True Believers of HIV/AIDS: Why Do They Believe Despite the Evidence?

A correspondent sent the following, asking whether it might be a relevant comment on one of the Nobel Prize posts. I think it’s more than that, it gets to the root of the problem that Rethinkers and Skeptics face, how to entice the indoctrinated public media and the committed mainstreamers to pay attention to the evidence that disproves HIV/AIDS theory. Andy D. wrote:

“I can find but three possible explanations for the ‘Establishment’s’ most arrogant and condescending behavior and unsubstantial, propagandistic websites and media appearances:
1. They are very well aware of the inconsistencies, problems and failings of HIV-AIDS-theory and their horrible implications regarding AIDS politics and medication, and find some overriding self-interested reason to continue to uphold what they know is wrong; or
2. They are unwilling to look critically at a theory they have established and promoted; or
3. They regard all ‘dissident’ propositions as so silly — what they call ‘moon-is-green-cheese’ pseudoscience — that they require no disproof.

I’ve seen again and again with honest scientists that they are happy to discuss and argue about their theses. Esteemed, intelligent and highly informed people like Peter Duesberg, Etienne de Harven, Heinz Ludwig Sänger, Kary Mullis or yourself should not be treated like nagging students asking the same stupidly absurd questions over and  over again.”

I touched on one aspect of an explanation for all this in “HIV/AIDS Illustrates Cognitive Dissonance” [29 April 2008]: Human psychology is such that true believers simply cannot grasp the implications of evidence that contradicts their belief. Andy’s questions spurred me to think about all this anew. How do people become true believers in the first place? If one could answer that question, it might point also to possible ways of helping people to change their mistaken beliefs.

Human beings are actually raised to be true believers. As babies and children, we are persuaded, urged, or disciplined in various ways to accept what our parents and our teachers tell us. Children  are delightfully curious and questioning, but at first they lack the background information to argue effectively against what they’re told. By and large, too, what children are told makes sense and works out in practice: “Don’t touch that hot stove!” and innumerable other commands, when ignored, prove themselves to have been good ones. So we tend to grow up with confidence in what our elders tell us, and as adults we readily substitute for parents and elders the “experts” , the “authorities”, the “Establishment”.

When we encounter someone who believes very differently than we do, we tend to be puzzled: “How could anyone believe that?!”

The answer is simple: They had different parents and teachers, and later they listened to different “experts” and “authorities”.

So to ask, “How could anyone believe that?!”, is the wrong question. The right question is, “How does anyone come not to accept what they’ve been told, what everyone around them ‘knows’?” (I’ve written more along these lines in Science or Pseudoscience: Magnetic Healing, Psychic Phenomena, and Other Heterodoxies, especially p. 47 ff. and p. 207 ff.).

When it comes to supposedly factual matters, textbooks and undergraduate courses emphasize learning what — according to the authorities — has already been found out and is already understood. There’s a significant difference here between “scientific” matters and non-scientific ones. If humanists and scientists can be persuaded to discuss their differing approaches to college teaching, it turns out that the scientists have a rather naïve view of their mission as one of transferring reliable, accredited information, whereas the humanists tend to emphasize the nurturing of critical thought. One indication of the difference is that science courses tend to be sequenced in linear hierarchy: students must take general chemistry before specialized inorganic, organic, and physical chemistry, and they must take some math and physics before physical chemistry, and so on. By contrast, great swaths of “upper-level” courses in the humanities have few if any prerequisites (more about this in To Rise above Principle: The Memoirs of an Unreconstructed Dean, p. 140).

So scientists and doctors, already trained by parents and earlier teachers to believe what they’re told, become even further accustomed during their “education” — more correctly, their indoctrination — to accept contemporary “knowledge” and beliefs. Once graduated and credentialed, as professionals and practitioners, to those habits of intellectual conformity there are added weighty practical considerations: straying from orthodox paths can incur serious, even disabling damage to one’s career and livelihood.

It isn’t that doctors and scientists “go along” cynically with beliefs and practices that they recognize as wrong or unsound. At best, when they’re conscious of some disparity between what they do and “what’s right”, they rationalize: for example, that they can do more to correct matters by “working within the system” than by becoming whistle-blowers. More usually, though, like other humans, they presume that, because their inherent desire is to do the right thing, therefore they cannot be doing anything that’s fundamentally wrong. That’s the basis of “cognitive dissonance”: psychological mechanisms common to all human beings can render us incapable of discerning facts that disprove our beliefs. I recommend highly the book by Thomas Gilovich, How We Know What Isn’t So: The Fallibility of Human Reason in Everyday Life (Free Press, 1991)  for an excellent and very readable discussion of various ways in which we can fool ourselves into not seeing facts that contradict our beliefs; we are simply oblivious to them.

