Defeating HIV/AIDS — in the court-room
Posted by Henry Bauer on 2012/05/26
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
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  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