Published in: Frontiers in Public Health, 7 August 2015 (doi:10.3389/fpubh.2015.00193)

A commentary on
Questioning the HIV-AIDS hypothesis: 30 years of dissent

by Goodson P. Front Public Health (2014) 2:154. doi: 10.3389/fpubh.2014.00154

A recent Opinion article by Dr. Goodson (1) expresses pseudoscientific views typical of HIV/AIDS denialism (2–13) and ignores the overwhelming evidence that HIV is a causative agent of AIDS, the evidence accumulated during more than 30 years of research.

Fulfilling the Koch’s Postulate 1: HIV is Invariably Epidemiologically Associated with AIDS

Dr. Goodson ignores the fact that Koch’s postulates for viruses have been completely fulfilled in the case of HIV (9, 14, 15).

The overwhelming evidence suggests an invariable epidemiological association of HIV with AIDS. AIDS occurs exclusively in HIV-infected people (16). HIV can be detected in all AIDS patients (17). High levels of HIV in the organism predict progression to AIDS (18–23). Many children born to HIV-infected mothers have developed AIDS and died (24). AIDS-related conditions, such as Pneumocystis pneumonia and disseminated Mycobacterium avium complex disease, have become much more common after the start of the HIV epidemic (25). Death rates are much higher in HIV-seropositive treatment-naïve than in seronegative individuals (26–34).

An HIV-triggered decrease in CD4⁺ T-lymphocyte count is a specific feature of HIV infection, and is extraordinarily rare in the absence of HIV (16, 35–37). The HIV-caused CD4⁺ T-lymphocyte depletion occurs through at least two mechanisms. (1) Direct killing of infected CD4⁺ T-lymphocytes. Dr. Goodson seems unfamiliar with the fact that HIV-1, HIV-2, and other representatives of the genus Lentivirus (e.g., Simian immunodeficiency virus), as well as some other retroviruses (e.g., Feline leukemia virus and members of the Avian leukosis virus group), exert a cytopathic effect in infected cells (38). (2) HIV directly kills Th17 CD4⁺ T-lymphocytes in the intestinal submucosa, triggering the damage of the mucosal integrity, translocation of microbial products from the intestine to the blood and chronic immune activation, resulting in further massive loss of CD4⁺ T-lymphocytes (39, 40).

Dr. Goodson claims that recreational drug use, clotting factor VIII, or receptive anal intercourse, but not HIV, are causes of AIDS. However, all of these claims have long ago been rejected by overwhelming scientific evidence (16, 35–37, 41–45).

Fulfilling the Koch’s Postulate 2: HIV has been Isolated from Patients at all Stages of the Infection

Contrary to Dr. Goodson’s claims, HIV has been isolated from patients at all stages of HIV infection, including AIDS, and propagated in cell culture (17, 46–54). Various protocols for HIV-1 isolation (without “contaminants” claimed by Dr. Goodson) have been developed, and each of these protocols can be considered “standard” (55–62). Detailed images of HIV-1 virions, revealing morphology typical of the genus Lentivirus, have been obtained using transmission electron microscopy (46–48, 53, 63) and electron cryotomography (64, 65). A combination of immunofluorescent and electron microscopy has allowed visualization of intracellular trafficking of individual HIV-1 particles toward the nucleus of the infected cell (66). The process of cell-to-cell transfer of HIV-1 between T-lymphocytes has been visualized using high-speed three-dimensional video microscopy (67).

Fulfilling the Koch’s Postulate 3: Accidental HIV Transmission in Humans

Dr. Goodson ignores several tragic cases of accidental HIV transmission to laboratory workers who worked with purified HIV-1, became infected after a needle-stick or mucosal exposure and developed AIDS-like symptoms. HIV has been isolated from their blood, and DNA sequencing confirmed that the HIV variant isolated was identical to the one they were working with (15, 68–70). Other well-documented cases include HIV transmission from a dentist in the USA to several patients (15, 71), and HIV transmission through blood transfusion to 11 children in the USA (72) and 75 children in the former Soviet Union (73).

In addition, the Koch’s postulates for HIV and another lentivirus, Simian immunodeficiency virus, have been fulfilled in experiments with animal models (15, 74).

HIV Laboratory Testing

Three types of assays are used for HIV detection: (1) ELISA – specificity 98.5–99.9% (75–77), (2) Western blot (77), and (3) PCR – specificity 98.3–100% (78–80). The probability that both ELISA and Western blot would give false-positive results is extremely low (<1/140,000) (77). Thus, contrary to Dr. Goodson’s claims, these tests are highly specific for HIV-1. Since the diagnosis is based on the combination of the three tests (77), HIV testing will produce similar conclusions irrespective of the country.

Dr. Goodson misrepresents the study by Rodriguez et al. (81), which has never stated that PCR “is not sufficiently accurate” (1).

Antiretroviral Therapy

Contrary to Dr. Goodson’s claims, antiretroviral therapy (ART) has profoundly improved the prognosis for HIV-1-infected patients, suppressing their viral load, restoring CD4⁺ T-lymphocyte count, and reducing the risk of developing AIDS or dying (Figure 1A) (82–104). The success of ART has been determined by its high specificity for HIV-1-encoded proteins (105, 106). Along with therapeutic agents for many other diseases, ART does have side effects, but these are far outweighed by its benefits (106). New anti-HIV agents should help to mitigate side effects, overcome drug resistance, and ultimately cure HIV infection, e.g., through excising HIV proviral DNA from the chromosome (107–109).

Dr. Goodson misrepresents the study by the ART Cohort Collaboration, which showed that ART is extremely beneficial for HIV-infected patients, but better clinical outcomes are observed when CD4⁺ T-lymphocyte counts at the start of ART are higher than 200 cells/μl (110). These conclusions have been corroborated by many other studies (111–117) and serve as a background to recommend starting ART early, when the HIV-triggered damage of the immune system is easier to restore (106).

Detrimental Impact of HIV/AIDS Denialism on Public Health

P. Duesberg, D. Rasnick, and some other HIV/AIDS denialists served on a controversial advisory panel of the South African president Thabo Mbeki. The policy of the South African government over HIV/AIDS during the period 2000–2005 is considered by a majority of scientists to have resulted in the death of at least 330,000 HIV-infected people (Figure 1B) (9, 12, 118). The Opinion article by Dr. Goodson (1) [as well as earlier published or publicly expressed opinions of P. Duesberg, K. Mullis, and other denialists, none of whom has ever worked with HIV/AIDS (2–5, 7–12)] is similarly harmful for public health, as it disseminates dangerous misinformation about HIV/AIDS that can affect prevention decisions made by uninfected people and treatment decisions made by HIV-infected people. Therefore, the following recommendations should be given to public health workers: (1) to learn and disseminate up-to-date knowledge on HIV/AIDS based on the most recent scientific literature, and (2) to be aware of HIV/AIDS denialism and be able to effectively counteract its detrimental impact on public health.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

I would like to thank Dr. Nicoli Nattrass for providing an electronic file for Figure 1B, Raymond W. Wong for providing PDF files, and Andrew Reddin for critical reading of the manuscript.

