This is my sixteenth entry into reviewing Robert F. Kennedy, Jr.'s book, The Real Anthony Fauci. Fauci became the head of NIAID, the National Institute of Allergies and Infectious Diseases, in 1984, at the time that the AIDS crisis was gaining momentum. Kennedy looks at HIV and AIDS and, of course, takes digs at Fauci, claiming Fauci promoted the deaths of millions. The previous entry is here. The first entry to the series is here.
HIV and AIDS. Chapter 5, The HIV Heresies and Chapter 6, Burning the HIV Heretics.
I thought of trying to analyze these two chapters step-by-step and page by page, but I found Kennedy's approach too disorganized. For example, he describes deficiencies in PCR testing on page 185, talks about it in more detail on page 191, then gets back to it in the next chapter. On page 181, Kennedy writes: "In July 1981, CDC reported a unique outbreak of immune deficiency-related health problems in a group of highly promiscuous gay men in Los Angeles, New York, and San Francisco." He doesn't return to defend that statement until page 222.
Instead, for this post, I'll first try going through highlights of the chapter five and then focus on Kennedy's arguments centering around Koch's postulates.
At the beginning of Chapter 5, Kennedy makes the point that "I take no position on the relationship between HIV and AIDS." (page 178) He then spends 65 pages presenting the arguments that HIV does not cause AIDS. He spends zero effort on analyzing the deficiencies of HIV-AIDS deniers' argument or why they are, at times, batshit crazy.
Further down page 178, Kennedy presents his thesis statement for the next two chapters. "Specifically, the original hypothesis on AIDS is an illustration of how vested interests (in this case, Dr. Anthony Fauci), using money, power, position and influence, can engineer a consensus on incomplete theories, and then ruthlessly suppress dissent."
On page 179, Kennedy introduces Dr. Peter Duesberg as "the world's accomplished and insightful retrovirologist" going on to say, "Specifically, Dr. Duesberg accuses Dr. Fauci of committing mass murder with AZT, the deadly chemical concoction that according to Duesberg causes and never cures---the constellations of immune suppression that we now call 'AIDS.'" This mass murder amounts to tens of thousands. (page 226)
Dr. Duesberg is the most prominent among those who promote the theory that HIV does not cause AIDS.
According to the index, Duesberg is cited on 25 pages. That only begins to highlight his presence in the book. RFK's book has subchapters titled "Peter Duesberg," "Do Retroviruses Cause Diseases?", "Punishing Duesberg," "Refusal to Debate [Duesberg]", "Duesberg's Theory," along with several more detailing Duesberg's theories. Furthermore, he is cited on several pages not mentioned in the index.
Duesberg has personal resonance in my life. I began researching HIV in the late 80s. My first exposure to him and his theories came through an article in the magazine Spin.
Bob Guccione, Senior, founded Penthouse, a popular and brazen (for its time) pornographic magazine. Bob Guccione, Junior, his eldest son, launched Spin, a music and pop culture magazine, in the late 80s.
For the Spin issue of September 1993, Bob Guccione, Jr. interviewed Peter Duesberg, PhD in chemistry, providing him a platform for denying that HIV causes AIDS.
At the time, I was a postdoc working in an HIV laboratory. Along with some cutting edge research, I was performing a lot of routine tests, such as growing HIV in culture and measuring how the drug AZT lowered HIV production in these cultures. These experiments were routine. I would fill wells in an array with white blood cells, add media with HIV virus stock, look at how the HIV killed the cells (in comparison to uninfected controls, the cells would naturally die over time), look at how different concentrations of AZT limited that killing, and then sequence the virus to look for changes in the enzyme AZT targeted.
Duesberg claimed that no one had ever performed the studies on HIV that I was performing, and which, as I said, were routine. I thought to myself at the time, "You have to be pretty smart to be that dumb."
Robert Gallo
Before getting into discussing Duesberg's theories, Kennedy diverts to talking about Gallo and his "den of thieves."
I have met Gallo (and Fauci and, briefly, Montagnier). In contrast to Fauci and Montagnier, I would characterize Gallo as being a vampire. Well after the world had pegged Gallo as dishonest in the discovery of HIV, I saw him make a fascinating presentation of the role of a protein called "tat" in the origin of Kaposi's sarcoma. I was impressed. Those conclusions turned out to be an artifact, so even that nod of acclaim that I was giving to Gallo, evaporated. Such egotistical, unethical researchers as Gallo set back research and stain science.
