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Part II: Literature Review

Mostly from Harper's.

In recent days (and weeks) I've read some articles I feel deserve comment. First to the plate, one to which I believe I've referred in the past as a potentially fine piece of writing which went downhill in a hurry:

"Crap Shoot: Everyone Loses When Politics is a Game" by Garret Keizer
This is the article the response to which has been fermenting longest in my mind. I initially quite enjoyed the concept of the article--writing about the culture of "players" in modern America. Unfortunately, the piece deteriorated from more or less a piece of literary nonfiction, academic in tone and citing to classical references to games and players (and as such making me eager for some discussion of Hesse's The Glass Bead Game), to something of a political rant. While I recognize in myself a tendency toward that far-left brand of paranoid, conspiratorial liberalism, I prefer my paranoia to be supported by fact. That may seem an oxymoron, but there's plenty out there to vindicate my positions and beliefs. Any of this factual support would have done wonders for Keizer's attempt at an intellectual discussion of the state of politics, which featured exercises in visualizing the President and his cronies rolling gleefully around on piles of money, laughing at the poor conservative ideologues being cheated out of government services, the money for which is instead being siphoned into Halliburton. A reference to America's choice in the last presidential election between two members of Skull and Bones goes much further in presenting an image of just how much "the game" has seeped into politics, and in fact every aspect of life, than do the political rants of a frustrated liberal. In focusing too much on the latter and too little on the former, and in the uneven tone of the article, which seems uncertain as to whether it falls into the camp of the abstractly academic or more practical political science, I think the editors of Harper's presented their readers with a work unfulfilled potential (albeit one that's still worth reading).

"Out of Control: Aids and the Corruption of Medical Science" by Celia Farber
"The latest issue of Harper's Magazine contains a stunning 15-page article by well-known AIDS denialist Celia Farber (formerly of Spin magazine) that extensively repeats UC Berkeley virologist Peter Duesberg's discredited theory that HIV does not cause AIDS." Richard Kim, The Nation Blog.

That sentence demonstrates a fundamental lack of understanding as to both the content and the overall aim of Farber's article. In sorting through some of the article's backlash online, I've (not unexpectedly) run across myriad knee-jerk reactions to this article. Most "stunning," perhaps, is this (.pdf format), whose authors accuse Farber of "[u]sing a plethora of false, misleading, biased and unfair statements," then go on to do the same themselves, relying primarily false logical claims and hypocritical statements in a miserably failed attempt to discredit Farber. Before getting into further discussion of Farber's article itself, I'll provide some examples of the shockingly poor scholarship on which this document is based:

(1) "It has been alleged that some of their subjects have died due to this experiment" (2, attempting to discredit the research of scientists Farber supports) .
"To try to get readers to conclude that an ARV related death can be generalised to conclude that the risks of ARVs outweigh their benefits is misleading and unscientific" (5).

(2) "Farber states that pregnancy itself can cause a false positive result. She supplies no supporting reference.
A properly conducted HIV-test protocol (which involves at least two HIV tests) has a very small chance of giving a false positive, irrespective of pregnancy status" (4).

Logically speaking, "...can cause..." = "...chance..." "Very small" is hardly quantitative, and smacks of the fuzziness that Farber complains of in her article.

(3) "Farber states that all 'babies born to HIV-positive mother are born positive but most become negative within 18 months.'
Farber is clearly confused by the passing on of the mother's antibodies to the child, a natural mechanism that protects the child from infectious disease as its own immune system develops" (5).

The Farber quote is taken out of context. Farber is referring here not to the actual medical condition of babies born to HIV-positive mothers, but to the tendency of doctors to draw conclusions as to infants' HIV status based solely on the sketchy medical evidence the authors here imply that Farber herself is relying on.

(4) "In footnote one, Farber makes various false statements about HIV tests. She comments that HIV tests are not even required for an AIDS diagnosis in Africa. She also claims most HIV tests come back indeterminate or negative when redone. She supplies no references.
Most people in the industrialised world, as well as many developing countries, have at least two different HIV antibody tests to confirm they are HIV-positive, as part of the HIV testing protocol. HIV tests are highly accurate. It is false that when most people are retested they test indeterminate or negative. Even the risk of a single HIV ELISA test giving a false positive is less than 1% with today's tests.
HIV tests are required for an AIDS diagnosis in South Africa. They are also standard in Botswana, Kenya, Uganda and many other clinics throughout Africa. An AIDS diagnosis cannot be considered definitive without an HIV test. Farber's comment about hopping on a plane from Uganda to Australia to change HIV diagnosis is simply silly hyperbole" (6).

