1. Why We Need Aids
Doctors who do not accept the official line on AIDS can find
themselves in a lot of trouble.
-- Harris L. Coulter
Institutional life today is dominated by the buzzwords of the
managerial revolution: devolution, entrepreneurship, quality
control, outcomes management, merit protection,
cost-effectiveness, accountability, equity, client
empowerment. Each is the index term for a set of instructions
that employees implement when managers give the signal. In
this way the activities of millions can be coordinated across
institutional boundaries; and executive officers congratulate
themselves that they are in control, not just muddling
through. Alas, there is evidence that the software bequeathed
by the managerial revolution is the shining path to acquired
helplessness. Most OECD nations are awash in institutional
failures. Accountants didn't notice the missing billions when
they audited the financial statements of the Bank of South
Australia, WA Inc, and Victoria's Tricontinental merchant
bank. We lavish funds on secondary education, but 85-90%
matriculate with serious deficiencies in written English
expression; the number of the numerate is few indeed.
According to employers, many leave the university not much
improved. Something is wrong. This book is about acquired
helplessness in one area of our national life, the AIDS
epidemic. The Commonwealth Department of Community Services
and Health has designated it "the nation's most significant
threat to public health". Presumably the First Assistant
Secretary who wrote these words meant "the most significant
threat to the nation's health". But the grammatical lapse
suggests one thesis that I argue: that the management systems
in place have immobilised governmental capacity to review AIDS
thinking and programs in the light of new evidence about the
epidemic. If that be so, then the grammatical slip hints at my
point-that we have managed to manage outcomes to the point
that they are a health hazard. On the face of it, the
designation of AIDS as the most significant threat to public
health is nonsense. Morbidity and mortality from AIDS is minor
by comparison with other diseases. What makes it seem
significant is the belief that AIDS is a viral epidemic,
together with projections of HIV's spread. In that way health
authorities conjure horrific mortality rates 10-20 years down
the track, not to mention unaffordable health care costs. This
catastrophic vision is the AIDS mirage. I call it a mirage
because health authorities embrace a contingent future as an
incontrovertible truth. The passion invested in the viral
epidemic dogma is transferred to the entire AIDS management
program, so that the whole is seized by cataleptic rigidity (a
panic symptom). Our AIDS management systems are incapable of
reviewing evidence which shows that there have been mistakes
about HIV causality, mistakes of diagnosis, mistakes about its
transmission, mistakes about HIV antibody tests, mistakes
about therapies. Indeed, the whole of AIDS science is in a
confused state. Of itself this is not startling. HIV/AIDS
doctrine is merely an hypothesis and the mortality rate of
scientific hypotheses is high. But it has converted to
full-blown faith. Scientists or administrators who voice doubt
risk their careers. This regimentation is partly a product of
the quality control mechanism of science, called "peer
review". This too is one of our failed practices, subverted by
the cronyism it was meant to prevent. This was admitted
recently by a chair of the Australian Research Council grant
panels, who said that peer review "is crooked, but it's the
only game in town". The conformism imposed by peer review
patronage is ordinary opportunism. But the people who lay down
the HIV/AIDS doctrine have integrated that doctrine into
professional and personal self-images.
These persons are the wounded healers of my story. Such is
their trauma that they cannot endure the thought of a world
without AIDS. That is why they resist, as "dangerous" and
"irresponsible", the best health news of this century-that
there is no viral epidemic. "Wounded healers" are carers
grief-stricken for patients who died because of a treatment
error. Since some may doubt the existence of such people, let
me introduce you to a healer conscious of his wounds. He is
Stephen Caiazza, a New York physician with a large practice
among gay men: "I'm a doctor, and I've buried all those
people, and their faces came to me at 3 o'clock in the morning
. . . I missed that [syphilis] diagnosis which I shouldn't
have missed . . . that's really horrible. You have to go
through your own catharsis before you can face that. We
doctors in New York are all [emotionally] exhausted." This is
a rare testimony, not because of its infrequency, but because
it got into print. In medical officialese, the vernacular
"wounded healers" is replaced by the vague term "impaired
physicians". If you look up the literature, you find that the
common syndrome is a breakdown of the capacity to deal with
human suffering. The common marker is alcohol and drug
addiction, which affects 10-12% of physicians and nurses at
sometime during their career. The medical profession doesn't
say much about impaired physicians; it frightens the chooks.
Stephen Caiazza is unusual in another way. He noticed that the
accepted description of AIDS' clinical signs didn't quite
match what he was seeing in his surgery. He hit on the idea
that AIDS was syphilis, called the "masquerade disease"
because its symptoms are so varied. He guessed that his
patients didn't test positive for syphilis because their body
chemistry had been distorted by a combination of syphilis,
antibiotics administered to control STDs, and recreational
drugs. This brought him face-to-face with the deepest cut of
all. Not only had his healing art failed, but his profession
had failed with him. Oedipus, when he knew the truth, put out
his eyes. Dr Caiazza suffered a breakdown that forced him to
withdraw from practice for several years.
The syphilis diagnosis of AIDS symptoms was hit upon
independently in several countries. It has been reported in
medical journals. But in his study, AIDS and Syphilis: The
Hidden Link, Harris L. Coulter describes how attempts by
Caiazza and others to bring this diagnosis to the notice of
physicians were cold-shouldered by the chiefs who set the
boundaries of "appropriate medical practice". There are no
research dollars to investigate the syphilis hypothesis or
other alternative hypotheses. Why not? The reasons are
explored in this book, but here is a preview.
- AIDS is syphilis in disguise, the treatment regime
requires a drastic rehabilitation of body chemistry, not
merely biochemical tinkering with the immune system. To purge
the body of a host of toxins, the patient must adopt a strict
regimen, which for gay men means relinquishing the lifestyle
that for many defines the gay identity. Doctors know this. Gay
men know it as well. The long-term survivors of HIV infection
have all abandoned the gay lifestyle. But one mustn't say
this. As a physician at San Francisco General explained: "if I
tried to go around and advise AIDS patients that they had to
[give up the lifestyle], I would be accused of quackery". The
palatable substitute for "cold turkey" is the softer landing
of "safe sex". The soft landing for AIDS patients is like the
lifestyle soft landing devised for patients with
cardiovascular disease, cancer and other conditions. The
recommended dietary regimen for cardiovascular disease seems
stern to patients when they encounter it. But it is pampering
compared with the regimen that the naturopath imposes.
Conventional medicine is more user-friendly. It was not
doctors but alcoholics who devised the total abstinence
solution for alcohol dependence. You have a problem with
drink? Then stop drinking. It's costless, self-reliant,
non-medical.
- The treatment for syphilis, a common STD, is low-tech,
unpatented, inexpensive antibiotics. The treatment for AIDS as
a viral disease requires high-tech, toxic, costly drugs that
are at best palliative and at worst lethal. In cash terms:
$300-400 total plus possible recovery vs. $2000-5000 per year
and death from the disease if not from the medical drug, AZT
(zidovudine). Fancy drugs, high cost, and death enhance
medical mystique. They also appeal to those powerful hidden
persuaders in modern medicine, the pharmaceutical giants.
- If AIDS is syphilis, then doctors have been in silent
partnership with patients to produce the epidemic. The
dramatic breakdown that came to light in 1981 was 10 years or
more in the making. It means that AIDS arose from a symbiosis
between patients and doctors, in which they agreed not to look
to the roots of the many illnesses that gay men presented in
clinics. It means, as Dr Caiazza believed to his dismay, that
doctors have made a horrible mistake.] By 1981, the medical
profession was already under heavy fire as being dangerous to
health. Physicians had by then adopted the clinical, legal,
and psychological strategies of "defensive medicine", meaning,
defence against wounded and litigious clients. To acknowledge
that AIDS arises by doctor-patient collusion to evade the
basic rules of good health could trigger a searching
examination of the role of medicine in modern society. That
agonising reappraisal could be evaded by attributing AIDS
symptoms to an unknown virus.
- The viral hypothesis is well adapted to postpone the moment
of recognition. It reaffirms the germ theory that lies at the
foundations of modern medicine. Thus it enjoys plausibility
with physicians as well as the public who have been inoculated
with the germ theory. It recruits the support of scientists
itching for a high-tech virus hunt. It activates the "Tally
Ho!" pose of medicine, featuring gallant doctors in pursuit of
low and cunning pests, whose carcasses will be triumphantly
exhibited to the cheering multitude and to the Nobel
committee. Culturally speaking, hunting viruses and making
vaccines is a diversion from reckoning with modern medical
practice as a cause of illness.
The syphilis hypothesis is not widely supported today among
those promoting alternative hypotheses. I have mentioned it
because Dr Caiazza's observations converge with current
thought in three significant ways:
- The case definition of AIDS is based on what critics
believe to be diagnostic error. The visible sign of this is
that the case definition of AIDS in the OECD nations is
completely different from the African case definition.
- Caiazza realised that the reliability of tests for the
presence of infectious agents presupposes a background of
normal blood chemistry. Evidence is now to hand that the HIV
test is not specific for that virus but indicates positive for
any one with a specific spectrum of antigens, such as
haemophiliacs and Africans.
- Caiazza was among the first physicians to experience the
indifference of the AIDS mandarins to any ideas but their own.
They remain steadfastly devoted to the viral hypothesis
despite the 100% failure rate of vaccines and therapy. They
dismiss unheard the alternative hypothesis currently proposed
by a team at the Royal Perth Hospital. Led by biophysicist
Eleni Papadopulos-Eleopulos, the team derive their explanation
from a new understanding of cell metabolism, which predicts
AIDS diseases as the consequence of cellular oxidative stress
induced by a variety of toxins, especially medical and
recreational drugs. Although it is completely different from
the syphilis hypothesis, these hypotheses have two things in
common: the pathology involves toxins artificially introduced
into the body; and the illness is treatable at low cost. The
Perth group have also drawn together the evidence of the
Western blot diagnostic test for HIV and argue that it is not
HIV-specific. If this is so, one of the three definitions of
AIDS, a positive antibody test, rests on the failure properly
to validate the test. In their view, it cannot be used to
determine whether haemophiliacs or Africans carry the virus.
They publish overseas because the clever country's medical
journals do not want to know about this.
Our healers are wounded. They cannot endure the thought of a
world without a viral epidemic. If the future resembles the
past, the response to these tidings is predictable. The truth
managers will go into damage control. The intruder will be
decried and the public browbeaten into submission so that
futility may continue undisturbed. The Tantrum Sanction is a
distinctive form of medical aggression, about which I will
have more to say. For now I point out that the Sanction
violates the undertakings of the Commonwealth health services
to health consumers. All Australians have a right to
participate in policy discussions. This right is intended to
empower clients vis-ˆ-vis health providers. Each of us,
whether medically qualified or not, may claim a hearing for
our views. In publishing this account of AIDS, I lay claim to
the status of a health care consumer who has undertaken to
communicate with his fellow Australians. Denunciation has no
place in such discussions. I call on the relevant ministers to
ensure that public authority is not abused to stifle
discussion. Finally, a note on style. We humanists believe
that narratives-myth, legend, drama, yarns, stories,
conversation-are one way that we endow life with meaning.
Narratives break through faceless abstraction to exhibit named
human beings acting and suffering. The basic event
contemplated by this little book is humanity's encounter with
the creature of its own making, scientific medicine. It is a
sub-plot in the larger drama of humanity's encounter with
science and technology. Many yarns about this encounter have
been told; many more are still to come. The essential plot of
the story I tell is not new. It was told by the medical
scientist Rene Dubos in his wise book, The Mirage of Health.
It was told again by Daniel Callahan in his courageous attempt
to grapple with health care for the aged, Setting Limits. The
story needs to be told many times, in many ways, because it is
a big picture that challenges our sense of self and our sense
of others. Lacking the philosopher's gift for evoking the big
picture. I find safety and meaning in yarns. So in this study
I tell many yarns to capture some facets of the basic plot.
Yarns are not science, but they do contribute something to
finding our way through the complex and baffling world of
modern medicine.
2. A Virus Invades The Mind
What God spared Egypt, Americans inflict on themselves.
-- Dr Harry Meyer, Former Director, National Biologics Laboratory
AIDS is the most political disease of our age. Since the first
cases appeared 14 years ago, the epidemic has become a
battleground for culture wars, for parliamentary wrangles, and
scientific dispute. AIDS has galvanised medical research into
a scramble for health dollars. It won celebrity as a human
rights cause, as a lawyer's bonanza and as a media sensation.
In its short career, AIDS has become the most talked-about,
anxiety-laden, fiercely contested, lavishly resourced, and
withal the most wept-over illness of modern times. If the
prestige of diseases is ranked by the resources allocated for
care, therapy development and research, then AIDS is the most
prestigious disease ever. The cause of this tumult is said to
be a microbe unknown to science until 1983. Even before its
discovery, the powers conferred on the minute entity rivalled
archetypal legends of pollution and plague. It was said to be
the cause of not one, but three, then 16, then 25 and now
today 29 diseases-an unprecedented feat for any microbe in the
history of human illness. Like the Greek fates, it gripped the
afflicted in its iron maw and dragged them to inexorable doom.
As one AIDS patient put it: "I felt that a microscopic junta
had seized my body; I was under its command". The virus, when
it was discovered, baffled science. The comprehensive report
of the Institute of Medicine/National Academy of Science,
Confronting AIDS (1986), may serve as a benchmark. The report
stressed that the progress of AIDS science was slowed by the
poorly understood, complex interactions of a wide variety of
cells that make up the immune system. The report acknowledged
that the mechanisms by which HIV depletes T4 cells "remain
mysterious". "Mystery" is the right word, for HIV is a freak
that defies the rules of disease causation. With all other
infectious agents, the quantities of the microbe greatly
increase as the disease progresses to greater virulence. Yet
this is not so for AIDS. Not only is there no or little
increase in quantities of HIV as the disease becomes more
virulent, but high levels of HIV antibodies are present in the
terminal stage. How was it possible for HIV to massacre T4
cells without greatly multiplying? In recent years, scientists
have increasingly abandoned faith in this etiological miracle.
The premier advocate of the HIV/AIDS dogma, Dr Robert Gallo,
admitted at a recent conference that his laboratory has never
recovered HIV from T4 cells. Yet he, more than any other
scientist, produced the conviction that HIV causes AIDS by
entering and destroying T4 cells. The latency period is also a
puzzle. The original picture of cell infection shows HIV
entering a T4 cell, converting to a provirus, and then going
to sleep. This is the kind of thing that thousands of silent
microbes do as "passengers" in the human body. But then it
wakes up and ravages the immune system. Why does it wake up?
