The truth about HEAL and AIDS
#2416 - 04/05/00 01:34 AM
If you have been reading this guy who has been posting here recently and you are wondering what's the story with him and those who profess similar theories take a look at this article from POZ which gives the whole story. An eyeopening story!
Or see the following link
HIV Naysayers Find Their Achilles' HEAL
An "AIDS Dissident" movement draws on PWA disgust with medical hype --
but sacrifices truth and safety in the process
by Bruce Mirken
It's a typical August afternoon in San Francisco, pleasant but not warm, as people file into the Castro district Metropolitan Community Church. Two young men wearing HEAL t-shirts check off the names of those entering the reservation-only event, billed in the local gay press as "Breakthrough Discoveries in Scientific HIV/AIDS Research." But not everyone is so sure about these "discoveries": Representatives of Project Inform and ACT UP/Golden Gate join AIDS Treatment News (ATN) publisher-editor John James in front of the building, handing out flyers warning the audience not to trust the information.
Once the near-capacity crowd of about 180 -- mostly gay men under 50 -- is seated, in walks the day's star, University of California, Berkeley professor of molecular and cell biology Peter Duesberg, Ph.D, shaking hands like a visiting dignitary. He has an impressive résumé: Author of several important papers on virology, member of the National Academy of Sciences, recipient of an Outstanding Investigator Grant from the National Institutes of Health (NIH). Duesberg strides to the podium to wild applause. He's a charming, avuncular speaker with a soft voice and a pronounced German accent, and the crowd is with him, laughing at his jokes and clapping as he tells them that mainstream science's efforts against AIDS "cannot claim to have saved a single life."
But the "startling new research" the ads promised never appears;
Duesberg's pitch is largely the same one he has been making for years,
somewhat updated: AZT and its cousins are poisons. Condoms and clean
needles haven't protected anyone. The CDC's AIDS definition is a
meaningless collection of "30 previously known diseases," arbitrarily
strung together to create the illusion of a new epidemic. Where real
illness occurs, Duesberg says, it is caused by recreational and
pharmaceutical drugs, not a virus.
If anyone has doubts, they aren't expressed. The applause and laughter
roll along with the professor's deft patter, and in the
question-and-answer period not a single skeptical question gets asked.
Several speakers simply give testimonials. One man who identifies
himself as a member of the New York City chapter of HEAL (Health
Education AIDS Liaison), an international network of self-defined "AIDS dissident" groups, denounces conventional AIDS medicine as "a malignancy in our society," concluding: "I think it's appropriate that we're meeting in a house of God today. We have to bring the higher power to this serious situation we're all in, whether it's Jesus or Buddha or -- "
"Duesberg!" a voice shouts, and the room rocks with laughter and
applause. Duesberg smiles.
Duesberg has long been known as the nation's leading AIDS dissident. But he is far from alone in this growing movement. HEAL, which began in New York City in 1982 as a forum for information on alternative AIDS treatments, now has 28 chapters worldwide. The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis boasts hundreds of members and publishes a monthly newsletter called Reappraising AIDS, while Continuum, an HIV-is-not-the-cause-of-AIDS British journal, has built an international readership. Favorable coverage of the dissident position has appeared in a number of mainstream media outlets, most notably Celia Farber's former AIDS column in Spin magazine, the PBS series Tony Brown's Journal and The London Sunday Times.
These HIV nonbelievers aggressively market their message: The San
Francisco HEAL chapter regularly plasters the Castro with brightly
colored flyers screaming, "Warning! Consumption of anti-HIV drugs has
been shown to be lethal!" HIV positive boxer Tommy Morrison, profiled in POZ last July, takes his HIV-is-harmless message on the road, to
audiences of high school and college students. He claims not only that
HIV doesn't cause AIDS but that sexual transmission of the virus is
AIDS-prevention workers nationwide say they've felt the dissidents'
impact. "I've heard numerous men say, 'Well, HIV doesn't really cause
AIDS,' and use that as an excuse not to stay safe," comments Dan
Wohfeiler, education director of Stop AIDS in San Francisco.
Elyzabeth Wilder, student chair of the AIDS Task Force at the State
University of New York at Purchase, says her group's efforts at condom
distribution and AIDS education were hindered last year by a new HEAL
chapter. "HEAL undermined all the work AIDS educators have been doing
for the last dozen years," Wilder says.
A letter from a HEAL supporter that appeared in the school's student
magazine summed up the group's advice, calling condoms "irrelevant" to
AIDS prevention and adding that "the key is not to take the 'treatments' your doctor prescribes. They actually cause AIDS and will kill you."
When PWAs start following such advice, the results can be tragic.
