The River: A Journey To The Source Of Hiv And Aids Edward Hooper Pdf Download
Investigating the origin of AIDS: some ethical dimensions
Abstract
The theory that AIDS originated from contaminated polio vaccines raises a number of challenging issues with ethical dimensions. The Journal of Medical Ideals dealt with a submission about the theory a decade ago; subsequent developments have raised further problems. Four areas of contention are addressed: whether the theory should be investigated; whether anyone should be blamed; whether defamation actions are advisable, and whether the scientific customs has a responsibleness to examine unorthodox theories.
- polio vaccines
- AIDS
- HIV
- research ethics
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- polio vaccines
- AIDS
- HIV
- research ethics
A decade agone, the Journal of Medical Ethics rejected a submission about the origin of AIDS on the grounds that, at 19 000 words in length, it was too long. The paper, by independent scholar Louis Pascal, argued that AIDS may have arisen from inadvertently contaminated polio vaccines used in Africa in the late 1950s. Afterwards, I bundled for publication of Pascal's piece every bit a working paper at my university.1 Not long afterward, the editor of the Journal of Medical Ethics wrote a forthright editorial explaining the journal's decision not to publish.two
When Pascal get-go raised his concerns in the tardily 1980s, linking polio vaccines to the origin of AIDS was totally off the scientific agenda. Today it is taken far more seriously—for example, it has stimulated considerable scientific enquiry. Hence it is appropriate now to reconsider some of the bug raised past Pascal and to examine ones that accept arisen in the years since. In this paper, four main questions are addressed. Should the polio vaccine theory be pursued? Should anyone be blamed for the origin of AIDS? Should defamation actions be used when they inhibit discussion of scientific ideas? Does the scientific customs have a responsibility to pursue unorthodox theories? But before delving into these bug, it will be useful to outline the polio vaccine theory and the scientific community'due south response to it.
Scientists widely concord that HIV, the human immunodeficiency virus responsible for AIDS, arose from simian immunodeficiency viruses (SIVs) that were transferred from monkeys or chimpanzees in Africa to humans. The question is how. The conventional theory has been that monkey claret got into humans through a hunter butchering a monkey, through humans eating undercooked monkey meat, through a monkey bite, or some other such means. This is called the "cut hunter" or "natural transfer" theory.
Pascal proposed that the transfer of SIVs to humans could have occurred by accident through polio vaccines given to hundreds of thousands of people in central Africa in the years 1957–1960, in the world'southward get-go mass polio vaccination campaign, run by polio pioneer Hilary Koprowski. These polio vaccines—fabricated from a modified, less virulent strain of live polio virus—were cultured on monkey kidneys, giving rise to the possibility of contamination with SIVs. Monkeys can carry SIVs without symptoms. No screening for SIVs could have been carried out since they were non discovered until 1985.
The most hitting evidence for the theory is the coincidence in space and time between Koprowski's African polio vaccination campaigns and early evidence for AIDS. Most of the earliest HIV positive claret samples and AIDS cases are in the very regions where polio vaccinations were carried out. The earliest known HIV positive blood sample is from Kinshasa—a vaccination site—in 1959. In addition, there is a precedent: monkey virus SV-40 is known to have contaminated polio vaccines given to millions of people.iii
Pascal submitted papers about this theory to several scientific journals in the late 1980s, without success. Subsequently advice from the then editor of the Journal of Medical Ethics nearly the suitable style and length, Pascal submitted a new newspaper addressing both scientific and ethical dimensions, only at 19 000 words it was far longer than the stipulated length. The Periodical of Medical Ethics'south editorial outlined the theory and, without endorsing it, stated that Pascal's thesis "is an important and thoroughly argued one and ought to be taken seriously by workers in the AIDS field".four The editorial also gave details on how to obtain the newspaper, leading to dozens of requests for copies in the post-obit years.
