Document:Lauritsen reviews Confronting AIDS

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New York Native
9 March 1987

Note added in The AIDS War: This review was published the same month that molecular biologist Peter Duesberg's first critique of the "AIDS virus" hypothesis was published in Cancer Research. Thought at the time I knew little about molecular biology, a number of my arguments coincided with Duesberg's – for example: Koch's First Postulate, the low numbers of cells infected, and the contradictions in the surveillance definition of "AIDS". I believe this article was, among other things, the first to criticize the CDC's AIDS-incidence projections, which did indeed prove to be greated inflated.

Of all AIDS books published to date, this is the most formidable. Prepared by a committee jointly sponsored by the National Academy of Sciences and the Institute of Medicine, and funded by some of the country's largest and most powerful foundations (Rockefeller, Mellon, Carnegie, etc.), this report was intended to inform an appropriate national response to the various problems arising from AIDS. Teh committee's mandate was laid down in the following terms:

The committee shall assess the current understanding of the virus that causes acquired immune deficiency syndrome (AIDS), its transmission, the natural history of infection and associated disease, the epidemiology of conditions associated with the virus, and the likely trends in these.

The committee also shall review the nation's response to AIDS both in the public and private sector and the current planning in regard to:

• research necessary for prevention and treatment
• provision of care and its financing
• public health measures designed to control the disease.

It is stated in the Preface that the committee had "an impressive breadth of credentials". Indeed it had, with members recruited from the upper ranks of the top medical schools (primarily Harvard), several branches of the federal government, and industry. Their collective expertise comprised such fields as "molecular biology, virology, immunology, epidemiology, neurology, psychiatry, infectious diseases, general medicine, health care, public health, economics, law ethics, and other disciplines".

To cover the broad range of issues involved, "two panels were constituted, one addressing issues in research, the other addressing issues in health care and public health".

The resultant report – nearly 400 pages of highly condensed and often technical material – reflects an enormous amount of intellectual effort. It is an impressive performance in every respect save one: the logic of its underlying premises.

A shaky etiological foundation

From the very first page, the report expresses absolute certainty on the question of etiology: "Human immunodeficiency virus (HIV), the [emphasis added] cause of acquired immune deficiency syndrome (AIDS)..." (p. 1) No qualifications. At one point, reference is made to "HIV and its unambiguous identification as the cause of AIDS (p. 177), which is rhetorical overkill. If the identification of HIV as the cause is "unambiguous", this is because dissenting viewpoints have been systematically excluded fromt he mass media, not because there is any convincing proof for the exclusive causal role of HIV. In fact, HIV has consistently failed to fulfill even a single one of Koch's Postulates, the series of tests which medical science has traditionally required a microbe to pass before it can be considered the cause of a particular disease.

As any scholarly report should, the book provides source references, which appear at the end of each chapter. Unfortunately, when references are most needed, they are not supplied. Especially is this the case when discussion turns to the "AIDS virus" and its often mysterious attributes and manifestations. Nowhere in Confronting AIDS is convincing evidence presented which coudl establish HIV as the cause of AIDS; at the same time, evidence is occasionally cited which would suggest either that HIV is not the cause of AIDS, or that it plays a causal role only in conjunction with other, potent co-factors.

For those who are true believers in the "AIDS virus" ideology, a number of bombshells are detonated in this book. To begin with, the report acknowledges that from many AIDS patients it is impossible to isolate HIV, and that some AIDS patients how no evidence of ever having been infected with the virus. (That is to say, they are negative for HIV itself as well as for HIV antibodies.) Normally, Koch's First Postulate, as well as common sense, would interpret this finding as casting grave doubt upon the proposition that HIV is the cause of AIDS. The authors do their best to explain away this awkward finding:

The failure to isolate the virus from all infected persons is most likely due to technical limitations in the lymphocyte culture methods and to the depletion of target cells in advanced states of the disease. (p. 40)

Well, of course if testing methods are so poor that no one can say for sure whether or not HIV is in a particular person's body, then one might say that a certain "ambiguity" does surround the causal role of that virus after all.

