| GMCarter 2006-06-05, 8:19 am |
| Denying AIDS and the Rwandan Genocide?
An example of the dishonesty of Valendar Turner and at least one of
Christian Fiala, David Crowe, David Rasnick, Etienne de Harven, Henry
Bauer, Ken Anderlini, Kevin Corbett and Martin Maloney
By Nathan Geffen and Jeanne Bergman, Ph.D.
4 June 2006
This article builds upon an issue raised by Nathan Geffen, Nicoli
Nattrass and Glenda Gray in a letter in Nature (Nature 441, 406, 25
May 2006).1 In places we copy directly from that letter without
reference. It is reprinted after this article.
There are so many instances of AIDS denialists egregiously
misrepresenting facts that one can only reach the conclusion that they
are dishonest or incompetent. Incompetence probably underlies their
persistent rejection of scientifically proven facts and erroneous,
obsolete, and thoroughly debunked claims. But we recently came across
an apparently deliberate misrepresentation of legitimate research
findings so deplorably wrong that it deserves special mention.
We recognize the seriousness of charging with dishonesty Valender
Turner (who, as far as we can ascertain, first made this
misrepresentation) and, for reiterating and signing their names to his
error, at least one of Christian Fiala, David Crowe, David Rasnick,
Etienne de Harven, Henry Bauer, Ken Anderlini, Kevin Corbett and
Martin Maloney. We would comfortably defend our accusation in a court
of law, because it is with high probability a true statement in the
public interest. Some of the denialists, of course, have already been
shown to be dishonest in other respects. For example, David Rasnick
has repeatedly misrepresented a prior temporary affiliation with the
University of California, Berkeley, despite requests from the
University that he desist from doing so.2
The deception at hand began with a letter by Valendar Turner, an
active member of “The Perth Group” of HIV denialists, last year in
Nature ("HIV drug remains unproven without placebo trial" Nature 435,
137; 2005).3 Turner wrote that without a placebo-controlled randomized
trial, statements that the efficacy of single-dose nevirapine in
reducing perinatal transmission has not been invalidated are
unwarranted. He contrasted the HIV transmission rate of 13.1% reported
in the HIVNET 012 study4 (which he notes “abandoned its placebo
group... under pressure of complaints that the use of placebo was
unethical”) and stated that the “HIVNET 012 outcome is higher than the
12% transmission rate reported in a prospective study of 561 African
women given no antiretroviral treatment (J. Ladner, et al. J Acquir.
Immun. Def. Syndr. Hum. Retrovirol. 18, 293-298; 1998).” Turner’s
inference is clear: perinatal HIV transmission was no better, perhaps
even worse, with antiretroviral treatment than without it.
Turner's point was then amplified by a group writing to defend
denialist Celia Farber from searing criticisms by Gallo et al. (2006)5
of her infamous article6 in Harper’s Magazine (March 2006). Farber had
quoted Turner's letter and written that he had “unpegged the core
claim of NIAID and its satellite organizations in the AIDS industry
regarding nevirapine’s “effectiveness”.7
The group of individuals listed above—Fiala, Crowe, Rasnick, de
Harven, Bauer, Anderlini, Corbett and Maloney–repeated the Turner
claims in their effort to defend Farber. Their document is sloppy and
littered with errors and admissions, but that's beyond the scope of
this article. Our concern here is that they wrote:
Turner is referencing an African study published in 1998 that stated
that “Presence of HIV-infection was assessed in 158 children [of
HIV-positive mothers]… Overall, 19 children were diagnosed as
HIV-infected [12%, even though there was no access to antiretroviral
therapy or other interventions]” (Ladner J et al. Chorioamnionitis and
pregnancy outcome in HIV-infected African women. J Acquir Immune Defic
Syndr. 1998 Jul 1; 18(3): 293-8).
(Fiala et al., 2006, brackets in the original)8
If it were true, a finding that only 12% of the children born to a
group of untreated HIV-positive Rwandan women were themselves infected
with HIV would be surprising. Of course, it would not refute the
findings of the HIVNET 012 study, which was a randomized controlled
study and has far greater empirical value than a retrospective
comparison of two cohorts from completely different studies.
Nevertheless, the argument raised by Turner and Fiala et al. appeared
on the face of it to have some, albeit small, merit.