In science and medicine as much as in everyday life, human beings want to “fit in”. We are social animals and want to be part of a group, and that applies on intellectual issues as much as in other matters. The highly creative astrophysicist Thomas Gold described the intellectual conformity in scholarship and research as an expression of “the herd instinct”, illustrating it by the furious opposition he encountered over his suggestions about the mechanism of hearing (about which he later proved to have been right) and the origin of petroleum (about which he may yet turn out to be right) — see “New ideas in science”, Journal of Scientific Exploration 3 [1989] 103-12. The histories of science and of medicine are replete with instances of great breakthroughs that were desperately resisted by the mainstream “authorities” for as long as possible (the concise essay about this by Bernard Barber remains well worth reading: “Resistance by scientists to scientific discovery”, Science, 134 [1961] 596-602).

That desperate resistance is a consequence of cognitive dissonance and the herd instinct. True believers have reached their beliefs not by considering the evidence but by taking things on faith from the authorities. When they are challenged, it threatens not only their belief but also their self image — their lack of critical thought — and their membership of the herd: if they came to see that the belief is mistaken, they would also have to become outsiders. All that is unacceptable in the extreme, and is therefore resisted by every available means. But true believers cannot respond substantively, because they haven’t arrived at their beliefs in that manner, they have taken matters on faith and don’t even know what the evidence pro and con is. So the desperate resistance typically takes the form of personal attacks, character assassination, guilt by association, and the like; see “Dissenting from HIV/AIDS theory” and “Questioning HIV/AIDS: Morally Reprehensible or Scientifically Warranted?”

A quite general corollary of cognitive dissonance and the herd instinct is that a significant number of counter-intuitive breakthroughs have been made by people who were outsiders rather than specialists in the relevant field; for references and discussion, including counter-examples, see T. F. Gieryn & R. F. Hirsh, “Marginality and innovation in  science”, Social Studies of Science 13 (1983) 87-106. The standard dismissal of Rethinkers by HIV/AIDS dogmatists, that the Rethinkers haven’t themselves done hands-on HIV/AIDS research, has no basis in empirical fact and the history of science.

These matters are highly pertinent for Rethinkers, or in general for anyone and any group that aims to bring down an established paradigm. A direct lesson is that it’s unusual for human beings to question what they have been taught to believe, because of the psychological mechanisms —  ranging from entirely unconscious to barely conscious — that conspire to safeguard us from “seeing” anything that might raise doubts. A bitter extrapolation from this is to recognize how enormously difficult it is to persuade someone else that their beliefs are provably wrong:

“It is difficult enough to reach a personal, informed view on matters over which controversy rages; there is little chance that the true believers or true disbelievers can be converted. ‘The most we can hope to achieve is to make the credulous more skeptical, and the skeptical more open-minded’” — p. 218 in Science or Pseudoscience: Magnetic Healing, Psychic Phenomena, and Other Heterodoxies,  citing Arthur C. Clarke, whose words on this subject are well worth attending to; see the Introduction and Epilogue in Arthur C. Clarke’s World of Strange Powers (ed. John Fairley and Simon Welfare, G. B. Putnam’s Sons, 1984).

——————

So, Andy: My view is that we should never be surprised when adherents to mainstream views seem impervious to even the plainest evidence. That’s NORMAL! And it’s so in science as much as in any other human activity. Most of us are still taught in school, college, university, that science is objective and that scientists care only about  learning the truth; but science isn’t done that way, it’s a complicated human activity; for a relatively brief discussion, see Scientific Literacy and the Myth of the Scientific Method ;  and for a comprehensive account, I recommend John Ziman, Real Science.

As to HIV/AIDS specifically, it’s extraordinarily unlikely that the dogma will be abandoned because of research or publication or critical thinking or re-thinking within the mainstream. Much more likely, it will be overturned under pressure from outside sources: perhaps political, because of the inordinate, disproportionate, and unproductive expenditures; perhaps legal, if enough “HIV-positive” people damaged by “antiretroviral therapy” win enough and sufficiently important court actions; or perhaps, again legal, if someone charged with transmitting HIV manages to bring the court to look at the scientific evidence; or if someone prominent enough among black leaders comes to realize that people of African ancestry are being disproportionately subjected, without good reason, to toxic medications; or if someone powerful enough in the major media becomes so interested as to actually look into the facts. Otherwise, I fear, the mainstream will just continue to fiddle with new medications, gradually continuing to make the treatments less toxic, and gradually extending the life-span of HAART-treated people to an average beyond the present middle forties. If that is the case, then it may take a horribly long time before the death toll from antiretroviral drugs becomes so obvious and widely known that the established view is finally held to public account.