It is an article of faith in the "AIDS virus" catechism that whenever someone's blood has HIV antibodies (a positive antiody test) the virus itself must also be there somewhere in the body – that once infected, the body never succeeds in ridding itself of the virus.

Anyone who has antibodies to the virus must be assumed to be infected and probably capable of transmitting the virus. A person infected with HIV...apparently never becomes free of the virus. (p. 6)

The leaps of faith required, the level of confusion, and a few repressed doubts are all poignantly expressed in the following paragraph:

In contrast to some viral infections, HIV induces antibodies that do not, in most cases, appear to effectively neutralize the establishment or consequences of viral spread in an infected host. Therefore, most patients with positive tests for HIV antibodies are considered to be simultaneously and actively infected by HIV. The resulting concerns about the equation of seropositivity with extant infection, continuing transmissibility, risk of disease in an infected individual, and issues of social stigmatization have caused HIV serologic testing to be very controversial. (p. 304)

To call this sort of reasoning controversial would be an understatement. It is illogical and reckless to extend the meaning of "most cases" to be the equivalent of "all cases", to say that one must "assume" that the virus is present so long as antibodies are, even though atempts to isolate the virus are repeatedly unsuccessful. Aside from its logical shortcomings, the latter proposition is probably just plain wrong. Jay Levy and his colleagues in California have recently demonstrated that a healthy body can not only "neutralize viral spread", but can completely eliminate the so-called "AIDS virus".

The "depletion of target cells" is not a very convincing explanation for the alleged "disappearance" of the virus. In The New York Times and other popular media, the impression is given that the "AIDS virus" attacks T4 cells, thereby depleting them and causing an inverted ratio of T4 to T8 cells. There are at least two problems with this theory. The first is that HIV appears to infect very few T4 cells – only about 1 in 100,000. Obviously, at this rate, only a minuscule proportion of T4 cells would be depleted, and the T-cell ratio would remain unchanged.

The second problem is that in AIDS patients, the immunological functioning of all T-cells is severely compromised. The cells are sick regardless of whether or not they are "infected" (nearly all of them are not) and regardless of what the T-cell ratio may happen to be. The authors of this report admit that the depletion of T4 cells by HIV is "mysterious" (p. 43), that "the exact mechanism of cell killing by HIV has not been established" (p. 195), and that there are "tremendous gaps in our understanding of the pathogenesis of the immunologic compromise of AIDS" (p. 196). To me it is mysterious that the authors do not entertain the possibility that something other than HIV is responsible for weakening all of the T-cells. Toxins, like "recreational" drugs, would very well explain the phenomenon, but the authors have a powerful block on the possible etiological role of drugs and other chemicals.

Needle-stick mysteries

At least one quarter of the total AIDS cases in the U.S. are intravenous drug users. This report follows the Public Health Service party line that IV drug users are developing AIDS because they "share injection paraphernalia (syringes and needles) and thereby transmit HIV through residues of blood". (p. 52) The fact that IV drugs users use drugs, and that the drugs they use are immunosuppressive and therefore likely to play a role in their acquiring immune deficiency, is something the authors shy away from.

One problem with the "shared needles" hypothesis is that it is not known for sure if all, or even most, of the IV drug users with AIDs really did "share needles". The research needed to establish this basic point would be straightforward and relatively inexpensive, but to my knowledge no one has done it.

Another problem with the "needle stick" etiology is posed by studies of health care workers who accidentally stuck themselves with needles that had been used on AIDS patients. There have been over 1,000 carefully monitored cases of this sort, and in not a single one has AIDS resulted from the accidental inoculation. Only one needle-stick case even developed HIV antibodies – the became briefly ill and then recovered completely. These findings might be interpreted as meaning that AIDS is not caused by an infectious agent (HIV or anything else), or that co-factors (like drugs) may be necessary for AIDS to develop.

It is interesting to note that the "shared needles" hypothesis, as well as other "modes of transmission" that are now part of the "AIDS virus" credo, emerged from analogies with hepatitis B and the ways that disease is believed to be transmitted. The report mentions, almost in passing: "In a comparable study of persons exposed to patients testing positive for hepatitis B surface antigen, about 26 percent devloped infection." (p. 62) The difference is stunning: in comparing accidental needle-stick injuries, 26 percent of those exposed to fluids from hepatitis B patients, versus less than one percent of those exposed to fluids from AIDS patients, became infected. The authors do not comment on this disparity, and perhaps it is just as well.

