By Hiram Caton

Rethinking AIDS Jan. 1995

My first public statement on AIDS was in the concluding section of a paper I presented in a symposium on misconduct in science in 1987. The paper was entitled "Truth Management in the Sciences." The concept signaled in the title was meant to be an addition to the repertoire of curve-fittings, selective reporting, and disinformation then recognized by psychologists of science. The concept suggested itself to me in the course of my examination of the furor over Derek Freeman's Margaret Mead and Samoa: The Making and Unmasking of an Anthropological Myth. I obtained access to unpublished material relating to the controversy. That look behind the stage confirmed what could be concluded from viewing the drama from the audience perspective. Anthropologists engaged in a face-saving exercise because, for many Americans, Mead's name was synonymous with the field. If her romance of the South Seas was perceived to be a hoax, anthropology's reputation would be damaged. In the urgency to save face, anthropologists abandoned the truth-finder's response to Freeman's book, which was to acknowledge his meticulous documentation of the long-suspected dubious research of the young Mead's first field trip. Instead anthropologists enlisted every available authoritative voice to blacken Freeman's character and to boost Mead's stock.

My paper defined truth management as deception practiced by science leaders who use authoritative institutions to persuade the public that they may trust the scientific consensus. The stratagem reconciles the professional understanding of science as an ongoing search that recognizes no absolutes with the public's need for certainty. Certainty is needed because science often operates at lethal or catastrophic margins, as with nuclear energy or the "therapeutic window" in medicine. The fraudulence of the consensus claim comes publicly to light when distinguished dissenters are pronounced outcast. I gave a short roll call of anathematized scientists: Fred Hoyle for his steady-state universe ideas, Thomos Gold for denying that fossil fuels are fossil products, Linus Pauling for megavitamin therapy, Peter Duesberg on HIV. The concluding portion of the paper discussed AIDS policy. I observed that AIDS is complex in its etiology, transmission, and effects on public health. Many uncertainties have surrounded it from the beginning and continue to do so. Devising a strategy to protect public health involves the weighted estimate of uncertainties and a host of value judgments that assign fiscal, legal, and health priorities. Imperfect knowledge together with the latitude for choice logically imply a variety of policy responses, and the logical contingency of all. Given theses initial conditions, the expectations of reasonable response is that scientists and public health authorities would present governments a variety of policy options. We might also expect AIDS scientists to conduct a continuing airing of differences. Yet this is not what happens. Scientists and health authorities put up a sham unanimous voice for a single policy option, which they advocate as the only rational and humane policy. Any dissent is irresponsible.

Many medical science representatives attended the symposium because the smoking gun of misconduct in Australia at that time was in medical science. A senior AIDS scientist had just forecast a vaccine for HIV in two or three years. It was a target I couldn't resist. In the course of the panel discussion, I referred to Duesberg's writings-and predicted that an in vitro vaccine would not work in vivo. "There will be no vaccine," I said.

That statement, plus the criticism of peer review that was the main focus of the paper, ran in the media as the symposium's main story. The editor of the Search, the journal of the Australian and New Zealand Association for the Advancement of Science, asked to publish it. It appeared in the last issue he edited.

By 1988 I had concluded that AIDS was not a disease entity, that the CDC definition of AIDS was diagnostic codswallop, and that there was no compelling evidence that HIV causes immunosuppression. Peter Duesberg sent a bucket of papers that I closely studied. In a letter of December 8,1992, I wrote him of a view I formed four years previous: "Your initial article on the HIV model seemed to me one of the finest scientific criticisms I have read...ever. The 1991 article in Proceedings and the use of drugs article are of the same quality."

