Respectful Insolence

The cost of antivaccinationism

We seem to have an infestation of a couple of very persistent anti-vaccinationist trolls. (It happens; every so often someone new thinks they can take me and my readers on. They’re usually pretty quickly disabused of that notion.) That infestation is why I thought now would be an opportune time to refer my readers to a post that shows the world to which we could return if the anti-vaccine contingent gets its way. Written by the always irascibly sarcastic Dr. Mark Crislip of Quackcast, it’s entitled Amanda Peet is My Hero (1).

Remember, Dr. Crislip is an infectious disease specialist. As he tells us, he doesn’t “make dime one if people do not get infected.” So he’s hoping that Jenny McCarthy and her brain dead ilk are successful. Well, not really. Dr. Crislip is very good at sarcasm, so much so that I can’t always tell when he is being sarcastic. This time I’m pretty sure he doesn’t really mean it.

I think.

Oh, wait, he left a footnote to let us know it was sarcasm. All is well.

Comments

  1. #1 Dawn
    August 14, 2008

    Oh, I’m sorry Orac. Did I piss you off when I pointed out that you posted an article on Gardasil when you hadn’t even read the vaccine literature yet supplied by Merck (hint hint – the maker of the vaccine)? Me, the internet troll pointed out one very alarming fact?? Yes, you made a very grave error, but an admission of wrongdoing will do instead of this other childish post.

    I think you might want to reconsider channeling your energy elsewhere…

  2. #2 Undergraduate-gal
    August 14, 2008

    Dr. Orac, now why would we believe we could take you on? To do that we would need you to get in the ring first.

    Instead you are linking to some other jerk.

    But let me tell you again who I’d like to come on here and show me how irrational and ignorant I am: That cowardly excuse for a scientist, the Steven Novella dude. I imagine he would be just about the right size for breakfast.

  3. #3 Keenacat
    August 14, 2008

    As long as internet trolls like you do not even sport basic math skills (let alone reading skills and understanding for medical information provided) I guess nothing’s gonna change anywhere soon. :)

    I want to give Orac some applause for his energy channelings in his blog. Maybe you, Dawn, can open your own blog so your voice might be heard alongside the society (however, I would recommend not to opt for a scienceblog.com).

  4. #4 Undergraduate-gal
    August 14, 2008

    Dr. Orac, now why would we believe we could take you on? To do that we would need you to get in the ring first.

    Instead you are linking to some other jerk.

    But let me tell you again who I’d like to come on here and show me how irrational and ignorant I am: That cowardly excuse for a scientist, the Steven Novella dude. I imagine he would be just about the right size for breakfast.

    But I guess John Moore wouldn’t let him, cuz we all know AIDStruth shills don’t debate denialists.

  5. #5 Orac
    August 14, 2008

    Did I piss you off when I pointed out that you posted an article on Gardasil when you hadn’t even read the vaccine literature yet supplied by Merck (hint hint – the maker of the vaccine)? Me, the internet troll pointed out one very alarming fact?? Yes, you made a very grave error, but an admission of wrongdoing will do instead of this other childish post.

    Not at all. It amused me how you made a mountain out of a molehill. I note that the Merck document only mentioned simultaneous administration of vaccines, which is not at all what I was talking about when I pointed out that vaccines are tested with the regular vaccine schedule.

    The point stands that it is unethical to withhold standard vaccines in a vaccine trial. That’s why new vaccines are tested in addition to (or on top of) the vaccine recommended vaccine schedule in place at the time of the test.

    As for “Undergraduate-Gal,” the only thing you’ve managed to do is to give me an acute case of the giggles–initially, that is, before you became profoundly boring just like all the other antivax trolls who came before you. You’re just like all the other antivaccinationists, spouting off arguments as though they were shiny and new and will drive the dreaded pharma shills from the field of battle–as though we haven’t seen them a million times before.

    As for your taking on Steve Novella, that would be truly amusing. He’s had tougher cranks than you as a light snack before bed. He demolishes them so thoroughly that they don’t know what hit them, and he does it so politely that they can’t even hate him for it.

  6. #6 Undergrad-gal
    August 14, 2008

    In the spirit of true scholarship, Dr. Orac, perhaps you’d care to reference, preferably link, to one of the heroic Dr. Novella’s vaunted debate victories over a “denialist” opponent?

    BTW, have you figured out yet why HIV+ drug abusers have a shortened life expectancy compared to non-drug abusing HIV positives?

  7. #7 Kev
    August 14, 2008

    Is it to get away from strident no-nothings Undergrad-gal? Because I know how they feel.

  8. #8 Left_Wing_Fox
    August 14, 2008

    BTW, have you figured out yet why HIV+ drug abusers have a shortened life expectancy compared to non-drug abusing HIV positives?

    Right, because the effects of heroin are completely benign when HIV is absent.

  9. #9 HCN
    August 14, 2008

    http://www.theness.com/neurologicablog/?p=324

    You were directed to that blog earlier, I see you did not post there.

  10. #10 wfjag
    August 14, 2008

    “Dr. Orac, now why would we believe we could take you on? To do that we would need you to get in the ring first.

    Instead you are linking to some other jerk.”

    Interesting, Undergraduate Gal, that you didn’t take the opportunity to post a comment to Dr. Crislip’s blog, especially since Dr. Novella did. After all, here’s your chance to Beard the Lion, assuming you can.

    Oh, before discussing your views, please first take a look at the pictures Peter Bowditch posted at http://www.ratbags.com/rsoles/vaxliars/pictures.htm (Full disclosure — that link is also available among the comments to Dr. Crislip’s blog). If you click the pictures a description of each disease shown is made. As Dr. Crislip explains, those diseases used to be fairly common in the U.S., and several still are in many places in the world which do not commonly vaccinate against them.

    So, U.G., looking forward to your attempt to challenge Dr. Novella — or Dr. Crislip, or Orac.

  11. #11 Eric Blood Axe
    August 14, 2008

    Off topic, did you see the piece on “bad science”, some more “Woo”, for you.

  12. #12 PalMD
    August 14, 2008

    Orac, you always get the good trolls. I just stuck with Chuck.

    Undergrad-gal, please study well for your epi exam. You have a little bit to learn.

    Honestly, if a roomful of experts are telling you one thing, and a random undergraduate disagrees, it’s really up to her to prove her point.

    As a hint, you can start with this:

    1) What is your hypothesis? (e.g. “HIV does not cause AIDS”)

    2) What evidence supports the hypothesis?

    3) How can I further test this hypothesis/is it disprovable/is it plausible?

    Go for it! Thank me later.

  13. #14 Undergrad-gal
    August 14, 2008

    “BTW, have you figured out yet why HIV+ drug abusers have a shortened life expectancy compared to non-drug abusing HIV positives?”

    “Right, because the effects of heroin are completely benign when HIV is absent.”

    Hehe, Foxie, that’s precisely what I thoughtwhen I read Dr. Orac’s learned ruminations:

    “Being an IV drug abuser is good for the loss of around 10 years. It’s unclear exactly why, although it’s been speculated that the difference between IV drug abusers and those who do not abuse IV drugs may be due to poorer compliance with therapy in the former group.”

    HCN: I;ve already told you I was too stupid to sign up succesfully over at Novella’s. I tried twice and wads given passwords, but they were not recognized when I tried to log on.

    But that’s all the same, because you’re obviously not too clever either, or you would have understood that I was asking for proof that Novella engages in debate with HIV “denialists”. Your link shows exactly the opposite.

  14. #15 Orac
    August 14, 2008

    Tell you what. I’ll personally e-mail Dr. Novella, with whom I’ve had a fair number of interactions in the past (he knows who I “really” am) and ask him what might be going on.

    Personally, I’m half-tempted to take the rationale that if you’re too “stupid” to figure out how to get a proper login either over at NeuroLogica Blog (Steve’s personal blog) or over at Science Based Medicine, then I have to wonder if you’re smart enough to be discussing vaccine science. But I wouldn’t do that. Oh, wait. I just did.

  15. #16 Undergraduate-gal
    August 14, 2008

    PAlMD, I think I’ll just go ahead and thank you right now but no thanks. Surely I would flunk my exam if I tried to prove a negative.

    But if a roomful of experts were to announce their presence, I might give it a go here.

  16. #17 Dawn
    August 14, 2008

    This post is even more laughable than the previous ones….I guess Orac that YOU didn’t know that many outbreaks have occurred due to the vaccinated and spread mainly among the FULLY vaccinated.

    Polio in Nigeria is one example. The Internation Herald Tribune posted an article about the polio outbreak that has been ongoing since 2005. They have yet to get it under control. There are 2 types they reported….from the wild strain and from the vaccine. Article dated 4/21/08

    The second is Wisconsin/Measles. Gee, it started with a FULLY vaccinated 5th grader. TMJ4 News did an article on 4/23/08. Although it started with a vaccinated child, authorities wish to keep the unvaccinated under house arrest. Um, o.k.. Why?

    Please tell us how the unvaccinated can hurt your vaccinated population again?? I feel like I am talking to a really smart, but stupid person…if that makes any sense.

  17. #18 Joseph
    August 14, 2008

    Polio in Nigeria is one example.

    If you go check the WHO stats on immunization coverage, you will see that Nigeria is one of the countries with lowest coverage of the Pol3 series. They seem to have started immunizing for it in the mid 1980s. Is it any wonder Polio is running rampant there?

    I’ve actually checked these stats in some detail for another country with relatively low coverage and a considerable number of cases, India. I’ve detrended the data and done some other checks. There is no question the Polio vaccine prevents Polio (it sounds ridiculous that I’d even have to state this). Anyone who thinks the Polio vaccine doesn’t work is not only a conspiracist, but clearly, they don’t know what they are talking about.

  18. #19 Dawn
    August 14, 2008

    Oh please Joseph, let’s keep WHO out of this friggin debate. They are one of the most corrupt organizations out there. Let’s just stick to the facts. Contact the AP for more info on the Nigeria outbreak because they are the ones that report about such things…they are usually “pro-vax” which is totally surprising after reading this article. Not so, in this case. I guess that is why the article was pulled so quickly – as usual…a reporter “screwed up” and told the facts instead of the same “ole bullshit” that vaccines are safe and effective. HA-HA

  19. #20 PalMD
    August 14, 2008

    PAlMD, I think I’ll just go ahead and thank you right now but no thanks. Surely I would flunk my exam if I tried to prove a negative.

    But if a roomful of experts were to announce their presence, I might give it a go here.

    Well the experts are here…

    And as far as proving a negative, hey, that’s just an example. Don’t like it? *You* state the question and set up the hypothesis. Go for it.

  20. #21 Interrobang
    August 14, 2008

    Please tell us how the unvaccinated can hurt your vaccinated population again??

    It’s called “the failure of herd immunity,” versus a known risk of certain kinds of immunisations. You’re conflating two separate phenomena, which is, incidentally, about trick #2 in the Denialist’s Playbook. Please try to keep up.

    I feel like I am talking to a really smart, but stupid person…if that makes any sense.

    That’s okay, I feel like I’m a really smart person talking to a really stupid, mendacious person. But some of us feel compelled to try making points anyway.

  21. #22 Dawn
    August 14, 2008

    Oh really Interrobang, I guess that YOU JUST DECIDED to join this conversation on a whim…..in case you didn’t know….MANY, MANY, MANY, outbreaks have been recorded throughout history among the VACCINATED populations. Do you want me to cite just a few for you?

  22. #23 PalMD
    August 14, 2008

    Oh, Dawn, you’re caps are so precious. Interrobang is a regular around here…one that actually knows how to read.

    Please do cite your evidence and its relevance…I’d love to discuss it.

  23. #24 Dawn
    August 14, 2008

    Orac stated: “Not at all. It amused me how you made a mountain out of a molehill. I note that the Merck document only mentioned simultaneous administration of vaccines, which is not at all what I was talking about when I pointed out that vaccines are tested with the regular vaccine schedule.

    The point stands that it is unethical to withhold standard vaccines in a vaccine trial. That’s why new vaccines are tested in addition to (or on top of) the vaccine recommended vaccine schedule in place at the time of the test.”

    I dunno. Are we reading the same vaccine literature? Again, read page 8.

    http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

    Again Orack….you stated what?? “are tested with the regular vaccine schedule”. Oh really? That is not what the drug manufacturer states.

    Hello? Planet Mars or Earth…come in..

    Why oh why can’t you just admit that you made a boo-boo?? Are you really that egotistical?

  24. #25 Dean
    August 14, 2008

    Are Dawn, Undergraduate-girl, and their ilk, scientifically illiterate
    * because they think it is fashionable?
    * because they are lazy?
    * Because they don’t have the ability to study science?
    * Because they are simply stupid?
    Given the evidence they present by posting screeds without trying to make any argument, point, or sense, I would weigh the choices at 10%, 20%, 30%, and 40%, respectively.

  25. #26 Joseph
    August 14, 2008

    They are one of the most corrupt organizations out there.

    Any evidence of this? Even if it were true, I consider it a practical impossibility that they anticipated I was going to attempt a detrended cross-correlation analysis (with a 3rd-order polynomial fit, plus a bit of smoothing so the graph is more clear) on their time series. This is a technique that is virtually unheard of in the biological sciences AFAIK. Then again, I might be part of the Illuminati too. You never know.

  26. #27 curious
    August 14, 2008

    Dawn and UG-gal,
    I guess I’m catching the middle of this debate. What exactly is the point that you’re arguing? Are you trying to say that vaccines don’t work? Or are you saying that vaccines cause some disease like autism? What is your point about AIDS, by the way, that it is not caused by HIV? I’d just like a concise statement of your hypothesis and a brief idea of why you think it’s true.

  27. #28 PalMD
    August 14, 2008

    Um, Dawn, that product info link…I do not think it means what you think it means. It may be helpful to your argument if you quote the particular contraction you feel you’ve discovered.

  28. #29 ozzy
    August 14, 2008

    Dawn seems to have skipped over this section:
    “Safety in Concomitant Use with Other Vaccines
    The safety of GARDASIL when administered concomitantly with hepatitis B vaccine (recombinant) was evaluated in a placebo-controlled study. There were no statistically significant higher rates in systemic or injection-site adverse experiences among subjects who received concomitant vaccination compared with those who received GARDASIL or hepatitis B vaccine alone.
    Post-Marketing Reports
    The following adverse experiences have been spontaneously reported [via that reliable database VAERS] during post-approval use of GARDASIL. Because these experiences were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or to establish a causal relationship to vaccine exposure.”

  29. #30 Joseph
    August 14, 2008

    Are you trying to say that vaccines don’t work?

    Some context: Dawn believes vaccines are a plot to control the world’s population. For more on this type of view, see this.

  30. #31 Baltimore Bert
    August 14, 2008

    Hey Orac,
    When are you dopes going to catch up with us experts and learn how to cure autism? You’re going to need another source of income when the government bans all smoking and there’s no more cancer. I think DAN may have some openings if you want to join the good guys.

  31. #32 Azkyroth
    August 14, 2008

    Dawn, any comment on the progress of the broccoli-centered plot to put a lawn gnome in the White House?

  32. #33 PalMD
    August 14, 2008

    Given that the trolls haven’t even been willing to state what it is they believe or don’t believe, even with an explicit invitation, I think an ad hom attack is justified…

    These two are a couple of idiotic, perhaps insane, trolls with a low level of literacy and numeracy who shouldn’t be trusted to operate heavy equipment…they need a cork on the fork to avoid auto-enucleation.

  33. #34 Dawn
    August 14, 2008

    I guess we have a couple of “extra special” people that don’t understand some things…

    I dunno. Are we reading the same vaccine literature? Again, read page 8.

    http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

    Again Orack….you stated what?? “are tested with the regular vaccine schedule”. Oh really? That is not what the drug manufacturer states.

    Hello? Planet Mars or Earth…come in..

    Why oh why can’t you just admit that you made a boo-boo?? Are you really that egotistical?

    I am not going to give up you egomaniac, are you>

  34. #35 PalMD
    August 14, 2008

    Dawn, please don’t give link-only assertions…what is the quote from your link that seems to contradict the assertion?

  35. #36 Dawn
    August 14, 2008

    Thank you PalMD.. sometimes I DO like to repeat myself….just to hear myself, ya know?

    Good ole Orac stated that Gardasil was tested in conjuction with other vaccines given….well Orac WAS WRONG and refuses to admit it. Please refer to page 8 of the following link.

    http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

    Again Orack….you stated what?? “are tested with the regular vaccine schedule”. Oh really?

  36. #37 PalMD
    August 14, 2008

    Dawn, you’re an idiot….what statement within your link contradicts orac’s?

  37. #38 Dawn
    August 14, 2008

    PalMD..Check the section “use with other vaccines”…

    Good ole Orac stated that Gardasil was tested in conjuction with other vaccines given….well Orac WAS WRONG and refuses to admit it. Please refer to page 8 of the following link.

    http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

    Again Orack….you stated what?? “are tested with the regular vaccine schedule”. Oh really?

    I don’t appreciate the “idiot” term from you PalMD. That is not very nice and totally unwarranted under the circumstances (Orac is the idiot, not me). I would like an apology.

  38. #39 Dawn
    August 14, 2008

    Orac stated in an earlier blog: “This is all nonsense, and it should have been flagged as such by Medscape. Vaccines are always tested with the rest of the routine vaccination schedule; this nonsense about Gardasil not being tested with other vaccines is just that–nonsense. It’s nothing more than the standard antivaccine trope that it’s some undescribed “interaction” between different dreaded vaccines that causes all those horrible problems–except that there really aren’t horrible problems to be found when one looks at the data dispassionatedly”.

    PalMD..Check the section “use with other vaccines”…

    Good ole Orac stated that Gardasil was tested in conjuction with other vaccines given….well Orac WAS WRONG and refuses to admit it. Please refer to page 8 of the following link.

    http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf

    Again Orack….you stated what?? “are tested with the regular vaccine schedule”. Oh really?

    I don’t appreciate the “idiot” term from you PalMD. That is not very nice and totally unwarranted under the circumstances (Orac is the idiot, not me). I would like an apology.

  39. #40 Azkyroth
    August 14, 2008

    …will someone please fix that record player?

  40. #41 Orac
    August 14, 2008

    Because I tire of Dawn’s disingenuous antics, here’s the quote from the document above that she refuses to cite because she knows that if she did it would show that she doesn’t know what she’s talking about:

    The safety and immunogenicity of co-administration of GARDASIL with hepatitis B vaccine (recombinant) (same visit, injections at separate sites) were evaluated in a randomized study of 1871 women aged 16 to 24 years at enrollment. Immune response to both hepatitis B vaccine (recombinant) and GARDASIL was non-inferior whether they were administered at the same visit or at a different visit.

    So Gardasil was specifically tested with the hepatitis B vaccine administered simultaneously.

