Thursday, September 07, 2006

I'm sorry Dean, was that a yes

I'm sorry Dean, was that a yes to both questions?

Dean Esmay asks how many Nobel Prize winners and National Academy members we have here at Moment of Science. Well let me see here...

besides myself,
and Timothy,
and Roy, we got...

well, I guess that makes zero.

This is just another example of Dean's refusal to apply either logic or reason to his thiniking on HIV/AIDS. How many Nobel Prize winners or National Academy members are there at Dean's World? And how many National Academy members think Duesberg's HIV/AIDS denial makes him a crackpot? Somewhere around 1000 I would guess.

"Yet these folks at the "A Moment Of Science" weblog think I'm either a liar or an idiot. Well okay. I'm no liar, but I may be an idiot. If so, I've got some well-credentialed idiots who are also on my side."

Well, in fairness, you do have some well-credentialed people on your side, yes better than any of us in some cases. But most of the well-credentialed ones aren't idiots, they're just wrong. None of them are dishonest enough to lie about the Lancet study the way that Hank did. An none of them are big enough idiots to repeat that lie without reading the paper, and then refuse to correct their statements after reading the paper.

So Dean, other than noting that there are no Nobel laureates, nor any idiots here at Moment of Science, I guess the only question I have in response is how many people at Dean's World have read the Lancet paper by now? Aziz? So, maybe 1?

Well, two of us have read it, and as you've failed to amend here, I'll assume that you still haven't. Otherwise you've answered yes to both parts of my question.

Oh, and Dean, your continued use of Walter Gilbert as an example of a well-credentialed AIDS denialist damns your credibility even further.

"What you should believe is that Nobel laureate Walter Gilbert, one of the founders of Molecular Biology, believes there is something very wrong going on here."
In addition to refusing to appy logic and reason, Dean ignores simple facts like Walter Gilbert is no longer a skeptic on HIV.

Dear Dr. Jeffreys---I am afraid that those comments go back to the late 80's. At that time I was a skeptic--the argument based on Koch's postulates to try to distinguish between cause and association. However, even during that time we had several AIDS projects going within Biogen--one to try to stimulate T-independent B-cell activation (a pet approach of mine), another to develop soluble CD4--to use as an antiviral agent. That second project got to clinical trials (and failed because the virus in patients didn't have the high affinity for CD4 that
the lab-grown virus had.) Today I would regard the success of the many antiviral agents which lower the virus titers (to be expected) and also resolve the failure of the immune system (only expected if the virus is the cause of the failure) as a reasonable proof of the causation argument.

yours truly

Walter Gilbert (emphasis added)

If anyone would like a copy of the Lancet paper in question, to see what a simple error of fact Dean refuses to correct for his readers, please shoot me an email at my profile, and I'll send it to you. We certainly didn't ask Dean to give up HIV/AIDS denial completely, just read a paper and accurately note what was being measured there (mortality during the first year of treatment, not lifespan), but I suppose if he lets the light of reason in, even a tiny bit, the whole edifice of denial will disintegrate and fall in on his head.

No wonder he's afraid to acknowledge the truth.

UPDATE: Dale points out in comments that I have said several times that the increase in CD4 cells was observed to improve over calendar years in this paper, but that the average CD4 increase of about 100 is fairly constant over calendar years. The increase in CD4 cells in 1995-96 is 90, in 2003 it was 103. It doesn't really affect my main point, but since I was criticizing others for their interpretation of the paper, I add table 2 showing the average increase in CD4 cells for each calendar year so that readers can see what the data show.

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Comments on "I'm sorry Dean, was that a yes"


Blogger Dean Esmay said ... (9/08/2006 1:59 AM) : 

When you grow up and stop acting like a spoiled brat throwing a temper tantrum, you might get a more reasoned response.

So far all I can tell you is I simply haven't had time to sit down and read the paper--and that your antagonistic, churlish behavior isn't doing much to make me rush on it.

One piece of advice though: when you call someone a "liar" when maybe they just got something wrong? You immediately drop about a thousand points on the credibility scale. And even further on the general human decency scale.

Grow up, little scientist.

Oh by the way? How about we have a survey of those NAS members to ask how many of them think Duesberg is a crackpot? Might want to ask the Indian Academy of Sciences too, since they still publish his papers.


Blogger Dean Esmay said ... (9/08/2006 2:34 AM) : 

Oh, by the way: please look very carefully at what Dr. Gilbert's statement said, and did not say. I suggest you ask him point blank a) what he thought of Harvey Bialy's book about Peter, and b) whether he thinks that HIV skepticism is unscientific "crackpottery." You might even ask him if he is certain that the two points he gave as "reasonable proof" are completely correct and beyond reproof.


