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I am Albert Einstein, and I heartily approve of this blog, insofar as it seems to believe both in science and the importance of intellectual imagination, uncompromised by out of date emotions such as the impulse toward conventional religious beliefs, national aggression as a part of patriotism, and so on.   As I once remarked, the further the spiritual evolution of mankind advances, the more certain it seems to me that the path to genuine religiosity does not lie through the fear of life, and the fear of death, and blind faith, but through striving after rational knowledge.   Certainly the application of the impulse toward blind faith in science whereby authority is treated as some kind of church is to be deplored.  As I have also said, the only thing that ever interfered with my learning was my education. I am Freeman Dyson, and I approve of this blog, but would warn the author that life as a heretic is a hard one, since the ignorant and the half informed, let alone those who should know better, will automatically trash their betters who try to enlighten them with independent thinking, as I have found to my sorrow in commenting on "global warming" and its cures.
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TAC drug pushers joined by Tina of the Times

August 30th, 2006


Ms Rosenberg can’t read science, but has her own sources

Manto hounded, even Barack throws in his two cents

Ever since Toronto, the South African press and the TAC have been piling on Dr. Mantombazana “Manto” Tshabalala-Msimang, demanding her head from President Thabo Mbeki for her booth at the AIDS 2006 Conference. In the frenzy of support for ARVs and suspicion of ordinary food even Barack Obama has added his two cents (“It is not an issue of Western science versus African science, it is just science and it’s not right.”). Today (Wednesday (Aug 30) the New York Times joined in, supporting the Treatment Action Campaign’s call for Mbeki to fire the Health Minister of South Africa for her booth at the Toronto conference.

To anyone familiar with the scientific literature in the field, her despised fruit and vegetable stand could be fairly described as an island of sanity in a sea of fantasy, a reminder of reality which reasonably suggested that basic nourishment might be a better answer to African “AIDS” than toxic drugs without proven scientific rationale. To the South African press and the TAC, however, who apparently have their own sources of information on the subject, the stand was a “joke” by a “clown” who “embarrassed South Africa” at AIDS 2006.

Having visited South Africa to research her long article, When a Pill Is Not Enough, published in the magazine on Aug 6, Tina Rosenberg, as the Editorial Observer columnist today (Wed Aug 30) in For People With AIDS, a Government With Two Faces, agrees. An editorial writer at the Times since 1996, when she won a Pulitzer following a MacArthur fellowship, she must have been briefed by the same inside sources at some point, because she now acts as the perfect propaganda mouthpiece for the TAC, the drug companies and NIAID, whose group view she expresses as if she had thought of it herself:

Mr. Mbeki and his health minister, Manto Tshabalala-Msimang, have now largely gone silent about AIDS —” undoubtedly an improvement. It would be a further improvement if Mr. Mbeki fired her, as many in South Africa have long demanded. The government should also be pushing the provinces that lag behind and encouraging South Africans to get tested and take their drugs.

What the government says and doesn—™t say still matters, unfortunately. I met some South Africans who can get antiretrovirals free at their local clinic but still prefer herbal medicines. They could live, thanks to the government—™s highly reluctant actions. Instead, they will die because of its words.

Sorry to say, Ms Rosenberg is evidently yet another victim of the AIDS meme, which renders its host blind to the scientific literature in HIV∫AIDS and deaf to any view other than “HIV bad, ARVs good.”

In other words, the papers indicating that a heterosexually driven pandemic in Africa and Asia is impossible, and that ARVs do not actually improve basic health or slow the death rate, and that it is nutrient deficiency and nutrient supplementation which are, with drugs and other assaults on the system such as starvation, both cause and cure of AIDS, might as well be written in invisible ink, as far as Tina is concerned, and the medically qualified and far better briefed Dr. Mantombazana “Manto” Tshabalala-Msimang is a no account ignoramus challenging modern science with primitive nostrums and an “embarrassment” to her administration, because the TAC tells her so.

On the contrary, as Dr Harvey Bialy has pointed out in Comments here, Dr. Mantombazana “Manto” Tshabalala-Msimang is a qualified MD and a member of the special AIDS panel Mbeki called together in 001, which examined the scientific dispute over the causes anmd cures of AIDS. According to Duesberg biographer Bialy, a microbiologist and member of the same panel, Dr. Mantombazana “Manto” Tshabalala-Msimang was a faithful believer in Western science and the HIV∫AIDS paradigm when she joined the deliberations, but emerged from the intensive review a convert to the dissenting camp.

The New York Times
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August 30, 2006
Editorial Observer
For People With AIDS, a Government With Two Faces
By TINA ROSENBERG

At the AIDS conference in Toronto this month, South Africa—™s booth included lemons, garlic and beets as part of its recommended treatment for H.I.V. South Africa—™s health minister has long touted salad, vitamins and assorted quack cures over antiretroviral drugs, which she has called toxic.

Such embarrassments are normal for the government of President Thabo Mbeki, who said not too long ago that he knew no one with AIDS. This in a country with the world—™s biggest AIDS epidemic. At the Toronto conference, Stephen Lewis, the United Nations special envoy for AIDS in Africa, broke all diplomatic conventions, saying South Africa—™s views were more worthy of a lunatic fringe than of a compassionate state.

And yet, more than a quarter million South Africans —” more people than in any other nation —” are now taking antiretroviral drugs. Most of them get the medicines free through the government health system. The AIDS budget has soared over the last two and half years. Among people being treated, deaths and hospitalizations have dropped tremendously. Can this lunatic government be compassionate as well?

South Africa is doing AIDS treatment on a mass scale even though the health system is close to nonexistent in some areas, clinics often have few nurses and no doctors, and rich countries are luring English-speaking health workers away.

But top officials can take little credit. They delayed the antiretroviral rollout, threw up obstacle after obstacle and have left large pots of money unspent. The program—™s progress so far is really a lesson in the power of balanced government and citizens—™ groups.

The courts have forced the government into action. This week an appeals court ordered officials to begin antiretroviral treatment for prisoners with AIDS and held the government in contempt for ignoring a June ruling to start doing so. Some regional governments, especially in the provinces containing Johannesburg, Cape Town and Durban, have leapt at the chance to provide antiretrovirals, and that is mainly where people are being saved.

The most important factor, however, is the Treatment Action Campaign, probably the world—™s most effective AIDS group. It was founded by Zackie Achmat, who chose not to take the antiretrovirals he needed until the government had agreed to make them available to all.

The group, financed largely by international and local foundations and European governments, became famous for distributing its “H.I.V. Positive” T-shirts —” Nelson Mandela wore one —” and organizing mass protests like its 2003 civil disobedience campaign, which pushed the government into the antiretroviral rollout.

Mr. Mbeki and his health minister, Manto Tshabalala-Msimang, have now largely gone silent about AIDS —” undoubtedly an improvement. It would be a further improvement if Mr. Mbeki fired her, as many in South Africa have long demanded. The government should also be pushing the provinces that lag behind and encouraging South Africans to get tested and take their drugs.

What the government says and doesn—™t say still matters, unfortunately. I met some South Africans who can get antiretrovirals free at their local clinic but still prefer herbal medicines. They could live, thanks to the government—™s highly reluctant actions. Instead, they will die because of its words.
But such TAC inspired contempt for the intelligence of Thabo Mbeki and Dr. Mantombazana “Manto” Tshabalala-Msimang is nothing new for Rosenberg, who has been an editorial writer at the Times since 1996 and is enlightened on some topics – she has called for the use of DDT to save lives, for example. But she dismissed the Mbeki position as “spectacular irrationality” in her Aug 6 piece on the horrendous reasons why South Africa women do not hurry to tell their men they are HIV positive or to take ARVs to save their babies from HIV (one husband greeted the news by pouring boiling water over his wife).

South Africa—™s post-apartheid government, besieged with problems, largely ignored AIDS. As president, Nelson Mandela did not publicly speak in South Africa on AIDS until 1998, more than three years into his term. Then came spectacular irrationality —” the government of Thabo Mbeki spent years insisting AIDS was a Western plot, that the drugs were poison, that it was better to use African —œcures,—? that all those people were dying of something else. Now the public troublemaking of government officials has died down. What has replaced it is not the crusade so badly needed but just an official silence.

The boiling water story was in her Times magazine story on Aug 6, When a Pill Is Not Enough, a lengthy piece which showed just how horrendous are the social problems created by the HIV∫AIDS AIDS meme as it sweeps across South Africa, contrary to science and sense. The stigma and its accompanying dangers are why African women resist being tested, according to Rosenberg. This is presumably true, but we also detect signs in her reporting that African women are also a little bit skeptical of the whole thing, based on instinct and Mbeki’s influence, presumably. It is this failure to accept the absolute authority of Western science that condemns Dr. Mantombazana “Manto” Tshabalala-Msimang and Mbeki in the mind of Tina Rosenberg, no doubt. But the irony is that she is the naive one, for the mainstream literature actually backs their assumptions, as she would find if she bothered to read it for herself.

(Here is her very long piece, When a Pill Is Not Enough, in all its thorough depiction of the South African scene through the lens of HIV belief. Expand it at your peril by clicking “Show::)

The New York Times
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August 6, 2006
When a Pill Is Not Enough
By TINA ROSENBERG

In the whole AIDS epidemic, no question is more heartbreaking and confounding than this: Why would a mother choose to condemn her baby to death?

Mothers with H.I.V., the virus that causes AIDS, pass it along to their newborns at birth 25 to 30 percent of the time, and in poor countries, some half a million babies a year are born with H.I.V. But the rate of transmission can be cut to 14 percent with a simple and cheap program: H.I.V.-positive mothers take a single pill of an antiretroviral called nevirapine when they begin labor, and their newborns are given nevirapine drops.

At the Alexandra Health Center and University Clinic in South Africa, pregnant women can get nevirapine free. The antenatal clinic is a complex of low brick buildings on a pretty hospital campus in the middle of the township of Alexandra, a bleak neighborhood on the outskirts of Johannesburg. The clinic has a doctor only on Thursdays, but an advanced midwife and two nurses attend a crowd of patients every day. I had been in South Africa for four days when I visited the clinic, and I had already seen the stigma that AIDS still carries in the country —” those dozens of funerals every Saturday in the townships? Oh, say family members, it was asthma, or tuberculosis, or —œa long illness.—? I thought I understood how powerful denial could be. But I was unprepared for what Pauline Molotsi, a registered nurse at the clinic, told me.

About twice a week, a woman who has tested H.I.V.-positive begins labor at the clinic but refuses to take the nevirapine that might save her baby—™s life. —œShe says, —˜Oh, no, I—™m not positive,—?—™ Molotsi told me. Even though the only person who will know her H.I.V. status is the nurse —” who knows already, since she is holding the patient—™s chart —” the woman won—™t take the incriminating pill. —œThey have not accepted their status,—? Molotsi said. —œThey are still in denial.—?

In most of the world, the biggest reason so many babies are born with the AIDS virus is that their governments do not offer nevirapine; because of shortages of health-care personnel, in many countries this program, like all AIDS programs, is available only in urban hospitals. But in South Africa, there—™s a different problem. Nevirapine is widely available, yet more than 70,000 babies a year are born there with H.I.V. The government can get nevirapine, condoms and AIDS treatment out to the most remote corners of the country —” by truck or wheelbarrow, to modern hospitals and to clinics with no electricity. But it cannot penetrate what has become the most difficult terrain in AIDS work: the insides of people—™s heads.

A significant minority of women in South Africa refuse to take an AIDS test. It—™s not only that they do not want to confront painful facts that could lie buried a while longer. It—™s also that being tested can be dangerous. At the Alexandra clinic, I listened to a tall young man named Vernon as he gave pretest group counseling to about two dozen pregnant woman. —œThink about your baby before you think about yourself,—? he urged them. He assured them the results of their H.I.V. tests would be confidential but encouraged the women to tell their families and partners. —œDon—™t hide it. Don—™t use the phone —” tell him face to face. You use the phone, he will hunt you down. Try to prepare him. Some people are very violent. He will beat you. But when he—™s alone, he will think about it. If anything happens to you, your family knows you went to tell him your H.I.V. status and never came home.—? This speech seemed unlikely to encourage many women to be tested. But it obviously reflected reality. Prudence Mabele, who works for a feminist organization, told me about a woman whose husband greeted her disclosure by pouring a kettle of boiling water over her.

Other women end up infecting their babies through breast feeding because they cannot follow the clinic—™s advice to bottle-feed only —” tantamount in some areas to announcing you have H.I.V. The very present danger posed by disclosure outweighs the future risk that the baby will get sick. And there are those whose denial is so deep it engulfs them. —œLabor is already a stressful environment,—? says Macharia Kamau, a Kenyan who is Unicef—™s representative in South Africa. —œYou are pregnant, poor, vulnerable, marginalized, uneducated. At that point, what do you rely on? What your mother told you when you left home? Your cultural beliefs —” or this stranger who—™s standing there saying, —˜Take this pill?—?—™

As AIDS passes the quarter-century mark, in several countries the epidemic appears to be declining. South Africa is not one of them. In 1990, South Africa and Thailand both had H.I.V. prevalence rates in adults of less than 1 percent. Today, Thailand—™s rate is 1.4 percent. But in South Africa, AIDS exploded in the 1990—™s, and now 18.8 percent of adults are infected —” and the number is still rising, though very slowly. Last year 300,000 new South Africans were infected with H.I.V. At the Alexandra Health Center, about 60 percent of women test positive. Choose any two 15-year-olds in South Africa; the odds say one of them will get AIDS.

South Africa is not even the worst of it. In Botswana, 24.1 percent of adults have H.I.V., and in tiny Swaziland, a third of all adults do. AIDS rates in southern Africa are far higher than they are anywhere else in the world. No one really knows why. South Africa has astronomical rates of sexual violence —” more than a quarter of the time, a young woman—™s first sexual experience is coerced —” and a strong culture of male entitlement to sex, but so do many other countries. Much of the blame may go to apartheid, which kept male workers in hostels and their families in villages far away. Similar geographical dislocations come from mining, southern Africa—™s main industry. Separating families encourages people to maintain ongoing relationships in two places. This is more dangerous than serial monogamous relationships, as H.I.V. is far more contagious when freshly caught.

South Africa—™s post-apartheid government, besieged with problems, largely ignored AIDS. As president, Nelson Mandela did not publicly speak in South Africa on AIDS until 1998, more than three years into his term. Then came spectacular irrationality —” the government of Thabo Mbeki spent years insisting AIDS was a Western plot, that the drugs were poison, that it was better to use African —œcures,—? that all those people were dying of something else. Now the public troublemaking of government officials has died down. What has replaced it is not the crusade so badly needed but just an official silence.

In the last few years, however, South Africans have forced their government to begin saving lives despite itself. The country is now spending millions to provide free antiretroviral drugs to AIDS patients, equip maternity clinics with nevirapine and run prevention campaigns. South Africa is successfully pushing services out to its people. But that doesn—™t mean people always use them. Mothers sometimes reject nevirapine. People decline AIDS tests. Some sick people refuse to take free antiretrovirals. Some orphans will starve —” even though help is available —” rather than make the shameful admission that their parents died of AIDS. And of course, millions of people who know better continue to risk their lives every time they have sex.

All over the world, human psychology, local custom and the pressures of poverty are AIDS—™s best friends. None of this should be foreign to Americans. We know we should quit smoking. We know we should go have that lump checked out. We know we should give up the French fries. But we don—™t. In America, as around the world, a good amount of sickness and death is at least in part self-inflicted. In all aspects of health care, the challenge of providing not just solutions but ones patients will embrace is only now beginning to get attention. We are accustomed to thinking of noncompliance as the patient—™s fault. But when a pregnant woman chooses to keep the nevirapine tablet in her pocket, the real failing belongs to the health system, which did not consider what would help her to follow medical advice. Such thinking is always crucial for health professionals but never more so than with AIDS, a disease that is shrouded in the dark and forbidden —” sex, drug use, betrayal, rejection, death, rape, the struggles of intimate relationships —” and that primarily hits the notoriously irrational young.

But the AIDS establishment has not yet assumed this challenge. —œThe technology is doing O.K., it—™s moving,—? says Peter Piot, executive director of the United Nations—™ AIDS agency, Unaids. —œBut we have grossly, grossly neglected the social, cultural and personal stuff that makes it work.—?

In a bland corporate research office in a strip mall in the Johannesburg suburbs one day late last spring, American and South African investigators were intently trying to prove Piot wrong. They were sitting behind a two-way mirror, watching five young women from Soweto talk about vaginal gel. The research office, normally employed to assess South Africans—™ views on laundry detergent or breakfast cereal, was now the site of a series of focus groups designed to solve one of the biggest problems in AIDS prevention: the failure of the condom.

It is a social failure, not a mechanical one. Condoms prevent AIDS transmission quite well when people use them consistently. But men would rather not, and in Africa men usually call the shots. One of the most chilling findings of AIDS researchers is that marriage can be a risk factor. Studies in Kenya and Zambia found that young, married, monogamous women had higher rates of AIDS infection than sexually active single women of the same age; if condom use is hard for single women to negotiate, it is nearly impossible for married women. Even women who know their husbands are unfaithful cannot demand condoms, for to do so indicates a lack of trust. Husbands can get violent, or accuse the woman of infidelity. Condoms are also not an option for couples who wish to conceive. Women need a method of H.I.V. protection that they can control, that does not impede fertility and that men do not object to. +

It does not exist —” yet. But one form of it, a vaginal microbicide, may be available within five years. The Johannesburg focus groups were designed to test three different gels, for use once a day, that may someday contain an ingredient that kills H.I.V. before it can infect the woman. The sessions were run by the International Partnership for Microbicides (I.P.M.), which is based near Washington. I.P.M. scientists realize that creating an effective medicine is just half the battle, and so they are taking a proactive approach to marketing the gel; before the microbicide—™s active ingredient has even been invented, researchers have spent years figuring out how to get women in a variety of cultures to use it.

—œA microbicide could be marketed as a sexual aid, or as something to make a woman feel more attractive inside and out,—? Dr. Zeda Rosenberg, I.P.M.—™s C.E.O., told me when I first met her in 2004. She was still puzzling it out when I spoke to her this year in South Africa. —œMaybe H.I.V. prevention would be a secondary selling point,—? she said. —œThis could be a lubricant that stops H.I.V. If the product made sex great, they would use it even if there were a trust issue.—?

The focus groups were a chance for I.P.M.—™s researchers to hear from their target market. Five young women from Soweto, all paid to participate in the study, sat around a table laden with platters of food and chatted in Zulu, Sotho and English about the gels, which they had been using for the last three weeks. The moderator asked whether they would want to use the gels to avoid getting H.I.V. All responded with enthusiasm. —œI would recommend it to women who are married but do not trust their husbands,—? said a participant. Just as important, they talked about how they handled the issue with their boyfriends. —œI didn—™t tell my boyfriend, but he noticed something different,—? said Dimakatso, a young-looking girl with a ponytail. She explained to him what she was using, and it was no problem.

But most women preferred stealth —” and it worked. Some didn—™t tell because South Africans don—™t normally discuss sex. Others said their boyfriends were superstitious. —œHe will think I am using something for witchcraft,—? said one woman. Overall, the women preferred the gel whose texture was easiest to hide from their sexual partners.

Women—™s groups have been talking about a microbicide for more than a decade, since it became obvious that AIDS was developing into a woman—™s disease. But the rest of the world wasn—™t listening. In the late 1990—™s, Rosenberg was senior scientist for H.I.V.-prevention research at the National Institutes of Health. She, along with some others, tried to focus money and research on developing an AIDS-prevention product that women could control. —œIt was difficult to get people—™s attention,—? she says. —œIt was not considered interesting scientifically. It was seen as a product-development issue, not a scientific problem. Scientists in drug and cosmetic companies don—™t get papers published.—? Research was slow to get moving. Rosenberg left N.I.H. and eventually became C.E.O. of I.P.M. It is one of several organizations working to develop a microbicide.

For a microbicide, the traditional public-health approach —” invent it, put it out there and tell people to use it —” won—™t cut it. Nearly as important as whether it kills H.I.V. is whether a microbicide feels acceptable, whether it can be used discreetly if necessary and how it is packaged and promoted. Dr. Mark Mitchnick, the group—™s senior scientific consultant, worked on sunscreens and other products before switching to AIDS prevention. —œOne thing I learned with sunscreen is that people will often need a second reason to buy,—? he says. —œYou want people to use sunscreen because it protects against melanoma. But people buy it because it prevents wrinkles.—?

—œThe cosmetics industry can get women to use all sorts of topical products they don—™t need,—? Rosenberg said. Maybe the same tools could be used to make a microbicide popular. —œIs there a way to think about it that isn—™t H.I.V.? Public health can—™t tell us that.—?

Every weapon in the fight against AIDS needs to pass these same two tests —” it has to work and people have to use it. But particularly in poor countries, where most of these services are by necessity free, AIDS treatments and prevention strategies are usually offered as if marketing were unnecessary. That is especially true for antiretroviral therapy. After all, the logic goes, it—™s a lifeline. Surely no one would throw it back.

And when they have access to it, most people donѪt. Antiretrovirals are now saving lives all over South Africa. The public-health system has gone from 0 to 175,000 people on antiretrovirals in two years. Add in programs run by businesses and nongovernmental groups like M̩dicins Sans Fronti̬res, and more than a third of South Africans who need antiretrovirals are now taking them, and the figure continues to rise. Patients who have agreed to start antiretrovirals are very good about taking their medicine, and when they do, few are dying.

But the surprise is that South Africa has indeed had to sell AIDS treatment —” and it—™s often a hard sell. —œPeople think the health department wants them to be dead,—? said Sylvia Maguma, a traditional healer, or sangoma, I met in the township of Bekkersdal. I heard many people say this. It may be a hangover from the apartheid years, when it was literally true, and more recently, the government has spent years criticizing as poisonous the same drugs it is giving out now. Some antiretrovirals do have awful side effects, especially at first. But denial and stigma make things worse. People with AIDS tend not to admit, even to themselves, that they are sick; they seek help only when death is imminent. They start the antiretrovirals too late, and then the rumor spreads: the medicines killed her.

But there is something else at work here: the weight of traditional culture. In the township of Tembisa I met Vusi Ziqubu, a 33-year-old who was dying of AIDS. He could get free antiretroviral treatment at his local clinic. But he preferred the herbal remedies of Grace Mhaula, his sangoma. —œHe was gone,—? said Mhaula of the moment she first saw Ziqubu. —œHe was frail, smelling of death.—? Mhaula gave him a solution of herbs to drink four times a day. When I visited him in his house, he was thin, but looked strong and was up and around.

It is commonly said in South Africa that 80 percent of blacks go to a traditional healer first when they are sick. To South Africa—™s poor, the bones of the sangoma are the reassuring and trustworthy medicine their families have used forever. It is the clinic—™s fabulous tales of invisible bugs that sound to them like hoodoo. The science of the rich is the magic of the poor, and vice versa. And the sangoma, unlike the nurses at the clinic, can spend time with the patient.

But traditional healers can be a dangerous first stop for people with H.I.V., and not just because they often mean a delay in starting antiretrovirals. Sometimes the consequences are more dire. —œI discourage older men from going to young girls to cure AIDS,—? said Mhaula, but horrifyingly, some healers do not, spreading the message that sex with a virgin is curative. Many sangomas, Mhaula said, induce diarrhea or vomiting to clean out the illness, which can be debilitating for someone sick with AIDS.

So South African officials have begun to train traditional healers about H.I.V. Training often lasts only a few days, and it varies greatly in quality, but it is nonetheless useful and has reached thousands of sangomas. Mhaula took the training and trained others herself. I met her in April, and I later found out that she died suddenly three weeks after I visited her, of an infection unrelated to AIDS. She was an enormous woman of 53 who greeted me in a muumuu and fuzzy pink slippers. The daughter of two traditional healers, she had been one herself since the late 1970—™s. But she also worked in the labs of a multinational drug company for 27 years, and the company paid her college tuition. Arthritis forced her into early retirement, but she was bored at home. At Tembisa—™s health clinic, she received training in H.I.V. counseling and caring for the terminally ill. Her own daughter died of AIDS six years ago, and Mhaula was raising her daughter—™s child.

Off her patio was a small room —” her indumba, or consulting room. The walls were lined with hundreds of glass jars and plastic tubs containing mixtures of herbs. Animal skins and straw mats covered the concrete floor. Hanging from the ceiling were candles, the clothes of her ancestors and beaded necklaces. There was a plate of bones. When her clients (she does not call them patients) visited her, she read the bones. When she was alone, she put on the clothes of her ancestors and called their spirits. There were seven different ancestors that she talked to.

Mhaula walked me through what she did when she recognized symptoms of H.I.V. —œI say: —˜Think about it. We live in the modern age. Don—™t you think we should go to the clinic? You will be in a safe environment.—™ They say, —˜Will you go with me?—™ I say, —˜Yes.—™ Sometimes they want me to go get their test results. They say, —˜Don—™t tell me the results, just give me imbiza—?—™ —” the herbal mixture she makes that she says boosts the immune system. —œI say, —˜How are you going to change your behavior?—™ They say, —˜I—™m not yet ready.—™ I tell them: —˜It—™s good to have one partner. You must use condoms.—?—™

Working with traditional healers is hugely important for fighting AIDS in South Africa. But it has a dangerous side. The problem lies in the stack of white tubs that were behind the door of the indumba —” Mhaula—™s imbiza. She was careful not to call it a cure. It might indeed strengthen the immune system —” it has never been tested in clinical trials, so we don—™t know. But it cannot be taken with antiretroviral drugs. That meant Vusi Ziqubu had to choose.

—œTraditional healing is being manipulated to put forth a political agenda,—? says Jonathan Berger, head of policy and research at the AIDS Law Project in Johannesburg. —œIt—™s a way to push the anti-Western-medicine line by appealing to culture and tradition.—? When I was in South Africa, a —œcure—? called the mopane worm was on the front pages of the tabloid papers. Health officials—™ embrace of a long line of charlatans has encouraged a thriving industry in such cures. Hundreds of sangomas sell them.

They are very tempting to people fearful of the impersonal clinic. —œWith us, you don—™t have to take it the rest of your life,—? Mhaula told me. —œAnd there are no side effects. Patients come in, and they are so afraid, and then I give them the imbiza and I give them some porridge to eat. And it—™s all right.—?

Imbiza seemed to be helping Ziqubu —” for now. But there was another patient taking Mhaula—™s imbiza, a close family friend, a mother of three children. She was doing well, Mhaula told me —” please come talk to her. Two days later, I came back to meet the woman. But she had already died.

AIDS is a disease of taboos. For its sufferers, psychological comfort, like that provided by traditional healers, is paramount —” sometimes more important than even staying alive. But over the next few years, word will spread about the Lazarus effect of antiretroviral drugs. Although logistical and personnel problems will no doubt remain, few people will be able to argue that the drugs are poison, and few will shun them for herbal remedies.

There is also reason for optimism that other weapons in the fight against AIDS will win more public acceptance. Improvements in service will encourage more women to protect their babies. In the Alexandra clinic, the resourceful nurse Pauline Molotsi has hit on a strategy that sometimes helps. If an H.I.V.-positive woman does not want to take the nevirapine, Molotsi thrusts a piece of paper and a pen toward the woman, essentially making her take responsibility for her decision. —œWould you really like your baby to have the virus?—? she asks. —œIf you don—™t take the pill, you will have to sign.—? At Chris Hani Baragwanath Hospital in Soweto, which has an unusually well-financed and -run antenatal clinic, 98 percent of pregnant women agree to be tested for H.I.V. There will always be psychological barriers, but good service can overcome them.

That may not be true with South Africa—™s most basic challenge: to bring down AIDS—™s astronomical prevalence in the general population. Help could come from the brand-new technology of microbicides, but it could also come from the very old one of circumcision, which may offer some protection from H.I.V. infection. (Clinical studies due to conclude next year may tell how much protection.) That—™s the future, though. For the moment, AIDS prevention is entirely a conundrum of psychology and culture —” one we know very little about how to solve. The small list of countries that have had some success with prevention includes such dysfunctional places as Haiti, Zimbabwe and Cambodia. Experts can point to some good programs in these countries, but plenty of nations with rising AIDS rates have the same programs. The country that had an early drop in AIDS prevalence, Uganda, probably achieved this because its particular culture of openness brought the disease into the public eye, and the country treated it like World War III.

In South Africa, where AIDS has already exploded through the general population, prevention is an even more overwhelming challenge. One disturbing fact: Surveys show that South Africa—™s teenagers know about AIDS and how it is transmitted. They know the behaviors that put people at risk. But they don—™t apply this information to themselves. There is no correlation between information and behavior change. Two-thirds of young people who test H.I.V.-positive —” in anonymous surveys, so they don—™t know it —” do not consider themselves at risk for AIDS. Especially for teenagers, the psychology of sexual behavior resides in some deep and mysterious place, apparently shielded from the reach of traditional public-health messages as if by a lead curtain. The question is whether anything can get through.

South Africa is trying to answer that question with a controversial H.I.V./AIDS-prevention program called loveLife, which generally serves youths from 12 to 17. It is as far from the traditional campaigns as it could be. I went to the community hall in Emzinoni, a black township in Mpumalanga province in the country—™s east, to hear a dialogue staged by loveLife. Outside, geese ran in the dirt yard next to purple loveLife banners. Inside the auditorium, vibrant music blared and balloons filled the stage. A pop star named Elle sang a song about believing in yourself. A woman in jeans and a pink hat and a man in khaki shorts strode back and forth in front of the crowd, each with a microphone in hand, bantering in Zulu and English with about 500 Emzinoni parents and children, leading them in games and discussions about AIDS. Sithembile Sefako, the woman, and Mnqobi Nyembe, the man, are trainers from loveLife—™s national office. They are local versions of a motivational speaker like Tony Robbins, traveling the country holding these events —” but the problems they are discussing are not the ones Tony Robbins usually has to confront.

Sefako asked for volunteers for a little play: a university student named Beauty comes back from college to tell her parents she is pregnant and has H.I.V. Afterward, the actors compared their skit to reality. —œOur parents scream at you and call you names,—? said the young man who played the father. —œThey say: —˜I—™ve seen you walking in the street! I knew you were going to fall pregnant!—™ They beat you.—?

—œWe use culture as an excuse,—? Sefako said. —œThey say, —˜I can—™t talk to my children, it—™s not right.—™ We hide behind culture.—?

Next Sefako opened a discussion about responsibility for teen sex. A girl in a flowered cap said: —œMost guys force us. Then they say if you are going to open a case with the police, we—™ll beat you. We—™ll come with a group and we—™ll kill you.—?

—œGuys compete,—? one boy said. —œYou say, —˜I—™m going to sleep with six girls before Sunday.—?—™

—œIs it true most women are falling pregnant to prove they can bear children?—? Sefako asked.

One girl said: —œWe mustn—™t lie. Most fall pregnant because they want the money—? —” the South African government—™s grant of $30 per month per child. —œThey think, I—™ll buy myself sneakers and jeans.—?

A man differed: —œThe reason women fall pregnant is that we see females in the street in a miniskirt.—?

—œAre you saying young girls are getting raped because of what they wear?—? Sefako asked.

—œYes, because of the way they are dressing, they end up in trouble.—?

A girl responded: —œThen what about someone who rapes a 3-year-old child?—?

—œA child from 10 upward knows how to sleep with a guy, and she knows the way she is dressing,—? the man responded. The crowd hooted.

These unnerving comments contrasted bizarrely with the festive tone of the event. What was most remarkable to participants, however, was not what people were saying but that they were saying anything at all. Nelson Mandela often said that when he told traditional chiefs that he planned to speak out about AIDS and sex, they told him he would lose their support. What passes for communication between parents and children about sex is often just a cryptic warning to girls to —œstay away from boys—? and to boys, nothing. Yet children whose parents do talk to them about sex abstain longer and are more likely to use condoms. In general, openness is the anti-AIDS —” if the sick came out of hiding, it would be easier for their friends and neighbors to accept that they, too, are at risk. That—™s one reason loveLife—™s principal slogan is —œTalk About It.—?

By 1997 AIDS was a crisis of biblical proportion in South Africa, with 13 percent of adults infected. The red-ribbon billboards that passed for an AIDS-prevention campaign were failing disastrously, especially with young people. For girls —” who tend to have sex with older men —” the riskiest age was between 12 and 17. The Kaiser Family Foundation, a health organization based in California, pledged that if South Africans could decide what was needed to prevent the spread of AIDS in young people, the foundation would pay the bill for the first five years.

Kaiser hired Judi Nwokedi to help plan the program. Nwokedi is a charismatic whirlwind who is head of government relations for Motorola in South Africa. A psychologist by training, she worked with sexually abused children and on AIDS projects while in exile in Thailand and Australia. Nwokedi met with AIDS groups, government officials and international experts to forge agreement on the basics. She also commissioned surveys of South Africa—™s teenagers. The surveys found that teenagers tuned out the traditional prevention messages and were most receptive to an AIDS campaign that was about more than just AIDS. The teenagers also said their parents didn—™t talk to them about sex or relationships —” and they desperately wanted that kind of communication and wanted their parents to set limits. Significantly, the study found that poorer girls realized their first sexual encounter would probably be coerced and violent.

The next question was how to reach the children and young people at risk. —œThe normal way of AIDS or any peer education with young people was to pack them into the church hall or the school hall,—? Nwokedi says. —œThey would have to sit there while someone would stand up there and talk at them. And whatever they told you, you went out and did the exact opposite because you were so angry that they kept you there for five hours. I wanted H.I.V. education to have another dimension —” it had to be interactive, engaging, question-and-answer, vibrant debate.—?

Under apartheid, young people identified with collective action. Now they were tired of politics, tired of —œwe.—? An expansion of electrical service in the late 1990—™s had allowed the number of households with televisions to soar. Young people were tuning into the global popular culture they saw on TV, with a very high level of awareness of brands.

The working title for the campaign had been the National Adolescent Sexual Health Initiative. Nwokedi, consulting with teenagers, public-health leaders and marketing experts, nixed it. —œYou—™re dead before you can even go out to young people,—? she said. —œThey—™d call it Nashi as an acronym —” that was soooo public health!—?

The AIDS-prevention program had to be branded. The closest model was a recent relaunch of Sprite. —œSprite took the brand off the shelf into the communities,—? Nwokedi says. —œThey did basketball, sponsored concerts, sent cool kids onto campus, talked up Sprite in Internet chat rooms. It was very driven by celebrities in the community creating the hype. I was looking at what is tactile about your brand, what experiences you create.—?