    What Dawn steadfastly refuses to understand is that new vaccines are always tested against the background of the regular vaccine schedule. Once again, it is unethical not to provide subjects in clinical trials the full, regular, medically recommended vaccine schedule. Instead she perseverates over one small paragraph in a package insert, not realizing that there are certain standards of medical care and for clinical trials that you won’t find in a product-specific document published by a drug company. No doubt she will continue to perseverate over that one small paragraph to the exclusion of all else because she does not have the knowledge base to know how clinical trials are conducted or the understanding of medical ethics to know why her perseveration is nonsense.

    Truly, Dawn is Ferrous Cranus.

  41. #42 Dawn
    August 14, 2008

    Ferrous Cranus: Were is YOUR evidence? Gee, cause the manufacturer of Gardasil just updated his in 2008?? Do you mean to tell me that the manufacturer is not aware of his product being tested in conjunction with others recently?

  42. #43 TexDoc
    August 14, 2008

    Thanks for the rejoinder, Orac. The perseveration was becoming truly nauseating. These two trolls do, at least, justify Pope’s assertion: a little learning is a dangerous thing.

  43. #44 Orac
    August 14, 2008

    Sadly, I didn’t end Dawn’s perseveration. She will continue. I’ve dealt with her kind before. they truly are Ferrous Cranus. Nothing gets through, no reason, no science, nothing that contradicts their fixed beliefs.

  44. #45 Dawn
    August 14, 2008

    Oops…too many beers. I just realized that I was just speaking to the moron that started this thread…Orac. Oh well, same sentiments as stated before, just different person.

    Were is YOUR evidence Orac? Gee, cause the manufacturer of Gardasil just updated his in 2008?? Do you mean to tell me that the manufacturer is not aware of his product being tested in conjunction with others recently?

    I know. Blah, blah, blah. At least you have some smart people working this thread…like Tsu Dho Nimh. This is THE ONLY PERSON that checks anything out. Wow….one person. That is truly sad.

  45. #46 Azkyroth
    August 14, 2008

    Oops…too many beers.

    -Posted by Dawn

    …that explains a lot.

  46. #47 Orac
    August 15, 2008

    Indeed it does. It explains a great deal about Dawn.

  47. #48 TexDoc
    August 15, 2008

    Alas, Orac, I fear you are correct. Maybe Dawn is evolving towards Terminator 2 of Stupid: She can’t be reasoned with, she can’t be bargained with, she absolutely will not stop, ever, until our brains are dead.

  48. #49 ozzy
    August 15, 2008

    Dawn,

    Get a clue! In the link you posted, and what Orac has already posted about, the insert on page 7 states:

    “Studies with Other Vaccines
    The safety and immunogenicity of co-administration of GARDASIL with hepatitis B vaccine
    (recombinant) (same visit, injections at separate sites) were evaluated in a randomized study of 1871
    women aged 16 to 24 years at enrollment. Immune response to both hepatitis B vaccine (recombinant)
    and GARDASIL was non-inferior whether they were administered at the same visit or at a different visit.”

    You really need to stop drinking.

  49. #50 Abstruse
    August 15, 2008

    Alas, Orac, I fear you are correct. Maybe Dawn is evolving towards Terminator 2 of Stupid: She can’t be reasoned with, she can’t be bargained with, she absolutely will not stop, ever, until our brains are dead.

    LOL

    BTW, since this post has devolved away from any discussion think someone could tell me how to get the cool quote indentations? I would really appreciate it.

  50. #51 Dawn
    August 15, 2008

    Orac stated in an earlier blog: “Vaccines are always tested with the rest of the routine vaccination schedule; this nonsense about Gardasil not being tested with other vaccines is just that–nonsense. It’s nothing more than the standard antivaccine trope that it’s some undescribed “interaction” between different dreaded vaccines that causes all those horrible problems–except that there really aren’t horrible problems to be found when one looks at the data dispassionatedly”.

    HELLO? Are you guys really that stupid? Is Hep B ALL of the routine vaccinations? You guys need to go to the CDC’s website for further info. Shit. And I thought I needed another beer. I guess I might.

  51. #52 HCN
    August 15, 2008

    Just show with real evidence that any of the vaccines are worse than the actual disease. Like show DTaP is worse than diphtheria, tetanus and pertussis, or that the MMR is worse than measles, mumps and rubella. But the caveat is that you must use real scientific evidence.

    No commercial websites, no information from a Yahoo group, no anecdotes, no news reports, no books to read and no minutes from meetings. Real science, with at least a link to the abstract.

    In the meantime, an amusing website to read about the risks of the vaccine versus the disease:
    http://www.sciencebasedmedicine.org/?p=186

    … and a reproduced list of good disease/vaccine posts made a while ago:
    http://holfordwatch.info/2008/07/19/a-paediatricians-series-on-vaccinations

  52. #53 ChrisC
    August 15, 2008

    Oh for heavens sake Dawn, get a clue…

    For one thing, it’s almost impossible to discern what position you are arguing, so I’ll have to rely on intuition a little. What I think you are trying to argue is that Gardasil has not been tested with other vaccines. From the document you linked to (it really would have been easier had you provided a quote as well as the reference):

    “Results from clinical studies indicate that GARDASIL may be administered concomitantly (at a separate injection site) with hepatitis B vaccine (recombinant) (see CLINICALPHARMACOLOGY,Studies with Other Vaccines). Co-administration of GARDASIL with other vaccines has not been studied.”

    Concomitantly means at the same time. Now…sit down for a moment, scratch your head and ask yourself “what age were the participants in the clinical trial?”… the document you linked to contains the answer: 16-26.

    Now, engage that noddle of yours and ask yourself: “at what age are routine vaccinations generally administered?” consult the Google! In the US, the CDC (are they as corrupt as the WHO, or simply in cahoots?) recomends shots between the ages of 0-6. See:
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm

    Now, ask yourself, “why would there be the imputus test the Gardasil (or other HPV vaccines) concomitantly when, for the purposes of the clinical trial, Gardasil was administered 10 years or more _after_ the administration of routine childhood shots?”. Hmmmmm…

    In short, your complaint is stupid and the document you provided in no way invalidated Orac’s claims. It really makes you look like a nong that you thought it did.

    I also can’t help myself in responding to your claim about Polio vaccination in Nigeria. As a disclaimer, I’m not an epidemiologist… I’m a simple mathematician…and what is happening in Nigeria is textbook example of the mathematics of mass immunisation.

    A concept in mathematical epidemiology is “herd immunity”. I would spell it out for you, but it would be a waste of time because you’d obviously claim that RAND corporation had gotten to me and implanted such nonsence in my head. Anyhoo…during the late 90’s early 00’s, a large push was made to reach the herd immunity threshold for polio in Nigeria.

    That was until August, 2003, when several Muslim leaders in north of the country banned the immunisation program, alleging that the US was introducing HIV or sterilising drug into the vaccine in a crusade against Islam.

    During the next 10 months, the reduction in immunisations led to a fall in the immunised population that was great enough to allow polio to become endemic within Western Africa. 12 countries who had long been free of the disease, like Cote d’Ivoire, experienced their first polio cases in years.

    After 10 months, the immunisation program was restarted. By the end of 2006, the number of polio cases within Nigeria had halved. Increasing immunisation and political control in other West African states led to polio being declared According to that evil WHO and it’s partner in crime UNICEF, 1,500 children were paralysed thanks to the ban. The mutant vaccine virus you refered to, was only able to spread thanks to the reduction in immunisations…and still accounted for less than 5% of polio cases.

    Please…get a clue

  53. #54 Jo
    August 15, 2008

    Dawn doesn’t think anything in her link contradicts Orac’s statements – she’s baiting all of you,
    OR
    she doesn’t understand the difference between a “vaccine schedule” and “co-administration.”

    Take your pick – either way, it’s not worth the effort you’re all putting into arguing with her.

  54. #55 StuV
    August 15, 2008

    Dawn, get help. You are clinically insane.

  55. #56 trrll
    August 15, 2008

    Good ole Orac stated that Gardasil was tested in conjuction with other vaccines given….well Orac WAS WRONG and refuses to admit it.

    Wow, this is just amazingly stupid. Gardasil is administered in early adolescence. All of the other standard vaccines are administered in childhood. So the only other vaccine that an individual is at all likely to receive close to the same time is HBV, and it was tested with that.

    Think about it rationally for just a moment, if you can. Do you seriously imagine that they somehow managed to find a population of adolescents to test Gardasil upon who somehow missed all of the normal childhood vaccines? That’s pretty crazy, don’t you think? Where would they have found them? One of those mythical Amish populations that supposedly don’t vaccinate? And if you actually were crazy enough to image that that’s what they did, you could have easily checked it out by looking at the Methods sections of studies of Gardasil safety. For example, this one, which reads

    Individuals were excluded from participation when they were pregnant (determined by urine or serum ß-human chorionic gonadotropin testing), were allergic to any vaccine component, had received any blood product or component in the previous 6 months, had any known immune or coagulation disorder, or had received any inactivated vaccine product within 14 days before enrollment or any live vaccine product within 21 days before enrollment.

    Nothing at all about excluding people who received the normal vaccines in childhood.

    I mean, like, DUH

  56. #57 HCN
    August 15, 2008

    StuV said “Dawn, get help. You are clinically insane.”

    Really, she is not insane. She is just very close minded, and will only read or attempt to read stuff that is fed through through specific websites. She cannot be bothered with anything that contradicts her opinions, which she gets from other people.

    Even if primary source material goes against what she has been told. This is illustrated by her refusal to even look at original research. Noted in her plea here:
    http://scienceblogs.com/insolence/2008/08/why_medscape_why.php#comment-1052286
    … where she screams “For this discussion – let’s leave PubMed OUT OF IT.”

  57. #58 Undergraduate-gal
    August 15, 2008

    PAlMD

    The argument regarding Gardasil is that it’s been hyped up by Merck. It has not been shown to be worth the hassle and the cost. It has not been shown to be safe nor effective. In the interest of the marketing campaign, the possible consequences of the results from study 013, showing increased risk of precancerous lesions in already infected women, have been ignored and/or suppressed. As a separate issue, the efficacy and safety in children is only “inferred”. Likewise, the long term efficacy and safety of the vaccine have not been established.

    Although we cannot assume that the study participants haven’t received (or been offered) childhood vaccines, the authors nevertheless pointed out that it has only been tested with Hep B. In many instances there was no placebo group receiving aluminum-free placebo (feel free to disabuse me on this one, because the reports are not always clear on that. I can find only one example where they specify a third group given saline solution with the expected reduction in immediate side-effects).

    It is only an assumption, a shaky assumption, that HPV is exclusively sexually transmitted. There are indications from the FDA that HPV “infection” in itself should not be viewed as a disease, and that the risk is negligible in the absence of “cofactors” whose presence is marked by “persistent infection”. From the 2007 petition: “It is the persistent infection, not the virus, that determines the cancer risk.”

    etc. etc. etc.

    If you go through the different document, there are just too many unknowns, too many assumptions heaped on assumptions to close the book on HPV, Gardasil and cervical cancer. And it’s certainly not worth touting th vaccine and forcing it down people’s throats via lobbied lawmakers.

    So if one doesn’t want to close the book what can one do? On one hand, you have Merck, not exactly the most reliable of self-reporters, on the other VAERS, which you guys think is totally discredited. So what option does one have? Should we just wait and see if the Vioxx scenario repeats itself?

    PAIMD, I am not sure why you keep asking for my hypothesis or points concerning HIV?AIDS here. I have stated several of my objections to Novella’s and Orac’s points in the appropriate thread. My point here was that Orac’s chest thumping about “Taking him on” is BS. He and particularly Novella don’t have the guts for a fair fight.

    But ok, if you want a simple one:

    “HIV” has never been purified, consequently there is no viral gold standard for the HIV tests.

    Of course you sexy science guys don’t consider that a problem, so I guess there’s not much to discuss

  58. #59 Undergraduate-gal
    August 15, 2008

    Whoa” steady there Trrll. Sprinkle some ARVs on your cornflakes and take a deep breath. I know it must be exciting for you to think you have finally scored a point on a denialist, but the point has already been made. Of course nobody thinks they tested this on girls in the age group the marketing campaign is actually targetting.

    But since you are here, I think your expertise would be more gainfully employed if we could persuade you to comment on the controverversial study 013, which seems to suggest a role for “cofactors” in cervical cancer almost greater than the one they play in AIDS – if that is possible?

  59. #60 ChrisC
    August 15, 2008

    “It is only an assumption, a shaky assumption, that HPV is exclusively sexually transmitted.”

    *Slaps self*

    For one, you’re not even wrong… five minutes with pubmed found this:

    Sonnex C, Strauss S, Gray JJ, Department of GU Medicine, Addenbrooke’s Hospital, Cambridge, England.
    Sexually Transmitted Infections 1999 Oct;75(5):317-9:
    Detection of human papillomavirus DNA on the fingers of patients with genital warts.

    There are multiple, non-sexual routes for HPV infection. However, the fact is the vast majority of HPV infections stem from sexual activity:

    Rice PS, Cason J, Best JM, Banatvala JE
    Rev Med Virol 1999 Jan-Mar;9(1):15-21:

    Non-sexual transmission makes liekly makes up a tiny number of cases. If anything, a higher prevalance of non-sexual transmission cases would add wieght to the case for early childhood immunisation.

    Then we get this:
    “It is the persistent infection, not the virus, that determines the cancer risk.”

    Teh stoopid…it burns us…

    Most cases of cervical cancer are require a HPV infection to cause cell changes. See:

    -Walboomers JM, Jacobs MV, Manos MM, et al (1999). “Human papillomavirus is a necessary cause of invasive cervical cancer worldwide”. J. Pathol. 189 (1): 12-9.

    -Lowy DR, Schiller JT (2006). “Prophylactic human papillomavirus vaccines.”. J. Clin. Invest. 116 (5): 1167-73.

    There is no “assumptions” about HPV as a risk factors, any more than there are “assumptions” about HIV as a risk factor for AIDS. Your argument is akin to saying that a rabies vaccine doesn’t prevent encephalitis, or that a flu vaccine doesn’t prevent pnuemonia. HPV is a necessary, yet not a sufficient condition for most cases of Cervical cancer.

    “The argument regarding Gardasil is that it’s been hyped up by Merck”

    I tend to agree… I think the way Merck has aggressivly marketed is product, while keeping the costs extrodinarily high, is disgracefull. This doesn’t mean that I jump at shadows, make stuff up and otherwise turn my cognitive abilities off for the day, simply because I don’t like the way Merck has behaved.

  60. #61 Soren
    August 15, 2008

    As for Novellas Ass kicking of denialists, I refer you to his blog, for example this post
    http://www.theness.com/neurologicablog/?p=65

    or indeed this article co authored with Tara Smith

    http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0040256&ct=1

    Cheers

    Soren

  61. #62 undergraduate-gal
    August 15, 2008

    Chris,

    It seems we agree om most of the “facts” about transmission, sexual or otherwise. However, we don’t agree about the implications of them.

    I take exception to you calling the FDA stoopid.
    I don’t think they wrote anything stoopid in this particular quote about persistent infection.

    It may very well be that, “Most cases of cervical cancer are require a HPV infection to cause cell changes”. But if that is so, they forgot to demonstrate it in your reference:

    -Walboomers JM, Jacobs MV, Manos MM, et al (1999). “Human papillomavirus is a necessary cause of invasive cervical cancer worldwide”. J. Pathol. 189 (1): 12-9.

    I have never called HPV a risk factor. Presumably this is again the FDA, which you have quoted inaccurately. I may have, however, have called HPV a marker pending better proof of causation.

    Soren,

    I am aware that Steven Novella has smeared rethinkers, or cherry-picked and misrepresented “arguments” such as those from Truthseeker, then triumphantly “rebutted” them. Bill O’Reilly does the same with reader mail 6 days a week. Do you consider that “asskicking”? If this is your definition of fair debate, no wonder you’re all so smug about nothing.

  62. #63 Orac
    August 15, 2008

    PAIMD, I am not sure why you keep asking for my hypothesis or points concerning HIV?AIDS here.

    My guess is that he’s doing it because your comments show muddled thinking and it’s not clear exactly what you are arguing. You’re all over the place. His request is simply a device to try to get you to focus and make a coherent point.

    Clearly, PalMD has failed in his endeavor. You are steadfastly refusing to focus.

  63. #64 Not THAT Dawn
    August 15, 2008

    Hi, Orac. Can I change my name so I am not associated with the idiot using my name? You know, the anti-vax one who threatens. Her comments are getting really depressing, especially when people think it’s me who’s that dumb….

  64. #65 chris
    August 15, 2008

    BTW, since this post has devolved away from any discussion think someone could tell me how to get the cool quote indentations? I would really appreciate it.

    Use these tags:

    blockquote , /blockquote

    in angle brackets >

  65. #66 Undergraduate-gal
    August 15, 2008

    Dr. Orac, are you still here?!

    Since you’re in the guessing mode, as usual, tell me have you figured it out yet? You know the one about why HIV positive drug addicts have a shorter life expectancy than non-drug using HIV positives.

    Or is that question not focused enough for you?

  66. #67 PalMD
    August 15, 2008

    What a friggin moron.

    Did it ever occur to you that being a drug addict isn’t particularly good for you? Ignoring HIV, drug addicts have shorter lives than non-drug addicts. The question itself is idiotic.

    UG, keep practicing your “would you like fries with that?”

  67. #68 Orac
    August 15, 2008

    Ah, but Undergraduate-gal apparently thinks that the reason IV drug abuse is bad for you is because it, not HIV, is The Real Cause of AIDS, aside from the fact that sharing needles is a great way to transmit HIV from one person to another.

  68. #69 Undergraduate-gal
    August 15, 2008

    Tsk tsk PA, you should have learned by now that you need to check before you call somebody a “friggin moron”. These are your boyfriend ORAC’s words, not mine:

    “Being an IV drug abuser is good for the loss of around 10 years. It’s unclear exactly why, although it’s been speculated that the difference between IV drug abusers and those who do not abuse IV drugs may be due to poorer compliance with therapy in the former group.”

    I think it’s pretty moronic as well, but I don’t think it’s very nice of you to use that kind of language about your loved ones, or anyone else for that matter.

    Dearest Orac, I think drug use can be bad for you for a number of reasons, but what has that got to do with HIV transmission? Is your hypothesis that when HIV is transmitted via needlestick it kills you 10 years faster?

    BTW., needles don’t seem to be such a great way to transmit HIV and especially AIDS among health workers.

  69. #70 Evinfuilt
    August 15, 2008

    BTW., needles don’t seem to be such a great way to transmit HIV and especially AIDS among health workers.

    That couldn’t be because they don’t actually take the needle out of a patient, fill it up with the latest drug and inject it into themself… could it.

  70. #71 trrll
    August 15, 2008

    I know it must be exciting for you to think you have finally scored a point on a denialist, but the point has already been made.

    The point that I am making is just how crazy denialist thinking actually is. Even an instant of rational thought would have told Dawn how unlikely it is that Merck somehow found a test group of young women who had not received their normal childhood vaccinations. Why would they do such a thing? It would be hard to find such a population, and since such a group would not be representative of the target population expected to be vaccinated in practice, it would not help Merck with their FDA application.

