The discovery of antiretroviral therapy (ART) transformed HIV infection from a death sentence into a manageable chronic disease.¹ Yet a small group of “AIDS denialists” rejects the science underlying ART, believing it rests on rotten foundations and that the therapy is toxic. These ideas have had deadly consequences. Most infamously, South African president Mbeki set up a panel of AIDS denialists and HIV scientists to debate the issue while delaying the use of ART in the public sector. Over 330,000 South Africans died unnecessarily as a result.²

In an earlier article³ for the Skeptical Inquirer I described the different varieties of AIDS denialism, highlighting the views of Berkeley virologist Peter Duesberg, who believes—despite never having done any clinical research on HIV—that it is a harmless “passenger virus” and that AIDS is caused by recreational drugs, malnutrition, and even antiretroviral therapy itself. He and the other AIDS denialists on Mbeki’s panel recommended that HIV testing be halted and that immune deficiency be treated through “massage therapy, music therapy, yoga, spiritual care, homeopathy, Indian Ayurvedic medicine, light therapy and many other methods.”⁴

This article draws on my recent work revisiting the problem of AIDS denialism, this time focusing on its organized character.⁵ I argue that the symbiotic connection between AIDS denialism and alternative healing modalities is facilitated by a shared conspiratorial stance toward HIV science, which has had powerful community-building effects. AIDS denialism gains social traction through four symbolically and organizationally important roles: the “hero scientists” (notably Duesberg) who provide a patina of scientific legitimacy for the movement; the “cultropreneurs” who offer fake cures in the place of ART; the HIV-positive “living icons” who seem to provide proof of concept by appearing to live healthily without ART; and the “praise singers,” sympathetic journalists and filmmakers who publicize the movement.

Figure 1 shows the organizational connections between the key AIDS denialists. Duesberg is particularly in­fluential. He sits on the boards of Rethinking AIDS (an organization that promotes his views about HIV) and Alive and Well (founded by HIV-positive “living icon” Christine Mag­giore to promote alternative therapies). He also served on Mbeki’s Panel and received extensive coverage in House of Numbers, a recent “documentary” funded in part by Rethinking AIDS.

Figure 1. AIDS denialist networks. Names marked by an asterisk (*) are also linked to Mattias Rath (The Rath Health Foundation); name marked with a pound sign (#) was invited onto Mbecki's panel but did not attend; names in italics are journalists/filmmakers.

Duesberg does more than merely question or rethink HIV science: he actively publicizes his unfounded claims. Mark Wainberg, a microbiologist and past president of the Inter­national AIDS Society, called him “probably the closest thing we have in this world to a scientific psychopath.”⁶ Duesberg’s supporters, however, interpret such criticism as evidence of his unfair oppression by a corrupt “AIDS establishment.” Accord­ing to Celia Far­ber, Duesberg’s leading praise-singer, “As AIDS grew in the 1980s into a global, multibillion-dollar juggernaut of diagnostics, drugs, and activist organizations, whose sole target in the fight against AIDS was HIV, condemning Duesberg became part of the moral crusade.”⁷

David Rasnick, who writes with Duesberg, is also a hero scientist of sorts. He assisted the Rath Health Foundation with its illegal South African trial (which resulted in several unnecessary deaths) in which AIDS patients were taken off antiretroviral therapy and put onto high-dose vitamin products in­stead. The Alive and Well website claims he is the creator of protease inhibitors, but his name does not ap­pear on any of the relevant patents. More important is Kary Mullis, an eccentric chemist who won the Nobel Prize for inventing the polymerase chain reaction. Mullis, who openly discusses his experimentation with hallucinatory drugs and alleged encounters with extraterrestrials, has never worked on HIV; however, precisely because he won a Nobel Prize, he is a symbolically important hero scientist.

Robert Leppo, a venture capitalist who sits on the board of Rethinking AIDS, funds Duesberg’s laboratory as well as Rethinking AIDS. Farber describes Leppo as the “reluctant hero of the underground” who “saved Dues­berg from utter dissolution” after his federal funding was supposedly cut off “as punishment for advancing a scientific hypothesis that differed from that of the establishment.”⁸ Leppo was also the executive producer of an AIDS denialist film, The Other Side of AIDS, the promotional material of which describes him as “deeply involved in researching new medical protocols and alternative therapies, many of which are AIDS related.”

The link between AIDS denialism and alternative medicine is embodied by what I term “cultropreneurs.” Cul­tro­preneurs use AIDS denialism and related conspiracy theories to undermine the credibility of antiretroviral therapy—a convenient marketing device for their alternative therapies. For example, the Rath Health Founda­tion describes antiretroviral therapy as a form of genocide inflicted on society by the “pharmaceutical drug cartel.”⁹ Gary Null, who sells a variety of books and alternative healing products, makes similar conspiratorial suggestions and often features AIDS denialists on his radio show.