Instead of a fear-driven, preachy, stodgy Nashi, the AIDS prevention campaign became loveLife —” positive, hip and fun, —œan aspirational lifestyle brand for young South Africans,—? as the group—™s literature says. Today loveLife is one of the 15 best-known brands in South Africa. The country is dotted with 1,750 loveLife billboards. Radio call-in shows reach three million young listeners a week. LoveLife has TV spots and TV reality shows, including one that sent attractive young people into the wilderness to compete in AIDS-related games, like using the other sex—™s tools of seduction. A Web site (www.lovelife.org.za) and magazines feature not only graphic information about H.I.V. but also fashion, gossip and relationship advice.

There are very few South Africans who lack strong opinions about loveLife. South Africa has other AIDS-themed TV series and media campaigns and many other behavior-change programs. But at $25 million a year, loveLife is the giant, and it attracts most of the controversy. Initially, I was a skeptic. LoveLife struck me as empty cheerleading —” telling young people who live in cardboard houses and eat a few handfuls of cornmeal mush each day to look on the bright side, when there is no bright side.

LoveLife started out promising too much, pledging to halve the rate of new H.I.V. infections among young people in five years. More recently, it has suffered management problems. South Africans cluck about the fact that the Global Fund to Fight AIDS, Tuberculosis and Malaria cut off a loveLife grant last year —” one of only three grants stopped worldwide. The money was being used to, among other things, build rooms where teenagers could go, known as —œchill rooms,—? in health clinics. Brad Herbert, who was chief of operations at the Global Fund at the time, told me that the grant was canceled because construction was too slow and expensive, but that there were no charges of impropriety. (The grant arrived six months late, and loveLife officials argue that the delay caused cash-flow and exchange-rate problems.)

But many people also question loveLife—™s basics. Virtually every South African adult I met thinks that the messages on loveLife—™s billboards —” the media most visible to adults —” are incomprehensible. Many —” like —œGet Attitude!—?—” indeed appear to have nothing to do with AIDS. But loveLife—™s leaders argue that the billboards, like all of loveLife—™s media, are not there to educate young people but to draw them into the face-to-face programs. They promote loveLife as an exclusive club that you, as a teenager, can join. The celebrity gossip and fashion advice in loveLife magazines is also not a message but a delivery system. —œThe logic of the brand is to create something larger than life, a sense of belonging,—? says Dr. David Harrison, a tall, lanky, white physician who became head of loveLife in 2000. —œThat creates participation in clinics, schools —” people go because they like to be a part of loveLife.—?

As Sprite did, loveLife uses kids to recruit their peers. It has programs now in a third of the country—™s high schools, a seventh of the nation—™s health clinics, 130 community organizations and 16 loveLife centers. All these programs are run by what loveLife calls, with a typical typographical flourish, groundBREAKERs. They are young people between 18 and 25, trained and hired for one year at minimum wage to talk about sex, AIDS and relationships, help run school sports competitions (South Africa—™s only public-school sports in most of the country), radio stations and computer workshops. Perhaps most important, they are taught how to motivate young people by sharing their own personal histories. That is crucial, as loveLife—™s challenge is not to impart information but to cut through fatalism and denial to get young people to apply the information they already know.

I met Harrison in loveLife—™s headquarters in the Johannesburg suburb of Sandton, a pleasant campus of modern buildings with interiors painted in loveLife—™s trademark purple and white. He said that loveLife—™s research found that what particularly put young people at risk was coerced sex. Other factors were low self-esteem, absence of belief that the future offered any reason to make wiser choices today, peer pressure, lack of parental communication and the popular belief that a girl is not a woman until she has a baby. Poverty, low education and marginalization also led to higher rates of AIDS.

LoveLife cannot do much about those last three. Instead it tries to promote family and society communication and help young people acquire the skills and motivation to resist pressure to have sex, especially unprotected sex. —œWhen I ask young people what made them change, they never say, —˜You gave us information,—™ —? Harrison says. —œThey say: —˜I feel an identity with a new way of life. I can be like my friend whose life has changed.—?—™

There have been some good recent analyses about how to tinker effectively with teenagers—™ heads. A study last year led by Dolores Albarracín of the University of Florida examined evaluations of hundreds of H.I.V.-prevention programs. The group found that threats and fear don—™t work. This finding argues against —œAIDS kills—? messages and also against more sophisticated programs that encourage teenagers to confront how AIDS has ravaged their families. For young people, not surprisingly, one of the most effective arguments for making healthier choices is that their peers are doing the same. Programs that produced the most behavior change combined H.I.V. information, attitude change and training in skills like saying no to sex without a condom.

The most serious criticism is that loveLife is aimed in the wrong direction. —œLoveLife is too focused on individual choice,—? says Warren Parker, the executive director of Cadre, an AIDS group. —œWe need community organizing around the issues of sexual violence, gender imbalance.—? The question of whether to try to change an individual—™s behavior or a society—™s culture is a big debate in AIDS work. Certainly in South Africa, both seem necessary.

—œTo stop the epidemic in the long term we need to tackle sexual violence,—? says Piot of Unaids. —œBut the problem is we still have a crisis. If we—™re going to wait till men and women have equality and no one has to sell their body —” well, we can—™t wait for that.—?

LoveLife—™s message is the same public-health gospel a Nashi would have used: abstinence, fidelity, condoms. But that message is received very differently if it comes during a five-hour lecture in the church hall than it is if it comes from Sibulele Sibaca, a petite, enthusiastic, energetic 23-year-old from Langa, a township outside of Cape Town. Today she is a corporate social investment manager in Richard Branson—™s Virgin Group in South Africa. That, she says, is because of loveLife. When she was 12, her mother died of AIDS. When she was 16, her father followed. —œBefore I joined loveLife, I had a serious history of self-destruction,—? she said by phone from Cape Town. —œI saw my life ending up in the township, pregnant, not knowing who the father of my child is.—?

She got through high school. A friend told her about loveLife, and she began going to its programs. —œI had been engaging in highly risky behavior, but loveLife helped me realize there were things I wanted to achieve in my life, and I couldn—™t afford to have sex without a condom,—? she said. —œThe reality is that every young person has a dream, but a lot of us look at our situation and think, Who are we kidding? But the minute someone triggers in your brain that it is possible, you start looking at life in a different way.

—œSeeing billboards of a dying person didn—™t tell me about me,—? Sibaca says. —œBut when someone says, —˜You have such amazing potential that H.I.V. shouldn—™t be a part of it—™ —” then it wasn—™t about H.I.V. It was about me. No one is wagging a finger at me. These were people the same age as me. It wasn—™t a celebrity telling me their story living in a million-dollar house. It was another young person from the same township as me.—?

She applied to be a groundBREAKER. LoveLife trained her to do motivational speaking and gave her facts and ways to talk about teen pregnancy, peer pressure, H.I.V. and other issues. She went to work in a high school, visiting the same class every day for 21 weeks. I asked her whether she felt it helped anyone. She told me about one girl in her class two years ago, also from Langa. —œShe was 15 and came to me and said, —˜My boyfriend is pressuring me to have sex without a condom.—™ Her fear was that her boyfriend would break up with her if she said no, and she had to hold on to him because he gave her money and clothes that her family could not provide her with. I gave her all the different choices and consequences and said, —˜Are you willing to live with those consequences at age 16?—™

—œShe came to me the next week and said, —˜I—™m single.—™ She had broken up with her boyfriend. I hugged her and started crying —” she saw her fears and was willing to go through with it anyway.—? Sibaca saw the young woman again a few months ago. —œShe was not H.I.V.-positive and not pregnant, and she was going to study law next year.—?

This is cheerleading —” but it—™s not empty cheerleading. LoveLife cannot promise any South African teenager that life will be good. But living on one meal a day is even harder if you have AIDS. It seemed valuable to help young people realize that there were reasons to stay healthy and that the choice is theirs.

In Orange Farm, a forlorn and violent township southwest of Johannesburg, I visited a loveLife center, a complex of buildings that draws kids in with a basketball court, a radio-production facility and a computer workshop —” but first, kids have to do AIDS training. LoveLife seemed to be Orange Farm—™s only after-school alternative to drinking, gangs and sex. In a mining district in rural Limpopo, I visited several health clinics. Nurses at clinics are famous for simply yelling at kids who come in with gonorrhea or a request for contraception, or threatening to tell their mothers. Now these clinics have loveLife chill rooms manned by groundBREAKERs. They have persuaded nurses not to drive teenagers away and will escort teenagers into their appointments.

I watched groundBREAKERs give talks on H.I.V. in schools and after school. The quality of their programs varied with their skills and the local environment. Some were pretty good. At Serokolo high school in the Limpopo mining town, I watched 23-year-old Tebatso Klass Leswifi run a class through a quiz on H.I.V., with discussion that ranged from whether girls become pregnant because of the country—™s child grant to why you would want to know your H.I.V. status. He also works at the local health clinic and helps run a league with 10 basketball teams. The high school—™s aerobics team —” also coached in part by Leswifi —” put on a show to the music of the pop hit —œGloria.—? I met a 17-year-old named Princess who said she calls Leswifi every day for some words of wisdom to motivate her to stay in school. In another Limpopo health clinic, however, I watched about 20 bored-looking kids sit through a lecture by groundBREAKERs on H.I.V. and loveLife—™s programs. It was done in the rote-memorization style still typical in South Africa—™s rural schools, with practically no discussion. Still, I heard too many young people tell me loveLife had changed their lives to dismiss it. The organization seemed a little like a cult —” and that—™s good. Many young people I met told me that loveLife had saved them in big or little ways, and they said they were on a mission to pass that along to others.

There are strong indications that loveLife does indeed change young people—™s behavior. In 2003, the Reproductive Health Research Unit of the University of the Witwatersrand in Johannesburg did a survey of 15- to 24-year-olds. It found that people who had participated in loveLife—™s programs were only 60 percent as likely to be infected with H.I.V. as those who had not, and the risk diminished further for those who had participated in more than one program. There was also a strong association between loveLife participation and increased condom use —” although there was no statistically significant effect on abstention or partner reduction. Since the study was not a randomized, controlled one, it could not prove that loveLife programs caused the behavior change.

LoveLife has not, of course, produced the promised 50 percent drop in new H.I.V. infections. But loveLife—™s face-to-face programs have been working nationwide since only 2002. —œIt is too early to dismiss this,—? says Purnima Mane, the director of policy, evidence and partnerships at Unaids in Geneva. —œIt can take five or six years to see results.—? And last month, the South African government reported that new surveys of pregnant women showed that rates of infection in teenagers are holding steady, while the rates of other age groups are rising. This suggests something is working with teenagers.

LoveLife currently reaches around 40 percent of South Africa—™s youth with face-to-face programs. That—™s a lot, but more would be better —” given the scope of the catastrophe, $25 million a year is not that much. There are other programs that take a different but equally sophisticated approach, and it would help if they were broadened as well. Where the likelihood your partner is infected is as high as in South Africa, ordinary success might not be enough.

The thinking behind loveLife —” get into their heads —” needs to become part of every AIDS program, in South Africa and around the world. Governments are still setting goals of providing —œaccess—? to medicines or condoms, but access and accessed are very different things. It will be a complicated and expensive change, because what works in one culture may not work in another. It will also require people to take into account what works. It sounds strange to say it, but this is often not a factor. Across Africa, groups are turning to abstinence-only programs not because they work —” they don—™t —” but because that—™s what Washington wants to finance. Rigorous evaluation to show which AIDS programs are effective is also necessary, something that is only an occasional afterthought today.

Without attention to the social, psychological and cultural factors surrounding the disease, we are throwing away money and lives. This is the new frontier. Twenty-five years into the epidemic, we now know how to keep people from dying of AIDS. The challenge for the future is to keep them from dying of stigma, denial and silence.

Tina Rosenberg writes editorials for The New York Times. She has written for the magazine about AIDS, malaria and tuberculosis, among other subjects.To anyone who does read the science it is not possible to finish this saga without being amazed at how willing the sensitive liberal mind is to take a false premise and run with it into endless Ptolemeic extrapolations, cultural, social and intellectual, all demonstrating the infinite social and cultural enlightenment and sensitivity of the writer.

****************************************
She is one of the most ferociously intelligent people I have ever met, and certainly is unique in the public courage she displayed, and has maintained despite the vicious and untrue attacks from many quarters, in turning 180 degrees because she actually attended to all that those remarkable meetings had to offer.

She is my favorite person in South Africa.

Dr. Harvey S. Bialy:
******************************************

Misreporting Manto

Meanwhile Dr. Mantombazana “Manto” Tshabalala-Msimang’s intelligence and expertise isn’t recognised by anyone in the press, because the AIDS meme is ubiquitous in that realm both here and abroad, with the distinguished exception of Harper’s Magazine and a few others, not to mention two dozen books. During and after the AIDS 2006 the South African papers have pursued Dr Manto Tshabalala-Msimang with all the outrage of shared ignorance.

Allafrica.com reported her behavior as familiar quackery exhibited at three previous AIDS Conferences where Dr. Mantombazana “Manto” Tshabalala-Msimang had presented her alternative to ARVs in the form of beetroot, lemon, garlic and African potato.

South Africa’s exhibition stall was dominated by woven baskets of plump lemons, wilted beetroot, African potatoes and clumps of garlic.

A staff member hastily added his own two bottles of antiretroviral medication after journalists asked why ARVs – also part of government’s treatment plan – were not on show.

Shortly afterwards, Tshabalala-Msimang opened the stall and said it was important to allow people in the rural areas to make up their own minds on whether they “preferred alternative medicine or antiretrovirals”.

Anxious to have readers shaking their heads in disapproval, the reporter like everyone else hostile to Manto seems unaware that not having enough food or the right foods to eat creates exactly the major symptoms of AIDS and always has – the immune system becomes dysfunctional. That is what the mainstream literature shows repeatedly, as we have pointed out earlier.

But apparently ignorance breeds arrogance more often than humility and the stall was in tatters by the end of the Toronto conference, trashed by the TAC:

Dr Harry Moultrie of the paediatric Aids clinic at Chris Hani Baragwanath Hospital, who attended the opening, said the inclusion of the foods at the South African stall was “despicable”.

He added that there was “no scientific evidence showing that any of the products were effective” against HIV.

By the end of the week, the stall was in tatters after being trashed by Treatment Action Campaign (TAC) supporters chanting “Fire Manto now”…

The South African government stand, decorated with the lemons, beetroot and garlic linked to Health Minister Manto Tshabalala- Msimang—™s aversion to anti-retroviral drugs, was invaded by Treatment Action Campaign (TAC) activists, some lying on the ground to symbolise South Africa—™s Aids dead.

—œFire Manto now!—? they chanted to passers-by, charging that South Africa—™s Aids response was —œthe worst in the world and not the most comprehensive—?.

The TAC activists were also busy trashing Manto back home:

AIDS activists occupied several government offices Friday and took to the streets demanding the resignation and arrest of South Africa’s health minister, accusing her of allowing unnecessary and preventable deaths because of her policies on AIDS.

South African Health Chief’s Ouster Eyed

The Associated Press
Friday, August 18, 2006; 8:43 PM

CAPE TOWN, South Africa — AIDS activists occupied several government offices Friday and took to the streets demanding the resignation and arrest of South Africa’s health minister, accusing her of allowing unnecessary and preventable deaths because of her policies on AIDS.

The Treatment Action Campaign staged the protest against Health Minister Manto Tshabalala Msimang following the death in a Durban prison earlier this week of a prisoner with HIV/AIDS.

The campaign said government was to blame for not giving him antiretroviral medicines – a charge the prison department has denied.

The dead man was one of 15 prisoners who recently won a court case against the Department of Correctional Services and Department of Health for the government to provide medication to prisoners.

Activists have repeatedly demanded the dismissal of Tshabalala-Msimang, accusing her of delaying provision of ARVs. Friday, protesters carried signs reading: “Arrest Manto.”

She has attracted criticism at the international AIDS conference in Toronto for using the South African stand to promote beets, garlic and lemon as remedies for the disease.

Dozens of activists, led by the Treatment Action Campaign’s president Zackie Achmat, briefly occupied the offices of the Human Rights Commission _ an independent watchdog _ to pressure it to play a bigger role in securing treatment for AIDS patients.

“When good people keep silent, evil people triumph,” Achmat told human rights commission representatives. “We’ve had enough of evil people triumphing. We need good people like you.”

The demonstrators then moved into nearby local government headquarters, demanding that local authorities should do more against the disease.

South Africa has the highest number of people living with HIV in the world. A government survey, conducted in October 2005, estimated that 5.5 million South Africans are living with the virus, accounting for more than one-eighth of the estimated cases worldwide. UNAIDS estimates that nearly 19 percent of people aged 15 to 49 in South Africa country are HIV-positive.
© 2006 The Associated PressAs noted earlier, in Toronto there was quite a lot of official hostility too. A special session was aimed at bringing South Africa into line, since Mbeki and Manto have done fairly well in quietly discouraging the provision of scientifically unproven and toxic drugs to their electorate, frustrating the drug industry and its supporters among activists (estimates vary from 141,000 to 250,000 of nearly 500,000 candidates who are getting their ARVS):

At a special conference session devoted to the price of political inaction, the TAC’s Mark Heywood said South Africa’s response to HIV was presently in chaos with only 17 percent of people with AIDS receiving treatment while an outbreak of multi-drug resistant TB in KwaZulu-Natal was going unmanaged.

As Mark and the TAC pulled out all the stops in Toronto, they were joined on the warpath by Clinton, the UN special envoy and the WHO director of HIV∫AIDS, among others:

Stephen Lewis, United Nations Special Envoy for HIV/AIDS in Africa, told Health-e he believed that the political indifference in South Africa was a hurdle to people accessing treatment in South Africa.

HIV/AIDS Director at the World Health Organisation Dr Kevin de Kock said he struggled to understand why African leaders were resistant to making HIV/AIDS the single most important issue that they were dealing with…

Indian doctor Dr Jaya Shreedar said she was yet to hear anything good about South Africa.

“You guys are like a worst practice example,” she said, adding that government officials in India, also under fire for their lax response to the epidemic, were saying that “we can’t be as bad as what the South African health minister is.”

Meanwhile, Gregg Gonsalves of the AIDS Rights Alliance of Southern Africa said there was a sense that the South African government had moved beyond denial to betrayal.

“The virus of denialism is seeping around the region to neighbouring countries such as Lesotho. If South Africa cannot scale-up (treatment) what does it say to leaders in the rest of the region?” he asked.


All this was dismissed by an angry Dr. Mantombazana “Manto” Tshabalala-Msimang who fired back in remarks to reporters at the end of the Conference:

An angry Tshabalala-Msimang later said she didn’t mind being called “Dr Beetroot” and said she had never attended an AIDS conference where South Africa had not been bashed by its own media.

“People say ‘your stall is great’. I don’t know what they are reporting on at home. We haven’t shocked the world, we have told the truth,” she told South Africans at a party at the home of Nogolide Nojozi, the country’s consul-general in Toronto on Tuesday night.

Later at the end of the week she called the TAC antics “disgraceful”:

“I think the TAC was just a disgrace, a disgrace not only to the [health] department but a disgrace to the whole country. But I think, as South Africa, we really demonstrated that we are doing pretty well.”

Manto defends Aids policies

Manto Tshabalala-Msimang blamed South Africa’s poor media coverage at last week’s global Aids conference in Toronto on the Treatment Action Campaign (TAC), whose activists led criticism of her government’s policies.

“I think South Africa did very well,” Tshabalala-Msimang told the South African Broadcasting Corporation radio.

“I think the TAC was just a disgrace, a disgrace not only to the [health] department but a disgrace to the whole country. But I think, as South Africa, we really demonstrated that we are doing pretty well.”

TAC supporters were blamed for attacking South Africa’s stand at the Toronto conference, which included a display of Tshabalala-Msimang’s often-criticised prescription of olive oil, beetroot and garlic as a defence against HIV/Aids.

The conference ended on Friday with a broadside delivered by the UN special envoy on HIV/Aids in Africa, Stephen Lewis, who derided South Africa’s “lunatic” approach to an epidemic which infects an estimated one in nine of its 45-million people.

South African newspapers on Sunday joined the fray, describing the Toronto display as “a salad stand” and demanding President Thabo Mbeki — who is also often accused of mishandling the HIV/Aids crisis — sack his controversial minister.

“Tshabalala-Mismang has become a comic figure who comes across as a clown, if her behaviour in Toronto is anything to go by,” the influential Sunday Times said in an editorial.

“For how long must South Africans suffer the embarassment of a senior Cabinet minister who does not appear to take her work seriously?”

South Africa’s government has frequently been criticised for acting too slowly against HIV/Aids and remaining reluctant to provide sufferers with anti-retroviral (ARV) drugs, the only medication known to slow the progress of the disease.

The government did launch a public ARV programme in 2003 and is now providing the drugs to about 175 000 people.

But activists say the drugs only reach a fraction of the people who need them and accuse Tshabalala-Msimang of creating deadly confusion by continuing to promote her home-grown approach to the disease.

City Press Sunday columnist Khathu Mamaila wrote that Tshabalala-Msimang’s determination to promote natural foods such as beetroot and garlic instead of ARVs had “reduced South Africa to an international joke”.
And when asked about the issue, Bill Clinton had supported her attention to nutrition, though as always emphasising that it was no substitute for the ARVs he has attached his reputation to.

In an earlier session, former US president Bill Clinton was asked to comment on the fact that Tshabalala-Msimang “has been particularly keen on nutrition, encouraging olive oil and African potato and things like that to boost the immune system.”

“Improving nutrition will increase our capacity to deal with HIV and AIDS, as long as it’s not a smokescreen of denial, but another part of what it takes to give people a healthy life,” Clinton replied.”

But since Manto returned home she has faced a continual barrage from the TAC and the press, and now the Times’ Tina has piled on.

Worries that Mbeki’s caution will spread

Why is all this fury erupting? There seem to be two reasons. One is that the spread of the “virus of denialism” has ARV marketers worried. What if India really does follow in South Africa’s footsteps in questioning the rationale of ARV delivery to Indian children? Their Academy of Sciences Journal of Biosciences had the temerity (independence of mind) to publish Peter Duesberg’s masterpiece of evisceration of the HIV∫AIDS ARV rationale in 2003, after all. Denialism spreading in Africa and India, with China next?

This concern seems to be the main reason for the mounting attack on Manto and her sanity about nutrition, and on Mbeki’s long held skepticism about whether the mainstream knows what it is doing in HIV∫AIDS, that culminated in the New York Times editorial today.

The second reason appears to be that the TAC, at first refused admittance to the UNAIDS conference in New York earlier, then allowed in after making a fuss, has been emboldened by the support it found there and in Toronto.

South Africa: Beetroot Battle At World Aids Conference

August 21, 2006
Posted to the web Monday August 21, 2006

Anso Thom

Beetroot, lemon, garlic and African potato were at the heart of a bitter conflict between Health Minister Dr Manto Tshabalala-Msimang and AIDS activists over government’s AIDS programme at the International AIDS Conference in Toronto over the past week.

From the start of the conference, it was clear that Tshabalala-Msimang was going to repeat the controversial behaviour she has displayed at the past three international AIDS conferences, by once again emphasizing nutrition as an “alternative” to antiretroviral medication.

South Africa’s exhibition stall was dominated by woven baskets of plump lemons, wilted beetroot, African potatoes and clumps of garlic.

A staff member hastily added his own two bottles of antiretroviral medication after journalists asked why ARVs – also part of government’s treatment plan – were not on show.

Shortly afterwards, Tshabalala-Msimang opened the stall and said it was important to allow people in the rural areas to make up their own minds on whether they “preferred alternative medicine or antiretrovirals”.

Dr Harry Moultrie of the paediatric Aids clinic at Chris Hani Baragwanath Hospital, who attended the opening, said the inclusion of the foods at the South African stall was “despicable”.

He added that there was “no scientific evidence showing that any of the products were effective” against HIV.

By the end of the week, the stall was in tatters after being trashed by Treatment Action Campaign (TAC) supporters chanting “Fire Manto now”.

South Africa took top spot in many guises at the world’s biggest AIDS conference, but usually for the wrong reasons.

Our country had the highest HIV/AIDS deaths in the world last year – 320 000 – and it has the second highest number of people living with AIDS in the world, over five million.

At a special conference session devoted to the price of political inaction, the TAC’s Mark Heywood said South Africa’s response to HIV was presently in chaos with only 17 percent of people with AIDS receiving treatment while an outbreak of multi-drug resistant TB in KwaZulu-Natal was going unmanaged.

“There has been an absence of moral, political and strategic leadership from the African National Congress and the government.

“(Our government) has been unique in the way it has sought to make a virtue out of its refusal to be pressured into responding to AIDS. This has very directly facilitated the spread of the HIV epidemic,” Heywood told the large audience.

He accused Tshabalala-Msimang of repeatedly promoting and juxtaposing the value of traditional medicine as opposed to “western medicine”, thus “creating a pseudo politics around “Western vs African” traditions of health care.

In an earlier session, former US president Bill Clinton was asked to comment on the fact that Tshabalala-Msimang “has been particularly keen on nutrition, encouraging olive oil and African potato and things like that to boost the immune system.”

“Improving nutrition will increase our capacity to deal with HIV and AIDS, as long as it’s not a smokescreen of denial, but another part of what it takes to give people a healthy life,” Clinton replied.

Stephen Lewis, United Nations Special Envoy for HIV/AIDS in Africa, told Health-e he believed that the political indifference in South Africa was a hurdle to people accessing treatment in South Africa.

“Gauteng, KwaZulu-Natal and the Western Cape are doing moderately well, but [the treatment programme] would be happening far more quickly if the political leadership drove it.,” he said.

HIV/AIDS Director at the World Health Organisation Dr Kevin de Kock said he struggled to understand why African leaders were resistant to making HIV/AIDS the single most important issue that they were dealing with.

Indian doctor Dr Jaya Shreedar said she was yet to hear anything good about South Africa.

“You guys are like a worst practice example,” she said, adding that government officials in India, also under fire for their lax response to the epidemic, were saying that “we can’t be as bad as what the South African health minister is.”

Meanwhile, Gregg Gonsalves of the AIDS Rights Alliance of Southern Africa said there was a sense that the South African government had moved beyond denial to betrayal.

“The virus of denialism is seeping around the region to neighbouring countries such as Lesotho. If South Africa cannot scale-up (treatment) what does it say to leaders in the rest of the region?” he asked.

An angry Tshabalala-Msimang later said she didn’t mind being called “Dr Beetroot” and said she had never attended an AIDS conference where South Africa had not been bashed by its own media.

“People say ‘your stall is great’. I don’t know what they are reporting on at home. We haven’t shocked the world, we have told the truth,” she told South Africans at a party at the home of Nogolide Nojozi, the country’s consul-general in Toronto on Tuesday night.
A third factor may be that, now with the price of AIDS drugs forced down to unprecedented low levels, the drug companies are twice as keen to deliver them to as many people as possible.

Whatever the reasons, the storm has built since, into what may be a watershed showdown between the two views, at least in South Africa. As in the States, this may well benefit dissenters by bringing attention to their case, and the fact that it rests on a more honest reading of the scientific literature than the one promoted by NIAID.

The press attack at home was led by the Sunday Times of South Africa calling for Mbeki to sack (fire) his Health Minister for being a “clown” who doesn’t care to do her job responsibly:

Tshabalala-Msimang has become a comic figure who comes across as a clown, if her behaviour in Toronto is anything to go by.

For how long must South Africans suffer the embarrassment of a senior Cabinet minister who does not appear to take her work seriously?

This is from the Sun Aug 20 edition:Time to sack Health Minister

Time to sack Health Minister
20 August 2006
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—˜AS PRESIDENT of the Republic I have come to the conclusion that the circumstances dictate that, in the interest of the Honourable Deputy President, the government, our young democratic system, and our country, it would be best to release the Hon Jacob Zuma from his responsibilities as Deputy President of the Republic and member of the Cabinet.—?

This is what President Thabo Mbeki said as he dismissed his deputy after Judge Hilary Squires had condemned what he called a generally corrupt relationship between Zuma and his financial adviser, Schabir Shaik.

This was a brave move by the president, a clear indication that he was not prepared to keep in his Cabinet a politician who was compromising the integrity of our government.

It is a move that he should perhaps repeat.

It is tragically ironic that a country like South Africa, which has one of the largest antiretroviral programmes to combat the spread of HIV/Aids, is the country with the highest number of Aids deaths in the world.

South Africa—™s Comprehensive Plan for Management, Care and Treatment of HIV and Aids is supposed to give hope to more than five million people living with HIV/Aids in this country.

But when there are only 141000 receiving treatment out of the 453000 people targeted by the plan for the current year, it becomes difficult to figure out whether it is political posturing or a lack of political will that is responsible for this sorry state of affairs.

This partly explains the bizarre exhibition of garlic, lemon, African potato and beetroot displayed by Health Minister Manto Tshabalala-Msimang at the 16th International Aids Conference, which ended on Friday in Toronto, Canada.

Tshabalala-Msimang has become a comic figure who comes across as a clown, if her behaviour in Toronto is anything to go by.

For how long must South Africans suffer the embarrassment of a senior Cabinet minister who does not appear to take her work seriously?

Few people, if any, deny that nutrition is an important weapon in the arsenal to combat HIV/Aids.

However, pretending that antiretrovirals come second when there are so many people infected and dying of this epidemic is dangerous.

Why Tshabalala-Msimang chose not to display her own government—™s comprehensive plan for HIV/Aids treatment at the conference boggles the mind.

The silence by President Thabo Mbeki in the face of the embarrassment dished out by Tshabalala-Msimang in Toronto this week begs the question of whether he agrees with his Health minister.

It is now time Mbeki took action against Tshabalala-Msimang.
c Sunday TimesA South African Web discussion

A web discussion followed at Should Manto Tshabalala-Msimang lose her job? This has allowed their main arguments to be posted by some of the brightest dissenters in the US, including the whiplash defense of the Minister of Health’s competence by Dr Harvey Bialy (you saw it here first!):

A few words of truth concerning the very Hon. Manto Tshabalala-Mismang.

When I first was introduced to the Minister at the opening reception of President Mbeki’s AIDS Advisory Panel in 2000, the ice in her eyes and the frost in her handshake made me think the tip of the Motherland had broken off and was closing on the antarctic.

By the end of the Panel meetings a few weeks later, we were dancing Pata Pata into the wee hours.

She is one of the most ferociously intelligent people I have ever met, and certainly is unique in the public courage she displayed, and has maintained despite the vicious and untrue attacks from many quarters, in turning 180 degrees because she actually attended to all that those remarkable meetings had to offer.

She is my favorite person in South Africa.

Dr. Harvey S. Bialy:

And Barack Obama can go bugger himself, and preferably in front of the TV cameras too.

What this expansion of debate can achieve is to back Manto by pointing out how her President’s stance rests not on ignoring the scientific literature, as the TAC and Tina would have people believe, but on a correct reading of it. Unfortunately, it seems clear that neither she nor Mbeki will ever make this point themselves, presumably for fear of contradicted by officials from NIAID and their allies.

Here is the ANC Mbeki page message yesterday, on the topic of understanding the South African government’s position on AIDS. It emphasizes how African AIDS is quite different from European and American AIDS, and thus needs different policies:

HIV AND AIDS

Understanding South Africa’s approach to AIDS

Can Africa follow in the footsteps of the countries of the North in addressing the challenge of HIV and AIDS in the region? What lessons can be learnt? The challenge of HIV and AIDS in Europe and North America has been portrayed as a
problem facing marginalised communities – Africans in diaspora, immigrants, men who have sex with men, injecting drug users and so on. Very few cases of HIV infection are attributed to heterosexual relationships.

These countries have many more resources to support their social security system and their populations have access to much more complex health systems. With the advent of antiretroviral drugs, many of the people living with HIV and AIDS in these countries were put on antiretroviral treatment.

However, UNAIDS, the joint United Nations programme on HIV and AIDS, has reported that new cases of HIV infection and other sexually transmitted infections are increasing in these countries. UNAIDS says, the rate of new cases of HIV infection in Canada, which hosted the recent International AIDS Conference, has increased by 20% over the past five years.

In an article entitled “The real story of HIV rates in UK”, published in July 2004, this is how BBC News reported on HIV infection in Britain:

“The number of people living in Britain with HIV is increasing every year because more people are joining this group than are leaving it. People join the group in two ways: people with HIV migrate to Britain from abroad (imported infections); and people living in Britain pick up HIV (domestic infections).

“Because HIV is still incurable, people only leave the group by moving away from Britain or by dying. The two communities that are bearing the brunt of HIV in Britain are the gay community and the African community.”

Despite the difficulties in reducing infection rate, it is necessary to discuss whether South Africa and Africa in general would have been able to follow the path of the North in responding to HIV and AIDS. Is it feasible for Africa to
meet expectations that are based on a model from the North?

In sub-Saharan Africa, HIV and AIDS is a generalised challenge not limited to a specific and small section of the population. Most of the cases are attributed to heterosexual relationships.

Our understanding of the difference in the manifestation of this challenge in Africa as opposed to the North is that Africa has high levels of poverty and underdevelopment affecting the vast majority of its population. There are
serious health system challenges in our continent, including shortage of human resources and inadequate infrastructure. Access to affordable and quality medicines and limited social security support for the poor, who constitute the
majority of our populations, remains a challenge.

With all these challenges, and the fact that we have significantly higher numbers of people estimated to be living with HIV and AIDS than Europe, adopting
a model which focuses exclusively on antiretroviral (ARV) therapy would not solve our problem.

As we developed the most appropriate response to the epidemic on the continent, we had to acknowledge that the high prices of antiretroviral drugs as they
entered the market meant that we would have had to divert resources from other social needs – education, water, housing and so on – to provide ARVs. Even if we
had done so, the probability of these drugs reaching the patients and patients taking them at a required frequency was very low.

What did South Africa do under these circumstances? We said that since there is still no cure or effective vaccine for HIV and AIDS, let us focus on prevention as the first element of our response. Simply put, our first challenge was to make sure the problem did not get any worse than it was.

Secondly, we encouraged our people to find out their HIV status, and made voluntary counselling and testing services available in more than 80% of our facilities.

We then had to look at how to respond to the needs of those already infected. We asked ourselves: what can we do to prolong the period between HIV infection and development of an AIDS defining condition? What can we do to maintain optimal health for people living with HIV and AIDS?

We introduced the Healthy Lifestyle campaign that promotes regular physical activity and encourages people to avoid health risks like smoking, alcohol and substance abuse, as well as unprotected sex to deal with the challenge of both
re-infection and new infections.

To deal with the broader problem of the poor nutritional status of our population, we introduced interventions that encourage intake of necessary micronutrients, like providing appropriate vitamin supplementation to pregnant women and children. Vitamins and minerals are now added to staple foods like maize meal and wheat flour and communities are encouraged to produce and eat fruits and vegetables.