This is the problem of "cofactors". At this moment it is a
watershed in AIDS science. Those who believe in cofactors
argue that HIV isn't quite the lethal agent it has been made
out to be. It is a harmless passenger except when Factor X
intervenes. The discoverer of HIV, Luc Montagnier, holds this
view. He proposes that the cofactor is the bacterium
derivative Mycoplasma fermentans, which is implicated in one
of the major AIDS defining diseases, Pneumocystis pneumonia
(PCP). Danish doctors who controlled Mycoplasma with
antibiotics achieved remission from PCP. Since 1992 Montagnier
has promoted antibiotic control of HIV by the indirect method
of controlling its supposed bacterial cofactor. Robert Gallo,
for his part, promotes his newly discovered herpes virus,
HHV-6, which infects T4 cells, as a cofactor influencing the
differential rates at which HIV+ persons progress to AIDS. HIV
is the only microbe that behaves differently according to the
geographic location of its host. In Africa it acts like other
infectious agents, attacking male and female alike. But in
North America and Europe it is sociotropic, seeking out adult
gay men and intravenous drug users. Moreover, the risk factors
vary by geography. In Africa they are not receptive anal
intercourse and drug use, but parasitic diseases and
malnutrition. Reports in the Western press of the horrendous
levels of HIV infection in Africa, and the coming
"depopulation" of the continent, are based on immunoassay
tests whose reliability has been challenged. Professor P.A.K.
Addy, Head of Clinical Microbiology at the University of
Science and Technology in Kumasi, Ghana, states that
"Europeans and Americans came to Africa with prejudiced minds,
so they are seeing what they wanted to see . . . I've known
for a long time that AIDS is not a crisis in Africa as the
world is being made to understand." As one wit put it, in
Africa the AIDS virus is the Human Rumor Virus. Management of
the epidemic depends on the assumption that the test for HIV
antibodies is a reliable indicator of the presence of the
virus. Under the Australian definition of AIDS, an HIV+ test
classifies patients as Category 3 AIDS. However, scientists at
the Royal Perth Hospital argue that the most specific HIV
test, the Western blot (WB), is unreliable. The problem, they
say, is that cross-reactivity of sera proteins defeats the
specificity of the tests. The tests detect HIV in
haemophiliacs, leprosy patients and other cohorts who do not
progress to AIDS. This view is shared by Philip Mortimer,
Director of the Virus Reference Laboratory in London, who
states that owing to the want of WB specificity for HIV, "it
may be impossible to relate an antibody response specifically
to HIV-1 infection". This creates an ethical challenge for
AIDS case management. Are persons who test HIV+ being told by
counsellors that the specificity of the test is in question?
HIV's weird ways as a cell pathogen present a further paradox.
Lab data show HIV-associated cell death to be far less than
natural T4 cell death. This means that the immune system's
normal replacement of normal T4 cell depletion is handily
superior to HIV's supposed killing rate. How then does HIV
shatter the immune system? Does it work by proxy? Does it,
like a small contingent of commandos, trick lymphocytes by
changing the surface proteins they use to recognise one
another? Are T8 suppressor cells killing off the T4 helper
cells? This is the multi-antigen-mediated-autoimmunity (MAMA)
hypothesis of Robert Root-Bernstein, which states that a
combination of antigens compromise immunity by causing the
immune system to turn against itself. Despite these
uncertainties about the microbe's attack on the body, its
assault on the mind was immediate, violent, and overt. The
purple splotches that are the first signs of Kaposi's sarcoma
triggered anxiety and depression among gay men. The need for
crisis counselling was quickly recognised; today crisis
counselling is a major part of AIDS care. The warning sign
from 1985 was not symptoms but the results of HIV immunoassay
tests. Test results are so dreaded that counselling is made
available before and after the test. By 1988 AIDS counsellors
had identified a syndrome that they called AFRAIDS. It affects
people who believe that they have the virus although they test
negative. Their symptoms mimic seroconversion symptoms of
weight loss, night sweats, and diarrhoea. A positive test
result is usually interpreted as a death sentence of uncertain
execution date. In awarding three haemophiliac boys
compensation against the Commonwealth Serum Laboratory and the
Australian Red Cross, Victorian Supreme Court Justice Ashley
told the boys that $1 million compensation "might not seem a
great amount of damages for someone who, without any fault of
his own, has received a premature death sentence".
The attack on the mind is not limited to affected individuals
and their loved ones. Effects on communities began in 1981 as
an alarm cry among gay activists and infectious diseases
scientists. This handful of men and women recognised a mission
to warn gay men of an awful threat stemming from their
lifestyle. At first they were shouted down. As Randy Shilts
describes in And the Band Played On, the gay press denounced
the idea of a "gay plague" as yet another bout of self-hatred
among gay men, in league with heterosexual disgust with the
gay lifestyle. The battleline was drawn at bathhouses. The
"alarmists" wanted them promptly closed. Closure would slow
transmission of the infectious agent while having the
educative effect of alerting gay men to epidemic danger. Yet
bathhouses were a symbol of gay liberation, and the bathhouses
experience was interwoven with gay consciousness. To allow
public health officers to close the bathhousess was to endure
a mighty defeat to gay power. The alternative course-that the
gay community should take the initiative in their
closure-would be a public retreat from gay liberation. Three
years of struggle passed before bathhousess were closed. In
that period gay consciousness reacquired inhibitions that had
been discarded. Next it was the turn of heterosexuals. The
media took scant notice of AIDS until 1984. The turnaround
event was the announcement, in April, that government
scientist Robert Gallo had discovered the viral cause of AIDS.
The high level press conference convened by Health and Human
Services Secretary Margaret Heckler made world headlines.
Public belief that AIDS is a viral epidemic may be dated from
that moment. Gallo's virus gave credibility to the speculation
that blood-products from blood banks may be contaminated.
Blood suppliers moved quickly to implement costly procedures
to ensure blood product safety. However, according to Shilts,
the public were finally convinced of the reality of AIDS only
when the film celebrity Rock Hudson was stricken and died in
1985. Hudson, a closet gay, was for most fans the epitome of
heterosexual romance. That paradox somehow communicated the
message that AIDS was a threat to heterosexuals. It made a
large impact on President and Mrs Reagan, who had long been
friends with Hudson. From that moment, the previously silent
White House gave its blessings to the war on AIDS. Funding
shot up from $61.5 million in 1984 to $766 million in 1987 and
$1 billion in 1988.
By 1987, media reporting on AIDS and safe sex education had
penetrated the consciousness of most sexually active men and
women. The US Surgeon General summed up the effects of the
massive campaign by declaring that "AIDS has killed the sexual
revolution". There were many signs prior to AIDS that the
balmy days of user-friendly consumer sex were in eclipse.
Playboy Clubs-those heterosexual bathhousess-closed throughout
the world; the Playboy empire narrowly missed collapse. Signs
of sexual anxiety were ubiquitous. Rape and child sexual abuse
became a media obsession. And the first cases of child sexual
abuse remembered in adult years came to light. Called today
the "false memory syndrome", it is a highly contagious
therapeutic suggestion expressing unresolved conflicts about
sexuality. Also to be counted in the toll of anxiety is the
adoption, in the last decade, of rules against sexual
harassment and sexist language. Casual relations between women
and men that permitted touching and frank expression of desire
were out, together with mini-skirts, cleavage, and one-night
stands. That working class amusement, wolf whistles from
construction sites, were out; good manners and baggy clothing
were in.
The HIV virus also vexes the minds of scientists. I have
mentioned their perplexity about its strange ways as a disease
agent. They urgently called for and obtained massive research
funding that today enlists about 10, 000 scientists who
produce 7000 publications per year. Despite this surfeit of
truth, there exists no article that critically reviews the
evidence for HIV's destruction of cells and demonstrates that
such destruction creates "opportunities" for diseases as
diverse as dementia and tuberculosis. The cry of helplessness
was sounded last year by Science in reporting findings of the
9th Annual World AIDS Congress in Berlin. In noting that
neither a cure nor a vaccine was remotely on the horizon, the
editorial stated that "the more rapidly knowledge of the
disease accumulates, the faster assumptions that seemed solid
a year ago begin to crumble". This means that the taxpayer is
funding more research so that less will be understood.
This mirage is not the only sign of the AIDS virus' assault on
the mind. The identity of the virus has been the source of
confusion, law suits, and recriminations. For two years, AIDS
science accepted that three viruses caused AIDS-Gallo's human
T-cell lymphotropic virus type III (HTLV-III), the Pasteur
Institute's lymphadenopathy-associated virus (LAV), and Jay
Levy's AIDS-associated virus (ARV). Although there was much
rejoicing that the viral agent had been found, which was it
exactly? Gallo and Montagnier, ardent for the Nobel Prize,
fought for acceptance of their respective discoveries. In 1986
an international nomenclature committee decreed that Gallo had
erroneously classified his virus as an HTLV type. It belonged
instead to the same viral family as the Pasteur Institute's
LAV. Jay Levy's ARV was also deemed to belong to the LAV
family. The committee made a fresh start by naming the AIDS
virus "HIV" (human immunodeficiency virus). Gallo strongly
protested this decision. He maintained that LAV was a
laboratory contaminant, and that the mechanism of the viral
cell damage was inextricably bound up with the HTLV type of
viral activity. Montagnier, on the other hand, maintained that
Gallo's virus was pinched from a sample of the virus that he
had sent to Gallo.
Thus the rival architects of AIDS science attributed delusion
to one another, and AIDS science was stuck with the
embarrassment of two or three AIDS viruses. More of this was
to come. Once the technique for HIV isolation was developed,
the hunt was on. In 1986 Montagnier's group isolated a
variant, HIV-2. The patient had not come from an AIDS region
of Africa and he produced no antibodies to HIV-1. On the other
hand, HIV-2 was also found in a group of prostitutes who were
free of AIDS. In 1987 the laboratory of Myron Essex found
HTLV-IV, Gallo found HIV-3, and a Swedish laboratory
discovered HTLV-V. The relationship between these strains of
AIDS viruses, and their causal relation to the disease, is a
matter of speculation. In 1987 another mirage appeared on the
AIDS battlefield. Writing in Cancer Research, Peter Duesberg
undertook a detailed examination of the evidence adduced to
support the belief that HTLV-I causes some types of leukaemia
and that HIV-1 causes AIDS. He concluded that the evidence in
both cases was suppositious and in conflict with basic rules
for infectious diseases. He made the point mentioned above,
that the quantity of HIV in AIDS patients is far less than
what is required for infection. The titres of HIV in AIDS
patients varied from 0 to 100 particles per millilitre. By
contrast, titres of other infectious agents must reach
billions or trillions per millilitre before they become
pathogenic. Duesberg also cited rigorous laboratory work to
recover HIV from the T cells of AIDS patients. In a sample of
91 patients, three had no HIV. This was proof, he claimed,
that HIV is not a necessary condition for AIDS. This was a
serious criticism from a serious source. The discovery of
reverse transcription by Howard Temin and David Baltimore won
them the Nobel Prize because of the significance attached to
the reverse transcription ("retro") process, in which an RNA
virus converts itself into a DNA provirus. The discovery
stimulated speculation that reverse transcriptase might be the
mechanism of virus-induced cancer. Duesberg was among the
young scientists who bought a ticket on that train (Robert
Gallo was another). He led the race by elucidating the genetic
nature of the retrovirus family and mapping the three key
genes gag, pol and env. There is nothing inherently
implausible about Duesberg's criticism of the evidence for HIV
causality. The progress of science is littered with the bones
of false starts and superseded theories. One such belief is
that the reverse transcriptase enzyme is something special. It
isn't. The enzyme is natural to the human genome. When
Duesberg's criticism is combined with the Royal Perth group's
theory of cellular oxidative stress, and their criticism of
immunoassay tests, a comprehensive view of the foul-up and the
right road ahead emerges. It is this. AIDS diseases are not
viral. They are caused by introduced toxins. The indicated
therapy is to use reducing agents to halt the oxidisation of
cells by these toxins and prevent further introduction of
them. At first Duesberg's alternative attracted notice from
the scientific press as a startling case of a talented
scientist who had run afoul of orthodoxy. The truth
managers-influential journal editors and heads of
institutes-branded him pariah and he was ostracised by
colleagues. The Royal Perth group didn't get a hearing at all.
This is odd. Faced with what they said was the gravest health
crisis of the century, the AIDS establishment did not do what
rational method would seem to suggest: to investigate the
alternative hypotheses with all vigour. The opposite happened:
the alternative case was cast aside as "lunatic". A clue about
why alternative hypotheses are dismissed emerges from a recent
book. In The Plague Makers: How We Are Creating Catastrophic
New Epidemics-And What We Must Do to Avert Them, Jeffrey A.
Fisher, MD, argues that the mass prescription of medical
drugs, particularly antibiotics, contributes significantly to
viral overload and/or immune suppression, which in turn
multiplies the incidence of illness. He points out that
doctors have created plagues in hospitals. In the US there are
two million hospital acquired infections annually, resulting
in a mortality of 80, 000. That is three times the annual
mortality from AIDS; yet the medically induced epidemic is
scarcely noticed. This is only one item in a long list of
sicknesses, side-effects and injuries acquired from doctors
and clinics. Seeing AIDS as a calamitous plague expresses this
predicament allegorically. It tells the story of doctors
wounded by the failure of their healing art, and distressed by
the half-conscious sense that modern therapeutics may abet
sickness and suffering. We may call this predicament the
Acquired Anxiety Syndrome.
The signs of this Syndrome are the daily diet of newspapers.
There is incessant reportage of the aggression, mayhem,
litigation, suffering, misunderstanding and politicking that
occur in the health arena: incorrect surgery; misdiagnosis; a
drug that killed or maimed; a host of diseases transmitted in
hospitals and through blood banks; large compensation payouts
for an IUD or silicone implants; therapeutic advances that
prolong chronic illness; disputes about the causes of illness
and the effectiveness of therapies; client disaffection about
waiting lists; abuse in psychiatric wards; the revolt of women
against reproductive technology; patients abusing doctors for
saving a life not worth living; disability groups attacking
initiatives to eradicate heritable diseases; spiralling health
care costs; $7 million spent by the NSW Medical Tribunal to
strike one doctor from the lists; health managerial reforms to
control of "outcomes"; a panel commissioned to steer the
health minister out of a tight spot. Earlier this year, a New
South Wales court awarded Rhonda O'Shea a large settlement
because it found that her doctor and the pathologist had been
negligent in failing to diagnose indications of cervical
cancer from a Pap smear. Expert testimony given to the court
revealed that the false positive and false negative rates of
Pap smear are a "closely guarded secret". The secret is being
kept from patients like O'Shea who, if they had the
information, might follow her example: "I want to make clear
to people that just because their doctor says something, it is
not gospel . . . what I have learned is to take the issue into
my own hands".
