Evidence-based medicine? Wishful thinking

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

A corollary of Angell’s conclusion is that some part of contemporary medical practice, promoted or endorsed by mainstream institutions, is based on misleading information and thereby either medically harmful, or just medically useless but wasteful of time and money, or occasionally medically helpful but only by coincidental chance.
Proponents and groupies of mainstream medicine like to use the phrase “evidence-based medicine” as though it described contemporary practices. It doesn’t, far from it. Evidence-based medicine is a venture that was launched about a quarter century ago precisely because so little medical practice was based on sound evidence. There has been no appreciable improvement.
AIDS Rethinkers and HIV Skeptics are familiar with the discrepancy between the HIV=AIDS theory, promoted by all official bodies, and the actual data about HIV and about AIDS: “HIV tests” do not detect “HIV”; the epidemiology of positive “HIV” tests shows that “it” is not infectious and not sexually transmitted; there is no correlation between “HIV” numbers and “AIDS” numbers; etc. etc. etc. But this discrepancy between official pronouncements and the actual facts —findings published in the primary medical-science research literature — is not unique to HIV/AIDS. Rather, it illustrates the degree to which current medicine is misguided and often harmful.
For example, individuals with “high” cholesterol are routinely administered statins, in absence of evidence that “high” cholesterol is in itself harmful and actually bespeaks cardiovascular disease. Moreover the statins have such serious “side” effects as mental confusion, muscle weakness and eventually muscle wasting, and more:

A report from the Institute of Medicine (Evaluation of Biomarkers and Surrogate Endpoints in Chronic Disease, 2010) points out that all the measures currently used as indicators of cardiovascular disease are not valid measures of cardiovascular disease: blood pressure, cholesterol (total, “bad”, ratio . . . ), C-reactive protein, troponin — none of them is a valid indication of heart disease, still less are any of them causes of heart disease. Cholesterol does not cause cardiovascular disease, whether it be high, low, bad, good, or anything else. “High” blood pressure does not cause heart disease or heart attacks or strokes. It is just that all those things are correlated with one another — correlated primarily because all of them increase naturally, normally, with age. The Institute of Medicine report mentions that 243 risk factors have been identified for cardiovascular disease. Risk factors are correlations, symptoms, not causes. Therefore it should not be surprising that the presently routine treatments — blood-pressure lowerers (antihypertensives), cholesterol lowerers (statins), and more — have not been proved to be of benefit:

“there are no valid data on the effectiveness” of
“statins, antihypertensives, and bisphosphanates”
[the last are prescribed against osteoporosis]
Järvinen et al., The true cost of pharmacological disease prevention,
British Medical Journal, 342 (19 April 2011) doi: 10.1136/bmj.d2175

All this comes from the primary, peer-reviewed medical-science literature, and it is at odds with “what everyone knows”, and with what we hear from the doctors and the drug companies and the National Institutes of Health and the media. That’s an extraordinary thing to say, but anyone can confirm it for themselves by looking at the publicly available medical-science publications.

An impetus for me to do that was the experience of having planned surgery called off at the last moment because my blood pressure was said to be too high, about 190/90. My protests that stress has this effect, that my pressure goes up several tens of points just from being in a doctor’s office, fell on deaf ears. So for many weeks I monitored my blood pressure frequently, and found that it varies between 120 and 180 systolic and between 70 and 90 diastolic, during the day and from one day to the next, even without any unusual stresses that I’m aware of. Literature and Google searches soon delivered a wealth of information concordant with those observations, most notably that it is perfectly normal for blood pressure to increase with age. Indeed, some decades ago, the medical rule of thumb had been that systolic pressure approximates 100 plus one’s age — which would have made 180 normal for me.
Current data suggest a somewhat lower rate of age-induced increase, but the essential point is this: It has been known for more than a century that blood pressure normally increases with age, yet the official guidelines define hypertension — blood pressure too high — without taking this into account. The consequence is that perfectly healthy, symptom-free seniors are liable to be diagnosed with hypertension and subjected to medication: one third of Americans, and 75-80% of those aged 60 or more, are defined to suffer from hypertension and require treatment:

One of the pervasive and severely damaging problems with contemporary medical “science” and practice is the confusion of correlation with causation. The notion that high blood pressure, pre-hypertension or hypertension, means higher than the average healthy 25-year-old is absurd on its face, and reflects that pervasive confusion. EVERY ailment and disease becomes more prevalent with age, so all those are correlated with one another: hearing loss, dementia, heart disease, cancer, blood pressure, organ failure, etc. etc. etc. Those correlations are no basis for claiming that high blood pressure causes any of those things, any more than that dementia (say) causes cancer or that hearing loss causes heart disease.

