Document:Cohen reviews Farber

From AIDS Wiki
Jump to: navigation, search
NOTWITHSTANDING ANY OTHER NOTICE ON THIS PAGE, the material on this page is NOT available under the GNU Free Documentation License; in accordance with Title 17 U.S.C. section 107, it is posted in the manner of bulletin boards in schools and workplaces, to encourage public education and citizen awareness, without profit or payment, for persons and entities engaging in non-profit research and educational activities and purposes only.


Review of Serious Adverse Events
by Marcus A. Cohen

The Townsend Letter
October 2006


FarberBook.jpg

Since mid-summer 2005, I've published seven columns in Townsend about AIDS. This column, the eighth focusing on AIDS, reviews Serious Adverse Events: An Uncensored History of AIDS by Celia Farber. Why the sudden spate of columns on AIDS? Over the past year, familiarization with AIDS research and treatment has convinced me that efforts to quell dissent within this field are the most stifling in the medical world. Such a situation requires exposure – as often as possible. In this connection, I'll quote from a 1990 editorial in the Annals of Internal Medicine, which commented on disagreement over practice guidelines and reflected the thinking of a good number of clinicians. I believe the last sentence applies in spades to censorship by the HIV-AIDS establishment:


"Whoever sets guidelines should expect disagreement. Indeed, they should encourage it. The debate may not be easy on egos and may threaten vested interests, but it is good for the improvement of medicine. It is unfortunately common to hear an interest group advance its opinions and then cry foul when other groups have opinions of their own. If the disagreement is on the interpretation of evidence, that is all for the good; but if it is on who is allowed to define what is the correct practice of medicine, then we are all in trouble." [1] [italics added].


Celia Farber, an independent investigative reporter, has covered the AIDS scene in the US and abroad for 19 years. In March 2006, Harper's Magazine published an article by her that roiled the HIV-AIDS establishment, producing an immediate ripple effect like a small boulder catapulted into standing water. "Out of Control: AIDS and the Corruption of Medical Science" reinvestigates the turbid circumstances surrounding the AIDS community's acceptance of nevirapine, an antiretroviral drug developed to prevent the transmission of HIV from mothers to children. Toward the article's end, Faber also relates the nevirapine story to the political context of HIV-AIDS research, bringing up Professor Peter Duesberg, who was a respected virologist before he published articles in peer-reviewed journals in the late 1980s contending HIV doesn't cause AIDS. (Duesberg is also a cancer researcher; his work in this field is still widely respected.)

Prior to her article in Harper's, Farber had consistently grounded her reports on the observations and views of researchers, clinicians, and patients skeptical of the orthodox position on HIV and AIDS therapy; her stories kept open questions about AIDS causation and sounded alarms on the toxic effects of anti-HIV drugs. In her first book, Serious Adverse Events, Farber asks more of the same questions and heightens the level of the alarms.

Serious Adverse Events contains 12 pieces, many of them reprinted without changes, the rest updated to incorporate new information. These articles, which appear in the book as numbered chapters, still bear their original titles. All but one appeared in either Spin, Gear, Red Flags, Mothering, or Harper's Magazine. Chapter One, about Professor Peter Duesberg, was originally written for Harper's, but was replaced by her story on nevirapine, so this is a new publication. Also previously unpublished is a preface and epilogue, both offering fresh observations. Together, these pieces cover most of the important issues and developments in AIDS since the mid-1980s.

Long or short, there's not a slow read among the 12 chapters. Farber has a gift for images mirroring situations into which individuals fall when they challenge the AIDS establishment, and for quotes sharply defining (or deflating) the people on which she trains her investigative sights. One of her most memorable images comes three paragraphs into the opening chapter, "The Passion of Peter Duesberg." In the following excerpt, she's finally located the Donner Lab, screened by woods at the outskirts of the University of California campus at Berkeley, en route to interview Duesberg at his office in the lab. She describes her first glimpse of him:


"Thanks to large donations from two pharmaceutical companies, Berkeley's biology facilities are undergoing extensive renovation. There are bulldozers here and there, and near the Donner lab is a huge gaping hole where a building has just been demolished. In the distance, I spot Peter Duesberg weaving on his bicycle past the bulldozers on his way into the lab. In the heat of the sun, it seems to me that their jaws might just reach down and snap him up, putting a quick, merciful end to the nearly twenty-year battle between the Establishment and the troublesome scientist."


As her chapter on Duesberg proceeds, recounting the abrupt shut-off of research funds after publication of his papers arguing that HIV has no active role in AIDS, the derision and ostracism he's suffered in the scientific community and media for persisting in his dissent on HIV, and his emotional and intellectual responses to the ordeal he's been through, that initial image of Duesberg threatened by bulldozers hangs in the mind. Even when Farber speaks of renewed respect for him because of his research on aneuploidy (an abnormal number of chromosomes observed in all malignant cells, proposed as the initiator of cancer), the image of an imperiled Duesberg lingers. The word "passion" in the chapter title, by the way, is used as it is in the Gospels in reference to the suffering and crucifixion of Jesus; in Farber's "passion" of Professor Duesberg, the torment is real, the crucifixion figurative, of course.

