You are hereOut of Control, AIDS and the Corruption of Medical Science
Out of Control, AIDS and the Corruption of Medical Science
The March 2006 issue of Harper's Magazine contains an article titled Out of Control, AIDS and the Corruption of Medical Science by the well-known AIDS denialist, Celia Farber. The article essentially repeats all the old lies and distortions about HIV and AIDS that Peter Duesberg and his very small following of "believers" have been promoting for years. Harper's is (or was) a serious magazine read by intelligent people, so it's of significant concern that they have published an article like this one.
Responses to Harper's Magazine's Out of Control
- Rebuttal and Letters
- *Behind Harper's Folly: Farber, Hodge and the Denialist Deception
- Drug Trials and Error
- *Further lies from Farber in Harper's Magazine
- The Nation
- New York Times
- CJR Daily
- Poynter Online
- Gay City News
- The Advocate
- The Body
- ACT UP
Letters to Harper's Magazine in Response to the Farber Article
- Errors in Celia Farber's March 2006 Article in Harper's Magazine (Gallo et al)
- Open Letter from People Involved in the Struggle Against HIV/AIDS
- Dr. John P. Moore
- Dr. Daniel R. Kuritzkes
- Nathan Geffen and Dr. John P. Moore
- Reply from Mr Stark to Geffen and Moore
- Follow-up Letter by Dr. John P. Moore
- Reply from Mr. Stark to "Errors in Celia Farber's March 2006 Article..."
- Dr. Bette Korber
- Dr. Andrew McMichael
- Dr. Robert C. Gallo
- Dr. Richard Marlink and Dr. Catherine Wilfert
- Dr. Dana Gabuzda
- Dr. Donald Kennedy
- Dr. Michael M. Lederman
- Dr. Robert Gallo and Dr. Luc Montagnier
Harper's Publishes AIDS Denialist
The Nation, Blog Posted: 03/02/2006 @ 3:49pm, by Richard Kim
The latest issue of Harper's Magazine contains a stunning 15-page article by well-known AIDS denialist Celia Farber (formerly of Spin magazine) that extensively repeats UC Berkeley virologist Peter Duesberg's discredited theory that HIV does not cause AIDS.
Read the full blog.
Robert Gallo MD, Nathan Geffen, Gregg Gonsalves, Richard Jefferys, Daniel R. Kuritzkes MD, Bruce Mirken, John P. Moore PhD, Jeffrey T. Safrit PhD
4 March 2006
This document describes the errors in Celia Farber's March 2006 article in Harper's Magazine, titled "Out of Control: AIDS and the Corruption of Medical Science." Our primary concern is with rebutting Farber's misconceptions about HIV/AIDS and antiretrovirals (ARVs). We have not focused our attention on misleading or biased reporting that relate to the NIH; none of us is an NIH employee. We have also ignored the sections on Peter Duesberg's career problems, his rejected funding proposals, and how he is (or is not) regarded by other cancer researchers nowadays; we have no interest in Duesberg, other than to note that he is not an AIDS researcher and has no practical experience in studying HIV.
Using a plethora of false, misleading, biased and unfair statements, Farber attempts to cast scientific institutions and scientists as dishonest. But intellectual dishonesty is the norm for Farber and other AIDS denialists including David Rasnick, Peter Duesberg, Kary Mullis and Harvey Bialy – all people she mentions favourably in her article. David Rasnick works for a vitamin entrepreneur, Matthias Rath. They have conducted unauthorised experiments on people with HIV in South Africa, convincing their subjects to take Rath's vitamin products in dangerously high doses, instead of scientifically recognised treatments for AIDS. It has been alleged that some of their subjects have died due to this experiment. Farber implies financial motives permeate scientific research. Why does Farber not make similar allegations against the AIDS denialists, many of whom are involved in the marketing of unproven alternative medicines?
HIV has been shown to be the cause of AIDS in numerous studies. ARVs have been shown to reduce death and illness in people with HIV. They have also been shown to reduce mother-to-child transmission (MTCT) of HIV. They often cause side-effects. On rare occasions these can be fatal, but death from HIV/AIDS is a far greater risk. The evidence shows beyond doubt that the benefits of ARVs far outweigh their risks.
We present two tables below. The first is a list of errors in Celia Farber's article in the March 2006 issue of Harper's. The list is possibly incomplete. All of these errors should have been found in the fact-checking process. The second table contains some relevant points about the authorities Farber cites in support of her views.
27 February 2006
Dear Sam Stark: (Editor of Harper's Magazine)
We are disappointed that Harper's, a reputable magazine known for its accurate, groundbreaking and incisive reporting, has published Celia Farber's article in the March 2006 issue. Ms. Farber's article contains numerous falsehoods, inaccuracies and unsubstantiated allegations. Frankly, Ms. Farber's article is pseudo-science. It is also dangerous because of its potential to convince people in desperate need of antiretroviral medicines not to take them, with life-threatening consequences.
Ms. Farber is sympathetic to, and has herself long perpetuated, the factually incorrect views that HIV is not the cause of AIDS and that the risks of antiretrovirals outweigh their benefits. However, it has been demonstrated beyond reasonable doubt that HIV is the cause of AIDS and that the benefits of antiretrovirals, appropriately prescribed and monitored, far outweigh their risks. This is the view of every credible scientific and medical institution in the world, without exception.
While the right to free speech allows Harper's to publish whatever it chooses, your magazine has earned its reputation by publishing accurate, properly researched, fact-checked articles based in science, not conspiratorial nonsense.
By publishing Ms. Farber's article, you have insulted the dignity of people living with HIV, undermined 25 years of scientific research and endangered the lives of laypeople living with HIV. To rectify matters, in so far as they can be rectified, we urge you to allow a detailed response from the scientific and AIDS activist communities. This response should be given equivalent space to Farber's article. We await your urgent reply.