Cholesterol and blood pressure, then, are two illustrations of Marcia Angell’s reluctant conclusion that “It is simply no longer possible . . . to rely on the judgment of trusted physicians
or authoritative medical guidelines”. So what does one do?

One has to search and digest the literature for oneself and weigh those data against official proclamations and doctors’ advice. That’s what M. Aziz did when circumstances of his own family led him to realize the neglected importance of vitamin D. He relates his experience in Prescribing Sunshine: Why vitamin D should be flying off the shelves, soon to be available in paperback, currently available at $2.99 for Kindle.
Some time ago, official guidelines for the recommended intake of vitamin D were increased considerably, but Aziz suggests that even more would be beneficial. His book is well worth reading for its cornucopia of citations from the medical-science literature, some of them revealing connections previously unknown to me, for example between vitamin D and immunity, and telomeres, and cholesterol, and HIV/AIDS; as well as the fact that vitamin D is a steroid and hormone-like. And the fact that under sunlight we manufacture vitamin D in the skin from . . .  cholesterol! By lowering cholesterol, we may even be accentuating deficiency of vitamin D. . . .
Of course one needs to be skeptical and judicious with all claims, those from alternative or complementary medicine as well as from mainstream sources. Thus one should not accept without further ado the claim that lowering cholesterol could even bring on Alzheimer’s disease, which is suggested by Henry Lorin because cholesterol is an essential component of all cell walls: Alzheimer’s Solved (www.booksurge.com; ISBN 1-4196-1684-6).

Drug peddlers’ ads ignore FDA

Advertising of prescription drugs direct to consumers is permitted, in the developed world, only in the United States and New Zealand (Marcia Angell, The Truth About the Drug Companies: How They Deceive Us and What To Do About It, Random House, 2004, p. 125). Anyone who watches TV or reads magazines knows how attractive these ads can make their medications seem: radiantly satisfied users are shown, and the “side” effects are hidden in the finest print in magazine ads while on TV or radio they are described in cheery, lighthearted tones and words intended to make them seem ignorable, mild inconveniences at worst. My favorite illustration of that is in the ads for sexual stimulants, where one is advised to consult one’s doctor if experiencing “changes in hearing or vision”, which doesn’t quite acknowledge the occasional cases of irreversible deafness or blindness.

The overwhelming majority of HIV-positive people who have taken antiretroviral drugs have found the “side” effects extremely debilitating. On a number of occasions I’ve cited the gruesome descriptions from the NIH Treatment Guidelines, including that people on HAART suffer more “non-AIDS” events than “AIDS” events, chiefly heart, kidney, or liver failure. A backhanded official acknowledgment of these awful “side” effects is the prominence given to the problem of ensuring “compliance” by patients to taking the pills. An actual demonstration is that in clinical trials in an orphanage, the children found the side effects of the drugs so painful that “compliance” had to be ensured by surgically implanting tubes direct into their stomachs (www.guineapigkids.com, accessed 13 May 2009) for ready insertion of the drugs. Another illustration is that AIDS clinics report a 40% drop-out rate from medication [Drug non-adherence, imaginary epidemics, and sexual nonsense, 30 August 2009].

The drug peddlers nevertheless like to illustrate their advertisements for antiretroviral drugs with photos of radiant men in the pink of condition. This has been so egregious that “In a strongly worded letter, FDA marketing division chief Thomas Abrams ordered pharmaceutical companies to create ads that are more ‘representative’ of the realities of HIV . . . . The ad for Crixivan features three athletic men and one woman who have just scaled a dramatic mountain peak, an athletic feat that many perfectly healthy people probably couldn’t do. Meanwhile, the ad for Combivir shows a muscular and attractive African-American with a towel over his shoulder, hinting that he has just completed a rugged workout. The text tells us he’s ‘living proof’ of the power of Combivir. . . . [T]he HIV drug ads . . .  fail to spell out the potentially deadly kidney and liver problems, diarrhea, nausea and other side effects that are endemic to anti-retroviral treatments” (Daryl Lindsey, 8 May 2001, “The ‘Joe Camel’ ads of AIDS?”).

Despite that “strongly worded” admonishment from the FDA, 3 years later the FDA had to actually ban two advertisements by Abbott Laboratories.

