The End of Aetiology

Printer-friendly version

Copyright 1999 The New Republic, Inc.
The New Republic

The River: A Journey to the Source of HIV and AIDS
by Edward Hooper
(Little, Brown, 1070 pp., $35)

Virus
by Luc Montagnier
(W.W. Norton & Company, 249 pp., $24.95)

Jerome Groopman is the Recanati Professor of Medicine at Harvard Medical School. His new book, Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine, will be published by Viking next spring.

I.

The story of the AIDS epidemic has been told many times from many vantage points--biological, clinical, sociological, psychosexual, economic, geopolitical--and in the many voices of its protagonists--clinicians, laboratory scientists, epidemiologists, people with HIV, activists, journalists, public health officials. The multiplicity of perspectives and personae notwithstanding, each rendering of the disaster discloses in its way the magnitude of the suffering that has been caused by this pandemic, and the continued threat that it poses.

AIDS was first recognized in 1981, in Los Angeles and New York. Dr. Michael Gottlieb, a clinical immunologist at UCLA, informed the Center for Disease Control in Atlanta that unusual infections, such as Pneumocystis carinii pneumonia, were occurring in a handful of previously healthy young gay men. Dr. Alvin Friedman-Kien, a dermatologist at NYU, reported to the same federal agency on the appearance of a rare cancer, called Kaposi's sarcoma, in a similar population of young male homosexuals. All these affected men had impaired immune defenses. It took some three years until the cause of their immunodeficiency was identified as HIV.

Taxonomically, HIV is a retrovirus, that is, a type of virus whose genes are composed of RNA, and then "reverse transcribed"--copied back--into a DNA form upon entering a susceptible blood cell. After this reverse transcription, the viral DNA permanently integrates itself into the DNA of the host cell, generally a T-cell or macrophage. (T-cells and macrophages are types of blood cells that are essential to immune defense.) This means that once you are infected with HIV, you are infected for life. Over time, the virus eats away at the host immune system by destroying helper T-cells and disarming tissue macrophages. Since those are the cells that protect us against fungi, TBlike bacteria, herpes viruses, and cancers such as Kaposi's sarcoma and B-cell lymphoma, their loss causes us to fall prey to these infections and these tumors.

What gottlieb and FriedmanKien observed as a medical oddity in 1981 is now the second most common cause of infectious death in the world, just behind influenza and respiratory illness. Significantly, in industrialized countries the death rate has sharply declined over the last two years, due to the introduction of anti-HIV protease inhibitors. These agents were developed in part through rational drug design, an approach that wedded high performance computing with a three-dimensional representation of the desired target. In the case of HIV, the 3-D topology of its critical protease enzyme was deciphered; and computers screened drugs in a virtual format to see which agents docked on the surface of this target enzyme and would prevent it from working. Six different anti-viral drugs were developed by this method.

Those drugs have restored countless sufferers to a better quality of life and staved off what previously was a steady decline to death. How long the protease inhibitors will work, and for how many, is an open question. As with all anti-microbials, the bug mutates and develops resistance. Moreover, the protease blockers are cumbersome to take, and in some people they have significant side effects, such as diarrhea and lipid deposition in the abdomen and neck. Emerging viral resistance and drug toxicity make the quest for new and better treatments all the more urgent; but it is unarguable that the death sentence of AIDS has been stayed for many in the West. In developing countries, however, the situation continues to be grim. In nations with yearly per capita expenditures of a few dollars for health care, the protease inhibitors are too costly to be distributed, and the death toll climbs unchallenged.

Strategies aimed at the prevention of HIV have not been as successful as those aimed at its therapy. The prospects for a vaccine are still remote, given the wide antigenic variability in strains of the virus as well as its capability of mutating quickly to escape the grip of the immune system. Educational efforts have clearly had an impact, manifest in the reduction of sexually transmitted diseases both in the gay and heterosexual communities. There is appropriate concern about "slippage" in adherence to safer sex practices, particularly among the young, but the message about AIDS and condoms and needles continues to be forcefully articulated from high school hygiene classes to MTV. Funding for HIV research remains a priority within the National Institute of Health. Pharmaceutical and biotechnology companies see HIV as a lucrative target, given the need for lifelong daily anti-viral therapies.