Patrick Donnelly, former program director of the Whole Foods Project in New York City, speaks grimly of his friend Steven Simmons. For years, the two men had emphasized alternative/holistic approaches to their HIV infection, but by early 1996 they were both experiencing health problems. Donnelly began seeing a conventional doctor and combining standard anti-HIV treatments with the alternative methods and soon found his health coming back, but his friend took a different path.
Simmons attended the International AIDS Conference in 1996 on behalf of People for the Ethical Treatment of Animals, campaigning against animal research. There he met members of ACT UP/San Francisco, a renegade chapter that opposes virtually all standard AIDS treatments and has much in common with the Duesberg/HEAL viewpoint.
"He came back with their worldview that all the drugs are evil,"
Donnelly remembers. "So not only did he not go on any of the cocktails, he also stopped his PCP and MAI prophylaxis. He promptly got PCP for the fourth time, and still didn't change his mind."
The two argued intensely, but Simmons was adamant. "For Steven, it was a black-and-white world of us vs. them," Donnelly recalls, "and the
dissident message sort of played into his worldview." Simmons' health
deteriorated, and in October 1996 he was diagnosed with lymphoma of the brain. He died three months later.
The AIDS dissident movement hasn't always presented issues in such
simplistic terms. Key dissident leaders of the '80s -- the late PWA
activist Michael Callen, clinician and researcher Joseph Sonnabend, MD, and physiologist Robert Root-Bernstein, MD -- vociferously challenged the evidence that HIV causes AIDS, and advocated for research on various theories about possible causes and cofactors. But they never purported to have "the" answer, much less claimed that whatever caused AIDS was noninfectious. (Indeed, Callen and Sonnabend, along with PWA Richard Berkowitz, invented the concept of safer-sex education.) And while Callen and Sonnabend railed against AZT monotherapy -- now widely viewed as having hurt more PWAs than it helped -- they also fought hard to add PCP prophylaxis to the standard of care.
But many observers argue that a dissident movement once focused on
asking hard questions and spurring innovative research has largely
ossified into a stern purveyor of rigid, and possibly dangerous,
doctrine. Duesberg went from challenging the level of proof that HIV
causes AIDS to insisting he knew the "real" causes -- recreational and
pharmaceutical drugs. And HEAL "was much more positive in the old days," says Donnelly. "It was about everything we weren't looking at -- nutrition, Chinese herbs -- and not so much who was evil in the AIDS world."
It may, at first glance, seem puzzling that this movement is making
headway now, in the protease era, when PWA death rates have been cut by half and an ever-growing mountain of data correlates an undetectable viral load with health. For most scientists, doctors and AIDS activists, recent developments have put to rest any doubts that HIV is the primary cause of AIDS.
For rest of article see following posting
PART II From POZ 5/98
So what's going on here? "There's an old saying that a half-truth is like half a brick: You can throw it further," ATN's John James says. "No one would give these people the time of day if there wasn't some truth in what they say." James emphatically rejects the notion that HIV is harmless, but is equally convinced that certain concerns the dissidents raise -- like excessive drug company influence over research agendas and the obstacles to mounting studies of unpatentable alternative treatments -- are real.
And many observers say that drug company hype and a rush to judgment on early intervention with protease cocktails have heightened pressure on PWAs to "get with the program." Indeed, some AIDS docs -- not just
outspoken dissidents -- believe too many people are starting therapy too soon, before the evidence is in. According to Northern California
alternative-treatment activist Michael Onstott, the "hit early, hit
hard" campaign intersects with doctors' arrogance to create a powerful
resonance for the HEAL/Duesberg message among some PWAs. "There's a lot of distrust for the medical establishment," observes Onstott, who has used nutritional and alternative treatments for years but also takes a protease-based cocktail. "They may have had bad experiences with doctors who have big egos, closed minds and a cookbook approach."
What most frustrates Onstott is that the dissidents take a fragment of
truth and make unfounded leaps in logic. "They're still insisting the
drugs aren't going to work when they already have," he says. "It's clear that the medications have saved lives," though he acknowledges that they have failed some PWAs and produced nasty side effects in others.
And critics argue that dissidents often mix fact and fantasy into a
misleading package that appeals to PWAs justifiably skeptical of drug
company hype. Indeed, much of Duesberg's San Francisco talk was dubious at best. At one point, he asserted that antiretroviral drugs "are given to 200,000 people annually without ever having been tested, at least in the published literature, in rats, mice, birds or anything," turning HIV positive people, he claimed, into human guinea pigs. The truth is that the National Library of Medicine's AIDSLINE database lists thousands of animal studies of these drugs. He showed a slide with data purporting to demonstrate that PWAs are heavy users of recreational drugs (to support his drugs-cause-AIDS theory), but failed to include figures for drug users who didn't develop AIDS.
