Document:Drug Consumption 6

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AIDS Acquired by Drug Consumption and Other Noncontagious Risk Factors
Pharmacology & Therapeutics 55: 201–277, 1992
Part 6: Why Did AIDS Science Go Wrong?
by Peter Duesberg

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The Legacy of the Successful Germ Theory: A Bias Against Noninfectious Pathogens

Unlike any other scientific hypothesis, the virus-AIDS hypothesis became national American dogma before it could be reviewed by the scientific community. It had been announced by the Secretary of Health and Human Services in 1984 before it had been published in the scientific literature. Unlike any other medical hypothesis it captured the world without ever bearing any fruits in terms of public health benefits. From the beginning the hypothesis has absorbed the critical potential of its many followers with the question, whether Montagnier from France or Gallo from the U.S. had won the race in isolating the “AIDS virus” and who owned the lucrative patent rights for the “AIDS test.” This question was so consuming that the presidents of the two countries were called to sign a settlement, and a revisionist paper was published by the opponents describing their fierce controversy as an entente cordiale against the real enemy, the “deadly” AIDS virus (Gallo and Montagnier, 1987). During the 1980s press accounts consistently called HIV “the deadly virus” (Duesberg, 1989c).

Clearly, the enthusiastic acceptance of the virus-AIDS hypothesis was not based on its scientific rigor or its fruits. It was instead grounded on the universal admiration and respect for the germ theory. The germ theory of the late 19th century ended the era of infectious diseases, which now account for less than 1% of all mortality in the Western World (Cairns, 1978). It celebrated its last triumph in the 1950s with the elimination of the polio epidemic by antiviral vaccines.

But the germ theory continues to inspire both scientists and the public to believe that a “good” body can be protected against “evil” microbes. Accordingly, even the greatly feared and highly stigmatizing “AIDS test” for a presumably new, sexually transmitted “AIDS virus” was readily sold to all governments, medical associations and even to the AIDS risk groups (Section 6.2), despite the absence of convincing evidence for transmissibility. In the words of one observer, “The rationale for such programs is often the historical precedent of syphilis screening,” which “never proved to be effective” and led to “toxic treatments with arsenical drugs, assuming the tests were correct...” and “deep stigma and disrupted relationships....” “Patients required a painful regimen of injections, sometimes for as long as two years” (Brandt, 1988). Even epidemiologists failed to recognize that AIDS and HIV were only spreading in newly-established behavioral and clinical risk groups and that HIV was a long-established virus in the general populations of many countries (Section 3.5.1). Instead of considering noninfectious causes, they simulated “coagents” (Eggers and Weyer, 1991) and “assortative scenarios” (Anderson and May, 1992) to hide the growing discrepancies between HIV and AIDS and intimidated skeptics with apocalyptic predictions of AIDS pandemics in the general populations of many countries that have raised fears and funds to unprecedented levels (Section 1) (Heyward and Curran, 1988; Mann et al., 1988; Mann and the Global AIDS Policy Coalition, 1992; Anderson and May, 1992).

Even now, in an era free of infectious diseases but full of man-made chemicals, scientists and the public share an unthinking preference for infectious over noninfectious pathogens. Both groups share an obsolete microbophobia but tolerate the use or even indulge in the consumption of numerous recreational and medical drugs. Moreover, progressive scientists and policy makers are not interested in recreational and medical drugs and man-made environmental toxins as causes of diseases, because the mechanisms of pathogenesis are predictable. Further, prevention of drug diseases is scientifically trivial and commercially unattractive.

By contrast, microbial and particularly viral pathogens are scientifically and commercially attractive to scientists. Beginning with Peyton Rous, at least 10 Nobel prizes have been given to virologists in the last 25 years. And many virologists have become successful biotechnologists. For example, a blood test for a virus is good business if the test becomes mandatory for the 12 million annual blood donations in the U.S., e.g. the “AIDS test.” The same is true for a vaccine or an antiviral drug that is approved by the Food and Drug Administration.

