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How Gallo proved that HIV was not the cause of AIDS

April 23rd, 2006


His original paper’s result ignored by the world for twenty years

Robert Gallo‘s recent letter to Harper’s, just published in the May issue (see previous post), provoked a thought which we thought deserved a post of its own, for the result of checking one of his sentences reminded us of a little known fact: one of his original papers at the beginning of the HIV?AIDS affair in May 1984 had a surprising result which has been long overlooked.

In fact, the press conference at which Margaret Heckler, Heath Secretary of the Reagan administration, presented Gallo as the savior of the day in being about to publish four papers in Science finding HIV was the probable cause of AIDS, appears to have been mistaken.

Contrary to the report typed rather too hastily by Larry Altman for the front page of the New York Times the day after the press conference, the ebullient Bob had actually proved that HIV was almost certainly not the cause of AIDS. In fact, in this helpful result he preceded Peter Duesberg by at least two years in demonstrating that the linkage between HIV and AIDS was unsustainable.

Going back to the Gallo letter in Harper’s, this is why the most remarkable sentence Gallo pens is the one saluting his moment of epiphany when he decided that HIV was the cause of AIDS: “In 1984, when my colleagues and I were first to claim—and in my view demonstrate—the linkage of HIV to AIDS, we showed that we could isolate HIV from forty-eight individuals who had AIDS.”

The bold effrontery will amuse seasoned admirers of the pr genius of HIV?AIDS’s greatest scientist, and not just because in the first place it was Luc Montagnier of the Pasteur who first “linked” HIV to AIDS in a 1983 paper. Luc Montagnier hadn’t claimed that HIV alone could be the cause of AIDS, and he was happy to forward HIV to Robert Gallo on request, and in fact did so twice, since Bob lost the first batch.

Montagnier was not amused when Gallo subsequently claimed to have discovered it all by himself, however, and after an extended international wrangle at the governmental level over royalties, which established that Gallo’s virus was in fact Montagnier’s, discovered by Gallo in the two Federal Express packages from France when they arrived at the NIH and the receipts were signed and returned to Montagnier, found he had to share credit for HIV with Gallo as the “co-discoverer”. But that’s another story.

For the paper Gallo is referring to in his letter to Harper’s is “Frequent Detection and Isolation of Cytopathic Retroviruses (HTLV-III) from Patients with AIDS and at Risk for AIDS”, the key paper of four published on May 4, 1984 in Science, which demonstrated that HIV was almost certainly not the cause of AIDS.

How Gallo managed to pass this off so brilliantly at a press conference before it was published, as suggesting so powerfully that HIV was the cause of AIDS that the celebrated Larry Altman of the Times reported that inverted conclusion the next day, is a puzzle that science historians have yet to solve. We put it down to the fact that Larry was in a hurry to get his story on the front page, and no one ever bothered to read the paper itself once the Times had spoken.

But that paper’s landmark finding is the reason why Gallo is forced to leave the number “forty-eight” standing out there in his letter all by itself, not saying 48 out of how many, because in fact he found the virus in blood from 48 individuals out of 119, and 22 of the 48 did not have AIDS, rather than all of them being “individuals who had AIDS”, as he states above in what must have been a slip of his pen in writing to Harper’s.

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“So the historic irony is that the man who proved that HIV was not the cause of AIDS twenty years ago was Robert Gallo himself. Luckily for him, however, the science of AIDS has been run by press conference ever since, so no one has noticed.”

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In fact, the paper shows that he found virus more often in “pre-AIDS” people without AIDS (18 out of 21, or 86%) than people with AIDS (26 out of 72, or 36%), and he found that it wasn’t able to survive in a dish more than “2 to 3 weeks” in the blood of AIDS patients and “pre-AIDS” patients, while it flourished in established T-cell lines.

“Pre-AIDS” patients were people in a risk group – ie gay in this case – who had developed some chronic swelling of the lymph glands (lymphadenopathy), or some undefined low count of white blood cells (leukopenia). They must have often been in the early stage of HIV infection, before antibodies had mounted sufficiently to erase the infection, as this paper revealed happens in the majority of cases even in people who progress to AIDS.

Clearly, according to the paper, the best way to get rid of HIV is to get AIDS proper, easily achieved by taking large amounts of designer drugs and eating badly. In other words, if you think that HIV is the problem, hurry up and have fun and get AIDS, and you’ll likely get rid of HIV entirely. We are saying no more than the paper says with its data.

Thus the paper suggested not “strong evidence of a causative involvement of the virus in AIDS,” as Gallo wrote at the end of it, but the exact opposite. That is to say, it demonstrated that HIV was almost certainly ruled out as the cause of AIDS, since not only did it flout Koch’s first postulate by being found in only one third of AIDS patients’ blood samples, but it was more likely to be seen in pre-AIDS patients than people with AIDS, in whom it mostly wasn’t found.

So the historic irony is that the man who proved that HIV was not the cause of AIDS twenty years ago was Robert Gallo himself. Luckily for him, however, the science of AIDS has been run by press conference ever since, so no one has noticed.

If a Nobel prize is ever awarded for solving AIDS, however, surely Gallo as well as Peter Duesberg is in line for this honor. For nothing could have been more helpful that to rule out HIV at that early stage in the search for the true solution to defeating the novel outbreak of immune system deficit.

Clearly the real culprits in this gross neglect of Robert Gallo’s initial breakthrough finding are the people, whoever they are, who prevented this original scientist from getting his true message across to the press and public, and instead pressured him to stick with a misunderstanding of his true achievement for over twenty years, at the cost of many lives lost to AZT and current antiviral medications, which his paper showed so long ago are inappropriate, and which we now know have unpleasant side effects involving large humps and dying of liver failure.

Whoever they are, they must have exerted massive pressure on this leading figure in the drama of what was the best reported health disaster of all until bird flu came along. For Bob Gallo is not famous for his reticence. The financial or political interests behind this must have been very large to win this distinguished scientist’s presumably reluctant coperation.

Harper’s prints six pages of HIV?AIDS letters

April 21st, 2006


“Gallo versus Farber” headlined on cover – A torrent of overclaiming by Robert Gallo – Farber suggests solution: do the experiments

Here’s a first look at Harpers this month, for those still bereft of their subscription or newstand copies, as we are (click the photos twice for supersize). This copy is from Barnes and Noble on Manhattan’s Upper East Side, one of the few places to have it today. On the front flap, there is a special listing for the Gallo versus Celia Farber letters column debate, six pages of it: “Robert Gallo and Celia Farber, an Exchange”. On the cover, also, “Robert Gallo and Celia Farber”. Not a word about the Impeach Nixon essay by Lewis Lapham, which attracted so much attention to the same March issue. Clearly Roger D. Hodge, the new editor, recognizes the importance of continuing the debate.

The lead letter is by Rebecca Culshaw, the assistant professor of mathematics at the University of Texas at Tyler who modeled HIV?AIDS for ten years until she recently gave up on it making any sense, and posted her renunciation of HIV as the cause of AIDS, Why I Quit HIV on LewRockwell. She commends Harper’s, saying that the paradigm is a model which neither accounts for observations nor yields good predictions, and after twenty years without a cure or a vaccine, it is high time for a scientific debate.

Next is Mark Biernbaum, Ph.D., a gay, HIV+ psychologist and researcher who had not heard of the issue before he read Farber’s piece, and found it confirmed doubts that had long gathered in his mind. “I wondered why my friend passed away from liver failure…” He has often interrupted medications on his own initiative and recently his doctor has backed him on the stand, advising him to stay off the drugs as much as possible because they are immunosuppressive. He is baffled by the “vitriolic, character assassinating responses” he had seen to the Harper’s piece and sees no reason why Duesberg should be called “crazy” and Farber a “crackpot” for suggesting chronic drug use and malnutrition cause illness. “In science”, he says, we “test rival hypotheses in order to rule them out. No hypothesis regarding AIDS can be rejected until its espousers receive funding to test it.”

This is followed by what may be the most politically significant letter, by activist playwright Larry Kramer, the HIV+ founder of ACT-UP. It is a classic example of how the Farber’s piece, appearing in the very long established (a century and a half) and well trusted Harper’s, throws a spanner in the mental works of all who have long taken the conventional wisdom of HIV?AIDS as scientific and medical gospel, only to find the reputable Harper’s questioning not only the way the research is done, but the science itself. First Kramer hurries to mark the piece as outlandish – “putting aside the question of how (it) got into an estimable magazine like Harper’s” – “scary”, “validating secret fears, irrational as these fears may or may not be”,”, “even I can see holes in her arguments”, “she portrays the NIH as horrific (but) millions of us who a few years ago were counted as dead are still alive” which “in my eyes this alone makes Dr Anthony Fauci… a hero of great stature”, “much of what Farber dredges up is not new”.

That comforting set of beliefs out of the way, Kramer then allows that “her argument has not been answered to the satisfaction of a lot of people. I would guess that it is going to be a lot less easy now to sweep this debate under the carpet by naming Farber and Duesberg and other “crazies” and “HIV-deniers.” Agreeing that “too much money and greed” control treatment he calls for a more mature discussion with “less namecalling”, and returning AIDS to the top of the agenda because it “is still spreading like wildfire”

Next up to bat, a couple of MDs at the Elizabeth Glazer Pediatric AIDS Foundation, Richard Marlink and Catherine Wilfert, who claim to have devoted a substantial portion of their lives in pursuit of the truth about AIDS, without finding a single persuasive reason to doubt that HIV causes AIDS – to think otherwise is to “fantasize”, they say – or that nevirapine is not “safe and effective” in preventing mother-to-child transmission. Without treatment “millions of children across the globe will sicken and die by the millions”.

Marlink and Wilfert claim rather wildly that the Harper’s piece is “grossly inaccurate”, “years of careful research has proven beyond doubt that HIV causes AIDS”, that antiretrovirals “save lives”, the “egregious errors’ include confusing “longterm use of drug cocktails including nevirapine” with “a single dose to prevent mother to child transmission” which is not “harmful”, and that several studies have confirmed this, including HIVNET 012, whose records may have been a mess but whose conclusions were still valid, as the Institute of Medicine panel confirmed. Placebos were not included in the trials because once “AZT (sic) was shown to dramatically reduce the likelihood of transmitting the virus it would have been unethical, according to accepted international standards, to deny protection to infants by providing their mothers with a placebo.”

(How this result is scientifically established without the use of a placebo is not made any clearer than it was in the trial of AZT, with which their Freudian slip confuses the nevirapine trial.)

The next letter is a heart rending cry from Joyce Ann Hafford’s sister Rubbie King, who reports that when her sister joined the drug trial she “experienced a severe reaction almost immediately, but it was never suggested she stop taking the medicine. The idiots did not take her off the drugs until it was too late.” To these scientists the life of her sister meant nothing, she writes. “She was just another black guinea pig, whose life was reduced to nothing more than an “oops”. Meanwhile, I am left to raise her two children.”

She says her sister was an “incredible person, not a lab rat” and thanks Celia and Harper’s for the “dignity and respect” they have granted in “caring enough to tell the truth.”

Following this, the least pointed letter of the bunch, a long screed by a Greenwich Village MD, Paul Bellman, in private practice as a specialist in HIV+ patients for twenty years, who seems to have long been vaguely aware that things are not adding up but permanently unable to grasp the nettle that HIV is as irrelevant as Duesberg reasons it is. After the obligatory insulting description of Celia’s work he says its “rhetoric and poorly drawn examples” inspire him to add some “historical perspective”. He outlines how little was understood in the early days of HIV?AIDS, including “why it was so hard to find the virus”, so co-factors were thought crucial, and that this has led to the current notion that “overactivation of the immune system induced by HIV” might be the answer to some of the loss of CD4 cells. Some “desperate patients latched on to Peter Duesberg’s radical hypothesis that HIV wasn’t the cause of AIDS”, hoping for another therapy, but “Duesberg offered little more than rhetoric” and was “remarkably ignorant about the clinical realities.”

In the mid-90s the landscape was transformed by an “accurate viral-load test” and “virus shown to correlate strongly” with “clinical progression to AIDS”, so it became “crystal clear that HIV causes AIDS.” The only question is how, which is “far from being fully answered” and is crucial to meet the challenges of toxicity of the meds and drug resistance. David Ho’s promise ten years ago of a cure from antivirals has not been realized and we need to know how they can be “complemented” with other therapies.

Bellman names examples of drug companies funding members of the panels who control treatment guidelines and formulate clinical trials, and says he has sarcastically suggested that the HIVNET group at the NIH be “moved to the Department of Highways” because it only “greases the wheels of the pork barrel system.” He suggests “a great story” would be on the “small core group of key opinion leaders” who set guidelines and direct clinical funding, “run medical education and profoundly retard research into areas that frontline clinicians plead is important”, who need to be “exposed by brilliant reporters” and “careful editors.”

Finally, the letter from Robert Gallo, who as we understand it was actually the first to respond to “Out of Control:AIDS and the Corruption of Medical Science” with a bullying letter before this one that he worked out jointly with other HIV researchers and activists, with its peremptory demand “by Monday evening” for Harper’s to apologize for printing Celia Farber’s article amd agree to retract it and publish a long correct version of the true science of HIV?AIDS.

Apparently Gallo eventually cooled down enough to write a more temperate and less presumptuous missive, which starts off well by saying Harper’s is a magazine he has “trusted for its high standards”. From then on, however, the comments of the Director of the Institute of Human Virology at the University of Maryland in Baltimore are a characteristic stream of Gallo sloganeering, overclaiming, and misrepresentation all aimed at dodging the bullet by denying the single issue that concerns him, which is Farber’s “misinformed view that HIV does not cause AIDS,” and not her other “innumerable other problems of fact and interpretation” (which possibly have less bearing on Gallo’s position and royalty income). “I will only say this,” Gallo promises, “There is more evidence that HIV causes AIDS than there is for the cause of any other single human disease caused by an infectious agent, past or present.” (Italics ours)

Gallo then explains that “not only has HIV fulfilled Koch’s postulates but also additional criteria that have been developed through the advent of new scientific methods.” Moreover “that HIV is the single cause of AIDS has been concluded by every single qualified group that has studied the question, including the US National Academy of Sciences, the US Centers for Disease Control, the US Institute of Medicine, the US National Institutes of Health, the American Medical Association, the Canadian Centre for Infectious Disease Prevention and Control, the Pasteur Institute and the World Health Organization.”

Following this full dress parade of top level institutions who have adopted his scientific opinion Gallo replays his vision of how the culprit was identified and prosecuted, beginning with his 1984 claim of a “linkage” of HIV to AIDS.

He recalls finding “evidence of declining CD4 T-cells” in the “1 in 1000 to 2000 “healthy” Americans with HIV antibodies”, his early finding that the “virus primarily targets immune-system cells (now known as CD-4 cells), which he doesn’t mention is now abandoned by the field; he remembers that “we could pick out patients with AIDS or pre-AIDS within blind coded samples”, that “infected blood donors went on without fail to develop AIDS”, and other claims which are less than meets the eye either because the possibility that drugs administered to HIV+ patients lead to “AIDS” is discounted, or because any symptom without HIV is not counted as “AIDS” (transfusion cases have predictably “all but disappeared”, for example). Gallo denies any trouble isolating virus from any patient with antibodies, and says his HIV blood test is close to perfect.

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Special note:

How Gallo proved that HIV was not the cause of AIDS

The most remarkable sentence Gallo pens here is the one saluting his moment of epiphany when he decided that HIV was the cause of AIDS: “In 1984, when my colleagues and I were first to claim—and in my view demonstrate—the linkage of HIV to AIDS, we showed that we could isolate HIV from forty-eight individuals who had AIDS.” This has a special effrontery will tickle long time admirers of the pr genius of HIV?AIDS’s greatest scientist, and not just because it was Luc Montagnier of the Pasteur who first “linked” HIV to AIDS in a 1983 paper.

For the little appreciated result of the paper from 1984 that Gallo is talking about is actually the opposite of what Gallo said it was, and which the New York Times reported. The paper actually demonstrated that HIV was almost certainly not the cause of AIDS. The world, however, was misinformed by the hasty front page reporting of Larry Altman of the New York Times, who wrote that the four unpublished papers would identify HIV as the cause of AIDS, and the rest is history.

We describe the true contents and result of the paper in our next post, just in case anybody is interested. These show that Bob Gallo actually preceded Peter Duesberg by two years in demonstrating that the least likely candidate for the cause of AIDS was the retrovirus which, it later transpired in a legal battle between the US and France over royalties, Gallo had newly discovered in two federal Express packages from Luc Montagnier at the Pasteur Institute.

Since this result is not widely appreciated we will cover it in detail in our next post so that Robert Gallo can get the full credit he so richly deserves.

End of special note

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Gallo says that “Ms. Farber” completely misrepresents the history of HIV therapy by following the “strange logic of a few dangerous people” that these medications are harming people or may themselves cause AIDS – (does Gallo realize this includes Larry Kramer?)-. On the contrary current antiretroviral treatments have allowed people to live to a “reasonably normal age” and all but ended pediatric AIDS in the developed world, which “alone could prove that HIV is the single cause of AIDS.”

In the mid-1980s he and his colleagues worked with “several lab technicians” who “accidentally infected themselves with HIV and in every case went on to develop AIDS. This is more evidence than Robert Koch ever had before he claimed a microbe caused a disease.”

He is sorry that after 25 years there are people who refuse to accept this overwhelming body of evidence. He puts it down to a “disturbing rise in anti-science opinion” and he is surprised that Harper’s has embraced this trend “especially given the tragic consequences of the anti-IV nihilist rhetoric in lives lost.” This is “about preserving human lives” and “there is no room for.. shallow and sensationalist thinking.”

This parade of propaganda lines interspersed with faulty claims presents a tempting target for Celia Farber in her two and a half column reply, but in the imperturbable Harper’s manner she smoothly avoids falling into that muddy pit. “Much of the critical response generated by my article has focused on a very brief summary of Peter Duesberg’s critique of the medical consensus regarding HIV and AIDS”, she notes, and a long article could certainly be written about that and other critiques of the HIV hypothesis. But “I did not write that article”. She has instead written the story of three lives changed, one ended, by the war on AIDS, and how AIDS science has been corrupted by quasi-religious zealotry and powerful financial interests.

The heart of the piece, she says, was how whistleblower Jonathan Fishbein exposed the NIH coverup of the disastrous clinical trial in Uganda (HIVNET 012) of the highly toxic nevirapine from Boehringer Ingelheim, which killed Joyce Ann Hafford in Tennessee. Scientific standards have slipped and controls for safety and scientific validation have been removed, while bad science is “defended with missionary zeal”.

To say that the HIVNET trial suffered merely from “record-keeping problems” is “obscene”, she says.

Drug company money is everywhere – Boehringer Ingelheim funds the Elizabeth Glaser Pediatric AIDS Foundation (source of the letter from two MDs above) substantially, and the panel that judged the HIVNET 012 results valid included six (of nine) receiving annual NIH grants from $120,000 to nearly $2 million, some from the division responsible for the trial. If it was valid, “why did the FDA tell Boehringer Ingelheim to withdraw its application or face a public rejection?”

Contrary to the Glaser MDs, her article did distinguish long-term nevirapine treatment from single-dose, and reported continuous treatment killed Joyce Hafford, illustrating “the callous disregard with which many patients are treated by the medical establishment that speaks in their name.” Meanwhile the “life saving” nevirapine is being given poor pregnant women around the world while the FDA has refused to approve it for mother-to-child transmission of HIV in this country.

As to Gallo’s response, his “research has been the subject of several devastating investigations, one of which found him guilty of scientific misconduct”. He minimizes the the HIVNET scandal and ignores Joyce Ann Hafford, “which is typical”, her life and those of five others Celia has more recently discovered safely filed away under “lessons learned” in the long march against HIV, like the thousands of lives cut short by high dose AZT.

His letter is “riddled with assertions of fact that dissolve under careful scrutiny into highly debatable interpretations of ambigious data”. But the letters section of a magazine is no place to debate the fundamentals of AIDS science.

