Mark Hoofnagle has a PhD in physiology from the University of Virginia and is currently a 3rd year medical student. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.
This is truly annoying because it is so patently wrong. It's wrong in lots of different ways, but I'll help point out some of the major flaws. What happens when journalist becomes the story, rather than reports it?
You see, there is this journalist, Celia Farber, who apparently has been following the HIV denialists since the beginning. From reading this interview with her in Discover Magazine, it would seem that she is suffering from some sort of Stockholm Syndrome. Not only that, but the journalist interviewing her shows a complete lack of suspicion, and seems to be one of those modern journalists who thinks that everything has two valid sides to report on. Not everything does.
Instead of chronicling the history of HIV denialism, she has truly drunk deep of the Flav-R-Ade. Ever wonder how to tell if a journalist has lost her objectivity? How about this?
It's changed in that so much of what the orthodoxy proclaimed has not come true. The paradigm has failed miserably on virtually all counts. So the orthodoxy right now is particularly venomous and vicious against anybody who is what they call an AIDS denialist.Uh oh. I sense someone begging the question. The interviewer follows up with a WTF.
What are the failures of the paradigm?Good question, but I would have also asked, "WTF is the 'HIV paradigm'?"
Response? Right out of the HIV denialist handbook: (all emphasis mine, --PalMD)
The chief one is what used to be called the heterosexual AIDS explosion, which was the model. It was the core of the HIV theory--that there was a virus that was lethal, that was transmissible via unprotected sexual intercourse, needles, and other methods of transmission--blood-to-blood transmission. What they actually said was that there was a model of tertiary transmission. So anybody who sleeps with anybody who sleeps with anybody who's ever slept with anybody who ever was a drug addict, et cetera. It was a very terrifying model.Well, at least we can tell we're not dealing with a medical professional. I'll give her the benefit of the doubt and assume that she isn't trying to lie.
No sane, competent medical organization has ever said that anyone who comes in contact with anyone, etc, ad infinitum is going to get HIV. That's just a lie (OK, someone lied; maybe she is just repeating it). Physicians and epidemiologists have always seen HIV like any other infectious disease---they have mapped it, found its transmission patterns, put together risk assessments. It's called science. Duh!
And as far as "heterosexual AIDS", um, ever been to Africa? Oh wait, I'm sure you'll have an excuse for that one. Nutrition? Toxins?
Wait, wait, there's more. After citing a single study about transmission, she bemoans the proliferation of panic-mongers, but at least there is a vigorous debate going on, right? Like in the New England Journal, or Lancet, or something?
Well, there's been a ruckus, a wild debate about this all over the Internet. At the very least, it means that the spread of HIV is extremely difficult, which is quite different than the terror, dread, bubonic-plague model we were given. That's just the first piece.Once again, I have to wash the burning stoopid from mine eyes. I wouldn't think it would be so easy for a so-called journalist to ignore 25 years of some of the best medical and epidemiologic research ever done, but hey, I guess anything is possible.
Of course, no good HIV denialist could go anywhere without talking about AZT, the first HIV drug to actually show promise. It is not used as mono-therapy today (and hasn't been in years) because resistance develops too quickly. It still is a very important part of HAART (highly active antiretroviral therapy), the treatment that has been responsible for saving so many lives. The science behind the therapy is interesting, but difficult. AZT inhibits one of the steps of viral replication. Thinks that's an oversimplification? Wait till you read this:
Here's what's strange about AZT's history. On a cellular level, AIDS is the opposite of cancer. Cancer is a proliferation of cells. And AIDS is a decimation of the cellular system. The first drug that was offered was a drug that decimates the cellular system. Why? Why treat an immune suppression with a powerful immunosuppressive drug? It makes sense in cancer. It does not make sense in AIDS. So that is a mystery I cannot answer. I do not think that they [the medical establishment] wanted to kill people. I chalk it down to the terror of the time. The terror of the virus has dissipated greatly. They basically used to say you'd fall down, bubonic-plague style, in the middle of the street. It was an irrational fear, and it was in advance of data. And it was drawing on cohorts of people who were very sick and were dying very fast.