Thousands of lives have been sacrificed to this bias for infectious theories of disease, even before AIDS appeared. For example, the U.S. Public Health Service insisted for over 10 years in the 1920s that pellagra was infectious, rather than a vitamin B deficiency as had been proposed by Joseph Goldberger (Bailey, 1968). Tertiary syphillis is commonly blamed on treponemes, but is probably due to a combination of treponemes and long-term mercury and arsenic treatments used prior to penicillin, or merely to these treatments alone (Brandt, 1988; Fry, 1989). “Unconventional” viruses were blamed for neurological diseases like Kreutzfeld-Jacob’s disease, Alzheimer’s disease and kuru (Gajdusek, 1977). The now extinct kuru was probably a genetic disorder that affected just one tribe of natives from New Guinea (Duesberg and Schwartz, 1992). Although a Nobel Prize was given for this theory, the viruses never materialized and an unconventional protein, termed “prion,” is now blamed for some of these diseases (Evans, 1989c; Duesberg and Schwartz, 1992). Shortly after this incident, a virus was also blamed for a fatal epidemic of neuropathy, including blinding, that started in the 1960s in Japan, but it turned out later to be caused by the prescription drug clioquinol (Enterovioform, Ciba-Geigy) (Kono, 1975; Shigematsu et al., 1975). In 1976 the CDC blamed an outbreak of pneumonia at a convention of Legionnaires on a “new” microbe, without giving consideration to toxins. Since the “Legionnaire’s disease” did not spread after the convention and the “Legionnaires bacillus” proved to be ubiquitous, it was later concluded that “CDC epidemiologists must in the future take toxins into account from the start” (Culliton, 1976). The Legionnaire’s disease fiasco is in fact the probable reason that the CDC initially took toxins into account as the cause of AIDS (Oppenheimer, 1992).

The pursuit of harmless viruses as causes of human cancer, supported since 1971 by the Virus-Cancer Program of the National Cancer Institute’s War On Cancer, was also inspired by indiscouragable faith in the germ theory (Greenberg, 1986; Duesberg, 1987; Shorter, 1987; Anderson, 1991; Editorial, 1991; Duesberg and Schwartz, 1992). For example, it was claimed in the 1960s that the rare Burkitt’s lymphoma was caused by the ubiquitous Epstein-Barr virus, 15 years after infection (Evans, 1989c). But the lymphoma is now accepted to be nonviral and attributed to a chromosome rearrangement (Duesberg and Schwartz, 1992). Further, it was claimed that noncontagious cervical cancer is caused by the widespread herpes virus in the 1970s, and by the widespread papilloma virus in the 1980s – but in each case cancer would occur only 30 to 40 years after infection (Evans, 1989c). Noninfectious causes like chromosome abnormalities, possibly induced by smoking, have since been considered or reconsidered (Duesberg and Schwartz, 1992). Further, ubiquitous hepatitis virus was proposed in the 1960s to cause regional adult hepatomas 50 years (!) after infection (Evans, 1989c). In the 1980s the rare, but widely distributed, human retrovirus HTLV-I was claimed to cause regional adult T-cell leukemias (Blattner, 1990). Yet the leukemias would only appear at advanced age, after “latent periods” of up to 55 years, the age when these “adult” leukemias appear spontaneously (Evans, 1989c; Blattner, 1990; Duesberg and Schwartz, 1992). Although the Virus-Cancer program has generated such academic triumphs as retroviral oncogenes (Duesberg and Vogt, 1970) and reverse transcriptase (Temin and Mitzutani, 1970), it has been a total failure in terms of clinical relevance. Indeed, the pride of retrovirologists in retrovirus-specific reverse transcription is the probable reason that inhibition of DNA synthesis with AZT is perceived, even now, as a “specific” antiretroviral therapy (Section 4.3.3).

The wishful thinking that viruses cause “slow” diseases and cancers faces four common problems:

  1. The diseases or tumors occur on average only decades after infection;

  2. The viruses are all inactive, if not defective, during fatal disease or cancer;

  3. The “viral” tumors are all clonal, derived from a single cell (with a tumor-specific chromosome abnormality) that had emerged out of billions of identically infected cells of a given carrier;

  4. Above all, no human cancers and none of the “slow viral diseases” are contagious (Rowe, 1973; Duesberg and Schwartz, 1992).

Therefore these viruses all fail Koch’s postulates, the acid test of the germ theory. And therefore these viruses are all assumed to be very “slow,” causing diseases only after long “latent periods” that exceed by decades the short periods of days or weeks that these viruses need to replicate and to become immunogenic. Because of their consistent scarcity, defectiveness and even complete absence from some tumors and slow diseases (Duesberg and Schwartz, 1992), the search for the presumably pathogenic latent viruses has been directed either at antiviral antibodies, i.e. “seroepidemiological evidence” (Blattner et al., 1988), or at artificially amplified viral DNA and RNA (Section 3.3) or at the “activation” of latent viruses, euphemistically called “virus isolation” (Section 2.2).

