Inventing the AIDS Virus, Peter H. Duesberg
Regnery USA 1996, 720 pages, ISBN 0-89526-470-6.

Book Review- New York Review of Books

The May 23 issue of the New York Review of Books has a long article by Richard Horton (editor of Lancet) titled "Truth and Heresy About AIDS." It is a review of Duesberg's Inventing the AIDS Virus, and also of two collections of essays edited by Duesberg that were published at about the same time. Horton's review essay is very long, and will not be available on-line as far as I know, so I will post a summary with quotations. Direct quotations are indented. My commentary is included in brackets throughout, and at the end.

I hope this summary is widely read. I do not think the NYR will object to the direct quotations, especially since I urge all readers to purchase this issue and read the article in its entirety. I think the NYR has covered itself with glory by devoting so much space to such a substantial article, even though I am severely critical of some parts. I have to use quotations because it is so important not to give the ever-present HIV-obscurantists a chance to complain that anything has been misreported.

The review essay is in 5 parts.

PART ONE

After characterizing Duesberg as "a brilliant virologist, and the former recipient of an award for outstanding investigative research from the NIH," Horton summarizes the Duesberg position:

"If AIDS was caused by an infectious agent, Duesberg claims, one would expect it would have five specific characteristics: (1) it would spread randomly between the sexes: (2) the disease would rapidly appear -- at least within months: (3) it would be possible to identify "active and abundant [HIV] microbes in all cases", (4) cells would die or be impaired, beyond the ability of the body to replace them; and (5) we would see the development of a consistent pattern of symptoms in those infected. None of these expectations has been met. In the US and Europe, men are affected far more commonly than women; the onset of clinical disease takes a median of ten years; the virus is difficult to isolate in patients with AIDS. Nor are the direct effects of the virus on one group of target cells, called CD4 lymphocytes, believed to be responsible for the observed immunodeficiency. And the symptoms vary strikingly, for example, between Africa and America, although they have a supposedly common infectious origin."

Arguments such as these have persuaded respected scientists to express their skepticism that HIV is the cause of AIDS. Kary Mullis, who won the Nobel Prize for chemistry in 1993, writes in his foreword to Inventing the AIDS Virus, "I like and respect Peter Duesberg. I don't think he knows necessarily what causes AIDS; we have disagreements about that. But we're both certain about what doesn't cause AIDS. We have not been able to discover any good reasons why most of the people on earth believe that AIDS is a disease caused by a virus called HIV. There is simply no scientific evidence demonstrating that this is true."

Horton goes on to describe Duesberg's "drug-AIDS hypothesis," and then concludes:

" Here Duesberg's arguments take him into dangerous territory. For if HIV is not the cause of AIDS, then every public health injunction about the need for safer sex becomes meaningless; every call to offer clean needles to injecting drug users may be unnecessary -- or worse. Duesberg notes that "the clean needle program of the AIDS-establishment would appear to encourage rather than discourage intravenous drug use." And he writes, most remarkable of all, that "screening of blood for antibodies to HIV is superfluous, if not harmful, in view of the anxiety that a positive test generates." In his opinion "AZT is AIDS by prescription"; this drug should "be banned immediately."

[It may be "dangerous" for Duesberg to oppose AZT, but it is far more dangerous for the AIDS establishment to prescribe it, especially for infants, in view of the acknowledged toxicity and inadequate evidence of clinical benefit. Avoiding known venereal diseases is sufficient reason to refrain from unsafe sex practices, regardless of what one thinks about AIDS.]

Horton concludes Part One with the obvious question:

"How could so many scientists have got it all so badly wrong?"

[Indeed, that is a very excellent question. But in the next section seems to answer it by saying in effect that -- "Of course, they couldn't have got it wrong. To forestall that unacceptable possibility, their most dubious evidence must be accepted as absolute, unchallengeable fact."]

PART TWO

Horton observes that the Duesberg dissent emphasizes that even a perfect correlation cannot prove causation without "functional evidence" -- i.e., evidence of how the virus supposedly does its damage. He goes on to comment that That "functional evidence" is now accumulating rapidly. However, researchers readily admit that there are huge gaps in our understanding. In the recent authoritative account, The Molecular Biology of HIV/AIDS, edited by A.M.L. Lever, scientists write:

"Despite knowing so much about the molecular biology of HIV we still have little understanding of how HIV causes AIDS and why progression to disease can take a long and variable time.

