"What God spared Egypt, Americans inflict on themselves" — Dr Harry Meyer, Former Director, National Biologics Laboratory
AIDS is the most political disease of our age. Since the first cases appeared 14 years ago, the epidemic has become a battleground for culture wars, for parliamentary wrangles, and scientific dispute. AIDS has galvanised medical research into a scramble for health dollars. It won celebrity as a human rights cause, as a lawyer's bonanza and as a media sensation. In its short career, AIDS has become the most talked-about, anxiety-laden, fiercely contested, lavishly resourced, and withal the most wept-over illness of modern times. If the prestige of diseases is ranked by the resources allocated for care, therapy development and research, then AIDS is the most prestigious disease ever.
The cause of this tumult is said to be a microbe unknown to science until 1983. Even before its discovery, the powers conferred on the minute entity rivalled archetypal legends of pollution and plague. It was said to be the cause of not one, but three, then 16, then 25 and now today 29 diseases-an unprecedented feat for any microbe in the history of human illness. Like the Greek fates, it gripped the afflicted in its iron maw and dragged them to inexorable doom. As one AIDS patient put it: "I felt that a microscopic junta had seized my body; I was under its command".
The virus, when it was discovered, baffled science. The comprehensive report of the Institute of Medicine/National Academy of Science, Confronting AIDS (1986), may serve as a benchmark. The report stressed that the progress of AIDS science was slowed by the poorly understood, complex interactions of a wide variety of cells that make up the immune system. The report acknowledged that the mechanisms by which HIV depletes T4 cells "remain mysterious".
"Mystery" is the right word, for HIV is a freak that defies the rules of disease causation. With all other infectious agents, the quantities of the microbe greatly increase as the disease progresses to greater virulence. Yet this is not so for AIDS. Not only is there no or little increase in quantities of HIV as the disease becomes more virulent, but high levels of HIV antibodies are present in the terminal stage. How was it possible for HIV to massacre T4 cells without greatly multiplying? In recent years, scientists have increasingly abandoned faith in this etiological miracle. The premier advocate of the HIV/AIDS dogma, Dr Robert Gallo, admitted at a recent conference that his laboratory has never recovered HIV from T4 cells. Yet he, more than any other scientist, produced the conviction that HIV causes AIDS by entering and destroying T4 cells.
The latency period is also a puzzle. The original picture of cell infection shows HIV entering a T4 cell, converting to a provirus, and then going to sleep. This is the kind of thing that thousands of silent microbes do as "passengers" in the human body. But then it wakes up and ravages the immune system. Why does it wake up? This is the problem of "cofactors". At this moment it is a watershed in AIDS science. Those who believe in cofactors argue that HIV isn't quite the lethal agent it has been made out to be. It is a harmless passenger except when Factor X intervenes. The discoverer of HIV, Luc Montagnier, holds this view. He proposes that the cofactor is the bacterium derivative Mycoplasma fermentans, which is implicated in one of the major AIDS defining diseases, Pneumocystis pneumonia (PCP). Danish doctors who controlled Mycoplasma with antibiotics achieved remission from PCP. Since 1992 Montagnier has promoted antibiotic control of HIV by the indirect method of controlling its supposed bacterial cofactor. Robert Gallo, for his part, promotes his newly discovered herpes virus, HHV-6, which infects T4 cells, as a cofactor influencing the differential rates at which HIV+ persons progress to AIDS.
HIV is the only microbe that behaves differently according to the geographic location of its host. In Africa it acts like other infectious agents, attacking male and female alike. But in North America and Europe it is sociotropic, seeking out adult gay men and intravenous drug users. Moreover, the risk factors vary by geography. In Africa they are not receptive anal intercourse and drug use, but parasitic diseases and malnutrition. Reports in the Western press of the horrendous levels of HIV infection in Africa, and the coming "depopulation" of the continent, are based on immunoassay tests whose reliability has been challenged. Professor P.A.K. Addy, Head of Clinical Microbiology at the University of Science and Technology in Kumasi, Ghana, states that
"Europeans and Americans came to Africa with prejudiced minds, so they are seeing what they wanted to see . . . I've known for a long time that AIDS is not a crisis in Africa as the world is being made to understand."
As one wit put it, in Africa the AIDS virus is the Human Rumour Virus.
