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The Epidemiology of Fear
by John Lauritsen
Psychological warfare is being waged against gay men in the United
States. For the past month or so the media have been disseminating
hostile propaganda, with the message that we will all die, that we
must die. These death threats do not issue from the usual bigots --
not from Roman Catholic agitators, or menopausal beauty queens,
or fundamentalist TV hustlers, or quack psychiatrists, or Hasidic
zealots. We are not being drummed to death by voodoo witch
doctors, or anathematized by prurient priests. We are being cursed
in the name of science, and the imprecations directed against us
have the imprimatur of the Public Health Service (PHS). The
prognosis of doom is emanating from that peculiar form of medical
survey research known as "epidemiology".
HIV Antibodies = Death?
Michael Specter, writing in the Washington Post, was one of the
first to propound the death message, in his June 3, 1988 article,
"AIDS Virus Likely Fatal To All Infected". Specter writes:
The AIDS virus [sic] will almost certainly kill everyone it infects
unless effective drugs are developed to treat it, federal researchers
have predicted for the first time....
After studying a group of gay men from San Francisco for the past
decade, however, researchers have produced a statistical model that
predicts 99 percent of those infected will eventually develop
acquired immune deficiency syndrome "if they do not die from
other causes."
Because no one has ever been cured of AIDS, a 99 percent AIDS
rate means that virtually all would die unless a treatment is
developed.
These grim statements are allegedly based on epidemiological
research conducted in San Francisco, as discussed in a report that
appears in the June 3, 1988 issue of Science, "A Model-Based
Estimate of the Mean Incubation Period for AIDS in Homosexual
Men". The authors are Kung-Jong Lui, a mathematician with the
Centers for Disease Control (CDC); William W. Darrow, of the
CDC's AIDS program; and George W. Rutherford, III, of the AIDS
Office in the San Francisco Department of Public Health.
The headline on the second page of Specter's article is even more
emphatic, "AIDS Infection Proving Fatal in All Cases". After
inaccurately describing the San Francisco study, and repeating the
latest doomsday estimates from the PHS (300,000 AIDS cases in
the U.S. by the end of 1992), Specter lays out the ramifications of
the "finding" that everyone with HIV antibodies will develop AIDS:
"Public health service officials...hope the new study will encourage
those at highest risk to be tested so that they will seek medical
attention if needed...."
Many physicians are prescribing AZT for their patients who are
infected but have not developed AIDS, although the drug has not
yet been proven effective for those patients. Public health officials
say that this study is likely to encourage other doctors to prescribe
it to patients infected with HIV.
Now, let's step back for a moment and observe what's happening
here. First, a number of crucial semantic distinctions are being
obliterated. "AIDS", a condition or disease that is said to be
invariably fatal, is now being conflated with "HIV infection", which
in turn is a misnomer for testing positive for antibodies to a
retrovirus that has not yet been shown to be harmful. (Readers of
the Native are aware that Peter Duesberg, a molecular biologist at
Berkeley, has provided a powerful, and so far unanswered, critique
of the hypothesis that HIV is the cause of AIDS.) The concept of
AIDS is expanding to encompass not only AIDS-Related Complex
(ARC), but also so-called "HIV infection", and even membership in
a "high risk group". To be a gay man is becoming more and more
equivalent to being a person with AIDS (PWA).
Second, AZT is being promoted as the appropriate treatment for
"HIV infection". Persons who test positive for HIV antibodies will
now find themselves between the Scylla of AIDS and the Charybdis
of AZT poisoning, with the long-term prognosis of the latter being
worse than that of the former. This amounts to a reinstatement of
the Judeo-Christian death penalty for sodomy. Lovers of other men
must die. ("They shall surely be put to death; their blood shall be
upon them." "The wages of sin is death.") (I have written two major
exposes on AZT for the "Native", the upshot being that the FDA-
conducted trials of AZT, on which approval of the drug was based,
were invalid and indeed fraudulent; that there is no scientifically
credible evidence AZT has benefits of any kind; and that AZT is a
highly toxic drug, incompatible with life. ["AZT on Trial", Issue
235, and "AZT: Iatrogenic Genocide", Issue 258.])
Specter was not alone in putting forth this interpretation of the San
Francisco study. On June 3, 1988, Paul Reger, a science writer for
the Associated Press, wrote: "AIDS eventually will kill 99 percent
of the people infected with the virus, according to a new study that
says it takes an average of 7.8 years for the disease itself to show
up." And a New York Times article by Bruce Lambert, "New York
Called Unprepared on AIDS " (July 14, 1988), contained a header,
"Almost all carriers of the virus are expected to become ill", and
quoted Dr. James O. Mason, director of the CDC, as saying, "We
have to assume that everyone infected will ultimately become
symptomatic."
