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Chris has been excoriating Tom Bethell (author of “The Politically Incorrect Guide to Science”) over on The Intersection and elsewhere (see, for example, here, here, and several posts here). However, since he’s not yet done a takedown on Bethell’s chaper on AIDS (titled “African AIDS: a Political Epidemic”), he suggested I have a go at it. Man, I knew the book would be bad, but it reaches a whole new level of terrible.
Bethell’s central thesis will be familiar to anyone who’s read the anti-HIV arguments by Peter Duesberg and others. As the chapter title suggests, Bethell claims that AIDS in Africa is a made-up epidemic; AIDS is really due to simple malnutrition and dirty water supplies, rather than a virus. Government officials, scientists, and journalists are either too brainwashed or too scared to speak against the “AIDS orthodoxy.” The evil liberals aren’t concerned about AIDS because the real concern of the left, according to Bethell, is overpopulation in Africa (and hence the emphasis on condom use to prevent AIDS). Public health officials aren’t actually concerned about disease in Africa–just overpopulation. Little did I know.
However, Bethell’s story is long on emotion and hyperbole, and short on facts. His references read like a report I wrote in my 9th grade English class: newspapers, a few books, magazines (heavy-hitters like Rolling Stone and SPIN), and a grand total of 2 references from science journals. Really, he should leave off the “Politically” portion of the title–the Incorrect Guide to Science is much more apt.
Okay, okay. Enough snark. (C’mon, reading this was 20 minutes of my life I’ll never get back–I think I’m entitled to some seething). So, on to address Bethell’s claims.
The “invention” of the AIDS epidemic in Africa
First, his suggestion that HIV was “invented.” Bethell claims that, following a 1985 meeting in the Central African Republic, “overnight there were millions of Africans who had AIDS,” and that HIV was not required for this diagnosis. Well, kind of. As Bethell notes but then subsequently ignores, well-equipped laboratories in Africa are few and far between. That was the whole point of the 1985 meeting: to try and figure out a clinical spectrum of AIDS that could be used to diagnose patients when viral confirmatory tests were lacking. By both necessity and practicality, then, the clinical definition did not include a positive HIV test–what use would that be when there was no clinical laboratory to carry out the testing, and no money to pay for it? Doctors basing their diagnosis on symptoms rather than a positive identification of a particular pathogen is nothing new, and it happens here in the U.S. every day as well. But as you’ll see, Bethell (and other AIDS-deniers) hold that illness to a much more rigorous standard than they do the rest of infectious disease agents.
So instead, AIDS was defined according to four major symptoms: weight loss of 10% or more; pronounced weakness or lack of energy; diarrhea lasting for more than a month; and fever. Other symptoms commonly found included a persistent cough, chronic herpes infection, and swollen glands. There was a bit more to it than this, however: indeed, Bethell includes a diagnostic matrix which assigned a number of points to a variety of symptoms (for example, cough was worth 2 points, while generalized Kaposi’s sarcoma was worth 12). Bethell quotes a journalist named Rian Malan (author of the aforementioned article in Rolling Stone) that “almost anyone in any African hospital could be said [to have AIDS].” What they neglect to mention, however, is that any physician is also going to take an extensive medical history. Simply coming in with a cough, diarrhea and weakness in an otherwise healthy individual isn)t going to trigger a diagnosis of AIDS, any more than someone entering a hospital with a headache and weakness won’t automatically be diagnosed with a brain tumor, even though the symptoms may be consistent.
Bethell also tries to insinuate that HIV was somehow “removed” from the definition of AIDS in Africa, saying that following the African meeting, “HIV was no longer necessary for an AIDS diagnosis.” However, the meeting he keeps harping on took place in 1985. The HIV virus was only identified a year prior, in 1984–so it’s absurd and disingenuous to assert a newly-discovered virus was “removed” from the case definition of AIDS. Heaven forbid he let a little thing like honesty stop him, though, even while he chastises other reporters for ignoring the “real” AIDS story in Africa.
Sexual discrimination in AIDS cases
Next, Bethell says that
…infectious epidemics normally break out evenly between the sexes; viruses are not supposed to discriminate by sex. (In the U.S. today, however, over half of the new HIV infections are diagnosed among black men, so this virus apparently discriminates both by sex and by race).
