07 March 2006

Baby with the bathwater

I seem to have hit a sore spot with a comment I left on Chris Mooney's Intersection. The topic was perhaps the least politically correct subject of all. Less correct than creationism or even global warming denial. Even giving a micrometre of credit to anyone involved with the idea that HIV doesn't cause AIDS is a dangerous game, indeed.

First, I need to make it clear that I claim no expertise on the epidemiology of AIDS, and I am not (repeat: NOT) a member of the HIV/AIDS dissident camp. The idea hadn't even been on my mind for at least 14 years. But then Harper's magazine had to go and run a feature by Celia Farber, a journalist who made promoting the lack of a causative link between the virus and the syndrome her life's work since she was writing for the pop culture magazine Spin back in the early 1990s.

I didn't even notice the article the first time I read my copy of Harper's. I was too busy marveling over Lewis Lapham's case for the impeachment of George W. Bush, perhaps the most succinct summary of the argument yet. But I digress.

Anyway, Chris lamented that Lapham's journalistic judgment must be slipping to allow Farber's prose to find its way into his publication. "Say it ain't so ...." said Chris, who admitted he had yet to read the story. So I read it. It was lying right there beneath the latest This Old House, so what the heck?

What I found was a much more complicated story than yet another round of HIV doesn't causes AIDS. From my posted response:
Only five of the 40-ish columns that comprise the feature deal with HIV-AIDS denial theory ... the other 35 columns of Farber's feature are very troubling, but not because of anything to do with HIV epidemiology, but because they detail the tragic story of the Uganda nevirapine study, which she documents thoroughly. And the final section of the story, dealing with the aneuploidy-cancer hypothesis, is also worthy of a read. Farber devotes as much space to that topic as she does [once respected, now persona non grata and leading HIV/AIDS dissent biologist Peter] Duesberg's denial of an HIV link to AIDS.
The Uganda nevirapine study, as documented by Farber, is a tale of botched research and alleged coverups that reach the National Institutes of Health. People have died and are dying, she says, because of diagnostic errors resulting from mismanaged handling of field tests of the drug. (And in a blatant attempt to inject a little contemporary culture into her work, Farber calls the affair a real-life analog of The Constant Gardener).

My point, probably poorly made, was that Farber tells an important story that has nothing necessarily to do with whether or not HIV causes AIDS. There may be a problem with her take on the affair -- a group of scientists and other professionals has already produced a long list of objections to the Harper's piece, for one thing. But those objections aren't all factual errors, and my initial reaction is Farber's story shouldn't be ignored simply because she then proceeds to drag the HIV/AIDS dissidents into her reportage.

The reaction from many quarters of the science blogosphere was to lump in anyone who denies the HIV/AIDS connection with other anti-science denial movements, like intelligent design advocates and climate change skeptics. To be fair, there are some similarities. For example, the HIV/AIDS dissidents have a petition with 2300 signatures (according to Farber) from experts who doubt the connection. It brings to mind the infamous Oregon petition alleging signed by thousands of experts who doubt we're warming the planet but turn out mostly to have no real climatology expertise. And as Tara "Aetiology" Smith pointed out, the creationists have a petition, too.

But I think it would be a mistake to paint the HIV/AIDS dissidents with the same brush as the other right-wing anti-science crowds, which seem to have a great deal of trouble with reality. And here's why:

First, the expertise of the HIV/AIDS dissidents tends to be far more respectable, and their theories more sophisticated and heterogenous, than those of the climate change or ID types. That doesn't make them right, but it does mean they have to be dealt with differently. For every Philip Johnson, (a lawyer with no scientific training who has signed on to both the ID and HIV/AIDS dissent movements), there's at least one, and perhaps two or three experts like Rebecca V. Culshaw, an accomplished mathematical biologist whose work is still being published by the scientific press.

There's also the inconvenient presence on that list of Kary Mullis, the inventor of the polymerase chain reaction, a little thing that won him the Nobel prize and just happens to make possible much of the molecular biology that informs modern medical research. What has he done for us lately? Maybe not much, but you can't dismiss out of hand someone who made such a contribution to science. And the other anti-science movements don't have anyone of his stature on their side.

Second, it's simply not fair to compare the scientific consensus on biological evolution with the current thinking on the epidemiology of AIDS or even the global warming orthodoxy. Like many things medical, the pathology and molecular biology of AIDS is far more complicated and involves far more unexplained elements.

[UPDATE: Third, the AIDS denial gang isn't integrated into the corporate-Christian-Republican alliance that is funding their anti-science agenda with millions of dollars and elaborate propaganda campaigns. For the most part, it seems to be drive by eccentrics, people who have personal encounters with unusual pathologies and the usual paranoiacs who doubt everything from official sources.]

Tara, for one, has written some excellent exercises in demolishing the AIDS/HIV dissent theory (here's a good recent one) and I wouldn't know where to start if I found myself handed the "con" side of a formal debate on the question "Does HIV cause AIDS?" But I suggest, very humbly and meekly, that there is a slim outside chance that there might be a wee of merit to a least some elements of the idea that maybe, just maybe, HIV isn't the whole story when it comes to explaining a syndrome that is manifested by 25 or more diseases.

Phew. That was rough.

Getting back to the item that started me down this path. No, the Harper's piece wasn't perfect. I think Farber and Lapham would have accomplished more if they had just left out the five columns that rehashed HIV/AID denial. Maybe Farber wasn't the ideal choice to write the piece. But the best pieces of investigative journalism usually aren't perfect. And sometime you have to wade through the crap to find the gems.

