AIDS denialism at the Italian Journal of Anatomy and Embryology

LAST YEAR HIV/AIDS DENIALISTS TRIED to publish their nonsense in the (rather dubious) journal Medical Hypotheses in two articles – the first was what appeared to be a “critique” by Marco Ruggiero and some of his colleagues and students at the University of Firenze targeting the HIV/AIDS surveillance policies of the Italian Ministry of Health, and which (perhaps facetiously) proposed that the Ministry might actually be themselves AIDS denialists.

The second was a piece of pseudoscholarship by various then board-members of the internet-based denialist support group Rethinking AIDS (including Peter Duesberg, Henry Bauer, David Rasnick and Christian Fiala) together with some kid who was working in Duesberg’s lab at the time. See the second part of an earlier Reckless Endangerment post and the comment thread for a discussion.

The attempted publication of both papers in Med Hype led to a furore which culminated the withdrawal of the articles concerned by the publisher, and later in the sacking of hitherto Med Hype editor Bruce Charlton, when he refused the publisher Elsevier’s demands to institute some semblance of competent review of articles prior to their publication.

For a brief overview of how obtuse and fatuous the Ruggiero Med Hype paper was, see the comments from Fulano de Tal here. Chris Noble also nails a neat example of Ruggiero's hopeless maths and logical fallacies.

While Bruce Charlton tried to make out that Ruggiero’s Med Hype paper was an “innocent bystander”  in the fracas that arose from the more prominent Duesberg et al debacle in the same edition, and that he was merely “teasing” the Italian health authorities with his supposed analysis, it has since become clear that Ruggiero is a true HIV/AIDS denialist rather than conducting a cheeky spoof of them (as Snout had originally thought possible).

In December Ruggiero exhibited a poster at a cell-culture conference in Firenze in which he claimed:

"For more than 25 years it was assumed that HIV was the sole cause of AIDS. Although there have been a few voices of dissent since the early days (Science 1988: 241:514-17. J Biosci 2003: 28:383-412. See also: Bauer HH, "The Origin, Persistence and Failings of HIV/AIDS Theory"), in the past three years definitive evidence has accumulated demonstrating that HIV cannot be considered the (sole) cause of AIDS.


"In 2006, a large meta-analysis of ten years of highly active antiretroviral therapy (HAART) demonstrated that "the virological response after starting HAART has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death" (Lancet 2006: 368:451-8).


"In 2008, Professor Luc Montagnier, after having been awarded the Nobel Prize, stated: "We can be exposed to HIV many times without being chronically infected. Our immune system will get rid of the virus within a few weeks, if you have a good immune system" (quoted in the documentary "House of Numbers", 2009. URL: http://liamscheff.com/daily/2009/ 04/ 0l/ house-of-numbers/), thus reversing the long-assumed cause-effect relationship between HIV and AIDS whereby HIV inevitably brings on AIDS.


"Therefore, HIV infection itself reflects an already deficient immune system; it is the immunodeficiency that causes chronic HIV infection and not vice versa, as commonly believed.


"Finally, a review in 2009 demonstrated that HIV has been present in humans since at least the early 1900s, thus definitely ruling out the possibility that it could have been responsible for a syndrome that appeared only at the beginning of the 1980s (Curr Opin HIV AIDS 2009: 4:247-52). Quite obviously, if HIV caused AIDS, then AIDS should have been observed in earlier periods, when the hygienic and nutritional conditions of human populations were much worse than in the 1980s (i.e. during the two world wars and the depression in between. The very fact that AIDS was never described before the 1980s despite the persistent presence of HIV in humans, clearly demonstrates that HIV cannot be the cause of AIDS."

Now Snout’s first opinion of this poster was that it was intended as a prank to liven up a boring conference, and to see if anyone was awake enough to spot an obvious absurdity. After all, what serious scientist would try to claim that HIV was not the cause of AIDS based on referencing:

1) the notorious and long-discredited misrepresentation by denialists of the conclusions a 2006 Lancet paper by May et al and the ART Cohort Collaboration?

