Chapter 4
The Debate That Wouldn't Die

The Controversy Reignites (1991–1992)

From Isolation to Organization

In mid-1991, the struggle by Duesberg and other HIV dissenters to create credibility for their claims in both popular and professional arenas was given a significant boost by the founding of an organization. The impetus came from a molecular biologist named Charles Thomas Jr., a former Harvard professor and current director of a small biotechnology research institute in San Diego. Thomas later commented that he believed "it was a matter of civic duty" to get involved, saying, "I've worked on viruses and I can read and understand this literature. … I felt real fabrications were taking place."^[1]

The group took form in a flurry of faxes between Thomas, Duesberg, Robert Root-Bernstein, Berkeley law professor Philip Johnson, and an actuary from Kansas City named Robert Maver. Thomas originally dubbed the organization "Friends of HIV," and, in a "Dear Colleague" form letter mailed to potential supporters, he asked them how they liked the title.^[2] In the end, sobriety prevailed over facetiousness and the organization became the "Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis." The group submitted a statement to both Science and Nature in June 1991 and asked that it be published as a letter to the editor. The full statement read: "It is widely believed by the general public that a retrovirus called HIV causes the group of diseases called AIDS. Many biomedical scientists now question this

hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken."^[3]

The letter was notably restrained in tone and in content. By calling simply for reappraisal and by not advocating an alternative hypothesis or making any of the more controversial claims that had been advanced earlier by Duesberg and other dissenters, the letter was well suited to attract support. It went to Nature and Science with twenty-eight signatures, and by the following year Thomas had gathered a total of fifty-three. The signatories were mostly from the United States, but there were a few from Switzerland, Italy, Britain, Germany, and Australia. The list included familiar names, like Harvey Bialy, Gordon Stewart, and John Lauritsen. But others were new to the public controversy, and many of them came with respectable credentials. Of the fifty-three who had signed by June 1992, twelve had M.D.'s and twenty-five had Ph.D.'s. Twenty of the fifty-three gave academic affiliations with departments like physiology, biochemistry, medicine, pharmacology, toxicology, and physics.

Yet remarkably enough, the letter never saw publication, having been rejected not only by Nature and Science , but by Lancet and the New England Journal of Medicine as well.^[4] While this gatekeeping may have kept a minority view out of the prestigious scientific and medical publications, it also guaranteed favorable publicity for the group in the mainstream media. One journalist with the San Diego County edition of the Los Angeles Times interviewed Thomas and wrote a story focusing on the suppression of dissent and the plague of "political correctness" in biomedicine.^[5] The Chronicle of Higher Education also profiled the group in December 1991, in an article that described Duesberg's fight to recover his Outstanding Investigator Grant and noted that Duesberg's representative in Congress, Ron Dellums, had looked into the NIH's handling of the grant application.^[6]

Meanwhile, backing for Duesberg arrived from an unlikely quarter. "Professor Peter Duesberg … is probably sleeping more easily at night," suggested John Maddox, the editor of Nature , in a September 1991 piece in the "News and Views" section called "AIDS Research Turned Upside Down." Maddox summarized two recent and perplexing studies that suggested the presence of autoimmune mechanisms in the development of AIDS. "None of this would imply that HIV is irrelevant to AIDS," Maddox concluded, "but that an immune response to foreign cells, most probably lymphocytes, is also necessary.

Duesberg will be saying, 'I told you so.'" In the past, "Duesberg has been pilloried for his heterodox views … and faced with the threat that his research funds would be snatched away," wrote Maddox. "Now there [is] some evidence to support his long fight against the establishment (among which, sadly, he counts this journal)."^[7]

"Pilloried Professor May Be Right about Aids," proclaimed London's Daily Telegraph .^[8] "New Study Vindicates Duesberg, Calls AIDS an Autoimmune Disease" read an article in the Bay Area Reporter .^[9] Others were more cautious in their conclusions. A reporter for Science , in an article called "Duesberg Vindicated? Not Yet," cited "numerous … researchers [who] failed to see any connection between [the two studies] and the stand taken by Duesberg." One of the researchers whose article had provoked the fuss told Science: "We have nothing in common with [Duesberg's] idea that HIV has nothing to do with AIDS." No fan of the autoimmune hypothesis himself, Duesberg agreed, saying "Those studies have nothing to do with [my position]."^[10]

Joseph Palca, the reporter for Science , focused on Maddox's motives for endorsing Duesberg, given that Duesberg occupied such an extreme position in the debate. Maddox explained to Palca: "I'm not for a minute saying Duesberg is right in all points. But I feel sorry that Nature has not done more to give his view prominence. It would have hastened the process by which the scientific community is coming around to the view that the pathogenesis of AIDS is more complicated than the baby-talk stories we were all given a few years ago."^[11] This was the real issue, Joseph Sonnabend commented in a column in the gay and lesbian magazine NYQ —the "vast gulf between the simplistic view of the pathogenesis of AIDS that has been presented by those who lead the AIDS research establishment … and the painful reality that we have almost no understanding of the pathogenesis of this disease." The "baby-talk story"—that HIV causes AIDS in all infected people by directly killing T cells and that the only cofactor is the passage of time—"was not arrived at as the result of years of intense and painstaking research," Sonnabend complained, "but was almost instantly discovered in 1984, and presented not as speculation but as established fact."^[12]

The "Drug-Aids Hypothesis"

As the implications of Maddox's intervention were sorted out in various arenas, Duesberg scored another partial victory:

the publication in a professional journal of a formal statement of his own hypothesis as to the causes of AIDS. The article was published in Biomedicine & Pharmacotherapy after a yearlong, ultimately unsuccessful, campaign by Duesberg to publish once again in the far more prestigious Proceedings of the National Academy of Sciences . The Proceedings had published Duesberg's views on AIDS twice before but each time had sent the submissions out for peer review, breaking with its ordinarily relaxed procedures for academy members. Both times the reviews had been critical; both times editor Igor Dawid ultimately had relented. This time Dawid put his foot down, writing Duesberg in February 1991 that the article had been rejected. One referee had called the paper a "flight of ideas" and "grossly incomplete," while the second referee favored publication. The third referee acknowledged, "I am no expert in the fields concerned" and made a political argument: "In all likelihood the publication of this article in PNAS would be harmful to the reputation of the journal, and has a potential for being harmful to the HIV infected segment of the population."^[13]

What was all the fuss about? In "The Role of Drugs in the Origin of AIDS," Duesberg presented what could be considered the fourth version in a sequence of publicly expressed views about the etiology of AIDS. Back in 1987, Duesberg had started out saying he didn't know what caused AIDS; all he was certain of was that it wasn't HIV. "The charge was then leveled that I was destructive, I was only negative, I was not contributing anything," Duesberg later recalled.^[14] But very soon afterward, he began making statements consistent with the immune overload hypothesis. In 1990 his student Bryan Ellison's Policy Review article had expanded this hypothesis (as reworked by Root-Bernstein) and extended it to the other risk groups, formalizing it as the risk-AIDS hypothesis. But in the very course of discussions with Ellison as the article was being written, Duesberg had become increasingly uncomfortable with the generalized focus on any and all forms of risk behavior.^[15]

In place of the risk-AIDS hypothesis, Duesberg began to formulate a more parsimonious explanation, the "drug-AIDS hypothesis," which emphasized toxicological causes of AIDS. In a move that signaled his disagreement with some of the other HIV dissidents, such as Sonnabend and Callen, Duesberg dismissed the significance of repeated infections. AIDS was not caused by an infectious agent—not HIV, not CMV, not Epstein-Barr virus, not any combination of the above. Drug consumption—not promiscuous sex—was the lifestyle practice associated with AIDS, Duesberg increasingly became convinced.

Leaving aside the hemophilia and transfusion cases, which had their own explanations, nearly every case of AIDS in the United States and Europe could be attributed to drug abuse.

In his 1992 article in Biomedicine & Pharmacotherapy , Duesberg presented his case in more formal terms. The article included 132 references, mostly to scientific publications but also to popular works by Jad Adams and John Lauritsen. Ever since the turn of the century, Duesberg wrote, "evidence has accumulated that addiction to psychoactive drugs leads to immune suppression and clinical abnormalities similar to AIDS, including lymphopenia, lymphadenopathy, fever, weight loss, septicemia, and increased susceptibility to infections and neurological disorders." These clinical abnormalities became epidemic in the early 1980s as a result of "a massive escalation in the consumption of psychoactive drugs," Duesberg explained, with reference to Justice Department statistics. "Thus the American AIDS epidemic is a subset of the AIDS epidemic." Indeed, only half of the drug-induced immunodeficiency cases receive public notice, due to the hegemony of the HIV hypothesis: "Only the pneumonias, tuberculoses, and dementias of the 50% of American intravenous drug users with HIV are recorded as AIDS, while those of their HIV-negative counterparts are diagnosed by their old names."^[16]

How would Duesberg prove a claim that AIDS is caused by drugs? Koch's postulates were not relevant in this case, since they applied only to infectious agents. Duesberg was arguing that the relation between drugs and AIDS was analogous to that between smoking and lung cancer: prolonged and repeated exposure to the toxic substance or substances eventually resulted in disease in some percentage of cases. The problem is that causal relationships of this sort are notoriously difficult to establish, and epidemiologists devote considerable energy to teasing out the various lifestyle risk factors that might confound the relationship (Is the smoker also overweight? Does the smoker drink alcohol?). But Duesberg was not an epidemiologist and had conducted no controlled studies. Nor did his proven expertise in molecular biology or retrovirology have much bearing in this case. Duesberg simply set out to construct a persuasive argument, relying on his background in chemistry and facts at his disposal from his scouring of the published literature.

