Dr. Kaiser responds

I was pleased to see that Dr. Kaiser responded to post from earlier this week. If you'll recall, Dr. Jon Kaiser is a doctor in California who is promoting a nutritional supplement to help treat HIV disease. I was hoping his response would be substantive, containing references to data I had missed in my research of the story. In this I was disappointed.

Dr. Lipson,

I was surprised when I read your recent blog about my career, expertise and perspective on HIV treatment.

Facts and science can be manipulated to support any opinion, so it is a fruitless exercise to engage in a point by point correction of your numerous mischaracterizations. But I will speak to a few of the core issues you raised.

Translation: "I have no actual data to refute your points, but I am about to drag you through a tangled heap of rhetorical mis-steps and logical fallacies."

I arrived in San Francisco during the height of the AIDS epidemic. Since that time, I have treated over two thousand HIV-positive patients and have dedicated my life to helping individuals with this condition live normal life spans. Back in the days before any effective drugs were available to treat this condition, and HIV infection was regarded as 100% fatal, I decided reject that belief. I then began exploring ways to help my patients outlive that prediction. Many of these patients are still healthy and alive today.

As I stated in my original piece, a number of older HIV docs were internists or other type of specialists, such as hematologist/oncologists, rather than infectious disease specialists and had to invent the field of HIV medicine as the epidemic developed. Not that Kaiser is an internists, having completed only one year of post-graduate training, but arriving in SF during the height of the epidemic would give any doctor an interesting, frightening, and humbling experience. Except Kaiser wasn't humbled in the face of disease; he "decided to reject" the fact that before anti-retroviral therapy became available, HIV was almost uniformly fatal. There have always been a few long-term non-progressers, some of whom may have certain genetic protection against HIV, such as a CCR5 mutation. But I view with some skepticism his claim that he yanked patients away from certain death with his revolutionary ways.

I would be surprised if the seven pharmaceutical companies who have enjoyed my participation as a consultant or speaker, the American Academy of HIV Medicine on whose Reimbursement Committee I have served, the International Journal of Infectious Diseases on whose editorial board I have participated, or the World AIDS Conference which invited me to present my research study results, share your perspective on my expertise and legitimacy as an HIV researcher and treatment specialist.

None of those facts actually make one an "HIV expert". I'm not saying he isn't an expert, but serving on the "reimbursement committee" of a lower-tier HIV organization hardly makes one an expert. As for his presentations, well, one traditional definition of "expert" is someone from out of town with slides. He seems to fit this definition, but having only one peer-reviewed publication in his field, one that required an editorial note to explain his conflict of interest, argues against him being an expert by other standards.

Despite your belief that a micronutrient supplement can't possibly act as a potent immune modulator, several pharmaceutical companies have already expressed interest in investigating K-PAX's Immune Support Formula in combination with their drugs.

Perhaps he hasn't read my piece all that carefully, or he just has a thing for straw men. I have no way of knowing what is in his heart, but I never argued against the plausibility of micronutrients assisting in the treatment of HIV---just that the data and claims he presented were not good evidence to support it. Perhaps some day evidence will support the use of his supplement, but that day has not yet come.

Over the course of my career, one of the more important lessons I've learned is that it's not about one side being right and the other side being wrong. Such finger-pointing divides the research and treatment communities, and ultimately, it's the patients who lose out in the end. We see this trend playing out today in the debate on healthcare reform; the right and left devote extraordinary time to discrediting the opposition, a dialogue which ultimately impedes moving forward on important issues.

Actually, in science it often is about being wrong. There is not always a "middle ground" in science. To claim that patients "lose out" by scientists vigorously debating facts is absurd. This is exactly how science works, and to search for a compromise rather than the truth is a mistake. The dialog is the science. Moving forward without examining facts is not called science, it's called religion.

From my perspective, it's not whether you believe that drugs or natural approaches are the best treatment option; it's that utilizing both approaches together yields the best possible outcome. This treatment philosophy has been proven in diabetes (weight loss, exercise, and insulin), heart disease (weight loss, exercise, and medications), osteoporosis (calcium supplements, vitamin D supplements, and exercise), and hypertension (diet, exercise, stress management, and drugs).

Without evidence that "utilizing both approaches...yields the best possible outcome" it is simply a bold assertion. It is a plausible assertion, but the history of medicine is littered with plausible assertions that never panned out.

Comprehensive care paradigms, which blend conventional drug treatments with natural approaches, will no doubt continue to prove useful in many additional diseases. And as the debate continues around these emotionally charged issues, patients deserve to hear the whole story, with as little vitriol and personal opinion as possible, so they can make informed decisions about their health.

"No doubt"? Science is doubt. And I agree that "patients deserve to hear the whole story." Do you tell your patients that you own the company whose products you sell? Do you tell them that there is no good evidence yet available to support their use?

I was hoping Dr. Kaiser would turn out to be a well-intentioned but misguided healer. I may have been wrong. I think it may be time to go over to his website and examine the rest of his claims a bit more closely. Stay tuned.