Medicine isn’t science — nor should it be

My graduate-studies mentor was Bruno Breyer, PhD (Bonn), MD (Padua). He carried on clinical research at a hospital as well as unrelated scientific research at the university. Quite often he would sigh, “The trouble with doctors is that they’re not scientists”.
He was talking about research, of course, not about the practice of medicine. Medical practice is fundamentally different from science: its focus is the individual, whereas science deals with universal laws, principles, theories.
Admittedly, medical practice can be informed by scientific knowledge; but it can equally be misled by mistaken scientific views. AIDS and HIV are exemplary in this respect — exemplary in the sense of representative, for there are ample other instances. Before the “HIV” era, AIDS patients were treated as individuals suffering from specific infections, and treated in some cases very successfully, as with Michael Callen who lived more than a dozen years after having been at death’s door. Following the adoption of the mistaken scientific belief that “HIV” was the cause of AIDS, medical practice has increasingly made antiretroviral treatment routine instead of treating individual patients according to their manifest individual ailments.
Modern medical practice is increasingly infected by a misguided, purportedly “scientific” mind-set. I’ve mentioned before how sicknesses and their treatments have been “scientifically” created and sold (Selling sickness and huckstering medications). I’ve just started reading Jeremy Greene’s fascinating account (Prescribing by Numbers — Drugs and the Definition of Disease, Johns Hopkins University Press, 2007) of how medical practice has become increasingly independent of clinical symptoms and diagnosis and increasingly dependent on “scientific” markers, so that heart disease is diagnosed by cholesterol level and not by chest pain, and hypertension is declared solely on the basis of pressures, moreover pressures that are perfectly normal for large numbers of people.
The present essay springs from a recent series of articles about chronic Lyme disease (“Lost in the Woods”: Salvos launched in Lyme debate; In search of hope, facts; The doctor of last resort), which afflicts some unknown number of individuals but is said by official medicine not to exist. The established view is that Lyme disease, caused by a spirochetes bacterium (Borrelia burgdorferi) transmitted to humans from deer ticks, consists of an acute infection that is satisfactorily treated by a few weeks of the oral antibiotic, doxycycline. The Centers for Disease Control and Prevention (CDC) call for treating acute Lyme disease with a regimen of 14 to 28 days, and another 28-day course if that doesn’t do the job.
“Most doctors, citing guidelines issued by the Infectious Diseases Society of America, believe nearly all cases of Lyme are acute, with the exception of a very small number of patients who have post-Lyme inflammatory illness. They take the position that chronic Lyme disease doesn’t exist; that short-term antibiotics decimate the spirochetes in all but the rarest of cases”. And those doctors respond to queries about chronic Lyme disease with “copies of The New England Journal of Medicine, talk about ‘evidence-based medicine’ and [they] say the crux of chronic Lyme isn’t Borrelia but rather the vagaries and vicissitudes of middle-aged, middle-class life”.
A minority of doctors (some 20%), though, have not pooh-poohed what their patients experience and what they observe in the way of symptoms: “an acute case of Lyme can develop into a crippling, chronic version of the disease that attacks the body and the brain, they believe. . . . They liken the naysayers to those who first labeled multiple sclerosis the ‘faker’s disease’”.
Those who are convinced that they suffer from chronic Lyme have campaigned to make long-term treatment permissible, successfully so in several states that have legislated protection for doctors who decide that their patients require such care.
How unscientific official practices are, how not evidence-based, is illustrated by the manner in which the CDC and State Departments of Health acquire — or, rather, do not acquire — knowledge about infectious diseases: There exist no regulations to require primary-care physicians, or specialists, or clinical laboratories, or hospitals to report instances of Lyme disease. As a result, it is almost a matter of chance, whether or when officialdom receives enough data to make possible an informed estimate of how common or rare it is and what physicians ought to know and do about it. That in itself ought to suffice to discount the arrogant certainty with which some authorities currently dispute the existence of a chronic form of Lyme disease.
Yet dismissive comments about individuals imagining their symptoms are not uncommon: “‘I think chronic Lyme seems to be an idea that’s infectious’, said Dr. Stephanie Nagy-Agren of the Veterans Affairs Medical Center in Salem”; and “the Infectious Diseases Society of America . . .  says there’s no evidence to prove it exists”. . . . “Dr. Thomas Kerkering, . . . . infectious diseases section chief . . . has spent much of the past decade ‘de-mything’ chronic Lyme, which he likens to chronic fatigue syndrome and fibromyalgia before it. He lumps the three into disease ‘catch-alls’, faux ailments designed to give a name to the stresses of daily living. . . . ‘Those of us who stick to the scientific evidence are pilloried’”. “Anecdote squared does not equal data”, Kerkering likes to say.
Kerkering proclaims himself to be an advocate of “‘evidence-based medicine’, the concept of applying the most scientifically sound research to clinical decision-making”. He treats acute Lyme disease only if the CDC-approved blood test is positive. Whereas another hospital in the same area reports seeing 25-30 cases of Lyme, Kerkering’s team has confirmed only 4 cases out of 50 suspected ones.