At another point, he presented a graph with two lines: One curving
sharply upward, indicating U.S. AIDS cases, and another absolutely flat, showing the number of HIV positive Americans stuck at one million. If one causes the other, he asked, how can the lines be so different? But Duesberg was comparing apples and oranges: The actual count of reported AIDS cases, updated monthly, vs. mere estimates of infections, recalculated only once in the past decade (another Duesberg error: The official guess for several years has been 650,000900,000, not a million, people living with HIV).
Asked about these contradictions, he goes on the counterattack: "This
country spends roughly a billion dollars on HIV testing each year in
order to get a picture of how many people are infected, what to do about it and how to control it." This should produce reliable numbers, he argues.
Nonsense, replies CDC statistician John Karon. "It's not the number of
HIV tests that matters, it's whether they're done in a representative
sample." Since most tests are done for people who feel at risk, the
results don't constitute such a sample and are thus irrelevant to the
But often there is a kernel of truth in dissident arguments, even if the conclusions are bogus. One recurrent theme, for example, is the
pharmaceutical industry's influence over the research agenda. After the first burst of optimistic protease studies in early 1996, Reappraising AIDS published a lengthy critique of these "corporate-sponsored" trials and declared, "One of the continuing scandals of AIDS research is the general lack of thorough drug testing."
AIDS activists who accept HIV as the cause have long voiced similar
concerns. John James writes regularly about how research tends to chase ideas with commercial potential, leaving worthwhile but unprofitable approaches unstudied. ACT UP/New York member George Carter cites nutritional supplementation as an area that has been neglected by mainstream research, saying bluntly, "Lack of patentability, and arrogance at NIH, are part of the reason [supplements] are not comprehensively studied." Many argue that research on potential cofactors ranging from HHV-6A to nutritional deficiencies has lagged unconscionably. Activists also regularly criticize industry drug trials. ACT UP/Golden Gate, for example, has slammed Bristol-Myers Squibb for allegedly downplaying certain side effects of d4T, and Carter observes: "In AIDS, examples abound of underplaying toxicities. But this doesn't negate the benefits the drugs have given to people with AIDS. Drug companies do important research."
The difference is that the dissidents portray a black-and-white world in which, for instance, because of the pharmaceutical industry's
profit-hungry nature, every product it promotes is evil. But people like Carter, James and Onstott see a world with many shades of gray in which no one -- scientists, government officials, drug companies or even activists -- is either 100 percent good or 100 percent evil. It's no surprise that a profit-driven company will put the most optimistic spin on its studies, they say, but that doesn't necessarily mean its drug is not effective.
A prime example of this good-versus-evil worldview is PCP prophylaxis.
Once energetically advocated by such dissidents as Michael Callen, it is now denounced by the movement he once helped lead. "Using powerful
antibiotics such as Bactrim every day for months to years is a new and
potentially deadly practice," writes HEAL/Los Angeles founder Christine Maggiore in her widely distributed booklet, What If Everything You Knew About AIDS Was Wrong? In a letter to Continuum, HEAL/New York president Michael Ellner called PCP prophylaxis "one of the deadliest 'AIDS' myths of all."
Maggiore and Ellner simply ignore the numerous studies showing that PCP prophylaxis prolongs lives, but again they may be heaving at least part of a brick, Onstott says. "What they're right about is that there's overkill with a lot of immunosuppressive drugs. There are people taking 35 different drugs on regimens no one should be subjected to." He acknowledges that use of antibiotics for years may weaken resistance to some infections, but says this problem can often be alleviated with nutritional supplements, and adds: "What they're wrong about is judicious intervention with some of these drugs. HEAL absolutely denies that PCP prophylaxis is beneficial. But it's been absolutely shown that PCP prophylaxis saves lives." Indeed, Gene Fedorko, a nine-year veteran and former president of HEAL/New York told POZ in 1995 that he knew of many PWAs who had to be rushed to emergency rooms with "raging cases of PCP" after following HEAL's advice.
Some longtime dissidents have managed to maintain clear distinctions
between medical-establishment hype and clinical truths. Sonnabend, for
example, blasts the recent rush toward "hit early, hit hard" with
antiretroviral therapy as "crystal ball medicine," while recognizing the mounting data that HIV plays some role in the disease and seeing
firsthand in his own practice that protease cocktails help people with
But most dissident propaganda leaves scant room for such pragmatic
distinctions, and with this all-or-nothing attitude comes a
conspiratorial worldview. After all, if the truth is so obvious, then
somebody must be suppressing it. "The AIDS Crisis: An Epidemic of Lies," screamed a 1995 HEAL/Los Angeles leaflet, while a recent HEAL/San Francisco flyer declared, "AIDS...Where the doctor takes your
money...the government takes your rights...the medicine takes your
life...a virus takes the blame...and science takes the credit."