Another 3 years on, and the drug pushers had still not mended their ways:
”Certain omissions in these ads do not technically violate current FDA regulations, but they do violate those regulations’ intent. . . . Current ads [fail to] . . . highlight life-threatening side effects” [Kallen et al., “Direct-to-consumer advertisements for HIV antiretroviral medications: A progress report”, Health Affairs, 26 #5 (2007): 1392-8].

Another two years on, and the apparently toothless tiger of the FDA overlooks or ignores such ads as this one, which appeared recently as a full page on the inside cover in both gay publications in Washington DC, Washington Blade and Metro Weekly.

Perhaps the FDA could insist that photos in such ads always be of people who have been compliantly on the advertised drugs for at least a year?

Inventing more epidemics; the Research Trough; and “peer review”

Kevin De Cock, director of HIV/AIDS at the World Health Organization, famously let slip the fact, demonstrated by a quarter century of assiduous but unsuccessful searching for epidemics, that there had not been and would not be any epidemic of heterosexually spread “HIV” outside Africa [WHO SAYS that WE’VE BEEN VERY WRONG about HIV and AIDS? (Clue: WHO = World Health Organization), 10 June 2008;  More De COCK AND BULL stuff and nonsense, 15 June 2008].

Not even so authoritative a statement can compensate, though, for decades of propaganda and loose, ignorant talk about “everyone is at risk”. Nor can anything curb the appetite for grants among HIV/AIDS researchers. Thus

“Jeffrey Samet, professor of medicine and public health at Boston University Medical Center, is lead investigator on . . . [a] study on HIV and hospitalized Russian drinkers. Samet’s $3 million, five-year grant from the National Institute on Alcohol Abuse and Alcoholism, which is already in its third year, is designed to show that a program of HIV intervention aimed at alcohol and drug users getting in-patient substance abuse treatment settings bolsters safe sex practices. Russia is in the midst of a significant HIV epidemic” (Doug Lederman, “One-Man Peer Review”, 28 July 2009).

Given that the specifically legislated concern of the National Institutes of Health is the health of American citizens, Congressman Darrell Issa, a California Republican, was moved to question whether this study could conceivably further the Institute’s mission. Possibly channeling the late Senator Proxmire, who was wont to assign “Golden Fleece” awards for such taxpayer-funded make-work-for-researchers projects, Issa’s staff also pointed to grants for “Substance Use and HIV Risk among Thai Women” and “Venue-based HIV and alcohol use risk reduction among female sex workers in China”.

Connoisseurs of the academic Research Trough will relish such not-so-disinterested ensuing comments as

“’NIH’s peer review system is the envy of the world because it ensures only the highest quality science is supported through federal funding,’ said Mark O. Lively, president of the Federation of American Societies for Experimental Biology. ‘Any short-term compromise of the peer-review process, through Congressional micro-management of the grant-making process, is a grave threat to biomedical research, the quality of U.S. science, and the health of our fellow citizens.’”

Worth a chuckle as well is Professor Samet’s explanation of the study’s potential benefits to American taxpayers:
“the techniques used to study Russian alcoholics are aimed less at protecting the drinkers themselves than their ‘unknowing partners,’ . . . ; the HIV epidemic is one of many factors that could further destabilize Russia, which could have significant political and economic implications for the U.S.; HIV can lead to the spread of tuberculosis, which is not contained within borders, etc.”

“Samet joked that the House ‘thoughtfully considered the issue’ for ‘about three seconds’”.

I didn’t time myself, but I might even have beaten that 3-second record in my thoughtful consideration of the thoughtful reasons offered thoughtfully by Samet in explaining the potential value of his study to America and its citizens.

Add to that the absurdity of the “study” itself. The question is, if you subject hospitalized alcoholics to safe-sex indoctrination, using the fear of HIV/AIDS as emphasis, will they practice safer sex later?  Or will they at least say in subsequent surveys that they did so? After all, there’s no other way to check on their sexual behavior than questioning them. This would be a waste of money even were it carried out with solely American alcoholics.

