"The Impact of the Truck"
The International AIDS Conferences, the documentary "The AIDS Catch," and the Policy Review article and ensuing debate were three arenas in which the causation controversy bubbled into clear public view in 1989, 1990, and 1991. Elsewhere, the controversy was not invisible, but it simmered more quietly. In scientific communities and gay communities, in the mainstream press and the alternative press, various players pushed their claims, seeking to establish their credibility or undercut that of others. In the process, dissenters who had been predicted to fade into oblivion instead demonstrated their staying power. This quiet jockeying for position would set the stage for a fierce resurgence of the causation controversy in 1992.
Formal scientific debate continued throughout this period. One exchange that was followed closely by insiders took place in the Journal of Acquired Immune Deficiency Syndromes between Duesberg and Alfred Evans of the Department of Epidemiology and Public Health of the Yale University School of Medicine. Evans was an authority on Koch's postulates and had been writing about them since the 1970s; he emphasized that "the postulates of causation have changed and will continue to change with the new technology and new concepts of pathogenesis." Revealing his historical bent, Evans also noted that Duesberg's offer to be injected with HIV was reminiscent of a similar act by German researcher Max von Pettenkofer. In 1892 at the age of seventy-four, von Pettenkofer drank a milliliter of "a fresh culture of cholera vibrio derived from a fatal case" to attempt to prove his point that cofactors were required to cause the disease. Von Pettenkofer was lucky: he didn't develop serious cholera, although he did have gas and diarrhea for a week afterwards. Evans urged Duesberg not to follow in von Pettenkofer's footsteps.
Duesberg also published articles and letters in Science, Nature, The Scientist , the New England Journal of Medicine , and the Pasteur Institute's Research in Immunology , among other places. In these publications Duesberg tended to restate his earlier views while responding to critics. Increasingly, he invoked other dissenters as allies in his writings, citing work by scientist and nonscientist alike—Jad Adams, Celia Farber, John Lauritsen, Harry Rubin, Joseph Sonnabend, Katie Leishman, Anthony Liversidge, and Gordon Stewart. Robert Root-Bernstein, the young physiologist whose letter to Lancet had attracted Duesberg's notice, also kept busy. He expanded on his position in a
1990 article in a journal called Perspectives in Biology and Medicine . Although careful to maintain an official position of agnosticism, Root-Bernstein stressed the prevalence of risk factors among people with AIDS—chronic or repeated infectious diseases, drug use, anesthetics, antibiotics, semen exposure, blood exposure, and malnutrition.
For the average layperson not inclined to peruse the pages of the medical and scientific journals, the easiest place to learn about the HIV dissidents during this time period was, ironically enough, the pages of Robert Gallo's Virus Hunting , a book for the general reader published in 1991. Though in the past Gallo had declared himself "too busy" even to bother reading Duesberg's articles, this book included an entire chapter entitled "About Causes of Disease (and, in Particular, Why HIV Is the Cause of AIDS)"—a chapter that, amid discussion of Montagnier's mycoplasmas and Root-Bernstein's risk arguments, devoted a full ten pages to refuting Peter Duesberg.
"When are we ready to say that we know the cause of a disease?" asked Gallo, taking aim at the crux of the controversy. "To a greater extent than we might want to believe, there are few hard-and-fast rules [and] certainly no cookbook recipe to follow," he added, noting that Robert Koch "has been taken too literally and too seriously for too long." But most diseases did have a sine qua non , though other factors might contribute to the severity, speed of onset, or likelihood of development. Gallo offered the analogy of head injury in the case of a truck that crashes into a group of bicyclists, some of whom are wearing helmets, some of whom hit concrete, and some of whom are clad in red shirts: "We could argue that the cause of the head injury was concrete, the red shirts, the absence of a helmet, or the truck—but we don't. The impact of the truck is the sine qua non , the cause. The others are influential positive or negative factors or correlations with no influence at all, as in the case of the red shirts." "Of course there are diseases where there is true multifactorial [causation]," Gallo later commented, reflecting on the etiology of some types of cancer. But "HIV causes AIDS, nothing else: you take it away, [AIDS] goes away."
