Altman on AIDS (and homosexuality)

“AIDS and homosexuality”  described how two of Dennis Altman’s books helped me get a better feel for the intensity of emotional release that “gay liberation” beginning with Stonewall had brought to some number of gay men; which made it even more plausible for me that the small proportion of gay men who contracted AIDS did so as a result of a decade or so of exuberant but unwise “fast-lane” living.

A few years after AIDS appeared, Altman published AIDS in the Mind of America, (Anchor/Doubleday, 1986). Neither there nor later has he expressed doubts about  HIV = AIDS; yet his writings continue to provide evidence for the lifestyle hypothesis. For example, Altman views sex and sexuality as central to his and others’ sense of identity:
He cites (p. 7) Richard Goldstein: “For gay men, sex, that most powerful implement of attachment and arousal, is also an agent of communion, replacing an often hostile family and even shaping politics. It represents an ecstatic break with years of glances and guises, the furtive past we left behind”. Another man put it like this: “Whenever I threw my legs in the air, I thought I was doing my bit for gay liberation” (p. 143).
Altman acknowledges, directly but also indirectly, that there was a great deal of unwise behavior: “Far too many of us assumed that modern medicine could cure any of the illnesses that seemed to accompany ‘fast-lane’ living” (p. 93). Some gay men were more interested in having fun than in the political activism of gay liberation: “We’d be out partying on Fire Island during the Gay Pride marches” (p. 104) — and for a sense of what partying on Fire Island in the 1970s meant, see the 2003 TV documentary, When Ocean Meets Sky. There were T-shirts saying, “So many men, so little time” (p. 142). For most heterosexual people, promiscuity might mean several extramarital partners during the life of a marriage, to some gay mean it meant more partners than several in a single night (p. 144). Being responsible was commonly interpreted as having frequent checks for syphilis and gonorrhea, and such “doubtful practices as taking a couple of tetracycline capsules before going to the baths” (p. 143) — practices that can wreak havoc on the intestinal immune system.

Altman also knew that the average age of the early AIDS patients was mid-30s (p. 20), surely a pointer to the result of years of burning the candle at all ends, rather than a sexually transmitted disease since the latter tends to strike at younger ages already. Altman knew that hepatitis and enteric parasites, not easily treatable, had become well known among gay men in the 1970s (p. 143), and Altman himself had experienced an opportunistic infection, toxoplasmosis, in the mid-1970s (p. 96).

I would guess that for those gay men for whom sexual freedom was a central feature of gay liberation, cognitive dissonance would be hard at work to avoid a lifestyle explanation for AIDS and to accept the virus hypothesis. Yet if Altman had followed the statistics, he would have learned that AIDS remained largely a phenomenon of gay men and drug abusers, with the addition — following on the re-definition of AIDS as “HIV-positive” — of TB patients and people of African ancestry. Surely such restriction to a few social sectors makes no sense for a sexually transmitted condition. Admittedly, the mainstream emphasis on AIDS in Africa muddies the waters by providing apparent support for the prevalence of heterosexually associated AIDS.

At any rate, Altman has been far from alone among gay men in failing to recognize the significance of the evidence for the lifestyle explanation; exceptions have been few indeed. A powerful incentive will have been the degree to which AIDS had been associated since the beginning with gay men, and a desire that the stigma of AIDS should not fall only on gay men. Official agencies had included representatives from gay groups in discussion from the earliest years (pp. 12-3). It was a shibboleth (p. 22) that the most characteristic gay activity of the 1980s was to examine the skin for signs of Kaposi’s sarcoma. Chapter 5, “The Gay Community’s Response”, recounts how prominent a role gay men played in everything to do with AIDS research and treatment, and they were the chief pressure groups for public funding (Chapter 6).

So AIDS in the Mind of America makes the lifestyle explanation for AIDS yet more plausible, and also illustrates how difficult it must nevertheless be for even highly intelligent, well-read, cultured gay men to take it seriously. The book is also of historical interest, not least for reminding how hysterical the popular reaction was to the notion of a fatal sexually transmitted disease (pp. 60-5, 184-5): medical personnel refusing to treat AIDS patients, airlines suggesting they might not load passengers suffering from AIDS, schools excluding “HIV-positive” students. In hindsight this makes remarkable reading: suggested measures to be taken included the possible quarantining of gay men, suggested by no less than James Chin, then epidemiologist for California and recently author of The AIDS Pandemic which makes the extraordinary suggestion that 20-40% of sub-Saharan adults are in concurrent sexual relations with about a dozen people at any given time and change those partners about annually.