If only it didn’t cast so revealing a light on what our “medical science” has come to, all the foregoing would be funny enough in itself without the added titillation that there is no HIV epidemic in Russia, never has been, and never will be, according not only to Kevin De Cock but also to the data published by European authorities. For example, the incidence of newly identified “HIV infections” in Russia was running at <300 per million in 2006, that is 3 per 10,000, which can be accounted for quite adequately by the “false positives” induced by flu vaccinations and the like, together with the veritably growing epidemic of testing:

(From “Prevalence of HIV and Other Infections and Risk Behaviour among Injecting Drug Users in Latvia, Lithuania And Estonia in 2007”, brought to my attention by a good friend in Estonia. More data from Estonia will be presented and discussed in future posts)

*********************************

But what do facts matter when propaganda is called for? As yet another not-so-disinterested group (USAID) would have us believe,

“Russia has the largest AIDS epidemic in Eastern Europe and Eurasia, accounting for approximately 66 percent of the region’s newly reported HIV cases in 2006. According to UNAIDS, the 2005 national HIV prevalence estimate was 1.1 percent, and an estimated 940,000 people in Russia were living with HIV (although the officially diagnosed caseload is considerably lower). Russia’s HIV prevalence was very low until 1996, when 1,515 new cases were suddenly reported. While its pace has slowed since the late 1990s, the country’s HIV epidemic continues to grow. According to UNAIDS, a decline in new cases occurred between 2001 and 2003, but new cases are now increasing again, with 39,000 new HIV diagnoses officially recorded in 2006, bringing the total number of HIV cases diagnosed and registered with health officials to 370,000, according to EuroHIV. Officially documented HIV cases only represent people who have been in direct contact with Russia’s HIV reporting system.
USAID’s initial HIV/AIDS activities in Russia focused on HIV prevention among high-risk groups during 1998– 2000. In fiscal year 2008, USG programs continued to support HIV/AIDS awareness, prevention, research, access to treatment, and technical guidance for Global Fund AIDS programs. These programs are creating models to provide assistance in measuring the evolving and growing HIV epidemic and increase local and national government capacity to respond to the epidemic in an organized and sustainable way.”

Note the usual offering of UNAIDS estimates that are much greater — in this case nearly 3-fold — than the actually available data; the determined emphasis on intermittent stochastic increases as a way of masking the lack of any overall upward, let alone any epidemic trend; the citing of “66%” of the region’s numbers of cases without mentioning that Russia also has by far the largest population in that region.

Books like How to Lie with Statistics (by Darrell Huff, W.W. Norton, 1954), Damned Lies and Statistics: Untangling Numbers from the Media (by Joel Best, University of California Press, 2001),and More Damned Lies and Statistics: How Numbers Confuse Public Issues Politicians, and Activists (by Joel Best, University of California Press, 2004) were clearly intended to forewarn consumers about the devious tactics of advertisers and PR gurus. It would seem that HIV/AIDS propagandists have chosen instead to use them as manuals for how best to deceive without appearing to be actually lying.

**********************

Despite my attempts at mood-lightening levity in pointing to these absurdities and corruptions and deceits, I am actually very sad about all this. More than half a century ago, my cohort of science students had the idealistic attitude that remains characteristic of so many young people, and moreover the history of science into the middle of the 20th century gave us good grounds for believing that we were entering a profession outstanding for its honesty and potential service to humankind.

After one of my closest friends from that period had read the MS of my HIV/AIDS book, he remarked that an unfortunate side-effect of debunking HIV/AIDS theory would be a loss of trust in science. It’s very sad indeed that such lack of trust has been so thoroughly earned through conflicts of interest personal and institutional, not to say sheer greed, cutting of corners, and general corruption. To what have we come when Marcia Angell, former editor of the New England Journal of Medicine, is moved to write that the pharmaceutical industry has co-opted “every institution that might stand in its way, including the U.S. Congress, the Food and Drug Administration, academic medical centers, and the medical profession itself” (Angell 2004: xviii); “[C]onflicts of interest and biases exist in virtually every field of medicine, particularly those that rely heavily on drugs or devices. 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” (Angell 2009; emphasis added).
[Marcia Angell, 2004, The Truth About the Drug Companies: How They Deceive Us and What To Do About It, Random House; 2009, “Drug companies & doctors: a story of corruption”, New York Review of Books, 56 #1, 15 January].

As for Mark O. Lively’s remark that “NIH’s peer review system is the envy of the world”, he should have said “the envy of researchers around the world”, because the peer reviewers are at the same time those who themselves benefit from the grant system. Those who are reviewers this time are the grant applicants the next time, and it’s a matter of mutual back-scratching. Nowadays “peer review” in science bears the same relationship to objective assessment as did the “financial analysis” by Wall Street reviewers that pronounced a bunch of worthless paper to be AAA-OK reliable investments.

