The Case of HIV and AIDS - Part 5    Part 1  Part 2  Part 3  Part 4

Richard Horton In The New York Review

Part 5 Contents
Richard Horton In The New York Review  pp 699-713
A Statement by A. Arthur Gottlieb  p 71

Richard Horton In The New York Review

Richard Horton, editor of The Lancet, wrote an 8500-9000 word review article "Truth and Heresy About AIDS" in the New York Review of Books, 23 May 1996. This article, with its many footnotes, gives a false impression of scientific scholarship. Horton's selectivity did not properly allow readers to evaluate (a) the books under review; (b) the relative merits of hypotheses competing with the orthodox hypothesis that HIV is a cause of certain diseases; (c) the positions of a number of scientists who have challenged the orthodoxy. I documented these assertions in a "Review of a Review," about the same length as Horton's article, which I submitted for publication in the New York Review, but which was rejected.

Selectivity and a tendentious presentation. Horton's article purportedly dealt with three books. Two of them were authored by Duesberg, namely the collection of his scientific papers concerned with HIV and AIDS, and the more popularly written book published by Regnery. The third book purportedly under review by Horton was Aids: Virus- or Drug Induced? published by Kluwer (1996). This book is a collection of 27 articles. Twelve of these were originally published in the scientific journal Genetica (1995). Only four of the articles are by Duesberg and co-authors. One of the articles even represents a position supporting the orthodoxy about HIV and AIDS. My two articles from the Yale Scientitic are reproduced updated in the Kluwer collection ("HIV and AIDS..." pp. 271-295; and "To fund or not to fund..." pp. 297-307). Although the Kluwer collection was formally under review, Horton did not describe it as a collection, he did not describe what this collection contains, and in particular he did not mention a single article in that collection, with the sole exception of

one item from me on the non-funding of Duesberg.¹ Indeed, in 1995-1996, some scientists who disagree with objections raised by Duesberg and others nevertheless have deplored publicly that Duesberg cannot get funding.² Horton represented this view in his own journal The Lancet (6 July 1996) after promoting it in the New York Review. So increasing support for this view is a very recent and welcome development.

However, in his review, Horton did not mention my much longer article "HIV and AIDS: Have We Been Misled?," nor did he mention or take into account independent documentation contained in that article which goes counter to his views. He also systematically ignored other articles in the Kluwer collection documenting defects in articles published in scientific journals, purporting to show that "HIV causes AIDS." Readers of Horton's review cannot learn from his review the existence of these articles and the information they contain. A fortiori, they are not given the means to evaluate that information. These readers have no way to know, let alone appreciate, the extent, specificity, and seriousness of criticisms by the variety of scientists in that book. Horton mentioned Duesberg repeatedly as a critic of the established views, but by not referring to the multiple articles in the Kluwer collection, he made it appear as if Duesberg is more isolated than he actually is in raising objections.

Horton also did not give any information which might make readers wary of statements and figures put out by the CDC and WHO (World Health Organization). For example, he did not inform readers of the CDC definition of AIDS, and of other definitions of AIDS used in Africa. Indeed, the WHO allows African doctors to use a clinical definition, the "Bangui definition," which does not even require an HIV test.³ Horton invoked both the CDC and the WHO for AIDS statistics (p. 16, bottom of column 4), but they have both put out figures which cannot be trusted for multiple reasons, some of which are listed in my "HIV and AIDS..." article, but none of which is mentioned by Horton.

Footnotes for page 700
¹ Horton states p. 20, column 3: "This issue is examined in detail by Serge Lang of the Department of Mathematics of Yale in AIDS: Virus- or Drug Induced? His review of the NIDA grants application is revealing..." However, Horton did not include a proper reference citing my article as an independent article in what is a collection of articles

² See for instance a letter from Stuart Derbyshire in Nature 377, 26 October 1995, p. 672.

³ "R. Widy-Wirski MD et al., "Evaluation of the WHO Clinical Case Definition for AIDS in Uganda," Journal of the American Medical Association 260 (1988) pp. 3286-3289.