Poison in South Africa

Several publications have attempted to calculate the precise life-saving benefits of antiretroviral drugs (Walensky et al., Journal of Infectious Diseases 194 [2006] 11-19; Antiretroviral Therapy Collaboration, Lancet 372 [2008] 293-99; Bhaskaran et al., JAMA 300 [2008] 51-59). All of them are based on rather elaborate computerized models replete with hordes of assumptions, and they deliver outputs that not only differ with one another [numbers are cited in “HAART saves lives — but doesn’t prolong them!?”, 17 September 2008] but that are also at stark variance with plain facts adduced quite directly from observations on patients:
1. The Antiretroviral Therapy Cohort Collaboration (Lancet 2006; 368: 451–58) analyzed data from more than 22,000 patients on HAART and found that the therapy decreased viral load “but such improvement has not translated into a decrease in mortality”; in other words, no life-saving benefit at all.
2. Death statistics for the USA show that, even by 2004, half of all HIV/AIDS patients were dying at or below age 45. Since the introduction of HAART in 1996, both the average time between a diagnosis of AIDS and death and the very slow and steady changes in median age of death from 1982 to 2004, refute the claim that HAART renders “HIV/AIDS” a chronic but manageable disease that offers prospects of virtually a normal life-span [“HAART saves lives — but doesn’t prolong them!?”, 17 September 2008].

Since the observed facts contradict the estimates, the only thing demonstrated by those calculations of supposed benefits from HAART is that one can obtain any desired result from a computer model if one uses a sufficient number of suitable assumptions; and the only thing that consumers of such outputs need to remember is GIGO: Garbage In, Garbage Out [“Antiretroviral therapy has saved 3 million life-years”, 1 July 2008].

To the spurious claims of life-saving benefits from HAART, there has now been added (biology news net) an even more dubious extrapolation: Those supposed benefits have been (mis)applied to calculate how many South African lives could supposedly have been saved, if antiretroviral drugs had been distributed sooner and more widely (Chigwedere et al., JAIDS, online publication ahead of print, 10.1097/QAI.0b013e31818a6cd5) . The overall assumptions are indicated (indicted?) already in the Abstract [emphases added]:

“Using modeling, we compared the number of persons who received ARVs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period”.

“In 1999, President Thabo Mbeki, under pressure to provide zidovudine (ZDV or AZT) for prevention of mother-to-child HIV transmission (PMTCT) and AIDS treatment, announced that the drug was toxic and dangerous to health and that the government was not going to provide it”; thus implying that AZT is not toxic — or, at least, as though this somehow doesn’t matter: “its side effects were clearly documented and disclosed”, citing for the latter a 1987 paper (Richman DD, Fischl MA, Grieco MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med. 1987;317:192–197), one of whose authors (Fischl) had subjected Kim Bergalis to such high doses that she died within a couple of years (“The Stories of Those Who Believed in AZT”, Peter Duesberg; several cases are described in “The cure that failed”, Tom Bethell, National Review 10 May 1993).

In case the latter reports of AZT toxicity appear to come from biased sources, have a long look at the official Treatment Guidelines.  One of the “Factors associated with immunologic failure” — i.e., likely causes of destruction of the immune system — is “Medications, both antiretrovirals (ZDV [270], TDF + ddI [271-273]) and other medications” (p. 37). AZT/ZDV is also responsible (Tables 9 & 10) for “Rare but serious cases [i.e., potentially fatal] lactic acidosis with hepatic steatosis”, bone marrow suppression, anemia, mitochondrial toxicity (which can cause hepatic steatosis); in combination with other “life-saving” antiretroviral drugs, “Hypersensitivity reaction that can be fatal” (Table 10). Among the “Potentially Life-Threatening and Serious Adverse Events” (Table 18a), ZDV features under “Lactic acidosis, hepatic steatosis, pancreatitis (severe mitochondrial toxicities)”, “Stevens-Johnson syndrome (SJS), Toxic epidermal necrosis (TEN)”, bone marrow suppression, “Hepatotoxicity (clinical hepatitis or asymptomatic serum transaminase elevation)”. Among the less serious “side” effects “Compromising Quality of Life and/or With Potential Impact on Medication Adherence” (Table 18c), ZDV features as causing “fat maldistribution”.

In other words, contrary to what is implied by Chigwedere et al., ZDV is toxic to a potentially fatal degree. That’s also admitted implicitly by some number of mainstream researchers, even some who claim benefits from HAART, for example, Walensky et al. (Journal of Infectious Diseases 194 [2006] 11-19) whose calculation of supposed benefits of antiretroviral drugs ascribes no benefit at all to AZT/ ZDV treatment from its introduction in 1987 up to the era of HAART. The immediate drop in death rate when ZDV monotherapy was stopped is yet another direct measure of the drug’s toxicity [“HAART saves lives — but doesn’t prolong them!?”, 17 September 2008].