And this is the heart of the issue, she says: the claims and counter claims of Gallo, Duesberg, David Ho and the Perth Group (“which has advanced its own highly original critique of the HIV paradigm”) cannot be adjudicated in magazines or on blogs.

“Mark Biernbaum gets it exactly right. Only carefully designed studies that rigorously test the various hypotheses about AIDS can advance our understanding of this disease. The suppression and demonization of competing viewpoints, and the refusal to acknowledge mistakes, especially when those mistakes cost lives, will accomplish nothing.”

Referee wins the first round in a knockout

Rather like a referee parting two boxers and telling them the match is over till they get weighed, Farber and Harper’s thus win the first round (there will be another round of letters we hear) decisively by rising above the fray with what seems to them the only possible constructive suggestion for outsiders to make. Let’s stop all the namecalling and wrangling over untested claims, they say, and the interpretations without proof (there is none yet for HIV as the cause of AIDS or explanation of how it works and no sign there ever will be) and give money to Duesberg and others to test the validity of HIV and the best alternatives as the cause or causes of AIDS.

We at NAR would say that the longed for conclusive evidence is in fact already there, in the literature, if only people would read it, though confirming studies will always be welcome. In fact, in the Fermat manner we plan soon to post the promised solution to HIV?AIDS that the literature seems to us to indicate without much doubt as soon as we have time to do so.

Meanwhile, we certainly agree with the emphasis on providing funds to Peter Duesberg and anybody else who wants to provide further evidence that HIV is or is not the cause of HIV?AIDS. Duesberg has already suggested experiments which the ex-editor of Science, Daniel Koshland, strongly supported without avail at the NIH. The most telling sign that something has been very wrong with the science of HIV?AIDS from the very beginning has been the scorning of Peter Duesberg, an effort to consign him and his questioning to oblivion which now even extends to a refusal to fund his research in cancer.

For it is this reluctance to support, ie effort to silence a scientist who enjoyed the best reputation of anyone involved in the field then and who has done nothing since to deserve any less regard, and who may even be the most promising cancer researcher now at work, which is precisely what makes the HIV/AIDS hypothesis reek like fish which has been rotten for twenty years.

Larry Kramer corrects our lashing, wins apology

April 19th, 2006

Signs he may yet acknowledge his own historic oversight

Larry Kramer has noted via Peter Duesberg that we have been unfair to him in the preceding posts A confused Larry Kramer asks Peter Duesberg to explain his own case,Larry Kramer billed $19,000 annually for drugs “I never took”.

We are alarmed to hear this, and hurry to try to make amends for the unfairness he can point out. We have no special desire to make Larry unhappy, since like many people we find his public persona charming for its warmth, openness, vulnerability, expressiveness, idealism and community spirit, not to mention his urging restraint in the baser pleasures.

Nor do we severely blame him for being misinformed and misleading others in this great issue, since virtually everyone else of influence is in the same boat. The AIDS danger is really the HIV?AIDS meme, which has now infected billions.

Why Larry is unique, so far, in this debate

The prime responsibility for the almost universal misapprehension among the political leaders of the world, that they don’t need to be aware of the Duesberg critique of HIV?AIDS because there is nothing in it, belongs to those who have forcibly peddled bad science so authoritatively for twenty years to people high and low who had no easy means of checking it.

Moreover, it is clear from Larry’s initial concerned reaction to Celia’s article in Harper’s and now his letter to that magazine, printed in copies of the May issue reaching subscribers last weekend and on the newstands now, that he is openminded to the whole idea that there may be something seriously wrong with the HIV?AIDS hypothesis, now that people he respects have raised the issue so convincingly.

We blame Larry only for a mistake which the whole world has made, which is not listening well enough to people of standing and integrity who warned him repeatedly that the science of HIV?AIDS was an empty box, and for assuming that all modern scientists and medical men and women are in some sense godlike creatures who are above error, let alone the mortal sin of sacrificing human lives to maintaining their career paradigm.

But even for his blind faith in scientists and doctors we don’t blame him overmuch, because we imagine that like everyone else whose brain is infested with the AIDS meme he must fundamentally be in terror of what is happening, and naturally cling to the only saviors he sees, that is to say, the health authorities, led by friendly, super bureaucrat and global bug buster Tony Fauci, the best dressed man at the NIH.

As Peter Doshi demonstrated in the April issue of Harpers, the art of raising money from the public by terrorizing us with new bugs such as the flu virus is considered an official strategic weapon in the government health game at the CDC and a skill worth instructing in lectures.

In a predicament where your very life is threatened by a lurking invisible microbe, as Larry has long believed, ideas rule emotions and vice versa, and in a career artist, whose stock in trade is the emotions created by ideas, this symbiosis is almost a professional qualification.

In other words, there are few people more likely to come down with the brain infection of the AIDS meme, one of the most powerfully insidious and infectious memes on the planet, than a poet and playwright.

So we actually congratulate him for showing an openminded willingness now to consider a different point of view, which is an attitude shown by no other leading figure in this arena so far. If anything does happen politically to move this mountain of a paradigm, Larry Kramer will be able to take some of the credit, it is clear.

A correction in response to Larry Kramer

He has three complaints. First, the publishing of his note was an invasion of privacy. Secondly, Tony Fauci was not the facilitator of his liver transplant. Thirdly, he never had Hepatitis C.

Our answers in short are (a) if he thought the email was private, we apologise, but the material we reproduced was only the same as he has often said in public, even as testimony to the FDA. Duesberg did not reveal the truly personal mail he sent him, in further correspondence, merely the public level intial query; (b) we certainly accept his correction that Tony Fauci was helpful in the initial treatment of his liver disease but didn’t arrange his transplant in any way, and we apologize for saying that, and have corrected it; and finally (c) we never did say that he had hepatitis C, we just mentioned it as one of the possibilities which might have caused liver damage when he said he never took drugs, which we took to mean all drugs, though he may have meant simply recreational ones. Larry Kramer does not have hepatitis C.

On the privacy issue, we did reproduce what Larry wrote to Duesberg initially only because it was purely public material that he had mentioned many other places, including testimony to the FDA. But since we feel that email privacy is an increasingly knotty issue these days, we discuss it further here, but hide the section because it is not directly relevant to the blog theme, which is the appalling neglect of the scientific literature by virtually everybody in HIV?AIDS, from scientists and doctors to reporters, activists and patients.

Larry writes that he thought his email to Duesberg was a private exchange. This complaint is one to which we are sensitive. We don’t much like the habit people have of too freely copying our email to people we have never even met, and we were brought up on the principle that gentlemen do not read other’s private correspondence. We certainly wouldn’t normally want to make public anything written on the firm understanding of privacy. This is especially true in this case, since Larry Kramer was finally reaching out to Duesberg to learn more, and this may be one of the more important events in the history of HIV?AIDS.

In this case, however, nothing was said in the email about confidentiality, and Duesberg forwarded it to us without any proviso. As it happens we emailed him back anyway regarding the privacy issue, saying we assumed that his forwarding the email to us meant that we could quote from it, unless it mentioned something personally compromising or embarrassing.

We never got a reply, so perhaps we shouldn’t have gone ahead. But it definitely seemed a publicly quotable exchange in tone and content, and Larry Kramer’s experience in dealing with HIV positivity is an extremely important case that he has often testified on in public.

Here is what Larry said again, for reference. This is all we quoted from him:

would you explain something to me. i never used poppers. i never took drugs. i never had any chemo. i do not suffer and never have from malnutrition. i did not start taking anti-hiv drugs until 2001 when i got my liver transplant and they were required. i tested positive in 1987. you say these are the causes of hiv infection. i am hiv infected. i have and had many friends in the same boat, who simply do not fall into your criteria.

In other words, a set of facts about his own case, and that of many friends, which he asked Duesberg to explain in the light of his own view.

Most of this information appears to be wrong, however, as we discovered when checking on the Web, where it is contradicted by other things Larry has said in the past. This was the point of our post ie that Larry seemed to have an unreliable memory, and in general seemed to be too casual about the scientific and medical facts of the matter, which he was asking Duesberg to comment on, and it seemed to imply that he had left this responsibility to his doctors, mastering only the rationale of the drugs they give him.

In other words, it seemed to be another sign of how he has partly abdicated the leadership of his community in HIV?AIDS to conventional doctors and scientists, and ignored the many efforts made to warn him that their authority was questionable, and to get him to look at the other side of HIV?AIDS, talk to Duesberg and read his papers.

Later, however, we found other testimony which showed he has paid a lot of attention to the topic – everything but what Duesberg had to offer. Indeed Kramer seems to have set a very good example in thinking and checking for himself in guarding against the toxicity of drugs, even without believing they are the chief cause of HIV?AIDS among gays, as Duesberg has long insisted.

In making this point we thought it best to quote his own words, and now he asserts that they were private, though without making a big issue out of it. and without specifying what information he considered private. Well, we apologize, though in reviewing it again, we have to say that we still don’t think it deserves that status. After all, the contact was initiated by Larry, in a dispute of public concern, with a scientist who is the prime source of information on the other side of the position Larry has long taken himelf. Larry called upon Duesberg to inform him of his reasoning, and he presented him with the facts of his own case, which he has already vouchsafed, several times in public. These facts proved to conflict with his own previous statements on record.

So we don’t think it is private to the extent it deserves locking away from public inspection. In fact, the opposite. Of course what Larry is really saying is that he didn’t expect it to be reviewed publicly and critically. But this issue is a matter of life and death for many people around the world, including as it happens Larry Kramer, and it is important that it not be muddied by errors in email by between the main figures involved.

The real issue is whether Peter Duesberg breached Larry Kramer’s confidence in revealing the email query to us, and as we have noted, he didn’t. The follow up exchange which was more personal to Larry Kramer he did not forward to us. This is important, because we would not want to give the impression that any email sent to Duesberg on a private basis is liable to be exposed and critiqued in public. There is no reason to think this.

Personally we think that any correspondence in email which is not copied to other by the sender should be kept private unless the sender OKs its distribution. Anything copied to a list is not private. No one is going to write freely if every word they say is going to be going to be posted on a blog, for sure, given the illbred and irrstional responses the Web often generates.

That said, however, we recognize that the new Web world is sweeping away these niceties like beach houses in a tsunami. Recent news stories show that, for all practical purposes, it is vain to assume privacy of anything at all in email or on the Web. Even if a strong notice to that effect is posted at the top, PRIVATE AND CONFIDENTIAL – NOT TO BE COPIED, it is bound sooner or later to leak, either through someone pressing the wrong key or because it is a matter of strong group interest. Secrets are as badly kept on the Web as in live gossip, or worse. Since Email and Web records are permanent, stored in computers all over for ever, it is folly to write anything which you wish to disown later.Larry Kramer billed $19,000 annually for drugs “I never took”

But there is something else at work in this case. We don’t think it should be overlooked that Larry is writing not to an established friend but to a man that he has helped, unwittingly or not, to torment for twenty years. Unfortunately Peter Duesberg is not someone he has supported in that scientist’s Olympic, self sacrificial effort to bring truth and light to this life and death issue. Instead, he has compounded Duesberg’s experience of professional ostracism, which, the scientist has said, has been the most painful penalty exacted for his scientific integrity in saying publicly what he reasons to be true.

Duesberg’s difficult and morally and scientifically outrageous public rejection, which has raised a huge obstacle to his own research, has been magnified by the unresponsiveness of Larry Kramer. As political leader, he could have acted earlier to change everything, simply by listening to the Duesberg side at all.

Over the years he has instead chosen to pal around with Dr Fauci and say that any questioning the science of HIV?AIDS was “beyond any intelligent comprehension”, as quoted in our last post, referring to ACT-UP San Francisco’s unusually disruptive activism in support of questioning HIV theory.

It is a tragedy of HIV?AIDS that Larry, the great questioner of officials and drug companies, did not as far as we know show any serious move in Duesberg’s direction earlier, any serious interest over two decades in attentively examining what Duesberg has said about HIV?AIDS. Instead, in odd contrast to his alertness to the possibility of HIV drugs ruining his health, we have to note his continuing neglect of truthseeking in a life or death issue, where even though his own life is at stake he has played a leading role in denying re-examination of the central premise. But we salute his reaching out now to Duesberg, and his new openmindedness about the problems with HIV?AIDS science.

Dr Fauci did not arrange for Larry to jump the liver queue

Larry primarily writes to say that we have mistakenly written that Tony Fauci helped him win a liver transplant, and this is not the case. We accept that completely. However, the rapprochement between the two is legendary in the field, an unfortunate one if it has kept Larry from evaluating what Duesberg had to say without prejudice, which seems likely.

“You have to remember that for the first six years, no one paid much attention to AIDS in Washington,” said Larry Kramer, an ACT UP co-founder and playwright, who once called Fauci a “monster” and an “incompetent idiot.”Now 20 years into the AIDS battle, Fauci has the grudging respect of Kramer and other activists, a testament to both his scientific and political skills.

Fauci was able to turn them around by seeking their input. When protesters demonstrated at his office at the National Institutes of Health (NIH) in Bethesda, Maryland, in the late 1980s, he invited them up to talk. “If you got beyond the theatrics and listened to what they were saying, a lot of what they were saying made sense,” Fauci said.

CNN 2001

A warrior in the AIDS fight never rests

(CNN) — During the early years of the AIDS scourge, activists took to the streets, protesting what they felt was the U.S. government’s inaction in the face of the deadly epidemic.

Among the targets of gay health groups and the AIDS Coalition to Unleash Power (ACT UP) was Dr. Anthony Fauci, the nation’s lead scientist in the AIDS/HIV fight. These groups frequently called Fauci and other researchers “murderers” for responding too slowly and even burned effigies of them.

“You have to remember that for the first six years, no one paid much attention to AIDS in Washington,” said Larry Kramer, an ACT UP co-founder and playwright, who once called Fauci a “monster” and an “incompetent idiot.”

Now 20 years into the AIDS battle, Fauci has the grudging respect of Kramer and other activists, a testament to both his scientific and political skills.

Fauci was able to turn them around by seeking their input. When protesters demonstrated at his office at the National Institutes of Health (NIH) in Bethesda, Maryland, in the late 1980s, he invited them up to talk. “If you got beyond the theatrics and listened to what they were saying, a lot of what they were saying made sense,” Fauci said.

Still, it was difficult for his family not to take the attacks personally, admits his wife, Christine Grady. “I thought they were unfair because I knew how hard he worked and how dedicated he was,” said Grady, a former nurse and a bioethicist who also works at the NIH. “And some of the accusations were: ‘He doesn’t care about this; he’s not doing enough; he’s a killer.’ ”

Fauci’s strategy of bringing advocates into the decision-making process worked, Kramer said, and won him the support of AIDS activists. “Letting the patients in, so to speak, was one of the smartest things anyone could have done, or else there would have been revolution, havoc,” Kramer said.

Several months after Fauci first met with protesters, he unexpectedly ran into Kramer at an AIDS conference in Montreal, Canada, in 1989, and the two men began to discuss their differences. “We had a nice talk, like two old warriors,” Kramer said, laughing.

These discussions eventually led the NIH to begin a plan to speed up the introduction of new AIDS treatments. The practice, called “parallel track,” allows AIDS patients — who have exhausted all other limited treatments — unprecedented access to experimental medications not yet approved by the U.S. Food and Drug Administration.

Reflecting back on the evolution of their relationship, Kramer said, “We’ve been in this together for over 20 years, and we’ve both aged 20 years and matured and grown to respect each other’s positions a lot more, which have changed a lot.”

Preparing for the epidemic

As director of the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) since 1984, Fauci has been at the forefront in the national effort to conquer AIDS. Under his leadership, the NIAID has grown from the sixth-largest to the third-largest NIH institute, with a $2.4 billion annual budget.

“The all-around multidimensional component of his work in the disease is not surpassed by anyone,” said Dr. Robert Gallo, another well-known AIDS researcher and co-discoverer of HIV.

Hard work, organizational skills and discipline have served Fauci well in his 33-year career. He prides himself on excellence and gives credit to the Jesuits who taught him in his youth.

“I often talk about the fact that I’ve been trained for many years by the Jesuits,” Fauci said. “And they’re very, very well-recognized for the kinds of qualities they try to impart upon the people they teach — you know, things about economy of expression, precision of thought, knowing what you’re doing, what is the question you’re asking.”

Anthony Stephen Fauci was born December 24, 1940, in Brooklyn, New York. He grew up in the Bensonhurt section of the borough, where his father, Stephen, was a pharmacist and his mother, Eugenia, a homemaker. As a teen, Fauci commuted to Manhattan, where he attended Regis High School, excelling academically and playing on the basketball team.

He won a full scholarship to the College of the Holy Cross in Worcester, Massachusetts, and majored in Greek, Latin and philosophy, earning a bachelor’s degree in 1962.

He received his medical degree from Cornell University Medical College in Ithaca, New York, in 1966 and then completed an internship and residency at the New York Hospital-Cornell Medical Center in New York City.

In 1968, he joined the National Institutes of Health, the focal point of medical research in the United States, as a clinical associate in the Laboratory of Clinical Investigation at the NIAID.

His work was excellent preparation for his eventual role in the AIDS fight. He rose through the ranks, studying the effects of infectious diseases on the regulation of the human immune system. By 1980, he had become chief of the NIAID’s Laboratory of Immunoregulation, a position he still holds.

He helped pioneer therapies for formerly fatal diseases such as Wegener’s granulomatosis, which is characterized by inflammation of blood vessel walls; polyarteritis nodosa, an autoimmune illness that affects arteries; and lymphomatoid granulomatosis, which causes the deterioration of the veins and arteries.

Having ‘the absolutely perfect job’

However, Fauci found his calling in June 1981 after reading an article in the CDC’s Morbidity and Mortality Weekly Report on cases of a strange infectious disease affecting gay men. The report would change his life. By the year’s end, he was turning his lab into a research center for the disease that would become known as AIDS.

“Every once in a while, one is privileged to meet somebody who you know is in the absolutely perfect job at the time for his particular skills,” said C. Everett Koop, U.S. surgeon general from 1981 to 1989.

Fauci and his colleagues were among the first to recognize that the body’s own activated immune system is the engine that drives HIV, the virus that causes AIDS.

But his most notable contribution to scientific literature appeared in the journal Nature in 1993, when he reported that HIV infection is never latent in the body but always lurking in the lymph nodes.

“If you look at the lymph node of HIV-infected individuals, those people have virus that’s alive, well and replicating even during the period of what we were calling the clinically latent period,” Fauci said.

The finding was significant, Gallo said, because it meant “there’s no time to relax.”

“I think it unified thinking that therapy should be given throughout the period, even when people are feeling well,” Gallo said. “And it pointed to the lymph nodes as a terrific site of virus replication and focused some research direction toward the tissue as opposed to simply looking at the blood.”

Fauci’s contributions have helped to change the course of HIV/AIDS research. As a result, scientists no longer think in terms of eradicating the virus but instead focus on the long-term control of HIV. And research continues on a way to block transmission of the virus via a vaccine.

In addition to his research and administrative roles, the physician-scientist also displays the skills of a savvy politician. Fauci regularly testifies before Congress seeking funding for the NIAID and educating lawmakers about the HIV/AIDS epidemic.

“I’ve never seen a time,” said U.S. Rep. Nancy Pelosi, D-California, a member of the House Appropriations Committee, “when Dr. Fauci came before a committee of Congress where he has not left the panel better informed and impressed by his credentials and his commitment to finding an end to this terrible scourge.”

Taking time out for family

A medical doctor by training, Fauci still makes rounds, seeing patients at least once a week at the NIH’s Warren Magnuson Clinical Center. He also is the main editor of Harrison’s Principles of Internal Medicine, a widely read medical textbook. And he is credited as the author, co-author or editor of more than 1,000 scientific articles.

An admitted workaholic, he arrives at the office before 7 a.m. Fauci frequently puts in an 80-hour week, including working on Saturdays. His myriad professional duties have cut in to the amount of time he spends with his family.

“I would not like to be his wife,” Kramer said, laughing. “A woman of great patience.”