A common notion promoted by cultropreneurs is that AIDS symptoms are caused by stress and harmful mental states. For example, Michael Ellner, the president of HEAL (Health Education AIDS Liaison), runs a “medical hypnosis” service and claims¹⁰ that it is the shock of an HIV diagnosis that kills people because such a diagnosis creates “very toxic emotional states,” which supposedly “knock out and undermine” the body’s natural defenses. Repairing the victim’s mental state is thus his solution to AIDS—a convenient prescription given Ellner’s line of work.

Roberto Giraldo, another member of HEAL who sits on the boards of organizations such as Rethinking AIDS and Alive and Well, describes himself as a “natural health counselor” and runs a clinic of “integral psycho immunology” in Brazil. Infamous for advising Mbeki’s health minister on nutritional alternatives to ART, Giraldo subsequently went on to promote organized AIDS denialism in Latin America.

Cultropreneurs, and indeed all alternative therapists, rely on anecdotal evidence and testimonies of people who were pleased with their treatments. The “living icon,” the person who through his or her very existence “proves” that HIV disease can be fought with alternative remedies, thus plays a crucial role in the cultropreneur’s success. The most important of these icons for the AIDS denialist movement was Christine Maggiore, who not only actively promoted the cause of AIDS denialism but tragically also put her own health and that of her family on the line.

In the preface to her widely distributed book, What if Everything You Thought You Knew about AIDS Was Wrong?, Maggiore says she lost faith in HIV science after a series of inconsistent HIV tests. This prompted her to conduct her own investigation “outside the confines of the AIDS establishment” and to start her own organization, Alive and Well, to “share vital facts about HIV and AIDS that are unavailable from mainstream venues.” Writing in 2000, she observed that her HIV status had been “decidedly positive” for five years, but that she was enjoying good health and was living “without pharmaceutical treatments or fear of AIDS.”¹¹

The saga of Maggiore’s test results is a crucial foundational narrative for her as an AIDS denialist and features prominently in House of Numbers. Indeed a central AIDS denialist claim is that because different HIV tests can deliver different results, the entire edifice of AIDS science is flawed. Mag­goire’s test results are presented as a case in point.

The laboratory report shown in House of Numbers purporting to be Mag­giore’s first HIV test result is a positive Elisa test (for the presence of HIV antibodies) and a positive Western blot test (for HIV antigens) showing reactive bands for the p24 and gp120/160 antigens but not for p31. The absence of p31 suggests either a relatively new HIV infection or a 4.8 percent chance of a false positive test—thus the correct procedure in such a scenario is to counsel patients that the result is inconclusive and further testing is necessary.

Maggiore states that the second test came back “indisputably positive” and she was told that she had “five to seven” years to live and that her only treatment options were the eventual use of ART. Maggiore’s response was to find another doctor who “didn’t routinely fill people with toxic pharmaceuticals and lethal predictions” and to conduct further tests. These were apparently indeterminate, positive, negative, and positive. Evidence for the negative test result is unclear, however, as the clip shown in House of Numbers focuses on a fragment of the test result that shows nothing demonstrative of a negative result. But when the film shows the final test result, it is clear that all bands on the Western blot are positive for HIV antigens—an unequivocally positive result.

Maggiore concludes from her experience that HIV tests are “unreliable and inaccurate.” Yet the progression of her HIV tests from indeterminate to positive is consistent with her first test having been conducted soon after she became infected with HIV and sub­sequent tests being performed in line with clinical practice and culminating in an unambiguously positive test result.

Maggiore’s book, endorsed by Dues­berg, Rasnick, and Mullis, is a good illustration of AIDS denialist tactics. The first tactic is to deny the evidence. Thus, in her section on ART, Maggiore makes the baldly false statement that four years into the era of highly active antiretroviral treatment “there are still no reports in scientific journals that provide evidence for health improvement in patients taking these powerful drugs.” The second tactic is to dismiss the evidence that does not suit the case; for example, to reject studies showing that CD4 counts (an indicator of immune functioning) im­prove for people on ART because they are “surrogate markers” of the presence of HIV.

When she was pregnant in 2002 with her second child, Maggiore was featured on the cover of Mothering (a now-defunct pro-alternative healing and anti-vaccination magazine) with a red circle slash symbol over the letters “AZT” (an antiretroviral drug used to reduce the chances of transmitting HIV from mother to child) emblazoned across her abdo­men. After the baby, a daughter called Eliza Jane, was born, Maggiore in­creased the risk of transmitting HIV to the baby yet further by breastfeeding her. Tragically, Eliza Jane died at age three of what the Los Angeles coroner ruled to be AIDS-related pneumonia. Seven weeks earlier, Maggiore had stated on a radio show that her children had “excellent records of health,” yet the coroner reported that Eliza Jane was under-weight, under-height, and had pronounced atrophy of her thymus and other lymphatic organs. He found Pneumocystis jirovecii, a common AIDS-related opportunistic infection that is the leading cause of pediatric AIDS deaths, in the baby’s lungs and protein components of HIV (p24) in her brain.