It would be wearisome as well as pointless to cite the innumerable presumptions and assumptions in Chigwedere et al., but I can’t resist pointing to the throw-away phrase highlighted in the following passage:

“we estimated the average life-years that ARV therapy adds to patients with AIDS in Africa. Primary studies done in Africa (including South Africa), a meta-analysis, and a comparison with the developed countries show that other than increased mortality at the start of treatment, patient responses to ARV treatment in Africa are similar to those observed in the developed world. 20”

Reference 20 is Braitstein P, Brinkhof MW, Dabis F, et al; Antiretroviral Therapy in Lower Income Countries (ART-LINC) Collaboration; ART Cohort Collaboration (ART-CC), “Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries”, Lancet 367 [2006] 817-24; the pertinent information is “Mortality was higher in low-income settings (124 deaths during 2236 person-years of follow-up) than in high-income settings (414 deaths during 20 532 person-years)”. In other words, in Africa 14.9 of every 100 people treated with HAART die in the first year of treatment, whereas in the developed world only 2 of every 100 people treated with HAART die in the first year of treatment.

Now, that throw-away reference by Chigwedere et al. implies that response to HAART after the initial deaths has been found to be similar in low-income settings to that in high-income ones, but the cited reference doesn’t exactly say that. The ratio of deaths at 9 months is indeed lower than initially, but it is still between 1.5 and 2 times (adjusted and unadjusted hazard ratios respectively) higher in the low-income countries; whether 1.5-2 is  “similar” to 1 is a matter of opinion. Nor is there any obvious reason to assume that the decrease to month 9 will continue thereafter; for example, I might speculate that since the Africans beginning treatment are initially ill, whereas about 70% of those entering treatment in the United States are not ill (asymptomatic HIV-positive with CD4 <200), the Africans would be more likely to succumb to the “side” effects of the drugs, so that the mortality ratio would increase again after its initial decline during the brief exposure of 9 months — almost at once, the most seriously ill Africans succumb to the poisonous drugs, and those who are not so ill succumb more slowly but still appreciably more quickly than in the United States.

In any case, the vastly different criteria for beginning treatment in low- and in high-income countries, and the vast difference in disease burdens of many kinds — both acknowledged in the cited article — suggests that the attempt to extrapolate to low-income settings the benefits calculated for high-income settings is in itself invalid a priori — doubly so, of course, since the benefits calculated for high-income settings are spurious, as shown (see above) by the direct data on >22,000 patients from the Antiretroviral Collaboration and the death statistics for all HIV/AIDS patients in the United States: half the deaths from “HIV disease”, even by 2004, occurred by age 45.

Nor are the technical deficiencies in Chigwedere et al. the only reason to discredit their conclusions. One might also note that the authors lack any credentials to discuss such matters of economic and political policy as “what was reasonably feasible in the country during that period”, which is the whole point of the article. Indeed, one might question the very purpose of publishing these calculations. Even were they impeccably correct technically, they add nothing — and claim to add nothing — of medical or scientific relevance. This is an exercise in propaganda and politics, hardly appropriate for a journal whose raison d’être is described thus:  “JAIDS Journal of Acquired Immune Deficiency Syndromes , non-HIV, and AIDS-related information from all relevant clinical and basic sciences, with a strong focus on molecular biology, cell biology, epidemiology, and clinical virology. Each issue of JAIDS publishes vital information on the advances in diagnosis and treatment of HIV and non-HIV infectious [sic], as well as the latest research in the development of therapeutics and vaccine approaches”. (The reference to “non-HIV” is curious: do they want the Journal to be able to continue even after HIV has been shown not to cause AIDS?) The 3 editors-in-chief specialize in “Basic Science Articles: David D. Ho, M.D. . . . Clinical Articles: Paul A. Volberding, M.D. . . . Epidemiology Articles: William A. Blattner, M.D.”, which brings to mind not only the incongruity of an article on public policy but also what I’ve said about doctors as scientists [“Nobel Prizes Illustrate that Doctors are Not Scientists”, 19 October 2008].

But I’d like to reiterate the main point, which cannot be overemphasized. A decade after the introduction of HAART, we know that its theoretical basis is wrong [“HAART and HIV/AIDS: Dilemmas, Paradoxes, and Errors”, 12 October 2008], and we know that half the people whose lives are being supposedly saved by HAART meet their death by age 45 [“HAART saves lives — but doesn’t prolong them!?”, 17 September 2008]. No amount of sophisticated computer modeling can gainsay those facts.