Management of the epidemic depends on the assumption that the test for HIV antibodies is a reliable indicator of the presence of the virus. Under the Australian definition of AIDS, an HIV+ test classifies patients as Category 3 AIDS. However, scientists at the Royal Perth Hospital argue that the most specific HIV test, the Western blot (WB), is unreliable. The problem, they say, is that cross-reactivity of sera proteins defeats the specificity of the tests. The tests detect HIV in haemophiliacs, leprosy patients and other cohorts who do not progress to AIDS. This view is shared by Philip Mortimer, Director of the Virus Reference Laboratory in London, who states that owing to the want of WB specificity for HIV,
"it may be impossible to relate an antibody response specifically to HIV-1 infection".
This creates an ethical challenge for AIDS case management. Are persons who test HIV+ being told by counsellors that the specificity of the test is in question?
HIV's weird ways as a cell pathogen present a further paradox. Lab data show HIV-associated cell death to be far less than natural T4 cell death. This means that the immune system's normal replacement of normal T4 cell depletion is handily superior to HIV's supposed killing rate. How then does HIV shatter the immune system? Does it work by proxy? Does it, like a small contingent of commandos, trick lymphocytes by changing the surface proteins they use to recognise one another? Are T8 suppressor cells killing off the T4 helper cells? This is the multi-antigen-mediated-autoimmunity (MAMA) hypothesis of Robert Root-Bernstein, which states that a combination of antigens compromise immunity by causing the immune system to turn against itself.
Despite these uncertainties about the microbe's attack on the body, its assault on the mind was immediate, violent, and overt. The purple splotches that are the first signs of Kaposi's sarcoma triggered anxiety and depression among gay men. The need for crisis counselling was quickly recognised; today crisis counselling is a major part of AIDS care. The warning sign from 1985 was not symptoms but the results of HIV immunoassay tests. Test results are so dreaded that counselling is made available before and after the test. By 1988 AIDS counsellors had identified a syndrome that they called AFRAIDS. It affects people who believe that they have the virus although they test negative. Their symptoms mimic seroconversion symptoms of weight loss, night sweats, and diarrhoea. A positive test result is usually interpreted as a death sentence of uncertain execution date. In awarding three haemophiliac boys compensation against the Commonwealth Serum Laboratory and the Australian Red Cross, Victorian Supreme Court Justice Ashley told the boys that $1 million compensation
"might not seem a great amount of damages for someone who, without any fault of his own, has received a premature death sentence".
The attack on the mind is not limited to affected individuals and their loved ones. Effects on communities began in 1981 as an alarm cry among gay activists and infectious diseases scientists. This handful of men and women recognised a mission to warn gay men of an awful threat stemming from their lifestyle. At first they were shouted down. As Randy Shilts describes in And the Band Played On, the gay press denounced the idea of a "gay plague" as yet another bout of self-hatred among gay men, in league with heterosexual disgust with the gay lifestyle. The battleline was drawn at bathhouses. The "alarmists" wanted them promptly closed. Closure would slow transmission of the infectious agent while having the educative effect of alerting gay men to epidemic danger. Yet bathhouses were a symbol of gay liberation, and the bathhouses experience was interwoven with gay consciousness. To allow public health officers to close the bathhousess was to endure a mighty defeat to gay power. The alternative course-that the gay community should take the initiative in their closure-would be a public retreat from gay liberation. Three years of struggle passed before bathhousess were closed. In that period gay consciousness reacquired inhibitions that had been discarded.
Next it was the turn of heterosexuals. The media took scant notice of AIDS until 1984. The turnaround event was the announcement, in April, that government scientist Robert Gallo had discovered the viral cause of AIDS. The high level press conference convened by Health and Human Services Secretary Margaret Heckler made world headlines. Public belief that AIDS is a viral epidemic may be dated from that moment. Gallo's virus gave credibility to the speculation that blood-products from blood banks may be contaminated. Blood suppliers moved quickly to implement costly procedures to ensure blood product safety. However, according to Shilts, the public were finally convinced of the reality of AIDS only when the film celebrity Rock Hudson was stricken and died in 1985. Hudson, a closet gay, was for most fans the epitome of heterosexual romance. That paradox somehow communicated the message that AIDS was a threat to heterosexuals. It made a large impact on President and Mrs Reagan, who had long been friends with Hudson. From that moment, the previously silent White House gave its blessings to the war on AIDS. Funding shot up from $61.5 million in 1984 to $766 million in 1987 and $1 billion in 1988.