Discussion also continues over the means to best combat the disease: how to effectively educate different risk groups about the threat; how to coordinate intellectual and material resources to generate new and more potent therapies; what breakthroughs are needed to create the long-elusive vaccine; whether drug companies have a moral obligation to provide expensive therapies to indigent developing nations. AIDS activists press for better distribution of drugs and information, and question the profit margins made by the pharmaceutical companies, and hector candidates who do not support subsidies for treatments in the developing world. In general, the activists have effected significant changes within both governmental and corporate structures. People with AIDS and their advocates are integrated into the decision-making process in the White House, at the NIH and at other governmental agencies, and they are often consulted by the drug manufacturers about the distribution of products in the affected communities.

II.

It was to be expected that some would reject the mainstream view--which is to say, the scientifically warranted view--of the AIDS epidemic and the progress made to date, and produce manifestos and books of historical and biological revisionism. Peter Duesberg, a professor of biology at Berkeley, is a prime example. He is the champion of the contrarian position that HIV is really an epiphenomenon, an innocuous fellow traveler, and not a pathogen. Duesberg contends that the immune system of AIDS victims collapses because of the destructive effects of excessive sex and illicit drugs, and the toxicities of anti-HIV agents, such as AZT.

Duesberg's view is simply not supported by the facts. First, HIV acts as a pathogen in vitro, readily destroying T-cells in the test tube. Second, people who were sexually conservative and did not use illicit drugs--such as health care workers who suffered needle sticks while caring for AIDS patients- -contracted HIV and developed immune deficiency. Third, there is an animal model of AIDS: monkeys carry related retroviruses known as simian immunodeficiency viruses, or SIV. Pure SIV inoculated into chaste monkeys produces AIDS-like immune collapse. And most dramatically, the therapy of people with AIDS by means of anti-HIV protease inhibitors causes a dramatic reduction in virus production and consequent restoration of immune function.

Given these forceful observations at the lab bench and the patient's bed, the Duesberg hypothesis is touted by fewer and fewer people. But there has been also another non-mainstream theory about AIDS, a theory that was aired and largely refuted, and is now resurrected in Edward Hooper's tome. Hooper re-visits the scenario that HIV entered the human population by means of contaminated lots of oral polio vaccine. This is said to have occurred during the widespread vaccination efforts in Central Africa in the late 1950s. Hooper is not a crank. He accepts HIV as the etiology of AIDS. He distances himself from the Duesberg nonsense, as well as from the fringe that in the past pursued scenarios about the origins of the virus in Caribbean pigs, secret military biological warfare, or a plot to wipe out homosexuals. Instead Hooper takes up the cause of a few journalists and medical researchers who focus on a colony of chimpanzees in the Congo in 1957-1958.

Now, the chimps might have been carrying a strain of SIV, the simian cousin of HIV. The SIV isolates known so far are not pathogenic for chimpanzees, but they could be pathogenic upon infection of humans. The oral polio vaccine hypothesis posits that kidneys were harvested from SIV-infected chimpanzees; and these kidney cells may have been used for cultivation of polio virus by Hilary Koprowski at the Wistar Laboratory in Philadelphia to make vaccines. The SIV-contaminated oral polio vaccine from Philadelphia may have been given to Africans in the Congo in the late 1950s. The chimp SIV strain then could have genetically evolved into what we know now as HIV. All of this is possible. None of this is proven.

The mainstream scenario subscribed to by AIDS researchers is that a chimpanzee SIV was indeed the progenitor of HIV, but that the transmission of these chimp viruses occurred via blood contamination of Africans: as uncooked meat in the diet or during butchering accidents, when chimpanzee blood may have entered open cuts. Yet Hooper refuses to endorse these quotidian routes of transmission, and becomes the prosecuting attorney for an iatrogenic, or medically caused, case.

When I first learned of the OPV/AIDS theory in June 1992, I had been investigating theories of origin for more than two years. Suddenly, here was a more plausible explanation than any other I had come across, but I was still far from convinced. However, when further research consistently pointed to the same conclusion, I found, after several years, that I was starting to describe myself as "more than 90 percent persuaded" on the basis of the steadily accumulating stream of evidence. ... But how is it that so many of those who should have been searching ... the virologists and vaccine-makers, the molecular and evolutionary biologists, even the epidemiologists -- have failed to do their job?

There seem to have been several factors at play. First, most of them were not on the field trip: they were busy in their labs, peering into microscopes (or preparing grant applications). Second, there have been so many crackpot hypotheses of origin, so many silly and spurious conspiracy theories, that many observers became jaded and skeptical about iatrogenic theories per se. Third, many of those who had followed the controversy at a distance had read Koprowski's reply in Science, or heard about the Wistar expert committee's negative report, and had assumed that the matter had been laid to rest, that another theory had crumbled when subjected to the fierce light of scientific examination.

