Monday, February 13, 2012

The cost of denying HIV/AIDS.

The Italian Journal of Anatomy and Embryology is down an editor after publishing a paper that denies the causal link between HIV and AIDS. The paper calls for "a reevaluation of the HIV-AIDS hypothesis and of the prescription of anti-viral drugs to HIV antibody-positive subjects."

Peter Duesberg of UC-Berkeley is the lead author of a controversial paper published in December.

HIV/AIDS denial seems especially bizarre to the twenty-somethings (re:me) who have spent a lifetime knowing about helper T-cells and the cunning little virus that has figured out how to hijack them. To hijack us.  But denial comes in many flavors. Some blame their treatment regimens for AIDS-related illness, pointing to the isolated toxicity of anti-retroviral drugs. Of course, sometimes the best treatment defies intuition. Chemotherapy, for instance, takes blind aim at its enemy and makes patients sicker so that they may get better.

Others believe, still, that AIDS is a moral disease tied to drug use and reckless behavior. There is not much to say to this, except that this argument is the unsettling minority even within the larger minority of HIV/AIDS denial community. 

All of these skeptics demand clearer proof that a connection between HIV and AIDS exists --even when the proof is overwhelming, even when years and pages of evidence spill out of books on the topic.

WHO statistics of the AIDS epidemic as of 2010. 

This quest for proof where proof exists has always struck me as very curious. The MMR autism controversy and subsequent antivaccination movement, at least, involves fear of a condition that has no pinpointed cause. Here are concerned parents grasping wildly for explanation, any explanation, as to why their child should have to live with autism.

If there is a triumph of the AIDS epidemic, it is that we have found an explanation, tested it, and accepted it. We have moved on to develop treatments for HIV, then better treatments. We have even launched elaborate crowd-sourcing efforts to find the best treatments from whoever can provide it. As a result, HIV/AIDS has lost some of its fury as an acute condition with a quick death sentence, and HIV+ patients are living longer than ever before. In context, things are going fairly well. What reason is there to deny the link to HIV that sparked all the progress in effective AIDS treatment --the only link that makes sense to the mainstream scientific community? 

I read through this paper, and it seems silly more than anything. An incomplete WHO table of reported South African AIDS deaths appears as a figure, in which Duesberg offers the empty data cells as proof of his sincere efforts to find the truth. It reads like a half-hearted shrug; "Hey, I tried."

Perhaps the grossest statement of all is the one in which Duesberg refutes the estimated 300,000 preventable deaths that occurred in South Africa after President Thabo Mbeke, also not convinced of the link between HIV and AIDS, banned the distribution of anti-retroviral drugs in public hospitals. Instead, Duesberg suggests that lives were saved by Mbeke's policies.

The publication of this article has caused a stir, and it prompts us to question what place we will allow skeptical beliefs to have in our scientific community. What happens when the proponent of a radical belief is a respected molecular biologist teaching at UC Berkeley and a member of the United States National Academy of Sciences? What is the public to think, when journals occasionally offer equal space to these papers?

I don't have any easy answers to offer. But skepticism will always have great bioethical implications when it involves health policy. It is a debate that rages on for now.

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