New York City Health Commissioner, Dr. Stephen C. Joseph, was
quoted as saying:
"I don't know anybody in the field who does not agree that
eventually the overwhelming percentage of infected people will
have serious if not severe symptomology, in the high 80's, 90's -- as
close to universal as you get in medicine."
Before analyzing the San Francisco study, which does not support
the statements made by Specter, Reger, Lambert, Mason, and
Joseph, a basic point needs to be emphasized. Although there is
undeniably a correlation between HIV antibodies and the
development of AIDS, the correlation is far from perfect, and it is
only a hypothesis that the relationship is causal. Duesberg has
persuasively argued that, even in patients who are dying from
AIDS, HIV remains biochemically inactive, or latent; and that a
virus, like anything else, has to do something to get something
done. It has yet to be proven, in even a single case, that HIV has
played any role at all in causing AIDS. It remains to be
demonstrated whether, and if so how, HIV is capable of causing
illness of any kind.
The San Francisco Study
The Science article, "A Model-Based Estimate of the Mean
Incubation Period for AIDS in Homosexual Men", has the typical
shortcomings of reports written by public health officials. In
particular, the report contains an inadequate description of
methodology, which does not even appear in one place; part of the
methodology appears on the first page, and then more methodology
appears, incongruously, on the second page. So far as I can tell, this
is what was done:
A number of epidemiological studies have utilized a cohort of 6709
homosexual and bisexual men who enrolled at San Francisco City
Clinic between 1978 and 1980, in order to participate in various
studies of hepatitis B. Investigators Lui, Darrow and Rutherford
obtained a subsample of 84 of these men, for whom the
approximate date of seroconversion could be estimated -- that is to
say, men who had a positive HIV-1 antibody test within 12 months
of a negative antibody test. The authors offer the following
description: "The 84 men include 83 men who were selected at
random or returned for hepatitis B vaccine follow-up, could be
located and gave written consent for their stored sera to be tested
for HIV-1 antibody, and one man who died from AIDS in 1982."
In the time period involved, from 1978 to the present, 21 of the men
(25% of the total) developed AIDS. On the average, for these 21
men, the time between seroconversion and a diagnosis of AIDS
(which the authors refer to as "the incubation period") was 4.8
years.
Using these data, Lui developed an arcane mathematical model,
whose projections were intended to estimate two things:
1.the proportion of the total sample of "infected" men who would
eventually develop AIDS, and
2.the "mean incubation period" for those who would develop AIDS.
He estimated the latter at 7.8 years. With regard to the former, the
following conclusion was reached:
Let p be the proportion of infected individuals who will eventually
develop AIDS.... The maximum likelihood estimate of p is 0.99
with a 90% confidence interval (0.38, 1.00)....
Confronted with this statement, Specter, who is obviously
unfamiliar with statistical language, simply latched on to the
"maximum likelihood estimate" of 99%, and ignored what
followed. And yet the statement, "with a 90% confidence interval
(0.38, 1.00)" is crucial. Translated into plain English, the above
statement reads as follows:
Let "p" be the proportion of individuals with HIV antibodies, who
will eventually develop AIDS.... With about 90% certainty, p lies
somewhere between 38% and 100%.
Note the difference. With only a 90% confidence interval, the
estimate of "p" has a 62 percentage point spread, all the way from
38% to 100%. Statistically, this means that the estimate is wildly
unstable. In fact, if someone asked me to analyze data with a
confidence interval anywhere near this large, I'd simply tell him to
go away, and to come back when he had data worth looking at. And
a 90% confidence level is rather low. Normally in research one
prefers at least a 95% confidence level, in which case, according to
Lui, "p" would be somewhere between 27% and 100%! At any rate,
these statistics are a far cry from Michael Specter's statement, "The
AIDS virus will almost certainly kill everyone it infects."
To make sure that I had interpreted the key statement correctly, I
called both Kung-Jong Lui and William Darrow, and to my near
amazement, they both agreed with me on almost everything. Lui
said that my rewording of the conclusion regarding "p" was correct,
and that the statements made in the press had been inaccurate and
misleading. He said that Specter's statements, which I read to him,
were wrong, and that if Specter had called him, he would have told
him so. Darrow also agreed that media coverage of their article had
been far from satisfactory, and that existing data were not adequate
to estimate, with any degree of precision, the proportion of all
people with HIV antibodies who would eventually develop AIDS.