3. The swine flu epidemic: Strong cure, no disease
The progress of medical science in the last hundred years has
been stupendous. The ultimate goal of medicine, the
eradication of disease . . . is no longer Utopian. -Henry E.
Sigerist, MD The right to a long life, which is theoretically
averaged at 100 years, is a basic right of every individual.
-Hiroshi Nakajima, Director, WHO [TP1] Everyone knows that HIV
causes AIDS, but until about a decade ago no one knew that. We
believe that HIV causes AIDS because the doctors tell us it
does. It's gospel. They might amputate the wrong limb, or
misdiagnose cervical cancer, or cause 25% of pensioners to be
hospitalised through misprescription of drugs, but they
couldn't blunder about a thing like AIDS. Could they? Well,
yes they could. The phantom swine flu epidemic of 1976 proves
that it is possible. The very same people who gave America the
swine flu scare gave the world the AIDS epidemic just five
years later. By learning how one epidemic was concocted, we
learn how a few people in positions of power can set a whole
nation on a wild goose chase. Our heroes are a medical elite
whose institution is the Centres for Disease Control (CDC), a
branch of the US Public Health Service. They are a special
breed whose tasks mingle medical forensics with diplomacy,
intelligence gathering, and rapid response capabilities. The
intelligence gathering is meant to be so sensitive that no
case of infectious disease diagnosed in a nation of 250
million escapes its notice. The organisation is wired up for
around-the-clock surveillance when need requires, and for
rapid response to any threat to health from biological agents
suspected to be infectious. The CDC expresses the public will
to prevent and conquer infectious disease. In February 1976 an
army recruit at Fort Dix, New Jersey, died in what the CDC
called a "respiratory epidemic" on the army post. Examination
revealed that the lad carried an influenza virus similar to
influenza A virus causing illness in swine. A search of the
army post discovered five other confirmed cases, and eight
probable, among the 500 troops who went on sick call with
respiratory complaints. The CDC's vigilance systems were
triggered. The new virus was thought to represent a major
mutational shift in human influenza viruses. There was no
immunity to it in the general population. Could it cause a
national pandemic? If so, would it be as virulent as the 1918
virus? It seemed that the very scourge that had caused nations
to establish infectious disease control agencies had now
returned to put modern infectious disease control systems to
the test. The 1918-19 world pandemic had taken 20 million
lives, 600, 000 in the US. The spectre of that calamity is the
reason why, on the basis of one death and 13 cases, all at the
same site, the CDC called a national epidemic. The Centres
created two panels of experts charged with providing
statistically valid advice. The two panels did not agree on
the probability that a pandemic would occur. One panel rated
the probability at 10-25%, the other at 40%. The panels did
agree that if the pandemic occurred, and no protective
measures were taken, there would be 56 million cases of swine
flu. The attack rates would be highest among the young and
would decrease with increasing age. They predicted the death
rate to be 23.4 per 100, 000; in raw numbers, about 55, 000
deaths.
This is scary stuff, but Washington is bloated with bogus
advice from glossy experts. Skilful lobbyists representing
interests of all descriptions peddle panaceas. To the
medically untrained mind that deals constantly with deceptive
persuasion, the CDC's forecasts seemed far-fetched. How then
did it mobilise the political establishment? It was easy. The
CDC was then one of the few remaining credible government
agencies. It enjoyed an untarnished reputation as a
responsible, dedicated, internally harmonious, well-informed
agency untouched by scandal. This reputation gave its
Director, Dr David Sencer, the clout he required. Less than
six weeks after the first case diagnosis, he had rallied
America's senior health officers behind his proposal for a
$135 million crash program to inoculate 210 million Americans.
On 24 March, President Ford told a press conference that
"every man, woman and child" should be vaccinated, and that
the government would see that the necessary supplies were
available. 1976 was an election year. Congress quickly agreed
to the President's package. The media fell in by giving
currency to the CDC's tag line, "killer flu stalks the
nation." When the vaccine was delivered in late September, not
one new case of swine flu had been reported in the US since
the Fort Dix "epidemic". Indeed there was none in the Western
Hemisphere. Volunteers who submitted to experimental infection
with the new virus suffered only a mild illness. Public
support for inoculation had faded. Opinion polls revealed
indifference, and comedians cracked election season jokes
about President Ford's "Flugate". Editorials in the media and
in the medical press were calling the epidemic a false alarm.
The CDC remained steadfast. Where others saw in the Fort Dix
statistics 13 mild flu cases, the CDC saw one death and
extrapolated to 55, 000 deaths. It countered public
indifference by a renewed education campaign. As June Osborn,
a CDC scientific advisor, explained: "The successful practice
of public health requires salesmanship of a high order". The
CDC is skilled in marketing anxiety. The inoculation of what
would eventually be 45 million persons commenced on 1 October.
Trouble quickly developed. Three weeks on, 41 deaths were
associated with vaccination, but the CDC's investigations
showed that this was a statistically normal rate of mortality.
By mid-November, 11 cases of neurological damage from the
vaccine were reported; a month later, this number had
increased to 54, with 10 fatalities. There was still not one
new case of flu, but prevention was creating a medically
induced epidemic. On 16 December Dr Sencer announced
suspension of inoculation until adverse side-effects could be
investigated. His attempts to restart the program two months
later failed and the vast project was shelved. In all, 52
persons died of side-effects, 500-600 were impaired or
hospitalised, compensation claims reached $1.7 billion, and
not one case of human-to-human swine flu infection was
reported outside Fort Dix. The swine flu mirage triggered
evaluations of epidemic management. In their study of decision
making in this case, policy experts Richard Neustadt and
Harvey Fineberg found fault with developing a vaccine of
unknown risks when there was no evidence of an epidemic. They
wrote: "The threat was never established . . . in the absence
of manifest danger, [inoculation] was a mistake . . . since
research has not yet found a good predictor of virulence, one
may have no means to establish in advance the severity of a
presumed pandemic". This is a soft landing for the CDC.
Neustadt and Fineberg do not report central facts relevant to
the CDC's epidemic mismanagement.
- When the first consignment of vaccine was delivered from
manufacturers in March, it was found to produce no antibodies.
So it was useless as a preventative. On investigation it
transpired that the virus given to manufacturers by the CDC
was not swine flu. Two million doses of the incorrect vaccine
were discarded.
- Difficulties were experienced in establishing the proper
dosage of the vaccine. Dosages that produced ethical/legal
minimum side-effects evoked insufficient antibodies, while
dosages that were efficacious produced side-effects. In test
cohorts, 2% suffered severe reactions, 5% developed fever, and
20% experienced headache and malaise. These data persuaded
insurers that writing liability insurance for the program was
not tenable. The vaccine clearly met the "unreasonably
dangerous" test established in US law for liability in
administering medical drugs. Insurers guessed that the
liability pay-outs might be as high as $5 billion, for which
the premiums would be $342 million. But insurers would have no
part of it because the data provided by the CDC were too
indeterminate for actuarial computation.
- The CDC's alarm that the Fort Dix virus represented a
dangerous antigenic shift was not well founded. Research
conducted in 1931 by Richard Shope indicated that the 1918
virus by itself produced only a mild illness. It became lethal
only when combined with the bacillus Haemophilus influenzae
suis, which had been isolated from 1918 influenza patients.
Shope showed that humans alive in 1918 had high levels of
immunity to the swine virus recovered from living swine. He
also concluded that the swine virus and the 1918 influenza
virus were the same. Experiments conducted in March and April
1976 showed that persons alive during 1919-29, a decade of
many flu epidemics, produced antibodies to the Fort Dix virus.
All these facts taken together were strong evidence that the
Fort Dix virus was harmless. This conclusion was further
reinforced by tests made by the UK Common Cold Research Unit.
Doctors there injected the Fort Dix virus into six volunteers.
The result was that four developed mild flu symptoms, while
two were unaffected.
- The evidence indicated that the contagion level of the virus
was very low. None of those who were in contact with the Fort
Dix virus fell ill, including the sergeant who gave the
deceased recruit mouth-to-mouth resuscitation.
- The CDC's smoking gun, the deceased recruit, collapsed and
died while on a strenuous training exercise. Such deaths are a
familiar aspect of military training. He insisted on
participating in the exercise contrary to medical direction of
light duties only.
- An alternative to a vaccine was available in the therapeutic
drug, Amantadine, which had been extensively tested for 10
years prior to 1976. It is not specific to any strain of flu
virus and it had been found to reduce symptoms within 48
hours. Given the other data about the Fort Dix virus,
Amantadine would have been a reasonable response.
- Under US law, informed consent had to be given by each of
the proposed 210 million inoculates. The informing process had
to include the administering physician's plain language
statement of the hazards of the vaccination. In addition,
under the indemnification conditions established in a special
Congressional law, physicians were indemnified only if they
charged no fee for giving the injections. Thus, the epidemic
management burdened physicians with the prospect of spending
many hours in counselling for no charge. Most of them opted
out, and advised patients against inoculation. A survey of
inoculates after the event showed that 13% were given no
information about side-effects.
- The CDC's expert panels' estimates of the probability of a
national pandemic, and its morbidity/mortality consequences,
were made in the absence of information that the swine flu
virus is harmless in the absence of the bacillus. In his study
of the epidemic's management, Cyril H. Wecht, MD, cited
numerous incidents of relevant facts hidden or ignored, and
disinformation disseminated by the CDC and other agencies. He
felt justified in saying that the facts of the case show "just
how unprincipled the agency's actions apparently were.
Half-truths and omissions seemed to come in a steady stream
throughout the immunisation program." The full significance of
the swine flu mirage is not appreciated unless it is realised
that it was not due to an unfortunate lapse in one agency. The
entire spectrum of relevant US Public Health Service agencies
formed a combined front of official prestige and unimpeachable
scientific authority to sanction belief in the urgency of the
vaccine method of epidemic management.
A proper review of the swine flu episode, and corrections made
accordingly, might well have spared us the AIDS epidemic.
Let's look at what such a review might have indicated.
Public health services operate in an environment of high
public expectations. June Osborn described it well:
"Ironically the very success of medical science [has]
distorted the image of its practitioners . . . the discovery
of antibiotics and vaccines at first awed the public but later
made them as demanding as spoiled children". The child was
spoiled because Mother Medicine had accustomed the public to
demand feeding. Or to change the metaphor, doctors and
patients had come to regard medical service as a smash repair
shop. When something is broken, you take it in for a fix, the
quicker the better. Health is not thought of as an ongoing
condition to be lived and striven for. Instead it is an
endowment that from time to time is compromised by injury or
sickness.
Doctors and government promote this mechanical notion of
health. Its trinity is Diagnostics, Pharmaceuticals, and
Surgery. Omitted from the conception is prevention, and its
associated conception of health as natural therapy actively
lived. Prevention is not funded by medical insurance. Doctors
have no time to instruct patients on how to live healthily.
They write a contract with patients that reads: "You smash, we
repai". No thought is given by doctors, patients, or
governments to the cumulative effects of injecting millions
with medical drugs. The decision to proceed with the
inoculation is understandable in this context. Had the vaccine
not been administered, but an epidemic did materialise, there
would have been a great outcry. Besides, public health
agencies are committed to smash repair medicine of the utopian
kind-conquering disease. This goal activates a cluster of
powerful private and public motives. One is zeal in "saving
lives". Doctors need only to inflect an anxious voice, shed
some tears, and wave the "saving lives" flag to win the
applause of millions of "spoiled children" (as June Osborn
called them) for projects that are manifest nonsense, for
example, "conquering disease" (equivalent to a promise of
immortality). The nonsense is kept in countenance by
exaggerating the effects of temporary local victories. Just
before the onset of the AIDS epidemic, the CDC had celebrated
two triumphs: it had developed a vaccine for hepatitis B and
it had "eradicated" smallpox in Africa. In this vision,
infectious microbes are not a natural, ineluctable part of the
earth's biota, harming some organisms and helping others. They
are alien invaders to be exterminated with the ingenious
weapons of science. This attitude is so integral to
contemporary medico-social thought that no alternative to it
is ethically acceptable, at least not in our culture. But as a
conception it is new. We need only step back a century to find
in the West the same stoic attitude toward sickness that
prevails in Asia and the Third World today. Among ourselves,
diagnosis of an untreatable disease is a terrible experience,
registered in the saying: "If you get AIDS, you die". But in
Japan, the Zen master says: "Also if you don't get AIDS, you
die". The transition from the older to the contemporary
attitude toward sickness and death is expressed in Charles
Darwin's reflection on the value of epidemic control. He
wrote:
There is reason to believe that vaccination has preserved
thousands, who from a weak constitution, would formerly have
succumbed to smallpox . . . the weak members of society [thus]
propagate their kind. No one who has attended to the breeding
of domestic animals will doubt that this must be highly
injurious to the race of man . . . [but] the aid which we feel
impelled to give to the helpless is mainly an incidental
result of the instinct of sympathy, which was originally
acquired as part of the social instincts, but subsequently . .
. rendered more tender and more widely diffused. Nor could we
check our sympathy, even at the urging of hard reason, without
deterioration in the noblest part of our nature . . . if we
were intentionally to neglect the weak and helpless, it could
only be for a contingent benefit, with an overwhelming present
evil. We must therefore bear the undoubtedly bad effects of
the weak surviving and propagating their kind.
Darwin was far enough into the transition to progressive
values to forget his own insight that one season's survivors
are the next season's mortality. The Zen master, if he were a
biologist, might point out that the human species is host to
many thousands of inactive microbial passengers, any of which
can mutate into a harmful pathogen. Pathogenic bacteria, for
their part, mutate into antibiotic-resistant strains under the
pressure of medically induced selection. The "conquest of
disease" will be a while coming. But Darwin was right about
the "instinct of sympathy". The modern therapeutic state is
geared to extend the appearance of compassion and assistance
to all the suffering. I say the "appearance" because outcomes
depend on adequate funding and much else. An advantage of the
mechanical conception of health in democracies is that the
patient is not required to be an agent in the healing process.