    Of course nobody thinks they tested this on girls in the age group the marketing campaign is actually targetting.

    Well, let’s check and see what age group the marketing campaign is actually targeting.

    Here’s what Merck’s web site says in its “Information for Parents” section

    GARDASIL is for girls and young women ages 9 to 26.

    Here is what it says in the Prescribing Information for Gardasil

    INDICATIONS AND USAGE
    GARDASIL is a vaccine indicated in girls and women 9-26 years of age

    The same prescribing information gives data from the groups they tested it on. What were the ages? 9 to 26.

    Now the stupidity here really is comparable to that in Dawn’s posts. Think about it rationally for a moment, if you can The FDA maintains tight control on the marketing of pharmaceuticals. Do you really imagine that the FDA would permit Merck to market Gardasil to an age group in which it has not been tested?

    But since you are here, I think your expertise would be more gainfully employed if we could persuade you to comment on the controverversial study 013, which seems to suggest a role for “cofactors” in cervical cancer almost greater than the one they play in AIDS – if that is possible?

    Possible? Obviously. Axiomatically, it is always possible, for any disease, that there are unidentified cofactors. Clearly, HPV is an important determinant of disease in the study populations, based on the vaccine’s clearly demonstrated efficacy. But if you could find a cofactor of equal or greater importance, and develop a treatment against it, then you could go into competition with Merck.

  71. #72 N.C.
    August 15, 2008

    UGG:

    First, you’re either accidentally mistaking or intentionally conflating what the lower lifespan means. There are many other third factors that could confound the relationship here; drug users may have a lower rate of compliance with antiviral therapy, for example, or may just be in poorer physical condition in general prior to infection. Both of those would adversely effect lifespan in this group.

    Second, health care workers don’t share used needles with their patients, health care workers especially don’t use needles on themselves (most exposure is through accidental cutaneous sticks and cuts), and sharps are very strictly controlled and carefully handled to minimize exposure. Even then, the risk of contracting HIV in this manner is somewhere around 1%.

  72. #73 Inquisitive Raven
    August 15, 2008

    Let me add to NC’s comment. I’ve read that IV drug users are prone to drawing blood into the syringe and re-injecting it to get as much drug as possible out of it. This seems like a practice tailor made to transmit blood borne disease. If someone with better information could confirm or deny that I’d appreciate it.

    You can’t do that with the needles used for blood drawing; they don’t have plungers. Since a needle known to be exposed to blood is more hazardous, not having a means of forcing the contaminated material deeper into the tissue in the event of an accidental stick seems kind of important, no?

    Similarly, since the needles used to inject drugs in a medical setting are used once, the plunger is already depressed in the event of an accidental stick with a used needle and cannot force the needle contents deeper. If the plunger was not depressed, the needle is not contaminated and while you may have to treat the effects of any drugs it contained, it’s not a disease transmission risk.

  73. #74 Undergraduate-gal
    August 15, 2008

    Trrll,

    Please, huffin’ and puffin’ for a minute! You bite on anything, don’t you sailor? The age/marketing thing was a joke fer cripe’s sake! But fair enough, maybe you weren’t around when we discussed shooting up neonates and fetuses.

    Anyway, here’s the link to the study which you were commenting on obviously without having a clue as to what it was.

    http://www.naturalnews.com/downloads/FDA-Gardasil.pdf (p. 13)

    It’s the first of Merck’s two phase III gardasil trials -with no study subjects under the age of 16 funnily enough (-;

  74. #75 PalMD
    August 15, 2008

    Citing Mike Adams! That must be a violation of of Orac’s corollary to Scopie’s Law…

  75. #76 wfjag
    August 15, 2008

    Dear U.G.:

    Thinking that VAERS provides reliable information wanders into my area (attorney). I’ll leave it to others whose areas of expertise you don’t understand to debunk your assertions in them. But, not even lawyers think VAERS is a reliable database. As an example, check “A vaccine database, contaminated” by Walter Olsen (Feb. 21, 2006) at http://overlawyered.com/2006/02/a-vaccine-database-contaminated/#comments He was commenting on Dr. James Laider’s now well-known experience with reporting to VAERS that the influenza virus had turned him into The Incredible Hulk. The report was accepted and duly entered into the VAERS database. Later Dr. Laider was called by investigators to confirm his report (a spot check). He confessed that it was a spoof to see if the report would be accepted. He was told that, even then, that the report could not be removed from the VAERS database unless he consented. He did, and it was removed.

    In short, it doesn’t matter how insane the reported side-effect is, once reported, it goes on the VAERS database and stays there unless the person who made the report consents to its removal. Given products liability and mass tort lawsuits and the demonstrated history of some trial attorneys fabricating evidence (e.g., Dr. Andrew Wakefield), there is no reason to trust VAERS. There are also many “true believers” and just plain ignorant, who report things they believe, but which just ain’t so. These, and other, problems with VAERS have been known for quite a while. If you expect to be taken seriously by anyone knowledgable in medicine, science or law (and a lot of other professions), don’t rely on the VAERS database as your support. It was co-opted and corrupted long ago.

  76. #77 Azkyroth
    August 15, 2008

    Dearest Orac, I think drug use can be bad for you for a number of reasons, but what has that got to do with HIV transmission? Is your hypothesis that when HIV is transmitted via needlestick it kills you 10 years faster?

    You really don’t see how pumping what are essentially pleasantly-acting neurotoxins into your body, a habit that is known to be associated with impairment of activities like exercise and eating properly as well as putting physiological stress on the body correctly, might affect prognosis?

  77. #78 Azkyroth
    August 15, 2008

    Bleh…”putting physiological stress on the body directly” rather.

    Oh, shit, teh st00pid is contagious! D:

  78. #79 Undergraduate-gal
    August 15, 2008

    Oopss my second word to Trrl up there has mysteriously disappeared. It was “Please Stop”

    Hey Palmist,

    Instead of classifying an FDA document as an antivax site (you must be a centipede if you’re still walking after all the times you’ve shot yourself in the foot just in this thread), how about the lesson you were going to teach me about HIV purification and viral gold standards.

    Your and Orac’s contributions haven’t exactly been impressive lately. If that’s what you guys call kick ass, you’d better not give up your dayjobs in mum’s basement.

  79. #80 khan
    August 15, 2008

    A question:

    Before there was any tetanus vaccine, what was the incidence and prognosis of tetanus?

    Note: I am up to date on all vaccines.

  80. #81 CyberLizard
    August 15, 2008

    @khan:

    Tetanus

    The Disease: Lockjaw. Severe, uncontrollable, painful spasms of every muscle in your body followed by cardiovascular collapse.

    The historical disease: 600 cases and 180 deaths each year in U.S. More than 500,000 deaths per year worldwide.

    Death: 1 in 3.

    World Wide disease: in 2002, 198,000 children died from tetanus out of about a million cases.

    Vaccine efficacy: Unknown from clinical trials, but the series of three gives levels of neutralizing antibody that suggests 100% efficacy and cases are rare in the vaccinated.
    In 2002 it is estimated that the vaccine saved 643,000 lives world wide (8).

    Vaccine Side effects. Not autism. Mostly local symptoms and rarely severe allergic reactions (1 in a million).

    This is from the article referred to in the original post: http://www.sciencebasedmedicine.org/?p=186

  81. #82 CyberLizard
    August 15, 2008

    Shoot, somehow I screwed up the blockquote. Should have gone down to just above the last sentence. :P

  82. #83 trrll
    August 15, 2008

    You bite on anything, don’t you sailor? The age/marketing thing was a joke fer cripe’s sake!

    I’m afraid that I’m going to have to continue taking everything you write seriously. If I discarded everything you’ve written that has been so nonsensical that I’ve wondered if you might be joking, there wouldn’t be anything left at all.

    Anyway, here’s the link to the study which you were commenting on obviously without having a clue as to what it was.

    Yes, I’ve already seen that study, but it is not necessary to refer to any study to answer your question about whether it is possible that there are cofactors–because it is axiomatic no matter what the disease, there is always a possibility of unidentified cofactors.

    It’s the first of Merck’s two phase III gardasil trials -with no study subjects under the age of 16 funnily enough

    Try to think rationally about it for a moment, if you can. Can you figure out why it might be better to have multiple studies looking at different age ranges, rather than a single study with all of the ages mixed together?

  83. #84 curious
    August 15, 2008

    UG-gal,
    Would you please state your basic idea… at this point no justification is required, I just want to know what you’re talking about. If you’re not trying to make a point, then what are you trying to do?

    I assume that by posting here you’re trying to convince us of something about vaccines, but you’re not doing it in a way that can possibly succeed because we don’t understand what you’re talking about. I’m open to hear what you have to say, if you would just say it.

  84. #85 Joe
    August 15, 2008

    Hey Undergraduate-gal

    This article may help you http://www.apa.org/journals/features/psp7761121.pdf

    The article is titled Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments

    After you become a “graduate,” you may be surprised at how much better educated people know.

  85. #86 Joe
    August 15, 2008

    I wrote “Hey Undergraduate-gal” I should have included ‘Dawn’ I simply forgot the name.

    Recently, I had a conversation with a neighbor who is always short on money. Yet, she spent extra $ to have her tires filled with nitrogen “to hold the pressure”. I told her she was defrauded; she knows that I taught the gas laws in college (and refills are free). She replied that “some people disagree with [you].”

    Dawn et al: The difference between ignorance and knowledge is that ignorance is unlimited.

  86. #87 Prometheus
    August 15, 2008

    UGG (W) and Dawn seem to be mighty confused about vaccination, viruses and a whole lot of other things.

    Re: Gardisil, HPV and cervical cancer:

    HPV is a dsDNA virus that encodes proteins that block growth suppression systems (E5) and block the p53 tumor suppressor protein (E6) (and other proteins which also interfere with cell-cycle control and lead to cancerous transformation), leading to uncontrolled cell division. It is this uncontrolled cell division that leads to the visible manifestation of a “wart”. In some cases, this uncontrolled cell division leads to cancer.

    It is clear that some HPV’s need additional “help” to cause cancer – often another virus or damage to another tumor repressor gene. However, at least two HPV’s (16 and 18) can do this all on their own. [note: Gardisil targets HPV's 1,6,16 and 18 - the four most common strains]

    Now, does this mean that HPV is the only factor in cervical cancer or that having even HPV 16 or 18 always leads to cancer? Not necessarily – nothing in biology, let alone medicine – is absolute. However, would reducing the incidence of HPV infection reduce the incidence of cervical cancer? Almost certainly!

    Dawn seems unable to read the rather dense medicalese in the Gardisil package insert. To someone who reads this sort of “prose” all the time, it simply stated that when Gardisil and Hep B vaccine were given at the same time, the vaccines produced as much of an immune response as they did when given separately.

    As has been exhaustively pointed out, there was no selection for subjects who either were or were not “up to date” with their other vaccinations. As has also been pointed out, it would be unethical to withold routine vaccines from test subjects.

    And, finally, even if Merck had wanted to restrict its testing to otherwise unvaccinated subjects, the latest study on that topic shows that only 0.3% of children are “completely unvaccinated”. In other words, it would have been prohibitively difficult for Merck to recruit only “unvaccinated” subjects for the Gardisil study.

    Not only that, but don’t you think that the “unvaccinated” subjects might be that way for some religious, moral, philosophical or psychopathological reason and – as a result – would not be likely to consent to be a part of a vaccine study? Seriously, just think it through!

    Re: HIV and AIDS:

    This particular “horse” has been beaten for so long that it seems pointless to argue further. Suffice it to say that only a small number of fanatical dogmatists continue to cling to the outdated and disproven “hypothesis” that AIDS is not caused by HIV. This is not because the scientific and medical “authorities” have decreed that HIV causes AIDS; it is because that’s what the data show (and mounds of data, at that).

    To those that claim the medications used to treat HIV infections lead to AIDS (like the fellow in my Virology class last year), please explain why AIDS was seen – and had a more rapid progression – prior to the use of any of the HIV drugs (in fact, prior to the discovery of HIV).

    Those who claim that it is the “lifestyle” that leads to AIDS, please explain the hemophiliacs and transfusion recipients who developed AIDS – which also happened prior to the development of any of the HIV drugs.

    Those wondering why IV drug abuse could reduce life expectancy in HIV infections by ten years should be prepared to discuss how much IV drug abuse reduces life expectancy in people without HIV infections. [hint: more than ten years]

    Rather than sniping at what are, in fact, minor and even trivial “issues” in the HIV/AIDS data, how about coming up with a coherent alternative hypothesis and defending it with data and reason (rather than whale.to “references” and emotional outbursts).

    Now, I have no illusions about how effective these arguments will be against the like of UGG (W) and Dawn – they are as closed-minded as the rest of the anti-vaxers. However, I hope that people who are sincerely looking for information will read this and see which “side” of the argument is using reason and data, and which “side” is simply parrotting what they’ve read on the Internet.

    Prometheus

  87. #88 Natalie
    August 15, 2008

    It’s the first of Merck’s two phase III gardasil trials -with no study subjects under the age of 16 funnily enough

    This is a joke, right? You actually don’t get that a two-phase trial has two separate phases? All you’ve proved is that they didn’t test Gardasil in young girls during the first half of the trial.

  88. #89 PalMD
    August 15, 2008

    It’s not a joke, it’s just a few people who are so blinded by ideology that they can’t reason.

  89. #90 Undergraduate-gal
    August 15, 2008

    I’m not surprised at the likes of Orac and PALMIST, but usually you don’t chicken out like that Trrll.

    According to the FDA document, those two studies were the sum, the whole, the totality of the phase III trials given to the FDA for consideration.

    “Phase 3 Studies
    Two randomized, double-blinded, placebo-controlled phase III studies evaluated the clinical efficacy and safety of Gardasil™. The two studies, the FUTURE I and FUTURE II studies, evaluated the clinical endpoints of CIN 2/3 or worse and external genital lesions due to HPV.”

    Perhaps YOU have read in that treasure trove, Merck’s
    “Information for Parents section”, the phase III studies where they do age group 24-26, Dumbo?

    Now are you now going to tell us how 3% more smokers translates into 44.6% increased risk of precancerous lesions, or are you going to continue to dodge like all the other chickenshits here?

  90. #91 Undergraduate-gal
    August 15, 2008

    Natalie and Palmist, I take it you have discovered by now that you missed the mark and hit your foot yet again. Palmist has done nothing but, since he claimed to be channeling a roomful of HIV experts. What a joke.

    Natalie I feel sorry for; it’s such a pretty name.

  91. #92 anonymous antivaccinationist
    August 15, 2008

    I typically only lurk here, and a few other science blogs on occasion and won’t have much to offer along the lines of baiting, sorry to say. I’ll simply offer some skeptical observations beyong the vaccine monograph as it relates to this particular vaccine.

    GARDASIL’s efficacy against all high grade cervical lesions caused by all dangerous, cancer associated HPV strains — even among the sub-population who tested negative for both HPV 16 and 18 before the experiment began — is disappointingly small (6% to 27% depending on the study and the sub-population).

    In both the FUTURE I & the FUTURE II studies, Merck declined to release GARDASIL’s overall efficacy against all high grade cervical lesions caused by all dangerous, cancer associated HPV strains for the sub-populations of subjects who tested negative for any and all HPV exposure when the experiments began. Therefore, we are currently left to wishfully assume a higher than 27% efficacy for this sub-population based solely on FUTURE II’s published results for the slightly larger sub-population that had not been exposed to either HPV 16 or 18 when the experiment began. Nor did Merck supply a breakdown by dysplasia grade for this sub-population, leaving open the possibility that most of GARDASIL’s “effectiveness” came against lower grade 2 dysplasias.

    The use of a highly pharmacologically alum adjuvant as the sole “placebo” in both the FUTURE I & FUTURE II studies makes it impossible to accurately assess the overall risks of vaccination vs. non-vaccination in the real world. Furthermore, the fact that GARDASIL has been studied for safety in just a few hundred pre-teens (again using an alum injection as the “placebo”) is highly problematic.

    That’s all, carry on.

  92. #93 Natalie
    August 15, 2008

    Natalie and Palmist, I take it you have discovered by now that you missed the mark and hit your foot yet again.

    Is that supposed to be a response?

  93. #94 Undergraduate-gal
    August 15, 2008

    OMG It just hit me, you don’t even know it yourself!

    Both studies were limited to age-group 16-23.

    That’s it for me. Please stay out of it from now on children and let Trrll handle the rest. There’s a required minimum level if not of intelligence then at least ability to be embarrased by yourselves. If it’s of comfort to you, I think Steven Novella would have fared only marginally better.

    Trrll, I know you’re an expert on unidentified cofactors.
    How does this strike you – rather how does this strike Ascher et al. and Kaslow et al.?

    “Persistent crack users were over three times as likely as non-users to die from AIDS-related causes, controlling for use of HAART self-reported at 95% or higher adherence, problem drinking, age, race, income, education, illness duration, study site, and baseline virologic and immunologic indicators. Persistent crack users and intermittent users in active and abstinent phases showed greater CD4 cell loss and higher HIV-1 RNA levels controlling for the same covariates. Persistent and intermittent crack users were more likely than non-users to develop new AIDS-defining illnesses controlling for identical confounds. These results persisted when controlling for heroin use, tobacco smoking, depressive symptoms, hepatitis C virus coinfection, and injection drug use. CONCLUSION: Use of crack cocaine independently predicts AIDS-related mortality, immunologic and virologic markers of HIV-1 disease progression, and development of AIDS-defining illnesses among women” (Cook et al., “Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women”, AIDS 22 [2008] 1355-63 ).

  94. #95 StuV
    August 15, 2008

    UG-G, are you EVER going to make a point, for crying out loud?

  95. #96 Natalie
    August 15, 2008

    OMG It just hit me, you don’t even know it yourself!

    Both studies were limited to age-group 16-23.

    Hmm, not according to the FDA: http://www.fda.gov/bbs/topics/news/2006/new01385.html

    Four studies, one in the United States and three multinational, were conducted in 21,000 women to show how well Gardasil worked in women between the ages of 16 and 26 by giving them either the vaccine or placebo.

    and

    Two studies were also performed to measure the immune response to the vaccine among younger females aged 9-15 years. Their immune response was as good as that found in 16-26 year olds, indicating that the vaccine should have similar effectiveness when used in the 9-15 year age group.

    So a) there were six studies, not two, and b) girls 9-15 did participate in studies.

  96. #97 Natalie
    August 15, 2008

    For anyone who’s interested, the PDF of the medical review of Gardasil has a table listing all the studies done (it’s actually more than 6) on pages 44 and 45:
    http://www.fda.gov/cber/review/hpvmer060806r.pdf

  97. #98 curious
    August 15, 2008

    UG-gal,
    Why don’t you state your point? I don’t even understand the relevance of the ages of girls who were in the Gardasil studies to begin with. Are you trying to say that Gardasil was approved prematurely?

    As for your data on drug use and AIDS… I don’t understand what you’re trying to show there either. Is it that AIDS is caused by drug use directly with no viral cause? Why won’t you just explicitly write down your view so we know what you’re talking about?

