HIV/AIDS Denialism meets medical ignorance: Henry Bauer on Christine Maggiore’s death

EVEN MORE DEPRESSING than the news this week of Christine Maggiore’s immediate cause of death in late December are the predictable cognitive contortions and misrepresentations of AIDS “dissidents” as they try to maintain their denial in the face of plain and evident fact. Here’s Henry Bauer’s contribution, which I think is a fine a specimen as I’ve seen of weasel words, distortion, medical ignorance, obfuscation and Henry’s very own brand of alterno-bizarro probability statistics.

I’ve interspersed it with my own comments.

First point, directly as to what caused Christine’s death: The death certificate is unequivocal. There is no mention of HIV or AIDS. That’s the official verdict, and her death will not be reported as an AIDS death and will not be included in AIDS-death statistics.

The fact that Maggiore’s HIV infection wasn’t mentioned on her death certificate does not “unequivocally” mean that it wasn’t, in reality, the underlying cause of death. The doctor who completed the death certificate, according to Maggiore’s own words, was “really smart and very well versed in natural health care and not at all into the HIV paradigm”. Disseminated herpes in an adult always has an underlying cause of immunosuppression severe enough to allow that illness to manifest. And no, pneumonia in itself is not sufficient cause. The fact that no medically credible cause of Maggiore's immunosuppression is mentioned on the death certificate is an obvious and striking omission, but not evidence that it was absent in reality.

She died of “disseminated herpes viral infection”, with “bilateral bronchial pneumonia” as an underlying cause, and “oral candidiasis” as an accompanying symptom not contributing toward cause of death.

Wrong, Henry, but nice try characterising oral candidiasis as an accompanying symptom. The oral candidiasis was listed as a contributing cause of death, but not contributing to the pathogenesis of the main immediate cause. A fine distinction that your readers will probably miss. Incidentally, if oral candidiasis was of a severity to be listed as contributing cause of death, we’re not just talking about a few soft palate spots here.

The continuing hysteria over “HIV/AIDS” tends to allow people to forget that there are a great number of possible reasons for immune deficiency, including
just about any illness or disease.

Nope. Causes of immune deficiency sufficient to cause disseminated herpes infections in a 52 year old are very, very, few. A few specific cancers and their treatments, transplant anti-rejection drugs and HIV/AIDS are the only plausible candidates. Maggiore did not, according to her death certificate, have cancer, and nor had she had a transplant. That narrows it down a bit.

Unless, of course, her MD was "not into the cancer paradigm or the transplant paradigm" and therefore decided such details were of not worth mentioning in her official death notification.

The original 1980s AIDS included 3 specific conditions: Pneumocystis carinii pneumonia (PCP), candidiasis (thrush, yeast), and Kaposi’s sarcoma (KS). Much
later it was realized that PCP — now more properly termed Pneumocystis jiroveci
— is a fungal infection of the lungs, not a microbial one.

Pneumocystis was reclassified as a fungus rather than a protozoan following analysis of its genome and as part of recent and ongoing shakeups of the taxonomy of microorganisms. Not sure what Henry means by “not a microbial one”.

Candidiasis is fungal. KS, it’s now acknowledged, is found in many individuals who are neither immune-suppressed nor HIV+. So the original “HIV-associated” AIDS was comprised of opportunistic FUNGAL infections

.
Aside from Kaposi's sarcoma, whose direct cause aside from immunosuppression we now know is a herpes virus, and PCP - a fungal disease, there were eleven other broad "AIDS defining" opportunitistic infections predictive of an underlying immunosuppression in the initial case definition, including other fungi such as cryptococcus, protozoal infections such as cerebral toxoplasmosis and chronic cryptosporidiosis, the mycobacterial infection disseminated MAC and other viral diseases such as end-organ CMV disease and PML. It's not clear why Henry thinks the reclassification of Pneumocystis as a fungus is so significant.

Seven of the 25 AIDS-defining opportunistic diseases in the 1993 CDC AIDS case definition are unusually severe and otherwise rare manifestations of common human herpes-virus infections such as HHV1 and HHV2 (herpes simplex) or HHV5 (cytomegalovirus), or are tumors aetiologically associated with herpes-viruses such as the not-rare HHV8 (KS-associated herpes-virus) and the almost ubiquitous HHV4 (Epstein Barr Virus). The occurrence of these severe manifestations of infection and tumors all indicate an underlying cause of serious immunodeficiency. HHV3 (Varicella Zoster Virus) is also a common cause of illness (shingles) in people with HIV/AIDS, but shingles is not itself AIDS-defining.