Bethell claims that, by insisting on an African AIDS epidemic, officials at the CDC could claim that AIDS was an urgent plague, no one was immune, and everyone was at risk. These numbers also, he claimed, created an equal division between the sexes, a phenomenon not seen in the U.S. So, apparently, the idea of AIDS in Africa was just a ploy to get people in the U.S. to accept AIDS as a viral disease, instead of the “lifestyle” disease that many HIV-deniers had claimed (and continue to claim–more on that later).
Additionally, once again he’s being misleading about the data. AIDS is found in all races. Yes, it is diagnosed more commonly in black men, especially when you take into account that they’re in the minority numerically in this country. But again, this isn’t unique to AIDS, something Bethell again ignores. Rates of all STDs are higher in minority populations. It’s not a matter of the virus “discriminating by race;” it’s that in the U.S., minorities are more likely to live in poverty and not receive as much education about STD prevention as their white counterparts. (But that’s probably too “politically correct” for Bethell). You can find the latest AIDS stats here, showing that about half the new infections in 2004 were in blacks, ~30% in whites, and ~20% in hispanics. If you scroll down further, you can also see the data that show it’s increasing among heterosexual women, though Bethell claims the “everyone is at risk” idea was just implemented as a scare and fund-raising tactic.
The HIV test
Bethell cites a 1999 WHO report, claiming that from 1982-1999, only 12,825 AIDS cases had been reported in South Africa. Bethell fails to note, or perhaps (giving him the benefit of the doubt–I’m feeling generous) he is simply unaware, that reported cases are only the tip of the iceberg. Additionally, while he uses those statistics to support his case that AIDS is a made-up disease in Africa, on the very next page he decries the “same old unreliable WHO estimates of HIV/AIDS.” Can’t have it both ways. He claims that the WHO numbers were then inflated when surveillance was undertaken in an effort to determine the actual seroprevalence of HIV. Though he only mentions surveillance undertaken at prenatal clinics in South Africa, those are far from the only surveys undertaken. Here, for instance, they discuss
The survey’s fieldworkers visited 12,581 households across South Africa, of which 10,584 (84%) took part in the survey. Of the 24,236 people within these households who were eligible to take part, 23,275 (96%) agreed to be interviewed and 15,851 (65%) agreed to take an HIV test.
These were men and women, young and old. What did they find?
Based on this survey, the researchers estimate that 10.8% of all South Africans over the age of 2 years were living with HIV in 2005. Among those between 15 and 49 years old, the estimated HIV prevalence was 16.2% in 2005.
Funny, that. Matches up pretty nicely with other estimates made (including those done when testing pregnant women), and matches up with the death statistics. Ain’t it nice when multiple lines of evidence converge to the same result?
Additionally, while Bethell shrugs off HIV tests taken during pregnancy and attributes the high prevalence found to false-positives, this page shows that even among pregnant women, the number of HIV+ women has been steadily increasing over the years. If they were simple false positives, there’s no reason for the prevalence to increase.
He also describes more reporting by Rian Malan on deaths in South Africa, where Malan reportedly talked to coffin makers. Accoridng to Malan, business was so bad that coffin makers were closing their doors–certainly evidence that the AIDS epidemic was manufactured, right? I can’t speak to South Africa’s coffin economy, but statistics found here show a different story.
In February 2005, the South African government and Statistics South Africa published the report “Mortality and causes of death in South Africa, 1997-2003″. This large document contains lists of how many people died from each cause over a six year period, according to death notification forms.
The government’s report reveals that the annual number of registered deaths rose by a massive 57% between 1997 and 2002. Among those aged 25-49 years, the rise was 116% in the same six year period. Part of the overall increase is due to population growth and more complete reporting of deaths. However, this does not explain the substantial rise in the proportion of deaths occurring among persons aged 25 to 49 years. In 1997, people in this age group accounted for 23% of all deaths, but in 2003 they made up 34%
Additionally,
The MRC (Medical Research Council of South Africa) analysed a 12% sample of death certificate data from the year 2000-2001, and compared it to all the data from 1996. When they looked at deaths for which HIV was a reported cause, they saw that rates (deaths per thousand) had increased according to a distinctive age-specific pattern. The greatest increases were in the age groups 0-4 and 25-49 years, while death rates among teenagers and older people remained more or less unchanged.