Not surprisingly, he met his wife, Christine Grady, at the bedside of a patient. Able to speak Portuguese, Grady was the interpreter for an HIV patient from Brazil. She assured Fauci that the patient would follow the doctor’s strict orders to rest, but the patient actually said he was planning an outing to a Brazilian beach.

“A day or two later, Dr. Fauci came to me and said, ‘I’d like to see you in my office at the end of your shift,’ ” Grady recalled. “And I thought, ‘Oh my God, he knows what happened!’ ”

But Fauci didn’t reprimand her; instead, he asked her out on a date.

Now married for 16 years, the couple have three daughters, ranging in age from 15 to 9. Fauci picks the girls up from gymnastics in the evening when he leaves work, and the family eats dinner together at around 9:30 p.m.

“We’re ordinary people, trying to raise a family,” Fauci said, “and we happen to be caught up, both of us, professionally in one of the most historically significant epidemics in the history of mankind.”

At 60, Fauci shows no signs of slowing down.

“I think any other person might have contributed the service that he has done and then said, ‘OK, I burned out, now I’m moving on,’ ” Pelosi said. “But he seems to be growing — rather than growing tired of it.”

And his peers see a continued strong role for Fauci.

“He’s got more history yet to make, and he will,” Gallo said. “At this point in time, I certainly think he’s the greatest science administrator, combining both scientific leadership as well as science, that I have ever seen.”

But Fauci’s achievements don’t seem to faze him.

“It’s tough to get impressed with what you do,” he said, “when you’re in the middle of an engagement, a war, if you want to use that metaphor, in which this foe or enemy that you’re fighting is galloping uncontrolled throughout most of the world.”

How Tony came to Larry’s play attacking him, and how the two embraced in the lobby afterwards, makes a touching legend:

Fauci, meanwhile, has won round many of his critics in the activist community. His most complicated relationship has been with Larry Kramer, the writer who helped form protest groups ACT UP and Gay Men’s Health Crisis and who used to regularly call Fauci a “monster” and an “incompetent idiot”. In 1991 Kramer wrote a play called The Destiny of Me in which an Aids patient spends much of his time attacking his physician, a man called Anthony Della Vida – Anthony of Life. No prizes for guessing who he is based on. “The mystery isn’t why they don’t know anything, it’s why they don’t want to know anything,” the lead character shouts.Gamely, Fauci turned up to the premiere at the Lucille Lortel Theater in Greenwich Village. After the show, the two men met in the lobby and embraced. Kramer was overheard to say, “Will you still take care of me? Will you still be my doctor?” Fauci replied: “I will always take care of you Larry.”

That’s from this article, a good rundown of Tony’s comet like progress through the HIV?AIDS universe, where he was present at the creation.

(from Web page http://lists.essential.org/pipermail/ip-health/2003-May/004788.html)

[Ip-health] FT on Tony Fauci, SARS and AIDS

James Love james.love@cptech.org

Mon May 26 11:22:02 2003

This is a long and interesting article about Tony Fauci, but also about policy making in the US on AIDS, SARS and other important issues. It begins with a story about Karl Rove’s involvment in the $15 billion forAIDS. Also:

* When health secretary Tommy Thompson spoke at last summer’s UN Aids

conference in Barcelona, the stage was invaded by activists shouting the

slogan “Where is the 10 billion?” – a reference to the amount of money

experts say needs to be spent on Aids programmes in the developing world

each year. Later Fauci was called in by the White House and asked to help

come up with a programme for Aids in Africa that Bush could adopt.

* The night before the president’s State of the Union address in January,

he got a call from senior staff at White House to come and help them

prepare the text. Bush had adopted the most generous version of the plan

Fauci had proposed, which involves spending $15bn on Aids over the next

five years, including the use of generic copies of Aids drugs. The

legislation was passed last week.

http://news.ft.com/servlet/ContentServer?pagename=3DFT.com/StoryFT/FullStor=

y&c=3DStoryFT&cid=3D1051390236276&p=3D1012571727132

Can this man cure Sars?

By Geoff Dyer

Published: May 22 2003 12:42 | Last Updated: May 22 2003 12:42

Tony Fauci boards the Washington metro and scans his BlackBerry for

messages. He has come from a briefing with health secretary Tommy Thompson

about the Sars virus and is rushing back to his office to discuss an Aids

vaccine project with a colleague.

On the screen, there is an e-mail from the president’s closest adviser

Karl Rove. Fauci is writing an opinion piece for a Washington newspaper on

a plan the president announced recently to spend $15bn (=A39.2bn) on

combating Aids in Africa. Fauci helped to put the plan together and Rove

has returned his draft with some comments.

A day earlier Fauci was in the front row before an invited audience in the

East Room of the White House where President George W. Bush was appealing

to Congress to pass his Aids bill, which he says could save two million

lives. “I love Tony’s commitment to humans, to what’s best for mankind,”

said the president. “I’m glad you are here, Tony.”

Dr Anthony Fauci runs the infectious diseases department at the National

Institutes of Health (NIH), a government-funded research organisation that

this year will spend a mammoth $27bn on the work it does from its 300-acre

tree-lined campus in the Washington suburb of Bethesda. The campus is so

vast it has its own metro stop.

Since the 1980s both Republican and Democrat administrations have eagerly

sought his counsel. The reason is that infectious diseases frighten us,

both privately and on a mass scale, and politicians are not good at

dealing with that fear. They tend to try to sound positive, and are then

contradicted by fast-changing circumstances. Reliable information from a

trustworthy doctor, even if it is bad news, can have a balming effect.

“I am basically just a nerd,” says Fauci.

Nerd, or family doctor to the nation, Fauci is now manning the nation’s

defences against Sars. When it comes to Iraq, the Pentagon wheels out

Tommy Franks and when the economy is looking poorly, people hang on Alan

Greenspan’s every word. When there is a new health threat, it is Fauci who

is called on. And in the post-9/11 America, where fears about new bacteria

and viruses are ever-present, this short man has taken on an ever-larger

role.

Fauci is one of those rare people who routinely works a 16-hour day. Sars

has turned that into 20. “We are in the middle of a public health crisis

here and so I tend to get pulled in lots of different directions.”

Across the world in Beijing and Hong Kong, a World Health Organisation

team is grappling to contain the Sars crisis. Led by David Heymann, the

WHO official who was also one of the scientific pioneers in the early days

of Aids, the team has found that the virus does not seem to transfer quite

as quickly as it initially seemed. Swift public health steps have also

brought the pneumonia-like infection under control in other developing

countries with large populations, such as Vietnam. But, with a mortality

rate of around 15 per cent, it is highly dangerous. And if it were to

become entrenched in a society with a weak health system, such as the

western provinces of China, it could be devastating.

Fauci says he was worried by Sars as soon as it first came to light in

March. “The thing about infectious diseases is that most of the time they

are just a blip on the radar screen.” (In 1976, for instance, when more

than 200 legionnaires fell ill in hotels across Philadelphia, it was a

horrific event – but it didn’t spread.) “Then once in a while you get one

that looks really scary,” he says.

When he first heard about Sars, some experts were saying it might be a

form of “avian” flu, a disease that killed six people in Hong Kong in 1997

but was quickly brought under control. “But the people in Hong Kong, they

are real smart, and they insisted it was not avian flu,” says Fauci. “I

thought, oh my God, this is not just a blip on the radar.”

Just how scary is it? Last year 1.12m people died of malaria, disease

older than the bible. Aids, a relative newcomer, killed 2.86m. (These are

not the sort of statistics you round up or down to the first decimal

point.) As many as 500,000 people died from influenza, which was fewer

than the 745,000 who succumbed to measles, but many more than the 21,000

victims of dengue fever.

Sars has killed nearly 700. Yet Hong Kong and other parts of China have

been gripped by something approaching panic, Toronto has been placed

off-limits in the minds of many (even though the World Health Organisation

has lifted its travel advisory on the Canadian city) and the ailing

airline industry has been dealt another blow.

Over-reaction? Not from the public health point of view. Officials live in

constant fear of a repeat of the Spanish flu, an epidemic that in 1918

killed 20m people around the world in just one season. The early reports

of Sars out of Hong Kong raised a terrifying spectacle of rapid transfer.

After one of the first recorded victims stayed at the ninth floor of the

plush Metropole Hotel, 13 other guests fell ill, perhaps from having

touched the same door handles or elevator buttons. When another person

with Sars flew from Hong Kong to Beijing, several passengers were

infected. When there is a risk that such a virus might be transferred

easily by air, health officials say tough measures are essential.

The day I met Fauci, he received an anxious call from a Washington radio

station at 6.30am. They wanted to know about the risks of bringing Sars

patients to the NIH clinical centre for examination. Some disgruntled

staff had complained to a local paper about the decision. Fauci said that

all the necessary precautions were being taken to protect staff, including

new special face masks moulded to the individual’s face.

Afterwards, he pointed out that many years ago his wife Christine Grady,

who was a nurse at the NIH, continued to work with HIV patients while she

was pregnant with their first child – even though they were not sure then

how the disease spread. “And anyway, we are the National Institutes of

Health. This is what we do.”

The NIH pours billions of dollars every year into the basic medical

research that underpins new drugs. It has sponsored the work of 80 Nobel

prize winners and a large slice of the decoding of the human genome was

conducted around the corner from Fauci’s office on the seventh floor of

Building 31.

Fauci has been running the NIH’s institute for infectious diseases and

allergies since 1984. This makes him the central figure in the search for

treatments and vaccines for Sars. Many other researchers will be involved,

of course, in both the public and private sectors. The US Army’s

infectious diseases unit is currently screening existing drugs to see if

they might work, while a number of companies are discussing vaccine ideas.

But at the centre of the process is Fauci, pulling the strings and

allocating funds.

Fauci is the complete opposite of the scientist as engaging eccentric –

with a shock of unchecked hair and new insights scribbled on bits of paper

falling out of a white lab-coat. He is short and trim and has a firm

handshake. He wears glasses that give him a scholarly look, but he is

dressed in jacket and tightly knotted tie, which makes him look like a

Washington bureaucrat, especially beside his young researchers at NIH. He

is a meticulous man who carries a comb in his back pocket and tidies his

short-cropped hair between meetings he hurries to and from.

The grandson of a Sicilian immigrant, Fauci grew up in the working-class

Brooklyn neighbourhood of Bensonhurst. The family lived above his father’s

drugstore, where he ran errands from an early age. In his teens he

commuted to a Jesuit high school on Manhattan’s Upper East Side where he

was a top student and captained the basketball team. Before going to

medical school at Cornell he did a degree in Greek, Latin and philosophy

at another Catholic institution, College of the Holy Cross in Worcester,

Massachusetts.

Fauci likes to keep his 62-year-old body in shape and his head clear.

Every lunchtime – work permitting – he slips into his jogging gear and

trots the half mile to the bike path on Beach Drive in Bethesda where he

runs for an hour. Not that Fauci is a lunch-time only athlete. He and

Grady have completed a number of marathons. They met at the NIH 19 years

ago, when, having lived in Brazil for two years, Grady was called in to

translate for a Brazilian Aids patient. In his serious doctor’s tone,

Fauci told the man, who had a problem with his legs, to change the

dressings every day and to keep his legs constantly up. The man replied

that he was so sick of hospital he planned to spend all day on the beach

and to dance all night. Grady assessed the situation and translated for

Fauci: “He said he will do exactly as you said.”

Even by the standards of workaholic Washington, Fauci’s schedule is

demanding. As well as his political role, he is the one of the few heads

of the NIH’s 18 institutes to run his own research lab, where he does work

on the basic functioning of the immune system and the impact HIV has on

it. I am half his age, yet by midday in his company I was tired. Zeda

Rosenberg, who worked for him at NIH for seven years, describes how at 7am

each day they would meet for two hours to go through all the relevant

academic journals to keep track of the advances in Aids research. Fauci

himself has published 1,045 scientific papers. “He is just a very

dedicated man,” says Rosenberg.

On an average day Fauci is home by nine every night to have dinner with

his three teenage daughters at their Washington house just north of

Georgetown. Then he is usually working again until at least midnight,

catching up on the latest research, writing papers or working on the

revised edition of one of the most widely used medical textbooks he wrote.

Every Saturday and some Sundays are also taken up with work. He rarely

takes holidays anyway and has not managed one since September 11, 2001. He

likes to fish and occasionally goes to the movies but looks somewhat

perplexed when asked what he does for entertainment. “There are some

people who fit work in around having fun and then there are others who

like to work and have fun only occasionally,” he says.

Now Sars could deprive him of a break this year. He is blunT about the

challenges posed by the disease. Even if it is brought swiftly under

control, it could turn out to be seasonal, like flu, with another possible

outbreak this time next year. “None of the current therapies is working

very well at the moment,” he says. “Unlike bacterial infections, there are

not many therapies for viruses. There is not one for smallpox, or for West

Nile fever. There really are only a handful that work, such as for

hepatitis and herpes.” (Viruses are pieces of genetic material that infect

a cell and direct it to produce new viruses. Some are transferred in the

air, others by blood and some by sex. But when they infect an animal or a

human who is not immune they can quickly invade the cells of their host.)

There are few “Eureka” moments in medical research, dramatic discoveries

that quickly lead to new treatments. Instead, there is the hard graft of

chipping away at complex problems from many different angles, until

solutions appear, a process that is only just beginning with Sars. In the

case of Aids, for instance, after 20 years work, there is still no

vaccine. Fauci does not think a Sars vaccine will be ready for at least

two years, but he is quietly confident about the scientific chances of

getting one. “Unlike HIV, about 85 per cent of the people who are infected

with Sars actually recover. What that means is that the human body can

respond in a way that will eradicate the virus,” he says. “In HIV, there

are no instances of people spontaneously eliminating the virus from the

body.”

When Tony Fauci began his career as a researcher in infectious diseases in

1968, many scientists considered it to be yesterday’s field, an area where

the big problems had already been solved. With the development of

antibiotics from the 1940s, diseases such as diptheria and scarlet fever

went from life-threatening afflictions to treatable infections. Jonas

Salk’s vaccine had taken the dread fear out of polio and the tuberculosis

sanitoriums were being emptied. Euphoria governed medical science.

Researchers liked to think they were on the crest of a wave sweeping away

the threat from parasites, viruses and bacteria.

In 1967, William Stewart, the US Surgeon-General, captured the mood of

inevitable scientific progress harnessed to American power, around the

time of the launch of the Apollo space missions, when he testified that it

was “time to close the book on infectious diseases”. Scientists, he

suggested, should concentrate instead on chronic diseases such as cancer.

Fauci was planning to stay at the NIH for a couple of years before

returning to New York to be a physician, but even then he thought there

were still some interesting challenges in infectious diseases. And, as he

says about Stewart’s remarks 35 years later: “He could not possibly have

been more incorrect.”

Infectious diseases are back. For a start, the drugs do not work as well

as they once did. With increased and sometimes incorrect use, resistance

to antibiotics has grown, breathing new life into some old pests. In the

late 1980s, patients turned up in New York hospitals with new strains of

tuberculosis that did not respond to drugs. These later swept through

Russia in the 1990s.

On top of that there have been new and frightening diseases. In Zaire in

the mid-1970s, a man walked in from the jungle with a severe fever that

made him vomit black blood. He died shortly after. Within days, many of

the nuns who took him in had also fallen ill with Ebola, one of the most

easily transmissible viruses.

Viruses continue to jump from one species to another, including humans,

and the new host often has little immunity. Every year brings a different

strain of influenza, many of them originating in China. In 1999 and again

last year, several people in the US died from West Nile fever, a virus

indigenous to the Middle East which is transmitted by mosquito.

Microbes (a virus is one type of microbe, bacteria and fungi are others)

love chaotic economic development. Teeming new cities with poor sanitation

that lack strong health systems, rapid migrations of populations from

country to city, changing sexual habits, the breakdown in traditional

family structures – all these provide fertile territory for the spread of

new diseases. Foreign travel exacerbates the problem, quickly transferring

a virus from a small African village to a large, western city. The

microbes that caused the 1918 Spanish flu were transported around the

world by boat. Today, they would catch a flight.

And then there is HIV/Aids. In the slightly more than 20 years since the

human immunodeficiency virus was identified, more than 20 million people

have died. By 2010, the total number of infected people is expected to

reach 105 million, most of them in poor countries. It is the biggest

public health disaster since the Black Death in the 14th century.

Bookshops are full these days of grim warnings that the advances made in

the last century were no more than a truce in the battle and that

infectious diseases will come back with a vengeance. Richard Krause, a

predecessor of Fauci at the NIH, called his 1981 book on microbes The

Restless Tide – a reflection of the tug-of-war between science and

disease, the never-ending capacity of hostile microbes to renew

themselves.

This alarming view is not universally shared. Medical science still has

its utopian streak, these days in the form of genetics. The decoding of

the human genome has raised hopes of big advances in the understanding and

treatment of diseases. Some researchers talk of an era of “personalised

medicine”, with each patient walking around with a card that shows his or

her genetic make-up so that treatments can be tailored specially. “We will

look back on 1950-2050 as the greatest period of human intellectual

endeavour since the Renaissance,” says George Poste, who used to run

research at drugs company SmithKline Beecham.

For Fauci, these advances will generate some useful tools for the study of

infectious disease. Researchers were able, for instance, to pin down the

genetic make-up of the Sars virus within weeks of its appearance. However,

genetics technologies will not alter the capacity of infections to

reinvent themselves. “It is extremely unlikely that all of a sudden we are

going to discover a completely new cancer or arthritis,” he says. “But it

is possible all of a sudden to get hit by a new microbe.” Indeed, the

events of the last few years have been a form of vindication for

infectious disease specialists such as Fauci. “We will never be free of

emerging diseases,” he says. “I am not blowing smoke. Look at what has

just happened.”

At Least Once a Week Fauci still still does roundS in the NIH Clinical

Center, its on-site research hospital, to visit Aids patients who are

usually undergoing some form of experimental treatment. The junior doctors

who guide him along the ward are a little wary, for as well as being the

head of one of the NIH’s institutes he is the author of one of their

textbooks. He fires questions at them in a friendly but brisk manner. As

he has to run off to a meeting downtown, he asks them to be brief. “You

don’t need to tell me his heart rate. I mean if he has a heart rate of

170, you should tell me, but if it is 80 you don’t need to.”

It was the HIV/Aids epidemic that changed Fauci’s life. Shortly after he

first read in 1981 about a strange disease afflicting gay men in Los

Angeles, he shut down the research he had been conducting in his lab and

devoted it entirely to Aids. His mentors told him he was risking his

career and there were few resources made available by a hostile Reagan

administration. And for several years every patient he treated died.

In the early years, most of the victims of Aids in the US were gay men,

many of whom viewed the disease as a form of persecution. Fauci soon found

himself in the middle of a fierce battle. Colleagues at the NIH attacked

him for focusing too much on Aids and predicted that other important

diseases would be neglected. The growing band of highly-educated Aids

activists were outraged, however, at what they thought was government

indifference to the epidemic. And they picked a target for their anger:

Tony Fauci. In May 1990, about 1,000 activists blockaded the NIH campus,

setting off pink smoke bombs and building a fake graveyard on the lawn.

In the ego-driven science world, Fauci has been followed by whisperings

that he is really an administrator, rather than a top-notch scientist.

“Science in a suit,” as he is sometimes described. Oft-cited research he

published in the 1990s, which showed that HIV could be found in the body’s

lymph nodes where it interferes with the immune system, has only partly

dispelled this impression. Behind the quick-fire Brooklyn banter lurks a

need for professional approval. The walls of his waiting room are covered

in honorary degrees, as are those in his office and the walls in the

meeting room next door. He has 25 in total and is due to get another three

this summer including one from Yale. Rivals mutter that he lobbies heavily

for the honours.

Despite the huge investments, an Aids vaccine is still a long way off and

some researchers doubt the current crop of candidates will work. However,

there are now 19 anti-retroviral drugs on the market, many the result of

NIH research, and in rich countries Aids is no longer a guaranteed death

sentence.

