By Mike Chappelle

Z magazine Oct./Nov. '00

Dear Noam,

You point out the need to "do the work" in order to show that outcomes of medical research are determined by the source of funding. It seems to me this work has already been done. In fact the history of modern medical research, medical education, and public health is one long tale about how the source of funding (from the senior "Partners in Science" ) defined the field of inquiry for the scientists (the junior partners,) thereby limiting the outcomes. The story is well-documented and uncontroversial, although not generally known. To oversimplify: During the so-called Progressive Era, US philanthropists and their foundations acted to establish the medical model we now refer to as Western medicine. They took this action in the context of a radical public health movement taking place during the period. This movement was calling for "the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health." Radical public health was accurately perceived by dominate elites as a threat to their interests. Thus, as an alternative to it, philanthropists funded research institutes based on the "German model." A model that was the least holistic or socio-economically oriented of its day. Then, after wresting control of medical education away from medical practitioners and transfering this control to elite universities (which were being restructured with foundation funding as well), they embedded the type of science developed in the institutes into medical schools as the appropriate knowledge base. Parallel to these developments the co-opting of the public health movement proceeded, eliminating its radical elements as much as possible, and removing it from local control. The US medical version of the German model that resulted was exported to other parts of the world. American foundations eventually transfered the bulk of the funding of the US system to the federal goverment, again unknown but uncontroversial (I would be happy to provide a brief bibliography upon request. Also as to your personal experience, while it points to problems in science, it is of a different kind than what's found in medical science where corporate interests are off the scale).

Restricting medical research to an examination of what can be seen under a microscope pushed consideration of the social causes of disease (poverty, malnutrition, industrial poisoning of the environment and workplace, etc.) as far to the background as possible. Today this can be clearly seen in cancer research, where the agri-chemical-pharmaceutical industry directs the field of inquiry in both public and private research. The predictable result is that cancer research tries desperately to pin cancer on a virus or gene. Meanwhile the enivronment "keeps falling off the cancer screen." Industrial causes of cancer and other diseases (as noted by Edward Herman) being obfuscated by "corporate junk science."

Cancer research is especially relevent when talking about AIDS. In many ways the war on AIDS can be seen as continuation of the war on cancer -same viruses, same virologists, different decade. Cancer virologists, after failing for years in their own specialty, were able to take over control (from epidemiologists) of the AIDS epidemic . In other words, the same researchers who had been alleging viruses cause cancer started alleging a virus causes AIDS.

Why they were able to pin AIDS on a retrovirus but not cancer is a longer discussion. For now I'll just mention that HIV was announced to be the cause of AIDS at a press conference in 1984. The standard peer review process, where the checks and correctives you mention should have kicked in, was bypassed. A small minority of scientists at the top of the NCI/NIH, by citing each others work, and with the support of medical writers such as Lawrence Altman and Gina Kolata ("a faithful apologist for corporate science") of the New York Times, were able to establish the HIV hypothesis. For cancer researchers this was the start of their second "gold rush."

You rightly point out the need to study the fundamental biology. I think, however, you'd be suprised to find how much fundamental biology is contradicted by AIDS (for instance the role of antibodies.) You also point out the advantages to an understanding gained by immersion in the field. Immersion in a field is, of course, usually a good thing, but only if one is free to pursue all avenues of reasonable thought. If not free to queston, immersion reinforces a narrow range of thinking "encouraged" by outside constraints (the needs of the senior "partners.) In such cicumstances an "uneducated" but independent mind will have a better chance of seeing the reality of the situation. In fact we can learn a lot just by remembering our own experience and trusting it. Do you recall when we first talked about these things in the early 1990s? I said that one reason I believed HIV does not cause AIDS was that AIDS did not act like an infectious disease because it was not spreading beyond the orginal risk groups in the United States. That, based on the original definition of the disease, AIDS cases here had already peaked. You replied that two of your doctor friends were predicting hospital beds (in the Boston area?) would be overflowing with AIDS patients within two years: a reasonable prediction if HIV was the cause of AIDS. However the hospital beds did not overflow. Doesn't this suggest a failure in the HIV model? Other dire predictions (without either cure or vaccine being made available) have likewise failed to materialize. As regards drugs and treatment, this also requires a full discussion, which I hope can be pursued in this forum.