Procrustean epidemiology

In the past couple of years, a very striking change has taken place in the way in which AIDs is conceptualized. Before the "AIDS virus" bandwagon really got underway, AIDS was understood as a condition – a condition in which the body's immunological system was severely deficient. The condition was not new. It was well known that immune deficiency could result from many causes, including protein deficiency malnutrition; many different chemicals, including Cyclosporin (used in organ transplants) and Cortisone; radiation; and simply old age. The question was why immune deficiency was occurring in relatively young people for whom the usual explanations did not seem to apply. Some researchers believed that AIDs was a condition representing a late stage of a disease caused by a specific infectious agent; other believed that AIDs was caused by toxins; and still others believed that AIDS was cuased by a combination of factors, including repeated infections, exposure to sperm, drugs, and various other environmental factors.

Now that the HIV ideology has achieved almost total hegemony, AIDS has come to be conceptualized as a disease: "HIV infection". This has resulted in much confusion. Even a perfectly healthy individual who happens to have HIV antibodies is now referred to as being "infected". (As discussed above, it is "assumed" that the virus is also present in his body.) Further, an "infected" individual (i.e. antibody positive) is now regarded as being sick, even though he may be perfectly healthy by all rational criteria. More than once the authors of Confronting AIDS refer to the cost of "care for a seropositive individual" (p. 158). Why an individual suffering from nothing more than the presence of antibodies in his blood should required "care" is beyond comprehension.

And so, under the tutelage of our Public Health Service, "AIDS" and "HIV infection" are rapidly becoming synonymous. However, the equation of AIDS with HIV infection contains two glaring contradictions. The first is that a not-inconsiderable proportion of AIDS patients show no evidence of ever having been infected with HIV; the virus cannot be isolated from their bodies, and they are negative for HIV antibodies. The second contradiction is that hundreds of thousands of people are estimated to be HIV seropositive, and yet the vast majority of them are not sick in any way.

In Appendix E: "The Centers for Disease Control's Surveillance Definition of AIDS", we learn that the CDC has found a remarkably procrustean solution these problems. ^[1] They have changed their surveillance definition of AIDS. What happens if an AIDS patient consistently tests negative for HIV and for HIV antibodies? Well, under the new definition, such cases are simply lopped off. AIDS cases without HIV cease to be AIDS cases. Or, as the CDC puts it, "patients are excluded as AIDS cases if they have a negative result(s) on testing for serum antibody to HIV, do not have a positive culture for HIV." (p. 316)

At the same time, the CDC is sufficiently flexible that it can also declare on faith that the patient is infected with HIV, even though there is no evidence whatsoever that he is. Students of language will appreciate the following paragraph, taken from Appendix F: "CDC Classification System for HIV Infections":

Although HTLV-III/LAV infection is identified by isolation of the virus or, indirectly, by the presence of antibody to the virus, a presumptive clinical diagnosis of HTLV-III/LAV infection has been made in some situations in the absence of positive virologic or serologic test results. There is a very strong correlation between the clinical manifestations of AIDS as defined by CDC and the presence of HTLV-III/LAV antibodies. Most persons whose clinical illness fulfills the CDC surveillance definition for AIDS will have been infected with the virus.

May it be recorded in the annals of science that the CDC succeeded linguistically in establishing HIV as the cause of AIDS, even though the virus never succeeeded in fulfilling even one of Koch's Postulates.