Maggiore and her supporters, however, denied that HIV had anything to do with the death, relying instead on a rival report by Alive and Well advisory board member Mohammed Al Bayati, an animal toxicologist who is neither a medical doctor nor board-certified in human pathology and who consults on “health issues related to AIDS, adverse reactions to vaccines and medications” for $100 per hour.¹² According to him, Eliza Jane died because of an allergic reaction to an antibiotic.

Maggiore also raised questions about the autopsy tests and dismissed the presence of p24 capsid protein in Eliza Jane’s brain (a clear indication of HIV infection) as being the result of a medical “scavenger hunt” designed to make an HIV diagnosis. Farber agreed, writing that the coroner had gone out of his way to make the death look like it was AIDS-related simply because she was Maggiore’s child. Farber attributed public anger against Maggiore for Eliza Jane’s death—manifested in angry emails, web postings, and even printed flyers—to “the impossibly censorious and even brutal treatment one can expect if one is branded an ‘AIDS denialist.’” She observed:

I started to see the story as one that was less and less medical, more and more psycho-social—a story of an almost crushing kind of mob rule, where the victims have no rights. Few could resist the delicious temptation to condemn a “denialist” mother, or to appropriate EJ as their own tragic little girl. It was all done in the pitch-perfect tones of the AIDS morality play some of us know so well.¹³

Farber’s argument is remarkable for its failure to consider that Eliza Jane was the victim in this instance, and that the “AIDS morality play” she sneers at is rooted in genuine social concern about the wellbeing of children. As Wain­berg put it, “Maggiore was so mis­guided in believing this concoction of bullshit, that it cost not only her life, which is her business, but also the life of her three-year old kid, and that is everybody’s business.”¹⁴

John Moore (a virologist) and I made a similar point, arguing in a New York Times op-ed (“Deadly Quackery,” June 4, 2006) that those who stand in positions of authority, be it president of a country (Mbeki) or a parent, should not indulge their own intellectual questionings and rejection of the scientific consensus when it is others who pay the price. This prompted a subsequent email exchange with Maggiore—later posted by Rethinking AIDS on the Internet¹⁵—which is illuminating for the way in which scientific evidence is immediately deflected by AIDS denialists with further questions as if the questions themselves are sufficient to dismiss the evidence. Maggiore questioned our conclusion (based on the coroner’s report) that Eliza Jane had died of AIDS and asked me to explain “how does Eliza Jane’s eight-year-old brother, raised in the same manner as his sister, test HIV negative?” She also disputed our observation that she was spreading “dangerous views” by claiming she was simply raising “unanswered questions” in the hope of being provided with “answers and references.”

I subsequently provided her with references showing high death rates among untreated HIV-infected children and pointing to the benefits of ART in extending life (and she predictably responded by raising problems with the design of the trials, including their reliance on “surrogate markers” and denying that there had been any scientific advance showing how HIV causes AIDS). When I argued that not all children born to HIV-positive mothers test negative, and hence that her son Charlie was one of the “lucky ones,” she responded by asking for a “more cogent explanation.”

I also expressed the wish that

When you reach the stage when HIV has undermined your immune system sufficiently to start causing you serious health problems, I sincerely hope that you start taking antiretroviral therapy. By all ac­counts, you are a good mother to Charlie, and it would be sad for him to lose you unnecessarily early. Three of the survey fieldworkers who work in my research centre started antiretroviral treatment in the past two years and they are all doing very well—and one of them even gave birth to a (HIV-negative) child. This is all great cause for celebration and hope in this horrible epidemic.

She responded by pointing out that she was in her fourteenth year of living with HIV “with no medications and no health problems” and asking rhetorically, “How long do you suppose I might expect to continue in this way?”

(Although Maggiore lived longer than average, she eventually progressed to AIDS and died three years later. Most people progress from HIV infection to AIDS within ten years, but 5 to 15 percent are able to fight off the infection for much longer—a feat scientists believe is genetic.) With regard to my fieldworkers, she said:

How do you measure “doing well”—clinical health, lab markers? I know a great number of HIV positive women who have given birth to HIV negative children without taking anti-HIV meds. The common factors among them are natural good health prior to testing positive, excellent nutrition, regular use of vitamin supplements, regular exercise, no use of AIDS meds, prescription drugs or street drugs, no smoking or drinking. Why are their experiences not “cause for celebration and hope” for a healthy, low cost alternative to toxic drugs whose long-term effects on mother or child remain unknown?

