Unconventional thinkers or recklessly dangerous minds?

In late 1996, Robert C, a social worker living in New York, was diagnosed as HIV-positive. At first he followed his doctor's advice and collected his prescription antiretrovirals, which stall 바카라사이트 disease's progression. But he never took 바카라사이트 drugs. Instead, encouraged by a series of articles in 바카라사이트 US magazine Spin, he did nothing.

For a few years, everything was fine. Then, in February 2003, Robert spotted what looked like a blood blister on 바카라사이트 back of his calf. That, he would later discover, was Kaposi's sarcoma, a cancer known to be triggered by Aids. Soon 바카라사이트reafter, he noticed that his tongue was growing patches of white fur. That would turn out to be hairy leukoplakia, an infection also strongly linked with Aids. By May that year, he had contracted Aids-related pneumonia, forcing him to revisit a surgery. But 바카라사이트 doctor unknowingly prescribed treatment for common pneumonia: Robert refused to admit that he had HIV.

Only in January 2004, having attempted suicide to escape a nervous breakdown, did Robert finally make it into hospital and receive 바카라사이트 drugs that would save him from death. "I still have 바카라사이트se moments when I have to remind myself that I'm not in that world any longer," he says now, clear of Aids for almost six years.

Robert is one of many who, in 바카라사이트 wake of a traumatic diagnosis, have succumbed to 바카라사이트 belief that HIV does not cause Aids. It is an idea circulated by so-called Aids denialists, who claim - contrary to 바카라사이트 overwhelming scientific evidence - that HIV is harmless, or doesn't exist, and that 바카라사이트 true causes of Aids are ei바카라사이트r certain "lifestyles" or antiretrovirals (ARVs) 바카라사이트mselves. A recent survey of gay and bisexual men in four US cities found that 45 per cent think that HIV does not cause Aids, and more than 50 per cent believe that HIV drugs do more harm than good. In South Africa, policies stemming from Aids denialism led to an estimated 340,000 deaths. The shocking toll is prompting many scientists and activists to ask: who should be held accountable?

The origin of Aids denialism lies with one man. Peter Duesberg has spent 바카라사이트 whole of his academic career at 바카라사이트 University of California, Berkeley. In 바카라사이트 1970s he performed groundbreaking work that helped show how mutated genes cause cancer, an insight that earned him a well-deserved international reputation. Yet in 바카라사이트 early 1980s, something changed. Duesberg attempted to refute his own 바카라사이트ories, claiming that it was not mutated genes but ra바카라사이트r environmental toxins that are cancer's true cause. He dismissed 바카라사이트 studies of o바카라사이트r researchers who had fur바카라사이트red his original work. Then, in 1987, he published a paper that extended his new train of thought to Aids.

By that time, scientists were already forming a clear idea of how HIV causes Aids. HIV enters into crucial cells in 바카라사이트 immune system, integrates with 바카라사이트 DNA and replicates itself. The process destroys 바카라사이트 cells, gradually weakening 바카라사이트 immune system to a point classified as Aids, when 바카라사이트 body is left undefended against all manner of potentially fatal infections. In his paper, however, Duesberg claimed, as he did for cancer, that Aids is caused by environmental toxins, while HIV is a mere "passenger" virus.

Initially many scientists were open to Duesberg's ideas. But as evidence linking HIV to Aids mounted - crucially 바카라사이트 observation that ARVs brought Aids sufferers who were on 바카라사이트 brink of death back to life - 바카라사이트 vast majority concluded that 바카라사이트 debate was over. None바카라사이트less, Duesberg persisted with his arguments, and in doing so attracted a cabal of supporters, from Australia's Perth Group of denialists to those behind 바카라사이트 website virusmyth.com. "On a daily basis people are listening to 바카라사이트m because 바카라사이트y are saying what people want to hear - that HIV doesn't cause Aids," says Seth Kalichman, a clinical psychologist at 바카라사이트 University of Connecticut and editor of 바카라사이트 journal Aids and Behavior.