  98. #99 ozzy
    August 15, 2008

    Dawn,

    There are two other risk factors listed in the analysis. Let me give you a hint as to your question. What happens if people with a known risk factor have a much greater individual risk of developing precancerous lesions? Think hard about this one. You might have to do some math. The distribution of all risk factors in the Gardasil group was ~10% higher than the placebo group. What would happen if these risk factors result in a 2X higher risk of developing precancerous lesions in these individuals?

  99. #100 PalMD
    August 15, 2008

    Without evidence to the contrary, I’d say that UGG is not capable of stating a clear point for debate. She’s been asked several times.

    Oh, and UGG, I will take fries with that, thanks.

  100. #101 ozzy
    August 15, 2008

    Thanks Natalie. I wonder why Mike Adams didn’t post that document…

  101. #102 ozzy
    August 15, 2008

    Oops. I meant UG not Dawn.

  102. #103 D. C. Sessions
    August 15, 2008

    Before there was any tetanus vaccine, what was the incidence and prognosis of tetanus?

    Incidence was never all that high, but the prognosis — well, do you remember the punchline to the joke about the two campers, one of whom gets bitten on the butt by a rattlesnake?

  103. #104 Buckeye
    August 15, 2008

    CONCLUSION: Use of crack cocaine independently predicts AIDS-related mortality, immunologic and virologic markers of HIV-1 disease progression, and development of AIDS-defining illnesses among women”

    So this study demonstrated that being a crack whore is a good predictor of whether you will get AIDS?

  104. #105 Azkyroth
    August 15, 2008
  105. #106 Undergraduate-gal
    August 15, 2008

    Curious,

    I’m sorry if you really are curious, but I was promised a “room full of experts” for this discussion. You don’t qualify. In fact, the only reasonably qualified person here so far is Trrll.

    If you are interested in the basics of the HIV/AIDS debate, you can go to aidsmythexposed.com

    Natalie, you’re a sweetheart, but please no more.

  106. #107 Undergraduate-gal
    August 15, 2008

    Curious,

    If you really are interested in the basics of the HIV/AIDS debate, you can go to for example aidsmythexposed.com

    Natalie, you’re a sweetheart, but please no more.

  107. #108 Joe
    August 15, 2008

    UGG and dawn- please respond. What makes you think you know this stuff?

    This article may help you http://www.apa.org/journals/features/psp7761121.pdf

    The article is titled Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments.

    What is your competence?

  108. #109 D. C. Sessions
    August 15, 2008

    The article is titled Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments.

    What is your competence?

    You do realize that this is Catch-22, don’t you?

  109. #110 Joe
    August 15, 2008

    DC Sessions-

    I get it- Asking the cluelescenti is not profitable.

  110. #111 DBC
    August 15, 2008

    /delurking

    Damn, we get some good trolls here! Ornery ones, of late. I think if we put U-G in a room with cooler, they’d combust. Of course, they wouldn’t be hot enough to melt steel, but still…

    I remember doing some reading on some “AIDS isn’t real” sites a long time ago. I note from the provided link to aidsmyths.whatever that they’re still referencing the same silly “papers” from the early 90’s.

    I also can’t help but note that the MSN group in question insists that I read scores of FAQ pages and references before posting. I find this surprising, since Dawn and U-G don’t seem to feel any obligation to go read…well, anything.

    No, wait- I’m not actually surprised at all.

    \relurking

  111. #112 Dan
    August 15, 2008

    This threat is too long for me to catch up on. But based on quick glancing I assume that the name Undergraduate-gal implies not graduated from high school. If that is not the case, I fear for the reputation of whatever college she goes too.

  112. #113 Militant Agnostic
    August 15, 2008

    UGG proves that BB King was right when he sang

    “You can lead a horse to water, but you can’t make him drink
    You can send a kid to college but you can’t make him think”

    The song is called “Heed my Warning”

  113. #114 D. C. Sessions
    August 15, 2008

    This threat is too long for me to catch up on. But based on quick glancing I assume that the name Undergraduate-gal implies not graduated from high school. If that is not the case, I fear for the reputation of whatever college she goes too.

    I wouldn’t really start worrying until she graduates.

  114. #115 Natalie
    August 15, 2008

    Natalie, you’re a sweetheart, but please no more.

    Yeah, it must suck to be caught in your blatant lie. Sorry about that – guess I’m just a stickler for facts.

  115. #116 Tsu Dho Nimh
    August 15, 2008

    Dawn says: “HELLO? Are you guys really that stupid? Is Hep B ALL of the routine vaccinations?

    For the age usually given the Gardasil, perhaps they are. It’s not “all vaccines on the schedule”, it’s the “scheduled vaccines”.

  116. #117 curious
    August 15, 2008

    I’m sorry if you really are curious, but I was promised a “room full of experts” for this discussion. You don’t qualify. In fact, the only reasonably qualified person here so far is Trrll.

    Hi UG-gal,
    I think the problem here is not our expertise, it’s that you’re not actually participating in a discussion. We don’t know what you’re talking about because you haven’t told us your position. Not many scientists are going to know much about an AIDS debate because no such debate exists in scientific discourse, it only exists on internet forums… and why do you want to direct me to a website so that I can understand your view, when you, yourself, are right here on this forum? Just tell us your view.

  117. #118 weevil
    August 15, 2008

    Let me help the unfortunate reader with interpreting this. Sometimes PubMed is not the best tool to use. . .

    My grandmother was born in 1890 in the rural south. She had the benefit of four years of education, back in the days when children didn’t go to school when it was time to plant or harvest, so a year of school might add up to four months. She had a favorite saying, which I heard dozens of times while growing up: “There ain’t no cure for the dumbass.” Bear in mind that ‘the dumbass’ was not not a person but a condition. A normally rational person could get a case of ‘the dumbass’ and it might take months to recover. It was most frequently manifested in matters of love, but was not limited to romantic matters.

    She also had a diagnosis which might be offered up when she saw a severe case above-named malady: ‘He’s flat eat up with the dumbass.’ This diagnosis was delivered, with a sad shaking of the head, only when the sufferer had demonstrated that he, or she, had lost contact with reality.

    One of the basic principles of diagnosis and treatment of the above-named malady is that there is no treatment: only time or reality can cure it.

    So, for all of you wondering what might be going on with UG or Dawn, it’s simple: they are ‘flat eat up with the dumbass.’ Nothing you can say or do will help.

    However, the other lesson I learned from my grandmother is that those who suffer from this disease are an endless source of amusement. They lack self-awareness and revel in demonstrating the depths to which they will sink. So sit back and enjoy the show. . .

    weevil

  118. #119 Tsu Dho Nimh
    August 15, 2008

    “Persistent crack users were over three times as likely as non-users to die from AIDS-related causes

    Well DUH! Crack screws up the immune system, wrecks your lungs and the crack addicts I met during my work in a couple of large public hospitals weren’t interested in food or exercise.

    To quote from the article: Previous studies, the authors point out, have shown that cocaine causes immune alterations in T-cells, inhibits the functions of other immune cells like macrophages and neutrophils, suppresses cell-signalling chemicals (cytokines), and increases HIV replication in cells in the test tube.

    Recent studies have also found that cocaine increases the permeability of the blood-brain barrier, thus increasing the vulnerability of the central nervous system to HIV infection, and that crack users develop chronic lung disease because of inhaling crack contaminants. There was a predominance of respiratory diseases in the women who developed AIDS-defining conditions; 18% developed bacterial pneumonia, 10% PCP and 4% TB.

    http://www.druglibrary.org/SCHAFFER/cocaine/crakref1.htm has along list of studies on the damage that crack cocaine does to lungs … add that to the know risk of the immunosuppression from HIV and of course they die sooner.

  119. #120 ChrisC
    August 15, 2008

    Well…we’ve struck AIDs denialism now. We’ve only got to get to evolution denialism and we’ve got the bioscience sweep.

  120. #121 DLC
    August 15, 2008

    Wow. go away for a few days and see what happens?

    “If you’re not an expert, don’t post here” ?
    Then you who said that should not write another word, because you have proven your complete lack of understanding repeatedly.

    Joe recommends : “Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments ”
    That won an Ig Nobel prize when it was published, but it’s still a good piece of work.

  121. #122 Dawn
    August 15, 2008

    What the CDC recommends in conjunction with Gardasil….again, the only vaccine ever tested (placebo) is Hep B. Nothing else has been tested according to the drug manufacturer. Again, Orac was INCORRECT.

    http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2008/08_7-18yrs_schedule_pr.pdf

  122. #123 trrll
    August 16, 2008

    What the CDC recommends in conjunction with Gardasil….again, the only vaccine ever tested (placebo) is Hep B. Nothing else has been tested according to the drug manufacturer. Again, Orac was INCORRECT.

    Try answering the simple question that I asked before. Where do you imagine that they found adolescents who had not received the standard childhood vaccines? And if they did exclude adolescents who had received the usual vaccines in childhood, why does the methods section say they only excluded girls who had had other vaccines in the last three weeks? The other standard vaccines are given much earlier than that.

    So it turns out that Orac was exactly correct. Don’t you think that you should apologize to him?

  123. #124 trrll
    August 16, 2008

    Trrll, I know you’re an expert on unidentified cofactors.
    How does this strike you – rather how does this strike Ascher et al. and Kaslow et al.?

    “Persistent crack users were over three times as likely as non-users to die from AIDS-related causes, controlling for use of HAART self-reported at 95% or higher adherence, problem drinking, age, race, income, education, illness duration, study site, and baseline virologic and immunologic indicators. Persistent crack users and intermittent users in active and abstinent phases showed greater CD4 cell loss and higher HIV-1 RNA levels controlling for the same covariates. Persistent and intermittent crack users were more likely than non-users to develop new AIDS-defining illnesses controlling for identical confounds. These results persisted when controlling for heroin use, tobacco smoking, depressive symptoms, hepatitis C virus coinfection, and injection drug use. CONCLUSION: Use of crack cocaine independently predicts AIDS-related mortality, immunologic and virologic markers of HIV-1 disease progression, and development of AIDS-defining illnesses among women” (Cook et al., “Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women”, AIDS 22 [2008] 1355-63 ).

    Have you ever actually met any crack users? They are generally in generally poor health even if they are not HIV-infected. Like other stimulants, cocaine suppresses the appetite, so stimulant users tend to eat poorly and often do not get proper nutrition. Cocaine also produces a high level of sympathetic nervous system activation, which is a stress on the body. One would expect a crack user to be more likely to die from any virus, whether it be influenza or HIV. This is pretty basic. What is your point here? That there are other factors in addition to HIV that influence survival? Do you seriously believe that anybody disputes that?

    What is abundantly clear, however, is that crack in the absence of HIV may result in poor health, but it does not result in AIDS.

  124. #125 Undergraduate-gal
    August 16, 2008

    Do seriously believe anybody disputes the direct causal link between drug use and progression to AIDS?

    Yes, Dr. Trrll, Dr. Orac, for example wasn’t aware of it.

    Over at AIDStruth.org, where I get all my news, don’t you? they say it’s a denialist myth. Are you a denialist, Dr. Trrll? Don;t you know that:

    “M.S. Ascher and team examined the drug use data of several research cohorts and found no correlation between drug use and AIDS.”

    That’s no as in NO CORRELATION whatsoever, Dr. Trrll.

    And just so you won’t try and twist it, Kaslow et al. drive the point home for you:

    “No evidence for a role of alcohol or other psychoactive drugs in accelerating immunodeficiency in
    HIV-1-positive individuals. A report from the Multicenter AIDS Cohort”

    Coates et al chime in:

    “No significant association with risk of progression to AIDS was noted for use of various recreational drugs (singly or in combination), history of specific infections, age at enrollment, or smoking and drinking status at enrollment. Only estimated duration of HIV infection appeared to be associated with increasing risk of development of AIDS”.

    You want something newer?

    Chao et al:

    “In the 2008 published study, Recreational drug use and T lymphocyte subpopulations in HIV-uninfected and HIV-infected men, which studied the issue in the MACS cohort, the conclusion was “no clinically meaningful associations between use of marijuana, cocaine, poppers, or amphetamines and CD4 and CD8 T cell counts, percentages, or rates of change in either HIV-uninfected or HIV-infected men.”

    NIAID has looked at the whole bunch of these studies and quite authoritatively says:

    “Observational studies of HIV-infected individuals have found that drug use does not accelerate progression to AIDS (Kaslow et al., 1989; Coates et al., 1990; Lifson et al., 1990; Robertson et al., 1990). In a Dutch cohort of HIV-seropositive homosexual men, no significant differences in sexual behavior or use of cannabis, alcohol, tobacco, nitrite inhalants, LSD or amphetamines were found between men who remained asymptomatic for long periods and those who progressed to AIDS (Keet et al., 1994). Another study, of five cohorts of homosexual men for whom dates of seroconversion were well-documented, found no association between HIV disease progression and history of sexually transmitted diseases, number of sexual partners, use of AZT, alcohol, tobacco or recreational drugs (Veugelers et al., 1994).”

    http://www.aidstruth.org/new/denialism/myths

    Now all you turncoats – Dr. Orac excepted of course as he is still mulling over the mystery of how drug abuse could cut life expectancy for HIV+ – are saying it is common sense that drug abuse accelerates progression to AIDS?

    Are you calling all AIDS researchers liars, Dr. Trrll?!

    Btw, did you find those phase III gardasil studies for me where they include age groups 9-15 and 24-26?. You did read Anonymous Antivaccinationist’s Comment didn’t you? the Merck denialists are proliferating, Dr. Shll, and I thought you said above you were very serious about defending Merck’s honour. But now cat’s got your tongue it seems.

  125. #126 Random lurker
    August 16, 2008

    it has been explained multiple times that drub abuse cuts down life expenctancy even without HIV…

    Oh, my ed… were you born stupid, or did you have to practice to go from a half wit to become a complete idiot?

  126. #127 Random lurker
    August 16, 2008

    Sorry, forgot to spellcheck… I meant drug abuse cuts life expectancy.

    Which make me wonder what drugs Ugg is on.

  127. #128 Undergraduate-gal
    August 16, 2008

    Dear Anonymous Antivaccinationist,

    I hope you don’t me including you after all. I suppose you wouldn’t mind some useful critique of your points, and Dr. Trrll is your only hope in this “room full of experts”. You just need to get through the hate barrier to his softer side. It might take a little baiting, so you’d better start learning (-;

  128. #129 Another Lurker
    August 16, 2008

    “Curious,

    I’m sorry if you really are curious, but I was promised a “room full of experts” for this discussion. You don’t qualify. In fact, the only reasonably qualified person here so far is Trrll.

    If you are interested in the basics of the HIV/AIDS debate, you can go to aidsmythexposed.com

    Natalie, you’re a sweetheart, but please no more.”

    This made me laugh. I´ve read though most of the comments now and I admit that at first Ugg did annoy me to the point where I wanted to physically harm her. After reading this post however I just realised that she is probably schizophrenic. That is, she has lost contact with reality. When she writes this stuff she gets high on imagined importance and power. She sees herself screaming down all her opponents with her childish (haven´t heard anything like it since fifth grade or so) insults and then proclaim herself “winner”.

    Ok back to lurking.

  129. #130 LRM
    August 16, 2008

    <delurk>

    UGG writes:

    Do seriously believe anybody disputes the direct causal link between drug use and progression to AIDS?

    Talking to yourself, UGG? Because you couldn’t possibly be talking to Trll, who asked the following

    What is your point here? That there are other factors in addition to HIV that influence survival? Do you seriously believe that anybody disputes that?

    Now, read both quotes above carefully and ponder this, if you’re up to the task: are you and Trll asking remotely similar questions? If you are stumped, here’s an easier exercise for you; please state which of the following sentences must be true to the exclusion of the other:

    A. “Crack cocaine does not cause AIDS.”
    B. “Crack cocaine is bad for your health.”

    I am sure that you will be more than equal to the challenge, if you only manage to tear yourself away from that tasty, refreshing cup of denialist brand cool-aid (TM).
    But if you find yourself stumped, here’s the answer: both A and B can be (gasp!) true at the same time. And that, UGG, was Trrl’s point – if you look up, you may still be able to spot it (though, with your track record in this thread, I’m not holding out much hope).

    Incidentally, what does that extensive list of studies showing a distinctive lack of correlation between recreational drug use and the acquisition and progression of AIDS tell you about Life, Universe, and Everything? Just curious.

    </delurk> (?)

  130. #131 Zeno
    August 16, 2008

    I presume that Undergraduate-gal must be on summer vacation from classes. Perhaps once school resumes she’ll have less time to devote to trolling and more time to devote to trying to learn something. The evidence of her comments on this post suggests that the attempt to learn things will require intense effort on her part and is likely to fail. Even English comp will be a trial for her, since she can’t for the life of her come up with a thesis statement.

    If only they gave advanced degrees in trolling.

  131. #132 trrll
    August 16, 2008

    Do seriously believe anybody disputes the direct causal link between drug use and progression to AIDS?

    Yes, Dr. Trrll, Dr. Orac, for example wasn’t aware of it.

    Are you calling all AIDS researchers liars, Dr. Trrll?!

    Here, we have a prime example of the distortions of denialist thinking and argumentation. Rather than responding to what I actually said

    That there are other factors in addition to HIV that influence survival? Do you seriously believe that anybody disputes that?

    …the denialist confabulates a straw-man statement and attacks that. And then goes into a stupid quote-mining exercise, and ends by implying that I am “calling all AIDS researchers liars” based upon her disagreement with the imaginary statement that I never made.

    So why try to shift the discussion from cofactors in general to AIDS and drug use? Probably because one of the most thoroughly disproved crackpot notions about AIDS is that it is a consequence of illicit drug use. And in fact, many studies have failed to find any correlation between drug use and progression to AIDS, but even there the literature is hardly absolutely unanimous. For example Chao et al. (2008), in their study of the outcome for non-injecting drug users note

    These findings are consistent with previous reports that recreational drug use was not associated with HIV disease progression in MSM ([Chaisson et al., 1995], [Di Franco et al., 1996], [Kaslow et al., 1989] and [Page-Shafer et al., 1996]). A lack of association was also observed among injection drug users ([Chaisson et al., 1995] and [Vlahov et al., 1998]). A randomized, placebo controlled trial among HIV-infected persons found no short-term (21 days) effect of marijuana smoking on immune phenotypes, including the proportion of CD4 and CD8 T cells (naïve or memory), B cells and natural killer cells (Bredt et al., 2002). Our prospective study, together with a previous epidemiologic analysis (Ascher et al., 1993), did not find short-term or long-term adverse effects of use of marijuana on CD4 cell count. Although an adverse effect of use of cocaine on CD4 cell count has been suggested by others ([Larrat et al., 1996] and [Siddiqui et al., 1993]), this association was not observed in our study, even in those who used cocaine weekly or more frequently.