Blogger Pharma Bawd said ... (9/08/2006 7:12 AM) : 

Thanks for the advice Dean. After reading your own attacks on The New York Times and John Moore, for instance, I was under the impression that you wouldn't mind an aggressive approach to correcting errors. Sorry, if that aggression is only applied to correcting the traditional media.

I don't believe I've called you a liar, though I did call Hank one because I believe he's at least read portions of the paper.

As far as reading the whole paper, you need only read this sentence:

The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of
HAART, which were estimated using Cox regression."

from the abstract under Methods, to see that what Hank wrote is untrue. I did try to address this with Hank at his blog by the way and he declined to respond. So I appreciate your willingness to read the paper.

There are, as I mentioned in a previous comment, plenty of "gems" from the paper for you to seize on, so that the opportunity for making a "tactical withdrawal" when you make this correction at Dean's World should make you eager to read the whole paper in short order.



Blogger Dean Esmay said ... (9/08/2006 6:35 PM) : 

OK. I'm going to read it. I doubt either way that it will allay my skepticism, but I grant I may have gotten something wrong, and Hank may have been completely wrong. If so, then at least the authors should be asked why they made such a definitive declaration in their own summary.

I further admit that there's something difficult going on here: once you plunge your head into this horrible debate, it is hard not to get emotional about it. Indeed, as I see it there are two positions, both equally antagonistic and disturbing:

1) These "denialists" are slandering an entire field of well-meaning researchers and medical professionals who are just trying to save lives. We need to get as many people as possible on these drugs or they'll die horrible deaths.

2) The establishment has made a horrible mistake and as a result a lot of people have been led off into the weeds and even more people have been treated inappropriately and may have even died due to iatrogenic causes. Indeed, on the matter of Africa, it's particularly disturbing, for there's a very good chance that more lives would have been saved by clean water, sanitation, and decent food than by the drugs.

It is very disturbing no matter which way you look at it, no?

I would urge you to look at my Are You and AIDS Questioner? piece and instead of looking for sensationalism just look at what I literally said, and what I did not say. I am not a part of any cult, and Peter is a friend (and his friendship quite possibly makes me lose perspective) but he is not some sort of leader I look to. Indeed, if you look closely, while I think you will find I have sometimes been snarky and overbearing, I have usually tried to restrain such urges. For I do not--I repeat, I DO NOT--believe there is any grand conspiracy of deception here. If there are any real "bad guys" in this story (in my narrative, anyway) there are a small handful of them. Most doctors and most researchers are entirely well-meaning in this entire affair.

I do urge you, if you have Gilbert's email address, to ask him the simple questions I asked. Indeed, I'll tip my hand: I happen to know Gilbert read Harvey's book, pre-publication, and even made suggestions for revision before it was published. Harvey and Wally know each other personally, by first name, so this is no joke. My guess--and this is a GUESS--is that if you ask him he will probably state that he thinks that the orthodox view is probably correct but the skeptics (the serious ones, not the flakes on the internet) are not idiots and not dishonest. But you go ahead and ask him, and see what he says. I have no fear for his answers, for I do not believe I have been in any way dishonest about his position. Overstate? Perhaps. I am imperfect after all.

I would also ask you to dial down the rhetoric a bit. Perhaps you have convinced yourself that I am deriving some sort of profit out of my skepticism, or am trying to be some sort of ass who is slamming the medical and research community. I am not. Believe it or don't, but I certainly do not see myself that way and do not mean to come off that way. Nor, I say again, do I believe in any grand conspiracies to bilk the public into poisoning people. I categorically reject all such assertions, and if I have implied that I ask you to point to where I have and I will clarify my remarks, for that has NEVER, EVER, been my intent.

As my co-blogger Dave Price likes to say, "empiricism is a harsh mistress." I believe that. And so if you are an empiricist, you understand that she makes you take some uncomfortable positions sometimes.

Anyway: I am merely a blogger. A well-read one, but merely a blogger. My nom-de-guerre is not "AIDS Dissident." I write about a thousand subjects other than this. And I deal with people who tell me I am wrong on a daily basis. I write about this solely becuase I care, not because I want to demonize anyone or make a grand name for myself. Indeed, I have never profited so much as one dime from writing about this. Indeed, if anything, I have paid a personally heavy price just for my skepticism. And I care about people dying, and want to be sure no horrible mistake has been made here.

And yes, I know Hank personally, although we are hardly best friends. I know Harvey personally, although he and I often argue about many many things--I'm a Bush supporter and a neocon and he hates all that, after all. I know Peter well enough to call him by first name. But there's no cult here, and no grand movement. Indeed, I often wish I'd never written about this at all.

I am also currently unemployed and looking for a job, which is playing games with my head.