Adam Sitze, Assistant Professor, Department of Law, Jurisprudence, and Social Thought Amherst College
Alyx Beckwith, Friends of TAC, US
Andrew A. Lackner, D.V.M., Ph.D., Director, Tulane National Primate Research Center, Professor of Microbiology, Immunology and Pathology
Andrew J. Feinstein, Chairperson Friends of TAC UK, former ANC MP
Bette Korber, Laboratory Fellow, Theoretical Biology and Biophysics, Los Alamos National Laboratory
Daniel Moshenberg, George Washington University
Dennis Burton, Professor of Immunology, Scripps Research Institute
Douglas F. Nixon, MD., Ph.D., Associate Professor of Medicine, University of California, San Francisco
Elke Zuern, Assistant Professor Politics, Sarah Lawrence College
Fernando Arenzana-Seisdedos, Department of Virology, Pasteur Institute, France
Francois Venter, MD, President Southern African HIV Clinicians Society
Guy Taylor, Globalise Resistance
Harry Blatterer, Dr, University of New South Wales
Ingrid Meintjes, Treatment Action Campaign
Jack Lewis, Director Community Health Media Trust, South Africa
John P. Moore, PhD, Professor of Microbiology and Immunology, Cornell University
Judie Blair, Director South Africa Development Fund, US
Julie Davids, Executive Director, Community HIV/AIDS Mobilization Project (CHAMP)
Keith Alcorn, Editor aidsmap.com
Lynn Morris, Professor, Head of AIDS Unit, NICD, South Africa
Mark Heywood, Director AIDS Law Project, South Africa
Mark Wainberg, Professor Molecular Biology/Virology, McGill University
Matt Sharp, AIDS Treatment Activist Coalition, USA
Michael Kasper, Reference Librarian/Collection Development Coordinator, Amherst College Library
Nathan Geffen, Policy Co-ordinator, Treatment Action Campaign, South Africa
Nicoli Nattrass, Professor of Economics and Director of the AIDS and Society Research Unit at the University of Cape Town, currently a Visiting Fellow at Yale
Nokhwezi Hoboyi, Co-editor Equal Treatment, Treatment Action Campaign
Polly Clayden, HIV i-Base, UK
Premesh Lalu, PhD, Senior Lecturer History, University of Western Cape, South Africa
Preston A. Marx, Professor, Tulane National Primate Research Center
Quentin Sattentau, Department of Pathology, University of Oxford
Richard Jefferys, Basic Science, Prevention & Vaccines Project, Treatment Action Group
Robert C. Gallo, MD, Director Institute of Human Virology, University of Maryland Baltimore
Ronald S. Veazey, DVM, PhD, Professor of Pathology, Tulane University School of Medicine
Ryan Clary, Senior Policy Advocate, Project Inform
Sammie Moshenberg, Director of Washington Operations, National Council of Jewish Women
Sanjay Basu, AIDS Program, Yale School of Medicine
Sharon Ekambaram, Project Office Chris Hani Institute, South Africa
Simon Wain-Hobson, Professor of Virology, Pasteur Institute, France
Sipho Mthathi, General Secretary Treatment Action Campaign, South Africa
Zackie Achmat, Chairperson Treatment Action Campaign, South Africa
Individual Letters to Harper's Magazine
To the Editors,
I am writing regarding Celia Farber's article "Out of Control", published in the latest edition of Harper's Magazine. The article is unfair, inaccurate, contains many deceptive statements and, overall, shames the reputation of a serious magazine. Ms. Harper makes many, silly scientific errors in her article, most of which could have been detected if the magazine had been appropriately diligent in its fact-checking. Only a few of the errors, however, are new and original ones; the majority are a repetition of the myths and willful misunderstandings about HIV and AIDS that have been perpetuated over the past 20 years by Ms. Farber and her fellow-members of a small clique of AIDS denialists. The truth about HIV and AIDS has been published many times, in scientific publications, on the NIH's website, and as a statement signed by over 5000 individual scientists, physicians and health-care workers in 2000 - the Durban Declaration. Ms. Farber and her friends choose, quite deliberately, to ignore these inconvenient facts, because to acknowledge them would be to destroy the entire basis of her article. If Harper's Magazine cares about accuracy and truth in reporting, it would grant equivalent space to bona fide scientists to publish a detailed rebuttal of Ms. Farber's falsehoods about HIV and AIDS. I very much hope you will consider doing this: morality and fairness demand that you do.
The central theme of Ms. Farber's article is that medical professionals, government officials and AIDS activists have united in a global conspiracy to enrich themselves at the expense of the public, by acting as the poodles of the pharmaceutical industry in promoting drugs that don't work for a disease that doesn't exist. It's a compelling story - for lovers of conspiracy theories. But is it remotely plausible? Conspiracies only work when very, very few people are involved: if one wants to keep a secret, tell nobody else what it is. Is it realistic to believe that none of the hundreds of thousands of people involved in this alleged conspiracy over a 25-year period would have broken ranks by now? Surely someone would have spilled the beans, because of an attack of conscience, or a fight over the scale of the bribes? But no: this hasn't happened, because the conspiracy does not exist. AIDS researchers and activists are united by one theme: the desire to prevent HIV from spreading further and to treat those who are already infected by this lethal virus. You might also want to take into account that at least one of the leading denialists, Dr. David Rasnick, a source of much of Ms. Farber's "information", is a paid employee of Matthias Rath, a multi-millionaire peddler of vitamin pills as a "cure" for AIDS who is engaged in a sales war against the pharmaceutical industry in South Africa. Of course, Ms. Farber neglects to point this out, but again in the interests of fairness, it's as relevant to the article as the calumnies perpetuated against bona fide scientists who know that antiviral drugs work as treatments for AIDS whereas vitamin pills do not.
