HIV/AIDS Skepticism

Pointing to evidence that HIV is not the necessary and sufficient cause of AIDS

Posts Tagged ‘misleading statistics’

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

Posted by Henry Bauer on 2009/08/02

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:

HIVestoniaRussiaEtc(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)

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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.

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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.

Posted in experts, Funds for HIV/AIDS, HIV risk groups, HIV skepticism, HIV transmission, HIV/AIDS numbers, sexual transmission, uncritical media | Tagged: , , , , , , , , , , , , , , , | 8 Comments »

Statistics….

Posted by Henry Bauer on 2009/06/26

Here’s an illustration of how to lie with statistics. Have the media disseminate estimates as though they were facts:

Few sexually active teens in US get HIV test — CDC
Thu Jun 25, 2009 3:08pm EDT
CHICAGO, June 25 (Reuters) – Nearly half the HIV-positive U.S. adolescents and young adults are unaware of their infection, and less than a quarter of sexually active high school students are tested for the virus, U.S. health officials said on Thursday.”
— Unnamed “officials”, easily confused with “experts”
— “Nearly” half giving a spurious sense of exact knowledge
— Giving a number for something that cannot be measured

“Only 22 percent of sexually active high school students are tested for human immunodeficiency virus, the U.S. Centers for Disease Control and Prevention said in an analysis using data from a 2007 survey of students in grades 9-12 (ages 14-18).”
— “Sexually active” is self-reported, of course
— So is being tested, since that’s confidential

“people aged 12 to 24 represented 4.4 percent of the estimated 1.1 million people in the United States infected with HIV, the virus that causes AIDS. Yet they represented 10 percent of the estimated 232,700 people living with the virus without knowing it.”
— It cannot be known how many are “infected” without knowing it.
— CDC models for the “epidemic” have been shown to be invalid in a number of respects, see The Origin, Persistence and Failings of HIV/AIDS Theory.
— Note the misleading precision of “232,700”; so much more impressive than being honest and saying “about 230,000”. Even were the models valid, they couldn’t be more precise than that.

“HIV testing was more common among students who had ever been taught in school about AIDS or HIV infection than among those who had not”
— Hurrah for successful propaganda.

Posted in experts, HIV in children, HIV risk groups, HIV skepticism, HIV tests, HIV/AIDS numbers, sexual transmission, uncritical media | Tagged: , | 3 Comments »

ABUSED WOMEN and “HIV”

Posted by Henry Bauer on 2008/08/22

“HIV” is the worst evil in the world, according to HIV/AIDS believers:
— They want to give drug addicts fresh needles, because cocaine and heroin are so much better, so much more healthy than “HIV”; see COCAINE AND HEROIN AREN’T GOOD FOR YOU! [a Golden Fleece Award, 13 June 2008];
— They will treat Africans for worm infestation only if that makes antiretroviral treatment more efficient; see PARASITIC WORMS are *NOT* GOOD for you!, 24 July 2008; ARE INTESTINAL WORMS GOOD FOR US? ARE THEY GOOD FOR AFRICANS? FOR AFRICAN CHILDREN?, 30 December 2007;
— They will provide food to malnourished Africans only if that helps with antiretroviral treatment ; see DRUGS OR FOOD?, 25 December 2007; FOOD IS GOOD FOR CHILDREN, 8 January 2008;
— “HIV” does ALL SORTS of dreadful things, like instigating bone fractures; see TALKING OF HIV’S MAGICAL POWERS…, 29 DECEMBER 2007.

And so on. No doubt about it, “HIV” — or, of course, “HIV/AIDS” — is the worst evil in the world.

Therefore it makes sense to study — and to acquire research grants to study — whether abused women are at greater risk of “HIV” than non-abused women are. If one finds that they are at greater risk, that would provide a compelling reason to regard the abusing and battering of women as a bad thing and perhaps even to look for ways of helping abused women and of trying to prevent such abuse.