Kerkering happens to be fundamentally wrong about what evidence-based medicine is. That phrase has become a sound-bite wielded by those of Kerkering’s ilk who wish to emphasize how authoritative their views are, when in point of fact the push for evidence-based medicine was launched in the 1990s because so little of medical practice is actually based on evidence. And that has hardly changed in the meantime; see, for instance, Carey, “Medical guesswork — from heart surgery to prostate care, the health industry knows little about which common treatments really work”, Business Week, 29 May 2006; and for a comprehensive overview, see Centre for Evidence-Based Medicine.
It could not be otherwise, because scientific experiments cannot be carried out on human beings, and so it is a long, slow, uncertain process to gather and weigh the evidence as it accumulates fitfully, unsystematically, from the actual experiences of individuals and their individual doctors. The history of medicine is actually the history of placebo; there were no “scientifically sound” treatments before aspirin, sulfa drugs, and antibiotics (Shapiro & Shapiro,  The  Powerful Placebo — From Ancient Priest to Modern Physician, Johns Hopkins University Press, 1997). Moreover aspirin was “discovered” because of its presence in folk remedies used since times immemorial, and modern “scientific” drug development remains a matter of trials and errors, still often guided by folk traditions of medicinal plants.

It is the chronic sufferers and the maverick doctors who treat them who are practicing evidence-based medicine. The evidence that should count is what a patient experiences, not the generalizations that officialdom promulgates on the basis of inadequate data. In medicine, it is precisely anecdotes that count, the stories we tell our doctors when we consult them, the very reasons why we consult them.
Kerkering cites the strength of the placebo effect, and that by converse (nocebo, psychosomatic illness) people can talk themselves into being ill when they are actually experiencing nothing more than the stresses of everyday life. Absolutely correct. But were Kerkering to practice what he preaches, were he being truly scientific, then he would test his diagnosis of “talking themselves into it” by listening to what they say, telling them he knows what the problem is, and giving them the remedy that will have them cured in a week or two — not telling them that this remedy is a placebo:
— If they come back uncured, he would then have to change his diagnosis.
— If they are cured by the placebo, then Kerkering would have done what a doctor is supposed to do: Heal his patients, even if — or perhaps especially if — it’s “all in their minds”.

Officialdom’s acknowledgement, that “in the rarest cases” the short-course antibiotic doesn’t eliminate the spirochetes and that “a very small number” of patients suffer “post-Lyme inflammatory illness”, is tantamount to admitting the reality of chronic Borrelia-caused disease. Beyond that, it is not clear to this lay person why it should seem impossible that a spirochetes infection might sometimes go undiagnosed for too long and then cause a variety of symptoms including mental confusion; after all, that’s the case with spirochetes-caused syphilis: if it isn’t diagnosed and successfully treated soon after infection, in its secondary and tertiary stages it does precisely the things that chronic Lyme disease is held responsible for by those who suffer from it and the maverick physicians who practice evidence-based medicine with them.