Kaposi’s sarcoma, it is true, can occur in relatively immunocompetent individuals and in a generally indolent form. Such “classic KS” rarely killed the mostly elderly Mediterranean and Jewish men it has afflicted ever since Moritz Kaposi himself first described the condition in Vienna in 1872. However, disseminated disease always indicates severe underlying immunosuppression. KS was one of the first AIDS defining conditions identified because it appeared at rates and severity and in a population not previously seen. KS was common among gay men in the 1980s because they had both unusually high prevalence of KSHV (it’s sexually transmissible) and also the immunosupression underlying the development of severe tumor disease.

Popper use, incidentally, doesn’t predict KS or any other AIDS defining illness independently of HIV and KSHV. Popper use does, however, correlate with both HIV and KSHV seropositivity, since poppers are used as sexual stimulants in the subcultures where the incidence of both viruses is high, and HIV and KSHV are both STIs.

As Tony Lance’s literature reviews have revealed, the chief part of the immune system that protects against fungi is provided by intestinal microflora. There are reports that disturbing, damaging, these microflora allows fungal infections to take over. That’s why anal douching is positively correlated with AIDS
incidence among gay men…

Utter nonsense. The correlation between anal douching and AIDS (or anything that looks remotely like AIDS) in the absence of HIV infection is zero. Anal douching correlates with receptive anal sex which correlates with HIV infection which correlates with AIDS. Silly.

…and why vaginal douching conduces to yeast infections in women.

Vaginal douching can change the local pH and local commensal bacterial flora which can predispose to thrush overgrowths. It has nothing to do with the intestinal microflora, and nothing to do with the T cell immune deficiency characterising AIDS.

My personal experience has been of antibiotic treatments bringing on
candidiasis: a few weeks on Bactrim seems guaranteed to deliver me episodes of
penile or oral thrush.

Too much information, Henry. Candida species are normal flora of the skin, parts of the gastrointestinal tract and vagina. Mild candidal overgrowths of skin and orifices are extremely common for any of a number of reasons including excessive moisture (particularly around skin folds) and use of broad spectrum antibiotics which knock out competing normal bacterial flora. AIDS defining candidal infections (of the lungs, trachea, bronchi or oesophagus) are not mild overgrowths: they are serious diseases and pathognomonic of a severe deficiency in cell mediated immune function.

Christine Maggiore had been under tremendous stresses for years. She had been using naturopathic treatments including fasting and “holistic cleansing”,
procedures that might well be counterproductive in terms of the intestinal
microflora. There are ample reasons why Maggiore was immune deficient in absence
of “HIV”.

No there aren’t, not for immunodeficiency of this severity.

It’s also often forgotten that, by the early 1990s, so many HIV-negative cases of clinical “AIDS” had been reported that a new condition was defined,
“idiopathic CD4-T-cell lymphopenia” (ICL): low CD4 counts for unknown reason,
and NOT AIDS.

ICL of sufficient severity to cause disseminated herpes infections is as rare as hen’s teeth.

Christine Maggiore had a history of positive, negative, and indeterminate “HIV” tests.

The canard that Maggiore had negative diagnostic test results following her positive diagnosis is an extraordinary claim that is regularly trotted out to support assertions that HIV testing is unreliable, and has never to my knowledge ever been supported by even ordinary evidence. Such claims are almost always the result of misunderstanding the nature of what tests were done, such as confusing a viral load level below the limits of detection for a negative HIV diagnostic test. If you make an extraordinary claim like this you need to be able to provide evidence for it, Henry.

There is therefore at least as much basis for ascribing her death to ICL as to anything else, including HIV/AIDS. The official conclusion, however, is neither of these, it is disseminated herpes brought on by bronchial pneumonia.

The probability of a random person dying from opportunistic disease due to ICL is infinitessimal. The probability that a person with untreated HIV infection will die with AIDS within 15 to 20 years of diagnosis is greater than 75%.

An honest, evidence-based statement from HIV/AIDS believers might be: Although the official verdict is that the death was not owing to AIDS…

No, the question of whether AIDS was an underlying cause was not addressed, because the "MD" who filled in the certificate was "not into the HIV paradigm".

…we question the credibility of the attending physician, and suggest that the opportunistic herpes infection that caused death might have resulted from an
underlying HIV infection of long standing.

There is no other plausible explanation of T-cell immunodeficiency sufficient to cause disseminated herpes.