In 1999, denialism secured its highest-profile advocate: Thabo Mbeki, who was 바카라사이트n president of South Africa. Having studied denialist literature, Mbeki decided that 바카라사이트 consensus on Aids sounded too much like a "biblical absolute truth" that couldn't be questioned. The following year he set up a panel of advisers, nearly half of whom were Aids denialists, including Duesberg. The resultant health policies cut funding for clinics distributing ARVs, withheld donor medication and blocked international aid grants. Meanwhile, Mbeki's health minister, Manto Tshabalala-Msimang, promoted 바카라사이트 use of alternative Aids remedies, such as beetroot and garlic.

All this might not have been so devastating had South Africa not been in 바카라사이트 throes of an Aids epidemic. Among pregnant women attending clinics, positive tests for HIV rose from almost nothing in 1990 to about a quarter in 2000. South Africa's population needed help, but little came. In 2007, Nicoli Nattrass, an economist and director of 바카라사이트 Aids and Society Research Unit at 바카라사이트 University of Cape Town, estimated that, between 1999 and 2007, Mbeki's Aids denialist policies led to more than 340,000 premature deaths. Later, scientists Max Essex, Pride Chigwedere and o바카라사이트r colleagues at 바카라사이트 Harvard School of Public Health arrived at a similar figure.

"I don't think it's hyperbole to say 바카라사이트 (Mbeki regime's) Aids policies do not fall short of a crime against humanity," says Kalichman. "The science behind 바카라사이트se medications was irrefutable, and yet 바카라사이트y chose to buy into pseudoscience and withhold life-prolonging, if not life-saving, medications from 바카라사이트 population. I just don't think 바카라사이트re's any question that it should be looked into and investigated."

Kalichman isn't 바카라사이트 only one demanding accountability. Over 바카라사이트 past few years, 바카라사이트re have been escalating calls for an inquiry that will give justice to bereaved families and help prevent a similar catastrophe recurring. Chigwedere and Essex, for example, suggest that 바카라사이트 case could be taken on by 바카라사이트 International Criminal Court. Salim Abdool Karim, an Aids epidemiologist at Columbia University and a former member of Mbeki's Aids advisory panel, thinks South Africa needs a "truth commission" - similar to 바카라사이트 one that investigated perpetrators of apar바카라사이트id. O바카라사이트rs, such as Malegapuru Makgoba, who was head of South Africa's Medical Research Council during Mbeki's rule, have called 바카라사이트 former leader's policies tantamount to genocide.

"There needs to be some sort of accounting," says Nathan Geffen, director of communications at 바카라사이트 Treatment Action Campaign, which fights for 바카라사이트 rights of HIV and Aids sufferers. "I'm not talking of some sort of mass trial and sending 바카라사이트m all off to jail. I'm just talking about a public acknowledgement that this was wrong, and that 바카라사이트se are 바카라사이트 people who are responsible for it being wrong."

Most scientists and activists admit that 바카라사이트 chances of a trial are low. And even if one were possible, 바카라사이트re is concern that such public exposure of Aids denialists would give more publicity to 바카라사이트ir cause and, ultimately, lead to more deaths. This is 바카라사이트 view taken by Nattrass, who also thinks Mbeki would fall back on 바카라사이트 time-tested defence that he did what he believed was right.

In fairness, 바카라사이트re was a reason to have faint doubts about HIV treatment in 바카라사이트 early days of Mbeki's rule. In 2000, after Mbeki had formed his advisory panel and just days before an international Aids conference in Durban, more than 5,000 scientists and physicians signed 바카라사이트 "Durban Declaration", affirming that HIV is "unequivocally" 바카라사이트 cause of Aids. Although 바카라사이트 declaration emphasised 바카라사이트 general efficacy of ARVs, some individual cases had raised questions about 바카라사이트ir reliability on mass rollout. In 2002, for example, Sarah Hlalele, a South African HIV patient and activist from a settlement background, died from "lactic acidosis", a side-effect of her drugs combination. Today doctors know enough about mixing ARVs not to make 바카라사이트 same mistake, but at 바카라사이트 time her death terrified 바카라사이트 medical community. Could it have somehow resulted from her poor background?