Fauci, meanwhile, has won round many of his critics in the activist

community. His most complicated relationship has been with Larry Kramer,

the writer who helped form protest groups ACT UP and Gay Men’s Health

Crisis and who used to regularly call Fauci a “monster” and an

“incompetent idiot”. In 1991 Kramer wrote a play called The Destiny of Me

in which an Aids patient spends much of his time attacking his physician,

a man called Anthony Della Vida – Anthony of Life. No prizes for guessing

who he is based on. “The mystery isn’t why they don’t know anything, it’s

why they don’t want to know anything,” the lead character shouts.

Gamely, Fauci turned up to the premiere at the Lucille Lortel Theater in

Greenwich Village. After the show, the two men met in the lobby and

embraced. Kramer was overheard to say, “Will you still take care of me?

Will you still be my doctor?” Fauci replied: “I will always take care of

you Larry.”

When health secretary Tommy Thompson spoke at last summer’s UN Aids

conference in Barcelona, the stage was invaded by activists shouting the

slogan “Where is the 10 billion?” – a reference to the amount of money

experts say needs to be spent on Aids programmes in the developing world

each year. Later Fauci was called in by the White House and asked to help

come up with a programme for Aids in Africa that Bush could adopt.

The night before the president’s State of the Union address in January, he

got a call from senior staff at White House to come and help them prepare

the text. Bush had adopted the most generous version of the plan Fauci had

proposed, which involves spending $15bn on Aids over the next five years,

including the use of generic copies of Aids drugs. The legislation was

passed last week.

The plan’s critics point out that it only covers 14 countries and most of

the money bypasses international organisations set up to deal with the

crisis – a sort of healthcare unilateralism. Some say that Fauci is not a

development expert, yet he is designing treatment plans for Aids. His

advice is sought on the risks of smallpox attack and the necessary

quarantining procedures for Sars, areas well beyond his expertise.

Donna Shalala, who was health secretary for most of the eight years of the

Clinton administration, explains why Fauci has so much influence: “He can

discuss complex issues in plain English, but he is not afraid to tell you

the truth. He does not compromise on the science.” She adds: “We learned

from the British experience with mad cow disease. You have to let credible

scientists do the talking and get the politicians out of the way. The

public trust them.”

Added to that is the phenomenon that has changed almost every aspect of

public life in America: September 11. (Fauci was in Manhattan that day and

watched the unfolding horror from a 23rd floor window.) After the attacks

and the anthrax scare that followed, vice president Dick Cheney, said to

be obsessed with the dangers of microbes, asked if he could visit Fauci’s

facilities at the NIH. He was so impressed that he arranged for Bush to

visit later. “It has been a remarkable two years,” said health secretary

Thompson at that briefing.

And Thompson should know how important Fauci is to this administration.

The health secretary was accused of bungling the initial response to the

anthrax attacks by playing down the risks. Within days new cases appeared.

Some things are better left to a doctor.

– At 62 Anthony Fauci works a 20-hour day, runs every lunch-time and

rarely takes a holiday

Geoff Dyer is the FT’s pharmaceuticals and biotechnology correspondent

As these stories make clear Larry’s warm feelings towards Tony Fauci developed far earlier than his liver transplant, and have nothing to do with the director of the NIAID department of the NIH easing his path through to obtaining a replacement of his liver, which we have no evidence for at all.

Correcting the record, Larry writes that

dr. fauci had nothing to do with my obtaining a liver transplant. i applied and qualified and was accepted into a ucsf study run by dr. michelle roland that was attempting to learn if transplants would be effective in people with hiv and/or hepB and/or hepc. i believe i was the 20th or so person to be accepted. indeed they were having trouble early on in getting qualified candidates to apply because the fear of death from the t/p was great and the early results were mixed. indeed my partner was very nervous about my entering. but since several of my ny doctors had told me that i had only six months left to live on my old liver, i figured i had nothing to lose. needless to say the success of my t/p so early on was of great value to both the study and myself.

So we apologize wholeheartedly to Larry and to Tony Fauci for ever believing otherwise. Why did we believe it? We thought we had a very good source for it – none other than Larry Kramer. We read that implication in the following words, part of the long interview Larry gave to the MIX Film festival of 2003. A second look shows that it wasn’t stated as a plain fact, and that the quote may not have meant what we reasonably took it to mean, and on the contrary, Fauci did not intervene to ensure Kramer got any priority in the line for new livers:

(November 15, 2003) LK: I don’t know. I don’t know. You don’t know how close I came to dying a couple of years ago because of the Hepatitis B in my liver. I was given six months to live. I don’t know if you remember – I looked like this. And, I had no energy. And they told me that was the end, because livers were not available. And the days were ticking away. Just prior to that, Dr. Fauci the man I had called a murderer many years before has become one of my closest friends. Talk about a moving story of irony. He saw me somewhere and he said, You look terrible. And they put me in the NIH hospital, and they discovered a lot of this shit, that had not been discovered in me before.

But then it continues,

And there was a Hepatitis B experimental drug in trial there. And so, I got what is called Adefovir, and that calmed down my liver for a while, but then it stopped calming down the liver and that’s when I only had six months to live. And I was down there one day to pick up the medicine – you had to go there once a month to get the medicine – and my doctor down there – a woman called Judy Falloon said, I think you may be eligible for a liver transplant. The minute she said that, I knew I was going to get that fucking liver. I just knew it! And she didn’t say how I could get it. She said I had to apply. They were just beginning to transplant people with HIV and Hep-B co-infecteds we were called – and there was, in fact, a NIH trial out of San Francisco, with Michelle Roland – our old ACT UP lady out there – putting it together – that wanted people like me. So, that’s how I got the liver. I didn’t get it because I was *Larry* *Kramer*. I got it because they had this trial just starting and nobody wanted to go into it.

So when Larry writes,

i hope i can have a straight-forward correction of this mistake and its unkind implications.thank you.

larry kramer

we do apologize. We were wrong in concluding that Fauci was behind the offer of a liver transplant, although that was what seemed to be implied, since he initiated his NIH care. Apparently it was only that he saw Larry looked terrible and got him into the NIH clinic.

The mistake is easy to make. In another account Larry thanked Dr Fauci for his repaired conditon but again, did not say that he had helped to arrange the transplant:

I received the liver of a 45-year-old man. Dr. Fung and his fellow surgeons say in all seriousness that we are as old as our livers, and he thinks it possible I have another 20 years of life. Indeed, I feel 45 at most.

Thank you, Drs. Fung, Fauci, Faloon, and Kottler, and thank you, Gilead, for saving my life.

(Here is the full quote – click show}.

This is the testimony of Larry Kramer to the FDA’s Antiviral Drug Advisory Committee, Aug. 6, 2002 in Bethesda, Maryland.

DR. GULICK: Thank you very much.

Next to sign up to speak is Larry Kramer.

MR. KRAMER: Good afternoon.

My name is Larry Kramer. I am a writer. I am the cofounder of Gay Men’s Health Crisis, the world’s first AIDS organization, and I am the founder of Act-Up, the protest group.

Needless to say, I am not accustomed to appearing on behalf of any drug company. I have paid my own expenses to appear before you today to testify in behalf of adefovir, which I consider to be a wonder drug, and which I believe helped to save my life.

I tested HIV-positive in November 1988 although I believe I was infected at least 10 years earlier. I believe my hepatitis B also goes back to the mid-to-late 1970s. In February 1994, I began low-dose AZT, not for HIV, but for my declining platelets for which it has continued to prove most useful.

In August 1995, I began taking 3TC Epivir for my hepatitis B. In August 1999, I was on vacation in London when I became very sick with a fever of 103 degrees. I immediately flew home only to discover that no reason for the illness could be found. In retrospect, I believe this is when I became resistant to 3TC. The dreadful, malign, and evil GlaxoSmithKline, which I have hated since it was the dreadful, malign and evil Burroughs Wellcome, was finally getting back at me.

I should say that over this period, a persistent cough that I had had so long I cannot pinpoint its commencing became increasingly worse, so that there were days when I could not speak a sentence without hacking. No tests or specialists could define its cause or recommend anything to suppress it. Believe me, I tried everything.

In August of 2000, Dr. Anthony Fauci saw me and told me that I looked sick and he was concerned. I weighed 135 pounds, down some 30 pounds from my normal weight. Indeed, I looked and felt like I was 100. I had no energy or appetite.

He admitted me to the hospital at NIH where two days later I received the news from Dr. Jay Hoofnagle that my liver was in very bad condition indeed. He told me, as he did Dr. Fauci, of a new experimental drug called adefovir which might be of help to me. In any event, there was nothing else to take.

On October 13th, 2000, I underwent the first of what would be five tappings of my increasing ascites. The first one relieved me of 10 liters. This is what I looked like just over a year ago.

On October 16th, 2000, I started adefovir in an NIH trial under the supervision of Dr. Judith Faloon. My hepatitis B viral load at this date was 8 billion copies per millimeter of blood.

For the next months, my liver functions indicated great trouble. More and more from my various doctors, particularly Dr. Donald Kottler of St. Luke’s and Dr. Samuel Seigal of Mt. Sinai, as well as Dr. Fauci, I was hearing the time was running out on my liver. More and more I was hearing that I had just six more months to live.

I accepted this fate and was prepared to die. Early in 2001, Dr. Faloon told me that she believed I might be eligible for a liver transplant. For the first time, transplants were being done on people coinfected with HIV and hepatitis B. Indeed, the NIH was preparing a protocol to study just these.

She gave me a list of possible transplant centers and firmly suggested I investigate them. She repeated her suggestion on my next monthly visit to NIH for my adefovir. So began the arduous, exhausting, time-consuming task of locating a transplant center that would accept me and investigating whether my insurance would pay for me.

As anyone who has had to deal with an expensive, rare, and life-threatening disease, these are no easy tasks given the state of our entrenched bureaucracies particularly when one has been told he has so little time left to accomplish all of this.

I believe this is where adefovir became particularly life saving. I was now feeling wonderful and full of the energy necessary to pitch right in and fight. So, to repeat, as my liver was evidently deteriorating quickly, my overall health was actually improving.

My taps for ascites were still needed, but my hepatitis B viral load was decreasing. I had been investigating and what I was hearing was frightening. I might die from such a transplant, too. My initial visits to Mt. Sinai, New York, where I live were not calming. Doctors were unpleasantly discouraging, and it was evident that they were uncomfortable performing surgery on people like me.

Eventually, after much precious waste of time, thankfully, they turned me down. Then, I heard about, and eventually met, Dr. John Fung, the head of the University of Pittsburgh Medical Center’s Thomas E. Starzl Transplant Institute.

For those of you who do not know this, Dr. Starzl actually invented the liver transplant, and the Starzl Institute is the parthenon of transplants. Dr. Fung was far more encouraging and supportive of my transplant, and I applied for evaluation and listing there.

Unlike Mt. Sinai and almost every other medical center I have discovered, Dr. Fung believes that the transplanting of the coinfected can no longer be considered an experimental operation.

This has now been confirmed, as you know, rightly in the New England Journal, and he is willing for the rights of the coinfected to now be treated equally. Indeed, in rapid order, I was accepted for listing by Starzl and Medicare and Empire Blue Cross approved me for a liver transplant.

As I said, the closer I was getting to my transplant, the better I was now feeling. I was gaining weight, and my energy was strong. I was feeling so good that I was wondering if I should put off the transplant perhaps indefinitely, that if I stayed on the adefovir, which was obviously why I was feeling so much better, perhaps in addition to reducing my ascites and my hefty viral load, it would also cure the cirrhosis that was causing my rampant end-stage liver disease.

Wisely, I was advised not to be so casual, that adefovir has not yet accomplished that. By the time I left the NIH adefovir trial in October 2001 to transfer to the one at UPMC, my hep-B viral load had decreased to 4,000 copies per millimeter of blood.

By the time I left the NIH one year after starting adefovir, there was no ascites in my system as per an ultrasound there. I had my liver transplant on December 21, 2001. Dr. Fung said the old one was truly on its last legs.

I was the 22nd coinfected person to receive a new liver, and at 66, the oldest person. I believe my transplant is considered to be a great success. I do know that each and every single day, I feel wonderful. My awful cough disappeared the minute I came out of the operating room. My HIV viral load and T cell count continue approximately what they had been before, almost undetectable for the first and in the 400s for the latter, although now I must take the dreaded cocktail.

But because I am HIV-positive, I require next to no anti-rejection drugs, the only benefit I have found from being HIV-positive, and there is no detectable hepatitis B in my system. No one will say that it has gone from my system completely, but no one will say it hasn’t, and I am still on my daily dose of 10 mg of adefovir.

I received the liver of a 45-year-old man. Dr. Fung and his fellow surgeons say in all seriousness that we are as old as our livers, and he thinks it possible I have another 20 years of life. Indeed, I feel 45 at most.

Thank you, Drs. Fung, Fauci, Faloon, and Kottler, and thank you, Gilead, for saving my life.

Has anyone got any questions?

Thank you.

DR. GULICK: Thank you very much.

Sorry, Larry, for any implication on our part that Fauci moved you ahead of others on the line, which we didn’t mean to imply, and which is probably what worries you. Here is the full quote for reference (click show):

(November 15, 2003 MIX Festival transcript of interview with Larry Kramer)

LK: I don’t know. I don’t know. You don’t know how close I came to dying a couple of years ago because of the Hepatitis B in my liver. I was given six months to live. I don’t know if you remember – I looked like this. And, I had no energy. And they told me that was the end, because livers were not available. And the days were ticking away. Just prior to that, Dr. Fauci the man I had called a murderer many years before has become one of my closest friends. Talk about a moving story of irony. He saw me somewhere and he said, You look terrible. And they put me in the NIH hospital, and they discovered a lot of this shit, that had not been discovered in me before. And there was a Hepatitis B experimental drug in trial there. And so, I got what is called Adefovir, and that calmed down my liver for a while, but then it stopped calming down the liver and that’s when I only had six months to live. And I was down there one day to pick up the medicine – you had to go there once a month to get the medicine – and my doctor down there – a woman called Judy Falloon said, I think you may be eligible for a liver transplant. The minute she said that, I knew I was going to get that fucking liver. I just knew it! And she didn’t say how I could get it. She said I had to apply. They were just beginning to transplant people with HIV and Hep-B co-infecteds we were called – and there was, in fact, a NIH trial out of San Francisco, with Michelle Roland – our old ACT UP lady out there – putting it together – that wanted people like me. So, that’s how I got the liver. I didn’t get it because I was *Larry* *Kramer*. I got it because they had this trial just starting and nobody wanted to go into it.

*SS:* *By the way, what year did you test positive?*

LK: That’s a long time before. I tested positive for HIV in, I can’t remember, in ’85,’86 or ’87. Somewhere in there. I can’t remember. But, I knew I had Hep-B, from the late ’70s – then I knew.

*SS:* *At that era, a lot of people were advocating for early medication* *before symptoms – how did you resist that?*

LK: Because my doctor Jeff Green said, I don’t think you need it. We had ordered Crixivan, which was the first one out, and I had the bottle in my hand. And we were going to start, and he called me up and he said, let’s wait awhile. I said, fine with me.

*SS:* *So, which HIV meds are you taking?*

LK: I took AZT when my liver started going bad, when my platelets went down. AZT, unknown to a lot of people, raises your platelets, so I took it for that. And then, I took Epivir, 3TC – whatever it’s called – for the Hep-B. And, that’s all I took for a number of years. And then since the transplant started, I’ve taken a bunch of them. I took Viracept, until I became resistant to it. I took Sustiva, which I loathed, until fortunately I became resistant to it, because it drove me nuts. And now, I’m on something which is an amazing drug, because it has absolutely no side effects – it’s like taking aspirin – it’s called Reyataz. Only now, they’ve just discovered – Steve Miles, the UCLA AIDS man has just discovered that Reyataz interacting with the other *drugs* I *take* is bad for Hepatitis-B. We know so much now, and I have so many doctors that I correspond with. I mean, talk about patient empowerment. I brought it to a new art. I have six doctors who I e-mail everything about me, and I pester them all to death, and I *take* advantage of everything that I possibly can, to get the information I need – just what we advocated everybody to do. They don’t like that I do this group e-mail. And, not one of them who answers me will copy all the others – out of courtesy. They only send it to me, and I got to send it around. Too many cooks, *Larry*!

*SS:* *Which one of these *drugs* do you feel exist as a consequence of ACT* *UP?*

LK: All of them. I have no doubt in my mind. Those fucking *drugs* are out there because of ACT UP. And that’s our greatest, greatest achievement – totally.

Finally, Larry does not have Hepatitis C, just B.

i do not have and did not have hepC. heb B and hiv are my lot. both are now undetectable and have been since the transplant.

Of course, we didn’t say he had Hepatitis C, only speculated that was one of the reasons why his liver might have declined in the absence of any drugtaking, which was his claim. As noted earlier, however, the interview and other quotes elsewhere in fact make it clear that he was taking drugs before his liver transplant, including AZT, by the mid nineties.

The fate of many may now ride on Kramer’s actions

We are still not sure why the activist playwright told Duesberg that he took no drugs, but it may have been that he meant he did not take hard drugs, or recreational ones.

The important thing is that he now shares a suspicion of the toxicity of anti-HIV drugs with Duesberg, who has argued all along that the main attack on the immune system of HIV?AIDS patients comes from alien chemicals snorted or injected. Will Kramer now take a greater interest in learning what Duesberg has to say on the cause of AIDS? Let’s hope so. The whole battle that Kramer has fought is for the patient’s right to take charge of his or her own destiny.

We hope that the signs are correct, and that this most important player finally realizes that this means above all taking charge of the facts of medicine and science behind the treatment he is offered. The challengers to this conventional treatment give twenty different reasons for concluding that HIV is not the cause of anything and that the anti-HIV medicines he is taking after his liver transplant are damaging to …. the liver.

Let’s hope he will now listen to Duesberg, as he has shown he is willing to do. This might contribute to a great turnaround in a matter which is a life and death issue for so many, not to mention vast sums of public money in an era where every dollar counts in the fight for global health.

Much hangs on what Larry Kramer does now. Will he investigate and confirm that Peter Duesberg deserves to be taken seriously, and help to win funding for the embattled scientific idealist to bring a resolution through experiments to a twenty year old dispute which never should have gone on so long, putting at risk the lives of so many, including Kramer’s own?

Andrew Sullivan sideswipes Harper’s

April 16th, 2006


But the shoot-from-the-hip talking head is misled about his own predicament

It now seems clear that it is not just Larry Kramer whose homework on the rationale of HIV?AIDS has been neglected in favor of partying, politicking, playwriting, appearing on television and on panels and performing rhetorically on the eternal theme “They all want to murder us”. Though very different in stance ebullient Brit Andrew Sullivan’s political instincts have led him to make the same knee-jerk responses as Kramer when he hears that HIV is questioned.

Thus in his “Daily Dish” blog two weeks ago, ironically on April 1, he reveals that it goes without saying that HIV causes AIDS and to think otherwise is a superstition peddled by magazines “like Harper’s”, whatever that phrase means (Saturday, April 1, 2006 Andrew Sullivan’s Daily Dish – Elites and Medicine 1 Apr 2006 02:01 pm:

One of the most persistent sub-currents out there among people with HIV and AIDS is superstition, or the notion that all drugs are somehow poisonous, or that homeopathic quackery can replace actual science, or that HIV doesn’t cause AIDS, and so on. This is particularly widespread among some gays and African-Americans, some of the populations most at risk. You have magazines like Harper’s giving credence to “theories” that HIV is unrelated to AIDS – in 2006!

Saturday, April 1, 2006

Elites and Medicine

01 Apr 2006 02:01 pm

A reader makes a good point:

“One interesting case study for elitism is medicine. Your familiarity is through experience with HIV; mine, cancer. The point though is the same. There was at first an unresponsive God-like community that made unassailable pronouncements about the science and medicine. Correctly this was rebelled against. But now we have charlatans and healers who have no basis, except anecdotes if that, for their claims. And substantial members of the public believe them over the science. Part of this is because for cases like AIDS and cancer, sometimes science hasn’t an answer yet. Nonetheless, the “everyone’s opinion is equal” attitude is now as destructive as the God-like elitism. Somehow we need a happy medium – acknowledging expertise while demanding that it explain itself. The anti-knowledge forces are not just religious fundamentalists; read some of the anti-medicine nonsense out there.”