References

Keywords: HIV, AIDS, antiretroviral therapy, AIDS denialism, pseudoscience, public health

Citation: Karetnikov A (2015) Commentary: Questioning the HIV-AIDS hypothesis: 30 years of dissent. Front. Public Health 3:193. doi: 10.3389/fpubh.2015.00193

Received: 30 April 2015; Accepted: 23 July 2015;
Published: 07 August 2015

Copyright: © 2015 Karetnikov. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

AIDSTruth began in 2006 to provide accurate information that countered the nonsense of AIDS denialism. We have long since reached the point where we—the people who have in one way or another been involved in running this website—believe that AIDS denialism died as an effective political force.

We have therefore decided that there are no further compelling reasons to continue updating this website. However, the website will continue existing indefinitely. It is a valuable source of accurate information on HIV, and it serves as an important archive of the battle against AIDS denialism.

AIDS denialism includes the views that (1) HIV does not cause AIDS, (2) the risks of antiretrovirals outweigh their benefits for people with HIV, and (3) there has been no large HIV epidemic in sub-Saharan Africa.

HIV was proven to be the cause of AIDS in 1984. By 1987 there was no reasonable doubt. And since then barely a month has gone by in which a study doesn’t in some way reconfirm this finding. The efficacy of antiretrovirals, starting with AZT in 1987, is unequivocal. There were of course bumps in the early years of treatment. AZT was prescribed too early and in doses too high, but even so observational data from that time two decades ago shows that it did more good than harm. By 1996 the benefits of triple-drug antiretroviral treatment were profound. And in the past month, the publication of the START and TEMPRANO studies has shown yet again, in randomised clinical trial conditions, how effective these medicines are at keeping people with HIV healthy.

Also in the past month, the World Health Organisation has announced that over 15 million people are on antiretroviral treatment. The South African government counts over 3 million on treatment. Data shows how antiretroviral treatment has turned around declining life-expectancy in South Africa. This demonstrates the absurdity of the view that there is no large HIV epidemic.

AIDS denialism has cost many lives across the world. It will continue to exist in marginalised pockets, just like other conspiracy theories and pseudo-scientific ideas. But the proponents of AIDS denialism are no longer taken seriously by the vast majority of people affected by HIV, and they no longer have any relevant political power. Our work is done.

The AIDSTruth team

She reflects on some of the arguments in the book in a piece for The Scientist, which has also published a short extract of the book on its website.

There is a substantial body of evidence showing that HIV causes AIDS—and that antiretroviral treatment (ART) has turned the viral infection from a death sentence into a chronic disease.1 Yet a small group of AIDS denialists keeps alive the conspiratorial argument that ART is harmful and that HIV science has been corrupted by commercial interests. Unfortunately, AIDS denialists have had a disproportionate effect on efforts to stem the AIDS epidemic. In 2000, South African President Thabo Mbeki took these claims seriously, opting to debate the issue, thus delaying the introduction of ART into the South African public health sector. At least 330,000 South Africans died unnecessarily as a result.2,3

The “hero scientist” of AIDS denialism, University of California, Berkeley, virologist Peter Duesberg, argues that HIV is a harmless passenger virus and that ART is toxic, even a cause of AIDS. He has done no clinical research on HIV and ignores the many rebuttals of his claims in the scientific literature.4,5 As I describe in my new book, The AIDS Conspiracy: Science Fights Back, this has prompted further direct action against Duesberg by the pro-science community.

Read the rest of Nicoli Nattrass’s article in The Scientist.

Read an extract of The AIDS Conspiracy: Science Fights Back.

The article will have no influence on medical science. Nor is it likely to influence the South African government; the days of state-supported AIDS denialism are gone. Nevertheless its publication and the subsequent unnecessary publicity it received in the world’s leading science journal, Nature, provide a good opportunity to explain how we do know there is a massive HIV epidemic in South Africa.

The two main arguments Duesberg et al. offer are that (1) the population has increased by 20 million in the past three decades and (2) mortality reports released by Statistics South Africa (Stats SA) show relatively few AIDS deaths.

The first argument, that the population has increased, can be swiftly dealt with.

The annual number of births in South Africa over the last two decades has been between 1 and 1.2 million. By the best estimate the number of deaths rose between 1997 and 2006 from about 400,000 to about 650,000 annually. This rise in deaths, as I explain below is entirely consistent with our large HIV epidemic, but it is still far below the number of births: hence South Africa’s population has risen. Source: ASSA2008 Provincial Outputs

The second argument is one that has been raised repeatedly by denialists, despite the fact that a little bit of analysis shows it is wrong.

Stats SA regularly publishes a mortality report which tabulates death statistics based on death notification forms. Every time someone dies in South Africa, a death certificate is supposed to be filled in and eventually finds its way into national statistics. A doctor is supposed to indicate the underlying cause of death and Stats SA always publishes the top 10 such causes for natural deaths. It is true that HIV as the underlying cause of death features near the bottom of the top 10 and is quite low. For example in 1997 there were just over 6,600 recorded HIV deaths and this rose to just under 18,000 in 2009.

The reason for this massive underestimate of HIV deaths is explained in an article published in 2005 by Medical Research Council researchers:

In a country such as South Africa, where the HIV status of the deceased is often unknown or the medical certifier does not have access to a full medical history, mis-classification to the immediate cause of death rather than the underlying cause often takes place. Furthermore, since 1992 it has been possible for traditional headmen to complete an abbreviated death notification form, often resulting in misclassification of the cause of death to a generalized ill-defined rubric … in some rural areas.

In addition, some doctors are reluctant to write HIV as the underlying cause because, even though the cause of death is noted on a confidential form, they remain worried that insurance companies will access the forms and thereby deny funeral and life-insurance payouts to the families of the dead.

But the evidence for a massive increase in deaths due to AIDS is nevertheless abundant from the death data.