These interventions are aimed at strengthening the body’s ability to fight infections and maintain good health for a longer period. When infections occur, we provide appropriate treatment as most of the opportunistic infections can be
treated even in the presence of HIV.

There is also another element that is peculiar to Africa and that is African traditional medicines. The World Health Organisation (WHO) estimates that 80% of our people use traditional medicine for various conditions including HIV and AIDS. So we decided to encourage research and development of these medicines and create an appropriate regulatory environment for them.

Over the past few years, we made progress in reducing the price of medicines, increasing social expenditure and, to a certain extent, improving our health system. Progress in these three areas created a possibility, by the end of 2003, of introducing antiretroviral therapy. Based on WHO recommendations, we made antiretroviral therapy an option for HIV positive people whose CD4 count had dropped to 200 and less.

We evaluated facilities that could provide this treatment with a target of having at least one service point in every district by the end of the first year of implementation and we achieved that. We took this approach because we wanted to ensure that people in both rural and urban areas have access to more or less the same level of care. We now have 231 health facilities providing ARVs free of charge and they are spread across 72% of local municipalities.

Our targets are set in terms of establishing infrastructure and making services available to our people. While we make all the efforts to market these services, we avoided setting targets based on the number of people using the services because there are a number of factors influencing uptake and some of these factors are outside the control of the state.

The WHO, for instance, launched an initiative to put three million people on antiretroviral therapy by 2005 popularly known as the ‘3by5’ initiative. At the AIDS conference in Toronto, it was reported that about 1,6 million people were on ARVs almost 8 months after the ‘3by5’ target was missed.

In South Africa, the experience in the mining industry has been similar. Only a quarter of the HIV-positive workers at AngloGold Ashanti who need AIDS drugs had taken up the company’s offer of free treatment, a local newspaper, Business Day, reported on 22 April 2005. About 2,700 were estimated to be requiring treatment but just 730 workers were taking antiretroviral medicines after one and half years of providing free drugs. This represents 27% of people initially targeted by AngloGold.

Experts can discuss the AngloGold’s experience in detail. But it highlights the complexities involved in implementing a programme of this nature.

We should not mislead the public and claim that there can be easy victories in our efforts to curb the spread of HIV infection and reduce the impact of AIDS. Our collective duty is to emphasise prevention and ensure understanding of all
the interventions that government is making available at different stages of the progression of this condition.
Special note: No trials have ever shown that HAART is better than doing nothing.

In her aversion to Clinton’s campaign to feed the Kool Aid of ARVs to her people, Dr. Manto Tshabalala-Msimang reminds us of a vital point, emphasized in Comments here recently by Robert Houston in response to Mark Niernbaum, that no trials of the HAART regimen for defeating HIV∫AIDS have ever included placebos. Apart from a handful of AZT studies earlier, one of which showed that AZT killed you earlier than HIV by seven to seventeen years, there has been not ONE trial conducted where any of the AIDS patients have not been medicated, in the last ten years, with ARVs.

Let’s state that clearly. There has never been a placebo group in any AIDS drug trial in the era of HAART – never a group which are not given any ARVs at all, so that the trial could then compare the effect of not giving drugs at all to a group, with the other groups that are given different combinations of medications.

The rationale for this is the supposed “ethical” necessity of giving people ARVs because we “know” that they are beneficial. But it conveniently avoids the possibility of producing results that would allow us to see if they are indeed beneficial, or whether they are in fact soon detrimental, (contrary to the misleading experience of the patients), and ultimately fatal, as many indications suggest, including the recent Lancet study that demonstrated death rates have not been improved in ten years of expanded use of HAART.

But of course to the agitators in AIDS there is nothing better than HAART pills, which they wish to swallow at the earliest opportunity. After all, the companies that produce them are the main source of funding for activists in HIV∫AIDS, even if TAC has somehow recently persuaded a court in South Africa to agree they are not directly funded by the drug companies.

How better could they express their gratitude than by helping their patrons market drugs with grotesque side effects to the hapless millions of South Africa, who had no idea they had anything unusual wrong with them before the Aids meme arrived, other than the degradation and danger of poverty and zero hygiene, the ubiquitous TB microbe, starvation and a range of diseases that we are sure that only “Coming Plague” author Laurie Garrett has completely investigated

Now they “all have AIDS”.

Clinton, Obama mining Africa for PR gold

August 30th, 2006


Obama takes HIV test with wife in Kenya, both negative

Times weighs in, mounts propaganda blitz

Last week, ABC 20/20 showed us that blacks in the US, especially down South, are in an uproar over their new status as the key expansion sector of the domestic ARV market. Jesse Jackson took an HIV test (negative) and marveled at the 5.2 million people positive in South Africa. Preachers complained that the Bible was no guide, HIV not being mentioned.

But the real HIV∫AIDS propaganda activity currently among blacks is overseas, with the message carried to Africa by two of the most glamorous US politicians on stage today, Barack Obama and Bill Clinton. The efforts of both were magnified by the lens of Times coverage, which offered much reinforcement of the paradigm in word and picture (Evelyn Hockstein took good photos for the Times).

Both Clinton and Obama toured to ecstatic crowds, according to the Times reporters.

Inside the rural hospital here that he recently helped renovate, where Rwandans were hunted down and killed during the genocide he regrets he didn—™t try to stop as president, Mr. Clinton heard people once skeletal from AIDS tell of their resurrections to robust health.

Yesterday a lengthy Times front page article covered the topic of Clinton and AIDS with much overt endorsement of the paradigm, including a picture from Rwanda of John Gumiriza, restored to health and standing by a photo taken of him in skeletal condition in 2005, “before he started taking antiretroviral drugs, which have been provided to him and others at reduced cost.”

Persuasive evidence indeed, for most readers, right before their eyes, for the blessings of ARVs aimed at the dire threat of HIV, unless it occurs to them that perhaps adequate food was included in the package.

According to our reading of the mainstream literature on HIV?AIDS, which his advisory staff has yet to read and understand it seems, Mr Clinton is now a major menace to the health of Africans, as he is intent on bringing ARVs to as many as possible in Africa, and has the friends to do it, including now Bill Gates. To this effort he brings all his expanding enthusiasm for doing self promotional good in the world and making his reputation safe with posterity, but none of the mental alertness which won him a Rhodes scholarship in his youth, nor any of the sophisticated cynicism which he must have accumulated in achieving the Presidency, and surviving impeachment.

Since he left office more than five years ago at age 54, one of the youngest former presidents ever, Mr. Clinton has made a lasting mark in a cause that he came to only late in his presidency: fighting the AIDS pandemic across Africa and the world.

Few public figures in America have spawned as much speculation about what motivates them as Mr. Clinton. Abroad, even fewer inspire the affectionate reception Mr. Clinton received as he raced across seven African countries in eight days in July. Crowds at roadsides and in hospitals wanted to touch him —” and he obliged by shaking hands, kissing babies and hugging people with AIDS….

But on this trip, Mr. Clinton seemed anything but a man tormented by guilt. Rather, he reveled in his role as a private citizen championing people with AIDS.

In this euphoric mood of serve-the-public self-importance there is clearly no room for naysayers, especially ones which question the entire premise of what he is doing. Not that any of them could get near him. Just like the other Bill, he is surrounded by a phalanx of paradigm guardians who will make sure that Mbeki or any other skeptic doesn’t dent his faith:

When doctors specializing in public health met him at the William J. Clinton Foundation in Harlem in the fall of 2002, Howard Hiatt, the former dean of the Harvard School of Public Health, bluntly asked Mr. Clinton why those present should expect that —œyou—™ll be able to accomplish now what you didn—™t undertake in your presidency —” an attack on this plague?—?

—œEveryone was worried,—? said Richard Marlink, who headed Harvard—™s AIDS Institute. —œIs this a campaign with photo ops and press releases or a long-term commitment?—?

In the years since, doctors at the forefront of AIDS treatment have worked with Mr. Clinton…

Result: for the foreseeable future more and cheaper ARVs will flow into grateful African hands and veins and it does not seem impossible that a Nobel peace prize will result.

His foundation also has negotiated steep cuts in the price of AIDS medicines through deals with drug companies that cover more than 400,000 patients in dozens of countries, helping propel momentum for treatment of the destitute…

The Clinton foundation—™s budget last year was $30 million, raised from private donors. Mr. Clinton, who oversees its operations full time, has plunged into many causes, from childhood obesity to tsunami relief to global warming, but he has made his most substantive contribution on AIDS…

The only criticism come from people who say he should have acted earlier, but they forgive him for it in the light of his recent performance. One reliable commentator drawn on by the reporter Celia Dugger is young Greg Behrman, who might be called the Laurie Garrett of HIV?AIDS.

The debate over whether Mr. Clinton missed a political opportunity to lead the charge on global AIDS years before Mr. Bush seized it is far from over.

Greg Behrman, the author of —œThe Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time,—? offers a split verdict.

—œThere are two acts here,—? he said. —œClinton—™s post-presidential leadership has been extraordinary. As president, though, the record is clear. Clinton was not a leader on global AIDS and the consequences have been devastating.—?

We met Greg last year, when he published his book by expanding his thesis at Oxford, where he was a Rhodes scholar. Asked how he checked the science he was relying on, Greg told us that he had merely relied on what he was told, and hadn’t checked it at all. We told him several times over a period of weeks that perhaps he should go backstage and check things out, but he merely laughed, of course. His book was done and out at that point, and he was interested in publicity.

What was he supposed to do, withdraw it and rewrite it? No, the only thing he was interested in was whether dissenters posed any threat to his book, so we warned him (this was last summer) that Celia Farber’s article was due to come out at some point in a major magazine. None of this mattered, the book was glowingly reviewed in the Times as “well researched” and Greg is now family with the Council of Foreign Relations, fellow alarmist Laurie Garrett’s berth.

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By SHERI FINK
Published: July 13, 2004

THE INVISIBLE PEOPLE
How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time
By Greg Behrman
352 pages. Free Press. $25.

MOVING MOUNTAINS
The Race to Treat Global AIDS
By Anne-Christine d’Adesky
487 pages. Verso. $30

In ”The Invisible People,” Greg Behrman, an AIDS policy coordinator for the Council on Foreign Relations, tracks anemic global AIDS spending through several American administrations, profiling a dizzying array of power brokers. Anne-Christine d’Adesky’s ”Moving Mountains” — by turns journalistic, textbook-like and polemical — discusses the myriad obstacles to preventing and treating AIDS in poor countries but highlights successes that prove it is possible. (Many of these issues are being discussed this week at the 15th International Aids Conference in Bangkok.)

”The Invisible People” grew from Mr. Behrman’s Oxford University master’s degree research on the H.I.V./AIDS pandemic as a threat to American national security. Noting that life expectancy in several African countries had dropped by more than 30 years and that the disease was spreading quickly in Asia and Eastern Europe, he began to wonder, ”What had the United States done to address this crisis?”

Mr. Behrman writes that as the disease emerged in the Ronald Reagan years of the 1980’s, conservative leaders imposed ”a vituperative, ill-informed brand of moralism on policy, making it clear to the administration that there would be a political price to pay for engaging AIDS.” The opening act in the global AIDS tragedy revealed the government’s misguidedly self-interested objective: it banned foreigners with H.I.V. from entering the United States, a policy with little public health merit that remains on the books today.

Money is Mr. Behrman’s useful but necessarily limited gauge of global AIDS-fighting commitment. From 1990 to 1999, as tens of millions of H.I.V. infections accrued worldwide, the majority in sub-Saharan Africa, American spending on global AIDS inched to $215 million from $100 million during the presidencies of George H. W. Bush and Bill Clinton. By comparison, the United States, with roughly one million citizens infected over the decade, invested up to $10.6 billion a year to combat the domestic epidemic.

Well researched and unsparing, ”The Invisible People” presents many of the more maddening and inexcusable reasons for the languishing American response to global AIDS in the 1990’s, including Congressional antagonism to foreign aid spending, ”passive racism,” and disarray among United Nations health officials, who failed to offer plausible global figures on H.I.V. prevalence until 1998. Mr. Behrman also points to the early silence of domestic AIDS activists, African-American leaders and heads of countries being ravaged by the disease, although he fails to suggest what types of health programs could have been used to fight global AIDS before effective treatments existed.

The Clinton administration takes the biggest beating in ”The Invisible People” for not recalibrating American spending, for not viewing AIDS as a global security threat and for opposing South Africa’s move to obtain low-cost generic antiretroviral medication. Inequities in drug access galvanized pioneers like Dr. Paul Farmer, Doctors Without Borders and the Brazilian government to prove what should not have needed to be proved: that residents of lower-income countries benefit from treatment and also often adhere to their drug-taking regimens better than American patients do.

To show what it took in recent years to force down the cost of effective AIDS regimens from $10,000 a year to less than $200 in some countries and to create the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mr. Behrman takes us into meetings between politicians, grass-roots activists, Christian missionaries, African leaders, generic drug manufacturers and a ”motley crew” of luminaries from Bill Gates to Bono to ex-President Clinton himself. Responding to the advocacy, it was ultimately President George W. Bush, making a ”180-degree turn on global AIDS” in 2002, who rallied Congress to commit billions of dollars to the fight.
etc. etc.Anyhow, as the Times tells us, Clinton is aiming to consolidate his place in history with his AIDS triumph, and he is loving very minute of it:

After he left office, Mr. Clinton considered his future with a keen eye on history, analyzing what former presidents had done…..

In recent years, the fight against AIDS has leapt onto the world stage, claimed by Mr. Clinton and his Republican successor, George W. Bush…(Now) Mr. Clinton is warmly embraced across the developing world.

—œGeorge Bush has actually delivered more resources, but Clinton is ten times more popular in Africa,—? said Princeton Lyman, who was American ambassador to South Africa under Mr. Clinton. —œThat—™s because, just like he does everywhere, he portrays that sense that he cares.—?….

In Johannesburg, Mr. Clinton and a frail Nelson Mandela, about to turn 88, clutched each other—™s hands like a long-lost son and his beloved father.

En route to the airport in Lilongwe, Malawi, where crowds of people strained to catch a glimpse of him, Mr. Clinton suddenly halted the motorcade, conducted an impromptu interview in the middle of the road, then plunged into a throng of young men reaching out to touch him.

At a hospital in Mafeteng, Lesotho, Mr. Clinton strolled into a sunny courtyard with 6-year-old Arriet Moeketsi, a little girl in a polka-dot dress. Arriet, who takes AIDS medicines donated by Mr. Clinton—™s foundation, trustingly leaned her face against the former president and never let go of his hands during a prolonged news conference.

This is a pic of poor Arriet, 6, HIV positive and resting her head on the hand of the man who brought her “life saving” ARVs, in Lesotho’s Mafeteng Hospital.

Bill and Melinda were along, since

The two Bills, as they have been dubbed, have taken to doing high-profile AIDS advocacy events together, with Mr. Clinton bringing star power and Mr. Gates his deep pockets.

—œHe plays a unique role in shining a light on the problem,—? said Mr. Gates.

Anyone who wants to get to Clinton might try Ira Magaziner or Tom Hunter, but good luck with that:

From the start, Mr. Clinton had a host of issues on his agenda, but quickly found himself drawn into AIDS. He turned to his old friend Ira Magaziner, a fellow Rhodes scholar and corporate consultant who had managed the Clintons—™ failed health care reform effort. Mr. Magaziner has since led the foundation—™s AIDS program.

The two men discovered in 2002 that the Bahamas was paying $3,500 per person a year for generic AIDS drugs. —œI said, —˜Ira, please find out why in the hell these people are paying $3,500 for $500 drugs,—™ —? Mr. Clinton said…

Since 2004, Mr. Clinton has campaigned to raise the profile of children with AIDS. A scant 20,000 children in the developing world were then getting drug treatment, while more than 500,000 a year were dying. The Clinton foundation has raised $4.4 million to buy drugs for 13,000 children, train health workers, renovate pediatric wings and pay for lab tests.

—œChildren are alive in numbers we couldn—™t have imagined a couple of years ago because of what he—™s done,—? said Peter McDermott, chief of H.I.V. and AIDS programs at Unicef.

Mr. Clinton—™s ambitions seem to grow daily, and his foundation is now branching out in Africa from AIDS into poverty. As he relaxed one recent evening in a sumptuous, $2,260-a-night suite in Johannesburg, with zebra skin rugs underfoot (the lodgings provided to him gratis by a rich South African businessman who owned the hotel), he got excited just thinking about fertilizer…

Mr. Clinton was joined on his trip by Sir Tom Hunter, a Scottish entrepreneur who has promised to spend $100 million of his fortune in collaboration with the foundation, much of it on economic development.

All in all, a publicity triumph not only for Bill but for the Times, which is thus one more step removed from having to face up to its own abysmal record in misreporting the epi-pandemic for 22 years during which not a single article has been printed in the newspaper of record written and edited by anybody free of the HIV∫AIDS meme.

The New York Times
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August 29, 2006
Clinton Makes Up for Lost Time in Battling AIDS
By CELIA W. DUGGER

RWINKWAVU, Rwanda —” Bill Clinton worked the crowd of AIDS survivors, clasping the outstretched hands of children alive because of the AIDS medicines his foundation donated.

Inside the rural hospital here that he recently helped renovate, where Rwandans were hunted down and killed during the genocide he regrets he didn—™t try to stop as president, Mr. Clinton heard people once skeletal from AIDS tell of their resurrections to robust health.

Since he left office more than five years ago at age 54, one of the youngest former presidents ever, Mr. Clinton has made a lasting mark in a cause that he came to only late in his presidency: fighting the AIDS pandemic across Africa and the world.

Few public figures in America have spawned as much speculation about what motivates them as Mr. Clinton. Abroad, even fewer inspire the affectionate reception Mr. Clinton received as he raced across seven African countries in eight days in July. Crowds at roadsides and in hospitals wanted to touch him —” and he obliged by shaking hands, kissing babies and hugging people with AIDS.

Here on Mr. Clinton—™s fourth visit to Rwanda, it was clear the efforts by his foundation had personal meaning. He said he was sorry his administration failed to intervene during the 1994 genocide. —œThe United States just blew it in Rwanda,—? he said flatly. Paul Kagame, Rwanda—™s president, said he had accepted Mr. Clinton—™s repeated apologies.

But on this trip, Mr. Clinton seemed anything but a man tormented by guilt. Rather, he reveled in his role as a private citizen championing people with AIDS.

—œThe reason I do this work I do is that I really care about politics and people and public policy,—? he said in one of several interviews, scornfully dismissing questions about whether his global AIDS work is a form of redemption for what he failed to accomplish on the issue as president, or for the Monica Lewinsky scandal. —œI—™m 60 years old now, and I—™m not running for anything, so I don—™t have to be polite anymore,—? he said. —œI think it—™s all a bunch of hokum,—? he added, calling such speculation psychobabble.

—œI have never met anybody who spent all their time talking about everybody—™s motives who at the end of their life could talk about very many lives they had saved,—? he said.

Mr. Clinton was adamant that he had done all he could about global AIDS with a Congress hostile to foreign aid, though he conceded that his administration fought too long to protect the patent rights of pharmaceutical companies against countries trying to make or import cheaper AIDS medicines.

—˜Everyone Was Worried—™

After he left office, Mr. Clinton faced some skepticism as he took up the cause of people with AIDS dying faraway deaths in poor countries. His administration, which sought more resources to combat AIDS domestically, had a far weaker claim to leadership on AIDS worldwide.

When doctors specializing in public health met him at the William J. Clinton Foundation in Harlem in the fall of 2002, Howard Hiatt, the former dean of the Harvard School of Public Health, bluntly asked Mr. Clinton why those present should expect that —œyou—™ll be able to accomplish now what you didn—™t undertake in your presidency —” an attack on this plague?—?

—œEveryone was worried,—? said Richard Marlink, who headed Harvard—™s AIDS Institute. —œIs this a campaign with photo ops and press releases or a long-term commitment?—?

In the years since, doctors at the forefront of AIDS treatment have worked with Mr. Clinton. Dr. Marlink volunteered to help Mr. Clinton—™s foundation in South Africa. Dr. Hiatt, who serves on the board of Partners in Health, a nonprofit group that works with Mr. Clinton in Rwanda, said the former president —œhas really perceived the seriousness of the problem.—?

Mr. Clinton and his foundation have undertaken projects with two dozen developing countries, raising money to post nurses in rural clinics in Kenya, mustering experts to train hospital managers in Ethiopia and buying drugs for thousands of sick children, among other things.

His foundation also has negotiated steep cuts in the price of AIDS medicines through deals with drug companies that cover more than 400,000 patients in dozens of countries, helping propel momentum for treatment of the destitute.

Dr. Bernard Pécoul, who led a campaign for access to medicines for Doctors Without Borders from 1998 to 2003, credited Mr. Clinton and his foundation for showing independence from the politically powerful drug industry and helping to accelerate the decline in prices for generic AIDS medicines in developing countries.

—œThey have been very clever in supporting generic policy in the United States, a country where it—™s not easy,—? he said. —œAnd sometimes they—™ve been even more courageous than the United Nations system, which is under pressure from member states.—?

The Clinton foundation—™s budget last year was $30 million, raised from private donors. Mr. Clinton, who oversees its operations full time, has plunged into many causes, from childhood obesity to tsunami relief to global warming, but he has made his most substantive contribution on AIDS.

He said Rwanda was one of the first countries he chose to work in because —œthey had a really good chance to dig out of the hole and I wanted to help them do it.—?

For years, he tried to coax Dr. Paul Farmer, known for his work caring for the poor in remote, rural Haiti, to recreate his model of AIDS treatment in Africa, the heart of the epidemic.

Last year, Dr. Farmer and the group he co-founded, Partners in Health, arrived in Rwinkwavu. With support from the Clinton Foundation and others, he has transformed a dilapidated facility that lacked even a doctor into a thriving rural hospital.

More than 1,500 people have been put on AIDS medicines here. Reproducing the pioneering model used in Haiti, Dr. Farmer has community workers, many of them peasants, deliver antiretroviral medicines to people with AIDS every day, minimizing reliance on scarce doctors and nurses.

Like most international leaders and American advocates for people with AIDS in the 1990—™s, critics say, Mr. Clinton—™s efforts on global AIDS did not match the epic scale of the human tragedy as it unfolded across Africa and millions died and were orphaned.

In recent years, the fight against AIDS has leapt onto the world stage, claimed by Mr. Clinton and his Republican successor, George W. Bush.

There is a measure of irony in this. Since 2003, Mr. Bush has marshaled billions of dollars in American assistance for a global assault on the disease, financing lifesaving treatment for hundreds of thousands of people with AIDS. Yet because of his foreign policies, notably the war in Iraq, he is often met by protests when he travels abroad, while Mr. Clinton is warmly embraced across the developing world.

—œGeorge Bush has actually delivered more resources, but Clinton is ten times more popular in Africa,—? said Princeton Lyman, who was American ambassador to South Africa under Mr. Clinton. —œThat—™s because, just like he does everywhere, he portrays that sense that he cares.—?

On his recent tour of Africa —” his fifth since 2001 —” Mr. Clinton showed a remarkable ability to establish a human connection with people he met.

In Johannesburg, Mr. Clinton and a frail Nelson Mandela, about to turn 88, clutched each other—™s hands like a long-lost son and his beloved father.

En route to the airport in Lilongwe, Malawi, where crowds of people strained to catch a glimpse of him, Mr. Clinton suddenly halted the motorcade, conducted an impromptu interview in the middle of the road, then plunged into a throng of young men reaching out to touch him.

At a hospital in Mafeteng, Lesotho, Mr. Clinton strolled into a sunny courtyard with 6-year-old Arriet Moeketsi, a little girl in a polka-dot dress. Arriet, who takes AIDS medicines donated by Mr. Clinton—™s foundation, trustingly leaned her face against the former president and never let go of his hands during a prolonged news conference.

Bill and Melinda Gates, the billionaire philanthropists, watched. Mr. Clinton had visited an AIDS project of theirs in Durban, South Africa, and they had come to Lesotho to see his work. When Mr. Clinton left the hospital with Arriet, a Clinton volunteer asked the Gateses to stay back so photographers could follow him.

The world—™s wealthiest couple seemed to take no offense. The two Bills, as they have been dubbed, have taken to doing high-profile AIDS advocacy events together, with Mr. Clinton bringing star power and Mr. Gates his deep pockets.

—œHe plays a unique role in shining a light on the problem,—? said Mr. Gates, after he made it into the courtyard.

Mr. Clinton has come a long way on global AIDS. For most of his presidency, his trade office fought to protect the patent rights of pharmaceutical companies against attempts by developing countries to make or import cheaper generic medicines. —œI think it was wrong,—? he now says of that approach.

During the first six years of his presidency, federal spending to fight AIDS worldwide stagnated at paltry levels, never topping $141 million.

But by his last budget, spending more than tripled to $540 million, but Mr. Clinton says that was far from enough. Even so, he contends that no one could have done better.

The Role of Congress

The Democrats controlled Congress for only his first two years in office, he pointed out, when —œeverybody—™s obsession—? was the AIDS problem in America. After that, the Republican-dominated Congress that later supported Mr. Bush—™s $15 billion, five-year global AIDS plan fiercely resisted spending on foreign assistance.

—œHave you forgotten what I had in the Congress?—? he asked. —œThat the Republican Congress spent all their time trying to trash me?

—œAnd the only reason they gave money to George Bush for AIDS is they wanted to have something they looked progressive on since they were cutting taxes for rich people like me,—? he said.

Michael Gerson, who was a senior adviser to Mr. Bush on global health issues, noted that the Republican Congress was, in fact, open to persuasion that global AIDS was a spending priority. But he also said the issue had ripened by the time Mr. Bush was president. The price of antiretroviral drugs fell after Mr. Clinton left office, helping change the view that it was too costly and difficult to treat people in poor countries.

But Mr. Gerson also said of the Clinton record: —œI don—™t believe they were visionary or pushed the system. I don—™t think they were thinking big.—?

The debate over whether Mr. Clinton missed a political opportunity to lead the charge on global AIDS years before Mr. Bush seized it is far from over.

Greg Behrman, the author of —œThe Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time,—? offers a split verdict.

—œThere are two acts here,—? he said. —œClinton—™s post-presidential leadership has been extraordinary. As president, though, the record is clear. Clinton was not a leader on global AIDS and the consequences have been devastating.—?

After he left office, Mr. Clinton considered his future with
a keen eye on history, analyzing what former presidents had done.

He concluded that another former Southern governor, Jimmy Carter, a Nobel Peace Prize winner who is now recognized for his work on human rights, democracy and neglected diseases, was —œthe only person who—™d done anything that remotely resembled what I thought I could do.—?

From the start, Mr. Clinton had a host of issues on his agenda, but quickly found himself drawn into AIDS. He turned to his old friend Ira Magaziner, a fellow Rhodes scholar and corporate consultant who had managed the Clintons—™ failed health care reform effort. Mr. Magaziner has since led the foundation—™s AIDS program.

The two men discovered in 2002 that the Bahamas was paying $3,500 per person a year for generic AIDS drugs. —œI said, —˜Ira, please find out why in the hell these people are paying $3,500 for $500 drugs,—™ —? Mr. Clinton said.

They learned the Bahamas was buying through middlemen, so the foundation helped the country purchase directly from Cipla, the Indian generic-drug manufacturer. —œSo our first victory was a lay-down,—? Mr. Clinton said. —œAll of a sudden, they could treat six times as many people for the same amount of money.—?

Opportunities proliferated, and Mr. Clinton—™s enthusiasm grew.

His name opened doors with generic drug makers. With growing demand for AIDS drugs already on the horizon, as well as the economies of scale that come with that, Mr. Magaziner took a team of volunteer consultants to India in 2003 to negotiate for lower prices. Companies opened their books.

—œThe name Clinton in India holds more charisma and credibility than any other American name,—? said Dr. Yusuf K. Hamied, Cipla—™s chairman.

Through cost cutting, spurred by breakthrough talks with companies that supplied ingredients to the drug makers, the team got deals. Cipla, for example, halved the price of the most common AIDS triple-drug therapy, already declining due to competition, to $140 a person per year.

Similarly, Mr. Clinton was able to use his relationships with political leaders, like President Thabo Mbeki of South Africa, who had questioned whether H.I.V. caused AIDS. The country had not begun treating its people for the disease, though almost five million had been infected. —œHe was getting killed in the global press about it,—? Mr. Clinton recalled.

Mr. Clinton, who knew him from his own time as president, met with Mr. Mbeki in 2003 as one politician to another. —œI said, —˜You know, I really want to help you, and as you know, I may be the only one of those involved in this work who—™s never been publicly critical of you,—™ —? Mr. Clinton said he told Mr. Mbeki. —œ —˜But this is something you have to do.—™ —?

Mr. Mbeki soon invited Mr. Clinton—™s foundation to help the country write a comprehensive treatment plan. South Africa now has more than 130,000 people on antiretroviral drugs, still far short of what critics say is needed.

Since 2004, Mr. Clinton has campaigned to raise the profile of children with AIDS. A scant 20,000 children in the developing world were then getting drug treatment, while more than 500,000 a year were dying. The Clinton foundation has raised $4.4 million to buy drugs for 13,000 children, train health workers, renovate pediatric wings and pay for lab tests.

—œChildren are alive in numbers we couldn—™t have imagined a couple of years ago because of what he—™s done,—? said Peter McDermott, chief of H.I.V. and AIDS programs at Unicef.

Mr. Clinton—™s ambitions seem to grow daily, and his foundation is now branching out in Africa from AIDS into poverty. As he relaxed one recent evening in a sumptuous, $2,260-a-night suite in Johannesburg, with zebra skin rugs underfoot (the lodgings provided to him gratis by a rich South African businessman who owned the hotel), he got excited just thinking about fertilizer.

Mr. Magaziner has people riding trains and trucks that carry fertilizer to figure out why a commodity that should enable farmers to grow more food and avoid hunger costs so much in Africa.

—œYou follow the trail!—? Mr. Clinton said.

Mr. Clinton was joined on his trip by Sir Tom Hunter, a Scottish entrepreneur who has promised to spend $100 million of his fortune in collaboration with the foundation, much of it on economic development.

—œTom, where—™s Tom?—? Mr. Clinton called out excitedly as he chatted with representatives of a nonprofit group that promotes solar-powered lights during an event here in Rwinkwavu.

What if Rwanda could manufacture such lights locally? Mr. Clinton mused. Why not electrify villages so children can study at night? —œIt might be possible to get a factory here that would serve all of central Africa!—?In this context it is worth recalling how Abigail Zuger at the Times after the Toronto conference in Fight Against AIDS: Small Triumphs, Sunny Optimism and Grim Reality (Aug 22) noted how impressive it is that such godlike presences as the two Bills and wife Melinda should arrive in their midst to bestow their charisma and powerful blessings upon the less fortunate.

Readers who know what is really going on in HIV∫AIDS must have been excited for a moment when they read the line that ended her third paragraph:

Bill, Bill and Melinda dropped into our world for a few days here. It was an unsettling experience, much like coming home from work to find Mr. Gates regrouting your bathroom shower, Mr. Clinton fixing that broken window, and Mrs. Gates cheerily watering the plants.

Famous strangers were suddenly all over our turf, up on the podium at the International AIDS Conference talking with fluent enthusiasm about adherence and second-line drugs, microbicides and pre-exposure prophylaxis.

If they can make some order in our house, that’s fine. We can certainly use the help. But have they been warned that the foundation is irremediably cracked and leaking?

But it was not the long awaited revelation that there is something theoretically rotten in the house of Gallo, just the useful view that building up the health infrastructure is a vital component of bring health aid to Africa. Well done Abigail!

Once you start taking care of people, there is no end. It takes a real health care system to treat even a single illness; AIDS drugs given without one are, in the end, just very expensive scaffolding.

All they do is let people live long enough to need everything else — TB drugs and decongestants, insulin and hemorrhoid creams, cardiac catheterizations and hip replacements, mosquito netting, malaria pills and polio vaccines. Idealists would point out that food and water, housing, jobs, autonomy and civil rights should probably head that list.


The old generation of AIDS celebrities now often skips this gigantic biennial event. (Robert Gallo, the co-discoverer of H.I.V., complained to a Toronto newspaper about the ”circus” atmosphere and the lack of quality science.)

And so this year’s flashing cameras were aimed not at hostile activists and defensive researchers screaming at one another, but at Mr. Clinton and Mr. and Mrs. Gates.

What a pleasant change. This polished threesome may not grasp the more abstruse science of AIDS, but they seem reasonably familiar with the basics. And they are so optimistic as they describe the small triumphs that, thanks to the drugs their money is buying, are now studding the bleak landscape of AIDS in the developing world.

Mr. Gates even told us he sees a ”happy ending” down the line.

It was nice to hear, but those of us who work in the developed world can tell him right now that his project, like the worst nightmare of a home renovation, will not have an end.

With our 10-year head start in disbursing AIDS drugs, we have learned many times over that the drugs are just the beginning. Once they are bought and dispensed, the work only gets harder. Side effects and failures are just part of it. Eventually, inevitably, you have to deal with that leaky foundation — the health care system itself.

AIDS drugs demand an infrastructure. It has taken this country almost 20 years to cobble the first layer together: a network of people trained to administer drugs and watch for problems. At its best now, in states like New York, it functions like a smooth machine, delivering freely available medications, all the necessary tests and probably some of the best, most comprehensive AIDS care in the world.

Still, the beneficence stretches only so far.

And so when patients in our New York clinic need an appendectomy, a cardiac bypass, hernia surgery or a shattered ankle repaired, their wonderful state-sponsored AIDS-specific medical insurance will not pay.

For chemotherapy, a new hip, intensive physical therapy, a prolonged psychiatric hospitalization, cataract surgery, a hearing aid or the services of a good podiatrist, we simply have to cross our fingers and send them out into the fractured disaster that is the rest of our health care system and hope for the best.

Jackie found a breast lump a few years ago. By the time the mammogram had led to the biopsy and to the oncologist and the surgeon and the radiation and the chemotherapy, months had passed with that excruciating slowness familiar to those who know the scheduling habits of overcrowded Medicaid clinics. If the process had taken a few weeks instead of six months, would she have lived?

Bernard never even made it from the neurologist to the neurosurgeon before his brain tumor — a huge one, but not malignant, as it turned out on autopsy — put him into a terminal coma.

Charles, never much for medical care to begin with, gave up after a long afternoon’s wait in the cardiology clinic and just went home. A slightly more forgiving system may have saved his life.

Every one of them had AIDS which we had managed, with huge effort, to get under perfect control. The same goes for dozens of our other patients who have died from drug addiction or depression or even random urban violence.

What a waste, we say, every time.

Once you start taking care of people, there is no end. It takes a real health care system to treat even a single illness; AIDS drugs given without one are, in the end, just very expensive scaffolding.

