A Paradigm Under Pressure

HIV-AIDS model owes popularity to wide-spread censorship

by Gordon Stewart, MD

AIDS entered the medical domain quietly in 1981 with a report in Los Angeles of five cases of severe pneumonia caused by a parasite, Pneumocystis carinii, common in animals but uncommon in humans. All five were young homosexual men who engaged in anal intercourse very frequently, with multiple changes of partners; had histories of previous attacks of gonorrhea and other sexually-transmissible diseases (STDs); and used mind-altering drugs regularly. They became fatally ill with uncontrollable diarrhea, weakness, and wasting. Also in 1981, a series of cases of an unusual form of skin cancer, Kaposi's sarcoma, was reported in New York City in young homosexual men with similar histories, many of whom also had the same kind of pneumonia together with opportunistic infections in the mouth, gullet, intestine, and skin, with enlargement of lymph glands.

Within a few months, many similar cases attracted attention in Los Angeles, San Francisco, and New York City because they were all homosexual men in their twenties who used drugs freely, either by inhaling volatile nitrites from 'popping' capsules or by injecting or ingesting heroin, amphetamines, and other illicit drugs. Although usually previously healthy except for attacks of STDs, they succumbed rapidly to debilitating illness as described above, with the same unusual pneumonia, yeasty white saliva, uncontrollable diarrhea, and other infections to which they seemed to have no immunity. They lacked energy, lost weight, and suffered pitifully before early death. This condition was described in the official publication of the US Centers for Disease Control at first as a gay-related wasting syndrome and then, after further investigation of immune status, as Gay-Related Immune Deficiency (GRID). A similar disease was noted in non-homosexual drug addicts who shared needles for heroin injection, and a similar loss of immunity -- already well recognized in patients who were rejecting skin and other surgical grafts -- was described in hemophiliac patients who began about this time to receive transfusions of the corrective Factor VIII, prepared from pooled donations of blood plasma. GRID was then renamed the Acquired Immune Deficiency Syndrome (AIDS).

Thus defined, AIDS spread rapidly in the USA in promiscuous homosexual men and drug addicts, and then in conurbations in Europe and Australia. There were no reports in females, older persons, or children until similar cases were detected in much smaller numbers in women or girls who used drugs or were partners of bisexual males. In late 1983, Science magazine published a report from the Pasteur Institute in Paris claiming discovery of a new retrovirus in a culture from an enlarged lymph gland in an otherwise asymptomatic homosexual man. Workers at the US National Cancer Institute in Washington then claimed that the new retrovirus in this culture was one which they had already isolated from many homosexual men with AIDS in the USA. The virus presumed to be present in these cultures was pronounced in 1984 by the US Secretary of Health to be the sole cause of AIDS and after some argument about priorities and patents,. named the Human Immune Deficiency Virus (HIV).

In this way, AIDS entered the public domain in headlines as a plague already causing thousands of cases in North America as the start of a lethal, global pandemic. This pronouncement -- without confirmation by isolation of the original retrovirus -- was accepted instantly by responsible medical scientists and hence by health authorities worldwide because antibodies, allegedly specific for indirect detection of HIV, were found in the blood of patients with AIDS. Wider testing supported the belief that HIV had spread beyond the risk groups defined above to the general population by heterosexual transmission. This became a dogma accepted without further question by an international consensus. Up to this point, the origins and causation of AIDS had been investigated openly and without prejudice. However, with the "discovery" of HIV as the putative, universally infectious retrovirus and the conversion of this hypothesis into a dogma by the consensus, all dissent began to be suppressed by anonymous censorship, which became absolute, amazingly pervasive, and apparently immune from disclosure of conflicts of interests.

While all this was happening, I was acting as a consultant to the World Health Organization (WHO) on social and behavioral aspects of communicable diseases. Although I accepted HIV as a possible participant in the complex pathogenesis of AIDS, I was impressed by the overriding fact that, in all countries with reliable registration procedures, full-blown AIDS was confined to the original risk groups of homosexual men and drug users, and to those -- like female partners of bisexual men and their infants -- who were passively exposed to the same risks. This trend was so invariable by 1987 that predictions based on appropriate mathematical formulae were accurate in numbers and distribution, year by year. There was no evidence whatsoever in 1987 that AIDS was being transmitted heterosexually in general populations except in headline propaganda about the scare of AIDS internationally. But I found then that, although the data and opinions that I offered to the WHO received attention internally, they were barred from publication. Meanwhile, medical literature exploded, with worldwide coverage in all media, to accommodate the consensus view that AIDS was becoming a global pandemic. Alarming figures accepted at face value by WHO from some third world countries were used to support this assertion.