Prophylaxis via organ failure and bankruptcy

A year ago, I wrote:

“Clinical trials on human beings are under way to gauge how well tenofovir and emtricitabine protect against HIV infection, with the hope that a regular diet of them could be recommended as prophylaxis. It’s already known, mind you, that these drugs can produce bone demineralization with chronic use, kidney damage, lactic acidosis (including fatalities), liver damage (including fatalities), and liver cancer. The danger of side effects is greatest when first starting the drugs but also when one stops taking them.” Read the rest of this post [“To avoid HIV later, damage your kidneys and liver now” , 19 January 2008]

Why would anyone contemplate such a highly risky procedure to avoid a condition which, IF contracted, can be managed satisfactorily? After all:
“Today any HIV/AIDS patient who sticks with a medication regimen will be successful in keeping AIDS under control, . . . said clinical pharmacist Neha Sheth, PharmD, assistant professor at the University of Maryland School of Pharmacy. Sheth was among a panel of experts who presented a two-day minimester titled ‘Women: The Changing Face of HIV/AIDS’ this month for students from the University of Maryland schools of social work, dentistry, law, nursing, medicine, and pharmacy.”

But even if this is too rosy a painted picture: IF a person does happen to become “HIV-positive”, there follows on average a decade of asymptomatic life without drugs that have dangerous “side”-effects; and IF illness ensues at any time, it would be treated, at worst with the same medications having the same highly dangerous “side”-effects as from the “prophylaxis” under test, at best with newer medications with lesser “side” effects that are continually being introduced. Prophylaxis under these circumstances seems like a losing proposition — but clinical trials continue:

“HIV Prevention Pill Nearing End of Trial
In June, people on three continents will know if the pills they’ve been taking to prevent HIV infection were the real thing or placebos. As the test of tenofovir, said to be an HIV prevention pill, nears the end of the trial period, questions of its effectiveness remain. Researchers worry that the pill’s success may tempt people in high-risk lifestyles to be even more risky, thinking of the pill as a safety net against infection.
The tenofovir pill, PreP (pre-exposure prophylaxis for HIV prevention), is being studied as a result of the drug’s ability to boost temporarily the immune system enough to fend off HIV infection by about 80% when administered within just a few days after exposure. Study participants are taking the pill, or a placebo, on a daily basis, however, to determine how effective a prevention it can be.
At this time, the most effective means of preventing exposure to the AIDS-causing virus is to use condoms when engaging in sexual activity and to avoid other risky behaviors. Doctors fear potential patients taking the prevention pill may forego the use of condoms, expecting the pill to eliminate all risks of infection. The patients for whom the pill proves ineffective may unknowingly spread the virus to others before the pill’s performance on the individual is determined, a situation that may spread the AIDS epidemic even further rather than keeping it in check.
Dr. Albert Liu says he’s heard of people using PreP and other antiretroviral drugs in lieu of condoms outside the study’s parameters and before the drug went into the trial phase. Liu is director of HIV prevention intervention studies at San Francisco’s Department of Public Health. He and his colleagues fear this misuse of the drug will counterbalance any benefits.
Doctors warn PreP is not a pill to pop before a night on the town and other precautions must be maintained as well for maximum benefit. As tested, it is a daily medication that comes with side effects that have been linked to kidney and liver damage.
Another area of concern is cost. As currently marketed, a daily supply could cost between $500 and $900 per month, with cost depending upon an individual patient’s access to insurance coverage and variables from one insurance carrier to another. AIDS activists are hopeful the cost would drop if the drug becomes widely prescribed.”

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In sum: IF the process being tested were to prove effective in preventing people from becoming “HIV-positive”, it would be likely to encourage riskier behavior and a greater chance of spreading “HIV”, as well as exposing those taking the pills to highly dangerous “side”-effects a decade or more earlier than would be the case if they were not “taking advantage” of prophylaxis; all at an annual cost of ≥$6000.

This is a “lose – win” situation:
Lose for “pre-patients”, for their sexual partners, and for taxpayers, since payment for HIV/AIDS treatment is guaranteed by the federal government (unlike for any other illness, disease, or personal tragedy — in those cases, it would be unacceptable socialized medicine).
Win, however, once again, for the drug companies and their lobbyists — and, of course, for the researchers and doctors who get the grants and the consultant fees. Read what a former editor of the New England Journal of Medicine has to say about “Drug Companies & Doctors: A Story of Corruption”, even apart from the HIV/AIDS business.

Science Studies 101: Why is HIV/AIDS “science” so unreliable?