Accordingly cancer-, AIDS- and other slow-virologists try to discredit Koch’s postulates in favor of “modern concepts of causation.” For example, Evans states that, “...Koch’s postulates, great as they were for years, should be replaced with criteria reflecting modern concepts of causation, epidemiology, and pathogenesis and technical advances” (Evans, 1992). And Blattner, Gallo and Temin point out that Koch’s postulates are just a “useful historical reference point” (Blattner et al., 1988), and Weiss and Jaffe find it “bizarre that anyone should demand strict adherence to these unreconstructed postulates 100 years after their proposition” (Weiss and Jaffe, 1990) – but they all fail to identify a statute of limitation for adherence to the virus-AIDS hypothesis. In addition, “cofactors” are assumed (a) to make up for the typical inertia of the viral pathogens or carcinogens, (b) to account for the clonality of the cancers via a clonal cellular cofactor, and (c) to help to close the enormous gaps between the very common infections and the very rare incidences of “slow” disease or cancer, that even the long “latent periods” could not close (Duesberg and Schwartz, 1992). The tumor virologist Rowe “recognized that the latent period may cover much of the life span of the animal and that the virus did not act alone but that the tumor response might require...treatment with a chemical carcinogen” (Rowe, 1973).

Despite the total lack of public health benefits and even negative consequences of these theories, such as the psychologically toxic prognoses that antibodies against HTLV-I or against papilloma virus signal future cancers (Duesberg and Schwartz, 1992), or that antibodies against HIV signal future AIDS and the need for AZT prophylaxis, the public and the majority of scientists have held on to them much longer than was justified in terms of scientific evidence. The irresistible appeal of the germ theory was the basis for each of these unproductive theories of the past, as it is the basis now for the universal and enthusiastic approval of the virus-AIDS hypothesis.

But unlike the mistaken germ theories of the past, the virus-AIDS hypothesis was a windfall not only for (1) the virologists and epidemiologists, but also for (2) the biotechnology companies who could develop virus-tests and antiviral drugs, (3) the AIDS patients who were relieved that a God-given, egalitarian virus rather than behavioral factors were to blame for their diseases, and (4) the politicians who had to confront the public and the gay (homosexual) lobby requesting action against AIDS. Indeed, a thoroughly intimidated public was happy, once more, to be offered protection by its scientists against another “deadly” virus, albeit for the highest price-tag ever.

Big Funding and Limited Expertise Paralyze AIDS Research

Ironically, AIDS research suffers not only from being tied to an unproductive hypothesis, it also suffers from the staggering funds it receives from governments (Section 1) and from conceptually matched private sources. Intended to buy a fast solution for AIDS, these funds have instead paralyzed AIDS research by creating an instant orthodoxy of retrovirologists that fiercely protects its narrowly focused scientific expertise and global commercial interests (Booth, 1988; Rappoport, 1988; Nussbaum, 1990; Duesberg, 1991b, 1992b; Savitz, 1991; Connor, 1991, 1992).

The leaders of the AIDS orthodoxy are all veterans from the wars on “slow” and cancer viruses. Naturally they were highly qualified to fill the growing gaps in the virus-AIDS hypothesis with their “modern concepts of causation” (Evans, 1992), including long “latent periods,” “cofactors” and “seroepidemiological” arguments of causation (Sections 3.3, 3.4 and 3.5). When it became apparent that the first order mechanism of viral pathogenesis, postulating direct killing of T-cells, failed to explain immunodeficiency, the bewildering diversity of AIDS diseases, the many asymptomatic HIV infections, and HIV-free AIDS cases, the scientific method would have called for a new hypothesis. Instead the virus hunters have shifted the virus-AIDS hypothesis from a failed first order mechanism to a multiplicity of hypothetical second order mechanisms, including cofactors and latent periods, to fill the ever growing discrepancies between HIV and AIDS. By conjugating these second order mechanisms with a multiplicity of unrelated diseases, the virus-AIDS hypothesis has become by far the most mercurial hypothesis in biology. It predicts either diarrhea or dementia or Kaposi’s sarcoma or no disease, 1, 5, 10 or 20 years after 1 or 2000 sexual contacts with an antibody-HIV-positive person with or without an AIDS disease.