All they do is let people live long enough to need everything else — TB drugs and decongestants, insulin and hemorrhoid creams, cardiac catheterizations and hip replacements, mosquito netting, malaria pills and polio vaccines. Idealists would point out that food and water, housing, jobs, autonomy and civil rights should probably head that list.

Can Mr. Gates’s billions really begin to pay for a new world? That’s what it will take for his happy ending.

Abigail Zuger, who writes regularly for The Times, is a physician in Manhattan.
Barack and wife test negative in Kenya

Meanwhile the Great Black Hope of the Democratic party, the silver tongued Barack Obama has also been touring Africa and on Saturday (Aug 26) he capped his visit, wildly cheered by crowds everywhere he went, by taking an HIV test in Kenya, with his wife.

According to the science, Obama could have been in the very small fraction of the non gay US population which is HIV positive not through heterosexual adventurism (doesn’t transmit HIV at all, according to the biggest study) but perinatally ie through his umbilical cord at birth.

No such luck. Both tested negative. One lingers on the vision of what would have happened if either had tested positive, however. Retesting would have been hasty, but supposing that had been positive too.

Then perhaps Barack Obama would have taken a second and more penetrating look as to what was going on in this scientifically compromised arena, where the peer reviewed literature tells us that HIV is a mere pussy cat of a virus, and that drugs and nutrients are the cause and cure of the syndrome.

Then he might have conferred more profitably with President Thabo Mbeki of South Africa, still the only politician and statesman of international stature who is capable of reading the NIAID censored critique of HIV?AIDS for himself and demanding answers to the obvious outrages to common sense.

On Sunday, he visited a program to start small businesses, and also stopped by an AIDS prevention program in Kibera. The program is affiliated with the University of North Carolina and he met with students who are part of local abstinence campaigns. The group, called Carolina for Kibera, estimates one in five of the slum’s population is HIV positive.

AIDS prevention has been a theme of Obama’s visit. On Saturday, he and his wife, Michelle, underwent public HIV tests at a hospital in Kenyan city of Kisumu in an effort to reduce the public stigma associated with HIV testing.

But if politics is the art of the possible, who can blame Obama, Clinton, or for that matter Greg Behrman, if they ever did look into the situation and see it for what it really is, and take no action? This is no longer a matter of a scientific correction that might save a lot of lives. It is a huge political and economic juggernaut which will crush any politician or author who stands in its way, unless and until the tipping point is somehow reached in the world of ideas, where madmen scribbling sometimes change the world of action.

But even though the editors of Harpers have distinguished themselves historically by taking the first all important step of bringing the topic into the mainstream of political debate, given the countervailing power of the forces of celebrity, commercial interests, institutional inertia, media and electoral politics and mental inertia on the part of most people involved, there may be a long way to go before that tipping point is reached.

At this stage, however, every voice raised against the status quo is important, however, particularly on the Web. So every reader is encouraged to contribute to Comments here and to spread the word on our behalf. And to those that have done so already, many thanks.

See Obama Visits Notorious Slum in Nigeria

August 27, 2006
Obama Visits Notorious Slum in Nigeria
By THE ASSOCIATED PRESS

Filed at 6:20 p.m. ET

NAIROBI, Kenya (AP) — Sen. Barack Obama visited one of the world’s worst slums Sunday, where he told residents he wants everyone in America to know about their plight and promised to push the U.S. and Kenyan government to help.

About a third of Nairobi’s total population, at least 700,000 people, are crammed into a single square mile in the slum of Kibera, with little access to running water and other basic services.

”I love all of you, my brothers — all of you, my sisters” Obama told a crowd in Kibera. ”I want to make sure everybody in American knows Kibera. That’s why we have all the news crews.”

The Illinois Democrat arrived in Kenya Thursday for his first visit to his father’s homeland since taking office.

On Sunday, he visited a program to start small businesses, and also stopped by an AIDS prevention program in Kibera. The program is affiliated with the University of North Carolina and he met with students who are part of local abstinence campaigns. The group, called Carolina for Kibera, estimates one in five of the slum’s population is HIV positive.

AIDS prevention has been a theme of Obama’s visit. On Saturday, he and his wife, Michelle, underwent public HIV tests at a hospital in Kenyan city of Kisumu in an effort to reduce the public stigma associated with HIV testing.

”Everybody in Kibera needs the same opportunities to go to school, to start businesses, to have enough to eat, to have decent clothes,” Obama said over a megaphone as hundreds of cheering people surrounded him.

The slum stands in sharp contrast to the elegant homes, luxurious hotels and impressive office buildings found elsewhere in the city. Kibera residents are mostly squatters, with no legal claim on the land.

Kenyans have claimed Obama as one of their own, even though he was mostly raised in Hawaii and did not know his Kenyan father well.

Obama’s father, also named Barack, grew up herding goats and going to tin-roof schools, but he won a college scholarship in Hawaii. There, he married Obama’s mother. The two soon separated, however, and Obama’s father eventually returned to Kenya and worked as a government economist.

His father died in a car crash in 1982, leaving three wives, six sons and a daughter.

Earlier Sunday, Obama flew to Wajir, a rural area in northeastern Kenya near the borders with Somalia and Ethiopia. The area is at the epicenter of a severe drought that has hit the Horn of Africa region after erratic and insufficient rains during the April-June season.

Malnutrition levels in parts of the northeastern province are more than double the 15 percent level at which an emergency is declared by U.N. standards.

Obama said he inspected a project to help prevent disease among the herds of cattle, goats and camels raised by the region’s Muslim herders.

He also learned about efforts to resolve conflicts among local clans, which he said is important for preventing the violence and turmoil in neighboring countries.

Obama and his family traveled Saturday to Nyangoma-Kogelo, a tiny village in the rural west where his father grew up. Obama stopped at his father’s grave and also visited his 85-year-old grandmother.Obama Gets a Warm Welcome in Kenya

The New York Times
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August 26, 2006
Obama Gets a Warm Welcome in Kenya
By JEFFREY GETTLEMAN

NAIROBI, Kenya, Aug. 25 —” If Senator Barack Obama is ever thinking of running for president —” or changing careers to rock star —” he got excellent practice in Nairobi on Friday.

Thousands of people lined the streets, waiting hours in the intense sunshine just for a glimpse of him.

Local newspapers overflowed with breathless coverage, including the headline, —œVillage beats the drums for returning son.—?

Everywhere he went he had to part seas of shutter-snapping journalists and mobs of ecstatic fans.

A riot nearly broke out when he slipped past his bodyguards at a downtown event and simply smiled at the crowd.

—œObaaammmaaaa!—? the people yelled.

Mr. Obama, a freshman Democratic senator from Illinois, was in Kenya—™s capital on Friday as part of a tightly scripted four-country tour in Africa to raise awareness for AIDS and to reconnect with his roots.

His father was a goat herder-turned-economist from western Kenya and, though Mr. Obama was never close to him or spent much time in Kenya, many Kenyans claim him as one of their own.

—œHe—™s our lion,—? said George Mimba, a computer consultant, after shaking Mr. Obama—™s hand.

—œHe will help us,—? said Bob Osano, a marketing agent stuck behind a metal barricade.

Schools in western Kenya have been renamed for Mr. Obama. Unofficially, so has a popular brand of beer.

All week, people near Nyangoma-Kogelo, the village where Mr. Obama—™s father grew up, were scrambling to prepare a welcome fit for royalty, fixing roads, practicing skits and ironing their Obama T-shirts.

On Saturday, Mr. Obama plans to visit the village and sit in a tin-roof house with his grandmother, who speaks no English and will be waiting for the rising Democratic statesman with an egg, apparently a grandmother-grandson tradition in these parts. He also plans to take an H.I.V. test in public to help promote awareness of the virus.

Mr. Obama seems to be many things to people here: a role model; a black man succeeding in a white man—™s world (he is the only African-American in the United States Senate); a friend in a high place; and the embodiment of American opportunity and multiculturalism (his mother is white and from Kansas). In Kenya, people who are half-white and half-black are called —œpoint fives.—?

Wycliffe Muga, a local commentator, said the backdrop to the excitement was that many Kenyans are fed up with their own leaders and the country—™s persistently high levels of corruption and crime. They place their hopes in outsiders like Mr. Obama, who they think will help from abroad.

—œCall it the donor mentality,—? Mr. Muga said. —œPeople are saying, —˜We have a senator now; we have a man in power.—™ They forget he is a U.S. senator representing the state of Illinois.—?

It was a point Mr. Obama had to make when he was asked at a news conference on Friday about lowering American subsidies on farm produce so African farmers could compete.

He responded that many of his constituents were soybean farmers. —œIt—™s important to me to be sure I—™m looking out for their interests,—? he said. —œIt—™s part of my job.—?

Mr. Obama, who sits on the Senate subcommittee for African affairs, used the news conference to show off his fluency in all things African.

He said —œZimbabweans were ill served—? by their dictatorial president, Robert G. Mugabe. He spoke of the troubled Darfur region of Sudan, saying, —œWe—™re on the verge of an enormous humanitarian crisis.—?

Regarding Kenya, he talked about his meetings earlier in the day with President Mwai Kibaki and the opposition leader Uhuru Kenyatta.

He praised Kenya—™s lack of major ethnic conflict and its history of clean elections. But he added, —œYou—™re starting to see the reassertion of ethnic identity as the basis for politics,—? which he said was not good.

Before arriving in Kenya, Mr. Obama visited South Africa, where he met with apartheid-era freedom fighters and people with AIDS. After five days in Kenya, he will travel to Chad to speak with refugees from nearby Darfur, and to Djibouti, where American forces are stationed in a counterterrorism operation.

Of course, he could not escape Beltway politics, even 7,500 miles away.

One Kenyan journalist, after a long preamble on the virtues of the American Constitution, asked him, —œWhat will you do to liberate Congress from the White House?—?

Mr. Obama threw a few jabs at the Bush administration for not consulting lawmakers enough and vowed, —œYou—™re going to see a change in the balance of power soon.—?

And then came the questions everybody wanted to ask: Does he harbor presidential ambitions? If so, will he run for president in 2008?

—œI don—™t know what to do with these two questions,—? Mr. Obama said, cracking a toothy grin.

—œThe day after my election to the United States Senate, somebody asked me, am I running in 2008. I said at that time: —˜no.—™

—œAnd nothing so far,—? he said, ever so slightly stressing those last two words, —œ has changed my mind.—?

McKiernan quotes Sam Walter Foss

August 28th, 2006


Prominent blog challenger revealed as earnest truthseeker

Well known and prolific HIV∫AIDS blog comment poster with the moniker “McKiernan” finally broke down on the Larry Altman’s Guide to AIDS Conferences comment thread last night and revealed that he was no troll or spoiler, as many other posters had thought, but an earnest seeker after truth in the realm of HIV?AIDS. An ex Air Force man who lost lost two sisters to cancer and chemotherapy, he retains a certain skepticism as to the economic motivations of modern medicine.

McKiernan clinched this surprise revelation by quoting from a verse which describes the behavior of paradigm scientists and their cult like followers in the TAC and elsewhere to a T:

The Calf-Path

by Sam Walter Foss

(NH 1858-1911)

One day, through the primeval wood,

A calf walked home, as good calves should;

But made a trail all bent askew,

A crooked trail as all calves do.

Since then three hundred years have fled,

And, I infer, the calf is dead.

But still he left behind his trail,

And thereby hangs my moral tale.

The trail was taken up next day,

By a lone dog that passed that way.

And then a wise bell-wether sheep,

Pursued the trail o’er vale and steep;

And drew the flock behind him too,

As good bell-wethers always do.

And from that day, o’er hill and glade.

Through those old woods a path was made.

And many men wound in and out,

And dodged, and turned, and bent about;

And uttered words of righteous wrath,

Because ’twas such a crooked path.

But still they followed – do not laugh –

The first migrations of that calf.

And through this winding wood-way stalked,

Because he wobbled when he walked.

This forest path became a lane,

that bent, and turned, and turned again.

This crooked lane became a road,

Where many a poor horse with his load,

Toiled on beneath the burning sun,

And traveled some three miles in one.

And thus a century and a half,

They trod the footsteps of that calf.

The years passed on in swiftness fleet,

The road became a village street;

And this, before men were aware,

A city’s crowded thoroughfare;

And soon the central street was this,

Of a renowned metropolis;

And men two centuries and a half,

Trod in the footsteps of that calf.

Each day a hundred thousand rout,

Followed the zigzag calf about;

And o’er his crooked journey went,

The traffic of a continent.

A Hundred thousand men were led,

By one calf near three centuries dead.

They followed still his crooked way,

And lost one hundred years a day;

For thus such reverence is lent,

To well established precedent.

A moral lesson this might teach,

Were I ordained and called to preach;

For men are prone to go it blind,

Along the calf-paths of the mind;

And work away from sun to sun,

To do what other men have done.

They follow in the beaten track,

And out and in, and forth and back,

And still their devious course pursue,

To keep the path that others do.

They keep the path a sacred groove,

Along which all their lives they move.

But how the wise old wood gods laugh,

Who saw the first primeval calf!

Ah! many things this tale might teach –

But I am not ordained to preach.

In his honor, we are putting up a symbolic picture of our well known commentator checking out a HIV paradigm follower:

Elle “science writer” lets down Maggiore

August 28th, 2006


Gretchen misleads Christine, reports semi-fictional piece for Elle

Elle editor sends corrections to its lawyers

A member of the press reporting on HIV?AIDS turned in a typically disbelieving, fact-mangled profile on dissenter Christine Maggiore to Elle magazine, which publishes it this month as Gretchen Reynolds’ article “The Believer” (Elle, September 2006. on newstands now, $4).

The Contents page (buried some 60 ads deep from the cover) of the 560 page, ad thick Fashion Shopping Celebrity Sex How To glossy celebration of the power of female charms describes it thus, one all important factual error right there in the headline:

468 The Believer
Activist Christine Maggiore maintains that HIV does not cause AIDS, and not even her daughter’s death from the disease could change her mind. By Gretchen Reynolds

Elle now has its lawyers poring over the copious collection of errors objected to by Christine which were racked up by the unfortunate female reporter, a freelance. All the errors were published despite fact checking over the telephone with Christine Maggiore, which omitted some checks and ignored Maggiore’s corrections to others.

Needless to say, Maggiore is smarting from the betrayal of trust as well as from the inaccurate, discrediting reporting. Reynolds led her to believe that she respected Maggiore’s point of view and she was not going to be the only source critical of HIV?AIDS quoted in the piece. In fact it is a profile of Maggiore as misguided wretch who failed to follow the precriptions of conventional wisdom and paid for it.

Big, big mistake

Big mistake. Christine Maggiore is quite capable of defending herself. She writes:

Last fall, I met with Gretchen Reynolds, a freelance journalist on assignment from Elle, a fashion magazine that includes articles on health and current affairs. A self-described science writer, Reynolds said she was working on piece about AIDS that would explore unanswered questions about HIV, introduce some the individuals raising those questions, and include something on the controversy surrounding the death of my daughter.

As it turns out, Reynolds’ dishonesty was not limited to her pitch. I am the sole focus of “The Believer,” a mendacious and sensationalistic article that abstains from any intelligent examination of science fact. Reynolds errors are so extravagant and numerous, the magazine’s editor-at-large, Lisa Chase, asked me for a complete list to forward to Elle’s legal department for investigation.

She got the list. Here it is. First, some selections. The wretched Gretchen can’t seem to get much right, even that which she can observe with her naked eye, such as the skirt length Christine was wearing, or the color of her husband’s hair. But worse, she maligns even the quality of Christine’s relationships with cheap mistakes.

A two-month pre-coital courtship with my husband is described as “they met, dated once or twice, had sex.”

My two day wait for treatment of a faulty root canal is described as me “still being bothered by an excruciating mouth abscess” a year after my daughter’s death.

My husband’s four-day trip to New York last year was described as him “spending long periods away from [home] in New York and elsewhere.”

I am described as wearing a “cut off denim miniskirt” when I wore a skirt with a hemline that falls mid-knee.

The article states, I “scheduled the appointment [for an abortion], arrived at the office, and then, at the last moment, uncertain, unsettled, left.” In fact, as I explained to Reynolds, a doctor halted the procedure after a pre-operation ultrasound mistakenly indicated I was 15 weeks pregnant.

My husband is described as having “dark, unruly hair” when his hair is sandy blonde and straight.

The article includes a fictitious scene in which I “set my son up with his homework at the kitchen table.” In fact, school he attends does not assign homework until third grade which he begins this fall.

These examples of blatant sloppiness are only the minor errors, as Maggiore rates them, but they reveal a carelessness for the reputation and dignity of the source which already condemns the hapless Gretchen as incompetent and irresponsible, if not downright biased. (On the other hand, let’s remember that freelance reporters do not normally get paid enough for their work to allow them to do it as well as they would wish).

The list of major errors reveals that Gretchen completely messed up her description of Eliza Jane’s symptoms, misreported Maggiore’s critique of the process and of HIV and evidently automatically assumed that Christine and her experts were wrong, ie that child died of HIV?AIDS, when she clearly died of an allergic reaction. In other words, the writer was not capable of imagining that conventional wisdom may be wrong, contrary to the impression given in her introduction to Christine. So the whole interview was conducted under false pretenses.

What the list of errors brings out is just how faulty the assumed expertise (and ethical conduct) of journalists, doctors and coroners may be, but it will also be useful now as a corrective to the ongoing hideously false tale of Christine as misguided challenger of modern scientific professionalism who paid for her “mistake” with the life of her daughter.

Is Gretchen John Moore’s alter ego?

This obscene and almost criminal libel, which is now happily peddled by scientists and activists at AIDSTruth.org who should know better – and specifically stated by John P. Moore of Cornell at the session on HIV Science and Responsible Journalism, to his everlasting shame – is actually dispensed with by one single error that Christine lists, the plain fact that the child’s lymphocyte count was as high as anyone would wish.

12) In her “quick primer” on AIDS, Reynolds mentions that AIDS conditions occur when CD4 T lymphocyte cells are depleted, weakening the body’s ability to fight off infection,” but does not mention that my daughter’s total lymphocyte count at the time of her death was well above normal and five times higher than World Health Organization’s guidelines for diagnosing AIDS via total lymphocyte count (Costello C et al. Predictors of low CD4 count in resource-limited settings. J Acquir Immune Defic Syndr 39: 242-248, 2005).

Eliza Jane died of allergy, not AIDS

In other words, Christine Maggiore’s infinitely precious daughter plainly did not die of HIV?AIDS, but at the hands of conventional medication with known risks.

As she herself has said,

“I believe the unfortunate irony in this situation is that the one time we were asked to and that we complied with mainstream medicine, we inadvertently gave our daughter something that took her life.

We made that point in A lay dissenter’s travails and courage – Christine Maggiore: A personal tragedy, our original post (May 19 2005) on this tragic tale, and we can only hope that this vile process of the press magnifying the tragic irony by reporting the lie instead of the truth will come to a halt with Elle’s so far responsible treatment of Christine’s corrections.

Hardly a serious magazine, but still damaging

But it is hard to imagine that the magazine will print any major correction, or if it did that the readers would notice. Flipping through it, in fact, it is clear that it probably had no business treating the topic in the first place, especially if it didn’t think there was something to Christine’s stance. The concerns of almost all the coverage seem to center on enhancing the attraction of its readers for the opposite sex, either in glamor (Lindsay Lohan is the cover story just now (pics)), clothing, cosmetics or health, and standard HIV drugs are no way to enhance your health or attractions for the opposite sex.

The news it should be bringing its readers is that the mainstream medical and scientific literature tells us that if they fear HIV, they don’t have to worry about contracting it from successful suitors, even if one is HIV positive. HIV simply doesn’t transmit, heterosexually.

The woman it should profile next is the savior of all heterosexual lovers from the fiendish witchcraft of the HIV?AIDS paradigm, Nancy Padian. Let’s hope editor Lisa Chase can assign a writer who can get her facts straight on that one.

We suggest a chastened Gretchen herself, now that she will learn the error of her ways with the embarrassing process of being grilled by the Elle lawyers.

The basic problem is endemic

What’s of more general concern is the evidence that the writer, an obviously smart and accomplished professional, simply is incapable of true balance ie of giving Christine full credit for her view, ie believing that Christine has valid reasons to contradict the conventional wisdom, or at least of giving her views equal credit with those of the paradigm footsoldiers that she, the reporter, consults. Though a practiced writer of talent Reynolds is apparently not aware that a global monster of medical belief in HIV∫AIDS can have a very small head, that is to say, be initiated and controlled by the one or two scientists who originated this misdirection, and the federal bureaucrats who diverted all AIDS funding into it and protected it from nearly all media review.

The truth is that this is par for the course, and quite predictable and understandable. The idea that the scientific critique of HIV∫AIDS is not a conspiracy theory on the same level as the 9/11 is not going to get through unless the writer is shown the scientific literature, and given time to adjust to the knowledge of its existence and its apparent validity, in that so far it offers an alternative explanation for all that has happened in HIV∫AIDS, and one much more in line with mainstream research now than the original speculations of how HIV caused AIDS.

Apparently Christine Maggiore may have made the mistake of not having plenty of the key literature on hand, and merely argued her own case based on her own excellent book and common sense. This is simply not enough to persuade mainstream reporters and editors, even ones who understand that sometimes conventional wisdom is science and in medicine is proved wrong. Judging from the piece this is what happened, though it is no fault of Maggiore if the writer didn’t give her a chance to present her case in convincing fashion, which is likely.

All in all, as the experience of Celia Farber at the hands of the Observer reporter showed earlier, the chances of even a smart and sophisticated writer catching up in several weeks with what is going on in HIV∫AIDS well enough to educate his or her editors is low to non existent, especially if a publication has zero intellectual or serious public affairs content, and no investigative side at all, as is evident in the case of the ad-fat Elle and its alluring commercial celebration of the grand prizes of sexual and social success on behalf of its readers.

Elle celebrates belief, not skepticism. Thus the upside down title, The Believer, when the woman profiled is precisely a disbeliever, which is her entire claim to fame. Her view is represented as “faith” – the word is used in the article headline:

The Believer: For more than a decade, HIV-positive activist Christine Maggiore has fought against the assertion that HIV causes AIDS. Last year, he young daughter died of AIDS, and not even that could shake her faith. By Gretchen Reynolds.

In line with this stifling, foregone conclusion of an introduction, her predicament is represented as one of clinging to a belief even when the death of her daughter has exacted a price for what is represented as an unwarranted disdain for authority, medicine, science and sense, as expressed by the pieties mouthed by Jay Gordon, the primary pediatrician chosen by the trusting parents who has belatedly decided it was AIDS that the child suffered from, though it wasn’t his opinion at the time. Now he is saying foolishly (if the article is accurate):”I feel we failed that child…We could have saved her. I regret this case more than any I’ve ever had in my career.” This looks like utter rubbish. Saved her how? With HAART? The credulous Reynolds doesn’t even ask.

Perhaps the most objectionable lines in the piece are these, a brief assumption of the role of judicious arbiter on the part of the writer which is entirely unwarranted:

Modern science cannot, at least not yet, explain all aspects of AIDS. But, to be frank, it does a more persuasive and dispassionate job than Maggiore.”

The paradigm’s role players now covering their asses are more “persuasive” to Reynolds, it seems, than the mother who has lost a child the one time she entrusted her welfare to standard medicine, though applied it seems by a Denver pediatrician who practices “anthroposophical” medicine, he says, according to the article (shades of Rudolf Steiner! Perhaps he supplies patients with Hawthorne Valley Farm yogurt, certainly the best yogurt in the world).

Oh sure. The mouthpieces of unexamined conventional wisdom are in their “dispassionate” way more convincing than an intelligent woman who has studied the topic for years, written one of the most cogent books on the subject, staked her reputation in every way on the conclusions of her independent study, and whose infinitely loved daughter was the subject of the treatment which Dr. Gordon might have perpetrated, he says, if only he had suspected that Eliza Jane was HIV positive (the coroner has never claimed she was).

Here’s a decent piece about Christine

If the sloppy and petty-authority-credulous Gretchen would like to check out a respectable article on Maggiore, she should read this one for a start, on Gadfly, The Trials and Tribulations of Christine Maggiore by Kathleen F. Phalen. Kathleen Phalen is everything that Reynolds is not – capable of independent thought, for one, and capable of treating her source with the respect that she deserves.

(The email address of editor-at-large Lisa Chase and of the wretched Gretchen is included in the notes below – click “show” to expand. With Slate now reporting this sentence from Reynold’s copy, we suggest she deserves all the complaints she gets: “Modern science cannot, at least not yet, explain all aspects of AIDS. But, to be frank, it does a more persuasive and passionate job than Maggiore.”)

Facts from Christine Maggiore:

Elle Magazine Makes Me a Believer

Last fall, I met with Gretchen Reynolds, a freelance journalist on assignment from Elle, a fashion magazine that includes articles on health and current affairs. A self-described science writer, Reynolds said she was working on piece about AIDS that would explore unanswered questions about HIV, introduce some the individuals raising those questions, and include something on the controversy surrounding the death of my daughter.

As it turns out, Reynolds’ dishonesty was not limited to her pitch. I am the sole focus of “The Believer,” a mendacious and sensationalistic article that abstains from any intelligent examination of science fact. Reynolds errors are so extravagant and numerous, the magazine’s publisher, Lisa Chase, asked me for a complete list to forward to Elle’s legal department for investigation.

Below please find my letter to Ms. Chase along with a summary of Reynolds’ deviations from reality. The article is found in the September issue of Elle, and if you can make your way through all the spins without becoming nauseated, please consider sending your own comments to editor-at-large Lisa Chase (lchase@hfmus.com) and writer Gretchen Reynolds (gretchenxr@msn.com)

===

Dear Lisa,

Thank you for your response to my concerns regarding Gretchen Reynolds’ article “The Believer” (Elle, September 2006).

As I mentioned during our telephone conversation, I asked Corrie Pikul for permission to tape record the fact check after noting two false claims at the beginning of our review:

1) That my former boyfriend had died of AIDS years ago, when in fact, he is alive and well.

2) That I held up my children to cheering crowds on stages and at rallies, when in fact, my children have never joined me on a stage or at any public event.

Below is a list of most of the errors in the article, which are divided between points major and minor as per our discussion. Please note that I provided Ms Reynolds with documents and explanations for all points of fact listed here.

I look forward to learning how this matter can be resolved, and in the meantime, am grateful for your interest and involvement.

With appreciation,

Christine Maggiore

Major Errors:

1) Reynolds states that “In all probability, Eliza Jane became infected with HIV during gestation, labor or breastfeeding,” when in fact, the autopsy report does not give her HIV status, and we have no laboratory evidence from the coroner of a positive HIV test, despite multiple requests for such evidence by our attorneys.

2) Reynolds states that the coroner found “strands of HIV’s molecular proteins throughout [my daughter’s] inflamed brain” when in fact, her brain was normal (not inflamed) per a CAT scan taken at the emergency room, per the findings at autopsy, and per a neuropathology exam included in the autopsy report. Further, the finding of a single protein, rather than “strands of HIV’s molecular proteins,” was added as an amendment to coroner’s report four months after the original autopsy.

3) Reynolds claims that “the pathologists didn’t order an HIV test in the normal course of investigating the death of a white, middle class three year old
” as if race and income dictate testing decisions. Instead, the coroner’s office has stated that cases of unexplained death “are not routinely tested for HIV because AIDS is so obvious.”

4) Reynolds changes my definition of pneumonia from the correct one, “inflammation of the lung caused by disease,” to a medically incorrect interpretation, “swelling of the lungs,” and falsely attributes this mistake to me. The correct definition is crucial to the story as my daughter’s autopsy report states that medical examiners found “no inflammation” of her lungs, thereby ruling out pneumonia.

Reynolds compounds this error by omitting a correct reference to swelling, that is, that the autopsy notes swelling of all my daughter’s vital organs, a hallmark of toxic reaction, especially in lungs described at autopsy as having “no inflammation.”

5) Reynolds claims my daughter endured “a day of nausea, vomiting and wheezing,” before she died, a description of events that is not in 911 transcripts; in medical, EMT or hospital records; in my testimony included in the autopsy report; or in my interview with Reynolds.

Please note that the error about “a day of vomiting” was specifically corrected during the fact check yet appears in the article nonetheless, and the unsubstantiated allegation that my daughter was also “wheezing” and had “nausea” was not mentioned during the fact check.

6) Reynolds claims that, “a number of pathologists have examined both the original autopsy and the alternative version. All have publicly concluded that the original was correct,” when disagreement with the original findings by pathologists and other medical experts appears in the public record. In fact, the “alternate version” of the original autopsy was published in a peer reviewed medical journal with an editorial board consisting of 10 PhDs and 12 MDs with whom I have no association.

7) Reynolds claims my response to the coroner’s September declaration was “an immediate ‘it’s not true!'” when in fact, my first public statement on the issue came during a December 5th broadcast of ABC’s PrimeTime, and did not contain the words “It’s not true!” (Per the program transcript: “I believe the unfortunate irony in this situation is that the one time we were asked to and that we complied with mainstream medicine, we inadvertently gave our daughter something that took her life.”)

8) Reynolds claims I “fought back” against the September declaration my daughter died of AIDS by hiring a pathologist. In fact, the pathologist’s request to receive a copy of the autopsy report was submitted to the coroner’s office in May, four months before the declaration was issued.

9) Reynolds claims “as soon as Eliza Jane had been declared dead, a large, unwieldy investigative mechanism swung into action” when in fact, the police investigation began several weeks after her death, and the Department of Children and Family Services was not involved until four months later.

10) Reynolds states that “DCFS closed its investigation after insisting that [my son] be tested for HIV or lose custody” when in fact, Charlie had three times tested HIV negative prior to the DCFS investigation. As reported in the Los Angeles Times, “After reviewing recent test results from three labs showing that the boy is HIV-negative, the Los Angeles County Department of Children and Family Services is expecting to close its child endangerment investigation

11) Reynolds claims, “When I ask [Maggiore] about the current HIV tests that isolate actual viral RNA, she dismisses them as meaningless, saying they reveal only ‘protein strands,'” when in fact, I cited the test kit’s disclaimer for Reynolds which states that it is “not intended to be used as a screening test for HIV or as a diagnostic to confirm HIV infection.”

12) In her “quick primer” on AIDS, Reynolds mentions that AIDS conditions occur when CD4 T lymphocyte cells are depleted, weakening the body’s ability to fight off infection,” but does not mention that my daughter’s total lymphocyte count at the time of her death was well above normal and five times higher than World Health Organization’s guidelines for diagnosing AIDS via total lymphocyte count (Costello C et al. Predictors of low CD4 count in resource-limited settings. J Acquir Immune Defic Syndr 39: 242-248, 2005).

13) Reynolds states that my daughter had “sores in her mouth suggestive of herpes” when the autopsy report makes no mention of sores of any kind in her mouth.

14) Reynolds writes that I looked into “HIV deniers
at the suggestion of a friend,” omitting the well known fact that a year into my positive diagnosis, I experienced a series of conflicting HIV test results that fluctuated between positive, negative and indeterminate, and that this prompted my investigation into AIDS science.

15) Reynolds quotes Dr Jay Gordon as saying, “I’m sure I urged [Maggiore] to have the children tested,” yet medical records show that Gordon did not discuss or order HIV tests for Eliza Jane or her brother Charlie, not even at an exam with Charlie two days after his sister’s death.

16) Reynolds writes that “At last on May 14
Maggiore called Philip Incao [to see Eliza Jane]” omitting a May 7 exam with Dr Incao that followed the visit with Dr Gordon. Reynolds also omits that at the May 7 and May 14 exams, records show my daughter had no cough. Instead she writes, “the child’s runny nose, cough and malaise lingered.”

17) Reynolds’ article leaves out why my daughter’s case was referred to the LA County Coroner’s office: A physical exam, two chest Xrays, a CAT scan, a spinal tap, blood work and other tests performed at the ER provided no insight into why Eliza Jane had died.

18) Reynolds omits mention of the fact that the credibility of Dr James K Ribe, the coroner brought in to resolve my daughter’s case, has been challenged by the District Attorney as well as in numerous judicial proceedings, or that Ribe is currently a defendant in a civil suit for having altered autopsy reports of several murder victims to conform to a confession later determined to have been fabricated by police.

Minor Errors:

A two-month pre-coital courtship with my husband is described as “they met, dated once or twice, had sex.”

My two day wait for treatment of a faulty root canal is described as me “still being bothered by an excruciating mouth abscess” a year after my daughter’s death.

My husband’s four-day trip to New York last year was described as him “spending long periods away from [home] in New York and elsewhere.”

I am described as wearing a “cut off denim miniskirt” when I wore a skirt with a hemline that falls mid-knee.

The article states, I “scheduled the appointment [for an abortion], arrived at the office, and then, at the last moment, uncertain, unsettled, left.” In fact, as I explained to Reynolds, a doctor halted the procedure after a pre-operation ultrasound mistakenly indicated I was 15 weeks pregnant.

My husband is described as having “dark, unruly hair” when his hair is sandy blonde and straight.

The article includes a fictitious scene in which I “set my son up with his homework at the kitchen table.” In fact, school he attends does not assign homework until third grade which he begins this fall.

Mathias Rath saves us from World War III

August 25th, 2006


Times ad may embarrass HIV?AIDS critics

But it also suggests how obvious is paradigm error

Anyone who realizes how AIDS reduces to the garbage in-garbage out health problems of drugs and nutrition, with no proven contribution of HIV science on either side of cause or cure, will be taken aback by nutrition activist Dr. Matthias Rath’s ad today (Fri Aug 25) in the New York Times.

“Stop Bush! Stop WWIII!” the headline announces at the top of the one third page ad at the bottom of the Times page A13, with an image of Rath, hand on chin, on the right, and a text which, under the subhead “Protecting the Multi-Trillion Dollar Drug Investment Business”, informs readers that the Bush Administration plans to embark on WWIII in response to “the imminent collapse of one of the largest investment industries: the multi-trillion dollar pharmaceutical drug business with disease.”:

The outrageous step of preparing WWIII cannot be explained by the desire to gain access to oil fields. Only the foreseeable economic loss of catastrophic proportion can trigger such a desperate action. This is the imminent collapse of one of the largest investment industries: the multi-trillion dollar pharmaceutical drug business with disease.

The scandals from the deadly side-effects of Vioxx, Baycol and other widely used drugs are already threatening the economic basis of the largest drug makers in the world. Now the survival of the entire pharmaceutical industry is at stake. Constructed as an investment business based on patented drugs, this industry has been unmasked as a giant organized fraud: it promises “health” but its entire existence depends on the continuation and expansion of diseases as multi-billion dollar drug markets.