A corollary that seems to me obvious, though apparently not to HIV/AIDS believers, is that if abused women are NOT at greater risk of “HIV”, then there’s no need to give further thought to the plight of abused women?

My e-mail friend Andy D. found this as absurd as I did, and drew my attention to the several news items in which the HIV status of abused women is treated as a matter of the highest newsworthiness:

AIDS infection risk higher in abused Indian women, study says” (John Lauerman, Aug. 12, Bloomberg)
“Indian women who are physically and sexually abused by their husbands are four times more likely to have HIV than other wives . . . . AIDS prevention should focus more on mistreatment of women . . . .
India’s AIDS epidemic is the third largest of any country in the world, and infections among women are rising . . . . Health officials should target wives who are forced to have unsafe sex, along with their husbands, for preventive measures, said study author Jay Silverman, an associate professor of society, human development and health at the Harvard School of Public Health in Boston.
’Sexual abuse of adolescent girls and women is driving the HIV epidemic in India and around the world . . . . We need to make it a major priority for prevention.’
The findings echo a 2004 study of women in South Africa, . . . [where] abused women were 50 percent more likely to be HIV-infected than non-abused women, regardless of their own behavior.
’In many settings, women’s risk of HIV is largely driven by the behavior of their male partners,’ said Kristin Dunkle, an assistant professor of behavioral sciences and health education at the Emory Center for AIDS Research in Atlanta . . . .
About 0.73 percent of women who had been physically and sexually abused were infected, compared with 0.19 percent among non-abused women . . . . Almost all the women, 95 percent, reported that they had no extramarital sexual relations themselves . . . . That points to known patterns in the behavior of abusive husbands that puts their wives and children at higher risk of HIV infection . . . . Sexually abusive husbands may force their wives to have intercourse without condoms, or unprotected anal sex, both of which can significantly increase HIV infection risk . . . . The men may also be having risky sex with women outside the marriage, increasing their own chance of infection . . . . ‘We have to get to the men,’ Silverman said. ‘And we have to provide women with reasonable alternatives if they’re being abused, so they can maintain their children and not become destitute.’
. . . . ‘To be truly successful in addressing the spread of HIV in India, we must think of ways to address the all-too-widespread mistreatment of wives,’ said Donta Balaiah of the Indian Council of Medical Research, who helped write the study. The study was supported by the U.S. National Institute of Child Health and Human Development in Bethesda, Maryland, and the Indian Council of Medical Research in New Delhi, which funds and promotes research in the country.”

Another version was in CBC News: “Prevent abuse of women to stem rise of HIV: researchers” (August 12) :
“ . . . . despite a lower prevalence of infection among India’s general population, women account for a rising percentage of HIV cases. . . . ‘married Indian women who experienced both physical and sexual intimate partner violence demonstrated an HIV infection prevalence approximately four times greater than that of non-abused women,’ . . . . The risky sexual behaviour of husbands was the major source of women’s infection . . . . They suggested that doctors and public health officials focus on preventing intimate partner violence to help reduce the spread of HIV/AIDS.”

The scientific publication on which these stories are based is Silverman et al, JAMA 300 [2008] 703-710.

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As I said at the outset: The prime reason for trying to do something about abuse of women is apparently to prevent the spread of HIV.

That’s a heartless HIV/AIDS cart-before-horse stupidities. To my mind, any abuse of human beings is a thoroughly despicable and detestable thing, and we should do everything we can think of to prevent it. Naturally enough, the more it can be prevented, the more beneficial COROLLARIES there will be — for the women’s emotional and mental as well as physical health, and that of their family members; and much more. How on earth does “HIV/AIDS” come to take priority over everything else? Perhaps because any mention of it brings the money flooding in?