1. The number of recorded deaths in SA in 1997 was 316,505. This rose to 613,040 in 2006 and has since declined to 572,673 in 2009. Improved registration and population growth only explains this partially. I am not using false accuracy here; these are the actual counts of recorded death certificates. According to Stats SA, about 80% of deaths are recorded. Sources: Stats SA P0309.3 reports 2005 and 2011
2. The number of recorded deaths from opportunistic infections associated with HIV has risen dramatically. For example Tuberculosis deaths rose from 22,071 in 1997 to 77,009 in 2006. This is by far the biggest cause of recorded deaths. Influenza and Pneumonia deaths rose from 11,518 in 1997 to 52,791 in 2006 to become the second-largest cause of death after TB. Deaths due to Intestinal Infectious Diseases was not in the top 10 in 1997. In 1998 it was 9th at 8,808. In 2006 it was 3rd at 39,239. Most of the increases in these causes of death were almost definitely due to HIV.
3. By contrast death from Ischaemic Heart Disease rose marginally from 9,797 in 1997 to 13,025 in 2006.Diabetes deaths rose a bit more significantly, from 10,828 to 19,549 (and South Africa is indeed experiencing a diabetes epidemic). While these causes of death are not commonly associated with HIV, it’s quite conceivable that their relatively small increases are at least in part explained by HIV since we know that HIV also increases the risk of death from non-AIDS causes. For example, the SMART trial found that untreated HIV causes increased risk of dying from heart disease.
4. With the introduction of antiretroviral treatment (ART) in the public sector in 2004, the number of people on treatment has risen to approximately 1.5 million. This correlates with a decline in recorded deaths in recent years, which is what would be predicted by an increase in the number of people taking ART. This decrease in deaths is the one silver lining of the South African epidemic.
5. Andrew Warlick and I prepared the graph below for the Treatment Action Campaign some years ago. It shows the changing age pattern of deaths in South Africa. It is perhaps the most compelling proof of the massive HIV epidemic in SA. It destroys AIDS denialism in one pretty picture. It shows how in 2004 the women who died in South Africa were mainly young adults, not old people. This was in contrast to 1997 as well as the situation in Brazil in 2004, a country with a comparatively tiny HIV epidemic. Only the presence of the large HIV epidemic in South Africa can explain this.

   

   Constructed using mortality data from Statistics South Africa and Instituto Basileiro de Geografia e Estatística

6. In 2002, Stats SA closely analysed a 12% sample of death certificates. The death certificates often contained synonyms for deaths caused by HIV and, in contrast to the standard mortality reports that Stats SA publishes, these were counted as AIDS. It offers clear evidence of the growing epidemic. In 1997 TB and HIV were responsible for 6.5% and 4.6% of underlying causes of death respectively. This steadily rose to 9.7% and 8.7% in 2001. The only larger causes were Unspecified unnatural causes (15.3% and 8.2% in 1997 and 2001 respectively) and ill-defined causes of mortality (8.6% in 1997 and 2001). Influenza and Pneumonia deaths rose dramatically too. But deaths due to diseases not usually related to AIDS didn’t show similar increases. For example, heart disease deaths declined.
7. In 2001, the Medical Research Council published a meticulous study based on the Department of Home Affairs Population Register. The report carefully and convincingly showed rising HIV mortality in adults.
8. The Actuarial Society of South Africa uses multiple sources to calibrate its models in order to come up with the best estimate of the number of annual AIDS deaths in South Africa. Their latest published model,ASSA2008, calculates that between 1997 and 2008, 2.1 million people died of AIDS in South Africa. That’s an average of nearly 500 people per day. It’s difficult to fathom such a catastrophe. By comparison it’s almost the equivalent of the 2004 Tsunami happening in just one country every year, year after year. In 2006, the worst year of the epidemic so far, over 700 people died daily.

All of the above is of course ignored by Duesberg et al. But it is well known to experts on the South African epidemic. This raises a perplexing question: who were the peer reviewers of the Duesberg et al. article? It is very unlikely that any genuine expert in AIDS statistics would have given their paper the go-ahead.

This note first appeared on a Facebook page. It is republished here with the author’s permission.

After speaking with Shannon, we decided it would be beneficial to those interested in Kim’s history to hear my own personal story.

I was diagnosed with HIV in the fall of 1984. It was my final year of undergraduate work at KU, and i was deciding whether to attend medical school. after receiving the news in a very seedy sedgwick county health department office, I was terrified, horrified and in shock. I had been in a monogomous relationship with a man for almost a year. He began to hear rumors that a man he had dated previously was “sick”. After his test results came back positive, it was my turn. Neither of us knew what to do or where to turn. In those days there was talk of quaranteening the infected in asylums or deserted islands. We were a pariahs, angels of death. From that moment on we couldn’t plan for our futures or make decisions beyond what was for dinner because we expected to drop dead at any moment. That is what was happening to those in our situation.

Randy became ill quite quickly, and had no choice but to begin the hellish drug treatments that were available at the time. I on the other hand was more fortunate in that my health remained good for more than a decade. During that time I watched as friend after friend fell from opportunistic diseases that a compromised immune system could not fight off. I felt like i had no future and just kinda twittled my life away, waiting for the end. Randy died about 4 years later, and I was alone; I thought for the rest of my short life. I saw an HIV specialist regularly. He gave me the option of going on antivirals, or waiting until i was truly sick to start. On his advice I waited and waited. In 1995 my T-cells began to plummet, and we decided it was time. New, more promising therapies were on the market, and he had every hope we could keep the virus in check. I continued with my regular check-ups and my T-cells and my overall health improved. Soon i almost forgot that i was sick. I began to have hope that maybe i could beat this, maybe I’d be the first.

After about a year of therapy, and a normal T-cell count, we decided to get off the drug therapy. They are harsh, complicated and overwhelmingly expensive. Within 6 months my T-cells were once again at an alarmingly low level and I went onto a new drug regimen that I remain on to this day, and will for the rest of my life. My T-cells remain in the normal range, I have an undetectable <0 number of virus in my blood, and remain healthy, at least physically (LOL).

I WANT EVERYONE TO READ AND UNDERSTAND. THE HIV VIRUS AND THE CONDITION CALLED AIDS IS VERY REAL, AND VERY TREATABLE.

Until i returned to Wichita in 2002 to try and save my baby sister Tricia, and re-met Kim, I had never heard of these lie-mongering denyers. Knowing Kim as a strong-willed, highly intelligent young woman, I thought it odd that Kim was so influenced by them, but I know we each have our own path. The lies they concocted, then spewed to the public is the one and only reason Kim is where she is today. PLEASE, PLEASE don’t let these lies continue to hurt and kill the ones you love and care about. Stomp the lies and the people that perpetuate them into the dirt.