The logic of this Bush motivation (a nuclear World War III to solve the drug industry’s problems?) seems a little hard to understand, but it seems to have sprung from a remark by Linus Pauling, whose two Nobels didn’t prevent him from being generally abused in the public prints by know nothing reporters for advocating the vital importance of key nutrients, especially his belief in Vitamin C as a cancer preventive, since he eventually died of prostate cancer in his nineties, after taking enormous amounts of Vitamin C daily for decades (for his rejoinder, see below).

Pauling apparently told Rath at one point that

“Your discoveries threaten entire industries. One day there may even be wars just to prevent this breakthrough from being widely accepted. This is the time when you need to stand up!”

Now Rath feels the time has come to speak out in precisely this way. He feels he spoke out earlier on the Iraq war successfully and now he spikes Bush’s nuclear weapons by speaking out now:

On March 16, 2003, 4 days before the Iraq War started, Dr. Rath published an Open Letter in the New York Times stating that it was the Bush Administration’s plan to escalate it into a “war that includes the use of weapons of mass destruction.” This strategic plan was made public with the intention to prevent its implementation. Today’s Open Letter goes one step further: it reveals the economic motives behind the ongoing WWIII agenda of the Bush Administration…Now World War III Is No Longer Possible!

The next months will see the Bush Administration threatening military action and wars against Iran, North Korea and other countries. However, with the publication of this information the launch of WWIII will no longer be possible because:

1. The agenda behind these war plans has now been revealed…

Rath apparently thinks that the drug industry is suffering from lack of profits, but is this so? He is sure that it is severely threatened by his advocacy of the nutrient approach, which is certainly true in HIV?AIDS, if reason ever prevails in that arena. Whether this will topple the drug industry on a global scale seems unlikely, however.

The scandals from the deadly side-effects of Vioxx, Baycol and other widely used drugs are already threatening the economic basis of the largest drug makers in the world. Now the survival of the entire pharmaceutical industry is at stake. Constructed as an investment business based on patented drugs, this industry has been unmasked as a giant organized fraud: it promises “health” but its entire existence depends on the continuation and expansion of diseases as multi-billion dollar drug markets.

To protect its business with patentable drugs from competition by effective, non-patentable therapies, the stakeholders of the pharmaceutical business have consistently excluded research with non-patentable natural substances. Moreover, they have strategically barred basic knowledge of biological science in this field from entering the medical practice to fight global diseases including heart disease, cancer and immune deficiencies. If this basic knowledge had been implemented into medicine when it became available decades ago, neither the scope of most diseases nor the size of the drug investment business would have reached today’s magnitude.

As it happens, the scientific literature now contains a large number of studies and papers supporting this theme, that the benefits of added nutrients are still neglected, which is an inconvenient truth for the pharmas given that demand for vitamins and minerals are not easily exploited through patents.

But does Rath’s ad reflect some newfound confidence in the way things are going in South Africa? As far as we can judge it would seem to provide, in its irrational view of international affairs, only more cannon fodder for the TAC, and we expect it to be posted on the AIDSTruth.org site as an example of how Rath is just another anti-HIV crackpot.

However, this would be as misleading as the other pages of that highly irresponsible site, which carries more misleading information on the science of HIV?AIDS than any other right now, partly because it refuses corrective discussions with critics.

Rath may be a lesser chemist than Linus Pauling, but as Pauling recognized, he has in general the right idea. As prominent HIV?AIDS critic and scientist David Rasnick (pic) also has recognized, in going to work with Rath in South Africa for the last two years or so, Rath has generally the right idea about the causes and cures for African AIDS.

The point made about the rightness or wrongness of critics of HIV?AIDS science by this ad for Rath’s somewhat amateurish ideas about international political economics seems to us to be the opposite of what his critics might claim. What it shows is how easy the HIVAIDS paradigm is to see through, as the existence of so many thousands of other critics outside HIV?AIDS science also shows, as they reject the claims of scientists in the field as unconvincing and unacceptable even in terms of common sense.

What it indicates is that the paradigm is so irrational and replete with inconsistencies that not only a Dr Rath but even people with far less understanding of medical science who can barely read a scientific paper simply know in their bones, that the whole traveling roadshow is run by confidence tricksters.

Certainly there is every reason to suppose that Dr Rath is on the right track with his vitamins and minerals, even if he may be overlooking some factors (critics say he is not taking into account that balance is all important), since as we have noted previously there is every indication in the literature that these are the keys to both the causes of HIV?AIDS symptoms and the cures for the same.

For the same reason, we believe that Linus Pauling was on the right track with his thinking in this field. A few months before he died we asked the chemistry Nobelist how he reconciled his ideas with the fact he got prostate cancer in the end, and he replied cheerfully that if he hadn’t warded off prostate cancer with Vitamin C it would have progressed faster and he would have died much earlier.

Meanwhile he had achieved the distinction of being the only member of the National Academy of Sciences refused publication of an article on Vitamin C he wished to put in its periodical, the Proceedings of the National Academy, after a swarm of antagonists had raised objections to what they apparently viewed as quackery.

Soon he would be joined by Peter Duesberg in that distinction, which we believe is still unique to those two members of the Academy.

Stop Bush! Stop WWIII!

Stop Bush! Stop WWIII!

Matthias Rath, M.D. is the world-renowned scientist who led the breakthrough in the natural control of major diseases. His colleague and friend, the late Nobel Laureate Linus Pauling stated: “Your discoveries threaten entire industries. One day there may even be wars just to prevent this breakthrough from being widely accepted. This is the time when you need to stand up!”

On March 16, 2003, 4 days before the Iraq War started, Dr. Rath published an Open Letter in the New York Times stating that it was the Bush Administration’s plan to escalate it into a “war that includes the use of weapons of mass destruction.” This strategic plan was made public with the intention to prevent its implementation. Today’s Open Letter goes one step further: it reveals the economic motives behind the ongoing WWIII agenda of the Bush Administration.

The world is closer to WWIII than ever. Until today no one has provided a convincing answer as to “why?” The purpose of this Open Letter is:

1. To expose the agenda behind the Bush Administration’s plan to launch WWII.

2. To Prevent the execution of this plan through this public exposure.

3. To enable the people of America and the world to compare the events of the coming months with this analysis and take the appropriate actions.

The Bush Administration’s Goal: Launching World War III

Under the pretext of fighting terrorism, the Bush Administration has been preparing the USA and the world for WWIII. Already the Iraq war was designed as the launching pad for a war with weapons of mass destruction. The obvious reason why no post-war plan had been prepared was that this war was never intended to end. For the last three years the Bush Administration has been alternately threatening Iran, North Korea and other countries with a military strike. Moreover, in September 2005 the Bush Administration announced a change in its military doctrine to specifically include a nuclear first strike – even without any UN mandate.

The recent war in the Middle East was nothing else than a substitute war designed and controlled by the Bush Administration. Its deliberate brutality was intended to escalate this war into an open military conflict between Iran and the U.S. thus beginning WWIII. But this plan failed. As this war dragged on and casualties rose, world opinion eventually terminated it. Now is the time to answer urgent questions.

Why Does the Bush Administration Seek to Launch World War III?

Parallel to the global military escalation, the Bush Administration has domestically made every preparation to turn U.S. democracy into a dictatorship. Again under the pretext of fighting terrorism a series of empowerment laws have been passed, including the Patriot Act, the Homeland Security Act, the Biodefense Act and others.

The common denominators of these acts are:

1. The abolition of most U.S. civil rights.

2. The granting of direct access to executive and legislative power for the pharmaceutical and petro-chemical industries – the drug and oil cartels.

The only step needed to activate this entire set of empowerment legislation is a world war with the ensuing martial laws.

Protecting the Multi-Trillion Dollar Drug Investment Business

The outrageous step of preparing WWIII cannot be explained by the desire to gain access to oil fields. Only the foreseeable economic loss of catastrophic proportion can trigger such a desperate action. This is the imminent collapse of one of the largest investment industries: the multi-trillion dollar pharmaceutical drug business with disease.

The scandals from the deadly side-effects of Vioxx, Baycol and other widely used drugs are already threatening the economic basis of the largest drug makers in the world. Now the survival of the entire pharmaceutical industry is at stake. Constructed as an investment business based on patented drugs, this industry has been unmasked as a giant organized fraud: it promises “health” but its entire existence depends on the continuation and expansion of diseases as multi-billion dollar drug markets.

To protect its business with patentable drugs from competition by effective, non-patentable therapies, the stakeholders of the pharmaceutical business have consistently excluded research with non-patentable natural substances. Moreover, they have strategically barred basic knowledge of biological science in this field from entering the medical practice to fight global diseases including heart disease, cancer and immune deficiencies. If this basic knowledge had been implemented into medicine when it became available decades ago, neither the scope of most diseases nor the size of the drug investment business would have reached today’s magnitude.

Now that the deceptive strategy of this “business with disease” has been unmasked, its entire credibility is at stake and with it the survival of multi-trillion dollar markets of patented drugs. The desperate effort to prevent the largest financial collapse in history is the driving force behind the plans for WWIII.

Now World War III Is No Longer Possible!

The next months will see the Bush Administration threatening military action and wars against Iran, North Korea and other countries. However, with the publication of this information the launch of WWIII will no longer be possible because:

1. The agenda behind these war plans has now been revealed.

2. The governments of the world can no longer be coerced by the Bush Administration into such wars – regardless of the pretext.

3. The governments of the world can now establish a new world parliament. As a precondition to lasting world peace, this global government has to be founded on the principle –One Country – One Vote.”

4. The people of America have the opportunity to peacefully remove those politicians who continue to threaten world peace.

5. The people of the world now have the chance to significantly reduce today’s most common diseases, including heart disease, cancer and immune deficiencies by terminating the investment business with these diseases.

Math guy refuses top prize

August 22nd, 2006


Fields medalist from Russia spurns group approval, and millions.

Is this an example for HIV∫AIDS enthusiasts?

Here is news from the one area in modern life which is almost exempt from accusations of bias – mathematics. Grigory Perelman, 40, a Russian who solved a part of the Poincare Conjecture, was awarded the Fields Medal and turned it down, according to Kenneth Chang in the Times today (Tues Aug 22).

Dr. Perelman refused to accept the medal, as he has other honors, and he did not attend the ceremonies at the International Congress of Mathematicians in Madrid.

“I regret that Dr. Perelman has declined to accept the medal,” Sir John M. Ball, president of the International Mathematical Union, said during the ceremonies.

Many people in HIV∫AIDS are unlikely to understand this. Why would any sane person refuse the delights of group approval? they will ask. Isn’t this what makes life worth living? Don’t we all need and seek love from our peers? Is there anything better than the audience clapping as one accepts the prize which validates ones professional life, which is the source of most of one’s identity these days, even if one is playing three card monte with the trust of millions?

Did Robert Gallo turn down the Lasker prize just because people pointed out that HTLV-1 seemed unlikely after all to cause leukemia? Did David Baltimore rush to open up his lab at MIT over the weekend when he heard Howard Temin had discovered reverse transcriptase? You bet. A Nobel can transform your life. Ever after receiving it one’s opinions about things that one knows very little about are sought after, including who else should get the prize.

Clearly the Russian is mad:

He has declined previous mathematical prizes and has turned down job offers from Princeton, Stanford and other universities. He has said he wants no part of $1 million that the Clay Mathematics Institute in Cambridge, Mass. has offered for the first published proof of the conjecture.

Maybe he should have been dragged to the Toronto World AIDS Conference in Montreal to teach him what he is missing.

Meanwhile, we can see how twisted this lack of interest in fame is from the following article, also today’s, which puzzles over whether fame is worth it, but notes that a lot of people are seriously disappointed when they realize they never will be famous: The Fame Motive by Benedict Carey

In a 1996 study, Richard M. Ryan of the University of Rochester and Dr. Kasser, then at Rochester, conducted in-depth surveys of 100 adults, asking about their aspirations, guiding principles, and values, as well as administering standard measures of psychological well-being.

The participants in the study who focused on goals tied to others’ approval, like fame, reported significantly higher levels of distress than those interested primarily in self-acceptance and friendship.

Surveys done since then, in communities around the world, suggest the same thing: aiming for a target as elusive as fame, and so dependent on the judgments of others, is psychologically treacherous.

Freud might have agreed: he is said to have fainted only twice in his life, both times when he perceived a threat to his legacy.

But of course fame’s not a primary motive for most of the HIV faithful. They simply want to belong. Whether it’s believing that a retrovirus means everyone in the world must take prophylactic drugs (it’s coming, folks!), or that bacon is spiritually bad for you, or Jesus was the son of God, they will go along with whatever it takes.

Update (Sun Aug 27)” Georhe Johnson in the Times Week in Review tells us a little more about the mathematician why isn’t interested in celebrity:

The Math Was Complex, the Intentions, Strikingly Simple by George Johnson

Unlike Brando turning down an Academy Award or Sartre a Nobel Prize, Dr. Perelman didn’t appear to be making a political statement or trying to draw more attention to himself. It was not so much a medal that he was rejecting but the idea that in the search for nature’s secrets the discoverer is more important than the discovery.

“I do not think anything that I say can be of the slightest public interest,” he told a London newspaper, The Telegraph, instantly making himself more interesting. “I know that self-promotion happens a lot and if people want to do that, good luck to them, but I do not regard it as a positive thing.”…..

It has taken nearly four years for Dr. Perelman’s colleagues to unpack the implications of his 68-page exposition, which is so oblique that it doesn’t actually mention the conjecture. The Clay Institute Web site carries links to three papers by others — 992 pages in total — either explicating the proof or trying to absorb it as a detail of their own.

Those intent on parceling out credit may have as hard a time with the intellectual forensics: Who got what from whom? Dr. Perelman’s papers are almost as studded with names as with numbers. “The Hamilton-Tian conjecture,” “Kähler manifolds,” “the Bishop-Gromov relative volume comparison theorem,” “the Gaussian logarithmic Sobolev inequality, due to L. Gross” — all have left their fingerprints on The Book. Spread among everyone who contributed, the Clay Prize might not go very far.

A purist would say that no one person deserves to stake a claim on a theorem. That seemed to be what Dr. Perelman, who has said he disapproves of politics in mathematics, was implying.

“If anybody is interested in my way of solving the problem, it’s all there — let them go and read about it,” he told The Telegraph. “I have published all my calculations. This is what I can offer the public.”

The work for its own sake! These darn mathematicians, who can explain their craziness?

Math Was Complex, the Intentions, Strikingly Simple

The New York Times

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August 27, 2006

Ideas & Trends

The Math Was Complex, the Intentions, Strikingly Simple

By GEORGE JOHNSON

LONG before John Forbes Nash, the schizophrenic Nobel laureate fictionalized onscreen in “A Beautiful Mind,” mathematics has been infused with the legend of the mad genius cut off from the physical world and dwelling in a separate realm of numbers. In ancient times, there was Pythagoras, guru of a cult of geometers, and Archimedes, so distracted by an equation he was scratching in the sand that he was slain by a Roman soldier. Pascal and Newton in the 17th century, Gödel in the 20th — each reinforced the image of the mathematician as ascetic, forgoing a regular life to pursue truths too rarefied for the rest of us to understand.

Last week, a reclusive Russian topologist named Grigory Perelman seemed to be playing to type, or stereotype, when he refused to accept the highest honor in mathematics, the Fields Medal, for work pointing toward the solution of Poincaré’s conjecture, a longstanding hypothesis involving the deep structure of three-dimensional objects. He left open the possibility that he would also spurn a $1 million prize from the Clay Mathematics Institute in Cambridge, Mass.

Unlike Brando turning down an Academy Award or Sartre a Nobel Prize, Dr. Perelman didn’t appear to be making a political statement or trying to draw more attention to himself. It was not so much a medal that he was rejecting but the idea that in the search for nature’s secrets the discoverer is more important than the discovery.

“I do not think anything that I say can be of the slightest public interest,” he told a London newspaper, The Telegraph, instantly making himself more interesting. “I know that self-promotion happens a lot and if people want to do that, good luck to them, but I do not regard it as a positive thing.”

Mathematics is supposed to be a Wikipedia-like undertaking, with thousands of self-effacing scriveners quietly laboring over a great self-correcting text. But in any endeavor — literature, art, science, theology — a celebrity system develops and egos get in the way. Newton and Leibniz, not quite content with the thrill of discovering calculus, fought over who found it first.

As the pickings grow sparser and modern proofs sprawl in size and complexity, it becomes that much harder, and more artificial, to separate out a single discoverer. But that is what society with its accolades and heroes demands. The geometry of the universe almost guarantees that a movie treatment heralding Dr. Perelman is already in the works: “Good Will Hunting” set in St. Petersburg, where he lives, unemployed, with his mother, or a Russian rendition of “Proof.”

To hear him tell it, he is above such trivialities. What matters are the ideas, not the brains in which they alight. Posted without fear of thievery on the Internet beginning in 2002, his proof, consisting of three dense papers, gives glimpses of a world of pure thought that few will ever know.

Who needs prizes when you are free to wander across a plane so lofty that a soda straw and a teacup blur into the same topological abstraction, and there is nothing that a million dollars can buy? Until his death in 1996, the Hungarian number theorist Paul Erdos was content to live out of a suitcase, traveling from the home of one colleague to another, seeking theorems so sparse and true that they came, he said, “straight from The Book,” a platonic text where he envisioned all mathematics was prewritten.

Down here in the sublunar realm, things are messier. Truths that can be grasped in a caffeinated flash become rarer all the time. If Poincaré’s conjecture belonged to that category it would have been proved long ago, probably by Henri Poincaré.

It has taken nearly four years for Dr. Perelman’s colleagues to unpack the implications of his 68-page exposition, which is so oblique that it doesn’t actually mention the conjecture. The Clay Institute Web site carries links to three papers by others — 992 pages in total — either explicating the proof or trying to absorb it as a detail of their own.

Those intent on parceling out credit may have as hard a time with the intellectual forensics: Who got what from whom? Dr. Perelman’s papers are almost as studded with names as with numbers. “The Hamilton-Tian conjecture,” “Kähler manifolds,” “the Bishop-Gromov relative volume comparison theorem,” “the Gaussian logarithmic Sobolev inequality, due to L. Gross” — all have left their fingerprints on The Book. Spread among everyone who contributed, the Clay Prize might not go very far.

A purist would say that no one person deserves to stake a claim on a theorem. That seemed to be what Dr. Perelman, who has said he disapproves of politics in mathematics, was implying.

“If anybody is interested in my way of solving the problem, it’s all there — let them go and read about it,” he told The Telegraph. “I have published all my calculations. This is what I can offer the public.”

He sounded a little like J. D. Salinger, hiding away in his New Hampshire hermitage, fending off a pesky reporter: “Read the book again. It’s all there.”

Highest Honor in Mathematics Is Refused, by Kenneth Chang and

The Fame Motive, by Benedict Carey.

The New York Times

August 22, 2006

Highest Honor in Mathematics Is Refused

By KENNETH CHANG

Grigory Perelman, a reclusive Russian mathematician who solved a key piece in a century-old puzzle known as the Poincaré conjecture, was one of four mathematicians awarded the Fields Medal today.

But Dr. Perelman refused to accept the medal, as he has other honors, and he did not attend the ceremonies at the International Congress of Mathematicians in Madrid.

“I regret that Dr. Perelman has declined to accept the medal,” Sir John M. Ball, president of the International Mathematical Union, said during the ceremonies.

The Fields Medal, often described as mathematics’ equivalent to the Nobel Prize, is given every four years, and several can be awarded at once. Besides Dr. Perelman, three professors of mathematics were awarded Fields Medals this year: Andrei Okounkov of Princeton; Terence Tao of University of California, Los Angeles; and Wendelin Werner of the University of Paris-Sud in Orsay.

Dr. Perelman, 40, is known not only for his work on the Poincaré conjecture, among the most heralded unsolved math problems, but also because he has declined previous mathematical prizes and has turned down job offers from Princeton, Stanford and other universities. He has said he wants no part of $1 million that the Clay Mathematics Institute in Cambridge, Mass. has offered for the first published proof of the conjecture.

In June, Dr. Ball traveled to St. Petersburg, Russia, where Dr. Perelman lives, for two days in hopes of persuading him to go to Madrid and accept the medal.

“He was very polite and cordial, and open and direct,” Dr. Ball said in an interview.

But he was also adamant. “The reasons center around his feeling of isolation from the mathematical community,” Dr. Ball said of Dr. Perelman’s refusal, “and in consequence his not wanting to be a figurehead for it or wanting to represent it.”

Dr. Ball added, “I don’t think he meant it as an insult. He’s a very polite person. There was never a cross word.”

Despite Dr. Perelman’s refusal, he is still officially a Fields Medalist. “He has a say whether he accepts it, but we have awarded it,” Dr. Ball said.

Beginning in 2002, Dr. Perelman, then at the Steklov Institute of Mathematics of the Russian Academy of Sciences in St. Petersburg, published a series of papers on the Internet and gave lectures at several American universities describing how he had overcome a roadblock in the proof of the Poincaré conjecture.

The conjecture, devised by Henri Poincaré in 1904, essentially says that the only shape that has no holes and fits within a finite space is a sphere. That is certainly true looking at two-dimensional surfaces in the everyday three-dimensional world, but the conjecture says the same is true for three-dimensional surfaces embedded in four dimensions.

Dr. Perelman solved a difficult problem that other mathematicians had encountered when trying to prove the conjecture, using a technique called Ricci flow that smoothes out bumps in a surface and transforms it into a simpler form.

Dr. Okounkov, born in 1969 in Moscow, was recognized for work that tied together different fields of mathematics that had seemed unrelated. “This is the striking feature of Okounkov’s work, finding unexpected links,” said Enrico Arbarello, a professor of geometry at the University of Rome in Italy.

Dr. Okounkov’s work has found use in describing the changing surfaces of melting crystals. The boundary between melted and non-melted is created randomly, but the random process inevitably produces a border in the shape of a heart.

Dr. Tao, a native of Australia and one of the youngest Fields Medal winners ever at age 31, has worked in several different fields, producing significant advances in the understanding of prime numbers, techniques that might lead to simplifying the equations of Einstein’s theory of general relativity and the equations of quantum mechanics that describe how light bounces around in a fiber optic cable.

Dr. Werner, born in Germany in 1968, has also worked at the intersection of mathematics and physics, describing phenomena like percolation and shapes produced by the random paths of Brownian motion.

The medal was conceived by John Charles Fields, a Canadian mathematician, “in recognition of work already done and as an encouragement for further achievements on the part of the recipient.”

Since 1936, when the medal was first awarded, judges have interpreted the terms of Dr. Fields’s trust fund to mean that the award should usually be limited to mathematicians 40 years old or younger.

The New York Times

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August 22, 2006

The Fame Motive

By BENEDICT CAREY

Money and power are handy, but millions of ambitious people are after something other than the corner office or the beach house on St. Bart’s. They want to swivel necks, to light a flare in others’ eyes, to walk into a crowded room and feel the conversation stop. They are busy networking, auditioning, talking up their latest project — a screenplay, a memoir, a new reality show — to satisfy a desire so obvious it is all but invisible.

“To be noticed, to be wanted, to be loved, to walk into a place and have others care about what you’re doing, even what you had for lunch that day: that’s what people want, in my opinion,” said Kaysar Ridha, 26, of Irvine, Calif., a recent favorite of fans of the popular CBS reality series “Big Brother.” “It’s strange and twisted, because when that attention does come, the irony is you want more privacy.”

For most of its existence, the field of psychology has ignored fame as a primary motivator of human behavior: it was considered too shallow, too culturally variable, too often mingled with other motives to be taken seriously. But in recent years, a small number of social scientists have begun to study and think about fame in a different way, ranking it with other goals, measuring its psychological effects, characterizing its devoted seekers.

People with an overriding desire to be widely known to strangers are different from those who primarily covet wealth and influence. Their fame-seeking behavior appears rooted in a desire for social acceptance, a longing for the existential reassurance promised by wide renown.

These yearnings can become more acute in life’s later years, as the opportunities for fame dwindle, “but the motive never dies, and when we realize we’re not going to make it in this lifetime, we find some other route: posthumous fame,” said Orville Gilbert Brim, a psychologist who is completing a book called “The Fame Motive.” The book is based on data he has gathered and analyzed, with the support of the John D. and Catherine T. MacArthur Foundation.

“It’s like belief in the afterlife in medieval communities, where people couldn’t wait to die and go on to better life,” Dr. Brim said. “That’s how strong it is.”

The urge to achieve social distinction is evident worldwide, even among people for whom prominence is neither accessible nor desirable. In rural Hindu villages in India, for instance, widows are expected to be perpetual mourners, austere in their habits, appetites and dress; even so, they often jockey for position, said Richard A. Shweder, an anthropologist in the department of comparative human development at the University of Chicago.

“Many compete for who is most pure,” Dr. Shweder said. “They say, ‘I don’t eat fish, I don’t eat eggs, I don’t even walk into someone’s house who has eaten meat.’ It’s a natural kind of social comparison.”

In media-rich urban centers, the drive to stand out tends to be more oriented toward celebrity, and its hold on people appears similar across diverse cultures.

Surveys in Chinese and German cities have found that about 30 percent of adults report regularly daydreaming about being famous, and more than 40 percent expect to enjoy some passing dose of fame — their “15 minutes,” in Andy Warhol’s famous phrase — at some point in life, according to data analyzed by Dr. Brim. The rates are roughly equivalent to those found in American adults. For teenagers, the rates are higher.

Yet for all the dreamers, only one or two in 100 rate fame as their most coveted goal, trumping all others, the data collected by Dr. Brim and others show.

“It’s a distinct type, people who expect to get meaning out of fame, who believe the only way to have their lives make sense is to be famous,” said Tim Kasser, a psychologist at Knox College in Galesburg, Ill. “We all need to make meaning out of our lives, and this is one way people attempt to do it.”

Therapists and researchers, including Dr. Brim, have traced longing for renown to lingering feelings of rejection or neglect. After all, celebrity is the ultimate high school in-group, writ large. It appears a perfect balm for the sting of social exclusion, or neglect by emotionally or physically absent parents.

In her memoir, “In the Shadow of Fame,” Sue Erikson Bloland, daughter of the renowned psychoanalyst Erik Erikson, writes, “He had the kind of charisma that made people hungry to know him — to become privy to what he was thinking and feeling and writing about.”

Dr. Erikson’s dogged pursuit of recognition, she writes, was partly due to a sense of abandonment: he never knew his biological father, who disappeared before he was born. Decades later, Dr. Erikson still sought comfort and guidance from others, “but his pursuit of reassurance was not simply the charming humility it was generally interpreted to be,” she writes. “It expressed a persistent and tormenting self-doubt.”

Another factor may also be at work in many people who are preoccupied with becoming famous, one linked to a subconscious but acute appreciation of mortality. In recent experiments, psychologists have shown that, when reminded that they will one day die, people fixate on attributes they consider central to their self-worth.

Those who value strength squeeze a hand grip with more force; those who prize driving ability, cooking skills or physical appearance intensify their focus.

“Given this awareness of our mortality,” said Jeffrey Greenberg, a psychologist at the University of Arizona, “to function securely, we need to feel somehow protected from this existential predicament, to feel like we are more than just material animals fated only to obliteration upon death.

“We accomplish that by trying to view ourselves as enduringly valuable contributors to a meaningful world. And the more others validate our value, the more special and therefore secure we can feel.”

The odds of achieving some measure of notoriety — a Nobel, an Oscar, a plaque in the Curling Hall of Fame — are so remote that it is no surprise when unrealized ambition curdles into psychological struggle.

In a 1996 study, Richard M. Ryan of the University of Rochester and Dr. Kasser, then at Rochester, conducted in-depth surveys of 100 adults, asking about their aspirations, guiding principles, and values, as well as administering standard measures of psychological well-being.

The participants in the study who focused on goals tied to others’ approval, like fame, reported significantly higher levels of distress than those interested primarily in self-acceptance and friendship.

Surveys done since then, in communities around the world, suggest the same thing: aiming for a target as elusive as fame, and so dependent on the judgments of others, is psychologically treacherous.

Freud might have agreed: he is said to have fainted only twice in his life, both times when he perceived a threat to his legacy.

What of fame-seekers who actually slip through the looking glass and make it? Few celebrities confess to their fame-yearnings, and few if any have consented to anything like a psychological study of motivation and psychological well-being. And someone at the center of a scandal has an experience different from a beloved writer of children’s books.

Many prominent novelists, actors, writers and musicians find lasting satisfaction in seeing others moved by their work. And the limos and V.I.P. seating and private beach parties cannot be too difficult to endure.

Still, scholars, psychologists and some celebrity memoirists seem to agree that, for all its rewards, fame can also eat its own — as the historian Leo Braudy has written, “lurking behind every chance to be made whole by fame is the axman of further dismemberment.”

Public recognition can bring a heightened focus on the self. Mark Schaller, a psychologist at the University of British Columbia, studied the careers of Kurt Cobain, Cole Porter and John Cheever.

In their works, Dr. Schaller found, all three of these artists began referring to themselves more frequently after they became famous. The increase was slight in the case of Mr. Cobain, the rock star who committed suicide in 1994 at age 27. It was far more pronounced in Mr. Porter’s songs, and in the stories of Mr. Cheever, who also reported drinking more heavily after receiving wide acclaim.

These three artists are hardly a representative sample, and each probably had some self-destructive tendencies before achieving popular success. But increased self-consciousness can plunge almost anyone into rumination over soured relationships or lost opportunities, psychologists find. And famous people in particular are forced to judge themselves against ideals set by others.

“If you or I hear our own voice on tape, or see ourselves on camera, we might say: ‘Wait a minute, I’m a doofus. I’m not the sharp guy I thought I was,’ and we can cope with that, we can try harder,” Dr. Schaller said. “But it’s a little different if you’re a Bruce Willis or somebody. The ideals others have for you are crazy. It’s virtually impossible to meet them, and you can’t escape this heightened self-awareness.”

None of which may dissuade a single soul from grabbing for the ring if given a chance — or from longing and half-expecting lightning to strike. Because who really knows? Fame is fickle, sometimes random, and its effect on any one person is not predictable. Perhaps that is the source of its catnip fragrance: the unknowns, the secret horrors and joys, the private alchemy revealed only to those for whom the door swings open.

In compiling his research, Dr. Brim, 83, thought much about how an intense desire to reach this unknowable, alluring state of being might affect older people’s behavior, if the motive did not fade.

“I concluded that several things could happen, and one of them is to find another source of approval,” he said. “That might be a great love, if you’re lucky. Or perhaps it is a deepening belief in God. But I think many people suffer with realization that they are not going to be famous and there’s nothing they can do to solve it.”

The feeding trough of health care

August 22nd, 2006


Health care now 16%, heading to one quarter of GDP

Who knows, who cares what the bill is?

OK, what have we got? In HIV∫AIDS, maybe a few billion dollars a year, max, a few hundred thousand unknown lives blighted or ended early, a million people in far away lands misled into taking obnoxious drugs to no purpose. Tops. What’s the big deal?

In the grand scheme of things, and more particularly, in the context of health care spending in the US, this is a mere drop in the trough, as it were, nothing serious compared with the grand total spent on health care, which is heading from almost a sixth now toward one quarter of GDP by 2030.

According to Making Health Care the Engine That Drives the Economy by Gina Kolata today (Mon Aug 22) in the Times health care is the biggest gravy train in the economy, something that Americans are willing and able to pay almost anything for. And one of its chief characteristics is that no one knows what the bill is most of the time.

We have a friend who put his aged aunt in the hospital recently and took a serious interest in the billing process when he found out that she wasn’t eligible for Medicaid for nursing care after 100 days unless she was reduced to penury first. He examined her surgery bill (it came with a hospital six day stay bill of $45,000, luckily paid by Medicare) and found a surgeon’s cavalier personal charge of $9000 for a three hour hip operation had been reduced by Medicare to $1380. Meanwhile the nursing home is now charging her $408 a day because Medicare stops after 100 days, which works out at $12,320 a month. She will have to sell everything she owns before Medicaid will come back in.

No wonder people used to go bankrupt mainly because of a sudden illness. Now they can’t even go bust. They have to pay forever if they have any income at all, since the bankruptcy law changed early this year. Their income, life savings and property are all attached. Meanwhile, the new law last year bans Medicare from forcing down the price of drugs.

Where does AIDS science figure in all this? Not very large. It is the system equivalent of stealing tips. No wonder Washington doesn’t take much interest in whether it is all kosher or not.

Besides, America helping out with much needed lifesaving drugs is good international pr which is cheap at the price.

What’s happened is that the scientists discovered what doctors have always known – sell a patient a bill of goods about what is wrong with him/her and you can milk them for a lifetime.

AIDS has thus grown into one of the bigger pigs feeding at this enormous health care trough. The dissidents can pull at its tail as hard as they like, they ain’t gonna budge it one inch.

What they need is a two by four.

But why bother? The nation can afford it, as the economists in the article say.

Making Health Care the Engine That Drives the Economy:

The New York Times

August 22, 2006

Prospects

Making Health Care the Engine That Drives the Economy

By GINA KOLATA

Angus Deaton, an economist at Princeton, had a hip replacement last year. And while he was happy with the outcome, he wondered how much it had cost.

He got a few answers. His hospital room was $10,000 a day. “Telephone and television were extra,” he said.

As for the total cost, there were so many charges associated with one service after another — anesthesia, pain management, physical therapy, the surgery itself — that he was never able to figure out how much each of them cost. “Maybe if I devoted my life to this for six months I could find out,” Dr. Deaton said. “The price that is paid is the price an insurer negotiates, and that is kept in a vault somewhere.”

All he knows for sure is that insurers say they pay, on average, $50,000 for a hip replacement.

Dr. Deaton’s story is the sort that makes people cringe. The United States already spends nearly 16 percent of its gross domestic product on health care, and it is almost impossible to know where all that money goes. Projections are that health care will take up even more of the G.D.P. as the population ages and as more expensive drugs and medical devices are developed.

But a new economic approach to health care expenditures views costs in a very different light. Economists agree that huge increases are coming. But some say that may be just fine.

By 2030, predicts Robert W. Fogel, a Nobel laureate at the University of Chicago Graduate School of Business, about 25 percent of the G.D.P. will be spent on health care, making it “the driving force in the economy,” just as railroads drove the economy at the start of the 20th century.

Unless the current system is changed, most health care costs will continue to be paid by insurance, especially Medicare, which means that the taxpayers will foot the bill. But Dr. Fogel says he is not alarmed. Americans can afford it, he says, because the nation is so rich.

“It takes so little of household income to satisfy expenditures on food, clothing and shelter,” he explains. “At the end of the 19th century, food, clothing and shelter accounted for 80 percent of the family budget. Today it’s about a third.”

Other economists agree.