To some critics, the paranoia in these slogans borders on cultlike. But the genius of the dissident movement is, above all, that its message is supremely comforting to people in trouble -- such as Frank Green. Founder of the small HEAL chapter in Cleveland, Green gained reassurance when he discovered the dissident movement. Living in New York City in the '80s, Green was a drug user, "strung-out and living in an abandoned building." After testing positive in 1988, "I felt powerless," he says. "I felt I could do nothing but wait for death or put myself in the hands of doctors. I felt like I was setting myself up for a lifetime of taking pills and dependency."
The dissident movement was a revelation. "I decided, based on what I'd
read, that it was at least a possibility that AIDS was not caused by HIV and that I, Frank Green, might not die from AIDS," he remembers. "When I realized that, I stopped using drugs and my health improved ... I had hope again. I felt freed." Even if he turns out to be wrong about HIV, Green is satisfied with the choice he's made. People on three- or four-drug anti-HIV cocktails "are completely trapped in this lifestyle," Green says. "Their lives are built around these drugs. I wouldn't want a life like that ... I'm not afraid of death. I'm afraid of medical dependency."
For those PWAs who buy the dissident line, no faceless, invisible virus threatens their lives. There is no need for the conventional treadmill of drug combos, lab tests, doctor visits. Just live a healthy life and all will be fine. "I think that's what a lot of people would like to believe," Onstott says. "It's appealing to say, 'If I just clean up my life and avoid these drugs, I'll be OK.'"
Indeed, Patrick Donnelly says, his friend Steven Simmons drew comfort
from sticking to what he thought was the true and moral path -- but he
died nonetheless. As for Donnelly, "I've made the choice to take ideas
from whatever toolbox I can find that works."
The (Radical) Right Stuff
Some dissidents¹ not-so-hidden agendas
One reason many are wary of the "AIDS dissident" movement is that its
leadership is peppered with right-wingers, many of them overtly antigay.
The editorial board of Reappraising AIDS includes at least three
ultraconservatives who reject much of modern science, not just HIV
medicine: Tom Bethell and Phillip E. Johnson are outspoken creationists who discount science's understanding of evolution, and Charles Thomas once gave a lecture called "Scary Science," denouncing virtually the entire U.S. environmental movement as a conspiracy to hand control of our lives over to the government.
For many years Peter Duesberg collaborated with graduate student Bryan
Ellison, who railed against the "abominable sin of homosexuality" in a
1995 fundraising letter. The two collaborated on an early version of
Duesberg's book, Inventing the AIDS Virus, as well as a 1990 article for
Policy Review, the journal of the conservative and antigay Heritage
Foundation. But Duesberg says that he never noticed homophobia in
Ellison. Offering no substantiation, he adds, "People say he may be gay
Duesberg has appeared at least twice on Radio Free America, a talk show
produced by the antisemitic, racist and antigay Liberty Lobby. According
to the Anti-Defamation League, Liberty Lobby "has been associated with
almost every far-right movement in the United States" for decades,
including efforts to deny that the Holocaust ever occurred.
After he and Ellison split, Duesberg got his book published by Regnery
Publishing, a specialist in right-wing books whose authors include Pat
Buchanan and Mark Fuhrman, the notorious LA cop from the O.J. Simpson
case. The publisher is not known for AIDS books, but has published
Asked about this, Duesberg avoids discussing his own politics but rails against scientific censorship. "I do not have the choice of Anthony Fauci or Martin Delaney, who have five publishers," he declares. "I thought America is a democracy. It's now bad if you are on the right or on the left?" Contacted for comment, HEAL/San Francisco cofounder Dennis McKown at first blasted "all these rumors about Peter Duesberg seeking Pat Buchanan's publisher" as "sheer hogwash." When confronted with the details, he retorted, "I don't see what this has to do with the facts here."
It may have a lot to do with them. Dismissing HIV plays into aspects of a far-right agenda embraced by several leading "dissidents." In his
latest book, Defeating Darwinism, Johnson of Reappraising AIDS bemoans
how America no longer accepts God as "a fact." This, he argues "seemed
to make chastity obsolete" and allowed "homosexual activists" to claim
"victim status." Bethell took a similar tack in a 1991 Los Angeles Times column, complaining that gays used AIDS as a pretext to "proselytize in public about their private acts."
Ellison made the connection more bluntly in his 1995 letter. "Militant
'gay rights' organizations ... now use your tax dollars to defile your
tender school-age children or grandchildren with their perverted 'AIDS
education,'" he wrote. "For the first time in history little children
are being taught in their classrooms about anal and oral sex!...God must be weeping."