Confusion worse confounded: Explaining AIDS Rethinking to non-thinkers

Innumerable aspects of mainstream “HIV/AIDS” practices and semantics have so muddied the facts that it has become very difficult to educate people who have not been previously exposed to actual evidence about HIV and AIDS; “naïve” people, if one may use the terminology of HAART treatment.
The pervasive term, “HIV/AIDS”, and the pervasive phrase, “HIV — the virus that causes AIDS”, even make it difficult for the naïve individual to think of those two things as distinct from one another, and that is the first barrier to learning the actual facts. The popular confusion between “HIV” and “AIDS” is incessantly re-emphasized in the media, and this makes it easy for the mainstream to get away with semantic tricks like re-naming AIDS-associated nephropathy as HIV-associated nephropathy (Kidney-disease denialism (a special case of HAART denialism); and of course that’s only one of many possible illustrations of the mischief brought on by linking “HIV” and “AIDS” as though they were inseparable. This mischief, this confounded confusion (pun intended) makes it enormously difficult to explain a Rethinking position to the naïve ones who have previously heard only the standard mainstream sound-bites. What they need to grasp is that
1. “AIDS” has been progressively redefined. Nowadays almost any seriously life-threatening condition might be called “AIDS”, whereas 1980s AIDS comprised just Kaposi’s sarcoma and some very specific, highly opportunistic, primarily fungal infections.
2. “HIV” tests actually detect not a virus but one or more of a number of substances — a dozen proteins, or various bits of DNA or RNA — that were frequently present in 1980s AIDS patients. “HIV” tests are 1980s-AIDS tests, not tests for a virus. Everything called “HIV-associated” is actually “AIDS-associated” or “HAART-associated”.
3. Because in 1984 the whole apparatus of medical research and practice began to behave as though 1980s-AIDS tests detected a virus, more and more complex rationalizations have had to be constructed in attempts to explain away the evidence that has increasingly exposed the failings of HIV/AIDS theory: no vaccine, no microbicide, “life-saving” drugs that don’t prolong lives, “prevention” approaches that don’t prevent, no mechanism by which “HIV” could produce illness, etc., etc. (browse blog posts under “HIV absurdities”, for example).

1.   “AIDS” has been progressively redefined
The original AIDS was critical illness, typically followed by death within months of diagnosis: either AIDS-KS (blood-vessel damage occasioned by abuse of nitrite inhalants) or advanced fungal infections (Pneumocystis carinii pneumonia or candidiasis [yeast infections or thrush]) which gained hold upon serious damage to the immune-system functions of the gut.
Following the conclusion-jump in 1984 that “HIV” was the cause of AIDS and that 1980s-AIDS tests detect “HIV”, an increasing number of other conditions were included under “AIDS”.
Following the introduction of AZT, an increasing number of “HIV-positive” people became ill and died as a result of AZT-poisoning, which produces visible symptoms similar to those of 1980s-AIDS: wasting of body tissues, loss of vital functions, dementia.
The manner in which “AIDS” is diagnosed changed from clinically observable illness to being based on laboratory tests. In 1993, this change in mode of diagnosis reached its ultimate and tragic conclusion, at least in the United States, when the Centers for Disease Control and Prevention defined “AIDS” purely in terms of “HIV-positive” and CD4 counts in peripheral blood — cell counts that are now being recognized as fallacious markers for the health of the immune system.
(It is worth noting that the shift from clinically based diagnosis to lab-test-based diagnosis is not unique to HIV/AIDS. Heart health, too, used to be diagnosed by clinical symptoms — shortness of breath, numbness of arm, chest pains — but increasingly is gauged on the basis of cholesterol levels and blood-pressure numbers. PSA tests — at least for a couple of decades — became enshrined invalidly as markers for prostate cancer. Blood-sugar levels became accepted markers for diabetes, even for “pre-diabetes”. Actively complicit in these invalid shifts have been the drug companies, who market medications based on lab-test results, medications intended for lifelong use with inevitably resulting iatrogenic liver disease, neuropathy, mental confusion, and other “side” effects.)