To understand what is going on in AIDS, we need to transcend the limits of medical thinking put in place by robber barrons turned philanthropists --the non-scientist, decision making, senior partners. To do so I believe it helps to think in terms of the two major categories of disease: diseases of wealth and diseases of poverty. Diseases of wealth (cancers, coronary heart disease, arthritis etc.) are rare or non-existant in lesser developed countries --until those countries start to industrialize, pollute and otherwise poison their inhabitants. Diseases of poverty are the infectious diseases (tuberculosis, etc. ) which disappeared in the developed nations as the living standards of their inhabitants rose. Diseases of poverty are not merely linked to poverty -they are caused by poverty and cured by decent living conditions. It is poverty that causes hunger and malnutrition, which eventually weakens the immune system enough so that any one of an approximately infinite number of microbes, which are and will always be ubiquitous on the planet, begin to multiply in any individual. AIDS is unique because it belongs to both categories. This is because AIDS is not a disease but a syndrome. A syndrome is a collection of diseases. In AIDS there are 30 diseases, all old diseases, some caused by poverty and malnutrition, others through toxic poisons ie: drugs, both recreational and medical. Hence the differences between Western AIDS and African AIDS.

The question then, of which AIDS is but one example, comes down to this: Do we want a "Star Wars" approach to health? Whereby microbes, be they "returning," "mutating," or "emerging," are to be sought out and terminated one by one by one by one in a never ending battle with nature. Such an approach, as you noted, is historically irrelevant in terms of public health. Shouldn't we instead be trying to think of a more holistic-social approach -one along the lines of the radical public health movement of the early 20th century? An approach which puts an end to the poisoning and/or food depravation of the world's citizens and instead "boosts the immunity" of communities "through the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health."

As I said, all this oversimplifies. But these are the areas I believe to be relevant and necessary for a serious discussion.

Mike Chappelle

Reply from Noam Chomsky:

As Mike Chappelle notes, this is a continuation of a long discussion. It gets nowhere because we are, plainly, not connecting. Let's try to clarify what is at stake.

There is a fair measure of agreement. Specifically, we agree that there is a serious moral issue about HIV-AIDS. Let's make it concrete, referring to southern Africa.

South Africa's trade union confederation and human rights commission, nurses and doctors from poor areas, and many others have bitterly condemned the government's hesitation on HIV-AIDS and AIDS policy generally, describing it as a symptom of the government's lack of concern for the poor black majority, even threatening legal action to force the government to provide drugs to HIV carriers.

This would imply to me that the Trade Union Confederation & Human Rights Commission are playing what we usually call a 'sympathetic/race card' in suggesting a "lack of concern for the poor black majority" placing the responsibility of medical attention (i.e. cheap pharmaceuticals) for the population, on the South African government. The 'suffering of the masses' can only be relieved by loans from the IMF & western banking institutions, which Mbeki is also critical of, AND the various South African medical/trade establishments are being pressured to accept. Suppose Mike succeeds in convincing them of his stand. If he turns out to be right, then South Africans will save money (and incidentally, the drug companies will be pleased to be relieved of the pressure, which they have been strenuously resisting, to make drugs available well below the cost they prefer). If he turns out to be wrong, millions of people will be condemned to a hideous death and the country will be devastated. So the moral issues are doubtless very real.

I would argue that pharmaceutical multinationals, which would directly benefit from cheap African labor, would not be putting up much of a struggle over a reduced profit margin when they HAVE weighed the benefits of getting the patents on 1000's of indigenous plant & animal organisms (stealing cultural medicine.)

There are other areas of agreement: source of funding can affect outcomes, and for many reasons, the dominant "medical model" is highly flawed. I gave a few examples: the lack of attention to public health, the "90-10 rule" (90% of the research for the ailments of 10% of the population), etc. Among the overwhelming majority of scientists who regard the HIV-AIDS link as having been credibly established, and therefore call for making drugs available to HIV carriers, many not only agree with these general conclusions but have also dedicated much of their lives to them. Doubtless issues of the highest importance, but not relevant here.

The issues that actually are in dispute reduce to these:

(1) Is HIV a cause of AIDS?

(2) Has virtually the entire biological and medical community been so totally taken over by drug companies that they are engaged in vast and uniform falsification about (1), cutting off critics from funds, publishing opportunities, etc.?