Note also the HIV/AIDS-typical abuse of statistics and data in this:

“India’s AIDS epidemic is the third largest of any country in the world”
only because India has so large a population. The HIV-positive rate in India is among the lowest in the world. Moreover, the HIV/AIDS guru at the World Health Organization admitted that there had not been and would not be a heterosexually spread epidemic there, see WHO SAYS that WE’VE BEEN VERY WRONG about HIV and AIDS? (Clue: WHO = World Health Organization), 10 June 2008. A year ago, it was conceded that there were about 2.5 million “HIV/AIDS” people in India rather than the 5.7 million estimated earlier (for example, REDIFF: India Abroad — “India’s HIV/AIDS affected reduced to half in revised figures” July 06, 2007; acknowledged in the Silverman et al. article). The earlier number had corresponded to a rate of 0.9%, so the newly estimated rate is 0.4% — as I said, among the very lowest in the world.

However:
“and infections among women are rising”

This illustrates a common way in which statistics are abused for the purpose of misleading. If something starts at zero and then “increases” to barely noticeable, that’s an enormous increase if you express it in percentages!

This device is used pervasively in marketing medicines. “Take XXXXX”, we are assured, and “cut in half” our risk of YYYYY; where YYYYY might be heart attack, stroke, just about anything undesirable. If you are inclined to take this sort of thing at face value, then you should read Malignant Medical Myths by Joel Kauffman (read this for an excellent summary). If the risk of YYYYY is, say, 1%, does it make sense to try to reduce this to 0.5% when the “side” effects of prolonged dosing with XXXXX brings its own tangible risks? The only clinical trials worth attending to are those for which the important data are rarely published: namely, changes (if any) in ALL-CAUSE MORTALITY. If XXXX is good for you, then it should lower ALL-CAUSE mortality, not just the risk of YYYYY.

Silverman et al. further illustrate misleading via numbers with “Despite recent reductions in HIV prevalence among both the general population and many high-risk groups, the percentage of all infections occurring among Indian women (currently estimated at 39%) has continued to rise relative to that among men” [emphasis added].
How impressive that “39%” appears! An enormous “increase”!
But in India the overall rate for women is 0.22% and for men 0.36%, both extraordinarily low by any standards. Yet these trivially low rates allegedly cause India to be “recognized as the source of increasing HIV prevalence among its South Asian neighbors”!
I suppose a prevalence of even 0.4% poses a threat to neighbors like China, Laos, and Pakistan where the prevalence is estimated at 0.1%; let alone to those where it’s estimated at LESS than 0.1% (Afghanistan, Bhutan, Bangladesh, Sri Lanka); but surely the threat is the other way around from Myanmar (1.3%) or even Nepal (0.5%). This is worse than ludicrous.

Silverman et al. reported that “7.68%” (2161) of 28,139 women had been both physically and sexually abused; and “0.73%” (205) tested HIV-positive. A statistical test marked the difference between that 0.73% and the 0.19% among non-abused women as “statistically significant”. Maybe, although we lay people wonder why fewer than 1 in 10 of those “at risk” abused women were actually HIV-positive; but bear in mind that “statistically significant” is not the same as PROVEN. More important, what’s statistically significant is NOT that physical and sexual abuse are CAUSATIVE of testing HIV-positive, only that the two things are CORRELATED; and

CORRELATION NEVER PROVES CAUSATION

Note, too, the usual abundance of assertions about matters that are not known:
“women’s risk of HIV is largely driven by the behavior of their male partners”
— Were all the male partners investigated to arrive at that “largely”?
— And who established “known patterns in the behavior of abusive husbands”?

Where I would thoroughly agree — at least for the purpose of the published study — is that “’We have to get to the men,’ Silverman said”.

I wish the authors had done that, and had tested all the husbands of those abused women of whom 95% had not had extramarital relations, because an essential — but missing — part of the study is to discover, how many of those husbands are themselves HIV-positive. If they aren’t, then they didn’t infect their wives, after all.

My prediction is that very few of those husbands are HIV-positive, certainly many fewer than 95% of them.