By 1987, media reporting on AIDS and safe sex education had penetrated the consciousness of most sexually active men and women. The US Surgeon General summed up the effects of the massive campaign by declaring that "AIDS has killed the sexual revolution". There were many signs prior to AIDS that the balmy days of user-friendly consumer sex were in eclipse. Playboy Clubs-those heterosexual bathhousess-closed throughout the world; the Playboy empire narrowly missed collapse. Signs of sexual anxiety were ubiquitous. Rape and child sexual abuse became a media obsession. And the first cases of child sexual abuse remembered in adult years came to light. Called today the "false memory syndrome", it is a highly contagious therapeutic suggestion expressing unresolved conflicts about sexuality. Also to be counted in the toll of anxiety is the adoption, in the last decade, of rules against sexual harassment and sexist language. Casual relations between women and men that permitted touching and frank expression of desire were out, together with mini-skirts, cleavage, and one-night stands. That working class amusement, wolf whistles from construction sites, were out; good manners and baggy clothing were in.
The HIV virus also vexes the minds of scientists. I have mentioned their perplexity about its strange ways as a disease agent. They urgently called for and obtained massive research funding that today enlists about 10, 000 scientists who produce 7000 publications per year. Despite this surfeit of truth, there exists no article that critically reviews the evidence for HIV's destruction of cells and demonstrates that such destruction creates "opportunities" for diseases as diverse as dementia and tuberculosis. The cry of helplessness was sounded last year by Science in reporting findings of the 9th Annual World AIDS Congress in Berlin. In noting that neither a cure nor a vaccine was remotely on the horizon, the editorial stated that "the more rapidly knowledge of the disease accumulates, the faster assumptions that seemed solid a year ago begin to crumble". This means that the taxpayer is funding more research so that less will be understood.
This mirage is not the only sign of the AIDS virus' assault on the mind. The identity of the virus has been the source of confusion, law suits, and recriminations. For two years, AIDS science accepted that three viruses caused AIDS-Gallo's human T-cell lymphotropic virus type III (HTLV-III), the Pasteur Institute's lymphadenopathy-associated virus (LAV), and Jay Levy's AIDS-associated virus (ARV). Although there was much rejoicing that the viral agent had been found, which was it exactly? Gallo and Montagnier, ardent for the Nobel Prize, fought for acceptance of their respective discoveries. In 1986 an international nomenclature committee decreed that Gallo had erroneously classified his virus as an HTLV type. It belonged instead to the same viral family as the Pasteur Institute's LAV. Jay Levy's ARV was also deemed to belong to the LAV family. The committee made a fresh start by naming the AIDS virus "HIV" (human immunodeficiency virus). Gallo strongly protested this decision. He maintained that LAV was a laboratory contaminant, and that the mechanism of the viral cell damage was inextricably bound up with the HTLV type of viral activity. Montagnier, on the other hand, maintained that Gallo's virus was pinched from a sample of the virus that he had sent to Gallo.
Thus the rival architects of AIDS science attributed delusion to one another, and AIDS science was stuck with the embarrassment of two or three AIDS viruses.
More of this was to come. Once the technique for HIV isolation was developed, the hunt was on. In 1986 Montagnier's group isolated a variant, HIV-2. The patient had not come from an AIDS region of Africa and he produced no antibodies to HIV-1. On the other hand, HIV-2 was also found in a group of prostitutes who were free of AIDS. In 1987 the laboratory of Myron Essex found HTLV-IV, Gallo found HIV-3, and a Swedish laboratory discovered HTLV-V. The relationship between these strains of AIDS viruses, and their causal relation to the disease, is a matter of speculation.