“We have to spend our money on something,” says Robert E. Hall, a Stanford University economist.

In a paper published in The Quarterly Journal of Economics, Dr. Hall and Charles I. Jones of the University of California, Berkeley, write: “As we get older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”

David Cutler, an economist at Harvard, calculated the value of extra spending on medicine. “Take a typical person aged 45,” he said. “They will spend $30,000 more over their lifetime caring for cardiovascular disease than they would have spent in 1950. And they will live maybe three more years because of it.”

He added, “Are you willing to do that? Yes, it costs a lot, but we’re rich enough where the alternative use of the money isn’t as valuable.” Still, Victor R. Fuchs, also an economist at Stanford, notes that buying health care is fundamentally different from buying a television or a car.

“Most of it involves transfers from the young to the old,” he said. “Down the road, most medical care will be for people over age 65, and most of the payments will be from taxes on younger people.”

Dr. Fuchs calls it the restaurant check problem.

“You go out to a restaurant with a bunch of friends and you sort of understand that you will split the check,” he said. “The waiter comes along and says, ‘The lobster looks very good, and how about a soufflé for dessert?’ The restaurant check balloons, but you are not so careful because you figure everyone is splitting it.

“That’s the way medical care gets paid for,” he said.

Dr. Fuchs added, “We want to spend our money on the things that will bring the most value for the dollar. When we are spending collective money as we are in health care, then it becomes much more difficult.”

The issue, he says, is not how much is being spent but whether spending more is the answer. Are those extra dollars buying marked improvements in health or are they making any difference?

That, Dr. Deaton said, was the point of his exercise in trying to find out the cost of his hip replacement: “Is it worth spending all this money on a hip replacement?”

In London, he said, a hip replacement costs £5,000, or about $9,500.

“Don’t you think people would prefer to have it for £5,000?” Dr. Deaton said. “It is probably true that if we spent twice as much money on health care we’d be better off. But half the money we spend is wasted.”

That, Dr. Hall pointed out, is an important issue. “We all know that especially in Medicare, where more and more of the spending is going to occur, there isn’t anybody who has responsibility for making sure the money gets spent well,” he said. “Some huge improvements will have to be made as the consequences of that waste get greater.”

Still, the wasted money is, in a sense, a separate discussion, he said.

The real questions for the future of medical spending, he said, are: “Does it make sense in terms of how we value different things? What do people think a life is worth? And what do you get?”

Attack on Mbeki and nutrients ends AIDS bash

August 21st, 2006


Simple approach doesn’t rate with UN fantasist when there are toxic drugs to push

How Dr. Mantombazana “Manto” Tshabalala-Msimang should have defended herself

Why Mexico City 2008 may be very different!

The dresses made of hundreds of condoms by a Brazilian “artist” and the rest of the artefacts of the Toronto AIDS Conference were packed up on Friday, presumably with a sense of coitus triste, since the world’s biggest ever gathering of HIV enthusiasts – 26,057 people wasted money and time attending this event without double checking its basic premise – won very little recognition from the locals, including the disappointment of being stood up by Prime Minister Stephen Harper, and not even attracting the most celebrated HIV?AIDS scientist in the history of the world, Robert Gallo.

Gallo was allegedly miffed because he wasn’t invited to give the main speech, possibly because when he agreed to give it in South Africa in 2000 he somehow failed to turn up (could this have been because he feared the HIV critics in the HIV Review Panel Mbeki commissioned that year before the conference might have stuck around? The Gallo family is known for 100% reliably producing emergencies when Peter Duesberg is expected to appear at a meeting where Gallo is scheduled to speak).

Laurie Garrett at the HIV Science and Responsible Journalism session is our prime source on this. As usual her prime source was a newspaper, the Toronto Globe and Mail, which had just published a story suggesting that the whole shebang was a waste of money and time:

LAURIE GARRETT: Well something interesting on that … there’s a story in today’s Globe and Mail. It’s part of their package of set up of this conference. The story is all basically alluding to the conference as being a total waste of time, just a bunch of glitz. Why is everybody here? Maybe that explains why there’s no banners welcoming us to this city as we come into the airport, why this is the first international AIDS conference I’ve ever been to where there’s no visibility, no red ribbons, nothing about AIDS on the streets. You don’t see it. You’d think we’d gone to the moon. But put that aside. The Globe and Mail piece has a long article that’s basically one voice. It’s Robert Gallo saying this conference sucks and that’s why I didn’t come. Why didn’t they interview the organizers to find out that Gallo was insisting he could only come if he could have a plenary speech. And when he was denied a plenary spot because he’d be previously offered one in Durban South Africa and then didn’t show up, that is why he is not here. So you have this report that biased towards giving everybody the perspective or the sense that this is a trash meeting, that one of the great scientists in the world says there’s no reason to come. And there wasn’t sufficient delving to really get to the bottom. They didn’t ask the organizers why isn’t he here.

In the case of the Canadians, as Hank points out on Barnesworld it may have had something to do with the fact that only 272 new cases of HIV/AIDS were discovered in Canada last year. Indeed, according to all reports local excitement was zero, with some 15,000 tickets unsold locally, and only scientists of the level of distinction of John P. Moore of Cornell bothering to turn up. As Lawrence Altman had told us previously, all the researchers with high-splash index science worth publishing in the top journals know better that to put themselves into this biennial zoo, even when it is on their doorstep.

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

SPECIAL NOTE: The next is in Mexico City, also nearby, in 2008. This is dangerously close to Cuernavaca and devilish critic and author Dr Harvey Bialy, currently the most fearsome live threat faced by the paradigm priesthood, many of whom he terrorizes almost daily with email messages well designed to undermine their confidence in the long term viability of their regime. We do not think it is impossible that many more key dissidents will attend and that Bialy and Peter Duesberg will give a joint press conference in 2008, since by that time the AIDS Monolith, even if not yet past its tipping point to collapse, will be in much deeper trouble than today. Only six months have passed since the watershed Harper’s piece, Celia Farber’s “Out of Control: AIDS and the Corruption of Medical Science”, gave mainstream editors an excuse to at least look at alternative views in HIV?AIDS, and the printing presses are already pumping out two of four more books on the topic, and a handful of mainstream media have dipped their toe (New York Post, New York Observer, Time Out Chicago, Boston Globe, and soon Canada’s Alive) in the forbidden stream. Mexico will come after an interval five times longer. END OF SPECIAL NOTE ********************************

Harper’s excuse, in fact, was that the meet was “too political”. The last Canadian PM to turn up at a local AIDS Conference was booed, and Harper seems to have good instincts (perhaps the guy also reads Harper’s religiously, since one can imagine it would be his favorite magazine). His substitute was booed this time (he sent three Ministers and the Canadian Attorney General).

The locals also feel that the AIDS gang are a little jumped up with all their demands that everyone pay so much attention to them, according to an otherwise fully propagandized columnist in the Globe on Saturday:

The very success of AIDS advocacy seems to have made it intemperate, and led some of its leaders to believe they have a “right” to bully and jeer, and a “right” to call people before them to bully and jeer them. Such was the reception given to Canada’s Minister of Health, Tony Clement, when he, in fact, did attend the conference. This was, at best, ill manners, and less than should be expected from visitors to a world conference toward our government’s representative.

It has a whiff of imperiousness derived from self-righteousness.

Insider Edition content

AIDS CONFERENCE

Mr. Harper wasn’t the rude one

Headshot of Rex Murphy

REX MURPHY

The mammoth XVI International Aids Conference ended yesterday. Some press accounts put the number of delegates in Toronto at 24,000, others pegged it as high as 30,000-plus. Take either number, and it’s a massive gathering.

It must be quite an undertaking just to organize a meeting of this size. The logistics of travel and organization, the effort to secure funds from governments and private agencies to underwrite it, the labour that must go into setting an agenda that will meet the approval of so many different agencies, organizations and individuals attending — each must require a staggering effort.

It is plausible to ask whether a gathering of this size can honestly be called a “conference” at all, at least if, by conference, we mean an occasion for deliberation and exchange of views, an exercise in presentation, response and disinterested meditation on questions of research, policy and practice.

Considerations of this kind seem to have been behind the decision of Dr. Robert Gallo, the celebrated co-discoverer of the HIV virus, not to attend the Toronto meeting. At the 2004 conference in Barcelona, he was set upon by photographers and press as if he were a rock star, which led him to the totally wholesome reflection: “This is bad! I’m not Mick Jagger.”

He sees a “degradation” in the purposes of these meetings, their reliance on celebrities to garner attention, a “circus quality” that is inseparable from the designedly mass nature of these events. These high-profile assemblies are only conferences by courtesy of designation: In reality, they are media events. They are designed by their scale, and by the presence of their celebrity presenters, to leverage the greatest amount of world coverage for their cause. Which is an utterly legitimate ambition. A legion of causes, at any given moment, are all, sadly, in competition for the attention and consideration of the world.

And of the world’s causes — which range over a terrifically bleak terrain from Darfur to malnutrition — AIDS, curse though it is, may be said, in one particular, to be better situated than most. A great platoon of great names from the world of style and performance have commended the AIDS cause to the world almost from the epidemic’s outbreak. Good for the cause, and good for those who back it: It is as high on the world’s agenda as it is because of the skill and dedication of those who have chosen to support it.

The meeting in Toronto — the third time the international conference has been held in Canada — will be seen as part of that success. Not every meeting will have Bill Gates, the world’s richest philanthropist, as a lead speaker. And not every cause will be able to take advantage of the media magnetism of one of the world’s greatest political celebrities, Bill Clinton, to bring global attention to its needs.

AIDS remains a great scourge of our times, but in the catalogue of the world’s miseries, it is better placed, more prominently supported, and more widely understood than most.

On this understanding, I am a little puzzled by the acerbity of the comments that fell on Stephen Harper’s head for not attending the conference. As Mr. Harper has pointed out, three ministers of his government were in attendance, as was the Governor-General.

So it is not fair to say the government of Canada was not represented, or ignored the meeting. In fact, Canada contributed $4.5-million toward holding the event.

But the tone of the criticisms coming out of the meeting, from Stephen Lewis to Richard Gere, suggested nothing less than a moral default on Mr. Harper’s part for not attending. The last Canadian PM who did attend an AIDS conference was Brian Mulroney, and he got booed for his courtesy. It was very reasonable for Mr. Harper to anticipate that the same reception awaited him.

The very success of AIDS advocacy seems to have made it intemperate, and led some of its leaders to believe they have a “right” to bully and jeer, and a “right” to call people before them to bully and jeer them. Such was the reception given to Canada’s Minister of Health, Tony Clement, when he, in fact, did attend the conference. This was, at best, ill manners, and less than should be expected from visitors to a world conference toward our government’s representative.

It has a whiff of imperiousness derived from self-righteousness.

This is a stain on a noble effort, and a failing of courtesy. The failing of courtesy was not Stephen Harper’s refusal to attend, but the peremptory attitude that suggested that he had to. It’s something that happens, I suppose, when conferences grow so large, and those who organize them so important, they assume everyone has to oblige them.

Rex Murphy is a commentator with CBC-TV’s The National and host of CBC Radio One’s Cross-Country Checkup.

Bell Globemedia © Copyright 2006 Bell Globemedia Publishing Inc. All Rights Reserved.

Nancy Padian actually said at the HIV Science and Responsible Journalism that she was surprised “so few” people had turned up to the important session, presumably because she was hoping to get the message out as widely as possible that her studies in the nineties, proving beyond a shadow of doubt that HIV fails to transmit between lovers engaged in heterosexual sex often enough to form an epidemic of any kind, let alone a global pandemic, were NOT in any way contrary to the standard text, and anyone who thought so was misreading them, even though she had made the point very clearly in the paper at the time, and anyone can read it still. We will cover the point very thoroughly in our posts deconstructing every line of this session, and especially the Padian study issue, imminently.

But we await further information from the horse’s mouth as to whether the Conference really was less than met the eye, especially from the mysterious GS who has appeared in Comments to give us the real dope. Our new surprise informant is an HIV scientist, he says, actually researching how to defeat the nefarious Virus, but with enough of his wits about him still to see the points made by Irresponsible Blogs are not entirely invalid.

Nutrients rule – if not in Toronto

Meanwhile we hope he or others will throw further light on the attention if any paid at the Conference to nutrients as a factor in curing the symptoms of AIDS in Africa or indeed here, since as noted earlier in our post on the Causes and Cures of AIDS the literature indicates that this is the crux of the matter and HIV treatment is entirely irrelevant to any cure.

As indicated in early reports on the Conference, the South Africans installed a booth there where delegates could contemplate simple and non toxic nutrient immune system boosters such as beetroot and garlic supplied for very little money by a more conventional God than Western Pharma and minimal agricultural toil, but these were immediately scorned and derided by the HIV ideologues of TAC addicted to the idea of costly and immune system damaging commercial drugs designed by scientists in suits and supplied by profit making companies, and so ARVs were hastily added to the display.

However, this concession didn’t impress one UN official who was so filled with virtue that he couldn’t stop himself ending the conference by attacking Mbeki’s policy of encouraging the alternative treatment of basic and specific nourishment in a speech on Friday:

A top United Nations official delivered a blistering attack on South Africa on Friday at the closing of the 16th international AIDS meeting here, saying that its government “is still obtuse, dilatory and negligent about rolling out treatment.”

In a keynote address, the official, Stephen Lewis, the ambassador to Africa for AIDS for the United Nations, said South Africa “is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state.”

U.N. Official Assails South Africa on Its Response to AIDS

Jorge Uzon/Agence France-Presse — Getty Images

Participants at the international AIDS conference in Toronto on Friday performed a play aimed at easing prejudice against people with H.I.V.

By LAWRENCE K. ALTMAN

Published: August 19, 2006

TORONTO, Aug. 18 — A top United Nations official delivered a blistering attack on South Africa on Friday at the closing of the 16th international AIDS meeting here, saying that its government “is still obtuse, dilatory and negligent about rolling out treatment.”

In a keynote address, the official, Stephen Lewis, the ambassador to Africa for AIDS for the United Nations, said South Africa “is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state.”

South Africa has the largest number of H.I.V.-infected people in the world. Its president, Thabo Mbeki, has continually expressed skepticism that H.I.V. causes AIDS, and the country has questioned antiretroviral treatment and delayed providing it to pregnant women and AIDS patients.

In his remarks, Mr. Lewis said, “The government has a lot to atone for,” and “I’m of the opinion that they can never achieve redemption.”

He said he felt his job demanded that he advocate for the tens of millions of H.I.V.-infected people, including those in South Africa, even though many say a United Nations official has no right to criticize a member state.

Mr. Lewis has long been critical of countries for failing to help women who become infected.

“Gender inequality is driving the pandemic, and we will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle,” he said.

The inequality of women makes them highly vulnerable to becoming infected through “marital rape to rape as a war crime,” Mr. Lewis said, adding that, while sexual violence occurs everywhere, in Africa, “The violence and the virus go together.”

Preventing the transmission of the AIDS virus from infected pregnant women to newborns, which can be done with simple regimens, is “very near the top in the hierarchy of preventive measures,” he said. But the vast majority of pregnant women in the world, he said, go without such prevention, and even the women who receive it are not given full treatment to help keep them alive, so their children often become orphans.

Yet the world is doing very little for orphans whose number is expected to grow to 18 million by 2010. “I appeal to everyone to recognize that we are walking on the knife’s edge of an unsolvable human catastrophe,” Mr. Lewis said.

Mr. Lewis’s term as envoy ends in December at which time, he said, he hopes his successor will be an African woman.

Other speakers urged training more nurses and health workers in poor countries to deliver the antiretroviral drugs and preventive measures needed to stop the AIDS epidemic. The many international programs that are scaling up efforts to deliver antiretroviral drugs to poor people cannot succeed without large numbers of health workers to monitor the care of AIDS patients.

“We need hundreds of thousands of new nurses” in poor countries, said Dr. James McIntyre, an AIDS expert in South Africa.

But low salaries and poor working conditions are driving health workers into other jobs and away from those countries, leaving “too few people with the right skills,” said Anders Nordstrom, the acting director general of the World Health Organization. “It’s not enough to provide money and drugs and to train people, as important as they are” in the scale-up programs, he said. “You need to pay people.”

Disease is also taking its toll. Countries with 15 percent H.I.V. prevalence rates can be expected to lose 30 percent of their health workers over a 10-year period, Dr. Nordstrom said. At a news conference, he said antiretroviral drugs needed to be offered to more health workers.

Nurses and others involved in the care of AIDS patients often work in unsafe or dangerous conditions, said Dr. Pedro Cahn, the new president of the International AIDS Society, the main organizer of the AIDS conferences. This conference was the largest ever, drawing 26,057 participants.

Dr. McIntyre, the South African, cited the frustration of nurses who deal with high death rates among their patients because of the lack of antiretroviral drugs. He quoted an unidentified nurse who said, “If I wanted to be an undertaker, I wouldn’t have trained as a nurse.”

As the conference speakers delivered their remarks, hundreds of Africans, Asians and people from around the world began dismantling the global village created here to promote discussion of H.I.V. One exhibit, called “Dress Up Against AIDS,” included 10 dresses by Adriana Bertini, a Brazilian artist, made from thousands of condoms. Nearby were women from the Masaka district of Uganda who displayed their crafts, including mats, straw bowls and drums. In another booth, Kenyan workers showed off sandals and beaded necklaces. In others, attendants handed out pamphlets on programs for H.I.V. and AIDS.

The next AIDS conference will be held in Mexico City in August 2008.

The sad thing is that however ignorant U.N. special envoy on AIDS in Africa Stephen Lewis may be of the medical literature (not to mention the general rule that UN officials are not meant to attack the governments of member nations, however inflated they may feel with virtuous motives when standing up and standing for for establishment science and the rights of women everywhere not to be sexually tyrannized by men) which has stated in crystal clear terms since 1997 that his group scientific-political fantasy of heterosexual pandemic is impossible (Thank you Nancy, sorry you have been forced out into the open finally, and had to write your sadly self-compromising mea exculpa on the AIDSTruth site), the defenders of a more realistic approach are equally without grace in this respect.

Poor Mantombazana “Manto” Tshabalala-Msimang, South Africa’s Health Minister, quotes absolutely no textual authority in reply, thus probably convincing most readers of newspapers who carried this exchange that she had indeed made the country a laughing stock in the knowledgeable environs of the world’s greatest (we are talking quantity here) scientific conference.

South African newspapers on Sunday joined the fray, describing the Toronto display as “a salad stand” and demanding President Thabo Mbeki, who is also often accused of mishandling the AIDS crisis, sack his controversial minister.

“Tshabalala-Mismang has become a comic figure who comes across as a clown, if her behavior in Toronto is anything to go by,” the influential Sunday Times said in an editorial.

“For how long must South Africans suffer the embarrassment of a senior cabinet minister who does not appear to take her work seriously?”…

The government did launch a public ARV program in 2003 and is now providing the drugs to about 175,000 people.

But activists say the drugs only reach a fraction of the people who need them and accuse Tshabalala-Msimang of creating deadly confusion by continuing to promote her home-grown approach to the disease.

City Press Sunday columnist Khathu Mamaila wrote that Tshabalala-Msimang’s determination to promote natural foods such as beetroot and garlic instead of ARVs had “reduced South Africa to an international joke.”

“Maybe she should be allowed to work for the department of agriculture,” he said.

South Africa Defends AIDS Policies

By REUTERS

Published: August 20, 2006

Filed at 9:50 a.m. ET

Skip to next paragraph Reuters

JOHANNESBURG (Reuters) – South Africa’s health minister on Sunday defended her AIDS policies after a blistering attack by a top U.N. official, but newspapers said she had made the country a laughing stock and demanded her resignation.

Mantombazana Tshabalala-Msimang blamed South Africa’s poor media coverage at last week’s global AIDS conference in Toronto on the Treatment Action Campaign (TAC), whose activists led criticism of her government’s policies.

“I think South Africa did very well,” Tshabalala-Msimang told SABC radio.

“I think the TAC was just a disgrace, a disgrace not only to the (health) department but a disgrace to the whole country. But I think, as South Africa, we really demonstrated that we are doing pretty well.”

TAC supporters were blamed for attacking South Africa’s stand at the Toronto conference, which included a display of Tshabalala-Msimang’s often-criticized prescription of olive oil, beetroot and garlic as a defense against AIDS.

The conference ended on Friday with a broadside delivered by the U.N. special envoy on AIDS in Africa, Stephen Lewis, who derided South Africa’s “lunatic” approach to an epidemic which infects an estimated one in nine of its 45 million people.

South African newspapers on Sunday joined the fray, describing the Toronto display as “a salad stand” and demanding President Thabo Mbeki, who is also often accused of mishandling the AIDS crisis, sack his controversial minister.

“Tshabalala-Mismang has become a comic figure who comes across as a clown, if her behavior in Toronto is anything to go by,” the influential Sunday Times said in an editorial.

“For how long must South Africans suffer the embarrassment of a senior cabinet minister who does not appear to take her work seriously?”

South Africa’s government has frequently been criticized for acting too slowly against AIDS and remaining reluctant to provide sufferers with anti-retroviral (ARV) drugs, the only medication known to slow the progress of the disease.

The government did launch a public ARV program in 2003 and is now providing the drugs to about 175,000 people.

But activists say the drugs only reach a fraction of the people who need them and accuse Tshabalala-Msimang of creating deadly confusion by continuing to promote her home-grown approach to the disease.

City Press Sunday columnist Khathu Mamaila wrote that Tshabalala-Msimang’s determination to promote natural foods such as beetroot and garlic instead of ARVs had “reduced South Africa to an international joke.”

“Maybe she should be allowed to work for the department of agriculture,” he said.

Dr. Mantombazana “Manto” Tshabalala-Msimang’s best answer

We think that Dr Mantombazana’s (she is a qualified physician) best response may be her physical self, at 66 positively glowing with health according to her pic. We challenge most ladies of the same age in Western nations to look half as good. But it is astonishing that someone on Mantombazana “Manto” Tshabalala-Msimang’s staff or elsewhere in the South African government doesn’t simply search the literature and produce the many papers that state loudly and clearly for any layman to understand that the key deficits of the immune system which are so typical of HIV?AIDS, such as the lack of selenium and zinc (in correct proportion to copper), are very quickly remedied by supplements or the appropriate food.

Needless to say, in Africa sometimes the problem is basic nutrition across all fronts, ie insufficient food period. One of the saddest news stories this week concerned the need for many HIV?AIDS patients in Africa to stay on drugs because otherwise they don’t get the food that is supplied with the medication.

Of course, the staff don’t even have to search the literature, they can simply go to the nearest mainstream textbook. For example, the latest professional bible of nutrition and the immune system, Diet and Human Immune Function, edited by David Hughes of the UK Institute of Food Research, Gail Darlington of Epsom and St. Helier University Hospitals NHS Trust, Surrey and Adrianne Bendich of GlaxoSmithKline Consumer Healthcare, New Jersey, with a foreword by William Beisel, emeritus professor of the Johns Hopkins School of Hygiene and Public Health, Baltimore (Humana Press 2004).

This will quickly give them (and Mr Lewis too, if he has time to read any science at all) a clear picture, nicely outlined in the chapter on “HIV Infection”, by Ph.D’s Marianna Baum and Adriana Campa of Florida International University in Miami, of the completely dominant influence of nutrition on the outcome of treatment of those supposedly suffering from HIV. Naturally the chapter pays lip service to the HIV faith, but every page confirms that nutritional factors rule both decline and recovery. At the end of the 14 page chapter are eight “take home messages”. Listen to the first:

“HIV-1 infection is characterized by protein-energy malnutrition and micronutrient abnormalities, which may persist even after administering effective antiretroviral treatments.”

Other key conclusions:

“Nutritional repletion should be an adjuvant to antiretroviral therapy”…

“Vitamin B1, B2, B3 and B6 deficiencies are accompanied by lack of energy, fatigue, and neuropsychological abnormalities…”

“Vitamin B12 deficiency is associated with faster disease progression and mortality and neurologic abnormalities, which improve with vitamin B12 repletion…

“Vitamin A deficiency is associated with …faster HIV disease progression and mortality.” And finally,

“Selenium and zinc deficiency are associated with immunodeficiency, oxidative stress, increased HIV-related morbidity, and mortality.”

A few key sentences from the body of the article:

“The risk of dying from HIV-related diseases decreased by 33% for every 1 mg/d increase in dietary zinc intake, and this relationship was independent of antiretroviral therapy and CD4 cell count at baseline and over time. The relative risk for mortality for those with an intake under the median (9.34 mg zinc/d) was 11 (eleven!) times greater.”

“Selenium status is predictive of HIV-related prognosis and survival. In a cohort of chronic drug users with HIV-1 infection only selenium deficiency was an independent predictor of survival when joint effect of nutritional deficiencies that had singly predicted mortality was evaluated. This significant effect of selenium persisted when controlling for CD4 count at baseline and over time.”

“Selenium deficiency was associated with decreased length of survival of 31.4 mo, compared with 57.4 mo for those with normal plasma selenium levels.”

“Supplementation of antioxidants, including selenium, may prove to be an important part of the ammunitions used to fight the catastrophic sequelae of the HIV disease and AIDS.”

“A long term double blind placebo-selenium supplementation trial (200mcg selenium/d) in healthy study participants demonstrated a 51% reduction in total cancer mortality and a 41% reduction in total cancer incidence…”

Actually, we see in the study referenced by Baum that she did in 1997, an even more exciting way of expressing these results is that selenium deficiency is associated with a ten to twenty times higher mortality in AIDS patients, ie 90-95 per cent reduction in chances of death if you have adequate levels of selenium. This is much higher than CD4 count, which is associated with only a 31 per cent reduction in risk of death if it is normal over the course of the study, which is barely significant. With very low CD4 levels (under 200 initially in the three and a half year study period), mortality was only three times higher. And similarly, according to another study Baum’s group did, zinc deficiency yields a three to five times greater chance of death than adequate zinc levels in the blood plasma. An Italian study in 1995 showed a reduction of opportunistic infections of 13 fold – 92% – with one month’s zinc supplementation to AIDS patients on AZT, which benefit continued for two years, whereas those untreated with zinc but on AZT did no better. The AIDS symptoms PCP and candidiasis were virtually wiped out with zinc.

(Special note for the strong minded:

Have a HAART

It is important to say here that HAART is associated with an increase in selenium and zinc plasma levels, as noted in our earlier post. This is probably a main reason why AIDS patients given HAART may leap from their beds and climb mountains, as they say, and why we are constantly told that dying Africans brought into clinics in wheelbarrows are restored to health and walk back to their villages after three months of ARVs and adequate food.

But why is there this special boosting effect, which studies haven’t yet explained (except in HIV related terms, of course, with the recovery mechanism undemonstrated)? This book suggests an answer.

Apart from the usual stimulation of the immune system by introducing a poison, which it takes as evidence of a pathogen, the phenomenon is probably due to protease inhibitors, though it is not clear why, since these two elements are not of course in the chemical makeup of the drugs. Possibly there is a digestive effect, due to a broad spectrum antibiotic effect knocking out parasites and pathogenic bacteria in the intestines. These would be associated with the diarrhea and malabsorption of trace elements in the gastrointestinal distress common in AIDS, and why doctors may advise patients to take yogurt and other probiotics to increase the beneficial microflora of the gut, known to improve the performance of the immune system, as another chapter, “Probiotics and immunomodulation”, in this book explains. Yet another chapter describes how drugs knock down the immune system: “Use of drugs that affect nutrition and immune function”, including glucocorticoids (corticosteroids), which are very relevant to AIDS risk groups. A section of that chapter describes “Drugs and HIV Infection”.

Of course all this is temporary as the recent study result tells us, showing HAART hasn’t dented long term survival rates in the last decade.)

And of course, while lip service is paid to ARVs throughout, any reader wearing non-HIV spectacles will find that one of the editors, Adrianne Bendich Ph.D from GlaxoSmithKline, in her review of drugs provides enough valuable patient oriented information on adverse drug side effects to get her into a little trouble if anyone from Glaxo reads it carefully, so in gratitude we won’t emphasize that too much. And given the contribution of Baum and Campa to the enlightenment of those is search of a better answer to the “mystery” of HIV?AIDS, we won’t draw attention to them either. Otherwise we can imagine them having to write out “We didn’t mean to diss HIV” 100 times on the AIDSTruth.org site, just as Nancy Padian has been forced to do.

In fact, the TAC has mercilessly pursued Mantombazana “Manto” Tshabalala-Msimang on this front from the beginning of the Conference, and is now joyfully posting the news reports and editorials on the AIDS Truth web site.

C’mon guys and gals, read the texts. They won’t bite

All we mean to do is urge someone on Mantombazana “Manto” Tshabalala-Msimang’s advisory staff to order this volume from Amazon forthwith, instead of being kicked around by the TAC and the ignorant editorial writers of the South African press for peddling olive oil, beetroot and garlic as home remedies – even though there are in fact plenty of studies supporting the anti-infection properties of garlic, the Mediterranean diet based on olive oil is acknowledged to be exemplary, and beetroot is good for the liver, the key to health and detoxification (beetroot contains betaine, closely related to another methyl donor choline, a B complex factor shown in mainstream studies to support liver function and promote liver regeneration).

Quote the mainstream authorities back at the TAC goons, Manto. Learn the simple, mainstream validated picture which is the answer to HIV?AIDS and all its “conundrums”.

As for us, we would have advised her or anybody else at the HIV?AIDS conference, if they wanted to do anything useful with their time there other than watch the lunacy of faith in action, they should have made sure to meet Marianna K. Baum and Adriana Campa.

They are the true heroes of HIV?AIDS research, not the once globally celebrated specialist in useless achievements in AIDS, Robert Gallo, whose only signal achievement so far is to show beyond reasonable doubt that HIV was not the cause of AIDS before any other scientist did.

John Moore escapes spitball with swift exit

August 16th, 2006


Temporarily floored by absurdity, Geiger fails to act

‘Intellectual powerhouse’ researches goo and rings

According to his report filed in Bill, Melinda and Bill Comments just now, Michael Geiger of HEAL, San Diego turned up on Monday in Toronto for John Moore’s presentation in the “Novel Targets for Drug Development Session, intent on “exposing his empty bag of tricks.”

Unfortunately, Moore’s presentation on “Entry Inhibition as Models for Microbicide Development” so horrified Geiger that he managed (according to him) only to hit the back of Sam Broder’s toupee with a spitball.

This is unfortunate, since Geiger had a very good question ready, judging from his note, one which could have seen him publicly confront the New York Times Op-Ed writer on “Dangerous Quackery” with the final solution to Africa’s AIDS problem, no gel required:

Moore started his lecture out by saying one of the most bizarre statements that I have ever heard. He said that One in Four women in Africa get HIV infected from heterosexual activity! Simply not believable, as our own American Made HIV has been found to be completely non-transmitted sexually, by Nancy Padian. All should by now be familiar with Padian’s study, that showed zero sexual transmission in 370 or so heterosexual couples over a six year period.

Why can’t we just bottle up our own HIV and ship our own non-sexually transmitted HIV to Africa? That would solve the supposed HIV problem over there!

But we can sympathise with his reaction to the appalling revelation of what Moore and his hardworking group – an “intellectual powerhouse”, according to Moore, when he presented them for applause – have been up to.

Then Moore disgusted me again by talking about doing things to monkeys vaginally and anally that I have never even seen in the raunchiest of porn videos

Even if Michael’s account is a little over the top, as a report on the session, it doesn’t seem that his description of Moore’s presentation is anything but sober fact. (You can check it out on video, he notes, at this KaiserNetwork page.)

He promises it will be the most affordable goo lube in town. And best of all, “it will not be Nasty, Runny, or Smelly!”

What it adds up to is this: there can be no more vivid example of the absurd lengths to which scientific visionaries such as Moore will go before questioning whether what they are doing makes any sense at all.

No wonder Geiger was momentarily at a loss, faced with Moore’s effrontery. He went there to write a satirical report, and found the event itself was pure satire.

Just as I was took one more huff to launch, Dr. Moore called his goo team an “Intellectual Powerhouse”! I choked on this statement. I choked and could not launch. As I was choking on the silliness of his words, he said his final thank you, asked if there were any questions, all you could hear was the audience choking and no-one could even get out a question, and he slyly shuffled off the stage.

That, perhaps, is the entire story of HIV∫AIDS and the XVI International AIDS Conference, Toronto, 2006. The total sum of the foolishness on display is so staggering that it is impossible for critics to get a handhold.

All they can do is gape, and reach for a drink.

Did anyone ask the macaques?

Michael’s full posted report in Comments:

INTELLECTUAL POWERHOUSE OF VAGINAL GOO AND ANAL RINGS?

The other day, was the “Novel Targets for Drug Development Session. Dr. Moore was the third speaker, and the one that I came here to enjoy. I did not come here to join Dr. Moore in his monkey business. No indeed. I am here for much more than that. I intend to expose Dr. Moore for the not-quite-an-emperor with no clothes that he is, with no sexually transmitted virus causing AIDS in his hands. Nothing but an empty bag of tricks!

Moore started his lecture out by saying one of the most bizarre statements that I have ever heard. He said that One in Four women in Africa get HIV infected from heterosexual activity! Simply not believable, as our own American Made HIV has been found to be completely non-transmitted sexually, by Nancy Padian. All should by now be familiar with Padian’s study, that showed zero sexual transmission in 370 or so heterosexual couples over a six year period.

Why can’t we just bottle up our own HIV and ship our own

non-sexually transmitted HIV to Africa? That would solve the supposed HIV problem over there! If he shipped the supposed sex transmitted African HIV over here, it would solve his and Nancy Padian’s problem of having non-sexual HIV here in the west!

Continuing with the story, Dr. Moore was very nervous through-out his lecture. He stumbled through a lot of it, and you could cut through his nervousness with a knife. I think he knew that I was right there, and he probably knew that I was lining him up in the sight of my spitball shooter, disguised as a pen of course. He even looked RIGHT AT ME! Time stopped. Here I was, and there he was. I had him then and there, just like a deer in the headlights! But just as I had his beady little eyes

lined up in my sights, and was ready to launch my mighty spitball, he hit me first, and beat me back with his own launch and bombardment of a discertation on “Vaginal Goo and Anal Rings!” Well, you just can’t shoot a spitball when laughing, so my first opportunity was missed.

John promised to make his goo in many forms. Either gel, cream, suppositories, sponges, or vaginal and anal rings. I just know the Anal Rings are gonna be a big hit with the gay community, as they are already obsessed with nipple rings, Prince Albert Penile rings, diamond rings, gold rings, silver rings, chrome rings, leather rings, cock rings and just about any type of ring things. And the gooier, the better! He promises it will be the most affordable goo lube in town. And best of all, “it will not be Nasty, Runny, or Smelly!” What more could I want? What more could the gay community want on a Friday night? What more could those oversexed and overpopulating Africans want? These vaginal and anal ring things will be the biggest seller ever put on the world market in all of history! Is Dr. Moore an evil genius? What if his microbicide cocktail rings of goo creates 3 headed baby monkeys? Little wonder, Bill Gates wants to get in on this upcoming gooey ring thing blockbuster!