Today I am in a loving and healthy relationship with the love of my life and soul-mate Mando. After nearly 16 years together he is still HIV-negative and that is because of the care of great physicians and incredible advancements in HIV therapies. My life hasn’t turned out exactly how i had planned, but I have played the cards I was dealt as best I could and so far I am winning the hand.

Please feel free to contact me about what I have said. If you have any questions I will be glad to answer, or find the answers for you. And again, if you can find the time to stop and say hi to Kim, you’ll feel better for doing it. She is still a loving, caring, and generous spirit, even if she is trapped inside an unhealthy body.

My best love to all of you.

Phillip

P.S. Forgive the typos, Mrs. Cates really did teach me better than this.

OPINION: Doctors call them Thabo’s children – the thousands of kids infected with HIV by their mothers at birth who still fill hospital paediatric wards, suffering from a range of debilitating infections.

When many of them were born, they did not get antiretroviral medication that could have prevented their mothers from passing HIV on to them. This was because then-president Thabo Mbeki had decided that ARVs were “toxic” and somehow less desirable than a fatal, incurable virus.

But by 2000, at the height of Mbeki’s AIDS debating society, four independent studies had shown that two ARVs, AZT and nevirapine, could cut HIV transmission from mothers to babies by up to 50%.

Also by 2000, research showed a radical change in the death patterns of South Africans with a peak in young women and men, rather than the elderly, that could only be explained by AIDS.

It is well documented that some 330,000 people died under Mbeki’s watch because his government delayed the introduction of ARVs.

What is less known is that Mbeki’s refusal to accept that AIDS was caused by a viral infection caused his government to under-fund health services at the very time that hospitals were starting to see a surge in AIDS patients. They closed nurses’ training colleges and flat-lined health budgets to save money, hastening the collapse of health services that we see today.

Yet in a series of articles published in Independent newspapers countrywide recently, Mbeki’s loyal director general, Frank Chikane, has tried to portray his former boss as a deep thinker who took a principled stance after thorough research. Chikane’s criticisms of Mbeki are mild – painting his bizarre refusal to accept that HIV causes AIDS as a bit of a public relations blunder requiring some spin-doctoring – rather than a criminally irresponsible academic obsession that caused death, suffering and hardship for hundreds of thousands of South Africa citizens who depended on their president for leadership.

Chikane constructs his defence of Mbeki on three pillars. Firstly, that Mbeki believed that ARVs (especially AZT) were “toxic” and were being foisted on poor countries by evil pharmaceutical companies. Secondly, that he was defending “the historically disadvantaged” from “racism”. Thirdly, he was defending his own right to “think independently” of Europe and the US.

According to Chikane, “there could be no disagreement about AZT’s toxicity”.

However, he fails to spell out that four trials had shown that a four-week course of AZT and a single dose of nevirapine were safe and had been able to cut mother-to-child transmission by up to half – potentially saving 150,000 of the 300,000 babies born HIV positive annually at the time.

The first of these trials was carried out in the US as early as 1994, while two others were in Thailand and the fourth in South Africa in 2000.

In any medical treatment, risk is balanced with the seriousness of the condition. Chemotherapy is not acceptable to treat a cold but it is to treat an almost incurable disease such as cancer. Ditto ARVs: there are side-effects but the side-effect of HIV is death, so the risk is justifiable.

Chikane argues that Mbeki felt South Africa was “being asked to do what no developed countries were no developed country was doing” – namely to use AZT and nevirapine, “as monotherapy rather than as a combination of drugs”.

Chikane adds that Mbeki was disturbed that the World Health Organisation (WHO) approved of the use of single-dose nevirapine to prevent mothers from passing HIV to their babies in developing countries.

He fails to mention that, at a meeting in 1999 between then health minister Nkosazana Dlamini-Zuma and the Treatment Action Campaign (TAC) two months before Mbeki became president, Dr Zuma said that price of AZT was the major barrier to introducing it to prevent mother-to-child HIV transmission.

Chikane also fails to mention that the South African Medicines Control Council (MCC), despite all manner of political contortions to rob the body of its independence from government, found in 2000 that the benefit of using ARVs to prevent mother-to-child transmission outweighed the risks.

Time and again, Chikane raises the bogeyman of big bad Pharma – the all-powerful pharmaceutical companies – as being at the forefront of the “war” against Mbeki in a bid to safeguard their profits.

Yet at a time when Mbeki could have formed a powerful alliance with organizations like the TAC to fight for cheaper ARVs, Mbeki turned on them with viciousness, accusing TAC’s Zackie Achmat of having CIA links and the TAC of being a pawn of the pharmaceutical companies!

In addition, he fails to recall that Boehringer Ingelheim, the manufacturers of nevirapine, offered the drug free to South Africa for five years – an offer spurned by government because its president believed it was poison!

Describing the attacks on Mbeki as “ferocious” and unexpected, Chikane says “we” were forced to ensure that the Cabinet had to make compromises on HIV/AIDS and Mbeki was absolved from taking responsibility. So much for leadership!

In describing Mbeki’s inner circle’s discomfort at having to confront the then-president about his position on AIDS, Chikane inadvertently reveals Mbeki’s dictatorial manner, his narcissism and his inability to accept criticism.

He tells us few “could risk” raising Mbeki’s HIV stance with the president; that Mbeki felt those who wanted him to back down were “cowards” and that “there was no one bold enough to take on this cause” than himself.

It is hard to have sympathy for such a man, let alone such a president. Nowhere is there mention of the impact of Mbeki’s bizarre views of those living with, or affected by, HIV. Nowhere is there sympathy for the current president and health minister, who are trying valiantly to address the irresponsible legacy of the Mbeki regime. Instead, all Chikane offers is puff, paranoia and conspiracy – vintage Mbeki but wholly out of touch with current reality. – Health-e News Service.

This is a corrected version of a position argued by the author at a debate that took place at the University of Cape Town in August 2010 about traditional and scientific medicine. Geffen is the treasurer of the Treatment Action Campaign, but this paper presents his personal views only. He is also author of the book Debunking Denialism (Jacana 2010)

Scientists can be elitist and patronising. In that way, they are no different to any other people with power, including some traditional healers and including people who defend science, like myself.

There are multiple knowledge systems. Cultural diversity, including African culture, is a valuable treasure. Traditional medicine is used by people across the world. African traditional medicine, in particular, is used by millions of people across Africa. It is therefore important to build relationships with traditional healers to ensure that their patients receive appropriate care. Many organisations, such as the Treatment Action Campaign (TAC), attempt to do this, with varying degrees of success.

