AIDS Denialism, Medical Hypotheses, and The University of California’s Investigation of Peter Duesberg

AIDStruth.org, April 2010

AIDS denialist and U.C. Berkeley Professor Peter Duesberg has recently received media coverage following the withdrawal of a paper of his by the publisher, Elsevier, and an investigation into his conduct by the University. [1] Here, we provide some background and a timeline of events in the unfolding drama.

AIDS denialism, which Peter Duesberg has promoted tirelessly for the past quarter century, has claimed many victims from the ranks of HIV-positive people who believe in its tenets: that HIV is harmless or non-existent, antiretroviral drugs (ARVs) cause AIDS, and lifestyle choices and alternative therapies can prevent AIDS-related illness and death. [2] These deaths, caused by the fusion of ignorance and lies, are regrettable and tragic. They are dwarfed in scope, however, by what happened at the end of the millennium in South Africa. There, hundreds of thousands of people died when the apparatus of state was placed in service of Duesberg’s theories on HIV and AIDS.

The South African tragedy began in 2000, when Thabo Mbeki, the president from 1999-2008, was beguiled by denialist disinformation on the Internet and invited a number of denialists, as well as AIDS scientists and clinicians, to participate in a Presidential Advisory Panel on the causes and appropriate response to the AIDS epidemic. The denialists included Duesberg and his business associate David Rasnick, who was later found guilty in South African court of helping to conduct an illegal and fatal human trial to test vitamins as a “cure” for AIDS. [3]  The panel was irretrievably split between the scientists and the denialists, who held that AIDS is caused by poverty and malnutrition, not a virus, and that ARVs are toxic. The denialist position had a veneer of legitimacy because of Duesberg’s position at Berkeley.  Government resistance to the use of antiretrovirals for mother-to-child transmission prevention and for AIDS treatment followed, persisting even when donors were prepared to provide free or discounted drugs for these purposes. [4]

While it is impossible to quantify precisely the deaths and suffering resulting from this state-sponsored AIDS denialism, several scholars have made conservative estimates of the death toll in peer-reviewed, published studies relying on rigorous statistical methods and multiple sources of data. Nicoli Nattrass, a South African social scientist, was the first, in 2007/8. [5] In 2008, a study from Max Essex’s group at Harvard University, first-authored by Pride Chigwedere, was published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS). [6] The researchers had not consulted each other, but the two studies reached remarkably similar conclusions. As a result of Mbeki’s AIDS denialist policies, between 300,000 and 400,000 South Africans died early and avoidable deaths from 2000 to 2005, and many infants were needlessly infected with the virus because their mothers were denied proper and available treatment. In addition, Nathan Geffen of the Treatment Action Campaign submitted a commentary to JAIDS that discussed the damage the Mbeki administration's policies had caused to the South African people. [7] He called for investigations into the role played by Mbeki’s various external advisors, including Duesberg. That article was peer- reviewed and published in August, 2009.

After the Chigwedere et al. JAIDS article was published in 2008, Duesberg wrote to the editor accusing Max Essex, the senior author, of having an undisclosed financial conflict of interest. In essence, Duesberg charged that Max Essex could personally benefit from promoting the use of ARVs. The complaint was forwarded to the Harvard School of Public Health, which investigated and found the complaint to be factually inaccurate and groundless.

Subsequently, Duesberg submitted a paper to JAIDS that was critical of the Chigwedere paper and that again questioned whether HIV caused AIDS and argued that ARVs were toxic. Duesberg and his co-authors also claimed that there was no statistical evidence that HIV had caused the deaths of South Africans, or even that AIDS deaths had occurred in significant numbers in South Africa. The paper was peer-reviewed and rejected. One of the reviewers warned that Duesberg could face an official investigation by his university or by the National Institutes of Health (NIH) Office of Research Integrity for two issues.  First, Duesberg failed to disclose that his co-author David Rasnick had conducted illegal clinical trials for vitamin pill manufacturer and distributor Matthias Rath, who is infamous in South Africa for attacking antiretrovirals as toxic and promoting vitamins as an alternative treatment.  The reviewer noted that the connection between Rath and Rasnick should have been declared as a potential conflict of interest. Duesberg was clearly aware of and sensitive to the issue of conflicts of interest, as he had leveled that very charge against Essex—his omission was not the result of ignorance.