We are reminded that the “HIV” tests encountered difficulties before finally being licensed, that it took nearly a year after Gallo’s claim to have identified HIV.

As in his earlier books, Altman mentions some of the uneasiness in the relations between lesbian groups and organizations of gay men. Cited is a complaint that “women’s health issues” were being ignored in favor of funding AIDS ventures (p. 94); one outcome of which was that the Centers for Disease Control & Prevention looked intensely for some way to include women among at-risk groups and coming up with cervical cancer as an AIDS disease.

Given my interest in science, and how it has become increasingly unreliable and corrupt in recent decades (scimedskeptic.wordpress.com), I was struck by a citation (p. 180) from historian June Goodfield who recognized already around 1980 that “grantsmanship as much as discovery, has become the art form of American science” (An Imagined World, Penguin, 1982, p.105).

Once again I recommend Altman’s book as well worth reading. My interest in his work led me to get his autobiography and to learn of several similarities to my own history: son of German-speaking refugees, growing up in Australia, experiencing the University of Sydney at roughly the same time, continuing education in the United States.

Penalties for Scientists’ Sins of Omission

Jail terms of 6 years have been imposed on Italian seismologists for misleading the public about the possible danger of a possibly impending major earthquake following a host of smaller tremors (Jailing of Italian seismologists leaves scientific community in shock):
“the seismologists got the science right, but left the job of public communication to a civil protection official with no specialist knowledge of seismology. His statement to the press was, to put it mildly, a grossly inaccurate reflection of the situation: “The scientific community tells us there is no danger, because there is an ongoing discharge of energy. The situation looks favourable.” At this point, the seismologists should have stepped in. But they did not” (Italian earthquake case is no anti-science witch-hunt).
Under this precedent, scientists are required to correct any public statement that they know to be inaccurate. So, for example, whenever it is publicly stated that positive HIV tests bespeak infection by a human immunodeficiency virus, every HIV/AIDS researcher should publicly correct that, given that no test is 100% certain: Stanley H. Weiss and Elliott P. Cowan, “Laboratory detection of human retroviral infection”, Chapter 8 in AIDS and Other Manifestations of HIV Infection, ed. Gary P. Wormser, 4th ed. 2004.
There are innumerable other aspects of HIV/AIDS dogma that persistently misrepresent reality as represented in data in the published mainstream literature. Thus every statement that a single act of unprotected intercourse can cause infection should be immediately accompanied by a correction that the probability is on the order of a few per thousand (and for most people hunderdds of teimes leess than that, since the probability that ones’s partner is infected is on average only a few per thousand). Every statement that AIDS has become a manageable chronic disease should be accompanied by detailed specification of the common “side” effects of antiretroviral drugs — including perhaps the information that the notorious AZT, acknowledged in practice if not in words to have been too toxic at the original high doses, is present in smaller but far from negligible amounts (typically 300 mg twice a day) in many treatment “cocktails” under pseudonym (zidovudine ZDV; Retrovir), for example in a recent “Preferred Regimen for Pregnant Women” [LPV/r (twice daily) + ZDV/3TC1 (AI) — Treatment Guidelines  updated to October 2011; the “AI” marks the strongest possible recommendation used in these Guidelines: “A: Strong recommendation for the statement; I: One or more randomized trials with clinical outcomes and/or validated laboratory endpoints”]. The first dosage of AZT was often 1500 mg/day, though at first as high as 2400 mg (400 mg every 4 hours). A clinical trial comparing this with 750 mg revealed no significant difference in mortality, less than 10% of AIDS patients on these regimens surviving for more than 33 months (Joseph Sonnabend, “Remembering the Original AZT Trial”, 29 January 2011).  One might wonder whether current regimens of 300 mg twice a day are appreciably less toxic than 750 mg/day had been in that long-ago trial.