I hardly need to point out that the authors here supply no references. Furthermore, note phrases such as "most people in the industrialised world" (em. added), "many developing countries," "many other clinics" as contrasted with "HIV ELISE test," "South Africa...Botswana, Kenya, Uganda"--the use of non-quantitative adjectives such as "many," qualifiers such as "in the industrialised world," and short lists of specific examples simply do not provide logical grounds for refutation of Farber's point (which, incidentally, was also overstated in the authors' reference to it--the sweeping generalization that "HIV tests are not even required for an AIDS diagnosis in Africa" is the authors' own interpretation). This is among the most intellectually dishonest statements I've read.

(5) "Farber points out that Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has taken money from Boehringer Ingelheim and implies this disqualifies them from commenting on the safety of short-course nevirapine.
It is the function of the EGPAF, a registered charity, to prevent MTCT. The fact that the EGPAF has taken money from Boehringer Ingelheim does not disqualify it from commenting on the safety of nevirapine" (7).

Again, the authors supply their own interpretation, that Farber "implies this disqualifies them from commenting." An equally valid interpretation would be that Farber intends to provide a grain of salt to go along with the sugar that most of us are accustomed to being spoonfed. To deny that a researcher's source of funding might have any effect on the direction of his or her research is a surprisingly naive position for a group of scientists to take--a smattering of legal education might provide some enlightenment as to the effect of economic forces on the pharmaceutical industry (think Vioxx...).

(6) "Footnote 4 also states that AIDS happens to have the same symptoms as 'chronic malnutrition, malaria, parasitic infections and other common African illnesses.'
HIV, not poverty, predicts progression to AIDS in Africa.
...
Sewankambo et al. (2000) is a study of nearly 20,000 people, both HIV-positive and HIV-negative in a Ugandan district. People with HIV were much more likely to get sick or die. Furthermore death rates in civil servants and the better-educated (i.e. not the poor) were higher than the general population. This was associated with HIV infection (7)."

This is disingenuous both because the cited study makes no reference to AIDS and because Farber makes the claim, which the authors of this document have not refuted, that HIV is overdiagnosed in Africa.

(7) "Footnote 4 further states that HIV tests are prohibitively expensive in Africa. T (sic)
HIV tests are widely available across Africa. They are not prohibitively expensive for large numbers of people."

Same fallacy of generalization: "widely available," "large numbers of people"--what's a large number of people? 50? 1000? They could be widely available for large numbers of people and utterly unavailable for even larger numbers of people. This response basically says nothing.

That's probably enough of that. On to the article itself:

For all the controversy surrounding Farber's article, it is actually founded upon a simple premise: AIDS research skipped over some important preliminary steps in its hurry to fix the problem, and as such, our understanding of the disease is fundamentally flawed. Farber and Dr. Peter Duesberg do not make the claim to which so many people violently react (namely, that HIV does not cause AIDS), but rather that there is thus far insufficient proof that HIV does cause AIDS. Their primary call is for more research on the fundamental nature of HIV and AIDS before drug companies move forward with similarly flawed trials on uninformed African subjects. Farber devotes most of her attention to one such study (HIVNET 012) whose methodology was unquestionably flawed but whose questionable results nevertheless prompted a strong corporate push for further trial and FDA approval. At the same time, she discusses the knee-jerk hostility which effectively blacklisted Dr. Duesberg in the United States, not because of the quality of his research, but because of its results. Farber's weaving of the two stories, a tactic maligned in dailyKOS, makes for engaging reading and a fascinating overview of the effects of politics and economics on the scientific community.

In the spirit of linguistic hostility so pervasive in modern America, Farber has been deemed an AIDS denialist, when in reality her piece reads as much more intellectually honest than any rebuke I have yet read. Until I am presented with scientific or logical evidence that any of Farber's claims (that the nature of HIV and AIDS requires further study, that political and economic forces feed the development of AIDS treatments, that there have existed drug trials treating African women as guinea pigs) are false, I remain in the mode I believe the article was intended to provoke in its readers: a slightly more informed but even further curious skepticism.

Scientists among readers, please comment and inform me in my ignorance! Here is an edited version of the article in question.

I think there were more articles I meant to comment on, but that should be sufficient for now. Part III awaits, and I'm getting hungry.