The above reveals either a credulous misunderstanding of biology, or an outright lie. I hope it is the former (but this is in a science magazine, so...). I'm really starting to doubt she has ever spoken to real HIV researchers or doctors, or cracked open a biology text. I don't think she knows a reverse transcriptase from a typewriter ribbon.
Look, I'm not going to fisk the entire story, but I do want to point out just a couple more logical fallacies. We started up top with "begging the question". Why don't we move on to the argumentum ad ignorantium?
Interviewer: "So do you believe that it's impossible to transmit the disease through sexual contact?"
Idiot: "I have lived in New York City for the last 20-some years, and I don't know anybody who has acquired HIV through sexual contact. "
Well that says it all, doesn't it? She doesn't personally know anyone (as far as she knows) who has gotten HIV through sex. Well, let's see, if we're going that way---I'm an actual doctor, and I know hundreds of people who have. I win.
Look, there's no sense in going any further in this inane interview. The real issue isn't that there is another really stupid HIV denialist out there. The story is that a major science magazine is giving her an outlet to spread her lies. This story doesn't have two sides. HIV causes AIDS, and we know quite a bit about the whole thing. Areas of disagreement arise in deciding priorities and approaches to research, prevention, and treatment. Giving a big spread to a denialist adds nothing. If I tell Discover that I've been following the gravity controversy, and I want an interview ("inverse square my ass!!), will they give it to me? I think not.
Perhaps Discover needs a lesson in skepticism. Volunteers?
Comments
I'm boggled by the source. I expect this kind of thing in Harpers and Spin, not Discover.
"And as far as "heterosexual AIDS", um, ever been to Africa? Oh wait, I'm sure you'll have an excuse for that one. Nutrition? Toxins?"
Not to give any credence to the loonies, but as we all know there are factors that make heterosexual transmission much more likely in Africa, especially higher rates co-infections like TB, syph, schisto, etc. that affect the immune system (not simply immunosuppression but shifts in type of prevailing response Th1 vs Th2 and so on) or result in genital lesions.
Other factors, not sure how important they are: traditional medicine that uses injections (and reused needles), Southern Africa dry vagina preference (use of astringents - changing vaginal ecology, making abrasion more likely).
Aside: I'm a proponent of male circumcision, both infant and adult, for purposes of reducing STD transmission.
Posted by: Colugo | May 9, 2008 2:06 PM
The stupid doesn't just burn; it sears with a thermonuclear blast.
I can't resist, however, pointing out that Celia Farber has in fact referred to yours truly as "low rent riff-raff."
That honor was one of the highlights of my three years of blogging. ;-)
Posted by: Orac | May 9, 2008 4:24 PM
Damn, Orac, now I'm actually jealous!
Posted by: PalMD![[TypeKey Profile Page]](http://scienceblogs.com/denialism/nav-commenters.gif)
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May 9, 2008 4:37 PM
Southern African dry vagina preference???!!! Yikes.
Posted by: Steve Bloom | May 9, 2008 5:06 PM
And as far as "heterosexual AIDS", um, ever been to Africa? Oh wait, I'm sure you'll have an excuse for that one. Nutrition? Toxins?
Thimerisol?
Kidding.
Posted by: Mike the Mad Biologist | May 9, 2008 6:17 PM
LOL! Mike FTW!
Pop by a local library to check out the current Discover spread on Duesberg... Im at writing to Discover about it.
Posted by: ERV | May 9, 2008 6:53 PM
"HAART ... the treatment that has been responsible for saving so many lives."
Well that's a credulous statement. How can you possibly know how many lives it has saved?
You're assuming HIV infection generally progresses to AIDS, but you have no basis for assuming that. If you give an HIV patient HAART and they never get AIDS, you assume they were cured by HAART. But it's just as possible, or more possible, that they never would have gotten AIDS.
Lots of people are tested for HIV now. There is a great difference between noticing that all AIDS patients are HIV positive, and the fact that SOME HIV patients get AIDS.
No one knows if AZT works or if HAART works. The early AZT trials were cut short because of the assumption that AZT was working. AZT became the gold standard, even though no one knows if it helps more than it harms.