However, In critiques of medicine and, on the other hand, efforts to accommodate traditional healing, humanities researchers sometimes stand accused of being relativist, i.e. promoting or implying multiple incompatible positions as being true or valid. They also sometimes stand accused of being less than forthright about the problems with traditional healing. With this in mind, I present seven frank points which I hope will inform this discussion.

1. For the most part what is true is independent of what we believe. Many cultural or traditional beliefs, despite being fiercely held, are false. This applies to all knowledge systems. The scientific method is the best way to ascertain true facts about the universe and correct the often dogmatic beliefs that we acquire via tradition. In contrast to untested traditional and cultural beliefs, scientific knowledge depends on carefully controlled and recorded observations and experiments, done according to continuously refined standards developed across the world by people with diverse races, languages, creeds and cultures. The scientific method sometimes elicits the wrong answers, but it generally corrects mistakes over time. It has greater explanatory power and is right more often than dogma or tradition.

2. Once the placebo effect is exhausted, what heals is independent of what is believed to heal. It is one thing to acknowledge that different people have different knowledge systems, but knowledge systems are often factually wrong about the treatment of human illness. Traditional healing, whether it be Western Judeo-Christian traditional methods, homeopathy, acupuncture, Chinese herbs or African traditional medicine often has a healing effect. But it is very seldom that these effects are found to be more effective than what we call placebo, which is admittedly a complex concept in need of much greater understanding. Traditional healers can also have a profound effect on the psychological health of people. For example in Debunking Delusions, I describe the profoundly beneficial effect of a visit by Busisiwe Maqungo, a woman with HIV who takes antiretrovirals, to her traditional healer.
   But there can be dire consequences of believing that something heals when it actually does not. TAC recently held a press conference in which we criticized ETV for hosting a faith-healing advertisement of a church called Christ Embassy. TAC has subsequently received many angry letters from members of this church since that press conference. We and the letter-writers have different knowledge systems. But consider this:

a. A woman with XDR TB and HIV was doing well on TB and antiretroviral treatment at a health facility in Cape Town. Her TB had smear-converted to negative.

b. But then she attended a Christ Embassy ceremony and was led to believe that she had been faith-healed. She consequently saw no need to continue taking her medicines.

c. Over a period of about a year she became ill and developed XDR TB again. She died.

d. Before she died, she transmitted XDR TB to her family members. They are now fighting for their lives.

These sad facts are true independently of how much respect we afford the knowledge system of the adherents of Christ Embassy.
In Debunking Delusions, Andile Madondile describes his visits to traditional healers which delayed him going onto antiretroviral treatment and consequently almost led to his death. As with Christ Embassy, no matter how much respect we afford the knowledge system of traditional medicine, it should be acknowledged that Andile’s story is a familiar one played out frequently in South Africa often with deadly consequences.

1. There is very little traditional medicine that works out the box (beyond placebo). Millions of dollars are spent testing traditional and herbal medicines (read Eduard Ernst and Simon Singh’s book Trick or Treatment to see how many studies have been done on acupuncture for example). In South Africa, there are researchers testing traditional medicine at the University of the Western Cape, University of Cape Town, University of Kwazulu-Natal and the Medical Research Council. Yet I know of only one traditional medicine that has been found to be effective at treating an HIV-related opportunistic infection, herpes, and even that study, published in an obscure journal, has not to my knowledge been repeated. Some traditional medicines show promise, but there have been many failures, for example African potato in people with HIV, Hoodia to control appetite, as well as mixed results with garlic.

Nevertheless many proven medicines have their roots in what we would consider natural items: Paclitaxel, an anti-cancer drug, is derived from the Pacific Yew tree. Zidovudine, the first antiretroviral, was first made using an extract from herring sperm. There are many more. But getting an effective medicine is not as simple as scraping off the bark of a yew tree or extracting sperm from a herring. A complex technological process has to be carried out to get the final beneficial medicine.

1. It is right that patients may choose, but it is not right that healers may offer whatever they choose. Choice is often poorly understood in this debate and it is used as a mantra to justify unethical behavior. Patients should have choice. Patients can choose the healing method they wish. But healers should not have unlimited choice. In fact they do not have unlimited choice in South African law or in any reasonable ethics system. We do not accept it when we are sold a dud DVD player or a car, or when we receive unsound financial advice or even when our General Practitioner fails to treat us properly. Likewise traditional healers cannot be said to have a choice in what they offer their clients. They are obligated not to do anything to their patients that will endanger their lives.

2. The economic incentives involved in traditional medicine are immense. In this debate, the economic interests of doctors and members of the pharmaceutical industry are frequently pointed out. But if you read Andile Madondile’s story in Debunking Delusions or walk around the alternative health shops in the Waterfront Craft Market or you watch who is selling traditional medicines at the Site B train station in Khayelitsha, it is clear that there’s serious money in traditional medicine as well as alternative medicine. And yet it remains largely unregulated despite the false and dangerous claims that many of these healers make and the delays in seeking appropriate treatment that they often cause.

3. There are racial misnomers in this debate. There are many high-quality African scientists working on AIDS: Peter Mugyeni, James Hakim and Paula Munderi to name a few. Yet the worst quacks I have dealt with over the last few years, who have hidden behind the paradigm of traditional medicine, have been mostly white. All cultures have traditional medicine. My culture too has its traditional medicines. Homeopathy is decidedly European in origin and complete quackery. In fact it is the romanticisation of African traditional medicine, while other forms of traditional medicine are not so much romanticized anymore at least not by academia, that suggests a racial undercurrent.

At its worst, the romanticisation of traditional medicine has been accompanied by a dangerous distorted form of African nationalism, exemplified by Thabo Mbeki, but in more recent times by Sowetan columnist Andile Mngxitama.
Natural science is empowering and socially uplifting when correctly utilised. Science is universal and to portray it as ‘western’ and not suited to some parts of Africa is like saying African children should not be taught mathematics at school. Presenting science as un-African, even if this presentation is implicit, is in fact racist.

1. Humanities courses need to teach science better. The quality of debate about medicine in the humanities indicates that graduates are not being equipped with the skills to differentiate between good science, bad science and outright nonsense. Are humanities courses teaching students basic statistics, how to read medical abstracts and articles, how medical research is carried out and how to search pubmed? It is this frequently encountered apparent lack of knowledge that undermines respect for what emanates from the humanities.

Ends

Achieve, Spring 2010. Reprinted with permission from Achieve.

Introduction

More is known about HIV than about any other virus. Less than three decades ago, doctors were perplexed by the appearance of Kaposi’s sarcoma and Pneumocystis pneumonia (PCP) in young gay men. Since then, scientists and doctors, spurred by the activism of people with AIDS, discovered the virus now called HIV and proved that it causes AIDS by crippling the immune system until the body can no longer resist life-threatening infections.