The second issue was Duesberg’s selective citation of bits from the scientific literature while ignoring contradictory evidence, his distortion of the incomplete but still formidable knowledge of how HIV affects the immune system into the basis for his claim that it does not harm people, and his blatant misrepresentation of the contents and findings of a 2006 Lancet paper by May et al. [8] The May et al. article reported success rates of ARVs at various points in time.  Duesberg misreported the results, claiming that “hundreds of American and British researchers jointly published a collaborative analysis in The Lancet in 2006 concluding that treatment of AIDS patients with anti-viral drugs has ‘not translated into a decrease in mortality.’” In fact, the article never suggests that people with HIV/AIDS who take ARVs don’t live longer than those who do not.  Rather, the sentence fragment Duesberg quoted is part of a finding that, over a period of 8 years, virological response in the first 6 months after starting ARVs improved markedly, but the number of deaths from all causes within the first year of treatment did not significantly change, decreasing only a little from 2.2% to 1.3% of the participants who started HAART that year. That is, only a small number of people on ARVs died during their first year of treatment, and even that number declined, unevenly, by almost half.  This conclusion in no way can be interpreted to mean that ARV treatment has not resulted in radically reduced rates of AIDS-related mortality. The paper is very clear, and it is most unlikely that Duesberg could have honestly misinterpreted the article as saying otherwise. The JAIDS editor, Bill Blattner, rejected the Duesberg et al. paper on the basis of all the peer reviews he received and his own editorial judgment.

Next, on June 9, 2009, Duesberg resubmitted the paper, addressing none of the key criticisms raised by the JAIDS reviewers, to Medical Hypotheses, where the editor, Bruce Charlton, accepted it two days later. [9] None of the papers MedHyp publishes are peer-reviewed; it is unclear if Charlton even read the Duesberg paper, considering the near-instantaneous acceptance, and even less likely that any fact checking was performed. Charlton has described himself as “agnostic” on HIV as the cause of AIDS, and his magazine had previously published other AIDS denialist articles, in addition to papers attributing chronic fatigue syndrome to aluminum in vaccinations, [10] investigating navel lint, [11] positing high heels as a cause of schizophrenia, [12] and asserting the “very particular twinning between a Down person and Asiatic people” in appearance. [13] The published version of the Duesberg paper contained a statement noting the previous rejection by JAIDS and offering copies of the JAIDS reviews to anyone who requested them. Although several people have since requested the reviews, Duesberg has not kept his promise to release them.

Various AIDS researchers and activists, including John Moore and Francoise Barré-Sinoussi, wrote to Elsevier (the publisher of Medical Hypotheses and some 2,000 other journals) requesting an investigation into why and how the Duesberg paper could have been accepted for publication. In addition, a multi-signatory letter was sent to the United States National Library of Medicine, requesting an assessment of whether Medical Hypothesis should remain listed on PubMed, the Library of Medicine’s database of peer-reviewed and legitimate articles. After an internal enquiry, Elsevier temporarily retracted the Duesberg paper, along with a second AIDS denialist article, pending the outcome of a more thorough investigation. That investigation, conducted by other Elsevier editors, commissioned five peer reviewers.  All five reviewers recommended rejection, and the paper was permanently retracted. In addition, Elsevier elected to reform the publishing policies of the journal, converting it to a peer-reviewed format. The editor, Bruce Charlton, has refused to accept the publisher's instructions to date and says he will serve out his contract without changing the policy; Elsevier has indicated that in that case Charlton will be removed from his position.

Around the same time, in August 2009, two people sent formal letters of complaint to Duesberg’s institution, the University of California, Berkeley, concerning the contents of the Medical Hypotheses paper. They noted the lack of disclosure of Rasnick's potential conflict of interest and the poor quality of scholarship throughout the work. Both letters were signed. One of the writers has since publicly disclosed himself as Nathan Geffen; the other has elected to preserve the right to confidentiality.

U.C. Berkeley began an investigation into Duesberg’s conduct, led by Public Health faculty member Art Reingold, M.D., M.P.H. Duesberg chose to announce the investigation, speaking with a ScienceInsider reporter about it [14] and also probably causing the official letters of complaint to be posted on a public website, despite their being marked as confidential. The investigation is ongoing, press coverage is increasing, and more and more of the facts are becoming known.