In late 1993, I received a letter from Nevile Hodgkinson, then the science writer at the London Sunday Times, requesting a statement of my view on the epidemic. In April 1994 his feature bused on responses like mine appeared under the headline: "The Conspiracy of Silence." The article concluded with a quotation from my submission. In its report on the feature, Nature also quoted my words. The science editor at The Australian decided to run Hodgkinson's article and requested a fuller statement from me. I obliged. There were many consequences. The AIDS mandarins sent foxes flying denouncing The Australian for printing such "loony fringe" opinion with their permission. I did four radio news interviews and one talk-back. Producers from three television networks rang to sound me out about a documentary on the challenge to AIDS science. However, the mandarins, when contacted, threw such a tantrum that all three producers backed away. Not intimidated was the editor of the University of New South Wales Press. She invited me to write a book for the newly established Frontline series, whose aim is to disturb dogmatic slumbers on selected public issues. I asked for two days to think about it. Out in Perth, Val Turner had seen the publicity and established contact with me. I soon had the papers of the Perth Three and Val's scholarly tutoring service as I wrote The AIDS Mirage. Also about that time I begun to harvest the riches of John Lauritsen's reporting on Robert Gallo and on nitrites was especially important during the writing phase.

The pre-publication response to The AIDS Mirage bore out the expectation that the media would like it. Several national current affairs programs were keen and the print media came on strong. But when producers contacted the mandarins for their opinion, they got the tantrum treatment. Running the story, they were told in an urgent voice, placed the AIDS education effort at risk, which in turn would make the media accomplices to homicide. This oldest of doctor tricks, based on the charming belief that any deviation from the Doctor's advice threatens life. Worked again. Nevertheless, the print media and radio picked up the story and one television science producer will begin filming a documentary in January 1995. There have been other ruptures in the media consensus. A New Zealand journal, Health Care Analysis, is giving critics considerable space, and the Perth Three have finally gotten into the popular press on African AIDS and on unreliability of the Western Blot test.

Truth management in the medical sciences is at risk if authorities cannot maintain diagnostic and treatment orthodoxy among the primary clients of a particular service. For AIDS, the salient client groups are guy men, hemophiliacs, and lately mothers of HIV+ infants. Gay men must be kept on side. Their vocal defection in numbers from just one pillar of orthodoxy, such as treatment, would seriously impair credibility of the whole edifice. The AIDS Mirage maps the course of truth management in AIDS science. It also predicts one key medical blunder that might, if client groups become aware of it and pressed the point, bring down AIDS science.

The gay men who presented with wrecked immune systems in 1981 were pursuing a "live fast, die young" lifestyle, as they well knew. Common health sense would have put them, and others living as they did, on a rigid diet and fitness regimen to detoxify their bodies and rebuild the immune system. Instead, doctors invented a causality in which lifestyle is neutral to disease causality and to therapeutics. Why? Because conventional medicine defines sickness as conditions that respond to pharmaceutical and surgical procedures in the medical armamentorium. Patients are sidelined as spectators in the healing process managed by doctors. They are told that they can do nothing to escape the iron grip of scientifically confirmed disease agents. This thinking leads to a therapy consisting of highly toxic drugs that attack the very immune cells whose rehabilitation is wanted. The therapeutic is lethal, yet it is consistent with the logic of chemotherapy.

The few studies of long-term survivors of HIV infection indicate that they either abandoned or never commenced AZT therapy. The survivors also commenced diet and fitness regimes. This means that they maintain health by rejecting standard therapy, and by becoming doctor-free agents of their own health. There is a need to assemble as many such cases as possible, and to support client groups who will carry the message into the corridors of medical self-esteem.

The AIDS saga illustrates the crisis of contemporary health services. The crisis is expressed in the spiral of costs, in growing millions of doctor junkies, in the over-mastering complexity of health services, in endless litigation and in the need for health rights tribunals. The process is driven by anxiety of death harnessed to belief that doctors can somehow forestall death. Yet doctors invariably lose all their patients, while billions of people today thrive without benefit of doctors. The AIDS Mirage focuses contemporary medicine as but one of many ways of coping with human suffering. It is costly, it induces dependency, and in the case of AIDS, it is a 100 percent failure that fuels anger among patients. An alternative is alive and well at your local fitness center.*

Hiram Caton is head of the School of Applied Ethics at Griffith University in Brisbane, and Fellow of the Australian Institute of Biology.