I have to agree. One of the most persistent sub-currents out there among people with HIV and AIDS is superstition, or the notion that all drugs are somehow poisonous, or that homoepathic quackery can replace actual science, or that HIV doesn’t cause AIDS, and so on. This is particularly widespread among some gays and African-Americans, some of the populations most at risk. You have magazines like Harper’s giving credence to “theories” that HIV is unrelated to AIDS – in 2006! In the early days, you had people like Larry Kramer telling everyone that AZT was poison, despite the fact that it was then and remains today a critical component of many effective anti-HIV cocktails (it was disastrous only as over-dosed mono-therapy). Every day, I get emails telling me to try aspirin or St John’s Wort for HIV. The right response, I think, is not to take what the science establishment says on faith – let alone the public health establishment. The answer is to try and understand the science as best you can, to ask the right questions, to keep asking, to get second opinions. There is an alternative between fundamentalism and relativism, between authority and nihilism. That alternative is curious and empirical skepticism, which must, of course, respect those whose knowledge of any particular subject is inevitably far deeper than our own. That kind of skepticism is important not only for a patient with a life-threatening disease, but also for liberal democracy and liberal learning. We need to recover it.

To this cheeky dismissal of his betters, one can only say, if Andrew is truly interested in demonstrating empirical skepticism perhaps he should make a supreme effort to heave himself out of his pundit’s armchair and hit PubMed on his desktop to find out the difference between superstition and “actual science” as peer-reviewed in leading journals, and the difference between “theories” and professional scientific reviews of those “theories”, if only for his own benefit, since he seems to be so cheerfully taking a standard range of HAART drugs known to have rather unpleasant effects on the body, though not in his case, he tells us.

I’ve been on the new meds for a couple of months now and after a week or so of torpor, have no side-effects that I can speak of. My viral load – i.e. the amount of virus in my bloodstream – went from 141,000 particles per cubic mililiter of blood in late May to 1500 after ten days on June 2 and has now come down to a grand total of 121. Still not good enough. We’re hoping for under 50 at the next count. My CD4 cell count – a sign of the strength of your immune system – has gone back into its normal range. Thank God for the evil pharmaceutical companies. One day, when the history of this period is written, I have a feeling we will look back with astonishment as we recognize that advances in medical science, particularly pharmaceuticals, were arguably one of the most significant developments of this era. And yet the people who pioneered these breakthroughs were … demonized and attacked. Baffling and bizarre. I’m merely grateful the attacks haven’t stopped the research progress.

Here’s the whole post:

From andrewsullivan.com Daily Dish September 19 2005:

BACK FROM THE DOC: Just an HIV update. I’ve been on

the new meds for a couple of months now and after a

week or so of torpor, have no side-effects that I can

speak of. My viral load – i.e. the amount of virus in

my bloodstream – went from 141,000 particles per cubic

milliliter of blood in late May to 1500 after ten days

on June 2 and has now come down to a grand total of

121. Still not good enough. We’re hoping for under 50

at the next count. My CD4 cell count – a sign of the

strength of your immune system – has gone back into

its normal range. Thank God for the evil

pharmaceutical companies. One day, when the history of

this period is written, I have a feeling we will look

back with astonishment as we recognize that advances

in medical science, particularly pharmaceuticals, were

arguably one of the most significant developments of

this era. And yet the people who pioneered these

breakthroughs were … demonized and attacked.

Baffling and bizarre. I’m merely grateful the attacks

haven’t stopped the research progress. They’ve merely

slowed it. Oh, and I talked my doc into giving me a

pre-emptive treatment of Tamiflu. I won’t use it,

unless the birdshit hits the fan. But I’ll have it

just in case. I’m not relying on Mr Bush. Fool me once

All very impressive, with those specific numbers.

“My viral load – i.e. the amount of virus in my bloodstream – went from 141,000 particles per cubic milliliter of blood in late May to 1500 after ten days on June 2 and has now come down to a grand total of 121. Still not good enough. We’re hoping for under 50 at the next count. My CD4 cell count – a sign of the strength of your immune system – has gone back into its normal range.”

There is something very persuasive about quantitities one can measure so precisely. Gauging precisely with instruments is the essence of good science, after all. You get away from human speculation and nail down the facts with cold, objective measurement.

But maybe Andrew should read Peter Duesberg’s letter in Nature on May 19, 1995 (page 197) and mathematician Frank Bulanouckas’s even more damning letter that follows it and see that all these “virus particles” are not measured accurately by PCR (they cannot be, as Kary Mullis, who won the Nobel for inventing PCR, has said) and probably exceed by as much as 60,000 fold the real count of virus in his blood, so it is not as impressive as readers may think.

Plasma virus levels determined by QC-PCR correlated with, but exceeded by an average of 60,000-fold, virus titers measured by endpoint diln. culture.

That’s from the abstract of the 1993 paper Duesberg quoted in his letter to Nature, which letter read as follows – we quote it in full since it is a classic statement which illuminates the shell game perpetrated by the HIV wide boys with Maddox acting as the muscle:

“HIV an illusion”

Letter from Peter Duesberg and Harvey Bialy, Nature 375: 197, 18 May 1995

SIR-In an editorial in the 19 January issue of Nature, John Maddox invited “Duesberg and his associates” to comment on the “HIV-1 dynamics” papers published the previous week, indicating that these new results should prove an embarrassment to us. Although we do not think that a scientist should be embarrassed for pointing out inconsistencies and paradoxes in a hypothesis that have only been reportedly resolved 10 years later, we nonetheless prepared a fully referenced, approximately 2,000-word critique of the Ho et al.2 and Wei et al.3 papers that we believed met the criteria of “not being longer than it needs to be, and pertaining to the papers at hand” that Maddox set out in his widely read challenge.

Unfortunately, he did not share our view and agreed to publish only a radically shortened version, and only after he had personally “gone over it with a fine-tooth comb” to remove our perceived misrepresentations of the issues. We found these new conditions so totally at variance with the spirit of free and fair scientific debate that we could not agree to them.

Readers of Nature who are interested in these questions, and feel that they do not need to be protected by Maddox from our ill-conceived logic, can find the complete text of our commentary in the monograph supplement to the most recent issue of Genetica4. Here we would point out only that the central claim of the Ho et al.2 and Wei et al.3 papers-that 100,000 HIV virions per ml plasma can be detected in AIDS patients with various nucleic-acid amplification assays is misleading. The senior author of the Wei et al. paper has previously claimed that the PCR method they used overestimates by at least 60,000 times the real titer of infectious HIV5: 100,000/60,000 is 1.7 infectious HIVs per ml, hardly the “virological mayhem” alluded to by Wain-Hobson.6 Further, Ho and a different group of collaborators have just shown7 that more than 10,000 “plasma virions,” detected by the branched-DNA amplification assay used in their Nature paper, correspond to less than one (!) infectious virus per ml. And infectious units, after all, are the only clinically relevant criteria for a viral pathogen.

Finally, in view of Wain-Hobson’s statement6 that “the concordance of their [Wei and Ho’s] data is remarkable,” note that Loveday et al.8 report the use of a PCR-based assay and find only 200 HIV “virion RNAs” per ml of serum of AIDS patients-1,000 times less than Ho and Wei. So much for the “remarkable concordance.”

Peter Duesberg. Harvey Bialy.

“HIV an illusion”

Letter from Peter Duesberg and Harvey Bialy, Nature 375: 197, 18 May 1995

SIR-In an editorial in the 19 January issue of Nature, John Maddox invited “Duesberg and his associates” to comment on the “HIV-1 dynamics” papers published the previous week, indicating that these new results should prove an embarrassment to us. Although we do not think that a scientist should be embarrassed for pointing out inconsistencies and paradoxes in a hypothesis that have only been reportedly resolved 10 years later, we nonetheless prepared a fully referenced, approximately 2,000-word critique of the Ho et al.2 and Wei et al.3 papers that we believed met the criteria of “not being longer than it needs to be, and pertaining to the papers at hand” that Maddox set out in his widely read challenge.

Unfortunately, he did not share our view and agreed to publish only a radically shortened version, and only after he had personally “gone over it with a fine-tooth comb” to remove our perceived misrepresentations of the issues. We found these new conditions so totally at variance with the spirit of free and fair scientific debate that we could not agree to them.

Readers of Nature who are interested in these questions, and feel that they do not need to be protected by Maddox from our ill-conceived logic, can find the complete text of our commentary in the monograph supplement to the most recent issue of Genetica4. Here we would point out only that the central claim of the Ho et al.2 and Wei et al.3 papers-that 105 HIV virions per ml plasma can be detected in AIDS patients with various nucleic-acid amplification assays is misleading. The senior author of the Wei et al. paper has previously claimed that the PCR method they used overestimates by at least 60,000 times the real titer of infectious HIV5: 100,000/60,000 is 1.7 infectious HIVs per ml, hardly the “virological mayhem” alluded to by Wain-Hobson.6 Further, Ho and a different group of collaborators have just shown7 that more than 10,000 “plasma virions,” detected by the branched-DNA amplification assay used in their Nature paper, correspond to less than one (!) infectious virus per ml. And infectious units, after all, are the only clinically relevant criteria for a viral pathogen.

Finally, in view of Wain-Hobson’s statement6 that “the concordance of their [Wei and Ho’s] data is remarkable,” note that Loveday et al.8 report the use of a PCR-based assay and find only 200 HIV “virion RNAs” per ml of serum of AIDS patients-1,000 times less than Ho and Wei. So much for the “remarkable concordance.”

Peter Duesberg

Department of Molecular and Cellular Biology,

University of California,

Berkeley, California 94720, USA

Harvey Bialy

Bio/Technology, New York, New York 10010, USA

Notes and References

1. Maddox, J. Nature 373, 189 (1995).

2. Ho, D. D. et al. Nature 373, 123-126 (1995).

3. Wei. X. et al. Nature 373, 117-122 (1995).

4. Duesberg, P. & Bialy, H. Genetica Suppl. (in the press).

5. Piatak, M. et al. Science 259. 1749-1754 (1993).

6. Wain-Hobson, S. Nature 373, 102 (1995).

7. Cao, Y. et al. New Engl. J. Med. 332, 201-208 (1995).

8. Loveday, C. et al. Lancet 345, 820-824 (1995).

Here is the full abstract from Science in 2000:

High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR

Piatak, M., Jr.; Saag, M. S.; Yang, L. C.; Clark, S. J.; Kappes, J. C.; Luk, K. C.; Hahn, B. H.; Shaw, G. M.; Lifson, J. D.

Science (Washington, DC, United States) (1993), 259(5102), 1749-54 CODEN: SCIEAS; ISSN: 0036-8075. English.

Quant. competitive polymerase chain reaction (QC-PCR) methods were used to quantify virion-associated human immunodeficiency virus type-1 (HIV-1) RNA in plasma from 66 patients with Centers for Disease Control stage I to IVC1 infection. HIV-1 RNA, ranging from 100 to nearly 22,000,000 copies per mL of plasma (corresponding to 50 to 11,000,000 virions per mL), was readily quantified in all subjects, was significantly associated with disease stage and CD4+ T cell counts, and decreased by as much as 235-fold with resolution of primary infection or institution of antiretroviral therapy. Plasma virus levels determined by QC-PCR correlated with, but exceeded by an average of 60,000-fold, virus titers measured by endpoint diln. culture. Quantitation of HIV-1 in plasma by QC-PCR may be useful in assessing the efficacy of antiretroviral agents, especially in early stage disease when conventional viral markers are often neg.

Larry Kramer billed $19,000 annually for drugs “I never took”

April 14th, 2006

Andrew Sullivan joins him in setting a very bad example

Having been called out of order for crucifying the increasingly bewildered playwright Larry Kramer by a distinguished comment writer to the last post, we feel rather guilty at having to drive the nails in further, but after all, the self-serving arrogance of the misinformed exploiting the trust of the ignorant and vulnerable is the theme of this blog. (Click photos twice for maximum size)

At 71 Kramer is still the grand old activist hero of the gay community when it comes to HIV?AIDS, influential in media circles and a performer who can pack the great Cooper Union hall with hundreds of men so attentive that you can hear a condom packet drop as he declaims his poetically styled despair at their unwitting cooperation with the Bush administration in murdering each other with irresponsible partying.

PERSONAL RESPONSIBILITY DEPT.

NOWHERE

New Yorker Issue of 2004-11-22

Posted 2004-11-15

Larry Kramer delivered a long and fiery speech at Cooper Union last Sunday night. That, of course, was nothing new. Kramer, the playwright who founded the activist group act up and was the signature voice of the age of aids, is famous for his fury: once, he and thousands of his supporters invaded St. Patrick’s Cathedral during Mass; another time, they wrapped Jesse Helms’s house in a giant yellow condom. Over the years, they hounded pharmaceutical companies and the government into developing and providing drugs and treatments.

In the early days of aids, straight people disliked Kramer for his aggressive honesty and gays ridiculed him for what they saw as his prissiness about sex, but now, at sixty-nine, he seems to have outlived the animosity of both groups. He has also outlived almost all of his friends. “It’s funny,’’ the playwright Tony Kushner said recently. “These days, audiences are fond of Larry. They seem wistful. Can you imagine that? Being wistful about Larry?”

Kramer surprises people who have seen him screeching on television or have read one of his radioactive e-mails. In conversation, he tends to speak so softly that one has to lean in to hear him. At Cooper Union, Kramer wore his usual uniform: overalls and a sweater with an American flag on it, over a red turtleneck. He looked stooped, old. He spoke for more than an hour, at the same lectern that Abraham Lincoln (who Kramer ceaselessly insists was gay) used when he addressed New Yorkers, in 1860. On Sunday night, the Great Hall was full; hundreds of people were turned away.

The speech, entitled “The Tragedy of Today’s Gays,” began with a dire assessment of the Presidential election. “I hope we all realize that, as of November 2nd, gay rights are officially dead,’’ Kramer said. “And that from here on we are going to be led even closer to the guillotine. Almost sixty million people whom we live and work with every day think we are immoral. ‘Moral values’ was at the top of many lists of why people supported George Bush. Not Iraq. Not the economy. Not terrorism. ‘Moral values.’ In case you need a translation, that means us.’’

But Kramer has never been harder on others than he has been on homosexuals themselves. It is the main reason that he has occasionally been dismissed as a febrile modern version of Cotton Mather. “I know many people look to me for answers,” he went on. “Perhaps that is why many of you are here. You want answers? We’re living in pig shit, and it’s up to each one of us to figure out how to get out of it.” By pig shit, he meant, more or less, a heedless life of unprotected sex and crystal-meth addiction. “It takes hard work to behave like an adult,” he continued. “It takes discipline. You want it to be simple. It isn’t simple. Yes, it is. Grow up. Behave responsibly. Fight for your rights. Take care of yourself and each other. These are the answers. It takes courage to live.”

He went on, “Does it occur to you that we brought this plague of aids upon ourselves? I know I am getting into dangerous waters here, but it is time. With the cabal breathing even more murderously down our backs, it is time. And you are still doing it: you are still murdering each other. . . . From the very first moment we were told, in 1981, that the suspected cause was a virus, gay men have refused to accept responsibility for choosing not to listen, and, starting in 1984, when we were told it definitely was a virus, this behavior turned murderous.”

A few weeks earlier, there had been a tribute to Kramer at the 92nd Street Y, produced by Kushner. On that evening, actors read from Kramer’s novel “Faggots,”from his plays “The Normal Heart” and “The Destiny of Me,” and from other works, including his prescient 1983 essay “1,112 and Counting,’’ in which he asked, incredulously, how many more people would have to die before gays got serious about aids. That was, roughly, seventy million infections ago.

“I guess if you live long enough people give up and accept you,’’ Kramer said that night, with something approaching giddiness. “I got invited to the National Cancer Institute, to a conference that is so high-level I don’t even understand the topics. And Harvard just called.”

Kramer understands, however, that acceptance doesn’t mean much, in the scheme of things, since it seems not to extend to gay people in general. “Nobody listens to us,” Kramer said at Cooper Union. “There is not a single person in Washington who will get us or give us anything but shit and more shit. I’m sorry. This is where we are now. Nowhere.”

COMMENT

PERSONAL RESPONSIBILITY DEPT.

— Michael Specter

Meanwhile Tony Fauci, that he once called a “murderer”, is now his savior and best friend since he arranged for Larry to get a new liver, at a time when HIV-positive patients were typically low priority candidates for these organ transplants.

All Larry’s crowd-swaying rhetoric and newfound fondness for Tony Fauci is precariously predicated on one tragically questionable premise, however, and that is that the decline in gay men’s immunity to the impressive range of chemical and biological assaults on their bodies to which they are exposed in heavy partying is not due to the alien substances and internal flora and fauna themselves but to a negligible wisp of RNA whose genetic machinery is so limited that it cannot even reproduce without the help of a healthy cell.

That wisp is HIV, a 9 kilobase retrovirus, an otherwise inert entity belonging to a species of virus which has never been proven to cause any harm to any person (pace Robert Gallo and his not so leukemic HTLV-1 for which the US blood banks test blood for his profit and our supposed security, although most of the population in Japan in a certain large region have it in their veins with nil effect on their leukemia rate – Hi Bob!) despite billions being spent on testing them in the Nixon War on Cancer in the vain hope that such retroviruses might be a cause of human cancer, since one and only one of the species is able with a little encouragement to cause a tumor in chickens, which is hardly a cell killing activity.

Faced with long and alien words like ‘retrovirus’, however, it’s possibly understandable that the artistic temperament of key players in HIV?AIDS gay politics such as Larry and the ebullient Brit Andrew Sullivan should be short circuited into a kind of mental paralysis which leaves them the passive recipients of whatever their more authoritative connections want to tell them.

Kramer has paid no attention even to members of ACT-UP the organization he founded when they changed their tune. A typically presumptuous 2000 piece by a reporter in POZ, always resolutely head-in-the-sand when it comes to HIV?AIDS, contains this quote:

But if the ((ACTUP/SF HIV rejecting)) members see themselves as unheeded, others see them as unhinged, and increasingly a public health menace. “To maintain that AIDS is not caused by HIV, to disrupt government and other official hearings to argue that money should not be voted for AIDS research and patient aid, to utilize vicious smear campaigns and to threaten legitimate activists with physical harm is beyond any intelligent comprehension,” said ACT UP founder Larry Kramer in a widely circulated e-mail in June. “Truly, in the face of our worldwide plague, such actions can only be construed as crazy”

*************************************************

“Larry’s research method into whatever is really going on in HIV?AIDS, scientifically and medically, consists of a) palling around with Tony Fauci of NIAID and b) forwarding copies of articles by Celia Farber to his well placed media and activist friends and asking what they think of them.”

****************************************************

Andrew Sullivan sideswipes Harper’s

For it now seems clear that it is not just Larry whose homework on the rationale of HIV?AIDS has been neglected in favor of partying, politicking, playwriting, appearing on television and on panels and performing rhetorically on the eternal theme “They all want to murder us”. Though very different in stance Sullivan’s political instincts have led him to make the same knee-jerk responses as Kramer when he hears that HIV is questioned.

Thus in his “Daily Dish” blog two weeks ago, ironically on April 1, he reveals that it goes without saying that HIV causes AIDS and to think otherwise is a superstition peddled by magazines “like Harper’s”, whatever that phrase means (Saturday, April 1, 2006 Andrew Sullivan’s Daily Dish – Elites and Medicine 1 Apr 2006 02:01 pm:

One of the most persistent sub-currents out there among people with HIV and AIDS is superstition, or the notion that all drugs are somehow poisonous, or that homeopathic quackery can replace actual science, or that HIV doesn’t cause AIDS, and so on. This is particularly widespread among some gays and African-Americans, some of the populations most at risk. You have magazines like Harper’s giving credence to “theories” that HIV is unrelated to AIDS – in 2006!