A dire scenario

Based on their almost certainly false premises that "HIV infection" is equivalent to "AIDS", and that all those with HIV antibodies should be considered to be "infected", the authors of Confronting AIDS develop a truly grim scenario:

The estimate provided to the committee by the Epidemiology Working Group was that 25 to 50 percent of seropositive persons will develop AIDS as defined by the CDC within 5 to 10 years of seroconversion, and that a higher percentage cannot be ruled out on the basis of present studies. (p. 91)

No evidence is given for this incredible statement. No source is cited. Nevertheless, the authors plunge ahead to formulate nightmarish projections:

• By the end of 1991, there will have been a cumulative total of more than 270,000 cases of AIDS in the United States, with more than 74,000 of those occurring in 1991 alone.
• By the end of 1991, there will have been a cumulative total of more than 179,000 deaths from AIDS in the United States, with 54,000 of those occurring in 1991 alone. (p. 86)

And so on. If any evidence to support these projections was offered in Confronting AIDS, I overlooked it, and indeed I know of none. Not a single health care worker has developed AIDS from needle-stick accidents or other contacts with AIDS patients, not a single monkey or ape has developed AIDS as a result of being injected with fluids from AIDS patients, and yet we are asked to believe that in four year's time there will be over a quarter of a million AIDS cases in the U.S. alone, all owing to "infection" with a virus that has scarecely been proven to be harmful.

Research

The committee recommends that by 1990 the U.S. Congress should appropriate no less than $1 billion annually for research on AIDS. (p. 248) They make a great many specific recommendations for research. While generally thoughtful, these are predominantly based on the assumption that HIV is known "unambiguously" to be the cause of AIDS. In consequence, future research needs are perceived mainly as comparising studies of the "structure and replication of HIV", the "natural history of HIV infection", "epidemiological approaches to understanding the transmission and natural history of HIV infection", as well as searches for effective "antiviral agents" and for an HIV vaccine.

$1 billion per year is a lot of money, a bonanza for the Medical Industrial Complex. And yet, with such an astronomical sum begin proposed, it is deflating to contemplate that the most fundamental AIDS research – and relatively inexpensive research at that – has not yet been done. Nor has the committee proposed doing it. We need to know the characteristics of people with AIDS. As it is now, we know almost nothing about the gay men with AIDS other than the "homosexual/bisexual" label that has been slapped on them. We do not know their medical histories; nor their drug-taking habits; nor whether they smoked or drank; nor what their sexual practices were; nor what their diets were like; nor what specific bars, baths, discos, clubs, etc. they frequented. The case-control study of the first 50 gay men with AIDS, conducted by the CDC five years ago, was a case study in incompetence, and is obviously out of date. ^[2]

Likewise, we know almost none of the characteristics of the IV drug users with AIDS other than the fact that most of them are black. We don't even known for sure if they "share needles".

The "patient characteristics" statistics, which the CDC periodically releases to the media, have been incomplete and misleading. We have no idea, for example, what percentage of the total AIDS cases are Haitians; the CDC decided, for political reasons, that the Haitians should disappear as a "risk group", and disappear they did.

It may be that the Public Health Service, and the committee that prepared the report published as Confronting AIDS, feel that this kind of research is no longer necessary, since HIV has been "unambiguously" identified as the cause of AIDS. To which one must reply, in ruthless honesty, that we do not know how AIDS is caused. In addition, even if HIV were the primary cause (and this is only a hypothesis), there would still remain the question of co-factors. For if one thing is certain at this point, it is that HIV alone does not cause AIDS.

Dismissal of co-factors

For whatever reasons, co-factors are given short shrift in Confronting AIDS. The authors mention co-factors only to dismiss them:

Another major question has been whether co-factors in the form of environmental agents, genetic influences, or coexisting infectious diseases might increase the likelihood of HIV infection or the presence of clinical disease. The existence of such cofactors is often suggested, but there are no data to support the concept, with the possible exception in Africa of genital ulcers. Furthermore, some recent data fail to support he previously proposed association betwen either nitrite use or elevated cytomegalovirus titers and the development of clinical AIDS (Polk et al., 1986) (pp. 45-46)

This statement is outstandingly untrue. The concept of cofactors is supported by innumerable studies and by the basic epidemiology of AIDS. In the U.S., AIDS is, and has been for the past six years, restricted almost entirely to intravenous drug users and gay men. In six years the proportions of these two risk groups have hardly changed at all. What this means is that somehow there must be cofactors in the environments of these two risk groups that are causing them to develop AIDS. A truly infectious disease does not remain compartmentalized. Legionnaire's Disease has not confined itself to Legionnaires.

