Dean's World

The anonymous "Pharma Bawd" recently asked if I am ignorant or dishonest regarding recent findings on Highly Active Anti-Retroviral Therapy, i.e. the "AIDS cocktails" that we've all heard so much about. In evidence of my dishonesty and/or ignorance, she cited this Lancet Study article I wrote on September 1, wherein I quoted Hank Barnes.

I took Hank's word for it when I wrote that. Hank's a man I personally know to be honest and honorable if not always correct. (And wouldn't it be nice if we could all say that about each other?)

Now in truth, I do not, and never have, believed that the question of AIDS etiology should be worked out through weblogs. Weblogs might play a valuable role in raising questions and forcing the research community to be more forthcoming to the taxpayers, but I do not think webloggers like me can answer most of the hard questions.

What I do think, however, is that weblogs can force both science journalists and taxpayer-funded researchers to be more honest, more transparent, and more accountable for the tax funding that researchers receive.

I also repeat something I have said many times: if you are receiving taxpayer funding for your research, then there is absolutely nothing wrong with everyday taxpayers asking questions, even hard and pointed questions. We've given you tens of thousands, hundreds of thousands, even millions or hundreds of millions of dollars to pursue your research. On some subjects, such as Global Warming, Cancer, Heart Disease, Diabetes, Earthquake Research, or AIDS, we've given you literally billions of dollars of our money.

In the particular case of AIDS, we taxpayers have now spent more money and more man-years than we did in both the Mercury and Apollo missions. We spent fewer years, and fewer dollars, putting a man into orbit and putting a man on the moon than we have so far on HIV (or cancer, for that matter).

Yet to this day no one in the HIV research community can tell us exactly the mechanism by which HIV destroys the immune system. The old theory, that it acts primarily by targeting and killing T-Cells, has already been discredited. No one I'm aware of, including the anonymous "Pharma Bawd," claims that this is what this virus does. So what does this virus do exactly?

I remember well when David Ho introduced the AIDS Cocktail (HAART) to the world and told us that attacking the virus would fix the problem. "It's the virus, stupid" was the war cry. And initially, Ho's cocktails were hailed as the great breakthrough. By using PCR amplification, they claimed they could measure the amount of virus in a person's system and attack that virus directly. If we could lower the amount of virus in someone's system, we could extend their lives.

This was all in the early 1990s, more than 10 years ago. And the initial claims were promising. After all, at the time, anyone diagnosed with AIDS was supposed to be dead within a year or so, and they were horribly sick until they died. Suddenly, after going on the non-AZT cocktails (or cocktails with a lot less AZT in them anyway) they got better and even started to live longer and feel better.

Most said, "Wow, these drugs are awesome! Patients live a lot longer and feel a lot better!"

A few of us said, "Wow, so these drugs are less toxic than AZT, so they live longer. Huh. Well that looks like progress anyway."

Now in 2006, a Lancet study has concluded that the AIDS cocktails do not increase lifespan. "Pharma Bawd" says I'm stupid and/or dishonest because she says the study only says they don't live longer during the first year. They don't live any longer during the first year, but after the first year they supposedly live longer. And Hank's a liar because he misquoted the study.

OK, I've read the study. Twice now. I admit that some of the language is dense and, as a non-biologist, I can't understand all of it. I understand most of it, but some of it still confuses me. But, to be fair to the study's authors, they were not writing for laymen like me. Nevertheless, they wrote this conclusion:

Interpretation: Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.

In short, the virus (measured by PCR amplification) went down, and the leukocytes went up, but the patients didn't actually live longer. During the first year anyway.

This for a virus that they used to tell us was 100% fatal within a year or two, and for which they told us that HAART (i.e. the cocktails) was the miracle that extended lives. The drugs were the reason that Andrew Sullivan and Magic Johnson are still with us, they told us.

Now, in 2006, it's this: "If you have AIDS, these drugs cannot improve your lifespan over the next year. But possibly, if you keep taking them, then past 1 year you might live longer. If you don't die in the first year." According to the anonymous "Pharma Bawd" and her better reading of this paper, anyway.

If I'm reading it right, and accepting all of anonymous "Pharma Bawd's" assertions, that's what it says. So I ask anonymous "Pharma Bawd" if she thinks I'm quoting her correctly. She's smarter than me after all, so let her explain if she thinks I've been unfair.

In any case, just for anyone who cares, here is the entire paper verbatim (which anonymous "Pharma Bawd" supplied me with, and for which I thank her sincerely). So I invite you to read it and tell me if I've missed something important, or been unfair somehow. It's a PDF, so you'll need Acrobat Reader if you don't have it already.)

So, you read it. And tell me what you think I've missed, or if you think I've been unfair to the authors somewhere. I won't edit you. You just go ahead and tell me what I missed.

I also offer to give Pharma Bawd an unrestricted comment account on Dean's World, with the following caveats: given that I've had more than one person pretend to be a "scientist" in the Dean's World comments, I will not allow total anonymity for those who wish to speak on such matters. If they are speaking *as professionals* in their *personal field*.

I don't care if some anonymous physicist or biologist or archaeologist or lawyer or architect or psychologist wants to comment upon matters unrelated to their field, or just leave off-the-cuff comments. But if you want to comment here and actually talk about your area of specialization, *as a professional*, then I'm not going to put up with complete anonymity anymore.

If you want to claim to be a scientist, and to speak as a scientist, then you must reveal your actual name and your actual credentials. Preferably publicly, but if not publicly then to me privately. I just need a real name, a real email address, and real phone # and credentials that I can verify.

You don't have to go public with it. If you ask me to keep it private I will. Ask any of my co-bloggers or friends online and they will tell you I am an honorable man. If you ask me to keep something private then I will.

But I will no longer put up with people like "Dale," the anonymous "molecular biologist" from the University of Rochester med school who made all sorts of bloviating claims but could not back them up when (repeatedly) challenged, and whose best defense of his anonymity was "Professor Harvey Bialy might send me nasty emails."

I'll give a public forum to any credentialed scientist who wants to answer these questions publicly. I'll even bend over backwards: so long as you provide me and me alone verifiable evidence of your credentials, I'll let you in. And give you my word that I will never publicly "out" you, if you're too afraid to just publicly identify yourself.

So now it's your move. The most conservative interpretation of the Lancet paper linked above is that during the first year of treatment the AIDS cocktails do not save lives. So are you willing to stand by that or what? And is that an unfair question for me, a taxpayer who has given you billions of dollars and decades of support to ask?

You tell me.

And let anyone tell me (or any of my co-bloggers) if they think I'm being unfair in my questions.