Admittedly, since on many occasions Maggiore did not test HIV-positive...

Extarordinary claims demand extraordinary evidence, not copy-pasting from other internet sites that make the same claim with a similar lack of evidence.

...we have to acknowledge that this suggestion is not objectively conclusive. Indeed, since positive and negative tests were experienced in about equal
numbers, the odds are no more than about 50:50 that the death was owing to
HIV/AIDS.

Bauerian mathematics strikes again. Wow.

An honest, evidence-based statement from HIV Skeptics and AIDS Rethinkers might be: All the evidence is compatible with the conclusion that Maggiore succumbed to an opportunistic herpes infection consequent on multiple possible reasons for immune deficiency, including intense stress, bacterial or viral pneumonia, and practices unfriendly to the essential microflora that provide so much of the immune system.

An honest evidence-based statement from "HIV Skeptics" and "AIDS Rethinkers" would be, well, very surprising. There are very few “possible reasons for immune deficiency” of a severity capable of resulting in disseminated herpes virus infections in a 52 year old, and essentially only one for a 52 year old with a 16 year history of untreated HIV infection and no history of transplantation or cancer treatment.

While we cannot definitively exclude the possibility that there was an
underlying long-standing “HIV” infection, if that were the case then “HIV” tests
failed to reveal it on many occasions.

Such as when, exactly?

The odds that Christine did NOT die of “HIV/AIDS” are certainly much greater than 50:50, we suggest appreciably greater than 90:10.

Bauerian mathematics str…
…oh, never mind.


UPDATE: February 3rd 2010


By now we know there is no doubt at all that Christine Maggiore died with PCP resulting from AIDS. On the other hand, it is less clear the relevance of the "herpes virus infection" that appears on her death certificate.




Until recently, you could hold small doubts as to her exact cause of death, but over the past year or so her denialist "friends" have unwittingly made public the whole story, even as they were frantically trying to deny it.



Back in January 09 Celia Farber posted on the net a private email written by Maggiore on December 19, during her final illness. It detailed her symptoms - insidious onset of breathlessness and severe lethargy over several weeks, with an X-ray showing bilateral pneumonia, despite the evidence of clinical signs on chest ascultation.

Regarding my health, I finally figured out what’s going on…but it got really scary. Here’s the scoop I just sent a friend:I have been through the absolute worst health nightmare ever. The cleanse, while definitely bringing about some profound benefits, left me feeling weak and dehydrated. I lost my appetite almost completely about 10 days ago and for some weird reason could only tolerate hot tea and hot chicken broth. I had been in touch with the cleanse doc who said all was typical, uncomfortable but typical. Not one to quit, I kept going. Then I started to have trouble breathing, I was feeling winded after the most simple task like making the bed. This last Sunday, I stopped being able to sleep at all. So finally, genius that I am, I made an appointment to see my MD who is really smart and very well versed in natural health care and not at all into the HIV paradigm.I could only get in to see her yesterday.
She said I was totally dehydrated and having a reaction to the herbs in the cleanse which she thought were suspicious. I asked her to check my lungs and she said they sounded clear. I told her I thought I should have a chest Xray anyway, just to be sure, but she was skeptical because I hadn’t had a cold, flu, cough or fever. But I insisted so she wrote me up to go to a radiology place that would give an immediate reading. By then I felt so ill I had to ask my neighbor to drive me and thank god he was there with me because I never would have made it to the radiologist without his help. As it turned out, the Xray showed a very serious case of bi-lateral bronchial pneumonia. The doctor immediately gave me IV rehydration, IV natural cortisone, and IV antibiotic. She said if I did not improve by the next day, I would have to go to the hospital which I argued would give me worse treatment, lousy food and maybe a MRS infection as a parting gift. I went back again today, had more IV treatments and she said if I can make it through the weekend without having to go to the hospital, she will be very happy. She also said I’m pretty tough to have had such severe pneumonia and keep going. I have three natural cortisone treatments I am to take everyday, and today I started with another antibiotic called Z pack which is different from the one used in the IV.
It’s a little scary because she asked me if I am allergic to the antibiotics she’s giving me but I’ve never taken them, so I don’t know. She stayed next to me during the IV antibiotic to make sure I was not going into reaction which sort of made me feel like I might be having a reaction! But I didn’t and I slept for the first time since Sunday last night.My appetite is getting back to normal and I am on total bed rest for two weeks. I can’t imagine doing otherwise.