In other words, our exchange was clearly fruitless. It illustrates how people in denial can, as psychologist Seth Kalichman observes, construct a reality that is “impenetrable by facts.”¹⁶ When Eliza Jane died, Maggiore told re­porters: “I have been brought to my emotional knees, but not in regard to the science of this topic. . . . I am not second-guessing or questioning my understanding of the issue.” Maggiore remained in denial to the end, dying in 2009 at the age of fifty-two of bilateral bronchial pneumonia and disseminated herpes viral infection, each of which is a common AIDS-related opportunistic infection. That she was prepared to endanger her own life, and that of her family, speaks volumes about the passion and sincerity with which AIDS denialist beliefs can be embraced and to the powerful psychological forces at work within those beliefs.

A professional independent pathologist conducted an autopsy on Mag­giore, but the report was never released by the family. Instead, Al Bayati offered a predictable “interpretation” of it—namely that despite the presence of AIDS-defining conditions, Maggiore, like her daughter, had died of antibiotic poisoning. Clark Baker, a retired traffic cop and active AIDS denialist, came up with a variation on the typical AIDS conspiracy theory, stating that “it is clear that corrupt officials from within the LA County Department of Health have pressured officials into making false claims that Maggiore and her daughter died of HIV so that pharmaceutical marketers could induce useful media idiots to perpetuate the myth on their behalf.”¹⁷

The death of this important living icon was obviously a hard blow for organized AIDS denialism. Maggiore’s organization Alive and Well posted a memorial notice when she died, but visitors to the website today are still greeted with a “message” from Christine Maggiore on the “about us” page that gives no indication that she is dead.¹⁸ Anti-AIDS denialist sites respond to such attempts to obscure and downplay the deaths of living icons by publicizing them—see for example www.aidstruth.org/denialism/dead_denialists. Other at­tempts have been made to create new “living icons”—for example, the people profiled on a website called We Are Living Proof¹⁹—but none of them comes close to being able to replace Mag­giore’s symbolic and organizational power.

The symbolic importance of Mag­giore—and now of her death—is illustrated in this posting by a one-time AIDS denialist. He talks about how his “dissident” beliefs encouraged him to ignore his positive HIV test result, but that when he heard that Maggiore had died, alarm bells started ringing for him for the first time:

In 2008 I had bumped into the website aidstruth.org and, while reading it in a “yeah blah blah whatever” kind of attitude, I saw the “denialists who have died” and “who the denialists are” sections. Something clicked. And very soon after I paid one of my usual visits to the Alive and Well site and found the memorial text about Maggiore’s death. It didn’t mention the cause (of course) so I Googled away thinking “please, let it be a traffic accident or something,” and bam! Pneumonia. . . .

You know how denialists usually say it’s just a coincidence, like “why not? Anybody can have pneumonia,” but having recently read the list of dead denialists and wondering if those weren’t too many untimely coincidences, for me Maggiore’s death is where I drew the line. For me it was the “one too many” coincidence. That’s where I secretly started to wonder if I had been wrong.²⁰

Medical science is more trustworthy than alternative medicine precisely because the former is built on randomized controlled trials, whereas the latter rests on anecdotes and individual testimonies. It is thus somewhat ironic that a single death—Maggiore’s—has possibly done more than scientific rebuttals to fight AIDS denialism. Precisely because this death was that of a living icon who rejected HIV science in favor of alternative therapies, it carried disproportionate weight for those tempted by AIDS denialism. It illustrates how the battle for science and reason is not always just about “the facts,” as some facts are symbolically more important than others.

Notes

1. For a recent readable summary of the evidence, see Volberding, P., and S. Deeks. 2010. “Antiretroviral Therapy and Management of HIV Infection.” The Lancet 376: 49–62.

2. Nattrass, N. 2008. “AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa.” African Affairs 107 (427): 157–76.

Chigwedere, P., G. Seage, S. Gruskin, T. Lee, M. Essex. 2008. “Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa.” Journal of Acquired Immune Deficiency Syndrome 49: 410–15.

3. Nattrass, N. 2007. “AIDS Denialism versus Science.” Skeptical Inquirer 31 (September/October): 31–37.

4. http://www.info.gov.za/otherdocs/2001/aidspanelpdf.pdf

5. Nattrass, N. 2012. The AIDS Conspiracy: Science Fights Back (Columbia University Press, New York). Additional references and citations for this article can be found here.

6. www.whale.to/a/wainberg_h.html.

7. Farber. C. 2006. “Out of Control: AIDS and the Corruption of Medical Science.” Harper’s Magazine March: 37–52.

8. Farber, C. 1999. “Ignoring the Flames.” Impres­sion August. Available at www.virusmyth.com/aids/hiv/cfflames.htm.

9. http://www4.dr-rath-foundation.org/THE_FOUNDATION/the_truth_about_arvs/index.html.