But of course it is not only with respect to HIV/AIDS that experts fail to correct public statements. Whenever someone claims that there is no doubt that human-generated carbon dioxide is adding appreciably to the rate of global warming, for instance, the computer modelers should rush to point out that all they claim is some sort of statistical probability. When it is mentioned that the universe began about 13 billion years ago in a Big Bang, astrophysicists should hasten to remind us that this is an inference based on various other inferences and assumptions as well as evidence. Indeed, whenever any scientific conclusion is broadcast as tantamount to truth, scientists should leap to correct that and point out that science is perpetually self-correcting — in other words, changing all the time — and that it never claims or can claim or should be allowed to claim final certainty.

Current circumstances are quite different, though. In an increasing range of fields of science, one finds dogmatic adherence to and promulgation of a contemporary mainstream consensus as beyond doubt, together with excommunication of dissenters as heretics, under the more modern term of “denialist”, which the unwary may not recognize as synonymous with heretic — see my latest book, Dogmatism  in Science and Medicine: How Dominant Theories Monopolize Research and Stifle the Search for Truth.

Defeating HIV/AIDS — in the court-room

A few days ago I posted hurriedly  the splendid news that the Office of Medical and Scientific Justice  had been able to organize witnesses and defending lawyers to achieve a signal success against the HIV/AIDS true-believers and the misguided belief that “HIV-positive” individuals present a danger to their sexual partners.
An Army sergeant was acquitted despite admitting that he had not informed several women of his status as “HIV-positive” before they engaged in consensual condom-protected sexual intercourse. The crucial point: there was reasonable doubt as to whether the sergeant was “infected with HIV” because

it was established that
 no “HIV” tests prove infection

Lawyer David Steele was an observer at the proceedings and describes them in an audio piece  that makes fascinating hearing. Listen also to Steele’s interview on the Robert Scott Bell show.

I was reminded of the remark that “the most rigorous peer review . . . comes from cross-examination . . . in the courtroom” (Sheldon Krimsky, “Protecting scientific integrity”, Chemical Heritage, 27 [#1, Spring 2009[ 42-3).

In the Robert Scott Bell show, astonishment was expressed several times that someone could be found to be infected on the basis of antibody or PCR tests and in absence of any symptoms of illness. Actually, diagnosis on the basis of lab tests and irrespective of clinical condition or examination has become quite routine practice in medicine. As I had mentioned in “Medicine isn’t science — nor should it be”, Jeremy Greene in Prescribing by Numbers recounts the history of how this has come about. But surely everyone is now familiar with the constant refrain of “know your numbers” — about cholesterol, blood pressure, blood sugar, just about anything that can be measured by numbers.
So ingrained is this that even recommendations by mainstream medical associations have not been able to bring about change in actual practices. For example, for years competent clinicians and researchers have warned against routine use of PSA tests as a purported way of screening for prostate cancer, because PSA numbers produce so many false positives and unnecessary biopsies that carry a certain risk, for instance of infection; yet this abuse of PSA tests continues to be widespread. The Institute of Medicine has pointed out that many of the biomarkers in common use are simply not valid measures of the ailments that they supposedly detect: Tumor size is not a measure of cancer progression or prognosis. Blood pressure or cholesterol (“bad”, total, ratio, whatever) do not measure progression or prognosis of heart disease (Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease, Institute of Medicine, 2010).
Moreover, treatments intended purely to bring the numbers to a supposedly appropriate value have not been shown to preserve health; a recent article in the British Medical Journal points out that “there are no valid data on the effectiveness” of “statins, antihypertensives, and bisphosphanates” (the last are prescribed against osteoporosis; see Järvinen et al., “The true cost of pharmacological disease prevention”, British Medical Journal 342 [19 April 2011] d2175). doi: 10.1136/bmj.d2175. Indeed, statins do more harm than good: “side” effects include myalgia, fatigue, dyspnea, memory loss, and peripheral neuropathy (Langsjoen et al., BioFactors 25 [2005] 147–152).
But try telling that to your family physician or your specialist and see how they react.