Kennedy's narrative doesn't do justice to the seedy tale of Gallo's (temporary) stealing of the discovery of HIV, the monetizing of early HIV testing, and the French tragedy in refusing to use the early testing. The French prime minister was charged for crimes in this matter and acquitted. The French health minister was convicted of manslaughter, and the director of France's National Blood Center served four years in prison.
On page 182 Kennedy says, "Before the appearance of AIDS both men [Montagnier and Gallo] had vainly strived to implicate retroviruses as the culprit in leukemia." I take exception to this comment. The retrovirus investigated, HTLV-1, did prove to increase the likelihood of acquiring leukemia. Oncoviruses, viruses that promote cancer, are now understood to be common, with approximately 12 to 20% of cancer cases associated with them.
Koch's Postulates
Moving along, perhaps the most significant sign that Kennedy's arguments are desperate can be found in how he cites Koch's postulates as evidence that HIV doesn't cause AIDS. These arguments begin on page 192.
Koch's postulates were first published in 1890 and represented the primary attempt to provide a guide for determining an infectious agent as the cause of a particular disease.
To prove that an organism causes a disease, Koch put forward four principles.
1) The microorganism must be found in abundance in all [infected] organisms suffering from the disease but should not be found in healthy organisms.
2) The microorganism must be isolated from a diseased organism and grown in pure culture.
3) The cultured microorganism should cause disease when introduced into a healthy organism.
4) The microorganism must be re-isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.
Although they represented a landmark in the discourse of the then new field of microbiology, over the course of the last 135 years his postulates have been shown to be incomplete time and time again. Only a charlatan would present them as absolutes.
The first exception to Koch's postulates presented itself less than 20 years later in a very famous case. Intrepid public health researchers discovered the common link between cases of typhoid: a woman who infected several households without she, herself, presenting dramatic signs of illness. She became known as Typhoid Mary and her existence violated Koch's hypothesis that "the microorganism . . . should not be found in healthy organisms." The belief that Koch's postulates were absolute slowed down the recognition of Typhoid Mary's role in the outbreaks. Nowadays, the concept of asymptomatic carriers and carriers with modest, overlooked symptoms is well understood in many diseases. A relevant example: "CMV [cytomegalovirus] is a common virus that infects 50 to 80 percent of people at some time during their lives but rarely causes obvious illness." [source] "People with a compromised immune system (such as people with HIV/AIDS or those receiving chemotherapy) may experience more serious illness involving fever, pneumonia and other symptoms." In AIDS patients, CMV can cause blindness.
Postulate #1, argument #1 from Kennedy, page 193. "Koch's first postulate requires that a truly pathogenic virus [comment: Koch's doctrine came out before the discovery of viruses] can be found in large quantities in every patient suffering from the disease. The failure of the HIV/AIDS hypothesis to meet this critical threshold remains one of Dr. Fauci's most exasperating dilemmas. [comment: no it hasn't] For starters, Gallo claimed that he found HIV virus in fewer than half of the ailing AIDS patients from whom he drew blood."
Now, Kennedy cites Gallo's competency? Gallo tried to culture the virus, at that time, a difficult task. Gallo eventually used Montagnier's culture and even stole Montagnier's photo of the virus for the initial publication. I've tried culturing the virus. You need what is called a high titer because initiating the infection has to overcome cellular defenses. That is why researchers have resorted to other means of detecting the virus in infected persons.
"Furthermore," Kennedy says, "every one of the thirty discrete illnesses we call AIDS occurs in persons uninfected by HIV." A poorly written sentence. There are not thirty discrete illnesses called AIDS. As for whether the opportunistic infections that often characterize AIDS can be found in people without HIV infection, of course, they can. These are infections that have always been around and they are called opportunistic infections because they are infections. This was put forward on day one from the first reports (which Kennedy goes on to cite). Why they were appearing with alarming frequency in a particular cohort was the problem, that was the point of the paper. To cite the first report of what would become known as AIDS: "The occurrence of pneumocystosis in these 5 previously healthy individuals without a clinically apparent underlying immunodeficiency is unusual." Unusual, not exclusive. Pneumocystis pneumonia and other "AIDS-defining" infections were never considered exclusive to AIDS patients.