But possibly there was a fourth reaction too--one involving protection of the profession and fear of peer reaction. Because, if the OPV/AIDS theory was proved to be true, then the implications--and likely repercussions--were almost too awful to contemplate.

Some, the virologists and vaccine-makers, might feel that the theory could turn people against vaccines in general. Some, like primatologists, might be concerned that it would lead to awful retribution against African primates-- especially chimpanzees. And some--those in certain institutions and pharmaceutical companies, or public health departments--would simply have dreaded the glare of unwanted publicity. Beside, they may have felt, why should they be held responsible for mistakes that occurred forty years earlier?

Before we assess Hooper's musings on the "awful" consequences, let us first examine the oral polio vaccine hypothesis. Hooper is 90 percent persuaded of its truth. Where is the remaining 10 percent? He doesn't exactly say, but the rest of the evidence, I suppose, is direct rather than circumstantial: the fingerprints on the smoking gun. Just as DNA fingerprinting is a powerful tool in criminal cases to nail down the perpetrator, so DNA fingerprinting is used in virology to determine the identity of pathogens. In this instance, however, the fingerprints of the chimpanzee SIV and the fingerprints of the earliest isolates of HIV do not match. They are too dissimilar to posit that SIV contaminating an oral polio vaccine moved into man and became HIV.

Or, to put it another way, SIV has an alibi. Hooper imagines it at the scene of the crime--widespread oral polio vaccine distribution--but it is too far away to be the culprit. Its exculpatory distance is measured in the rate of genetic change of these retroviruses. The first known HIV strain comes from a man in the Congo in 1959. It would take twenty to forty years, at a minimum, for the known chimpanzee SIV to evolve into the human Congo HIV in 1959, and thus acquire similar DNA fingerprints. But the oral polio vaccine was made in the United States, and then distributed in the Congo, in 1957-58. The fingerprints of the chimp SIV do not match the fingerprints of the African HIV. And there is no evidence that the chimpanzee SIV changed into HIV within the chimp, before allegedly being passed into a human. No jury would convict.

There are other problems with the prosecution's case, albeit less directly dismissed. Kidney cells themselves are not supportive of growth of either SIV or HIV. Blood cells, specifically T-lymphocytes and monocyte-macrophages, are the sites of virus replication and release; and T-lymphocytes and macrophages require complex conditions to spawn HIV and SIV. (Indeed, one of the major hurdles in the study of HIV after it was first found at the Pasteur Institute was the difficulty in producing the virus in tissue culture; only after the NIH group identified permanent T-cell lines that resisted the destructive properties of HIV could the virus be produced in significant quantities.) Thus, it is unlikely that chimpanzee kidney cell cultures, even if they were contaminated with a few blood cells, could be the source of much retrovirus.

These retroviruses, moreover, are relatively fragile, despite the devastation they cause within the host. Their exterior protein shells are easily broken, rendering the virus inactive. So the survival of a miniscule amount of chimp virus in the few T-cells or macrophages that might contaminate kidney cell cultures is difficult to envision, particularly given the shipment of the tissues from Africa to the Wistar Institute in the United States, and then back to Africa.

Much to hooper's credit, he repeatedly acknowledges that the evidence supporting the oral polio vaccine hypothesis is entirely circumstantial. He states that it is actually not known whether chimpanzee tissues were used at the Wistar Institute by Koprowski's team for manufacture of the Congo vaccine. Also, none of these SIV retroviruses were found in European polio vaccine lots. As for the lack of matching DNA fingerprints, given the slow rate of evolution of chimp SIV into Congolese HIV, Hooper raises the question whether there might be accelerated genetic change when a new pathogen (like SIV) first enters a naive host (like man).

But there is no clear precedent for this, which rather enfeebles the idea. In fact, healthy researchers handling SIV-infected monkeys who became infected themselves, did not show such accelerated mutations in the simian virus. Similarly, sexual partners or transfusion recipients who contract HIV were linked to the source of their infection--the sexual contact or blood donor--by similar DNA fingerprints. The virus did not change its gene make-up so radically in a short interval. I am unaware of a deviation from this paradigm in the countless published studies of retroviral transmission.

Writing about Hooper's book in The New York Review of Books, Helen Epstein recently addressed the issue of how a monkey virus such as SIV could evolve into HIV. She cited the work of Dr. Opendra Narayan, a researcher in the University of Kansas. "I ... agreed with Hooper's view that AIDS just didn't look like an old African disease," Epstein observed. "It looked like HIV had crossed from primates to people quite recently.