Recent comments and e-mails reminded me of my career change, about 3 decades ago, from chemist to science-studies scholar. I had begun to wonder: What is it exactly that has made science so strikingly reliable?

(This is a long post. If you prefer to read it as a pdf—of course without hyperlinks to some of the on-line references—here it is: sciencestudies101).

Over the years, teaching chemistry and publishing research in electrochemistry, I had become increasingly aware that research practices and practitioners differ significantly from the ideal images that had attracted me (1). My education, like that of most scientists, had been strictly technical: chemistry, physics, math, biology, statistics. Recreational reading had added some history of chemistry, which also focused on the technical aspects—progress, discoveries, breakthroughs. We were not exposed to history, philosophy, or sociology of science in any meaningful way; nor are most people who study science even nowadays.

Mid-20th century, that lack of exposure to the context and significance of scientific activity was partly a matter of Zeitgeist, I recognize in hindsight. Philosophy of science was rather in flux. History of science as a whole was not so different in approach from the history of chemistry I had read—and perhaps not so different from how history in general was being taught: as milestones of achievement made by great individuals (largely, of course, men). Sociology of science had been founded only in the late 1930s. It was the 1960s before historians of science and philosophers of science began to engage seriously with one another, an engagement illustrated by Thomas Kuhn’s “The Structure of Scientific Revolutions”. Sociologists of science, too, began to engage with the historians and philosophers of science.

Following World War II, some scientists and engineers were looking for ways to make their knowledge an effective influence in public policy. Emblematic of this quest was the Bulletin of the Atomic Scientists. Starting about 1960, there were founded a variety of free-standing academic courses, a few research centers, and some organized academic programs under the rubric of “science and society”. These science-based ventures and the history-philosophy-based ones soon recognized each other as concerned with the same issues, yet even after a half-century, no truly integrated multi-disciplinary approach to understanding scientific activity has matured into an overall consensus (3). There persists a distinct internal division between those whose backgrounds are in the practice of science and technology and those whose backgrounds are in the humanities and social sciences (3, 4, 5). But despite differences over modes of interpretation and what is most worth looking into, there has accumulated a body of agreed facts about scientific activity. Most important for the present purpose is that many of those facts about science are at variance with commonplace conventional wisdom. Misconceptions about scientific activity are pervasive, not least among practicing scientists and medical practitioners.

I was lucky enough to participate in the early days of one of the first programs in the world in what has become known as “science and technology studies” (STS). At Virginia Tech, we began with physicists and chemists, economists and sociologists, mathematicians, statisticians, political scientists, and other as well, telling one another how we thought about science. We scientists learned to be less sure that our research reveals unchanging, objective, universal facts about the real world. The humanists and social scientists learned that the physical and biological sciences uncover facts about the real world that are more trustworthy than the knowledge accessible in such disciplines as sociology. We learned also how different are the viewpoints and intellectual values to which we are schooled in the various disciplines: in a sense, the differences are not so much intellectual as cultural ones (6,7, 8). I learned even more about such cultural differences between academic fields through having responsibility for the variety of disciplines embraced by a college of Arts & Sciences (10).

A salient fact is that “the scientific method” is more myth than reality (2, 11). What makes science relatively reliable is not any protocol or procedure that an individual scientist can follow, it is the interaction among practitioners as they critique one another’s claims, seek to build on them, and modify them, under constraints imposed by the concrete results of observations and experiments. Because individual biases predispose us to interpret the results of those observations and experiments in congenial ways, the chief safeguard of relative objectivity and reliability is honest, substantive peer-review by colleagues and competitors. That’s why I was grateful to “Fulano de Tal” when he pointed to errors in one of my posts: we rethinkers do not have the benefit of the organized peer-reviewing that is available—ideally speaking—in mainstream discourse [see Acknowledgment in More HIV/AIDS GIGO (garbage in and out): “HIV” and risk of death, 12 July 2008].

Because proper peer-review is so vital, conflicts of interest can be ruinously damaging (12, 13). Recommendations from the Food and Drug Administration or the Centers for Disease Control and Prevention are too often worthless—worse, they are sometimes positively dangerous (14)—because in latter days the advisory panels are being filled overwhelmingly with consultants for drug companies. That’s not generally enough appreciated, despite a large and authoritative literature on the subject (15-20).