An alternative argument might be that we are all, collectively and individually, simply too stupid to realize that we have wasted 25 years of our professional lives working on the wrong subject; that we lack the intellectual capacity to weigh the evidence, to understand the underlying science, to reject flawed hypotheses. Is this possible, given the sheer numbers and professional qualifications of the people involved (see, for example, the aforementioned Durban Declaration)? Ms. Farber mentions in her article a few scientists, and a larger number of laymen, who have chosen not to believe that HIV causes AIDS. By doing so, she makes a classic error: scientific truth is not established by one or two people, it is created by consensus within a research community. It is always possible to find dissidents and denialists for any argument put forward by humans, be it scientific, political or the best shade to use for the bathroom wallpaper. But the mere existence of dissidents and denialists does not mean that they are right. Those familiar with the quiz show "Who wants to be a millionaire" will know that the best lifeline available to a contestant is to "Poll the audience". Almost always, the majority opinion of the audience is the correct answer; only a perverse person would elect to go with the outliers. The causal relationship between HIV and AIDS has been accepted by numerous professional organizations, including the National Institutes of Health, the World Health Organization, the United Nations, the Pasteur Institute, the UK Medical Research Council and many others of equivalent standing. Why? Because the scientific facts are so rock-solid, Ms. Farber's ill-informed opinions notwithstanding.
In the interest of fairness and accuracy in reporting, you have an obligation to publish this letter. You should also commission an article of equivalent length from bona fide scientists, or at least from an objective science writer who understands the subject, to present the real facts about HIV and AIDS to your magazine's readership.
John Moore, PhD
Professor of Microbiology and Immunology, Weill Medical College of Cornell University, New York
To the editor:
As Chair of the HIV Medicine Association, which represents over 3,300 medical professionals who devote their lives to treating patients with HIV/AIDS, I am writing to express my dismay at the article by Celia Farber in the March, 2006 issue of Harper's ("Out of Control: AIDS and the Corruption of Medical Science"). The uncritical recitation of discredited and sensationalist allegations of research misconduct not only misrepresents the facts surrounding the HIVNET 012 trial, but ignores the substantial body of scientific evidence that has confirmed results of that trial. The dramatic reductions in spread of HIV from mothers to their babies through the use of single-dose nevirapine and similar antiretroviral strategies stand as testimony to the fundamental validity of the trial results. Even more shocking is Farber's lionization of Peter Duesberg, the prophet of HIV/AIDS denialists.
In parroting Duesberg, Farber brushes aside the overwhelming epidemiological, clinical, and virological data that provide incontrovertible proof of HIV as the cause of AIDS. With 40 million infected, and with 3 million deaths from HIV/AIDS worldwide in 2005 alone, those of us on the front lines of global efforts to halt the spread of HIV/AIDS and to ease the burden of those already afflicted know that HIV kills. Ignorance of HIV kills, too. It is sad that the editors of Harper's have chosen to spread ignorance, rather than knowledge in this critical arena.
Daniel R. Kuritzkes, MD
Chair, HMA web page
To Harper's Magazine Editor, Staff and Publishers
We, Nathan Geffen and John P. Moore, organised the open letter that was sent to Harper's Magazine earlier today. We are also compiling a list of the very many factual errors in Celia Farber's article (March 2006), with explanations of each of them. We will send this to you once it is finished, probably by the end of this week. We have identified approximately 50 errors so far, all of which should have been detected by any fact-checking process appropriate for a magazine of Harper's stature. Perhaps Ms. Farber provided you with a biased list of people the magazine could call upon for "fact-checking"?
In view of the error-riddled nature of the article, we believe that Harper's Magazine has an absolute obligation to its readership to respond appropriately. We believe this response should include:
- Withdraw editorial support for Farber's article and publish this withdrawal on the Harper's Magazine website.
- Publish a retraction in the April or May issue of Harper's Magazine and on the website immediately.
- Publish the list of errors and corrections in a prominent position on the website as soon as you have been able to fact-check it (the fact-checkers obviously should not include the individuals who "fact-checked" Ms. Farber's article, or any other individuals suggested to you by her, or them).
- Publish a general rebuttal of the Farber piece in the April or May issue of Harper's Magazine.
- Undertake to review Harper's fact-checking process, with special regard to articles on science (the common procedure of a writer suggesting fact-checkers for the article is seriously flawed).
We request a rapid response to our letter. We are available for discussions on this matter by telephone, and you should note that Professor Moore lives and works in Manhattan, so could meet with you in person.
Nathan Geffen (Policy Co-ordinator, Treatment Action Campaign, South Africa)
John P. Moore, PhD (Professor of Microbiology and Immunology,Weill Medical
College of Cornell University, New York)
Dear Mr. Geffen (et al.): Sincerely,
Thank you for writing. Of course, I will give your letter the attention that all such serious allegations deserve. Please do send it by the end of this week, so that I can consider it for publication in our May issue.
666 Broadway, 11th floor
New York, NY 1001
Dear Mr. Geffen (et al.):
Dear Mr. Hodge,
I have written twice to Harper's Magazine about Celia Farber's article without the courtesy of a reply, even an acknowledgment, so I'm hoping that a more personal letter to you as editor of the article will be read and responded to.