... I discovered that Narayan had actually succeeded in turning an apparently harmless monkey virus into an AIDS virus in his own laboratory.

Narayan works with a genetically engineered virus called a SHIV (simian human immunodeficiency virus), which is a version of HIV that is used to infect lab monkeys. This SHIV grows in monkeys but does not cause disease in those monkeys, and it is not passed to other monkeys through sex, biting, or other natural means. However, this SHIV can be passed from one monkey to another artificially in laboratories, for example through blood transfusions or through bone marrow transplantation. If the SHIV is transmitted artificially from one monkey to another rapidly enough, through a process known as "passaging," it can turn into a virus that spreads easily and causes AIDS in monkeys.

Something similar may have happened with HIV. If a hunter or monkey-meat butcher became infected with a harmless monkey virus and then shortly afterward passed it on to someone else, who then passed it on to someone else in a few weeks later, it is possible that the monkey virus might have turned into HIV.

Epstein's interpretation of Narayan's work on SHIV, to argue for a short time-frame of SIV evolution, betrays a lack of understanding of the underpinnings of the experiment. SHIV is a chimera, an artificial product of genetic engineering whereby large pieces of a clone of the human virus HIV are grafted in the laboratory into the backbone of the monkey virus SIV. SHIV does not exist in nature, in monkeys or in man. It is not "a monkey virus," but something akin to a griffin or a minotaur. Its genetic elements would not arise through the normal course of transmission from primates to man. SHIV is not a precedent for a "harmless monkey virus" turning into HIV in "a few weeks"; it is, rather, a hybrid creation that can only be spawned in a test tube. And it is a sign of Hooper's probity in his lay analysis of the scientific literature that he does not make the error that Epstein does.

And so, after 843 pages of often vivid and flowing prose about the AIDS epidemic and its social impact, and the parallel stream of circumstantial evidence, Hooper prudently makes his closing arguments not for conviction but for further research studies to settle the issue. But those studies are relatively simple: they would consist in an examination of the records of production of the accused oral polio vaccine lots to see if they were made from virus grown in chimpanzee kidneys, and in rigorous assays of any remaining stocks of vaccine, for DNA fingerprints of either chimpanzee SIV or Congo HIV. Such studies would take little time and would consume scant resources. If the Wistar group chooses, it can respond with the data to solidify their previous published rebuttals.

As to hooper's listing of potential repercussions as "almost too awful to contemplate," he underestimates the merciless ethic of scientific inquiry. The vast majority of scientists pursue the truth regardless of where it leads and whom it offends. The falsification of data, and the suppression or neglect of experimental results, could not be sustained in the research community. A worldwide cover-up abetted by hundreds or thousands of researchers is almost impossible even to imagine, except in pulp fiction.

Indeed, the best researchers relish challenges to dogma and encourage contrarian views. They are eager to wrestle with opposing data--so long as the struggle is on a plane of rationality, and the contest is played by the rules of the scientific method: cause and effect and reproducibility of results. I am of the opinion, obviously, that the oral polio vaccine hypothesis is incorrect; but I would change my mind if I were provided with solid experimental data that verify it, and under those intellectual circumstances I would have to accept that genetic evolution of retroviruses can be radically accelerated under certain conditions. And every scientific colleague I know who is dedicated to authentic inquiry would respond in precisely the same way. This is not an idealistic picture of how science works; it is a realistic picture.

Hooper is anxious that some people would be turned against vaccines in general, but surely not a greater number of people than those who now debate the safety and the need for vaccination, particularly among children. The weight of expert opinion in public health is strongly on the side of vaccines, invoking their great value in preventing past scourges such as polio, measles, and diphtheria. If forty years ago a lot of oral polio vaccine was contaminated, then let us know it, and let us safeguard all current vaccines, and use the knowledge wisely in the development of future vaccines.

As for the rampant slaughtering of primates, especially chimpanzees, as an act of revenge, this is a bit farfetched. It is already widely accepted in the scientific community that African primates are the reservoir of this family of retroviruses, and that SIV was transmitted to man in Central and West Africa and evolved into HIV-1 and HIV-2. The oral polio vaccine hypothesis does not make the animals more culpable--since no one sees them as "responsible" now for the pandemic.

What about the "glare" of unwanted publicity for universities, pharmaceutical companies, and public health departments? Surely none of them enjoys being trapped in such a spotlight, but all of these institutions have matured greatly, and surely they know that cover-ups bring only calumny, in the end, and nothing like a frank and open articulation of error, particularly error that occurred four decades ago. In sum, my bet is strongly against Hooper's hypothesis.