A Representative Sample?
Even the grossly unstable estimate of "p" (38% to 100%, with 90%
certainty) applies only to the sample studied: 84
homosexual/bisexual men, non-randomly selected from the San
Francisco City Clinic Study. It would be wrong to assume that this
sample was at all representative of the total universe of people with
HIV antibodies. This is one of the most basic questions in survey
research: How representative is a sample of a particular universe or
population? To what extent is one justified in projecting findings
from the sample to the target universe?
Michael Specter, in his article of June 3, says that "The researchers
randomly selected 84 of the men for follow-up studies...." This is
simply not true. (In research sampling, "random selection" has a
precise meaning: namely, that every individual in the population
being sampled has an equal and a known probability of being
selected.) In fact, the investigators randomly selected 515 HIV-1
seropositive men from the total cohort of 6709, but were only able
to determine the year of seroconversion for 84 (of whom one had
been dead for 6 years). They settled for what they could get.
Therefore, the 84 men may not even be representative of all
seropositive men in the total cohort.
Normally reports on survey research contain a description of the
sample. One wants to know the characteristics of the people
studied, so one can have some idea how typical they are of the total
population the sample is intended to represent. There is no such
description in the Science report. However, William Darrow was
also the principal author of another epidemiological report utilizing
the San Francisco City Clinic cohort ("Risk Factors for Human
Immunodeficiency Virus (HIV) Infections in Homosexual Men",
American Journal of Public Health, April 1987). The AJPH report
does cite some characteristics of a sample of 359 men drawn from
the City Clinic cohort, who were seronegative when first tested
(1978-1980). Darrow told me he saw no reason to assume the
characteristics of this sample would differ greatly from those of the
84 men in the other study.
These 359 men were, putting it euphemistically, "living in the fast
lane". They were indeed "burning the candle at both ends". With
regard to recreational drug use, 84% were cocaine users, 64% used
amphetamines, 51% used quaaludes, 41% used barbiturates, 20%
used needle drugs, and 13% shared needles. The investigators
asked about poppers ineptly, but it appears that the great majority
of these men were into poppers as well. In the area of sex, 95%
practised receptive anal intercourse with steady or nonsteady
partners, 57% averaged more than four different sexual partners per
month, 44% practised insertive or receptive fisting with nonsteady
partners, and 18% shared douching equipment. In terms of medical
history, 74% had been treated for gonorrhea, 73% had had
hepatitis, 57% had experienced bleeding with intercourse, 30% had
been treated for amebiasis, and 28% had been treated for syphilis.
I would like to make two points, as nonjudgmentally as possible.
First, if the 84 men studied by Lui, Darrow, and Rutherford were at
all similar to the 359 men in the AJPH study, then they can hardly
be representative of the total universe of 1.5 to 3 million
individuals in the U.S. estimated by the CDC to have HIV
antibodies. Second, it would be surprising if people who lived like
this did not become seriously sick; a lifestyle of heavy drug use,
multiple venereal diseases with frequent antibiotic treatment, and
unhealthy and dangerous sexual practices, may be quite sufficient
to cause a condition of immune deficiency, with or without HIV or
any other specific infectious agent.
Refutation: New York Blood Center Data
A basic principle of analysis is that data must make sense. This may
seem too obvious to mention, but novice analysts often are slaves to
the numbers they see in front of them, and will concoct bizarre
explanations rather than come to grips with contradictions in the
data. In actual practice, when data don't make sense, it is almost
always because they are wrong. There are many ways that errors can
occur in survey research -- from outright cheating, to errors in
coding or study design or mathematics or sampling, to a finger slip
on the part of the keyboard operator entering computer tabulation
specifications. It is the task of a good analyst to spot and track
down such errors.
In the case of epidemiological research, the data ought to make
sense in the context of what is known about AIDS. If the findings
from the Lui, Darrow and Rutherford study are to have predictive
value beyond the 84 men studied, then they should bear comparison
with other studies of seropositive individuals.
A study conducted at the New York Blood Center flatly contradicts
the findings of the Lui study. According to a New York Times
article by Lawrence K. Altman, "AIDS Mystery: Why Do Some
Infected Men Stay Healthy?" (June 30, 1987):
In New York, at least 13 men who volunteered in 1978 for the
hepatitis B vaccine trial were already infected with the AIDS virus
[sic] and have lived for nine years without developing AIDS,
according to Dr. Cladd E. Stevens, the head epidemiologist at the
New York Blood Center.
An astonishing point is that the immune systems for all 13 of these
men look 'perfectly normal,' Dr. Stevens said in an interview....