    It is worth noting the difference between the kind of balanced discussion of conflicting results that you get from a scientist versus our denialist’s confabulation of that into “That’s no as in NO CORRELATION whatsoever, Dr. Trrll.” Of course, a scientist would never say “no correlation whatsoever” because that would imply the ability to prove a negative, which is impossible. Scientific conclusions are more along the lines of “If there is a correlation, it is too small for us to detect with our study protocol.” But of course, that doesn’t provide an excuse to imply that somebody is lying.

    So maybe there is a little bit of an effect, but it is so small it is hard to detect. Indeed, The recent Lancet meta-analysis by The Antiretroviral Therapy Cohort Collaboration concluded–after pooling results of fourteen different studies (for maximum statistical power) of HIV individuals on modern antiretroviral therapy ends up concluding the same thing as Dr. Chao–no effect on mortality of use non-i.v. recreational drug use. But i.v. drug users do a bit worse, with life expectancy about 8 years shorter.

    So does that mean that somebody is LYING? Not necessarily. The older studies were carried out on a population that had not have the benefit of the most modern antiretroviral therapy. So it would not be at all surprising that the greater life span afforded to HIV patients of all types has unmasked a small effect of i.v. drug use that simply wasn’t detectable back in the early days when the drugs could only extend survival by a year or two. And in fact, as cited in the Lancet article, other recent studies are detecting a negative correlation of i.v. drug use and survival. The Lancet study discusses a number of possible explanations

    For example, the disparity in life expectancy between HIV-infected injecting drug
    users and non-injecting drug users is very large. This finding is consistent with previous findings Lloyd-Smith et al., 2006; Sterne et al., 2007) There may be several reasons for this discrepancy, such as
    issues of adherence, inadequate or unequal access to treatment, active illicit drug use, hepatitis C co-infection,
    higher rates of smoking and alcohol use, and socioeconomic status.

    Another that occurs to me is that multiple reinfections by different strains of HIV results in gene transfer that accelerates development of HAART resistance.

    Needless to say, none of this even remotely supports the HIV denialist fairytale that “mainstream” scientists somehow have failed to consider the possibility that other factors besides HIV infection may affect survival.

  132. #133 Undergraduate-gal
    August 16, 2008

    Dr. Trrll, you have, if nothing else, demonstrated that you’re the only person resembling an expert in this urinal. You should really keep better company.

    A few points:

    1. I am not quote-mining. I have kept to the AIDStruth.org quotes and linked to them. You are not suggesting that AIDStruth.org would engage in quote-mining, are you? (-:

    2. I did not write that Ascher said “there is no correlation between drug use and progression to AIDS whatsoever”. I wrote Ascher reported that they had FOUND none whatsoever. That’s why they didn’t even have to come up with the “drug users have poor treatment compliance” line.

    3. All the popular “cofactors” that are routinely suggested were controlled for, and crack use remained a powerful independent predictor of progression to AIDS and death, so you citing studies speculating about anything else is not to the point.

    4. This study lasted eight years with a mortality of 25%. Persistent crack users had considerably lower baseline CD4 count, 3 times higher baseline viral load and 3 times the death rate of non-crack users. Regular or intermittent crack users were nearly 60% more likely to develop an AIDS-defining illness than non-users. After controlling for other factors, crack use remained the single most important influence on viral load and CD4 count.

    Dr. Trrll, are in all seriousness calling this a “small effect”? Are you seriously suggesting that all pre-’96 studies were so short-lived (forgive the pun), or the study protocol so poor, that all these differences were completely undetectable, even in people with heavy or multiple drug use?

    Your sources single out IV drug use as the worst health risk. Crack cocaine is not an IV drug. So per your own argument, IV drug use would have an even bigger effect. But still it was not large enough to be detectable, singly or in combination with other drug abuse, pre-’96?

    General Trrll, despite what I view as your rather extraordinary efforts in your testimony both yesterday and today, I think that the reports that you provide to us really require the willing suspension of disbelief.

  133. #134 trrll
    August 16, 2008

    Dr. Trrll, are in all seriousness calling this a “small effect”? Are you seriously suggesting that all pre-’96 studies were so short-lived (forgive the pun), or the study protocol so poor, that all these differences were completely undetectable, even in people with heavy or multiple drug use?

    As I noted before, the simplest explanation is that prior to the availability of highly effective antiretroviral therapy, crack was a minor factor, in the same way that cancer did not even make top 5 leading causes of death in 1900, because people usually did not live long enough to get cancer–they were killed off by infectious diseases first. With the advent of antibiotics, lifestyle risks that previously played a minor factor became dominant. It may be that something similar has happened with HAART.

    Of course, it is also possible that by targeting persistent female users of crack cocaine, they managed to identify a particularly vulnerable population of heavy cocaine users. It is notable that 8-year survival of the group that they identified as intermittent crack users did not differ significantly from non-users. So it could well be a small effect in a study that considered all cocaine users, or for which the study population did not include a large number of heavy users. Cook et al comment:

    One caveat to our findings is the non-representativeness of our longitudinal cohort, limiting the generalizability of our results.

    Cook et al offer additional caveats:

    our analysis does not conclusively demonstrate that crack use causes AIDS-related morbidity and mortality. We have not ruled out other processes that could account for these associations, such as greater sexual risk taking, poorer diet and nutrition, substandard living conditions, and other unknown confounders.

    Greater sexual risk taking is a major confound here, as heavy female crack users frequently engage in prostitution to support the expense of their habits. So as with IV drug use, we have again the possible phenomenon of multiple re-infection with different HIV strains increasing the possibility of picking up genes for antiretroviral resistance.

    Of course, as I’ve commented before, it would not surprise me at all if heavy crack use contributed to a poor prognosis, as even in the absence of HIV, heavy use of cocaine is associated with overall poor health. So while HAART may be able to keep HIV at bay in somebody who is eating and sleeping properly, it may not be able to do so in a person who is suffering from poor nutrition, sleeping irregularly, and in a continuous state of drug-induced physiological stress. If the poor prognosis arises from the failure of HAART, then it would not be surprising that earlier studies did not observe such an effect.

  134. #135 anonymous antivaccinationist
    August 16, 2008

    “Dear Anonymous Antivaccinationist,

    I hope you don’t me including you after all. I suppose you wouldn’t mind some useful critique of your points, and Dr. Trrll is your only hope in this “room full of experts”. You just need to get through the hate barrier to his softer side. It might take a little baiting, so you’d better start learning (-; ”

    I don’t really need a critique of the points I raised, they are supported by the May 06 briefing document (VRBPAC) that was reviewed and discussed prior to this vaccine being licensed and available trial data. Baiting the people that frequent this forum is futile, we’re all right… or didn’t you know?

    AA

  135. #136 sailor
    August 16, 2008

    “The Disease: measles.
    The historical disease: 400,00 cases a year in the US with 400 deaths.”

    As a pre-vaccine measles case, I thought just about ALL kids got measles, I am really surprised for a population of 300 million the rate only used to be half a million.
    When I looked at figures not long ago it seemed to me the death rate from measles was way lower than 400 by the time the vaccination came out. This is NOT an anti-vaccination comment, (I get lots of shots) just a comment.

  136. #137 trrll
    August 16, 2008

    The use of a highly pharmacologically alum adjuvant as the sole “placebo” in both the FUTURE I & FUTURE II studies makes it impossible to accurately assess the overall risks of vaccination vs. non-vaccination in the real world.

    This is kind of a ridiculous objection, since the study was designed to address the risks of Gardasil, not vaccination in general. So the only proper placebo control is an injection that is identical except for the absence of Gardasil. In any case, it is hard to see any rational basis to worry about toxic effects from the tiny amount of aluminum in a vaccine, which is about equivalent to the normal daily intake of aluminum from foods. We do, after all, routinely drink out of aluminum cans, cook in aluminum pots, and wrap our food in aluminum foil.

  137. #138 Azkyroth
    August 16, 2008

    The population wasn’t 300 million back then, and they wouldn’t all have necessarily have gotten it at the same age or in the same year.

  138. #139 HCN
    August 17, 2008

    Sailor, the population before the measles vaccine in the USA was 2/3 of what it is now (179,323,175 in 1960,from the USA population Wiki page, munged URL, en.wikipedia.org/wiki/Demographics_of_the_United_States).

    Here are some representative numbers:
    Now for measles:
    Year____Cases____Deaths__Year____Cases____Deaths
    2000_______86______ 1____1950___319124____468
    2001______116______ 1____1951___530118____683
    2002_______44______ 0____1952___683077____618
    2003_______56______ 1____1953___449146____462
    2004_______37______ NA___1954___682720____518
    2005_______66______ NA___1955___555156____345
    2006_______55______ NA___1956___611936____530
    Total_____460______3 or more___3831277___3624

    Taken from http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-full-g.pdf

    There is also the fact that death is not the only side effect from the disease. From http://archpedi.ama-assn.org/cgi/content/full/160/3/302 it says “Approximately 1 in 1000 children with clinical measles develops encephalitis. Although most children with encephalitis recover without sequelae, approximately 15% die and 25% of survivors develop complications such as MR. We assumed that approximately 1 in 5000 cases of measles leads to Mental Retardation.”

  139. #140 Undergraduate-gal
    August 17, 2008

    Dr. Trrll,

    Of course Cook et al. would come up with caveats, possible alternative explanations, “unknown confounders”. As you’ve just told us, that’s what scientists – especially HIV scientists – do.

    However, the “multiple re-infection with different HIV strains” story also adds multiple strains on my suspension of disbelief. That is assumption heaped on assumption

    Most of the other factors Cook has attempted to control for. But the possible causes are not so important as the fact that groups with similar profiles have been studied often before and none of this ever came out. The question is why?

    We both know that studies like Ascher et al. and Kaslow et al. have been used to hit Duesberg over the head and close the case on chemical AIDS, poor nutrition-related AIDS, drug abuse-related AIDS, medicinal as well as illicit – incidentally the same things you’re now pulling out of the hat as possible “confounders” and “cofactors”.

    So how does the AIDS establishment divert attention from that uncomfortable fact and maintain their monocausal religion of HIV/AIDS? Just like you, they try to shift the focus to the second person in the Trinity, namely HAART, and postulate that all these “cofactors” interfere with the effects of HAART, rather than allowing that they could cause AIDS in any direct way, shape or form.

    But this comes at a cost. In order to exalt HAART you have to throw AZT under the campaign bus. AZT is now admitted to be so ineffective that no amount of “sexual risk taking”, drug use and general ill health were able to ,ake a dent in the results of pre-’96 studies… at the time when this utterly useless, highly toxic drug was hailed as Saviour.

    The natural “latency period” from infection to first AIDS event is now estimated at 11 years on average. AZT would have had to actually shorten that period considerably in order to disguise the adverse effects of(other) “cofactors” such as crack use.

    AZT is still widely used.

    Apart from that, I am pleased to see that you pesronally are open to the possibility that all kinds of physical and psychological stress factors can contribute directly to the progression of “HIV disease”.

    AA: Baiting the people that frequent this forum is futile

    Aw shucks AA! Are you saying there’s no chance a room full of kickass experts like that sexy Novella dude are gonna come out from under their rocks and help a poor dimwit Undergrad-gal with her summer epi exams?!

  140. #141 Undergraduate-gal
    August 17, 2008

    Correction:

    “The natural “latency period” from infection to first AIDS event is now estimated at 11 years on average”.

    Should be,

    “The average period from infection to death in natural history infection.”

  141. #142 trrll
    August 17, 2008

    Of course Cook et al. would come up with caveats, possible alternative explanations, “unknown confounders”. As you’ve just told us, that’s what scientists – especially HIV scientists – do.

    Yes, it is what all scientists do. Consider both the strengths and the limitations of the evidence in the light of alternate hypotheses. As opposed to what denialists do: cherry-pick out the bits and pieces that fit their biases.

    Most of the other factors Cook has attempted to control for. But the possible causes are not so important as the fact that groups with similar profiles have been studied often before and none of this ever came out. The question is why?

    And here, of course, you dismiss the obvious, logical hypotheses that explain all of the data, because they don’t fit with your prejudices.

    You cannot consider that the fact that the results have changed could mean that conditions have changed. What has changed? HIV infected patients are surviving much longer than before, due to HAART. And if heavy cocaine use interferes with the life-prolonging effect of HAART, then we will see a deleterious effect of cocaine that was not evident before, when HIV patients received less effective medications and survival was much shorter.

    We both know that studies like Ascher et al. and Kaslow et al. have been used to hit Duesberg over the head and close the case on chemical AIDS, poor nutrition-related AIDS, drug abuse-related AIDS, medicinal as well as illicit – incidentally the same things you’re now pulling out of the hat as possible “confounders” and “cofactors”.

    And harping on a single study of an extreme sub-population–heavy female users of crack cocaine, a tiny fraction of the total population affected by AIDS and HIV–does not rescue Duesberg’s drug abuse notion, which has been overwhelmingly disproved by study after study. Again, it is typical of denialist thinking to dismiss all of the many studies that don’t fit your prejudices, while seizing upon the single one that does–even if it means ignoring the limitations that the study’s authors themselves have so clearly explained.

    But this comes at a cost. In order to exalt HAART you have to throw AZT under the campaign bus. AZT is now admitted to be so ineffective that no amount of “sexual risk taking”, drug use and general ill health were able to ,ake a dent in the results of pre-’96 studies… at the time when this utterly useless, highly toxic drug was hailed as Saviour.

    Times change. The evidence is clear that AZT monotherapy extended life of HIV patients, but not by nearly as much as HAART. We are several generations beyond AZT, and each succeeding regimen was accepted because it extended life better than the one before. And longer survival means more opportunities for other factors to come to the fore, just as happened with antibiotics, in which better treatment of bacterial infections unmasked the hazards of unhealthy diets and drugs that increase the risk of heart disease and cancer (I imagine that germ theory denialists are convinced that antibiotics cause heart disease and cancer, just as HIV denialists are convinced that antiretroviral drugs cause AIDS)

    The natural “latency period” from infection to first AIDS event is now estimated at 11 years on average. AZT would have had to actually shorten that period considerably in order to disguise the adverse effects of(other) “cofactors” such as crack use.

    From 96-99 to ’03-’05, average life expectancy with HIV infection has increased by over 13 years, and that doubtless underestimates improvement since the era of AZT monotherapy, since the the first protease inhibitor came into use in ’95. That’s a lot of time for the deleterious effects of steady crack use to add up, even if crack use (or associated factors like poor nutrition and unsafe sex) does not specifically interfere with the effectiveness of the HAART regimen, as seems quite probable.

    AZT is still widely used.

    Who, specifically, is still using AZT monotherapy? The main reason why the benefits of AZT were so limited was the rapid development of resistance. Modern antiretroviral regimens use combination therapy that greatly slows development of resistance.

    Apart from that, I am pleased to see that you pesronally are open to the possibility that all kinds of physical and psychological stress factors can contribute directly to the progression of “HIV disease”.

    As I’ve noted, this would not be particularly surprising, especially now that the greatly extended life-span of HIV-infected people gives much more time for the effects of such factors to accumulate. But the notion that the medical “establishment” did not recognize the possibility that there could be cofactors influencing the progression of HIV/AIDS is a sheer denialist fantasy. Moreover, none of this alters the fact that the notion that AIDS is somehow a consequence of illicit drug use (or even more idiotically, of the therapies that have so dramatically extended survival and health) has been definitively disproved. Heavy cocaine use may well worsen the prognosis of HIV infected women–but heavy cocaine users who don’t have HIV do not develop AIDS.

  142. #143 Undergrad-gal
    August 17, 2008

    Trrll,

    I repeat:

    1. Almost all studies in the developed part of the world have been carried out on “extreme subgroups”.

    2. The estimated net median survival time, without AIDS meds, even in poor Africans, is now 11 years. In the latter case, it’s up from nine – close to a 20% miscalculation, and nobody says they’ve gotten it right yet. So much for the data that goes into the different models of HIV-disease.

    3. You are claiming AZT extends life. That means even in the ’80s median survival time in a developed country should have been well into the second decade, depending on how much credit you want to give to AZT. That’s easily long enough for the influence of “cofactors” to show itself.

    There is no way you can reconcile Ascher et al., Kaslow et al., NIADS sweeping statements etc. with Cook et al. One or the other has to go, and the trend is clear: the early studies were ermm… not reliable. I guess we can only wait and see if the powers that be think it’s politically expedient to allow more studies like Cook et al.

  143. #144 trrll
    August 17, 2008

    1. Almost all studies in the developed part of the world have been carried out on “extreme subgroups”.

    When you start playing these kind of games with language, it is obvious that you are clutching at straws. “Subgroup” has a technical statistical meaning; it refers to an analysis that is restricted to a small portion of your study population. And we are talking about one very specific subgroup of the larger population of people infected with HIV: extremely heavy female users of one particular drug of abuse: cocaine. Subgroup analyses are fraught with statistical hazards, because the variable by which you select out which subjects to study and which to ignore is inevitably going to be correlated with other potentially confounding factors (some of which may be unknown). So it is easy to get fooled. As Cook et al. point out, persistent use of crack by women is likely to correlate with risky sexual behaviors and poor nutrition. But of course, that doesn’t fit with your biases, so you simply ignore it.

    2. The estimated net median survival time, without AIDS meds, even in poor Africans, is now 11 years. In the latter case, it’s up from nine – close to a 20% miscalculation, and nobody says they’ve gotten it right yet. So much for the data that goes into the different models of HIV-disease.

    Uh, yes, poor Africans with HIV for the most time do not have access to the optimum HAART treatment, and their survival time is much shorter, even though they generally or not heavy crack users. Do you have a point here? Both studies that we are discussing were of patients in the developed world.

    2. The estimated net median survival time, without AIDS meds, even in poor Africans, is now 11 years. In the latter case, it’s up from nine – close to a 20% miscalculation, and nobody says they’ve gotten it right yet. So much for the data that goes into the different models of HIV-disease.

    I said I would take everything you say seriously, but this is so nuts that I have to ask: are you joking? You cannot compare survival of patients in Africa, with different HIV strains, different endemic opportunistic diseases, different nutrition, different access to health care, different treatment compliance, etc., etc. to that of patients in the developed world.

    There is no way you can reconcile Ascher et al., Kaslow et al., NIADS sweeping statements etc. with Cook et al.

    And here we see once again the fundamental difference between scientific rationality and denialist rationalization. Scientists look for the explanation that fits the data; denialists look for the data that fits the explanation. To the scientist, they are not at all difficult to reconcile; it is obvious that these are very different studies, of very different patient populations, receiving very different medical treatments. It is not at all surprising that the outcomes should be different, and there are multiple simple potential explanations of why this should be the case. But the denialist is not trying to consider all of the evidence in the light of multiple hypotheses–she is just looking for an excuse to ignore a result (or in this case, multiple carefully repeated results) that if considered rationally would require her to dicard her pet notions.

    And of course, the ironic thing is that even the Chao et al. data is inconsistent with the notion that AIDS is a consequence of drug abuse. But there is a (very small, specialized) patient subpopulation taking drugs that is sicker, and for the denialist, desperate for anything that she can twist to buttress up her prejudices, that is close enough.