I have the paper you sent, and I thank you. I have scanned through it twice but not yet sat down to read it carefully. I will do so, probably in the next week.

I will offer you this observation: in over 20 years of making friends with scientists and writing about science, I have found only three issues which seem to make people very angry. One of them is Intelligent Design--and if you look carefully at my remarks on that little imbroglio, you will discover that I AM NOT an Intelligent Design advocate, I just think the scientific community has reacted wrongly to this bit of pseudoscientific fluff. And then there is HIV and AIDS, which raises HUGE anger in lots of people, and which disturbs me because I think that whenever there is this much anger there is something wrong.

The third is Global Warming, and if you think my skepticism on this matter is unscientific, I urge you to at least read this carefully, then ask if I'm being unreasonable.

Anyway, I have now spent more time writing this than I might have in just reading the paper you so kindly forwarded to me. My initial scans of the paper tell me I think you're over-reacting to call Hank a "liar," but I HAVE NOT DIGESTED IT IN FULL, and I do have a life outside of this. So give me a little time will ya? Thanks.


Blogger Dean Esmay said ... (9/08/2006 6:43 PM) : 

I'll link this discussion again in the morning, by the way, without any snarkage.

I hope you have a good weekend.


Blogger Pharma Bawd said ... (9/08/2006 11:26 PM) : 


I want to clarify again, I don’t think this paper is going to allay your skepticism about HIV/AIDS. What I’m trying to get cleared up is that this paper absolutely does not say that HAART does not reduce mortality. It doesn’t even say that HAART doesn’t reduce mortality in the first year of therapy. It only says that the reductions in mortality that HAART produced when it was introduced in 1995-96 remain unchanged today, ten years later, despite the effects they’ve had in reducing viral replication and increasing CD4 cell count.

So I don’t expect this paper to change your mind. I just don’t want it to be used in internet discussions as evidence that “HAART does not work”. In short I don’t want it to become the next Padian paper.

The definitive statement the authors made:

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

is referring only to the first one year of HAART in treatment naive patients.

Compared to no treatment, HAART has reduced mortality even in just the first year of treatment. What they found in the Lancet paper is that first year mortality has not continued to decrease since the introduction of HAART in 1995, even though improvements have resulted in better virological control.

I agree that this is a difficult debate not to get emotional about. And the rhetoric is overheated, with one side or the other constantly about to violate Godwin’s Rule.

As for your piece, the questions you ask there are quite different than the ones being discussed in the internet discussions of HIV/AIDS.

“Have they told us everything?”

Yes, given the tremendous number of papers on PubMed I think they’ve told us far more than anyone can process. And certainly everything important is out there somewhere. Whether that information has been accurately conveyed to citizens...

“Are they spending our money wisely?”

This is a budgeting/policy question, quite different than: Does the virus HIV exist? Does HIV cause AIDS? Can HIV be transmitted through heterosexual contact? All of these questions I would answer with an unequivocal Yes! Whether the amount or the allocation of spending is done “wisely” or not we can all honestly answer differently as we all have different priorities.

As for the AIDS Questioner Campaign, I don’t have much of a problem with what you wrote, and to the extent that “I Question Orthodox AIDS” means “I don’t think an HIV+ diagnosis is an automatic death sentence” or “I think antibiotics, vaccines, food and clean water are greater priorities in Africa than anti-retrovirals for treating AIDS” I don’t have a problem with it either. But look what I find when I click through to the “AIDS dissident” listing provided by the link:

“An AIDS dissident is an individual who denies the veracity of, challenges, or questions, in some way, the prevailing scientific consensus that the human immunodericiency virus (HIV) is a necessary cause of acquired immune deficiency syndrome (AIDS).”


“However, all are in agreement that HIV could not be an underlying necessary cause of the ever-changing collection of diseases that are called "AIDS".”

So, according to them you do have to agree that HIV does not cause AIDS. It’s really not a group for people who think: “We should allocate more funds for cancer research instead of AIDS research.”, for example.

Regarding Gilbert, I’m not going to contact him because I basically agree with your statement:

“if you ask him he will probably state that he thinks that the orthodox view is probably correct but the skeptics (the serious ones, not the flakes on the internet) are not idiots and not dishonest.”

At one time his position was more than just that, he did believe that HIV had not been proven to be the cause of AIDS, today based on the evidence provided by the effectiveness of drugs that specifically target HIV, he accepts that HIV does cause AIDS.

I’m going to avoid commenting on global warming or intelligent design. There’s already enough on the table.

Take your time on the paper. I need to concentrate on other things aswell.

I hope the job search is short and successful. You have a good weekend too.

ps: Don’t drink anything.