Healing is conceived as technical skill in manipulating subtle
and refractory organic processes. The patient is a bystander
who, from time to time, may be conscripted to dietary or
exercise chores. But for the most part doctors do not try to
change lifestyles. This view of medicine's social role
dominated the CDC's response to another epidemic that received
scant public attention until after the damage was done. During
the 1960s and 1970s, US doctors reported sexually transmitted
diseases at the rate of 5-7 million cases per year. Thus the
CDC knew the dramatic increase of chlamydia and the high rates
of infertility that it causes. It knew of the increase of
syphilis and of STDs that previously were rare. It was
especially concerned about the spread of hepatitis B, which
clustered in gay populations. It enrolled a cohort of 7000 gay
men to study their lifestyle and viral load in connection with
the search for a vaccine. From this study it knew that
syphilis, gonorrhoea, and hepatitis B were endemic in the gay
populations of the cities. Parasitic infections of the colon,
known as "gay bowel", were also endemic. It was found that the
annual hepatitis infection rate among gays was an astonishing
12%, as against a 1% lifetime rate for the general population.
The stage was set for rapid transmission of unusual pathogens.
Thus on the eve of AIDS, the CDC was fully aware of the
increase of sexually transmitted disease and the possible
bacterial and viral "bomb" that the sexual revolution had
planted. It was of course concerned: it promoted improved
clinical descriptions of STDs, particularly the interactions
of simultaneous infections; and it promoted more effective
therapies. However, it did not mount a vigorous safe sex
campaign to reduce the incidence of STDs and to warn young
women and men of the grave consequences of some infections. It
did not because it was confident that antibiotics in the
cabinet of every GP could restore health to those affected by
STDs, no matter how many of them there were.
4. Donald Francis invents a viral epidemic
The AIDS virus attacks the mind. About 40% of AIDS patients
develop neurological and associated psychological symptoms.
They begin with a slowing of speech and thought, short term
memory failure, and difficulty in concentrating. These
deficits become more pronounced and new ones appear:
deteriorated motor coordination, apathy, confusional states;
then irritability, hyperactivity, incontinence, and delirium
or mania, or both. As death approaches, the patient lies
immobile, staring vacantly ahead, silent and unresponsive. The
mind has been destroyed. These symptoms are indistinguishable
from those caused by encephalopathic or cerebral atrophy
conditions. Yet they are special because they terrify friends
and lovers who know that HIV did it. The virus assaults the
minds of about half those who are diagnosed to be HIV+.
Although they may be otherwise healthy, they experience
feelings of powerlessness, shock, isolation, anger, denial,
guilt, anxiety, apathy, and suicidal thoughts. Depression and
malaise disrupt work and social relations. These symptoms are
indistinguishable from garden-variety panic and depression,
but for one thing: HIV did it. The virus terrorises the minds
of some people so much that they believe that they are
infected even though they test negative. They mimic the
mononucleosis-like symptoms of initial HIV infection. The
syndrome is called AFRAIDS. It's indistinguishable from
ordinary hysteria but for one thing: HIV did it. The virus
brutalises the minds of carers, family and friends of AIDS
patients. They experience grief, social withdrawal, and are at
risk of chronic psychological disorders. Carers have recorded
their anguish in witnessing the slow death: "He looked
pathetically decrepit, his face almost unrecognisable from the
skin lesions of Kaposi's sarcoma"; "There are simply no words
in human language to express the suffering of any one person
with AIDS"; "You could literally see every function in his
body closing down one by one". Descriptions of this kind have
been recorded for many diseases. The tertiary syphilis
patient, for example, is ghastly. Large ulcers disfigure the
face, scalp, trunk, and legs. The mouth and nose are eaten
away; mind and brain are gone. This spectrum of wounds endured
by carers of AIDS patients is indistinguishable from
disturbances experienced by others who care for the dying,
except for one thing: the patients in their care suffer from
AIDS.
The virus attacked the minds of Sydney morticians so violently
that they got up a law to prohibit viewing the remains of
those who died of AIDS or of any unexplained infection. If the
next-of-kin choose not to have the corpse cremated, it is
placed in a sealed plastic bag by apprentices wearing
disposable infection-control clothing. Politicians are at high
risk from HIV mental attacks. During the 1984 general
election, the Queensland Heath Minister startled the
government by announcing that three infants were dead and a
fourth was dying from contaminated transfused blood. It was
the signal for the Opposition to pummel Labor's initiative to
extend human rights protection to homosexual acts. A National
Party leader blamed the deaths on Labor's "promotion of
homosexuality as a norm". The Queensland legislature needed
but one day to pass a law banning blood donation by anyone in
a risk group. Hair-trigger though this response was, it did
not satisfy a Sydney clergyman, who demanded that gay men be
quarantined. The Prime Minister, thrown from his horse by the
uproar, huddled with minders. The outcome was to call an
emergency meeting of health ministers to consider strict
guidelines for blood donation. It was much the same elsewhere.
When the AIDS panic was at full tide in the US, state
legislators introduced, in just one year, 450 bills relating
to AIDS. No doubt about it, HIV drives people bananas. Those
who suffer from the Acquired Anxiety Syndrome must number in
the millions. It drives you crazy because you can't see the
damned thing. Neither can scientists. The electron microscope
lets them see virus particle concentrations in excess of 1
million per millilitre. But those concentrations of HIV
haven't been found. Thus, as Donald Francis states, direct
visualisation of viruses is often "difficult". So there's no
telling where it will strike next. Innocent babes, the
all-American idol Rock Hudson, a romper-stomper type
right-wing activist, a sports superstar. God help us! Or does
God side with the bug? Is the plague Jehovah's way of bringing
corrupt, luxuriant nations back to the path of righteousness?
Health bureaucrats easily refuted the quarantine proposal;
rounding up millions, pinning them in special facilities for
the duration of their lives, isn't the sort of empire
Australians like to build. It's nuts. HIV doesn't spare
clergymen. But AIDS scientists have no credible answer to the
Jehovah hypothesis. Suddenly, from out of the blue, the
wretched microbe struck in Kinshasa, Haiti, New York, Rio,
Sydney. Virologists classify microbes into phyla and orders
and try to date their evolutionary origin. All the viruses,
bacteria, fungi, and parasites that pester us and livestock
have been around for a long time; some protozoans for maybe a
billion years. So AIDS must have been around for a long time.
Yet there was nary a sign of it until 1981. The public had to
be given a plausible scientific story about origins; otherwise
evangelists would sweep the field with the Jehovah hypothesis.
There was also the KGB to worry about. Using East German
conduits, the KGB put out the story that the virus was a
weapon devised in the US biological warfare program. This
sensational notion was endorsed by a few reputable scientists
and by British anti-vivisectionists, who said that HIV is a
recombinant animal-human hybrid. The Strangeloves who
allegedly masterminded this devil's work at the Fort Detrick
biological weapons facility were named in some publications.
They were scientists in leading universities. If the dark
forces behind the scenes could assassinate President Kennedy,
would they scruple about devising an unstoppable killer to use
on the Reds, or Africans, or homosexuals? Here again the virus
showed its incredible power to induce delusional states. The
CIA and the State Department were frantic for the bug boffins
to come up with a plausible story. The boffins obliged.
Government scientist Robert Gallo had what he touted as
invincible proof that the virus was transmitted from monkeys
to humans at least 400 years ago. If you are a virologist,
chopping millions of years down to a few centuries is pretty
neat. You need only a few more strides to bring you up to the
epidemic. Here are the steps. For four centuries HIV was doing
its work in an isolated African population that doctors never
reached. This secures the key dogma that the virus is an
inexorable killer: it was killing, but no MD attended the
isolate. The virus spread when maidens left the forests for
Kinshasa, where the flesh trade was brisk. Bisexual Belgian
businessmen collected the virus from these girls and gave it
to male prostitutes in Haiti. A Canadian airline steward
picked it up in Haiti and spread it to thousands of his
contacts in San Francisco, New York, and Los Angeles. This
incredible story was actually believed. It is reported with a
straight face in AIDS literature, but with no explanation of
why scientists think it plausible. The reason is that
infections of their technicians by laboratory animals is a
standing hazard. The story was told to me in all sincerity by
a scientist in Myron Essex's lab shortly after he discovered
that simian immunovirus (SIV) had about 70% of its genes in
common with HIV; stir in a couple of lucky mutations, and,
Presto! SIV became HIV. This was his Eureka. He was on a high;
he had found the key that fits all locks.
Gallo's monkey story was meant to be the last word about
origins, but the virus outsmarted him. HIV used his story to
start a new cycle of stories. Here's one of them. Keep the
monkey, discard the bites and the prostitutes. Add scientists
in a Philadelphia lab circa 1957. The scientists are growing
the poliomyelitis virus in a culture of African green monkey
kidney cells. They need lots of polio virus because they are
making polio vaccine. The bug boffins don't know that the
kidneys of healthy green monkeys are the ancestral home of
SIV. So SIV contaminates the vaccine unnoticed. The vaccine is
ready for trial. Naturally it will be trialed in the Third
World because that's where the greatest need is. A benevolent
drug company provides 300, 000 doses of this latest pride of
humanitarian science. It is administered by compassionate
disease conquerors to children and young adults in Zaire,
Rwanda and Uganda. But an invisible tragedy has struck. The
vaccine is contaminated. SIV mutates to HIV. Add sex holidays
decades later. Voilˆ the African AIDS Belt and an epidemic
down the middle of the international fastlane. This story was
told by Julian Cribb in the Weekend Australian in 1992. It won
him the Walkley prize for investigative journalism. It's wild.
Sixty million doses of possibly contaminated polio vaccine
were administered over the years, yet it seeded only one AIDS
epicentre. Still Julian won the prize because people are so
keen to know where the virus came from. Cribb collected no
bouquets from our AIDS scientists. They hate the story. They
will not even reply to it. They hate it with the same fervour
that the US State Department hates the Fort Detrick story. No
doubt about it, HIV sends minds into spins. It has defeated
AIDS science, which threw in the towel on the origin of the
AIDS virus some years ago. The CDC's official epitaph was
written by Donald P. Francis in 1989. He said: "From the
moment AIDS was recognised as a strange and frightening
phenomenon, speculation about its origin was irresistible.
Growing just beneath the fear and speculation was the
xenophobia that has often accompanied transcontinental
propagation of epidemics". (Francis knows about Africa. He
served humanity, on secondment from the CDC to the WHO team
that staunched African haemorrhagic fever and smallpox.) He
goes on to discuss theories of simian origin and mutation
origin. He rejects both and tosses it in: "It is doubtful that
the origins of the virus will ever be fully known". He means
it will never be known at all. Don Francis, MD, DSc, is unduly
modest. He knows the origin of the AIDS virus because he led
the CDC virologists who postulated a viral cause of AIDS. That
moment of creativity is what we today know with certainty
about the origin of the virus. Indeed, it exhausts what we
know about its origin. Let's have a look. Atlanta, May 1981.
The CDC's hypersensitive sentinel system receives a message
from its Los Angeles listening post. A cluster of five
homosexual men with Pneumocystis pneumonia (PCP) and
candidiasis (thrush), three of whom had abnormalities of
cell-mediated immunity. The next CDC surveillance report (5
June) described the cluster and postulated a "cellular immune
dysfunction related to a common exposure that predisposes
individuals to opportunistic infections such as pneumonia and
candidiasis". The definition will be used as a surveillance
criterion by doctors all over the country. It is the first
step in the definition of AIDS.
July. Doctors attending gay men are eagle-eyed. They report
26 cases of Kaposi's sarcoma (KS) accompanied by immune
dysfunction. KS is a puzzle. Some doctors call it an
inflammation; others a cancer. Among Europeans, it is rare,
and prefers older men of Mediterranean origin. But in Africa
it prefers children of both sexes, its prevalence is
significant, and it kills like cancer. Now KS is going for gay
men ranging from 26 to 51 years of age, in Los Angeles and New
York. Very odd. August. The CDC switches the epidemic
vigilance light to amber. An unusual incidence of disease
associated with unexplained immunosuppression has been
flagged. The concept of opportunistic infection, accompanied
by a deficit of cell-mediated immunity, is bedded down as the
revised surveillance definition of a disease called informally
Gay Related Immune Deficiency (GRID). With it is bedded down
the concept of an underlying common cause. Another foundation
stone of AIDS science is set in place. September. The CDC
switches the epidemic light to green. In Washington the
National Cancer Institute (NCI) convened a KS workshop on the
15th. Fewer than 20 cases are available for study. Not many as
populations go, but the Public Health Service lives by the
motto that you should shut the door before the horse bolts.
Medical scientists study the data. The common immunodeficiency
factor is that most of the patients have significantly
elevated CD8+ and significantly lower CD4+ T lymphocytes and
lower ratios of CD4 to CD8 cells in peripheral blood. Thus, in
only three months, the basic pathology-immunosuppression-had
been identified and the probable mode of transmission by
sexual contact had been established. Lowered counts of T4
helper cells but elevated counts of T8 suppressor cells. The
workshop debates what, if anything, this means. The technology
for counting T lymphocytes is new; there is little clinical
experience to go on. The immune system is composed of a wide
variety of differentiated cells that interact in a complex and
patchily understood manner to provide protection against
infectious diseases. While acknowledging that the distinction
between T4 and T8 cells is oversimplified, the workshop
fastened on it as a reasonably sensitive measure. So it is
added to the surveillance definition of GRID. Another
foundation stone of AIDS science had been laid. The workshop
moved on to discuss the cause of this "strange and frightening
phenomenon". Strange, because doctors had not encountered KS
and PCP of this virulence. The PCP bacterium is carried by 95%
of us. When on rare occasion it does act up, the sickness is
mild. The KS story is similar. Since it was identified in
1872, doctors have debated whether KS is a cancer or an
unusual inflammation. Since the cells that cause the condition
have never been identified, no rational therapy has been
devised. Some patients may live with KS for years. So the
puzzle before the workshop was that two usually mild diseases
were taking a new and aggressive course. The men in whom they
appeared were apparently healthy at the time of onset. They
worked, jogged, travelled. Suddenly they were ill. This aspect
of the clinical signs was captured in the surveillance
definition, "no known cause for diminished resistance". Here
opinion divided.
The NCI thought that there were plenty of known causes of
diminished resistance among these men. The cardiovascular
patient can also look healthy shortly before a fatal coronary,
but autopsy will show extensive vascular damage. So it was
with the gay patients under study. They were calamities
waiting to happen.
- They all had numerous sexual partners. They had infestations
common among fastlane gay men: Epstein-Barr virus
(mononucleosis), cytomegalovirus (CMV) and several other
herpes viruses, varicella zoster virus, adenovirus, chlamydia,
toxoplasma gondii, respiratory syncytial virus, hepatitis A
and B virus, gonorrhoea, candida albicans (thrush), syphilis,
plus a variety of enteric and protozoan infections. Each of
these viruses, particularly CMV, could cause immune
suppression, and CMV had been implicated as a cofactor for KS.
Could not the novelty of the syndrome be due to interaction
between these viruses, bacteria, and protozoans? This was the
"viral overload" hypothesis.