After quickly reviewing his case for the implausibility of the reigning hypothesis, Duesberg began by noting the "chronological coincidences" between the AIDS and drug epidemics in the United States. Moreover, "drugs and AIDS appear to claim their victims from the

same risk groups." Intravenous drug users comprised about a third of all AIDS patients, Duesberg explained. And about 60 percent of AIDS patients in the United States were male homosexuals, who, according to Duesberg, were disproportionate consumers of drugs. Duesberg reported on a number of studies, including a 1990 survey of "3,916 self-identified American homosexual men, the largest of its kind," which found that 83 percent had used one or more drugs—including poppers, cocaine, amphetamines, and LSD—during the previous six months. Finally, Duesberg turned to another "risk group," healthy antibody positives who had taken "cytocidal DNA chain terminators" such as AZT. "Thus an unknown, but possibly a high percentage of the 30,000 Americans that currently develop AIDS per year have used AZT prior to or after the onset of AIDS."^[17]

Even if accepted at face value, these arguments about prevalence of drug use among AIDS risk groups were not particularly weighty in establishing the role of drugs in the causation of AIDS. Indeed, in his own attacks on the HIV hypothesis, Duesberg had frequently invoked the maxim that "correlation is not causation": just because HIV, or drug use, or anything else had been correlated with AIDS, researchers could not necessarily conclude that they had identified a cause. However, AZT presented Duesberg with a particularly convenient target, because by 1992 no one liked the drug very much despite its widespread administration. AZT did not cure AIDS, and it had substantial and potentially dangerous side effects. The initial study that showed it prolonged life in AIDS patients had been ended early when, for ethical reasons, the drug was supplied to study participants getting only a placebo, and some argued that, as a result, there was no clear evidence of the drug's long-term effects.^[18] Since 1990 the drug had also been prescribed to asymptomatic HIV positives in hopes of preventing progression to AIDS. But recent studies had been equivocal, suggesting that while the drug might indeed delay the onset of opportunistic infections, it might have no ultimate effect on longevity. By this reading, HIV positives faced a Hobson's choice in the short term—refuse AZT and suffer minor opportunistic infections or take AZT and endure its adverse effects—but arrived at the same place in the end. Another often-criticized but much publicized study had suggested that AZT might be less effective in African-Americans and Latinos than in whites.^[19]

To be sure, most doctors continued to prescribe AZT (or chemically related drugs), and public health authorities continued to promote it

as the indicated treatment for HIV positives with abnormally low T-cell counts. But enthusiasm for the drug had waned appreciably. Over the years, particularly in New York, some in the AIDS movement had come out against AZT—including dissenters in the causation controversy, like Ortleb, Lauritsen, Sonnabend, and Callen, as well as some who accepted the HIV hypothesis.^[20] Callen—who was well known for the accomplishment of being alive a decade after his AIDS diagnosis—attributed his survival, in large part, to his refusal to take AZT.^[21]

In his critique, Duesberg emphasized the drug's side effects: anemia, nausea, muscle atrophy, hepatitis, insomnia, headaches, seizures, and vomiting, among others. Yet although none of these conditions would justify an AIDS diagnosis, Duesberg did not explain his claim (perhaps borrowed from the title of Lauritsen's book, AZT: Poison by Prescription ) that AZT is "AIDS by prescription." Certainly if Duesberg were held to the same rigorous standards of proof that he proposed for the HIV orthodoxy, his argument would have to be found wanting. He had provided no conclusive evidence isolating long-term drug use as the cause of AIDS; he could point to no controlled longitudinal studies of the kind he insisted that the AIDS establishment must perform. And along the way he presented a number of arguments that can only be characterized as specious: "Within 48 weeks on AZT, 172 (56%) out of 308 Australian AIDS patients developed one or more new AIDS diseases, including pneumonia and candidiasis. This indicates that AZT induces AIDS disease within less than 1 year and thus much faster than the 10 years HIV is said to need to cause AIDS."^[22] This was like arguing that if a flu sufferer took aspirin, and four hours later her fever returned, then aspirin must cause fever even more rapidly than the influenza virus. Perhaps comments such as these were intended only to goad his critics and were not meant to be taken too seriously. Or perhaps by this point, Duesberg was so embittered by the behavior of his scientific colleagues—who, he believed, had black-balled him, tried to silence him, and succeeded in cutting his funding—that he was willing to employ any rhetorical device at his disposal to cast doubt on the worth of their accomplishments.

By a different calculus, Duesberg might be said to have achieved his objectives with the article in Biomedicine & Pharmacotherapy: he had supplemented what, after all, was his main point—that HIV could not be the cause of AIDS—by proposing an alternative explanation in a legitimate scientific publication. In the past, experts had taunted Duesberg: "Perhaps he would be willing to tell us what, in his view, is

the cause of AIDS and what he would do about it. … It would seem only fair for Professor Duesberg either to come up with an equally strong candidate or to lend his support to eradicating HIV and thus AIDS."^[23] Now Duesberg could claim to have met that challenge, and he could return to exerting public pressure on the proponents of the AIDS orthodoxy to prove the official story of AIDS causation.

The HIV Heretics and the "Murdoch Press"

Suddenly, in spring 1992, the causation controversy exploded in the pages of the British press. Between April 26 and May 31, more than twenty articles or opinion pieces on the topic were published in the pages of the Times, the Sunday Times, the Independent, and the Daily Telegraph, or released over the wire by Reuters. The furor was kicked off by the Sunday Times, which—along with the technically separate daily Times, also owned by publishing mogul Rupert Murdoch—had been prone toward headline-grabbing coverage of AIDS. These newspapers had explored the controversial view that the AIDS epidemic might be the unintended by-product of vaccine trials in Africa in the 1950s, which may have exposed vaccine recipients to monkey viruses similar to HIV. They had also fiercely questioned the view that heterosexuals were at risk of AIDS. Now, in a frontpage, headline story, accompanied by a much longer, forty-four hundred-word, double-page spread inside the newspaper as well as a sidebar on Montagnier, science writer Neville Hodgkinson described a "Startling Challenge to Aids Orthodoxy" mounted by "two of the world's experts on viruses," Montagnier and Duesberg.^[24]

Both scientists, Hodgkinson reported, "are to challenge the orthodox view that HIV is the exclusive cause of Aids" at an alternative AIDS conference to be held in Amsterdam the following month. Hodgkinson emphasized the shift in Montagnier's position on causation over the years, quoting the French scientist as saying: "We were naive. … We thought this one virus was doing all the destruction. Now we have to understand the other factors in this." And he described the rude reception that Montagnier had received in 1990 when he tried to present his views on cofactors at the International Conference in San Francisco. Hodgkinson quoted one observer: "There was Montagnier, the Jesus of HIV, and they threw him out of the temple."^[25]

One of several members of the group profiled by Hodgkinson was

Dr. Kary Mullis, a scientist who in 1983 had invented the technique called polymerase chain reaction that had transformed biotechnology research. (The Financial Times has called PCR "probably the most important development in genetics research since the discovery of gene-splicing in 1973," noting that the market for the technology is likely to be worth $1 billion a year by 1996.^[26] In October 1993, Mullis received the Nobel Prize in chemistry for inventing PCR.) Mullis had no expertise in AIDS, but his dissent carried a certain weight, given that his invention had actually been employed to support the orthodox position. Before the invention and distribution of PCR, scientists had been able to find HIV in only one out of every ten thousand to one hundred thousand T cells, raising serious questions about how the virus could be destroying the immune system. But once the same researchers began using PCR, they were able to find the virus in about one percent of T cells—which didn't answer all the questions but at least came closer to doing so. Mullis, however, was not impressed; he told Hodgkinson: "I can't find a single virologist who will give me references which show that HIV is the probable cause of AIDS."^[27]

The science editor of the daily Times, Nigel Hawkes, followed up with a shorter article the following day describing the alternative conference to be held in Amsterdam. "Professor Montagnier's presence is likely to give a higher profile to a campaign over AIDS which has been ignored or dismissed by mainstream medical opinion," wrote Hawkes.^[28] Meanwhile, Reuters Financial Report noted the financial implication of the Times 's articles for Wellcome Foundation, the British-based parent of Burroughs Wellcome, manufacturer of AZT. Shares of Wellcome stock "took an initial tumble on the article," dropping fifty-two pence.^[29] A few days later, the Times 's rival, the Independent, weighed in with a report from Steve Connor, a science correspondent who had coauthored a well-known book about AIDS. Connor quoted Dr. Kenneth Calman, Britain's chief medical officer, who had appeared on television to express his concern that the Times articles might encourage complacency in response to AIDS.^[30]