Blogger Pharma Bawd said ... (9/08/2006 11:39 PM) : 

Oh, I would be remiss if I didn't recommend
this article submitted by a very well-respected virologist/epidemiologist.

It's long but you can consider it an introduction to how epidemiologists establish disease causation from someone who has made substantial contributions in the field.


Blogger Aziz Poonawalla said ... (9/09/2006 1:49 PM) : 


look, I am more sympathetic to your view on this than Dean's position.

But your approach on this issue is needlessly hostile, needlesly antagonistic, and needlessly insulting.

My advice to you is to treat Dean like a smart layman - a very smart layman. And treat him with respect as you point out why hes wrong. I can speak from experience that you can change his mind that way. Or maybe not; if he still at teh end of teh day doesnt come around, at least it shoudl have been in the right spirit.

I wont be fwding future emails from you to him on your behalf unless you change your attitude about the debate.

and yeah, you are right, Dean did accept Hank's extreme interpretation uncritically. No, I havent read the paper, just the abstract, and even that was enough to illustrate how offbase Hank was.

Bt its not the end of the world if a blog post on a blog somewhere isnt updated accordingly. So kindly lay off the hysterics about Dean being dishonest or disingenous or whatever.


Anonymous Anonymous said ... (9/09/2006 2:03 PM) : 

Pharma Bawd,

Not to nitpick but if you are going to take Dean to task for not reading the Lancet paper, might I respectfully suggest that you reread it yourself? The authors do not claim, as you have written twice now, that immunological markers 6 months after starting have improved with calendar year. What Table 2 and the text show is that correcting for CD4 counts at the start of HAART (which have changed from 1996 - 2003) the average increase in CD4 counts after 6 months on HAART has remained at ~ 100 cells/ul.

In all other regards though I would agree with your statements about the authors' conclusions.



Blogger Pharma Bawd said ... (9/09/2006 5:45 PM) : 


The 1995-96 increase in CD4’s was 90, the 2003 increase was 103. Its not huge but it is an improvement.

Yes, a greater increase was seen the first year between 1995-96 and 1997 (108) than over the entire ten year period, and the average increase is about 100. I take your point that I should have been more precise while criticizing others, but I think you understand my point in commenting on this paper is not to make a positive assertion about how much better HAART has gotten over the past ten years, but rather to prevent a meme from forming around this paper that “HAART does not work”.

Thanks for pointing it out, I’ll make a jpeg of table two and add a note to this post so people can see what it says themselves.


Blogger Pharma Bawd said ... (9/09/2006 5:54 PM) : 


I understand. Thank you for forwarding my messages to Dean, if I feel the need to send him an attachment in the future I will request a different email address from Dean.

In my defense, consider that I’ve recently read nearly every thread on HIV and AIDS at Dean’s World, that’s dozens of threads, thousands of comments, tens of thousands of words,... Not all from Dean obviously but many statements from him are there, and not all of them are respectful to his opponents, ie: me.

“Bt its not the end of the world if a blog post on a blog somewhere isnt updated accordingly.”

I disagree that this is quite so simple. I don’t recommend that you waste the time necessary to read all the discussion of “the Padian paper” on DW, Barnesworld, and Aetiology but if you ever do perhaps you’ll see why I’ve reacted so harshly to Hank’s initiation of a similar misinterpretation of this paper from the Lancet.

Your point is taken that if I hope to persuade Dean or others, this was not the best approach to take. Hopefully, now that I’ve had a few opportunities for catharsis, I’ll be able to adopt a more productive approach.




Anonymous Chris Noble said ... (9/09/2006 7:27 PM) : 

Dean writes:And then there is HIV and AIDS, which raises HUGE anger in lots of people, and which disturbs me because I think that whenever there is this much anger there is something wrong.

The thing that causes HUGE anger is that one group of people continuously takes papers saying A and then claim that they really say B.

Hank Barnes and Celia Farber can't manage to accurately describe the Padian paper. It wasn't 175 couples followed for 10 years. There was 282 years of follow up.

This misrepresentation has lead to the unusual step of the author making a public statement.

Hank Barnes and Celia Farber continue to tell the same untruths and half-truths after Nancy Padian has admonished them.

Now Hank Barnes/D. David Steele is spreading more untruths about another paper and you credulously accept his interpretation. Why? The same person has also spent time trolling on evolution webboards demanding "proof" for evolution. Why see Hank as scientifically literate let alone an authority?


Blogger Orac said ... (9/11/2006 8:29 PM) : 

"But your approach on this issue is needlessly hostile, needlesly antagonistic, and needlessly insulting."

Oh, Dean's been known to call people he doesn't agree with liars over a disagreement. Trust me on this one, as one who's been on the receiving end more than once.


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