There's a relevant example in the form of Randy Shilts' And the Band Played On, a fantastic book from 1987 that documents the negligence and tragic bigotry of the Reagan administration in the early days of AIDS research. Yes, Shilts tarnishes his work by buying into the now-discredited "patient zero" thesis, in which the entire AIDS epidemic in North America is traced back to a single promiscuous flight attendant. But the rest of the book, its investigation of the politics of AIDS in particular, remains a classic of the genre.

So don't throw out the baby with the bathwater just yet. And remember what Chet Raymo said: "Science must be radically open to marginal change, and marginally open to radical change." In this case, that doesn't mean anyone should change their sexual habits on the silly assumption that "everything you've been told about AIDS is wrong" as one writer has it. What it does mean is there's enough wiggle room on the existing knowledge base to allow for the occasional dose of skepticism.

I'm guessing that Lapham was thinking somewhere along those lines.

8 Comments:

Anonymous Tara said...

Hi James,

First, I disagree with much you say. I've not seen the Harper's article yet (Celia was supposed to send me a copy but hasn't, and it's not easy to find here--need to hit a good bookstore), and indeed, she may have a good story with the nevirapine angle (though many "facts" were taken apart in the objections you linked). But by bringing in the denial angle, she's lost any credibility with me regarding the other story--and therefore, loses a lot of her audience.


You say,

that there is a slim outside chance that there might be a wee of merit to a least some elements of the idea that maybe, just maybe, HIV isn't the whole story when it comes to explaining a syndrome that is manifested by 25 or more diseases.

Indeed--and people are looking into this. Does HIV alone cause AIDS? Are there cofactors (such as other viruses) that make it more benign, or more lethal? Some research here at U of Iowa is focusing on Hepatitis G virus--in men co-infected with that virus, they seem to have longer survival rates. How? Why? Not known yet, but contrary to denialist's claims, many scientists *are* looking into factors beyond HIV. (Note--not instead of, but in addition to). Also, genetics has been shown to play a role--those with the CCR5delta32 mutation are practically resistant to infection. Are there other genetic components that make one more, or less, susceptible? Another active area of research.

Additionally, I disagree that their scientists are "more respectable." Mullis might be a Nobelist, but he also believes in astrology. And I wouldn't call Culshaw an "expert"--she's a mathematician, and admittedly doesn't know much about HIV pathogenesis. I emailed her to find out more about her background in infectious disease epi, but she's not responded--my guess is that it's lacking to non-existent.

Finally, IMO there are more than "some similarities" between creationism and HIV denial--I just happen to be working on a paper outlining many of them. I can pass along a copy if you like--drop me an email.

3:41 PM  
Anonymous Tara said...

Aargh, that should have read, "I *agree* with much of what you say. Proofread, dummy...

3:42 PM  
Blogger Orac said...

"The reaction from many quarters of the science blogosphere was to lump in anyone who denies the HIV/AIDS connection with other anti-science denial movements, like intelligent design advocates and climate change skeptics. To be fair, there are some similarities."

And those similarities are quite eerie.

Also, Kary Mullis is a bit of a crank, as Tara pointed out. You will also find that the scientists who sign on to the "HIV doesn't cause AIDS" line usually have no significant experience actually studying the virus. (That goes for Peter Duesberg, too.) In fact, most of them are not even immunologists or virologists, the two most relevant specialties.

"But I suggest, very humbly and meekly, that there is a slim outside chance that there might be a wee of merit to a least some elements of the idea that maybe, just maybe, HIV isn't the whole story when it comes to explaining a syndrome that is manifested by 25 or more diseases."

Straw man argument. No scientist that I'm aware of says that HIV is the be-all and end-all explanation for AIDS and that we shouldn't study other factors.

You're also misstating HIV denialist arguments. Let's not forget that, at their heart, HIV denialists don't just state that factors other than HIV may contribute to AIDS. No, they deny that HIV has ANYTHING TO DO with AIDS. THAT is the HIV denialst argument in a nutshell. It is that argument that scientists reject, that HIV is basically a harmless virus and that AIDS is caused by something else. The scientific evidence is overwhelmingly in favor of HIV as the primary cause of AIDS. That isn't to say that other factors might not alter susceptibility to HIV or contribute to HIV pathogenesis, but it IS to reject the contention that HIV doesn't cause AIDS.

5:12 PM  
Blogger Orac said...

"Maybe not much, but you can't dismiss out of hand someone who made such a contribution to science. And the other anti-science movements don't have anyone of his stature on their side."

Well, not quite. Linus Pauling also won the Nobel Prize. Later in his life, he turned to medicine and was an advocate that megadoses of vitamin C could cure cancer, a concept that has been thoroughly refuted by clinical trials. Nonetheless, Pauling continued to believe it. He associated himself with quacks and cranks and thus tarnished his legacy. By flirting with HIV denialism, Mullis risks the same fate.

A Nobel Prize is no guarantee of not succumbing to crankery.

5:16 PM  
Blogger James Hrynyshyn said...

No. But a Nobel is a guarantee of a platform and, whether its deserved or not, a credibility beyond the area of expertise that the prize recognized. My point is that makes such people formidable opponents. More formidable than creationist cranks.

5:20 PM  
Anonymous Anonymous said...

The "real" denialists are those who deny the massive evidence that says HIV is a fraud. Peter Duesberg will one day been see as a true hero of science.
terry

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