Think about it. 0.73% of Indian women are physically and sexually abused and HIV-positive. Each has a husband, so those husbands represent about 0.73% of Indian men (only “about” because the ratio of males to females is not 1 and varies with age). In the overall population of India, however, only 0.36% of men are HIV-positive. Therefore physically and sexually abusive husbands must be twice as likely as other men to be HIV-positive AND ALL OF THOSE MUST HAVE INFECTED THEIR WIVES — a truly remarkable set of circumstances, especially given that the claimed average rate of sexual transmission of “HIV-positive” without use of condoms is about 1 per 1000. It gets only more remarkable when one takes into account that about ¾ of all “HIV transmission” in India is NOT owing to marital sex, if India is at all comparable to Asia as a whole, see HIV/AIDS ILLUSTRATES COGNITIVE DISSONANCE, 29 April 2008. Then the husbands of those poor HIV-positive abused women must themselves be not twice as likely but 8 times as likely as other Indian heterosexual men to be HIV-positive?

The fact of the matter is that testing HIV-positive does not mark infection by a sexually transmitted agent, it is a sign of physiological stress. That physically and sexually abused women are 4 times as likely as untroubled women to be seriously stressed should be no surprise to anyone, not even to researchers who conjure up imaginative grant proposals.

Posted in clinical trials, experts, Funds for HIV/AIDS, HIV absurdities, HIV as stress, HIV risk groups, HIV skepticism, HIV tests, HIV transmission, sexual transmission, uncritical media | Tagged: , , , , , , , , , , , | 1 Comment »

HIV/AIDS SCAM: Have antiretroviral drugs saved 3 million life-years?

Posted by Henry Bauer on 2008/07/06

In the previous post [Antiretroviral therapy has SAVED 3 MILLION life-years, 1 July 2008], I showed that the impression conveyed by “millions” is misleading. The claim actually amounts to an estimate that HAART has saved, at an annual cost of about $20 billion, only about 13% of AIDS victims, in other words about 1 in 8, which is hardly what’s implied by the commonly used description of HAART as “lifesaving”.

I referred also in that earlier post to “dishonesty” in the Walensky et al. article. That charge reflects the fact that only a by-the-way sentence on the fourth page of the article modifies drastically the claim, made in the Abstract, of “at least 3.0 million” life-years saved: “Of these, 1,184,851 years have already been realized, and 1,629,041 years are being accrued by current patients”. The claimed 3 million turns out to be less than 1.2 million! Yet that is once again fudged or masked by the last sentence of the article: “Ten years after the introduction of potent combination ART, at least 3 million years of life have been saved in the United States” [emphasis added]. Counting projected future savings as already in hand might not survive an independent audit.

Repeating the calculations in the earlier post with the lower figure of 1.2 million of actually realized savings, we find that there were saved by 2003 not 13% of patients but only 6%, at expenditure of more than $180,000 per saved life-year, or $12.5 million per life; and our productivity in GDP terms then represents a measly return of 0.36% on this human capital. Such are the numbers that Fauci apparently believes to justify current expenditure on HIV/AIDS. One can be sure, moreover, that the computer model was designed and the calculations made with a view to presenting as rosy a picture as possible. If this is the best they can come up with, then it’s time to stop talking about HIV/AIDS as a manageable, chronic but not fatal disease.

Not only is the claimed benefit of treatment much less than impressive, the claim actually lacks any solid foundation whatsoever. It relies on a computer model that makes a number of unjustifiable assumptions, and it ignores such central issues as the acknowledged toxicity of the antiretroviral treatment as well as how the definition of AIDS has changed, and thereby the health-state of people being treated.

Here is the essence of the Walensky article: “The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) model was used to estimate per-person survival benefits. CEPAC is a widely published computer-based state-transition simulation model of HIV disease that incorporates CD4 cell count; HIV RNA level; ART efficacy; OI incidence, treatment, and prophylaxis; and other important clinical information [16–18, 21]. “State transition” means that the model characterizes the progression of disease in an individual patient as a sequence of transitions from one ‘health state’ to another. . . . In the model, the level of HIV RNA determines the rate of CD4 cell count decline, and the absolute CD4 cell count governs the monthly risk of OIs and death”.
One hardly needs to read any further, given that Rodriguez et al. (JAMA 296 [2006], 1498-1506) found a lack of correlation between “HIV RNA level”—otherwise known as viral load—and the rate of CD4 decline. This fact alone would be enough to vitiate the model; but there are also no valid studies of ART efficacy using untreated controls. As to prophylaxis of opportunistic infections, more is said below.