In addition, Horton systematically shifted the attention:

- away from the quality of the science concerned with the "HIV causes AIDS" hypothesis;

- away from very testable aspects of a hypothesis that drug use may cause certain diseases used to define AIDS;

- and toward Duesberg personally.

I shall give some examples.

(a) In his review, Horton wrote (p. 14, column 4): "Is AIDS a single disease? No, says Duesberg." But it's not a question of what Duesberg says. Horton did not properly inform his readers by failing to tell them of the circular CDC definition, or the different Bangui definition. Horton himself wrote as if AIDS is a single disease, for instance p. 20, column 4, where he refers to "the current widely acknowledged uncertainty about the origins and mechanisms of HIV disease." Horton's focus on what Duesberg "says" skewed the presentation of facts concerning AIDS and the role of HIV, and made Duesberg appear more isolated than he actually is in raising objections.

(b) Concerning Africa, Horton wrote (p. 16, column 4): "The AIDS pandemic in sub-Saharan Africa, driven mainly by heterosexual transmission, provides Duesberg with an opportunity to stretch his theory beyond the bounds of all reasonable beliefs." In light of the different definitions of AIDS, how legitimate is it to compare African AIDS and American AIDS? What constitutes reasonable beliefs remains to be determined. But there are many facts which are not a matter of "belief." Horton did not mention articles providing such facts, and critical of the orthodoxy on Africa, such as those by Neville Hodgkinson and by Papadopulos-Eleopulos and Harvey Bialy, a long time scientific observer of conditions in Africa.⁴

(c) Readers of Horton's review did not learn of these or other critical analyses in the Kluwer collection, despite the fact that this collection was one of the three books purportedly under review. Such articles also include those by Mark Craddock, the Ellison-

Footnote for page 701
⁴ N. Hodgkinson, "Cry Beloved Country," Kluwer collection, pp. 347-358. E. Papadopulos-Eleopulos, V. F. Turner, J. M. Papadimitriou and H. Bialy, "AIDS in Africa: Distinguishing fact from fiction," World J. Microbiology & Biotechnology Vol. 11 (1995), pp. 135-143.

Duesberg-Downey analysis of the Ascher et al article,⁵ and articles by Papadopulos-Eleopulos et al, mentioned in the previous part on journalistic suppression and manipulation.⁶

(d) Horton did not inform his readers that others besides Duesberg have raised questions about the role of nitrite inhalants in causing certain diseases. (Cf. my "HIV and AIDS..." article.) For example, Horton in his review did not mention the position and conclusions of Harry Haverkos, who chaired the meeting of 24 May 1994, sponsored by NIDA, on the toxic effects of nitrite inhalants. Thus he made Duesberg appear more isolated than he actually is in making objections.

(e) Horton asserts (p. 20, column I): "For Duesberg, laboratory based experimentation must take precedence as the foundation for scientific reasoning, while others are content to rely on epide-miological considerations." Horton thereby misrepresented the fact that Duesberg's criticisms have also borne heavily and concretely on the defective way epidemiological data have been gathered, reported, and interpreted. A fundamental problem is whether HIV is a cause or coincidence. It has been noticed (but not studied systematically) that the measurable presence of HIV (e.g. via antibodies) may follow certain pathogenic syndromes, rather than precede them. I urge readers to compare the information given in the article by Papadopulos et al. mentioned in footnote 4, with Horton's paragraph dealing with Africa (starting p. 15, column 4). As remarked in the Papadopulos article, HIV positivity sometimes followed weight loss by several months, and possibly years. Similarly, in connection with the possibility that a new herpes virus causes Kaposi's sarcoma, recall the New York Times report (16 December 1994) that "the possibility exists that the virus is present in Kaposi's sarcoma only after the cancer develops."

Thus epidemiological studies can be questioned if they do not clarify or take into account whether the measurable presence of HIV antibodies (or HIV itself) signifies a cause or a coincidence of certain diseases. There are difficulties in making the determination, but the questioning is legitimate in evaluating the presence

Footnotes for page 702
⁵ Ellison et al., "HIV as a surrogate marker for drug use: A re-analysis of the San Francisco Men's Health Study," Kluwer collection, pp. 97-104.