- It was also observed that all patients used nitrite
inhalants. Poppers became fashionable among gay men in 1972.
By 1981, legal sales had reached $250 million annually and
National Institute of Drug Abuse reported that more than 5
million people were using them at least once a week. Drug
manufacturers extensively promoted them in gay publications as
"better living through chemistry". Gay men used them
heavily as relaxants to facilitate anal intercourse. But heavy
use of nitrites was known to cause severe symptoms and
immunosuppression, and there was evidence that they were also
mutagenic and carcinogenic.
- The KS cohort of men had yet another factor in common ,
anorectal mucosal trauma. Trauma arises from various ways that
gay men mobilise the anus for sex. Enemas are used prior to
intercourse and intercourse is usually vigorous. The
anorectal damage caused by these activities can be extensive.
Trauma allows semen to enter the bloodstream. But semen is an
antigen when it enters the blood of another, and is
immunosuppressive.
- Most fast-lane gay men are on heavy antibiotic medication to
contain their infectious diseases. Much of this is
self-administered because medical lore among gay men states
that dosages in excess of prescription maximums are required.
These medicines are purchased on the black market and they are
not necessarily from a reliable pharmaceuticals source. Thus
gay men are pouring large doses of antibiotics into their
systems unaware that antibiotics are immunosuppressive.
Such was the NCI case. Its central idea was that the cause of
the novel syndrome was to be sought amidst this thicket of
potential causes. There was no need to postulate a new
infectious agent. This was to become known as the
multi-factorial model of AIDS. The CDC felt confident of its
case. It knew the clinical diseases of gay men thoroughly from
the 7000-man cohort of its hepatitis study. Nitrites, they
believed, could be dismissed. Nitrites had been in use for
over a century. Viral overload was no use either. The
hepatitis cohort answered to this description, but the novel
KS and PCP symptoms had not been found among them. No, there
had to be a new infectious agent, a point source of immune
cell destruction. This is the single-virus, single-disease
model that came to dominate AIDS science. The architect of the
CDC position was Don Francis. He had taken his PhD at Harvard
under the supervision of Myron Essex, who was a colleague of
Robert Gallo. His thesis had been a study of feline leukaemia
virus-a retrovirus. His study of 134 cats claimed that
infection with the retrovirus caused immune suppression that
led in turn to cancers and other diseases. Francis' thesis was
a seminal study because it supported the concept of a viral
cause of cancer. The Grail of a cancer virus had been sought
since about 1970. It was indeed this Grail that launched the
study of retroviruses by Duesberg, Essex, and Gallo. But the
aching expectation of a breakthrough had been disappointed
until 1980, when Gallo discovered a human leukaemia virus
(HTLV-I). (Duesberg, we noticed, challenged this claim in
1987.) It was only weeks after the CDC received the initial
notification of five cases in San Francisco that Don Francis,
at age 39, experienced his first AIDS Eureka. His training as
a viral epidemiologist made him impatient of the fuzzy
causality of the multi-factorial model. Viral causality by
contrast is clean and geometrical: one virus, one disease. His
doctoral thesis had provided a distinctive viral causality.
Now he had found the human clinical application that
virologists had vainly sought. The syndrome looked ever so
much like the leukaemia syndrome in his cats. In an inspired
moment it was vouchsafed to him that the cause of GRID was a
virus; specifically, a retrovirus. Gallo had just discovered
human T-cell leukaemia virus. It made sense.
A second Eureka occurred in March 1982 after numerous
discussions with Essex, Gallo, and his colleagues at the CDC.
All the pieces came together. Francis presented a lecture to
NCI scientists in which he outlined his doctoral work, the
data on the hepatitis cohort, and IV drug users. He argued
that the risk factors for GRID and hepatitis were virtually
identical. "Combine these two diseases, feline leukaemia and
hepatitis, and you have immune deficiency," he said. Feline
leukaemia modelled the latency period, while hepatitis
modelled the risk factor. The NCI was not convinced. Apart
from the fact that a new virus was a speculation, Francis'
sketchy model did not connect immunosuppression with the
specific opportunistic infections, nor with their virulence.
Why these diseases and why their virulence? How could a virus
infect and kill not only T4 cells, but macrophages, B cells
and other elements of the immune system? There was no answer.
The indications today are that no answer will be forthcoming
from the standard model. In May 1994, the National Institute
of Drug Abuse (NIDA) held a conference on AIDS and drugs. Some
of the outcomes of this conference were:
- the toxicity of nitrites was well established in the medical
literature by 1980, but the CDC chose to ignore it;
- a large study in 1985 provided significant evidence for the
KS/nitrites link in gay men, but still the CDC turned a deaf
ear;
- current studies by NIDA scientists again confirm the
KS/nitrites;
- gay activists have campaigned against nitrites since 1983;
- a leading AIDS scientist acknowledged that his lab's four
year study of KS tended to confirm a nitrite aetiology for KS;
the scientist even conceded the obvious point that HIV could
not be the cause of KS in gay men who are not HIV+;
- it was also acknowledged that no lab till now has isolated
HIV from KS cell necrosis.
The NIDA conference reveals retrospectively the diagnostic
blunder of the clause crucial to the definition of AIDS, "no
known cause for diminished resistance". It now seems that the
CDC engaged in the "unprincipled actions" that Dr Wecht
detected in its handling of the swine flu epidemic. The
nitrite evidence was ignored. The same story can also be told
of the second AIDS diagnostic disease, PCP. This disease is
developed by intravenous drug users, who inject opioids.
When AIDS was defined as a sexually transmissible disease, KS
and PCP were significantly related to drug abuse. There was no
good reason to postulate an infectious agent and every reason
to investigate further the toxic effects of these drugs. At
the Royal Perth Hospital, medical physicist Eleni Eleopulos
had developed a model for these effects. When it came to the
attention of AIDS scientists, they called her "an agent of the
AIDS virus". Such is AIDS science.
5. AIDS Mania
"Hampered only by a lack of money."
-- Don Francis
"From the start, AIDS has been a show business disease".
-- Luc Montagnier
"The world is dying of AIDS."
-- Playwright Larry Kramer
"Infotainment" is the buzzword for information packaged so
that it attracts viewer interest. The evening news and popular
science programs exemplify its adroit use. A concept driving
infotainment was expressed long ago by H. L. Mencken, a
publicist who entertained two generations with his sardonic
wit. Mencken said that "what ails the truth is that it is
mainly uncomfortable, and often dull". But infotainment need
not be hedonic. Viewers have a hearty appetite for conflict,
violence, personal threat. No news program is complete without
them. Likewise with science. In the decades prior to the AIDS
epidemic, science infotainment was replete with stories
playing to the craving for calamity and enjoyment of the sense
of personal threat. Fallout from nuclear testing, spring made
silent by pesticides, overpopulation, nuclear winter, and the
Greenhouse Effect are a few of the comprehensive doom
scenarios that recruited large followings hungry for
Apocalypse. This curious hankering for threat is probably a
first cousin to entertainments that feature the thrills of
risk-taking and narrow escapes, such as bungy jumping,
highspeed skiing, rock and mountain climbing, horror movies,
sporting mayhem and so on. Social psychologist Irvine
Schiffler calls these thrills the "charisma of hoax". Just as
there is a little larceny in every heart, so Schiffler thinks
that each of us is an actor fantasing a role in calamity play.
AIDS has been an unsurpassed show business disease because it
dramatised cultural conflicts and rescued sexual expression
from tedium by infusing it once again with danger. The amazing
infotainment success of AIDS is best appreciated by
considering how very dull the disease is when the gloss is
removed. Unless you are a virus hunter or truth tracker, the
real AIDS disease is unspectacular. Let's see just how
everyday it is. The National Centre in HIV Epidemiology and
Clinical Research provides the following data:
- The cumulative Australia-wide death toll from AIDS as of
September 1993 was 3017.
- The number of AIDS deaths per year peaked in 1991, at 556;
in 1993 it fell to 364.
- The cumulative number of AIDS cases as of September 1993 was
4354. About 60% occur in Sydney.
- Infection peaked in 1983-4, when between 3000 and 4500
individuals became infected.
The rate of infection since the 1988 is estimated at 600 per
year. The current infection rate is estimated at 3.5 new
infections per 100,000 persons. 98% are male. Comparing AIDS
as a cause of death with other causes, we find that in 1993 it
was slightly more than the number of homicides, about a sixth
the number of road fatalities, and about a fifth the number of
suicides. It is not in the same league with cardiovascular
disease (41,127 deaths, 1991) or cancer (31,284 deaths, 1991).
This profile holds right through OECD countries, albeit at
lower rates than Australia. Germany, its population 80
million, had 9000 AIDS cases as of 1993, while at the same
date the UK, with 57 million, had 7000 AIDS cases. Even in the
US, where the incidence of the disease is highest, the annual
mortality from AIDS is just over half the mortality from
hospital-acquired infections. Yet there is no public outcry
about the lethal hospital epidemic. The virus is not a
bushfire spreading through Australia or the Pacific region.
The cumulative HIV+ diagnosis in the Western Pacific as of
September 1993 is as follows:
Australia 17568
Cambodia 178
Hong Kong 289
Japan 2731
Malaysia 6225
New Zealand 884
Philippines 459
Singapore 190
Vietnam 792
In Australia, the incidence of HIV infection is established on
the basis of just over 1 million tests per year. The number
diagnosed as HIV+ is steadily declining; currently it is about
600 per year. These figures falsify three key premises of AIDS
science. The first is the official line that AIDS is the most
significant threat to the health of Australians. It is much
less a threat than suicide. Another falsified premise is that
the latency period of HIV is 10 years. If that were so, the
annual number of new AIDS cases should be 0.10 x 17,568 =
1757. The actual number of new cases (about 350 per year) is
indicative of a latency period of 50 years. This conundrum
could be read another way. Assume that the 10-year latency
period is correct. In that case the 75% who do not progress to
AIDS in 10 years are false positives; that is, they test
positive for HIV but do not carry the virus. For
haemophiliacs, the false positive rate is even higher.
Although 90% of this cohort test positive for HIV, only 0.06%
progress to AIDS.
The impression that AIDS is the most significant threat to the
health of Australians is due to the media appetite for
calamity infotainment. Hyping is the accepted means of
promoting research. Consider the current campaign to hype
melanoma. The public have no interest in the private agendas
of melanoma scientists. They do not care about the search for
a predisposing melanoma gene or about a "vaccine" therapy for
melanoma sufferers. These projects are costly (a single
injection of the melanoma "vaccine" costs $100, 000) and
interesting to scientists, whereas the prevention of melanoma
is cheap and dull (just cover up). In order to pump up support
for research, the public are fed scare stories. Consider the
present push for melanoma research. We are told that the risk
of getting melanoma doubled between 1980 and 1990. "That is
really an absolute public health disaster," a breathless
doctor exclaimed, "which is unmatched by any other malignancy
and practically any other disease in Australia. If this rate
continues, by the end of the 1990s we will have a melanoma
incidence comparable with breast cancer."
That's an infomercial - a commercial presented as information.
The creative challenge is to transform the uninteresting fact
that people die into a gripping story that pumps up anxiety.
The trick is to personalise the message: melanoma is coming
after YOU-FAST. This anchors free-floating anxiety to a
seemingly concrete, immediate threat (my sunburn). Melanoma
isn't anyone's terminal illness of choice. Histrionics have
become so much a part of the science trade that scientists
speak openly about it. Luc Montagnier told an interviewer that
"the media and the public think of us [scientists] as a cross
between magicians and movie stars". Not for him to disappoint
the fans. Steven Schneider, a Greenhouse promoter, was frank
about the science infomercial: Scientists should consider
stretching the truth to get some broad base support, to
capture the public's imagination. That, of course, entails
getting loads of media coverage. So we have to offer up scary
scenarios, make simplified dramatic statements, and make
little mention about any doubts we might have . . . each of us
has to decide what the right balance is between being
effective and being honest. There you have it. You can't say
that you haven't been warned. Big Science aggressively markets
its goods and services using proven promotional methods. Again
Luc Montagnier: "I'm a gambler out for a big killing. Like a
roulette player at the table, I'm addicted to getting results
out of my laboratory . . . people are making major discoveries
in other domains, but they receive none of the attention
accorded to AIDS [scientists]".
AIDS has the pizzazz of a sex terrorist. The craving for risk,
for danger as a stimulant, is apparent in the government's
current Travel Safe campaign. Overseas travellers are handed
an Australian National Council on AIDS glossy flier that
announces "AIDS: A WORLD TRAVELLER". Its bland message reminds
that the precautions urged domestically apply internationally.
But travellers may also be handed other information that
describes an alarming rise of HIV infection in Asia,
especially Thailand and India. By the year 2000, 40% of the
world's HIV infection will be in Asia; 15-22% of Thai sex
workers are already HIV+; 30-60% of Indian sex workers are
HIV+; 77% of the UK's heterosexually transmitted HIV was
acquired overseas, and so on. The titillating message is
clear. In the brothels of Bangkok, Calcutta and Manila, danger
lurks for incautious Australian men. The effect of the story
is heightened by not mentioning that the incidence of AIDS in
Australia is far higher than in any Asian country. The
entertainment version of this infotainment spectre was
circulated through pubs in the early days of the epidemic. A
joke tells about a businessman who took a Haitian beauty to
bed. On waking in the morning, he found her missing; but
written in lipstick on the mirror was the message: "Welcome to
the World of AIDS". Let's look at the eagerness with which
scientists have latched on to the craving for calamity.
Professor R. V. Short, a Monash University reproductive
biologist concerned about overpopulation, recently speculated
that the AIDS epidemic might prove to be the population crash
we had to have. Luc Montagnier stated in a Le Monde interview
that, "we will kill AIDS or it will kill us". In recent number
of the Scientific American, Gerard Piel stated that "at its
present rate of transmission, HIV will infect 200 million
people by 2010. The African share of the casualties might then
approach 100 million. "(p. 92) . The tide of doom reached its
highwater mark between 1985 and 1987. It was as if scientists
were in competition to launch the most titillating picture of
impending disaster. William Haseltine, Harvard AIDS scientist
and collaborator with Robert Gallo, declared the epidemic to
be "a major peril to our entire species. We haven't seen
anything that we can't control except nuclear bombs, that's of
this magnitude. We've got big problems". Another Harvard
scientist, Myron Essex, added the exhortation that "we must
act fast enough now so that we won't have 20-40 million
Americans infected 5-10 years from now". The action he
indicated was unstinting funding of AIDS research. Dr Matilda
Krim, Director of the Sloan-Kettering Cancer Institute, a
recipient of AIDS research dollars, likened AIDS to the 1918
influenza epidemic: "In ten years it could affect even a
million people [in the US]. Worldwide, it can be 10 million,
100 million. God knows." Jerome Groopman, MD, yet another
Harvard scientist, told a Discover Magazine reporter in 1986:
"This is much, much worse than anything I would ever have
envisioned. To think there are going to be a quarter of a
million people in the US alone with the disease by [1990]".
