is a real retrovirus and causes AIDS, but less settled are such questions as: How do you test for HIV? How bad is AIDS in Africa, and what should be done about it? How important are pathogenic and toxicological cofactors or oxidative stress? How does HIV even cause AIDS? Public health authorities’ confident, soundbite answers make these sound like settled questions, but in understanding AIDS we’re barely out of the dark ages.
The skeptics have made important contributions to the understanding and treatment of HIV. Five stand out.
First, the skeptics fill in details and correct mistakes. The conventional narrative about HIV and AIDS may be essentially correct, but imprecise — wrong on small points that eventually will be better understood. If HIV needs cofactors to do its dirty work (perhaps only sometimes), or if it’s only one of many causes of the various immunodeficiencies lumped into the syndrome “AIDS,” then people like Bauer and Culshaw have as much to contribute to AIDS science as their mainstream counterparts.
Second, the skeptics have implicitly questioned whether medical professionals take a public-health approach or an individualized approach to treat- ing patients. This question reflects the larger healthcare debate: one look at the practice of AIDS medicine ought to give pause to proponents of government, by-the-books health care. HIV medicine is like cancer medicine in one sense: the drugs hurt you, but they are supposed to hurt HIV more. (In fact, AZT, the first and best-known anti-HIV drug, was originally created to be an anti- cancer drug. It was shelved because it was deemed too toxic for cancer chemotherapy. It is still in use against HIV and is given even to newborns to pre- vent perinatal transmission.) The difference is that chemotherapy runs for a few days or weeks, whereas HIV meds are taken for the rest of your life. When that is the standard treatment regimen, you want your doctor to be intimately concerned with your wishes, your well- being, and your values — not just read- ing “best practices” out of the latest letter to the editor of a medical journal.
Third, the skeptics point out the danger of the tight nexus of government and the HIV research establishment. They view HIV research as a make-work program created in the nick of time to save jobs in the failing War on Cancer. A bunch of virologists were looking for cancer viruses and couldn’t find enough of them. Along came HIV, and they had a new virus to research. Many of the skeptics think government funding and direction of research has the welfare state has done for HIV what libertarians think the War on Drugs has done for crime, or the welfare state has done for poverty.
Fourth, perhaps without meaning to, the HIV dissenters provide a reference point for understanding other controversies. One of Culshaw’s chapters is entitled “Science by Consensus.” If that
How do you test for HIV? How bad is AIDS in Africa, and what should be done about it?
sounds familiar, it’s because it is a common criticism of global-warming hysteria — that it embraces a conclusion simply because enough scientists have accepted a politically charged narrative, without demand for a good reason to reject the null hypothesis. The problems in HIV science are institutional, and they are not confined to the HIV controversy or to medical science.
An article could be written just on these last two points. Skeptical science journalism is an under-appreciated genre. Gary Taubes proposes in “Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health” (2007) that, contrary to what the government has been telling us for decades, refined carbohydrates are responsible for much of the incidence of several “diseases of civilization,” from heart disease to diabetes to cancer to Alzheimer’s. He persuasively argues, for example, that evidence “suggests that eating a porterhouse steak in lieu of bread or potatoes would actually reduce heart-disease risk, although virtually no nutritional authority will say so publicly. The same is true for lard and bacon” (169). While reading “Good Calories, Bad Calories,” I made a list of parallels between it and the HIV skeptical literature. I stopped counting after more than a dozen such. The story is basically the same: substitute fat for HIV, and carbs for lifestyle factors in immunodeficiency. Different critics of mainstream science arrive independently at critiques of similar or identical form.
Finally, the skeptics point out when HIV-related science is done badly. There is a lot of bad science; it’s not surprising that some of it is done in the name of understanding HIV, at which ungodly great gobs of government and private money have been thrown. One small flaw in the protocol of a study, or the interpretation of its results, and the results may be worthless. The skeptics make a convincing case to this reader
Enough research has been done on HIV that one could find data demonstrating almost anything.
that, if the mainstream is correct, it’s as much despite sloppy science as because of good science. Bauer notes the care- less work done even by such respected concerns as the Centers for Disease Control:
“Up to and including 1985, CDC had listed among AIDS cases, first, those who were homosexual or bisexual men; second — among the remaining cases only — intravenous drug abusers (IDU); and then hemophiliacs, trans- fusion recipients, heterosexual contacts, and other. Every case went into only one of those categories, making it impossible to detect possible combinations of two or more risk factors that might be an especially powerful inducement to AIDS. (190)”
A problem with government science, as with all central planning, is that when one “expert” panel decides what will be considered true, reality is short- circuited. Many lives may be endangered because half a dozen researchers have made bad decisions. Here, the foundational epidemiological work appears unbelievably bad, and there’s more where that came from.
