Dear Nature Medicine (medicine@natureny.com),

I was misquoted in Jascha Hoffman’s December 30, 2004 article New York City foster home accused of unethical AIDS drug trials

You cited me as the reporter who broke the story of orphans being used in NIH clinical trials at the Incarnation Children’s Center in New York City’s Washington Heights neighborhood.

That is correct.

You attributed to me the following “belief”:

“The accusations were first published by Liam Scheff, a freelance journalist who does not believe that HIV causes AIDS.”

Neither you nor your writer, Jascha Hoffman, contacted me for interview, so your statement is based in speculation.

Had you asked me if I believed that HIV caused AIDS, I would have given you the following answer.

First – I’m not sure what the relevance of a “belief” is to science. I like to examine evidence freely, without preconception.

That said,

I consider it possible that HIV causes AIDS, but I also recognize the wide variance in worldwide AIDS definitions – the WHO, Bangui, CDC, etc, which all allow for clinical diagnoses of AIDS in the presence of unknown or negative HIV-antibody or PCR test results.

I also accept the wide variance in interpretation criteria for HIV antibody and PCR tests, and their flexible nature.
I additionally accept the complex clinical nature of disease.

The idea of single causation of any illness is a popular convention in modern medicine. Whether it is the best descriptor of disease causation – and you can quote me here – is, I believe, a highly debatable point.

I believe that AIDS, like most illnesses, in practical terms, is a multi-factorial disease. I hear the true-believers in virus labs shudder at the thought – but so what?

Is there such a thing as an AIDS patient whose condition can’t be traced to a variety of factors – including the conceptual, restrictive, defensive, dogmatic approach to treating those people unlucky enough to receive an HIV-positive antibody result?

AZT, Nevirapine and Protease Inhibitors (oh my) – along with their known toxicities – the only permissable, researchable, fundable treatment – or you are a “non-believer.”

And there’s the crux of your statement about me.

I am, in your words, a “non-believer” in the paradigm that HIV is the single cause of AIDS and that AZT is the single cure.

I do not deny the possibility that HIV may play a role in AIDS, or that current HIV research may shed light on important issues in science.

On the other hand, I am in strong support of research into competitive approaches which take a broader – dare I say – multi-factorial view. Anathema that it is to the mainstream.

What can I say? I believe in competition.

Call me irresponsible.

But quote me correctly.

By the way, you forgot to mention that I was quoting you – Nature Medicine – in my article.

When I said, “If we don’t know how HIV works, or if it makes anyone sick, then it’s unethical to treat any HIV-positive person with potentially fatal pharmaceuticals,”
I was responding to your article.
(“HIV Pathogenesis” by Mario Stevenson of the University of Massachusetts Medical School, July 2003, as a feature in your “20 Years of AIDS Science” special edition).

From the article:

“Despite considerable advances in HIV science in the past 20 years, the reason why HIV-1 infection is pathogenic is still debated ... considerable efforts have gone into identifying the mechanisms by which HIV-1 causes disease, and two major hypotheses have been forwarded.”

I believe that “hypothesis” has the same meaning, inside and outside the walls of medicine – An idea, which should be challenged and tested for its strength and veracity.

If you can have two competing hypotheses simultaneously, trying to describe the possible mechanisms of disease, then you already accept a multi-factorial approach.

So much for belief.

The same piece concludes:

“There is a general misconception that more is known about HIV-1 than about any other virus and that all of the important issues regarding HIV-1 biology and pathogenesis have been resolved. On the contrary what we know represents only a thin veneer on the surface of what needs to be known.”

I’m pleased that you and Mr. Stevenson had the courage to admit that what is presumed to be known about HIV is in fact, still debated.

If you’d let some other folks into the club, maybe we could all get on with this thing, and find a way out of it.

Please make a correction to the text of your misrepresentation of my position.

Sincerely,

Liam Scheff
Journalist