(The actual 1991 figure was 46,986). Pulling out all the
stops, Harvard celebrity Steven J. Gould told a New York Times
reporter that AIDS might eventually reduce world population by
25%.
Why didn't credible health authorities calm the feeding
frenzy? Because credible authorities instigated it. Consider
this authoritative statement of the orthodoxy in Confronting
AIDS (1986):
If the spread of the virus is not checked, the present
epidemic could become a catastrophe. The Institute of
Medicine-National Academy of Sciences Committee on a National
Strategy for AIDS therefore proposes perhaps the most
wide-ranging and intensive efforts ever made against an
infectious disease . . . a massive, continuing campaign should
begin immediately to increase awareness of the ways persons
can protect themselves against infections.
The media loved it. Editors and television producers groomed
their symbiotic relationship with experts. HIV mutated to the
Media Transforming Virus. The more the media craved calamity,
the more forthcoming scientists were. Big-name entertainers
got into the act as well. Rock Hudson has been mentioned.
Randy Shilts credits his celebrity with collaring
free-floating anxiety and sympathy and directing it toward the
disease. Benefit concerts and candlelight vigils were held.
Comedians diverted audiences with AIDS jokes. Phil Donohue and
Oprah Winfrey squeezed the story to the last tear. Oprah
beguiled her viewers with a stupendous spectre: "Research
studies now project that one in five heterosexuals could be
dead from AIDS at the end of the next three years. That's by
1990. One in five. It is no longer just a gay disease. Believe
me." They loved it. Oprah knows entertainment. America
exported AIDs infotainment to Oz. Here is Glynns Bell in The
Bulletin cover story of 17 March 1987.
He is a victim of the AIDS holocaust, a disease that is
insidiously spreading through nearly every country in the
world. Caused by a treacherous and slow-acting virus, it knows
no national borders, no age or sex, no color, creed or race.
It has already infiltrated Australia and lies silently poised
to strike at the heart and health of the country.
After pausing to note that this evocative image is discordant
with the actual number of AIDS cases, Bell sugar-coated dull
facts with an exciting fantasy: "But the time bomb is ticking.
Australia is counting down to the moment when AIDS stops being
a localised firefight and, like herpes, become all-out warfare
on the general population". Our newspapers were an obliging
conduit from the World Health Organisation's epidemic hyping.
WHO created the monster figures on African AIDS by multiplying
reported AIDS cases and infection by 100. Journalists were
delighted at the prospect of catastrophe. Thus the Sunday
Express, in 1986, reported excitedly: "the deadly disease AIDS
is now so out of control in black Africa that whole nations of
people are doomed, leaving vast areas of now populated land
devoid of a single living person within the next ten years".
The justification for balancing truth with effectiveness was
what WHO AIDS director Jonathan Mann, MD, called the "hidden
factor". The hidden factor is the AIDS cases not counted
because they haven't been reported. African doctors didn't
know whether to laugh or cry at this showmanship. After asking
"Where are all the graves?" Dr. Konotey-Ahulu went on to pose
a second question: "Why do the world's media appear to have
conspired with some scientists to become so gratuitously
extravagant with the untruth?" Mann pontificated about
Australia too. In 1987 he predicted 15, 000 AIDS cases by
1991. The actual figure turned out to be about 1000. Mann has
since left WHO for an AIDS post at Harvard, but his legacy
lives on. WHO recently projected 120 million HIV+ persons
world-wide by the year 2000. This figure is obtained by
pumping up Asian infection rates in the same way that African
AIDS was hyped. Its most recent extravaganza is a claimed
sevenfold increase in the number of Asian AIDS cases in just
one year. Dr Gordon Stewart, an epidemiologist at the
University of Glasgow, made a study of WHO predictions and
actual outcomes. He found that they erred from ten to a
hundredfold. At the same time he made his own predictions
based on the standard computation for viral contagion. His
predictions match the data on AIDS cases and suggest, as Peter
Duesberg has also suggested, that HIV is an old virus that
long since reached stability in human populations. He writes:
"Nobody wants to look at the facts about the disease. It's the
most extraordinary thing I've ever seen. I've sent countless
letters to medical journals pointing out the epidemiological
discrepancies and they simply ignore them . . . this whole
heterosexual AIDS thing is a hoax."
Here are some of the facts supporting Stewart's case. In
1990-1, the number of confirmed female-to-male transmissions
of HIV in New York was one. Since 1981, out of 30,943 cases of
men with AIDS in New York, there are only 11 confirmed
male-to-female transmissions. Africa is not dying of AIDS. In
Uganda, of 1 million HIV+ persons, there are only 8000 AIDS
cases; in Zaire there are 4636 cases for 3 million HIV+
persons. The cumulative total of AIDS cases for the African
continent is 152,463 as of 1992. But we must bear in mind that
African AIDS is clinically completely different from First
World AIDS. The major categories are not PCP and KS, but
traditional African illnesses such as tuberculosis, diarrhoea,
and fever. There is no new mortality. A special definition of
AIDS for Africa, the Bangui definition, greatly inflates the
number of sicknesses counted as AIDS. The definition
disassociates AIDS diagnosis from an HIV+ test. No wonder the
continent seems to be swallowed by the epidemic.
6. Junk science goes belly-up
I knew that if this retrovirus was the cause of AIDS . . . we
would need to convince the academic community as totally, as
widely, and as quickly as possible.
-- Robert Gallo.
Scientists in the United States are forced to produce results,
which sometimes warps their sense of ethics.
-- Luc Montagnier.
The incredible Gallo incident will be a scar on the history of
science.
-- Don Francis
Gallo was certainly committing open and blatant scientific
fraud.
-- Joseph Sonnabend.
Australian AIDS science is a mosaic of research whose key
elements stem from Robert C. Gallo, MD, Director of the
Laboratory for Tumor Cell Biology, National Cancer Institute.
He made world headlines in April 1984 as the discoverer of the
"AIDS virus". The media rejoiced that the path to vaccine
prevention of AIDS was open, and that a vaccine was likely be
ready for trial in two to three years. His contribution did
not end there. Dr Gallo devised a test for the presence of the
virus and mastered the art of growing the virus in the large
quantities needed for research. The media applauded that lives
would be saved by protecting blood banks and that accurate
epidemiological work could now be undertaken.
The worldwide conviction that HIV is the cause of AIDS dates
from this moment. The event was packaged to produce optimal
belief. Health Secretary Margaret Heckler greeted the press
conference in the National Academy of Sciences auditorium
packed with journalists and television crews. She declared
that "today we add another miracle to the long honor roll of
American medicine and science. Today's discovery represents
the triumph of science over a dreaded disease." The discovery
was a sorely needed answer to the chorus of critics who
complained that the Reagan administration was doing too little
to combat AIDS. Heckler dazzled critics with Gallo's American
"miracle " and reminded the public of the gratitude it owed to
medicine for triumphing over "dreaded disease". Then it was Dr
Gallo's turn. He outlined the science of his virus, HTLV-III,
emphasising that it had been shown to cause immunosuppression.
He discussed his work's relationship to other research,
particularly the work of the Pasteur Institute, and conceded
that HTLV-III "may be" the same as the Institute's LAV virus.
The journalists reporting this event didn't notice the
telltale signs that there was something fishy about the
occasion. A obvious anomaly was that the announcement was made
prior to publication of the articles presenting the evidence.
A firm rule of scientific publication bans this practice. It
hobbles the critical reception because scientists cannot
comment on research that they haven't seen. Further,
prepublication celebrity suborns scientists to see in the
articles what the media have acclaimed. In this case the
priming was unusually strong. By designating Gallo's findings
the shining path to victory over AIDS, Secretary Heckler in
effect laid down the orthodoxy governing AIDS research
funding. But this in turn set limits to critical opinion. As
it happened, there were quite a few scientists who gave
Gallo's claims little credence. But their voices were not
heard because journalists didn't search for critical comment;
and in a very short time the orthodoxy was so entrenched that
critical views seemed aberrant, even "loony".
The other visible anomaly was the Pasteur virus. On the day
prior to the press conference, The New York Times published a
frontpage story sourced to Dr James Mason, the CDC chief. He
gave full credit to the Pasteur team for isolating the new
retrovirus a year previously, for proving that it caused AIDS,
and for developing immunoassay tests. On the surface, this was
only a priority dispute that left a Cabinet member furious
that a subordinate had rained on her picnic. But had reporters
looked beneath the surface, they would have found significant
misconduct stemming from rivalry but also doubts that either
virus was pathogenic. Here are a few things that journalists
missed at that crucial moment in the creation of AIDS
science.
- Dr Joseph Sonnabend, then head of the AIDS Medical
Foundation in New York, had been close to Gallo's work. He was
well aware that Gallo had tried to convince peers that his
HTLV-I, isolated in 1980, was the long-sought cancer virus
(leukaemia). Gallo was largely successful but there were
doubters. When AIDS came along, he appropriated Don Francis'
concept that a retrovirus was the probable cause and pressed
for HTLV-I as the cause of AIDS. Sonnabend states that "when a
few colleagues and I tried to show that HTLV was not involved
in AIDS, all the journals refused to publish it". He and his
colleagues were aware that the Pasteur claims for LAV were
guarded. Not all of their small sample of AIDS patients tested
positive. They claimed to demonstrate only modest
pathogenicity for LAV. Montagnier himself believed that LAV
was only one agent in a mix that caused AIDS. Gallo went well
beyond these tentative results, and indeed this difference was
the basis of his claim to have discovered the AIDS virus.
However, Sonnabend was among the inner circle who believed
that Gallo's AIDS virus was simply the Pasteur virus under a
new name. Sonnabend states that on hearing the announcement of
Gallo's discovery: "I remember feeling sick to my stomach. I
wanted to protest, but all my colleagues told me to just keep
quiet. None of the science reporters seemed to see what was
going on."
- Dr Michael Lange, of St Luke's Hospital in New York City,
was at the Pasteur Institute at the time of the announcement.
Aware of the tentative claims made for LAV, he was dumbfounded
by Gallo's extravagant claims. He writes: "The cause of AIDS
was discovered by government fiat . . . from that point on
AIDS research turned into seedy, criminal politics, and it
remained that way".
- The originator of a technique used in all AIDS laboratory
research, Nobelist Kary Mullis was also flabbergasted. "Why
they did it I cannot figure out," he later said. "Nobody in
their right mind would jump into this thing like they did . .
. it had nothing to do with any well-considered science. So
[Gallo] had a correlation. So what?"
- Peter Duesberg was also taken aback. He knew that passenger
retroviruses were numerous among animal species; there was no
reason why the human genome shouldn't host them as well. He
believed that no known animal retrovirus attacks its host by
killing cells, but here was Gallo claiming that it clobbers
the entire immune system. Yet this it did only after 1981.
Duesberg was suspicious.
- The Pasteur Institute had become ensnared in Gallo's web
from the moment Luc Montagnier decided to commit resources to
the viral search. Their perception was that Gallo had the
ambition and the means to preside over world virological
research. Team member Jean-Claude Chermann characterised the
labours at Pasteur as a sort of involuntary subsidiary of
Gallo's empire. "For any research project, we needed the great
god Gallo's blessing", he lamented. "It was only in that way
that we would be taken seriously by our own bosses and wrest
the necessary finances from them. Poor backward creatures that
we were, we needed American sanction." A French journalist
reviewing the contest in 1990 wrote of Gallo that "his
sovereign grip on world virological research was in fact so
absolute that no major discovery could hope to be recognised
without his having approved it himself". Gallo struggled with
the Institute for control of the AIDS virus, although he
always behaved as if the relation were cordial. He used his
influence to throw stumbling blocks in the path of the
Institute. When the Pasteur team submitted their original
findings to Nature, the submission was rejected with the
comment: "The virus you claim may only be the result of
contamination in the laboratory . . . wait a little while
before making your results officially known. Follow Gallo's
example. He worked for two years before publishing his
findings on the first human HTLV retrovirus." (When Montagnier
launched his Mycoplasma hypothesis, Gallo hosed it down by
saying that evidence too was a contamination artefact.)
Relations between Gallo and the Pasteur Institute became
hostile when the US Patent Office shut the door on the
Institute's application for an immunoassay patent. The
Institute made its initial application for a US patent in
1983, but it stalled. Gallo and the US Department of Health
applied for a patent on the day of Heckler's announcement. It
was granted almost at once. The French cried "Foul!" The
public wrangling threatened to undermine the integrity of AIDS
science. It was settled by an unprecedented agreement between
heads of state (Reagan and Jacques Chirac), which gave a
percentage of US royalties on test kits to the French.
Although Gallo and Montagnier professed satisfaction with this
outcome, the "kiss and make up" arrangement was part of the
deal. In reality the French believed that they had scored only
a small victory over "Robert Gallo's steamroller". The French
actually believed that Gallo had no rightful propriety in the
kits because his virus and his cell lines derived from their
virus. In June 1994, the Director of the Pasteur Institute
renewed the old objections. Dr Maxime Schwartz wrote to NIH
Director Dr Harold Varmus that the agreement must be
renegotiated because the previous agreement was based on "a
cover-up of the true facts" and "deliberate fabrication" that
gave a specious basis for American claims. "The French test
kit was developed in the absence of any input from the
American scientists," Schwartz told Varmus, "whereas there is
no evidence that the American test could have been developed
if the American scientists had not received the French virus."
The Americans agreed to renegotiate, and after strenuous
bargaining, the French demands were met. The reason probably
was that Schwartz's letter coincided with a detailed report,
in June 1994, by the Inspector-General of the US Department of
Health and Human Services on the issues between Gallo and the
Pasteur Institute. The report finds entirely in favour of the
French. It states that Gallo obtained his patent by unlawfully
concealing relevant information from the patent office
attorney; that he admitted this unlawful act; that Pasteur
scientists were first to discover the AIDS virus, to isolate
it successfully from several AIDS patients, to describe it in
a scientific article, and to use it to make a diagnostic blood
test for antibodies to the AIDS virus. In short, miraculous
American science has no entitlement at all to patent, or to
patent royalties, or to credit for discovering the AIDS virus.