If AIDS education is a pretext to "defile" children, what better way to stop the defilement than to sow doubt that a sexually transmitted virus causes AIDS? Which leads many PWAs to ask: Can these "dissidents" ever be considered our allies?
Thank you carol and the above people for this thread. I was unaware of the complexities in this arena.
I find my self educatedly in the gray with all this and also subscribe to alternative health measures. After 9 years med free i take a standard cocktail.
After i continue my research on this subject and why others failed i my go completely alternative under a doctor watchfull eye just incase it goes awry. I don't take this desicion lightly as i risk permantly diabling my cocktail by resistantce leaving me quite up the creek without a paddle, and i have no intentions of gambling with my life: however as well an my schooling and educations dictate i find holes is most aternative regiems that may be "fixed" to use a poor term. Research and experience being the main culprit.
Personally I am working on an alternative or holistic cocktail.
(with the help of experienced and educated alternative practitioners that i have not personal interest in causes or crusades, just healing
Nonetheless i am very very grateful for all the infomation presented and if anyone know's of webpages that offer comitted data and discussion treads on these two options of therapy, with non-agenda research ond sources to back their data and information please pass it on.
I myself am also working of a web site to offer this.
GREAT article! I knew there was something overly persistant about this guy and HEAL in general. They must be getting frustrated cause no one wants to listen to them anymore. The new medications ARE saving so many people's lives. I lived through all my friends dying--funerals every two weeks. Just awful, awful. It's no conspiracy. It's just the medication works. Sure they have side effects. But so does aspirin. Because of the medications it's so different. No more hospital visits. No more bedside vigils. No more certain death. I feel like I've lived through a miracle!
i am not the guy you are referrign to, but i am very interested in the whole issue. don't make any fast judgments, but read even more. i have been reading A LOT about the controversy and, at times, it gets too scientific. fortunately, i have some scientific background and could follow.
i am not affiliated nor with HEAL or any other organization.
people who do not believe the HIV=AIDS hypothesis DO have many strong arguments that nor you or i can deny.
please read more.
consider this article that follows:
Non-Infectious HIV is Pathogenic
Exclusive report from the Gordon Conference on the Chemotherapy of AIDS. Ventura, California
by David Rasnick, Ph.D.
I just returned from my first AIDS conference, the Gordon Conference on the Chemotherapy of AIDS, held March 9-14 in Ventura, California. I went to present a poster of a paper that refuted one of the fundamental concepts of the prevailing HIV-AIDS model. The paper had just been published in a scientific journal, and I was eager to defend it against the scrutiny of my peers.
Also I knew that David Ho and his co-workers would be making presentations advancing the HIV model. I was determined to subject their ideas to scientific scrutiny face-to-face.
Gordon conferences are some of the world's most prestigious scientific gatherings. Unlike nearly all other conferences, which seek to maximize the number of paying participants, Gordon conferences are generally limited to 100 attendees, all of whom must apply for acceptance. This makes them serious and productive events. All participants get a chance to attend every presentation, and to meet and question every presenter, either during formal Q&A periods, or informally during the social breaks.
Over my 20-year career as a pharmaceutical drug designer, I Îve attended about nine Gordon Conferences, where I have presented papers. Usually those conferences related to my specialty: proteases and the drugs that inhibit them.
Ho Charms Critics
Of the 100 attendees, 90% were American, and 43% were pharmaceutical company employees. I noticed
something new to me at a Gordon Conference: a non-scientist participant, specifically, a representative of Project Inform, a political group devoted to promoting the HIV hypothesis.
The six-day event began on a Sunday. The special opening lecture was given by David Ho, director of NYU Medical School's Aaron-Diamond AIDS Center, and Time's 1996 Man of the Year.
His talk was titled, "Chemotheraphy and Pathogenesis." Surprisingly, I was not the only critic in the audience.
Somebody in the front row challenged Ho's criteria for what constitutes an assay of infectious virus, a challenge that has profound implications for the basic tool of contemporary HIV science: the viral load test. He also disputed the mathematical basis of Ho's "virological mayhem" model, the paradigm upon which HO wants to base "anti-HIV" therapy.
The specifics of these objections were never made clear because Ho sidestepped the questions with the skill of a seasoned bureaucrat, and in doing so chewed up all the discussion time.
Another surprise was an obvious lack of Ho supporters in the audience. In subsequent breaks I found several others who openly rejected the validity of the "viral load" test and Ho's model of HIV/T4-cell dynamics.
Ho could easily become the next Anthony Fauci, who-as Director of the NIH's Institute of Allergies and Infectious Diseases-is the government's reigning king of HIV science. Ho is far more charming than Fauci and is coated with several layers of Teflon. Regrettably, Ho left the conference early Tuesday morning so I never got to talk with him. But I did get to take up the validity of the viral load test with one of his collaborators.