Soon afterward, the Independent published an opposing commentary by William Leith, who compared resistance to Duesberg and Montagnier with the opposition that Darwin and Copernicus had encountered from scientists of their day. "Why do people react so badly to new scientific discoveries?" Leith asked rhetorically.^[31] Connor responded with his own op-ed piece, which asked some pointed

questions about what Leith had referred to as "the Duesberg-Montagnier theory." Montagnier's name brought credibility, and the dissenters were understandably anxious to "enroll" him by presenting him as a fellow traveler. But Connor was having none of it. "Readers of several British newspapers could be forgiven for forming the impression that Professor Duesberg has won over a powerful ally," wrote Connor. In fact, Connor explained, Montagnier would be attending the alternative conference in order to oppose Duesberg. He quoted Montagnier's current opinion of Duesberg: "He's wrong because he doesn't take all the data into account, whether deliberately or not. I will go to the conference to prove Duesberg is wrong."^[32]

Connor argued that the Times 's misrepresentation of Montagnier's relationship to the HIV controversy was typical of an article that devoted two pages to Duesberg "but largely ignored the welter of evidence against his claim." Malcolm Dean, writing in the "News & Comment" section of the British medical journal Lancet, made a similar point in an article on "AIDS and the Murdoch Press." Decrying the Times 's "deep Conservative bias which the editor desperately tries to conceal by anti-establishment campaigns," Dean argued that "of course sceptics should be given space, but iconoclasts should be pushed as hard as establishment figures to justify their assertions."^[33]

Mavericks and High-Flyers

Darwin, Copernicus, Galileo—such names are often invoked to enhance the credibility of anti-establishment figures in science. These comparisons put a premium on challenge and innovation while equating "normal" science with dogma, superstition, and intellectual stagnation. In fact, the heroic imagery of revolutionary science appealed to many of the protagonists in the causation controversy, constituting an important dimension of what Pierre Bourdieu would call their scientific habitus—the particular set of dispositions and "generative schemes of perception, appreciation and action" that engender "the choice of objects, the solution of problems, and the evaluation of solutions."^[34]

Duesberg himself was a good example—a brilliant high-achiever, with a history of swimming against the current, a researcher who disdained the mediocrity that he equated with establishment science. The peer review process that governed the scientific world punished the "Mozarts" while rewarding the "Salieris," Duesberg explained, leaving

little doubt as to how he would classify himself. Peer review was "good for technicians, but not for innovation"; it constituted the "stabilization of mediocrity."^[35]

For Root-Bernstein—at twenty-seven the second youngest to receive a MacArthur "genius grant" in the 1981 cohort of winners—the $144,000 award meant that he could abandon a "restricting" and "boring" postdoctoral fellowship and conduct a study of scientific creactivity. One reviewer of Root-Bernstein's book Discovering noted its clear sympathies: "Root-Bernstein's characters venture the heretical notion that the clustered, prize-ridden, hierarchical culture of modern science may actually impede important discovery. … What do today's superstar academic-administrator-researchers really think of seminal investigators like Mendel, a monk who discovered the laws of heredity in a monastery garden without federal grants …? Would establishment science even listen to such outside maverick voices today?"^[36]

Kary Mullis, called by Time magazine the "hippie-holdout biochemist" and the "Last of the Great Tinkerers," says he conceived of the breakthrough technique of PCR "while winding through the mountains of Northern California" at midnight in his Honda Civic.^[37] Claiming to read widely in cosmology, mysticism, mathematics, virology, chemistry, and artificial intelligence,^[38] Mullis published an article in Nature on "The Cosmological Significance of Time Reversal" while a graduate student in biochemistry at the University of California at Berkeley.^[39] "If you're too establishment-oriented, you're not likely to come up with something really original," Mullis told the Los Angeles Times .^[40] In 1993, when he won the Nobel Prize, Mullis was pictured on the front page of the local San Diego Union-Tribune in a wetsuit, surfboard under one arm; reporters marveled at the collection of giant inflatable penguins that adorned his living room.^[41]

Mavericks, innovators, individualists—these were people who were unafraid to cross disciplinary boundaries and venture outside of their areas of expertise. And they shared a critical view—call it a loathing—of contemporary "big science" and the way it squelched imaginative efforts. "When a new theory deviates from that held by the majority, it is labeled 'controversial' rather than 'original,'" Duesberg wrote in a commentary piece in The Scientist, with specific reference to Montagnier, Root-Bernstein, and himself; "and the 'controversial' label is tantamount to a death sentence, manifested by non-invitations to meetings, non-citations in the literature, non-nominations for awards, and non-funding of research grants."^[42]

Gathering of the Tribes

Sponsored by a Dutch organization called the Foundation for Alternative AIDS Research, which stressed "freedom of information" and "freedom of thought," the alternative conference promised by the Sunday Times took place from May 14 to 16, 1992. Many of the key HIV dissenters were there: Michael Callen, Joseph Sonnabend, John Lauritsen, Joan McKenna, Gordon Stewart, Robert Root-Bernstein, Joan Shenton, Celia Farber, Jad Adams—along with, of course, the featured attractions, Duesberg and Montagnier. Other supporters of alternative positions came from a number of countries on the Continent, including Switzerland, Belgium, and the Netherlands. Representatives of the orthodox position were also in attendance, including three Dutch researchers, Roel Coutinho, Jaap Goudsmit, and Frank Miedema. In all, about two hundred people showed up for the event.

A Reuters report quoted the Secretary of Britain's Medical Research Council, who denounced the claims presented at the alternative conference as "a lethal cocktail of untruth and ignorance."^[43] But Nigel Hawkes, writing from Amsterdam for the Times of London, framed the issue as one of freedom of belief versus the suppression of heresy. He led off with: "In an old church in Amsterdam once used by religious liberals escaping persecution, a group of free-thinkers yesterday met to denounce the authorised version of Aids. …"^[44] Hawkes noted that "Montagnier insisted that the virus was a necessary part" of the spread of the epidemic, but he presented Montagnier as sympathetic to the dissenters: "'Dogmatism is a deadly sin in the process of science,' Professor Montagnier concluded. This was clear evidence, some might say, that he backed the efforts of the alternative Aids group to take a fresh look at a disease that has been spreading for a decade without a cure or a clear understanding of how it functions being found."

The considerable debate in the British press caused some Canadian publications to pick up the issue. The magazine Macleans published a long article on the Amsterdam conference,^[45] and the Toronto Star ran a story describing what it called "The New AIDS Controversy."^[46] But in the United States, home to most of the prominent HIV heretics, the alternative conference was almost entirely ignored by the mainstream press. National Public Radio's Weekend Edition ran a brief and not terribly illuminating report picked up from a correspondent for the

Canadian Broadcasting Corporation.^[47] But only readers of the gay press would have been likely to know significant details or to have followed the specific controversy concerning the role of Montagnier.

Initially, writers in gay publications followed the lead of the Sunday Times in assuming that Montagnier had defected to the dissident camp. An article in the New York-based magazine QW , entitled "HIV Does Not Cause AIDS, Virus Discoverer Claims," commented: "Although the multifactorial approach is not new, it is surprising coming from someone who is considered relatively conservative and has championed the traditional 'HIV causes AIDS' theory."^[48] Similarly, Neenyah Ostrom's article in the Native was headlined: "Montagnier: HIV Is Not the Cause,"^[49] while the San Francisco Sentinel reported that "other respected AIDS experts have begun to agree with Duesberg, most notably, Luc Montagnier. …"^[50]

Claims such as these apparently provoked consternation at San Francisco's Project Inform. One of the most authoritative voices on treatment issues within the AIDS movement, Project Inform had taken many anti-establishment stands. But on the question of causation, the organization stood squarely in the mainstream. Indeed, Executive Director Martin Delaney had become friends with Robert Gallo—initially out of the pragmatic position that it was more useful to the cause of AIDS research to have Gallo on board, but ultimately out of genuine respect for the researcher's talents and a belief that Gallo was being unfairly treated in the controversy surrounding the discovery of HIV.^[51] Delaney immediately wrote to Montagnier at the Pasteur Institute to express concern about the Times 's implication of an alliance between Montagnier and Duesberg and to request clarification of his views. Just before leaving for the alternative conference, Montagnier sent off a letter in response, which Delaney released to the press.^[52]

In the letter, Montagnier described the Sunday Times article as "misleading since it mixed a correct account of my interview with anti-HIV non scientific theories." However, "as you may recall from our meeting in 1990, my permanent position has been to keep an open mind and not to neglect any facts." Montagnier went on to reiterate his belief that mycoplasma may serve as cofactors, and that various indirect mechanisms—particularly one called "apoptosis" or "programmed cell death"—may be involved in T-cell depletion. But he stressed: "This is just opposite to the view that AIDS is not caused by HIV and is not a transmissible disease."^[53]