But the coup to rename dozens of unrelated diseases with the common name AIDS, proved to be the most effective weapon of the AIDS establishment in winning unsuspecting followers from all constituencies. By making AIDS a synonym for Kaposi’s sarcoma and candidiasis and dementia and diarrhea and lymphoma and lymphadenopathy, the road was paved for a common cause. Who would have accepted, prior to AIDS, that a dental patient caught candidiasis from her doctor’s Kaposi’s sarcoma? Or which scientist would accept it even now knowing the original data rather than just the corresponding press release? According to the sociologist David Phillips “researchers use newspapers as a ‘filter’ to help them decide which scientific article is worth reading” (Briefings, 1991) or more often which article is worth knowing about.

The control of AIDS research by the nationally and internationally funded AIDS orthodoxy via the popular and scientific press is almost total. It instructs science writers that faithfully report every “breakthrough” in HIV research and every “explosion” of the epidemic. It feeds scientific journals with over 10,000 HIV-AIDS papers annually and with advertisements for HIV tests and antiviral drugs (Schwitzer, 1992). The AIDS doctors are controlled by the companies created, consulted or owned by the AIDS establishment (Barinaga, 1992; Schwitzer, 1992). For example, the Physician’s Desk Reference 1992 instructs AIDS doctors about AZT with an exact copy of Burroughs Wellcome’s instructions. Science writers are warned against reporting minority views. For example, Fauci states: “Journalists who make too many mistakes, or who are sloppy, are going to find that their access to scientists may diminish” (Fauci, 1989). And Ludlam points out, “Whilst I support, and encourage the reporting of, minority views... If the belief that AIDS is not due to HIV becomes prevalent... [it] could lead directly to the deaths of countless misinformed individuals” (Ludlam, 1992). Any challengers are automatically outnumbered and readily marginalized by the sheer volume of the AIDS establishment. For example, the 12,000 scientists attending the annual international AIDS conference held in San Francisco in 1990 were only a fraction of the many who study the information encoded in the 9000 nucleotides of HIV. Says the HIV virologist Gallo when asked about a dissenter: “Why does the Institute of Medicine, WHO, CDC, National Academy of Sciences, NIH, Pasteur Institute and the whole body of world science 100 percent agree that HIV is the cause of AIDS?” (Liversidge, 1989).

Consequently there is no “peer-reviewed” funding for researchers who challenge the virus-AIDS hypothesis (Duesberg, 1991b; Maddox, 1991a; Bethell, 1992; Farber, 1992; Hodgkinson, 1992). Since HIV became the dominant focus of the billion-dollar AIDS-research (Coffin et al., 1986; Institute of Medicine, 1988), there has not been even one follow-up of the many previous studies blaming sexual stimulants and psychoactive drugs for homosexual AIDS (Sections 4.4 and 4.5). None of the former “lifestyle” advocates (Section 2.2) have investigated whether drugs might cause AIDS without HIV. Instead drugs, if mentioned at all, were since described as risk factors for infection by HIV (Darrow et al., 1987; Moss et al., 1987; van Griensven et al., 1987; Chaisson et al., 1989; Weiss, S.H., 1989; Goudsmit, 1992; Seage et al., 1992) – as if HIV could discriminate between hosts on the basis of their drug habits (Duesberg, 1992a). For example, Friedman-Kien concluded in 1982 and 1983 with Marmor et al. (1982) and Jaffe et al. (1983b) that the “lifetime exposure to nitrites...” was responsible for AIDS (Section 4.3.2). In 1990 he and his collaborators just mentioned nitrite use in HIV-free Kaposi’s sarcoma cases (Friedman-Kien et al., 1990) and in 1992 they blamed viruses other than HIV for HIV-free AIDS cases, and drug use was no longer mentioned (Huang et al., 1992).

Likewise all studies investigating transfusion-mediated immunodeficiency in hemophiliacs were frozen around 1987 (Table 3), once the virus-AIDS hypothesis had monopolized AIDS research. The question whether immunodeficient (!) HIV-free hemophiliacs would ever develop AIDS defining diseases was left unanswered and even became unaskable.