Bauer hypothesizes that AIDS is not a new syndrome, and that HIV is not a virus but an artifact of imprecise medicine, bad science, and circular definitions. It is, he suggests, a composite indicator of general health and a surrogate marker for many conditions. It would then be like a fever: not some- thing for which one is “positive or negative” for life, but a temporary state that may come and go as one experiences such challenges as illness, stress, or pregnancy. Arguments between skep- tics and the establishment about the accuracy and usefulness of HIV tests are easy to turn up with a quick web search, so I won’t recapitulate them here. Suffice it to say, as is often the case in medical practice, what patients are told is a simplified version of a messy truth. The standard testing protocol in the United States is not positive or negative for the virus, but produces results along a continuum of reactivity with HIV antibodies.
In a comparison of seroprevalence studies, psychiatric patients’ likelihood of being HIV positive appears to rival that of STD clinic patients and gay men. A study found that, for patients presenting at a hospital emergency department, “penetrating trauma was the only clinical presentation predictive of HIV seroprevalence independent of age, race, and risk-factor status” — that is, being seriously physically injured made people more likely to test positive. And among drug users, testing positive was associated with the drug used — with crack cocaine carrying a higher risk than three IV drugs, which we can presume are often injected with shared needles. Some of the correlations could be attributable to other factors — for example, more serious wounds might follow from a more reck- less lifestyle, which also predisposes to AIDS risk behavior — but the studies, taken together, are supposed to suggest a connection between the amount of stress on the body and how likely one is to test positive, as Bauer’s hypothesis predicts. Then again, enough research has been done on HIV that one could probably find a certain amount of data demonstrating almost anything.
Bauer shares more of these curious findings, but science at its best is not about an accumulation of facts with which to oppose others’ facts; it’s about crafting and testing hypotheses that explain all the observations. Bauer’s more compelling evidence is marshaled in several chapters examining the con- sequences of the fact that seropositivity varies independently with sex, age, race, and population density.
These chapters are the crux of the book. I don’t think that they comprise anything like an open-and-shut case against the HIV theory, but they are manifestly the work of a scientist and a freethinker of the sort that medical schools and research institutions ruthlessly weed out. That alone inclines me to value Bauer’s analysis.
Some of Bauer’s references are to scattershot data from genealogy web- sites rather than, say, academic journals. He does not establish the reliability of these websites. He uses a quantitative method he apparently invented, with- out any outside critique of its value or reliability, to claim “satisfactory agreement” between sets of data. The reader can be forgiven for wondering whether Bauer massaged the data to get the results he wanted (as some researchers in every subject area do). Occasional weaknesses such as these, however, appear to be the exception.
Bauer’s chastisement of scientific carelessness is refreshing. Unquestioning propagation of public- health statistics, and bad interpretations thereof, both by journalists and by activists, lead to more and more tax- payer and philanthropic funds inefficiently chasing whichever disease has the most lobbyists fighting for it.
It doesn’t always take a Ph.D. in molecular biology to know bad science when one sees it. I still remember a shocking blurb I saw on the front page of The Wall Street Journal (Sept. 19, 2008). Without further explanation, it said that the World Health Organization had reduced its estimate of the number of people who get malaria each year from 500 million to 247 million. First-world people have learned to gloss over statistics about “bad things happening to people over there,” but think about the numbers! If you can’t be sure how many people are infected with some- thing, not even to within a quarter of a billion people, what do you know about the toll the infection is taking?