Gallo's book did not dispute the possibility of contributing causes—indeed, over the past few years, he had been proposing that a virus called HHV-6 (human herpes virus, number six) might speed up the process by which HIV destroyed T cells. But HIV could also do its work without HHV-6, while HHV-6 alone did not cause AIDS. HIV, in other words, was both a necessary and sufficient cause. Montagnier,
by contrast, was now proposing that a mycoplasma might be a second necessary cause along with HIV—a claim that Gallo found "astonishing." Montagnier's cofactor theory provided "added longevity to confused and confusing … arguments that HIV is not the primary cause of AIDS," Gallo complained. What particularly irked him was that Montagnier had thereby "lent some support to Duesberg (who, interestingly enough, dismissed Montagnier's idea)."
Gallo could hardly deny that Montagnier had impressive credentials for commenting on questions of medical science. But he was quick to observe that "the vast majority of people who have raised, re-raised, and re-re-raised objections to the conclusion of an HIV cause of AIDS"—here Gallo names Jad Adams, Katie Leishman, Anthony Liversidge, and Chuck Ortleb—"seem to have little or even no experience in science or medicine." What of Duesberg? Gallo acknowledged his colleague's indisputable scientific accomplishments, but stressed that they might not have prepared him to comment credibly on AIDS: "He made very significant contributions to our understanding of the molecular biology of animal (especially chicken) retroviruses many years ago and is a member of the National Academy of Sciences. On the other hand, he is not an epidemiologist, a physician, or a public health official. More important, to my knowledge Duesberg has never worked on any naturally occurring disease of animals or on any disease of humans, including AIDS. Nor, I believe, has he ever worked with HIV."
During the 1989–1991 period, Duesberg also continued to receive publicity in the mass media, including a long and generally sympathetic feature article by Garry Abrams in the Los Angeles Times that asked whether the scientist was "Hero or Heretic." Abrams noted that Duesberg was shocked to learn in fall 1990 that the NIH had declined to renew his five hundred thousand-dollar-a-year Outstanding Investigator Grant. While renewal of such grants is far from automatic, the review committee had written that Duesberg had become "less productive, perhaps reflecting a dilution of his efforts with non-scientific issues." This was a serious blow to Duesberg, and Abrams implied that it was direct punishment for heresy, with the phrase "non-scientific issues" serving as a euphemism for Duesberg's campaign against the orthodox position on AIDS.
One symptom of the thickening of debate was that the media began covering the media coverage. USA Today ran an article on Spin magazine, "the only general interest publication pushing [Duesberg's] theory."
Charles Trueheart reported on the Policy Review debate for the Washington Post , suggesting that the authors' emphasis on the role of personal behavior in the cause of AIDS "may explain why their article appears in this conservative journal."Lies of Our Times , an alternative magazine dedicated to policing the writings of the New York Times , complained that the newspaper had never mentioned Duesberg since Philip Boffey's original article in 1988, and it claimed that "the silence of the Times kept Duesberg out of the major media for three years."
Duesberg also was promoted in places like the New York Native by authors like Lauritsen. Elsewhere in the gay press, the causation controversy was a marginal issue but one that provoked periodic heated exchanges. Writing in the Bay Area Reporter , a San Francisco gay newspaper, columnist and AIDS activist Michael Botkin described the "peculiar revival of interest" in Duesberg's theories. Duesberg "continues to be shunned by virtually all serious AIDS activists," wrote Botkin, "but has sparked some interest from heterosexual, HIV-negative, radical-posing journalists." But while some commentators worried about the consequences of knee-jerk anti-expertism, others expressed the opposite concern—that gays were inexplicably naïve and were following the medical establishment like placid sheep. In a discussion of Duesberg's arguments and Montagnier's "startling admission," Ralph Garrett wrote to the San Diego Gay Times: "In the face of such a scandal, among the questions we in the gay community should be asking ourselves is how could we have credulously surrendered our lives and deferred our better judgement to an authority which has proved to be just as corruptible as any other? … What madness could have come over us?"