BOOK REVIEW (NEW YORK TIMES)
For almost a decade, Peter Duesberg has been publicly arguing that AIDS
is not caused by H.I.V. infection. Given his prominence as a professor
of molecular and cell biology at the University of California, Berkeley,
and his membership in the National Academy of Sciences, his arguments commanded
attention. Since he first made this claim, in 1987, many major biomedical
research journals have arranged for formal, published debates between Mr.
Duesberg and other distinguished scientists. They have disagreed almost
uniformly with his increasingly strident contentions, but he has remained
undaunted, writing voluminously about his belief.
"Inventing the AIDS Virus" is the next assault in Mr. Duesberg's
war on what he perceives to be a monolithic scientific establishment. Any
reviewer who is also a scientist, as I am, is placed in an awkward position,
for his iconoclasm is extreme. One wants to begin with a rebuttal that
evokes the overwhelming numbers of biomedical scientists, physicians, public
health and health care professionals who have considered the evidence in
depth and have arrived at conclusions very different from his. But the
book's central theme is that we are all wrong-that the entire scientific
army is out of step except for Mr. Duesberg. And he perceives self-interested
collusion behind that nearly universal agreement. After eight years of
such exchanges, he continues to object vehemently to the nearly unanimous
conclusion in the microbiological community that H.I.V. is a newly pandemic
virus that over a period of years causes inexorable depletion of immunologically
important cells in almost all the people it infects, thus leading to AIDS.
The importance of the argument is clear: if H.I.V. is the cause of AIDS,
it follows that prevention of the further spread of H.I.V. is critical
to stem the swelling tide of the disease. Scientists at the National Institutes
of Health, the World Health Organization and elsewhere who have studied
the new phenomenon of lethal immunosuppressive illness are convinced not
only that the advent of H.I.V. explains the worldwide spread of AIDS but
that it represents a striking premonitory example of an emerging infection
and deserves intensive, coordinated reaction around the globe.
They are all wrong, Mr. Duesberg says: myopic or worse. He hints at
vested interests and implies that diligent, intelligent scientists at every
level have bought into an empty H.I.V. hypothesis for self-aggrandizement
or material gain.
At the core of Mr. Duesberg's thesis is his belief that, by definition,
there can be no such thing as an illness induced by a virus that has its
overt onset years after initial infection. Further, he asserts that no
virus can cause more than a single disease, or any disease that appears
after a neutralizing immune response develops.
This remarkable belief flies in the face of decades of progress in understanding
infectious diseases. Early in this century, when the germ theory of disease
was quite new, research focused on examples of acute, clear-cut interactions
between parasitic microbes and their infected hosts. But with each passing
decade, the potential complexity of so-called host-parasite relationships
has become better appreciated. In recent years, many chronic viral infections
(such as recurrent herpes simplex or the reactivation of the latent chicken
pox virus to cause shingles) have been studied in depth, and investigation
of the role played by viruses is considered by most researchers to offer
a particularly rich source of insight into the cause of other chronic diseases
and even of cancer.
Those of us struggling with the problems presented by AIDS are somewhat
inured to the author's acrid complaints and accusations, for he has indeed
had his day in court many times over. He has made his views familiar through
initial colloquies in the journals Science, Proceedings of the National
Academy of Sciences, and Nature, and he has maintained a reiterative public
correspondence contending that H.I.V. does not cause AIDS. In itself his
dissent is not unreasonable, for in most arenas, but particularly in science,
conflicting interpretations should always be attended to carefully.
In this book Mr. Duesberg now goes considerably farther, saying in essence
that there is no pandemic at all-that nothing unusual is happening, that
there is no such thing as AIDS. He ascribes the loss of life-more than
300,000 deaths in this country alone in the 15 years since the epidemic
surfaced- to drugs or to underlying generic ill health or both.
Gay men in whom AIDS was diagnosed in the early years, he asserts, were
not being truthful if they denied drug use. More recently, he believes,
the decimation of their ranks is exacerbated by treatment with AZT (zidovudine).
Mr. Duesberg feels that AZT is so toxic it should be banned by the Food
and Drug Administration.
It is generally held that the large number of hemophiliacs now suffering
from AIDS were made ill by their use of Factor VIII concentrate (needed
to stem their bleeding), which is prepared by pooling plasma from literally
thousands of donors. Before the development of heat-treated plasma in 1983,
and before blood donor screening became possible in 1985, many hemophiliacs
were given clotting factor contaminated with the virus and became infected
with H.I.V. But Mr. Duesberg argues that H.I.V. is not the cause of their
illness: they were sick anyway, and are simply dying of their underlying
disease and, again, of the toxic effects of AZT.