Since Farber's article appeared, I had been wondering why a respected magazine such as Harper's would publish such a thing. Your quotes in Gay City News help me to understand your underlying thinking (forgive if I am being presumptive here, but I have little hard information to go on). As I understand it, you believe that Peter Duesberg has been punished by the scientific community, that the scientific community has refused to debate with him, and that the principle of freedom of speech has been compromised. Specifically, you say: "Part of the story is that a certain kind of name-calling, a certain kind of moral blackmail, takes the place of scientific debate. People like Peter Duesberg have been persecuted for trying to have a scientific debate." I'd like to address these comments, if I may.
Firstly, it is simple untrue that "debate has been stifled". Duesberg's views on HIV and AIDS first arose in the early 1990's. They were discussed, at great length, when he and a few others first promulgated them, leading to several publications by both sides in the scientific literature. He was not simply ignored, his arguments were analyzed and found wanting on scientific grounds. Duesberg was entitled to express an opinion, did so, and the overwhelming majority of competent, professional scientists did not agree with him. In simple terms, he was judged to be wrong in what he proposed. Naturally enough, Duesberg and his supporters do not agree with the majority opinion that is ranged against him; again, he's entitled to react this way, but he's not entitled to say that his views were not noticed - they were. The real problem, however, and the one that underlies Farber's article, is that Duesberg and his supporters pay no attention to the counter-arguments used to rebut his views. I say this with some confidence, because the multiply flawed scientific statements in Farber's article are simply not new; they have been around ever since Duesberg first spoke out, and they persist on all the AIDS denialist web-sites. They have all been rebutted (our response is, likewise, often not new), but our rebuttals are simply ignored. It appears to us that the denialists simply adopt an "American in Paris" attitude; they shout out the same words, but a little louder. After several years of this sort of behavior, it frankly all becomes a little tiresome. What more is there for us to say that has not been said ad nauseam, and simply ignored by Duesberg and his supporters? Their thinking is fossilized in place, rooted in the AIDS science of the late 1980's, with 20 years of ever-increasing knowledge simply ignored. Is this appropriate? I think not. If I may draw an analogy? Discussions between scientists who know that Darwinian evolution explains how species arose and diversified are on a hiding to nothing when they discuss the subject with creationists (intelligent design proponents) who BELIEVE otherwise. The chances of The Discovery Institute members or Pastors from fundamentalist churches ever conceding they are wrong are non-existent, whatever the scientific facts say. The same situation now applies to the AIDS denialists over HIV and AIDS; they ignore what science says, because they cannot back away from their fossilized positions.
Secondly, you say that: "Peter Duesberg have been persecuted for trying to have a scientific debate." Again, the debate was held, years ago, and Duesberg was shown to be wrong. Was he "persecuted" for his views, and should he have been? Well, it is certainly true that he compromised his own credibility as a scientist for being so egregiously wrong, and being wrong, in science as in all professions, has its consequences. If I made a serious mistake, even of a technical nature, in my own scientific publications, I would suffer consequences, such as a loss of trust in my judgment as a scientist. This situation is not unique to science, for it applies in all professions. Will Bernie Ebbers ever be considered for appointment as Head of the Federal Reserve Bank? Does Jason Blair have a serious future in journalism? Could Gary Hart make a political comeback? I doubt it; once trust is lost in one's judgment, credibility, integrity or ability, it's a hard road back (I'm not suggesting Duesberg is a criminal by making these analogies, I'm simply trying to place his career in a non-scientific context with which you might be more familiar). You might also want be aware that Duesberg had already seriously damaged his standing in the scientific community BEFORE he made his proposals about HIV and AIDS, by dissenting from the view that oncogenes had any relevance to human cancer (this was in the mid-1980's and he was wrong in what he said). Only after that did he turn his attention to HIV research. I do not know whether his present views on aneuploidy and cancer are right or wrong (this is not an area of science that I follow). But I do know several cancer specialists who do believe Duesberg is, once more, seriously misguided (he probably also some supporters). In summary, my view is that Duesberg was the architect of his own professional downfall, not for holding unpopular views, but for holding ones that were seriously flawed on a scientific level. As I say, science is a hard profession; one messes up, one takes the hits that will come from one's peers.
You also say in 'Gay City News': "My general position is I am very skeptical about absolutist arguments, so I want to hear the entire argument. More argument is better." All you needed to do to hear the entire argument is to call on professional AIDS researchers and clinicians. Did you think of doing so? Did it not occur to you that Farber might simply be wrong, that she might be presenting only one side of a multi-faceted situation? Did you consult the NIAID's web-site that presents the facts on HIV and AIDS (incidentally, this web-site was not prepared under political supervision by administration appointees or bureaucrats; it was prepared by scientists, under the direction of scientists, with multiple external inputs; it has no political connotations)?
When you say: "It was very, very thoroughly fact-checked over the course of three months ... A lot of what people are describing as errors are differences of opinion about the data." Really? You also say that: "I don't feel like I am qualified to judge (whether HIV causes AIDS)". Yet you seem to have been prepared to make the judgment that genuine errors of scientific fact are merely "differences of opinion about the data". In whose opinion are they merely "differences of opinion"? Farber's? Duesberg's? People they have suggested you call for an "independent opinion"? Have you consulted scientists OTHER than people suggested to you by Farber and her supporters in the AIDS denialist groups? In effect, you have made a judgment, and in my opinion, it is a flawed one.
You might be wondering why scientists like myself are taking so seriously what Harper's Magazine has published. It is because we feel we have been stabbed in the back by a magazine that should be supporting science and medicine, and the professionals that are trying to alleviate human suffering. To be attacked by a liberal, intellectual magazine is very hard for us to understand. Suppose a writer came to you with an article suggesting that people with black skins had low intelligence because of genetic factors, that a well-known scientist had proposed this theory, and that he had been "persecuted" for his views by the scientific community? Would you have published this story? I think not, for it would be inconsistent with both the scientific facts and with liberal thinking. Yet you have published an article that liberal intellectuals would find equally offensive if they understood the scientific flaws in what Duesberg proposed and what Farber perpetuates. Perhaps we still suffer too much from C.P. Snow's "Two Cultures". Perhaps science is simply not understood by the layman. If so, that's the fault of all of us. But instead of attacking science, should you not be working with scientists to understood the real facts, not a few people's perverse interpretations of them?
