Science Guardian

Media skeptics might get their facts straight about what they do believe as well as debunking what they don’t

On the subway today we saw a young man standing on the platform reading New York Magazine. The cover headline in black capitals: Sex + The Supervirus.

With a world weary sigh, we fired up the New York Magazine newyorkmetro.com website when we got home to find, to our pleasant surprise, what seemed to be not the expected sensational salute to a renewed dire AIDS threat to Gotham but the sophisticated reassessment of David France’s The AIDS Superbug - How Sexual and Medical Politics Combined to Creat a Phantom Epidemic.

Or so we thought. Unfortunately, it turned out to be that France’s coolheaded skepticism was merely a veneer, and under it when scratched was revealed the same old inconsistent fantasy of infectious AIDS swallowed whole, with its worn out tale of contracting the virus in a moment of drug fueled gay abandon, Larry Kramer screaming that gays were murdering gays, celebration of the heroic research valor of David Ho, and so on.

The standard thoughtless, anomalous cliches of standard AIDS-think, in other words, are used as a platform for a pose of sophisticated deconstruction of thoughtless, inconsistent AIDS alarm.

It would be less annoying if the pretense of thinking for themselves was not attempted at all by New York Magazine editors and writers, rather than disappoint us in this manner. The effect with the public is to doubly reinforce the AIDS HIV paradigm against questioning by implying that sophisticated mainstream skeptics, not easily bowled over by new alarms, can use it as a trusted touchstone by which to judge supposed new dangers.

Deconstructing deconstruction

Let’s attempt our own deconstruction of this piece which purports to deconstruct AIDS sensationalism, according to the different view of AIDS that comes from HIV skeptics.

What we learn in the article, “The Invention of Patient Zero: How crystal-meth-fueled promiscuity, AIDS medical politics, and one very sick man combined to create a phantom superbug,” by David France, is that the new Patient Zero, as it were, was involved in “a weekend of crystal meth and multiple sexual encounters” last October, and was used as a “bottom” by seven or eight partners one of whom was HIV-positive…..

According to Dr. Larry Hitzeman, a colleague of the New York patientÂ’s doctor at Cabrini Medical Center, the man had by then negotiated a long courtship with crystal meth. “For five years, he took it one time a month on average,” Hitzeman said at the FIT meeting on the case. “He was taking it every weekend for the past two years.”…. Crystal, for most, is one of the most dangerously addictive substances around. It is also a powerful disinhibitor, with a remarkable ability to concentrate the attention on sex for hours at a time. …. Among gay men, stories echoing the New York patientÂ’s headlong collapse into addiction are commonplace.

Hmm… Just applying every day common sense, one wonders here which is more likely to cause an eventual collapse in health—a steady diet of crystal meth over years, or one night’s engagement in “bottom” activity with seven or eight partners who test positive for antibodies to a retrovirus that cannot be demonstrated to kill cells?

The 46 year old was a shadow of his former self by mid-November and by January, “tests showed him resistant to most AIDS drugs. On February 11, the New York City health commissioner, Dr. Thomas Frieden, called a press conference to alert the world to the case. “WeÂ’ve identified this strain of HIV that is difficult or impossible to treat,” Dr. Frieden announced ominously. “Potentially, no one is immune.”

Supervirus superalarm

On the evidence of this one case, which would thus be termed anecdotal evidence by any scientist, we suddenly had a whole new supervirus, untreatable and, according Dr. Frieden’s imagination, causing AIDS immune system collapse in mere weeks, rather than the decade that is the average for HIV. Small wonder there were headlines round the world, including twelve stories in the New York Times within a week. Even William Buckley rose to the occasion. “Murderers need to be stopped,” he editorialized in National Review. Gay men raced to their doctors and gay activists blamed the complacency that had set in with the advent of drugs that “managed” the disease.

The only problem was that the “new” virus could not be located in any other body, and by March it had to be announced that the patient was responding to treatment. Meanwhile other AIDS scientists were skeptical.

“When I first heard this, I said, Holy shit—there is no evidence,” says Dr. Robert Gallo, an eminent virologist. “Clearly, conclusively, scientifically, it was inappropriate to make that statement.”

If this sounds like professional penis envy, the New York Times thought so too, in general, as evidenced by the Larry Altman piece we covered earlier. That is to say, the motivation for correcting the alarmist response seemed to be less in the cause of truth than “NIH”, as in “not invented here”. Didn’t make it any less correct, though, or any less refreshing to hear Robert Gallo calling for reality based science.