Mike tells us that he has done the required work and knows the answers to these questions: Yes, Yes.

At this point, others have three choices:

(a) accept Mike's conclusions without further inquiry

(b) accept the very broad consensus of scientists

(c) seek to find the answers themselves.

As I mentioned, similar questions arise in many other areas, e.g., global warming (or taking my car to be fixed). The editors of the Wall Street Journal, relying on the handful of scientists (some highly respected in their fields) who reject the scientific consensus, urge that the Kyoto protocols and other conservation efforts be rejected: as in the case at hand, the alternatives raise very serious moral issues, and the rest of us have the same three choices: (a) accept the conclusions of the editors, (b) accept the scientific consensus, (c) explore the fields seriously and reach our own conclusions.

I do not detect any controversy so far either. So what is at issue? Only one thing, as far as I can see. Mike thinks the issue is resolved: we should follow course (a), accepting his conclusions without further inquiry, confidently proceeding to convince South Africans that they should accept his conclusions as well, with the range of possible consequences already outlined. I don't. There is no further issue that I can detect.

Noam Chomsky

My October 31, 2000 response:

Dear Noam,

In your response to Greg Nigh you dismissed the possibility that HIV was not the cause of AIDS, giving the following reason:

"If you believe that the source of funding of medical research may determine its outcomes -- e.g., on global warming, HIV-AIDS, or anything else, then its up to you to demonstrate it. It's of course possible, but in my opinion, pretty unlikely."

In your response to me you say:

"There are other areas of agreement: source of funding can affect outcomes, and for many reasons, the dominant "medical model" is highly flawed." *

Thus your original argument to Greg has changed from:

We should accept HIV=AIDS because it is unlikely source of funding affects outcomes. to:
We should accept HIV=AIDS in spite of the fact that source of funding affects outcomes.

Naturally then you have offered other reasons for accepting HIV =AIDS (the mainstream medical, scientific consensus) without further inquiry:

1. You imply that any alternative explanation for the majority of the biomedical community supporting HIV=AIDS (other than it being true) requires a vast and uniform conspiracy orchestrated by the pharmaceutical industry. You put this in the form of a question:

"Has virtually the entire biological and medical community been so totally taken over by drug companies that they are engaged in a vast and uniform falsification about (HIV=AIDS), cutting off critics from funds, publishing opportunities, etc.?"

Asking whether or not the pharmaceutical companies have taken over the biological and medical community is, in my opinion, the wrong question. It ignores the actual history, development, and organization of the medical and biological disciplines. This, in turn, leads to an inaccurate picture of the present structure of medical science and hence is not a useful framework in which to either agree or disagree. As I indicated in my first letter, we need to look at the hierarchical medical scientific system that was established in the United States during the so-called Progressive Era. At the top of the hierarchy were the philanthropists and their foundations, the "senior partners" in scientific medicine, who funded the system. This medical system remains in place today. Pharmaceutical companies take advantage of this fact. However, even if the pharmaceutical industry did not exist (and there were free drugs for all) the system would continue pretty much the same.

Your question then, as I would put it, should read:

Have biologists and doctors received a type of education which has built into it narrow ways of thinking about health and disease? Was this type of education the one favored by the "senior partners" of science? Has this education led the majority of biologists and doctors to internalize the "senior partners'" medical system? Do pharmeceutical companies take advantage of the medical system put in place by the "senior partners" to make enormous profits?

To all of this I would say yes.

Such a system does not require a "vast and uniform falsification" on the part of the biological and medical community. In fact many in the biomedical community are critical of pharmaceutical companies as well as the influence of pharmaceutical advertizing in medical journals, the overprescribing of drugs etc. As you point out some are even in favor of greater emphasis on the socio-economic factors of ill health. However the more complete picture is akin to what you have written about the media and the workings of the propaganda model: " news people, frequently operating with complete integrity and goodwill, are able to convince themselves that they choose and interpret the news 'objectively' and on the basis of professional news values."

I should also point out here that critics of HIV, including emeritus professors and members of the National Academy of Sciences (who have published on other topics for years), HAVE been cut off from funds, publishing opportunities, etc. This is simply a fact and one which is easily verified. (How much of this censorship is attributable to control of the journals through advertizing by pharmaceutical companies, and how much by the bias in the overarching system, is difficult to separate out.)