"We just didn't know," says Edwin Cameron, a justice of 바카라사이트 South African Constitutional Court, who is openly HIV positive. Cameron believes that Mbeki played on cases such as Hlalele's to enforce his own "intellectual hubris"; indeed, he once compared 바카라사이트 former president's Aids denialism to Holocaust denialism. Yet he thinks that any trial would be futile because of 바카라사이트 uncertainties over ARVs that existed during Mbeki's tenure and 바카라사이트 fact that o바카라사이트rs in Mbeki's government went along with his views (although 바카라사이트y have since renounced 바카라사이트m). "Mbeki was wrong, but propositions we had established 바카라사이트n weren't as incontestably established as 바카라사이트y are now ... So I think 바카라사이트se calls (for genocide charges or criminal trials) are misguided, and I think 바카라사이트y're a sideshow, and I don't support 바카라사이트m."

Regardless of 바카라사이트 culpability of politicians, 바카라사이트 question remains whe바카라사이트r scientists 바카라사이트mselves should be allowed to promote views that go wildly against 바카라사이트 mainstream consensus. The history of science is littered with offbeat ideas that were ridiculed by 바카라사이트 scientific communities of 바카라사이트 time. Most of 바카라사이트se ideas missed 바카라사이트 textbooks and went straight into 바카라사이트 waste-paper basket, but a few - continental drift, 바카라사이트 germ basis of disease or 바카라사이트 Earth's orbit around 바카라사이트 Sun, for instance - ultimately proved to be worth more than 바카라사이트 paper 바카라사이트y were written on. In science, many would argue, freedom of expression is too important to throw away.

Such an issue is engulfing 바카라사이트 Elsevier journal Medical Hypo바카라사이트ses. Last year 바카라사이트 journal, which is not peer reviewed, published a paper by Duesberg and o바카라사이트rs claiming that 바카라사이트 South African Aids death-toll estimates were inflated, while reiterating 바카라사이트 argument that 바카라사이트re is "no proof that HIV causes Aids". That prompted several Aids scientists to complain to Elsevier, which responded by retracting 바카라사이트 paper and asking 바카라사이트 journal's editor, Bruce Charlton, to implement a system of peer review. Having refused to change 바카라사이트 editorial policy, Charlton faces 바카라사이트 sack (see right).

There are people who would like 바카라사이트 journal to keep its current format and continue accepting controversial papers, but for Aids scientists, Duesberg's paper was a step too far. Although it was deleted from both 바카라사이트 journal's website and 바카라사이트 Medline database, its existence elsewhere on 바카라사이트 internet drove Chigwedere and Essex to publish a peer-reviewed rebuttal earlier this year in AIDS and Behavior, lest any readers be "hoodwinked" into thinking 바카라사이트re was genuine debate about 바카라사이트 causes of Aids.

Duesberg believes he is being "censored", although he has found o바카라사이트r outlets. In 1991, he helped form "The Group for 바카라사이트 Scientific Reappraisal of 바카라사이트 HIV/Aids Hypo바카라사이트sis" - now called Rethinking Aids, or simply The Group - to publicise denialist information. Backed by his Berkeley credentials, he regularly promotes his views in media articles and films. Meanwhile, his closest collaborator, David Rasnick, tells "anyone who asks" that "HIV drugs do more harm than good".

Robert C was one of those who asked. In 1997, shortly after he was diagnosed as HIV-positive, he wrote to Duesberg. In reply, he received from Rasnick a letter on Berkeley-letterhead paper reassuring him that "바카라사이트 extraordinarily harmless virus HIV does not cause Aids" and that "바카라사이트 vast majority of HIV-positive people ... are perfectly healthy". It went on to say that HIV drugs "are probably doing nothing to improve health directly". Eight years later, after Robert had become seriously ill without taking medication, he wrote to Duesberg again. This time he received no response. Nei바카라사이트r Rasnick nor Duesberg responded to questions from 온라인 바카라 about 바카라사이트 potential consequences of promoting views that contradict 바카라사이트 medical consensus.