The responsibility for this medical panic attack is spread widely: from the patient to the reporters who made him a caricature, to the city health commissioner for terrifying the city and the scientists who characterized the case, most notably Dr. David Ho, the top researcher at the world-renowned Aaron Diamond AIDS Research Center at Rockefeller University, and his deputy, Dr. Marty Markowitz, who warned of a “silent tsunami” of new infections spreading undetected across the land.

Fair enough, it seems. New York health officials jumped the gun, and the scientists should have known better.

In fact, examining the tale more closely, we see that much of it was woven from questionable belief rather than data.

On October 22, the patient was still sinking into the drug’s grip. He remembers staying up all night and through the next day, thanks to crystal. “He believes this was the night,” Dr. Markowitz told a group of AIDS doctors in February. His last HIV test was on May 9, 2003—like four previous tests, it was negative and his immune system tested normal.

His doctors have tended to credit his own theory of when he contracted the virus, in part because two weeks later he suffered severe flulike symptoms, suggestive of what is called acute seroconversion illness. About half the people experience these symptoms following initial exposure to HIV. By mid-December, he was rapidly losing weight, and his fatigue kept him in bed. Concerned, on December 16, he saw his doctor.

Finally, we get to the key data.

The news came back almost two weeks later, and it was bad: a massive viral load of 280,000 copies per milliliter, and a near total T-cell obliteration. A normal T-cell count is 700 to 1,200; he had just 80. It meant that just two months after his presumed exposure, he had developed full-blown AIDS.

Here, it seems to present some difficulties for the AIDS skeptics. A massive viral load and near total T cell obliteration. This contradicts the peer reviewed articles which state that it is antibodies rather than viral load per se that is seen in patients, in whom levels of active virus do not exceed 1 in 10,000 T cells, and inactive 1 in 300-400 T cells. Presumably this titer, if it is a fact, reflects the recent arrival of the virus in the man’s blood, when there is measurable virus until the antibodies multiply. Because according to the peer reviewed critique of HIV-AIDS, there is typically little or no actual virus to be found in AIDS patients of whatever stage of decline.

As to the low T cell count, the HIV skeptics also loudly argue that low counts do not necessarily indicate a weak immune system, since these counts vary among and within individuals without much correlation with the resilience of their system.

Both these points need to be checked with authoritative sources to be clarified and confirmed. Let’s call on Harvey Bialy in Mexico and see what he has to say. The author of Oncogenes, Aneuploidy and AIDS: The Scientific Life and Times of Peter Duesberg (North Atlantic Books, 2004, see post below entitled Bialy’s Bombshell Book) is the prime source on Duesberg’s reviews of AIDS-HIV, as his book demonstrates.

Harvey replies: “This is all basically true. The figures given apparently contradict the literature, as you point out. The operative words are “low” and “unnecessarily”.” But he himself won’t grant the quoted claims the honor of treating them as credible and working out what distortion, manipulation or misinterpretation is or was involved.

The heroic Ho

The article continues:

Mullen referred his patient to doctors at Aaron Diamond AIDS Research Center, among the most highly regarded facilities in the field. Under the direction of Dr. David Ho, the center has scored some of the most spectacular advances of any AIDS research team. Ho discovered the triple-drug-cocktail approach to treating HIV, credited for turning AIDS from a fatal illness into a chronic disorder, saving tens of thousands of lives. In 1995, nearly 50,000 Americans died of the disease; in 2003, approximately 18,000 succumbed, a fraction of the approximately 850,000 living with HIV. For his efforts, Ho was named Man of the Year by Time in 1996, famously edging out the likes of Bill Clinton and Mother Teresa.

This seems to establish the heroic status of David Ho, but there is a difficulty in that the AIDS skeptics claim that the efficacy of the drugs cocktail has not beeen established in scientific studies, despite the consistent reports in the media (and, I find, among friends of patients) that once given the cocktail medication, AIDS patients such as Zachie Achmat of South Africa leap out of bed and climb mountains, or at any rate, return to work and get back to living a fairly normal life.

In fact, in Peter Duesberg’s seminal paper in June 2003, written for the Indian Academy of Sciences Journal of Bioscience, there is a specific reference cited for the statement that those patients treated with David Ho’s protease inhibitor cocktails actually die at about four times the rate as those who escape such medications.