Lacking familiarity with the findings of science studies, scientists are likely to be disastrous as administrators. It was a Nobel-Prize winner who relaxed the rules on conflicts of interest when he headed the National Institutes of Health, with quite predictably deplorable consequences (21). There have been many fine administrators of technical enterprises, but few had been themselves groundbreaking discoverers. To convince the scientific community of something that’s remarkable and novel, a scientist must be single-minded, captivated by the idea and willing to push it to the limit, against all demurrers—very bad qualities in an administrator; the latter ought to be a good listener, an adept engineer of compromises, an adroit manager able to stick to principles with an iron hand well masked by a velvet glove.

Those who have the egotism and dogmatic self-confidence to break new ground also need luck to be on their side, for—as Jack (I. J.) Good likes to point out—geniuses are cranks who happen to be right, and cranks are geniuses who happen to be wrong: in personal characteristics they are identical twins (22, 23). This role of luck has important implications: it’s why Nobel-Prize winners so rarely have comparable repeat successes, and why they should not be automatically regarded as the most insightful spokespeople on all and sundry matters.

HIV/AIDS vigilantes like to denigrate rethinkers for not having had their hands dirtied by direct research on the matters they discuss. Historians and sociologists of science, however, know that some of the most acclaimed breakthroughs were made by disciplinary outsiders, who were not blinkered and blinded by the contemporary paradigm (24, 25).

Self-styled “skeptics” (26) like to denigrate heterodox views as “pseudo-science” just because those views are heterodox, ignorant of the fact that there are no general criteria available by which to judge whether something is “scientific”; and they tend to be also ignorant of the fact that “scientific” cannot be translated as “true” (2, 27, 28).

Most relevant to the question of the “truth” of scientific knowledge is that science and scientists tend to occupy something of a pedestal of high prestige in contemporary society; perhaps because when we think of “science” we also tend to think “Einstein” and other such celebrated innovators. But nowadays there are a great many run-of-the-mill scientists, and even considerably incompetent ones: “Science, like the military, has its hordes of privates and non-coms, as well as its few heroes (from all ranks) and its few field marshals” (29)—which serves to explain, perhaps, some of the examples of sheer incompetence displayed in HIV/AIDS matters (30). Pertinent here is the fact that much medical research is carried out by people trained as doctors; training for physicians’ work is by no means training for research.

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Those are some of the ways in which the commonplace conventional wisdom is wrong about science, but there are plenty more (24, 25, 32, 33). Those misconceptions play an important role in the hold that HIV/AIDS theory continues to have on practitioners, commentators, and observers, and they need to be pointed out in answer to the natural question often put to rethinkers: “But how could everyone be so wrong for so long?”

That’s why Part II of my book (31) has the title, “Lessons from History”, with chapters on “Missteps in modern medical science”, “How science progresses”, and “Research cartels and knowledge monopolies”. (About research cartels and knowledge monopolies, see also 34, 35). I’m enormously grateful to Virginia Tobiassen, the fine editor who helped me with the book, not least for the opportunity to augment the technical Part I with this Part II and the Part III that recounts the specific details of how HIV/AIDS theory went so wrong.

I’ve come to understand a great deal more since the book came out, among other things that perhaps the crucial turn on the wrong path came when Peter Duesberg’s rigorously researched and documented argument against HIV/AIDS theory went without comment, even in face of an editorial footnote promising such a response (36). Just as virologists ignored Duesberg’s substantive critiques, so epidemiologists ignored the informed critiques by Gordon Stewart (37) and immunologists ignored the fully documented questions raised by Robert Root-Bernstein (38); and just about everyone in mainstream fields ignored John Lauritsen’s insights into data analysis and his insider’s knowledge of interactions among gay men (39).

Peer review in HIV/AIDS “science” lapsed fatally from the beginning and has not yet recovered. Thus the only real safeguard of reliability was lost, it sometimes seems irretrievably.