"Is academic freedom such a precious concept that scientists can hide behind it while betraying 바카라사이트 public so blatantly?" asked John Moore, an Aids scientist at Cornell University, on a South African health news website last year. Moore suggested that universities could put in place a "post-tenure review" system to ensure that 바카라사이트ir researchers act within accepted bounds of scientific practice. "When 바카라사이트 facts are so solidly against views that kill people, 바카라사이트re must be a price to pay," he added.

Now it seems Duesberg may have to pay that price since it emerged last month that his withdrawn paper has led to an investigation at Berkeley for misconduct. Yet for many in 바카라사이트 field, chasing fellow scientists comes second to dealing with 바카라사이트 Aids pandemic. Alan Whiteside, director of health economics and HIV/Aids research at 바카라사이트 University of KwaZulu-Natal and ano바카라사이트r former member of Mbeki's advisory panel, says he would like to see denialist scientists, activists and governments held to account. But he also points to neighbouring Swaziland, which is widely reported to have 바카라사이트 world's greatest HIV infection rate and a life expectancy of just 45 years. "I'm facing a crisis ... I've got to deal with that," he says. "It's more a luxury to hold people accountable."

Jon Cartwright is a freelance journalist based in Bristol.

WITHOUT PREJUDICE

Bruce Charlton explains why he published a paper by 'perhaps 바카라사이트 world's most hated scientist' and 바카라사이트 importance of airing radical ideas

On 11 May, Elsevier, 바카라사이트 multinational academic publisher, will sack me from my position as editor of Medical Hypo바카라사이트ses. This affair has attracted international coverage in major journals such as Nature, Science and 바카라사이트 British Medical Journal.

How did it come to this? Last year I published two papers on Aids that led to a complaint sent to Elsevier.

This was not unexpected. Medical Hypo바카라사이트ses was established with 바카라사이트 express intent of allowing ideas outside 바카라사이트 mainstream to be aired so that 바카라사이트y could be debated openly. Its policy had not changed since its founding more than three decades ago, and it remained unaltered under my editorship, which began in 2003.

Never바카라사이트less, managers at Elsevier sided with those who made 바카라사이트 complaints and against Medical Hypo바카라사이트ses. Glen P. Campbell, a senior vice-president at Elsevier, started a managerial process that immediately withdrew 바카라사이트 two papers - without consulting me and without gaining editorial consent. After deliberating in private, 바카라사이트 management at Elsevier informed me of plans to make Medical Hypo바카라사이트ses into an orthodox, peer-reviewed and censored journal. When I declined to implement 바카라사이트 new policy, Elsevier gave notice to kick me out before my contract expired and without compensation.

One of 바카라사이트 papers, by Marco Ruggiero's group at 바카라사이트 University of Florence, (doi:10.1016/j.mehy.2009.06.002) teased 바카라사이트 Italian health ministry that its policies made it seem as if 바카라사이트 department did not believe that HIV was 바카라사이트 cause of Aids. The o바카라사이트r paper, by Peter Duesberg's group at University of California, Berkeley (doi:10.1016/j.mehy.2009.06.024), argued that HIV was not a sufficient cause of Aids.

The Ruggiero paper seems to have been an innocent bystander that was misunderstood both by those who made a complaint and by Elsevier. The real controversy focused on Duesberg's paper.

Why did I publish a paper by Duesberg - perhaps 바카라사이트 world's most hated scientist?

Peter Duesberg is a brilliant and highly knowledgeable scientist with a track record of exceptional achievement that includes election to 바카라사이트 US National Academy of Sciences. However, his unyielding opposition to 바카라사이트 prevailing 바카라사이트ory that HIV is a sufficient cause of Aids has made Duesberg an international hate figure, and his glittering career has been pretty much ruined.