Project Inform Stakes its Claims

The seriousness with which Project Inform took the resurgence of interest in the causation controversy was indicated by the publication in early June of a six-page "Discussion Paper" devoted entirely to the topic. The report began by blasting the media for their irresponsibility and sensationalism. Why do reporters love the HIV dissenters? Why have they confused Montagnier's position with Duesberg's, despite Montagnier's own disavowals? "Apparently because it makes a good story—'Conventional Wisdom Is Wrong! Top Scientists in Error Ten Years! Secrets! Coverup! Big Business, Big Science Collusion!' … Such is the sorry state of AIDS reporting in some circles today."^[54]

Focusing on four groups opposing the HIV hypothesis—the New York Native, Spin magazine, assorted journalists, and certain scientists—Project Inform was at pains to question the credibility of each and to uncover motivations for adopting heretical stances. Accusing the Native of a "supermarket tabloid" mentality, the report described the newspaper as "driven not by any scientific data but by a seething hatred of Dr. Robert Gallo. …" And for writers at Spin , as well as "a few journalists" writing for publications like the Times of London and the Atlantic Monthly , the apparent motivations were "a generic distrust of authority and government science."^[55]

In considering the fourth, crucial group of HIV dissenters—the scientists—Project Inform's report similarly emphasized the issue of credibility. Root-Bernstein "works in a field not directly related to AIDS" and "has not conducted or published any AIDS research other than editorials," yet "Spin calls him 'one of the leading AIDS researchers in the US.'" Kary Mullis, while "obviously a serious scientist," was similarly "an outsider to AIDS research"; furthermore, his PCR test "has if anything, helped to bolster the case for HIV." Of all the heretical scientists, only Sonnabend "is professionally involved with AIDS," but "primarily as a clinician": "While Dr. Sonnabend has earned respect in many ways, his arguments against HIV are no more valid than the others."^[56]

The case against the credibility of Peter Duesberg was given more extended treatment. Project Inform explicitly posed the crucial question: "Is Peter Duesberg an 'AIDS expert'? That depends on the definition of 'expert.'" The report reviewed the evidence in terms that mirrored Gallo's characterization of his colleague: Duesberg had never

conducted laboratory, clinical, or epidemiological research on AIDS or HIV. He was trained in chemistry, not the biological sciences. He had "no known professional expertise regarding the immune system, was not an expert in the study of human viruses or retroviruses, nor in human disease in general (except for cancer)." True, he once mapped the genetic code of a retrovirus, but that work "bears little direct connection to AIDS."^[57]

In focusing on formal credentials, Project Inform walked a fine line. This, after all, was a grassroots organization staffed by self-educated AIDS experts; its executive director, before the epidemic came along, had been a business consultant. A big part of Project Inform's work involved disseminating highly technical knowledge about AIDS to laypeople in order to create what might be called a mass-based expertise. In its reckoning of the tokens of expertise, Project Inform was not about to argue that academic degrees or journal publications are everything. Lacking the right credentials, Peter Duesberg could still be considered an AIDS expert of sorts—but not in a way that would make him stand out from the crowd: "Perhaps his most relevant work is that he has studied the medical literature on AIDS (as have thousands of patients, physicians, and activists), and this qualifies as a form of expertise." But "Duesberg's supporters and the media spread misinformation when they present him as an 'AIDS researcher' in the sense that phrase is usually meant." His published writings on AIDS were "simply editorials."^[58]

Project Inform noted that there was a "legitimate" scientific question that had been "lost in the fog" generated by media fascination with Duesberg and other dissenters: How does HIV cause AIDS? Following the lead of Gallo and others, the report emphasized that pathogenesis was separate from etiology; while part one of the report was entitled "Is HIV the Cause of AIDS?" part two was called "How Does HIV Cause AIDS?" Here Project Inform adopted an agnostic position, informing its readers about a variety of hypotheses, including "specific co-factors," "general infectious co-factors," "superantigens," "apoptosis" (Montagnier's position), "autoimmunity," "overactivation," and "antigen diversity threshold." Project Inform's point was that speculation about these pathogenetic mechanisms was an entirely mainstream endeavor and had been since the beginning. "Few if any researchers," the report argued, "ever claimed that AIDS was solely the result of HIV killing [helper T] cells. It was the media who spread that view, apparently to simplify AIDS for the public."^[59]

While reviewing the various positions on etiology and pathogenesis, the report also took time to blast Duesberg's alternative causal hypothesis: "By linking AIDS to behavior, rather than a virus, Duesberg paints all but the 'innocent' victims of AIDS as promiscuous drug abusers. … When such views are expressed by fundamentalists and right wing politicians, they are routinely and correctly branded as homophobia and racism . Such well-known bigots as Congressman William Dannemeyer today quote Duesberg as the scientific source of their views." Against these charges, the report reminded readers of a "simple truth" known by "anyone in a community hard hit by AIDS"—that "some who have died did have histories of promiscuity and drug abuse, but many, many others did not."^[60]

Left and Right

By labeling Duesberg homophobic, and by associating him with political enemies on the right, Project Inform sought to annul any credibility that Duesberg might enjoy in gay and lesbian communities. Duesberg himself, however, assiduously rejected any taint of homophobia: "In reality I've paid more … to them than … most of my fellow AIDS researchers, who're making millions of dollars by killing homosexuals by the hundreds of thousands with AZT. … It's actually absurd that I'm being labeled the homophobe, when I might in fact have found the real cause of their problem. …"^[61] Whatever Duesberg's beliefs, it is certainly the case that the political configurations in the Duesberg controversy have been more complex than simple labels could suggest. For example, some left-wing commentators have supported Duesberg out of a principled objection to monocausal disease models. "Ruling classes embraced modern medicine because the germ theory blamed disease on invisible microbes and not hazardous conditions," according to one pro-Duesberg magazine article from 1989.^[62] Yet the appeal of Duesberg's views to conservatives—certainly including those with little sympathy for the gay movement—cannot be denied.

Charles Thomas, the organizer of the Group for the Scientific Reappraisal, has described himself as "libertarian" and claimed that he left Harvard in disgust because the universities had become "totally corrupted by affirmative action, political correctness, the whole nine yards." He criticized the AIDS activist movement as one of "victimology": by portraying AIDS as an "act of God," rather than the consequence

of behavior, homosexuals generated sympathy and government funding.^[63] Philip Johnson, the Berkeley law professor on the group's steering committee, has also been known for his conservative views. Bryan Ellison made no bones about why he sought to promote Duesberg in the Heritage Foundation's Policy Review , as well as in California Political Review , a journal that has also featured articles about "Hollywood's leftward tilt" and Republican California Governor Pete Wilson's "liberal surrender."^[64] Tom Bethell, a columnist who has written in support of Duesberg in various publications, is well known for his right-wing positions, which have included endorsement of such political figures as Patrick Buchanan.^[65] Bethell's columns in the Los Angeles Times include one entitled "We May Regret Going Along with This: The Gay-Rights Agenda Precludes Any Public Doubts."^[66] Elsewhere he has expressed sympathy for homosexual "recovery" organizations (which encourage gays and lesbians to become straight).^[67]

The "Vietnam Syndrome"

Project Inform concluded its commentary with some speculation about Duesberg's motives for continuing to pursue the controversy. Portraying Duesberg as "a propagandist, not a reasoning scientist," Project Inform's report noted the incendiary quality of Duesberg's claims when he labeled AZT as "iatrogenic genocide": "He presses the hot buttons of genocide, distrust of authority, fear of doctors, and suspicion of business—all in two carefully chosen words." Why would Duesberg be doing this? What could he possibly stand to gain? And doesn't the fact that he is being silenced by the scientific establishment mean that the AIDS movement should support him? Project Inform had its analysis at the ready: "Having gone out on this limb, personally and professionally, he got stuck there and is hanging on with great tenacity. It is true that the scientific mainstream sometimes (but rarely) makes a giant error and clings stubbornly to it, it is far more common that individual scientists do so."^[68]

Had Duesberg—along with other dissenters whose credibility was on the line, like Sonnabend and Root-Bernstein—simply gone too far to turn back? Had they become trapped by the nature of their prior investments? Even Bryan Ellison acknowledged, in describing his mentor's progress: "He slowly got more and more into it, and now, what's he going to do, back out?"^[69] Yet such arguments cut both ways.