  144. #145 D. C. Sessions
    August 17, 2008

    On measles incidence pre-vaccine:

    The US population was lower, but the birth rate (remember, “Baby Boom”) was still close to 4 million per year. Of course we didn’t all get measles on some schedule; it runs in waves like most highly communicable diseases, but the average was about the same.

    The 400k reported incidence vs. estimated prevalence of almost 100% comes, simply, from the fact that as a “routine childhood disease” cases weren’t reported all that often. Paediatricians were required to report cases that they saw, but 50 years ago medical practice wasn’t as paperbound as it is now and undoubtedly compliance with the requirement was not universal. Much more to the point, I suspect that most parents simply didn’t take a child with measles to the doc in the first place: it cost money and there wasn’t anything to be done about most cases.

  145. #146 T. Bruce McNeely
    August 17, 2008

    Aw shucks AA! Are you saying there’s no chance a room full of kickass experts like that sexy Novella dude are gonna come out from under their rocks and help a poor dimwit Undergrad-gal with her summer epi exams?!

    Given the examples of your reasoning skills above, you are doomed.

  146. #147 anonymous antivaccinationist
    August 17, 2008

    @ TRRLL”This is kind of a ridiculous objection, since the study was designed to address the risks of Gardasil, not vaccination in general.”

    Regardless, you cannot compare safety to unvaccinated populations which makes your comment a bit specious.

    “In any case, it is hard to see any rational basis to worry about toxic effects from the tiny amount of aluminum in a vaccine, which is about equivalent to the normal daily intake of aluminum from foods. We do, after all, routinely drink out of aluminum cans, cook in aluminum pots, and wrap our food in aluminum foil.”

    You cannot compare ingesting aluminum to injecting it, no matter how many different ways you try. The few studies that I am aware of do indicate that the body burden is greater with injected aluminum. Human beings have been exposed ORALLY to injected Al for hundreds of thousands of years… injected, only about a hundred or so. Surely you see the distinction?

    AA

  147. #148 Undergrad-gal
    August 17, 2008

    Dr. Trrll, I think we are getting into the wilful misunderstanding zone now.

    You’re damn right I can’t compare Africans with poor access to health care to for example the US (outside certain inner city areas apparently) and Europe. HIV+ in developed countries ought to be surviving longer. But your initial argument was that they didn’t survive long enough, even on the “life-prolonging” AZT, for cofactors to play a detectable role in the early studies. You are per ususal arguing against yourself.

    As for the rest, you’ve got to be kidding! Of course Cook et al examined “special subgroups”, not only of heavy crack users but of regular users, intermittent users, non-users. That’s how you get the friggin’ comparisons in a reasonably well-planed study! More drug use = more AIDS. A clear gradation.

    And get off your “risky sexual behaviour” hobby horse already. Show me a large study population, especially in the early days, which didn’t consist largely of drug abusers and/or gays, and/or prostitutes and or haemophiliacs – in other words people practicing all kinds of risky behaviour involving exchange of bodily fluids, and/or eating poorly. What, in your opinion, makes crack addicts so special in tshese regards?

    There were plenty of subgroups with the same “confounder” profile as crack, and still all the studies from the first decade and a half found NO CORRELATION between drug use and progression to AIDS. Even Mary Jane Kreek’s 1989 study concluded that “heroin is a blessedly untoxic drug”, and was consequently used against Duesberg by AIDS Inc. hitman Jon Cohen in his 1994 Science article:

    According to Rockefeller University’s Mary Jeanne Kreek,
    who studies immune responses in heroin addicts, heroin
    users do not experience a decline in CD4 counts unless they are infected with HIV. Indeed, in 1989 Kreek reported in the Journal of Pharmacology and Experimental Therapeutics that 11 long-term heroin users had a mean of 1500 CD4s–a significant elevation from the norm and the opposite of what is seen in AIDS. “Heroin is a blessedly
    untoxic drug,” concludes Kreek.

    These days of course, Kreek is not so cool anymore. But Dr. Trrll, you can’t tell us the HIVists back then weren’t tripping over themselves to tell us just how harmless the drugs were, and just how dangerous the microbe.

  148. #149 Censored-gal
    August 17, 2008

    Note: Grizzled blog-warrior Orac has apparently decided that his “room full of experts” couldn’t handle a single undergrad. gal, and so have started censoring me. I can’t be bothered going down the hall and knock on doors every time I want to post and find the IP address blogged, so if Dr. Trrll wants to continue this, he has to suggest another venue.

    ———————–

    Censored Comment:

    Dr. Trrll, I think we are getting into the wilful misunderstanding zone now.

    You’re damn right I can’t compare Africans with poor access to health care to for example the US (outside certain inner city areas apparently) and Europe. HIV+ in developed countries ought to be surviving longer. But your initial argument was that they didn’t survive long enough, even on the “life-prolonging” AZT, for cofactors to play a detectable role in the early studies. You are per ususal arguing against yourself.

    As for the rest, you’ve got to be kidding! Of course Cook et al examined “special subgroups”, not only of heavy crack users but of regular users, intermittent users, non-users. That’s how you get the friggin’ comparisons in a reasonably well-planed study! More drug use = more AIDS. A clear gradation.

    And get off your “risky sexual behaviour” hobby horse already. Show me a large study population, especially in the early days, which didn’t consist largely of drug abusers and/or gays, and/or prostitutes and or haemophiliacs – in other words people practicing all kinds of risky behaviour involving exchange of bodily fluids, and/or eating poorly. What, in your opinion, makes crack addicts so special in these regards?

    There were plenty of subgroups with the same “confounder” profile as crack, and still all the studies from the first decade and a half found NO CORRELATION between drug use and progression to AIDS. Even Mary Jane Kreek’s 1989 study concluded that “heroin is a blessedly untoxic drug”, and was consequently used against Duesberg by AIDS Inc. hitman Jon Cohen in his 1994 Science article:

    According to Rockefeller University’s Mary Jeanne Kreek,
    who studies immune responses in heroin addicts, heroin
    users do not experience a decline in CD4 counts unless they are infected with HIV. Indeed, in 1989 Kreek reported in the Journal of Pharmacology and Experimental Therapeutics that 11 long-term heroin users had a mean of 1500 CD4s–a significant elevation from the norm and the opposite of what is seen in AIDS. “Heroin is a blessedly untoxic drug,” concludes Kreek.

    These days of course, Kreek is not so cool anymore. But Dr. Trrll, you can’t tell us the HIVists back then weren’t tripping over themselves to tell us just how harmless the drugs were, and just how dangerous the microbe.

  149. #150 trrll
    August 17, 2008

    You cannot compare ingesting aluminum to injecting it, no matter how many different ways you try. The few studies that I am aware of do indicate that the body burden is greater with injected aluminum. Human beings have been exposed ORALLY to injected Al for hundreds of thousands of years… injected, only about a hundred or so. Surely you see the distinction?

    Of course you can! It doesn’t matter whether a substance is taken up into the blood by the blood vessels of the gut or by the peripheral vasculature; once it is in the blood it is all the same. This is a fundamental principle of pharmacology and toxicology. Sure, there are a few substances that do not get out of the gut at all, but aluminum is not among them. To suggest that a few isolated injections of aluminum could somehow produce a greater “body burden” of aluminum than ingesting the same amount (and often much more–certain aluminum-containing antacids, for example) every day, year after year, is getting into tinfoil-hat territory.

  150. #151 Undergraduate-gal
    August 17, 2008

    Dr. Trrll, I think we are getting into the wilful misunderstanding zone now.

    You’re damn right I can’t compare Africans with poor access to health care to for example the US (outside certain inner city areas apparently) and Europe. HIV+ in developed countries ought to be surviving longer. But your initial argument was that they didn’t survive long enough, even on the “life-prolonging” AZT, for cofactors to play a detectable role in the early studies. You are per ususal arguing against yourself.

    As for the rest, you’ve got to be kidding! Of course Cook et al examined “special subgroups”, not only of heavy crack users but of regular users, intermittent users, non-users. That’s how you get the friggin’ comparisons in a reasonably well-planed study! More drug use = more AIDS. A clear gradation.

    And get off your “risky sexual behaviour” hobby horse already. Show me a large study population, especially in the early days, which didn’t consist largely of drug abusers and/or gays, and/or prostitutes and or haemophiliacs – in other words people practicing all kinds of risky behaviour involving exchange of bodily fluids, and/or eating poorly. What, in your opinion, makes crack addicts so special in these regards?

    There were plenty of subgroups with the same “confounder” profile as crack, but still all the studies from the first decade and a half found NO CORRELATION between drug use and progression to AIDS. Even Mary Jane Kreek’s 1989 study concluded that “heroin is a blessedly untoxic drug”, and was consequently used against Duesberg by AIDS Inc. hitman Jon Cohen in his 1994 Science article:

    According to Rockefeller University’s Mary Jeanne Kreek, who studies immune responses in heroin addicts, heroin users do not experience a decline in CD4 counts unless they are infected with HIV. Indeed, in 1989 Kreek reported in the Journal of Pharmacology and Experimental Therapeutics that 11 long-term heroin users had a mean of 1500 CD4s–a significant elevation from the norm and the opposite of what is seen in AIDS. “Heroin is a blessedly untoxic drug,” concludes Kreek.

    These days of course, Kreek is not so cool anymore. But Dr. Trrll, you can’t tell us that the HIVists back then weren’t tripping over themselves to tell us just how harmless the drugs were, and just how dangerous the microbe.

  151. #152 Militant Agnostic
    August 17, 2008

    Funny you should mention tinfoil hats trrll- “Tinfoil” is actually aluminum foil. The hysteria about aluminum toxicity is being propagated by the New World Order so that peope will be afraid to wear tinfoil hats thereby leaving them vulnerable to mind control EMF. Dawn, UGG and AA are unwitting tools of the NWO.

  152. #153 Laser Potato
    August 17, 2008

    “Tinfoil” is actually aluminum foil.”
    It originally WAS tin, but tin became too expensive, so they switched to aluminum.

  153. #154 anonymous antivaccinationist
    August 17, 2008

    “once it is in the blood it is all the same”

    Sigh. http://dx.doi.org/10.1016/S0264-410X(02)00165-2

    The body burden IS greater, excessive? According to whom? The microbial population in the human gut makes it rather impervious to Al. Al is not really any part of the concerns I have regarding vaccination, much worse than Aluminum going on here. Not that it matters – my only point regarding Al (I made several more) is that it makes it impossible to evaluate safety in the real world. This is logical, no conspiracy needed.

    It’s becoming painfully obvious that there will never be any meaningful discussion here, and I have better things to do than fend off accusations of conspiracy. I’ll exit the playground and let the bullies have their fun.

    Jab on.
    AA

  154. #155 Orac
    August 17, 2008

    Note: Grizzled blog-warrior Orac has apparently decided that his “room full of experts” couldn’t handle a single undergrad. gal, and so have started censoring me.

    My, you do have a vastly overinflated view of yourself. No, I did not “ban” you. You simply managed to trigger the spam filters with a word. (Which one I’m not saying.) I’ve been gone all day and didn’t get around to checking my spam filters until now.

    I rarely ban anyone, although flooding a comment thread with a large number of pointless comments, as “JoJo” did in another comment thread while I was gone, is a good way to annoy me enough to institute at least a temporary or to shut down the flooded comment thread.

  155. #156 Annie
    August 18, 2008

    I have yet to hear what the antivaccination peeps say about their responsibility of spreading these diseases to other people. I am very lucky to be relatively normal because I have access to medications that enable me to walk and type when I couldn’t before. Unfortunately the only side effect is if I catch something it could kill me. I can get TB really easy, so if I am on an airplane with an untreated TB patient, opps. What about if I catch measles or mumps because a kid ran around with it? Vaccinations are to protect society so if you don’t get the vaccinations, you should not be able to participate in society, like school, airplanes, playgrounds.

    You can spread out the vaccinations or not lump them all together or wait till they are a little bit older. Big deal so your kid has to get extra shots. At least he won’t kill me.

  156. #157 HCN
    August 18, 2008

    Annie, don’t you know that measles, pertussis and other vaccine preventable diseases are not a problem for healthy kids? There is no reason to vaccinate for them!

    I’ve encountered this “argument” more than once, more recently here:
    http://www.autismvox.com/uk-teenager-dies-of-measles/#comment-413730 (I can’t help to notice that “Clay” never bothered to answer back)

    They don’t like it when I ask them why my kid with the severe genetic heard condition (it occurs in about 1 out of 1000 kids) is less deserving of living than their “perfect” children.

  157. #158 Undergraduate-gal
    August 18, 2008

    Dr. Orac,

    In that case I apologize for thinking so higly of myself. But what is one supposed to think? All kinds of foul words and sentiments get through your spam filters without problems. Perhaps it was too much even for your filters to be told that heroin is blessedly untoxic. . .

    Since it was the identical message that got caught 3 times, it would have sufficed to post just one of them.
    But that’s all academic, as they say, since the illustrious Dr. Trrll has fallen to (nit)picking on aluminum in the meantime. It is a peculiar idea among pro-anything-the-vax-industry-ever-does-and-says’ists that something has to accumulate and stay in one’s body forever to have toxic effects.

  158. #159 Annie
    August 18, 2008

    So if your kid with measles touches me at the supermarket or sneezes, licks on fruit or me (all things I have seen at the supermarket) and I catch his measles. I will die. Even if you are a good mother, they are contagious for a couple days before symptoms show.

    Excuse me, but I have the right to walk in society and not have to worry about catching your brats measles, mumps, chicken pox, whatever. Because weekly, weekly there are news reports about if you were at such and such place you might catch measles (put your disease without vaccinations) and to see your doctor if you get a rash. By the time I get the rash, it will be too late for me and I will die. Its bad enough for me, but children get my disease. So you could kill your neighbors kid.

    Not only that, but your kid will be in big, big trouble if he needs the medication I am on. At least I did have the vaccinations (which might no longer work cause I am in my 40’s) but what happens if your kid at 12 gets ankylosing spondylitis (common time esp for boys) and to prevent complete fusing of his spine he will need a TNF. Which will make it very easy for him to catch things and get seriously ill. Your big decision will be a completely fused spine (including neck and into the skull) or catching the measles and dying. You choose. BTW, people with untreated AS fall and their necks snap and are dead instantly. You can’t wipe yourself, walk, turn your neck to drive and can;t watch for steps, sticks or stones so you fall a lot.

    On my list serve, a mother is pumping him with all the vaccinations while he is getting more and more permanently damaged. You can’t have live vaccines on the medication (or you might die) so she is racing against time. Unfortunately, she is not telling her anti vaccination pals she just doesn’t join in the chorus anymore.

  159. #160 Tsu Dho Nimh
    August 18, 2008

    UGG … you are confusing HIV infection’s progressing to AIDS (drug use is less important than duration of infection) with survival time after AIDS has been diagnosed (crack use shortens life expectancy significantly).

    Repe4at after me: HIV infection is not AIDS!

  160. #161 trrll
    August 18, 2008

    “once it is in the blood it is all the same”

    Sigh. http://dx.doi.org/10.1016/S0264-410X(02)00165-2

    The body burden IS greater, excessive? According to whom? The microbial population in the human gut makes it rather impervious to Al. Al is not really any part of the concerns I have regarding vaccination, much worse than Aluminum going on here. Not that it matters – my only point regarding Al (I made several more) is that it makes it impossible to evaluate safety in the real world. This is logical, no conspiracy needed.

    Uh, that paper you cite is about infants (and even then, does not substantiate a hazard from vaccine aluminum). But we aren’t talking about infants, because Gardasil is administered to girls and women who have spent a decade or more consuming 7 or 8 milligrams per day of aluminum from such things as aluminum-containing baking powders and nondairy coffee creamers. Normal adult body levels of aluminum are 30-50 milligrams. A single dose of vaccine contains 225 micrograms. So if every bit of it is absorbed, it would change body levels of aluminum by maybe 1%–hardly a blip, well within the range of individual variation, and far, far below the levels that have ever been shown to cause any kind of harm. So fretting about toxicity from the amount of aluminum in a dose of vaccine is very much getting into tinfoil hat territory.

  161. #162 trrll
    August 18, 2008

    You’re damn right I can’t compare Africans with poor access to health care to for example the US (outside certain inner city areas apparently) and Europe. HIV+ in developed countries ought to be surviving longer. But your initial argument was that they didn’t survive long enough, even on the “life-prolonging” AZT, for cofactors to play a detectable role in the early studies. You are per ususal arguing against yourself.

    My point is simple. When HIV was killing people more rapidly, a detrimental effect from heavy crack use could have made such a small difference as to be undetectable–especially if it occurred only in a subpopulation of women who were very heavy users of crack. So the life extension afforded by HAART to HIV-infected people in the developed world could easily unmask a detrimental effect of heavy cocaine use that might take a few years to accumulate–much the way antibiotics, by preventing people from dying young from infectious disease, have unmasked the dangers of dietary and lifestyle habits that increase risks of cardiovascular disease and cancer.

    The Lancet study makes it clear that people HAARt has extended the lives of people with HIV for many years, so that is quite a bit of additional time for potential detrimental effects of cocaine abuse to accumulate. I don’t see what lifespans in Africa have to do with that, and certainly you have failed to make any kind of coherent argument to that effect. Moreover, it is possible that some aspect of cocaine use–either the physiological effects of the drug itself, or one of the many confounding factors in that particular subpopulation–poor nutrition, poor living conditions, unsafe sexual activity–contributes to HAART failure. Obviously, if the detrimental effects of cocaine are due to HAART failure, then they wouldn’t have been evident prior to HAART–consistent with the many other studies that failed to detect such an effect prior to HAART.

    Of course Cook et al examined “special subgroups”, not only of heavy crack users but of regular users, intermittent users, non-users. That’s how you get the friggin’ comparisons in a reasonably well-planed study! More drug use = more AIDS. A clear gradation.

    And subgroup analysis increases the likelihood of being misled by confounding factors–as Cook et al. clearly explain, but you choose to ignore because it doesn’t fit your biases. And how do you reconcile your claim of a “clear gradation” with Cook et al.’s finding that neither survival nor time to newly acquired AIDS-defining illness was significantly altered in intermittent crack users?

    And get off your “risky sexual behaviour” hobby horse already. Show me a large study population, especially in the early days, which didn’t consist largely of drug abusers and/or gays, and/or prostitutes and or haemophiliacs – in other words people practicing all kinds of risky behaviour involving exchange of bodily fluids, and/or eating poorly. What, in your opinion, makes crack addicts so special in these regards?

    One of reasons that HAART is so successful in prolonging life is that the emergence of antiviral drug resistance in HIV is slower. But of course, that won’t help you if you manage to pick up a genes for antiretroviral resistance from somebody else. So it is plausible that unsafe sex could increase the risk of HAART failure. And female crack addicts frequently become involved in prostitution as a ready way to support their habits. Obviously, this would not have been as important prior to HAART, because drug-resistant strains of HIV developed rapidly with no help needed from outside.

  162. #163 anonymous antivaccinationist
    August 18, 2008

    TRRLL: Who is fretting about Al toxicity? Please try to refrain from blowing this out of proportion.

