Critical appraisal is essential 2 May 2003
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Carl Williams,
layperson
TQ11 0LQ

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Re: Critical appraisal is essential

Dear Editor,  

It is both disappointing and frustrating to continue to witness the lack of civility and respect that certain contributors persistently display in their responses to fellow debaters.   

The recent contribution by Eleopulos et al, A critical examination of the evidence for the existence of HIV, illustrates above all else that there is still the need for serious critical debate of the contentious issues regarding HIV/AIDS.  Through critical appraisal of evidence and meaningful dialogue between scientists, researchers and clinicians, such as this forum makes possible, there is an opportunity to eradicate false impressions, to identify and make allowances for assumptions and to correct erroneous interpretations so that responsible public health recommendations can be made and safe and effective medical practices ensured.  Those who attempt to stifle such debate, or to debase it with inane and meaningless commentary do so out of fear because their own views lack intellectual propriety.  

A meaningful and productive debate can only be achieved if commentary is unfettered by personal attacks on contributors and if contributors themselves refrain from making deliberately obliquitous remarks that are intended to distract the reader from the original comments, rather than answer them.   

If the current understanding of HIV/AIDS is supported by an irrefutable mountain of evidence and research as some contributors to this debate would have us believe, then it is perfectly reasonable to expect that each and every one of Eleopulos’s points should be fully considered and thoroughly confuted by both the researchers who support the accepted theory that HIV is a new exogenous retrovirus that is sexually transmitted and by those clinicians who make decisions daily by reference to that theory.  If such a confutation is not possible then surely it is time for the medical community to acknowledge this, rather than to continue to ignore the reality.  

In his rapid e-mail response to the allied BMJ article by Spurgeon, HIV denial, 18th February, Peter Flegg makes the following comments:

The standpoint of those in “HIV denial” has little in common with the scientific method, no matter how prettily “dressed up” they can make it appear. It is based firstly on an unbreakable conviction (faith?) that they are correct, so they ignore data that do not support their own hypothesis, champion data (irrespective of its provenance) that is supportive, misquote and misinterpret data to suit their own ends, and sometimes, as Brian Foley has demonstrated, knowingly mislead and lie. They are past masters at trying to pass off the prevailing scientific view on HIV as being rigidly entrenched in dogma, and like to view themselves as the modern-day Gallileos challenging the Orthodox Church. This flies in the face of what we have learned about HIV over the last two decades using and incorporating new scientific evidence and the systematic evaluation of data to reach a clear consensus.  

To adequately address the dissidents’ arguments is difficult, since it can too easily become bogged down in detail and seemingly trivial points of order. Questions are seldom answered directly, but always replied to, with the intention of dragging the debate further off course and hopefully into a blind alley. Blatant misrepresentation of the evidence, dressed up to look scientifically plausible, can help persuade interested third parties with no scientific background as to the strength of their case.  

In another response by Peter Flegg, Do not be seduced by the sirens of dissidence, 21st February 2003 he goes on to say:  

Anand may not realise it, but rebuttals of points similar to Rasnick’s have been made time and time again, but the dissidents ignore the message and refuse to behave like decent scientists should by modifying their views in the face of new evidence. Rasnick talks about problems with HIV testing, and quotes several sources, most of which are either not peer-reviewed or which are so old as to have been superceded by new data (of which he is no doubt aware but prepared to ignore). Of course HIV tests are not perfect, with 100% sensitivity and specificity, but recent assays approach this level and are some distance away from early assays used in the 1980s and often bedevilled by low (but unacceptable) false positivity rates.  

And lastly in a response entitled HIV/AIDS – there is no “debate” 3rd March 2003, Peter Flegg makes the following remarks:  

Whenever his claims are discounted, or a point by point rebuttal is given, instead of staying "on topic" and discussing these, he moves in a different direction. Good scientists are meant to accept new evidence and incorporate this into their hypotheses. The dissident approach is to ignore new evidence that is contradictory to their predetermined stance. After comprehensive rebuttal of any point of view, the dissident tactic is to quickly switch to a different topic. Then later, when no- one is looking, they can switch back to the original theme, hoping no-one will realise that these points were completely discredited on an earlier occasion.  