Thomas Ryan, a supporter of Duesberg writing in the gay magazine Christopher Street , used the metaphor of the U.S. government's pursuit of victory in Vietnam to describe the ongoing commitment of the establishment to the HIV hypothesis: they simply had invested too heavily to pull out. And this could be said not just of the scientists, whose professional reputations were at stake, but of the wider "AIDS community" that had fashioned its very identity in response to the ramifications of the HIV hypothesis. "If anything positive has resulted from the AIDS crisis, it is the solidarity it has inspired in the gay community, and nothing has so threatened that uity as the HIV debate," wrote Ryan.^[70] Or as Drew Hopkins, another Duesberg sympathizer also writing in Christopher Street , observed: "If HIV is not the cause, the entire body of AIDS advocacy is undone from its foundation. Every issue must be re-examined from a new, uncertain perspective. Such a confusing period would also generate a dangerous vulnerability. As AIDS has become a more and more political issue, it would take very little for a Pat Robertson, Jesse Helms, or William Dannemeyer to seize the day, using the period of reassessment on the part of the AIDS community to conduct still more virulent campaigns of fear and hatred."^[71]

"AIDS Without HIV"

The wave of publicity that seemed to propel Duesberg forward throughout 1992 picked up additional momentum in July, with the opening of the Eighth International AIDS Conference. Convening in Amsterdam like its "alternative" predecessor of a few months before, the conference was sidetracked by breathless reports in the mass media of an "epidemic" of cases of "AIDS" in people who tested negative for antibodies to both HIV-1 and HIV-2. "The patients are sick or dying, and most of them have risk factors," wrote Newsweek , describing a dozen such cases. "What they don't have is HIV."^[72] Perhaps a new virus was at work, a possibility that seemed to gain credibility in the media due to the coincidental report by a southern California scientist of the isolation of an apparently new retrovirus in AIDS patients.^[73] Or perhaps there were other routes that led to conditions like AIDS. Newsweek 's speculations must have inspired intense flashes of déjà vu in those familiar with the debates about causes of AIDS that had been enacted a long decade earlier: "Dr. Alvin Friedman-Kien of the New York University Medical Center notes that

gay men and IV drug users contract numerous infections, from gonorrhea to herpes and hepatitis. Some ostensible AIDS cases may simply reflect the immune-suppressing effects of common germs or of poor nutrition, he says."^[74]

Besieged by reporters, scientists, and activists, James Curran, the head of the CDC's AIDS office, was forced to address the new syndrome at a heated conference session. Curran acknowledged that the CDC had been tracking such cases, but insisted, "These are not cases of AIDS"; he then made the circular argument—which Duesberg must have appreciated—that a definition of AIDS requires the presence of HIV.^[75] Duesberg wasted little time sending in a letter to Science , offering to provide to anyone who was interested "a list of references to more than 800 HIV-free immunodeficiencies and AIDS-defining diseases in all major American and European risk groups," along with references to "more than 2,200 HIV-free African AIDS cases." Rather than rushing to conclusions about any new virus, Duesberg advised, Science should focus attention on alternative explanations "that could resolve the growing paradoxes of the virus-AIDS hypothesis."^[76]

Only days after the first reports of the mysterious cases, this newest controversy framed a debate in the pages of the Los Angeles Times about the arguments of Peter Duesberg. Steve Heimoff wrote one of the two, side-by-side, opposing op-ed pieces, leading off with the observation that reports of "AIDS without HIV" would "appear to signal at least partial, temporary vindication" of the Berkeley scientist.^[77] Describing Duesberg as "the unofficial leader of the revisionists," "an international star of virology long before anyone heard of AIDS," and "not just another conspiratorialist," Heimoff reported that many of his arguments "have the ring of common sense." It would seem that "there are now three legitimately contending theories regarding the causes of AIDS," Heimoff said: the official CDC theory, Montagnier's cofactor theory, and Duesberg's. Heimoff concluded: "If there is even a remote chance that Duesberg is correct—and the latest reports increase that possibility—then the powers that be must leap into action."

"Just because the Establishment has been wrong so often doesn't necessarily make all of its critics right," Duesberg's old foe Michael Fumento responded in the accompanying piece.^[78] "Duesberg's methodology in determining that HIV doesn't cause AIDS is less science than a game in which he tells his opponents to go into a round room and sit in a corner." Turning to Duesberg's alternative hypothesis,

Fumento noted that the theory failed to explain AIDS in Africa, where neither AZT nor recreational drugs were in significant use. This prompted Duesberg and Ellison to respond, in a letter to the editor, that the official WHO statistics "reveal a tiny African AIDS epidemic" despite large numbers of HIV positives. They complained that Fumento also pointed to "media-publicized cases of ordinary people developing AIDS" but that he failed to mention that "Ali Gertz used cocaine, Ryan White suffered from fatal hemophilia, Paul Gann had traumatic heart surgery, Kimberly Bergalis used AZT, and Magic Johnson is symptom-free."^[79]

In the gay and lesbian press, responses to the "AIDS without HIV" flap were generally dismissive. Many denounced the "media circus" or "media feeding frenzies" that seemed predictably to ensue when too many reporters knowing too little about AIDS found themselves together in one place with too little hard news to write about.^[80] Martin Delaney, writing in his regular column in the Advocate , insisted on the "clear point" that "these events have nothing to do with the so-called Duesberg theory," and he warned that Duesberg's "supporters will no doubt seize on the new information as an assault on the role of HIV."^[81]

On the far end of the spectrum, Chuck Ortleb penned an editorial for the New York Native , entitled "Honey, I Blew Up the HIV Paradigm." Attacking the CDC for "promoting the religious belief that HIV is the cause of AIDS," Ortleb pushed the Native 's current theory, that AIDS and the chronic fatigue syndrome were "variants of the same disease": "If the C.D.C. wants to know all cases of HIV-negative AIDS, we hereby report to them 13 million cases: the estimate of the number of people in the U.S. with Chronic Fatigue Syndrome [CFS]."^[82] While the CDC was unlikely to have been impressed by Ortleb's statistics, indirect support for the Native 's publisher arrived from an unlikely source, when Newsweek published a follow-up story on "AIDS without HIV" that played up the chronic fatigue angle. "As more cases come to light, it's becoming clear that the newly defined syndrome has as much in common with CFS as it does with AIDS," said the Newsweek reporter, Geoffrey Cowley.^[83]

Following on Newsweek 's lead, Time magazine published a cover story entitled "Invincible AIDS," which suggested that the global fight against the epidemic was in disarray.^[84] But over the next few months, the AIDS establishment struggled to put its house back in order. In August the CDC convened a special panel to review all cases of "AIDS without HIV" that had been reported or that investigators

had been able to dig out of medical records.^[85] The panel dismissed as flawed the reports describing a new virus. But they agreed that a syndrome did exist—the CDC had dubbed it "idiopathic CD4+ T-lymphocytopenia" (ICL) to describe the depletion of helper T cells by an unknown cause^[86] —though only thirty confirmed cases could be found in the United States. Moreover, in contrast to the earliest reports, it now appeared that more than half the ICL patients reported none of the AIDS risk factors. As compared with AIDS cases, people with ICL were more likely to be older than fifty, more likely to be white, and more likely to be female.

The consensus of panel members was that different patients were immune-suppressed for different reasons. Most likely there had always been small numbers of such cases, but they had never before come to national attention because there was little medical emphasis on T-cell testing. "Only in the last three to four years has CD4 [helper T-cell] testing become a mass industry," commented Martin Hirsch of Harvard Medical School.^[87] The following month, the WHO reported similar findings based on a review of cases of ICL from around the world.^[88]

The Dynamics of Closure: Whither the Controversy? (1992–1995)

The Definitive Study?

Overshadowed by the news about "AIDS without HIV" were other research findings that augured less favorably for the future success of the HIV dissenters, particularly Duesberg. First, over the summer of 1992, two groups of researchers reported on the latest advances in isolating HIV from T cells using PCR technology. Instead of finding the virus in one out of every ten thousand or one hundred thousand cells, scientists were now succeeding in finding the virus in one out of every forty to two hundred cells.^[89] The following January, Dr. Ashley Haase of the University of Minnesota and other researchers reported on their refinement of PCR called "PCR in situ," which allowed them to discover HIV in 10 to 30 percent of T cells and in high percentages of other cells as well. These findings, the authors explained, were "consistent with the emerging view that HIV infection per se could contribute substantially to depletion of immune cells in AIDS."^[90]

Further relevant data were published in March, when two groups

of researchers, one led by Haase and the other by Anthony Fauci, described finding "massive covert infection" of lymphoid cells in the spleen, tonsils, adenoids, and lymph nodes during the early stages of HIV infection—ten times more virus than could be detected in blood samples at that stage of illness.^[91] "These developments," wrote Nature editor John Maddox in the Times of London, "convincingly give the lie to Duesberg's only cogent criticism of the conventional view that it is difficult to recover virus from the helper T-cells circulating in the blood." Maddox continued: "Now it seems probable that these vital components of the immune system are damaged and perhaps killed off in the relative obscurity of the lymph nodes and the other organs of the immune system."^[92]

Another piece of news (which received little notice beyond a brief report in a New York Times article devoted mainly to other topics)^[93] arrived in a presentation at the International AIDS Conference that was designed specifically to prove Duesberg wrong. The report was by Kevin Craib and other researchers with the Vancouver Lymphadenopathy-AIDS Study, one of the principal cohort studies that had been tracking HIV-negative and HIV-positive gay men for nearly a decade. The study's authors noted Duesberg's argument that no controlled study had been conducted that could truly distinguish between lifestyle risk factors and HIV infection as possible causes of AIDS. "The purpose of this analysis," wrote Craib and his associates, "was to conduct just such a controlled analysis within a cohort of homosexual men."^[94]

Looking back over their accumulated data, Craib and his coauthors investigated the incidence of AIDS-defining illnesses and changes in T-cell counts over time and tried to relate those clinical developments to HIV status, to exposure to psychoactive drugs, and to sexual behavior. They found that half of the 350 HIV-negative men in the study reported using psychoactive drugs. And about a quarter of them reported having been the receptive partner in anal intercourse with "casual partners." But despite these high incidences of (hypothesized) risk behavior, there were no signs of immune dysfunction in the seronegative group—no AIDS-defining illnesses and no drop in T-cell counts. Of 134 AIDS-defining illnesses in the full cohort, "every single one occurred in men with pre-existing evidence of HIV infection." Cofactors might determine which HIV positives contract which (if any) opportunistic infections, the authors concluded; "but claims that AIDS is caused by other exposures and not by HIV are clearly not borne out by these data."