A few months after Pascal's paper was published, it was overshadowed by an independent account of the same theory by journalist Tom Curtis in the mass circulation magazine Rolling Stone. 5 Whereas Pascal's submissions had been ignored past the scientific community, ironically, publication in Rolling Stone made scientists accept the theory more seriously, with commentary and letters in leading scientific journals. In subsequent years there were further publications about the theory, including past AIDS activist Blaine Elswood,6 who had originally encouraged Curtis to investigate the story, and later by announcer Julian Cribb.vii My own role was to write commentaries on the dynamics of the scientific community as revealed by responses to the theory8, ix and later to provide a web site with relevant documents.10
In the latter role of the 1990s, attention to the theory macerated, although if annihilation the evidence was stronger than earlier. This dramatically changed in 1999 with publication of Edward Hooper's epic book The River,xi which provided voluminous new evidence in a powerfully written story. Leading evolutionary biologist William D Hamilton encouraged the Royal Society to hold a meeting to discuss the theory, though tragically he died before it was held. At the meeting, much new scientific work relevant to the origin of AIDS was presented.12
CREDIBILITY OF UNORTHODOX THEORIES
The book of relevant information and the scientific complexities of the debate are now far greater than when Pascal beginning presented his ideas. The upstanding dimensions remain relatively unexamined however, though they are just equally salient. As a matter of logic, none of the four primary questions discussed here depends on the polio vaccine theory having a sure level of scientific plausibility. Indeed, if the theory were widely accepted as plausible, some of the questions might not even arise! Nonetheless, before addressing the questions, information technology may be useful to discuss the plausibility of the polio vaccine theory today and when Pascal wrote his newspaper.
When discussing a scientific theory that is non accepted by the majority of the scientific community, there is no single standard criterion for assessing its plausibility. Some criteria that may be used are: (1) endorsement by some reputable scientists; (2) serious consideration in the general science press; (3) subsequent vindication; (iv) research undertaken in response to the theory, and (five) endorsement by informed non-specialists. "Endorsement" here refers to endorsement as a plausible theory or every bit a theory worth investigating, not necessarily belief that it is correct. If a theory satisfies several of these criteria, or satisfies one or two strongly, it could be said to exist more plausible than a theory that satisfies fewer criteria or satisfies them more weakly.
(1) The polio vaccine theory was endorsed equally plausible past several mainstream scientists around the time when Pascal was presenting his ideas.thirteen, 14 More recently, several scientists contributing to the Royal Club meeting accept treated the theory as plausible.15, sixteen
(2) Serious consideration in the science printing includes editorials and news items in leading scientific journals too every bit popular commentaries by leading scientists. Following the publicity almost the polio vaccine theory in 1992, quite a number of such items treated the polio vaccine theory seriously. For case, well known scientist Jared Diamond, in commenting on competing theories of the origin of AIDS, included the polio vaccine theory equally a possibility worthy of serious discussion.17 After publication of The River in 1999, a number of book reviews by scientists in scientific journals took the polio vaccine theory quite seriously, even when the reviewers did non personally support information technology.18, 19
(three) Subsequent vindication of a theory can retrospectively add weight to the merits that before it was worthy of consideration. The polio vaccine theory has not been vindicated in the sense that it is widely accustomed by scientists. Pascal'south piece of work could be said, however, to be partially vindicated in the sense that a decade later, subsequently much additional inquiry, some scientists believe the theory remains worthy of consideration.
(4) One test of the value of a theory is whether information technology stimulates enquiry. Of form, a theory need not be correct in society to stimulate inquiry, but this criterion reflects whether a theory is taken seriously. Quite a number of the contributions to the Royal Society meeting report extensive research triggered by the polio vaccine theory; some of this research has led to insights relevant to the origin of AIDS and some, in addition, has involved discovery of new information and development of new techniques (such as for mathematically analysing the development of HIV). Largely this inquiry was stimulated by publication of The River, but without earlier work such as Pascal'south, Hooper would not have undertaken the massive investigation that culminated in his book.
(5) Finally, a theory may take greater plausibility if information technology is endorsed, as worthy of attention or investigation, by informed nonspecialists. This benchmark is particularly important when a theory does not prevarication within a unmarried discipline, so that information technology cannot exist fully investigated or judged by any single group of specialists, and when there are adept reasons to believe that a theory may be opposed for non-scientific reasons, such as a threat to profits or reputations. Thorough investigation of the polio vaccine theory definitely requires skills from several fields, including epidemiology, phylogenetics, archival research, and investigative journalism. Therefore, information technology could exist argued, informed cess by non-specialists is relevant, since specialists from any given field take only a partial perspective. Raanon Gillon, editor of the Journal of Medical Ideals in 1992, could be considered an informed not-specialist when he stated that the polio vaccine theory ought to be taken seriously.iv More than recently, many of the reviews of The River that were published in newspapers and magazines could be considered to be endorsements by non-specialists.20, 21 (Some of these "non-specialists" are actually specialists in their own fields, a point reflecting the difficulty of talking almost expertise concerning a theory that crosses many disciplinary boundaries.)