St. Louis School HIV Crisis: Wrong Theory Causes Havoc

“Midwest high school copes with HIV scare”

“Infected person tells health officials as many as 50 teens might have been exposed
Normandy High School in St. Louis, Missouri, consults national AIDS groups
Students being tested for HIV at six stations in the high school gymnasium
Fallout: Sports rival initially balks at playing team; relationships strained”

“Officials refused to give details on who the person was or how the students at Normandy High School might have been exposed”
— thereby providing fertile grounds for the wildest rumors.
“but the district is consulting with national AIDS organizations as it tries to minimize the fallout and prevent the infection — and misinformation — from spreading” — the misinformation for which they are responsible through not revealing the actual facts.

“’There’s potential for stigma for all students regardless of whether they’re positive or negative,’ Normandy School District spokesman Doug Hochstedler said Thursday” — NO. The stigma was ensured by the manner in which this “news” was released.

“A teacher in a neighboring district singled out a girl who dates someone at Normandy High and instructed her to get tested, Hochstedler said” — thereby intensifying the stigma and lending more specificity to the rumors. Why was that girl “instructed” to get tested? What right has a teacher — or anyone else — to give such instructions? I sense some trial lawyers sharpening their pencils and scribbling on legal pads in anticipation of some very lucrative “work” opportunities.

“Hochstedler said that as far as he knows, no other district has had to handle a similar situation” — maybe because they didn’t accept the word of one HIV-positive person that 50 others might have been infected and didn’t make the allegation public?

“Students at the school of 1,300 are being tested, and the district is getting advice on the best ways to support kids in crisis” — but it will not be the actual best way of supporting the kids, namely, admitting that “HIV” is not infectious and doesn’t cause AIDS.

“Sophomore Tevin Baldwin said that many of his classmates in this working-class city of about 5,000 residents want to transfer out of the district, which encompasses other towns. ‘Nobody knows what’s going on,’ he said. The district declined to respond to his assertion.”
It’s like déja vu  all over again, as philosopher Joe Six-Pack might say. Hasn’t it been obvious for almost 3 decades that “HIV” hasn’t spread in the United States?!

“Normandy Superintendent Stanton Lawrence agreed that students remain focused on learning, despite concerns and distraction. There’s no hysteria or panic, and school is running routinely, he said” — at total odds with the preceding parts of this news report. Lawrence should be selling Brooklyn Bridges. “’They recognize this situation is what it is, and doesn’t mean school is over . . . . Their concern is heightened, but we have to face it and do the responsible thing’” — which might begin with not making such idiotic pronouncements.

Perhaps the best way of instilling fear and producing mass hysteria is by innuendo and vague suspicions, being unspecific and secretive [emphases added]:
“The St. Louis County Health Department said last week that a positive HIV test raised concern that students at Normandy might have been exposed. The department is not saying whether the infected person was a student or connected with the school, only that the person indicated as many as 50 students may have been exposed. . . .  The Health Department also will not say how any exposure might have occurred. Health Department spokesman Craig LeFebvre has said the possibilities include sexual activity, intravenous drug use, piercings and tattoos. . . . Hochstedler said the district doesn’t know the person’s identity, or even whether he or she is a student. ‘We do know there was some potential exposure between that person and students . . . . We don’t know the individual or the route of transmission.’ . . . Students are being tested at six stations in the high school gymnasium, one class at a time. Only representatives from the Health Department are with the students, who are offered educational materials and a chance to ask questions before they are given an opportunity to be tested with a mouth swab, Hochstedler said. They may decline. They exit through a separate door, and no one in the school would know who did or did not get tested. ‘It’s entirely up to the student’ . . . . The district will never know whether or how many of its students tested positive . . . . ‘Once they’re tested . . . it’s an issue between the department and the child and his family”.

Of course, the only sensible interpretation of all this high-level security and secrecy is that the authorities think the situation is as serious as, say, a terrorist threat or suspicion that a mass shooting is being planned.

A friend had e-mailed me the link to this story with the sole comment, “Madness”. Yes, madness indeed. And the “news” media lose no opportunity to add to the madness. Thus Yahoo News spices it up with an AP photo of the school and the caption, “At least 50 students at the school …” [emphasis added], going not responsibly, not fact-checkingly further than the story’s “as many as”.

What we know from the demographics of “HIV-positive” in the United States is that an individual may test positive after being vaccinated against flu, or taking an anti-tetanus shot, or having TB, or for a large number of other reasons having nothing to do with a life-threatening sexually transmitted virus (e.g., Figure 22, p. 83, in The Origin, Persistence and Failings of HIV/AIDS Theory). We also know that the probability of testing positive for any of those reasons is far greater for people of African ancestry than others; black females in particular are typically 20 times as likely to test positive under one of those numerous conditions. We also know that in the lower teenage years, females are more likely to test positive than males — perhaps under the physiological stress of menarche, the onset of menstruation.