The progressive re-definition of “AIDS” has muddied the waters as to what the actual causes of “AIDS” deaths have been and are. Rethinkers are therefore unable to answer natural, obvious, valid questions of the sort, “So what did they die of if not HIV infection leading to AIDS?”, because published data permit only speculation about the cause of death in specific cases, and the original medical records are unlikely to be more informative. The large wiggle room in such speculative discussions is illustrated by the ability of mainstreamers to insinuate “HIV” involvement in such deaths as those of Christine Maggiore and her daughter.

2.   “HIV” tests are not
The prime source of confusion is the non-specificity of “HIV” tests, which were actually 1980s-AIDS tests and have turned out to respond “positive” to an enormous range of physiological conditions, not all of them health-threatening, for example pregnancy, flu vaccination, or anti-tetanus shots. That simple fact in itself is very hard for people to swallow who have been indoctrinated by the pervasive sound-bites of the conventional wisdom. One might do well always to have close at hand a copy of the Weiss & Cowan article* with certain sections highlighted: there is no gold standard “HIV” test; no tests can “confirm” “HIV infection”; because the overall prevalence of “HIV” is low (outside Africa and the Caribbean), most “positive” tests are false positives.
* Stanley H. Weiss and Elliott P. Cowan, Chapter 8 in AIDS and Other Manifestations of HIV Infection, ed. Gary P. Wormser, 4th ed. (2004)

If one can open someone’s eyes to those two points, they might then be receptive to hearing about the people who have been and are being damaged by the prevailing errors and confusion: those who for some reason or another are likely to test “HIV-positive” and be subjected inappropriately to dangerously toxic “medications”. As to point 3, all the self-contradictions and conundrums disappear once the HIV=AIDS belief is abandoned.

Follow the money: Is HIV/AIDS fading away?

Trying to predict what might bring an end to the HIV/AIDS scandal, one suggestion has been that the U.S. Congress might examine carefully what it has been buying for the ≥$20 billion annually being spent on foreign aid and research and social services connected with “HIV/AIDS”. But it might be that such funding will slowly wither and whimper away rather than ending with a bang: all over the world, spending on this phantom threat appears to be declining, to the anger and astonishment and dismay of those who have been feeding so amply from this trough.

In the United States:
“AIDS protest targets Emanuel — A group of Yale AIDS activists, joined by faculty members, Harvard students and activists from New York City, staged a protest on campus yesterday in response to stagnant AIDS funding from the Obama administration”.
“AHF [AIDS Healthcare Foundation] issues call for action against cuts in AIDS funding”.
Even high-publicity campaigns by celebrities are not doing so well nowadays:
“Kim Kardashian . . . and several other celebs, including Ryan Seacrest, Lady Gaga, Jennifer Hudson, Justin Timberlake, P. Diddy and Usher, vowed on Wednesday to ‘digitally die’ and stay off Twitter and Facebook until $1 million has been raised for Alicia Keys’ Keep a Child Alive Foundation. The money will go to save real lives affected by HIV/AIDS in Africa and India. But as of 4 p.m. ET Friday, only $200,476 has been donated” (“Kim Kardashian is still ‘dead’”, USA TODAY).

In South Africa:
“SA reached 5.7M HIV cases, report says — In 2009, the country spent $2.1 billion on AIDS, wherein one-third of it came from international donors including $620 million from the United States. . . . with sufficient amount of money and effective programs, the estimated figure of 350,000 to 500,000 new infection cases annually can gradually brought down to 200,000 a year”; “under this maximum effort scenario, the one that would bring down the epidemic most rapidly, South Africa’s total spending would have to more than double…to somewhere between $4 and $5 billion” (South Africa: At least 5 million new HIV infections expected over next 20 years)  . But that needed increase is not coming: “Aids funding cuts putting pressure on health systems — Motlanthe”.

In Zimbabwe:
“The Global Fund, an international financing institution to Fight HIV, Tuberculosis and Malaria will not be financing Zimbabwe’s Round 10 application for unspecified reasons. The National Aids Council (NAC) Chief Executive Officer Dr Tapiwa Magure has described the news as shocking”.