The Berkeley epidemiologist Warren Winkelstein had already shown Duesberg unpublished figures, derived from the San Francisco Men's Health Study, that supported similar conclusions. Duesberg, however, insisted that unpublished data simply didn't count in the world of science, and he refused to acknowledge Winkelstein's findings unless they appeared in a peer-reviewed journal. Winkelstein maintained, in response, that these were really nonfindings and that scientists weren't generally in the business of publishing nonassociations.^[95] But in the end Winkelstein was induced to answer to his nemesis; and in March 1993, an immunologist named Michael Ascher, along with Winkelstein and other colleagues, published a commentary in Nature entitled "Does Drug Use Cause AIDS?"^[96] The article appeared the same week as the formal publication of Craib's study in Lancet —a double whammy that attracted the media attention that Craib's conference presentation had failed to elicit.^[97]

Ascher and his colleagues assembled a point-by-point argument that seemed intent on addressing every objection that Duesberg had ever voiced or might conceivably muster in the future. It was a strong piece of science and very much a political document, one which acknowledged as its motivation "the wide publicity attracted by [Duesberg's] assertion."^[98] Ascher and his colleagues reviewed the San Francisco Men's Health Study data for 1,027 study subjects over ninety-six months. According to interviews performed at the beginning of the study back in 1984, the 812 gay or bisexual men and the 215 straight men had used cocaine, marijuana, and amphetamines in roughly the same percentages during the two years prior to recruitment for the study. (For example, 36 percent of homosexuals/bisexuals and 39 percent of heterosexuals had reported using marijuana once a week or more.) Since 26 percent of the gay or bisexual men had been diagnosed with AIDS indicator diseases over the course of the study, one would therefore expect that roughly the same percentage of the heterosexuals would also have AIDS diseases, if drug use were indeed the cause. But in fact, there were no cases of AIDS indicator diseases in the heterosexual group.

Noting that "the clinical case definition of AIDS has been criticized as having subjective features and low specificity," the authors also presented data examining the relationship between T-cell counts over time, drug use, and one's status as antibody positive or negative. T-cell counts, after all, were "the primary pathognomonic feature of AIDS"; they were the best indicator of the health or impairment of the

immune system in people at risk of AIDS. The results were striking: The average numbers of T cells (per cubic millimeter) for the seropositives declined steadily from about seven hundred in 1984 to about four hundred in 1992, regardless of extent of drug use. But the average numbers for the seronegatives stayed the same, at one thousand to twelve hundred T cells—although ironically, the heavy and moderate drug-using seronegatives actually had slightly higher T-cell counts than the seronegative abstainers. This was a surprising finding, but it hardly helped Duesberg's case. The researchers concluded with their own challenge for their adversary: "The energies of Duesberg and his followers could better be applied to unraveling the enigmatic mechanism of the HIV pathogenesis of AIDS."

The Terms of the Debate

One of the dissenters' strongest arguments, which made an appearance in practically every published statement that any of them had made over the course of more than eight years, was that closure had been reached prematurely in 1984. A "probable cause" had been identified that was soon taken to be "the cause," yet no one bothered to prove it definitively. Instead, the world simply acted on what it took to be the truth. By the mid-1990s, however—particularly as a result of data from long-running cohort studies—the state of the evidence looked rather different. Indeed, one might even argue that the dissenters' challenge and the ensuing controversy had served to promote clearer argumentation on behalf of the HIV hypothesis. In that sense, ironically, the dissenters may have helped to reinforce the dominance of the position they opposed.

Does this mean that the end of the controversy was in sight? That would have been an overly hasty conclusion, and one that ignored recognized pitfalls along the path to closure in scientific controversies. In their consideration of the question of how scientific controversies end, H. Tristram Engelhardt and Arthur L. Caplan have noted the danger in assuming that complex disputes can be adjudicated through straightforward, rational means. The notion that a controversy can be "settled" presupposes prior agreement on "(1) how to acquire evidence relevant to the dispute and (2) how to reason with the evidence in order to reach a rationally defensible conclusion that will resolve the controversy." In fact, differing perceptions of what "the controversy" is and what sort of evidence might "settle" it are themselves often stakes in a controversy. This is all the more likely to be true,

Engelhardt and Caplan have observed, when "stakeholders in the debate belong to … different communities with different appreciations of the evidence at stake" or to "competing social groups" with opposing political and ethical agendas.^[99]

How does one prove disease causation? Without agreement on this basic question, there was little chance of consensus about the relation of HIV to AIDS. In the early 1980s, many researchers, including even Gallo, seemed to have Koch's postulates at least generally in mind as they sought to isolate the virus, to induce the syndrome in primates, and to trace transmission of AIDS through infected blood products (see chapter 2). But when challenged by Duesberg, researchers argued that Koch's postulates were rarely satisfied in practice, especially for viruses; and they pointed to well-known examples.

As Duesberg pressed his case, both sides moved toward the position that specific epidemiological evidence—especially controlled longitudinal data—is what could settle the question.^[100] But where epidemiologists such as Winkelstein insisted that the existing data from cohort studies already provided a definitive answer, Duesberg maintained that a meaningful cohort study had not yet been performed: The existing studies were created with the goal of studying the progression of "HIV disease." They were not set up to determine what causes AIDS, let alone to study drugs as a possible cause, and, Duesberg claimed, the data that had been collected about participants' drug use were superficial and inadequate. Neither Winkelstein nor the Vancouver group asked about drug use occurring as far back as ten years prior to entry into the study; nor had any of the cohort studies included blood tests for drugs, which Duesberg claimed were necessary to verify if the study participants were answering truthfully.^[101] From the perspective of Duesberg and his allies, these aspects of data collection rendered the cohort studies worthless in adjudicating between causal hypotheses. Duesberg's deconstruction of the cohort studies demonstrated clearly what science studies scholars have repeatedly argued: in situations of controversy, experiments alone cannot be expected to "settle" the dispute. "The problem with experiments," according to Harry Collins and Trevor Pinch, "is that they tell you nothing unless they are competently done, but in controversial science no-one can agree on a criterion of competence."^[102] Moreover, any experiment is—admittedly—an artificial stand-in for real-world conditions. Does the experimental situation adequately represent and capture reality? Nothing inherent in the experiment itself forces the observer to accept it as such.^[103]

Both sides remained convinced of the validity of their claims; each

side saw the other as dogmatically defending its position by means of a constant renegotiation of the rules. From Duesberg's standpoint, the defenders of orthodoxy were always "moving the goalposts" whenever its predictions were proved false; from the vantage point of the dominant position, the dissenters were forever cooking up newer and stricter criteria of proof that their opponents were then expected to meet. "Like a child who questions every answer with another 'why,' he plays a game which will never end until he says it is over," was how Martin Delaney characterized Duesberg's methodology in late 1992.^[104] But perhaps the real mistake was to imagine that there is one "scientific method" or set of "rules of evidence" upon which everyone could unproblematically agree.^[105] Indeed, if the controversy has demonstrated anything, it is that scientific "rules of the road" like Koch's postulates or epidemiological cohort data, far from being unchallengeable benchmarks, may be as subject to interpretation and debate as the empirical phenomena they are invoked to explain.

Most likely there is no scientific test that would settle the causation controversy to the satisfaction of all sides. A different sort of proof probably would spell the end of the controversy, however: if the AIDS establishment were to succeed in finding an impressively successful antiviral drug or vaccine, it is unlikely that anyone would continue to pay much attention to the dissidents. They would simply fade from the scene. This, however, is not entirely logical, for, as René Dubos has argued, it can be dangerous to infer medical etiology "backwards" from treatment effectiveness: "While drenching with water may help in putting out a blaze, few are the cases in which fire has its origin in a lack of water."^[106] Yet at its root the support for the dissenters stems precisely from disappointment with the establishment's lack of therapeutic success, as the dissenters themselves have been acutely aware. Michael Callen told a Canadian television program in 1989: "It seems to me that if … you've got a chemical that is anti-retroviral … and you give it to people who have a disease that you claim is caused by a retrovirus and they don't get better, that would tend to suggest—at a minimum—that something a lot more complicated than having or not having HIV is going on."^[107] The more time that has passed without a cure being discovered, the more persuasive has been the argument that the AIDS establishment has "produced nothing" and—by extension—their etiological hypothesis must be bankrupt. From a logical standpoint, this, of course, follows even less obviously than the converse claim that the existence of a successful treatment would verify the

causal hypothesis. But the argument has a rhetorical power that cannot be denied. "As long as there's no cure, this will lurk," Robert Gallo reflected in 1994.^[108]