Cocktails Don't Help Patients
Martin Markowitz-co-author on some of Ho's most famous papers, including the 1995 Nature article that introduced the virological mayhem model and popularized the viral load test-stayed through the Wednesday presentations, and I was able to question him several times.
The first instance occurred during the question period of a lecture he gave on treating early HIV infection. He and Ho have been treating a cohort of 20 patients for close to a year with protease inhibitor/AZT cocktails. The study is on-going and no results have been published, so Markowitz was discussing preliminary data. According to him, most of the subjects already had AIDS symptoms at the start of the experimental therapy-including five who'd previously been hospitalized-although a few had no history of symptoms.
Once the therapy began, HIV "viral load" for each patient dropped below the level of detection and has stayed that way, Markowitz said. He considered this an indication that the therapy was a good one.
But did eliminating viral load make the patients healthier? Markowitz had nothing to say about this during his lecture. Surely if the patients had gotten better when their HIV viral load went down, Markowitz would have bragged about it. But the subject didn't come up until I raised it in the question period.
How are we doing? I asked. "Some are healthy enough to work," he said happily. The implication was that were it not for the cocktails, these patients would not be healthy enough to work, but I suspected this was not the case.
Markowitz's smile vanished when I asked, During the 11 months on therapy, when their viral loads were
undetectable, did your patients do better, stay the same, or do worse? He didn't say a word. It was an
embarrassing moment for the audience.
I interrupted the uncomfortable silence by restating the question. Your patients should be doing better, right? Again Markowitz was speechless. He either didn't know how his patients had done over the course of therapy (which is very unlikely) or they were not doing well-despite having HIV "viral loads" of zero. During this revealing silence the lecture was ended by the announcement of a coffee break.
I left with one of my curiosities satisfied: the press accounts of miracles attributed to cocktail therapy-the fabled "Lazarus effect"-weren't showing up in scientific studies.
No Viable Drug-Resistant Virus
Monday and Tuesday afternoons were set aside for poster sessions. Since my paper on the kinetics of HIV protease undermined a crucial aspect of the current dogma, I wasn't sure how my poster would be received.
The paper, "Kinetics Analysis of Consecutive HIV Proteolytic Cleavages of the gag-pol Polyprotein," addressed the popular assumption that when antiviral therapy fails, it is because HIV has mutated into resistant forms (Rasnick, March 7, 1997, Journal of Biological Chemistry). In particular, the assumption that when proteaseinhibitor therapy fails, it is due to the emergence of HIV strains characterized by mutant proteases that are resistant to the inhibitors.
This belief is central to the HIV model. Protease inhibitors, especially when combined with AZT into a cocktail, often cause HIV "viral load" to disappear. When "viral load" counts start going back up or when AIDS symptoms manifest, it is assumed that new mutant strains of HIV have emerged, ones with proteases that resist the inhibitors.
But my calculations show that these theoretical mutant proteases could not be a part of a fully-functioning HIV. In order to produce a fully-functioning HIV, the protease must cut an HIV super protein at eight different sites.
Inhibitors work by plugging-up the protease's cutting site, blocking it from snipping the HIV super-protein into nine functioning parts.
A protease that would not accept an inhibitor into its active site-one that was resistant to the effects of these drugs-would also not be able to accept the HIV super protein into its active site. That the protease has to make eight successful cuts under these circumstances makes it demonstrably impossible that a resistant form could produce functional virus.
I noted that there is not one example in the literature of a human infected with viable, infectious HIV that possesses an inhibitor-resistant mutant protease. All the inhibitor-resistant mutants described so far were obtained from the proviral DNA of non-infectious virus. There was no reason, then, to think that "drug resistance" could explain instances where protease inhibitors failed to resolve AIDS or eliminate HIV "viral load."
The second major point of my kinetics analysis was that since the viral load test at best measures 99.8%
non-infectious viral particles, it should be replaced by an assay that measures the level of infectious HIV particles in blood plasma. I was certain that this proposal would be greeted by a chorus of disapproval. Surprisingly, that did not happen.
No one disputed anything I said. A number of people, including Jack Erickson-an HIV protease expert from the National Cancer Institute-openly agreed with my analysis and conclusions.
Erickson left my poster and walked straight over to Markowitz, who was at the other end of the room. I knew Erickson wanted to discuss with Markowitz the points of my poster, and I went over to join them.
Sure enough, my poster was the topic. Markowitz greeted me with a smile. Perhaps he did not yet recognize me from his earlier lecture. I started asking about the infectivity assay used in the March 1996 article he wrote with Ho (Science 271, p. 1582), which I held in my hand. The paper concerned the administration of cocktail therapy to five patients. Prior to this treatment, the patients had HIV "viral loads" between 12,000 and 643,000 (per ml of plasma). After therapy began, the viral loads for each patient went to zero, and stayed at zero for the duration of the study.