On the other hand, there is a widespread belief that they are effective and the media so report. A year ago, James Watson, asked by this writer why he believed the current theory in AIDS was correct despite the long peer reviewed critiques of Peter Duesberg, replied, “Because the drugs work, don’t they?”

Ho, who with his supposedly breakthrough cocktail treatment managed to attract copious funds and a position heading up a whole new research institution in Manhattan, the Aaron Diamond Center, as the piece notes, and ended up beating out Clinton and Mother Theresa for the cover of Time as 1996 Man of the Year, seems to have sunk in the professsion’s regard since. Other AIDS scientists now seem to think his focus on the virus is too narrow and pulls research away from the other factors that govern the decline of patients, the article states.

Some doctors say this approach deemphasizes the immunological issues involved, or whether environmental factors, like drug abuse, might be contributing….(More recently he) has quietly changed focus from basic research to vaccine investigation, a field that has not produced promising news in two decades.

Any AIDS skeptic can agree with this. Any vaccine hunt would, according to AIDS skepticism, by definition be a total wild goose chase, since the virus, according to the traditional view of immune response they subscribe to even in the case of HIV, already does exactly what a successful vaccine would—stimulate enough antibodies to get rid of HIV and inoculate the body against any fresh incursion.

The article goes on to note that funding is running lower for AIDS research now that affluent Americans are no longer scared of AIDS, viewing it as a manageable disease.

In IRS filings, Aaron Diamond reported $9.4 million in donations and research grants in 2003, the last available year, down dramatically from $20 million in 2000.

However, Ho’s rising income has not been interrupted.

Ho’s compensation package, meanwhile, has gone in the other direction—in the last reported year it was $518,000. With the stipends and consultancy fees from pharmaceutical firms, he is one of the highest-compensated medical researchers in the world.

Criticism is focused on Ho, apparently, because of his famously “poisonous personality with little patience for dissent.”

Some wonder if he didn’t see potential in the mysteries of this new case. “David Ho has a huge shop that he has to maintain,” says Dr. Cecil Fox, an AIDS pathologist and veteran of many skirmishes, who owns a biotech company in Arkansas. “If he finds a new phenomenon, naturally he’s going to jump on it with all four feet.”

What true skeptics would say

All this is music to the ears of AIDS skeptics who have argued for years that it is the rewards rather than good science which drives most of the king pins of AIDS science, from Gallo to Max Essex, Ho and Anthony Fauci.

AIDS skeptics would not simply blame crystal meth for the man’s decline, it seems sure. According to a Ho collaborator, the handsome homosexual “had thousands of sexual contacts over the past three years. I said it right. Thousands.” In fact, the article continues,

While the rate of HIV transmission seems to have dropped in each of the past three years, case reports of syphilis and drug-resistant gonorrhea are soaring among gay men, suggesting more people are having unprotected sex.

Precisely how this statistic manages to gallop off in opposite directions at once, is not explained. If condom use is down, why is HIV transmission supposedly down? The answer would seem to be that this is yet another indication of how barely infectious HIV is, and at the same time, an indication of the many assaults on the immune system that are endured by gays following this drug-fueled, physically exhausting life style of crystal meth, high activity and very probably low nutrition and rest.

One thing it is evidently not is an issue of safe sex versus unsafe sex, pace the activist playwright Larry Kramer, who is quoted fuming that it is another case of an irresponsible gay man threatening the loves of others and ruining the image of gays: “We are murderers, we are murdering each other.” His new book, The Tragedy of Today’s Gays, was published this month.

Finally we reach the crux of the matter, the supposed extremely mutated virus that was so different from the usual HIV that it resisted 19 of the 21 approved AIDS drugs.

Markowitz had never seen a more resistant strain….But that alone didnÂ’t cause Markowitz great concern. What worried him was the fact that this mutated virus seemed to cause disease so rapidly. On average, HIV needs about ten years to bring on full-blown AIDS, though in a small percentage of infected people—perhaps 45 in 10,000—it progresses in under a year. …. Here was a mutated and fast-progressing virus, a frightening combination… Markowitz came to the frightening conclusion that he was looking at a deadly new viral subspecies. “If you canÂ’t see the horse and you want to see a zebra, thatÂ’s your prerogative. But the data here is incontrovertible,” Markowitz said.