    I’ll state it AGAIN. The use of an aluminum adjuvant as the placebo makes it impossible to evaluate safety in unvaccinated populations. True or false?

    I only listed the previous study to show you that the body burden is greater, yes that was in infants – I guess I assumed that as long as we were extrapolating… Toxicity is NOT the issue, I didn’t claim it to be.

    Are you denying that the use of aluminum as an adjuvant is to stimulate and immune response? (and suspend germ particles in bacterial vaccines)

    http://dx.doi.org/10.1016/S0264-410X(02)00169-X

    Please, stop with the tin foil hat syndrome.

    Annie: people that receive measles vaccine are also capable of shedding this virus after vaccination. I suppose you don’t object to being subjected to *this* kind of exposure though? Please explain to me why this is ok, because I’m confused.

    http://www.ncbi.nlm.nih.gov/pubmed/11858860?dopt=AbstractPlus

    Sensationalizing disease (or vaccine damage for that matter) does nothing to further this debate.

    AA

  163. #164 Dawn
    August 18, 2008

    Annie: If you DON’T WANT to catch these diseases – then stay in your bubble. FYI – read the vaccine package inserts. People can “shed” this damn crap for up to 6 weeks. People vaccinated with “live-virus” vaccines are a contagious risk to others for that long – particularly compromised immune persons, preggos, and infants!! Don’t believe me? Read any one of them!! I will even supply you with a link to see for yourself!

    http://vaers.hhs.gov/pdf/PackageInserts.pdf

  164. #165 trrll
    August 19, 2008

    Who is fretting about Al toxicity? Please try to refrain from blowing this out of proportion.

    I’ll state it AGAIN. The use of an aluminum adjuvant as the placebo makes it impossible to evaluate safety in unvaccinated populations. True or false?

    I’m not even sure what you are trying to say. WHAT unvaccinated populations? It seems fairly unlikely that people who refuse to get the far more crucial childhood vaccinations will choose to get Gardasil. Either Al is a safety issue or it is not. It sounds like you are trying to have it both ways, talking about the Al body burden to create FUD, than putting on a “Who me” act when people point out how utterly ridiculous it is to imagine that an amount of Al that is negligible compared to what is already in the body could be a safety issue.

    I only listed the previous study to show you that the body burden is greater, yes that was in infants – I guess I assumed that as long as we were extrapolating… Toxicity is NOT the issue, I didn’t claim it to be.

    It’s got to be either one way or the other. If there is no issue of toxicity, then clearly the presence of Al adjuvant in the placebo is not an obstacle to evaluating safety.

    Are you denying that the use of aluminum as an adjuvant is to stimulate and immune response? (and suspend germ particles in bacterial vaccines)

    Uh, yes, that is what “adjuvant” means. So what?

  165. #166 anonymous antivaccinationist
    August 19, 2008

    “Either Al is a safety issue or it is not. It sounds like you are trying to have it both ways, talking about the Al body burden to create FUD, than putting on a “Who me” act when people point out how utterly ridiculous it is to imagine that an amount of Al that is negligible compared to what is already in the body could be a safety issue.”

    Who me act? That’s rich… and infantile. If the placebo, on its own, has the ability to elicit certain side effects, (malaise, fever, etc…) you cannot compare the risk to those that might NOT receive the shot. I did mention body burden, because you claimed it was of no importance. It is, but that isn’t really my point. My point is using the adjuvant as the placebo obfuscates the results.

    “If there is no issue of toxicity, then clearly the presence of Al adjuvant in the placebo is not an obstacle to evaluating safety.”

    Toxicity, and the ability to produce side effects (without pharmacokinetic spin) are entirely different. It is an obstacle when evaluating the adverse reactions reported by the placebo group.

    “Uh, yes, that is what “adjuvant” means. So what?”

    Placebos should not contain an adjuvant, when they do – they produce side effects. Seems to me you should stop focusing on my position (and putting a tin foil hat on my head) and listen to what I am saying.

    By the way, using “uh” to address your opponent as if you are more intelligent, demeans your cause. Feel free to continue if you feel it adds heft to your argument.

    AA

  166. #167 Undergraduate-gal
    August 19, 2008

    AA,

    The generic “uh’s” and “you’re irrational to the point of unintelligibilty” obligatories in Dr. Trrll’s prose are just that, obligatory devices. They serve the same function as canned laughter on a sitcom by telling the audience what to think of you regardless of the quality of Dr. Trll’s argument. I’m afraid you will not be able to dissuade him from employing this cheap rethorical trick since all wannabe crankbusters feel naked without it and use it reflexively. Have a look, if you haven’t already at f. ex. PaIMD’s and Orac’s learned contributions in this thread. They are all of the same kind: “you’re not clear, you’re not focused” etc. But what am I telling you for? (-:

    The tricky part, though, is that sometimes they really don’t understand. That’s why boxing is a more honest sport: In boxing your opponent doesn’t have to know what hit him to understand he has been knocked on his ass.

    ————————-

    Speaking of which, Dr. Trrll, a good scientist doesn’t just keep repeating the mantra, “HAARTs have prolonged survival. HAARTs” have prolonged survival.” He would understand and repond directly to what I’m saying, that median survival from “HIV infection” to death in people living in relatively poor conditions, and with no AIDS drugs, is estimated at 11 years. An example is Africans. But When I told you that you were arguing against yourself by lecturing at length on how much worse the conditions are in Africa, you predictably responded with the generic “uh” reflex and suddenly couldn’t see the point of it anymore.

    The point, Dr. Trrll, is that median survival for an HIV+ in the developed world, with access to health care, would have been around 15 years right from the beginning. That gives you two choices my friend:

    1. If HIV+ people really died as quickly as you claim – so quickly in fact that the influence of “cofactors” was undetectable, something other than the virus must have killed them – and that something other must have been “cofactors”. Catch 22.

    2. If you admit the study populations didn’t die so quickly, you have yet to tell me how no cofactor influence was observed in all those studies.

    RIght now you’re betting on both horses. I have to ask you to choose one of them.

    If you go through just this thread, you will see that we have been told time and again by the enlightened readers of this blog that it’s a matter of common sense that drug abuse would affect health and survival time significantly. So why didn’t it show in any of the earlier studies, Dr. Trrll? Why were all these drugs so blessedly untoxic up until now?

    ——————————

    You’re saying Cook’s crack users are a very special, very extreme subgroup. Does that mean “fast track” gays and IV users are moderate subgroups in comparison? Why would all these orgiasts and needle-sharers not be just as prone to pick up drug resistant strains?

    Aside: The great thing about virology in general and HIVirology in particular is that, since it is mostly science fiction in the first place, every Dr. Shll has completely free reigns to defend his notions with more science fiction. Whenever the Virus needs another tall tale to patch up the endless absurdities the mortally flawed hypothesis generates you just invent a new unique property for it. In this case it is unique mutational powers. So when people seem to be doing well on the toxic drugs, it’s because the drugs are so fantastic that the virus couldn’t escape them. When people don’t seem to be doing so well on the toxic drugs, it’s because the virus has outsmarted the drug by mutating around it. That’s why speculation of this sort come free of charge:

    One of reasons that HAART is so successful in prolonging life is that the emergence of antiviral drug resistance in HIV is slower. But of course, that won’t help you if you manage to pick up a genes for antiretroviral resistance from somebody else. So it is plausible that unsafe sex could increase the risk of HAART failure (Trrll)

    Of course! somebody else who also happens to be HIV positive, with a super strain that happens to be drug resistant, just happens to selectively pass those genes on to the particular crack users in this particular study.

    It’s actually not all that easy to pick up HIV even once, especially not via sex. Dr. Trrll can go back and reread Padian et al. if he has forgotten. But who cares as long as the story is good: Crack users undoubtedly all experience multiple HIV infections in the course of a few years. They’re special in that regard compared to every other risk group, right Dr. Trrl?

    —————————-

    Dr. Trrll wonders how I “reconcile my claim of a “clear gradation” with Cook et al.’s finding that neither survival nor time to newly acquired AIDS-defining illness was significantly altered in intermittent crack users”

    To the first point the study authors offer this explanation:

    Mortality was dramatically higher among persistent crack users. Thirty-seven of the 54 persistent users died during the study – 68 per cent. This may be partly due to selection bias: women who died had less time to stop using crack and become classed as intermittent users.

    With regard to newly acquired AIDS-defining illness, I suggest you didn’t read to the bottom of the page:

    Progression to AIDS was significantly greater among both intermittent crack users (42%) and persistent users (39%). Both persistent and intermittent crack use remained associated with progression to AIDS after adjusting for HAART adherence, drinking, socioeconomic status, baseline viral load and baseline CD4 count. In the adjusted analysis intermittent users were 57% more likely, and persistent users 65% more likely, to develop AIDS than non-users.

    As for your precious molecular markers:

    The proportion of women with CD4 counts under 200 cells/mm3 stayed at 25% in intermittent users, went down throughout the course of the study from 29% at baseline to 17% at the end of the study in non-users, and varied erratically between 23% and 45% in persistent users. Similarly the proportion of women with HIV viral loads over 100,000 copies/ml went down from 17% at baseline to 2% in non-users at the end of the study and from 17% in intermittent users to 8%, but in persistent users, after an initial decline from 47% to 3%, it then varied between 8% and 27% for the rest of the study.

  167. #168 undergraduate-gal
    August 19, 2008

    P.S.

    Dr. Trrll tries to obscure this clear indication that more drug use leads to higher risk of AIDS by talking of relative time to new Aids-defining illness. Dr. Trrll is fond of asking people to think things through rationally. Here you have broad categories of self-reported drug use in people with all kinds of previous history, and he wants to nitpick about time to illness!

    Dr. Trrll, have a look at the viral loads and CD4 counts up there. Those markers were all considerably and consistently worse for persistent crack users. You tell me why they didn’t fall ill quicker than the intermittent users.

    You can always refer to Rodriguez et al., if you’re not sure of the answer.

  168. #169 dee
    August 19, 2008

    UGG, does HIV cause AIDS? Yes or no?

  169. #170 Undergraduate-gal
    August 19, 2008

    Dee,

    If this is what you guys complain I haven’t been willing to take a stand on, here you go:

    I have not been able to find convincing evidence that HIV causes AIDS, and I have looked pretty thoroughly.

    I have been able to find some evidence that a positive
    “HIV” test in certain circumstances indicates ill health.

    I have not been able to find any convincing evidence that any HIV test tests for the presence of a unique exogenous, pathogenic retrovirus.

  170. #171 Dee
    August 19, 2008

    Well, thanks for some honesty. Your understanding of evidence in a scientific context is clearly different to mine. I have no wish to get into a debate about basic biochemistry, epidemiology, cell and molecular biology – you obviously have made up your mind about the veracity of HIV tests and the existence of the virus.

    If HIV does not cause AIDS, can you account for the following? I’ve thrown in some basic science questions for you too, just for fun. Think of it as revision.

    How do you explain cases of Lab/Healthcare workers seroconverting after needlestick injuries and developing AIDS? Secret drug abusers? What is a dendritic cell?

    How do you explain the fact that rates of seroconversion associated with needlestick injuries have plummeted after the introduction of post exposure prophylaxis (which contains antiretroviral drugs)? How does PCR work?

    How do you explain the molecular evolution of HIV in response to various HIV medications? How do you explain the fact that evolution of resistance has in many well documented cases lead to an increase in viral load? How is DNA sequenced?

    How do you account for the recent Lancet study showing an increase in life expectancy (drug abusers or not) for those HIV positive individuals on HAART? What criticisms (if any) do you have of this study? In light of this study, would you advise a patient on HAART to stop taking their medication?

    dee

  171. #172 Undergraduate-gal
    August 19, 2008

    How do you account for the recent Lancet study showing an increase in life expectancy (drug abusers or not) for those HIV positive individuals on HAART? What criticisms (if any) do you have of this study? In light of this study, would you advise a patient on HAART to stop taking their medication?

    I don’t know. It compares drugs with other drugs, doesn’t it?

    I’m not a doctor I can’t give anybody medical advice. Personally I wouldn’t consider taking any of the drugs if I weren’t clinically ill.

  172. #173 ozzy
    August 19, 2008

    UG dodges right, UG dodges left…

  173. #174 Dee
    August 19, 2008

    You don’t know? I thought you had done your research ‘pretty thoroughly’? Maybe you need to do some more?

    ‘I’m not a doctor I can’t give anybody medical advice. Personally I wouldn’t consider taking any of the drugs if I weren’t clinically ill.’

    What do you mean by clinically ill? Think carefully. Many conditions can appear asymptomatic. Hepatitis C springs to mind.

    Any thoughts on any of my other points?

  174. #175 Prometheus
    August 19, 2008

    I think that UGG (W) has given us the defining statement of her scientific knowledge:

    “I have not been able to find convincing evidence that HIV causes AIDS, and I have looked pretty thoroughly.”

    Well, since virologists, microbiologists, immunologists and infectious disease specialists have been able to find “convincing evidence” that HIV causes AIDS, we are left to choose between two possible conclusions:

    [1] UGG knows more about the biology of HIV and the human immune system than all the people who conclude that HIV does cause AIDS. As a result, she is able to perceive something that the vast, overwhelming majority of doctors and scientists who research HIV and AIDS have somehow “overlooked”.

    [2] UGG is ignorant about the biology of HIV and the human immune system and is unable to perceive her own ignorance, thus leading her to erroneously conclude that she is right and the vast, overwhelming majority of doctors and scientists researching HIV and AIDS are wrong.

    I don’t know about the rest of you, but my money is on [2].

    I realize that – to many people – this may seem like an appeal to authority – that the majority of doctors and scientists “believe” it, so it must be true. However, I happen to be one of those people who knows enough about virology, immunology and infectious disease to realize that the data showing that HIV does cause AIDS is overwhelming.

    There are some scientists and doctors who express doubts, but they lack any data to support those doubts. If and when they come up with data – not just suppositions, hypotheses and “Just So Stories”, but real, hard data – that supports their claims, I will be excited to see it.

    I’m done with Dawn and UGG – they can languish in their ignorance for all I care.

    Prometheus

  175. #176 Undergraduate-gal
    August 19, 2008

    Darling Dee,

    I said I don’t know, as in I don’t know why or what exactly I need to criticize about the study other than remarking that it compares ARVs with ARVs.

    By clinically ill, I mean with moderate to severe symptoms.

    Hepatitis C certainly springs to mind when one is discussing phantom viruses. You have remarkable powers of meaningful association, Dee.

    Actually, I did have a couple of thoughs on your other points: You need to learn how to frame a question. You need to learn you cannot ask a dozen more or less random questions at the same time. You need to learn how to use the google search and wikipedia, so you don’t have to bother other people with your fragmented inquiries.

    I answered the question I thought had most relevance since it referred to the study commented on by Orac and Steve Novella in earlier posts.

  176. #177 dee
    August 19, 2008

    No need to get so defensive.

    I think all those questions are things you need to think about if you believe that HIV does not cause AIDS.

    So I’m genuinely interested in your answers. Go on, you might learn something!

  177. #178 Natalie
    August 19, 2008

    Wikipedia? This is where you suggest people do research? That certainly explains a lot…

  178. #179 HCN
    August 19, 2008

    UGG said “You need to learn how to use the google search and wikipedia, so you don’t have to bother other people with your fragmented inquiries.”

    Um, no… for medical inquiries it is best to start at http://www.medlineplus.gov, and then for some specific science to check out individual papers at http://www.pubmed.gov (which may require visiting a library to get something more than the abstract).

  179. #180 undergraduate-gal
    August 19, 2008

    HCN, I know you thought you scored a really good point there about where to take your medical enquiries, and I’m sure you’re right. But questions like, “What is a dendritic cell? How does PCR work? How is DNA sequenced”, can easily be handled by a google or wikipedia search. Or was I supposed to write a dissertation on each question?

    I see we’ve reached a level where the bimbos feel they can safely chime in again, and I think I’ve already explained that that’s not what I’m here for, so if you don’t mind, I’m going to follow AA’s example and take break until somebody worthwhile happens along.

  180. #182 Natalie
    August 19, 2008

    I see we’ve reached a level where the bimbos feel they can safely chime in again

    I had my suspicions before, but this makes me pretty sure that in addition to not being a college student, you’re also not a woman.

  181. #183 Dawn
    August 19, 2008

    Just because Natalie refrains from using the word “bimbo” does not mean that the rest of us do. So, if I use the word bimbo does that mean that I am not a woman either?

  182. #184 Undergraduate-gal
    August 19, 2008

    Ok, just a note before the PC police arrives. “Bimbo” is a word I use about anyone, boy or girl, who has nothing to contribute but little snide tangential or gotcha remarks.

  183. #185 franklin
    August 19, 2008

    Undergraduate Gal,

    I have a few questions about the Cook et al. study.

    Let’s say Cook et al. had followed a patient for five years, with two study visits per year. At the first nine visits she reports using crack cocaine in the previous six months, but at the tenth visit she reports no crack cocaine use in the previous six months.

    Would Cook et al. consider this patient a persistent user or an intermittent user?

    What if she had been killed in a car accident on the way to her tenth visit? Would Cook et al. consider her to be a a persistent user or an intermittent user?

    How does the methodology employed limit the validity of the conclusions that one can draw regarding persistent users versus intermittent users?

    How does the limited sample size of persistent users affect the statistical analysis (only 54 persistent users out of 1686 subjects)?

  184. #186 Dee
    August 20, 2008

    UGG, you shouldn’t need to look up the answers to those basic questions if you want to have a meaningful and informed discussion about these issues – you should already understand these concepts!

    So, your view that HIV doesn’t cause AIDS has some problems in light of some of the points I raise. I’m truly fascinated by how you reconcile these and other observations, and promise not to be snarky if you use wikipedia as a source.

  185. #187 Natalie
    August 20, 2008

    “Bimbo” is a word I use about anyone, boy or girl, who has nothing to contribute but little snide tangential or gotcha remarks.

    So correcting your claim that Merck never tested Gardasil on girls younger than 15 is “tangential”? I don’t think you know what that word means.

    And my opinion of your identity is actually based on your general tone toward any commenter with an identifiably female name.

  186. #188 Undergraduate-gal
    August 20, 2008

    Franklin,

    I appreciate clever questions, especially the kind the enquirer already knows the answer to.

    I agree there would be several confounders and general quibbles. For instance previous history, as I’ve previously mentioned, and the reliability of self-reporting. I consider it highly likely, for example, that some of those who got classified as intermittent drug users, were not 100% honest.

    Nevertheless, by the criteria chosen, Cook et al. observed that the molcular markers that are the essence of HIV science were consistently worse for the persistent drug user group, and they fared overall worse, also when different cofactors were controlled for.

    I must be up to you to find genuinely disqualifying weaknesses in this study that couldn’t be applied doubly to for example Ascher et al., an almost sacred study among Duesberg smearers.

    Dee, can’t you read? I suggested you google PCR. I haven’t said anything about where or how I get my information. HCN is even dizzier. Aparently s/he thinks somebody has told her/him to search for dendritic cells and post he link. But look, you’ve obviously scored some major points and so I concede them gladly; you don’t even have to tell me what they are.