Having read all the responses to these two BMJ articles, it is difficult to understand how Peter Flegg can draw the conclusion that it is the so-called dissident commentators who are guilty of the anti-scientific approach he has leveled in his remarks above.   

I became interested in this web debate after reading Gisselquist et al’s commentary in the International Journal of STD & AIDS 2003;14:148-161.  In that commentary the authors’ note:  

“The post-1988 consensus that ascribed over 90% of adult HIV to heterosexual transmission and an insignificant proportion to unsafe injections was not at the time-or later-supported by calculations from evidence associating HIV with sexual behaviours. Instead, the numerical estimate seems to have been derived by a process of elimination.”  

The authors go on to say:  

“Influential epidemiologic reviews published between 1987 and 1990 presented a variety of inferential arguments and hypothesis to support consensus estimates of sexual transmission.”  

Later under the section: Why was evidence ignored? The authors’ state:  

“It has been said that people often see what they wish to see.”  

In Brewer et al’s introduction to the same article pages 144-147, the authors make the following mention in their conclusion:  

“HIV is not transmitted by ‘sex’, but only by specific risky practices.”   

The authors conclude by saying:  

“Dispassionate assessment of our conclusions admittedly depends on a willing suspension of disbelief, since the current paradigm is deeply embedded.  Counter arguments can (and will) be levelled at each of the anomalies noted, but the depth and breadth of concerns deserve fair scrutiny.  At issue in a re-evaluation of the heterosexual hypothesis are the profound implications for our interventive approach, and for the kind of social and financial commitments that must be made.  Finally Africans deserve scientifically sound information on the epidemiologic determinants of their calamitous AIDS epidemic.”  

In looking at the research into the African AIDS epidemic I found that, in fact, large numbers of healthy, HIV positive individuals were living well into adulthood prior to 1973, at a time when HIV wasn’t even thought to exist.  See my letter: Further comments on debate 18th March 2003 Rapid responses to: Canadian aboriginals in Vancouver face AIDS epidemic David Spurgeon, BMJ 2003; 326:  

More recently I became aware of research that is documented in Jaap Goudsmit’s book ‘Viral Sex’.  In the book Goudsmit discusses an epidemic of Pneumocystis carinni pneumonia in children that emerged just before World War II and lasted for about twenty years. It affected only children in their first year of life, only in continental Europe, but thousands of children died...Adults were affected but only sporadically".  According to Goudsmit, the cause of the PCP epidemic in children even before the AIDS era, was HIV.   

1 The epidemics appeared in "institutionalized, debilitated children…premature, malnourished infants".{Walzer, 1987 *2041}
2. Such epidemics occurred in widely separated hospitals of Eastern and Western Europe only in children, without parents or any other adult group being affected.
3. "In the laboratory the most striking observation was a hypergammaglobulinaemia.  This means an abnormally high level of antibodies–a sign of chronic infectious disease and a hallmark of AIDS in children".  Yet, "the 1950s disease was importantly different from paediatric AIDS as seen since the 1980s".
4."No children who recovered from early PCP (with or without CMV) died years later of other manifestations of immunodeficiency".
5. The epidemic stopped and the children cleared HIV without any treatment while in the AIDS era with tens of billions of dollars spent on treatment, HIV has not been cleared even from one single individual.{Goudsmit, 1997 *1330}

In conclusion  

If, as Jaap Goudsmit has documented, illnesses that are now considered to be proof of AIDS existed more than 50 years ago in central Europe in very large numbers and more importantly, if those diseases were caused by HIV, then the currently accepted notion that HIV is a new sexually transmitted exogenous retrovirus needs to be re-examined.   

The fact that those who survived (what is now considered to be an AIDS defining illness) did not go on to develop further manifestations of AIDS (without the modern diagnostic, monitoring and treatment for HIV that is believed to extend the lives of those diagnosed HIV positive), has deep significance with respect to the current treatment of HIV and the notion that being diagnosed HIV positive on its own leads inevitably to an early death.   

It is surely time that the medical community take seriously the points made by Eleopolus et al.  To my mind her comments, as do Brewer's and Gisselquist's send an important message to the medical community in general and to the HIV community in particular: that the accepted paradigm on which research is undertaken, treatment recommendations and clinical decisions made, needs to be urgently reappraised.  

Yours  

Carl Williams    

Competing interests:   None declared