III.

Luc montagnier's book carries us away from hypothetical scenarios of the iatrogenic origins of HIV, and back to the actual historical record of the discovery and the spread of HIV. Montagnier, of the Pasteur Institute in Paris, as well as Queens College in New York, is largely credited with the discovery of HIV. He has produced a book that is part autobiography, part personal musing about the events surrounding the early days of AIDS, and part primer on AIDS biology, its clinical manifestations, and its treatment and prevention.

A good deal of Montagnier's book is devoted to the scientific and nationalistic competition that marked the discovery. Teams of scientists around the world were racing to identify the cause of AIDS. The epidemiology of the disease, which is spread by sexual contact, intravenous drug use, and blood transfusions, made an infectious etiology likely. Since T-cells were lost in afflicted patients, it was presumed that the microbe had a tropism for these cells. Most laboratories, therefore, sought to isolate the remaining Tcells from people with AIDS and to examine them, in tissue culture, for evidence of a new pathogen.

The obstacle proved to be the complexity in successfully propagating T- cells outside of the body, particularly in the presence of a destructive microbe that caused their rapid demise. Montagnier's group at the Pasteur Institute secured a lymph node from a man with the disease and succeeded, short term, in propagating the T-cells from this node. Using sensitive and specific assays for enzymes unique to retroviruses, the Pasteur group provided the first evidence that the T-cells harbored a new human retrovirus, which they named LAV. Pictures of the LAV retrovirus were taken, using an electron microscope, and its morphology resembled that of so called lentiviruses, or slow viruses, which were known to cause disease in horses and sheep. Yet the Pasteur group was frustrated in its effort to produce enough of this novel virus for more detailed characterization.

Meanwhile robert gallo at the NIH was also culturing T-cells from blood and lymph nodes of people with AIDS. He had long worked on techniques to grow T- cells, and had developed in his laboratory so-called permanent cell lines, or immortalized T-cells that grow in a relatively autonomous fashion. Gallo reasoned that these hardy T-cell lines might be able to support the AIDS retrovirus without being destroyed by it. He requested a sample of the novel virus isolated by Montagnier's laboratory, and (so the story goes) a researcher in Gallo's group, Mika Popovic, succeeded in making the French virus grow on the NIH's immortalized T-cell lines. As Montagnier recounts:

He Popovic was about to characterize it and notified Robert Gallo of this, but was told to keep silent. When ... Popovic called me ... he was careful not to tell me that he had learned how to cultivate our virus on a continuous cell line, and only laconically remarked: I know how to grow your virus.

In late March of 1984, Robert Gallo telephoned me to say he had isolated a new virus that was growing very well. ... In his opinion, it was the AIDS agent. Had he compared it with LAV the Pasteur virus ? I asked. I could not hear the answer.

In fact, the primary isolate grown in the NIH laboratories that was to be used in the lucrative HIV detection tests ultimately proved to be the Pasteur virus, which presumably had inadvertently contaminated Gallo's own T-cell cultures. This was not realized at the time, and Montagnier says that such information might have changed the presentation of Gallo's work at a press conference held on April 28, 1984, in Washington:

Gallo, sounding very tense, telephoned me before and after the event. I advised him to make sure to mention the work we at Pasteur had done. In fact, the press conference, as it was reported on the teletypes and later over the radio, proclaimed a great victory for American science. The Secretary of the U.S. Department of Health and Human Services, Margaret Heckler, lost her voice at an unfortunate moment, preventing her from reading the paragraph that was supposed to give credit to the work of the Pasteur team. Even after fifteen years, these events still leave a bitter taste in my mouth, even though I am aware that the extraordinary publicity Gallo rallied around his virus reflected onto ours.

Montagnier writes gently about this once vitriolic controversy; and his soft tone reflects more than a decade of slow reconciliation. The band-aid was a joint document prepared and signed by the Pasteur Institute and National Institutes of Health in March, 1987, elaborating a consensual account of the discovery and the sharing of royalty rights for the very lucrative HIV diagnostic tests. The clash of egos and the mutual accusations of the "French" team and the "American" team about who deserved credit for the identification of HIV received considerable media attention at the time, and was featured by many journalists as the acme of unsalubrious scientific behavior; and there is little new in Montagnier's recounting, alas, except his very negative view of the superstructure of French science.

