Book review.


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


Acquired Immune Deficiency Syndrome (AIDS) is more than just a disease. It is alternately a symbol of uncaring government repression, a badge of holiness or of disgrace, a symbol of the tragedy of liberation, a sign that there is no God, a sign that there is an angry God. It has helped change people's attitudes about prophylactics, sexuality and homosexuality and forced many to question the mindset that almost epitomizes western culture: the faith that we are able to control the natural world through our will and technologies and bend it to our needs and desires.

More than anything else AIDS functions as a mental and social fault line. Some say that we don't care enough about AIDS because its victims tend to be from socially marginalized strata; others say that we concentrate too many resources on it because its victims and their advocates are better connected to the mass media and politics than those associated with more widespread ailments such as cancer and heart disease. Though its status as a fatal illness should command enough respect, in public discourse it is somehow always more than just what it is; it has something to say about our culture, our safety, our efficacy, our compassion, our politics, our humanity.

"Silence=Death" goes the slogan, so it has become impossible to avoid hearing about AIDS, even if the prophecy we've heard repeated from newspaper op-ed pages and the Oprah Winfrey Show and public service announcements for the past eight or so years hasn't yet come true and you still don't personally know anyone suffering from it. Everyone seems to think they know something about AIDS, perhaps everything they need to know. Everyone has an opinion, even if that opinion is based on no more knowledge than can be gleaned from a public health pamphlet advocating condom use. The voices shouting in the echo chamber of AIDS debate occasionally drown out rational discourse. But disguised by the hand wringing and hysteria may be a story of single-minded government power pushing a bankrupt idea.

Rethinking AIDS by Robert Root-Bernstein, an Associate Professor of Physiology at Michigan State University, is a heady and disturbing dose of rational discourse that shakes to its core the establishment AIDS industry of scientists, government, activists and the mass media. Root-Bernstein tries to demonstrate that our current scientific and public health approach to AIDS is fatally flawed; that the Human Immunodeficiency Virus (HIV), commonly understood to be the cause of the range of diseases that we call AIDS, may in fact be no more than a co-factor, if that.

Root-Bernstein is not alone in making such a claim. First and most famous of the AIDS heretics is Berkeley molecular biologist Peter Duesberg, who first challenged the notion that HIV causes AIDS in the peer-reviewed scientific journal Cancer Research in March 1987. As a result Duesberg ended up being informed by the National Institute of Health in October 1990 that his "Outstanding Investigator Grant" would not be renewed after it runs out in 1993. (The committee that made this decision had as members the mother of one of the children of Robert Gallo, alleged discoverer of HIV and someone who holds a patent on an HIV antibody test.) Duesberg has become Gallo's bete noire; Gallo recently walked off the set while being interviewed by ABC TV's Day One "news-magazine" when they brought up Duesberg and he vowed he'd do everything in his power to prevent them from giving Duesberg's ideas any publicity. But joining the anti-establishment cause was Charles A. Thomas--a former Harvard biochemistry professor--and a society he founded in 1991, the Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis, which counts among its over 40 members retrovirologists, epidemiologists and immunologists, all of whom question the HIV dogma.

Because of the overriding sociological noise surrounding AIDS, it helps to be fortified with some facts that go beyond the propaganda of the mass media/government/activist axis. It's important to start with the basics: What causes AIDS anyway? What is AIDS?

AIDS was first conceptualized in 1980-81 after doctors in Los Angeles, San Francisco and New York began noticing many cases of Kaposi's sarcoma, pneumocystis pneumonia, consistent low-grade fevers and a cornucopia of unusual infections, protozoans, viruses and fungi in men aged 20-40 who were suffering from immune suppression for no noticeable reason. Because their common denominator was that they were sexually promiscuous young gay men, many with histories of drug abuse, the syndrome was first called GRID (gay-related immune deficiency). The search for a cause and a cure was on.

It seemed to bear quick fruit. On April 23, 1984, Margaret Heckler, Secretary of Health and Human Services for Ronald Reagan, proudly announced that a U.S. doctor, Robert Gallo, had discovered the cause of AIDS: a retrovirus, allegedly isolated as the Human Immunodeficiency Virus (HIV). She also promised a vaccine by 1986.

Gallo's claim of discovery was only the beginning of the web of controversy, confusion and possible fraud that would surround the conceptual romance of HIV and AIDS. It turned out that the virus had already been discovered a year earlier by a French scientist, Luc Montagnier of the Pasteur Institute. Montagnier had sent Gallo the virus to examine. A dispute ensued over the right to claim discovery and concomitant rights to patents on AIDS testing kits that depend on looking for antibodies to this retrovirus. This fight initially led to a compact between the French and American governments that would split royalties and name Gallo and Montagnier "co-discoverers" of HIV.