Scientists around the world have isolated HIV, photographed it with electron microscopes, and sequenced the genomes of its different subtypes. There are now highly accurate tests for HIV antibodies and the virus itself, and increasingly effective and tolerable antiretroviral drugs (ARVs) for its treatment. Science is a gradual process, and there is still much that is not fully understood about HIV, but the evidence that HIV exists, is transmissible by blood, semen, and vaginal fluids — and that it causes AIDS — is vast and thorough.

The Denialists and Their Cult

And yet there are thousands of people who persistently reject these facts. They believe that HIV is harmless or doesn’t exist. Some argue that AIDS has other underlying causes, such as drugs, depression, “dirty” sex, stress, malnutrition, or conventional medicine. Others say that AIDS is just an artificial clustering of familiar diseases. Those who reject HIV/AIDS science call themselves “AIDS dissidents,” but others usually refer them to as “HIV denialists” because they elevate personal denial into an ideology.

Most people are astonished by the existence of HIV denialism. “I had no idea there were ‘AIDS deniers,’ and I still don’t understand why someone would believe such a thing,” a blogger wrote upon reading of the deaths of denialist Christine Maggiore and her young daughter, both from AIDS. What is most baffling is the persistence of irrational beliefs, held firmly despite the evidence, despite the terrible deaths, and despite the absence of a coherent alternative theory. How can people ignore both scientific evidence and their own failing health? How could Maggiore do nothing to prevent HIV transmission to her children? How could she allow her child and herself to die needlessly? And how could her admirers, initially frightened, go on to rebuild the wall of denial?

HIV denialism can be understood if we view the movement as a kind of cult. Denialists refer to HIV medicine and science as “the orthodoxy,” giving the field a religious framework, and imagine themselves in an oppositional, visionary role.

The persistence of the HIV denialism can be understood if we view the movement as a kind of cult. Denialists refer to HIV medicine and science as “the orthodoxy,” giving the field a religious framework, and imagine themselves in an oppositional, visionary role. Many of the features that social scientists find typical of cults characterize the denialists. Most fundamentally, they maintain an intense “us-versus-them” worldview. Those inside belong to an exalted and secretive group — they feel superior but persecuted for knowing a hidden truth. They believe that the pharmaceutical industry, governments, researchers, clinicians, the United Nations, AIDS activists, foundations, and HIV organizations are united in an elaborate global plot, which ex-traffic cop Clark Baker calls “the most significant criminal conspiracy I have ever imagined” to kill healthy people with toxic drugs for profit.

Doctrine and Indoctrination

Many HIV denialists adopt alternative health and spiritual beliefs, including consciousness-altering practices that are typical of cults. The use of hypnosis by HEAL-New York stands out. Members believe that simply being told that they are HIV-positive makes people sicken and die. HEAL’s leader, Michael Ellner, uses hypnosis to extract people from the deadly mental “AIDS Zone” and to make them feel “at peace with testing positive.”

Ellner is not alone in thinking that words kill but viruses don’t. Cult scholars call this “mystical manipulation.” Denialist Matt Irwin developed the theory in AIDS and the Voodoo Hex: “The severe, acute psychological stress of being diagnosed ‘HIV Positive’ is quickly transformed into a severe, chronic psychological stress of living with a prediction of a horrifying decline that could start at any time. This causes a suppression of the immune system, with selective depletion of CD4 T-cells. … These factors have been studied in healthy people where they create the very same immunosuppression and immune dysregulation that may later be called ‘AIDS.'”

Denialist Michael Geiger is another proponent of “dangerous” thoughts, and even accused another dissident of helping to kill Christine Maggiore by worrying about her. “Have we as yet learned nothing … of how easy it is to plant projections of sickness and death onto our own selves, as well as our friends, acquaintances or even onto our children and thereby help to create those fears into our realities?” Ironically, Celia Farber regularly “projects” in just this way: “I feared for [Maggiore’s] life, always. I feared the battle would kill her, as I have felt it could kill me, if I couldn’t find enough beauty to offset the malevolence. This is a deeply occult battle, and Christine got caught in its darkest shadows.” Farber also blames the “AIDS orthodoxy” for long-distance mental homicide: “This is voodoo, what they are doing to [South Africa’s denialist Health Minister] Manto. It is heartbreaking. I sometimes think they killed [Maggiore’s daughter] EJ with their voodoo, too. What did EJ die of? Can anybody explain it and does it look like anything anybody has ever seen?” (EJ died of PCP.)

Cults often manipulate feelings of shame and guilt to control their members. Because both AIDS and the activities associated with HIV transmission are stigmatized, the HIV-negative denialist leadership often degrades those who have HIV, even if they are dissidents themselves. Peter Duesberg has always blamed AIDS in gay men on poppers and promiscuity; he dismisses those who say they didn’t engage in either behavior as liars. Clark Baker says that AIDS was invented because “a small group of promiscuous, addicted, nitrite-huffing, gonorrheal and syphilitic bath house veterans began to get sick” and “refused to accept blame for their self-destructive behavior.” A poster on a denialist forum attributes AIDS to “premature aging” from “snorting poppers, doing meth, drinking heavily, smoking heavily, eating poorly, not sleeping, having unprotected sex and taking the various pathogens of hundreds of sexual partners into your body.”

HIV-positive denialists who get sick are blamed for lacking commitment: “Given a choice between the opposing ideas of dying from the deadly HIV product or living a long healthy life based on the dissident belief that the HIV product is nothing more than a baseless commodity being sold by junk merchants, chosing [sic] the dissident dream is the far better choice. A pseudo dissident … will use the dissident view as a survival coping device … When ordinary illness strikes and they run to RX drugs and suffer the very types of health decline that the dissident model predicts, they attack the dissident message.”

Denialists who die from AIDS are often posthumously smeared as liars and secret addicts. When Raphael Lombardo died, Peter Duesberg wrote, “In hindsight, I think his letter was almost too good to be true. I am afraid now, he described the man he wanted to be and his Italian family expected him to be, but not the one he really was.” (Duesberg meant that Lombardo lied about drug use.) Liam Scheff rolled the reputation of Mark Griffiths down a slippery slope of innuendo into the gutter: “I knew Mark; he was cogent when I worked with him — never anything but. Almost. Sometimes he was — once or twice he’d been — a bit groggy. But he told me that it was alcohol. In fact he told me that he did consume alcohol — perhaps more than he should.” Scheff said drinking, not AIDS, killed Griffiths.