Another reason you give for accepting the HIV=AIDS hypothesis without further inquiry:

"Suppose Mike succeeds in convincing them (South Africa's trade union confederation and human rights commission, nurses and doctors from poor areas, and many others...) of his stand. If he turns out to be right, then South Africans will save money (and incidentally, the drug companies will be pleased to be relieved of the pressure, which they have been strenuously resisting, to make drugs available well below the cost they prefer). If he turns out to be wrong, millions of people will be condemned to a hideous death and the country will be devastated. So the moral issues are doubtless very real."

We agree the moral issues are very real. We also agree drug companies want to maximize their profits and make strenuous efforts to do so at the level they prefer. And, as you went on to say, they seek to steal cultural medicine and they value cheap African labor. However I don't think pharmaceutical companies will be pleased if South Africans cease to believe in HIV as the cause of AIDS, and therefore logically refuse to buy "antivirals" from the pharmaceutical companies, no matter how much the price comes down. Drug companies also would not be happy with "the threat of a good example" which South Africa, if allowed to improve health by improving living conditions, would represent to the poorer countries and people of the world. However the main problem I have with this paragraph is that you reduce the issue to one of saving money versus the risk of condeming millions of people to a hideous death. If this were an accurate description of the alternatives it might constitute a legitimate argument. However I think a fairer way of framing the issue is:

If HIV causes AIDS, if the numbers of people reported to be infected with HIV in Africa are accurate, if having HIV always leads to AIDS, and if medical drugs are the only way to treat AIDS then without these drugs millions of South Africans will be condemned to a hideous death.

However, if HIV is not the cause of AIDS and if Africans take the drugs anyway, then even more people will die (than in the first scenerio). They will die the hideous deaths from the causes of poverty and malnutrition, they will die from the additional loans they have to repay to the World Bank, IMF, etc. for the purchase of the drugs (which will increase their debt and poverty), and they will die from the toxic effects of the drugs themselves.

Three other reasons you have given for accepting the mainstream medical scientific consensus without further inquiry:

1. You compare the working of medical science in the area of AIDS to the working of science in global warming. However global warming lies outside of medical research. To gain insight on how the medical system has operated and continues to operate far more relevant comparisons are pellagra, SMON, the swine flu epidemic, and cancer.
2. In past postings you have pointed out that further inquiry is significantly more demanding than an unexamined acceptance of mainstream science. I agree. But, given that we have already agreed funding influences outcomes and that the moral consequences of our beliefs and actions in this case are serious, I argue it is necessary.
3. You point out that the corporate media is against the mainstream scientific consensus on global warming, which, it seems you imply, is a reason to accept global warming. However the corporate media is with the mainstream postition on AIDS. So rather than arguing against further inquiry wouldn't this in fact argue in favor of it? Or, to put it another way, the corporate media is against the position you agree with on global warming and with the position you agree with on AIDS, while, for what it's worth, the corporate media is against positions I agree with on both counts.

You concluded your arguments for accepting the position of mainstream science without inquiry by saying:

"Mike thinks... we should follow course (a), accepting his conclusions without further inquiry, confidently proceeding to convince South Africans that they should accept his conclusions as well, with the range of possible consequences already outlined. I don't."

Actually I never said or meant to suggest we follow course (a). So we both agree here as well -- no one should accept my conclusions without further inquiry.**

The choice then comes down to:

(A) making an inquiry that will take some time and energy. or:
(B) accepting the mainstream consensus which has been influenced by funding.

I argue for (A), and suggest that we do so in this forum, taking no one's word for anything. To accomplish such an inquiry as efficiently as possible and in a manner accessible to non-scientists, I propose:

1. A medical propaganda model.
2. A socio-economic model of public health.
3. That (1) and (2) fit, explain and predict the following phenomena better than the HIV hypothesis:

In the 1970s a number of cultural and socio-economic changes were underway, many related to the US aggression in Vietnam.