I hope you do respond to this letter. If you are interested in meeting to discuss what I have written, I would be willing to talk to you in person.
John P. Moore, PhD,
Professor of Microbiology and Immunology
Dear Mr. Geffen: In my capacity as editor of the Harper's letters section, I'm not in a position to publish either petitions or medical-review articles. If you draft your complaints as a proper letter to the editor, however, I will give it serious consideration for publication in our May issue. The optimum length for a letter to the editor is 250 words. The deadline for the May issue is Monday, March 13th. Please bear in mind that the article has generated an overwhelming response. Although I cannot promise that your letter will appear, I assure you that critical views such as your own will receive the space they deserve. Sincerely,
4 March 2006: Reply from Mr. Stark to "Errors in Celia Farber's March 2006 Article..."
666 Broadway, 11th floor
New York, NY 10012
Dear Mr. Geffen:
In my capacity as editor of the Harper's letters section, I'm not in a position to publish either petitions or medical-review articles. If you draft your complaints as a proper letter to the editor, however, I will give it serious consideration for publication in our May issue. The optimum length for a letter to the editor is 250 words. The deadline for the May issue is Monday, March 13th.
Please bear in mind that the article has generated an overwhelming response. Although I cannot promise that your letter will appear, I assure you that critical views such as your own will receive the space they deserve.
I was hoping to have a voice by participating in Nathan Geffin's reply to Farber's article, but as that will just be a 250 word letter to the editor, I've decided to write to you directly.
I think Harper's magazine, a magazine I have long valued as reputable journal and valuable source of information, has made a terrible and shameful mistake in going forward with the publication of Farber's article, and subsequently in your decision not to allow a counter-article from the scientific community. Farber opens with a tragic story of an HIV positive pregnant woman who dies while taking therapy; the question of whether her death is due to treatment or or AIDS is left open. We feel for her. The article then goes on to make Duesberg out to be some kind of maverick hero that the scientific community is unjustly trying to silence.
Opening with a heart wrenching "one woman's story", describing the death of a fine and caring woman and mother, sets us up to feel angry regarding HIV treatment — but there are thousands of stories of people who were given life and hope when they had access to medication, whose personal stories would bring you to the opposite place emotionally; I know and care about some of these people. But the key is the statistics, the sum of individual stories, not any one story; and the statistics are overwhelmingly in favor of both therapy helping and HIV causing AIDS. Therapy dramatically decreases the numbers of kids who contract HIV — and those babies who do get HIV at birth, without ongoing therapy, will face incredible suffering and hardship, and many die very young. Rapid progression to disease is much more common in children than adults. The clinical records of HIV+ babies are heart breaking. I used to maintain a database of pediatric AIDS cases. Case after case would be a chronology of suffering as the kids struggled to survive with a severely impaired immune system. This was in the early 90s, before we had good therapy to give, and 30% of the HIV+ mothers were transmitting to their babies. These babies were born into suffering, and death by AIDS is not an easy death. Of course even with therapy, the outcome is not always good, but the odds of a longer healthier life go up dramatically.
How many uncertain and afraid mothers who are HIV positive will your article reach and confuse? I don't know, but I think even one is too many to turn from a path of hope and help for themselves and for their children. This is now in your hands, and on your conscience. While Farber and Duesberg have the right to speak about their views, it is who you are responsible for what you choose to publish.
And Duesberg's deadly notion that HIV doesn't cause AIDS because it doesn't fit the semantics of Koch's postulates has lead to a dangerous trail of confusion that has done unutterable damage in the global effort to combat AIDS. By catching the ear of the South African government at a critical moment in the history of their epidemic, Duesberg sowed confusion and inaction where a strong message and clear education about transmission might have done great good. It is very hard for non-scientists to know who to trust, and HIV+ people and those who care about them want to have the hope that HIV doesn't cause AIDS; Duesberg feeds on that desire and he has the credentials that allow people to take him seriously.
A compellingly written but grossly inaccurate article like the one you published is a serious set back. HIV infects 40,000,000, and 20,000,000 million are already lost to HIV-AIDS. This isn't a scientific coverup — it is reality.
Clarity can save lives. One of our most powerful weapons in fighting this epidemic is education, passing along the truth as well as we can. You've muddled things.
Dr. Bette Korber
Bette Korber, Laboratory Fellow
T10, MS K710
Theoretical Biology and Biophysics
Los Alamos National Laboratory
I was dismayed by the article by Celia Farber that recently appeared on your magazine. What started out as an apparently well motivated piece of investigative journalism, ended up as a ridiculous peddling of totally discredited arguments about whether HIV causes AIDS. This would not matter but for the credence given to this rubbish by the President of South Africa and the consequent half hearted treatment and prevention policies of that government — in the part of the world that has the highest incidence of HIV infection.
This letter is not for publication but to request that you give space for a serious rebuttal. That would allow your readers to judge for themselves where the overwhelming weight of the evidence lies. Just ask any infectious disease physician whether judicious use of anti-retroviral drugs saves lives, reverses much of the immunodeficiency and restores health.
Yes I do work on HIV -I would love to be able to change our perspective of what HIV does, but the arguments in this article are nonsense.