Now new AIDS drugs are compared against AZT. There are no trials of HAART versus no toxic drugs. We don't know how well, or if, the drugs help patients, and we don't know if some patients are killed by the drugs. They are extremely toxic. If they inhibit the reproduction of HIV it might be just because they inhibit life in general.
Because you never compare the new drugs to no drugs, or to alternative treatments, you cannot draw any conclusions about the safety or effectiveness of HAART.
If you say that HIV patients are surviving and staying healthier longer thanks to HAART, well that is completely unfounded. How can you know? You have no basis for assuming HIV generally progresses to AIDS.
Posted by: pec | May 9, 2008 7:15 PM
Learn something. The stupid is burning my eyes.
Posted by: LanceR | May 9, 2008 8:59 PM
Howzit Colugo (if you remember our discussion on this last year over at ERV on a similar thread that went insanely ridiculous).
I must say that here in South Africa, the government still seems to be determined to screw up the HIV policy. However, with a good bit of private sector initiatives, and some passionate dudes in the leagal sector, there are some serious efforts being made to change things.
The longer I am here, the more I am convinced it is about education (as expected).
When Jacob Zuma testified in his rape trial that it was part of his culture when he had unprotected sex with a woman with whom he knew was HIV+, I asked some Zulu peeps I worked with at the time if what he said was true, and they said only if you are a high profile politician on trial (OK not exactly what they said, but you get the point).
Again, I was speaking to EDUCATED Zulu people (Zuma is educated too, so I'm not saying it's everything), but like other educated people (Afikaans, Zulu, Xosa, Tswane, English, Coloured does not matter), only someone ignorant or misguided believes that that type of behaviour is rational, let alone normal.
Posted by: scienceteacherinexile | May 9, 2008 9:07 PM
I forgot to mention, it seems that it will be worse here. While President Mbeki and his health minister Msimange are arguablly HIV/AIDS denialists, it seems that Zuma will be the next president.
The man who testified that he took a shower after the sex mentioned above to prevent HIV infection.
And on a side note, I still see you always get a troll on these things. Yeah Pec, are you kidding me with that same old crap?? The docs are only saying HIV causes AIDS so that they can claim victory for the treatments they come up with. How novel...
Posted by: scienceteacherinexile | May 9, 2008 9:21 PM
pec, you're a friggin' idiot, as usual.
And generally, we don't welcome HIV denialists around here. If you have something productive to add (which is doubtful), then fine. Otherwise, take it elsewhere.
Posted by: PalMD![[TypeKey Profile Page]](http://scienceblogs.com/denialism/nav-commenters.gif)
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May 9, 2008 9:30 PM
Don't worry. You're still fairly new. It took me a couple of years of blogging to be noticed by people like Celia Farber. (Granted, it took me only around six months to be noticed by J.B. Handley.) I'm sure you'll manage to have a high profile loon like Farber insult you soon enough. The day that happens, you'll know you've truly arrived as a skeptical blogger.
Posted by: Orac | May 9, 2008 9:59 PM
scienceteacherinexile: "The longer I am here, the more I am convinced it is about education (as expected)."
I totally agree. Education to correct the myths surrounding sex and HIV would go a long way. And so would better governance, as the powerful HIV nuts in SA demonstrate.
Posted by: Colugo | May 9, 2008 10:11 PM
Colugo said "I'm boggled by the source. I expect this kind of thing in Harpers and Spin, not Discover."
Nah, Discover has become a rag. I noticed it a couple of years ago with their stupid article on the dangers of mercury. The author had a short paragraph that mentioned the MMR vaccine. I wrote them and asked them why they included the MMR vaccine in an article about mercury without even mentioning that it is a live virus vaccine that has never contained thimerosal.
Absolutely no response. Plus, the next issues seemed to have very watered down criticisms to that article in the Letter to the Editor.
We had picked up a subscription to support son's school, but decided to not bother with renewing it after it expired.
Posted by: HCN | May 9, 2008 10:22 PM
By your idiot logic, which is based solely on your refusal to find out how anything works, not actual facts, if someone with the flue spits in my face and I failed to get the flue it would instantly disprove the flue virus, antiseptic treatments and flue shots, right? PalMD is right, you are an idiot.