2) A clumsy and dishonest campaign conducted on youtube and various other websites intended to quote mine and misrepresent some comments and opinions by Montagnier, and which he has since clarified as intending nothing like the denialist fabrication?

3) An absurd argument that AIDS should have been identified decades sooner than it was, given that the preponderance of molecular evidence is that HIV-1 first evolved and crossed over to humans decades earlier than 1981? (Presumably the virus ought to have spread instantaneously and in large numbers to all continents following its original crossover into humans in West Africa, which most likely occurred early in the 20th century).

Even sillier was the poster's sidebar on Derrida in which Ruggiero propounds:

“It is easy for any reader to realize that most articles on HIV and AIDS demonstrate that HIV is not the cause of AIDS, if the articles are read using the deconstructive approach proposed by the philosopher Jacques Derrida. Derrida's approach consisted in conducting thorough, careful, sensitive, and yet transformational readings of philosophical and literary texts, with an ear to what in those texts runs counter to their apparent systematicity (structural unity) or intended sense (authorial genesis). Deconstruction is the way to bring to light contradictions hidden in commonsense opinions and ideas.”

Now the first sentence is the sort of gibberish you might expect from someone who was either brain-damaged, or inebriated, or a tenured cultural studies academic in certain institutions, or more likely all three. The second sentence appears to be plagiarised from wikipedia. But on a scientific poster? And printed in Comic Sans? No, he had to be taking the mickey, thought Snout. 

http://icanhascheezburger.com/

Unfortunately, it seems, Snout was wrong.

There’ve been a couple of interesting developments over the past few months. Both Ruggiero and Bauer have managed to get HIV/AIDS denialist papers published in the allegedly "peer reviewed" and (currently still) PubMed listed journal the Italian Journal of Anatomy and Embryology.

Ruggiero’s paper, entitled “On the risk of contracting AIDS at the dissection table”, (PubMed listing here and readable in full from here) manages to reprise the interpretations of Italian public health policy he put forward in his sadly demised Med Hype essay, and concludes that:

"...HIV infection is not necessarily associated with AIDS and most HIV positive subjects do not develop AIDS provided they do not assume toxic drugs or engage in risky behaviours (Chamberland et al., 1995; Duesberg et al., 2003), whereas AIDS can occur even in the absence of HIV infection (Italian Ministry of Health official instruction No. 9 of April 29 1994)." 

We won’t go into this particular paper in much detail here, except to point out that it appears to be a rather ham-fisted attempt to cite as many times as possible Duesberg’s thoroughly discredited 2003 Indian Journal of Biosciences outing, as well as a rehash of Ruggiero’s earlier cogitations about Italian public health policy revealed in Med Hype. Note, however, Ruggiero's blatant misrepresentation of Chamberland et al 1995 to claim that "most HIV positive subjects do not develop AIDS provided they do not assume toxic drugs or engage in risky behaviours".

Also notable was Ruggiero’s recent appearance (June 4th 2010) on the Gary Null radio show in the US, and on the internet everywhere, on a program in which Null interviews various HIV/AIDS denialists associated with Rethinking AIDS, interspersing these with readings from a page on RA President David Crowe’s personal website. Vitamin salesman Null, of course is, according to Stephen Barrett's Quackwatch website "one of the nation's (the US's) leading promoters of dubious treatment for serious disease". Not only is Null an (alleged) quack, he is also notoriously litigious - even to the extent of suing recently when he poisoned himelf with his own product.

Anyway, this is the venue that Ruggiero chooses to announce to the world:

“And so we reverse the dogma: it’s not HIV that causes AIDS, but it is immune deficiency that causes chronic HIV infection, plus all other types of infection, of course. And so, if you can potentiate and strengthen the immune system you can get rid of the virus, but you know the virus is probably harmless, so it’s not a big point getting rid of that virus. But also you can get rid of all other harmful pathogenic microbes.”