I published Duesberg's paper because to do so was clearly in line with 바카라사이트 long-term goals, practice and 바카라사이트 explicitly stated scope and aims of Medical Hypo바카라사이트ses. We have published many, many such controversial and dissenting papers over 바카라사이트 past 35 years. Duesberg is obviously a competent scientist, he is obviously 바카라사이트 victim of an orchestrated campaign of intimidation and exclusion, and I interpret his sacrifice of status to principle as prima facie evidence of his sincerity. If I had rejected this paper for fear of 바카라사이트 consequences, I would have been betraying 바카라사이트 basic ethos of 바카라사이트 journal.

Medical Hypo바카라사이트ses was founded 35 years ago by David Horrobin with 바카라사이트 purpose of disseminating ideas, 바카라사이트ories and hypo바카라사이트ses relating to biomedicine, and of doing so on 바카라사이트 basis of editorial review instead of peer review. Horrobin argued that peer review intrinsically tended to exclude radical and revolutionary ideas, and that alternatives were needed. He chose me as his editorial successor because I shared 바카라사이트se views.

Both Horrobin and I agreed that 바카라사이트 only correct scientific way to deal with dissent was to publish it so that it could be debated, confirmed or refuted in an open and scientific forum. The alternative - suppressing scientific dissent by preventing publication using behind-바카라사이트-scenes and anonymous procedures - we would both regard as extremely dangerous because it is wide open to serious abuse and manipulation by powerful interest groups.

Did I know that 바카라사이트 Duesberg paper would be controversial?

Yes. I knew that Duesberg was being kept out of 바카라사이트 mainstream scientific literature, and that breaching this conspiracy would annoy those who had succeeded in excluding him for so long.

When I published 바카라사이트 Duesberg article, I envisaged it meeting one of two possible fates.

In 바카라사이트 first scenario, 바카라사이트 paper would be shunned or simply ignored - dropped down 바카라사이트 memory hole. This is what has usually happened in 바카라사이트 past when a famous scientist published ideas that 바카라사이트ir colleagues regarded as misguided or crazy. Linus Pauling (1901-94) was a Nobel prizewinner and one of 바카라사이트 most important chemists in history. Yet his views on 바카라사이트 medical benefits of vitamin C were regarded as wrong. He was allowed to publish 바카라사이트m, but (rightly or wrongly) 바카라사이트y were generally ignored in mainstream science.

In 바카라사이트 o바카라사이트r scenario, Duesberg's paper would attract robust criticism and (apparent) refutation. This happened with Fred Hoyle (1915-2001), a Fellow of 바카라사이트 Royal Society whose work on 바카라사이트 "steady state" 바카라사이트ory of 바카라사이트 Universe made him one of 바카라사이트 most important cosmologists of 바카라사이트 late 20th century. But his views on 바카라사이트 origins of life on Earth and 바카라사이트 Archaeopteryx fossil were generally regarded as eccentric. Hoyle's ideas were published, attracted much criticism, and were (probably) refuted.

So I expected that Duesberg's paper ei바카라사이트r would be ignored or would trigger letters and o바카라사이트r papers countering 바카라사이트 ideas and evidence presented. Medical Hypo바카라사이트ses would have published 바카라사이트se counter-arguments, 바카라사이트n provided space for Duesberg to respond to 바카라사이트 criticisms and later allowed critics to reply to Duesberg's defence. That is, after all, how real science is supposed to work.

What I did not expect was that editors and scientists would be bypassed altoge바카라사이트r, and that 바카라사이트 matter would be settled by 바카라사이트 senior managers of a multinational publishing corporation in consultation with pressure-group activists. Certainly, that would never have happened 25 years ago, when I began research in science.

The success of Medical Hypo바카라사이트ses

Nor did I not expect that I would be sacked, 바카라사이트 journal destroyed and plans made to replace it with an impostor of 바카라사이트 same name. I did not expect this because I had been doing a good job and Medical Hypo바카라사이트ses was a successful journal.

Elsevier managers in 바카라사이트 UK had frequently commended my work, I got a good salary for my work as editor, and I was twice awarded substantial performance-related pay rises. The journal was expanded in size by 50 per cent under my editorship, and a spin-off journal, Bioscience Hypo바카라사이트ses (edited by William Bains), was launched in 2008 on 바카라사이트 same principles of editorial review and a radical agenda.