10. www.ellner.info.

11. Maggiore, Christine. 2000. What If Everything You Thought You Knew about AIDS Was Wrong?, fourth edition revised. American Foundation for AIDS Alternatives, Studio City, CA.

12. http://www.toxi-health.com/consult.html.

13. Farber, C. 2006. “A Daughter’s death, a Mother’s survival.” LA City Beat (June 8). Available at http://justiceforej.com/Farber-CityBeat-EJ.pdf.

14. quoted in Law, S. 2009. “In Denial.” McGill Daily (November 16). Available at http://www.mcgilldaily.com/2009/11/in_denial/.

15. http://www.rethinkingaids.com/challenges/moore-maggiore-scovill.html.

16. Interview with Seth Kalichman: http://www.thebody.com/content/art52090.html.

17. http://www.pinknews.co.uk/?comments_popup=14994.

18. http://www.aliveandwell.org/html/top_bar_pages/aboutus.html.

19. http://wearelivingproof.org/.

20. http://denyingaids.blogspot.com/2010/07/how-aids-denialism-can-kill-you-part.html

AIDS denialists are eccentric but not irrelevant, because they campaign actively against the use of ARVs and promote the dangerous view that HIV is harmless (and some say not even sexually transmitted). South African president Thabo Mbeki took the AIDS denialists so seriously that he delayed the introduction of ARVs to prevent mother-to-child transmission of HIV and invited the leading AIDS denialists to serve on his “Presidential AIDS Advisory Panel” (Nattrass 2007). They recommended that ARVs be avoided and that all forms of immune deficiency be treated with vitamins and “alternative” and “complementary” therapies including “massage therapy, music therapy, yoga, spiritual care, homeopathy, Indian ayurvedic medicine, light therapy and many other methods” (PAAP 2001, 79, 86).

This leap—from the critique of mainstream biomedical science on AIDS to the promotion of unproven and unregulated alternative therapies—is a replay of the classic quack-marketing strategy of promoting belief in alternative remedies by sowing disbelief and skepticism about the medical establishment (Hurley 2006, 216). It is thus not surprising that AIDS denialism has been used by vitamin salesmen (notably the Dr. Rath Health Foundation), self-styled alternative healers, and some traditional healers to promote their worldviews and products (Nattrass 2007). One of South Africa’s current health-policy failings is that, instead of cracking down on those making unsubstantiated health claims and creating markets for their wares, the health minister (Manto Tshabalala-Msimang) has provided cover and support for them.

AIDS denialists downplay their links with the purveyors of alternative therapies, preferring instead to characterize themselves as brave “dissidents” attempting to engage a hostile medical/industrial establishment in genuine scientific “debate.” They complain that their attempts to raise questions and pose alternative hypotheses have been unjustly rejected or ignored at the cost of scientific progress itself.

Dissent and critique are, of course, central to science, but so, too, is respect for evidence and peer review. While it was intellectually respectable to dissent diametrically from mainstream views in the early days of AIDS science when relatively little was known about AIDS pathogenesis, this is no longer the case. In the 1980s, it was understandable that AIDS dissidents were uneasy about the claim that one virus could cause so many different diseases. But, once it was shown that HIV worked by undermining the immune system, thereby rendering the body vulnerable to a host of opportunistic infections, their concerns should have been put to rest. Similarly, the wealth of data on the successes of ARV treatment should have alleviated their initial worries about its overall therapeutic benefit. Thus one of the early AIDS dissident doctors, Joseph Sonnabend, had, by 2000, welcomed the life-saving capacity of ARVs, describing them as a “wonderful blessing” (Sonnabend 2000). However, this did not deter today’s AIDS denialists, who continue to cite his dated views on their Web sites in support of their unchanged views.1

Given their resistance to all evidence to the contrary, today’s AIDS dissidents are more aptly referred to as AIDS denialists. This stance may be attributable, in part, to a genuine misunderstanding of the science of HIV. For example, in his affidavit to the Australian court in the Parenzee case, a member of the Perth Group, Valendar Turner, testified that HIV had not been isolated because it had been identified only through the detection of reverse transcription (the process of writing RNA into DNA), an activity not unique to retroviruses (Turner 2006, 4). In subsequent testimony for the prosecution, Robert Gallo (the discoverer of retroviruses and codiscoverer of HIV) pointed out that HIV had been identified as a retrovirus through the detection of reverse transcriptase, which is an enzyme unique to retroviruses, not the activity of reverse transcription, per se. He added that “only a fool” would mistake the two (Gallo 2007b, 1310, 1313—1314).