Those facts cause me to dread the further “news” and rumors that will be leaking out from those ignorant, panicked, “everything is normal”, school administrators and health officials in St. Louis.

Nobel Prizes Illustrate How Research is Done and Evaluated

In the previous post [“Nobel Prizes Illustrate that Doctors are Not Scientists”, 19 October 2008], I emphasized contrasts between the Nobel Prize in Medicine and those in Chemistry or Physics. But the Prizes in Medicine and those in Chemistry and Physics also have much in common:
— Laureates almost never receive a second such award.
— Some of the awards came only after the lauded breakthrough had been desperately resisted or ignored by the mainstream.
— Some proportion of honored recipients of the Prize were later disparaged for some of their other ideas.

Those empirical facts illustrate important but little understood facets of scientific activity.

That Nobel laureates typically don’t later do further Nobel-worthy work demonstrates the importance of serendipity in scientific discovery. If there existed a “scientific method”, then those who had best mastered the method would always do the best work and would be awarded a succession of prizes; but there is no such method — or at least science is almost never done that way (see Scientific Literacy and the Myth of the Scientific Method).  Science is a communal activity. One of its greatest strengths is the communal activity of peer review — and when peer review fails (typically as a result of bias or incompetence), science becomes unreliable. Furthermore, the Zeitgeist — the contemporary communal context of knowledge and ideas — that any given generation of scientists experiences is an important determinant of when a particular advance will be made; hence the many instances of “simultaneous independent discovery” that can produce controversies about priority, about “Who did it first?”. That’s why awards singling out individuals make for a distorted view of science and of the characteristics of the individuals who are midwives to the great discoveries.

One of the least widely appreciated facts about science is that counter-mainstream evidence or theories are almost always fiercely resisted, even when those claims later become not only accepted but so highly valued as to bring Nobel awards (see Bernard Barber, “Resistance by scientists to scientific discovery”, Science, 134 [1961] 596-602). There’s no difference in that respect between fields. A few examples in Physiology and Medicine include:
— Marshall and Warren (2005, bacteria as causes of ulcers).
— Paul Lauterbur (2003, magnetic resonance imaging) had his first paper about that rejected by Nature. He later remarked that “You could write the entire history of science in the last 50 years in terms of papers rejected by Science or Nature” (cited at p. 161 in The Origin, Persistence and Failings of HIV/AIDS Theory).
— Stanley Prusiner (1997, prions as infectious agents); for many years he was sneered at for believing that proteins could behave like that.
— Barbara McClintock (1983, “jumping genes”).
— Peter Mitchell (1978); the prize was awarded in Chemistry, but really for physiological work, “for his contribution to the understanding of biological energy transfer through the formulation of the chemi-osmotic theory”, a view that had been pooh-poohed for years before he was vindicated.
— Einstein’s Prize Citation (1921) http://nobelprize.org/nobel_prizes/physics/laureates/1921/press.html emphasized his work on the photoelectric effect and Brownian motion with only a very cautious mention of relativity as being controversial — still, a considerable advance over the earlier widespread and intense opposition to relativity theory.
— Planck’s quantum theory (1918 Prize) had been so thoroughly ignored or disbelieved for so long that Planck later enunciated what has become known within Science Studies as “Planck’s Principle”: new ideas don’t win by convincing the opposition, they win only as the opponents die off.

In Chemistry and Physics, the resistance to challenges to mainstream views has sometimes taken the form of asserting that something is totally impossible, so that very few people even try it, for example, superconductivity not only at temperatures appreciably higher than “absolute zero” but in ceramic materials rather than metallic substances (Physics Prize, 1987, Georg Bednorz and Alexander Müller); or the maser and laser (Physics Prize, 1964, Charles Townes) — in his autobiography, Townes relates how eminent elder statesmen in physics urged him to drop work along these lines because such devices were impossible and his efforts would bring the Department into ill repute.

