Wednesday, July 25, 2012

“On the Front Lines of the AIDS Pandemic” by Harry Haverkos

by David Crowe

Harry Haverkos is an enigma for HIV and AIDS rethinkers. A product of the US medical establishment he pursued the theory that one of the two major AIDS indicator disease known as Kaposi’s Sarcoma [KS] (the other was Pneumocystis carinii Pneumonia, or PCP) was caused by the practice of many gay men to inhale amyl nitrite ‘Poppers’. Yet, even so, Haverkos always gave allegiance to the infectious HIV=AIDS=Death dogma. His new book, “On the Front Lines of the AIDS Pandemic” describes just how deeply he was embedded within the AIDS establishment even before the AIDS era officially began, in the years 1980 to 1984, while at the CDC (US Centers for Disease Control).

The use of amyl and butyl nitrite inhalants, known as Poppers, as recreational drugs was almost entirely restricted to the gay ghettoes of America in the 1970s and 1980s. Sniffing from the little bottle of ‘video head cleaner’ or ‘room deodorizer’ with the suggestive name (Iron Horse, Man Scent, Pig Sweat, Bolt, Rush, Ram, Hard Ware) had a direct effect on the blood, dilating blood vessels, producing a high and relaxing muscles that facilitated anal intercourse. Haverkos notes that all five of the original “AIDS” cases described by Michael Gottlieb had used poppers. Some people noted that since the vast majority of ‘out’ gay men used these inhalants, and the vast majority did not have AIDS, they could not be the cause. But when quantity was examined, the correlation became much stronger. As Haverkos noted in “Health Hazards of Nitrite Inhalants” which he edited and contributed to, the drugs are carcinogens and also immunosuppressive, so they were excellent candidates to be the cause of KS in the handful of mostly gay men discovered in 1981. His attention was drawn to these inhalants in early 1983 when a co-worker came up to him in the hallway of the CDC (Centers for Disease Control in Atlanta) and Haverkos relates that, “He was very excited and told me he knew the difference between KS and PCP…one single variable was highly associated with KS and asked me what I thought it was. I shrugged my shoulders, I had no idea. Paul said it was the poppers!”
Although this shows that Haverkos did not invent the theory that poppers were, if not the cause of AIDS-defining disease KS, at least a co-factor, he did pursue it, while most others, more sensitive to their career prospects, dropped it. But Haverkos did not ‘damn the torpedoes’. He describes that when resistance came he yielded. He provides a service in this book by describing in detail how upper echelons prevented poppers from being talked about at scientific meetings. First Jim Curran, coordinator of the CDC Task Force on Kaposi's Sarcoma and Opportunistic Infections from 1981 and 1982, mentioned the possibility of potential biases in the data (something he probably would not have done if the theory was aligned with his prejudices). Perhaps, he said, there were problems with the study design? What about Occam's razor (i.e., the virus theory can explain everything, but the poppers theory can only explain KS)? Another top CDC MD, Harold Jaffe, “felt we should continue to focus on finding the infectious agent, and not get waylaid with side hypotheses.” Dutifully, Haverkos re-analyzed the data, but the results were the same, poppers were still the most important factor. However, Haverkos bent over backwards to give the virus primacy, coming up with a theory where HIV caused a T-Cell (CD4) deficiency first and then the poppers were able to cause KS. Even so, Curran and Jaffe refused to co-author a paper with him and insisted that it be sent for internal CDC-wide clearance and approval, a process that everyone knew would take forever. Later in 1983 Haverkos asked to present data on poppers at a meeting in San Francisco but he was told he would be fired if he did, so he quietly dropped the idea, although he did talk to one influential doctor, Donald Abrams, about it. He perhaps realized that that he was wasting his time because he discovered that, at this time, “The CDC hierarchy had just submitted the budget request for 1984 and had listed their #1 accomplishment as ruling out a role for nitrites [as] the cause of AIDS”.
Haverkos seems to have been swept along by the force of the establishment, of which he clearly thinks he was and is part. When visiting the Pasteur Institute he and his wife were treated as honored guests, with seats at the head table despite missing most of a conference. This honor was not because of them, but because they represented the CDC and the Pasteur Institute was pleased about the organization “recognizing the new disease” (he does not note that AIDS is a syndrome, not a disease) and because of the CDC “suggesting that AIDS had a viral cause” Haverkos reports that he toasted the French for “finding the cause of AIDS” (LAV, now known as HIV). No mention of poppers or other non-infectious factors to spoil the collegial mood.
Between the lines one can understand how important being a member of the establishment is to Haverkos. He describes how well he was treated as a representative of the CDC with obvious and slightly surprised pride, and every time he mentions another former member of the CDC’s Epidemic Intelligence Service (EIS, the US medical system’s equivalent of the CIA) he provides the year that they were inducted into the service. This is useful because it shows not only how important fitting in was to Haverkos but also just how important EIS is in promulgating the CDC’s views throughout the United States. EIS members work within the CDC for only a short time and then find jobs around the United States and even overseas, but they never really leave the EIS, and continue to provide a backdoor conduit for the CDC to influence practices in virtually every major medical institution. EIS members continue to report to each other and to the CDC their entire working lives.