Thus, past near every one of these criteria, support is given for the plausibility of the polio vaccine theory. At that place are many other non-standard theories of the origin of AIDS, ranging from biological warfare experiments to microbes from space22; none of these theories has anything approaching the plausibility of the polio vaccine theory, co-ordinate to the v criteria.
With this prelude, it is at present time to turn to the four questions concerning the origin of AIDS that have significant ethical dimensions. As noted before, addressing these questions does not crave that the polio vaccine theory has a detail level of plausibility, merely withal information technology may be useful to know that while the theory has been and remains fiercely opposed by some scientists, by the five criteria outlined hither information technology should not be treated as outlandish, just rather as an unorthodox theory that some scientists and informed non-specialists accept considered and withal consider worthy of investigation.
SHOULD THE ORIGIN OF AIDS Exist INVESTIGATED?
Ever since the polio vaccine theory was first presented, quite a number of individuals have suggested that the origin of AIDS is non an appropriate topic for investigation. This betoken of view has not been systematically argued in print, but is normally made in private conversations and correspondence. There are two main rationales for opposing investigation of the origin of AIDS: (1) that all bachelor resources should be devoted to studying how to reduce the spread of AIDS and to develop treatments for it; (2) electric current vaccination efforts could be jeopardised if people believed AIDS arose from polio vaccinations.
One reply to the outset rationale is that information about the origin of AIDS may lead to insight that could help electric current efforts against AIDS. For case, studies of chimpanzees may reveal how they tin live with SIVs and non suffer the simian version of AIDS. If vaccinations led to AIDS, and then some vacinees would have been unaffected, some would take contracted AIDS and some, peradventure, developed immunity, specially if molecular immunity is a possibility.23 Hence, searching for surviving vacinees may reveal some who have amnesty to SIV/HIV, providing insight for how this might be promoted.
The value of studying the origins of diseases is widely recognised. A classic instance is cholera in London in the eye of the 1800s. Rather than simply treating the victims, John Snow studied patterns of illness and, without cognition of the causative amanuensis, inferred that a live agent, transmissible homo to human, was responsible and that water from the Wide Street pump was i transmission pathway.24 Therefore it is tempting to suggest that reservations virtually studying the origin of AIDS are due to something deeper than concern virtually wasted effort. This brings us to the second rationale: if people believe that vaccinations led to AIDS, and then current vaccination efforts may exist jeopardised.
Such a public reaction would exist unwarranted in that the principal risk of new disease from vaccination is to the entire species, not to individuals. If the polio vaccine origin of AIDS theory is correct, perchance a few hundred or yard individuals were inadvertently infected with SIV/HIV every bit a event of straight vaccination. All the rest of the tens of millions of HIV infections and AIDS deaths accept been through "conventional" routes such as sexual intercourse. But though a fright of vaccination might be unwarranted, the fear can be quite existent.
I way to approach this result is to contend that a theory should non be investigated if the negative consequences arising from the theory being thought to be correct outweigh the benefits from the cognition gained. This raises a host of additional bug, such as how the likely consequences are evaluated and compared and who is responsible for making decisions about whether to investigate a theory.
Another approach is to examine the social context in which theories are perceived and, if appropriate, attempt to change it. One chemical element of the context of the origin of AIDS issue is the belief that vaccination is an unalloyed skilful, a belief widely promoted by vaccination promoters. (This in plough is an element in a broader conventionalities that medical intervention is necessarily good.) In this context, information about negative consequences is especially damaging. A possible response is to promote vaccination with greater openness about hazards, such equally the minor take a chance that polio vaccination can atomic number 82 to polio. If members of the public had a more realistic understanding of risks of vaccination and of medical experimentation, and so investigation of theories about the origin of AIDS would not pose such a take chances to vaccination programmes, but instead would stand or fall more than on the basis of their ain claim.