Meanwhile, the struggle has gone on, and the HIV dissenters have continued to make the news. By now several of the principals have told their stories in book-length detail. Root-Bernstein's Rethinking AIDS: The Tragic Cost of Premature Consensus , published by Free Press, weighed in at 512 pages and included 100 pages of notes. It reviewed the anomalies in the HIV hypothesis, discussed a range of multifactorial theories of AIDS, and delved deeply into theories of autoimmune mechanisms.^[109] Lauritsen's The AIDS War: Propaganda, Profiteering and Genocide from the Medical-Industrial Complex , a reprinting of many of his articles, likewise ran nearly 500 pages.^[110] Ellison and Duesberg encountered more obstacles with their book, which was accepted but then dropped by two different publishers. By 1994 the book fell victim to a bitter feud that erupted between the two authors and led to a parting of the ways. Working alone, Duesberg finally published the book Inventing the AIDS Virus in 1996. In addition to 463 pages of new text, the book included reprints of several of Duesberg's scientific articles; it also featured a foreword by Kary Mullis. In this extensive review for the general reader, Duesberg summarized the views he had been putting forward for nearly a decade—not only on the HIV hypothesis and the drug-AIDS hypothesis, but on the status of the field of virology and the politics of science in general.^[111]

The ranks of the dissenters were depleted in December 1993 by the death of Michael Callen, who had lived with AIDS for nearly twelve years and played a central role in a range of activist projects.^[112] Other dissenters have continued to engage public attention. Notable occasions have included the appearances by Duesberg, Kary Mullis, and Philip Johnson at a special panel of the annual meeting of the Pacific Division of the American Academy for the Advancement of Science; a Florida physician's public self-injection with apparently HIV-infected blood to draw attention to "the greatest scam ever perpetrated"; and a freshman Republican Congressman's attempt to force government scientists at the NIH and CDC to consider the view that HIV does not cause AIDS.^[113]

Perhaps most noteworthy, however, was a high-profile "Special News Report" called "The Duesberg Phenomenon," published in Science in late 1994 and taking up an extraordinary eight pages of the

premier journal.^[114] "Because the Duesberg phenomenon has not gone away and may be growing," wrote Jon Cohen, the AIDS reporter for Science and the author of the news report, "Science has decided this was a good time to examine Duesberg's main claims." Cohen's strategy was to tackle Duesberg's arguments head-on; in a series of sidebars, he considered each of the critical test cases. Although scrupulous in presenting Duesberg's views, the article suggested that Duesberg was wrong on all counts: being HIV positive was the key variable associated with HIV-related illness for hemophiliacs; Koch's third postulate had been satisfied by the accidental infection of three laboratory workers, all of whom developed symptoms of immune suppression prior to taking any antiviral drugs; and large, recent studies of extended AZT use showed no evidence that the drug caused AIDS.^[115] Not surprisingly, this intervention ignited yet another wave of publicity: though Cohen may have intended exactly otherwise, his article propelled the Duesberg phenomenon onward. Indeed, a long article in The Scientist published in March 1995, which led off with the special report in Science , was entitled "A Controversy That Will Not Die: The Role of HIV in Causing AIDS."^[116]

Years after the publication of his article in Cancer Research , Peter Duesberg has settled in for the long haul. The HIV controversy has become his life; his office on the Berkeley campus is the war room of a campaign waged simultaneously on multiple fronts. Duesberg maintains a frenetic pace, juggling reporters and visitors between poring over the latest AIDS publications and preparing his latest rebuttals. Though he might not agree with much that Anthony Fauci has to say, he would doubtless concur with one prediction that the NIH scientist made back in 1989: "I am probably going to be answering Peter Duesberg for the rest of my life."^[117]

Causation and Credibility

The story told in part one—the story of the early search for the cause of AIDS, the initial consolidation of the HIV hypothesis, and the challenges subsequently posed to that hypothesis—has important implications for the study of scientific fact-making in politicized environments. The construction of belief about the causes of AIDS, and the dynamics of controversy, cannot be understood through an analysis of the "scientific field" as traditionally understood

as a self-contained arena in which credentialed researchers are the only important actors. Rather, a highly public and somewhat "open" field has been the site of incessant struggle, negotiation, cooperation, and interaction among a variety of individuals, institutions, and organizations. What are the tactics by which credibility is advanced or attacked in this field? What are the distinctive characteristics of the attempts to resolve controversy in this case?

Credibility Tactics

In an analysis of scientific controversy, Collins and Pinch have suggested that it can be useful to distinguish between struggles waged in what they call the "constitutive forum" and those that are enacted in the "contingent forum." The constitutive forum is the world in which scientific knowledge-production is traditionally believed to unfold—the world of "scientific theorising and experiment and corresponding publication and criticism in the learned journals." The contingent forum, by contrast, includes everything that is supposedly "external" to real science: "popular and semi-popular journals, discussion and gossip, fund raising and publicity seeking, the setting up and joining of professional organisations, the corralling of student followers," and so forth. Collins and Pinch's point is emphatically not that one domain is "scientific" while the other is "extra-scientific." Rather, they seek to show how scientific debates are advanced through recourse to different types of arguments, some of which seek to create the appearance of being "based on universalisable non-contingent premises," while others do not.^[118]

Clearly, the AIDS causation controversy has heavily depended on both modes of argumentation. Working within the constitutive forum, AIDS dissenters such as Duesberg have highlighted inconsistencies in the orthodox position, enumerated predictions that have not been fulfilled, pointed to violations of "classical methods" such as Koch's postulates, and made use of medical analogies that compare the conventional wisdom about AIDS to that of other diseases "mistakenly" thought to be caused by microbes. In response, the proponents of the orthodox position have spelled out specific lines of rebuttal, defended the mainstream position through "clarifications" and auxiliary hypotheses, and invoked their own medical analogies that compared AIDS to other conditions where Koch's postulates have not been satisfied. In Susan Leigh Star's terms, both sides have manipulated "hierarchies

of credibility" through "claims that one procedure or approach is more scientifically viable, or technically astute, than another."^[119]

At the same time, scientists and medical doctors, not to mention lay participants in the controversy, have been quick to employ the contingent forum to assail the credibility of their opponents. Their mechanisms for doing so have been surprisingly familiar, as revealed by a comparison with the controversy in the 1970s and 1980s over fluoridating public water supplies. In that controversy, as Brian Martin's analysis makes clear, the mainstream position has enjoyed a near-monopoly of scientific credibility, but dissenters have found ways to undercut the credibility of their opponents.^[120]

Certainly the most obvious tactic available to the dominant group in such controversies is to try to ignore their opponents—as scientists successfully did with Sonnabend but had more trouble doing with Duesberg. When this tactic fails, the dominant group is typically confronted with the question of whether or not to engage in public debate. Defenders of fluoridation expressed the same sorts of concerns that Fauci and others did about debating Duesberg. One fluoridation enthusiast wrote in the American Journal of Public Health: "A debate simply serves to give more credibility to fluoridation opponents." As Martin has observed, experts who refuse to debate risk being perceived as arrogant, yet simply by engaging in debate they risk undercutting their own expert status by being viewed as partisans. Scientists supporting the dominant position walk a tightrope in trying to retain both their scientific credibility and their moral authority.^[121]

In the AIDS causation controversy, as in that over fluoridation, actors on all sides have sought to undermine claims by venting ad hominem attacks against their opponents. In doing so, they have attempted to tarnish their opponents' credibility by challenging either their expert status or their motivations or both. As Martin has noted, supporters of the mainstream position tend to work especially hard to attack the credibility of those opponents who have the most legitimate credentials;^[122] and the intensity and range of criticism directed at Duesberg—that he's just a chemist, that he's never worked on human diseases, that it's all a "game" with him and "he has to know he's wrong"^[123] —would seem to bear out the general point. Although "more than one can play the game of attacking the credentials, motivations, and honesty of those with opposite views," Martin has said in reference to fluoridation, the majority position tends to win this "battle over reputation in an overwhelming fashion because they have

the preponderance of professional support and especially the backing of professional societies."^[124]

In the case of AIDS, defenders of the HIV hypothesis could point not only to all the prominent national and international organizations that agreed that HIV causes AIDS (as Gallo, for example, was apt to do), but could even invoke the general consensus among grassroots activists, who were themselves typically critical of established authority. As ACT UP member Michael Botkin wrote in his column in the Bay Area Reporter , what "bugged" him about the fans of Duesberg was "the way they completely ignore the opinion of the AIDS movement." Noted Botkin: "ACT UP is no dupe of either the federal government or the medical mainstream. Everyone loves a good conspiracy theory, and certainly it's easy to believe that the government is blind, incompetent and corrupt. But if Duesberg's theory has some substance to it, why hasn't it garnered some interest, if not support, in the savvy, skeptical AIDS movement?"^[125] This move on Botkin's part might be described as the "monopolization of oppositional credibility."