Misunderstanding the science of AIDS may be part of the story, but it does not explain why AIDS denialists are so hostile to and disbelieving of AIDS science. Part of the answer probably has to do with the belief that AIDS science cannot be trusted because the “scientific establishment” has been corrupted by the pharmaceutical industry (see, e.g., Farber 2006). This resonates with what Jon Cohen (2006, 1) calls “pharmanoia,” or “the extreme distrust of drug research and development that’s sweeping the world.” John le Carré’s novel (and subsequent hit Hollywood movie) The Constant Gardener, which provides a conspiratorial account of unethical medical trials in Africa, is a classic in this genre (Le Carré 2001). This book was cited approvingly in a South African AIDS-denialist document coauthored by President Mbeki as being “well researched” and “illuminating” about the way the pharmaceutical industry influences academic research (Mbeki and Mokaba 2002).

The pharmaceutical industry is, of course, far from angelic. There are documented cases where drug companies have designed trials in ways to promote sales of particular products rather than to test the best possible treatments; where clinical trials in poor countries have been unethical; where early research indicating dangerous side effects has been ignored for too long; where patent law has been abused to prevent low-cost competition; where too many resources have been spent on marketing “me-too” drugs (that is, drugs that are only marginally different from existing products) rather than investing in innovative drug development; and where unethical financial inducements have been made to doctors, researchers, and politicians (Goozner 2004; Angell 2005). However, what such cases suggest is that the pharmaceutical industry (and industry-funded research) needs to be carefully scrutinized and regulated. It does not imply that the entire industry and associated medical science are harmful to humans. As Cohen (2006) argues, the problem with the new pharmanoia is that it has put “Big Pharma” on a par with “Big Tobacco” and, through wild exaggeration, has turned “shades of moral grey into black.”

Robert Gallo, the discoverer of retroviruses, devoted ten pages of his book on discovering HIV to demolishing Deusberg’s speculations. (AFP Photo/Roland Magunia [Photo via Newscom])

The same applies to AIDS research, where the pharmaceutical industry has a clear incentive to fund and support those research activities most likely to generate profits in the future. This means that additional mechanisms need to be created to ensure that more risky and less profitable—but nevertheless important—areas of research, like vaccine development, are supported. It does not imply, as asserted by the AIDS denialists, that the pharmaceutical industry is funding a global conspiracy including all AIDS scientists, epidemiologists, and medical practitioners to invent a disease in order to market harmful drugs. (This tactic has also been used to great affect by Kevin Trudeau in his infomercials; see SI January/February 2006, “What They Don’t Want You to Know.”) Aside from there being no evidence for this, the idea is incoherent, because the profit motive driving pharmaceutical companies gives them an incentive to keep people alive on chronic therapy as long as possible, not to kill them off quickly with dangerous drugs. Disrespect for AIDS scientists and physicians is a defining characteristic of AIDS denialists. Protected by a cloak of hubris—only they have the intelligence and moral courage to see the world for what it is—they portray themselves as lone, persecuted standard-bearers of the truth. As AIDS scientist John Moore (2006, 293) commented bitterly, their stance implies that “tens of thousands of health care professionals and research scientists are either too stupid to realize that HIV is not the cause of AIDS, or too venal to do anything about it for fear of losing income from the government or drug companies.” Equally galling for scientists is the fact that most of the outspoken AIDS denialists are journalists or academics with no scientific training and that those who have medical qualifications have never actually worked on HIV.

In the normal course of scientific engagement, this would leave the denialists with little if any credibility. Gallo made this point very well in the Parenzee court case with regard to Turner: “Is he a virologist? Does he do experiments on AIDS?” he asked the defense attorney when presented with Turner’s belief that HIV had not been isolated. “No,” interjected the judge. “He’s qualified in emergency medicine.” “I see,” replied Gallo. “I am not. Don’t ever come to me if you are hurt” (Gallo 2007b, 1272—1273). In a subsequent e-mail message to the scientists and activists who run the anti-AIDS-denialist Web site www.aidstruth.org, Gallo talked of his amazement at the “mass ignorance coupled with the grandiosity of selling themselves as experts” displayed by the Perth Group, saying that “it would be like us arguing with Niels Bohr on quantum mechanics” (Gallo 2007a).

The only active AIDS denialist with any major scientific standing is Duesberg, who is a member of the National Academy of Sciences and the first person to isolate a cancer gene.2 But his credibility to speak on AIDS is tarnished by the fact that he has never conducted any scientific research on HIV, let alone published it in peer-reviewed scientific journals. He simply does not have any evidence to support his erroneous claim that AIDS is caused by recreational and ARV drugs rather than HIV.