In Italy, AIDS funding has been cut progressively for nigh on a decade: “Prime Minister Silvio Berlusconi’s government had yet to allot any funds for the national AIDS program in its 2002 budget. To make matters worse, a series of freezes and delays has prevented most researchers from receiving grants awarded for 2001” (Science 295: 1811-2). This is consistent, of course, with the position of the Italian Ministry of Health, that HIV and AIDS are not the same thing and that neither is a public-health threat (Ruggiero et al., Italian Journal of Anatomy and Embryology, 114: 97-108).

Naturally enough, the executive director of UNAIDS, Michel Sidibé, “is  wrestling  to  renew the momentum and turn the funding  situation around” (“New HIV infections drop, but treatment demands rise”, Science 330: 1301, 3 December 2010). At the International AIDS Conference in Vienna, Caritas International had warned that a cut in funding for programs to fight HIV in the world would set back efforts by two decades (“Un taglio negli aiuti ritarderà di vent’anni la lotta all’Aids”).  “Dwindling donations from rich countries imperils the 2006 U.N. and G8 goal of providing universal access to HIV drugs by 2010” (AIDS 2010 opens: leaders weigh in on global HIV/AIDS funding).

Among the self-contradictions in official statements about HIV/AIDS are the alarums about spreading infections on the one hand and yet claims of marked successes on the other hand. Thus the Sidibé interview is accompanied by a map showing claimed — of course, estimated — reductions of ≥25% in infection rates in half or more of sub-Saharan Africa and little change in the other half, with troubling increases only in the Caucasus region and a couple of small spots in South-East Asia:

If present actions have been so effective, why redouble them?

*                    *                    *                    *                    *                    *                    *                    *

Should any official bodies require further reason to look with jaundice at what passes for “research” into the prevention of HIV infection, they might find it in the “$823,200 of economic stimulus funds in 2009 on a study by a UCLA research team to teach uncircumcised African men how to wash their genitals after having sex”.

HAART denialism, contd.

That ART causes kidney disease is obfuscated by assertions that “HIV” itself does so. There are even claims that introduction of HAART was associated with a decrease in “incidence and occurrence of renal disease” [Mocroft et al., “Estimated glomerular filtration rate, chronic kidney disease and antiretroviral drug use in HIV-positive patients”, AIDS, 24 [2010] 1667-78; see “Kidney-disease denialism (a special case of HAART denialism)”, 2010/11/20]. The source references for that claimed decrease are Ross & Klotman, “Recent progress in HIV-associated nephropathy”, Journal of the American Society of Nephrology 13 (2002) 2997-3004 and Weiner, Goodman & Kimmel, “The HIV-associated renal diseases: current insight into pathogenesis and treatment”, Kidney International 63 (2003) 1618-31. I’ve now read both.
Unwary readers might interpret the claim of a decrease as a steady drop, but neither of these sources bears out that claim. There was a small drop in incidence around 1996-97, but this was followed by either no decrease or an actual increase:

Overall “HIV disease” mortality dropped by about half in 1996-97 when HAART was introduced, as shown in Ross & Klotman, Figure 2. I’ve discussed this in detail before [HAART saves lives — but doesn’t prolong them!?, 17 September 2008]. Halving of mortality in the space of about a year cannot be ascribed to antiretroviral action, because that would only allow the immune system to regenerate slowly; on the other hand, cessation of highly toxic monotherapy (chiefly AZT) could bring a rapid decline in mortality: stop taking poison and your chances of dying decrease dramatically and quickly.
The data from Ross & Klotman and from Weiner, Goodman & Kimmel show that after the initial decline in fatal renal disease, when monotherapy was replaced by HAART, there has been no continuing decline: HAART continues to cause kidney disease, just slightly less effectively or more slowly than AZT alone.
Mocroft et al. were misleading quite seriously by citing these sources as reporting HAART-associated decline in kidney disease. Presuming that they were not misleading deliberately, at the very least they demonstrated themselves to be untrustworthy when citing sources.