  187. #189 Dee
    August 20, 2008

    UGG, I know (all too well) what PCR is, and I understand its applications. The question is, do you?

    ‘But look, you’ve obviously scored some major points and so I concede them gladly; you don’t even have to tell me what they are.’

    But I’d still really like to know how you account for my questions if HIV doesn’t cause AIDS.

  188. #190 Undergraduate-gal
    August 20, 2008

    SIGH!!! Natalie, you hairy chest-thumping brute. I hope you’re packing a real lunchbox down south, because up north there sure is nothing even the size of a retrovirus.

    What you have corrected, jock, is a figment of your own imagination. Why do you think Trrll, gave up on pursuing that issue and went for the aluminum diversion instead? Because even he realized it was a loser and so abandoned it.

    That’s the difference between Trrll and a perfect bimbo like you. He actually discovered his (honest) mistake. I have no hopes of you ever discovering yours, so I emplore you once more, go to Hooters, impress some chick with the story of how you “corrected” me, whatever, but stop embarrasing whatever gender you belong to in this dignified forum.

  189. #191 Dee
    August 20, 2008

    There there. Any thoughts on those needlestick injuries and PEP?

  190. #192 Undergraduate-gal
    August 20, 2008

    Dee,

    PCR is a Xerox machine. It has zero signifance for the issues of HIV’s existence and/or pathogenicity. Just stop it. Your questions are NOT clever!

  191. #193 Dee
    August 20, 2008

    Neither are your transparent efforts to avoid answering me.

  192. #194 Undergraduate-gal
    August 20, 2008

    Dee, look up your initial needlestick question, look up the peer-reviewed references, take a hard a look at what “plummet” means, and come back post it all here.

    Alternatively, learn from guys like Trrll and Franklin, who actually have a vague idea what they’re talking about. Look at the questions they’re running with and which questions they ain’t running with. Ask yourself why that might be.

    Better yet, just forget about it and go do your toe nails. At least you seem to have understood that I’m desperately (transparent is far too mild a word) trying to avoid you.

  193. #195 dee
    August 20, 2008

    Thats fine, I take that to mean you don’t know, and you have no explanation.

  194. #196 Prometheus
    August 20, 2008

    UGG (W),

    Actually, PCR is not a “Xerox machine”. PCR makes “copies” of DNA between two primers.

    In your “Xerox machine” analogy, it would be a copying machine that would make multiple copies of a part of a huge text by taking the text (template) and the first and last pages of the section you wanted to copy (primers).

    Of course, to make the analogy more precise, you would have to allow for the copying machine also making copies of parts of the larger text that were between pages that were close to the pages (primers) you input.

    Seriously, there is a certain amount of background information that you need to have mastered before your “opinion” on things like HIV/AIDS can be anything more than a random repetition of what you’ve read on the Internet.

    I know that I promised to leave you alone, but this sort of transparent lack of understanding, coupled with your snarky arrogance of ignorance, forced my hand. Please, if you are capable of it, go out and learn something about biology and then decide if you’re smarter than everyone else or just under-educated.

    Prometheus

  195. #197 Undergraduate-gal
    August 20, 2008

    Prometheus,

    I humbly apologize. Let me rephrase that:

    PCR is a Xerox machine. It has zero signifance for the issues of HIV’s existence and/or pathogenicity.

  196. #198 Laser Potato
    August 20, 2008

    Oh god, I’m guetting flashbacks to cooler and his “fire can’t melt steel” malarkey now…
    http://scienceblogs.com/insolence/2008/02/the_troof_hurts.php

  197. #199 trrll
    August 20, 2008

    The point, Dr. Trrll, is that median survival for an HIV+ in the developed world, with access to health care, would have been around 15 years right from the beginning. That gives you two choices my friend:

    1. If HIV+ people really died as quickly as you claim – so quickly in fact that the influence of “cofactors” was undetectable, something other than the virus must have killed them – and that something other must have been “cofactors”. Catch 22.

    2. If you admit the study populations didn’t die so quickly, you have yet to tell me how no cofactor influence was observed in all those studies.

    Prior to availability of HAART, about half of HIV-infected patients would be dead about 10 years after becoming infected. With current HAART, mortality of HIV infected patients is just a bit worse than the general population, with over 90% of patients under 45 expected to survive another 14 years (Bhaskaran, K et al., JAMA 2008, 300:51). Excess mortality associated with HIV infection has decreased from 41 per 1000 person-years to around 6-8. That adds up to an average of 13 additional years per person, quite a few years for the effects of cofactors to add up.

    RIght now you’re betting on both horses. I have to ask you to choose one of them.

    If you go through just this thread, you will see that we have been told time and again by the enlightened readers of this blog that it’s a matter of common sense that drug abuse would affect health and survival time significantly. So why didn’t it show in any of the earlier studies, Dr. Trrll? Why were all these drugs so blessedly untoxic up until now?

    On the contrary, I’m evaluating the data, not betting on horses, so I don’t have to choose one. Life is not so black and white for scientists as it is for denialists; we have to be comfortable living with multiple hypotheses, and often have to suspend judgement pending additional data.

    So at the moment, we have 3 non-mutually exclusive hypotheses to reconcile the results of a large number of studies showing little or no impact of drug abuse on survival in the early days, and a smaller number of modern studies that do find an effect:

    1) The deleterious effect of drug abuse has been unmasked as HIV patients live longer. This increases the statistical sensitivity of studies and makes it easier to detect a deleterious effect.

    2) The risk does not apply generally to drug users but only to a subpopulation extremely heavy drug users–possibly only heavy female users of cocaine. Previous studies did not isolate this population, so the effect was not large enough to detect the adverse effect on survival

    3) Heavy female cocaine use is associated with some other factors that increase the risk of HAART failure, with plausible candidates being female prostitution, poor nutrition, or a pharmacological effect of cocaine that interferes with the efficacy of HAART drugs.

    As I said, these are not mutually exclusive; they could all be true to some extent, or interact in a synergistic way to produce a risk that is much greater than any of these factors would produce by itself.

    You’re saying Cook’s crack users are a very special, very extreme subgroup. Does that mean “fast track” gays and IV users are moderate subgroups in comparison? Why would all these orgiasts and needle-sharers not be just as prone to pick up drug resistant strains?

    I don’t have information to answer that question. Do you? What is the evidence that what you call “fast track” gays and IV users are exposed to as many different HIV strains as habitual female crack addicts? What modern studies can you cite that have studied these specific populations with respect to how well they do under HAART. We already have data from the Lancet study suggesting that HIV-infected IV drug users do not survive as non-IV drug users, so that is actually consistent with the multiple HIV strains hypothesis.

    Whenever the Virus needs another tall tale to patch up the endless absurdities the mortally flawed hypothesis generates you just invent a new unique property for it. In this case it is unique mutational powers.

    Clearly, you would very much like to believe that the high mutation rate of HIV is just an ad hoc hypothesis–a “tall tale.” But in reality it has been repeatedly confirmed experimentally and at this point is well understood.

    Of course! somebody else who also happens to be HIV positive, with a super strain that happens to be drug resistant, just happens to selectively pass those genes on to the particular crack users in this particular study.

    The investigators did their best to control for the drug compliance of the study subjects, but they obviously could not measure or control for the compliance of any HIV-infected sexual partners that they might have. One might reasonably speculate that the customers of crack-addicted prostitutes might include a high frequency of people with HIV, some of whom might not be so responsible about taking their meds. Poor compliance selects for drug resistant strains, which could then be passed on to accelerate HAART failure in a sexual partner who is taking her meds regularly. It is just a hypothesis, but it should be testable by genetic analysis of the strains of HIV in female crack users.

    Dr. Trrll wonders how I “reconcile my claim of a “clear gradation” with Cook et al.’s finding that neither survival nor time to newly acquired AIDS-defining illness was significantly altered in intermittent crack users”

    To the first point the study authors offer this explanation:

    Mortality was dramatically higher among persistent crack users. Thirty-seven of the 54 persistent users died during the study – 68 per cent. This may be partly due to selection bias: women who died had less time to stop using crack and become classed as intermittent users.

    I find this highly amusing. When the authors cautioned about the possibility that the excess mortality in the heavy crack users could be due to selection bias:

    One caveat to our findings is the non-representativeness of our longitudinal cohort, limiting the generalizability of our results….our analysis does not conclusively demonstrate that crack use causes AIDS-related morbidity and mortality. We have not ruled out other processes that could account for these associations, such as greater sexual risk taking, poorer diet and nutrition, substandard living conditions, and other unknown confounders.

    You brushed it aside, saying “Of course Cook et al. would come up with caveats, possible alternative explanations, “unknown confounders”. As you’ve just told us, that’s what scientists – especially HIV scientists – do.”

    But when their mortality statistics do not show a “clear gradation,” you suddenly find Cook et al.’s concerns for selection bias very persuasive.

  198. #200 HCN
    August 20, 2008

    It is funny watching UGG attempt to correct Prometheus, who just happens to teach at the university level (http://photoninthedarkness.com/?p=39). Without using any psychic powers I predict UGG’s grade point average is going to hover somewhere between a 1.0 and 2.0 out of 4.0.

  199. #201 franklin
    August 20, 2008

    Undergraduate gal,

    You say it is up to me to find disqualifying weaknesses in the Cook et al. study.

    What? Are you afraid to risk thinking about the methodological flaws in a study that, in your deluded state, you imagine supports HIV denialism?

    Most undergraduates I know are happy to critique the methodologic flaws of scientific papers because they are interested in learning how to think critically.

    You seem more like a sock puppet than an undergraduate.

  200. #202 Undergraduate-gal
    August 21, 2008

    Dr. Trrll,

    You state you find something “highly amusing”. You know very well you’re stretching the truth now. You don’t have a sense of humour.

    You’re finding inconsistencies in the strangest of places.
    I have all along been reporting what the study authors conclude. You’re asking me a specific question about mortality, but I am not even allowed to mention what the authors themselves have addressed that point? Life sure ain’t easy for us denialists.

    But, dear Dr. Trrll, your mirth seems to have made you overlook that I did offer a couple of comfounders that would blur the line between intermittent and persistent drug users: The unreliability of self-reporting and earlier history. I definitely didn’t say anything about what I find persuasive, so it seems your great joke is entirely self-fabricated.

    Dr. Trrll, a scientist ought to always attempt to critcize herself. Merely reporting the fact that such an attempt has taken place in this case is not an argument in itself. Do you understand that? If anything, it makes the final results even more persuasive when you know the researchers have done their damned best to fit them into the obligatory drug adherence-resistant strain model. Do you understand that? I was passing over these point lightly, because I don’t trade in taking cheap shots at your basic understanding of the way such a study would be worded. Do you understand that, my friend? The opportunistic “gotcha” strategy is all yours, and it’s only blog bimbos of the sort who hang out here that are impressed with it.

    Dr. Trrll, I hate to break this to you – again. This study didn’t last 40 years, ok? It went on for eight years. In fact HIV was only invented about 25 years ago. There was a very clear baseline difference in molecular markers between persistent crack users and intermittent and non-users. As one would expect, both on your drug adherence theory and my cocaine = AIDS theory, the gradation became clearer as the study progressed. As one would also expect, AIDS events were more frequent among the intermittent users than non-users regardless what the molecular markers might have indicated at baseline. It is not possible to say definitively what the primary cause is that goes without saying, Mr. Black&White. But after controlling and explaining away all they could, the authors still felt they had to conclude as they did. What do you and franklin want me to do about it?

    Come to think of it, maybe I was being unkind saying you have no sense of humour, because this was actually quite funny.

    Clearly, you would very much like to believe that the high mutation rate of HIV is just an ad hoc hypothesis–a “tall tale.” But in reality it has been repeatedly confirmed experimentally and at this point is well understood.

    But I suspect it was all straight-faced. I guess the repeated experimental confirmations you are referring to are those routinely conducted on african women sucah as this one reported in Washingtn Post in their 2007 overview of spectacular medical failures:

    Hospitals routinely use antiretroviral drugs, for example, to prevent infections in doctors and nurses stuck by HIV-infected needles. But when researchers asked healthy West African women to take such medicine every day, the difference in infection rates was so small that scientists could not determine whether the medicine worked.

    Of course the medicine worked! It just made the women select resistant strains, right?

    Or maybe it’s those Nevirapine experiments (also carried out on African women, because Nevirapine is too toxic for domestic use) which concluded that a single dose confers drug resistant mutations in 41% of the cases.

    I guess we needed to confirm and reconfirm this well understood fact on 875,000 pregnant African women, although every schoolgirl in Dr. Trrll’s class considers it quite elementary, according to even better understood neo-darwinian principles of selection, that if you withhold further Nevirapine for 6 months after delivery the drug resistant strains will disappear themselves, thus decreasing the risk of treatment failure to a measly 12%.

  201. #203 Militant Agnostic
    August 21, 2008

    Like Laser Potato I am also getting flashbacks to Cooler and like Cooler, UGG and Dawn are unable to use Occam’s Razor because they are not allowed to have sharp objects.

  202. #204 trrll
    August 23, 2008

    Dr. Trrll, I hate to break this to you – again. This study didn’t last 40 years, ok? It went on for eight years. In fact HIV was only invented about 25 years ago. There was a very clear baseline difference in molecular markers between persistent crack users and intermittent and non-users. As one would expect, both on your drug adherence theory and my cocaine = AIDS theory, the gradation became clearer as the study progressed.

    What “drug adherence theory?” I offered 3 hypotheses:

    1) The deleterious effect of drug abuse has been unmasked as HIV patients live longer. This increases the statistical sensitivity of studies and makes it easier to detect a deleterious effect.

    2) The risk does not apply generally to drug users but only to a subpopulation extremely heavy drug users–possibly only heavy female users of cocaine. Previous studies did not isolate this population, so the effect was not large enough to detect the adverse effect on survival

    3) Heavy female cocaine use is associated with some other factors that increase the risk of HAART failure, with plausible candidates being female prostitution, poor nutrition, or a pharmacological effect of cocaine that interferes with the efficacy of HAART drugs.

    Now I suppose that you could come up with a drug adherence hypothesis, if you really insist on doing so. Cook et al. tried to control for this, but they used self-reports of drug use, and perhaps people who are sicker are subject to selective recall and report more drug use, but it didn’t strike me as one of the leading hypotheses.

    As for your cocaine = AIDS notion, it has multiple problems: AIDS is observed in non-cocaine users, AIDS is not observed in cocaine users who are HIV-negative, and heavy cocaine users in the US was around long before AIDS emerged. Discovering that HAART does not work as well in warding off AIDS for heavy drug abusers as for people without habits that damage health (but do not produce AIDS) even in people without HIV does not rescue the drug abuse hypothesis of AIDS.

    But I suspect it was all straight-faced. I guess the repeated experimental confirmations you are referring to are those routinely conducted on african women sucah as this one reported in Washingtn Post in their 2007 overview of spectacular medical failures

    No, I am talking about the many, many laboratory studies that have examined the replication fidelity and the mutation and recombination rate of the HIV virus, as well as the studies documenting the association between the emergence of drug-resistant HIV strains and HAART treatment failure.

  203. #205 Undergraduate-gal
    August 23, 2008

    Dr. Trrl,

    Most studies assume that evidence of drug resistance (increasing viral replication) IS treatment failure. No further “association” is needed, although CD4 count may be taken into consideration and sought correlated with the viral load.

    Buffalo hump, for example, is not considered treatment failure if the viral load is low.

    In this study there is no talk of HAART or ART “treatment failure” or “resistant strains”:

    “Abstract

    Background: Studies of antiretroviral therapy (ART) programs in Africa have shown high initial mortality.
    Factors contributing to this high mortality are poorly described. The aim of the present study was to assess mortality and to identify predictors of mortality in HIV-infected patients starting ART in a rural hospital in Tanzania.

    Methods: This was a cohort study of 320 treatment-naïve adults who started ART between October 2003 and November 2006. Reliable CD4 cell counts were not available, thus ART
    initiation was based on clinical criteria in accordance with WHO and Tanzanian guidelines. Kaplan- Meier models were used to estimate mortality and Cox proportional hazards models to identify predictors of mortality.

    Results: Patients were followed for a median of 10.9 months (IQR 2.9-19.5). Overall, 95 patients died, among whom 59 died within 3 months of starting ART. Estimated mortality was 19.2, 29.0 and 40.7% at 3, 12 and 36 months, respectively. Independent predictors of mortality were severe anemia (hemoglobin <8 g/dL; adjusted hazard ratio [AHR] 9.20; 95% CI 2.05-41.3), moderate anemia (hemoglobin 8-9.9 g/dL; AHR 7.50; 95% CI 1.77-31.9), thrombocytopenia (platelet count <150 × 109/L; AHR 2.30; 95% CI 1.33-3.99) and severe malnutrition (body mass index <16 kg/m2;
    AHR 2.12; 95% CI 1.06-4.24). Estimated one year mortality was 55.2% in patients with severe anemia, compared to 3.7% in patients without anemia (P < 0.001).

    Conclusion: Mortality was found to be high, with the majority of deaths occurring within 3 months of starting ART. Anemia, thrombocytopenia and severe malnutrition were strong independent predictors of mortality. A prognostic model based on hemoglobin level appears to be a useful tool for initial risk assessment in resource-limited settings.”

    Predictors of mortality in HIV-infected patients starting
    antiretroviral therapy in a rural hospital in Tanzania
    Asgeir Johannessen*1, Ezra Naman2, Bernard J Ngowi2,3, Leiv Sandvik4, Mecky I Matee5, Henry E Aglen6, Svein G Gundersen6,7 and Johan N Bruun1

  204. #206 Dr Von Frankenmundt
    August 25, 2008

    Dear Dr Trrll:

    The high mutation rate of HIV is an assumption based on Eigen’s quasispecies model for RNA viruses.

    Maybe you flunk and maybe you don’t have a clue why retroviruses can’t fit this model.

    Can their complete dimeric RNAs ever be in sufficient quantity (without amplification) to be visible on those gels after extraction and fractionation ex vivo? Are we talking about femtograms here?

    Can you state Eigen’s model for us in terms of a typical RNA picornavirus? What exactly is the hypercycle? Please include the significance of synonomous codon substitutions and RNA secondary structures.

  205. #207 Undergraduate-gal
    August 25, 2008

    There! And that goes double for me Dr. Trrl, cuz I think you can’t, you being a biologist an’ all. I bet you don’t even believe in the concept of quasispecies.

    Where are all those virions, defect or not?

    And only one of the all diferent critters can infect the next person. That’s right, only one out of the Eigenous multitudes is fit to penetrate the mucosa of the sexual partner. They said so at the XVIIth, so you like can’t argue with it. Ain’t that something?

    Eigen sure is sexy, but that’s just cuz he’s abstracted the “competing sperm” theory of conception and made it into a viral theory. Just like the early virologists observed a parasitic infection in larvae or some such, and thought to themselves “As above so below (the level of the filterable)”.

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