Professor Frederick Richards, who headed a previous
investigation of Gallo's misconduct, called for misconduct
hearings to be reopened. He referred to a 1987 study of
similarities between the Gallo and the Pasteur viruses that
was concealed from his committee. The study, by the Los Alamos
National Laboratory, asserted that Gallo's claim to
independent discovery was a "double fraud". "The major purpose
of this whole investigation", Richards stated "was to find out
whether [Gallo's lab] stole the [Pasteur] virus. The answer
is, they stole the virus. But [my committee] didn't know that
at the time."
These are the latest of a long series of findings of
misconduct in the Gallo laboratory. A previous investigation
the Office of Research Integrity found that Gallo lied when he
denied growing the French cell culture in his lab; that he
"misrepresented and misled in favour of his own research
findings or hypotheses"; that his lab management was
"irresponsible", especially in his inability to document
crucial steps of his experiments; that the photo of HTLV-III
published with his path-breaking viral discovery was identical
to the photo published by the Pasteur team a year earlier;
that he reported in a Lancet article no adverse reactions to a
trial vaccine when in fact both (African) subjects of the
trial had died; that one of his staff and co-authors was
convicted of a felony in connection with research, while his
deputy laboratory chief was indicted. Nor is that the end of
it. In June 1994 researchers challenged a Gallo study
purporting to demonstrate the therapeutic value of a compound
to treat KS. The study seemed methodogically suspect to the
University of Arizona team. The statistical data seemed
irregular and the photos published with the article did not
seem right. So they undertook to replicate the findings. They
even replicated an experimental error that they suspected
might account for the dubious results. The attempt was
unsuccessful. Their original suspicions were confirmed and
they reported "serious systematic errors and omissions". The
implication of their critical article was that Gallo's
evidence of therapeutic benefit was at best unsound and at
worst faked. The Arizona team submitted their findings to
Science, the publisher of Gallo's paper. The journal's
reviewers rejected the submission on the grounds it was
"without serious merit and their experiments are an
extraordinary waste of time and effort". They accordingly
submitted to the Journal of the American Medical Association,
which printed it together with an explanation of the article's
rejection. The authors stated that the most troubling aspect
of the contretemps "has been the reticence and obstacles
encountered to public airing of our questions and the
inability of the peer review process to correct itself once
errors and inconsistencies were pointed out and bolstered by
further experimentation". Another aspect of the case was
conflict of interest among the co-authors of the Gallo
article. One was a scientist on the staff of the
pharmaceutical firm that manufactures the compound whose
benefits were validated.
What does this expose of chicanery mean for the evaluation of
the hypothesis that HIV is the cause of AIDS? In the first
instance it shows once again that peer review, the supposed
watchdog of science's quality and integrity, is heavily
compromised by patronage loyalties. It is awesome that Gallo's
plagiarism of the Pasteur micrograph of HIV could be published
in the same journal without the plagiarism being detected by
either the submission's reviewers or the journal editor. Some,
of course, noticed the plagiarism straight away. In the ideal
world that science is said to occupy, a letter pointing out
this serious misconduct would have been sufficient for a
retraction and the offender's dismissal. In the event, a
costly and protracted high-level investigation was needed to
establish this banal fact. Even then Gallo successfully
defended himself by a diversionary tactic. The institutional
rule that chiefs bear responsibility for the work of their
subordinates was derailed by the simple device of blaming the
lab photographer for a "stupid mistake". Gallo was not
dismissed nor was his prestige visibly impaired.
This is a cameo of the science culture in which sleaze
thrives. At every stage of the rise and progress of the HIV
hypothesis toward dogma, its influence is apparent. The belief
that HIV is the necessary and sufficient condition for AIDS
depends on the credibility of Gallo's initial claims to this
effect. The Pasteur team made this claim only tentatively. It
was converted to a certainty by a promotional campaign
conducted in the scientific press. The first shot was fired by
the New Scientist, which published a story touting Gallo's
findings in early April 1984. The story was based on science
writer Martin Redfearn's interview with Gallo, who had
provided him with prepublication copies of the Science
articles. The New Scientist resisted all entreaties by Gallo's
British colleagues that publication prior to the appearance of
the Science articles was unethical. The CDC then moved quickly
to spoil Gallo's triumph. It had allied itself with the
Pasteur Institute in a power struggle with the National Cancer
Institute. It planted The New York Times story through The
Times' science writer, Dr Lawrence Altman, who had been a CDC
scientist. The Gallo side struck back through its London ally,
Nature, which published its review of Gallo's discovery only
four days after the press conference. The article's title left
no doubt: "Causation of AIDS Revealed". The subtitle stated
that "the retrovirus responsible for AIDS has been identified
by Gallo's group at NIH; Montagnier's group in Paris has
helped". By assigning the Pasteur Institute a position to the
rear of Gallo in the Nobel prize queue, the author reversed
the implication of The New York Times article that Gallo did
nothing more than to discover the Pasteur virus a second time.
The Nature article claims that Gallo's publications provide
"compelling evidence for a primary association of this virus
with the disease". The author was Jerome Groopman, MD, one of
Gallo's Harvard friends.
Thus, within a period of one month, four highly credible
publications endorsed the idea that the cause of AIDS had been
"revealed". To reveal the discovery, these publications had to
conceal the fact that AIDS science had not advanced since
Montagnier's modest claims a year earlier. The modest claims
were inflated by the Pasteur side solely to counter Gallo's
overreaching. The exercise is a classic case of ambition
interacting with media celebrity to create convictions
unsupported by evidence. The process is called "truth
management" - the orchestration of prestige and authority to
create, from the fallible surmises of a small group of
friends, the appearance of incorrigible certainty girding the
Earth. The basic trick is to capture the free-floating human
sense of recognition (the Eureka feeling) and weld it to a
specific set of beliefs. This effect automatically converts
into certainty any belief to which it is attached. Generally
speaking, truth management is merely one application of the
arts of persuasion, promotion, and propaganda. It is not
distinguished by the novelty of its devices, but in the
boldness of their application to the one patch of modern
culture that is supposed to be impervious to these arts. The
details of the promotion of the viral theory show that
managing truth is not an occasional lapse from rigid
integrity. It is an indispensable tool, used daily by editors,
grant bodies, policy-makers and the like, to shape the
direction of otherwise "chaotic" science. To use an economic
analogy, it replaces individualistic laissez-faire in
discovery with "research management plans". Managed truth need
not be any more delusional than the laissez-faire alternative.
The mystique of authority and the charisma of Eureka are human
constants not easily eliminated from social processes. Life
would be the poorer without them. Research management schemes
instituted in the wake of the Dawkins reform of the tertiary
sector were a response to the chaos of many thousands of
academics pursuing their individual or small-group
convictions. Those schemes are similar to corporate or
defence-sector research management, both of which have yielded
a harvest of useable discoveries over long periods. But there
is skilful and unskilful management. Looking back on AIDS
research management, the error was to place all the funding
eggs in the one basket of the HIV hypothesis. Circa 1983-4,
there were congeries of supportable hypotheses about the cause
of AIDS. It was appreciated that the uncertainty of hypotheses
stemmed from basic ignorance about the immune system. This
predicament suggested that as research advanced, hypotheses
would rapidly change, at the very least in the direction of
refinement. The prudent strategy, then, would have been to
support research along different tracks, to provide insurance
against placing all bets on one horse that might not finish.
The opposite strategy was the one chosen. The choice was never
explicitly evaluated. The evaluation process was pre-empted by
a coterie who mystified AIDS research by engineering the
conviction that HIV is the cause of AIDS. The downstream costs
were predictable. When all funding for research intended to
have an urgent public use is placed in one basket, the funding
body is left empty-handed if the hypothesis is barren. Public
commitment to a barren hypothesis introduces another prestige
factor making it difficult to revise the hypothesis. That
factor is the loss of face involved in admitting error. The
need to keep up the appearance of the reliability of the
scientific consensus thus locked AIDS science into a no-win
predicament that becomes ever more intransigent as the
futility of the hypothesis becomes ever more apparent.
7. Medicine and human suffering
Also if you don't get AIDS, you die.
-- Zen Master
Most people want salvation in six easy lessons. This is not
possible.
-- Darryl Reanney
When the first attempt at gene therapy was approved after
years of debating its ethics, the medical team's PR section
released a human-interest story about the team and the
patient. The story was meant to disarm widespread suspicion of
"gene doctors" by replacing stereotypes with living persons.
The project was described, and the team chief commended its
therapeutic promise by saying: "My ambition is to take the
word 'incurable' out of the English language". This is yet
another expression of the bizarre mingling of science with
fantasy that RenŽ Dubos called "the mirage of health".
Although the mortality of mortals is plain to see, doctors and
the public act out elaborate "conquering disease" fantasies
that mute and forestall fate. The charade is bizarre because
it looks so much like perjury. On one level, doctors know that
the therapeutic benefits of gene therapy lie well in the
future, and that at best they will be enjoyed by a few, at
great cost. As for eliminating genetic diseases, that could
happen only in a world that we do not inhabit. But on another
level, doctors and patients somehow believe the hopeful
fantasy.
In a wise book, The Death of Forever, Darryl Reanney pondered
the human predicament before death. Animals are exempt from
it, he explains. Although they know fear, they do not
experience death anxiety because they lack self-consciousness
and foresight of the future. When the brain of Homo sapiens
evolved to the point where individual finitude could be
grasped, our kind struck a crisis of consciousness.
Self-consciousness functions as the handle on the self-control
necessary for tool-making and the wide latitude of action that
we call "choice". In that sense the evolution of
self-consciousness was the watershed for the species that
would soon dominate the earth. But the individual's awareness
of death undercut motivation by placing the futility of action
on display. "Shit happens, then you die", as our depressed
youth say. The solution to the crisis, Reanney thinks, was a
manipulation of consciousness through mythopoetic
psychotherapy. Early Man denied the finality of death by
placing individuals in a cosmic setting that linked ancestors,
the living, and coming generations in one great chain of
eternal life. The mythopoetic masking of death served
civilisation until scientific enlightenment precipitated a new
crisis of consciousness. The mythopoetic vision was attacked
as illusory. It was replaced by the mechanical world in which
the finitude not only of individual consciousness, but of the
Earth and the solar system, was affirmed in all its brute
factuality. On this vision, the human species is a nervous
mote disporting for an evolutionary millisecond prior to its
certain extinction. In the meantime, we are diverted by the
many recreations of the consumer society. Reanney's book is
meant to show how the sense of immortality can be recovered by
rethinking science and consciousness. While this is an
important initiative, his meditations are of concern here for
the light they shed on human suffering. He shows that its root
is independent of sickness. The fundamental human suffering is
knowledge of mortality. What to do? The culturally sanctioned
solution, Reanney believes, is "the pursuit of happiness", or
"pleasuring". That's the attractive road to salvation, but its
effect is to deepen the malaise. The authentic road to
salvation passes through the anguish of acceptance of death;
one must die many times. Reanney writes: "Is this then the
meaning of life? To struggle, to bleed in silence, to grow
through suffering? Is comfort the necessary adversary of
growth? . . . My answer has to be -yes"."
This is the wisdom of traditional religion and morality.
Reanney reaffirms it even though he is a secularist with no
brief for organised religion. When his book appeared in 1991,
it occasioned disquiet among our intelligentsia because an
important voice seemed to have turned reactionary. Reanney
himself thought that he was facilitating the evolution of
consciousness to a higher stage, but for that it was needful
to identify the "missing centre" of the secular culture. What
is the application of Reanney's wisdom to medicine? The
mission of medicine has traditionally been to heal where
possible, to comfort always, and above all to avoid harm.
Until a few decades ago, the mission was adjunct to faith
healing of many kinds. However, as the technical prowess of
medicine increased, physicians promised more and their public
insensibly cast them into the role of healing wounded souls.
Psychiatry and counselling were testimony that the whole
healing function could be "medicalised". Medicine assumes that
human suffering is rooted in pathology. Reanney says that it
is rooted in consciousness of self, whether well or sick. If
that is so, medicine relieves pain but leaves human suffering
untouched. Medicine is indeed so secondary to essential human
suffering, as Reanney understands it, that its relevance to
his theme did not even occur to him. Many doctors know from
constant experience that sickness, pain, and suffering run on
separate tracks that only occasionally converge. The infertile
woman who suffers from child absence is healthy and
experiences no pain, but the anguish may be acute. Despite
this, our culture assigns to medicine the mission of relieving
suffering. The role assignment springs from our belief in a
technological fix for all "problems". The upshot is that the
more we apply medicine to the relief of suffering, the more we
increase it. That is why "health consumers" pose so great a
challenge to "health delivery systems". They are in uproar
because they believed the promise that medicine would relieve
their suffering and then found that it didn't. Representative
of this pandemonium are the words of Kimberly Bergalis. Days
before she died, as she believed, of AIDS acquired from her
dentist, she spoke her mind to Florida health authorities: "I
blame Dr Acer [the dentist] and every single one of you
bastards. Anyone who knew that Dr Acer was infected and had
full blown AIDS and stood by not doing a damned thing about
it"
This is a curse. It is directed at a practice that the Florida
Board of Health adopted in good faith as a best practice
standard. The internationally accepted norm is that since AIDS
cannot be communicated by casual contact, there was no
rational ground for compelling health workers with AIDS to
withdraw from attending patients. In addition, there are
strong human rights reasons for allowing them to continue.
Kimberly also cursed the doctor who urged her to take AZT
therapy although she had no AIDS symptoms. She fell ill with
oral thrush and the symptoms of chemotherapy toxicity.
Kimberly's curse expresses the dilemma of medicine. Her death
was not due to lapses from best practice, but to adherence to
best practice. Kimberly cursed because she had not resolved
herself to mortality. Like most "health consumers", she
trusted assurances that medicine relieves suffering. The shock
of being killed first by her dentist and then by her doctor
was not an outcome that trust had prepared her to accept. So
she cursed. The institutional response to medical injuries is
health rights commissions that receive and evaluate
complaints. The remedy assumes that valid complaints stem
mainly from unskilful or negligent service, and that they can
be remedied by better training and increased institutional
vigilance. Health ministers extol this remedy and no doubt it
is an important safety valve. However, it does not meet the
problem of suffering. Many complaints fall into the Bergalis
category of an undesired outcome from standard practice-of
unavoidable "side-effects" of the system. As for mispractice
and malpractice, they too must have a statistical incidence
regardless of improvement. But no one wants to be a statistic.