Scientists have long known that Duesberg has not done original work with HIV, that his denialist claims have either been falsified or are not supported by evidence, and that his scholarly practices are often slipshod and perhaps even deceitful. Descriptions of Duesberg in the popular press have concentrated on the colorful or offensive aspects of his personality, and many who find his AIDS denialism offensive have nonetheless supported his academic freedom.  But academic freedom is not license to breach the well-established rules of scholarship.  Conflicts of interest must be declared, and deliberate misrepresentation is not acceptable conduct. Duesberg may have finally exhausted the patience of the scientific community and the University of California.

References

1. See, for example, Zoe Corbyn, “Berkeley Scholar in Dock over HIV-Aids Article,” Times Higher Education, April 24, 2010.

2. See “Denialists Who Have Died of AIDS” at http://www.aidstruth.org/denialism/dead_denialists

3. See Nicoli Nattrass’s 2007 Mortal Combat: HIV Denialism and the Struggle for Antiretrovirals in South Africa (Pietermartizburg: University of Kwazulu Press) and Nathan Geffen’s 2010 Debunking Delusions (Johannesburg: Jacana) for a discussion of Mbeki and the P residential AIDS Advisory Panel. See also the Durban Declaration that affirmed in response to the South African fiasco that HIV is the cause of AIDS, and was signed by over 5,000 people at the MD or PhD level or the equivalent: http://www.nature.com/nature/journal/v406/n6791/abs/406015a0.html.

4. Presidential spokesman Parks Mankahlana made it chillingly clear that preventing mother-to-child transmission would result in large number of AIDS orphans burdening the state when the mothers of HIV-negative children died: “Who’s going to bring the child up? It’s the state, the state. That’s resources, you see.” Geffen, op cit, p. 54.

5. Nattrass, Nicoli. 2007. Mortal Combat: AIDS Denialism and the Struggle for Antiretrovirals in South Africa, Pietermaritzburg: University of KwaZulu-Natal Press.  See also Nattrass, Nicoli. 2008. “AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa.” African Affairs 107(427):157-176.

6. Chigwidere, P, Seage, G 3rd, Gruskin, S, Lee, T, Essex, M. 2008. “Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa’, in Journal of Acquired Immune Deficiency Syndrome, 49: 410-415.  See also Chigwedere P, and Essex, M. 2010. “AIDS Denialism and Public Health Practice.” AIDS and Behavior 14(2):237-47.

7. Geffen, Nathan. 2009. “Justice After AIDS Denialism: Should There Be Prosecutions and Compensation?” JAIDS 51(4):454-455.

8. May MT, Sterne JA, Costagliola D, Sabin CA, Phillips AN, Justice AC, Dabis F, Gill J, Lundgren J, Hogg RS, de Wolf F, Fätkenheuer G, Staszewski S, d'Arminio Monforte A, Egger M. 2006. “Antiretroviral Therapy (ART) Cohort Collaboration. “HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis.” Lancet 368(9534):451-8.

9. Duesberg PH, Nicholson, JM, Rasnick, D, Fiala, C, Bauer, H. 2009. “HIV-AIDS Hypothesis out of touch with South African AIDS – A new perspective.” Med Hypotheses (withdrawn).  On what it means to have a paper withdrawn from Medical Hypotheses, see Orac’s Respectful Insolence blog post of September 15, 2009: “Pity poor Peter Duesberg: Even Medical Hypotheses has dissed him.” http://scienceblogs.com/insolence/2009/09/pity_poor_peter_duesberg_even_....

10. Exley, C., L. Swarbrick, R. Gherardi, Authier, F-J.  2008. “A Role for the Body Burden of Aluminum in Vaccine-Associated Macrophagic Myofasciitis and Chronic Fatigue Syndrome. Medical Hypotheses 72(2):135-139.

11. Steinhauser, G. 2009. “The nature of navel fluff.” Medical Hypotheses  72(6):623-625.

12. Flensmark, J. 2004. “Is there an association between the use of heeled footwear and schizophrenia?” Medical Hypotheses 63(1), 740-747.

13. Mafrica, F, and Fodale, V.  2007. “Down Subjects and Oriental Population Share Several Specific Attitudes and Characteristics” Medical Hypotheses 69(2): 438-440. 

14. Miller, Greg. “AIDS Scientist Investigated for Misconduct After Complaint.” ScienceInsider April 16, 2010: http://news.sciencemag.org/scienceinsider/2010/04/exclusive-aids-scienti...