Posted by: Kagehi | May 10, 2008 12:55 AM
Colugo,
there is no credible research to show that circumcision affects Transmission of STD's. It's simply Religious Mutilation that has become almost a common practice for no good reason.
Posted by: zed | May 10, 2008 2:13 AM
Re: circumcision, this paper was published but heavily criticized - PLoS ONE permits ongoing discussions, so feel free to jump in.
Posted by: James F | May 10, 2008 8:06 AM
Guccione Jr. Out as Discover CEO
Posted by: Bayesian Bouffant, FCD | May 10, 2008 8:35 AM
PalMD doesn't want me here because questioning AZT and HAART is very bad for business. He can't explain why he thinks these drugs are so wonderful, and he would rather not think too much about it. What if the drugs are not saving lives?
The reason he can't cite any clear evidence in favor of the drugs is that there is none. When there is no conclusive evidence for either side of a controversy, you believe whatever you want to be true. PalMD loves to believe that mainstream medicine has been making great progress against the major killers, including AIDS. He loves to think he's really smart and vastly superior to anyone who believes any aspect of non-materialist science.
What if the AIDS drugs don't work, or don't work very well, or harm more than they help? That would shake PalMDs world. So he prefers to ignore the fact that there is controversy, that the scientific consensus is based on fear and denial. No one wants to damage their career so they better just go along with the drug companies.
Posted by: pec | May 10, 2008 9:23 AM
Posted by: Bayesian Bouffant, FCD | May 10, 2008 9:29 AM
pec, you fracking moron, Oh, for dog's sake, learn something!
Try http://www.aidstruth.org/benefits-of-arvs.php for specific studies proving the efficacy of AZT and other ARVs.
Some highlights:
Jordan et al. (2002) Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy. BMJ 2002;324:757.
NIH (2006) International HIV/AIDS Trial Finds Continuous Antiretroviral Therapy Superior to Episodic Therapy.
Palella et al. (1998) Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus Infection. New England Journal of Medicine. Volume 338:853-860.
Now, are you just repeating lies you have been told, or are you actively a liar? You've been shown the evidence. Are you man enough to modify your position? Or will you continue to deny the evidence?
I've got a bet placed on this one...
Posted by: LanceR | May 10, 2008 9:40 AM
Ah, but see. We can't just wave a magic wand and "cure" it, like we do cancer (oh, wait no...), lupis? hmm, not that either, etc., etc., etc. And in Pec's insane world, if something is too complicated to "fix" with a bandaid, doctors a) don't know what they are doing, b) have ***all*** of their facts about it wrong, and c) some unproven, almost completely untested, and when used, failing, idea about how it works, which is based on bullshit is the *right* answer.
Posted by: Kagehi | May 10, 2008 1:50 PM
I don't want to feed the troll. However, everyone should know the AZT trial was stopped, early, not because of any "assumptions." It was stopped because AZT was so obviously effective that it was unethical to continue to administer placebo: Hirsch and Kaplan, ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, June 1987, p. 839-843. Downloaded from aac.asm.org (a PDF file).
Posted by: Joe | May 10, 2008 2:41 PM
New AIDS treatments are always compared against the earlier AZT-only treatments. They are never compared against no treatment, or non-toxic treatments. So if a newer drug combination is a little less toxic than high doses of AZT only, the newer treatment will appear to be effective.
But you have no way of knowing if the newer HAART treatments are better than nothing, because you have not tested that. Is medical science supposed to be evidence-based or faith-based?
The question has not been answered because it has not been asked. And everyone who wonders about any aspect of HIV and AIDS is labeled an HIV denier and becomes a target of rage.
Can you see why the effectiveness and safety of HAART is unknown?
I am NOT saying a treatment has to be a complete cure in order to be worthwhile. But a treatment should do more good than harm, and you really have no way to know if that is the case with HAART. Because you are comparing it to the early high-does AZT treatments, which may have been deadly.
Posted by: pec | May 10, 2008 7:50 PM
Another major problem with AIDS/HIV research is that the number of patients diagnosed as HIV positive has increased. In the earlier days of AIDS people were not tested for HIV unless they had AIDS. As HIV testing increased, HIV diagnoses increased. So more people with HIV, but not necessarily AIDS, were treated. Since we have no reason to assume that HIV infection always, or often, progresses to AIDS, the data can be extremely biased.