It remains to be established precisely how viral replication and viral gene expression are regulated and how they influence progression to clinically significant immunodeficiency.

The cell type which is first infected following HIV transmission has still not been defined."

Horton comments:

"These uncertainties do not mean that HIV is not the cause of AIDS. Here is an important distinction that Duesberg ignores. Though we may not understand exactly how HIV causes AIDS, we have a large, most scientists would say overwhelming, mass of evidence linking HIV to this form of acquired immunodeficiency. HIV has been shown to be a necessary factor for the occurrence of AIDS. Whether it is sufficient remains open."

[Throughout the article, Horton uncritically repeats as fact the claim that AIDS never exists except in the presence of HIV, ignoring that this is true only because the syndrome is defined that way, and never mentioning that exactly the same symptoms or (29) indicator diseases are diagnosed as AIDS only when HIV (usually, antibody) is either shown or presumed to be present. Tuberculosis (for example) accompanied by a positive antibody test is AIDS; if the test is negative, it is just tuberculosis. Horton does not even refer to the dozens of cases admitted by the AIDS establishment to exist and reclassified as "ICL" solely because no trace of HIV cannot be found even after prolonged efforts. The reason that so many scientists could be so wrong is that they have not bothered to observe elementary principles of logic in evaluating claims of correlation. Horton must know about the circular definition because the Duesberg books and articles make the point repeatedly. Hence his failure to note the point and respond to it appears to be a deliberate omission.]

Horton's position, then, is that HIV is necessary but not necessarily sufficient for AIDS. So he goes into the question of possible co-factors:

"Could drugs be an additional cofactor? Duesberg writes that there are high rates of drug use among AIDS patients, and he has correlated drug use "epidemiologically and chronologically" with the AIDS epidemic in both the US and Europe. He cites studies showing that 96 percent of representative groups of male homosexuals had used nitrite inhalants, up to 70 percent had used amphetamines, and up to 60 percent cocaine or LSD. His uncompromising rejection of the causal power of epidemiological evidence is temporarily set aside when he dogmatically affirms that distinct AIDS diseases occur in distinct risk group[s] -- because they use distinct drugs (e.g., users of nitrites get Kaposi sarcoma, users of intravenous drugs get tuberculosis, and users of AZT get leukopenia and anemia). . . . The duration and toxicity of drug consumption and individual thresholds for disease determine when AIDS occurs, irrespective of when and whether HIV infects."

"Here Duesberg has abandoned the skepticism about epidemiology that he deployed so tenaciously in his criticisms of HIV causality. In fact, the issues he raises have been tackled by researchers. Well-designed studies cited in A.M.L. Lever's book show that the annual probability of developing AIDS does not differ significantly between hemophiliacs infected via factor VIII [i.e., a clotting protein, whose absence leads to bleeding], homosexuals infected sexually and those who acquired HIV as a consequence of intravenous drug use. These findings provide presumptive evidence against a role for bacterial infections or for drug and alcohol use, all of which are more common in intravenous drug users, in disease progression."

[Duesberg is guilty of no inconsistency. Correlations point to suspects, but more is needed to prove causation. That is why Duesberg makes well-designed research proposals to (for example) study the effects of poppers in mice. After HIV was identified as a suspect in AIDS, biomedical researchers expected to see it infecting and destroying cells directly. Once they learned that HIV does not even infect most of the cells it is supposed to be destroying, and that, as Horton admits, there is no direct cell-killing mechanism, the HIV theory should have been reconsidered. Duesberg predicts that unbiased epidemiological studies, in which the HIV-positive subjects are (for the first time) compared with a carefully matched group of HIV negatives who are otherwise identical in health risks, will discredit the alleged correlation between HIV and immune deficiency, Kaposi's sarcoma, or other AIDS-defining diseases.

Correlation is not proof, but evidence well short of proof may be a sufficient basis for urging people to give up some recreational substance like cigarettes or amyl nitrites. A much greater degree of proof should be required before prescribing some highly toxic drug like AZT, that is likely to make them very sick.]