⁶ E. Papadopulos-Eleopulos et al., "A critical analysis of the HIV-T4-cell-AIDS hypothesis," Kluwer collection pp. 3-22; and another article by Papadopulos-Eleopulos et al., "Factor VIII, HIV and AIDS in haemophiliacs: an analysis of their relationship," Kluwer collection pp. 23-46.

and role of HIV. Scientific standards require that whatever difficulties exist be acknowledged and brought out explicitly.

Horton spreading misinformation uncritically. Horton in his review gave no inkling to his readers that government officials put out defective responses. For an example, see footnote 7 of "Joumalistic Suppression and Manipulation."

Such defective responses may be based on questionable scientific publications. For example, Horton reported the existence of Shalala's answer to Gutknecht in his footnote 34, without giving any indication of the defects in this answer, and without warning readers about these defects. He gave no specific information which might cause readers to be very skeptical of the unreliable mess in Science, especially in articles by Jon Cohen such as those which gave rise to Shalala's defective answer to Gutknecht's question 6 (see §8 of my HIV/AIDS article). Horton thus did not prepare readers to exercise the appropriate caution when he invoked such articles.

Furthermore, Horton also asserted (p. 16, column 4) that Kaposi's sarcoma was "once classed as a disease that defined AIDS and therefore also HIV." This assertion is at best misleading. Kaposi's sarcoma is still on the CDC list of AIDS defining diseases in the presence of HIV. Like Altman in the New York Times and Cohen in Science, Horton contributes to fudging the issue about relationships between AIDS (whatever it is), HIV and other viruses such as a presumed herpes virus.

So Horton contributed to the uncritical spreading of misinformation.

"An alarmingly uneven attitude." Even though The Lancet has published "letters" by Duesberg on the Ascher et al article and on hemophiliacs,⁷ Duesberg has not been allowed to publish longer pieces in The Lancet, either as a scientific article, or as a "Viewpoint." Aside from other items not mentioned by Horton in his review, he also did not mention the above Duesberg letters (let alone address or challenge their substance).

In the previous part on journalistic suppression and manipulation, I have analyzed how The Lancet rejected "many" letters, including the one by Gordon Stewart.

Footnote for page 703
⁷ Lancet 41 (1993): "HIV and the aetiology of AIDS," pp. 957-958; and "Aetiology of AIDS," p. 1544.

We have also just seen how Horton does not give to his readers information which would make them wary of statements on HIV and AIDS coming from government officials.

In his review, Richard Horton stated (p. 19, column 1): "The professional science journals, such as Nature and Science, which represent the majority opinion of researchers, have displayed an alarmingly uneven attitude during this dispute." Horton's own journal, besides Nature and Science, deserves being added to his list. So does his review (not to speak of his reply in New York Review dated 8 August 1996, see below).

The "dangerous territory" argument. It is legitimate to raise specific objections or questions against the way experiments are made or reported in certain scientific articles. Horton answered such objections in part by bringing up what he calls "dangerous territory" (p. 16, column 1):

Such an answer bypasses the specific objections and questions, and draws an invalid extreme conclusion. Even if HIV is ultimately determined to be non-pathogenic, there would still be no reason to abandon safe sex practices, just as there are reasons to be on guard against poppers. I also don't see it as illegitimate to bring up reasons why people might exercise some caution about taking prescription drugs purportedly acting against HIV, such as AZT. Doctors and pharmaceutical companies have made mistakes in the past (remember thalidomide). Very recently (1996), the Royal Pharmaceutical Society banned the use of poppers as a recreational drug in Britain, citing a "link" to the AIDS-defining disease Kaposi's sarcoma.

There is also the "status and peace of mind of spouses or partners, and children," as Gordon Stewart wrote in his letter of 3 January 1996, rejected by The Lancet. What if they have been misled by the categorical assertion that "HIV causes AIDS"?

