Why is HIV/AIDS so deadly?

FYI… This is the fifth of ten posts that have nothing to do with vaccines.

Once in a while, a new loon is pointed out to me, and I read their insanity. This is the story of such an occasion:

Why is HIV/AIDS so deadly? According to the World Health Organization, AIDS kills about 1.6 million people per year. We know what causes AIDS. We know that HIV infection can be prevented through safe sex, no sex, proper screening of the blood supply, administering drugs to HIV-positive people to lower their virus counts. We have very good screening tests to administer to people and make sure they get the care that they need. And we can explain all this to millions at a time through the use of all sorts of media.

So what gives?

The answer can be a little complicated. There are some political interests involved that misuse (or don’t use) the resources given to them to combat HIV/AIDS. There are also people in very high positions of authority who believe that the disease is a proper and just punishment for all sorts of “immoral” ways of being, e.g. homosexuality.

But there is also a group of people who believe that HIV doesn’t cause AIDS, though they should know better. One of these people is Kelly Brogan, MD. According to her website, she received her medical degree from Cornell University and two science degrees from MIT. She did her residence in psychiatry and is board certified in it. With all that education, all those hours, days, weeks, and months invested in learning how to heal people, Dr. Kelly Brogan has some interesting thoughts on HIV and AIDS.

For example, women with HIV should not take drugs to reduce the chances of passing the virus on to their babies. Why? Because:

“This was the case with a now infamous, but little-publicized perinatal trial of the drug nevirapine for the prevention of transmission of HIV from mother to baby. An NIH-funded trial staged in Uganda, HIVNET 012, was hailed as demonstrating a 50% decrease in transmission, and set the stage for world-wide drug dissemination and coercion of women like Joyce Ann Hafford, to their death.”

UPDATE (9/25/14): It looks like Dr. Kelly Brogan has taken down her article. But here is Google cache to the rescue: http://webcache.googleusercontent.com/search?q=cache:http://kellybroganmd.com/snippet/hiv-pregnancy-pharma-abusing-women/

Dr. Kelly Brogan quotes a Harper’s Magazine author who seems to claim that there was no control (or placebo) group in that study. But there was a control group…

The HIVNET 012 trial was conducted in 1998 in Thailand, with some startling results:

“In February 1998, a randomized, double-blind, placebo-controlled trial sponsored by the U.S. Centers for Disease Control and Prevention in Thailand of 393 mother/infant pairs showed that a short course of oral ZDV could reduce HIV-1 transmission by about 50% over a placebo—to an overall rate of 10%—in a non-breastfeeding population (CDC, UNAIDS, NIH, and NRS, 1998; Shaffer et al., 1999). 1 As a result, HIVNET 012 researchers formally dropped the placebo arms in a letter of amendment (known as Amendment I) to the protocol, and stopped enrollment on February 18, 1998.”

The study didn’t stop there, though:

“HIVNET 012 was redesigned and reopened on April 6, 1998—with approval of the Ugandan and U.S. institutional review boards—as a randomized, open-label, Phase IIB clinical trial.2 In this newly approved protocol, the target enrollment was 400 to 600 mother/infant pairs randomized in a 1:1 ratio. Women in the NVP arm of the trial would receive a single, oral 200-milligram dose of NVP at the onset of labor. Their infants would receive a single, oral 2-milligram-per-kilogram-of-body-weight dose of NVP suspension within 72 hours of birth. Women in the ZDV arm would receive 600 milligrams of oral ZDV at the onset of labor, followed by 300-milligram doses every 3 hours during labor. Their infants would receive oral 4-milligram-per-kilogram-of-body-weight doses of ZDV twice daily for the first 7 days of life. Boehringer Ingelheim Pharmaceuticals and GlaxoWellcome, respectively, donated the study drugs.

The HIVNET 012 protocol specified follow-up of mothers for adverse events for 6 weeks after delivery. Infants were followed for adverse events until 6 weeks of age, and for serious adverse events until 18 months of age. Researchers graded such events based on toxicity tables from the National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) for neonates, children, and adults, ranging from grade 1 (mild) to grade 4 (life-threatening). The 1997 Study Specific Procedures manual included the DAIDS toxicity tables, as well as a special grading system for adverse experiences related to skin rashes and dermatitis and hemoglobin in mothers (Jackson et al., 1997). As the medications were given for a week or less, the study did not modify drug doses for toxicity.”