Creating Pariahs

Like those leaving a cult, former denialists are treated with extraordinary hostility. Dr. Joseph Sonnabend was one of the first physicians to treat people with AIDS. He insisted on a very high threshold of evidence that HIV causes AIDS, was cautious in prescribing unproven treatments, and recognized that co-factors, such as drug use and frequent STDs, influence an individual’s risk of infection upon exposure and how fast HIV disease progresses. Denialists have often claimed Sonnabend as one of their own. When clips of him were used in the denialist film “House of Numbers” to support the denialist perspective, Sonnabend responded with a scathing blog at Poz.com, repudiating the film’s message and affirming that HIV causes AIDS and that ARVs save lives. He wrote: “It is hard to adequately convey the feelings of a physician who was able to finally help his patients in the mid-1990s, having lost hundreds to this disease before that time. By the time these drugs became available about 400 of my patients had succumbed to AIDS, a dreadful rate of mortality. The effect of these drugs was life saving to those with advanced disease whose survival had been limited before. The portrayal of these drugs as in effect only toxic is so unfair.”

Sonnabend was immediately savaged by denialists for betraying the cult. In one forum, “Ellis” wrote: “[Y]ou’re a disgusting fraud, in my opinion, having once bravely stood apart from the racket, now pointing fingers and calling names of those who still have the decency to not be bought and sold for dollars and popularity contests. Who cares if HIV causes AIDS, or ten thousand things cause AIDS? … Are you attempting to denigrate the film because of your own outlandish, humiliating lack of composure on camera? Because you sound like the old boozy floozy you really might be, not so deep down? Because you sold out to corporate pseudo-science a long time ago, do you now pour hatred onto those who still aren’t satisfied with the one-size-fits-none industrial diagnosis? Shame on you, deep, deep, deep shame. You absurd old sell-out.”

Celia Farber similarly attacked Sonnabend on the Spectator’s website, accusing him of personal and medical treachery: “I have countless hours of tapes from the ever shifting but consistently indignant Joe Sonnabend dating as far back at 1988 … through 2001, if not longer. After that, he became impossibly sycophantic to the orthodoxy. … As for me, like everybody else under Joe’s Bus, I forgave him because he seemed so abashed. I even invited him to my wedding. But he is a weak, dishonest man without any integrity, who loves the sensation of throwing everybody under the bus.” Sonnabend’s sin was to continue to evaluate the evidence, until the proof that HIV causes AIDS and that HAART is an effective treatment was conclusive.

Controlling the Flock

Peter Duesberg has always blamed AIDS in gay men on poppers and promiscuity; he dismisses those who say they didn’t engage in either behavior as liars.

Within cults, the milieu is controlled and members are isolated. For denialists, who have no ashram, this happens online and in small groups. People worried about HIV are urged not to take the antibody test, to avoid mainstream information about AIDS, and to “stay as far away from allopathic doctors as possible.”

Robert Lifton, a scholar of cults, identified the “principle of doctrine over person” as a characteristic feature. This doctrine “is invoked when cult members sense a conflict between what they are experiencing and what dogma says they should experience. The internalized message … is that one must negate that personal experience on behalf of the truth of the dogma. Contradictions become associated with guilt: doubt indicates one’s own deficiency or evil.” Many HIV-positive denialists struggle with the reality of failing immune systems, which undermines their belief that HIV is irrelevant. The long list of denialists who have died from AIDS (posted on AIDStruth.org) contrasts with the fact that not one of the HIV-negative denialist leaders has died young, let alone with multiple strange infections that happen to be AIDS-defining illnesses.

Some HIV-positive denialists defy the prohibition on HIV treatment when they develop AIDS; they start ARVs and experience a rapid return to health. But instead of abandoning denial, many struggle to frame an alternative explanation for the success of the meds. Noreen Martin insists that her AIDS is not viral: “My own experience with AIDS was due to a lifetime of negative health issues. When extremely sick, I took the medicines, ate healthy, took over 50 supplements a day, and had a good attitude. So, within a few months I was as good as new.” She stopped ARVs for three years. “During this time,” she wrote, “my fatigue slowly came back, my CD4s dipped and my viral load increased to over 3 million. Nevertheless, I never placed much stock in either of these numbers because after extensive research, I realized that neither were [sic] related to health. It was other conditions that caused the problems and the ARVs were powerful enough to keep them at bay. … Last fall, I became extremely tired again after being anemic for almost a year and fighting lymphedema for months, I took the ARVs, as I could barely get off the couch and could not function in life.” Her health again improved.

Another denialist said, “I have seen many friends get better on ARVs, but my understanding has always been that these drugs are broad spectrum in their efficacy — that they serve to kill virtually all pathogens, but also all the ‘good stuff’ in our bodies.” Another, a thoughtful woman struggling to reconcile her recurrent illness with dogma, wrote: “All I can say is that I’m doing what seems to be working at the time. If it stops working, I’ll make a new plan. And just because they call them antiretrovirals doesn’t mean that’s what they are.” The only way they can remain alive and in the dissident camp is to pretend that ARVs, so precisely designed to target the ways that HIV infects T-cells, are a supercharged all-purpose germicide.

Deprogramming

Some denialists with HIV are unable to ignore their own experience, and are pushing back against the cult rhetoric. One weary man, positive since 1996, wrote, “Frankly, I’m sick of the questions at this point. Some of us here are experiencing strangely similar symptoms. Some well known people have died just like the orthodoxy said they would. At what point are dissidents going to start asking the important questions, rather than repeat the words ‘AIDS ZONE’ over and over? I’m not in any AIDS zone, but something is happening beyond my control. I have never been closer to taking Atripla than I am today. I hate to type that … but it’s true.”

The denialist movement is also deeply split by conflicting theories of AIDS causality, different schools of quackery, and the basic question of whether the virus exists or not. Their unity is only maintained by their ritual invocation of long-disproved claims and their refusal to engage with scientific evidence. The most successful denialist propaganda avoids making direct claims and persuades only by innuendo and inference, because clear and specific statements generate hostility within the movement and can be easily disproven by evidence.

Still, it is very difficult for believers to break free of HIV denialism. Dissidents build their worldviews, their sense of themselves as heroic and embattled, their careers in journalism and alternative medicine, and their webs of social relationships around their rejection of HIV science and medicine. They have a lot to lose if they acknowledge that they are simply wrong. But as HIV treatments get better and better, and people with HIV live long and healthy lives using them, the psychological impulse to refuse to accept what was once a terrible diagnosis is diminished. Perhaps soon the only AIDS denialists will be HIV-negative people far removed from the communities most affected by the epidemic, and their cult won’t matter at all.

Jeanne Bergman is a veteran AIDS and human rights activist in New York City.