The Darby article: "Crucial and decisive"? In the previous part devoted to an analysis of joumalistic suppression and manipulation, I have discussed the case of the Darby article, published in Nature. In his New York Review article, Horton endorsed the Darby article with the statement that "another crucial,

and decisive, line of evidence refutting Duesberg comes from the hemophiliac population," (p. 17, column 1 and footnote 7, referring specifically to the Darby article). But instead of informing readers of the existence of Duesberg's questions and predictions published in a letter to his own journal, and explaining why Duesberg's criticisms are invalid (if indeed Horton can document that they are), Horton in his review simply did not mention the existence of Duesberg's letter, let alone his questions or predictions. Horton also did not mention Gordon Stewart's unpublished questions.

Thus one is at an impasse, when specific criticisms or questions are either defectively answered, bypassed, or censored. Since Gordon Stewart's letter was refused publication, and Horton does not mention it in his review, The Lancet and New York Review readers have no way to realize the existence of his two additional questions to evaluate the Darby article. In addition, The Lancet and Horton's review made it appear as if Duesberg is more isolated than he actually is in raising objections.

At the moment, the Darby article is being invoked by Horton and others in support of the orthodox view. Critical analyses (by Craddock, Duesberg, Papadopulos, Stewart, to name but four of which I have direct knowledge) are ignored or censored. On the basis of past performance by several scientific journals, especially Science and Nature, in publishing or endorsing articles which were subsequently shown to be deficient, I await more information about the Darby article to arrive at a more definitive conclusion. Caveat emptor!

A pattern: evading previous objections and introducing new material. In the issue dated 8 August 1996, New York Review published an exchange between Duesberg and Horton (p. 51). To reinforce some of his points, Horton followed a pattern which has been common in the past, namely: spokesmen for the orthodox view about HIV causality evade dealing with specific previous objections, or questions, or criticisms raised about scientific articles which they uphold as evidence against those who challenge the orthodoxy; at the same time, these spokesmen introduce new articles as further evidence, before these new articles have been subjected to scientific scrutiny.

- Horton ignored specific objections and questions which had been raised previously, for example concerning the Darby article which he himself had invoked as "crucial and decisive."

- Horton addressed one item in Duesberg's reply of 8 August 1996:

Horton then footnoted the reference for Duesberg's letter to the Lancet of 18 November 1995, without any explanation of the context of this letter or any description of its content. Horton thereby misrepresented the situation. Horton in his original review had not mentioned Duesberg's Lancet letter of 18 November 1995, let alone the substance of that letter. In that letter, Duesberg did not engage in the generality attributed to him by Horton ("ten reasons why he believes..."). Duesberg raised ten specific questions, called "highly relevant" by Gordon Stewart, about a specific article, namely the Darby article. He also made two predictions, as we have seen. Readers have no way of reconstructing the context of Duesberg's letter from Horton's account. On the other hand, in his review (p. 17, column 1), Horton had written flatly of Duesberg being refuted: "Another crucial, and decisive, line of evidence refuting Duesberg, comes from the hemophiliac population. The British researcher Sarah C. Darby reported last year..." Thus it's not a question whether Duesberg believes whether the causal association between HIV and disease is "insecure." The question is: do Darby's data refute Duesberg as claimed by Horton or do they not?

- Horton did not show any of Duesberg's objections in The Lancet about the Darby article to be invalid, if indeed he could do so.

- Horton did not follow up and nail down a debate about the proclaimed "crucial and decisive line of evidence" in Darby's article. Such a debate would have to include a publication of Gordon Stewart's two questions, a proper scientific answer to Stewart's question as well as to Duesberg's "highly relevant" ten questions, and tests of Duesberg's predictions. It could profitably include a discussion of Mark Craddock's and Papadopulos' critical comments on the Darby article. Since these were rejected by Nature, The Lancet (Horton) could very well solicit them to give substance to a scientific discussion. Instead of doing any of the above, Horton brought up new material, namely three new articles which had not even appeared at the time of his review. They appeared in May 1996. Horton concluded:

This sentence documents Horton's illegitimate scientific and journalistic practices.