It wasn’t all without some issues, though, and the trial was adjusted again:

“Researchers amended the study protocol in February 2000 (Amendment II) in response to findings in other studies that some women could develop viral resistance to NVP, and that some children treated with various antiretroviral drugs in utero or perinatally could possibly experience mitochondrial toxicity. The modification entailed extending follow-up of women in the NVP arm and all children in the 18-month study to 5 years, with yearly evaluations for NVP resistance in women who had received NVP (HIVNET 012 Investigators, 2000).”

And what were the final results?

“The 1999 Lancet paper also analyzed adverse events and toxic effects based on the first 556 mother/infant pairs assigned to treatment with ZDV (279 pairs) and NVP (277 pairs). The authors reported that “the rates of maternal serious adverse events were similar in the two groups (4.4% in the ZDV group and 4.7% in the NVP group),” and that “the occurrence of clinical or laboratory abnormalities in mothers was similar in the two groups.” The authors also reported that for infants, “the rate of occurrence of serious adverse events in the two groups was similar up to the 18-month visit (19.8% in the ZDV group and 20.5% in the NVP group).” The “frequency and severity of laboratory-detected toxic effects … were similar in the two groups.”

The second Lancet paper (Jackson et al., 2003), reported that infants assigned to the NVP arm continued to have a significantly lower rate of HIV-1 infection and a significantly greater likelihood of HIV-1-free survival through 18 months of age (Table 2.2). Specifically, the efficacy of NVP compared with ZDV was 41%.”

The Institute of Medicine, and others, back the study’s findings. That Harper’s Magazine article? It was widely chided for its inaccuracies regarding the relationship between HIV and AIDS.

So why does Dr. Kelly Brogan see this study as a bad thing? And who is Joyce Ann Hafford?

Joyce Ann Hafford was a 33 year-old woman who died from liver failure from the medications she was being given as she participated in a drug research study. She was HIV-positive, and she enrolled in the research study in an attempt to keep her unborn child from being born with HIV. The whole thing was an enormous mess. Ms. Hafford started showing signs of toxicity from one of the drugs, but her healthcare providers apparently put the blame on her condition and not on the drugs. The National Institutes of Health eventually confirmed that it was most likely the drug.

These things happen. I won’t deny that medications, even the life-saving ones, all have risks. At a population level, antiretrovirals are saving lives, but everyone needs to be monitored for side-effects. At the individual level, there are those who need to be treated for side-effects. Not treating HIV will inevitably lead to AIDS in 99.999999999% of people who are infected. Treating it will cause side-effects in a very, very small percentage of people being treated. It’s about weighing the risks.

Perhaps because Dr. Kelly Brogan is not an epidemiologist and most of her training appears to be in psychiatry, Dr. Kelly Brogan seems to believe that all antiretroviral drugs are the ultimate evil, which fits well with her statements about medical science:

“This medical-scientific-industrial marriage has brought us many a meme that we hold on to societally, as truths:

That depression is a chemical imbalance

That cholesterol causes heart disease

That exposure to bugs equals deadly infection, and vaccines protection

Cancer is a genetic time bomb

That HIV causes AIDS, the equivalent of certain death”

She links her last statement, the one about HIV and AIDS, to a known AIDS denialism group. I’m not even going to touch her statements and blog posts on vaccines. (She thinks that herd immunity is fiction, apparently. Something that made my head explode.)

And there you have it. People continue to die from HIV/AIDS in part because people who should know better continue to perpetuate the idea that HIV doesn’t cause AIDS, with variations to that theory. Some say that HIV is just a “passenger virus” and that it is an incidental finding with AIDS really being caused by the drugs used to treat HIV infection. Others say that HIV is a manufactured virus, aimed at homosexuals or at Africans, but still not a full-fledged cause for AIDS. And so on and so forth.

Without telling us her complete stance on the matter, Dr. Kelly Brogan certainly can seed some doubts in those who may not be initiated. But we are initiated, aren’t we, folks?

When anger is disguised as activism

FYI: This is the fourth blog post that is not related to vaccines… Or is it?

It’s a tricky balance to listen to testimonies and be skeptical about them. On the one hand, you want to believe everything you’re hearing. You want to give the person the benefit of the doubt and take them at their word. On the other hand, if you are a reasonable person in a position of authority and you need to recommend or take action based on the information you’re being given, then you have do use your best judgment and separate the wheat from the chaff.

The Interagency Autism Coordinating Committee recently held a meeting and public speakers were invited. The oral public comments are really something interesting to read. Yet something we need to keep in mind is that these are not the comments of unbiased people. Rather, they are the public comments of people who feel that they have been wronged or that they are currently being wronged by life, the government, members of the committee, etc. Keep that in mind should you want to read them.

