Markers of Credibility

Despite speculation about swine fever and mycoplasma, despite challenges from people like Lauritsen and Ortleb, and despite some scientific interest in cofactors, the basic fact remained: The proposition "HIV causes AIDS" was hegemonic in U.S. science and society as 1986 came to a close. That year, the American Medical Association

had published in book form an authoritative collection of articles on AIDS that had appeared in recent years in its journal, JAMA .^[83] Although the collection included the Sonnabend, Witkin, and Purtilo article from 1983 (buried near the end in a "Special Reports" section), it contained no articles published later than 1983 that questioned the relationship between HIV and AIDS. For the back of the book, the AMA's Task Force on AIDS had reviewed "the complete list of published articles" on AIDS in the medical and scientific literature, with the goal of preparing "a brief bibliography that could serve as a source document to guide the interested reader through the massive body of literature on AIDS." The section on etiology contained fifty-six references, of which fifty-four alluded to a retroviral cause of AIDS in the title. Only one of the fifty-six articles proposed an alternative etiology—an article by J. J. Goedert on the role of recreational drugs in causing AIDS. Even the Sonnabend, Witkin, and Purtilo article—included in the collection itself—failed to make it into this definitive bibliography.

Another important benchmark of the credibility of the HIV hypothesis was the influential Confronting AIDS , a survey of knowledge and a blueprint for action published by the National Academy of Sciences' Institute of Medicine. Prepared by a blue-ribbon panel consisting of prominent virologists, clinicians, public health experts, and social scientists, the 352-page report encapsulated the official, credible body of knowledge about AIDS circa 1986. Though ostensibly a study of "the AIDS epidemic," the report might more accurately be called "Confronting HIV "; early in the introduction, it explained that "AIDS" is only a surveillance definition used for epidemiological purposes and that the term "does not include the full spectrum of conditions now known to be associated with HIV infection."^[84]

Nonetheless, in a section entitled "The Causative Agent of AIDS," the report did briefly review the growing evidence that HIV caused the syndrome. First, antibodies reactive to viral proteins were found in "nearly all instances" of people with AIDS, while tests of people not in "high-risk" populations were "uniformly negative." Moreover, the prevalence of antibodies in different groups corresponded with what was known about the geography and timing of the epidemic. Second, the virus itself could be isolated from the white blood cells of most people who were antibody positive; the authors added parenthetically that "the failure to isolate the virus from all infected persons is most likely due to technical limitations in the lymphocyte

culture methods and to the depletion of target cells in the advanced stages of the disease." Finally, the blood transfusion data were compelling: they "clearly showed that the virus could be transmitted to a previously uninfected person who could then develop AIDS.…"^[85]

Elsewhere in the report, however, the authors acknowledged a good deal of uncertainty. They noted that it remained mysterious precisely how HIV caused the characteristic depletion of T cells, given the small percentage of cells that appeared to be infected.^[86] This was a problem but not an insoluble one, the report implied, noting that many researchers had begun speculating about the "indirect" means by which HIV could be causing T-cell loss. Montagnier, for example, had proposed that HIV initiated an autoimmune mechanism, whereby the immune system of the infected person was "fooled" into killing its own T cells; and other hypotheses were equally complex.

Another question was whether HIV worked alone to cause AIDS or whether some "cofactor" or "cofactors" might also be involved. But despite raising these various questions about how HIV caused disease and whether HIV worked alone, the main thrust of the report was to focus squarely on the problem of HIV infection. Thus chapter 6 of the report, "Future Research Needs," divided research priorities into the following categories: structure and replication of HIV, natural history of HIV infection, epidemiology of HIV infection, animal models for HIV infection, antiviral agents, vaccines against HIV, and social science research.^[87]

John Lauritsen, who titled his review of Confronting AIDS in the Native "Caveat Emptor," noted: "For those who are true believers in the 'AIDS virus' ideology, a number of disconcerting bombshells are detonated in this book. To begin with, the report acknowledges that it is impossible to isolate HIV from many AIDS patients and that some AIDS patients show no evidence of ever having been infected with the virus."^[88] Yet as Lauritsen was no doubt painfully aware, the "bombshells" simply failed to echo in the larger society or even in the sectors of it that concerned themselves principally with the epidemic. In a few short years, an industry had grown up around AIDS, encompassing doctors and researchers, service providers and grassroots educators, lawyers and writers, politicians and policymakers—a complex of individuals, groups, and formal organizations. And within this industry, HIV was the common link between actors and interests. The virus was the "obligatory passage point" that stood between people and the

grants they sought to obtain, the programs they endeavored to establish, and the propositions they wanted to advance. In its transformation into scientific fact and social reality, "HIV causes AIDS" had become a "black box"; and when people like Sonnabend or Lauritsen tried to reopen the box and review the evidence and arguments, theirs were isolated voices with minimal credibility. It would take someone with considerably more scientific capital to focus significant scientific and extrascientific attention on the question of whether HIV had in fact been proven to cause AIDS.