I wanted to know about patient 105, the one who started with the largest viral load, 643,000. He was the only patient for which "tissue culture infectious doses" (TCID) were measured. Prior to therapy-when his "viral load" was 643,000-he had 1,000 infectious doses of HIV (per ml of plasma). Two days after initiating therapy, his infectious doses dropped to zero, but his "viral load" had not dropped below 500,000.
I wanted to know the relationship between the "viral load" figure and the infectious dose figure. I started by asking, Did one "infectious dose" correspond to one infectious HIV?
Yes, Markowitz said, one infectious dose equaled one infectious virus.
How did you determine that an HIV (a "dose") was infectious? By looking for the p24 protein?
Yes, Markowtiz replied. Detection of p24 was accepted as evidence of a fully functioning virus.
Well, I said, p24 is not good enough.
With this, I figured our scientific discourse would proceed along predictable lines. He would ask me why p24 "wasn't good enough." I would explain, as documented in my paper, that p24 has been shown by many researchers, including John Erickson, not to be a reliable indicator of infectious virus. I was prepared with references to defend this statement. But Markowitz didn't bite.
As following his lecture when I had asked about the health of his patients, Markowitz simply said nothing.
I turned my attention to the disparity between the "viral load" and infectious dose figures. If infectious doses equaled infectious HIV particles, then the difference between patient 105's infectious doses and his "viral load" must represent non-infectious HIV particles.
I showed Markowitz the graph he and Ho et al. had published for patient 105. In one case a viral load of 643,000 corresponded with 1,000 infectious HIV particles, and in another case a viral load of over 500,000 corresponded to zero infectious HIV particles. Markowitz agreed with my interpretation of the data.
So I asked him, What was the significance of the hundreds of thousands of non-infectious viral particles per ml that you detected in the blood plasma of patient 105? He frowned, and seemed not to know what to do next. His puzzled look and silence lasted about 30 seconds. Then he simply turned and walked away.
It was the first time a scientist had ever run away from me. Typically scientists are bull dogs. They fight for their position. But the HIV guys don't. They run.
I noticed at this time that Erickson had vanished. He'd slipped away sometime during this strange exchange with Markowitz, and I never spoke to him again.
Were it not for Erickson's devotion to HIV, he and I could have been buddies and colleagues. He is otherwise a sharp scientist who knows enzymes and the technical particulars quite well. Regrettably, though, he yields to the virologists and physicians when it comes to HIV pathogenesis, and he takes his cues from the folks who run the HIV show.
As for Markowitz, I was determined to get an answer to my question. I cornered him two more times. On both occasions I had to literally stop him from walking away. In each instance I repeated my question about the significance of all that non-infectious HIV.
Both times he ran off without answering the question. In the midst of his second retreat he turned and called back with a meaningless response, devoid of even a hint of scientific or logistical merit: "Trust me!" I cried back, "Trust has nothing to do with it!" It was an absurd exchange, and I would have laughed were it not so pathetic.
If I was going to get responses for my remaining questions, I would need a stationary target.
I found one at the week's most frightening session: Wednesday night's special lecture by John Mellors of the University of Pittsburgh Medical Center's Graduate School of Public Health. The topic: "Chemotherapy of HIV-1 Infection: The Past, Present, and Future."
Mellors painted an accurate picture of the dismal history of HIV chemotherapy prior to the current era of protease inhibitor/AZT cocktails. I found myself nodding in agreement as he listed many serious mistakes inherent in traditional therapy, which used a single nucleoside analog, like AZT. Perhaps Mellors was a sensible and independent thinker, the sort I'm used to dealing with at Gordon conferences that don't focus on AIDS.
My hopes were dashed when he got to what he labeled the greatest mistake of the past ten years: treating AIDS patients with single rather than multiple "antiviral" drugs.
That's when it hit me: there was nothing courageous about Mellors's critique of the old therapy. In fact, it's the fashion now to recognize mono nucleoside protocols as flops-so long as cocktail therapy is promoted in their place, which is what Mellors was doing. But the failure of mono therapy was obvious long before protease inhibitors came along.
One Quarter Basketball Game
Mellors's talk assumed its frightening aspect with the appearance of a slide announcing: "viral load" and
T4-counting-rather than clinical symptoms.
He justified this by saying that the recent termination of study ACTG-320 last February put the final nail in the coffin of future clinical endpoint trials.
ACTG-320 was a phase III clinical trial involving almost 1200 people, roughly half taking two AZT-style drugs, and the rest taking a cocktail consisting of those same two nucleoside analogs plus a protease inhibitor. The trial was stopped early for reasons that are unclear.