Knowledge of the origin of AIDS may provide a needed warning about the hazards of certain biological procedures. If people believed that polio vaccines led, or fifty-fifty could have led, to AIDS, this would dramatically increment concern about present day procedures. Nearly polio vaccines are today still cultured on monkey kidneys. I of Pascal'southward original concerns was that polio vaccines might infect the man species with other SIVs, each with the chapters to cause millions of deaths. Although today's vaccines are carefully screened for immunodeficiency viruses, at that place is ever the risk of error. In 1992, the Wistar Institute, Philadelphia, where some of Koprowski'south polio vaccines had been manufactured, set up a commission to appraise the polio vaccine theory. Information technology establish that the theory was extremely unlikely simply nonetheless recommended that polio vaccines no longer be produced using monkey kidneys.25
As well every bit vaccinations, other cross-species transfers have the potential to introduce dangerous new diseases. Xenotransplantation, such as transplants of baboon livers to humans, is an avenue for simian viruses to find human hosts, especially since immune suppressing drugs are required for such transplants. More mostly, similar sorts of risks are posed by some types of genetic engineering. Furthermore, just as SIVs were unknown in the 1950s, then prions—implicated in mad cow disease—were unknown until the 1990s and boosted disease vectors may exist discovered in the hereafter. Recognition of the possibility that AIDS came from polio vaccines could sensitise scientists, regulators, and the public to such risks.
SHOULD SCIENTISTS Exist BLAMED?
If AIDS arose from contaminated polio vaccines, who or what is to blame? Alternatively, is it advisable or useful to destine blame at all?
Arraign has multiple dimensions. One is legal liability, something that is settled by courts and legal scholars. Another is educative value. A person blamed for an human activity may (or may non) learn a lesson, and the process of blaming tin can serve to warn others. The focus here, though, is on who or what is responsible for the origin of AIDS.
Participants on both sides of the controversy have been unanimous in denying that anyone involved in the African polio vaccination campaigns was responsible for AIDS, because SIVs had not been discovered at the fourth dimension and thus the potential for disease transmission was non recognised. The contamination, if it occurred, was inadvertent and thus not blameworthy.
More challenging is the issue of what might exist called "structural responsibility", namely the role of factors such as competition and colonialism. For example, it might be argued that the scientific reputation system, with its rewards for scientists who successfully stake a priority claim, encouraged polio pioneers to take risks. (The pioneers debate that they legitimately took risks for the sake of those who might otherwise be stricken with polio, at the fourth dimension a widely feared killer disease—rather like AIDS today.) This is to blame the reputation system, not any private. Similarly, colonialism might be blamed for the ease with which Third World people were fabricated bachelor for early mass vaccination campaigns. There has been little attending to this sort of structural responsibility, perhaps in part because the aforementioned factors—contest and neocolonialism—proceed to play a major role in scientific discipline today.
In societies characterised by individualism, there is a strong trend to focus on individual responsibility, leading to what tin be chosen a "blaming culture"—for example, in which patients are prone to sue doctors for any unsuccessful operation. Oft there is a tendency to arraign the victim, such as when poor people are blamed for their poverty.26 This tendency is institute in psychological studies, where the "fundamental error of attribution" is to accredit responsibility for events to individuals rather than structural factors. Blaming individuals has the effect of letting the system off the claw. Pressure for systemic change is thus diverted into a search for scapegoats. The conclusion from this line of argument is that earlier even thinking of placing responsibleness on scientists, the priority should be to learn general lessons for the practise of science.
SHOULD DEFAMATION Deportment BE USED?
At the end of 1992, Koprowski sued Tom Curtis and Rolling Stone for defamation. The case never reached court, being settled by Rolling Stone'due south payment of one dollar to Koprowski and publication of a "clarification".27 Yet, the legal activeness toll Rolling Rock half a million dollars and discouraged Curtis and others from pursuing further investigation of, and publication about, the polio vaccine theory. Koprowski as well sued Associated Press over a story by a different journalist.
Legally, Koprowski was certainly entitled to sue. In discussing this and other cases, Michael Curtis has, yet, strongly argued that defamation actions have a damaging effect on the open discussion that is necessary to seek the truth nearly scientific matters and that "complex criticism" should have heightened legal protection.28 This damaging effect can occur despite the honourable intentions of the suer. Ultimately, changes in police or legal do are necessary to fully address the spooky of scientific contend by defamation actions, which is but ane facet of the greatly increased use in recent decades of legal action to stifle costless speech.29, 30 If such litigiousness had existed in an earlier era, then one might inquire, provocatively, what would accept been the effect on John Snowfall'southward cholera investigations if he had been sued for defamation by the Southwark and Vauxhall Company, supplier for the Broad Street pump?
