Anthony Brink

I suppose one has a greater sense of intellectual degradation after an interview with a doctor than from any other human experience.----Alice James

A response sometimes heard to the expression of doubt about the integrity of the HIV-AIDS paradigm as a medical model for understanding disease incidence is, "How could all the doctors in the world be wrong?" There are many possible answers to this question.

One might point out that unanimity has never guaranteed the soundness of medical constructs, and examples of this abound. The history of medicine both ancient and modern is a wrecking-yard full of broken and abandoned ideas. In this century alone innumerable medical theses have collapsed to which nearly all doctors once subscribed, such as bacterial theories of scurvy, beriberi, and pellagra, and more recently, the immuno-surveillance and retroviral theories of cancer aetiology - for which billions of dollars funded thousands of convincing research papers during the "War on Cancer" declared by Nixon in 1971. Then there was swine flu: 1976 saw President Gerald Ford on television, at the behest of the American medical establishment, solemnly urging all Americans to get vaccinated against an imminent deadly influenza epidemic. About 50 million Americans were panicked into being immunised with useless or harmful vaccines rushed onto the market. Adverse reactions resulted in damages claims of $2.7 billion. Not a single case of swine flu appeared subsequent to the death of a sick recruit undergoing basic training in a boot camp in New Jersey (hardly an unusual event) that had ignited all the hysteria. Before HIV-AIDS, and alongside the mad cow craze in Britain and the avian flu folly in Hong Kong, the great swine flu fiasco was perhaps the most telling instance in recent times of how Medicine can lose its head.

Another answer to the question goes to the fact that most doctors have scarcely more than a layman’s grasp of the concepts that populate biology at its molecular horizon. For instance, most would gape dully if asked to define the peculiar characteristics of a retrovirus (like HIV, we’re told) as distinct from other viruses, or distinguish endogenous and exogenous retroviruses, or articulate the rival contentions advanced by molecular biologists about whether the whole of retrovirology might be a mistake, a wrong turn at a scientific road-fork, a bad inference drawn from the evidence of certain metabolic biochemical phenomena which look odd when seen against old-fashioned rules of molecular genetics, and the possibility that retroviruses might not exist as infectious agents at all - that it is rather the classical dogma that needs an overhaul. Taxed about the HIV theory of AIDS, most doctors can do little more than quote the claims of their authorities, like priests citing papal bulls and encyclicals, making obeisance to their cardinals.

A third answer would make the impudent point that it is fallacious to imagine that doctors generally have a superior capacity for reasoning than their patients. The notes given medical students speak to the scant education that doctors receive in this art. To read them is to see how flimsy medical and biological theories are dished up as fact for rote learning, making the kind of call-and-answer instruction one sees in farm schools in this country look like an adventure in lateral-thinking training. Doctors do so well at school because they’re the kind of guys who are the most easily schooled. In myths and legends to outdo the Hare Krishna people. Especially virologists, who occupy the haughtiest medical echelons, but who seem to have the dimmest bulbs in the upper storey. As revealed by what they swallow without a hiccup. And regurgitate to their students. Like the timeless French fancy ("Le Rage") that a bite from a dog acting wild and crazy can make you go mad and die. (But not the dog; man is the ‘end-host’.) You can go the same way from eating steak. Although nobody can plausibly say why. Or some cancers are caused by viruses and are infectious. Or the most hilarious notion of them all: semen and vaginal secretions can be deadly. Mothers’ milk too. But not spit. All of a sudden. After millions of years. Thanks to a mutated virus from monkeys. Or maybe the moon. And all of this without any evidence. Not a shred. And there’s a funny part to it. You might be feeling fine. But you’re sure to go in six months time from any one of a couple of dozen diseases or malignancies. No, make that two years, well actually five; shall we say eight, or ten, or twelve, maybe fifteen; OK perhaps your life is just shortened a bit. Definitely? Yes, most certainly; no, not necessarily. Look, we don’t know. How, why? We don’t have the faintest idea. Theories zigzag like a drunk at the wheel. ("We are still confused, only we are now confused at a higher level of understanding.") Excuse me. Is this the circus?