Furthermore, Kennedy can't seem to figure it out, even as a possibility, how people can have HIV and not AIDS.
AIDS is the end-stage illness that comes years after being infected with HIV. HIV destroys the immune system so a variety of common and uncommon infections appear. Why is that hard to understand? Diseases that take years to appear after infections are a very common thing. (I'll talk more about that below and in my next post.) People with HIV and not AIDS is a simple straightforward thing. Koch, 130 years ago, did not foresee this.
Kennedy claims that the HIV antibody test proves that the person who tests positive could not have HIV. Page 191, "Finally, and most importantly, critics point out that Gallo's HIV antibody tests flipped traditional immunology on its head. Throughout all of medical history, a high antibody level indicated that a person had already successfully battled against diseases, the presence of antibodies signals a welcomed immunity from the disease" and "Dr. Fauci never explained this inexplicable paradox."
No, no, no! This is so basic that I have to ask whether Kennedy knows anything about medical issues. Has Kennedy never heard of neurosyphilis? This is a disease progression that takes place years (decades) after the initial syphilis infection. All the time the person will be positive for syphilis antibodies, which makes sense, his immune system saw the initial infection. It fought the infection and the organism hid out. This gets to another bit of incompleteness in Koch's first postulate. It is possible to have the disease and not have an abundance of organisms found.
Neurosyphilis is far from the only chronic infectious disease. When I teach viral infections to my medical students, one of my first slides says, some viruses [that infect humans] are fast and mean. Some are slow and mean. Does Kennedy deny all slow viruses? Hepatitis A? Influenzas? Fast viruses. Hepatitis B and C? Slow viruses. You get infected with hepatitis B or C and then 20 to 30 years later you have a deteriorating liver. And, of course, you get antibodies produced early on and forever. (I've had this happen in family.)
Kennedy says that Fauci didn't want answered "why some HIV infected individuals never succumb to AIDS." (page 197) Those who are infected with HIV, and who, even in the absence of antiretroviral therapy, do not progress are termed called long-term non-progressors. Is it a weaker version of the virus (one that replicates just enough to survive but not cause damage)? Is it some aspect of the patient (they have a genetic difference or some other means that prevents the virus from progressing)? Or is it possibly environmental, for example, good health principles of the patient? Searching the National Library of Medicine for HIV non-progressors I received hits for 575 papers. If I tweaked the search terms, there would be many more.
Koch's postulate #2. The microorganism must be isolated from a diseased organism and grown in pure culture.
Kennedy writes (page 197) "Highly respected scientists including Éttienne de Harven argued that HIV has never been isolated or grown in pure culture." I've personally cultured HIV on numerous occasions as part of other research protocols. I've certainly spoken to many scientists who have discussed the difficulties and what sort of cells to use. Even Kennedy describes the intrigue in which Gallo stole Montagnier's culture (after having difficulty to start his own.)
Kennedy goes on to Koch's third postulate. "The cultured microorganism should cause disease when introduced into a healthy organism." Kennedy states on page 198, "No one has tried injecting HIV into a healthy human being [he doesn't mention it, but I assume he is conceding to ethical considerations], but scientists have stuck all kinds of mice and rats and monkeys and chimpanzees, and none of them has gotten anything resembling human AIDS."
There are several problems with Kennedy's conjecture. First, there have been 58 confirmed (and 150 more possible) incidences of accidentally acquiring HIV through working with HIV directly or working with HIV-infected patients, in the latter case, typically through needle stick accidents. Secondly, there are a whole number of animal models that can be infected with HIV. One problem is that in the natural course, humans take 10 years to come down with a disease effect, and several animals such as mice and rats, mentioned by Kennedy above, do not have that kind of a lifespan. Which gets to a point of possible criticism: these animal models that do get used usually have some modification in their genetics, anatomy, or virus to get the virus to function more quickly. These modifications could include, for example, transplanting human thymus into the animal (the organ which helps blood cells to differentiate).
Furthermore, there are naturally-occurring immune deficiency virus that directly target certain animals: cats, monkeys, and horses, for example (feline immunodeficiency virus, simian immunodeficiency virus, and equine immunodeficiency virus, respectively.) Transmission experiments have be done in these species. Beyond the ethics of animal experimentation, one limit to such experiments comes from the fact that larger, longer-lived species are very expensive to test over the course of years.
