The Establishment Hits Back
For the AIDS experts who thought Duesberg's arguments were pernicious nonsense, there were two choices, both of them fraught with some peril. They could continue to ignore Duesberg, at the risk of appearing closed-minded, imperious, or unscrupulous, and hope that he would eventually go away or that the media would simply lose interest. Or they could engage him directly and seek to show him up, at the risk of granting him further credibility or, at a minimum, publicity. "Many AIDS researchers refuse to comment publicly because they fear it will legitimize Duesberg," said NIH's Anthony Fauci, quoted in a March 1988 news article in Science .
Yet to many scientists, the political costs of ignoring Duesberg increasingly seemed to overshadow the risks inherent in engaging with him. Apparently in a move to undercut Duesberg's complaint of being marginalized, Dr. Frank Lilly of the Albert Einstein College of Medicine, the chairman (and the only openly gay member) of the President's Commission on the HIV Epidemic, an advisory body appointed by President Reagan the year before, responded to Duesberg's requests for an opportunity to make his views known by inviting him to testify at the commission's hearings in February. However, in what would prove to be a common theme in responses to Duesberg in the years to follow, commission members blasted Duesberg for the sin of playing to a public audience. One member, Dr. William Walsh, lectured Duesberg: "I would hope that you would press your theory within the scientific circles and not carry this uncertainty to the public.… Don't
confuse the public—don't confuse the poor people who are suffering with this disease." This appeal to Duesberg to avoid publicizing his dissent enraged Katie Leishman, who had promoted Duesberg earlier in the pages of Atlantic Monthly . She blasted the commission for its treatment of Duesberg, in an op-ed piece published in the Wall Street Journal entitled "The AIDS Debate That Isn't." Leishman reserved particular ire for Walsh: "The suggestion that the public and patients must be protected from confusion is not merely condescending but faintly sinister."
From the vantage point of the AIDS researchers and public health officials who were on the receiving end of all this criticism, the situation was rapidly getting out of hand. Into the fray stepped the American Foundation for AIDS Research (AmFAR), a prominent independent foundation that raised money for AIDS and dispensed it to a range of university-based and community-based research projects. With strong ties both to gay community representatives and mainstream researchers, AmFAR was well situated to play mediator. AmFAR sponsored a forum held at George Washington University in Washington, D.C., on April 9 and invited a range of panelists. Anthony Fauci, the most prominent government scientist present, had reservations about agreeing to participate but decided to come because "the scientific community can't afford to ignore [Duesberg] any longer."
At the forum, after Duesberg summarized what he termed the "paradoxes" of the HIV hypothesis, panelists and audience members hit back hard. Panelists insisted that Duesberg was simply wrong to say that viruses always cause disease within months and never do so in the presence of antibodies. And they noted that with the advent of a new technique for manipulating DNA called the polymerase chain reaction (PCR) it was now possible to find HIV in nearly 100 percent of samples from people with AIDS—though still not in every case, as Duesberg was quick to observe. As to the presence of HIV in so few T cells, Fauci stated that HIV also infected other immune system cells called macrophages and might hide in bone marrow cells. Fauci was particularly vehement in response to suggestions that AIDS really was linked to lifestyle: "What kind of risk behavior does the infant born of an infected mother have?" he asked. "And what about the 50-year-old woman who received a blood transfusion from an infected donor?"
Perhaps the most interesting data were presented by Warren Winkelstein, an epidemiologist from Berkeley's School of Public Health. Winkelstein's numbers came from the San Francisco Men's Health
Study, a prospective study of one thousand single men, gay and straight, twenty-five to fifty-four years old, who had been recruited by statistical sampling methods several years earlier, and who were reexamined every six months. One of several prominent "cohort studies" on HIV infection in the United States and around the world, the San Francisco Men's Health Study offered data of a kind that was simply not available at the time that closure had first been reached on the subject of HIV as the cause of AIDS.