Dr. Andrew McMichael
Weatherall Institute of Molecular Medicine
John Radcliffe Hospital
Headington Oxford OX3 9DS
Mr. John R. MacArthur, President and Publisher
Mr. Roger D. Hodge, Editor
Harper's Magazine, 666 Broadway, 11th Floor
New York, NY 10012
I was dismayed to see the article, "Out of Control", by Celia Farber in the March 2006 issue of Harper's Magazine, a storied publication that I have trusted for its high standards. Farber selected an interesting topic, namely the complexity of doing a clinical trial in a developing country, with a focus on HIV/AIDS. This could indeed make for an important analysis of why such trials are needed and of the associated difficulties and dangers.
However, Farber has chosen to mix that approach with her own misinformed view that HIV does not cause AIDS, thereby championing those who believe that HIV is either not the cause, or that AIDS does not exist at all, or a combination of both.
There are innumerable problems with both facts and interpretations in Farber's article. I will not dwell on them here. I will say only this: Anyone who visits an infectious diseases ward at any hospital in a major American city or, for that matter, in almost any city on Earth, cannot deny the reality of AIDS. As to HIV as the cause of AIDS, my summary response is this: There is more evidence that HIV causes AIDS than there is for the cause of any other single human disease caused by an infectious agent, past or present.
A few scientists claim that HIV/AIDS research has not fulfilled the postulates laid down by the Nineteenth Century German bacteriologist Robert Koch, who described what must be done to prove the cause of a human disease (Koch's postulates). HIV has more than fulfilled Koch's postulates, as well as additional criteria that have been developed through the advent of new scientific methods. That HIV is the single cause of AIDS has also been concluded by thousands of other scientists and by every single qualified group that has studied the question. This includes the U.S. National Academy of Sciences; the U.S. Centers for Disease Control; the U.S. Institute of Medicine; the U.S. National Institutes of Health; the American Medical Association; the Canadian Centers for Disease Control; the Pasteur Institute; and the World Health Organization.
In 1984, when my colleagues and I were first to claim — and in my view demonstrate — the linkage of HIV to AIDS, we showed that we could isolate HIV from 48 individuals who had AIDS. Characteristics of the virus told us that, like the disease, it was new in the human population.
A second deciding factor was that we could show that the virus primarily targeted immune system cells (now known as CD4+ T-cells), which are precisely the same cells that decline in the presence of the disease. Thirdly, we developed a blood test based on finding specific antibodies against HIV in infected persons. Many people not familiar with retroviruses (the virus family to which HIV belongs) sometimes believe that the presence of a specific antibody may indicate only that a person has been exposed to a virus or has become protected from a virus, as opposed to being infected by the virus. With HIV, though (like all retroviruses), antibodies mean one thing: That the virus is actively present, is integrating itself into the genes of the target cell and is replicating.
By developing an antibody test, we were able to carry out much larger surveys, which showed that, within an otherwise healthy population, HIV antibodies were present at a rate approximating one "healthy" American in every 1000-2000 people surveyed. However, these surveys also showed that the virus was often present in certain high-risk groups, namely intravenous drug users, hemophiliacs, sexually promiscuous persons and babies born to mothers who had AIDS. Further clinical study of those "healthy" HIV-infected persons showed that they bore evidence of declines in the CD-4 T-cells that are the harbinger of future AIDS risk. These results alone were sufficient to convince that HIV causes AIDS. But there is more.
My team and I also knew at the time when we published our first results that newer results obtained in collaboration with the Centers for Disease Control showed that we could pick out those with AIDS or pre-AIDS within blind coded samples (i.e., where we were not provided with any diagnosis but simply a sample) from patients whose only risk factor was having received a unit of contaminated blood. From this, we were also able to identify their infected blood donor, who, without fail, went on to develop AIDS. Later, our research showed again in coded samples that we could isolate HIV every time we found a patient with antibodies.
No test in medicine is perfect, but done correctly and with the back up of a confirmatory second test, the HIV blood test developed in our laboratory and subsequently refined by numerous commercial companies comes about as close as you can get.
The test developed by us in 1984 was soon licensed by the U.S. government to five major companies whose scale-up allowed testing by early 1985 throughout the United States and in most of the developed world. The test has saved countless lives, first by preventing transfusions of HIV-infected blood. In essence, what the U.S. government did in 1984-85 was to preserve the blood supply and allow the epidemic to be traced for the first time. Today, the risks of contracting HIV through blood transfusions are negligible in developed nations. The fact that transfusion-associated AIDS has disappeared in countries that employ current generation blood screening approaches documents that HIV causes AIDS because, by removing HIV contaminated blood, transfusion-associated AIDS has all but disappeared. But there is more.
Soon after the blood test was developed, a monkey model was developed, using a newly discovered simian immunodeficiency virus (SIV). This was shown to reproduce an AIDS-like illness in some species of inoculated monkeys. As Farber notes, HIV-infected chimpanzees do not develop AIDS. However, even here she is not absolutely correct. A small number of chimpanzees do develop an AIDS-like illness. In monkeys infected with SIV, the risk for AIDS varies by species. Generally those that are not the natural host develop AIDS, while those that are the natural host do not.
Ms. Farber does not understand that, in chimpanzees infected with HIV and in some species of monkeys who do not develop AIDS though they are infected with SIV, AIDS does not develop because the virus is far better controlled in these species and/or the immune system's response to the virus is much less . Most of them (if not all) had millennia of exposure to these viruses and adapted to them. When these viruses are introduced to primates in other regions of the world (Asia, for example) where the viruses have not been present, these monkeys, like humans, develop AIDS. Overall, these monkey studies were strongly supportive of the causative role of HIV in human AIDS. But there is more.