Chapter Eight, "The Rebel Genius," portrays Kary Mullis, who earned a Nobel Prize in 1993 for figuring out a method of rapidly mass-producing DNA segments, called the polymerase chain reaction (PCR). PCR tests have been used since, among numerous ways, to identify dead people through fragmentary remains, clear men convicted and jailed for rapes they didn't commit, and reconstruct genomes of long-extinct species for scientific study.

Like Duesberg, Mullis doesn't think HIV causes AIDS, and public airing of his disbelief has ticked off many of his scientific peers. But Mullis also has a reputation as an eccentric, in both his professional and private lives. The first paper he published (1986) offered his picture of the universe from a psychedelic viewpoint; giving lectures, he's displayed photos of naked girlfriends, "their bodies traced with Mandelbrot fractal patterns" (Farber's words). Farber bunches most of this offbeat stuff up front, together with her take on his eccentricities, transforming certain of those eccentricities into scientific virtues.

"Mullis," she writes, "who has been described in the press as possessing a 'creative nonconformity that verges on the lunatic,' struck me as a person with a pure and insatiable curiosity... For instance, at the end of the interview, he asked me to articulate why it would matter if I were to discover that the hotel lobby, the bar, the bartender, the drinks, and our conversation had all been an electronic mirage."

Quotes revealing character, deep scientific insight, and motivation are the highlights in her sketch of Mullis. Midway into the chapter, she has Mullis expand on why he feels researchers have gone off-track straining to grasp how HIV causes AIDS:


"A lot of people studying this disease are looking for the clever little pathways that will show how this works. Like, 'What if this molecule was produced by this one and then this one by this one, and then what if this one and that one induce this one' – that stuff becomes, after two molecules, conjecture of the rankest kind. People who sit there and talk about it don't realize that molecules themselves are somewhat hypothetical, and that their interactions are even more so. You don't need to look that far. You don't discover the cause of something like AIDS by dealing with incredibly obscure things.


By the time Farber draws the final lines of her portrait, Mullis, the eccentric, has been downplayed; another Mullis, dismayed by what he feels is happening in AIDS research, stands out, anguished, frustrated, and irate:


"Do we care about these people that are HIV-positive whose lives have been ruined? Those are the people I'm most concerned about. Every night I think about this... The horror of it is every goddamn thing you look at...seems pretty scary to me... God, I hate this kind of crap... It just drives me to – I'm making tears thinking about it. I don't see how to deal with it. I can't possibly write a book that will describe it to somebody. You can't do a damn 22.8-minute TV thing that is going to have any effect...


"Science Fiction," Farber's tenth chapter, exposes the shoddy research and hype that led in 1996 to mass adoption of drug cocktails – combinations of recently developed protease inhibitors, AZT, and other drugs – to prevent replication of HIV and drop viral load to negligible levels. Dr. David Ho, then newly chosen director of the Aaron Diamond AIDS Research Center in New York, had conducted the pioneering research on the combination therapy, giving cocktails to nine AIDS patients, measuring drug-resistant mutations, then calculating the amount of virus particles produced by infected cells.

Ho based the experiment on the premise that HIV replicates swiftly from the moment of infection, slightly faster than the mass-production of T-cells defending the body, eventually resulting in collapse of the entire immune system. In consultation with mathematicians, Ho devised a mathematical model to predict the rate at which HIV would multiply if unchecked by combination drug treatment. He reported his findings at the International AIDS Conference in Vancouver in the summer of 1996; after cocktail therapy for between 90 and 300 days, the nine patients showed no evidence of HIV in the bloodstream. Hit early and hard, Ho concluded, and it was possible to eradicate HIV permanently.

Farber quotes Dr. Steven Miles, professor of medicine, University of Minnesota Medical School, on the impact of Ho's findings and conclusion: "It was almost like an instantaneous religion, or a cult, right after Vancouver. You were either a part of that hit-hard-hit-early religion or you were not. It split the HIV community." Farber sums up the broader effects of Ho's research: "The 'breakthrough' provided hope to two main players: HIV-positive people could hope for a new lease on life, and the drug companies could sell drugs like never before. They could even keep their customers convinced, through the AIDS-care network itself, that total compliance with the draconian discipline of the cocktail was the only path to heroic survival. Miss one pill, the new wisdom held, and HIV, enigmatically, will 'mutate.'"