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…

Two media articles create the impression that I complained anonymously about Peter Duesberg to the University of California Berkeley. These are:

• Science Magazine (April 16, 2010) and
• Daily Californian (April 21, 2010).

There was nothing anonymous about my complaint. I believe that Duesberg failed to declare a conflict of interests of one of his co-authors in an article published in a journal called Medical Hypotheses. I consequently lodged a complaint with the University. I believe high quality journals should hold the first author responsible for a failed declaration of conflict of interests by co-authors (unless the co-author hid the conflict from the first author which is definitely not the case here). Duesberg was the first author of this article. Admittedly, Medical Hypotheses is not a high quality journal.

On 9 April 2010 UCB emailed me asking if I was prepared to have my complaint given to Duesberg in full with my name on it. I unhesitatingly answered yes immediately upon receipt of the email. My complaint has never been anonymous.

The real issue here is that Medical Hypotheses published an article co-authored by David Rasnick who has been found in a court of law to have conducted an unlawful clinical trial.

People died as a consequence of this trial and Rasnick bears partial responsibility for their deaths. The company he worked for, the Rath Health Foundation owned by Matthias Rath, makes its money by selling vitamins as alternative cures for a range of diseases including AIDS. This is an unequivocal conflict of interests in an article whose implicit theme was that antiretrovirals are not an effective treatment for HIV, because Matthias Rath’s business model is based on promoting such nonsense.

My complaint is copied in full below. It is self-explanatory. I intended the UCB process to run its course without me commenting to the media, but Duesberg apparently had no such qualms, leaving me with no choice but to make this statement.

I am unfamiliar with UCB’s rules and therefore am not in a position to determine if Duesberg has breached their academic disciplinary code. However, to my mind a breach of ethics took place and it was therefore worthwhile lodging a complaint with Duesberg’s institution. It is up to UCB to determine what if any action should be taken against Duesberg.

Here is the text of the complaint:

28 August 2009

President Mark Yudof

Office of the President University of California

1111 Franklin Street Oakland, CA 94607-5200

president@ucop.edu

Mary Croughan

Chair Universitywide Academic Senate University of California

1111 Franklin Street Oakland CA

Mary.Croughan@ucop.edu

Dear President Yudof and Chairperson Croughan

REQUEST FOR INVESTIGATION INTO PROFESSOR PETER DUESBERG

I am writing to request an investigation into the conduct of Professor Peter Duesberg. I am concerned that he has possibly breached the ethics and practices of scientific publishing in relation to a paper that recently appeared in the journal ‘Medical Hypotheses’, of which he is the first and corresponding author. [1]

Since publication the paper has been withdrawn by the publisher. Elsevier, states, “… we have received serious expressions of concern about the quality of this article, which contains highly controversial opinions about the causes of AIDS, opinions that could potentially be damaging to global public health. Concern has also been expressed that the article contains potentially libelous material.” [2] Since the paper is withdrawn, I have attached the article as it was originally published before withdrawal.

My concern however regards Professor Duesberg’s failure to declare a relevant conflict of interest. In the paper, he states, “I and my co-authors have no commercial or other non-scientific conflicts of interest with our AIDS paper for Med. Hypotheses.”

This statement appears inaccurate to me. One of the central themes of the paper is an attack on the use of antiretroviral drugs to treat HIV infection. As an example, the abstract states, “[W]e call into question the claim that HIV antibody-positives would benefit from anti-HIV drugs, because these drugs are inevitably toxic and because there is as yet no proof that HIV causes AIDS.”

Dr. David Rasnick is a co-author of the paper by Duesberg et al. Until recently, he worked as a researcher for a company, the Dr Rath Health Foundation Africa. This organization promoted and distributed (and in terms of South African law, sold) micronutrient products as alternatives to the use of antiretroviral drugs to treat HIV infection in South Africa. The organisation, with Dr. Rasnick’s direct involvement, also conducted an unauthorized clinical trial to evaluate its products as alternatives to antiretroviral drugs for treatment of people with HIV infection. The company has never published the results of this trial in a peer-reviewed medical journal, but has instead published paid advertisements purporting to report the trial’s results, a practice that is considered unethical in medical research. Dr. Rasnick is described in these advertisements as one of the researchers who conducted the trial.

A case was brought by the Treatment Action Campaign and the South African Medical Association against the company’s owner, Matthias Rath, the Rath Health Foundation Africa, Dr. Rasnick and others in the Cape High Court. I deposed the founding affidavit. The court was requested to interdict the unauthorized trial from continuing. The court found in favour of the plaintiffs and ruled that the defendants, including Dr. Rasnick, had indeed conducted an unauthorized clinical trial [3]. Several deaths occurred on the trial [4]. Also of note is that Dr. Rasnick has previously misrepresented his affiliation with the University of California, Berkeley [5].

In summary, the facts are that Dr. Rasnick, a co-author of the paper by Duesberg et al., has worked to boost the sales of an alternative (but ineffective) way to treat HIV infection. His employer, the Dr. Rath Health Foundation Africa, has actively attacked the use of antiretrovirals (a proven, effective way to treat HIV infection) as part of its marketing campaign for its products. Dr. Rasnick has helped to promote these products in paid advertisements. A paper co-authored by Dr. Rasnick that attacks the use of antiretroviral drugs is therefore of commercial value to his former (and possibly current) employer, Matthias Rath.

The affiliation between Dr. Rasnick and Matthias Rath is therefore a material and relevant fact that should have been disclosed in the paper by Duesberg et al. As the responsibility for making such a disclosure is the corresponding author’s, it appears to me that Professor Duesberg has likely committed an ethical breach that should be investigated by the University of California, Berkeley.

Regards

Nathan Geffen

TREASURER, TREATMENT ACTION CAMPAIGN

References:

1. Duesberg, P.H., Nicholson, J.M., Rasnick, D., Fiala, C. & Bauer, H.H. HIV-AIDS hypothesis out of touch with South African AIDS – A new perspective. Med. Hypotheses (2009).doi:10.1016/j.mehy.2009.06.024http://www.ncbi.nlm.nih.gov/pubmed/19619953

2. Duesberg, P.H., Nicholson, J.M., Rasnick, D., Fiala, C. & Bauer, H.H. WITHDRAWN: HIV-AIDS hypothesis out of touch with South African AIDS – A new perspective.

3. Zondi J. Judgment in TAC and Others v. Matthias Rath and Others. 2008.

4. TAC. Analysis of deaths on Matthias Rath illegal clinical trial. 2005.

5. TAC. The Citizen’s publicity for AIDS denialists is irresponsible. 2006.