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Monday, April 16, 2007

Duesberg in SciAm
So what do people think of Scientific American's decision to publish an article by Peter Duesberg, HIV/AIDS denialist extraordinaire?

The justification that they give, is that despite his completely wrong ideas about AIDS, he still has something to contribute in his original field - cancer. But is that enough of an excuse? They make it sound like if you don't have every possible human being working on a problem, somehow it will irreparably damage the scientific enterprise.

I think it's a greater amount of harm to return any legitimacy to this crank and denialist. A lot of his crackpot ideas haven taken hold in Africa, and the results are deadly. Denial of the real causes of HIV, stigma over AIDS diagnoses, and BS cures from local cranks are responsible for nothing but misery and death, and Duesberg bears some responsibility for this.

It's also, in my mind, like giving a podium to Hwang Woo Suk. When someone has shown that they simply can't be trusted in the scientific enterprise, it's time for them to be ignored, permanently. HIV/AIDS denialism has the same deceptive elements of all the other types of denialism, and people who promulgate it really should be banned from contributing to the literature. It's not just some cute iconoclasm or "funny ideas". They are liars who spread deadly ideas. And liars should not be trusted to do anything but contaminate the literature.

I am disappointed in SciAm.

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Monday, March 19, 2007

Let's get started
HIV/AIDS denialism, it's ugly, it's stupid, and it's taking hold in the popular imagination of South Africans according to Michael Specter writing for the New Yorker (PDF). The issue in South Africa isn't HIV/AIDS denialism itself, but rejection of Western Medicines out of fear and ignorance, and the willingness of politicians to exploit ignorance and fear to the detriment of the people by promoting a folk remedy of unproven efficacy.

Zeblon Gwala is a husky forty-nine-year-old man with an unusually vivid dream life. For many years, he worked as a long-haul truck driver, crisscrossing South Africa from his base, in Durban. But he is in a different business now. A few years ago, Gwala began to dream about herbs. Some nights he would see just one, on others two or three.

Gwala's grandfather, who died when he was a boy, was a traditional village healer, and in the dreams he would tell Gwala which herbs to collect and where to get them. Gwala kept a list next to his bed, and eventually, when it had grown to eighty-nine, his grandfather instructed him to divide the herbs into two groups and boil each batch. The resulting concoctions, the apparition assured him, would cure AIDS, the disease that was destroying his country. Gwala followed instructions. He quit his job, turned his garage into a factory, and opened a storefront dispensary in downtown Durban, wedged between a dry cleaner and a furniture store. He hung two signs next to the door: one has "Doctor Gwala" written on it, and the other says "H.I.V. and AIDS Clinic." There are no doctors, nurses, or medical technicians at this particular clinic, and just one product: ubhejane, which is the Zulu word for black rhinoceros. Every day, from eight in the morning until four-unless he runs out first-Gwala sells ubhejane in litre-sized milk containers. There are two kinds. The bottle with a white lid holds an herbal mixture intended to rebuild an immune system ravaged by the AIDS virus. The second, with a blue lid, is a potion to reduce the amount of the virus that has already accumulated in the bloodstream.

On a typical day, as many as a hundred people come to Gwala's clinic, each paying the equivalent of about a hundred dollars-nearly two weeks' pay-for a thirty-day supply. Gwala says that the medicine never fails. He also says that he has no idea how it works. "Ubhejane protects the cells from any virus,'' he told me when I met with him at his clinic, last fall. "I don't know how that happens. I am not a scientist. But what I do know is that people who were on the edge of death go back to work. It makes them feel better, and it gives them life."

This is a frightening development. With practices more fitting a charismatic cult leader, Gwala has been duping people into actually forgoing therapies of proven efficacy (HAART - Highly Active Anti-Retroviral Therapy). He offers instead the Colonel's recipe, a magical mix of seven herbs and spices that he asserts, while refusing to provide concrete evidence, cures HIV. Touting the known toxicity issues of HAART therapies, these charlatans are exploiting anti-scientific attitudes which have been pervasive in South Africa (a hot spot of actual HIV/AIDS denialism for many years). Amazingly though, HIV/AIDS denialism isn't limited to just third world countries, Australia, is the source of some of the most insidious HIV/AIDS denialists, known as the Perth group.