More importantly and completely misrepresented by Ms. Farber is the history of HIV therapy. She aligns herself firmly with the strange logic of a few dangerous people who say that these medications are harming people and/or may be themselves causing AIDS and should not be used. This is sheer lunacy. The current anti-retroviral treatments have converted AIDS from being a terminal illness within five to 10 years of infection, to a chronic treatable disease where many people can live a reasonably normal lifespan. To say differently is to mock the existence of millions of people around the world who have been successfully treated. Moreover, specific therapies aimed at pregnant mothers have all but ended pediatric AIDS in the developed world. The proof of this is documented ad nauseum. Here again, this evidence alone could prove that HIV is the single cause of AIDS. But there is more.
In the mid-1980s, my colleagues and I had the experience of working near several laboratory technicians who accidentally infected themselves with HIV. In every case followed, these heroic individuals went on to develop AIDS. Again, this alone can prove that HIV is the single cause of AIDS and is more evidence than Robert Koch ever had before he claimed a microbe caused a disease. But there is more.
Scientists are not all-knowing. Yet, certain self-proclaimed experts who have never conducted scientific research into HIV/AIDS or any other human disease are not shy about propagating dangerous misinformation. AIDS has been an easy target because the causative virus kills a cell in the body that is vital to protection against common infections. HIV silently destroys the host immune system over a one- to 15-year period. When sufficiently damaged the body becomes susceptible to opportunistic infections and selected cancers. This is the nature of immune deficiency. Thus, it is easy for the AIDS-nihilists to spin a web of confusion and misinformation by focusing on the effects of immune deficiency rather than the cause. For example, when HIV impairs the human immune system, certain fungal infections may appear. In a healthy individual, the immune system would quickly eradicate these infections. In HIV-infected persons, the failure of the immune system means that these infections can run rampant. It is also well established that certain, otherwise rare cancers appear with frequency in the presence of HIV. One example is Kaposi's sarcoma (KS), which is caused by a virus known as Human Herpes Virus 8 (also called Kaposi Sarcoma Herpes Virus). In the presence of HIV, this virus is very active and led to almost epidemic levels of KS among AIDS patients in the earlier years of the epidemic. Then came anti-HIV medications and KS has almost been eliminated, along with the fungal infections as immune restoration has resulted from these life saving therapies.
The article by Ms. Farber mirrors a disturbing rise in anti-science opinion (witness resurgent anti-Darwin, anti-evolution sentiments) that has permeated important public health and public policy debate. It is surprising that Harper's Magazine has embraced this point of view, especially given the tragic consequences of the anti-HIV nihilist rhetoric in lives lost. One need look no farther than South Africa, where such AIDS-nihilism has infected the leadership of the country and disrupted access to life saving prevention and treatment programs.
I am indeed sorry that, more than 25 years after the discovery of HIV as the cause of AIDS, there are those who still refuse to accept this overwhelming body of evidence. There are also those who deny nearly 40 years on that humans have ever stepped foot on the Moon or, centuries on, that the Earth is round. But the subject of HIV/AIDS is more sobering. This is not about Harper's Magazine, or about Celia Farber, Bob Gallo or the rest of the AIDS scientific and medical community. This is about preserving human lives. In this, there is no room for the propagation of shallow and sensationalist thinking, let alone writing, in a respected magazine.
Robert C. Gallo, M.D.
Director, Institute of Human Virology, University of Maryland
666 Broadway, 11th Floor
New York, NY 10012
e-mail: [email protected]
To the editor:
It is important that we have free and open debate in our society, but when gross misstatements, omissions, and innuendo threaten lives around the world, it becomes essential to set the record straight. As scientists who have devoted substantial portions of our lives to the pursuit of truth about HIV/AIDS–and speaking also for distinguished colleagues around the world, including James McIntyre, Moses Sinkala, Mark Wainberg, Waffa El-Sadr, David Ho, and Allan Rosenfield–we are appalled by Celia Farber's grossly inaccurate portrayal of AIDS research. It is fundamentally important for your readers to understand that years of careful research have proven beyond doubt that the HIV virus causes AIDS, that antiretroviral drug treatment saves lives, and that the drug nevirapine is safe and effective in preventing the spread of HIV from mothers to their babies.
It is impossible to list in a short space all the factual errors in Farber's article, but some of the most egregious ones distort the body of science behind the safety of the drug nevirapine. First, she confuses long-term treatment of pregnant women with a drug cocktail that — for their own clinical benefit — includes nevirapine, with the use of a single-dose of nevirapine for prevention of mother-to-child transmission. This very basic error leads the reader to believe that nevirapine in a single dose is harmful to pregnant women, a claim which is completely unfounded. Several major studies have demonstrated that single-dose nevirapine to prevent infant infections is safe and effective, and poses no significant toxicity in women or their infants. The recordkeeping problems with HIVNET012 were studied by an independent and irreproachable scientific panel under the auspices of the Institute of Medicine; they were found not to affect the study's conclusions in any way.
Farber also chooses to omit mention of several large, randomized, phase III studies, including the SAINT trial, that overwhelmingly confirmed that single-dose nevirapine significantly cuts a newborn's risk of HIV infection while posing no significant health risk to mothers or babies. And her article ignores a key ethical reason for the lack of a placebo arm in these trials. Once AZT was shown to dramatically reduce the likelihood of a mother transmitting the virus to her baby, it would have been unethical, according to accepted international standards, to deny women any protection for their infants by providing them with a placebo.
Most importantly, the conspiracy of scientists, drug companies, and activists that Farber has invented is a fantasy. These groups work tirelessly to save lives in the face of the world's worst-ever pandemic of infectious disease. Disinformation about the cause of AIDS and the risks of AIDS treatment impedes these efforts and will lead us in only one direction — to more lives lost, more communities devastated, and more threats to our security.