- First, how could Duesberg acknowledge data, let alone the "strength of the data," which was not even available at the time when Horton's review appeared?

- Second, there has been no time to have independent analyses of the three new articles mentioned by Horton. How do we know the strength of data before the data have been subjected to appropriate scrutiny?.

- Third, how can Duesberg "deserve censure" for not acknowledging data contained in articles which did not even exist at the time of Horton's review?

- Fourth, whether the data are strong or not strong is one of the items which is in contention. Gordon Stewart's questions (unpublished by The Lancet), Duesberg's questions ("highly relevant" according to Gordon Stewart), Mark Craddock's and Papadopulos' unpublished letters to Nature about the Darby article raise possibilities that the strength of the data is indeed questionable. Do those (including me) who have raised specific questions about the quality or validity of scientific data and interpretations published in the scientific literature, also "deserve censure" because we "fail to acknowledge the strength of the data," including data which is not even published today and may be thrown at us after our specific questions or objections concerning past data have been ignored?

An ad hominem attack. Horton's reply of 8 August 1996 introduced a major new issue, namely an ad hominem attack on Duesberg. Horton endorsed a suggestion of self-experimentation, made by Barry Bloom, whom Horton characterized as "a respected investigator at the Howard Hughes Medical Institute in New York." Thus Horton appealed to an authority figure. Horton wrote:

Horton's logic is deficient on several counts. First, self-experimentation by Duesberg would not "prove" (let alone "easily prove") anything about a virus which is supposed to take ten

years to achieve pathogenic effects. Second, the negation of one extreme is not the extreme of opposite type. There may be many possibilities in between. For example, there may be something to fear from poppers (amyl nitrites) or AZT, as well as HIV.

Horton's reply with the above challenge to Duesberg pushed the discussion to extremes in an unscientific and ad hominem manner. He turns the discussion to considerations of beliefs, rather than facts. ("If Duesberg seriously believes...") But it is not a question what "Duesberg believes." What is involved scientifically are, among other things: the possibility of making certain experiments (some of them on animals); whether certain data (epidemiological or laboratory) are valid (e.g. properly gathered and reported); whether interpretations of the data are valid; the extent to which certain hypotheses are compatible with the data; and whether specific objections to specific scientific articles are legitimately or substantially answered, if answered at all.

As a scientist and as a professor, I object publicly and vigorously to the Bloom-Horton ad hominem challenge, which I do not respect.

I object to his making it appear as if the scientific community respects the position he has defined about self-experimentation, by invoking a "respected investigator at the Howard Hughes Medical Institute."

I object to the Bloom-Horton position, that raising scientific objections in a situation when medical factors are involved, requires self-experimentation to give credibility to one's objections.

As things stand, Horton in the joumalistic context of New York Review shifted the discussion from what might have been a scientific exchange to an ad hominem exchange. Unfortunately, Duesberg wrote back directly to Horton that he is willing to inject himself with HIV if Horton could arrange the funding for such an experiment. Thus Duesberg caved in (under journalistic and psychological pressure) by accepting the legitimacy of Horton's point, although Duesberg's reply made the situation somewhat more complicated by suggesting that responsibility for such self-experimentation was to be shared institutionally. I object not only to Horton's unscientific journalistic and rhetorical thrust, but also to the fact that Duesberg did not reject outright the terms Horton was setting for the discussion.

It remains to be seen whether the Bloom-Horton challenge to Duesberg, that he engage in self experimentation to give credibility to his scientific objections, is respected by the scientific community.

Scientific and journalistic responsibility. On 2 August 1996, I submitted a letter to the editors of the New York Review, about 500 words long. This letter consisted essentially of the previous section on the ad hominem attack, but included a few introductory lines informing readers of my longer piece "Review of a Review." My letter was rejected.