Saturday, April 1, 2006

Elites and Medicine

01 Apr 2006 02:01 pm

A reader makes a good point:

“One interesting case study for elitism is medicine. Your familiarity is through experience with HIV; mine, cancer. The point though is the same. There was at first an unresponsive God-like community that made unassailable pronouncements about the science and medicine. Correctly this was rebelled against. But now we have charlatans and healers who have no basis, except anecdotes if that, for their claims. And substantial members of the public believe them over the science. Part of this is because for cases like AIDS and cancer, sometimes science hasn’t an answer yet. Nonetheless, the “everyone’s opinion is equal” attitude is now as destructive as the God-like elitism. Somehow we need a happy medium – acknowledging expertise while demanding that it explain itself. The anti-knowledge forces are not just religious fundamentalists; read some of the anti-medicine nonsense out there.”

I have to agree. One of the most persistent sub-currents out there among people with HIV and AIDS is superstition, or the notion that all drugs are somehow poisonous, or that homoepathic quackery can replace actual science, or that HIV doesn’t cause AIDS, and so on. This is particularly widespread among some gays and African-Americans, some of the populations most at risk. You have magazines like Harper’s giving credence to “theories” that HIV is unrelated to AIDS – in 2006! In the early days, you had people like Larry Kramer telling everyone that AZT was poison, despite the fact that it was then and remains today a critical component of many effective anti-HIV cocktails (it was disastrous only as over-dosed mono-therapy). Every day, I get emails telling me to try aspirin or St John’s Wort for HIV. The right response, I think, is not to take what the science establishment says on faith – let alone the public health establishment. The answer is to try and understand the science as best you can, to ask the right questions, to keep asking, to get second opinions. There is an alternative between fundamentalism and relativism, between authority and nihilism. That alternative is curious and empirical skepticism, which must, of course, respect those whose knowledge of any particular subject is inevitably far deeper than our own. That kind of skepticism is important not only for a patient with a life-threatening disease, but also for liberal democracy and liberal learning. We need to recover it.

To this cheeky dismissal of his betters, one can only say, if Andrew is truly interested in demonstrating empirical skepticism perhaps he should make a supreme effort to heave himself out of his pundit’s armchair and hit PubMed on his desktop to find out the difference between superstition and “actual science” as peer-reviewed in leading journals, and the difference between “theories” and professional scientific reviews of those “theories”, if only for his own benefit, since he seems to be so cheerfully taking a standard range of HAART drugs known to have rather unpleasant effects on the body, though not in his case, he tells us.

I’ve been on the new meds for a couple of months now and after a week or so of torpor, have no side-effects that I can speak of. My viral load – i.e. the amount of virus in my bloodstream – went from 141,000 particles per cubic mililiter of blood in late May to 1500 after ten days on June 2 and has now come down to a grand total of 121. Still not good enough. We’re hoping for under 50 at the next count. My CD4 cell count – a sign of the strength of your immune system – has gone back into its normal range. Thank God for the evil pharmaceutical companies. One day, when the history of this period is written, I have a feeling we will look back with astonishment as we recognize that advances in medical science, particularly pharmaceuticals, were arguably one of the most significant developments of this era. And yet the people who pioneered these breakthroughs were … demonized and attacked. Baffling and bizarre. I’m merely grateful the attacks haven’t stopped the research progress.

Here’s the whole post:

From andrewsullivan.com Daily Dish September 19 2005:

BACK FROM THE DOC: Just an HIV update. I’ve been on

the new meds for a couple of months now and after a

week or so of torpor, have no side-effects that I can

speak of. My viral load – i.e. the amount of virus in

my bloodstream – went from 141,000 particles per cubic

milliliter of blood in late May to 1500 after ten days

on June 2 and has now come down to a grand total of

121. Still not good enough. We’re hoping for under 50

at the next count. My CD4 cell count – a sign of the

strength of your immune system – has gone back into

its normal range. Thank God for the evil

pharmaceutical companies. One day, when the history of

this period is written, I have a feeling we will look

back with astonishment as we recognize that advances

in medical science, particularly pharmaceuticals, were

arguably one of the most significant developments of

this era. And yet the people who pioneered these

breakthroughs were … demonized and attacked.

Baffling and bizarre. I’m merely grateful the attacks

haven’t stopped the research progress. They’ve merely

slowed it. Oh, and I talked my doc into giving me a

pre-emptive treatment of Tamiflu. I won’t use it,

unless the birdshit hits the fan. But I’ll have it

just in case. I’m not relying on Mr Bush. Fool me once

All very impressive, with those specific numbers.

“My viral load – i.e. the amount of virus in my bloodstream – went from 141,000 particles per cubic milliliter of blood in late May to 1500 after ten days on June 2 and has now come down to a grand total of 121. Still not good enough. We’re hoping for under 50 at the next count. My CD4 cell count – a sign of the strength of your immune system – has gone back into its normal range.”

There is something very persuasive about quantitities one can measure so precisely. Gauging precisely with instruments is the essence of good science, after all. You get away from human speculation and nail down the facts with cold, objective measurement.

But maybe Andrew should read Peter Duesberg’s letter in Nature on May 19, 1995 (page 197) and mathematician Frank Bulanouckas’s even more damning letter that follows it and see that all these “virus particles” are not measured accurately by PCR (they cannot be, as Kary Mullis, who won the Nobel for inventing PCR, has said) and probably exceed by as much as 60,000 fold the real count of virus in his blood, so it is not as impressive as readers may think.

Plasma virus levels determined by QC-PCR correlated with, but exceeded by an average of 60,000-fold, virus titers measured by endpoint diln. culture.

That’s from the abstract of the 1993 paper Duesberg quoted in his letter to Nature, which letter read as follows – we quote it in full since it is a classic statement which illuminates the shell game perpetrated by the HIV wide boys with Maddox acting as the muscle:

“HIV an illusion”

Letter from Peter Duesberg and Harvey Bialy, Nature 375: 197, 18 May 1995

SIR-In an editorial in the 19 January issue of Nature, John Maddox invited “Duesberg and his associates” to comment on the “HIV-1 dynamics” papers published the previous week, indicating that these new results should prove an embarrassment to us. Although we do not think that a scientist should be embarrassed for pointing out inconsistencies and paradoxes in a hypothesis that have only been reportedly resolved 10 years later, we nonetheless prepared a fully referenced, approximately 2,000-word critique of the Ho et al.2 and Wei et al.3 papers that we believed met the criteria of “not being longer than it needs to be, and pertaining to the papers at hand” that Maddox set out in his widely read challenge.

Unfortunately, he did not share our view and agreed to publish only a radically shortened version, and only after he had personally “gone over it with a fine-tooth comb” to remove our perceived misrepresentations of the issues. We found these new conditions so totally at variance with the spirit of free and fair scientific debate that we could not agree to them.

Readers of Nature who are interested in these questions, and feel that they do not need to be protected by Maddox from our ill-conceived logic, can find the complete text of our commentary in the monograph supplement to the most recent issue of Genetica4. Here we would point out only that the central claim of the Ho et al.2 and Wei et al.3 papers-that 100,000 HIV virions per ml plasma can be detected in AIDS patients with various nucleic-acid amplification assays is misleading. The senior author of the Wei et al. paper has previously claimed that the PCR method they used overestimates by at least 60,000 times the real titer of infectious HIV5: 100,000/60,000 is 1.7 infectious HIVs per ml, hardly the “virological mayhem” alluded to by Wain-Hobson.6 Further, Ho and a different group of collaborators have just shown7 that more than 10,000 “plasma virions,” detected by the branched-DNA amplification assay used in their Nature paper, correspond to less than one (!) infectious virus per ml. And infectious units, after all, are the only clinically relevant criteria for a viral pathogen.

Finally, in view of Wain-Hobson’s statement6 that “the concordance of their [Wei and Ho’s] data is remarkable,” note that Loveday et al.8 report the use of a PCR-based assay and find only 200 HIV “virion RNAs” per ml of serum of AIDS patients-1,000 times less than Ho and Wei. So much for the “remarkable concordance.”

Peter Duesberg. Harvey Bialy.

“HIV an illusion”

Letter from Peter Duesberg and Harvey Bialy, Nature 375: 197, 18 May 1995

SIR-In an editorial in the 19 January issue of Nature, John Maddox invited “Duesberg and his associates” to comment on the “HIV-1 dynamics” papers published the previous week, indicating that these new results should prove an embarrassment to us. Although we do not think that a scientist should be embarrassed for pointing out inconsistencies and paradoxes in a hypothesis that have only been reportedly resolved 10 years later, we nonetheless prepared a fully referenced, approximately 2,000-word critique of the Ho et al.2 and Wei et al.3 papers that we believed met the criteria of “not being longer than it needs to be, and pertaining to the papers at hand” that Maddox set out in his widely read challenge.

Unfortunately, he did not share our view and agreed to publish only a radically shortened version, and only after he had personally “gone over it with a fine-tooth comb” to remove our perceived misrepresentations of the issues. We found these new conditions so totally at variance with the spirit of free and fair scientific debate that we could not agree to them.

Readers of Nature who are interested in these questions, and feel that they do not need to be protected by Maddox from our ill-conceived logic, can find the complete text of our commentary in the monograph supplement to the most recent issue of Genetica4. Here we would point out only that the central claim of the Ho et al.2 and Wei et al.3 papers-that 105 HIV virions per ml plasma can be detected in AIDS patients with various nucleic-acid amplification assays is misleading. The senior author of the Wei et al. paper has previously claimed that the PCR method they used overestimates by at least 60,000 times the real titer of infectious HIV5: 100,000/60,000 is 1.7 infectious HIVs per ml, hardly the “virological mayhem” alluded to by Wain-Hobson.6 Further, Ho and a different group of collaborators have just shown7 that more than 10,000 “plasma virions,” detected by the branched-DNA amplification assay used in their Nature paper, correspond to less than one (!) infectious virus per ml. And infectious units, after all, are the only clinically relevant criteria for a viral pathogen.

Finally, in view of Wain-Hobson’s statement6 that “the concordance of their [Wei and Ho’s] data is remarkable,” note that Loveday et al.8 report the use of a PCR-based assay and find only 200 HIV “virion RNAs” per ml of serum of AIDS patients-1,000 times less than Ho and Wei. So much for the “remarkable concordance.”

Peter Duesberg

Department of Molecular and Cellular Biology,

University of California,

Berkeley, California 94720, USA

Harvey Bialy

Bio/Technology, New York, New York 10010, USA

Notes and References

1. Maddox, J. Nature 373, 189 (1995).

2. Ho, D. D. et al. Nature 373, 123-126 (1995).

3. Wei. X. et al. Nature 373, 117-122 (1995).

4. Duesberg, P. & Bialy, H. Genetica Suppl. (in the press).

5. Piatak, M. et al. Science 259. 1749-1754 (1993).

6. Wain-Hobson, S. Nature 373, 102 (1995).

7. Cao, Y. et al. New Engl. J. Med. 332, 201-208 (1995).

8. Loveday, C. et al. Lancet 345, 820-824 (1995).

Here is the full abstract from Science in 2000:

High levels of HIV-1 in plasma during all stages of infection determined by competitive PCR

Piatak, M., Jr.; Saag, M. S.; Yang, L. C.; Clark, S. J.; Kappes, J. C.; Luk, K. C.; Hahn, B. H.; Shaw, G. M.; Lifson, J. D.

Science (Washington, DC, United States) (1993), 259(5102), 1749-54 CODEN: SCIEAS; ISSN: 0036-8075. English.

Quant. competitive polymerase chain reaction (QC-PCR) methods were used to quantify virion-associated human immunodeficiency virus type-1 (HIV-1) RNA in plasma from 66 patients with Centers for Disease Control stage I to IVC1 infection. HIV-1 RNA, ranging from 100 to nearly 22,000,000 copies per mL of plasma (corresponding to 50 to 11,000,000 virions per mL), was readily quantified in all subjects, was significantly associated with disease stage and CD4+ T cell counts, and decreased by as much as 235-fold with resolution of primary infection or institution of antiretroviral therapy. Plasma virus levels determined by QC-PCR correlated with, but exceeded by an average of 60,000-fold, virus titers measured by endpoint diln. culture. Quantitation of HIV-1 in plasma by QC-PCR may be useful in assessing the efficacy of antiretroviral agents, especially in early stage disease when conventional viral markers are often neg.

Ask-John – the time saving modern approach to scientific fact checking

But it is probably hopeless to suggest further reading of any kind for Andrew. It is pretty clear from the results that his sources for a second medical opinion on his trusted doctor’s advice are the same as Larry’s. That is to say, Larry’s research method into whatever is really going on in HIV?AIDS, scientifically and medically, which consists of a) palling around with Tony Fauci of NIAID and b) forwarding copies of articles by Celia Farber to his well placed media and activist friends and asking what they think of them.

The main problem with this approach is that it is circular ie the friends and colleagues consulted typically follow the same research procedure themselves: when in doubt Ask John. Heck, why not? The Ask-John method is how most scientists double check their understanding of HIV?AIDS, according to our own interviewing. When they see that the cause of AIDS has been challenged by Peter Duesberg in a top peer reviewed journal such as Cancer Research or the Proceedings of the National Academy, they do not read the article concerned. Instead, they mention it to John, their colleague in the field of HIV?AIDS, and John reassures them that there is nothing in it.

*************************************************

“There is no scientific question which has been settled so completely as the question of the cause of AIDS, the Ask-John method reveals. ”

*************************************************The reliability of the Ask-John approach to resolving cognitive dissonance in science was officially recognized in print more than a decade ago by none other than John Maddox, the editor of Nature, when he was provoked by the London Sunday Times running a huge series of articles in 1992 by science editor Neville Hodgkinson over several weekends reporting evidence that Duesberg was right when he reasoned that the chances of HIV being the cause of AIDS were smaller than a 9 kilobase wisp of RNA.

Maddox reacted swiftly to this suggestion that Nature had printed page upon page of HIV?AIDS papers based on a false premise by telling his readers that they need not buy the Sunday Times and look into the matter, he would let them know if there was anything worthwhile in the articles concerned. In other words, no need to read anything, just Ask John.

What is most reassuring to those who use the Ask-John method is the typically supreme confidence with which those they consult tell them what they need to know, eg that HIV causes AIDS, there is overwhelming evidence, that Duesberg is on the wrong track and there is absolutely no question about it. None at all. There is no scientific question which has been settled so completely as the question of the cause of AIDS, the Ask-John method reveals.

For example, only yesterday we asked the charming ex-editor of Scientific American, Jonathan Piel, whom we happened to run into quite by chance at a burial, whether he was aware of the challenge to HIV as the cause of AIDS. **************************************************

“If there is a less appealing topic in the whole of science and medicine, it is difficult to think of it.”

*****************************************************

Having moved on from science to other topics – his green eyed wife Madeleine runs two cable shows, one on a community issue and the other where she interviews people in science and the arts, but he told us he helps out only as a producer – Jonathan seemed to struggle to recall it but eventually allowed that he had heard something of the kind, but there was nothing in it. Nothing at all. Wait, we assured him, this was not quite the case, there definitely was something to it, according to the scientific literature. He grimaced momentarily as a frisson of cognitive dissonance hit his left frontal cortex, but in a second it resolved. No, he said decisively, evidently drawing on the results of Ask-several-Johns, that was quite wrong. Definitely nothing to it. Absolutely not.

Why people prefer to Ask John about the miseries of HIV?AIDS

Of course there is also a particular reason why Ask-John is the preferred method of researching questions about HIV?AIDS and its cause. Let’s face it, no one really likes to think too much about the whole unattractive field if they can help it. If there is a less appealing topic in the whole of science and medicine, it is difficult to think of it. The aesthetic drawbacks simply put a lot of people off. Explaining the scientific questions surrounding of HIV?AIDS would be a fascinating topic – the whole world misled!? surely not! – if it didn’t demand imagining the goriest details of human sexual activity, and the grimmest path of decline into the grave.

Certainly we find the whole subject area unappetizing for the most part, and admit quite frankly our only reason for pursuing HIV?AIDS is that it is the best example extant of how science can go very, very provably wrong, and a very important health paradigm can escape serious peer review for two decades even in a life or death matter. We believe a big reason that HIV?AIDS eludes scrutiny so successfully – it is as slippery as a naked Indian house burglar greased to evade capture – is that it is simply not dinner party conversation.

Opinion leader Larry’s dereliction of duty

But Larry is a leader of his community. The Ask John approach is an abdication of responsibility if you are a respected leader of the gay community in this life or death matter, certainly if you are aware of the serious professional challenge to the HIV?AIDS paradigm, as Larry has been from the first, since he is known to have been sent on request a copy of at least one of Duesberg’s early papers, and he is known to have followed Celia Farber’s columns in SPIN.

It is thus hard to sympathize with his evident disinclination over many years, to do any serious reading himself into the peer-reviewed, two decade long scientific challenge to his key assumption, the one peddled by the activist-friendly scientists, official and reporters who so zealously purvey the standard line in HIV?AIDS to the general public, especially when his own health is at stake, let alone the health and lives of his followers. Like the sensitive, thoughtful and street level columns of Celia Farber the twenty or so popular books on the topic are all very accessible, after all. Has he read any of them, apart from The Band Played On? They should have been his bedside reading, even if he can’t handle the Duesberg papers.

But sadly, it seems that Larry has just assumed all along that the scientific dispute is beyond him, although he has by his own account become a master of the complexities of which pills to take when.

Thus his response to being sent the latest cannonade fired by Duesberg into the side of the good ship HIV=AIDS, a vessel so many years becalmed in the doldrums of no cure, no vaccine, no explanation and still no hope of eventually avoiding death, was not promising. As mentioned Duesberg recently emailed him a pdf of his 2003 Journal of Biosciences paper. Larry’s response was a faint “It’s not quite within my ken, but I’ll try”.

He should try. Come on Larry, read it. OK, we admit that the chances of you being able to get through all 270 pages of the best recent briefing on the topic are small. We mean the book by Harvey Bialy, the uncompromisingly accurate and scientifically and socially precise account of the way scientists have really thought and behaved in HIV?AIDS and cancer research, “Oncogenes, Aneuploidy an AIDS: The Scientific Life and Times of Peter H. Duesberg” (North Atlantic Press 2004).

Bialy’s paperback is high quality, and parts are gossipy in a meaningful way, but it’s not for the science challenged. Larry tackling that might be too much like a tugboat trying to break through thick winter ice in Hudson Bay. Bialy’s clarity is as exact as Duesberg’s. But even with some familiarity with the scene it describes we had a hard time staying the course through every page of that scintillating but diamond hard jewel of science history and analysis, already saluted by some as a classic of its kind. A pity really since it is the one book that slows down the scientific shell game to slow motion for all to see.

But couldn’t lazy Larry have read and understood the gist of Peter Duesberg’s writings over the years, especially when his own life was at stake? Did he even try to? As an artist he would have appreciated the finesse and elegance of Duesberg’s texts, which we daresay are among the finest scientific papers extant in that regard. If truth and beauty are related, Duesberg’s historic papers persuade with style as much as substance, so even those readers who do not have time to pore over every sentence can be convinced that there is something to what he argues.

Angry and hysterical people who are alarmed at the idea that these papers overturn their world view accuse us of hero-worship when we compliment Dusberg for his work, but we challenge them to a) read his papers and b) suggest any in science that rival them in academic and even literary quality. We know of none. Certainly any effort by Robert Gallo or Anthony Fauci or David Baltimore to rival them in clarity, elegance and power of analysis will be a long time acoming.

It is that mastery of the topic that makes it quite easy for a patient lay reader to follow the points of Duesberg’s definitive latest paper, which sends the main pillars of the paradigm flying like pins in a bowling alley. This is the 2003 Journal of Biosciences paper, Duesberg, P., Koehnlein, C. and Rasnick, D. (2003) The Chemical Bases of the Various AIDS Epidemics: Recreational Drugs, Anti-viral Chemotherapy and Malnutrition.(J. Biosci. 28: 383-412), which can be downloaded as a pdf from that link, which is listed in the Scientific Papers page of Duesberg’s AIDS (non cancer) site. Anyone attentive can read the list of AIDS claims and facts which do not accord with established science or common sense and realize just how bereft of reason and evidence the current paradigm appears to be.