Walensky et al. considered “6 distinct eras of HIV/AIDS treatment from 1989 to 2003”. But about 50,000 AIDS deaths had already been reported up to 1989 (CDC 1990), about 35,000 of those during the AZT monotherapy years of 1987 and 1988. Some (or most or perhaps even all) of those deaths were caused or hastened by the AZT, and those lost life-years should surely be subtracted from the savings calculated from 1989 on, since HAART typically incorporates AZT or an analog of it, albeit at much lower doses than in the monotherapy era. Instead, Walensky et al. apparently seek to hide AZT toxicity by saying that “we excluded the early benefits of antiretroviral mono- and dual-drug therapy when survival benefits were more limited”, a fine illustration of double-speak: “more limited benefits” here stands for “no benefit, just caused harm”.

The first era commences with “prophylaxis for Pneumocystis jiroveci pneumonia (PCP) starting in 1989”, ignoring that Michael Callen and Josef Sonnabend had pioneered prophylaxis against PCP in AIDS victims years earlier. Callen cites data from the Centers for Disease Control and Prevention that more than 30,000 people had died of PCP by February 1989 even though the possibility of prophylaxis had been known since 1977. Callen himself had urged Fauci in May 1987 to recommend prophylaxis, but Fauci refused; nearly 17,000 PCP deaths occurred between May 1987 and February 1989 (pp. 30-31 in Michael Callen, Surviving AIDS, HarperCollins 1990). That is in direct contradiction to the claim that “88% of eligible patients in the pre-ART era were receiving OI [opportunistic infection, includes PCP] prophylaxis” (Walensky et al., p.12). How many of those 30,000 or 17,000 PCP deaths should be subtracted from Walensky’s 3 million — or actually 1.2 million — saved years of life? 30,000 lives lost to PCP, after all, already represent more than 2 million life-years, and even 17,000 lives amount to over a million-and-a-quarter life-years, either of which would wipe out entirely all the life-years claimed to have been saved between 1989 and 2003.

Walensky et al. cite an estimate that only 57% of known “HIV-positive” people are receiving treatment, and they assert that additional life-year-savings would result if more were being treated. But how many of the non-treated are avoiding antiretroviral drugs by choice? Certainly among gay men, knowledge of the fearsome “side”-effects of antiretroviral drugs has been widespread for two decades. Moreover, any reader of the official Treatment Guidelines learns that “In the era of combination antiretroviral therapy, several large observational studies have indicated that the risk of several non-AIDS-defining conditions, including cardiovascular diseases, liver-related events, renal disease, and certain non-AIDS malignancies . . . is greater than the risk for AIDS”. How then could Walensky et al. legitimately ignore these toxicities, as they do: “The analysis did not account for later ART-related toxicities that may result in, for example, cardiac disease or diabetes”. They wave aside the iatrogenic harm from ART even further by opining that “hyperlipidemia reduces overall life expectancy by ~1 month”. When your doctor tells you that your cholesterol is too high and that you should begin a lifelong course of expensive statin drugs — whose deleterious “side” effects also call for regular doses of Coenzyme Q10, which few doctors will tell you, however —, try responding that you have it on good authority that the potential benefit of conquering hyperlipidemia is only about 1 month of extra life. Let me know what your doctor says to that.