Bur recent revelations from the work of Chicago Tribune reporter John Crewsden and an internal NIH investigation seem to indicate that Gallo willfully attempted to steal credit for the HIV discovery and that one of his early papers that purported to show how HIV causes AIDS, contained "misrepresentations or falsifications." Gallo himself has admitted that the virus used in developing his AIDS test was one of the ones sent to him by the Pasteur Institute. The French are now suing for all past and future royalties--which would amount to tens of millions of dollars--from Gallo personally and from the U.S. government and for recognition of Montagnier as sole discoverer of HIV.

Meanwhile, billions of dollars have been funneled by the U.S. government pursuing Gallo's "HIV causes AIDS, alone and unaided" thesis. But after nearly a decade, it has paid off with nothing. We still have no vaccine. And we still don't know how a retrovirus is causing the array of diverse ailments and infections that we have labeled AIDS. The problem is that not one example of a retrovirus has ever been known to cause disease in humans, since retroviruses parasitically require a living cell in order to reproduce.

It is important to remember that AIDS is not a disease per se but a syndrome--a catchall name for a situation in which massive immunosuppression leads to the body's falling prey to a wide range of ailments, including pneumonia, dementia, wasting disease, candidiasis, lymphoma, tuberculosis and various sexually transmitted diseases such as herpes and Epstein-Barr Virus. These diseases were around before HIV was isolated; they will be around even if HIV were somehow eradicated. The"A" in AIDS stands for "acquired"; we diagnose massive immunosuppression as AIDS, supposedly, in the presence of HIV antibodies and when there is no other apparent reason for the problems of the immune system. But in around half of currently diagnosed AIDS patients, HIV has not even been checked for, as Root-Bernstein's book exhaustively demonstrates. I will return to this point later.

So how is HIV supposed to be doing its dirty work? According to the standard theory, upon entering the body it infiltrates and kills T-helper cells, a vital part of the immune system, by the billions. The precise mechanism by which it does this is not yet known, as even HIV partisans admit; they like to say that HIV is a "mysterious" virus. Without these mysteries the multi-billion dollar government-financed industry surrounding HIV would have little to do. On the subject of HIV's "mysteries," Kary Mullis, the inventor of the polymerase chain reaction that has enabled investigators to find viruses such as HIV, becomes caustic. "The mystery of that damn virus has been generated by the $2 billion a year they spend on it. You take any other virus and you spend $2 billion and you can make up some great mysteries about it, too."

Over the past few years, Duesberg, the members of the Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis and now Root-Bernstein, have been attempting to bring to public attention many anomalies that cast doubt on the notion that HIV, mysterious or not, could possibly be responsible for all the harms the standard paradigm claims.

Opposition to the HIV thesis is not monolithic. There are strong differences in emphasis between Duesberg, who until this book was the best-known of the AIDS heretics and Root-Bernstein. Duesberg asserts that HIV is completely harmless and even offers to be publicly injected with it under controlled testing circumstances; Root-Bernstein holds open the possibility that HIV has some role to play in immunosuppression. Duesberg places the entirety of AIDS causation on drug abuse; Root-Bernstein entertains a more nuanced, multifactorial hypothesis.

But the question of what does cause AIDS is secondary to establishing doubt that HIV is the sole explanation. It is not necessarily incumbent on one questioning HIV's role to counter with a fully worked-out alternative explanation.

And there are many reasons to doubt HIV's role as the sole necessary and sufficient cause of AIDS. Though it is supposedly killing T-helper cells by the billions, HIV is rarely detectable in large quantities in the bodies of those allegedly dying of its effects. What we call "the AIDS test" does not test for the presence of HIV itself--it tests for the presence of antibodies against HIV, which generally is a sign that the body has been exposed to and beaten off, the infection. This is the same principle behind vaccination, in which you are injected with an attenuated form of a virus in order to engender an antibody response that will keep you safe from that virus thereafter. The virus itself is very difficult to find, generally detectable in no more that 1 out of 10,000 T-cells, hardly a large enough presence to be doing the damage it is alleged to do.

Since the mechanism by which HIV is supposedly killing T-cells is still uncertain, the HIV hypothesis is based largely on correlation assumptions that are both factually and rationally weak. HIV is often (though by no means always) found where AIDS is found; and Gallo claims that the syndrome only appears after HIV appears; that there is no AIDS where there is no HIV.