For example, let's say in 1990 100 patients were found to be HIV infected and 50 of them died within 5 years. This outcome is, let's say, compared to another 100 HIV patients in 2000, where only 20 of the later group died within 5 years. The conclusion is that the later AIDS treatments are more effective at preventing death than the earlier treatments.
But you cannot draw that conclusion, since this outcome could result entirely from an increase in HIV testing. If an HIV infected patient is treated with HAART and survives longer than HIV patients survived in the 1980s or 1990s, it might have nothing to do with the treatment.
So the newer HAART treatments might be less toxic than high-does AZT-only treatments, resulting in comparatively lower mortality rates. And the newer patients might be over-diagnosed, because of the assumption that HIV always, or often, leads to AIDS.
I am NOT claiming that HAART doesn't work. I am just saying that most of the AIDS/HIV research is hard to interpret and misleading.
Posted by: pec | May 10, 2008 8:24 PM
Pec, you're a liar. Read the links I cited above. Actually read, for once. HAART has been shown to be a vast improvement over no treatment, and a large improvement over AZT alone.
For pete's sake, read for comprehension.
Posted by: LanceR | May 10, 2008 8:28 PM
"HAART has been shown to be a vast improvement over no treatment"
Well that has to be a lie, since depriving AIDS patients of conventional treatments is considered unethical. Experimental studies comparing HAART to placebo cannot have actually been done, can they? I read your links, and one of them claims to have made this comparison. But it's too vague to interpret. How exactly did they get permission to deprive AIDS patients of treatment?
"and a large improvement over AZT alone.and a large improvement over AZT alone."
Yes, but as I said high-dose AZT-only treatments were highly toxic. HAART might just be less toxic, less likely to cause liver failure, for example.
And, again, I am NOT saying I think HAART is harmful or worthless. I just don't know, and even though I have read a lot of the reports I have not found an answer.
Posted by: pec | May 10, 2008 9:25 PM
pec, just curious - do you have any dissident or iconoclastic views on the following or any other topics?
9/11, free energy (entropy), JFK assassination, the Knights Templar / Illuminati, anthropogenic climate change, Intelligent Design
Posted by: Colugo | May 10, 2008 10:10 PM
Gee, pec, I don't think we really need to study placebo effect in HIV/AIDS progression. We've got most of a continent where placebo is pretty much all they do. Any effect has to be better than none, right? Even your miniscule intellect should be able to wrap itself around that.
Reading for comprehension? Ur doin it rong!!1!!
Posted by: LanceR | May 10, 2008 11:22 PM
Ah. Google "Guccione Farber"
Posted by: Chris Noble | May 11, 2008 3:12 AM
"We've got most of a continent where placebo is pretty much all they do."
If you compare American AIDS patients receiving HAART to African patients who are untreated there will be many confounding variables, such as extreme poverty and over-crowding.
And you can't draw definite conclusions without experimental comparisons anyway.
Posted by: pec | May 11, 2008 7:28 AM
Colugo,
I am not at all into conspiracy theories. The 9/11 inside job theories are absurd.
And I don't think the AIDS drugs are a conspiracy either, just a possible mistake. A massive mistake. As "skeptics" are always saying, people can be good at fooling themselves.
Posted by: pec | May 11, 2008 7:30 AM
Well, pec, if you had actually read the studies I linked to above, you would be able to see that AIDS drugs are effective, useful, and definitely *NOT* a mistake.
Reading for comprehension, remember?
Come back when you get out of the sixth grade.
Posted by: LanceR | May 11, 2008 9:35 AM
OK, I'll stay above the fray and comment on a tangential point. You brought up the logical fallacy of begging the question--let's all commit to NOT saying "that begs the question ..." when we mean "that raises the question." Please?!?
Posted by: David Amulet | May 12, 2008 6:15 PM
No wonder Discover is looking more and more like Omni.
Posted by: idlemind | May 12, 2008 9:09 PM
I hadn't realised the full Bob Guccione Jr - Celia Farber - Anthony Liversidge - Spin - Omni- Discover connection before.
Posted by: Chris Noble | May 13, 2008 12:43 AM