Not that there is anything new in it. The same points have been made for twenty years, with no good answers yet except evasion, obfuscation and ad hominem politics. Duesberg’s own very readable book, Inventing the AIDS Virus (Regnery, 1995) is still as valid as ever, and makes the political context clearer as well. Then there is a slew of other books, including one by Christine Maggiore, which can be understood by a child of twelve, What If Everything You Thought You Knew About AIDS Was Wrong? There is really no excuse for anybody not to read this lay literature with attention, if they are diagnosed HIV positive.

Too late for Larry

But now, of course, it may be too late for Larry, who may well be on his last legs. After a liver transplant and years of deleterious drugs, it seems that Kramer is not in any shape to undertake such a challenge. That he didn’t do it in the past seems like wilful neglect, since he was after all the best known HIV?AIDS agitator in the gay community, which has lost so many lives, including many distinguished artists of all kinds. But now it seems that he has lost his grip completely, contradicting himself in his own account of whether he has taken drugs or not.

Certainly he misled Peter Duesberg in his recent attempt to get the lowdown from the scientist on his own particular case. As noted in the last post Larry told the distinguished Berkeley scientist that he had been diagnosed HIV positive in 1987 and had not taken any party drugs or anti-HIV drugs until the liver transplant he endured in 2001, when antiretrovirals were prescribed.

Here is what he actually wrote:

“would you explain something to me. i never used poppers. i never took drugs. i never had any chemo. i do not suffer and never have from malnutrition. i did not start taking anti-hiv drugs until 2001 when i got my liver transplant and they were required. i tested positive in 1987. you say these are the causes of hiv infection. i am hiv infected. i have and had many friends in the same boat, who simply do not fall into your criteria.”

As we pointed out this claim seemed rather inconsistent with his politics but he has said this before in public, for example, in his 2003 interview for the MIX Film Festival:

I never had to take any HIV drugs, until I got my liver. And the only reason I had to take it was because the transplant people insisted, to protect the liver. They wanted to keep HIV in check – whether it was out of check or not.- Larry Kramer Interview November 15, 2003, MIX -– The New York Lesbian and Gay Experimental Film Festival Interview Number: 035 Interviewer: Sarah Schulman

Of course, this is perfectly possible, since there are other reasons why a liver can be so damaged that a transplant is undertaken, including alcoholism and Hepatitis B and C.

The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. You cannot live without a functioning liver.

In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.

Causes

Cirrhosis has many causes. In the United States, chronic alcoholism and hepatitis C are the most common ones.

Alcoholic liver disease. To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Chronic hepatitis B and D. The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States and the Western world. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

Autoimmune hepatitis. This disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.

Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

Blocked bile ducts. When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.

Drugs, toxins, and infections. Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.[Top

But in fact we don’t have to look so far on the Web for the real causes of Larry’s liver deterioration into what his surgeon called a “really disgusting” condition. In the first place, he had Hepatitis B. Secondly, he was taking liver damaging HIV drugs, including AZT, according to his own words. His mind is apparently so muddled that this “I took no drugs” assertion is not only contradicted by statements he has made in the past, but in this 2003 interview, he makes a new and conflicting statement within a few pages.

So, which HIV meds are you taking? LK: I took AZT when my liver started going bad, when my platelets went down. AZT, unknown to a lot of people, raises your platelets, so I took it for that. And then, I took Epivir, 3TC – whatever it’s called – for the Hep-B. And, that’s all I took for a number of years. And then since the transplant started, I’ve taken a bunch of them. I took Viracept, until I became resistant to it. I took Sustiva, which I loathed, until fortunately I became resistant to it, because it drove me nuts. And now, I’m on something which is an amazing drug, because it has absolutely no side effects – it’s like taking aspirin – it’s called Reyataz. Only now, they’ve just discovered – Steve Miles, the UCLA AIDS man has just discovered that Reyataz interacting with the other drugs I take is bad for Hepatitis-B. We know so much now, and I have so many doctors that I correspond with. I mean, talk about patient empowerment. I brought it to a new art. I have six doctors who I e-mail everything about me, and I pester them all to death, and I take advantage of everything that I possibly can, to get the information I need – just what we advocated everybody to do

So it certainly looks as if Larry is good at pestering doctors, at least, for information. Why doesn’t he think of pestering scientists, or looking in the literature which is the ultimate source, or should be, of the doctor’s pescriptions.

Anyhow, it is clear that before his liver transplant, he was taking AZT. How early? Apparently not much earlier, but he was certainly taking some drugs before 1996, $19,000 worth of them annually, in fact. For in 1996 Larry himself was the author of a piece in the New York Times Magazine on July 14 in which he wrote:

The cost of my current drugs, which do not include a protease, already amounts to about $19,000 a year; this does not include visits to my doctor or the batteries of blood tests that he, and this virus, routinely require. And I am what’s called asymptomatic: I am not and have not been sick. A New York Times article earlier this year estimated that drugs for someone with full blown AIDS cost about $70,000 a year; in response, Tom Stoddard, New York University adjunct law professor and gay-rights advocate, wrote a letter to the editor saying that his cost $84,000 a year. Indeed, the seriously sick can find their annual drug cost exceeding $150,000.”

This statement was quoted by Duesberg in a subsequent papers. Thus in “The AIDS dilemma: drug diseases blamed on a passenger virus” by Peter Duesberg & David Rasnick in Genetica 104: 85-132, 1998 Duesberg referred to his drug use as follows:

Some insiders have described how the medical establishment urges HIV-positives to take countless anti-HIV drugs and how these drugs affect their lives. In “Checking in, my chart” the HIV-positive playwright Larry Kramer describes his own polypharmacy of 19 drugs composed by several AIDS luminaries such as Anthony Fauci, David Ho, Joseph Sonnabend, Alvin Friedman-Kien, and others: AZT, acyclovir [for genital herpes], Zantac, colchicine [mitosis blocker], propranolol, spironolactone, myphyston [for liver cirrhosis and hepatitis], Eucerin, Moisturel, Retin-A, mycolog, flucinonide, sulfacet-r, Nizoral [fungal dermatitis], Hisminal and Humbid [bronchitis], and Shaklee vitamins, zinc, NAC and a ‘turquoise stone which a fortune teller, many years ago, advised'(Kramer, 1994) – for an annual price tag of $19,000 (Kramer, 1996).

Nor is Kramer unaware that HIV drugs cause liver disease. In an interview on January 7, 2000 now at WebMD Transcript/AIDS Decade in Review With Larry Kramer, Richard Marlink MD and Parnessa Seele he was able to inform his MD listener that

“We’re finding out, for instance, that 50 per cent of people who take certain drugs die from liver disease rather than AIDS, because the drugs are so harsh on the liver. Norvbir has now been discovered to cause liver cancer in so many of the people who take it. I said to a friend of mine, David Sanford, who’s editor of the Wall Street Journal, who has AIDS, and who just feels so awful from all of these drugs, and I said ‘why don’t you get out there and say I feel awful from all these drugs?’ And he said, “well, because I’m alive.”

Thus the Ask-John method of confirmation at work, and an extraordinary quote from a Wall Street Journal editor, for whom, it seems, everything follows from the assumption that HIV is the danger being kept at bay, so everything suffered in this overriding cause is worth it, even, it appears, liver transplants and death. In other words, one’s own experience counts for nothing if authority says otherwise.

Elsewhere in print, months before his liver transplant, Larry also admitted to taking HIV meds prior to the transplant, and said that one them, 3TC (Epivir), “caused…the liver disease than now is requiring a new liver.” In other words, he conceded Duesberg’s point: that HIV drugs can cause the liver disease seen in HIV positive patients.

Apparently for years now poor Larry has not been in good shape and can forget what he said only a few moments earlier. Fair enough. That is no crime for a man of 71 who has endured whatever attacks the drugs have made upon his system throughout the years, let alone more recently the mother of all organ operations. And let’s give him credit for avoiding crystal meth and antiviral drugs as best he could. But one thing is clear. Over two decades Kramer has not been well qualified to lead his community in this vexed and deadly issue because he has not met his responsibility to double check the science thoroughly.

In the end, does the fault belong to the shepherd or the sheep?

That all these supposedly alert people have followed the Pied Pipers of ACTUP and the NIH into drug hell and eventually decline and death, and agitated for the privilege of doing so, is something that can surely be blamed on the sheep as much as the shepherd. For there is no reason why any one of them should have ignored the many warnings sounded at such great personal cost by Peter Duesberg and by other scientists, academics, journalists, lawyers and independent minded laypeople such as Kary Mullis, Walter Gilbert, Harvey Bialy, Serge Lang, David Rasnick, Richard Strohman, Charles Geshekter, John Lauritsen, Celia Farber, Charles Ortleb, Katie Leishman, Anthony Liversidge, Jad Adams, Joan Shenton, Marco Mamone Capria, Gordon Stewart, Gordon Moran, Neville Hodgkinson, Robert Leppo, Etienne de Harven, Rian Malan, Anthony Brink, David Crowe, Liam Scheff, Christine Maggiore, Robin Scovill, Michael Ellner, David Steele, Frank Lusardi, Marcus Cohen, Robert Houston, James Hogan, Tom Bethell, Bryan Owen, Robert Laarhoven, Dean Esmay, Rebecca Culshaw, Mark Biernbaum and countless others in a list (to be extended) which is an honor roll as far as this blog is concerned.

The mental paralysis induced by medical and scientific authority is a phenomenon which has no excuse for intelligent, educated people, seems to us, even if they are unfamiliar with the details of science and medicine. We will always remember telling an HIV-positive writer for Vanity Fair at the San Franscisco AIDS Conference about Duesberg and the fact that he had reviewed the HIV paradigm with every intention of hopping on the funding bandwagon himself only to find there was nothing in it, and suggesting the writer look into it himself before taking any more AZT.

We even took round a long piece we had written for Harper’s on the subject (never published, as noted in an earlier post, because of Lewis Lapham’s unwillingness to get into bed, politically speaking, with the Heritage Foundation, which published Duesberg in Policy Review while our draft was being reviewed) to this poor fellow when we were both back in New York. He opened the door a crack and reached his hand through to take the paper and said he would let us know.

Two weeks later we called and exactly like Arthur Ashe in similar circumstances, he said, yes, it all looked very convincing, but he would just have to continue trusting his doctors. Five months later he was dead.

Larry Kramer billed $19,000 annually for drugs “I never took”

April 10th, 2006

The activist playwright misleads us on his own experience

Having been called out of order for crucifying the increasingly bewildered playwright Larry Kramer by a distinguished comment writer to the last post, we feel rather guilty at having to drive the nails in further, but after all, the irresponsibility of leaders in science and politics exploiting the trust of the ignorant and vulnerable is the theme of this blog. (Click photos twice for maximum size)

At 71 Kramer is still the grand old activist hero of the gay community when it comes to HIV?AIDS, influential in media circles and a performer who can pack the great Cooper Union hall with hundreds of men so attentive that you can hear a condom packet drop as he declaims his poetically styled despair at their unwitting cooperation with the Bush administration in murdering each other with irresponsible partying.

PERSONAL RESPONSIBILITY DEPT.

NOWHERE

New Yorker Issue of 2004-11-22

Posted 2004-11-15

Larry Kramer delivered a long and fiery speech at Cooper Union last Sunday night. That, of course, was nothing new. Kramer, the playwright who founded the activist group act up and was the signature voice of the age of aids, is famous for his fury: once, he and thousands of his supporters invaded St. Patrick’s Cathedral during Mass; another time, they wrapped Jesse Helms’s house in a giant yellow condom. Over the years, they hounded pharmaceutical companies and the government into developing and providing drugs and treatments.

In the early days of aids, straight people disliked Kramer for his aggressive honesty and gays ridiculed him for what they saw as his prissiness about sex, but now, at sixty-nine, he seems to have outlived the animosity of both groups. He has also outlived almost all of his friends. “It’s funny,’’ the playwright Tony Kushner said recently. “These days, audiences are fond of Larry. They seem wistful. Can you imagine that? Being wistful about Larry?”

Kramer surprises people who have seen him screeching on television or have read one of his radioactive e-mails. In conversation, he tends to speak so softly that one has to lean in to hear him. At Cooper Union, Kramer wore his usual uniform: overalls and a sweater with an American flag on it, over a red turtleneck. He looked stooped, old. He spoke for more than an hour, at the same lectern that Abraham Lincoln (who Kramer ceaselessly insists was gay) used when he addressed New Yorkers, in 1860. On Sunday night, the Great Hall was full; hundreds of people were turned away.

The speech, entitled “The Tragedy of Today’s Gays,” began with a dire assessment of the Presidential election. “I hope we all realize that, as of November 2nd, gay rights are officially dead,’’ Kramer said. “And that from here on we are going to be led even closer to the guillotine. Almost sixty million people whom we live and work with every day think we are immoral. ‘Moral values’ was at the top of many lists of why people supported George Bush. Not Iraq. Not the economy. Not terrorism. ‘Moral values.’ In case you need a translation, that means us.’’

But Kramer has never been harder on others than he has been on homosexuals themselves. It is the main reason that he has occasionally been dismissed as a febrile modern version of Cotton Mather. “I know many people look to me for answers,” he went on. “Perhaps that is why many of you are here. You want answers? We’re living in pig shit, and it’s up to each one of us to figure out how to get out of it.” By pig shit, he meant, more or less, a heedless life of unprotected sex and crystal-meth addiction. “It takes hard work to behave like an adult,” he continued. “It takes discipline. You want it to be simple. It isn’t simple. Yes, it is. Grow up. Behave responsibly. Fight for your rights. Take care of yourself and each other. These are the answers. It takes courage to live.”

He went on, “Does it occur to you that we brought this plague of aids upon ourselves? I know I am getting into dangerous waters here, but it is time. With the cabal breathing even more murderously down our backs, it is time. And you are still doing it: you are still murdering each other. . . . From the very first moment we were told, in 1981, that the suspected cause was a virus, gay men have refused to accept responsibility for choosing not to listen, and, starting in 1984, when we were told it definitely was a virus, this behavior turned murderous.”

A few weeks earlier, there had been a tribute to Kramer at the 92nd Street Y, produced by Kushner. On that evening, actors read from Kramer’s novel “Faggots,”from his plays “The Normal Heart” and “The Destiny of Me,” and from other works, including his prescient 1983 essay “1,112 and Counting,’’ in which he asked, incredulously, how many more people would have to die before gays got serious about aids. That was, roughly, seventy million infections ago.

“I guess if you live long enough people give up and accept you,’’ Kramer said that night, with something approaching giddiness. “I got invited to the National Cancer Institute, to a conference that is so high-level I don’t even understand the topics. And Harvard just called.”

Kramer understands, however, that acceptance doesn’t mean much, in the scheme of things, since it seems not to extend to gay people in general. “Nobody listens to us,” Kramer said at Cooper Union. “There is not a single person in Washington who will get us or give us anything but shit and more shit. I’m sorry. This is where we are now. Nowhere.”

COMMENT

PERSONAL RESPONSIBILITY DEPT.

— Michael Specter

Meanwhile Tony Fauci, that he once called a “murderer”, is now his savior and long time friend especially since he took a hand in arranging for Larry to receive proper care at the NIH in surviving liver damage long enough to be able to win a liver transplant in Pittsburgh.

All Larry’s crowd-swaying rhetoric and newfound fondness for Tony Fauci – not to mention his need for a liver transplant – is precariously predicated on one tragically questionable premise, however, and that is that the decline in gay men’s immunity to the impressive range of chemical and biological assaults on their bodies to which they are exposed in heavy partying is not due to the alien substances and internal flora and fauna themselves but to a negligible wisp of RNA whose genetic machinery is so limited that it cannot even reproduce without the help of a healthy cell.

That wisp is HIV, a 9 kilobase retrovirus, an otherwise inert entity belonging to a species of virus which has never been proven to cause any harm to any person (pace Robert Gallo and his not so leukemic HTLV-1 for which the US blood banks test blood for his profit and our supposed security, although most of the population in Japan in a certain large region have it in their veins with nil effect on their leukemia rate) despite billions being spent on testing them in the Nixon War on Cancer in the vain hope that such retroviruses might be a cause of human cancer, since one and only one of the species is able with a little encouragement to cause a tumor in chickens, which is hardly a cell killing activity.

So says the most tested scientific literature.

Faced with alien words like ‘retrovirus’, however, it’s possibly understandable that the artistic temperament of key players in HIV?AIDS gay politics such as Larry and the ebullient Brit Andrew Sullivan should be short circuited into a kind of mental paralysis which leaves them the passive recipients of whatever their more authoritative connections want to tell them.

Kramer has paid no attention even to members of ACT-UP the organization he founded when they changed their tune. A typically presumptuous 2000 piece by a reporter in POZ, always resolutely head-in-the-sand when it comes to HIV?AIDS, contains this quote:

But if the ((ACTUP/SF HIV rejecting)) members see themselves as unheeded, others see them as unhinged, and increasingly a public health menace. “To maintain that AIDS is not caused by HIV, to disrupt government and other official hearings to argue that money should not be voted for AIDS research and patient aid, to utilize vicious smear campaigns and to threaten legitimate activists with physical harm is beyond any intelligent comprehension,” said ACT UP founder Larry Kramer in a widely circulated e-mail in June. “Truly, in the face of our worldwide plague, such actions can only be construed as crazy”

Opinion leader Larry’s dereliction of duty

Most people can be forgiven for not wanting to go into the scientific literature, or even discuss HIV and AIDS in social situations. It is hardly dinner party conversation. But Larry is a leader of his community, and HIV positive since 1987. It is hardly good enough that his research method into whatever is really going on in HIV?AIDS, scientifically and medically, consists of a) palling around with Tony Fauci of NIAID and b) forwarding copies of articles by Celia Farber to his well placed media and activist friends and asking what they think of them.”

But this Ask John approach is an abdication of responsibility if you are a respected leader of the gay community in this life or death matter, certainly if you are aware of the serious professional challenge to the HIV?AIDS paradigm, as Larry has been from the first, since he is known to have been sent on request a copy of at least one of Duesberg’s early papers, and if he never followed Celia Farber’s columns in SPIN, which seems doubtful, he certainly read her piece in Gear in which she discussed the dangers of protease inhibitors.

It is thus hard to sympathize with his evident disinclination over many years, to do any serious reading himself into the peer-reviewed, two decade long scientific challenge to his key assumption, the one peddled by the activist-friendly scientists, official and reporters who so zealously purvey the standard line in HIV?AIDS to the general public, especially when his own health is at stake, let alone the health and lives of his followers. Like the thoughtful and thorough SPIN columns of Celia Farber, the twenty or so popular books on the topic are all very accessible, after all. Has he read any of them, apart from The Band Played On? They should have been his bedside reading, even if he can’t handle the Duesberg papers.

But sadly, it seems that Larry has just assumed all along that the scientific dispute is beyond him, although he has by his own account become a master of the complexities of which pills to take when.

Thus his response to being sent the latest cannonade fired by Duesberg into the side of the good ship HIV=AIDS, that vessel so many years becalmed in the doldrums of no cure, no vaccine, no explanation and still no hope of eventually avoiding death, was not promising. As mentioned Duesberg recently emailed him a pdf of his 2003 Journal of Biosciences paper. Larry’s response was a faint “It’s not quite within my ken, but I’ll try”.

He should try. Come on Larry, read it. OK, we admit that the chances of you being able to get through all 270 pages of the best recent briefing on the topic are small. We mean the book by Harvey Bialy, the uncompromisingly accurate and scientifically and socially precise account of the way scientists have really thought and behaved in HIV?AIDS and cancer research, “Oncogenes, Aneuploidy an AIDS: The Scientific Life and Times of Peter H. Duesberg” (North Atlantic Press 2004).

Bialy’s paperback is high quality, and parts are gossipy in a meaningful way, but it’s not for the science challenged. Larry tackling that might be too much like a tugboat trying to break through thick winter ice in Hudson Bay. Bialy’s clarity is as exact as Duesberg’s. But even with some familiarity with the scene it describes we had a hard time staying the course through every page of that scintillating but diamond hard jewel of science history and analysis, already saluted by some as a classic of its kind. A pity really since it is the one book that slows down the scientific shell game to slow motion for all to see.