Unable to convince his scientific peers, Duesberg relies on the media (including the Internet) to promote his views directly to the public. His cause was assisted substantially by The Sunday Times in London from 1992 to 1994, when the science editor ran many long pieces attempting to discredit AIDS science. This enabled Duesberg to achieve a form of socially constructed credibility outside of conventional scientific channels (Epstein 1996, 105—178), which, in turn, prompted John Maddox (then editor of Nature) to go on the offensive and subject The Sunday Times during this period to regular critical review in Nature.

South African President Thabo Mbeki has encouraged AIDS deniers and slowed treatments. (Reuters/Finbarr O'Reilly, South Africa [Photo via Newscom])

Largely as a consequence of Duesberg’s profile, the scientific community was compelled to pay greater attention to his ideas than was warranted by their content. In 1991, Gallo (1991, 287—297) devoted ten pages of his book on discovering HIV to demolishing Duesberg’s speculations. A couple of years later, Science investigated Duesberg’s claims and concluded that none of them stood up to scrutiny (Cohen 1994). Undaunted, Duesberg and his colleague David Rasnick restated their long-refuted hypotheses in a 1998 article (which was followed immediately in the same journal by a point-by-point refutation [Galea and Chermann 1998]). None of this had any impact either on Duesberg or on journalists such as Farber, who continued to promote his views, largely unchanged from the early 1990s.

AIDS scientists are understandably baffled by such conviction-driven refusal to accept the implications of the weight of evidence to the contrary. As Gallo said of Duesburg in 1988, he is “like a little dog that won’t let go” (quoted in Cohen 1994, 1644). Moore (1996) went even further, comparing Duesberg to the Black Knight from Monty Python and the Holy Grail who, after having all his limbs hacked off by his opponent, keeps on trying to fight with his teeth.

One of Duesberg’s tactics is to exploit the uncertainty that is ever-present in science and demand increasingly exacting standards of “proof,” and, when this is not forthcoming, proclaim fallaciously that the alternative hypothesis must be true. As Maddox observed Duesberg has not been asking questions or raising questions he believes should be answered, but has been making demands and implying (but sometimes saying outright) to colleagues, “Unless you can answer this, and right now, your belief that HIV causes AIDS is wrong.” It is as if a person were to have told Schrödinger in 1926, “Unless you can calculate the spectrum of lithium hydride, quantum mechanics is a pack of lies” (interestingly, that deceptively simple question is only now being answered). (Maddox 1993, 109)

This kind of fallacious reasoning is evident among other kinds of denialists, too, such as evolution deniers who see any gap in the fossil record as proof that God must have created the world (Mooney 2005).

Their zealous attachment to key ideas has a further consequence: the inability or refusal of AIDS denialists to weigh up risks and benefits. Thus, as soon as any toxicity can be shown for an ARV drug in any context, they conclude that the drug should not be prescribed in any situation. For example, when clinical evidence emerged that adverse events occurred among mothers on long-term Nevirapine therapy, this was seized upon by Farber (2006) to argue that Nevirapine should never be used in any circumstances—even as a single dose to prevent maternal transmission of HIV, a drug regimen that had been shown to be safe. When this error was pointed out (Gallo et al. 2006), the AIDS-denialist group “Rethinking AIDS” backed Farber’s strategy on the spurious grounds that it moved “neatly” between the two trial results as part of a single argument against Nevirapine (Rethinking AIDS 2007). They claimed, without any evidence, that both trials showed significant adverse events, when, in fact, not a single life-threatening event has ever been shown for single-dose Nevirapine.

All “debates” with AIDS denialists end up in a stalemate simply as a consequence of their refusal to play by the rules of reasonable debate. This is evident in the “rapid-responses” Web pages of the British Medical Journal (BMJ), where AIDS denialists such as Papadopulos-Eleopulos and Rasnick accounted for a disproportionate amount of space before the BMJ revised its rules and excluded this “shouting match of the deaf” (Butler 2003). Typically, the denialists would paste large amounts of convoluted text into their rapid-response submissions and then argue at length with anyone who responded. After trying to engage with the denialists, Peter J. Flegg, a physician from Blackpool Victoria Hospital, finally erupted with the following:

What is taking place on this forum is a farce, not a debate . . . . Good scientists are meant to accept new evidence and incorporate this into their hypotheses. The denialist approach is to ignore new evidence that is contradictory to their predetermined stance. After comprehensive rebuttal of any point of view, the denialist tactic is to quickly switch to a different topic. Then later, when no-one is looking, they can switch back to the original theme, hoping no-one will realise that these points were completely discredited on an earlier occasion. (Flegg 2003)

Exactly the same tactics are evident on science blogs when AIDS denialists enter into “debate.” Tara C. Smith’s science blog “Aetiology” hosted several rambling and ultimately unproductive interactions with AIDS denialists—most notably Harvey Bialy (Duesberg’s biographer and fellow member of Mbeki’s AIDS panel). The denialists conceded nothing, not even when the case was clearly an open-and-shut one to any reader. For example, AIDS denialists persistently cite an old study by Nancy Padian that reported low HIV transmission rates between sexual partners (Padian et al. 1997) as supporting evidence for their claim that HIV cannot be transmitted sexually. When reminded that participants in the Padian study were strongly counseled to practice safe sex (which means that the study cannot be used to back the claim that HIV, per se, is difficult to transmit sexually) and when presented with evidence from other studies showing that the risk of sexual transmission can be 20 percent or higher in developing countries, the denialists simply changed the topic. This prompted Chris Noble to comment:

Well, we seem to have drifted a long way from the famous Padian study which according to Harvey Bialy “demonstrated so well that sexually transmitted HIV was a figment.”