1. Dominant elites began a restructuring of the world economy which negatively affected the gap between the have's and have not's, both between and within countries.
2. There was an increase in cultural freedoms, the result of the 60s, which meant more sexual freedoms. One of the consequences of this increase in sexual freedom was that some sectors of the population began taking prophylactic doses of medical drugs at rates previously unknown.
3. There was an increase in the availability of and demand for street drugs, both old drugs and newly synthesised "designer drugs". There was also a new level of acceptance for the taking of these drugs. These factors led to historically high levels of drug abuse among certain segments of the population.
4. 2 and 3 overlapped, creating a mix of medical and street drugs in individual bodies that had never before occurred.
5. As the years went by 1-4 had predictible results in terms of public health.
(a) In wealthy countries, old "conquered" diseases, such as tuberculosis began returning. Also groups of young adults, normally the healthiest sector of a society, began showing up ill with diseases "new" to young adults.
(b) In the poorer countries the old diseases of course had never been conquered. But as these countries grew poorer there was a predictable increase in morbidity and mortality. The only question was whether this predictable increase would be attributed to an increase in cases of the old diseases, or a "new" disease, or both.

A medical propaganda socio-economic model predicts that the search for causes and treatments of both these "new" and returning diseases would be limited to the microscopic level. Cultural and socio-economic factors would be pushed to the background as far as possible, both in terms of cause and remedies. A medical propaganda model predicts that critics, both scientists and non-scientists, who pursue a line of questioning that leads to socio-economic causality would be marginalized, thus serving notice to the medical scientific community about what happens to those who step too far outside the mainstream medical model.

Thus to summarize an increase in IMMUNE DEFICIENCIES, due to both an increase of drug taking (medical and street drugs) and an increase in poverty, would be predicted by the socio-economic model. (Other causes of immune deficiency such as being the recipient of large blood transfusions, the effects of drug taking by pregnant women on their babies, etc. need to be included in a broader discussion.) The way this increase in cases of immune deficiency was perceived and interpreted as a new disease called AIDS is predicted by the medical-propaganda model.

There are any number of ways to begin a comparison of the medical propaganda socio-economic model to the HIV=AIDS hypothesis. One is that we inquire into the treatments that came out of the HIV hypothesis, focusing on the drug AZT. AZT has been the drug of choice for the treatment of AIDS. A consideration of the history of this drug would not be overly technical or time consuming. If then, when we look into this drug (its development, approval, rationalization, case histories of people who took it, never took it, or quit taking it, its "side effects," types of birth defects caused by AZT, etc.) we don't find out things which raise serious doubts about what is going on in AIDS, we could end the inquiry right there. If what we find turns out to be eye opening, we move on to more fundamental aspects of the HIV hypothesis and the medical propaganda-socio-economic model.

Let me close by re-emphasizing that no one should take my word for any of this. And, to repeat the offer I made in my first posting, I would be happy to provide on request a short bibliography. (See also my article/book review in the Oct. 1990 issue of Z.)

Mike Chappelle

* You follow this sentence with: "I gave a few examples: the lack of attention to public health, the "90-10 rule" (90% of the research for the ailments of 10% of the population), etc."
I presume you give these examples to point out the medical model is flawed (because when you first gave these examples you were arguing money does NOT influence medical outcomes). If so I agree the medical model is flawed. The point I would add is that the flaw was built into the medical model. The model was designed to function first and foremost as a propaganda tool by the senior partners in science.
**Other reasons you have given in past postings for not making further inquiry, such as the example of trusting your mechanic, deserve further discussion. Also your point about the "90-10 rule," while true, needs to be put in the historical context. However I believe what I've written so far (in my previous posting as well as this one) makes the argument that it is worth the effort to begin a serious inquiry.

Reply from Noam Chomsky:

Please re-read the last response, which you did not understand. I'll repeat the main points briefly, but for the last time, unless someone has something new to say. There are much better ways to spend our time.

On HIV-AIDS (global warming, the truth of quantum theory,... and other cases where there is an overwhelming consensus among specialists who have worked hard on the topic), we have the following options:

(1) Do the required research ourselves and find the answers.

(2) Assume the consensus to be accurate

(3) Assume that our guess to the contrary is right even though we haven't done the work

We can exclude (1): neither you, your friend, nor I have done the required work. That leaves (2) and (3).

Your stance is (3). Who can you hope to convince? Not people with a degree of privilege, who have the opportunity for serious choices. Of course they will not pay the slightest attention to you. But it is conceivable that desperate people in poor countries might do so: in Africa, South Asia, and other areas of destitution (including parts of the West).