Denying the scientific consensus about what causes AIDS and how to treat it is not limited to South Africa, of course. H.I.V. itself is now on trial before the Supreme Court of South Australia. Last year, a thirty-five-year-old man who had unprotected sex with three women-and infected one-despite knowing that he was H.I.V.-positive, was found guilty of endangering their lives. He has appealed, saying that H.I.V. does not cause illness. His main witness is Eleni Papadopulos-Eleopulos, a medical physicist at Royal Perth Hospital, who claims that H.I.V. has nothing to do with AIDS. The Perth Group, as she and several other Australian H.I.V. denialists are known, has argued for more than twenty years that the virus has never been isolated or identified properly. Papadopulos-Eleopulos and her colleagues insist that AIDS in gay men results from drug abuse and repeated exposure to semen.


There is no exaggerating the harm that is done by HIV/AIDS denialism. The fruits of these beliefs are nothing short of death. The costs of discouraging the use of HAART will lead to nothing but human pain and misery, and the perpetrators of these anti-scientific garbage really should be thrown under a jail. I mean, exposure to semen? And their basis of saying the virus has never been isolated is based on a 20 year-old controversy between Gallo and Montagnier, the co-discoverers of the HIV virus, without acknowledging any of the subsequent papers that have identified the virus, RT-PCR'd the RNA, cultured it in cells, proven epidemiologically the role of the virus in disease, etc. Classic selectivity of denialists.

Finally, Specter covers Duesberg, perhaps the most persistent and dangerous of all the HIV/AIDS denialists.

Duesberg argues that recreational drugs are what destroy the immune system, not a retrovirus. He believes that a virus cannot be the cause of an illness if the illness becomes evident only many years after the initial infection. Viruses typically make people sick shortly after infecting them, before their immune system can respond. With H.I.V., more than a decade can pass between the moment a person becomes infected and the time when he becomes visibly ill. Duesberg also has written that no virus can cause disease after the body starts to produce a neutralizing immune response.

Duesberg contends that to prevent AIDS-and even to cure the disease-it is necessary only to eat properly and abstain from harmful drug use. In 1998, he and one of his collaborators, David Rasnick, wrote, "All infectious epidemics of the past, such as polio, cholera, tuberculosis, smallpox and syphilis, have long been brought under control, or even eliminated, at a fraction of the cost of AIDS with technology that was far less sophisticated than what is available now." The focus on H.I.V., Rasnick later argued, is "the biggest scientific, medical blunder of the 20th century''; the tens of thousands of researchers who have devoted their lives to treating the virus have been wasting their time and billions of dollars.


...

. In 1988, in an effort to put Duesberg's theories to rest, the American Foundation for AIDS Research sponsored a scientific forum, in Washington, D.C., on the origins of the epidemic. One after another, researchers presented data linking the increase of H.I.V. infections around the world to the growing number of AIDS cases. Duesberg rejected the data completely. This was at a time when in the United States AIDS was still widely seen as a death sentence, and people had even committed suicide after learning that they were infected. Anthony Fauci, the federal government's leading AIDS expert, sat silently for hours. Usually the most circumspect of scientists, he finally erupted. "This is murder,'' he said after listening to Duesberg speak. "It's really just that simple."


So many things wrong with Duesberg's point of view. For one, the basis of HIV latency is a major topic of study, and while not fully understood (although major advances have been made), it is clear that there is an initial infection, followed by latency of many years without clearance of the virus, followed by extensive viremia as the virus emerges from latency. Further, this idea that viruses that generate antibodies can't be harmful is insane. Has he never heard of chronic hepatitis B or hepatitis C? Classic examples of viruses, that generate antibodies, that lead to chronic disease and no clearance of the virus despite presence of antibodies. How about Herpes Viruses? HPV? Examples abound that disprove this fundamental assertion of the denialists, yet they persist, because they are overly invested in these overvalued ideas. Fauci is right, the persistent spreading of these lies is tantamount to murder.

Finally, let's survey the arguments of the HIV/AIDS denialists to see how many of the five tenets of Denialism are represented (Conspiracy, Selectivity, False Experts, Impossible Expectations, Moving Goalposts, and Metaphor/Illogical Arguments).

  1. Conspiracy:

    he former truck driver to meet senior government health officials, including Tshabalala-Msimang. He has also testified before Parliament on ubhejane's behalf. "I have personally seen hundreds of people who have taken ubhejane, and they get relief,'' he told me. "All I am saying is let's look at the results of that, as well as using drugs like A.R.V.s.

