Editor's note: A major goal at Red FLags is to stimulate broad discussion of issues that are vital to public health. With the following article written by health/science journalist, Stephen Strauss, we hope to continue the debate about the cause of AIDS.
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Occam’s razor, Tolstoy’s blender
And The Tragedy of Haemophiliac AIDS
by Stephen Strauss
I have come to see the “does HIV cause AIDS” dispute as a best-basher-wins-all rhetorical prize fight. In this corner William of Occam. Lightish-weight medieval scholastic, not just best remembered but only remembered for the principle formally stated as "Pluralitas non est ponenda sine neccesitate" or "plurality should not be posited without necessity." The sentiment was enunciated earlier by others but Occam relied on the principle so relentlessly it became known as Occam’s razor.
In the other corner Leo Tolstoy. Bulked up Russian novelist and intellectual heavyweight par excellence. Known for many things, but in this context for the beginning of Book Thirteen Chapter I, of War and Peace. There he writes: “Man's mind cannot grasp the causes of events in their completeness, but the desire to find those causes is implanted in man's soul. And without considering the multiplicity and complexity of the conditions any one of which taken separately may seem to be the cause, he snatches at the first approximation to a cause that seems to him intelligible and says: "This is the cause!"
Think of it as Tolstoy’s blender.
I say this is the core of the dispute because after spending the better part of a week reading through HIV “denialist” and “proponent” debate I am struck with how often the arguments on both sides are both razor-like and blender-like. I think ultimately the denialists have put their brains in a blender and then begun cutting the resultant glob with a toothpick, but before I argue that let me take you to the boxing match.
The denialist approach is likely best summed up in several paragraphs which molecular biologist Peter Duesberg and biochemist David Rasnick, two of the main controversialists, in a review paper published in 2003.
“Why would HIV take 10 years from infection to AIDS? Why is AIDS not self-limiting via antiviral immunity? Why is there no vaccine against AIDS? Why is AIDS in the US and Europe not random like other viral epidemics? Why did AIDS not rise and then decline exponentially owing to antiviral immunity like all other viral epidemics? Why is AIDS not contagious? Why would only HIV carriers get AIDS who use either recreational or anti-HIV drugs or are subject to malnutrition? Why is the mortality of HIV-antibody-positives treated with anti-HIV drugs 7–9%, but that of all (mostly untreated) HIV-positives globally is only 1×4%?,” they write
To this is added a kind retrospective bah-humbug. “Despite its spectacular birthday the HIV-AIDS hypothesis has remained entirely unproductive to this date: There is as yet no anti-HIV-AIDS vaccine, no effective prevention and not a single AIDS patient has ever been cured – the hallmarks of a flawed hypothesis.”(1)
On to this is added more extreme views sometimes by them, sometimes by others. AIDS isn’t really a disease unto itself but merely a lumping together of previous conditions to produce a “group fantasy” and an “epidemic hysteria.” The false premise for the newness of the disease is expressed in the oft quoted equation that “pneumonia + positive AIDS test = AIDS” but “pneumonia + negative AIDS test equals pneumonia.” As well laboratory animals are supposed not to develop any signs of the disease after being infected; HIV tests are too imperfect to be believed - indeed some denialists don’t believe the virus exists at all.
Finally, maybe HIV is just a “passenger virus” not the real cause of any of the diseases which part of the AIDS syndrome.