And in answer to Null’s question about what he would say to people diagnosed with AIDS, Dr Ruggiero’s medical advice is:

“Yes, well a person diagnosed with AIDS means that her or his immune system is not working, so I think that trying to kill a virus with drugs that are very toxic to the immune system couldn’t be the best idea. Sometimes some of those drugs they work because they are potent bactericidal, anti-mycotic drugs, so they can work against other pathogenic agents. But the best thing for a person with a deficient immune system is to stimulate the immune system...”

Snout is wondering: does the University of Firenze have a policy on its tenured professors using the university's name to provide pharmacologically ignorant - if not lethally negligent - medical advice over the airwaves and the net?

THE SECOND It J Anat Embryol ARTICLE was authored by Henry Bauer, together with Ruggiero’s sometime student Matteo Prayer Galletti. It’s called “Safety issues in didactic anatomical dissection in regions of high HIV prevalence” It’s even more woeful.

Now the first question is what is a paper which is mostly about pretending to examine the epidemiology of HIV/AIDS in South Africa doing in an Italian anatomy and embryology journal?

Henry himself seems to be confused about the difference between embryology (the study of the early development of organisms) and epidemiology (the study of patterns of disease) ...

... but that doesn't excuse the journal's editors.

Similar to Ruggiero’s earlier effort, Bauer bizarrely tries to justify this by bookending his inept ruminations about HIV/AIDS in South Africa in terms of the HIV transmission risk posed to medical students in that country through didactic dissection of cadavers. This is a transparently specious “framing” of his agenda. Bauer evidently has not the slightest idea about what goes on in a dissecting room, let alone the infection control policies and procedures in place in South African medical schools. If he had, he would have been aware that cadavers and specimens for student dissection are routinely pickled in formalin for months and sometimes years. A competent exploration of the issues of infection risk to students would examine the selection criteria for corpses for dissection, the handing procedures for bodies and the effectiveness of preparation, preservation and time in inactivating any potential infectious hazards that might have been present at the time of death.

Laughably, his "research" on this doesn’t appear to extend beyond a quick glance at the home page of the Anatomy Society of South Africa’s website and imperiously giving his nod of approval. No doubt the medical faculties of universities in Cape Town, Pretoria, Bloemein, Durban and elsewhere in RSA are heaving a collective sigh of relief at receiving the Great Man's endorsement.

Instead, as Bauer highlights on his blog and elsewhere, his purpose in writing the piece is to find a new and hopefully PubMed-listed venue for the drivel that was so incompetent it was even rejected by the publishers of Med Hype:

Henry H. Bauer 4 June, 2010

It may be pertinent to note that the substance of the withdrawn [Med Hype] articles, to which adherents of the HIV/AIDS hypothesis objected, has now appeared in the well-established mainstream peer-reviewed Italian Journal of Anatomy and Embryology:

Ruggiero et al., "On the risk of contracting AIDS at the dissecting table", 114: 97-108

Galletti and Bauer, "Safety issues in didactic anatomical dissection in regions of high HIV prevalence", 114: 179-192

That drivel being...

...that the HIV prevalence in South Africa has been overestimated:

Here he begins by contrasting the 2007 UNAIDS seroprevalence estimate of 18% with the 2008 HSRC estimate of 10.6%, intending to highlight the apparent discrepancy to cast doubt on their reliability. In fact the two figures are completely consistent: the UNAIDS estimate is the adult seroprevalence, while the 10.6% figure is for the whole population, demonstrating yet again Henry’s inability to read his sources accurately.

He then moves on to a long and rambling discussion of the uncertainties (and there are many) around underlying causes of death in notifications to Statistics South Africa. While a competent discussion of this could be potentially interesting (Bauer's is neither) it is of no relevance at all in estimating the prevalence of HIV, which for some years now is done by large and extensive nationwide seroprevalence surveys amongst the living.