The point is that HIV/AIDS is quite a natural consequence of deeply ingrained attitudes and practices in modern medicine. Once an approach has come into general use, it is extremely difficult to modify let alone discard it, no matter how much evidence accumulates that the approach does more harm than good. Too many interests become vested in the “standard” way of doing things: the authority and prestige of medical authorities, the unwillingness or inability of practicing physicians to question official doctrine or what drug companies tell them, the profits made by manufacturers and clinical labs from tests and devices, the profits made by Pharma which supplies the drugs used to treat the numbers . . . .
The HIV/AIDS blunder differs only in scale from present-day test- and drug-centered medical practice. Admittedly, antiretroviral drugs have done immediate harm to many more people (Hidden in plain sight: The damage done by antiretroviral drugs, 2011/07/25) than have the blood-pressure-lowerers and blood thinners and statins and bisphosphanates and the other popular prescription drugs — AZT alone killed about 150,000 in a decade in the USA alone (HAART saves lives — but doesn’t prolong them!?, 2008/09/17). Still, one has only to note the increasing rate at which drugs have to be withdrawn from the market, sooner and sooner after the initial approvals, and to note the proliferation of class-action lawsuits ( e.g. regarding Fosamax or Pradaxa) to realize that present-day drug-based medical practice represents a genuine danger to global public health.

It is simply no longer possible to believe
 much of the clinical research that is published,
 or to rely on the judgment
 of trusted physicians or authoritative medical guidelines.
 I take no pleasure in this conclusion,
 which I reached slowly and reluctantly
 over my two decades as an editor
 of The New England Journal of Medicine

—— Marcia Angell
“Drug companies and doctors: a story of corruption”
New York Review of Books, 56 #1, 15 January 2009

Unlimited insanity: Truvada to prevent HIV

In my memoir of serving as an academic dean, I had written “I would find myself thinking, Now I’ve seen everything; nothing can surprise me anymore, only to experience a novel surprise the next day or the next week”. That’s how I’ve been feeling the last few days as the media have being hyping the approval by the Food and Drug Administration of prescribing Truvada to prevent HIV infection — administering Truvada to perfectly healthy people as supposed prevention.

Truvada is emtricitabine (FTC) plus tenofovir (TDF). In “HAART is toxic: Mainstream concedes it, in backhanded ways”, I cited earlier blogs about the toxicity of tenofovir  and a few salient bits:
— The federal warning that “Tenofovir  . . . alone or in combination . . . may cause serious damage to the liver and . . .  lactic acidosis”
— The manufacturer’s warning that “Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with . . . nucleoside analogs, including tenofovir”
— “increasing exposure to tenofovir was associated with a higher incidence of CKD [chronic kidney disease] . . . . and there are numerous studies . . . demonstrating that tenofovir is associated with impaired kidney function”.

For the combination of  FTC plus TDF, the NIH Treatment Guidelines (updated 14 October 2011) cite as advantages superiority in suppressing viral load and also these disadvantages:
“• Potential for renal impairment, including rare reports of Fanconi syndrome and acute renal insufficiency
• Potential for decrease in bone mineral density”
(as well as failure to suppress viral load when combined with nevirapine [!])

Given these serious and quite common toxicities, what is the supposed benefit of PrEP — pre-exposure prevention or prophylaxis — with Truvada?
A couple of years ago I discussed the failure of TDF in a PrEP trial: “Pre-exposure prophylaxis: A flawed clinical trial that no one should take seriously”. The media descriptions of the evidence on which the FDA and its Advisory Panel approved Truvada for PrEP suggest that this evidence is again anything but trustworthy:
“The committee voted 19-3 in favor of approval for the prevention indication — PrEP for HIV-uninfected men who have sex with men and 19-2 with one abstention for HIV-uninfected partners in couples where the other partner is infected. The committee recommended by 12-8 with two abstentions in favor of approving the drug for individuals who engage in risky sexual behavior that could result in their contracting the virus” (Panel recommends approving Truvada to prevent HIV infection, Sandra Young, CNN, 10 May). Those votes mean that the panel judged it a greater risk when HIV-negative men have sex with men, or when the uninfected partner in a couple where the other is infected, than when “individuals . . . engage in risky sexual behavior that could result in their contracting the virus”? What possible basis could there be for such a comparative judgment?
“Committee members also heard concerns about the drug’s side effects, which can include nausea, vomiting, dizziness, loss of appetite and diarrhea, liver and kidney toxicity and loss of bone density”. Those committee members will not be able in the future to deny that they were voting to cause iatrogenic harm to healthy individuals who had other options for protecting themselves.
As history lauds in retrospect the FDA officer who held off from approving thalidomide, so in future we may look back approvingly on the attempt to block Truvada PrEP by one member of the committee:
“Dr. Lauren Wood of the National Cancer Institute said she voted against all preventive applications because clinical studies did not measure the dangers of drug-related renal problems among black people, who are among the hardest impacted by HIV infection and the most susceptible to kidney problems linked to AIDS drugs”.