I note that Bialy never once made a comment that was relevant to the study. These are the people that claim that HIV cannot possibly cause AIDS. You ask them for justification and they give you the “Padian study.”

You demonstrate that this study cannot be used to conclude that HIV is not sexually transmitted and they go all silent, bring up other studies or in Bialy’s case proceed to insult everyone that doesn’t worship Peter Duesberg.

I predict that in the future the exact same people will again cite the “Padian study” as proof that HIV is not sexually transmitted. (Noble 2006)

Exactly as he predicted, the denialists continued to misrepresent Padian’s study (see Farber quoted in Kruglinski 2006 and Turner 2006, 13—14) and, even when Padian herself protested about the way that AIDS denialists have misused her work and ignored the available evidence (Padian n.d.). The denialists dismissed her piece as “info-ganda” (George 2006).

This lack of respect for the integrity of scientists makes it very difficult for AIDS scientists to make any headway. As Brian Foley, a scientist who works with the HIV database at Los Alamos National Laboratory, commented after a long blog exchange with South African AIDS denialist Anita Allen:

There is no such thing as “scientific debate” really. Science is about experiments, data and theories to explain the data. If Anita says “The virus has never been isolated” and I say “In fact dozens of infectious molecular clones of HIV-1 have been generated and that is as good as “isolation” gets for retroviruses,” one of us has to be lying. (Foley 2006) Foley’s comments point to the central role of integrity and respect for expertise in science. He is saying that for Allen, who is not a scientist, to claim that HIV does not exist amounts to her accusing him of misunderstanding or lying about the vast HIV databank he has at his fingertips. For him, her refusal to accept the mountain of evidence (and his bona fides to report it) amounts to her opting to believe—and propagate—lies. As far as the scientific community is concerned, the “debate” over whether HIV causes AIDS has long been settled. As the AIDS scientists and activists who run the Web site www.aidstruth.org put it:

For many years now, AIDS denialists have been unsuccessful in persuading credible peer-reviewed journals to accept their views on HIV/AIDS, because of their scientific implausibility and factual inaccuracies. That failure does not entitle those who disagree with the scientific consensus on a life-and-death public health issue to then attempt to confuse the general public by creating the impression that scientific controversy exists when it does not. (AIDSTruth 2007)

Unfortunately, President Mbeki was precisely one of those who was convinced that a scientific controversy existed—and, by slowing the rollout of ARVs in the public sector for both HIV prevention and AIDS treatment, his belief resulted in the loss of many thousands of lives (Nattrass 2007). He has also been associated with Christine Maggiore, the controversial HIV-positive American AIDS denialist who does not practice safe sex and campaigns actively against the use of ARVs (Moore and Nattrass 2006). When Maggiore was pregnant with her second child, she was featured on the cover of Mothering magazine with “no AZT” emblazoned across her abdomen. She did not take ARVs to prevent infecting her baby with HIV and increased the risk of transmission yet further by breastfeeding the child. Tragically, her daughter died three years later of what the Los Angeles coroner attributed to AIDS-related pneumonia (Ornstein and Costello 2005). Maggiore, however, continues to deny that HIV had anything to do with the death, claiming instead that the child died because of an allergic reaction to an antibiotic, despite substantial evidence to the contrary (Bennett 2006).

People in positions of authority, be they statesmen like Mbeki or parents like Maggiore, hold the lives of others in their hands. For them to reject science in favor of AIDS denialism is not only profoundly irresponsible but also tragic. But responsibility for unnecessary suffering and death rests also with the AIDS denialists who promote discredited and dangerous views and encourage people to reject scientifically tested treatments.

Notes

1. See, e.g., virusmyth.net.
2. Another AIDS denialist with scientific credentials is Kary Mullis, who won a Nobel Prize in chemistry for inventing the polymerase chain reaction. However, he, too, has never done any scientific research on HIV or AIDS and, unlike Duesberg, is not active in the AIDS denialist movement. His autobiography (Mullis 1998) documents his skepticism about the relationship between HIV and AIDS as well as his encounters with aliens and his belief in flying saucers and astrology.

References