I have not seen the Polk study, which has not been publsihed in a medical journal. However, I can state with assurance that there is no way a single case-control study could invalidate the vast amount of evidence that indicts the nitrite inhalants (poppers) as playing a role in causing AIDS. It is, to say the least, peculiar that the authors could ignore the extensive literature on the nitrite inhalants – dozens of studies, conducted by top-notch research scientists, subjected to peer review, and published in prestigious medical journals. ^[3]

It is also peculiar that the authors do their best to avoid discussing drugs as a probable cofactor, even though the connection between drugs and AIDS was obvious to researchers six years ago, and has become ever more powerful. In discussing IV drug users, they write:

In terms of the natural history of HIV infection, IV drug users engage in a wide variety of behaviors that affect the immune system. They are thus performing natural experiments that may teach much about cofactors in AIDS. (p. 106)

Of course this gibberish needs to be translated. What "engage in a wide variety of behaviors" means is "use many different drugs". In other words, IV drug users use drugs that affect the immune system. The authors could not bring themselves to say, in plain language, that drugs might be cofactors.

The book contains a useful glossary, which includes an entry for "cofactor":

Cofactor. A factor other than the basic causative agent of a disease that increases the likelihood of developing that disease. Cofactors may include the presence of other microorganisms or psychosocial factors, such as stress. (p. 354)

One notes the stunning omission of any mention of drugs, or for that matter, environmental factors. To my knowledge, not a single study has identified stress as a cofactor for AIDS, though it probably is to some extent. If the authors were really concerned about the consequences of stress, they might have been more cautious in making projections. Someeone who has tested positive for HIV antibodies may well experience stress when told that there is a 25-50% or more chance he will die from AIDS in the next few years. In this sense, Confronting AIDS is itself a cofactor.

Public health measures

"The committee recommends a major educational campaign to reduce the spread of HIV. (p. 10) This is the problem in a nutshell. The committee can conceive of appropriate educational and public health measures only in terms of "preventing the transmission of HIV". All of the familiar points are touched upon, from "safe sex" to condoms to testing to sterile needles. The missing prong of a valid educational program to prevent AIDS (not just prevent transmission of HIV) is that of attacking the cofactors, which above all means DRUGS. Members of the high-risk groups may not wish to hear the message, but nevertheless, gay men must be told to stop using quaaludes, poppers, ethyl chloride, barbiturates, PCP, cocaine, Ecstasy, Eve, and all of the other "recreational drugs" that are prominent in the lifestyle of those whom the late Wallace Hamilton once referred to as the "AIDS crowd". Likewise, IV drug users must be told to stop shooting up – period.

The extensive public health measures recommended by the committee are all in the best liberal traidition. The guiding principle:

Believing that coercive measures would not be effective in altering the course of the epidemic, the committee recommends that public health authorities use the least-restrictive measures commensurate with the goal of controlling the spread of infection. (p. 16)

However, "coercive measures" are by no means ruled out completely. And indeed, having painted the picture of a killer virus on the loose, of more than a quarter of a million AIDS cases in the U.S. alone in the next four years, the committee might have been more consistent had they called for draconian measures to control the "spread of infection".

But enough. Those who are active in AIDS work will want to study this book, if only to understand Establishment thinking at this point in time. Confronting AIDS illustrates once again that group intelligence is below individual intelligence – that even a committee composed of brilliant individuals, as this one appears to have been, is capable of monumental folly. In sum, this is a well-intentioned book which has a great potential for harm. Let the reader beware!

Footnotes

1. ↑  In ancient Greek mythology, Procrustes was a robber who forced his victims to fit a bed of his. If they were too short for the bed, he stretched them; if they were too long, he lopped off their legs.
2. ↑  Harold Jaffe, et al., "National Case-Control Study of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia in Homosexual Men: Part 1, Epidemiological Results", Annals of Medicine, August 1983.
3. ↑  See Death Rush: Poppers & AIDS , by John Lauritsen and Hank Wilson, New York 1986.

© 1987 by John Lauritsen
Originally published in The New York Native
Reprinted in The AIDS War