Horton concludes his Part Two with an unwitting demonstration of the misuse of correlation evidence to protect the HIV theory:

"In Musuka district, in southwest Uganda, if you are an HIV-positive adult you are twenty times more likely to die than if you are HIV-negative. To claim that HIV is not causally associated with immunodeficiency-related diseases is to ignore the evidence of thousands of deaths."

"Another crucial, and decisive, line of evidence refuting Duesberg comes from the hemophiliac population. The British researcher Sarah C. Darby reported last year on deaths among the UK population of hemophiliacs between 1977 and 1991. Between 1977 and 1984, the annual death rate among patients with severe hemophilia was 8 per 1000. Between 1985 and 1992, this rate remained identical among HIV-negative hemophiliacs, but increased to 81 per 1000 in 1991-92 in those with HIV infection. Moreover, interruption of the spread of HIV clearly prevents the occurrence of AIDS. Contrary to Duesberg's hypothesis, preventing HIV transmission prevents AIDS."

[Such raw correlations between HIV (actually, proteins which are linked to antibodies to HIV), and such a very general condition as "death," can be very misleading when employed as proof of causation. The reasoning rests on a non-sequitur: More people with positive antibody tests die of something-or-other; therefore HIV causes immunodefiency." Most of those Ugandans did not die from "AIDS" --even though that syndrome is diagnosed in Africa by the very broad "Bangui" definition. Hemophiliacs have a multitude of health risks -- including, now, AZT. If epidemiologists accept as "decisive proof of causation" mere correlations between some factor and death from whatever cause, then it is no wonder that they can come to disastrously wrong conclusions. But I am sure Horton understands these elementary points -- so why does he disregard them?]

PART THREE

Horton said in PART ONE that "functional evidence of how HIV causes AIDS is now accumulating rapidly." In this brief section, he explains what he means by that statement:

"It was formerly thought that the virus, once integrated in a host cell, existed in a latent phase. Duesberg makes much of this belief. In l995 he wrote that HIV is latent, and neither chemically nor clinically detectable in 'HIV antibody-positives' [i.e., people with HIV] with and without AIDS."

Horton responds:

"This is not so. Soon after it is assembled, HIV undergoes tremendous replicative activity and a high level of virus can be found in the blood. Although the virus is then cleared from the blood, replication continues apace throughout the body's lymphoid tissue, which is the main repository of our immune system. This continued and damaging activity over the long term is believed to lead to immunodeficiency, leaving the infected individual susceptible to infections, such as Pneumocystics, and cancers, such as lymphoma."

[This is mainly handwaving, since even "tremendous replicative activity" does not show immune cell destruction. (HIV is grown for these experiments in "immortal" T-cell lines, which somehow avoid destruction.) Moreover, the conclusion -- "is believed to lead to immunodeficiency" -- is phrased in language which betrays its speculative nature. Anyway, Duesberg and his supporters argue that claims of massive replication of HIV (following the clearing of the primary infection) in the lymph nodes or elsewhere are an artifact of the quantitative PCR method which is employed to detect traces of viral particles. (Kary Mullis, the inventor of the PCR technique, is a famous Duesberg supporter.)

If live and active virus were really present in such quantity, it could be found without employing the PCR. Just as HIV-partisans have accepted obviously dubious epidemiological correlations as "proof," they have viewed claims of biochemical support for their theory with a notable lack of skepticism.]

PART FOUR

This section deals with the failure of AZT and other so-called "antivirals" to meet expectations. Horton reports:

"Trials of drugs to combat HIV infection have passed through three phases. The first period began and ended in 1987 with the publication of a single clinical trial that showed that AZT helped patients with HIV infection who had symptoms of disease to survive longer. AZT was licensed for use shortly afterward and optimism ran high. From 1987 to 1994, a deepening mood of pessimism bordering on cynicism set in. Several early studies were based on the notion that early treatment-- when the patient was infected but free of symptoms -- was the sensible and biologically plausible course. They seemed to indicate that intervention n symptom-free or early symptomatic stages of HIV infection might be beneficial. However, in 1992 J.D. Hamilton and his colleagues showed that AZT produced no survival benefit in patients with early symptoms. This result was followed by the devastating findings of the Anglo-French Concorde study group. In this, the largest and longest trial of AZT in HIV-positive men and women, early use of the drug conferred no advantages. Worse still, further studies have shown significantly more deaths in the group treated early. The Concorde study also showed that commonly used "soft" measures of a drug's efficacy, such as the lower or higher number of CD4 cells in the blood, were no substitute for "harder" clinical measures, such as survival."