My issue with this type of activism is that it is very negative, very angry. Consider this statement:

“Now the numbers continue to rise with little being done to find the cause or cure. My children acquired autism via toxins. We know based on medical tests the toxins were vaccines. Something needs to be done to prevent other children from such injuries. My children have no future. They are extremely affected. It was brought to my attention that some of the studies that this committee uses to base certain opinions were falsified and corruption was taking place. People need to be held accountable because children continue to be harmed.”

Indeed, children continue to be harmed because autistic children continue to be described as having “no future”.

But, if there is no passion, can there be activism and advocacy? Absolutely. Also, anger does not equal passion. Passion is motivation and desire to get something done, to pursue a goal. Anger? Anger just clouds judgment and gets nothing done. Anger only gets you in trouble and makes you sound like a loon (with all due respect).

So how do we take the testimony of an angry mom who sees no future in their living, breathing child who, by her testimony, plays hockey and travels? We take it with an enormous grain of salt.

Don’t try to reason with the unreasonable

FYI: This is the third of ten posts not related to vaccines.

I have a friend who is an amateur photographer. You may have seen some of this stuff over on his blog. We all went out to dinner the other night, and he brought his camera with him. His camera is not small. It’s a rather bulky DSLR camera, and he had a rather bulky lens on it. We walked down the street to where we were having dinner, and he took pictures of buildings and people along the way. No one really seemed to care. Our nation’s capital is a big city and most of us carry around a camera in our phones anyway.

It’s not the same way in England, apparently. My friend shared this video with me off of YouTube. In it you can see several photographers taking pictures around London and being harassed by security guards over taking pictures of several buildings. Before you watch the video, keep in mind a few things. First, the photographers are in London, a very touristy city. In 2011, there were over 15 million tourists who visited there. Surely, they took pictures. Second, notice that these are security guards and not law enforcement. Keep that in mind as you hear them trying to quote laws and regulations. Finally, keep in mind that the photographers are in public places with big cameras. If they are conducting “surveillance” of buildings to “bomb”, then they’re going about it in a very open and obvious way. I have the sneaking suspicion that terrorists don’t act the same way.

Oh, one more thing. Notice how the security guards stand their ground and so do the photographers. Their back-and-forth reminded me a lot of how we may try to reason with the unreasonable but end up nowhere.

HIV leads to AIDS, plain and simple

FYI: This is the second of ten posts that will not be related with vaccines.

Back in the late 1970’s and early 1980’s, there was a lot of scientific confusion as to what the relationship was between Acquired Immunodeficiency Syndrome (AIDS) and a newly discovered retrovirus first known as HTLV-III and then renamed to HIV. Thirty-plus years and millions of dollars later, we have come to understand that HIV infection, if left untreated, progresses on to AIDS. We came to understand this because we observed people with HIV and people without it. Then we went one more step further and observed people infected with HIV who were treated and those who were not treated. We did these observations in real-world situations and also in controlled situations. We also did these observations in animal models.

All the evidence is there, and it is very clear that HIV causes AIDS.

Still, there are a group of people out there who honestly believe that HIV doesn’t cause AIDS, that AIDS is the result of things other than HIV, or that neither HIV nor AIDS actually exist. (There are wilder theories than those, if that is possible, but I don’t have time for them.)

A few years ago, I came upon the comments of a man who has some “interesting” views of the relationship between HIV and AIDS. Here is the comment:

“Whether ORAC knows anything about medicine or science is unclear, but he knows NOTHING about how to conduct an investigation.

Having conducted thousands of criminal, civil and military investigations since 1980, it was clear from the onset that Deer’s so-called investigation resembled more of a hit-piece than a real investigation. As such, it was the perfect pretext for the kangaroo court known as the medical board review.

ORAC’s outrage is also telling. Since truth is the best defense in such cases, Deer’s defense should be extremely easy – unless, of course, he lied to destroy Dr. Wakefield’s career.

Because I have been involved in more than 100 criminal, civil and military cases involving medical and scientific incompetence since 2009, I am not at all impressed that ORAC is funded by the DoD, NCI or any other US government agency. And having recently cleared a US Marine of criminal charges by impeaching a top military infectious disease expert, I’d say that ORAC’s outrage is likely based upon his fear that he will be eventually be discovered as a charlatan as well.

If ORAC is telling the truth, nothing would preclude the use of his real name. The fact that he blogs on this pharmaceutical marketing website is telling.