...that HIV diagnostic testing in South Africa yields a high rate of false positive diagnoses:

According to his blog, “this publication (his J It Anat Embryol outing) adds estimates of the rate of false positives”. In fact it doesn’t, for the simple reason Henry has not the slightest clue about how HIV diagnoses are made in South Africa or elsewhere, or about how the accuracy of such diagnoses is evaluated.

“The overwhelming majority of HIV testing has been and continues to be done only via antibody tests (ELISA), which were designed and approved for screening and not for diagnosis.”

Leaving aside the fact that screening tests are always part of diagnostic algorithms and that ELISA tests are approved worldwide for this purpose, this is complete nonsense. In fact South African diagnostic testing algorithms employ at least two different tests before a positive diagnosis can be confirmed, and Western Blot testing (together with other tests) can be used to help resolve any clinical situations where there is doubt as to the predictive value of the two-test algorithm. See also here:

...that seroconversion to HIV-positive occurs without exposure to HIV:

Here Bauer makes a series of laughable misrepresentations of published papers. For example he cites the observations by Bailey et al and Gray et al that a small handful out of many thousands of men in African circumcision studies seroconverted within the first 1-3 of months following surgery, despite denying sexual activity during that period - not realising that seroconversion occurs weeks or sometimes months after the time of infection: these men most likely tested HIV negative at the time of surgery because they were still in the window period. Given the relatively high incidence of new infections in the study populations, it would be surprising if both teams had observed no cases at all in this time frame.

Even more ridiculous is the claim that because pregnant women in Africa have higher seroprevalence than the community as a whole this means that pregnancy itself must be causing false positive reactions. Henry doesn’t seem to have considered that pregnancy in women of childbearing age who are not using contraception might in fact correlate with unprotected heterosexual activity.

For further information on this, consult the groundbreaking research of Hummel and Skivington (1998)

...that a high proportion of people with HIV are elite controllers or long-term non-progressors:

"Official data indicate that this proportion is much higher than commonly assumed, perhaps as great as 50%.” - HIV Septic 4th June 2010 

Bauer first misrepresents a 2009 study by Okulicz et al, suggesting that the authors found that 6.2% of people were long term non progressors at 20 years after infection. In fact, Okulicz found that only 3.32% of HIV positive armed services personnel had no disease progression at 7 years and only 2.04% at 10 years. Elite controllers (those who consistently maintain a plasma HIV RNA less than 50) were even rarer at 0.55%.

Then he goes off on a strange and self contradictory chain of misrepresentations of US seroprevalence estimates, beginning with the bedrock factoid of denialist epidemiology, Duesberg’s fatuous and thoroughly discredited claim that HIV prevalence in the US is supposed to have been 1 million in 1985 (and has been constant ever since). In fact, current estimates put the HIV seroprevalence for the end of 1985 at closer to 420,000, and no credible studies done since the early 90s have put it at anything like a million in 1985.

 Source: CDC Fact Sheet: HIV In the United States July 2010

Next, he forgets the whole point of Duesberg's bogus claim - that HIV prevalence is supposed to have been flat because HIV is a "passenger" virus of longstanding. This is strange, because he was a co-author on the most recent paper (the Med Hype fiasco) where Duesberg has tried yet again to flog the flyblown remains of this particular dead horse.

Bauer projects from that supposed 1985 figure of 1,000,000 a prevalence for 2007 of 1,572,000, assuming a constant annual incidence of 55,000 and substracting the 583,000 recorded AIDS deaths. This is half as much again as the CDC's estimate of 1.056-1.156 million for 2006, which includes an estimated 21% who had yet to be diagnosed.

Along the way, he fails to notice that even the most recent CDC surveillance reports are nothing like a complete count of all HIV diagnoses – only 34 states had long term confidential name based reporting by 2007. Then he adds the 264,000 reported HIV (not AIDS) cases to the 469,000 PLWAs, subtracts this from his made-up "true" prevalence figure and ends up concluding that there must be 839,000 undiagnosed HIV positives among the US population. And the reason they're undiagnosed? Why, because they're elite controllers, of course.