Our present commitments to health care clients were greatly
increased by the High Court in Rogers v Whitaker (1993). The
patient, Mrs Whitaker, sued her physician because the outcome
of an elective operation on her blind eye to restore its sight
went wrong. Vision was not restored to the blind eye; in
addition she lost vision in her sighted eye. The blinded Mrs
Whitaker felt herself victimised. She had questioned the
physician closely on possible adverse side-effects, but he
advised that there was none. The facts as presented to the
court were that Dr Rogers was aware of the possible outcome,
but since it occurs in only 1 in 14, 000 operations, the risk
was too low to warrant mentioning. Accepted practice was cited
as supporting this decision. The court took another view. It
ruled that best practice by professional standards does not
necessarily express the best interest of the patient. Best
practice may only "serve the interests or convenience of the
members of the profession". As a result, physicians are now
under an exacting "duty to inform" patients of all facts that
a reasonable person may regard materially relevant to their
decision to accept or refuse a treatment offered by the
physician. Is this duty to inform honoured in AIDS medical
practice?
While state and commonwealth AIDS publications acknowledge the
requirement of informed consent and the right to refuse
treatment, the approach to AIDS is largely paternalistic. The
National HIV/AIDS Strategy booklet (1993), for example,
discusses AIDS education, research, and counselling services
without mentioning the toxic effects of the only therapy in
use and without mentioning that scientific opinion is divided
about whether AIDS is caused by a viral agent. The harmful
effects of recreational drugs are not mentioned. There is no
documentation of the informing process used in offering HIV+
patients AZT therapy. Hearsay suggests that considerable
pressure is sometimes brought to bear. Patients are apparently
made to feel that if they do not accept the therapy, they are
letting the doctor down and may jeopardise their future care.
This indeed is typical clinical experience regardless of
illness, and it is the reason why gay health advocates have
insisted on the right to refuse treatment. Public
pronouncements of leading AIDS doctors are a guide to
physician attitudes that patients are likely to encounter in
the clinic. Some months ago press coverage of the challenge to
the orthodoxy brought a flurry of public statements. Professor
Ron Penny, Director of the Centre for Immunology at St
Vincent's Hospital in Sydney, said flatly: "That issue is a
load of rubbish. There is absolutely incontrovertible evidence
that HIV is prerequisite for the development of AIDS. The
question about HIV is not under debate except by the loony
fringe." Professor John Dwyer agreed. The challengers, he
stated, are a "no longer credible minority" who are
"mischievous and egocentric". Professor John Mills, Director
of the National Centre for HIV Virology Research, chided The
Australian for "the worst form of irresponsible journalism" in
publishing dissident views "without consulting" world experts
like himself. Such comments confirm the allegations of "AIDS
dissidents" that the orthodoxy they criticise is kept in
countenance by aggressive intolerance. By branding critics
"loony", critics are pathologised and placed beyond the pale
of rational debate. This is an indirect way of saying that the
tenets of AIDS science are sacrosanct. "Loony" also conveys
the impression that the critics lack credentials, whereas many
are scientists of high achievement while others are
knowledgeable gay health activists. To acknowledge this fact,
however, would be equivalent to acknowledging that AIDS
science is in a state of flux and uncertainty. If this is the
response to fellow scientists, what would be the chances of a
patient who accepted at face value commonwealth and state
pledges to "empower" patient participation in medical decision
making? Would they be abused? If not, would there be any
willingness to discuss with patients concerns they might have
about particular aspects of AIDS science, such as the validity
of their test result? It seems unlikely. The dogmatism of AIDS
doctors effectively nullifies the pledge of patient
participation in decisions affecting their own health. It also
scuttles informed consent despite Rogers v Whitaker. AZT is
strongly promoted as a therapy. But if patients were informed
of the findings of the very medical scientists who give this
endorsement, they would learn that in a trial of 308
Australian patients, 30% died within 1-1.5 years of AZT
treatment; one or more new AIDS diseases appeared in 56% of
patients within a year; that side effects include leucopenia
(80%), anaemia (20%), and nausea (30%). Let the reader put the
informed consent test laid down in Rogers v Whitaker: if I
were HIV+ but had no symptoms, would I consider such
information material to my decision to accept or decline the
therapy? If the answer is "yes", another question follows: why
aren't HIV+ patients given information about the toxic effects
of AZT, the insecure clinical basis of its prescription, and
the unreliability of the AIDS test?
The experience of AIDS medicine tends to confirm that the
origin of human suffering is anxiety of death. Its vision of
calamity was not confected from the morbid anxieties of those
sick to death, nor from the depths of extreme pain, but sprang
from the minds of well medical scientists. The vision of mass
death expresses, I have argued, the trauma of a profession
that has assumed responsibilities beyond its capacity to
deliver. The inflation of a small number of sick persons into
an imaginary gigantic pool of suffering, and the urgency of
"saving lives" from an unknown virus, started an odyssey that
courses through fraud in Dr Gallo's laboratory, the
helplessness of accountability systems to detect and penalise
the fraud, and the haunting curse of Kimberly Bergalis. Our
health system is fortunately not in the advanced state of
crisis afflicting America. But we seem to be doing our best to
catch up. AIDS science and AIDS culture are American imports.
Our philosophy of health services does not differ greatly from
American philosophy. We believe that health care administers
essentially to human suffering whereas the alternative view is
that suffering springs from the nature of self-consciousness.
Suffering, like death, must according to Reanney and the Zen
master be lived through. There is no salvation in six easy
lessons. The choice lies in how suffering is lived through.
Presently we travel down the fork in the road that leads to
Kimberly's curse. There are many Kimberlys among us. But we
can retrace our steps, scale down our expectations of
medicine, and travel the alternative path on which suffering
is transfigured by its meaning. In the case of AIDS, retracing
the steps places the burden of suffering on the medical
profession's recognition that a phantom epidemic symbolises
its misconception of the aims of medicine.
8. Bibliography
Adams, Jad. AIDS: The HIV Myth. New York: St Martin's Press,
1989.
Cassell, E. J. The Nature of Suffering and the Goals of
Medicine. New York: Oxford University Press, 1991.
Commonwealth of Australia. AIDS: A Time to Care, A Time to
Act: Toward a Strategy for Australians. Canberra: AGPS, 1988.
Commonwealth of Australia. National HIV/AIDS Strategy,
1993-94 to 1995-96. Canberra: AGPS, 1993.
Connor, Steve. AIDS: Science Stands on Trial, New Scientist
12 February 1987, 49-58.
Dingell, J. D. Misconduct in Medical Research. New England
Journal of Medicine 328 (1993): 1610-1615.
Duesberg, Peter. AIDS Acquired by Drug Consumption and other
Noncontagious Risk Factors. Pharmacological Therapy 55 (1992):
201-277.
Duesberg, Peter. Retroviruses as Carcinogens and Pathogens:
Expectations and Reality,.Cancer Research 47 (1987):
1199-1220.
Dwyer, John. The Body at War: The Story of Our Immune System.
2nd ed. Sydney: Allen and Unwin, 1993.
Fisher, Jeffrey A. The Plague Makers: How We Are Creating
Catastrophic New Epidemics-And What We Must Do to Avert Them.
New York: Simon & Schuster, 1994.
Francis, D. P. The Search for the Cause. In The AIDS
Epidemic, K M Cahill (ed.), New York: St Martins, 1983.
Fumento, M. The Myth of Heterosexual AIDS. Basic Books: New
York, 1990.
Gallo, Robert. Virus Hunting. New York: Basic Books, 1991.
Goss, Kathleen and Michael Weiner. Maximum Immunity. Boston:
Houghton Mifflin, 1986.
Groopman, J. E. Causation of AIDS Revealed. Nature 308
(1984), 769.
Institute of Medicine/National Academy of Sciences.
Confronting AIDS: Directions for Public Health, Health Care,
and Research. Washington, DC: National Academy Press, 1986.
Kaslow, R. A. and Donald P. Francis, (eds). The Epidemiology
of AIDS. New York: Oxford, 1989.
Papadopulos-Eleopulos, E. Reappraisal of AIDS-Is the
Oxidation Induced by the Risk Factors the Primary Cause?
Medical Hypotheses 25 (1988): 151-162.
Papadopulos-Eleopulos, E., V.F. Turner, and J. M.
Papadimitriou. Is the Western Blot Proof of HIV Infection?
Bio/Technology 11 (1993): 696-707.
Reanney, Darryl. The Death of Forever: A New Future of Human
Consciousness. Sydney: Longman Cheshire, 1991.
Root-Bernstein, Robert. Rethinking AIDS: The Tragic Cost of
Premature Consensus. London: Macmillan, 1992.
Wecht, Cyril H. The Swine Flu Immunisation Program:
Scientific Venture or Political Folly? American Journal of Law
and Medicine 3 (1977), 425-445.
9. Glossary
Acquired Immune Deficiency Syndrome (AIDS). A disorder of
immunity characterised by abnormalities of immunoregulation
and opportunistic infections.
Antibody. A component of the immune system produced in
response to exposure to antigens. Antibodies help eliminate
infectious microorganisms in the body.
Antigens. A foreign molecule that stimulates the production
of antibodies.
AZT (zidovudine). A chemotherapy drug used to slow the
progression of AIDS diseases by preventing viral replication.
Its side-effects include leucopenia, anaemia, and nausea.
Like all chemotherapy drugs, AZT is immunosuppressive. Cecil
1095
Cell-mediated immunity. A defence mechanism involving the
coordinated activity of two subpopulations of T lymphocytes,
helper T4 cells and killer T8 cells. Helper T cells produce
substances that stimulate and regulate other cells of the
immune system.
Cofactor. A factor other than the basic causative agent of a
disease that increases the likelihood of the disease
developing.
Cytomegalovirus (CMV). A virus belonging to the herpesvirus
group, commonly associated with infections of patients who
have received medical treatment involving immune suppression.
In AIDS patients, CMV may produce pneumonia and inflammation
in various organs.
Cytopathic. Disease-induced change to cells.
ELISA. Enzyme-linked immunosorbent assay, a test used to
detect antibodies against HIV in blood samples.
Encephalopathy. Any degenerative disease of the brain. It is
a major AIDS-defining illness although it is not necessarily
caused by an infectious agent.
Gay men. A subgroup of homosexual men who identify themselves
with the gay community sharing a common identity.
Haemophilia. A rare, hereditary bleeding disorder of males
due to deficiency of Factor VIII blood-clotting proteins.
Health. The state of physical and mental well-being,
characterised by the absence of disease and infirmity.
Human Immunodeficiency Virus (HIV). A nine kilobyte
retrovirus of the lentivirus family, believed to be cytopathic
of T and B lymphocytes and haematopoietic stem cells, and
associated with two types of cancer, encephalopathy, and 26
opportunistic infections.
Human T-cell lymphotropic virus type III (HLTV-III). The name
given in 1984 to isolates of the supposed AIDS-related
retrovirus, called "HIV" since 1986. The isolate was not, as
originally believed, of the HLTV family.
HHV-6. A ubiquitous virus of the herpes family proposed as a
cofactor with HIV in the aetiology of AIDS.
Immune system. A group of cells that confer protection
against infectious agents. The cells are B and T lymphocytes
and monocyte-macrophages. The products of these cells are
antibodies and lymphokines. Much of the damage caused by a
wide range of diseases is due to abnormal immune system
responses.
Immunosuppression. The diminution of immune response.
Kaposi's sarcoma. An inflammation or a cancer of the
lymphatic vessel walls, which usually appears as a violet or
brownish skin blotch. It is a major AIDS-defining disease but
it is not an infection.
LAV. Lymphadenopathy-associated virus. The name given in 1983
to the first isolate of the supposed AIDS-related virus,
called "HIV" since 1986.
Lentiviruses. A subfamily of retroviruses that includes visna
viruses of sheep and other animal viruses.
Lifestyle. The manners, habits, and consumption practices
associated with specific social roles or with personal
definitions of self.
Lymphadenopathy. Generalised swollen glands in the absence of
an illness known to cause such symptoms.
Lymphocytes. A type of white cells found in most of the
body's tissues. They stimulate production of antibodies
against infection.
Mycoplasma fermentans. A derivative of the bacterium
Mycobacterium avium-intracellulare, rarely found in humans
prior to AIDS. It has been proposed as a cofactor in immune
suppression.
Nitrites ("poppers"). A family of relaxant drugs heavily used
by gay men after 1960. Nitrites are oxidising agents that
cause cellular anoxia and impair cell-mediated immune
response. They are also mitogenic, mutagenic and
carcinogenic, and may interact with common substances, such as
antihistamines, to produce toxic N-nitroso compounds.
Opportunistic infection. An infection caused by a
microorganism that rarely induces disease in persons whose
immune systems are normal.
Oxidative stress. A disturbance of the thiol cycle of cell
metabolism leading to cell necrosis. Stress is caused by
oxidising agents, such as recreational drugs, AZT, semen,
antibiotics, and radiation therapy. Oxidative stress has been
proposed as the mechanism of the immune system damage
associated with AIDS.
Provirus. A copy of the genetic information of a retrovirus
that is integrated into the DNA of an infected cell. Copies of
the provirus are passed on to each of the infected cell's
daughter cells.
Retrovirus. A family of viruses that contain the genetic
material RNA and have the capacity to copy this RNA into the
DNA of a cell. This process is called "reverse
transcription".
Reverse transcriptase. An enzyme produced by retroviruses
that allows them to produce a DNA copy of their RNA.
Safer sex. Sexual behaviour that prevents the transmission of
the HIV virus between partners. It is usually specified as
preventing the exchange of blood, semen, and vaginal
secretions. Seroconversion. The initial development of
antibodies specific to an antigen. For HIV, seroconversion is
believed to occur six to eight weeks after infection.
Seropositive or HIV+. Having antibodies to HIV in the blood.
In diseases other than AIDS, antibody response is usually
interpreted to mean that the infectious agent has been
immobilised.
Syndrome. A pattern of symptoms and signs, appearing
one-by-one or simultaneously, that together characterise a
particular disease.
Syphilis. A venereal disease caused by the spirochete
Treponema pallidum and transmitted by sexual contact or in
utero. Syphilis causes lesions to the skin and organs and may
be latent for long periods.
T lymphocytes (T cells). Cells of the immune system that
originate in the thymus gland. They are found in the blood,
lymph, and lymphoid organs.
T4 cells. Helper cells of the immune system that stimulate
immune response. Also called CD4 lymphocytes. T8 (CD8) cells
"turn off" T4 cell activity.
Virus. A non-living fragment of genes that lacks motility and
metabolism and depends on the DNA of host cells for
replication. Bacteria, plants, and animals are hosts to
viruses. Virus are very small, having a mass of about one
five hundred millionth of a T cell.
Western Blot. A test that identifies antibodies against
specific protein molecules. Commonly used to confirm tests on
samples found to be reactive to the ELISA test.