In its issue of 19 September 1996 (available at the end of August), the New York Review published a further exchange between Duesberg and Horton. These exchanges occurred under severe limitations of space imposed on "letters to the editors," not just in the present case of HIV and Duesberg. I regard Duesberg's two letters as grossly insufficient to inform readers of the New York Review properly about the scientific and journalistic issues involved, although they bring up some substantial points.

Horton devoted the greater part of his second reply to the ad hominem challenge, and some history of self experimentation.⁸ Thus Horton compounded the problems raised by his ad hominem attack. Self-xperimentation is something which a scientist may offer unprompted, as has sometimes been done in the past. Whether to do so or not is for each scientist to decide individually. I object to other scientists putting pressure for self experimentation, especially in a journalistic context.

I was sufficiently disturbed by Horton's continued emphasis on self-experimentation to submit my letter to the editors of 2 August as an advertisement, to occupy half a page in the New York Review. I sent a check for $3,500 to cover the cost for this space. Then the editor returned my check and agreed to publish my letter.

(a) Letters to the editor. Only two letters to the editors on the Horton review, other than those of Duesberg, were published: one by Meyer Friedman M.D., supporting the notion that "HIV is the cause of AIDS" (19 September 1996); and the other by me (31 October 1996)

Footnote for page 709
⁸ Horton wrote 55 column lines on the self-experimentation issue, about 7 words per line. Following these 55 lines (more than half of his reply), he stated: "Nevertheless, whether Duesberg does or does not inject himself with HIV is, in truth, immaterial to my central challenge to his argument." Being immaterial to the central challenge is incompatible with Horton bringing up the issue of self-experimentation in his first reply, and spending the greater part of his second reply again on this issue. The imprimatur of the New York Review contributed to making the self-experimentation challenge an important journalistic item. Among other objectionable effects, this item deflected attention from what Horton called the "central challenge."

under the circumstances just described. I have personal knowledge of four other people who wrote letters to the editor critical of the orthodox position on HIV, but their letters were not published. Among these is the well known writer James P. Hogan.⁹ By not publishing other letters directed against the orthodox position on HIV, the New York Review contributed once more to making Duesberg appear more isolated than he actually is in making objections.

It is important for people to have documentation on which they can base a more informed judgment about Horton's review, and the editorial judgment of the New York Review. From my letter to the editors, readers could learn that I wrote a 14-page "Review of a Review," but they could not learn the specific content, countering and documenting Horton's tendentious selectivity.

(b) The responsibility of the New York Review. The choice of Horton for a review article on the three books selected by the New York Review, including the Kluwer collection, was not a priori unreasonable, but it was New York Review's responsibility to evaluate his piece before publication. In fall 1995, I had hoped the New York Review would review the forthcoming three books which were indeed ultimately chosen, because I had such a rewarding experience with the New York Review in 1978, when it published my "Survey of a Survey" on the Ladd-Lipset "1977 Survey of the American professoriate." Hence I provided documentation to the New York Review's editor during the academic year 1995-1996 by sending him a variety of items on HIV and AIDS. Some of this documentation was included in my Yale Scientific articles as well as my "Journalistic Suppression and Manipulation" file as it developed throughout the year. The editor gave no evidence that he took this documentation into account in evaluating Horton's piece, with the single exception of my analysis of the non-funding of Duesberg.

The New York Review has been, among other things, a journal of appeal. It fulfilled this role when it printed my "Survey of a Survey" in 1978. With its world-wide circulation of 120,000, it is very influential in the academic and intellectual community. Members of these communities rely on the New York Review for

Footnote for page 710
⁹ Incidentally, Hogan has informed me that he has written a long manuscript on the question of HIV/AIDS, and has been trying to publish it, so far without success.

information they cannot get easily elsewhere. Flaws in the New York Review editorial judgment are therefore very serious.

The readers I know have little time, if any time at all, for seeking information independently. They rely on the selection made for them by the New York Review. Some have taken the time to look through the more elaborate documentation I have given to them, but others don't have the time. It is therefore very important that articles in the New York Review conform to the classical standards of science, as they were formulated particularly well by Feynman¹⁰, whom I quoted already in my discussion of the Baltimore case. It does no harm to repeat here the relevant quote from Feynman.