Most leading researchers, however, were not so quickly convinced. Many viewed MarkowitzÂ’s analysis as overly influenced by the Aaron Diamond CenterÂ’s preconceptions……At the Retrovirus Conference in Boston… it was decided, after a peer-review process, that the results were not significant enough to be discussed on a panel… Markowitz reportedly became furious….he began work on an emotional op-ed piece he hoped the Times would publish—and when the paper chose not to, he began to circulate it himself: “As I write, the extent of this potential, silent tsunami is being defined,” he warned. “This untreatable virus with an aggressive clinical course can bring us back to the eighties and early nineties—the truly darkest years.”

Lacking more evidence than this questionable anecdotal saga, however, other AIDS “experts” said, quite properly,”Not so fast.” (I put the word “experts” in quotation marks out of a sense that it is questionable if one is truly an “expert” in any real sense in a field if one cannot explain its apparent contradictions).

… many AIDS experts have questioned why news of this middle-aged manÂ’s declining health went any further than this…

At first, Commissioner Frieden was skeptical of the supervirus case…. He also challenged the conclusion that the patient was newly infected. What if the patientÂ’s flu symptoms were caused by something else—something as simple as the flu?

This tiny blip of healthy skepticism didn’t last too long, however, and soon Friedan was sending a “blast fax” warning a network of doctors. Then someone had the sense to google “AIDS and superbug”and found it had all happened before, in Vancouver, where two “superbug” cases were reported in 2001, where a doctor had said “In a matter of months, these people have gone from totally asymptomatic to very low immune systems.” Further research revealed that both Canadian patients responded well to treatment and now have fully suppressed viral loads. After he learned of this, , Friedan was red of face and somewhat chastened, David France explains later.

He then notes an interesting fact. HIV of the usual kind is also increasingly rated as drug resistant, whatever that means and however it is measured. AIDS skeptics, of course, will ask how a retrovirus which is hardly present, and whose particles are inactive save for one in ten thousand, can be shown to be either drug resistant or drug responsive.

Unfortunately, according to data generated by HoÂ’s institute, drug resistant HIV is now commonplace: Nearly 30 percent of newly diagnosed HIV cases are resistant to at least one AIDS drug, and 11 percent are resistant to drugs in two or more drug classes.

Just how strong the personal element is in all these discussions supposedly dedicated to saving people lives, now emerged in all its gory splendor in the New York piece, not to mention the hidden selfish advantages that network secretly behind the official idealism of some of the scientists in this line of work:

In much of the criticism, there was an undercurrent of resentment toward Ho. Many saw the announcement as grandstanding. Michael Petrelis, an AIDS activist and blogger from San Francisco, fanned the flames with revelations about Ho’s links to Frieden (who sits on the Aaron Diamond Board of Directors) and the San Francisco laboratory that does the resistance testing, ViroLogic (as a scientific adviser, he receives a stipend and stock options). “I’m not saying any of that is wrong, or undermines the concern that Ho or others have about this mutant strain. I’m saying, we should know these things as we consider this case. That’s all I’m asking for: Give us all of the facts.”

From there it gets worse, with France vouchsafing his own “relevant history”(volunteering for an AIDS services agency that has criticized Frieden), Ho smearing back (”I think it is only a couple individuals working really hard to spread bad news about us. Whenever there is some news surrounding me or our institution, the usual suspects emerge—itÂ’s not surprising to me,” and Ho’s deputy Marty Markowitz stoutly asserting that “This is not for amateurs…you must also yield to the expertise of people who do know better.” The circus expanded into a South Park episode featuring a supervirus, and a doctor in Connecticut claiming he was treating the couple that infected MarkowitzÂ’s patient in the first place. But in the end, on March 29, Frieden announced the investigation had failed to find any other case of the fearsome new mutation.

According to France, the problem is of crying wolf, and people paying less and less attention. Condoms are just as rare and drugs just as available at the mass gay revels as they ever were. All of the alarm, once punctured, leads to complacency. Dan Carlson, co-founder of the HIV Forum, says gays “need to talk about what HIV means to us.”

Meanwhile the dangers of meth are recognized, for a brief moment in the article—”on one level, the case is a cautionary tale about the dangers of meth, unprotected sex, and complacency” but then it passes smoothly on to inform us that the unfortunate patient Zero is “taking a lot of drugs” ie is injected twice a day, and “there are toxicities. He was short of breath for some time.” But he is responding to medications and heÂ’s back at work in a “slow return to health.” Perhaps, the piece ends, he will end up like the last patient to suffer from a “superbug” variant of HIV in 1998, a 39 year old who is now “doing welll on medication” and tending bees in Texas.