Then Moore disgusted me again by talking about doing

things to monkeys vaginally and anally that I have never even seen in the raunchiest of porn videos. He talked about inflaming monkeys vaginally to make sure they get his shiv virus, and he said that “Monkeys are Not That

Choosey”, and I am now sure this is a true fact! If monkeys are doing the goo thing with Dr. Moore, they certainly are not choosey, and have no taste! This was upsetting so I lined up my spitball shooter again for a second go at him, and just as I was launching it, Moore starts talked about doing the HAIL MARY with his monkeys, as he calls it, to protect them from “multiple repetitive challenge”!?! This sounded like some type of monkey orgy to me, and the visuals must have been just too much. Knocked me right off balance again. My projectile launched. But as my misaimed spitball flew, I think it hit Sam Broder in the back of the head, and was strangely absorbed and deflected by what must be a spitball proof toupee! I didn’t know he wore one, but it had to have been either a toupee or the thickest head I have ever known!

John went on and and on about his toxic goo and monkeys, and I needed to get just one more chance to have a shot at him. Third one is a a charm, as they say, so I awaited my chance. He wrapped up his speech by thanking his lab assistants, pharmaceutical companies, and everyone but the sexually assaulted monkeys. I lined up for my final fusillade (I only had 2 spitballs on my possesion at this time, most of the others I had brought along were confiscated by security when I boarded the plane for Toronto the other day). Just as I was took one more huff to launch, Dr. Moore called his goo team an “Intellectual Powerhouse”! I choked on this statement. I choked and could not launch. As I was choking on the silliness of his words, he said his final thank you, asked if there were any questions, all you could hear was the audience choking and no-one could even get out a question, and he slyly shuffled off the stage.

Seriously though, all jokes aside. This microbial thing is more than questionable. What will these chemicals do in utero? Or even anally? Just how safe and effective will they be for years of use. What about sperm exposed to these toxins? How about the children being born from these chemonuked sperms? I can see the point to be protected from actual STD infections, but to create a chemonuclear weapon to bombard ones most sensitive parts of the body? To bombard an obviously harmless retrovirus? Seems a bit much to me!

Just so you can witness this goo filled anti-microbe cocktail orgy and chokefest, a video of the entire event can be found at the Kaiser Video Link by clicking your

mouse on the following link:

“Novel Targets for Drug Development Session”

Dr. Moore is the final third of the video.

Check out his nervousness! I am sure some in the press will be noticing how he devoted his opening act on Sunday to trying to hide from the dissidents, and now nervously bumbling through his sessions! I am sure more than just the dissidents will be wondering what he is so afraid of!

John P. Moore’s informative lecture on abusing macaques for fun and profit:

A microbicide can be applied as a gel, crème, suppository, sponge or vaginal ring that gradually releases active ingredient, but in the most common incarnation, it is a gel. To be useful, a microbicide in the end has got to be safe for obvious reasons, effective, also for obvious reasons, but it also has to be affordable; essentially it is give-away technology. It is something that would be priced in the cents-per-usage for the developing world. Something that costs 10 bucks per use isn’t going to be terribly practical, so it has to be cheap. We always have to be aware for the need for affordability. Again, it has to be acceptable because it is going to be used in a sexual

setting, so anything that is sort of nasty or runny or smelly simply isn’t going to be used. That is a formulation issue that I am certainly not going to address today because I am going to address experiments in the monkey model and, to be honest, monkeys aren’t that choosy. ….

We did a Hail Mary experiment, which wasn’t in the paper, but I think it’s worth going over. We wanted to see if you could protect against multiple, repetitive challenges. So we put the three inhibitors, compound 167, BMS806 and C52L all at the highest doses. We have those to the macaques as a triple combination every day for five days and then did a SHIV challenge every day for five days. So they got five consecutive, daily, high-dose challenges. Obviously, all the controls got infected. Three out of the five inhibitory recipients got infected. If you put that either way, two animals were protected against five consecutive, daily, high-dose challenges, which I don’t think is all that shabby given the stringency of the model. So I think that is encouraging for the real world.

Transcript provided by kaisernetwork.org, a free service of the Kaiser Family

Foundation1

(Tip: Click on the binocular icon to search this document)

Novel Targets for Drug Development

XVI International AIDS Conference

August 14, 2006

1 kaisernetwork.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded

material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.

[Applause]

I. F ADEWOLE: Our third speaker is Dr. John P.

Moore. Dr. Moore is a professor of microbiology and

immunology of the Weill Medical College at Cornell

University, New York City. He is a [inaudible] Oxford

graduate, having received his bachelor, masters, master of

philosophy, and [inaudible] degrees from Oxford University.

Dr. Moore [inaudible] is a scientist of the Pediatric AIDS

Foundation and is a recipient of a non-restricted grant for

infectious disease research from the [inaudible] Foundation.

He also holds a merit award from the National Institute of

[inaudible] on Infectious Diseases. Dr. Moore’s topic today

is Entry Inhibition as Models for Microbicide Development.

Dr. Moore?

[Applause]

JOHN MOORE, PH.D.: Thank you for that introduction.

I’m not talking about new drug targets today; I’m talking

about the use of existing drug classes or inhibitor classes

Novel Targets for Drug Development

XVI International AIDS Conference

08/14/2006

1 kaisernetwork.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded

material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.

34in a different way, in a non-traditional way, not to treat

infection, but to try to prevent it by means of a topical

microbicide. A microbicide is an important arm of prevention

science strategy nowadays, simply because it is needed. With

the number of heterosexual transmissions that are occurring,

particularly in the developing world, with 80-percent of new

transmission from heterosexual intercourse, the need for

something particularly to block vaginal transmission is

extremely obvious. When you see that in South Africa, 1

woman in 4 now becomes HIV infected by the age of 22, that’s

a pretty serious issue.

A microbicide could reduce transmission and buy more

time for making an effective vaccine. Ultimately, the answer

to transmission is an effective vaccine, but we all know it

is not an easy thing to do and it will be some years yet

before that task is accomplished. In the mean time, other

prevention methods become center stage, particularly for

women to control their own protection is essential. Although

we’re all familiar with the ABC concept, most infections are

spread by unprotected sex. Abstinence and faithfulness are

not likely to protect married women or those who are sexually

abused. Women often cannot ensure that men use condoms and

condoms are also contraceptive, which means they cannot be

used when one of the desired outcomes is pregnancy. Instead,

Novel Targets for Drug Development

XVI International AIDS Conference

08/14/2006

1 kaisernetwork.org makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded

material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.

35a microbicide could fulfill many of the prevention science

gaps if one could be developed and applied properly.

A microbicide can be defined as a chemical entity

that can prevent or reduce HIV transmission when applied at

the site of entry to the body, be that vaginally or rectally.

It is probably, but not certain, that an effective vaginal

microbicide would also work when applied rectally. That is

certainly an assumption, but there is no defined strategy

that differs at present for the two sexual transmission

routes; it’s whatever is being made for one route would be

tested for another route.

A microbicide can be applied as a gel, crème,

suppository, sponge or vaginal ring that gradually releases

active ingredient, but in the most common incarnation, it is

a gel. To be useful, a microbicide in the end has got to be

safe for obvious reasons, effective, also for obvious

reasons, but it also has to be affordable; essentially it is

give-away technology. It is something that would be priced

in the cents-per-usage for the developing world. Something

that costs 10 bucks per use isn’t going to be terribly

practical, so it has to be cheap. We always have to be aware

for the need for affordability. Again, it has to be

acceptable because it is going to be used in a sexual

setting, so anything that is sort of nasty or runny or smelly

simply isn’t going to be used. That is a formulation issue

36that I am certainly not going to address today because I am

going to address experiments in the monkey model and, to be

honest, aren’t that choosy.

What I’m going to focus on for the rest of the talk

is microbicides that are based on entry inhibitors that are

already in clinical trials as antiretrovirals and because

they may meet many and perhaps all of these criteria. They

could be safe because they’ll have a lot of clinical

profiles; effective, which I’ll demonstrate to you in the

monkey model how they can be; affordable, because we’re

talking about conventional drugs by and large; acceptable is

a formulation issue that I’m not addressing.

The simple concept is that preventing HIV from

entering cells prevents it from entering the body and

establishing an infection; an entry inhibitor stops the virus

from going anywhere. They’re generally likely to be

reasonably safe. As I say, they’re likely to be affordable,

some of them anyway. And there is good evidence of efficacy

that I will show you. The kind of inhibitors that I’m going

to review in this talk — the one the my project group is

studying in the macaque model — include compound 167, BMS-

378806, T1249 and AMD3465. They’re sort of being done for

product development, trying to move toward clinical trials.

I will also mention C52L and CD4-IgG2 for experimental

purposes.

37

Most of the work we’ve done uses the R5 SHIV, SHIV-

162P3, a CCR5-using challenge virus. In some studies, we’re

using SHIV-89.6P, which is an X4 virus with, perhaps, some

CCR5 usage.

The small molecule CCR5 inhibitor compound 167 was

Marty Springer’s at Merck. It was being developed as a

clinical candidate alongside Schering-Plough’s and Pfizer’s

Maraviroc and Vicriviroc, but Merck abandoned it for clinical

development, which was unfortunate for Marty, but it was good

fortune for us because it meant we could get a clinically

relevant, high-quality, potent CCR5 inhibitor for macaque

studies. It is every bit as good a molecule as Maraviroc and

Vicriviroc. Bristol Meyer’s, Rich Colonno’s group, has been

development attachment inhibitors, of which BMS-378806 was

the first in the family. It is not longer being developed

clinically because it is being superseded by better

compounds, but it meant, again, that we could have access to

it. This compound binds to GP120 and inhibits CD4 binding

and subsequent conformational changes associated with co-

receptor binding. It is active against both R5 and X4

strains, so it is not co-receptor restricted.

We used, in early studies that have now been

published, a GP41 fusion peptide, C52L, made by my colleague

Min Lu at Cornell Medical School. This is very similar,

related to T20 and enfuvirtide (Fuzeon), a licensed drug. It

38is clearly a peptide. Min Lu engineered it for expression in

bacteria in an effort to make it somewhere cheaper than

enfuvirtide. It blocks fusion by inhibiting late-stage

conformational changes in GP41 and, again, this is a broadly

active tropism-independent inhibitor.

We’ve since moved on to work with T1249 from

Trimeris, which was the son of T20; it was Trimeris’ next

development stage in the Fuzeon (enfuvirtide) program. It

works in same way that C52L does; it’s more potent in vitro

and in vivo than Fuzeon. It was tested in clinical trials

and showed to have substantial antiviral activity, so there

is clinically relevant safety and efficacy data on it, but it

is no longer being moved forward as an antiretroviral drug.

I’ll mention briefly, and only briefly, PRO542, CD4-

IgG2, a tetravalent CD4-based fusion protein from Progenics,

which binds to GP120 and blocks virus attachment. That is a

protein, which puts it likely to be outside of the affordable

range in the kind of amounts it would need to be used at, but

we’ve used it as a research tool. This is being developed as

an antiviral drug by Progenics and it is in phase 2.

The CXCR4 inhibitor that we’re using is AMD3465 from

Anormed from Gary Bridger’s program. That is a specific

CXCR4 inhibitor with activity only against X4 viruses. It is

similar to compounds that are in clinical trials as antiviral

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39drugs to treat CXCR4 using viruses in infection, and it is a

perfectly credible compound to use in microbicide studies.

So we published at the end of last year — and I’m not

going to spend a lot of time reiterating the details of work

that was published eight months ago now — a paper by Ron

Veasey [misspelled?] on the work on compound 167, BMS-806 and

C52L. Now, the challenge virus, as I mentioned, is SHIV-

162P3 CCR5-using virus. The monkey model is the

progesterone-treated monkey model, which thins the vaginal

epithelium and renders the monkeys highly susceptible to

infection, so it is a very stringent model. We put in a

relatively high dose of virus compared to human transmission

and the vaginal epithelium is being deliberately thinned with

progesterone. All those exacerbate the risk of infection,

which means your controls get infected and you can do the

studies. But it does make the model stringent, so protection

against it is not trivial to achieve.

When we used compound 167 at 5 millimolar and we

protected 8 out of 10 animals. BMS-806 was the same

concentration and we protected 6 out of 8. Gp41 C52 peptide

to gp41, we protected 3 out of 5. Compared to 9 out of 9, it

gave statistically significant protection in each of the

arms.

We’ve since done a study, unpublished, with T1249, a

dose-ranging study applying T1249 at different concentrations to see where protection lies. It’s the first experiment we

did on this compound. We only had two animals per group, but

no protection at 0 or 0.1 megamil, but both animals that got

1 megamil and 5 megamil were protected, so it’s a titratable

response and we’re not working to fill in the gap to see just

how much can be used. This is 200 micromolars. On the scale

that Trimeris makes peptides, which is in the sort of tons-a-

year range, this becomes a practical concentration for use in

microbicide studies. So it is not out of the question in the

affordability range. We’re refining the existing dose-

response curve to identify an IC50 for in vivo protection.

We’re going to test it against other challenge viruses,

particularly X4 viruses, to see. They should block there,

but we want to test that. We, again, want to test it in

combination with other inhibitors for reasons that I will

come to in a minute. And then we need to develop a

formulation and product development strategy, which is

clearly not work that I’ll be doing; that’s work don’t by

Trimeris and others.

Now, the case for combination microbicides, in my

view, is absolutely obvious and almost inarguable. It is the

same as the arguments for using combinations for therapy.

You do not use monotherapy. For the same reason, it doesn’t

make a lot sense to use monotherapy for a microbicide. Using

combinations of inhibitors increases your breadth of coverage against divergent strains. In the real world, that is an important issue.

You reduce the probability of transmitting

viruses resistant to any single inhibitor and in several

circumstances, particularly with the entry inhibitors, can

generate genuine synergy. It is an overused term and is

often confused with additivity, but I mean genuine synergy

where two inhibitors reinforce each other’s action and reduce

the amount of compound. You create genuine dose-bearing

effects. So these are the theoretical arguments that I think

are very strong for combinations.

We did this in the published [inaudible] paper. Nine

out of nine control animals were infected; 21 out of 28

animals given 1 inhibitor were protected when we lumped them

all together; 16 out of 20 animals given 2 inhibitors were

protected; all three animals that we gave 3 inhibitors to

were protected. Because we had such good protection with

single inhibitors, it is not obvious the protection was

increased by combinations, but I think it makes sense to use

combinations. Overall, in that study, we used 51 animals and

protected 40 of them in a stringent model, so you can clearly

protect macaques.

In the real world, a microbicide shouldn’t just be

something that has to be used moments before intercourse.

Women or men if they use it rectally may want to have some

options in terms of timing. So how late after applying the

inhibitor will protection still apply? We addressed this in

the monkey model by doing delayed-challenge experiments. You

add the inhibitor — in this experiment we used the CCR5

inhibitor compound 167 — and then delay the challenge for 0.5 to 12 hours. You can see that at half-an-hour we protect 8 out of 10. At 2 hours we protected 2 out of 3. Even with a

6-hour delay, we’re still protecting 50-percent. One of the

animals was protected even after a 12-hour delay, so that

says that sustained protection might be possible. When that

is plotted out in a time course, you can see a sort of smooth gradation with the half protection for the compound 167 at about 6 hours.

We did fewer animals with BMS806 and the

[inaudible] is nice, but again, you can see that you can get

sustained protection over a six-hour period which, I think,

is quite encouraging.

We did a Hail Mary experiment, which wasn’t in the

paper, but I think it’s worth going over. We wanted to see

if you could protect against multiple, repetitive challenges.

So we put the three inhibitors, compound 167, BMS806 and C52L

all at the highest doses. We have those to the macaques as a

triple combination every day for five days and then did a

SHIV challenge every day for five days. So they got five

consecutive, daily, high-dose challenges. Obviously, all the

controls got infected. Three out of the five inhibitory

recipients got infected. If you put that either way, two

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43animals were protected against five consecutive, daily, high-

dose challenges, which I don’t think is all that shabby given

the stringency of the model. So I think that is encouraging

for the real world. If you pick the hibitor combinations and

formulate them right, they could be effective.

We want to address whether an X4 virus can be

blocked. CCR5-using viruses account for almost all

infections; at least the viruses that expand in the new host

are CCR5-using. But CXCR4-using viruses can be transmitted

and I don’t think we should neglect it. So we wanted to see

whether vaginal transmission of a CXCR4-using virus can be

inhibited. Rightly or wrongly — and I have a horrible

feeling that it’s going to turn out to be wrongly — we chose

SHIV-89.6P because of its extensive use in the vaccine model.

That can use CCR5, CXCR4 and various other GPCRs in cell

lines, but in primary macaque or human PBMC, it’s only

sensitive to CXCR4 inhibitors and is completely unaffected by

CCR5 inhibitors. So in PBMC — which, of course, is not

necessarily relevant to transmission events — it’s an X4

virus. We also couldn’t find any viral load reduction when

we dosed a macaque with a CCR5 inhibitor. It’s certainly

used in CXCR4, but it’s possible that it does use CCR5 under

in vivo conditions and bear this in mind when looking at the

next results.

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44

So we’ve used the Anomed AMD3465 compound and,

essentially, we haven’t gotten protection with it. With

AMD3465, 8 out of 10 animals were infected, compared to 8 out

of 9 controls. With compound 167, the CCR5 inhibitor, 3 out

of 5. When we put both together, 1 out of 2. So we haven’t

exactly achieved protection against X4 challenge virus with a

CXCR4 inhibitor. The question we’re addressing in the next

series of experiments is whether the problem there is the

inhibitor, which simply doesn’t work, or the virus, which is

unable to be blocked by a CXCR4 inhibitor. This is an

inhibitor that should work. It works well in vitro. It

should bind the receptor well in vivo, but the possibility is

that SHIV-89.6P uses both CCR5 and CXCR4 for transmission, so

that blocking neither receptor by itself is going to do the

job.

So this 1 out of 2, we’re going to obviously expand

into a large number of animals. We’re also going to test a

much purer CXCR4-using SHIV, SHIV-KU1. We also need to work

on formulation issues.

The X4 SHIV can be inhibited; it can be blocked.

When we did BMS806, we protected 1 out of 2, which is not

significant. C52L, though, protected both animals; the gP41

peptide and the combination protected both animals. All four

recipients of gP41 peptide were inhibited, so I would say

that we can block this challenge virus that is co-receptor

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45independent. The CD4-IgG2 molecule also protected all three

animals that we challenged with SHIV-89.6P. So, again, we

can block this virus, just not with the CXCR4 inhibitor, at

least not yet.

What we want to do when we’ve got the CXCR4 inhibitor

working is a duel challenge experiment. We want to apply an

R5 virus and an X4 virus — whatever the X4 virus is we

finally choose — and we want to apply them as a mixed

inoculant and see then if we can block broadly tropic viruses

in a mixture, which is what happens in the real world. You

don’t use a single clonal virus; women and men will encounter

diversity of virus swarms, so we want to mimic this by

putting in two viruses deliberately and measure the outcome

of infection using a discriminatory viral load assay based on

RTPCR that will detect each virus independently. So that it

what we’re working towards. We can also use the method for

blocking two 2 R5 viruses.

Steve and Kevin have put together a pretty neat assay

based on detecting the OMS genes of either virus or the gag

gene of both of them to allow quantitation of the both of

them together. The assay works extremely well. We used it

to measure viral load changes in duel-infected macaques

treated with a CCR5 inhibitor a couple of years ago in a

paper by Bolinski [misspelled?], so the methodology is there.

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46

The first experiment we did on this was five Chinese

macaques challenged vaginally with SHIV-162P3 and SHIV-89.6P.

One was uninfected, one was infected only with the R5 virus,

and the other three were duel infected, although in one the

R5 viral load was transient. So we’ve still got to work on

this to get more consistent infection, or else we’ll need to

up the control group significantly.

I’m going to switch to some in vitro research to wrap

it up because a microbicide needs to be effective against all

circulating HIV strains. As I said to you earlier, it

doesn’t matter if it just protects one challenged virus in

the monkey; that’s no big deal. But global diversity of the

HIV sequence is a very significant challenge for any

microbicide, exactly the same way as it is for a vaccine. A

vaccine needs to deal with broadly divergent viruses and so

does a microbicide in the real world. You can assess this

properly in the monkey model. There are only a limited

number of challenge viruses, but it has to be assessed in

cell culture systems using panels of test viruses, just as

they’re being set up to analyze the in vitro potential of

antibody-based vaccines. John Mascola [misspelled?] and

Vicky Palonici’s [misspelled?] group and David Montefure

[misspelled?] have established vaccine test panels for

neutralizing antibody-based vaccines, and we’ve adapted them

for our own use.

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47

Here we’ve tested three inhibitors at relatively high

concentrations, compound 167, BMSC — which is a sort of son

of BMS806 — and C52L peptide. Wen tested alone against a

panel of — I think it’s 30 viruses, we get approximately 100-

percent blocking, a bit down from BMSC, so they’re broadly

active against all the viruses in the test panel from all the

genetic subtypes. Obviously in the double combination and

the triple combination, we’re getting 100-percent hit. So

we’re getting breadth of activity against all the viruses

from all the subtypes. When we drop the concentrations down

a thousand-fold to give it a more stringent test, the single

compounds are only hitting 10 to 30-percent, but when we put

double compounds in together, the protection rate in vitro

increases, and when we put all three in, it increases a bit

more. So this, again, speaks that combinations will act

better against divergent viruses because it means that if you

miss one virus, the other inhibitor might get it.

So how are we going to move these into clinical

trials? Of course, I’m not because I’m not a clinician and

it’s not the kind of work I do. So agreements were

established between the IPM — the International Partnership

for Microbicides — and Merck and Bristol-Myers Squibb to

develop their compounds, the companies’ compounds as

microbicides using Gates Foundation funding. That would be

done on a basis of the compounds being done on a free, give-

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48away basis for the developing world, but the companies

retaining licensure for any use in the future in the

developed world, which can afford to buy it.

Studies on compounds with greater potency and breath

and activity are in progress, and I’ve shown some of them.

Obviously, suitable formulations need to be made — which

we’ll test for efficacy in macaques — and then one assumes

the IPM clinicians will test them for safety in women.

I’d like to thank the program project team that has

done this work, in particularly Ron Veasey [misspelled?], who

has done all the primate research, Robin [inaudible], Melissa

Pope and PJ Classer [misspelled?] are the intellectual

powerhouses of this team. Kevin [inaudible] and Steve

Olinski [misspelled?] have developed the viral load assay.

And all the people whose compounds I’ve mentioned — Marty

Springer, Min Lu, Rich Colonno, Gary Bridger, Bill Olsen, and

Mike Greenburg — really deserve a lot of credit, as well as

thanks, for having the vision to think in their company

environments of doing something outside the box. These are

people who’ve been developing drugs for drug use, traditional

pharmaceutical industry work, while they’re thinking

laterally and thinking, “Can my drug, my company’s drug, be

used for prevention?” I think that’s very laudable. The NIH

has funding this through a program project and Bristol-Meyers

has funded work with their compound. Thank you very much.

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49

[Applause]

MALE SPEAKER: Thank you very much. I know that some

are rushing off, but we do have a few minutes available for

questions for Dr. Moore.

Perhaps I could just ask everyone as they head out to

offer one last round of applause for our presenters and thank

everyone for their participation.

[Applause]

[END RECORDING]

Bill, Melinda and Bill – drug pushers all

August 15th, 2006


No sign of independent thought from rich activists

Dissenters read tea leaves to no avail

Well, the dissenters in HIV∫AIDS may have been excited to have been mentioned at all, in however back handed a way, at the Toronto Conference, but the sessions so far have shown that the minds of the Big Three in the private funding of HIV∫AIDS activity show every sign of being occupied by the AIDS meme as completely as ever. If Thabo Mbeki even mentioned the topic of dubious science to Gates, he didn’t make a dent.

Neither in Bill Gates’ opening address on Sunday, nor in the sessions yesterday, was there anything said by Bill Gates, Melinda Gates or Bill Clinton which veered from the basic party line – “Infectious pandemic, ARV exports, Condoms, Microbicides for Women”. Everything they said confirmed that they completely subscribe to this and see no reason to insert any caveat or caution.

Melinda talked of microbicides as the key to saving women from AIDS, Bill talked of the need to expand ARV delivery, Bill Clinton of the same to “save a lot more lives”.

Clinton wants more education to encourage abstinence and condom use for young people. He is delighted by the progress made in expanding ARV delivery at ever cheaper rates to the poor of Africa. He is ecstatic, he told the admiring audience, that “a study last week showed that in the poorest African villages people take their medicine at a stunningly high percentage accurately!” (Applause). “They’ll live if you give them the tools to live. They’ll do just fine!”

Bill Gates informed the same audience that “this male circumcision thing is very likely to be a helpful tool which will drop the numbers down in a very big way.” He also told Clinton “It would be great if we could get the drug price down even further to $50. That would be heroic, but it could be done.”

Gates’ belief in the message is matched by his strong support for expanding the propaganda machine world wide. He emphasized that “the (Gates) Foundation is the biggest funder of media based activities. We did a Global media launch at the UN. I was there. I saw we must get well beyond public service advertising in foreign countries, and get the word out in television shows and get the news people to understand the issues and see the scale of the epidemic in a country. Part of advocacy is media, including every important element, and it is one we put a lot into.”

The only spark of enlightenment came from Bill Clinton who allowed that nutrition was important. But he hurried to say that this didn’t mean that drugs were not the top priority. “Nutrition has got a bum rap because some people have offered it as a substitute. Increasing caloric intake will increase overall health. Improving nutrition will increase our capacity to deal with HIV∫AIDS, as long as it is not a smoke screen for denial.”

Dissenters may be comforting themselves that this is all just public go-along, and that even now a Gates staff member may be double checking what truth there may be to Mbeki’s tip that things are not as they seem in the world of HIV∫AIDS, despite the unanimity and virtuous self-congratulation.

But from what was said it looks pretty clear that the richest man in the world, his wife and the ex-President will be making sure that the world’s poor get their microbicides and ARVs if they and their money can manage it.

Gates may be a poker player who parlayed a quick trip across town to bag the nearest Operating System for IBM PCs into a fortune larger than the world has ever seen, at the cost of disturbing the peace of mind of many millions of PC buyers, but it seems that if you are a scientist with a theoretical pig in a poke you should go to market and look around for Bill.

Ban the critics in the media! – Toronto session

August 14th, 2006


Irresponsible for journalists to quote HIV∫AIDS review, say Moore, Geffen, Horton of Lancet.

Why have the HIV boys adopted a losing tactic?

Barnesworld relays news of a development that must have Dr Anthony Fauci of NIAID having kittens over the crumbling of his highly successful strategy, over two decades, of banning any mention of why HIV∫AIDS science may be fatally flawed.

Yesterday John Moore of Cornell and his partner in crime Nathaniel Geffen of Treatment Action Group drew even more attention to the anti-HIV critique by publicly lambasting journalists who mention it. The venue can hardly have been more prominent. It was one of the Conference’s first sessions, titled HIV Science and Responsible Journalism.

As reported by Michael Geiger of San Diego HEAL at BarnesWorld, Moore and Geffen were joined from the audience by Richard Horton of the Lancet, whose grand survey of AIDS matters last week included the enbarrassing revelation that HAART hasn’t done much to reduce the death rate of AIDS patients, as in “no reduction in all-cause mortality” in the 20,000 studied.

The post Signs of Civil War Erupt at Toronto AIDS Conference // John P. Moore – The Dissidents’ Best Friend on BarnesWorld, newly renamed “Barnes-ville”, describes the session in amusingly irreverent terms, pointing out the paradoxical truth that the more Moore et al try to quash dissent the more they call attention to it.

John P. Moore, The Rethinkers BEST FRIEND, has helped us all to further disseminate HIV Dissenter’s information to the world press today. Every time he opens his mouth, or puts keystroke to computer he either sells HIV Dissenter’s books, promotes HIV Dissent magazine articles, or further informs the world of the importance of HIV Dissent issues.

Now we (and probably Dr Fauci) are wondering why they don’t appreciate this simple truth, first voiced by author and critic Harvey Bialy, and we think we know the answer.

Sure, Harper’s Celia Farber piece in March (“Out of Control: AIDS and the Corruption of Medical Science”) paved the way, landing like a MOAB (the Mother of All Bombs, a 21,000 lb superbomb) from a great height on the deep bunker of NIAID’s protective guard against any mention in the media of the HIV∫AIDS review. But in their response, Gallo, Moore, Geffen and others chose the wrong strategy for a reason beyond being shell shocked.

Why is NIAID censorship cracking from within?

Surrounded by tyrannized conformists who do not speak out, these activists of questionable science imagine that the whole world is their captive. They fail to realize, as Dr Fauci always has, that dissent is catnip to the independent mind. Every good scientist knows that the future lies in correction, the key to progress, and that the inevitable result of advance is replacement of the conventional wisdom.

To make scrambled eggs in science, you have to break shells. As Kuhn pointed out, paradigms don’t just accumulate, they replace the old, which resists mightily, and review is a constant process. Anyone who stands in the way of this process is simply making a public announcement that they are fools, or self interested, or both.

Alas, the report doesn’t mention any dissenter standing up and making a good point. We hope that Michael Geiger, at least, who is known to be good at such things, did so, even though under such circumstances it is usually shouting into the wind.

Saving babes from AZT

Meanwhile David Crowe scored a small victory in Canada earlier by getting a letter into the Globe and Mail explaining the toxicity of AZT. The country’s equivalent of the New York Times, the newspaper printed a contradiction from a qualified pharmacist, it appears, but the letter won a spot on a talk show for Crowe, who heads up the Alberta Society for Reapprasing AIDS.

It might seem inconceivable that a woman would deliberately evade AIDS drugs for her infant, but that is only because the toxicity of ‘life saving’ AIDS drugs is rarely discussed. AZT, the drug given to the vast majority of pregnant, HIV-positive mothers, most of their infants and, in combination with other drugs, to many other HIV-positive people, is one of the most toxic substances known to man.

There was time for one call in, a woman who told listeners her brother had given up on taking AZT because of its toxicity.

Crowe’s letter was triggered by a case where a mother was sentenced to six months (conditional) for trying to avoid medicating her newborn. Meanwhile, more mothers-to-be clamor for the test. All those who ignore the scientific literature in their enthusiasm for the paradigm being celebrated in Toronto should ponder the real-life consequences of their neglect and denial.

—–

Michael at Barnes-ville on “John P. Moore, The Rethinkers BEST FRIEND”:

Barnes-ville

“Politics is the art of looking for trouble, finding it, misdiagnosing it and then misapplying the wrong remedies.” —- Groucho Marx

« AIDS World:Where Up is Down, and Down is Up | Main

August 13, 2006

Signs of Civil War Erupt at Toronto AIDS Conference // John P. Moore – The Dissidents’ Best Friend

The AIDS Conference in Toronto Canada opened today. Melinda Gates was one of the opening speakers, and strangely had nothing to say about HIV drugs. She did say she would like to see the research and production of microbials and oral preventatives that women can protect themselves from disease with, put into full speed forward research. Canadian Conference co-chair Dr. Mark (Put Duesberg and all the Denialists in JAIL) Wainberg, who also is the proud owner of HIV Drug Patents, was naturally back to his standard dope dealer routine. “One goal of the conference is to make sure drugs are available to those who need them around the world, regardless of ability to pay”, he said. Prime Minister Stephen Harper has said he will not attend the six-day conference because of other commitments, a decision that will thrill Re-Thinkers, but has rankled and baffled organizers, researchers and AIDS activists – not just in Canada but elsewhere in the world. Clement and Minister of International Co-operation Jose Verner are representing Canada. Perhaps Minister Harper (I love the name Harper, reminds me of a magazine article I read a few months back) is another one of the few leaders of a country to see through the thin veneer of HIV/AIDS pseudoscience.

There was an astounding amount of lackadaisical attitude on the part of the inhabitants of Toronto. Strangely, the only banner of notice was for the International Dragonboat Festival that had ended today. No red ribbons in the Park. Nothing advertised on the subway. There were newspaper accounts in the local press, but that was pretty much the only notice that the fair city was being descended upon by 25,000 HIV worshippers.

John P. Moore, The Rethinkers BEST FRIEND,

has helped us all to further disseminate HIV Dissenter’s information to the world press today. Every time he opens his mouth, or puts keystroke to computer he either sells HIV Dissenter’s books, promotes HIV Dissent magazine articles, or further informs the world of the importance of HIV Dissent issues.

Witness:This mornings first session, co-chaired by John P. (I Hate The Denialists) Moore, was about press coverage. It was called the HIV Science and Responsible Journalism session.

His message was the same old song; he hollers something to the effect of “Look at those damn AIDS denialists, No, don’t look at them, you’ll turn to stone”, in a bit of a falsetto shrill, of AIDS denialism kills and all of us AIDS Denialists should be cooked slowly over a picnic barbecue. He ranted about the abuse of science (he should know, he is to be considered an expert in abusing science), he droned on about the rethinkers not getting through the thick walls of Media Censorship to publish any of their own work in peer-reviewed journals like Science, Nature, the Lancet, etc. And naturally, he screamed that we are pure liars, with HIV Dissenter’s well-proven claims that AZT is one of the world’s most toxic chemicals.

It is always a pleasure to hear Dr. Moore uttering words such as AZT IS ONE OF THE WORLDS MOST TOXIC CHEMICALS”, if only he would leave out the rest of his driveling untruths.

Naturally, Nathan Geffen, policy coordinator for Treatment Action Campaign in South Africa, joined Moore in his screed filled screech in touting the AIDS(un)TRUTH website as the only responsible place for journalists reporting on HIV/AIDS to get the proper brainwashing. Strange, cause the only truth I could find on his site, was the words of Dr. Bialy, and the link to Harpers! Both Moore and Nathan Geffen, policy coordinator for Treatment Action Campaign in South Africa, plugged AIDS Truth as a means for journalists reporting on HIV/AIDS to get reliable information.