The proponents of the “HIV virus leads to AIDS proposition” – a group that one must acknowledge includes the vast majority of doctors, researchers and AIDS patients themselves – counter-punch the denialist argument point by point. Other illnesses, shingles for example, takes year to develop after infection Other things – the common cold – don’t have vaccines. Other things, the flu for example, mutate and in so doing resist easy self-limitation. Other things, hepatitis C for example, are passed along through exactly the same blood, body fluid infection mechanisms as HIV. While first generation drugs may have been very problematic, later AIDS treatments have made a big positive difference, with some estimates saying that after the “highly active antiretroviral therapy” regime was introduced in the late 1990s that death rates declined dramatically and equally important older AIDS patients saw a two to four year gain in average life expectancy.(2)
The anti-denialists continue that there are lots of things – cancer for instance – which still haven’t been cured. The problem with animal testing is that many animals – baboons for example - are already infected with an HIV strain. Indeed the virus in baboons is thought to be a vector towards the appearance of a lethal strain in humans. (3)
The suggestion that HIV + illness = AIDS, but illness – HIV = illness is just a word farrago. Many of the AIDS illness hardly existed before. “Prior to the appearance of HIV, AIDS-related conditions such as Pneumocystis carinii pneumonia (PCP), Kaposi's sarcoma (KS) and disseminated infection with the Mycobacterium avium complex (MAC) were extraordinarily rare in the United States. In a 1967 survey, only 107 cases of PCP in the United States had been described in the medical literature, virtually all among individuals with underlying immunosuppressive conditions. Before the AIDS epidemic, the annual incidence of Kaposi's sarcoma in the United States was only 0.2 to 0.6 cases per million population, and only 32 individuals with disseminated MAC disease had been described in the medical literature,” says a CDC report. (4) Now they are found in hundreds of thousands of people.
Moreover, various studies in Africa have shown that HIV-positive people are much, much more likely to die of the same illness as similarly infected HIV-negative individuals.
I neutrally present this verbal boxing match to you and then partisanly pronounce that there is something else in the data, something that is almost never mentioned, that absolutely convinces me personally HIV is the cause of AIDS.
Absolutely convinces.
It is the past and present and future fate of the world’s bleeders, the 1-in-10,000 people who carry mutations that turn them into hemophiliacs. Once they were front and centre in alls discussion of AIDS, 2 per cent of those with the disease, their plight symbolized by the innocent teenage Ryan White whose mere attending of a school sparked mass protests.
Now they are, as one recent newspaper headline put it, “the forgotten victims.” (5)
So forgotten indeed, that if you go the Centre for Disease Control’s website on AIDS and hemophilia it will announce “this site is being maintained for historical purposes, but has had no new entries since October 1998.” The effective obliteration of hemophilia from AIDS-discussion memory is striking, because of the ferocity with which the disease struck.
In the United States life expectancy for hemophiliacs rose from 40.9 at the beginning of the 20th century to 68 in the 1970s after the introduction of plasma derived clotting factor therapeutics. Then in the 1980s a holocaust. Deaths appeared everywhere and life expectancy plummeted to 49 years old, a level it hadn’t been at in 50 years. (6)
This die off was by no means an American phenomena. A British study (7) reported that annual death rate of severely AIDS infected hemophiliacs had rise from .9 per cent a year in the years 1977-1984 to 10 per cent 1993-1996. At the same time it stayed at .9 for those who were not diagnosed as carrying the HIV virus. How this massive differential played itself out in the lives of hemophiliacs was shown in a study of nearly 3,000 AIDS hemophiliacs in the U.S. (8)
I quote verbatim: “For the entire cohort, the life expectancy at birth was 38.7 years, and the median age at death was 35 years. However, when HIV-infected persons were excluded from the cohort, the life expectancy rose to 64.1 years, and the median age at death nearly doubled to 67 years.”
It was horrible but presented the HIV = AIDS theory with a perfect test group. Hemophiliacs’ only common denominator was the blood they needed to take. Accordingly there were no extraneous factors – let us say drug taking – which should effect how the disease played out in large most of them. They were well fed and lived in a relatively disease free zone so that the diseases of the tropics or malnutrition shouldn’t apply to them. But just as important, because they had been treated their whole life and would require to be treated afterwards, death rate statistics would be easy to come by.
If you could rid HIV from the blood they needed to exist, then went the HIV-leads-to-AIDS model, you should eliminate AIDS from future generations of hemophiliacs.
And when it was found in 1985 that heat treatment could render, in the sterile language of medicine, HIV “undetectable” the natural experiment commenced. The results have been jaw-dropping.
“When the heat treatment was shown to be effective in killing HIV. the infections ended. There have been no new infections in the entire western world. People under 18 should lead normal-length lives,” David Page, director of programs and communications for the World Hemophilia Society told me over the phone.
I have to pause here and reiterate what he is saying: The AIDS holocaust amongst hemophiliacs has stopped. Colder than cold. Those born after a certain date don’t get AIDS. Period. Statistics bear Page’s view out. The Centers for Disease Control and Prevention in their 2003 HIV/AIDS Surveillance reports says the estimated number of children fewer than 13 who came down with AIDS between 1999 and 2003 were 0. I should write that number bigger: 0.