Nor do doctors necessarily proceed from a more rational mindset than Joe Public does. The opposite may be the case. That HIV-AIDS as a medical construct could have taken root so richly among doctors, despite its absurd fundamental tenets (which fly in the face of everything known to virology), illustrates the point. As Harvey Bialy, scholar in residence at the Biotechnology Institute at the University of Mexico and editor at large of the prestigious science journal Nature Biotechnology puts it, the HIV theory of AIDS "turns immunology upside down and inside out." To begin with, never before was the presence of antibodies taken to be prognostic of future disease. They used to be thought of as good things – evidence, where the patient appears healthy, of a successful immune response to a pathogen defeated. Former molecular biology professor at Johns Hopkins and Harvard Universities, Charles Thomas predicts that after the balloon pops, historians will be studying the flight of common sense in the lunacy of the AIDS age, "for a 100 years, America gave AIDS to the world." But since HIV-AIDS as a diagnostic construct is still hegemonically regnant in our time, the point about the way doctors as a group tend to think needs illustrating with a different example. What better than the turn Medicine took during the Third Reich.

The Nazis’ virulently irrational and barbarous doctrines of racial hygiene found huge appeal for German and Austrian doctors in that era. No other profession was as well represented on Nazi party membership lists. From an ostensibly sober, rational profession functioning as an elite caste in a culture that seemed itself to be the fruit of the Enlightenment, just under half of them were card-carrying Nazis. Of course not all engaged in the sadistic butchery of untermenschen for which the Nuremberg Doctors’ Trials were conducted, but it would be a mistake to imagine that such criminals were aberrant quacks from the fringes, flourishing like vermin on the opportunities created within the Nazi eugenics paradigm. In fact many medical practitioners and academics tried or named in testimony at the trials had enjoyed international eminence in their professional fields. Dr Edwin Katzenellenbogen, for instance, (who got life imprisonment) had served on the faculty of the Harvard Medical School.

Scholars of religious thinking have long known that the more horrible and improbable the founding superstitions of a new faith, the greater its capacity to mobilize the popular imagination and the stronger the force of its revolutionary engine. In Medicine, Religion’s first cousin, the same sometimes applies. Like an infant upstart religion with imperial designs, the HIV-AIDS paradigm calls for a vigorous rebellion against long-established models of understanding. Woe betide any conservative scientists reluctant to become conversos to the rude new creed, who point out that the new theory is absurd on its face, that the link between AIDS and sex is no stronger than its link with sleeping; they become marginalised like Jews defying the demands of medieval Christendom, not racked and burned, but ostracised - scientifically defrocked, blacklisted and delegitimated, stripped of research funding, banned from lecturing podia, kicked out of their laboratories, rendered unemployable in academia or industry, menaced with confinement in psychiatric wards, isolated from graduate students in whom they might instill similar heretic doubts, and barred from publishing in the journals that once craved their papers. But naturally; radical political dissident Noam Chomsky, Professor of Linguistics at Massachusetts Institute of Technology has pointed out that "if you serve power, power rewards you with respectability. If you work to undermine power…you are reviled, imprisoned, driven into the desert." The AIDS phenomenon at root is a vast pumping aggregation of interests with enormous political and economic power. Doctors and scientists who challenge its sacred tenets risk attracting the wrath of the revolution’s red guards. They won’t be thrown from windows. But their careers will be over. For their reactionary intransigence these critics will be marked always with pejorative epithets, as persistent as tattoos, like ‘discredited’, ‘loony’, ‘maverick’, ‘dangerous’ and ‘irresponsible and pernicious’. Just to make sure we correctly tell the wits from the dunces. And to discourage us from asking, "Well, what are these guys actually saying?"

A fourth explanation lies in the fact that for all their social status and prestige, in truth doctors generally function close to the bottom of the food-chain in the medical-industrial complex, and serve as little more than a thoughtless delivery system for the pharmaceutical corporations – whose wares they peddle makes the medical drug industry one of the most profitable legal enterprises on the planet. Just how little room doctors are allowed for independent judgment founded on their own observations is revealed in the fact that in some places a doctor who declines to follow an approved treatment regimen such as chemotherapy for cancerous tumours, in view of his empirical assessment of its utter uselessness and lethal toxicity, risks sanctions from his controlling guild. Imagine the trouble a doctor would be in were he brazenly to announce his conclusion that having investigated the business, reactive HIV antibody test results are virtually meaningless - pointers to no more than heightened non-specific immunologic activity. And were he to refuse to diagnose negative or positive, selecting for life or death, like a Nazi doctor calling links or rechts. Or marking ‘+’ on the medical files of slow or crippled German children, to mark them for murder during the euthanasia programme.

In sum, one doesn’t have to cast about too far for answers to the question, "How could all the doctors in the world be wrong about AIDS?" Medicine’s penchant for screwing up magnificently, its characteristic intellectual sluggishness, and the appeal of "magical thinking" for its practitioners is plain to anyone who turns back a few pages.