In direct response to Duesberg's claims about Koch's postulates, Winkelstein organized his comments around what he described as a modern-day reformulation of those postulates, which consisted of five criteria. First, the "prevalence of disease should be significantly higher in those exposed to the factor than in unexposed controls." Winkelstein didn't have any data specifically on the prevalence of AIDS in the larger population, and his study (originally designed to examine progression to AIDS) had excluded from the outset any men already diagnosed with AIDS. But he did perform clinical and lab tests on his subjects upon entry, looking at a range of indicators considered to be predictors of AIDS, and the antibody-positive men had significantly higher prevalence rates for eighteen of the twenty-one indicators studied.
The second criterion was that incidence of disease (new cases) should be significantly higher in those exposed to the causal factor. This was precisely what Winkelstein had found. Thirty months into the study, of the 399 subjects who were antibody positive upon entry (all of them gay or bisexual), 13 percent had developed AIDS. Thirty-six subjects had seroconverted (become antibody positive) over the course of the thirty months; of these men, 8.3 percent had developed AIDS. And among 374 homosexual or bisexual men who remained seronegative throughout the thirty-month period, not a single person developed AIDS. Winkelstein estimated the probability that this association between antibody status and AIDS could have occurred by chance at less than one in a million.
According to the third criterion, a "spectrum of host responses" should follow exposure to the agent "along a logical biological gradient"; Winkelstein explained that this was demonstrated by the gradually declining T-cell counts in the antibody-positive group. Fourth, the disease must follow exposure to the causal agent: this criterion was confirmed by retrospective analysis of frozen sera that had been collected from gay men in San Francisco in 1978 for a hepatitis B vaccine study; analysis of the sera showed that gay men in San Francisco were
already infected before cases of the disease were known. And finally, elimination of the agent should decrease the incidence of cases: Winkelstein acknowledged that this criterion had yet to be satisfied, but he predicted that the decline in HIV transmission among gay men would eventually cause a corresponding decrease in the incidence of new AIDS cases.
During a lively question-and-answer period that followed the formal presentations, Anthony Liversidge, the interviewer who had elicited choice comments from Gallo, asked an important question about Winkelstein's data. Might not the same correlation between HIV infection and AIDS illness hold, asked Liversidge, if HIV were simply another opportunistic infection and not the actual cause of AIDS? Winkelstein acknowledged the point but argued that all the other evidence indicating a causal role for HIV made it highly unlikely that the correlation was "merely coincidental."
Opinion about the forum ranged widely in the gay and alternative press, from Ann Fettner's forthright denunciation of Duesberg as "homophobic" to Lauritsen's dismissal of the panel as a "kangaroo court." Interestingly, the AmFAR forum attracted a fair amount of attention in scientific publications but little in the mass media. (Possibly the mainstream reporters had lost interest once the apparent conspiracy of silence had ended, while by this point the larger scientific community was very much concerned about the potential ramifications of the controversy.) The position of reporters for both Science and Nature , the two most influential general science publications in the world, was that Duesberg had effectively been shown up. William Booth, writing his second article about Duesberg for Science , pointed to "vigorous head-shaking and audible groans" as Duesberg made his case. "If the … session accomplished anything," said Booth, "it was to confirm Duesberg as odd man out."
Writing in Nature , Rebecca Ward noted that the base of Duesberg's "credibility" all along had been "mainly among patient populations with the greatest interest in learning that HIV infection does not lead inevitably to a fatal disease," rather than among his scientific peers. At the forum, "Duesberg's quest for scientific credibility for his unorthodox theories … lost ground." Ward concluded with a prediction about the future course of the controversy, again distinguishing between Duesberg's popular credibility and his credibility in scientific circles: "Duesberg's theories will no doubt continue to receive attention from groups already mistrustful of the scientific establishment's
response to AIDS. But scientific acceptance for his ideas about AIDS, never very high, seems to be sinking." Little could Ward or Booth have guessed that, more than five years later, Duesberg would not only remain at the center of debate but would have garnered some backing from reputable scientists for his stance.