References:
1. “Are chemists not scientists?”—p. 19 ff. in reference 2.
2. Henry H. Bauer, Scientific Literacy and the Myth of the Scientific Method, University of Illinois Press, 1992.
3. —— , A consumer’s guide to science punditry, Chapter 2 in Science Today: Problem or Crisis?, ed. R. Levinson & J. Thomas, Routledge, 1997.
4. —— , Two kinds of knowledge: maps and stories, Journal of Scientific Exploration 9 (1995) 257-75.
5. —— , The anti-science phenomenon in science studies, Science Studies 9 (1996) 34-49; .
6 —— , Disciplines as cultures, Social Epistemology 4 (1990) 215-27.
7. —— , Barriers against interdisciplinarity: Implications for studies of Science, Technology, and Society (STS), Science, Technology, & Human Values 15 (1990) 105-19.
8. Chapters 11, 14, 15 (in particular) in reference 9.
9. Henry H. Bauer, Fatal Attractions: The Troubles with Science, Paraview, 2001.
10. Chapters 15, 16 in Henry H. Bauer (as ‘Josef Martin’), To Rise above Principle: The Memoirs of an Unreconstructed Dean, University of Illinois Press.
11. Chapters 4, 5 in reference 9.
12. Chapter 5 in reference 2.
13. Andrew Stark, Conflict of Interest in American Public Life, Harvard University Press, 2000.
14. Joel Kauffman, Malignant Medical Myths: Why Medical Treatment Causes 200,000 Deaths in the USA each Year, and How to Protect Yourself, Infinity Publishing, 2006.
15. John Abramson, Overdosed America: The Broken Promise of American Medicine, HarperCollins, 2004.
16. Marcia Angell, The Truth about the Drug Companies: How They Deceive Us and What To Do about It, Random House, 2004.
17. Jerry Avorn, Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, Knopf, 2004.
18. Merrill Goozner, The $800 Million Pill: The Truth behind the Cost of New Drugs, University of California Press, 2004.
19. Jerome Kassirer, On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health, Oxford University Press, 2004.
20. Sheldon Krimsky, Science in the Private Interest, Rowman and Littlefield, 2003.
21. David Willman, Los Angeles Times, 7 December 2003: “Stealth merger: Drug companies and government medical research”, p. A1; “Richard C. Eastman: A federal researcher who defended a client’s lethal drug”, p. A32; “John I. Gallin: A clinic chief’s desire to ‘learn about industry’”, p. A33; “Ronald N. Germain: A federal lab leader who made $1.4 million on the side”, p. A34; “Jeffrey M. Trent: A government accolade from a paid consultant”, p. A35; “Jeffrey Schlom: A cancer expert who aided studies using a drug wanted by a client”, p. A35.
22. Henry H. Bauer, “The fault lies in their stars, and not in them — when distinguished scientists lapse into pseudo-science”, Center for the Study of Science in Society, Virginia Tech, 8 February 1996; “The myth of the scientific method”, 3rd Annual Josephine L. Hopkins Foundation Workshop for Science Journalists, Cornell University, 26 June 1996.
23. Chapters 9, 10 in reference 9.
24. Ernest B. Hook (ed.), Prematurity in Scientific Discovery: On Resistance and Neglect, University of California Press, 2002.
25. Henry H. Bauer, The progress of science and implications for science studies and for science policy, Perspectives on Science 11 (#2, 2003) 236-78.
26. The mother of all “skeptical” groups is CSICOP, publisher of Skeptical Inquirer; see George P. Hansen, “CSICOP and the Skeptics: an overview”, Journal of the American Society for Psychical Research, 86 (#1, 1992) 19-63.
27. Chapters 1-3, 6, 7 in reference 9.
28. Henry H. Bauer, Science or Pseudoscience: Magnetic Healing, Psychic Phenomena, and Other Heterodoxies, University of Illinois Press, 2001.
29. “Science as an institution”, pp. 303-6 in Henry H. Bauer, Beyond Velikovsky: The History of a Public Controversy, University of Illinois Press, 1984.
30. Pp. 110, 192, 195 in reference 31.
31. Henry H. Bauer, The Origin, Persistence and Failings of HIV/AIDS Theory, McFarland, 2007.
32. Chapters 1, 4, 6, 7 in reference 2.
33. Chapter 12 in reference 9.
34. Chapter 13 in reference 9.
35. Henry H. Bauer, Science in the 21st century: knowledge monopolies and research cartels, Journal of Scientific Exploration 18 (2004) 643-60.
36. Peter H. Duesberg, Retroviruses as carcinogens and pathogens: expectations and reality, Cancer Research 47 (1987) 1199–220; Human immunodeficiency virus and acquired immunodeficiency syndrome: correlation but not causation, Proceedings of the National Academy of Sciences, 86 (1989) 755–64.
37. Gordon T. Stewart, A paradigm under pressure: HIV-AIDS model owes popularity to wide-spread censorship. Index on Censorship (UK) 3 (1999).
38. Robert Root-Bernstein, Rethinking AIDS—The Tragic Cost of Premature Consensus, Free Press, 1993.
39. John Lauritsen, The AIDS War: Propaganda, Profiteering and Genocide from the Medical-Industrial Complex, 1993, ASKLEPIOS. ISBN 0–943742–08–0.