A civil war began to erupt, when the panel discussion, which included such un-notables and unquotables as Marilyn Chase with Wall Street Journal, Tamar Kahn, science and health editor at South Africa’s Business Day, and Kim Honey, health editor at the Toronto Star, opened up a debate over whether journalists should challenge scientific consensus. For some strange reason, Geffen opposed it, and naturally, planted-into-the-audience, was Lancet chief editor Richard Horton who begged and pleaded for journalists to rise up to honk only on the Propaganda Horn. He accused journalists of being far too polite, of listening to the dissenting views of us damn denialists, and daring to print HIV Dissenter’s heretical words, because we are far too often invited to speak on the world’s stage. Strangely he asked, “Isn’t our job to keep the public informed about fact, not fiction?”

Well, I would certainly agree, and I hope he gets with the program sometime soon. Perhaps we should all give John Moore, Nathan Geffen, and Richard Horton, HIV Dissenter’s very first Honorary “Question Orthodox AIDS” Ribbons, when the conference ends. That is the only way I think they could benefit AIDS dissent more than they already have.

Michael Geiger

HEAL

San Diego

Posted by HankBarnes on August 13, 2006 at 05:00 PM | Permalink

Comments

I was thrilled when The Globe and Mail published my letter to the Editor about this today…….you can check it out on my blog.

Posted by: Peter Troyer | August 13, 2006 at 07:48 PM

16th International AIDS Conference: Stunning last minute addition.

Following the link below you can download a PDF version of the full transcription of the “last minute” addition to the Opening Session of the XVI Internal Aids Conference.

http://perso.wanadoo.fr/jan.spreen/english/16thiac.pdf

Posted by: jspreen | August 14, 2006 at 03:08 AM

Michael,

thanks for the update.

I’m glad they’re talking about “responsible journalism” when it comes to “HIV/AIDS” reporting.

If they were “smart”, they wouldn’t have even brought up the subject. Now they’re trying to make something “off limits”, possibly even taboo. That’s only going to make people more curious. It’s a big red flag when they’re telling people not to look behind the curtain.

For some of us, it’s an open admission of medical/scientific dictatorship. This isn’t what science is about…or is it?

Posted by: Dan | August 14, 2006 at 09:57 AM

Awesome comment by Guest Speaker Jan Spreen of France at the above link: “Germs do not create condition. They follow changes in condition”. This goes back to the fork in the road so to speak about the “germ theory” vs. pleomorphism in medicine. Pasteur the father of the germ theory supposedly recanted his position about this on his death bed; the terrain is everything, the germ is nothing!

This is why modern medcine misses the boat and will never cure anything with medicines and vaccinations regardless of what new disease or problem is on the planet. Until the terrain or the PH of the body is correct, there can be no health and well-being.

Posted by: noreen martin | August 14, 2006 at 10:09 AM

Open debate on censorship at the global AIDS Conference!! Whose idea was that?! Dr Fauci must be having kittens.

So who wrote this excellent post, apparently signed by Michael Geiger, but written in the inimitable style of Hank the Truthteller?

Either way, we hope there is a transcript of the session made available.

Posted by: TS | August 14, 2006 at 10:57 AM

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Larry Altman’s Guide to AIDS Conferences

August 11th, 2006


25 years of mental inertia on parade

Does the HIV meme ever leave?

Now we have the Toronto AIDS conference upon us. Dissenters must feel enormous conflict as they contemplate this monstrosity. On the one hand, the biggest and best target audience in the HIV∫AIDS world, assembled right on their doorstep, and easily accessible from New York, San Francisco, San Diego, Alberta and other locations of key dissenters, especially Toronto, where CBC-associated Colman Jones has been operating for years.

But on the other, the sheer size of this planetary sized snowball of nonscience is forbidding, to say the least. What hope have sense and reason, those frail levers of the individual mind, of moving this mountain? This great agglomeration of communal fantasy will gather 45,000 believers, all told, if all the 20,000 public tickets are sold at the $20 million event. They will include great names in celebrity and politics, including the world’s greatest disease philanthropist, Bill Gates, who will give the opening address, having just handed over another half billion to the Global AIDS, TB and Malaria Fund, Bill Clinton, co-chair of the International AIDS Trust with Nelson Mandela, the Canadian Health Minister Tony Clement and even Elton John will turn up, so they say. Alicia Keys will perform Sunday night.

For some reason the Canadian Prime Minister Stephen Harper is unable to participate owing to pressing business elsewhere, but this doesn’t seem to be the result of being tipped off that the whole thing is a giant mistake, predicated on a false reading of the scientific literature. That’s about as likely as the vision of Thabo Mbeki mentioning his realistic view of HIV∫AIDS to George W. Bush at the White House on Thursday, when our President cut short his vacation to hear what he had to say.

The crowd is so thoughtless that even mainstream scientists of any accomplishment no longer bother to turn up to this circus, according to Larry Altman, who gave us a reassuring rundown of what to expect in the Tuesday Science Section of the New York Times, the newspaper of record in HIV∫AIDS.

So comfortably conventional was Altman’s piece that despite close examination we could not detect one single glimmer of independent thought in the entire lengthy exercise, which covered Larry’s attendance at 13 of the 15 World AIDS Conferences that have taken place since 1985. Larry’s account did not veer from the conventional wisdom in any respect, however wide the gap between the scientific literature and what he was saying. It is now quite clear that the medical correspondent of the New York Times is nothing less than the propaganda partner of Dr Anthony Fauci, head of NIAID.

For what his deft rundown reveals is that even at the tippy top of the ladder, media reporters have been coopted for years into becoming the chief cheerleaders for the paradigm. In fact, Altman’s account is that of an activist, who gets “sad and angry” when he meets with an African leader who rejects the news he brings.

What precisely does Larry Altman get paid for?

This is the question that came to mind as one ploughed through this homily. Is not Altman meant to be an independent reporter, independently assessing what he is told by scientists? Is it not reasonable to expect independent thought from the mind of a senior medical correspondent of the paper of record when he tackles a disputed field where lives of millions are at stake?

Let’s deconstruct what Larry has learned after twenty years tracking AIDS with the HIV∫AIDS meme firmly entrenched in his brain. Has the meme now finally paralyzed all movement in his neural networks? It looks dangerously close to doing so, if it hasn’t already.

August 8, 2006

The Doctor’s World

Talking About AIDS, With All the World Watching

By LAWRENCE K. ALTMAN, M.D.

Perhaps we have a clue straight away in the title A Doctor’s World. Apparently Larry is a doc, an MD – not a scientist, educated at Tuft and trained at the University of Washington, and then the CDC, and now teaching at NYU. If so, then by nature he is not in any position to challenge science, since he is well trained to absorb established knowledge in medicine, not to question. He is more like an auto mechanic learning a manual. He has been learning, and teaching, the manual of AIDS for twenty years. But why does he not read the mainstream literature?

The 16th International AIDS Conference opens in Toronto on Sunday a huge arena for many groups to share the now huge body of knowledge.

Indeed, the manual is now huge, it is too long to allow any independent thought whatsoever.

I have attended all but two of the conferences since 1985, and I have watched the meetings change, reflecting one of history’s worst pandemics.

Larry, we understand. With barely time to read all the press releases and attend the press conferences and catch one or two people in the corridors in 13 Conferences, and with access to all the key people and covering the medical story throughout the year, in twenty two years you have never had time to think about whether the pandemic made any sense, or notice that for a decade the mainstream literature has been saying that the global pandemic is based on a false assumption, that “HIV positive status” is sufficiently infectious.

They have also have played a major role in lowering the price of antiretroviral drugs in poor countries.

Larry, are you an activist or a reporter? Activists may have continually made the mistake of assuming that all new drugs are good, but what excuse has an MD and CDC graduate got for not examining this assumption? This is the man on whom the Times and its readers are relying for an accurate and balanced report on the most politically charged and commercially profitable area of HIV?AIDS. Has he ignored Harper’s March issue, or read it and dismissed it – if so on what grounds?

In the last six years, the conference has been held in South Africa and Thailand… to give scientists in modern laboratories and hospitals their first view of the challenges in delivering antiretroviral therapy in developing countries, where a vast majority of the world’s H.I.V. infected people live.

But has what you and they ‘see” been interpreted through distorting lenses? Is it not better that they first read the literature thoroughly, so that they have a more sophisticated interpretation of what seems obvious in front of their eyes? Is this not the difference between “anecdotal” and “scientific” evidence?

In 1988 The mainstay of therapy then was AZT, which cost about $8,000 a year. Additional drugs were needed to treat the many and often fatal opportunistic infections that developed when the number of a patient’s CD-4 immune cells fell too low.

And why were additional drugs needed? AZT was a drug that was abandoned after it was discovered and tested as too damaging to the patient, even as it killed cancers. Before the dose was reduced, it evidently killed a lot of people earlier (2-3 years) than they were expected to die of the Virus (10-20 years). By some estimates 300,000 patients were lost to AZT, a catastrophe which is the crux of the new book, Wrongful Death, by Stephen Davis. Maybe, Dr Altman, you should read it, if this enormous debacle hasn’t yet triggered some skepticism in your mind?

King Carl XVI Gustaf of Sweden attended the conference in Stockholm. Former presidents, including Bill Clinton and Nelson Mandela of South Africa, have attended. Both have said they wished they had done more to prevent AIDS when they were in office.

The tendency of celebrities and politicains to cloak themselves in virtue by unwittingly supporting the paradigm in this field against review is a propaganda success for its promoters, but is all the more reason to ensure that the factual basis for their concern and attention should be gotten very, very straight.

The Toronto conference will be the third held in Canada. Prime Minister Brian Mulroney opened the 1989 meeting in Montreal, but his successor, Jean Chrétien, did not appear at the Vancouver meeting in 1996. The current prime minister, Stephen Harper, has not accepted an invitation to appear in Toronto, disappointing the organizers. But as Dr. Helene D. Gayle, the president of the International AIDS Society, an independent professional group that is chief organizer of the meeting, said, “AIDS conferences can sometimes be hard on politicians.”

Maybe Harper has been talking to Mbeki? But more important, is it not the professional duty of Altman as the Times guide to the field to note the interlocking career paths of key players in the arena? Gayle, who has just moved from the Gates Foundation, was at the CDC for years, as noted in an earlier post.

The conferences have also had their more startling moments. In a speech at the Durban conference in 2000, President Thabo Mbeki of South Africa refused to acknowledge H.I.V. as the cause of AIDS. Minutes later, he walked out of a televised forum as Nkosi Johnson, 11, spoke of being born with H.I.V. He wished, he said, that the government would “start giving AZT to pregnant H.I.V. mothers to help stop the virus being passed on to their babies.”

What precisely was it that told Larry Altman not to take Thabo Mbeki’s response seriously, and proceed to investigate what lay behind Thabo Mbeki’s judgement? Did Larry ever do a lengthy, respectful interview with Mbeki, then or later? Why not? We can’t find one listed at the Times. Would he not have jumped at the chance to do one with Tony Blair, if he had shown such a reaction? Mbeki is a world leader of stature, involved in top international negotiations in G8, for example, and leading peace initiatives in Africa and elsewhere. Why doesn’t he rate?

In 1996 in Vancouver, the audience cheered after a grandmother told the conference: “How did I get infected? The answer is very simple: It just doesn’t matter.”

Really? Does the AIDS meme paralyze all thought in Larry’s brain? Wouldn’t this have triggered some faint response in your mind? Do grandmothers usually serve as VD vectors?

There was a growing understanding that the AIDS virus, which had yet to be named H.I.V., had been spreading silently for at least a decade before the disease was first detected in 1981.

Silently stealing over minds everywhere, the AIDS meme…but Larry, all the evidence is that the “AIDS virus” spreads only with the maximum of effort, and not in the general population, and this has been the case from the beginning. And the evidence from the CDC’s estimates of prevalence in the US (roughly 1 million for the duration, once the artificial changes due to altering assumptions are removed) is that it has not spread at all. In fact, evidence from the testing of Army recruits suggests that not only has it not spread among the general population but that its prevalence is probably twenty times less than the CDC estimate.

Dr Altman, you are writing fiction and passing it off as fact, according to the mainstream literature.

At the time, there were no effective antiretroviral drugs. Some doctors were shunning AIDS patients. Hospital workers left meal trays at patients’ doors. Many people feared that they might become infected from casual contact despite epidemiologic evidence to the contrary.

And now they fear they might be infected through heterosexual sex, despite all evidence to the contrary. Larry, read the literature, where this question has been discussed for years, how exactly is HIV spreading in Africa and Asia if the largest studies show it cannot be transmitted between man and woman?

The cases in the United States, then fewer than 10,000, were mostly among gay men, intravenous drug users and hemophiliacs. But the totals were doubling every six months. In one presentation, Dr. Peter Piot, a researcher who is now the executive director of the United Nations AIDS program, reported a cluster of heterosexual cases in Africa. But few knew how wildly the disease was spreading there.

No inkling yet that this may not have happened? No inkling yet that the whole case for this wild spread has fallen apart, and that it was merely a wild expansion of estimates, which took conventional disease and placed it under a new umbrella, “AIDS”?

Activists proclaimed “No test is best” because of the stigma linked to the disease and the lack of effective therapy. Now the federal government wants all Americans to be tested.

Tested and then given dangerous drugs for a virtually non infectious agent for a disease which the literature shows is caused by toxic substances, including the very drugs they will administer – according to the unrefuted reviews in the literature of the mainstream studies in that literature?

Maybe the activists are saving the world from mass HIV testing and mass ARV taking, since the latest theory demands that ARVs should best be given “within a few days” of infection. So if the Feds do succeed in getting us all tested, then at least one million people will have to suffer the side effects of ARVs on the dubious basis of counteracting HIV, which has been demonstrated to be efficiently overcome by a normal immune response.

Conceivably, it might be argued that with HIV “spreading” silently no one can be tested in time to catch the “first few days” unless everybody is given HAART prophylactically. The ‘market’ would then expand to the entire US population, and then to the world.

By 1988, when the meeting was held in Stockholm, there were more discouraging findings for H.I.V. patients: a vast proportion would develop full-spectrum AIDS within a decade of being infected, countering earlier suppositions that a relatively small percent would be struck down by its debilitating complications.

Did this not correlate with AZT, later reduced drastically in dosage since even HIV∫AIDS scientists could see it was killing people in three years or less, when the Virus was supposed to kill them only in ten to twenty years, a supposed benefit never explained?

The Montreal conference in 1989 made me sad — and angry — when President Kenneth D. Kaunda of Zambia delivered an apology for his indifference to the epidemic, saying he had lost a son to AIDS in 1986.

A year earlier, denying my request to interview Mr. Kaunda about AIDS in the Zambian capital, Lusaka, his press secretary scolded me for going to Africa to report on an American disease. The president had more important things to do, the aide said.

Sad and angry – what are you, Dr. Altman, an activist or a reporter?

At the meeting, Mr. Kaunda pleaded with governments to support scientists to find a cure for AIDS, saying failure would turn the epidemic into “a soft nuclear bomb on human life.” But in the years of Mr. Kaunda’s silence, hundreds of thousands of Africans had become infected.

How responsible were you, Dr Altman, for selling this story? How had these thousands of Africans become infected, now we know they weren’t infected sexually?

Organizers moved the 1992 conference to Amsterdam from Boston to protest the new United States’ policy of denying visas to H.I.V.-infected people. Since 1990, no conference has been held in the United States.

Superstitious even by the rules of the paradigm. But nothing compared with the vile injustices forced on mothers who must give their children AZT or lose their custody. David Crowe has pointed to the scandal of a recent case in an August 7 letter to the Globe and Mail, which Dr Altman should read, if he wishes to ponder the consequences of blind faith in the current science.

The Berlin conference in 1993 was my dreariest. The epidemic was worsening, and the outlook for major scientific advances seemed bleak. A European study, presented at the meeting, showed that AZT alone did little good over the long term.

Well, well. And why was that a surprise for you, if you were familiar with its toxicity, as advertised on its label? And have you covered the possibility that protease inhibitors and HAART are following exactly the same pattern? See Lancet last week, where HAART was revealed as not yet having improved the death rate one iota in ten years.

For years, scientists said they had learned more about the AIDS virus than about any other microbe. But skeptics were numerous because therapeutic advances were few.

Skeptics are more numerous than that, since no good justification for the theory that HIV was the correct target was offered then or since, with all evidence was against it and no explanation for it.

Then, in 1996, reports at the Vancouver conference showed that a combination of new antiretroviral drugs, called protease inhibitors, and older ones could successfully treat AIDS, extending the lives of many people. Some patients got up from their deathbeds to live more normal lives in what seemed like Lazarus.

Otherwise known as HAART, based on a theory of David Ho that even his colleagues soon laughed at, and which has produced horrendous side effects and no reprieve from death since, see Lancet last week (Vol 368 Aug 5, 2006 p 427). Does nothing arouse your curiosity, Dr Altman? Does nothing vibrate your antennae? Since 1996, what has happened? Have deaths declined? Are there not other reasons for the initial benefits that the narrative of HIV∫AIDS claims prove that HIV is the correct target of HAART?

If Coca-Cola could deliver its product in Africa, an AIDS expert said in Vancouver, then the world could deliver AIDS drugs to poor countries. The drug cocktails, which cost about $20,000 a year, reduced the amount of H.I.V. detectable in the blood and increased the number of T cells, a crucial component of the immune system. The startling turnarounds in patients confirmed, in their own way, the causal role of H.I.V. in AIDS and refuted claims to the contrary.

Right. The initial improvement, often quite striking in seriously declining patients in Africa, which is the only “proof” offered now of the “Virus which causes AIDS” phrase which is part of the Times stylebook now. The current argument is that HAART cocktails produce immediate turnarounds in patients, therefore they must be directed at the right target. This supposedly refutes myriad arguments to the contrary, otherwise unanswered in the literature. But eventually, side effects, and death at the same rate as before. Some turnaround, Dr Altman. Is your curiosity not aroused as to whether there might be some other interpretation of the magical initial effect? Should you not cover the issue, constantly raised even by patients, as to whether they really do feel better for long?

Exuberant leaders talked about curing AIDS by ridding the body of H.I.V. Later, experiments showed that a cure remained beyond reach because the virus found hiding places in the body to escape the drugs.

So now drugs have to be taken forever. Based on keeping the presence of the virus as negligible as it would be anyway with a functioning immune system, which is then burdened by the drugs, which eventually cause what the virus is then blamed for, decline and death. Meanwhile, those who do not take drugs flourish with a normal immune system until some other threat overtakes them.

That year, as the treatments began to emerge, the United Nations created its AIDS program. In the years since, its director, Dr. Piot, has stressed that the political will of top world leaders is necessary to turn the epidemic around.

At the Geneva conference in 1998, the first country-by-country estimates of H.I.V. infections and AIDS deaths underscored the devastating impact of the epidemic in the developing world.

Did overall deaths rise? At least check that, Larry. Were populations decimated? Have predictions of disease and death proved out, except where “life saving” drugs have been added to the burden of poverty, hunger and malnutrition, and their associated conventional diseases? Or have populations expanded, sometimes by huge numbers (in sub Saharan Africa, for example) that make a nonsense out of claims that HIV has brought illness and death that will decimate whole societies. Look at the population statistics, Dr Altman, before retailing all these claims without examination.

And enthusiasm about promising reports of effective treatments was dampened by the recognition of unexpected complications. In the case of the drug cocktails, it was lipodystrophy, a side effect of protease inhibitors that causes fat to disappear from some areas of the body and redistribute in other areas, changing the body’s shape in peculiar ways.

Hideous side effects but sold to patients as worth the sacrifice to avoid the unproven depredations of the invisible Virus.

The Durban meeting, in 2000, was the first international AIDS conference held in a country with such widespread poverty. Speakers directly attributed the magnitude of the epidemic to the failure to advocate protective measure and to provide effective treatments to vast populations in Africa and elsewhere.

And you put on the spectacles they gave you to wear, rather than use your own?

A session was scheduled to announce what organizers thought would be favorable research findings: that a spermicide, nonoxynol-9, could be an effective microbicide against H.I.V. A microbicide, any substance that kills germs, can be formulated as a cream, gel, film or suppository. But the plenary session became a surprising disappointment: the product had failed.

And is now the subject of heavily funded research, to support the defense of women in under developed countries against their abusive men who will not wear condoms, and thus infect them from visits to prostitutes, although studies show that women infect men at a rate of 1 in 9000.

In Barcelona in 2002, Dr. Bernhard Schwartlander, a W.H.O. epidemiologist, provided the outline of what has become the agency’s efforts to treat millions of people. Though the plan has failed to meet its target, health officials say it has fundamentally changed attitudes about what can be done in poor countries.

What can be done in poor countries is deliver Western drugs and persuade the otherwise uninformed population that they need to take them, rather than the medicines normally prescribed for their ailments, you mean? Do you not have some responsibility as a prominent reporter and opinion maker to check out the questions surrounding the basis of this policy, as far as you reasonably can?

The last conference, in 2004, was held in Bangkok to focus attention on AIDS in Asia. Yet the Thai government had to cancel a summit meeting of 10 invited heads of state at the conference because only President Yoweri Museveni of Uganda accepted.

Is it at all possible that heads of state, like some domestic critics, might finally feel in their intuitive political bones that something is out of whack with the HIV∫AIDS story, as Mbeki has signaled, though they don’t quite know what it is?

This year in Toronto, to accommodate the disparate interests of the 24,000 participants, the sessions will cover a wide range of topics. Over six days, the presenters are to deliver 4,500 reports — and hundreds more in satellite meetings before and after the main event.

As an index of the busywork that the paradigm has generated, this is truly impressive. Alas, if the basic premise is inaccurate, it is also a demonstration that in modern science, failure to examine the premise critically does not prevent the expansion of research to infinite size if funding is available.

A few major advances have been announced at the international meetings over the years, but most gains have been incremental, as is true for meetings in other fields.

Does it not appear that research in this field has been unusually unfruitful, given that the advances at the fundamental level amount to disproving almost all early speculation about the modus operandi of the Virus, as well as finding no way of accounting for its supposed lethality after two decades, and no cure yet discovered, and with a vaccine now said possibly never to be achieved?

For these and other reasons, a number of leading scientists have stopped attending, choosing to present their findings elsewhere…some supporters complain that the quality of the scientific presentations has declined at recent conferences. Recognizing that criticism, Dr. Gayle, the president of the international society, said that the organizers had focused on strengthening the meeting’s scientific component.

But will they include any scientific review of the basic assumption, or will they and Dr Altman continue to ignore the unanswered review papers of Duesberg et al as if they didn’t exist? Don’t bother to answer. After all, no one involved would benefit from any revision, especially those paying for the show.

The conferences have come to attract a wide array of institutional sponsors and commercial exhibitors, who together are paying about half the $20 million cost of the Toronto conference, about the amount for similar meetings.

The spirit is in the opposite direction: implementing current belief as globally as possible:

Scientists have come far in the 25-year history of AIDS. Some infected patients now need to take only one pill a day. Only a few years ago, many regimens involved a dozen or so pills, taken several times a day. But scientists and political leaders still have much further to go. In the decade since the drug cocktails were introduced, 20 million people have become infected, underscoring that the need to build a system to deliver effective health care is as urgent and essential a need as lowering the cost of antiretroviral drugs.

That is why “Time to Deliver” is the theme for the Toronto conference. So many lives — and so much money — is now at stake, organizers say, that everyone involved in fighting the AIDS pandemic must be held accountable.

Thanks very much for the rundown, Larry. Now just one question: when you say, everyone must be held accountable, does that include the medical correspondent from the Times?

Talking About AIDS, With All the World Watching:

August 8, 2006

The Doctor’s World

Talking About AIDS, With All the World Watching

By LAWRENCE K. ALTMAN, M.D.

The 16th International AIDS Conference opens in Toronto on Sunday and will vastly differ from the first meeting, in Atlanta in 1985, four years after AIDS was discovered.

What began as a relatively small forum for 2,200 scientists to share their embryonic knowledge has evolved into a huge arena for many groups, including patients infected with H.I.V., their advocates, social workers, economists, lawyers and policy makers to share the now huge body of knowledge.

I have attended all but two of the conferences since 1985, and I have watched the meetings change, reflecting one of history’s worst pandemics. In some cases, they have helped shape the response to the epidemic, influencing attitudes, politics, policy and treatment. They have also have played a major role in lowering the price of antiretroviral drugs in poor countries.

In the last six years, the conference has been held in South Africa and Thailand. This was done in part to give scientists in modern laboratories and hospitals their first view of the challenges in delivering antiretroviral therapy in developing countries, where a vast majority of the world’s H.I.V. infected people live. These two conferences also helped doctors in developing countries get up to speed on AIDS and encouraged scientists to conduct research on AIDS problems peculiar to their geographic area.

Many AIDS experts point to the last decade as the beginning of efforts to narrow the gap between rich and poor countries in providing fairer distribution of treatment and care for H.I.V.-infected people. But the efforts started earlier. In 1988 at the Stockholm conference, I heard discussions about ways that people in poor countries might be given access to the same care and drugs as patients in rich ones. The mainstay of therapy then was AZT, which cost about $8,000 a year. Additional drugs were needed to treat the many and often fatal opportunistic infections that developed when the number of a patient’s CD-4 immune cells fell too low.

Besides the scientists, patients and advocates, heads of state and royalty have also attended some of the conferences.

King Carl XVI Gustaf of Sweden attended the conference in Stockholm. Former presidents, including Bill Clinton and Nelson Mandela of South Africa, have attended. Both have said they wished they had done more to prevent AIDS when they were in office.

The Toronto conference will be the third held in Canada. Prime Minister Brian Mulroney opened the 1989 meeting in Montreal, but his successor, Jean Chrétien, did not appear at the Vancouver meeting in 1996. The current prime minister, Stephen Harper, has not accepted an invitation to appear in Toronto, disappointing the organizers.

But as Dr. Helene D. Gayle, the president of the International AIDS Society, an independent professional group that is chief organizer of the meeting, said, “AIDS conferences can sometimes be hard on politicians.”

In Barcelona in 2002, demonstrators drowned out a talk by Tommy G. Thompson, the secretary of health and human services in President Bush’s first term. In San Francisco in 1990, protesters prevented Dr. Louis Sullivan, the secretary of health and human services under the first President Bush, from delivering a closing speech.

The conferences have also had their more startling moments.

In a speech at the Durban conference in 2000, President Thabo Mbeki of South Africa refused to acknowledge H.I.V. as the cause of AIDS. Minutes later, he walked out of a televised forum as Nkosi Johnson, 11, spoke of being born with H.I.V. He wished, he said, that the government would “start giving AZT to pregnant H.I.V. mothers to help stop the virus being passed on to their babies.”

In a K.G.B. disinformation campaign in 1986, a Soviet official told the conference in Paris that H.I.V. had been genetically engineered and that it had escaped from a government laboratory in the United States.

In 1996 in Vancouver, the audience cheered after a grandmother told the conference: “How did I get infected? The answer is very simple: It just doesn’t matter.”

The sessions at the first conference, in 1985, filled only a few rooms in a convention center in Atlanta. There was a growing understanding that the AIDS virus, which had yet to be named H.I.V., had been spreading silently for at least a decade before the disease was first detected in 1981.

At the time, there were no effective antiretroviral drugs. Some doctors were shunning AIDS patients. Hospital workers left meal trays at patients’ doors. Many people feared that they might become infected from casual contact despite epidemiologic evidence to the contrary.

The cases in the United States, then fewer than 10,000, were mostly among gay men, intravenous drug users and hemophiliacs. But the totals were doubling every six months. In one presentation, Dr. Peter Piot, a researcher who is now the executive director of the United Nations AIDS program, reported a cluster of heterosexual cases in Africa. But few knew how wildly the disease was spreading there.

A new H.I.V. test was about to be approved to protect the blood supply, but there was intense debate over its use in testing people. Activists proclaimed “No test is best” because of the stigma linked to the disease and the lack of effective therapy. Now the federal government wants all Americans to be tested.

Dr. Kevin M. De Cock, who now directs the World Health Organization’s H.I.V./AIDS program, recalled the audience’s silence at that first conference as pathologists described brain damage from the virus.

“The realization was sinking in that you were going to see dementia and terrible neurological disease,” Dr. De Cock said, and “everything we were learning about AIDS in those days was, This is worse than we thought.”

Two years later, on the eve of the 1987 conference in Washington, President Ronald Reagan gave his first speech on AIDS. At that conference, demonstrators protesting the slow drug approval process claimed that they were being denied potentially lifesaving treatments as scientists conducted lengthy clinical trials.

Dr. Jonathan Mann, then the leader of World Health Organization’s AIDS program, said the global epidemic had entered a stage in which prejudice about race, religion, social class and nationality was spreading as fast as the virus.

At the conference’s end, the mood was restrained, but there was real optimism that the widespread problems were not so awesome as to be beyond control.

By 1988, when the meeting was held in Stockholm, there were more discouraging findings for H.I.V. patients: a vast proportion would develop full-spectrum AIDS within a decade of being infected, countering earlier suppositions that a relatively small percent would be struck down by its debilitating complications.

The Montreal conference in 1989 made me sad — and angry — when President Kenneth D. Kaunda of Zambia delivered an apology for his indifference to the epidemic, saying he had lost a son to AIDS in 1986.

A year earlier, denying my request to interview Mr. Kaunda about AIDS in the Zambian capital, Lusaka, his press secretary scolded me for going to Africa to report on an American disease. The president had more important things to do, the aide said.

At the meeting, Mr. Kaunda pleaded with governments to support scientists to find a cure for AIDS, saying failure would turn the epidemic into “a soft nuclear bomb on human life.” But in the years of Mr. Kaunda’s silence, hundreds of thousands of Africans had become infected.

Organizers moved the 1992 conference to Amsterdam from Boston to protest the new United States’ policy of denying visas to H.I.V.-infected people. Since 1990, no conference has been held in the United States.

In Amsterdam, researchers presented a study showing that young American doctors were more reluctant to care for AIDS patients than comparable groups of doctors in Canada and France.

The Berlin conference in 1993 was my dreariest. The epidemic was worsening, and the outlook for major scientific advances seemed bleak. A European study, presented at the meeting, showed that AZT alone did little good over the long term.

For years, scientists said they had learned more about the AIDS virus than about any other microbe. But skeptics were numerous because therapeutic advances were few.

Then, in 1996, reports at the Vancouver conference showed that a combination of new antiretroviral drugs, called protease inhibitors, and older ones could successfully treat AIDS, extending the lives of many people. Some patients got up from their deathbeds to live more normal lives in what seemed like Lazarus.

If Coca-Cola could deliver its product in Africa, an AIDS expert said in Vancouver, then the world could deliver AIDS drugs to poor countries. The drug cocktails, which cost about $20,000 a year, reduced the amount of H.I.V. detectable in the blood and increased the number of T cells, a crucial component of the immune system. The startling turnarounds in patients confirmed, in their own way, the causal role of H.I.V. in AIDS and refuted claims to the contrary.

Exuberant leaders talked about curing AIDS by ridding the body of H.I.V. Later, experiments showed that a cure remained beyond reach because the virus found hiding places in the body to escape the drugs.

That year, as the treatments began to emerge, the United Nations created its AIDS program. In the years since, its director, Dr. Piot, has stressed that the political will of top world leaders is necessary to turn the epidemic around.

At the Geneva conference in 1998, the first country-by-country estimates of H.I.V. infections and AIDS deaths underscored the devastating impact of the epidemic in the developing world.

And enthusiasm about promising reports of effective treatments was dampened by the recognition of unexpected complications. In the case of the drug cocktails, it was lipodystrophy, a side effect of protease inhibitors that causes fat to disappear from some areas of the body and redistribute in other areas, changing the body’s shape in peculiar ways.

The Durban meeting, in 2000, was the first international AIDS conference held in a country with such widespread poverty. Speakers directly attributed the magnitude of the epidemic to the failure to advocate protective measure and to provide effective treatments to vast populations in Africa and elsewhere.

A session was scheduled to announce what organizers thought would be favorable research findings: that a spermicide, nonoxynol-9, could be an effective microbicide against H.I.V. A microbicide, any substance that kills germs, can be formulated as a cream, gel, film or suppository. But the plenary session became a surprising disappointment: the product had failed.

In Barcelona in 2002, Dr. Bernhard Schwartlander, a W.H.O. epidemiologist, provided the outline of what has become the agency’s efforts to treat millions of people. Though the plan has failed to meet its target, health officials say it has fundamentally changed attitudes about what can be done in poor countries.

The last conference, in 2004, was held in Bangkok to focus attention on AIDS in Asia. Yet the Thai government had to cancel a summit meeting of 10 invited heads of state at the conference because only President Yoweri Museveni of Uganda accepted.

This year in Toronto, to accommodate the disparate interests of the 24,000 participants, the sessions will cover a wide range of topics. Over six days, the presenters are to deliver 4,500 reports —and hundreds more in satellite meetings before and after the main event.

As in previous years, noisy protests are likely to punctuate the conference, adding to a circuslike atmosphere and making it seem more like a convention and social gathering than a scientific meeting.

The AIDS conferences are not intended to set agendas or to pass resolutions — like conferences on the environment, for example — or even to reach a consensus on how to fight the disease. A few major advances have been announced at the international meetings over the years, but most gains have been incremental, as is true for meetings in other fields.

For these and other reasons, a number of leading scientists have stopped attending, choosing to present their findings elsewhere. The United States is paying for about 175 people — government employees and representatives of nongovernmental agencies — to attend.

Some scientists continue to go wherever the conferences are held to attend refresher courses, learn of new findings and listen to reports from disciplines to which they are rarely exposed.

These scientists say they believe the activism and diversity of the participants are critical to keeping AIDS in the news. Still, some supporters complain that the quality of the scientific presentations has declined at recent conferences.

Recognizing that criticism, Dr. Gayle, the president of the international society, said that the organizers had focused on strengthening the meeting’s scientific component.

For journalists and participants, the conferences are challenging. A participant can listen only to a small fraction of the presentations, and at best has time to digest the material. All too often, presentations that a participant wants to hear are scheduled a few minutes apart in different areas of vast convention halls. Also, the race between meeting rooms is often interrupted by chance encounters with other participants who want to stop and talk.

The conferences have come to attract a wide array of institutional sponsors and commercial exhibitors, who together are paying about half the $20 million cost of the Toronto conference, about the amount for similar meetings. The other half of the cost comes from registration fees that range from $150 to $995, depending on the participant’s country. (Those from poor countries pay the least, and some receive scholarships.)

Scientists have come far in the 25-year history of AIDS. Some infected patients now need to take only one pill a day. Only a few years ago, many regimens involved a dozen or so pills, taken several times a day.

But scientists and political leaders still have much further to go. In the decade since the drug cocktails were introduced, 20 million people have become infected, underscoring that the need to build a system to deliver effective health care is as urgent and essential a need as lowering the cost of antiretroviral drugs.

That is why “Time to Deliver” is the theme for the Toronto conference. So many lives — and so much money — is now at stake, organizers say, that everyone involved in fighting the AIDS pandemic must be held accountable.


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