[But AZT is still widely used for asymptomatics, and is being forced upon mothers and their infants despite the lack of evidence of any health benefits. "Dangerous"? You bet! Horton attributes the failure to develop a vaccine or cure to the fact that "HIV does not play by the old rules." Another possibility is that HIV researchers do not play by the elementary rules of logic and empirical testing.]

Horton concludes his section on failed therapies with this observation:

"The obstacles to developing new treatments and ascertaining the precise mechanisms by which HIV damages the immune system have had profound effects on AIDS research in the U.S. For instance, the fifteen-member National Task Force on AIDS Drug Development, launched with government fanfare in 1993 by Donna Shalala, the Secretary of Health and Human Services, was recently disbanded owing to lack of progress. The $1.4 billion US AIDS budget is undergoing careful review: it is projected to increase by only 1.6 percent in 1997, according to the President's latest research and development budget. And the organization of AIDS research has recently been subjected to critical scrutiny by a congressionally mandated review panel chaired by Arnold Levine from Princeton. A consistent message running through his report is that HIV research, especially vaccine development, needs to be freed from the "impediment" of the NIH establishment. What is needed, according to the panel, is a climate in which more innovative and imaginative lines of investigation can be pursued."

A plausible example of what the committee had in mind might be an inquiry into the interaction between viral particles and potential cofactors, such as drugs.

[In brief: orthodoxy is getting nowhere, and we had better be prepared to consider some new ideas, much as we may hate the thought. I judge this to be the true overall message Horton is trying to convey.]

PART FIVE

[Horton gives a moving description of the brutal censorship that has characterized HIV-science since 1984. He quotes scientific politicians like John Maddox and June Osborn, who would not recognize the truth if it hit them straight between the eyes. As Horton himself said at the end of PART ONE, "How could so many scientists have got it all so badly wrong?" Horton's answer is all too painfully obvious]:

"I remember clearly the press conference called by the Wellcome Institute in London at the time of the Concorde study's publication. The gathering was not intended, as one might imagine, to explain to medical journalists the intricacies of the research and how it might be interpreted."

"The room was, instead, packed with financial journalists who were there to hear of the resolve of the company officials to destroy the credibility of a new study that they had helped to design and analyze, but which had gone against their project."

"Apparently under pressure from the company, two coauthors of the study withdrew their support from the clear implication of the trial that AZT was ineffective in otherwise healthy HIV-positive individuals. At the same time, in the final trial report published in The Lancet, it was noted that "representatives of the Wellcome Foundation, who were also members of the Co-ordinating Committee, . . . declined to endorse this report." if the latest crop of new drugs -- the protease inhibitors -- proves successful, both Merck and Abbott would each earn from their products several hundred million dollars in the US alone. An open debate with Duesberg could have grave commercial consequences."

[Oh yes it could, and that helps to explain why the drug companies and their scientific retainers have been so determined to prevent that debate from occurring, or from reaching the attention of the public. So now at last we get to the bottom line]:

"Yet another part of the current medical landscape that the Duesberg affair illuminates is political and ideological. What does the orthodox scientific establishment do to a scientist whose work and views are out of step with majority opinion? Apparently, in some cases, cut off his funding."

"One of the most disturbing aspects of the dispute between Duesberg and the AIDS establishment is the way in which Duesberg has been denied the opportunity to test his hypothesis. In a discipline governed by empirical claims to truth, experimental evidence would seem the obvious way to confirm or refute Duesberg's claims. But Duesberg has found the doors of the scientific establishment closed to his frequent calls for tests. To begin with, the grant he was awarded in 1985 to support his work on cancer was not renewed despite an appeal supported by the administration of the University of California at Berkeley. The experimental virology study section of NIH wrote that Duesberg was an "applicant whose productivity has recently diminished both in quantity and most disturbingly in quality." Between May 1993 and December 1994, six further grants to Duesberg to fund cancer research were rejected. In AIDS research, between February 1993 and August 1994, Duesberg tried to secure funding to investigate his hypothesis (which has with time hardened into more of a belief) that nitrite inhalants are a cause of AIDS. These applications were made to the university-wide AIDS Research Program at the University of California and twice to the National Institute of Drug Abuse. His two grant applications to NIDA -- both entitled "Animal tests of the AIDS risks of nitrite inhalants" -- were supported by letters from Daniel E. Koshland, then editor of Science. All three applications were rejected, and the validity of his hypothesis still remains unknown."