Another example of Haverkos’ acceptance of the infectious theory is his description of Gallo’s four papers in the May 4, 1984 issue of Science as “seminal” without a word about the numerous government investigations that followed into the corruption of Gallo’s work – the misappropriation of the work of others, his lies to the US patent office, the modifications to his laboratory notebooks after the investigation began. Not even the fact that Gallo violated scientific protocol by reporting his findings first at a press conference is criticized.
Although Haverkos never pushed too hard on poppers, even the slightest whiff of disloyalty was fatal. At the end of this short book, that only describes his years at the CDC, he was pushed out, told he needed to be more discreet in discussions both inside and outside of the CDC. But Haverkos was not treated as harshly as a Duesberg. In 1984 he fell into a job at the National Institutes of Health (NIH) which was just as deeply embedded in the new HIV=AIDS=Death paradigm and arguably more prestigious than the CDC.
Although Haverkos recognized the role of poppers early on, even before the ‘probable cause of AIDS’ was announced to be HIV, he was blind to the possible involvement of other non-injection drugs, such as cocaine, in the development of so-called “AIDS” diseases. Investigations were always oriented towards injection drug users, blinding investigators towards drug use in many other so-called AIDS victims. Consequently, the partner of an injection drug user who was found to be HIV-positive would be recorded as a sexual transmission case even if they were also a non-injection drug user. And injection drug use was blamed on a virus transmitted by sharing needles rather than the toxicity of the contents of the syringe.
Haverkos illustrates how medicine is a field for conformity. He quotes a textbook as saying that an epidemic is ‘an increase, often sudden, in the number of cases of a disease above what is expected in that population in that area’ without commenting on the definition’s absurdity and vagueness. This definition gives organizations like the CDC the power to declare an epidemic (or not) at any time and is highly subject to ascertainment bias – if you go looking for cases more carefully you will find more cases, the number of cases will then be higher than previously, and you will have created an epidemic. The definition he quotes for pandemic is no better – “an epidemic that has spread over several countries or continents, affecting a large number of people.” In the context of AIDS, it should be obvious that bundling several unrelated diseases together, and then going looking for them, could easily result in the discovery of a false epidemic and a false pandemic. Yet, because the definitions are written in a text book, the world will take the declarations of the CDC seriously. It is essentially the laundering of opinions into scientific facts.
This book is important for people who want every detail of the early days of the development of the HIV=AIDS hypothesis. But it is not without flaws. It is expensive at US$60, almost a dollar a page. Although chronology is important in a story like this, the book is too autobiographical, with extraneous details such as an anecdote about Haverkos’ parents delaying telling him about the death of his grandmother while he was visiting France to avoid interfering with his important work on AIDS. The book covers an important portion of the history of AIDS but it is really too short, it should have covered at least up to 1990 by which point the HIV=AIDS=Death dogma had become ossified and Haverkos had done much more work on Poppers. AZT, the first AIDS drug, had not yet been trialled by the end of this book, let alone rushed into combat.
The book has the appearance of being self-published. The first word in the book is a spelling mistake (“Forward” instead of “Foreword”). Subsections are indicated by five-hyphens and journal names are underscored as if it was typewritten. There is no index, an important oversight even though the book is short. Haverkos is also careless with abbreviations and short forms that the reader might not be familiar with. Harold Jaffe is just “Harold”, San Francisco is “SF”. These are small details, but important to readability.
The book also has errors. Some are peripheral to the main subject, such as his claim that the European Union did not exist in 1983 (it actually had 10 member states). Others call into question the accuracy of the material (as well as the editing), such as verbatim repetition of an early AIDS-like case, a man who worked in the garment industry. On page 56 the anecdote is described as happening in the context of September, 1982 but on page 78 it is repeated word for word with a specific date of March 1983.
Haverkos apparently has plans to publish more about his sometimes uncomfortable life with the AIDS establishment and people like myself who read the entrails of the syndrome that changed the world will almost certainly buy his next episode. It would be nice if more of his life with HIV and AIDS was put into a single larger book and some of the flaws in this book were corrected. Even if you do not agree with Haverkos on many issues, it is still an important perspective and an important window into this historical period when the HIV=AIDS=Death dogma germinated.

Harry Haverkos, MD
Bethesda, MD, USA
Former Associate Director, National Institute on Drug Abuse (NIDA)

No comments:

Post a Comment