So much for the false claim that HAART reduced the incidence of kidney disease. On to the false claim that kidney disease is “HIV-associated” rather than ARV-associated.

Weiner et al. speak of “intrinsic” acute renal failure in “patients with HIV infection”, and cite several sources for the claim that “HIV infection” has been found to be associated with a variety of “nephrological syndromes responsible for both acute and chronic renal failure”. Their two most recent sources date from 1990. One of them — Seney, Burns, & Silva, American Journal of Kidney Disease, 16 (1990) 1-13 — does not say “HIV”-associated, its title is “Acquired immunodeficiency syndrome and the kidney”, and the text describes work with AIDS patients. The other is a review that draws on 115 sources and notes that “HIV-associated nephropathy” was formerly termed AIDS-associated nephropathy [Glassock et al., “Human immunodeficiency virus (HIV) infection and the kidney”, Annals of Internal Medicine, 112 (1990) 35-49]. In point of fact, all the reviewed observations were derived from patently ill AIDS patients.
For anything to be properly described as “HIV-associated”, it should be proven to be associated with being “HIV-positive”, not with being an AIDS patient.

According to Glassock et al., hyponatremia (too little sodium) is the most common electrolyte or fluid abnormality associated with AIDS or AIDS-related complex; found, in other words, in people who were clinically ill, with Pneumocystis carinii (PCP) in a high proportion of the studied cases. Possible causes of nephrotoxicity include such drugs as pentamidine, which was a common treatment for and prophylaxis against PCP.
The peculiar distribution of this “HIV-associated” nephropathy “has suggested to some investigators that HIV infection is not responsible, directly or indirectly, for the renal damage”. That conclusion does seem natural, even obvious, given that 90% of the cases were in blacks. Among nearly 3000 AIDS patients in New York and Miami, nearly 180 (6%) had advanced kidney disease, the risk factors being black and abusing drugs intravenously; whereas among 1000 largely white gay men in San Francisco, only 13 (1.3%) had advanced kidney disease, and of those 13 the 3 most affected (on chronic dialysis) were black. If “HIV” were the cause of AIDS and of the kidney disease, the significantly lower rate in San Francisco and the extraordinary racial disparity would be a real mystery.
The ultimate treatment for renal failure is kidney transplant. Healthy immune systems reject transplants, and immunosuppressive therapy is needed to avoid that. Since “HIV” suppresses the immune system, kidney transplanting in “HIV-associated nephropathy” should be less problematic in terms of rejection; yet it isn’t:
“Despite the profound immunosuppression intrinsic to the HIV-infected patient, there remains such a remarkably intact capacity to respond to allogenic stimulation that acute rejection is an ever-present fear in HIV-infected transplant patients”; while the fear of opportunistic infections in “HIV-positive” patients “is exaggerated severalfold”.

Clearly, this review not only speaks against “HIV-associated nephropathy” as being HIV-caused, it also provides evidence that “HIV infection” is not associated with profound immunosuppression.
Moreover, hyponatremia, the most common electrolyte disturbance in AIDS, may be caused by stomach ailments that produce diarrhea or vomiting, plausibly in connection with intestinal dysbiosis. Here is further indirect support for the hypothesis that lifestyle-associated intestinal dysbiosis was a major factor in the AIDS outbreaks in the early 1980s.

There is no need to postulate “HIV-associated” nephropathy.

There is no need to postulate “HIV“.

Sterilizing the unfit

To improve humankind’s genetic pool, for a time it was regarded as proper to sterilize the undesirables and the unfit ones: the “mentally defective” in the United States and in Germany, the physically deformed also in Germany,  gypsies in Czechoslovakia, and a number of other countries practiced forced sterilization for various reasons at various times. Nowadays that is almost universally regarded as improper.

HIV/AIDS, however, may be unique in this respect as it is in so many other ways. Today’s Google Alert brought news that I am reluctant to believe: that Chile has forced sterilization on “HIV-positive” women. The news comes via Al Jazeera; those who might find that source not to their liking can read the full report from the US-based Center for Reproductive Rights.