This view is associated with the thesis that HIV is a dread new microbe, the same notion that has led some to aver that it must be the result of some biological warfare experiment gone awry (or fiendishly created to wipe out "undesirables"). Root-Bernstein lays to rest the notion that either AIDS or HIV is new to the world as of the late seventies and early eighties. Through painstaking reading of the extant literature, he has discovered many case histories dating back over the last century of people dying of a mysterious overload of opportunistic diseases such as Kaposi's sarcoma, pneumocystis pneumonia, candida infections and cytomegalovirus, all of which are now associated with AIDS. And HIV has been found in frozen blood samples dating back at least to 1959. Thus, the notion that HIV and AIDS burst on the scene together in the late '70s is without foundation.

Once this is realized, the tenuousness of the official HIV hypothesis becomes more and more apparent. The alleged "latency period" of the virus, another unusual attribute of HIV is repeatedly extended as people known to have HIV continue to live longer and longer. In 1986, it was assumed to be less than two years, by the beginning of 1992 it was between 10 and 15 years. No advances in knowledge of how HIV is doing its allegedly murderous work triggered these revisions, merely the observation that people continue to live healthily with HIV. Could this possibly indicate that HIV is not necessarily fatal, that a diagnosis of "HIV positive" need not be a death sentence, need not scare you into consuming AZT (the current FDA approved AIDS drug that is a known cell killer and immune suppressor)? Or will the "latency period" continue to stretch on infinitely in protection of the "HIV is the sole necessary and sufficient cause of AIDS" thesis that so many careers and reputations (including that of the U.S. government) depend on?

AIDS epidemiology also casts doubt on its status as a sexually transmitted single-cause microbe. In addition to anecdotal cases such as Marc Christian, Rock Hudson's lover who survived an estimated 600 unprotected sexual encounters with the dying Hudson without contracting either HIV or any illness, there is the simple fact that, despite a decade of activist and right-wing scare tactics, AIDS has never turned into the predicted plague breaking out of the initial risk groups of homosexuals, hemophiliacs and drug abusers. The official Centers for Disease Control estimate that the prevalence of HIV in the U.S. population has remained steady since 1985; around one million. (And only about 3 percent a year of these on average go on to develop symptoms of AIDS.) The much-hyped epidemic didn't happen. For a supposedly infectious virus, HIV shows an almost human preference for certain types of people and for males over females. For example, over 90 percent of AIDS cases in the U.S. are male, though in Africa the sexual distribution is almost even. What is in the nature of this microbe to make it sexually selective depending on what continent it is on? According To Root-Bernstein it is not the microbe but the nature of the differing immunosuppressive hazards in the two continents' populations that makes the difference.

The lack of massive heterosexual spread through prostitutes is crucial in showing that AIDS is not a standard sexually transmittable disease. Root-Bernstein cites many studies showing that no significant increase in HIV seropositivity (showing antibodies for HIV) among non-drug abusing prostitutes can be found in any major Western city. A study in the American Journal of Public Health concluded that "HIV infection in non-drug using prostitutes tends to be low or absent, implying that sexual activity alone does not place them at high risk, while prostitutes who use intravenous drugs are far more likely to be infected with HIV." Prostitutes in this study do evince the normal range of known sexually transmitted diseases.

And for a sexually-transmitted disease, HIV is rarely detectable in semen. "In all studies...less than a third of the infected men had any HIV present in the semen and then generally less than one virus genome per milliliter of semen, or perhaps one or two dozen virus-infected cells per ejaculate, on average. Approximately the same number of viruses are excreted in the saliva of HIV infected individuals and in vaginal secretions. This amount of HIV is considered to be incapable of transmitting disease," Root-Bernstein says (p.34).

Another blow to the notion of HIV's power to kill is [the fact that] though there are over "6,000 verified cases of health care workers reporting subcutaneous exposure to HIV-infected blood or tissue as a result of needle-stick injuries, surgical cuts, broken glass and so forth...only a few dozen health care workers are known to have become seropositive during the entire decade of the 1980s in the United States" (p.44). Compare this to hepatitis, a typical infectious disease, which causes about 15,000 accidental infections among health care professionals a year. Clearly, the notion of the single infectious killer retrovirus bringing down the healthy is impossible.

What does Root-Bernstein hypothesize is suddenly causing widespread immune collapse among so many people? No new killer microbe is necessary, he asserts and he makes his case painstakingly; this book's thoroughness does not necessarily make for fun or easy reading. Through case study after case study, medical citation after medical citation, he shows that the major risk groups for AIDS all have multiple immunosuppressive behaviors or risks that do not require the hypothesis of a single new cause. Multiple blood exposure to semen; the internal damage caused by anal sex and sex practices such as "fisting" which expanded greatly throughout the gay community in the 1970s and '80s; multiple blood transfusions; anesthetics and surgery; the overuse of antibiotics, opiates and nitrate drugs; severe malnutrition and exposure to infections such as cytomegalovirus and various sexually transmitted diseases, which are just as present in AIDS patients as HIV; all of these are known to be immunosuppressive or to expose the body to the risk of the multiple concurrent infections that characterize AIDS.