Kennedy argues that viral load (the number of virus particles) with HIV are low. From page 198, "Traditional viruses such herpes, influenza, smallpox, etc., only cause disease at very high titer---thousands or millions of infectious units per cubic millimeter of infected tissue." This is a poorly written sentence. Which herpes virus? There are eight of them in humans. Smallpox? No one has investigated viral loads in infected tissue for smallpox since it was eliminated as an infectious disease fifty years ago. Influenza viruses do multiply to high titers: as mentioned above, it is a fast and mean virus. Finally, "infected tissue" does not speak to the way HIV is measured except for perhaps in the rare instances of lymphoid biopsies or post-mortem examinations. HIV viral loads are measured as particles per milliliter (not cubic millimeter) of plasma.
I've read a lot of HIV viral loads in my life,. Typically during disease, when the immune system has collapsed the numbers run in millions. Below is a typical representation. Ten to the sixth power represents 1 million. (Source cited below graph).
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| Natural Progression of HIV The viral load is shown in red, and the CD + 4 cell counts in blue. (Figure adapted from Giorgi, 2011) |
This is not "infected tissue." This is plasma, which is cell free, and represents only the freely circulating virus, a fraction of the actively virulent virus.
Kennedy (page 199) states "the onset of AIDS symptoms almost always arrive decades later (an average of twenty years following exposure) when viral loads are at their lowest." I've never seen anyone say "decades," and viral loads at the time of AIDS are their highest as shown in the above graph.
Kennedy goes on to quote John Lauritsen, a journalist and author of The AIDS War, to say "The virus infects very, very few cells---as few as one in 100,000." I don't know where Lauritsen got his numbers, but I have spoken to others who cited the one in 100,000 number. They used the fact that it typically took 100,000 virions to successfully start an infection of cells in culture, an entirely different thing from the fraction of cells infected. It really depends on the moment in the disease course, but typically, the number of infected circulating cells are 1 to 15%.
On page 200, Kennedy says "But even the most faithful acolytes no longer believe that HIV kills T-cells in any way." There is a huge body of literature on HIV killing T-cells. I am certain some are written by "faithful acolytes."
Before Koch.
Not satisfied to to say that HIV violates Koch's postulates, Kennedy goes further back in time to say that HIV infection doesn't have the predictable spread of infection as shown in William Farr's investigation of typhus cases (1849). No, it didn't. There is more than one graph that describes disease spread and the final voice on that didn't come in 1849.
Kennedy says, page 202, that "In Western countries, AIDS has never broken away from its original core pool of homosexual men and drug addicts." AIDS is not a gay disease. In the year 2000, for the US, 41% of those living with AIDS were infected by male-to-male transmission. This number is slightly exaggerated. Bisexual men with AIDS are often pigeonholed as to getting HIV through gay contact.
Kennedy says, page 202, that "Dr. Fauci's acolytes claim this [HIV] is supposed to be "the most infectious virus that has ever existed." I doubt that anyone sane has claimed that.
A Note Regarding Kennedy's Use of Citations.
Kennedy's book makes a lot of citations. Relatively few of them are directed to foundational work. Instead, he tends to cite news articles, YouTube videos, and sometimes tweets from irrelevant sources as though they represent scientific authority. He quite often quotes people who demonstrate no expertise on a subject. He also quotes people who are experts but leaves out the parts where they disagree with him.
At the end of Chapter 6, he includes 180 citations. For citation number 151, he points to Elinor Burkett, "HIV, Not Guilty?" Tropic Miami Herald (December 23, 1990). For citation 152, he points to Elinor Burkett, "Is HIV Guilty?" Miami Herald (December 23, 1990). Are these even two different articles.
I call out these two because this "pair" of references are repeated as citations numbering, 156, 157, 158, 159, 160, 161, 163, 164, 165, 166, 167, 168, 169, 170, 176, 177. That's how you get 180 citations for a chapter.
At the end of the same chapter he cites "HIV & AIDS, Fauci's First Fraud," a YouTube video, 20 times. A YouTube video is not a legitimate citation. He might as well say "the internet." The content in the YouTube had to come from somewhere, and if that source is legitimate, that would be a legitimate citation. He cited the same video 8 times in the previous chapter.
Martin Hill Ortiz is a professor of pharmacology and author of several novels.
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