Having raised the backdrop for cocktail therapy, Farber devotes the rest of this chapter to bringing its fuzzy premises and substantial dangers center stage. While doing so, she demolishes David Ho's math model, emphasizes the absurdities of viral load, details the side effects of protease inhibitors, calls attention to invasive efforts to ensure compliance with the combination regimen, and fixes ultimate responsibility for promotion of AIDS cocktails on the media. All this she accomplishes chiefly by quoting experts critical of Ho and the cocktails (citing mainstream studies, too). Most of these experts subscribe to the theory that HIV causes AIDS.

Let's touch on the major points in this chapter; it strikes me as the most disturbing in the book, with the widest ramifications today. According to a physician Farber cites in the chapter, three out of four people currently placed on these drugs are asymptomatic. As she puts it, that's "one big medical experiment," the outcome of which is uncertain. Add another uncertainty, the long-term side effects, and that's a huge amount of potential risk riding on a gamble – that protease inhibitors will pay off at the last spin of the wheel – with the lives of HIV-positive people on cocktails.

Puncturing Dr. David Ho's mathematical model, Farber begins with an expert in math, Mark Craddock, at the University of Technology–Sydney. Craddock dismisses the model as "mathematical junk"; there's no way one person can churn out that much virus. "Ho's equations," says Craddock, "predict that over the course of ten years, an HIV-positive person will produce more particles of HIV than there are atoms in the universe."

Farber finishes off the model with a quote from Dr. Joseph Sonnabend, an AIDS clinical researcher originally at odds with the HIV establishment over treatment. "Of course it's wrong," Sonnabend exclaims. He then deflates another of Ho's ideas, that hitting HIV hard and early with cocktails can eradicate HIV: "The notion of 'eradication' is just total science fiction. Every retrovirologist knows this. The RNA of retroviruses turns into DNA and becomes part of us... You can't ever get rid of it."

For comments on the absurdities of measuring viral load, Farber summons Dr. David Rasnick (definitely not a subscriber to HIV), a scientist who was involved in the development of protease inhibitors, Rasnick observes that testing for HIV in breast milk requires 45 PCR cycles – a 35-trillionfold amplification – to detect sufficient genetic material! In essence, he goes on, they start with a number that's next to nothing, mass multiply it, and use that number to scare people into combination-drug therapy. HIV starts out undetectable and ends up more or less undetectable, contends Rasnick, who concludes: "All this stuff about wanting to get to zero, or to undetectable, is absurd because it implies that a single particle of HIV is lethal, but it's not... This is the biological equivalent of counting bumpers in a junkyard and saying they represent functional cars."

Doing the balance sheet on protease inhibitors, Farber is mostly on her own. There's a "virtual blizzard of data," she writes, that can be molded into plusses or minuses. Protease inhibitors have lifted patients, Lazarus-like, off their deathbeds. They've killed some patients. They've so impaired the lives of others that these people long for death.

In the minus column she puts in the unexpected "disruption of the body's fat-distribution mechanisms," resulting in heart attacks and strokes when markers for CD4 cells and viral load indicated that the protease inhibitors were "working." A study she cites, conducted at the University of Colorado Health Science Center, warns of kidney and liver failure; according to this study, the number of patients on these drugs who died of kidney and liver failure "surpassed deaths due to advanced HIV in 2002."

For support, Farber relies again on quotes from mainstream experts; Drs. Joseph Sonnabend, and Steven Mills. "The people for whom benefit has been proven beyond a doubt are really sick people who would have died without them," says Sonnabend. "But the target population for the drug companies are the healthy people, and these people will almost certainly have their lives shortened by these drugs."

"The vast majority – about 75 percent – of people who go on these drugs are completely healthy," says Dr. Steven Miles. "Large numbers of people are being inappropriately treated with drugs they don't need. And their lives are probably being shortened."

The surveillance system depicted by Farber to ensure compliance with the cocktails is scary: computer chips in bottle caps, recording the date and time of each opening; beepers; buddy systems; support groups; observation centers where patients taking the drugs are watched; groups of AIDS professionals infiltrating people's social networks to enlist them in helping push the drugs. "They call it 'treatment compliance,'" Farber writes, "and it has largely replaced safe sex as the core social imperative of the AIDS industry."

Who bears ultimate responsibility for the business of protease inhibitors? Farber turns to Dr. Joseph Sonnabend to answer this question. "Journalists," Sonnabend answers. "We have traditionally depended on the press to protect us from nonsense like this – not anymore. Now people who have feet of clay become oracles thanks to their publicists and the cooperation of journalists. And the real tragedy is that years have been wasted on this David Ho eradication hype."