    "The situation in America is one of intolerance,'' he continued, never raising his voice. "There are A.R.V.s. Only one approach to treating this deadly illness is permitted. You are not allowed to talk about anything else.'' He said that people are obsessed with whether H.I.V. causes AIDS, but that he considered such arguments "completely academic and not relevant for the treatment of sick people." He went on, "Let us be honest. Who benefits from A.R.V.s? Hundreds of millions of U.S. dollars have been spent on research and you have to get a return on your investment. It is the first rule of pharmaceutical companies, and they simply terrorize their opponents. Very frankly, in America there is an official literature-and there are a lot of people in the African-American community who feel maybe there is a conspiracy and that racism has a lot to do with it. Why, for instance, is AIDS the biggest problem that exists in Africa? You start to wonder if there is a social selection for this disease. Is it not a coincidence that Africa is the poorest continent in the world? Did you ever think that it's in the interest of some people for it to stay that way?"



    And here

    Rath is a German physician and health entrepreneur who urges people to substitute remarkably high doses of multivitamins for proved therapies like AZT. He has offices in the United States, Germany, Holland, and South Africa. (Duesberg's co-author David Rasnick has worked with him in South Africa.) Rath believes that huge doses of vitamins and micronutrients-which he sells on the Internet-can treat AIDS (as well as heart disease, cancer, diabetes, and many other maladies). Rath has placed advertisements in several newspapers, including the New York Times and the International Herald Tribune, railing against pharmaceutical companies and urging people to stop using their products. His ads almost always appear beneath headlines like "Why Should South Africans Continue to Be Poisoned with AZT?" and "Stop AIDS Genocide by the Drug Cartel." On his Web site, which notes, "The End of the AIDS Epidemic Is in Sight," he declares:

    Never before in the history of mankind was a greater crime committed than the genocide organized by the pharmaceutical drug cartel in the interest of the multibillion-dollar investment business with disease. Hundreds of millions of people have died unnecessarily from AIDS, cancer, heart disease and other preventable diseases and the only reason that these epidemics are still haunting mankind is that they are the multibillion-dollar marketplace for the pharmaceutical drug cartel.



  2. Selectivity - Take all of Duesberg's arguments, they're based on a selective reading of literature from 20 years ago.

  3. False Experts - Do I even need to list them? Duesberg, the Perth group, Gwali etc.

  4. Moving Goalposts - I didn't actually see any of this in this particular article (although it has previously been a characteristic of HIV/AIDS denialists, in particular the Perth group which has some crazy definition of what would prove HIV causes AIDS).

  5. Metaphor/Illogical Arguments:

    Vilakazi believes that Western society has turned the scientific method into a fetish. "Orthodox medicine has reached a dead end," he told me. "There is walking evidence and evidence that comes from a lab. There are plenty of people who rely on walking evidence. A person has terrible arthritic pains. An old man gives them herbs and they get relief. We can't say that the only thing that matters comes in reports from Western labs.'' Nobody denies that traditional remedies play an important role in medicine. Aspirin is a more modern form of willow bark, and thousands of other drugs have herbs as their base. Artemisinin, which when used in combination with other medicine is the best treatment available for malaria, is derived from an herb that the Chinese have relied upon for thousands of years. Nonetheless, most researchers would say that any potential medicine-herbal or chemical-needs to be subjected to the rigors of testing and analysis. Vilakazi disagrees. "Take Gwala, for example,'' he said. Vilakazi, who has no medical training, helped arrange for the former truck driver to meet senior government health officials, including Tshabalala-Msimang. He has also testified before Parliament on ubhejane's behalf. "I have personally seen hundreds of people who have taken ubhejane, and they get relief,'' he told me. "All I am saying is let's look at the results of that, as well as using drugs like A.R.V.s.



    The plural of anecdote is anecdotes, not data. And the logical flaw here is a silly straw man that the issue Western medicine has with these folk cures is that they come from natural compounds rather than the real reason - they have no proof of efficacy. And think about how stupid a straw man this is. He challenges Western medicine as being against all natural compounds? What the hell is going on here? Western medicine doesn't care where the drug comes from, just that there is proof. It can be purified from cow pies for all we care, it doesn't need to be synthesized in a lab. Shit, Premarin comes from horse piss, taxol from the Yew tree, antibiotics coming from fungi, insulin was originally made in pigs, vincristine and vinblastine, ergotamines etc. All these drugs, staples of medicine come from all sorts of interesting sources. Western medicine isn't biased against the source of the medication, it's biased towards having concrete evidence they work.

Classic denialism, hitting every single major criteria. These people are horrible human beings, and hard to see as anything but pure evil.

Source: Michael Specter, "
THE DENIALISTS; The dangerous attacks on the consensus about H.I.V. and AIDS." The New Yorker, March 12, 2007, p32.

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