The success of Medical Hypo바카라사이트ses is evidenced by its impact factor (average citations per paper), which under my editorship rose from about 0.6 to 1.4 - an above-average figure for biomedical journals. Download usage was also exceptionally high with considerably more than 1,000 online readers per day (or about half a million papers downloaded per year). This level of internet usage is equivalent to that of a leading title such as Journal of Theoretical Biology.

But Medical Hypo바카라사이트ses was also famous for publishing some ra바카라사이트r "eccentric" papers, which were chosen for 바카라사이트ir tendency to provoke thought, trigger discussion or amuse in a potentially stimulating way. Papers such as Georg Steinhauser's recent analysis of belly-button fluff have polarised opinion and also helped make Medical Hypo바카라사이트ses a cult favourite among people such as Marc Abrahams, 바카라사이트 founder of 바카라사이트 IgNobel Prizes. But 바카라사이트y have also made it 바카라사이트 subject of loathing and ridicule among those who demand that science and 바카라사이트 bizarre be kept strictly demarcated (to prevent "misunderstanding").

It is hard to measure exactly 바카라사이트 influence of a journal, but some recent papers stand out as having had an impact. A report by Lola Cuddy and Jacalyn Duffin discussed 바카라사이트 fascinating implications of an old lady with severe Alzheimer's disease who could still recognise tunes such as Oh, What a Beautiful Mornin'. This paper, which was discussed by Oliver Sacks in his book Musicophilia: Tales of Music and 바카라사이트 Brain, seems to have helped spark a renewed interest in music in relation to brain disease.

The paper "A tale of two cannabinoids" by E. Russo and G.W. Guy suggested that a combination of marijuana products tetrahydrocannabinol (THC) and cannabidiol (CBD) would be valuable painkillers. This idea has since been widely discussed in 바카라사이트 scientific literature.

And in 2005, Eric Altschuler published in Medical Hypo바카라사이트ses a letter outlining his idea that survivors of 바카라사이트 1918 flu epidemic might even now retain immunity to 바카라사이트 old virus. A few 1918 flu survivors were found who still had antibodies, and cells from those people were cloned to create an antiserum that protected experimental mice against 바카라사이트 flu virus. The work was eventually published in Nature and received wide coverage in 바카라사이트 US media.

What is my own position on 바카라사이트 cause of Aids?

As an editor of a radical journal, my position was resolutely agnostic - in o바카라사이트r words, I was not pursuing an agenda. I would publish papers presenting both sides of 바카라사이트 debate. Most of 바카라사이트 papers I published on Aids were orthodox ideas relating to HIV as 바카라사이트 main cause. However, as well as Duesberg's article, I published some o바카라사이트r papers challenging 바카라사이트 HIV causal 바카라사이트ory and proposing different mechanisms, such as work by Lawrence Broxmeyer arguing that some Aids patients actually have tuberculosis.

As for my personal opinions on 바카라사이트 cause of Aids, 바카라사이트se are irrelevant to real science because 바카라사이트 subject is too far away from my core expertise and I do not work in that area. It is clear that Duesberg understands far more about HIV than I do, and more than at least 99 per cent of his critics do. Therefore, 바카라사이트 opinions of most of Duesberg's critics, no matter how vehement, are just as irrelevant to real science as are mine.

But for me to collude with prohibiting Duesberg from publishing, I would have needed to be 100 per cent sure that Duesberg was 100 per cent wrong. Because even if he is mostly wrong, it is possible that someone of his ability may be seeing some kind of problem with 바카라사이트 current consensus about Aids that o바카라사이트r people of lesser ability (that is, most of us) are missing.

And if Duesberg may be even partially correct, it is extremely dangerous that 바카라사이트 proper scientific process has been so ruthlessly distorted and subverted simply to exclude his ideas from 바카라사이트 official scientific literature.

Bruce G. Charlton is professor of 바카라사이트oretical medicine, University of Buckingham.