Introducing this column, I summarized the content of Farber's article in Harper's. In three columns on African AIDS published in the Townsend Letter (Nov. 2005 — Jan. 2006), I discussed and quoted at length from her two field reports from Africa, first published in 1993. It's my impression that these reports have been reprinted without significant change; I needn't say more about them now. Counting Farber's portraits of Peter Duesberg and Kary Mullis, from which I've excerpted illustrative passages above, and the chapter on protease inhibitors, I've covered half her book; there's no space left to squeeze in even capsule descriptions of the six remaining chapters. I can say, without reservation, that they abound in the same vivid images and penetrating quotes that distinguish the chapters I've selected for review and that their content is equally important in counterbalancing the HIV establishment's positions on AIDS.

Gleaning Truth

"Truth," remarked Oscar Wilde, "is rarely pure, and never simple." Farber understands that truth shows a number of faces, some disguised, that it's no cinch discerning which face is authentic. I believe that soon after she started reporting on AIDS truth for Farber became everything consequential which the HIV orthodox sought to deep-six. Thereafter, she took upon herself the task of giving voice to people the orthodoxy attempted to squelch and airing reliable contradictory information the guardians of HIV doctrine aimed to smother under a shroud of silence. If it were in my power, I'd award her a commendation for public service – and several purple hearts for wounds to her psyche and reputation suffered in performance.

In the preface to her book, Farber reflects on the meaning of truth within the context of AIDS. I'm again going to quote several paragraphs, because paraphrasing or summarizing a writer as adept as Farber is in her selection and arrangement of words diminishes the acuity and subtlety of her thought. First, here is the context:


"The HIV-causes-AIDS model was nothing if not mechanistic, and ferociously reductionist. Its net trapped new and emerging technologies. It exploited ancient fears seeded in sex, shame, and death. The net trapped all those who turned up 'positive' on an antibody test, a test that has now all but lost all biological meaning and specificity. It was a mark of death, understood at the time as a sure death sentence...
This book is about the twenty-year war between those who believed in the death sentence and those who did not. It was, as I say, an informational war – a war of ideas, values, money, power, and the ways that all of those things cast impossible shadows on what was called 'irrefutable data,' and 'overwhelming evidence.'
From the ashes of that war, a new narrative is emerging, from the experiences of untold millions who fell into the net, usually by way of a single antibody test, and without any knowledge of the dissent against the official theory. The AIDS war divided those who believed and enacted its every dictum, from those who, very early on, saw a parallel reality, a sister ship loaded with a very different cargo of facts and interpretations. This could only happen at the time when the world was flooded with 'information,' and yet, mass media gained unsurpassed powers of persuasion. To question the core catechism that HIV was the single and direct cause of AIDS became an act of not only heresy, but grave moral 'irresponsibility,' finally escalating into open charges of murder.


Tomas Transtromer, a Swedish poet admired by Farber, gave her a phrase for the title of her preface – "The Truth Barrier." For Transtromer, she explains, this phrase invokes "the membrane where 'truth' struggles to reconcile itself with a disturbed world." She goes on: "Transtromer's frequent use of the word 'truth' is the equivalent of nature itself. In many poems Transtromer describes how easily 'truth' breaks when we try too hard to catch it, possess it, personify it. A 'scientific truth' is after all a secret of nature, not of man. It always rises to the surface and confronts the world. In the poem, 'Preludes,' he writes: 'Two truths draw nearer each other. One comes from inside, one comes from outside, and where they meet we have a chance to see ourselves.'"

For Farber then, truth is elusive. And when we catch sight of it, we seek to evade it, because we tend to avoid knowing ourselves. (She's following a Transtromer insight into our avoidance of self-knowledge.) Here's the last sentence of her preface, reinforcing the elusiveness of truth: "Whatever the truth may turn out to be, it is something that involves us all, moves through us, from inside and from outside, drawing nearer and slipping away."

Is there any certainty that Farber can latch onto? Yes, one. She writes:


"Beneath the industrial, social roar of all we mean when we say 'AIDS,' is yet another of nature's secrets that man presumes to have unlocked. My one certainty is that something very critical is working itself out here, through this epic scientific clash. Does HIV cause AIDS? I don't know if it does or not – I'm not really equipped to know. The story I have tried to tell, and which this book explores, is the story not of my own beliefs about science (I'm not a scientist) but of the epic human drama between those who say yes and those who say no to this question."


Farber's reporting is always clear-eyed, and her language is livelier than the writings of most journalists. The pieces selected for her book allow us to appreciate her "true" face in its complex make-up. If you care to explore the "parallel reality" in AIDS on which Farber concentrates, if you're curious to board a "sister ship" freighted with a cargo of facts and interpretations very different from those aboard the super freighter "HIV-AIDS," jot down Celia Farber's Serious Adverse Events on your required reading list.

Footnote

  1.   Fletcher RH, Fletcher SW, "Clinical practice guidelines", Ann Intern Med. 1990 Nov 1; 113(9): 645-646.

© 2006 by Marcus A. Cohen
Originally published in The Townsend Letter