"Although an overwhelming body of evidence exists to confirm the causal association between HIV and AIDS, the principle that original experimental investigation should be given primary importance in science, recently emphasized by the Levine committee, supports the argument that proposals made by serious scientists with proven records of high-quality research deserve careful consideration. This is especially the case in view of the current widely acknowledged uncertainty about the origins and mechanisms of HIV disease. It is not only Duesberg who points to this uncertainty. Michael Ascher and his colleagues at Berkeley wrote in 1995 that those who would see AIDS as a more-or-less conventional viral infection have consistently refused to recognize the paradoxes that are clearly evident in the experimental data -- the problem continues."

"And Jon Cohen commented in Science that no treatment, to date, has had much success. And unless that bleak reality changes, alternative thinkers will likely keep needling their establishment colleagues and urging them to rethink their basic understanding of the disease."

[Horton comments]:

"But how far will this rethinking be allowed to proceed? Duesberg, for his part, not only fails to understand the strengths and weaknesses of the epidemiological method; he also, as has been seen, recklessly deploys ill-thought-out epidemiological arguments to support his own drug-AIDS point of view. Nevertheless, as a retrovirologist, Duesberg deserves to be heard, and the ideological assassination that he has undergone will remain an embarrassing testament to the reactionary tendencies of modern science. Irrespective of one's views about the validity of some of Duesberg's arguments, one is forced to ask: At a time when fresh ideas and new paths of investigation are so desperately being sought, how can the AIDS community afford not to fund Duesberg's research?"

[Horton ends on so positive a note that I feel almost ungenerous in stating the obvious: Duesberg understands perfectly well the "strengths and weaknesses of the epidemiological method," and he "uses epidemiological arguments to support his own drug-AIDS point of view" only to establish that the drug-AIDS hypothesis is worthy of testing on a level playing field. Animal testing of the long-term effects of amyl nitrites is an example of the kind of research that the HIV establishment refuses to fund. This could be because the reviewing authorities think that the nitrite hypothesis has no merit, or it could be because they are afraid that it will be confirmed.]

CONCLUDING COMMENTS:

Why did Richard Horton choose to write, and the New York Review of Books make available, so many pages to a dissenting position that the HIV establishment, and the editors of Science and Nature, have always insisted to be unworthy of serious consideration?

Why does Horton take a schizophrenic position, so intelligently describing what is wrong with HIV-science at one point and so uncritically endorsing the conclusions of that same HIV-science at other points -- on the basis of correlations he must know to be faulty? Why does he end with that powerful concluding sentence, that might have been written by Duesberg himself?

Draw your own conclusions, but here are mine:

The most perceptive thinkers in the biomedical establishment can see that HIV-science is headed towards a crackup. They have long known how flimsy a basis there was for Gallo's announced "discovery" of the cause of AIDS at that decisive 1984 press conference, when the theory was set in concrete. For a long time they gave the benefit of the doubt to the Gallo's and Fauci's, but now they begin to see the handwriting on the wall. Even the hitherto acquiescent press has begun to revolt, with publicity in the Wall Street Journal and other newspapers about how the U.S. Government's CDC has deliberately furthered the false impression that HIV-AIDS is rapidly infecting the general population outside the original risk groups.

The HIV/AIDS establishment has been hoping desperately for a research breakthrough that would rescue the situation, perhaps in the form of discovery of a mechanism by which HIV could cause damage to the cells of the immune system. I surmise that the well-connected Horton knows that those hopes are fading. That is why "fresh ideas and new paths of investigation are so desperately being sought." Yes, the man said "desperately."

Eventually, the press and the public will catch on to the fact that this very expensive research establishment is spinning its wheels. In that case, how is the research community to extricate itself from a blind alley? Admitting a fundamental error is out of the question, with the financial and reputational interests that are at stake. Think of the blizzard of lawsuits and recriminations that would follow! The only way out is to move gradually to a new theory or perhaps a redefinition of the syndrome. That will be a very delicate operation; Horton is sending a signal that it is necessary to begin. *

Summary by Phillip E. Johnson