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."
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. 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."
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. 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. 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.
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)."
"Pilloried Professor May Be Right about Aids," proclaimed London's Daily Telegraph . "New Study Vindicates Duesberg, Calls AIDS an Autoimmune Disease" read an article in the Bay Area Reporter . 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]."
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." 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."
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."
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. 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.
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."
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."
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. 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.
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. 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.
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." 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." 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.
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."
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. 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."
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. 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. 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.
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. 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."
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."
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."
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."
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?"
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. Claiming to read widely in cosmology, mysticism, mathematics, virology, chemistry, and artificial intelligence, 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. "If you're too establishment-oriented, you're not likely to come up with something really original," Mullis told the Los Angeles Times . 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.
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."
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." 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. …" 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, and the Toronto Star ran a story describing what it called "The New AIDS Controversy." 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. 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." Similarly, Neenyah Ostrom's article in the Native was headlined: "Montagnier: HIV Is Not the Cause," while the San Francisco Sentinel reported that "other respected AIDS experts have begun to agree with Duesberg, most notably, Luc Montagnier. …"
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. 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.
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."
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."
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."
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."
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."
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."
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."
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."
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. …" 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. 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. 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." 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. 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." Elsewhere he has expressed sympathy for homosexual "recovery" organizations (which encourage gays and lesbians to become straight).
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."
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?" 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. 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."
"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." 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. 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."
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. 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."
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. 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. "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."
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. 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."
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]." 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.
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. 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. 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 —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. The following month, the WHO reported similar findings based on a review of cases of ICL from around the world.