Perhaps equally little known is the fact that Nobel laureates not infrequently are or later become proponents of claims that the mainstream promptly dismisses — sometimes justifiably, sometimes not (see especially Chapter 9 in Fatal Attractions: The Troubles with Science). Frequently these offbeat claims are in quite other fields than the Laureate’s award:
— C. G. Barkla, Prize in 1917 for work on X-rays, later “discovered” the non-existent “J-phenomenon” concerning X-rays.
— William Shockley, Physics Prize 1956 for work on transistors, became infamous for his notions about race, genetics, and eugenics, a throwback to
— Philipp Lenard , Physics Prize 1905, who enthusiastically supported Nazism by publishing Deutsche Physik, a textbook of revisionist physics that excluded all work by Jewish scientists (including Einstein).
—  Luis Alvarez (Physics, 1968) became an intemperate proponent of the asteroid-impact theory of dinosaur extinction, which most evolutionary biologists find overly simplistic or even quite wrong.
—  Hannes Alfvén received a Physics Prize in 1970 “for fundamental work and discoveries in magnetohydrodynamics with fruitful applications in different parts of plasma physics”, yet his application of those very ideas to cosmology has remained ignored, effectively dismissed by the mainstream.
— Brian Josephson, Physics 1973, believes that psychic phenomena are worthy of study, something dismissed out-of-hand as rank pseudo-science by science groupies.
—  Kary Mullis (Chemistry 1993) is widely disparaged because he recognizes that the Emperor of HIV/AIDS theory has no clothes.
— Linus Pauling (Chemistry 1954) was derided for his insistence on the benefits of “orthomolecular” medicine, in particular the desirability of vitamin supplements (especially vitamin C) considerably higher than the official “recommended daily amounts”; he has not even yet been properly credited for stimulating the general understanding of the benefits of anti-oxidants, of which vitamin C is one.

That Nobel laureates rarely win a second such award, and that on all sorts of topics they may harbor opinions that most people find obnoxious or silly, underscores the role of serendipity in scientific discovery. It’s a matter of being in the right place at the right time with the right preparation (Paula E. Stephan & Sharon G. Levin, Striking the Mother Lode in Science: the importance of age, place, and time, Oxford University Press, 1992); “with very few exceptions, it is not the men that make science; it is science that makes the men” (Erwin Chargaff, “A quick climb up Mount Olympus”, Science 159 [29 March 1968] 1448-9). As the saying goes, Nobel laureates are often people who have learned more and more about less and less, at times rivaling idiots savant in their extraordinary abilities narrowly restricted to one subject. (Some laureates, of course, are sensible even outside their specialty, and some remain apparently unspoiled by their celebrity status.)

Less obvious aspects of Nobel awards lend insight into differences among the sciences, for example, some of the differing mindsets of chemists and physicists is illuminated by the fact that  “Nobel Prizes in physics have been awarded about twice as often for experimental novelties as for theoretical ones, but in chemistry, experimentalists have been so honored five or six times as often as have theorists” (Scientific Literacy and the Myth of the Scientific Method p. 26).

It has highly unfortunate consequences that the public image of science is so largely colored by misguided beliefs about a “scientific method” that supposedly delivers reliable results no matter who the researchers happen to be, and the related belief that a few people so master “the method” as to be all-purpose wise men, and the implicit view that researchers are less subject to human fallibilities and failings than are businessmen and politicians. The most remarkable thing about science is that it has managed so often to become reliable despite being carried on by fallible individuals; for an analogy with the military, see pp. 303-6 in my book,  Beyond Velikovsky.

Nobel Prizes Illustrate that Doctors are Not Scientists

The prestige associated with Nobel Prizes and similar awards is often excessive and sometimes quite misplaced, for a variety of reasons. There is no need to point out that a single Prize per year in Literature cannot be decided objectively — decisive are subjective taste and judgment and regional or ethnic or national biases. That ideological or political considerations enter the award of the Prize for Peace is obvious a priori as well as from the history of the actual awards. The Prize in Economics, too, inevitably entails a certain degree of subjective judgment, as would be true in any social science. That there are awards only in Chemistry, Physics, and Physiology or Medicine means that a large amount of research in mathematical and physical science is simply not eligible.

The history of the awards in medicine and in science is also instructive about several aspects of these fields that are not widely appreciated. One of those provided the title for this post. The training of doctors is appropriate to their mission: to help suffering patients by applying the best available contemporary understanding. The training of scientists is also appropriate to their mission, but it’s a different mission: to advance understanding beyond the contemporary state, which means to discover things that reveal gaps or mistakes in contemporary understanding. That difference becomes of considerable practical significance when research in medical science is carried on by people trained as doctors.

Training for research in science begins only at the graduate level. Undergraduate science courses dogmatically instill familiarity with the present state of understanding. Only in graduate and postdoctoral work, as apprentice researchers, do neophytes begin to appreciate the fallibility of contemporary knowledge and to sense how ephemeral that knowledge is. Through actually doing research, one discovers errors in the published literature of research articles, reviews, monographs, and textbooks — sometimes quite fundamental errors. Through doing research, one learns to accept paradigms and theories only provisionally — though we tend to have that in mind more readily with the pet projects of our competitors than with our own scientific obsessions and passions. Doctors who venture into actually doing research do so without the benefit of an apprenticeship in research, and the consequences are sometimes all too obvious, as when MDs in the CDC assert in a formal publication that a correlation proves causation (pp. 194-5 in The Origin, Persistence and Failings of HIV/AIDS Theory).