More astonishing, Dr. Stevens said, for unknown reasons only one
of the 87 people in the New York Blood Center study who were
found to have become infected with the AIDS virus [sic] since 1981
has developed AIDS.
So then, in New York only one out of 100 "infected" individuals
(1%) developed AIDS, whereas in San Francisco 21 out of 84
(25%) developed AIDS. If HIV is the sole cause of AIDS, it is not
possible for both sets of data to be correct, notwithstanding the
possibility that the time periods may not be quite the same, or that
the characteristics of the two samples may be different. The
possibility that the difference (25% vs. 1%) could be due to chance
is less than one in a million. If, on the other hand, AIDS is caused
by toxins (like recreational drugs) and other lifestyle factors, then
both sets of data might be correct -- it would mean that the San
Francisco subjects pursued an AIDS lifestyle (or "deathstyle"), and
the New York subjects didn't, and that in either case, HIV had little
or nothing to do with the outcome.
Conclusions
Existing data do not support claims that all, or most, or even many
individuals with HIV antibodies will develop AIDS. As usual,
government "epidemiology" falls far short of the standards of
professional survey research. However, in the present comedy of
errors, the main culprits appear to be the media. Reporters like
Michael Specter, lacking the necessary training, are not up to the
task of interpreting AIDS epidemiology.
It is still nothing more than a shaky hypothesis that HIV has
anything at all to do with causing AIDS. In a couple of weeks, an
issue of Science is scheduled to run a forum or debate on the HIV
hypothesis, with Peter Duesberg arguing that HIV does not cause
AIDS; and Robert Gallo, William Blattner and H.M. Temin arguing
that it does. It will be the first time that Gallo & Co. have been
willing to defend their hypothesis in a civilized manner and in an
appropriate publication, complete with references. I suspect that
many readers of this debate will be shocked when they realize how
skimpy, indeed pathetic, the arguments on behalf of the HIV
hypothesis are. And of course, if HIV is not the cause of AIDS,
what exactly is the point of attempting to estimate the proportion of
HIV-infected individuals who will develop AIDS?
It is serious when death threats are directed against us. I sometimes
think that too much attention and sympathy have been given to
those who are sick and dying, and not enough to those of us who
have healthy minds and healthy bodies. We, after all, are also
targets of psychological warfare. We also are increasingly being
portrayed as sources of pollution, as threats to the "innocent"
heterosexual population. Perhaps we should form our own self-help
organization, which might be called "mens sana in corpore sano" or
"kalos kagathos" or "Gesundheit".
Our survival depends on not accepting the role of victim. If people
direct death wishes at us, we should direct death wishes right back
again at them. No one should be allowed to attack us with
impunity. At the same time we need to retain a sense of cool: an
appropriate balance of self-preservation, anger, and a sense of
humor. Aside from the fact that our lives are at stake, current events
really are pretty ridiculous, aren't they?
References
1.Michael Specter, "AIDS Virus Likely Fatal To All Infected", The
Washington Post, June 3, 1988.
2.Kung-Jong Lui, William W. Darrow, and George W. Rutherford,
III; "A Model-Based Estimate of the Mean Incubation Period for
AIDS in Homosexual Men"; Science, June 3, 1988.
3.For Duesberg's ideas, see: Peter H. Duesberg, "Retroviruses as
Carcinogens and Pathogens, Expectations and Reality," Cancer
Research, March 1, 1987; "A Challenge to the AIDS
Establishment", Bio/Technology, November 1987. Also, John
Lauritsen, "Saying No to HIV: An Interview With Professor Peter
Duesberg", New York Native Issue 220, July 6, 19877 and
Christopher Street Issue 118; and "Kangaroo Court Etiology", New
York Native, Issue 264, May 9, 1988.
4.John Lauritsen, "AZT on Trial", New York Native, Issue 235, 19
October 1987; and "AZT: Iatrogenic Genocide", New York Native,
Issue 258, 28 March 1988.
5.Paul Reger, "AIDS Prognosis", Associated Press dispatch, June
3, 1988.
6.Bruce Lambert, "New York Called Unprepared on AIDS", New
York Times, July 14, 1988.
7.Ibid.
8.William W. Darrow, Dean F. Echenberg, et al.; "Risk Factors for
Human Immunodeficiency Virus (HIV) Infections in Homosexual
Men"; American Journal of Public Health, April 1987.
9.Lawrence K. Altman, "AIDS Mystery: Why Do Some Infected
Men Stay Healthy?", New York Times, June 30, 1987.
Copyright John Lauritsen 1996.
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