An AP story tells me where the changed estimate came from: “In previous reports, WHO estimated the number of people who developed malaria outside Africa by using a map made in the 1960s that indicated the areas where malaria was likely to occur.” The report dryly notes that “many Asian countries have since begun gathering actual reports of malaria from doctors and health facilities.” That’s the state of the art in public-health surveillance in the same impoverished parts of the world where we’re supposed to be worrying about an AIDS epidemic.
And they’re not being any more careful about HIV and AIDS than they are about malaria. Kary Mullis, the alien abductee who won the Nobel Prize, has written an autobiography, “Dancing Naked in the Mind Field” (1998), which is a contrarian manifesto that’s great fun to read. Only part of it is about HIV, but it says:
An HIV positive man with tuberculosis has AIDS; if he tests negative he simply has tuberculosis. If he lives in Kenya or Colombia, where the test for HIV antibodies is too expensive, he is simply presumed to have the antibodies and therefore AIDS, and therefore he can be treated in the World Health Organization’s clinic. It’s the only medical help available in some places. And it’s free, because the countries that support the WHO are worried about AIDS. From the point of view of spreading medical facilities into areas where poor people live, AIDS has been a boon. We don’t poison them with AZT like we do our own people because it’s too expensive. We supply dressings for the machete cut on their left knee and call it AIDS. (179)
The politics of HIV is more complicated than the science of HIV, which might be surprising to many people — but it should not be to those skeptical of statism, as it isn’t to skeptics of HIV.
Lest I be accused of whitewash- ing the bizarre, offensive, or unscientific methods of some HIV skeptics, let me say that most of them are, to say the least of it, unconventional. Bauer believes in the Loch Ness monster. Mullis had his alien abduction experience. A few prominent skeptics have lied about their credentials. They are, as a group, not impressively professional. But sometimes a group that has a lot of crackpots in it is still worth paying attention to. Walk around a national LP convention and this quickly becomes apparent.
There is seriousness and subtlety in the scholarship of the skeptics. Those like Duesberg, who make the starkest claims, get the most attention, but others ask questions and frankly admit they don’t have all the answers. Bauer is one of these. Culshaw, though less circumspect than Bauer, is another: a good summary of her book is her definition of AIDS as “not a disease so much as a sociopolitical construct that few people understand and even fewer question” (7). No one who knows much about AIDS can disagree with that. Or consider Michelle Cochrane’s position in “When AIDS Began” (2004) that “orthodox science and official public health surveillance practices often elide or wholly neglect analysis of the social factors that gave rise to and abet [the AIDS epidemic], the socioeconomic correlates of the disease, and the epidemiological evidence of patients’ multiple and synergistic risk factors for immune deficiency” (xxvi). Hardly as dismissive as “HIV doesn’t cause AIDS.”
I don’t need to mention that plenty of researchers in the HIV establishment have questionable methods and morals as well. These defects are endemic to the most successful strata of academic and scientific society. A whole book has been written on the unstable personality and unscrupulous methods of the American “co-discoverer” of HIV (see “Science Fictions” by John Crewdson [Little, Brown, 2002]). Nor do I accept one of the most frequent and intense objections to the skeptics, which is that, by questioning the mainstream view, they promote unsafe behavior and the spread of AIDS. Prudent use of prophylactics, and discretion in choosing the number and nature of one’s sexual partners, was as good an idea before the era of AIDS as it is now.
But AIDS, it seems, is a black box that doctors lecture you about. Only bad patients would dare to ask why they should believe what the doctor is telling them, and only irresponsible scientists would ask questions about HIV. If anything, the skeptics advocate safer behavior than the mainstream. Many of them suggest that avoiding recreational drugs is of utmost importance in preventing or recovering from AIDS.
Prominent skeptics have lied about their credentials. They are, as a group, not impressively professional.
Meanwhile, mainstream doctors caution only that you use a condom when having sex under the influence of nitrite inhalants, and that heroin should be injected with clean, unshared, needles.
I’m not a cell biologist or a medical doctor or an epidemiologist. I can’t be sure, from books written for a popular audience and my best interpretation of highly technical papers, how right the skeptics are. When some of the skeptics say that HIV hasn’t been properly iso- lated, for example, I can’t tell if they’re making sense or not. I get the sense that they’re making mountains of molehills. (In fact, Duesberg argues against other skeptics that it has been properly iso- lated.) When they claim that the standards for declaring an HIV test positive or negative are arbitrary, they’re obviously right, to an extent — but I can’t tell how important their concerns may be. When your mechanic tells you to get your car’s oil changed every 6,000 miles, he’s using an arbitrary figure — 5,500 or 6,700 would probably do just as well — but that’s no indictment of your mechanic. Science can be messy and counterintuitive; that doesn’t mean it’s wrong.