Two-faced arguments are ubiquitous in the HIV/AIDS Wonderland. Typical of the mainstream Janus-faced propaganda were such comments as, on the one hand,  “What we need currently is additional tools” even though, on the other hand, there already exists a “powerful tool box” which nevertheless hasn’t been any good: “We are not winning the battle” — all these comments are from the same individual.
“”Existing interventions have not reduced the number of new infections annually” (FDA panel backs Gilead’s Truvada to prevent HIV).
“Truvada first made headlines in 2010, when government researchers showed it could prevent people from contracting HIV. A three-year study found that daily doses cut the risk of infection in healthy gay and bisexual men by 42 percent, when accompanied by condoms and counseling” (Truvada for HIV prevention backed by advisory panel, FDA may decide by June). That’s the study I debunked in “Pre-exposure prophylaxis: A flawed clinical trial that no one should take seriously

Apparently this panel of experts was not aware of Nancy Padian’s success, more than a decade ago, in totally preventing infections merely by counseling and advising use of condoms: “We observed no seroconversions  after  entry  into the study” (Padian et al., American Journal of Epidemiology 146 [1997] 350-7) among 175 discordant couples with >280 couple-years of follow-up; and they attributed the lack of transmission to the success of counseling. Since counseling brings no serious physiological side-effects, and the preventive success is 100%, there would seem to be no need for Truvada with its serious side-effects.

The case against approving Truvada PrEP is entirely separate from AIDS Rethinking: Mainstream data speak against administering so toxic a drug to healthy people, no matter how high may be estimated their risk of contracting a virus that supposedly causes illness only after an average latent period of a decade or so, and that is controlled without medication among some proportion of the infected, the “elite controllers”. Truvada PrEP incurs the certainty of early iatrogenic illness in exchange for some probability, which is undoubtedly low, given that the transmissibility of HIV with sex is on the order of 1 per 1000 unprotected acts.

On the PBS NewsHour on May 11, Anthony Fauci was featured. Not a single word was spoken about the toxic “side” effects. Not mentioned was the very low transmissibility, nor Padian’s astounding success with counseling and condoms. The only concerns mentioned had to do with cost and the need to adhere strictly to a pill-a-day. Fauci’s statements were fine examples of bureaucratic mumbo-jumbo, for instance:
“[I]t would add to the armamentarium of proven prevention modalities.
Prevention for HIV is really a comprehensive, multifaceted group of prevention modalities that’s kind of a tool kit. This one can be potentially very effective. So if it’s approved and added to the recognized prevention modalities, it would be an important advance in making available for certain people a very effective way to prevent HIV infection.”

To me, Fauci looked very stiff, as though he was unenthusiastic but trying to make up for it with plenty of “clearly”, “absolutely”, and the like. Could the utter absurdity of this FDA approval perhaps have penetrated his armamentarium of cognitive-dissonance modalities?

As I said at the outset: I thought I was familiar with all the aspects of the HIV/AIDS blunder, only to hear about this scandalous extrapolation of earlier misdeeds: hyping faulty evidence to give official approval to the poisoning of innumerable healthy individuals in a hugely expensive way ($12,000-14,000 annually).

Discriminating against heterosexual people?

Court rules HIV disclosure law can only be used to charge heterosexuals

“An appellate court has ruled that Florida’s HIV disclosure law can only be used to charge heterosexuals.
The court ruled that the law did not apply in the case of a woman accused of having sex with another woman who failed to disclose her HIV-positive status . . . . the judges found that because the law referenced ‘sexual intercourse’ that it could only be applied to heterosexual activity since it is only defined as ‘the penetration of the female sex organ by the male sex organ.’
[Reminds one of  "I did NOT have sex with that woman!"]
. . .  the ruling has already had an impact on a case in Treasure Island. There, a state attorney threw out a case against a gay man charged with failing to disclose his HIV-positive status to his partner of four years.”

As Jon Stewart of The Daily Show is increasingly wont to complain, reality is making life more and more difficult for people who want to satirize it.