So, in the HIV/AIDS context, it is far from irrelevant that those most responsible for making a dogma out of HIV/AIDS — notably Gallo and Fauci — are MDs, while prominent early skeptics were research scientists like Duesberg, Mullis, Gilbert, Root-Bernstein. As with all generalizations, of course there are exceptions: two of the most stubborn and extreme HIV/AIDS vigilantes, Moore and Wainberg, are PhDs, not MDs. But occasional exceptions don’t vitiate the explanatory utility of well-founded generalizations.

Another such generalization, also pertinent to the cases of Gallo and Fauci, is that the most capable researchers set their sights on obtaining academic positions, with the corollary that the overwhelming majority of outstanding work has come from universities rather than from industry, still less from government institutions — despite such exceptions as Nobel Prize work from Bell Telephone Labs or breakthroughs concerning trace-metal nutrients and leading work in radio astronomy from the government laboratories in the Commonwealth of Australia. One salient reason is that ambitious people seek the freedom to choose their own projects that academe offers (in principle!), whereas government-run labs are inevitably subject to a degree of bureaucratic control and hierarchic decision-making. Another practical reason is that academic researchers are in fierce competition for everything — grants, students, facilities — whereas researchers in federal laboratories experience nothing like that sort of competition. A sort of “natural selection” tends to bring the best and brightest to the fore in the intellectual free market of academe; whereas bureaucracy may supersede such “natural selection”, because researchers in government labs can’t always follow their best scientific judgment: they need to be on good terms with their bureaucratic superiors and may have to defer to their judgment. One visible consequence of these differences is that directors of government labs can accumulate staggeringly long lists of publications bearing their name even though their personal intellectual contributions may be meager.

There are quite objective indications, how different are the fields of medicine and of science: the recorded history of Nobel Prizes shows how much more often there have been mistakes in the Medicine Prize than in the Chemistry or Physics Prizes. In the latter, I have located no cases where a Nobel Prize was awarded for work that later turned out to be simply mistaken, wrong, and became generally repudiated; whereas in Medicine, there are a number of such instances or cases where the lauded discovery later turned out to be, if not entirely wrong, then seriously misleading or just not useful:
1903, Prize to Niels Finsen for light therapy as a cure for various conditions including tuberculosis.
1927, Julius Wagner-Jauregg, for treatment of mental illness by inoculation with malaria!
1949, Antonio C. de A. F. E. Moniz, for treatment of mental illness by surgery (lobotomy).
1975, to David Baltimore, Renato Dulbecco, Howard Temin “for their discoveries concerning the interaction between tumour viruses and the genetic material of the cell” — part of the red-herring search for viruses that cause human cancers, and responsible for the consequential error that reverse transcriptase activity demonstrates the presence of a retrovirus.
1976, to Carleton Gajdusek for discovering the first “slow virus”, which supposedly caused Kuru in humans and analogous brain disease in animals, for instance mad-cow disease. Since 1997 (Prize to Stanley Prusiner), it’s been believed that these diseases are not caused by viruses but by prions, a class of proteins.
1989, to Michael Bishop and Harold Varmus for the “discovery of the cellular origin of retroviral oncogenes”.

It’s also in the nature of medical matters that some of the consequences of apparent advances may later turn out to be disadvantageous, as with DDT (Prize to Paul Müller, 1948); or with studies of the role of cholesterol (Prize to Michael Brown and Joseph Goldstein, 1985) that led to the mistaken belief that lowering blood cholesterol could prevent atherosclerosis (inflammation or abrasion inside arteries, and elevated levels of  the amino-acid homocysteine, are nowadays believed to be precipitating factors, not the mere presence of cholesterol).

At any rate, comparison of Nobel awards in chemistry and physics with those in medicine demonstrates that the fields differ significantly in the degree to which one can be certain about the long-term significance of an apparent advance that is lauded by its contemporary mainstream.

I believe that these generalizations provide a useful context for such controversies as those about HIV/AIDS; but a disclaimer is in order, since comments like the preceding ones can be readily misinterpreted if one is so inclined. Therefore let me re-emphasize that these, like all generalizations, are subject to exceptions. Further, I have enormous respect and endless gratitude to a considerable number of doctors who practice as physicians and surgeons and who have helped me remain active to a respectable age; as just one instance of several available ones, I was treated wonderfully well and had a splendid outcome in the first clinical trial of angioplasty at the Clinical Center of the National Institutes of Health. Nevertheless, I would prefer that those valued doctors and surgeons not engage in research in retrovirology or statistical evaluation of data.