Fascinated by the past triumphs of the germ theory, the public, science journalists and even scientists from other fields never question the authority of their medical experts, even if they fail to produce useful results (Adams, 1989; Schwitzer, 1992). Medical scientists are typically credited for the virtual elimination of infectious diseases with vaccines and antibiotics, although most of the credit for eliminating infectious diseases is actually owed to vastly improved nutrition and sanitation (Stewart, 1968; McKeown, 1979; Moberg and Cohn, 1991; Oppenheimer, 1992). Indeed, the belief in the infallibility of modern science is the only ideology that unifies the 20th century. For example, in the name of the virus-AIDS hypothesis of the American Government and the American researcher Gallo, antibody-positive Americans have been convicted for “assault with a deadly weapon” because they had sex with antibody-negatives, Central Africa dedicates its limited resources to “AIDS testing,” the former U.S.S.R. conducted 20.2 million AIDS tests in 1990 and 29.4 million in 1991 to identify a total of 178 antibody positive Soviets, and communist Cuba even quarantines its own citizens if they are antibody-positive (Section 3.6).

Predictably the AIDS virus hunters, on their last crusade for the germ theory, have no regard for the current drug-use epidemic and its many overlaps with American and European AIDS. Even direct evidence for the role of drugs in AIDS is fiercely rejected by the virus-AIDS orthodoxy (Booth, 1988; Moss et al., 1988; Kaslow et al., 1989; Baltimore and Feinberg, 1990; Ostrow et al., 1990). Merely questioning the therapeutic or prophylactic benefits of AZT is protested by the AIDS establishment (Baltimore and Feinberg, 1990; Weiss and Jaffe, 1990; Anonymous, 1992; Freestone, 1992; Tedder et al., 1992). The prejudice against noninfectious pathogens is so popular, that the virus-AIDS establishment uses it regularly to intimidate those who propose noninfectious alternatives, to censor their papers (Duesberg, 1992e) and even to question their integrity.

For example, an editorial in Science called me a “rebel without a cause for AIDS,” because denying HIV was to deny a cause altogether. The editorial quoted Baltimore as saying I was “irresponsible and pernicious” (Booth, 1988). An article in Nature called my drug hypothesis a “perilous message” that would “belittle ‘safe sex,’ would have us abandon AIDS screening...and curtail research into anti-HIV drugs.” “Arguments that AIDS [is] the result of evil vapors [poppers (!)], malaria... [are from] the last century.” “We...regard the critics as ‘flat-earthers’ bogged down in molecular minutiae and miasmal theories of disease, while HIV continues to spread” (Weiss and Jaffe, 1990). This is said even though the article agrees that, “Duesberg is right to draw attention to our ignorance of how HIV causes disease...” (Weiss and Jaffe, 1990). Others declare “All attempts by epidemiologists to link AIDS to the use of amyl nitrite or other drugs as a direct cause of disease have failed... Duesberg’s continued attempts to persuade the public to doubt the role of HIV in AIDS are not based on facts” (Baltimore and Feinberg, 1990). Gallo called the author of the article, “Experts mount startling challenge to AIDS orthodoxy” in The Sunday Times (London) (Hodgkinson, 1992), “irresponsible both to myself [Gallo] and to HIV as the cause of AIDS” (Gallo, 1992). Further, Vandenbrouke and Pardoel argue, “If one is allowed to compare the evolution of scientific theories with the evolution of biologic nature in general, the poppers [nitrite inhalants] episode is the Neanderthal of modern epidemiology” (Vandenbroucke and Pardoel, 1989).

As a consequence there are no studies that investigate the long-term effects of psychoactive drugs (Lerner, 1989; Pillai et al., 1991; Bryant et al., 1992). The toxicologist Lerner points out that “fewer than 60 are currently enrolled in fellowship programs on alcoholism and drug abuse in the entire country” (Lerner, 1989), although about 8 million Americans alone are estimated to use cocaine (Weiss, S.H., 1989; Finnegan et al., 1992) and many more use other psychoactive drugs regularly (Section 4). This stands in contrast to the 40,000 annual AIDS cases that are studied by at least 40,000 AIDS researchers of which just 12,000 attended the annual International AIDS Conference in San Francisco in 1990.