SHOULD At that place BE A RESPONSIBILITY TO INVESTIGATE UNORTHODOX THEORIES?
1 of Pascal's nigh fervent claims was that the scientific community had an obligation to devote some attending to the polio vaccine theory. In particular, he felt editors had an obligation to either publish his articles or to provide audio reasons why the theory he was proposing should be rejected. He argued that, if the theory turned out to exist right, the implications were so great that a strong case was needed to justify rejection.
Pascal's assertion can be generalised: a theory deserves serious consideration if the combination of its implications and the run a risk that it is correct are sufficiently great. Suppose a theory has a 1% chance of being right only the implications would be a consummate revamping of ideas in the field or big social consequences. Then information technology might be argued that the theory would warrant 1% or more of research try and journal infinite. This is coordinating to an insurance policy: the chance of disaster is small but the consequences are large, then setting aside a modest proportion of money or endeavor for the unlikely contingency is considered worthwhile.
In practice, few scientists devote time and resources to investigating unorthodox theories. In many cases this is a positive hindrance to one's career.31 Certainly at that place is no extra funding for those scientists who are willing to devote a proportion of their energies to exploring or testing non-standard ideas. Only a few editors solicit publications about, and scrutiny of, views that are afar from orthodoxy. (A very few journals, such as Medical Hypotheses and Speculations in Science and Technology, actively promote this.) Furthermore, some scientists are vociferous in denigrating "fringe" theories and fields and those who champion them. Far from feeling any obligation to investigate anomalies and challenges to paradigms, fifty-fifty sympathetic scientists seem unable to undertake this because of lack of time, while many display active hostility. In the case of the origin of AIDS, some opponents of the polio vaccine theory have argued that, because it is incorrect (so they believe), information technology should non be investigated further.
The orientation of almost scientists to current paradigms and research agendas, especially where funding is available, is well documented in the sociology of science. Critics take argued that it can be more productive to be open up to challenging views.32 Certainly there are many cases, such equally continental drift, where discredited theories have later on been resurrected. The Wistar committee concluded that the polio vaccine theory was highly improbable, noting that the "most telling evidence is the case of the Manchester crewman who appears to accept been infected with HIV-1 fifty-fifty before the poliovirus trials were begun in Congo".33 Some years later, withal, the bear witness for this example was establish to be incorrect,34 revealing yet again the risk of prematurely rejecting a theory.
If science would do good from more scrutiny of challenging ideas, and so an ethical expectation for scientists to devote some fraction of their effort to these ends would aid promote this pragmatic cease. Achieving this would, however, require significant changes to the current economic and peerbased reward systems driving enquiry.
An awareness of the routine pressures against unorthodoxy, plus the additional pressures when challengers threaten the funding or status of dominant scientists or the interests of their patrons, should brand observers sceptical of claims that challenging views deserve no attention.
CONCLUSION
On the surface, the origin of AIDS is a scientific outcome, but, equally shown here, scientific disputation has been permeated by upstanding bug. What is most striking is the way that ethical concerns have been used as means for pursuing the debate. Opponents of the polio vaccine theory have argued that the origin of AIDS does not warrant investigation by referring to ethical concerns, namely maximising efficiency in efforts against AIDS and minimising damage to vaccination campaigns. Allegations take been made about unfair blaming for the origin of AIDS. Defamation actions are founded on claims about damage to reputation. Pascal argued that the scientific community has a responsibility to bargain with challenging theories that have significant social consequences.
While ethical dimensions can be examined on their own merits, in that location is an added dimension to the process when ethical concerns are deployed as means for pursuing a debate. The use of ethical claims as tools for social contention raises second club ethical dimensions nigh the use of those claims. The origin of AIDS fence is thus a complex combination of scientific noesis, ethics, and the practise of ability.
Acknowledgments
I thank Ed Hooper, Julian Savulescu, Steve Wunsch, and two anonymous referees for comments on earlier versions of this paper.
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