On the next page, Feynman recalls a specific instance when physicists fooled themselves for many years in determining the charge of the electron. Then on p. 343 he goes on to say:

Footnote for page 711
^l0 Surely You're Joking Mr. Feynman, W.W. Norton, 1985, p. 341. The piece is adapted from the Caltech 1974 Commencement Address.

Horton sure didn't lean over backwards to show how maybe he is wrong. He didn't lean over backwards to "give details that could throw doubt on" his interpretation, or to inform readers of documentation which would have made readers question the reliability of the scientific press and government officials. My "Review of a Review" lists a large amount of such important documentation which Horton did not report to NYR readers. Horton's review article did not abide by the classical standards of scientific reporting as expressed above.

(c) Evasion of scientific responsibility. Horton systematically evaded answering my scientific, documented challenges to specific points in his review-essay. After New York Review rejected my "Review of a Review", I submitted it for publication in The Lancet. Horton also rejected it, with a statement:

I answered him:

Therefore I find your alleged reason for not publishing my "Review of a Review" to be a non-sequitur, and to be incompatible with scientific publishing practices ....

... One major problem has to do with your continuing evasion to provide a formal response to my "Review of a Review". On the one hand you wrote me on 5 August: "Do let me know if you publish it elsewhere. That might well be the occasion to write a more formal response." On the other hand, your logic for refusing publication would also apply to any other publication besides New York Review. Indeed, why should the readers of any journal other than New York Review be any more aware of your original review article and the correspondence that followed in New York Review? You have therefore created a self serving Catch-22 scenario to justify your evasion to provide a "more formal response" to my criticisms. I object.

I accuse you, Richard Horton, of scientific and journalistic irresponsibility:

(a) In not addressing or responding to the documented scientific and factual points raised in my "Review of a Review". These points are independent of any journalistic context and deserve to be addressed.

(b) In refusing to publish my "Review of a Review" in The Lancet. As I wrote to you on 15 August, you would then have an opportunity to "write a more formal response".

However, whether or not you publish my "Review of a Review" in The Lancet, you owe a response to major specific scientific objections, as well as objections to your tendentious presentation. By not providing such a response, you are reinforcing your tendentious selectivity in the presentation of scientific material, and you are transgressing the norms of scientific discourse.

A Statement
Received 24 July 1997

Within the medical-scientific community, HIV is widely accepted as the causative agent of AIDS. Notwithstanding this consensus, a group of knowledgeable scientists have raised a number of meaningful questions about this thesis, while some remain unconvinced of its validity.

In this chapter, Prof. Serge Lang has well documented the basis of this controversy and has provided a sobering picture for the reader of the polity of thinking that has characterized this field. For example, legitimate questions about the effects of HIV and the role of cofactors in the pathogenesis of the immune dysfunction that is the hallmark of AIDS remain unanswered by those who are the proponents of conventional thinking in this field. Models of how HIV and cells of the immune system replicate, which have not yet sustained the rigor of thorough scientific discussion and critique at both the biological and mathematical level, are accepted as if they were laws nature. Major journals and scientific meetings have often failed to provide a forum for legitimate criticism of these models and other issues pertaining to HIV. Lang points out that this is an abuse of the process by which science seeks to achieve a complete understanding of a problem and that if a hypothesis is correct, it should be able to sustain legitimate critique. He properly alerts us to the dangers that rigidity of thinking holds for the advancement of scientific understanding.

As well, Lang asks to what extent are readers of scientific journals correctly informed of various points of view and do editors assert unreasonable control over the terms of disclosure in their journals? These are clearly important and disturbing questions. A review of the scenarios which Lang has painted should give the thoughtful reader pause as well as some insight into how doctrinaire thinking can develop and be perpetuated.

A. Arthur Gottlieb, M.D., F.A.C.P.
Professor and Chairman
Department of Microbiology/Immunology
Professor of Medicine
Tulane University School of Medicine
1430 Tulane Ave.
New Orleans, LA 70117