Instead of warning against drugs, the AIDS establishment “educates” the public with its “clean needle” campaigns that drugs (albeit illegal) are safe, but bugs are not. For example, AIDS researcher Moss, citing Napoleon’s line “On s’engage et puis on voit,” recommends “clean needles” for “harm reduction” (Moss, 1987). Mindful of its educators, the public is unaware and even disinformed about the health risks of recreational drugs. A popular joke in point is the response of two “junkies” (drug addicts) sharing a syringe filled with an intravenous drug to a concerned colleague: “We are safe, because we use a clean needle and condoms.” The long “latent periods” between the gratification from recreational drugs, such as tobacco, alcohol, cocaine and nitrite inhalants, to their irreversible health effects unfortunately give credence to the “perilous message” that drugs are safe but bugs are not.

Particularly the victims of drug consumption prefer egalitarian infectious causes over noninfectious behavioral ones that imply personal responsibility (Shilts, 1987; Lauritsen and Wilson, 1986; Rappoport, 1988; Callen, 1990). For example, the executive director of the San Francisco based national “Project Inform,” an organization operated mainly for and by male homosexuals, Martin Delaney, informs its clients about a study documenting a “level of sexual contact and drug use which was shocking to the general public” as follows: “It [the study] might just as well have noted that most wore Levi’s [jeans] for all this told us about the cause of AIDS” (Project Inform, 1992). The organization collaborates with the NIH and is supported by grants from pharmaceutical companies including Burroughs Wellcome, the manufacturer of AZT (Project Inform, 1992).

In 1987, before AZT, Delaney advised gay men in his book Strategies for Survival: A Gay Men’s Health Manual for the Age of AIDS about the health effects of nitrite inhalants: “Possible heart damage; fibrillation (compulsive, erratic heart rhythms); possible stroke and resulting brain damage. Conducive to high-risk sexual behavior; distortion of judgement and senses. Statistical link to Kaposi’s sarcoma (KS, an AIDS-related cancer); suspected immuno-suppression” (Delaney and Goldblum, 1987). Delaney’s advice about amphetamines reads as follows: “Liver and heart damage; neuropathy (nerve damage); possible brain damage; weight loss; nutritional and vitamin depletion; adrenal depletion (uses up the body’s energy reserves). Distorted judgment, values, senses, delusions of strength, anxiety, paranoia, rebound depression, financial strain, powerful addiction, conducive to high-risk sexual activity. Likely immunosuppression (not currently measured), potential for unknown and risky drug interactions, complication in treatment of brain disorders.” Delaney also warns about the effects of cocaine: “Heart and lung damage, stroke, cardiovascular irregularities, possible physical addiction. Distortion of judgment, values, and senses, dangerous delusions of grandeur and strength, intense anxiety, paranoia, financial strain, leads to poor judgment about high-risk sexual activity. Likely immunosuppression (not currently measured); increased stress, if smoked, complicates treatment of pneumonia.” The book also gives the basis for Delaney’s intimate knowledge of drug toxicity: “He...has done work for the National Institute on Drug Abuse” (Delaney and Goldblum, 1987).

Clearly big science is not always good science, particularly if it is conceptually paralyzed by an unproductive hypothesis. I hope that the scientific evidence collected for this article will focus attention on the noninfectious causes of AIDS and prove that it is not “too late to correct” (Red Queen) the spell of the virus-AIDS hypothesis by the scientific method. Considering noninfectious causes may prove to be as beneficial to the challenge of AIDS as it was, for example, to the challenge of pellagra. Indeed, a few investigators have recently smuggled recreational drugs as “cofactors” of HIV (Haverkos and Dougherty, 1988; Haverkos, 1990) or even more cautiously as cofactors of cofactors of HIV (Archibald et al., 1992) into the highly fundable virus-AIDS hypothesis. One investigator even dared to document that drugs are sufficient for pediatric AIDS, if only in preliminary reports (Koch, 1990; Koch et al., 1990). A complete report of the data (Section 4.5) was not published for political reasons (Thomas Koch, personal communication). And the “100 percent” consensus on HIV claimed by Gallo in 1989 (Liversidge, 1989) is eroding just a bit in the face of a growing group of dissenters, some of which united in the “Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis” (DeLoughry, 1991; Bethell, 1992; Bialy and Farber, 1992; Farber, 1992; Hodgkinson, 1992; Project Inform, 1992; Nicholson, 1992; Ratner, 1992; Schoch, 1992).

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