Seriously.

...that HIV testing produces a particularly high rate of false positive diagnoses in black people:

“this publication adds estimates of the rate of false positives, with special attention to the racial bias of existing “HIV” tests, a bias that stems from a failure to base the tests on appropriate control groups. That bias causes Africans to test “positive” about 20 times more often than they would under properly calibrated tests, and people of recent African ancestry also test positive about an order of magnitude more frequently than they would with appropriately calibrated assays.” [ibid HIV Septic]

Bauer begins by trotting out his standard explanation for the relatively higher HIV seroprevalence among African Americans compared to white Americans, dealt with in the previous article. Then he waves his hands about claiming that positive HIV diagnoses among Africans might have something to do with HLA types, but doesn’t elaborate on how.

Finally he suggests that Africans and people of recent African origin need to have special tests that have been “calibrated” in some way so that the resulting kits produce similar rates of positive results among black blood donors as the current tests do among whites, irrespective of the actual infection rates among such donors or the reasons why. Bizarre.

... and sundry other ludicrous claims that readers of Henry’s HIV Septic website have been laughing at for years.

...Such as the claim that:

“trauma and perhaps death itself can apparently produce substances that cross react with HIV tests – seroprevalence was found to correlate with degree of critical illness...”

What? You mean people with AIDS or at risk of AIDS might be more likely to become critically ill than other people?

“...it was higher in emergency rooms...”

Gosh. Sick people ending up in hospital? Who'd have thought it?

“...and it seemed to correlate with penetrative trauma.”

Yes Henry. Gunshot wounds and stabbings tend to be particularly prevalent hazards in the US among some of the most socially disadvantaged groups (including injecting drug users) where HIV prevalence is highest.

http://icanhascheezburger.com/

THE REAL QUESTION HERE is how does the kind of drivel like Bauer’s and Ruggiero’s articles end up in a "scientific journal" that alleges that its articles have been peer reviewed?

It should be obvious to any competent reviewer or editor that the pretext for submitting these pieces - which are about Italian and South African HIV/AIDS epidemiology respectively - to a journal of anatomy and embryology is from a point of view of academic relevance so tenuous as to make a mockery of any selection process for a specialised journal.

It is possible that the journal's referees, whose specialties are presumably in the areas of, well, anatomy and embryology, are insufficiently familiar with HIV epidemiology to have recognised what utter codswallop they were approving for publication. Although it’s difficult to believe that anyone with a even a basic science education couldn’t have spotted it, one would have thought that anyone so lacking in competence to assess the subject matter of the pieces should have had the humility and insight to disqualify themselves from the task.

However, Snout’s view is that the editors and reviewers of the Italian Journal of Anatomy and Embryology were probably fully aware that the trash they were publishing was junk science and in Bauer’s case at least consists of nothing more than the half-baked ramblings of a notorious loon who is completely ignorant of his purported subject  - but still chose to go ahead with publication anyway.

The question is, why did they deliberately publish what they knew, or should have known, was nothing more than the kind of pseudo-scholarship that belongs on crank websites like whale.to, and not in a scientific journal: Why did they embarrass themselves in this way, particularly when Bauer himself makes it perfectly clear he is simply using them to get his junk science into a PubMed listed journal - any PubMed listed journal?

"HIV/AIDS vigilantes tried to keep out of Medical Hypotheses and out of the database and abstracting service of the National Library of Medicine (PubMed) the publication by Duesberg et al. pointing out that AIDS deaths in South Africa are egregiously exaggerated — 20-fold times! — by the WHO computers.

"As earlier noted, this is now published in a well-established, peer-reviewed, PubMed-indexed journal, together with calculations using mainstream data showing that about half of all positive “HIV” tests in the USA are false in the sense of not presaging illness; and other tidbits."

Why have the editors of the Italian Journal of Anatomy and Embryology allowed their publication to

 be used in this way?