Some of the most powerful weapons available to the defenders of the dominant position in scientific controversies are the sanctions they can exercise against dissenters. Through control over professional organizations, funding institutions, and journals, they can suppress heretical views and even those who dare voice them. Martin has recorded a variety of examples in the case of fluoridation. When a Minnesota dentist spoke out against fluoridation, his local dental society suspended him for one year without giving him a chance to speak in his own defense. In 1964, when a U.S. sociology student conducted a survey of a group of doctors and discovered that only half the respondents favored fluoridation, the student reportedly was chewed out by an assistant dean "for abusing the good name of her school." An Australian chemistry professor claimed in 1973 that "his staff and equipment had been taken away because of his public opposition to fluoridation." When an article critical of fluoridation was submitted to an Australian journal, it was rejected over the telephone by an editor who claimed "it might encourage the antifluoridationists."^[126]

Arguably, these examples are reminiscent of the experiences of Duesberg. The Berkeley scientist has indeed had increasing difficulty getting his views represented in prominent scientific journals, while some of the comments by reviewers and editors have suggested that political considerations (such as protecting the journal's reputation)

have been one factor in the process. He has seen his funding terminated in circumstances that invited suspicion. And he has reported being ostracized by his colleagues and former friends. At the same time, as Martin has pointed out, dissenters in scientific controversies can use such experiences of "unjustifiable" scientific behavior as "a resource in their struggle": "Opponents of fluoridation frequently raise these cases of 'suppression' as showing the political rather than the scientific basis for the promotion of fluoridation."^[127]

Criticizing instances of suppression and gatekeeping is one example of a more general tactic that both sides in the causation controversy have employed—what Martin has described as "highligting discrepancies between the stated norms of scientific behavior and the actual behavior of certain scientists."^[128] Duesberg has made frequent reference to the charges of fraud that have been brought against Gallo, while opponents of Duesberg have argued that, by speaking to a lay audience, he has sacrificed his scientific integrity. And each side has accused the other of a dogmatism that is antithetical to the true spirit of scientific inquiry: their predictions have been falsified, their arguments have holes in them, yet they refuse to forswear their beliefs. "A powerful hypothesis has to explain and predict," dissenter Harvey Bialy has told Spin: "I ask you, what kind of scientist continues to support a hypothesis that fails to explain and fails to predict?"^[129] Writing in the San Francisco Chronicle , Martin Delaney has turned the argument back against Duesberg: "Duesberg is well aware of [contrary] evidence, having been briefed regularly by his faculty peers. Yet he clings to his views, in spite of any and all data, while presenting no original AIDS-related data of his own, a puzzling pattern for someone who claims devotion to science."^[130]

Mainstream and Alternative Media

The extensive participation of the media has had important consequences for how credibility struggles have been waged in the AIDS causation controversy. Of course, the media are not monolithic, and different sorts of media have played different kinds of roles. The gay press has been far more receptive to giving space to nonmainstream positions and to citing the noncredentialed as legitimate experts. Alternative news vehicles like Spin , the New York Native , and the Meditel television programs have themselves become important actors in the controversy, intent on advancing certain

positions and demoting others. But as a general rule, the media, by their very presence, have transformed the collective assessment of credibility.

According to Anthony Fauci, "the media are great equalizers in science, which is most disturbing to us scientists"; "any scientist quoted in the media becomes an 'expert.'" Because Duesberg was presented by the media as credible, many people became concerned that the HIV hypothesis is a hoax, Fauci explained, adding that his own sister had called him repeatedly to ask: "Are you sure he's wrong?"^[131] Journalistic norms of "balance" impelled reporters to present the controversy as having "two sides"; media consumers, unable to judge for themselves the relative solidity of consensus among AIDS researchers, assumed controversy was rampant.^[132]

Martin Delaney, along with other defenders of the established position, has emphasized the penchant for sensationalism and sympathy for anti-establishment views found among at least some journalists and publishers. Yet to dissenters like Duesberg and Jad Adams, the problem is precisely the opposite: the media are the obedient lapdogs of government science. As Duesberg put it: "The press has been functioning like this [taps tape recorder] for the AIDS establishment. They have been Sonys.… Fauci calls the press and there it goes in the New York Times and the Los Angeles Times . Front page. No Fumento balancing it, no second guy writing what you have said. [They] speak directly to the American public. Immediately. That's the difference."^[133] Duesberg's critics complain vehemently about the amount of ink that the media have devoted to him, but Duesberg's perspective is completely the reverse: "I mean, measure it against the … 1,000 [articles] on the virus hypothesis that the New York Times alone publishes a year.… You will have a factor of like 1,000 … to one … in their favor. And that's how it works in the propaganda business. That's why Goebbels and others were so successful." In Britain, Duesberg has acknowledged, the media have been more critical, as have been some alternative reporters in the United States like Farber and Lauritsen. But in general the United States "is actually extremely conformist in many ways," Duesberg has complained.^[134]

Various analysts have claimed that reporters covering science and medicine—who often fail to have a thorough grasp of the scientific principles at stake—can become especially dependent on their contacts.^[135] "Such symbiosis between journalist and source is common in the American media," according to an analysis by Rae Goodell, "but

especially intense in science reporting."^[136] One study of U.S. media coverage of the potential swine flue epidemic found that "in spite of the many hundreds of experts who might have been contacted for comment, the same group of medical spokespeople from government authorities was quoted to the virtual exclusion of anyone else."^[137] Duesberg has claimed that the same phenomenon is at work in AIDS reporting. Because journalists are so dependent on their official sources, they decline to cover nonmajority views out of fear of being "frozen out": "They won't get further information on the subject from the mainstream.… And then they're out." After all, he has said, "without AIDS, you can't be a science reporter these days."^[138]

"My regard for science reporters is very, very low," Duesberg has concluded; and that's one thing that he, Gallo, and Fauci would all seem to agree on.^[139] Yet everyone in the AIDS causation controversy also recognizes the singular importance of playing to the media. In explaining why most people accept the orthodox position, Duesberg told California Monthly : "Science is really now a popularity contest, made by newspapers. You hype something in the press, and people take it from there."^[140] Duesberg was being critical, but of course, he has played the same game; and he had little choice but to do so if he wanted to advance his claims in the controversy.

Democracy as Rhetoric and Reality

Perhaps the most important factor altering the grounds for credibility in the AIDS causation controversy is the deeply embeded concern with "democracy"—understood in various ways. The most obvious examples of this preoccupation relate to questions of "academic freedom" or "freedom of thought." Duesberg's supporters routinely insisted upon his "right to speak the truth"; a San Francisco Examiner editorial blasting Duesberg nonetheless acknowledged his "right to air his view even in the face of nearly unanimous scientific disapproval."^[141] A more profound democratizing claim, also pushed by some of the HIV dissenters, is that the scientific marketplace must be opened up to all those who seek to compete within it. "The 'AIDS establishment' is under the impression that it has a right to govern all discourse on AIDS," complained Celia Farber in Spin . "It feels no one has any business disrupting its conclusions and treatment strategies. But don't all those AIDS posters remind us, 'AIDS is everybody's disease'? Doesn't that include the people who question those who made the posters? Isn't it everyone's debate, too?"^[142]

This is a very different kind of claim, one which proposes that science ought to be opened up to anyone who seeks to present knowledge as credible or evaluate the credibility of others. Ironically, even Duesberg has had his doubts about such a project and would reserve science for the scientists. "I'm not excluding anybody else," Duesberg has hastened to add. "It would be great if others would participate too, but they're too easily misled or bought. I mean, [scientists] give them a slide … and it shows something with T-cells … and people say, 'Oh my god, these guys must know everything.' And so you can easily impact a gay activist or counteractivist by this type of information without telling them anything.…"^[143] There may indeed be limits to the extent that lay activits can contribute to answering questions such as what causes AIDS. At the same time, there is no avoiding the astonishingly public and contested nature of biomedical science in the late twentieth century, particularly in the AIDS epidemic. Like many of his mainstream critics, Duesberg would have us return to a mythical golden age when researchers did their work in peace, protected from the play of "politics." Yet his own interventions have helped to open the gates to the citadel—and the ordinary people who have gotten the chance to step inside are not likely to surrender that prerogative.

From Causation to Treatment

The democratizing claims of laypeople, while surfacing regularly in the causation controversies, have been even more pronounced in the evolution of debates about treatments for AIDS. These debates, the topic of part two, have been enacted concurrently with the causation controversies, and they involve some of the same protagonists; indeed, references in past chapters to topics such as AZT, which feature prominently in part two, suggest a certain overlap. More profoundly, the intervention of laypeople, particularly within gay communities, in debates about the nature and causation of AIDS from 1981 onward helped construct "knowledge-empowered" communities that could then participate in even more radical ways in debates about treatments.

Yet in certain respects, research into treatment is different from the sort of research involved in determining the cause of AIDS. Since drugs cannot be tested without patients willing to participate in clinical trials, laypeople occupy a central position in the very process of knowledge-making. And since the approval of drugs is often a highly

politicized process involving government agencis, pharmaceutical companies, and other players, debates about the safety and efficacy of treatments travel with particular ease between the pages of scientific publications, the mass media, and—in the case of AIDS—activists publications and the gay and lesbian press. The chapters that follow track the history of research into antiviral AIDS drugs and explore the crucial role of AIDS activists in transforming themselves into experts who could speak credibly about treatments. The interventions of the AIDS movement have had profound implications.for the social construction of belief—for what we come to think is true about the safety and efficacy of antiviral drugs.