At one point in the article, Farber asks, "Is nevirapine better than nothing?" For the hundreds of thousands of children who have been born free of HIV because their mothers took nevirapine, the answer is an undeniable "yes." The sad truth is that, without prevention and treatment, children and families across the globe will sicken and die by the millions. Our job should be to provide them with scientifically valid treatment options, not to fantasize about a world in which HIV does not cause AIDS.
Dr. Richard Marlink
Scientific Director, Care and Treatment
Elizabeth Glaser Pediatric AIDS Foundation
Santa Monica, CA
Dr. Catherine Wilfert
Scientific Director, Prevention of Mother-to-Child Transmission
Elizabeth Glaser Pediatric AIDS Foundation
Chapel Hill, NC
I fully agree with the letters sent to you by Dr. John Moore, Dr. Bette Korber, Dr. Daniel Kuritzkes, and Gregg Gonsalves posted at http://www.aidstruth.org/ and http://www.thenation.com/blogs/notion?pid=65330. Celia Farber's article on HIV and AIDS in the March issue of Harper's contains numerous inaccuracies, factual errors, and unsubstantiated allegations. Ms. Farber's article is also dangerous because of its potential to convince people who need antiretroviral drugs not to take them, with life-threatening consequences. I am disappointed to see an article that contains so many factual errors published in a reputable magazine such as yours, and strongly encourage you to publish a full response and rebuttal from the scientific and AIDS activist communities. Until then, I will no longer read your magazine.
Dana Gabuzda, M.D
Professor, Dept. of Cancer Immunology and AIDS
Dana-Farber Cancer Institute and Harvard Medical School
JF816 44 Binney Street, Boston, MA 02115
To the Editor
It's an extraordinary feat to offend the scientific community; I've been trying for years, with little to show for it. But your treatment of the work of Duesberg as something to be taken seriously has really done it. This is not a case of one lone responsible voice crying out against conventional wisdom; it is the voice of a scientist who knows that his views are producing human tragedy and doesn't care. I spent some time at Stanford trying to deal with William Shockley. He was a brilliant scientist in electrical engineering who turned his attention to the matter of racial difference, deploying his credentials in one field to accomplish mischief in another. Duesberg is different, and worse: without much distinction in his own field, he has contrived to gain attention by contributing to human misery. And he's getting help: President Mbeki of South Africa and Harpers!! What a team.
President emeritus, Stanford University
Dear Mr. Stark,
I have just finished reading Celia Farber's article entitled "Out of Control: AIDS and the Corruption of Medical Science" that appeared in the March issue of Harpers. I understand that there has been an enormous outpouring of criticism of this work from the scientific community; I will not add to it since Ms. Farber has been known for years as a profoundly biased and inaccurate reporter when it comes to HIV infection and AIDS. Nothing I can say will alter her reputation. My criticism instead is directed towards the editorial staff of Harpers and your journalistic responsibility for accurate reporting and fact checking. Yes you may elect to provide alternative perspectives and contrarian viewpoints but the key role of an editor in a free society is that when doing so, you pay scrupulous attention to the accuracy of your reports. Otherwise your work risks becoming nothing more than propaganda. Anyone with an axe to grind and a slick pen can write a compelling but factually distorted piece and you have been duped into publishing one because of your inattention to your duty. To report the kinds of gross factual errors in the Farber paper (as reviewed in excruciating detail by Gallo, Geffen et al in their March 4 letter to you) as fact does your readers and your reputation a profound disservice.
With profound disappointment,
Michael M. Lederman M.D.
Scott R. Inkley Professor of Medicine
Director, Center for AIDS Research
Case Western Reserve University
University Hospitals of Cleveland, Cleveland, Ohio
Mr. Roger Hodge
Misleading statements have been made about the history of HIV/AIDS research in the recent article "Out of Control: AIDS and the Corruption of Medical Science", (Harper's Magazine, March, 2006) as well as in some of the replies (Harper's Letters, May, 2006). The position of us both is that HIV is the essential and sufficient agent that causes AIDS. One of us (Luc Montagnier) has emphasized that there may be (and indeed there are) other factors that can favour HIV transmission (such as co-infection with other sexually transmitted disease organisms) and also promote faster progression toward the clinical stages of AIDS in untreated HIV infected people. Indeed, both of us have contributed to the identification of such factors but this does not put into question that HIV alone is the cause of AIDS. We hope to dispel another point of confusion. It is said that some AIDS patients are HIV negative (an argument made by those who deny the role of HIV in AIDS). This is not the case. First, false negative results are extremely rare nowadays when trained personnel carry out modern diagnostic assays in properly equipped laboratories. Second, there are other causes of severe immune deficiency, such as extreme radiation exposure and rare genetic diseases, just like a severe sore throat can be caused not only by streptococcus, pneumonia not only by pneumococcus, and lung cancer not only by smoking. However, the appearance of a new immune deficiency, AIDS, on an unprecedented, pandemic scale was caused by the spread of HIV within the human population.
Finally, we would like to emphasize that the major aspects of the history of the discovery of HIV, of the early evidence leading to the conclusion of its causative role in AIDS, and the development of the HIV blood test, have been jointly published by us. We do not have any significant difference in viewpoints on this history. (See Gallo RC and Montagnier, L. The Discovery of HIV as the Cause of AIDS. NEJM, 349:2283-2285, 2003; Montagnier, L. A History of HIV Discovery. Science, 298:1727-28, 2002; Gallo. RC. The Early Years of HIV/AIDS. Science, 298:1728-30, 2002; and, Gallo RC and Montagnier L. Prospects for the Future. Science, 298:167-1834.).
Robert C. Gallo, MD
Director, Institute of Human Virology,
Professor of Medicine and Professor of Microbiology and Immunology
University of Maryland Baltimore
President, World Foundation AIDS Research and Prevention