When Leung dramatically steps across the Canadian border and says that, by doing so, a person diagnosed as HIV-positive in the United States may become negative because the Canadian criteria for a positive diagnosis are different, it sounds damning — as it does when Celia Farber says in the March 2006 issue of Harper’s that one “could revert to being HIV negative simply by buying a plane ticket from Uganda to Australia.” Bauer lists the proteins that constitute a positive result for Western Blot tests performed by different entities and says that even the CDC, FDA, and Red Cross don’t agree with one another about what to con- sider as a positive result.
When dissidents criticize tests for HIV, they usually focus on the faults in antibody tests. Fair enough, because positive results on two types of anti- body tests are sufficient for a positive diagnosis. They less often mention viral load tests, which are more expensive than antibody tests but are said to be more reliable. They can detect HIV sooner after infection, and they detect the virus itself rather than antibodies. They obviously work pretty well if HIV is an infectious agent that causes AIDS. They’re used to screen the blood sup- ply, and after almost 30 years of blood transfusions in a world with HIV, the risk of infection by transfusion is very small. But then, Mullis’ Nobel-winning discovery is used in these tests, and he says that they use it incorrectly and the tests aren’t actually measuring viral load. . . .
In short, the specifics of any discipline are likely to be incomprehensible to outsiders. Even after tracking down journal articles, one gets the feeling that the best information about AIDS filters out slowly from the HIV researchers and doctors on the front lines, and so is inaccessible to most of us — including the HIV skeptics, who tend to cite papers that are many years out of date.
A more accessible example from Duesberg’s book, still widely regarded as the bible of the skeptic movement, shows how non-experts might be mis- led. In “Inventing the AIDS Virus,” he reproduces the laboratory label for AZT, the first drug that was considered a useful treatment for HIV infection. He claims that the label “reveals secrets not communicated to the unwitting patient” (324), because it has a skull and cross- bones on it and it stipulates that the sub- stance is “toxic by inhalation, in contact with skin and if swallowed. . . . Wear suitable protective clothing.” Here he is disingenuous at best: laboratory labels for plenty of everyday chemicals — e.g., pure caffeine — bear comparable labels. Most medicines hurt you if you take enough of them. (Nathan Crow shot many holes in Duesberg’s book in a review in the Sept. 1996 Liberty.)
Theories about how the establishment has screwed up something this big, for this long, rarely turn out to be true. There are astrophysicists and for- mer high government officials, with bona fides to match those of Mullis and Montagnier and Duesberg, who swear that we’re keeping aliens who crashed at Roswell at an Air Force base. They are sincere, they are good people, and they can make what seems, at first, a good case for their beliefs. But I don’t think we have aliens on ice at Wright- Patterson, and I don’t believe HIV is as harmless as a common cold virus.
On the other hand, I know the HIV dissident movement is not as simple as “the AIDS doctors who believe in HIV” versus “the people who say that HIV is harmless.” There ought to be meaningful discussion about the truth between those two extremes; lives might be improved or saved as a result.
George Bernard Shaw wrote in the preface to “Saint Joan” that, if called upon to adduce reasons to believe such an uncontroversial contention as that the earth is round, most of us could not do so, “because modern science has convinced us that nothing that is obvious is true, and that everything that is magical, improbable, extraordinary, gigantic, microscopic, heartless, or outrageous is scientific.” To say that “everybody knows” something is often to say that everybody believes it, but few know why.
The two areas around which “denialist” movements have most visibly grown up — HIV and climate change — are just this sort of issue. People are nervous at being unable to differentiate themselves, with logical explanations, from people they regard as kooks. But even if they’re wrong, Leung and Bauer and Culshaw and other skeptics can help us understand the truth, whatever it is. It’s safe to say they’re not completely wrong. We ought to read their books, listen to what they have to say, and not prematurely assume that “the science is settled.”