Clark Baker LAPD (ret)”

He did us all the favor of directing us to his website, the “Office of Medical and Scientific Justice”. It’s a pretty legit-sounding website that talks a lot about clearing people who are innocent from false accusations against them. Just read the “About” page:

“Having conducted thousands of criminal and civil investigations since 1980 with the LAPD and as a licensed investigator, Mr. Baker founded OMSJ in 2009 after witnessing the reluctance of government agencies and research centers to investigate allegations related to medical and scientific corruption (also known as JUNK SCIENCE).

Many of the agencies and companies that market junk science fund activist groups and local, state and national politicians who facilitate corruption that has cost taxpayers billions of dollars in wasted research dollars. Junk science is used to keep predators on the streets, convict the innocent and injure or kill 2-4 million Americans annually.”

Read in a vacuum, that all sounds great… Until you start reading into Mr. Baker’s ideas. (Tip o’ the hat to regular reader/commenter “Lilady” for the link.) It seems that Mr. Baker is an HIV/AIDS denialist. Among some of the claims on his website are the usual bits of anti-science strategy. First, deny the science and call it “junk science”, but never mind that 99.9% of scientists (that is, 100% of reputable scientists) know and understand that HIV does cause AIDS, that HIV is not a “passenger virus”, and that HIV without antiretroviral treatment is pretty much a death sentence. Second, to try and back up those anti-science claims, find something by a member of the 0.1% of whacky scientists and publish the hell out of it. Third, find instances of scientists misbehaving and then try and discredit their scientific work and that of their colleagues. Finally, cater to what the far right-wing groups and their members want to hear.

It really is quite humorous that Baker follows the same playbook of almost all other anti-science activists follow. Cherry pick and discredit. Cherry pick and discredit. Cherry pick and discredit and be mean about it. Cherry pick, discredit, be mean, and put yourself up on a pedestal as being more than you really are. Oh, and sue people. Don’t try and fight the science, just goddamn sue!

Unfortunately for humanity, Clark Baker is not the only AIDS denialist out there. There are plenty, and there are plenty with advanced degrees whose letters after their names give them some degree of credence. For one reason or another, people listen to them, and we all pay for it dearly.

No, seriously, walk away from “the jail of autism”

A few weeks ago, I told you about some parents who should walk away from their autistic (or other special needs) children and give them over to people who will look after those children’s needs. They should walk away because they have been led to believe that autism is worse than death. They see people in “online newspapers” gnashing their teeth that they have been dealt a “bad hand” in life and have children with special needs. Those same people are quick to blame anything and everything for their current position in life, and then they pretty much walk away from responsibility and become advocates for some pretty sketchy causes.

Today I heard a story about a woman who is right now waiting to be sentenced for first-degree child abuse. What did she do? This:

“According to the Benzie County prosecutor’s office, on Sept. 3, 2013, Stapleton put her 14-year-old daughter Isabelle – known as “Issy” – in her van, drove to a rural location in Elberta, Michigan, and lit two charcoal grills inside the closed vehicle.

The two were later discovered unconscious from carbon monoxide poisoning. Issy spent four days in a “coma-like state” before making what was described as a miracle recovery.”

Why did she do that?

“In the months before the crime, Stapleton recounted her daughter’s physically abusive behavior on her website. She posted pictures of a black eye that Issy reportedly gave her and described the teen’s “horrific,” often violent outbursts towards other members of the family.

Stapleton “thought this would be the best solution,” police officers said she told them in a statement, “if Issy and her went to heaven.””

Read that again, just so that you can ponder about it a bit more. According to the mother, it was better for her child to die than to continue to live. When asked how she’s doing, the mom said this:

“”The jail of Benzie County has been a much kinder warden than the jail of autism has been,” Stapleton told Dr. Phil McGraw in a clip provided exclusively to PEOPLE. “

I wish I were joking. According to this woman, being in jail is better than being the mother of an autistic child. I wonder where she got that idea? I wonder what kind of rhetoric she’s ben hearing online and elsewhere that a child with autism is “lost,” “gone,” or “dead”? After all, if the child is already lost, then the child is viewed as less than worthy of being alive. If a child is seen as dead, killing them a second time is not that much of a bad thing, right?

Once again, I call on parents of children with special needs who think those children are lost, gone, dead, or who feel that they (the parents) have been cursed or otherwise “sentenced” to a less-than-desirable life to just walk away from their children. We don’t need any more dead children because you’ve been told that autism is worse than death or that an autistic child is not a person.