Montagnier roundly criticizes the academics with whom he trained, the bureaucrats in the French government, and the senior faculty of the Pasteur Institute. He protests their shackling of young, aggressive, and independent- minded researchers.

The Pasteur Institute has many talented immunologists. Most, however, are interested only in fundamental problems and work on mice: humans are too " complicated" and the research we wanted to conduct was too "applied" for these researchers, which might seem surprising in an institution founded by Louis Pasteur.

I organized a seminar on AIDS retroviruses at the Pasteur Institute. Francoise Barre-Sinoussi a young researcher presented our findings. Being prudent, we only put forth a hypothesis: the virus whose characteristics we were presenting might be the AIDS agent. But we were also proud of ourselves, and certain that our Pasteur colleagues would welcome our findings with enthusiasm. The reaction was clearly colder than that. It's "the Montagnier gang" crowing again! said some.

This criticism has some merit, and it is corroborated by the contemporary brain-drain of French (and other European) researchers to America. (Montagnier's own move to New York occurred much later in his life, after he was well established at the Pasteur, and cannot be attributed to a snuffing of his nascent talent.)

But Montagnier's criticisms of French science are just about all that holds his reader. Otherwise there is not enough to make this book into an illuminating assessment of either the process of scientific inquiry or the logistics whereby government, industry, and academia can best coalesce around a seminal discovery like that of HIV. The book suffers from much unexplained detail, in scientific terminology and in the identities of the players in the early days of the AIDS drama; it is inside baseball, and there is no program roster. This is unfortunate. A genuine memoir from a person of Montagnier's learning and stature could have shed much light on the unmasking of the role of viruses in the pathogenesis of immune deficiency and cancer.

The second part of Montagnier's book is a primer on AIDS, and it is presented in a fluent and balanced fashion. The unknowns about precisely how HIV destroys the immune system--whether infections other than HIV (so-called co-factors, like herpes viruses and mycoplasma) augment the pernicious potential of the retrovirus, and the differences in virulence among different HIV strains--are all well covered. The impact of the protease inhibitors, as well as the clinical limitations of such treatments, are also accessibly delineated for a lay audience.

Montagnier's focus is on a vaccine, and he clearly articulates the daunting complexities involved in developing such a prophylactic. The virus's exterior coat is so changeable that it quickly eludes the grasp of the immune system. So a person vaccinated using protein from a single isolate of HIV would not be protected from infection by other isolates. Moreover, the initial virus isolate used to prepare the vaccine will likely so change over time as to be able to infect the person. Montagnier also rightly emphasizes that currently ninety percent of all new HIV infections occur among heterosexuals in under- developed countries, primarily Africa and South East Asia, and that health care in such areas is so limited that virtually none of the benefits of combination protease therapy or prophylactic antibiotic therapy against opportunistic infections are realized.

Montagnier does not deal with the oral polio vaccine hypothesis--an indication, perhaps, of how the notion had fallen off the radar screen of the scientific community before Hooper's attempt to revive it. But Montagnier does battle with Peter Duesberg. In forceful language, Montagnier asserts that such unfounded theories are more than parlor debates, because they endanger the health of the people who subscribe to them and who would otherwise benefit from anti-HIV therapy, if they accepted the virus as the underpinning of AIDS:

I did not think, when I first began writing this book, that I would have to explain once again why AIDS is an infectious, communicable disease caused by a retrovirus, HIV. ... A few scientists, however, led by Peter Duesberg ... persist in defending the indefensible--that AIDS is not an infectious disease but the result of aberrant behavior patterns, especially drug use. ... such a theory can lead to irresponsible behavior and may, as with cancer, prompt patients to seek treatment from charlatans ... I ... believe that, lacking a medical education Duesberg , ... did not take into account the complexity of this immunological disease of viral origin, and confused the co-factors (drugs, other infections) with the primary cause.

Beliefs can make the difference between life and death. Science demands that our beliefs about disease, its cause and its treatment, be weighed against empirical data; that our conceptions be examined and re-examined under the sharp light of the experimentalist. It is not enough for prominent scientists to invoke arguments from authority, and to rely upon the rhetoric of derision in the struggle against fallacious views such as Duesberg's. The most persuasive rebuttals are those that explain the facts. And the impartiality of science is also a matter of humaneness, because false and fantastical beliefs inflame the psychology of desperation and denial that grips people with serious illness. The only consequence of false hope is true anguish. In the shadow of deathly disease, ignorance does not end in bliss. Reality is not only the domain of suffering and loss; it is also the domain, the only domain, where genuine hope may exist.

(Copyright 1999, The New Republic)