When the records were unblinded, the data showed that only 8 patients had died in the cocktail group, versus 18 in the group not taking the protease inhibitor. Based on these figures, Mellors and the rest of the medical establishment are saying that cocktail therapy reduces mortality 50% compared to treatment without protease inhibitors.
Mellors regards the results of ACTG-320 as conclusive on two counts: one, that cocktail therapy reduces mortality by half, and two, that this benefit is predicted by "viral load." Studies of future treatments should merely look for fluctuations in "viral load" he believes. Waiting for patients to die-or for other "clinical endpoints" to manifest-would be unethical and unnecessary since "viral load" measurements supposedly predict who will and who won't succumb to AIDS.
But the leader of the trial, Scott Hammer of Boston's Beth Israel Deaconess Medical Center, admitted that
ACTG-320 had not proceeded long enough for differences in the two treatment groups to have reached statistical significance (Boston Globe, Feb 25). In over two decades earning my living as a scientist, I've never before witnessed scientists drawing conclusions of such import based on statistically insignificant data.
The concept of statistical significance is essential to the scientific method. Experimental results obtain meaning only after qualifying as statistically significant. Imagine declaring the winner of a basketball game after the first quarter, or the champion of the World Series after the first game.
Mellors didn't mention statistical significance, and I didn't get a chance to ask about it during discussion time. So I don't know how he might handle this objection, which I consider to be fatal.
Instead, Mellors accepts ACTG-320 as definitive, and sufficient to justify using surrogate markers as the sole criteria of whether or not therapies and drugs actually benefit patients. And he's not the only one. I'm afraid that the mood in AIDS drug research favors Mellors's view. I've heard others call for the end of statistically insignificant results of ACTG-320.
This is particularly frightening considering my earlier exchanges with Markowitz, who could claim no improvement in his patients who'd had their "viral loads" reduced to zero for extended periods of time, and who could attach no clinical meaning to the "viral load" test.
If the Markowitzs and the Mellors of the world have their way, the American public is in grave danger.
In the discussion period of Mellors's lecture, I decided to return to the questions that I'd wanted Markowitz to answer, about the meaning of "viral load." After all, that was the heart of the matter: Mellors's call to discard clinical endpoints was only as valid as the "viral load" figures with which he wished to replace them.
For starters, I wanted to compare his answers to Markowitz's. So I repeated my question about the relation between "viral load" and infectious doses. Mellors responded by proclaiming, "Viral load has nothing to do with infectivity!"
Ah-ha! Now I had a second HIV big shot admitting that the "viral load" figures did not indicate infectious HIV.
Assuming that "viral load" testing accurately counted HIV, and that infectious dose testing accurately counted infectious HIV, I offered my 99.8% figure from the Ho/Markowitz paper as the fraction of circulating HIV that was non-infectious.
Non-infectious HIV, then, is the source of RNA and proteins-including protease-from which the genetics and other characteristics of HIV are derived.
He agreed. (How could he not?)
Now I had him. Since non-infectious viruses have no conceivable clinical relevancy, then neither could any data derived from them.
What's the significance of all the non-infectious HIV? I asked. I had no idea how he could work himself out of this corner, but even I was stunned by his response: "The non-infectious particles [HIV] are pathogenic."
Now here was a first. I don't think that anybody's ever gone on record before proposing that non-infectious virus could cause disease.
I sat there flabbergasted, noticing the murmur that had broken out. In my astonished state I realized there was nothing else to be said.
In the meantime, the session was declared over, the time allotted for discussion having been exhausted by my cross examination, with no one else having had time to pose questions.
My God, I thought. Talk about a rich source of research opportunity. The pathogenicity of non-infectious viruses.
Anybody familiar with the antibody response and the premise of vaccinations can appreciate the revolutionary nature (and implausibility) of this idea.
My sense is that the audience did, given the intense murmuring, which continued even after the lecture had been dismissed. On the way out of the room an Indian scientist grabbed my arm and asked, "Did you hear that?"
Indeed I had. AIDS was caused by a deadly army of viral corpses.
Curing the Healthy
Though I looked far and wide, I could find not a single controlled experiment discussed anywhere at the
conference. It appears that the only thing that exists in the entire world of AIDS is HIV. Anything bad that happens to HIV-positive people is due to HIV; any improvement is due to therapy.
There was even one presenter who took credit for curing people who accidentally pricked themselves with needles tainted by HIV-positive blood. The patients were "aggressively" treated immediately with antiviral drugs, and didn't become positive. The scientist claimed this protocol was what prevented seroconversion one time in a thousand, a fact he did not mention. And neither did anybody else, though this fact is well known, and the attendees were all certified "AIDS expert
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