But couldn’t lazy Larry have read and understood the gist of Peter Duesberg’s writings over the years, especially when his own life was at stake? Did he even try to? As an artist he would have appreciated the finesse and elegance of Duesberg’s texts, which we daresay are among the finest scientific papers extant in that regard. If truth and beauty are related, Duesberg’s historic papers persuade with style as much as substance, so even those readers who do not have time to pore over every sentence can be convinced that there is something to what he argues.

Some people accuse us of hero-worship when we compliment Duesberg for his work, but we challenge them to a) read his papers and b) suggest any in science that rival them in academic and even literary quality. We know of none. Certainly any effort by Robert Gallo or Anthony Fauci or David Baltimore to rival them in clarity, elegance and power of analysis will be a long time acoming.

It is that mastery of the topic that makes it relatively easy for a patient lay reader to follow the points of Duesberg’s definitive latest paper, which sends the main pillars of the paradigm flying like pins in a bowling alley. This is the 2003 Journal of Biosciences paper, Duesberg, P., Koehnlein, C. and Rasnick, D. (2003) The Chemical Bases of the Various AIDS Epidemics: Recreational Drugs, Anti-viral Chemotherapy and Malnutrition.(J. Biosci. 28: 383-412), which can be downloaded as a pdf from that link, which is listed in the Scientific Papers page of Duesberg’s AIDS (non cancer) site. Anyone attentive can read the list of AIDS claims and facts which do not accord with established science or common sense and realize just how bereft of reason and evidence the current paradigm appears to be.

Not that there is anything new in it. The same points have been made for twenty years, with no good answers yet except evasion, obfuscation and ad hominem politics. Duesberg’s own very readable book, Inventing the AIDS Virus (Regnery, 1995) is still as valid as ever, and makes the political context clearer as well. Then there is a slew of other books, including one by Christine Maggiore, which can be understood by a child of twelve, What If Everything You Thought You Knew About AIDS Was Wrong? There is really no excuse for anybody not to read this lay literature with attention, if they are diagnosed HIV positive.

Too late for Larry

But now, of course, it may be too late for Larry, who may well be on his last legs. After a liver transplant and years of deleterious drugs, it seems that Kramer is not in any shape to undertake such a challenge. That he didn’t do it in the past seems like wilful neglect, since he was after all the best known HIV?AIDS agitator in the gay community, which has lost so many lives, including many distinguished artists of all kinds. But now it seems that he has lost his grip completely, contradicting himself in his own account of whether he has taken drugs or not.

Certainly he misled Peter Duesberg in his recent attempt to get the lowdown from the scientist on his own particular case. As noted in the last post Larry told the distinguished Berkeley scientist that he had been diagnosed HIV positive in 1987 and had not taken any party drugs or anti-HIV drugs until the liver transplant he endured in 2001, when antiretrovirals were prescribed.

Here is what he actually wrote:

“would you explain something to me. i never used poppers. i never took drugs. i never had any chemo. i do not suffer and never have from malnutrition. i did not start taking anti-hiv drugs until 2001 when i got my liver transplant and they were required. i tested positive in 1987. you say these are the causes of hiv infection. i am hiv infected. i have and had many friends in the same boat, who simply do not fall into your criteria.”

As we pointed out this claim seemed rather inconsistent with his politics but he has said this before in public, for example, in his 2003 interview for the MIX Film Festival:

I never had to take any HIV drugs, until I got my liver. And the only reason I had to take it was because the transplant people insisted, to protect the liver. They wanted to keep HIV in check – whether it was out of check or not.- Larry Kramer Interview November 15, 2003, MIX -– The New York Lesbian and Gay Experimental Film Festival Interview Number: 035 Interviewer: Sarah Schulman

Of course, this is perfectly possible, since there are other reasons why a liver can be so damaged that a transplant is undertaken, including alcoholism and Hepatitis B and C.

The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. You cannot live without a functioning liver.

In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.

Causes

Cirrhosis has many causes. In the United States, chronic alcoholism and hepatitis C are the most common ones.

Alcoholic liver disease. To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Chronic hepatitis B and D. The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States and the Western world. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

Autoimmune hepatitis. This disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.

Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

Blocked bile ducts. When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.

Drugs, toxins, and infections. Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis.[Top

But in fact we don’t have to look so far on the Web for the real causes of Larry’s liver deterioration into what his surgeon called a “really disgusting” condition. In the first place, he had Hepatitis B. Secondly, he was taking liver damaging HIV drugs, including AZT, according to his own words. His mind is apparently so muddled that this “I took no drugs” assertion is not only contradicted by statements he has made in the past, but in this 2003 interview, he makes a new and conflicting statement within a few pages.

So, which HIV meds are you taking?

LK: I took AZT when my liver started going bad, when my platelets went down. AZT, unknown to a lot of people, raises your platelets, so I took it for that. And then, I took Epivir, 3TC – whatever it’s called – for the Hep-B. And, that’s all I took for a number of years. And then since the transplant started, I’ve taken a bunch of them. I took Viracept, until I became resistant to it. I took Sustiva, which I loathed, until fortunately I became resistant to it, because it drove me nuts. And now, I’m on something which is an amazing drug, because it has absolutely no side effects – it’s like taking aspirin – it’s called Reyataz. Only now, they’ve just discovered – Steve Miles, the UCLA AIDS man has just discovered that Reyataz interacting with the other drugs I take is bad for Hepatitis-B. We know so much now, and I have so many doctors that I correspond with. I mean, talk about patient empowerment. I brought it to a new art. I have six doctors who I e-mail everything about me, and I pester them all to death, and I take advantage of everything that I possibly can, to get the information I need – just what we advocated everybody to do

So it certainly looks as if Larry is good at pestering doctors, at least, for information. Why doesn’t he think of pestering scientists, or looking in the literature which is the ultimate source, or should be, of the doctor’s pescriptions.

Anyhow, it is clear that before his liver transplant, he was taking AZT. How early? Apparently much earlier. He was certainly taking some drugs before 1996, $19,000 worth of them annually, in fact, including AZT. For in 1996 Larry himself was the author of a piece in the New York Times Magazine on July 14 in which he wrote:

The cost of my current drugs, which do not include a protease, already amounts to about $19,000 a year; this does not include visits to my doctor or the batteries of blood tests that he, and this virus, routinely require. And I am what’s called asymptomatic: I am not and have not been sick. A New York Times article earlier this year estimated that drugs for someone with full blown AIDS cost about $70,000 a year; in response, Tom Stoddard, New York University adjunct law professor and gay-rights advocate, wrote a letter to the editor saying that his cost $84,000 a year. Indeed, the seriously sick can find their annual drug cost exceeding $150,000.”

This statement was quoted by Duesberg in a subsequent papers. Thus in “The AIDS dilemma: drug diseases blamed on a passenger virus” by Peter Duesberg & David Rasnick in Genetica 104: 85-132, 1998 Duesberg referred to his drug use as follows:

Some insiders have described how the medical establishment urges HIV-positives to take countless anti-HIV drugs and how these drugs affect their lives. In “Checking in, my chart” the HIV-positive playwright Larry Kramer describes his own polypharmacy of 19 drugs composed by several AIDS luminaries such as Anthony Fauci, David Ho, Joseph Sonnabend, Alvin Friedman-Kien, and others: AZT, acyclovir [for genital herpes], Zantac, colchicine [mitosis blocker], propranolol, spironolactone, myphyston [for liver cirrhosis and hepatitis], Eucerin, Moisturel, Retin-A, mycolog, flucinonide, sulfacet-r, Nizoral [fungal dermatitis], Hisminal and Humbid [bronchitis], and Shaklee vitamins, zinc, NAC and a ‘turquoise stone which a fortune teller, many years ago, advised'(Kramer, 1994) – for an annual price tag of $19,000 (Kramer, 1996).

Nor is Kramer unaware that HIV drugs cause liver disease. In an interview on January 7, 2000 now at WebMD Transcript/AIDS Decade in Review With Larry Kramer, Richard Marlink MD and Parnessa Seele he was able to inform his MD listener that

“We’re finding out, for instance, that 50 per cent of people who take certain drugs die from liver disease rather than AIDS, because the drugs are so harsh on the liver. Norvbir has now been discovered to cause liver cancer in so many of the people who take it. I said to a friend of mine, David Sanford, who’s editor of the Wall Street Journal, who has AIDS, and who just feels so awful from all of these drugs, and I said ‘why don’t you get out there and say I feel awful from all these drugs?’ And he said, “well, because I’m alive.”

Thus the Ask-John method of confirmation at work, and an extraordinary quote from a Wall Street Journal editor, for whom, it seems, everything follows from the assumption that HIV is the danger being kept at bay, so everything suffered in this overriding cause is worth it, even, it appears, liver transplants and death. In other words, one’s own experience counts for nothing if authority says otherwise.

Elsewhere in print, months before his liver transplant, Larry also admitted to taking HIV meds prior to the transplant, and said that one them, 3TC (Epivir), “caused…the liver disease than now is requiring a new liver.” In other words, he conceded Duesberg’s point: that HIV drugs can cause the liver disease seen in HIV positive patients.

Apparently for years now poor Larry has not been in good shape and can forget what he said only a few moments earlier. Fair enough. That is no crime for a man of 71 who has endured whatever attacks the drugs have made upon his system throughout the years, let alone more recently the mother of all organ operations. And let’s give him credit for avoiding crystal meth and antiviral drugs as best he could. But one thing is clear. Over two decades Kramer has not been well qualified to lead his community in this vexed and deadly issue because he has not met his responsibility to double check the science thoroughly.

In the end, does the fault belong to the shepherd or the sheep?

That all these supposedly alert people have followed the Pied Pipers of ACTUP and the NIH into drug hell and eventually decline and death, and agitated for the privilege of doing so, is something that can surely be blamed on the sheep as much as the shepherd. For there is no reason why any one of them should have ignored the many warnings sounded at such great personal cost by Peter Duesberg and by other scientists, academics, journalists, lawyers and independent minded laypeople such as Kary Mullis, Walter Gilbert, Harvey Bialy, Serge Lang, David Rasnick, Richard Strohman, Charles Geshekter, John Lauritsen, Celia Farber, Charles Ortleb, Katie Leishman, Anthony Liversidge, Jad Adams, Joan Shenton, Marco Mamone Capria, Gordon Stewart, Gordon Moran, Neville Hodgkinson, Robert Leppo, Etienne de Harven, Rian Malan, Anthony Brink, David Crowe, Liam Scheff, Christine Maggiore, Robin Scovill, Michael Ellner, David Steele, Frank Lusardi, Marcus Cohen, Robert Houston, James Hogan, Tom Bethell, Bryan Owen, Robert Laarhoven, Dean Esmay, Rebecca Culshaw, Mark Biernbaum and countless others in a list which is an honor roll of truth seeking as far as this blog is concerned.

The mental paralysis induced by medical and scientific authority is a phenomenon which has no excuse for intelligent, educated people, seems to us, even if they are unfamiliar with the details of science and medicine. We will always remember telling an HIV-positive writer for Vanity Fair at the San Franscisco AIDS Conference about Duesberg and the fact that he had reviewed the HIV paradigm with every intention of hopping on the funding bandwagon himself only to find there was nothing in it, and suggesting the writer look into it himself before taking any more AZT.

We even took round a long piece we had written for Harper’s on the subject (never published, as noted in an earlier post, because of Lewis Lapham’s unwillingness to get into bed, politically speaking, with the Heritage Foundation, which published Duesberg in Policy Review while our draft was being reviewed) to this poor fellow when we were both back in New York. He opened the door a crack and reached his hand through to take the paper and said he would let us know.

Two weeks later we called and exactly like Arthur Ashe in similar circumstances, he said, yes, it all looked very convincing, but he would just have to continue trusting his doctors. Five months later he was dead.

A confused Larry Kramer asks Peter Duesberg to explain his own case

April 6th, 2006


But playwrights don’t read science papers it seems

As mentioned in the last post, ACT UP founder and Bush whacker Larry Kramer, who feels that other officials in Washington have it in for the gay comunity, but that NIAID director Tony Fauci is his best buddy, was sufficiently disconcerted by the appearance of the Celia Farber Harper’s article damning HIV drugs and the whole theoretical foundation of HIV?AIDS, that he actually asked Peter Duesberg to clarify the scene for him.

Duesberg had sent him a copy of his 2003 paper for Biosciences, which gives every reason under the sun why HIV?AIDS is clearly the worst scientific hypothesis since Aristotle thought that women had fewer teeth than men (apparently like Larry with HIV it didn’t occur to him to check the evidence for himself). The paper, Larry weakly replied, was a bit beyond his capacity, though he would “try” to get through it.

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“Aristotle could have avoided the mistake of thinking that women have fewer teeth than men, by the simple device of asking Mrs. Aristotle to keep her mouth open while he counted. He did not do so because he thought he knew. Thinking that you know when in fact you don’t is a mistake to which we are all prone.” – Bertrand Russell, An Outline of Intellectual Rubbish, Unpopular Essays,1950

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Interestingly, however, Larry then informed Duesberg that his liver transplant wasn’t due to taking anti-HIV drugs, since he didn’t take any of these or any other drugs, including poppers, since being diagnosed HIV positive in 1987. He only started taking anti-HIV drugs after the liver transplant, he wrote, when they were required.

If this is the case, we hasten to say, then it appears that his liver transplant was not due to drug intake, recreational or medicinal, and we apologize to him for ever suspecting it was.

(There are other reasons of course to need a liver replacement; possible Larry drank too much, or contracted hepatitis B and C from the thousands of personal encounters he has owned up to, not to mention heavy doses of antibiotics and anti-inflammatory and other medicinal but non-anti-HIV drugs. But without suggesting that he is misleading us, it does seem oddly inconsistent not to avail himself of the very drugs that ACT UP, the group he founded, wrenched from the grasp of unwilling officials and researchers before they had time to clear them for safety, resulting in the deaths of tens of thousands of people if the scientific critique is correct.)

The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. You cannot live without a functioning liver.

In cirrhosis of the liver, scar tissue replaces normal, healthy tissue, blocking the flow of blood through the organ and preventing it from working as it should. Cirrhosis is the twelfth leading cause of death by disease, killing about 26,000 people each year. Also, the cost of cirrhosis in terms of human suffering, hospital costs, and lost productivity is high.

Causes

Cirrhosis has many causes. In the United States, chronic alcoholism and hepatitis C are the most common ones.

Alcoholic liver disease. To many people, cirrhosis of the liver is synonymous with chronic alcoholism, but in fact, alcoholism is only one of the causes. Alcoholic cirrhosis usually develops after more than a decade of heavy drinking. The amount of alcohol that can injure the liver varies greatly from person to person. In women, as few as two to three drinks per day have been linked with cirrhosis and in men, as few as three to four drinks per day. Alcohol seems to injure the liver by blocking the normal metabolism of protein, fats, and carbohydrates.

Chronic hepatitis C. The hepatitis C virus ranks with alcohol as a major cause of chronic liver disease and cirrhosis in the United States. Infection with this virus causes inflammation of and low grade damage to the liver that over several decades can lead to cirrhosis.

Chronic hepatitis B and D. The hepatitis B virus is probably the most common cause of cirrhosis worldwide, but it is less common in the United States and the Western world. Hepatitis B, like hepatitis C, causes liver inflammation and injury that over several decades can lead to cirrhosis. Hepatitis D is another virus that infects the liver, but only in people who already have hepatitis B.

Autoimmune hepatitis. This disease appears to be caused by the immune system attacking the liver and causing inflammation, damage, and eventually scarring and cirrhosis.

Inherited diseases. Alpha-1 antitrypsin deficiency, hemochromatosis, Wilson’s disease, galactosemia, and glycogen storage diseases are among the inherited diseases that interfere with the way the liver produces, processes, and stores enzymes, proteins, metals, and other substances the body needs to function properly.

Nonalcoholic steatohepatitis (NASH). In NASH, fat builds up in the liver and eventually causes scar tissue. This type of hepatitis appears to be associated with diabetes, protein malnutrition, obesity, coronary artery disease, and treatment with corticosteroid medications.

Blocked bile ducts. When the ducts that carry bile out of the liver are blocked, bile backs up and damages liver tissue. In babies, blocked bile ducts are most commonly caused by biliary atresia, a disease in which the bile ducts are absent or injured. In adults, the most common cause is primary biliary cirrhosis, a disease in which the ducts become inflamed, blocked, and scarred. Secondary biliary cirrhosis can happen after gallbladder surgery if the ducts are inadvertently tied off or injured.

Drugs, toxins, and infections. Severe reactions to prescription drugs, prolonged exposure to environmental toxins, the parasitic infection schistosomiasis, and repeated bouts of heart failure with liver congestion can all lead to cirrhosis,

That is, we apologize if what he says is true, and not yet another example of the strange amnesia that seems to overtake so many HIV positive gay men who come down with AIDS symptoms of immune deficiency when asked if they have been in the habit of enjoying recreational drugs.

The confused statement he made to Duesberg is so clumsily phrased, however – he claims that Duesberg says that drugs are “the cause of HIV infection”, which is an amazing lack of understanding to show after twenty years of this discussion – that we suspect that he may have forgotten what he did take.

After all, the liver is what processes drugs like every other chemical adulteration in the bloodstream and it is the leading cause of death in “AIDS” patients in the last five years, even though it is not an AIDS symptom at all, according to the CDC. If Larry never took drugs of any kind it is an incredible coincidence that he had to have a liver transplant, which is hardly the most common operation among the non-drugtaking section of the population.

But who are we to question the word of a popular playwright? Here is what Duesberg, faced with this bafflingly inconsistent claim, politely wrote to set him straight.

Regarding the paper, “The chemical bases of the various AIDS epidemics ….”: This study describes evidence that all those AIDS defining diseases, e.g. Kaposi’s sarcoma, pneumonias, yeast infections, tuberculosis, dementia, weight loss, fever, diarrhea, etc, that have exceeded their long established backgrounds in the US and Europe since the 1980s can be reduced to the long-term use of recreational drugs and since 1987 also to prescriptions of DNA chain-terminators and other toxic chemicals as anti-HIV drugs. Indeed liver disease, which is not AIDS-defining and thus not (yet) attributed to HIV, is now the leading cause of death among AIDS patients. The liver is the primary target of chemicals, toxic or not. Yet, HIV is not (yet) said to infect the liver.

Thus the conclusion that AIDS is chemical, rather than viral, is restricted to what’s above established levels of old diseases and is now described as AIDS. Accordingly current AIDS includes a low percentage of AIDS defining diseases with long-established environmental, genetic and so-called idiopathic causes. Take for example the 50 cases of KS that were diagnosed annually in the US before AIDS, and the rare cases that Moritz Kaposi first described in Vienna over 1000 years ago….

I do not “say” that drugs “are the causes of infection. I say that drugs are the causes of AIDS-defining and other diseases, and that HIV is a harmless passenger virus. A passenger virus is defined as one that infects long before a disease occurs, that is neutralized by antibodies and is biochemically inactive and is therefore often undetectable during the course of a disease (Gallo’s nemesis!), and that is not necessary for any of the diseases its associated with. All this applies directly to HIV, is standard scientific knowledge and not my invention.

Perhaps even this muddle headed playwright who, as the founder of the most aggressive and disruptive activist group, ACT UP, is personally responsible for so much of the gay appetite for insufficiently tested HIV drugs and their consequences, will finally get the message, and instead of accusing the Bush administration of trying to kill off the gay population of the US will realize that his adored Tony Fauci has been with his help unwittingly or not trying to do that for the last two decades.

That is, of course, if everything Duesberg says is right. And given that he has maintained his impeccably argued and intensely peer reviewed critique of the HIV?AIDS theory as arrant nonsense in every respect for two decades without a whiff of refutation in the same peer reviewed high level journals, a critique which even a child could understand unless he or she were wearing HIV=AIDS spectacles like virtually all scientists, doctors, health workers, activists and officials in the field, we know of no reason whatsoever to doubt it.


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