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Noted by Walensky et al. is that “after 1992, ~70% of new AIDS diagnoses were made according to a CD4 cell count criterion of <200 cells/mm3 alone”. This criterion for an AIDS diagnosis is unique to the United States, and patients thus diagnosed may display no symptoms of illness. Thus up to 70% of “AIDS” patients receiving antiretroviral drugs in the United States since 1993 have been clinically healthy when they begin “treatment”. It would then be hardly surprising that survival rates increased from the years before 1993 when this CD4-count criterion was introduced, for initially healthy people will surely survive toxic drugs longer than people who are already ill: “projected per-person survival after an AIDS diagnosis increased from 19 months (1.6 years) in the absence of treatment to 179 months (14.9 years) by 2003, a gain of 160 months (13.3 years)” [emphasis added]. The all-knowing computer model can apparently be sure already in 2003 that patients will survive on average into 2018. But even this projection hardly justifies the assertion that AIDS is now “a highly treatable chronic condition”, given that even by 2004 — 8 years into the “lifesaving” HAART era — most deaths from “HIV disease” were still occurring among people around 40 years of age, just as two decades earlier [Table 42, p. 236, in “National Center for Health Statistics: Health, United States, 2007 with Chartbook on Trends in the Health of Americans”, Hyattsville, MD, 2007; see “HIV DISEASE” IS NOT AN ILLNESS, 19 March 2008].

Puzzling is the statement that “Mean per-child survival gains for the averted infections ranged from 60.5 years if the child was born before 1996 (before combination ART) to 45.8 years during 1996-1999, when combination ART was available”. If ART is better, why is the survival gain from it only ¾ of the earlier survival gain from pre-ART prophylaxis of opportunistic infections?

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It also remains for me a continuing mystery that so many AIDS researchers, reviewers of HIV/AIDS manuscripts, and editors of journals that publish this material are so lacking in elementary numeracy as to pepper their articles with numbers like “832,179 years in ART 3”, “2,813,892” years saved, and so on. Numbers no less than words should convey meaning. The only thing conveyed clearly by “2,813,892” is that the writers take computer outputs as sacrosanct and don’t think about what the numbers mean. Those extra digits are not only meaningless, they positively distract the reader, making necessary a mental rounding-off to recognize that the substantive claim is “about 2.8 million”; not many people, after all, are used to digesting 7-digit numbers and savoring their significance. In the Walensky et al. article, the mystery of this abusive mathematical incompetence is only deepened by the fact that the authors’ affiliations include departments of epidemiology and biostatistics.

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Walensky et al. “employed a model-based approach, conducting repeated analyses to explore the clinical consequences of alternative patient-care-innovation pathways”. The whole article deals not with actual patients but with “hypothetical patients”. This fulfills the suggestion, reported in a previous post, that one no longer needs human beings for clinical studies, computers can conveniently substitute [VIRTUAL HIV/AIDS RESEARCH AND TREATMENT, 17 June 2008]. The most convenient thing about this, of course, is that it’s much easier to get the results you want from a computer model you have yourself designed than from observations of real people.

Here’s the point to bear in mind whenever the gurus parade the outputs of their computer models:
A computer model can be guaranteed to mimic reality faithfully only if everything about that reality is already known in every detail. But if that is so, then one doesn’t need a computer model. Computer models are experiments carried out on surrogates of reality, surrogates that are unavoidably simplified and based on assumptions about reality. In the Walensky et al. case, the model incorporates assumptions about what happens to a person with a given viral load and CD4 count under no treatment, and what happens to individuals with given viral loads and CD4 counts under a variety of treatment regimens: all of which are based on guesses, because clinical trials with proper controls have never been carried out to determine properly the parameters needed for such a model. Moreover, as earlier mentioned, the article by Rodriguez et al. found no correlation between “viral load” and subsequent decline in CD4 counts. Further, the article ignores the well established phenomenon of “long-term non-progressors” or “elite controllers”, individuals who demonstrate that being “HIV-positive” does not necessarily lead to destruction of the immune system, illness, and death. How could the fates of non-treated “patients” be modeled when this phenomenon is ignored? When it is not even known what proportion of people are potentially elite controllers?

The outputs of this model deserve no credence whatsoever. The claim of more than 3 million saved life-years is utterly bogus. Even were it not bogus, it would reveal the claimed benefits of antiretroviral therapy to be at best marginal and procured at egregiously excessive cost.

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