In 1987 another mirage appeared on the AIDS battlefield. Writing in Cancer Research, Peter Duesberg undertook a detailed examination of the evidence adduced to support the belief that HTLV-I causes some types of leukaemia and that HIV-1 causes AIDS. He concluded that the evidence in both cases was suppositious and in conflict with basic rules for infectious diseases. He made the point mentioned above, that the quantity of HIV in AIDS patients is far less than what is required for infection. The titres of HIV in AIDS patients varied from 0 to 100 particles per millilitre. By contrast, titres of other infectious agents must reach billions or trillions per millilitre before they become pathogenic. Duesberg also cited rigorous laboratory work to recover HIV from the T cells of AIDS patients. In a sample of 91 patients, three had no HIV. This was proof, he claimed, that HIV is not a necessary condition for AIDS. This was a serious criticism from a serious source. The discovery of reverse transcription by Howard Temin and David Baltimore won them the Nobel Prize because of the significance attached to the reverse transcription ("retro") process, in which an RNA virus converts itself into a DNA provirus. The discovery stimulated speculation that reverse transcriptase might be the mechanism of virus-induced cancer. Duesberg was among the young scientists who bought a ticket on that train (Robert Gallo was another). He led the race by elucidating the genetic nature of the retrovirus family and mapping the three key genes gag, pol and env.
There is nothing inherently implausible about Duesberg's criticism of the evidence for HIV causality. The progress of science is littered with the bones of false starts and superseded theories. One such belief is that the reverse transcriptase enzyme is something special. It isn't. The enzyme is natural to the human genome. When Duesberg's criticism is combined with the Royal Perth group's theory of cellular oxidative stress, and their criticism of immunoassay tests, a comprehensive view of the foul-up and the right road ahead emerges. It is this. AIDS diseases are not viral. They are caused by introduced toxins. The indicated therapy is to use reducing agents to halt the oxidisation of cells by these toxins and prevent further introduction of them.
At first Duesberg's alternative attracted notice from the scientific press as a startling case of a talented scientist who had run afoul of orthodoxy. The truth managers-influential journal editors and heads of institutes-branded him pariah and he was ostracised by colleagues. The Royal Perth group didn't get a hearing at all.
This is odd. Faced with what they said was the gravest health crisis of the century, the AIDS establishment did not do what rational method would seem to suggest: to investigate the alternative hypotheses with all vigour. The opposite happened: the alternative case was cast aside as "lunatic".
A clue about why alternative hypotheses are dismissed emerges from a recent book. In The Plague Makers: How We Are Creating Catastrophic New Epidemics-And What We Must Do to Avert Them, Jeffrey A. Fisher, MD, argues that the mass prescription of medical drugs, particularly antibiotics, contributes significantly to viral overload and/or immune suppression, which in turn multiplies the incidence of illness. He points out that doctors have created plagues in hospitals. In the US there are two million hospital acquired infections annually, resulting in a mortality of 80,000. That is three times the annual mortality from AIDS; yet the medically induced epidemic is scarcely noticed. This is only one item in a long list of sicknesses, side-effects and injuries acquired from doctors and clinics. Seeing AIDS as a calamitous plague expresses this predicament allegorically. It tells the story of doctors wounded by the failure of their healing art, and distressed by the half-conscious sense that modern therapeutics may abet sickness and suffering. We may call this predicament the Acquired Anxiety Syndrome.
The signs of this Syndrome are the daily diet of newspapers. There is incessant reportage of the aggression, mayhem, litigation, suffering, misunderstanding and politicking that occur in the health arena: incorrect surgery; misdiagnosis; a drug that killed or maimed; a host of diseases transmitted in hospitals and through blood banks; large compensation payouts for an IUD or silicone implants; therapeutic advances that prolong chronic illness; disputes about the causes of illness and the effectiveness of therapies; client disaffection about waiting lists; abuse in psychiatric wards; the revolt of women against reproductive technology; patients abusing doctors for saving a life not worth living; disability groups attacking initiatives to eradicate heritable diseases; spiralling health care costs; $7 million spent by the NSW Medical Tribunal to strike one doctor from the lists; health managerial reforms to control of "outcomes"; a panel commissioned to steer the health minister out of a tight spot.
Earlier this year, a New South Wales court awarded Rhonda O'Shea a large settlement because it found that her doctor and the pathologist had been negligent in failing to diagnose indications of cervical cancer from a Pap smear. Expert testimony given to the court revealed that the false positive and false negative rates of Pap smear are a "closely guarded secret". The secret is being kept from patients like O'Shea who, if they had the information, might follow her example:
"I want to make clear to people that just because their doctor says something, it is not gospel . . . what I have learned is to take the issue into my own hands".