A rebuttal to Turner's letter was published in a subsequent issue of
Nature9, but it did not mention our critical point: the claim made by
Turner and echoed by Fiala et al. that the Ladner et al. study10 found
a 12% prevalence rate for a cohort of HIV-positive women not taking
antiretrovirals is a gross misrepresentation of what the study
reported. It is true that Ladner et al. found a 12% prevalence rate in
158 children born to untreated HIV-positive women. But those 158
children were only a fragment of the full cohort born to 275
HIV-positive women. The authors did not and could not examine the full
cohort for the simple reason that many women and children had been
lost to follow-up. Some of these had probably died of AIDS.
Ladner et al. had enrolled 275 HIV-positive women (and 286
HIV-negative women) in the study between July 1992 and August 1993.11
The women were between 24 and 28 weeks gestation. The researchers
determined the HIV status of 158 of the children of HIV+ mothers
enrolled in the study by antibody testing them at 15 months or by PCR
tests at 3 and 6 months of age. Why only 158 of them?
What Turner and Fiala et al. neglect to point out is Ladner et al.’s
sentence immediately preceding the section quoted by Fiala et al.
above: "Follow-up of the cohort was interrupted by the events of the
Rwandan civil war." (Ladner et al., op cit., emphasis ours.)
This statement about the disruption of the Rwandan civil war, one of
the greatest human tragedies in recent history, not only immediately
precedes the Ladner et al. quotation used by Fiala et al.; it is the
first sentence of that paragraph! And, lest the point be missed,
Ladner et al. return to the problem later, noting again that “We do
not know the HIV status of the entire sample of children born to
HIV-infected mothers as a result of interrupted follow-up.”
It is immediately clear to anyone with a rudimentary background in
statistics (or just some common sense) that they’re not comparing
apples to apples here. The low 12% figure, seized upon by Turner,
Farber and Fiala et al. to understate the rate of perinatal HIV
transmission by mothers without access to nevirapine, is an artifact
of war, of genocide, and of AIDS itself.
The Ladner et al. study enrolled 275 HIV-positive pregnant women.
13.1% of these pregnancies ended in still births and 7.5 % of the
newborns died, for a total reduction to the cohort of 20.6%--that’s 57
children, leaving 218 available for follow up. Only 158 of these
children were tested for HIV, and of these 19 (12%) were found to be
HIV-positive 3, 6 or 15 months later.
What happened to the other 60 missing children?
Fifteen months is long enough for many HIV-positive children and their
mothers to have died of AIDS. In a study conducted in Uganda between
1994 and 1998, Brahmbhatt et al. found that 30.9% of the children
perinatally infected with HIV died before their first birthday, and
54% by their second (Brahmbhatt, H. et al. Mortality in HIV-infected
and uninfected children of HIV-infected and uninfected mothers in
rural Uganda. J Acquir Immune Defic Syndr 2006; 41:504-508).
In Ladner et al.'s study, some of the children were possibly killed in
the war --women and children sick with AIDS would have been less able
to escape to safety. The surviving sample of the initial cohort was
not representative, but rather skewed in favor of HIV-negative
children. The actual figure for perinatal HIV transmission was almost
certainly much higher. (Brahmbhatt et al. found perinatal HIV
transmission rates in Uganda of 20.9%.)
We are by no means criticizing Ladner et al. Their paper is well worth
reading. It is competent and interesting science conducted in
staggeringly difficult circumstances. It was not their intention to
determine vertical HIV transmission rates in the absence of
antiretroviral intervention. Rather, the primary purpose of their
paper was to compare Chorioamnionitis and pregnancy outcomes in
HIV-positive and HIV-negative African women. The 12% statistic was a
detail they included while carefully repudiating its statistical
value.
The failure of Turner and of at least one of Fiala et al. to
acknowledge the interruption of the follow-up of the cohort is either
dishonest or grossly incompetent. On balance of probabilities it is
dishonest. Researchers with the skill and tenacity to find an
incidental HIV transmission rate figure buried in a not very well
known article are unlikely to have missed the sentence "Follow-up of
the cohort was interrupted by the events of the Rwandan civil war."
More than likely, Turner and at least one of Fiala et al. realised
this fact would negate the point they were making and deliberately
left it out. This is dishonesty.
Or perhaps the AIDS denialists also deny the Rwandan genocide took
place?
We accuse Turner and at least one of Fiala et al. of dishonesty for
this misrepresentation. We are prepared to accept that not all of them
intentionally omitted the relevant fact. When co-authoring an article,
one depends on one's co-authors' integrity; it is seldom possible to
check everything the others contribute. So if Fiala et al. indicate
who among them was responsible for this dishonesty, we will relieve
the remaining authors from the accusation of dishonesty on this
particular point. Valendar Turner, however, has no excuse. He was the
sole author of the letter to Nature that first misrepresented the
research. He looked for and found an article with a figure—12%—that,
if he dishonestly concealed the intervening genocide that prevented
follow-up, would allow him to make his case.