And, before you mention it, it doesn’t take having a special needs child or “walking a mile in a special needs parent’s shoes” to know that KILLING CHILDREN IS NOT JUSTIFIED AND NEVER WILL BE.

Big, fat, overfed trolls

I’ve come to the conclusion that anti-vaccine advocates are not in it for the children. They’re not in it to prevent any harm or avoid any damage to anyone. They’re in it for self-aggrandizement. The more I think about how they act and react to anything having to do with vaccines, the more I am convinced that they just want attention.

Let’s look at the latest “scandal” being pushed by the anti-vaccine groups. They claim that a scientist at CDC has come clean about purported hiding of data and institutional racism. When you point out that the data have always been there and that the analysis by BS Hooker was rife with poor epidemiological and biostatistical methodology, they call you a “pharma whore” and block your comments on their site. Ah, but they allow comments from anyone else that praises their misinformation. They love to be called “mavericks” who oppose the status quo.

That “status quo,” by the way, is vaccine-preventable disease at an all-time low, the world population at an all-time high, the near eradication of polio, the elimination of measles from the Americas, and chickenpox so rare that some young physicians have not seen a case in their entire careers. That’s the status quo they seek to destroy so that their fans can cheer for them and send them donations. The anti-vax crowd often says that we should “follow the money,” but not when the money leads to enormous mansions near Austin, Texas, or unquestioned admissions of rabid antivaxxers into public health programs.

They often accuse reasonable people of being “trolls,” people who comment for the sake of shock or to get a negative reaction out of people. And they do this while calling those reasonable people some pretty nasty names, or even threatening violence. Then they’ll go to science blogs and use trolling techniques to get reactions out of people there. Because we can’t resist calling them out on their BS, or BS Hooker, we respond. We feed the trolls.

One anti-vaccine fanatic who has previously threatened to reveal my identity to the world, which is laughable, recently sent me an article about one Bob Sears, MD. Bob is the kind of physician that, in my most humble and unimportant opinion, doesn’t really act like a physician. The anti-vax nut job was obviously trying to bait me into a discussion, but I’m tired of discussing anything with her, or with any anti-vax activist who sees Wakefield and that whole bunch of walking wastes of space as gods. What’s the point? The trolls are fat enough, so why feed them anymore?

We know that Dr. Bob, like others who should know better, is anti-vaccine. So why should I take the time to cover the story on him in which he is pretty good at burying himself in anti-scientific rhetoric? It gets boring. It’s exhausting. The reasonable people who read this blog will nod their heads. The crazies will froth at the mouth as they write comment after comment that goes to the spam folder or gets held in moderation because of bad language. (I refuse to publish comments with bad language.)

Because the anti-vax crew just wants attention, I’m going to try something new. I’m not going to play their game. My next ten posts will not be about anti-vaccine shenanigans. They will be about other pseudosciences or about vaccines themselves. But nothing about the anti-vaxxers themselves, not for a while. They can go be their own echo chamber in their sad little world.

Slowing down doesn’t mean giving up

Can you smell it? It’s the smell of fear and contempt from new students on a new academic year. It is delicious, and nothing gives me more pleasure than to impart my knowledge to unsuspecting “kids” that come along wanting to learn about this dark art called “epidemiology.” I’ll be a little busy with that for the next few months. I might not be able to post as often as I have, but I will post. Don’t you worry your pretty little head about that. It’s just a little bit of a slowdown.

While I get the next post ready over the coming week, I’d like to ask you all a questions. I’d like you to take a gander at The Kid’s blog and tell me if you can find one single post where he puts his epidemiological know-how to good use. After all, he fancies himself an epidemiologist. He introduces himself as one when he writes nonsensical letters to whine and complain about what he perceives to be injustices. But I keep failing to find a single blog post of his that uses epidemiology to address something. For example, in the latest brouhaha over Andrew Jeremy Wakefield and BS Hooker, The Kid never once defended the horrible epidemiology and biostatistics approach that BS Hooker had. The Kid never told us why it would be okay to use case-control data as a cohort study.

I’m willing to wager that it is because The Kid has forgotten all about the science to make room in his head for all the conspiracy theories that can fit in it. But that’s just me. So, if you can find one blog post where The Kid addresses some controversy or some issue from an epidemiological point of view, I’ll wash your car some day.

Next post this weekend, unless something happens between now and then. (And, no, Age of Autism releasing an alleged text message conversation between Andrew Jeremy and the CDC Whistleblower is not “something.” It’s the same old song, just enough to get their troops riled up. Besides, who signs their name in a text message? And it’s not like you can fake such a thing, is it?)

Is it?

Is it?