The researchers observed that nine other causes of death had increased substantially according to the same distinct age pattern as HIV. They then estimated how much of the increases were likely to be caused by HIV, and concluded that 61% of deaths related to HIV had been wrongly attributed to other causes in 2000-2001. In adults, tuberculosis accounted for 43% of misclassified deaths, and lower respiratory infections for another 32%. Among infants, most of the excess deaths had been misclassified as lower respiratory diseases or diarrhoeal diseases. According to the MRC results, HIV caused the deaths of 53,185 men aged 15-59 years, 59,445 women aged 15-59 years, and 40,727 children under 5 years old in the year 2000-2001.
Much higher than the “cumulative total of only 12,815 AIDS cases in South Africa since 1982″ he cites in his book.
One word on this–his reference for that number is this WHO document from 1999. Note on page 403 of that document:
Nearly all countries have AIDS case-reporting systems in place, but the proportion of AIDS cases reported varies significantly. Caution should therefore be exercised in considering this information.
Guess Bethell should have read a bit further than the first page.
What *really* caused “AIDS”
How does Bethell end his diatribe? By harkening back to the good ol’ days of colonial rule.
Sadly, I’m dead serious.
In tropical Africa, a deterioration of the physical infrastructure swiftly followed the end of colonial rule. Sewage and sanitation crumbled. The issue was too awkward to mention because it would strongly suggest that Africans were better off–or at least in better health–under colonial rule.
***
It has been comforting to Western intellectuals to attribute the bad health of Africans not to the hazards and difficulties of self-government but to bad luck. The culprit was the human immunodeficiency virus–the “savage virus”…
Bethell suggests that “clean water and rebuilt sanitation systems will work wonders for the health of Africans.” Well, gee, no kidding. Additionally, he suggests that this is a new focus for scientists and health workers. Sadly, again, I’m dead serious. Where he’s been over the past decades, while the “politically correct” group has discussed the issue of African poverty and lack of even basic sanitation, is a mystery to me.
The rest of the story
Finally, it’s interesting that Bethell only discussed AIDS in Africa. Bethell just happens to sit on the Board of Directors of the Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis. [Edited to add: thanks to commenters, I'll note that he is not currently on the board; see here for the current board, and here for the current homepage]. This group denies that HIV causes AIDS, period, and runs the virusmyth website. They are also aligned with other AIDS-denial groups such as Christine Maggiore’s “Alive and Well” group. Why, I wonder, didn’t Bethell choose to discuss this in his book? Wouldn’t a discussion of the idea that HIV simply doesn’t cause AIDS be a more straightforward exposition than this roundabout discussion of the over-diagnosis of African AIDS? Could it be that Bethell–he who chides reporters for being too cowardly to stand up for the truth and dig deep for the facts–realizes that some of his own ideas are too “politically incorrect” to try to sell even to his core audience of science deniers?
As I’ve mentioned before, the central gist of AIDS denial is a fundamental misunderstanding of the germ theory of disease. Deniers point out, for example, that immunodeficiency is possible without HIV, and use this as a “blow” against the idea of HIV causation of the disease. This is, of course, patently ridiculous. Just because Streptococcus pneumoniae causes pneumonia doesn’t rule out Staphylococcus causing it too. This also explains why there are conditions such as so-called “HIV-negative AIDS.” Immunosuppression in the absence of HIV could be due to a number of other things, including, potentially, other viruses. Conversely, the fact that not everyone who is HIV-positive develops AIDS is also to be expected. There are very few, if any, pathogens that cause disease in every single person who is infected. Every other disease has people who are infected, but healthy–we call this the “carrier state.” There’s no reason this couldn’t happen with HIV as well. It’s already been shown that people carrying a certain mutation appear to be resistant to AIDS. There are likely other factors that contribute to this as well. For instance, it’s been suggested that other viruses may play a role in progression of AIDS, either speeding it up or slowing it down. Additionally, differences in viral strains may make some more virulent and the progress to AIDS quicker. There certainly can be other factors we just don’t know about yet either–disease is a complicated process, and is never as simple as Koch’s postulates suggest.
One thing that is notably absent from Bethell’s essay is a statement that scientists’ knowledge is incomplete. No one suggests that we know everything about HIV. Indeed, as with every subject, there are gaps in our knowledge. In typical creationist fashion (Bethell has 2 full chapters denying evolution in his book), Bethell exploits these gaps in an attempt to discredit the entire HIV-AIDS connection–suggesting thousands of scientists, doctors, and public health officials are either mistaken, incompetent, or lying about HIV as the cause of AIDS–and therefore, we should just throw our hands up in the air and discard the whole theory, rather than working to fill these gaps in with additional knowledge. How terribly typical of his ilk, and how dismally unsurprising.
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