1http://www.nature.com/nature/journal/v441/n7092/full/441406c.html.
Last accessed 3 June 2006.
2See http://www.tac.org.za/newsletter/20...6.html#Citizen.
Last accessed 3 June 2006.
3http://www.nature.com/nature/journal/v434/n7030/full/434137a.html.
Last accessed 3 June 2006.
4This study tested a short-course of the antiretroviral nevirapine for
mother-to-child transmission prevention of HIV. It found that
administering a single dose of nevirapine to mother and a single dose
to child “lowers the risk of HIV-1 transmission by nearly 50% during
the first 14-16 weeks of life in breast-fed infants”. Guay LA et al.,
Intrapartum and neonatal single-dose nevirapine compared with
zidovudine for prevention of mother-to-child transmission of HIV-1 in
Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999 Sep
4;354(9181):795-802.
http://www.ncbi.nlm.nih.gov/entrez/...&Dopt=Citation.
Last accessed 4 June 2006.
5http://www.aegis.org/files/tac/2006/errorsinfarberarticle.html. Last
accessed 3 June 2006.
6http://www.aidstruth.org/Harpers_Out-of-Control-Article_March-2006.pdf.
Last accessed 3 June 2006.
7http://rethinkaids.info/GalloRebuttal/Farber-Gallo-29.html. Last
accessed 3 June 2006.
8http://rethinkaids.info/GalloRebuttal/Farber-Gallo-30.html. Last
accessed 3 June 2006.
9http://www.nature.com/doifinder/10.1038/4341067a. Last accessed 3
June 2006.
10http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed.
Last accessed 3 June 2006.
11The Ladner et al article’s abstract gives the numbers of
HIV-positive women enrolled as 286 and HIV-negative women enrolled as
275. This is a reversal of the numbers provided elsewhere in the text,
including in the statistical charts. We therefore assume the error is
in the abstract.
[END OF ACCUSATION OF DISHONESTY]
Nature 441, 406 (25 May 2006) | doi:10.1038/441406c; Published online
24 May 2006
HIV denialists ignore large gap in the study they cite
Nathan Geffen1, Nicoli Nattrass2 and Glenda Gray3
Treatment Action Campaign, 34 Main Road, Muizenberg 7945, South Africa
AIDS and Society Research Unit, university of Cape Town, Private Bag,
Rondebosch 7701, Cape Town, South Africa
Perinatal HIV Research Unit, university of Witwatersrand, PO Box 114,
Diepkloof 1864, South Africa
Sir:
Valendar Turner, in Correspondence ("HIV drug remains unproven without
placebo trial" Nature 435, 137; 2005), argues that there is no
evidence for antiretrovirals reducing the transmission of HIV from
mother to child. He points out that HIV transmission in people taking
the antiretroviral drug nevirapine was 13.1% in the HIVNET 012 study
in Uganda, whereas only 12% of women in a Rwandan study were found to
have transmitted HIV to their babies in the absence of antiretroviral
treatment.
Despite a rebuttal in Correspondence by the authors of the Ugandan
study, Brooks Jackson and Thomas Fleming ("A drug is effective if
better than a harmless control" Nature 434, 1067; 2005), Turner's
letter continues to be cited by AIDS denialists (for example, C.
Farber Harper's Magazine 37–52; March 2006).
The Rwandan study referred to by Turner enrolled 561 pregnant women,
of whom 286 were HIV-positive. Of the children born to HIV-positive
mothers, 158 were tested for HIV and 19 (12%, as Turner states) were
found to be HIV-positive. Why were only 158 children assessed? The
answer, conveniently ignored by the denialists, is that follow-up was
interrupted by the events of the Rwandan civil war (J. Ladner et al.
J. Acquir. Immun. Def. Syndr. Hum. Retrovirol. 18, 293–298; 1998).
Given that this interruption was sufficiently lengthy for many
HIV-positive children and their mothers to die of AIDS in the interim,
the surviving sample of the initial cohort cannot be regarded as
representative. The actual figure for HIV transmission was almost
certainly much higher. Failing to acknowledge this important caveat to
the study appears to us to be inconsistent with accepted academic
standards.
[END OF NATURE LETTER]
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