In 1987, Professor Peter Duesberg, a pioneer in retrovirology at the University of California in Berkeley, suggested instead that HIV was a latent virus incapable of causing AIDS which was due, in his view, either to suppression of immunity by toxic drugs or to a recrudescence of other diseases. A fuller statement of his view, published by the prestigious US National Academy of Sciences in 1989, caused a furor. Duesberg's arguments were not debated. He was almost universally demonized but not silenced. Indeed, his dilemma became the focus of all doubts about AIDS, from whatever source. This did not help his courageous effort to promote rational debate because, by attracting irresponsible support, it enabled the consensus to discredit responsible doubts.

In 1989 also, the Royal Society organized a learned symposium on epidemiology. With few caveats, this endorsed earlier predictions of tens of thousands of cases in the UK by 1992. When I suggested that this was exactly what was not happening, the editor of the Society's Transactions generously invited me to submit my data and analysis of the problem. A four-year correspondence ensued, of questions by numerous peer-reviewers and answers by myself, which ended in 1994 when my paper was finally rejected. Among the two-inch file of correspondence amassed in that time were such comments as "Why should I read a paper by someone who believes the earth is flat?", and "the alternative proposed by the author provides no coherent criticism of the accepted position, for reasons that were well articulated in the national press following the notorious Duesberg Channel 4 program." The first comment says more, I think, about the reviewer, than about my paper, while the latter defies belief. That peer reviewers selected for their specialist knowledge should take a cue from the popular press is somewhat unusual, to say the least.

Meanwhile, the passage of time showed that my predictions made in 1989 were accurate to within 10 percent of actual registrations of AIDS, whereas those published in the symposium, official projections, and other expert quarters were exaggerated, often by orders of magnitude. It seemed that I was right for the wrong reasons whereas they were wrong for the right reasons -- a not impossible contingency, which should have provoked debate.

Instead, since 1990, Nature , Science , the New England Journal of Medicine , the British Medical Journal and other mainstream, peer-reviewed journals have preferred to reject papers by others besides my colleagues and me containing verifiable data that throw doubt on the claim that AIDS is capable of causing epidemics in general populations of developed countries by heterosexual transmission of HIV, and also falsify the hypothesis that HIV is the sole cause of AIDS. The Lancet has published some short letters but has consistently refused to publish fuller reasons for dissent. This is interesting in a journal which, since 1945, has regularly accepted papers from me on other subjects, and often invited me to draft editorials and assist with reviews. Twice I have been invited by the Royal Statistical Society to present my views and then turned down peremptorily. On many occasions, I have been asked by the BBC and other networks to talk about AIDS only to find, at the last minute, that my appearance was canceled. This happened also when a program with several distinguished experts participating made by Meditel Productions for Channel 4 was unaccountably stopped.

Secretive censorship like this is familiar to everyone who has dared to question orthodox views on AIDS. The result is that essential questions are never debated openly except in a few lesser journals, or in well-informed non-medical magazines like Reappraising AIDS and Continuum . The barrier to discussion at a UN Global AIDS Conference was breached for the first time by the (Swiss) International Forum for Access to Science in Geneva in 1998 in a marginalized session. Otherwise, the censorship maintained by the international consensus of experts in the main research councils, learned societies, official committees, and WHO is unyielding; so also are the main channels in radio, television, and the press. This censorship is not unique, but in my 57 years as a professional, I have never encountered anything like it nor did I ever think that I would in the world of medical science where, as in all other science, difference of opinion is the sine qua non of all advance.

There are many reasons for the censorship I have encountered. Different reasons for different people -- scientists profess scientific explanations for rejecting articles, editors profess editorial reasons, such as, "it's no longer news." In all, however, colleagues and I attempting to publish have met an unholy alliance intent on rejecting any papers that offer serious criticisms of the orthodoxy. There are, naturally, vested interests involved; many bodies and individuals receive high rewards for their work within orthodox AIDS science. Underlying much of this, the pharmaceutical companies have their own obvious agenda.

The mainstream journals and media to which I refer pride themselves on their independence and support for open debat, but whenever they are presented with reasonable doubts about AIDS, they close ranks like regimented clams.

Gordon Stewart serves as emeritus professor of public health at the University of Glasgow, a consultant in epidemiology and preventive medicine, and as an RA Director.