Well, could there be something else in their blood, some unknown immunosuppressant that was killing hemophiliacs? This is an argument that Duesberg made in a 1995.(9) Only at roughly the same time blood that was being given for transfusion started being screened for HIV and this “HIV only” screening, produced a similar plummeting in AIDS due to blood transfusions. The estimates are that the number of people infected with HIV from blood transfusions is now vanishingly small – perhaps 1 in every 645,000 transfusions to 1 in every 5,000,000. This correlates with CDC estimates of people getting AIDS from blood transfusions between 1999 and 2003 was 2. That should also be written bigger: 2.
The number should turn to nil in the near future as new tests identify the virus in smaller amounts and during its several week incubation period.
So here is what HIV and hemophiliacs and blood transfusions tell us without an odor of mistake. If you get rid of HIV you get rid of AIDS. Period. Duesberg can twist and spin and try to come up with a mysterious other substance in the blood which might explain AIDS disappearance in hemophiliacs, but the contortions he has to go through would make Occam would spin. Nay, make Occam scream – in Latin – this makes no sense. Shave with my logic razor.
And Tolstoy would scream – in Russian – this makes even no sense to complexity-prone me. Forget my paean to complication, shave with Occam’s razor.
There are things to have a very critical eye about when it comes to AIDS – the much higher likelihood that black Africans and people of African descent will come down with the disease, the apparent inability of people to change their sexual habits even though no change means death, the difficulties of coming up with a vaccine for virus whose make up we think we know.
But the natural experiments on the bleeders and the blood recipients say there is nothing sensible to be said for the HIV denialists.
Nothing.
BIOGRAPHY - Stephen Strauss wrote articles, columns and editorials about science and technology for Canada’s Globe and Mail for more than 20 years. He has also authored three books, several book chapters, and for his efforts received numerous awards. He now writes on a regular basis for CBC.ca. Through all his time in journalism, he still remains smitten by the enduring wisdom of the motto of Austrian writer Karl Kraus. "Say what is."
REFERENCES
- Peter Duesberg, Claus Koehnlein and David Rasnick, “Chemical Bases Of Aids Epidemics” Journal of Bioscience; 28:383–412, June 2003.
- Porter K, Babiker A, Bhaskaran K, Darbyshire J, Pezzotti P, Porter K, Walker. “Determinants of survival following HIV-1 seroconversion after the introduction of HAART.” Lancet. 2003 Oct 18; 362(9392):1267-74.
- Elizabeth Bailes,1 Feng Gao,2,3 Frederic Bibollet-Ruche,2 Valerie Courgnaud,4 Martine Peeters,4 Preston A. Marx,5 Beatrice H. Hahn,2 Paul M. Sharp1, “Hybrid Origin of SIV in Chimpanzees” Science, vol. 300 13 June, 2003.
- The Evidence That HIV Causes AIDS U.S. National Institute of Allergy and Infectious Diseases
- Toronto Star 14 October 2004/ “Forgotten victims” may get Hep C aid; Health minister studying surplus Could help more than 5,000 people.
- http://www.niaid.nih.gov/publications/hivaids/16.htm
- Darby SC, Kan SW, Spooner RJ, Giangrande PL, Lee CA, Makris M, Sabin CA, Watson HG, Wilde JT, Winter M; UK Haemophilia Centre Doctors' Organization “The impact of HIV on mortality rates in the complete UK haemophilia population.” AIDS. 2004 Feb 20; 18(3):525-33.
- J. Michael Soucie, Rachelle Nuss, Bruce Evatt, Abdou Abdelhak, Linda Cowan, Holly Hill, Marcia Kolakoski, Nancy Wilber, and the Hemophilia Surveillance System Project Investigators “Mortality among males with hemophilia: relations with source of medical care.” Blood, Vol. 96 No. 2 (July 15), 2000: pp. 437-442.
- Peter H. Duesberg. “Foreign-protein-mediated immunodeficiency in hemophiliacs with and without HIV.” Genetica 95: 51-70, 1995