Nor is transfusion with H.I.V.-infected blood a cause of AIDS, Mr. Duesberg
says: studies show surgery patients die with equal frequency within the
first year after surgery whether they have been infected with H.I.V. or
not. This is correct but irrelevant: what he is failing to note is that
there is an interval of no less than two years between initial H.I.V. infection
and overt AIDS. According to Mr. Duesberg's fundamental assumption, such
a long interval between infection and disease is impossible.
What about infants born to H.I.V.infected mothers? The mothers, according
to Mr. Duesberg's reasoning, must have been drug users (it's the only possible
explanation of their infection, according to Mr. Duesberg's theories),
and all of the infants would have been damaged anyway, he asserts, since
they spent nine months in the wombs of drug users. That circular argument
is downright dizzying-especially since it is based on flawed premises at
every turn, not the least of which is the assumption that children born
to drug-using mothers are always born damaged.
As for H.I.V. and AIDS in other countries, Mr. Duesberg dismisses the
issue: existing indigenous diseases explain everything. According to the
Global AIDS Policy Coalition's most recent estimate, there have been 7,600,000
AIDS deaths in sub-Saharan Africa, with 1,300,000 in 1995 alone.
Mr. Duesberg seems oblivious of the fact that immune suppression caused
by H.I.V. takes a distinctive form. Nor does he acknowledge the existence
of enormous bodies of evidence based on epidemiologic or clinical science
that firmly implicate H.I.V. in AIDS. On occasion, when he feels the need
to deal with the reality of large numbers of people dying with profound
immune suppression, he invokes a diffuse (and unproved) immune incompetence
that he ascribes to drug use, life in underdeveloped countries or underlying
illness. Taken together, those dismissive statements almost seem to suggest
an assumption of "poor protoplasm."
At every turn Mr. Duesberg faults both modern microbiological science
and the way its insights have been translated into feasible public health
programs. His position is not simply that of a benign naysayer: much of
what he advocates would have truly malign effects on the health of the
Mr. Duesberg blithely disregards the mountains of data contributing
to the present understanding of microbial pathogenesis in general. He is
at least consistent in his iconoclasm, for he disbelieves many things.
He insists, for instance, that the late-stage neurologic disease that threatens
syphilis patients has nothing to do with the syphilis bacterium: it occurs
years later and thus must reflect instead the results of toxic treatments.
But syphilis patients don't get neurologic disease unless the syphilis
has gone untreated. In any case, the treatment for syphilis is penicillin,
which is not toxic.
He dismisses hepatitis C as a pathogen or even as a virus because it
cannot as yet be grown in cell culture (a technical problem that has been
true of virtually all viruses early in their recognition). But he goes
much farther, criticizing the F.D.A. for approving the screening of donated
blood for hepatitis C. Most analysts believe that policy has resulted in
dramatic reduction of the occurrence of post-transfusion hepatitis since
it was instituted in the early 1990's. Mr. Duesberg views it as collusion
between government and industry to dupe the public.
He scathingly rejects studies of so-called "slow viruses"
like those implicated in some cases of Creutzfeldt-Jakob disease. As for
any role for viruses in causing cancer in humans, he rejects the mounting
evidence as spurious.
Mr. Duesberg makes virtually no effort to substantiate his most contrarian
assertions, many of which are contradicted by reams of published data,
while he berates his adversaries for failure to identify the "one
paper that proves" that H.I.V. causes AIDS. A disproportionate number
of footnotes refer to Mr. Duesberg's own work.
For the thousands who are suffering from AIDS or trying to cope with
the escalating demands of treating this deadly illness, Mr. Duesberg's
suggestion that nothing new is happening is as outrageous as it is insulting.
Mr. Duesberg's last chapter sets forward what he thinks should be done
in its full simplicity: don't do drugs and don't have hemophilia or other
Mr. Duesberg's credentials make his assertions both distracting and
disabling of preventive response. Denial has always been the most devastating
social and political dynamic of the AIDS epidemic-and his book feeds it
abundantly. In sum, this book is destructive of personal morale, prevention
efforts and public understanding both of H.I.V./AIDS and of biomedical
science in general. It has the potential to wreak serious harm at a crucial
point in the AIDS epidemic, which has been judged by many to be one of
the greatest public health challenges of our time.