Root-Bernstein documents these assertions at copious and almost tiresome length, but it is important to show the reader that there are many possible common factors among those dying of immune suppression that are unfortunately being ignored in the rush to judgment on HIV. The studies that could help prove or disprove Root-Bernstein's theories are not being done, particularly his rather complicated, but compelling, explanation of how certain combinations of opportunistic infections that are as common in AIDS patients as HIV may lead to an autoimmune reaction in which the body's immune system turns on itself.

While this book can be understood by a lay reader, it does not condescend. It requires of readers a demanding level of thought about the workings of the immune system and the ability to remember the results of copious numbers of medical case studies.

Root-Bernstein makes a compelling case against continuing to channel funding for research on this disease on the assumption that HIV is the sole necessary and sufficient cause of AIDS. So how did we get to this state? Why are so many spending so much money on a wrong path?

There is a historical parallel. Years of time and effort were wasted searching for a "single cause" for cancer, which is now understood to be a multifactorial ailment. Again with AIDS it was assumed that this seemingly new phenomenon must have a single, somewhat new cause--despite the fact that all that is new about it is its prevalence. Root-Bernstein blames this, in America, on a massive sociological explosion of risk behaviors involving sex and drug practices and new attention to the health risks of hemophiliacs and recipients of blood transfusions. He blames the phenomenon, in Africa, on ancient problems of malnutrition, poor sanitation and the modern spread of sexually transmitted diseases. But a retrovirologist like Robert Gallo (who had earlier claimed that a retrovirus he discovered was causing a form of leukemia) fought for the importance of his retrovirus turf and managed to get the weight of the federal government and its research grant monopoly behind him. At that point, the fate of alternative approaches was sealed.

Don't expect this book to cause public breakthroughs any time soon. Though it is well-reasoned, thorough, calm and professional, it is certain to be attacked with invective and a refusal to respond point by point, the fate that Duesberg has suffered for the last six years. Root-Bernstein claims that many of his colleagues privately agree with him but refuse to say so publicly in fear of losing their funding as well. The emotional energy of AIDS activists who see continued massive government funding as their only hope--and who consider anyone who isn't getting with the prevailing program to have blood on his hands--combined with the cultural weight of "official" explanations promulgated relentlessly in every part of our culture, produces a powerful backlash against heretics.

Even journalists who write about AIDS heretics are not immune from reprisals. One writer for the Miami Herald was fired for criticizing AZT after a letter-writing attack from Martin Delaney, director of Project Inform, an AIDS activist group. Project Inform--which is funded by Burroughs-Wellcome, the developers of AZT whose sales depend on the HIV hypothesis--makes a practice of attacking the reputations and jobs of journalists who publicize questions about the hypothesis. Delaney circulated a six-page diatribe containing personal attacks on the AIDS heretics, accusing Spin's Celia Farber of spreading misinformation and of being a threat to public health. He even argued that she should be prohibited from writing about the subject.

From the beginning the HIV thesis was marinated in fraud and possible professional and pecuniary gain. It appears to be based only on a correlational and epidemiological pattern that ignores other possible explanations. Its importance has expanded beyond the possible wasting of money; if Duesberg and Root-Bernstein are on the right track, then the cries of some radical gay activists are right: the government's promotion of "cures" like AZT and programs such as needle giveaways is claiming lives and ignoring real risks of immunosuppression. Government's dominance of science can only be expected to lead to results like this. Instead of letting a thousand flowers bloom, the government has poured tons of manure on one superficially lovely scientific flower festooned with possibly fatal thorns.

But the diagnosis is not totally bleak: more and more people are beginning to question the orthodoxy. If you look hard enough, you can find the heretical thought even in the press: an article by Duesberg in the Summer 1990 issue of Policy Review, an article or two by iconoclastic right-wing journalist Tom Bethell in National Review and the American Spectator and most of all the writings of the indefatigable Celia Farber of Spin. A floodgate is beginning to burst, especially after this summer's conference in which many doctors came forward to discuss cases that were obviously AIDS but in whom no trace of HIV could be found by even the most sophisticated methods. I have seen the anti-HIV thesis discussed more on TV and in magazines in the last six months than in the prior six years. Even HIV's actual discoverer, Luc Montagnier, now admits that cofactors must be involved. (He hypothesizes a form of bacteria called mycoplasma as a possible culprit.)

Anyone who cares about AIDS, is interested in a curious intellectual adventure, or wants more evidence of how centralization of power and responsibility undermines a flourishing intellectual climate and a healthy culture--healthy in many senses--should read this demanding, often shocking and important book. *

Reviewed by Brian Doherty
Source: Liberty August 1993