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Robert Root-Bernstein, 'Rethinking AIDS; The tragic cost of premature consensus' The Free Press/Macmillan USA 1993, 527 pages, ISBN 0-02-926905-9.

Since 1983 it has been considered an established fact that the presence of HIV is the sole and sufficient cause of the disease known as AIDS. A closely related assumption has also been that AIDS is something new and unprecedented in medical history. These assumptions underlie our whole approach to tracking and containing the spread of AIDS, treating the disease itself, and determining new avenues for medical research. But now, in a pathbreaking book, Robert Root-Bernstein shatters these assumptions and reopens fundamental questions concerning what we really know about AIDS.

Root-Bernstein reviews the entire existing corpus of AIDS research, strongly challenging the HIV hypothesis. For example, he shows that many people infected with HIV remain healthy. Sexual transmission is difficult. Female prostitutes rarely contract HIV unless they also use drugs. AIDS has not become the heterosexual plague predicted just a few years ago. Sometimes HIV-positive people even rid themselves of the virus. Root-Bernstein also mines the annals of medical history over the past hundreds years to present cases of probable AIDS that long predate the current epidemic, and cases of apparent AIDS without HIV infection.

Explaining in detail the working of the human autoimmune system and effectively deconstructing the conventional wisdom about AIDS, Root-Bernstein then presents alternative "multifactorial" models of AIDS, which view the disease as resulting from numerous synergistic insults to the immune system, including HIV, and autoimmune models, in which these insults initiate a civil war within the immune system itself. In this view, a person must already have some impaired immunity - whether from illicit and prescription drug use, promiscuity, anal exposure to semen, transfusion, malnutrition, or other microbial infections - in order to contract HIV in the first place. Root-Bernstein thus refocuses attention on specific controllable factors that may determine, rather than increase, our risk of AIDS. He also offers hope to those with HIV that they may yet survive infection by eliminating exposure to these controllable factors.

Coming at a time when many in AIDS research and the public are becoming increasingly dissatisfied with the official AIDS establishment, Root-Bernstein's book should stimulate intensive reappraisal of our approach to AIDS both within the medical research community and in the society at large.

Robert Root-Bernstein, who held a MacArthur Prize fellowship from 1981 to 1986, is associate professor of physiology at Michigan State University.