The clear implication is that all’s well that ends well if the superbug was a false alarm and the patient responds normally to medications, which, it has to be assumed, are the protease inhibitor drug cocktails Ho invented and which are the standard treatment, effective enough it appears to allow one to go back to work or retreat to a bee farm.

OK, fair enough, let’s agree it was a false alarm, and David France and New York magazine are entitled to note that it resulted from bad science and poor behaviour of a suspiciously careerist nature. And if his admirable skepticism in the face of bureacracy and petty scientific motivations stops short at that point, and otherwise swallows the general AIDS ideology as if it was gospel, that is not unexpected. New York is not a magazine that investigates scientists or science.

A forgotten challenge

Yet there is one fact of which most readers were unaware, and which is worth contemplating. In 1998, David France did a piece for New York which asked what is in many ways now the final question in AIDS, whether these protease inhibitor cocktails really worked as well as advertised.

In Cocktail Hangover, France reported a grim tale in which early euphoria over the new regimen had crumbled as the drugs failed to work their promised wonders. “Alarming new problems with the miracle protease inhibitors suggest that the euphoria over the end of the AIDS epidemic was premature” ran the subhead. France continued:

In fact, when the curtain lifts on the International AIDS Conference in Geneva later this month, there is going to be some surprisingly gloomy news. Researchers will present evidence that not everybody taking the new protease inhibitors is responding miraculously. According to two surveys, more than 50 percent still have detectable virus. Even many of those who saw an initial drop in their viral load and an increase in their T-cells are now watching that progress slowly reverse itself. “Christ Almighty, we had people thinking the cure was in hand,” says Dr. Bob Gallo, the co-discoverer of HIV. “This is wrong.”

The report went on to detail bizarre new side effects, from heart disease and diabetes to “lipodystrophy”—a nasty accumulation of fat on the back and stomach, accompanied by wasting of the arms and legs—and at best a failure rate of 20 percent. In those who had taken many drugs previously, 70 percent. Moreover, the cocktails weren’t reaching HIV in “reservoir cells” in previously undiscovered crannies of the immune system. And the medications might be too toxic for lifelong use:

“Even if they want to stay on drugs that long, we don’t know if they can,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. “It’s sobering.”

Yet the drugs had achieved a lot, France hastened to assert.

This is not to dispute the fact that the cocktails — introduced so stunningly at the last world AIDS conference in Vancouver in 1996 — have changed the course of the epidemic entirely. Opportunistic infections that had once defined the disease are disappearing: 70 percent fewer cases of AIDS-related pneumonia; 83 percent reduction in CMV retinitis; Kaposi’s sarcoma practically vanished. Death rates have plunged, and Lazarus stories have literally reached biblical proportions (last month, Magic Johnson’s wife told 60 Minutes that prayer, not protease pills, had “cured” her husband).

Dr. William Paul, chief immunologist at NIAID, even expects to see reports in Geneva of rare patients who, thanks to a mysterious immune response in their own bodies, have gone off the pills and remain free of HIV. “I have heard of such spontaneous responses,” he says.

What’s the truth about the effect of these drugs then? Did these fears vanish as the record improved in the last eight years? As noted above, no less a figure that James Watson, renowned as the discoverer of the structure of DNA in 1953, told me a year ago that this was the reason he believed that AIDS theory was correct. “The drugs work, don’t they?”

When I double checked the latest paper by Peter Duesberg, summarizing his view of HIV as a nonviable candidate for causing AIDS, however, I found that, on the contrary, there was a referenced statement in the peer reviewed paper that the drugs in fact did not work. According to the study referenced, the patients who take them die four times as rapidly as those that don’t.

Tomorrow I will search out the reference and note it here. But for the moment, let’s point out that David France raised skeptical questions in 1998 about the most important point in AIDS, the one reason above all others that despite all the anomalies HIV continues to be accepted by thoughtful minds as the cause of AIDS.

In a future post I shall report on my investigation of this point which I intend to carry out by a) calling up David France and asking him to explain his current view on this topic, and b) by following up on the claims by a man who was at the Evidence of Harm dinner (see the “Evidence of Harm in Autism” post below) who told me that he had had a friend who had been an adamant supporter of Duesberg’s view rejecting HIV, until he finally grew so ill that he gave up and decided to accept the medications, whereupon he miraculously recovered.

Anecdote or not, this kind of report demands an explanation, since it occurs frequently. Most of all, however, the question of how this all-important issue—whether the drugs do “work”—has been buried needs to be answered if anyone is to believe in the HIV skeptics.