What then are you offering those people? One possibility is that your guess is wrong and the overwhelming consensus among people who have done the work is right. Then you are consigning tens of millions of suffering people to a hideous death. Suppose your guess turns out to be right. Then funding agencies, governments, and others will save money -- and the drug companies will award you the grandest prizes they can conjure up, since they will not be dragged kicking and screaming, under intense public pressure in the third world and the West, to sell drugs well below the price they want. It takes a good deal of self-confidence, to put it mildly, to adopt the former course. At least this much is transparent: don't pretend to be adopting a moral stance. I'm trying to say this as politely as I can. An appropriate answer would be considerably harsher.

The rest of what you say is hopelessly irrelevant, mostly pushing open doors and ignoring the issues.

Noam Chomsky

My response sent 11/12/00.

Dear Noam,

You have effectively banned further discussion on the AIDS controversy as well as any dissent from mainstream scientific opinions in general in this forum. However, for reasons of fairness, I hope you will allow me the courtesy of a final response to your last comments.

1. Your position is that:

Based on:

a) the overwhelming consensus of mainstream biology medical science,
b) your experience in the sciences and knowledge of the workings and history of science,
c) your assessment of the time required to "do the work," and the amount of time available,

2. You have decided to accept, with skepticism, HIV as the cause of AIDS.

To repeat my position:

Based on:

a) my experience as a layman with the epidemic and my assessments of the predictions, expectations, and reality of AIDS,
b) my reading on the history and developement of the structure medicine,
c)my reading on the war on cancer, infectious disease and biology in general,
d) my reading on AIDS: studies, drug trials, dissident opinions, etc.,
e) my work as a journalist which includes: interviews with both sides of the controversy including Nobel prize winners, members of the National Academy of Sciences, emeritus professors, journalists, HIV positive people, people with AIDS, people who take or have taken the medical drugs, never taken them, or taken them and come off them, AIDS researchers, historians of medicine and public health; as well as attending conferences and lectures,

I have decided that:

3. The minority opinion is, at the minimum, worth a serious look.

We agree 2 is a reasonable and moral position.

4. We disagree on 3:

a) You argue that 3 is an unreasonable, arrogant, irrelevant and immoral position to hold, and one has to be either a dupe of the pharmaceutical companies, overconfident to the point of being irrational, desperate or all of the above to advocate this position.
b) I say that whatever the cause of AIDS turns out to be, 3 is as moral, reasonable, etc. a position to maintain as 2.

Based on 1, 2, and 4a you have decided not to discuss the issue further at this time. I must point out however that you were discussing these issues before I made any comments. It seemed only fair to try to present what the dissident position actually is and make it part of the discussion.

Based on 1, 2, 4a, you have decided not to respond to any of my arguments.

I, in response to 1c, proposed that, rather than trying to master the whole subject all at once, we try to get a handle on things by examining one particular aspect of AIDS, the medical treatment AZT, saying if in examining the history of this drug, we discover there are in fact serious problems surrounding its use and approval, we could proceed. Based on 1, 2, 4a, you decided not to respond to this suggestion as well.

Your characterization of the minority opinion and me personally, as I'm sure you intend, leaves me little else to say at the present time in this forum. However, as you may know, President Mbeki of South Africa has convened a panel composed of orthodox and dissident scientists to devise a means to test the HIV hypothesis. Should anything come of this, or from any other source --such as world events (more poor countries follow the example of South Africa, a significant increase in the numbers of high ranking scientists turning dissident, etc.) you might find it worth the effort to resume the discussion and begin a serious inquiry. If such an opportunity should arise in the future I will send my comments to you directly and you can decide if they are worth posting in this forum.


Mike Chappelle

P.S. I will forward our exchanges to Walter Gilbert, (Nobel laureate, Department of Molecular and Cellular Biology at Harvard, Human Genome project ) in hopes that he will contact you on this issue. When I interviewed Gilbert for an article I wrote in the Ithaca Times he told me there was no good scientific evidence that demonstrates HIV to be the cause AIDS. This is not to argue anyone should take Walter Gilbert's word for things either but only to suggest that the minority opinion is at the least a respectable position.