Christine

A competent physician would have a high index of suspicion of PCP on that alone, even without knowing that she had had untreated HIV infection for over 16 years (as is clearly documented by her test results shown in House of Numbers released later in 2009). She was treated ineffectively with three different broad spectrum antibiotics (ceftriaxone, gentamicin and azithromycin) which would cover most causes of community acquired pneumonia - but not PCP. She died nine days after starting this treatment, refusing her doctor's advice to seek competent specialist treatment in hospital. It's not clear why she wasn't given treatment for PCP such as cotrimoxazole. Perhaps it was because her physician was not, as Maggiore put it, "into the HIV/AIDS paradigm".


Following her death, and unknown to the coroner or the treating doctor who completed the death certificate, her family arranged for a private autopsy, completed by a properly licensed pathologist, Dr David Posey. The family have never publicly released this report - it's clear they did not like the results: Posey apparently insisted in taking the ante-mortem clinical history into account in formulating his conclusions, as any competent pathologist would. This pathology report was to be kept under wraps, but Celia Farber spilled the beans back in July on the "New Scientist" thread. She made it clear that she knew that contrary to the information on the death certificate, the family had in fact arranged for an autopsy, and she further made clear that she did not accept the results, demanding a "panoply" of pathologists' opinions before she was prepared to accept plain and evident fact.


Ultimately, Moe Al-Bayati was engaged to produce a whitewash of the actual report for public consumption. It consists of his usual implausible, selective and specious reasoning including pointing the finger at antibiotics and steroids, and most notably omits any salient details of Maggiore's final illness. However, he makes it quite clear that Dr Posey found and demonstrated PCP in his examination: according to Al-Bayati, Dr Posey made the following observations:

"There was marked alveolar distention by frothy eosinophilic proteinaceous exudates. Diffuse alveolar damage was noted in both lungs. There was also proliferation of type 2 pneumocytes with modest infiltrates of acute and chronic inflammatory cells... In addition, growth of Pneumocystis jiroveci (carinii) was observed on the H & E stained sections of lungs, liver, pancreas,spleen, kidneys and bone marrow, and confirmed on the Gomori methenamine silver (GMS) preparation."

Al-Bayati also tells us that the December 18th Xray taken after Christine had been sick for several weeks and before she commenced treatment showed "patchy interstitial infiltrates in both mid and lower lung fields"- a finding typically associated with PCP, and virtually diagnostic in a 52 year old with insidious onset severe breathlessness and a 16 year history of untreated HIV. Bizarrely, Al-Bayati disregards all this and tries to make out that the pathological findings (which amount to a definitive diagnosis of Pneumocystis pnemonia) must have developed after she died, or were perhaps the result of the treatment she received.

For reasons that remain a mystery to this Snout, the public release of Al-Bayati's whitewash was assigned to Celia Farber and Clark Baker. Farber announced it on her Dean Esmay blog post Christine Maggiore's cause of death on December 10th last year.



It went down like a lead balloon.


Even Dean Esmay himself (a close friend of Celia's and a notorious denialist) noticed that Al-Bayati's "analysis" was being presented in place of the real report by David Posey MD. The thread was deleted on December 14th and replaced by a histrionic tirade by Farber entitled “People Have Died On All Sides of the HIV Causation Belief Spectrum”. It lasted less than two days, before Farber deleted this one too.


Snout's guess is that Maggiore's surviving family have told Farber in no uncertain terms they want her to STFU. If so, that's pobably good advice.


Moe Al-Bayati is of course the "veterinary toxicologist" retained by Maggiore to "reinterpret" her daughter's autopsy report from the Los Angeles Coroner's office, and which found that EJ had died from PCP secondary to AIDS. He was on the "advisory board" of her Alive and Well organisation, and is the author of a book he published himself through his company called Get the Facts - HIV Does Not Cause AIDS.

Medical science commentator David Gorski predicted this fiasco as early as January 2009:

"Indeed, if there is an autopsy and it shows that Christine Maggiore died of AIDS-related pneumonia, expect a replay of the Eliza Jane Scovill story. Expect more dubious attempts to spin the results as being something else. Expect HIV/AIDS denialists to trot out Dr. Al-Bayati again, who will dutifully examine the autopsy report and come up with an equally inane “explanation” for Maggiore’s death as he did for Eliza Jane’s."

Many of us care about Christine's and especially her daughter's death. So much so, that we don't want to see this happen to anyone else again. Both deaths were horrible and unnecessary, and no-one deserves to suffer like that.


Which is why telling the truth is much more important than self-serving denialist spin.