The scientific publisher Frontiers recently published a paper disputing the link between HIV and AIDS. Yet, the belief system known as HIV/AIDS denialism has no scientific basis. As demonstrated anew with every person who begins a successful therapeutic program, the causative link between HIV and AIDS is among the strongest and most investigated in modern medical science. The published manuscript was also weak -- a one-sided, poorly researched, inaccurate screed by a non-expert on HIV/AIDS with training in theology and education.
This resurgence of denialism in the scientific literature is deeply troubling, as denialism remains dangerous to the extent it is tolerated in credible forums. In response, conscientious scientists and activists should demand retraction of this piece and avoid the Frontiers brand unless and until retraction occurs.
What Do Denialists Believe, and Why?
HIV/AIDS denialists variously believe that HIV does not exist, or that it exists but is harmless. They assert that AIDS is caused by antiretroviral drugs or "lifestyle factors." A wide variety of motivations and convictions underlie these anti-scientific conclusions. Some deny communicable disease in general, suggesting that measles, for example, is the result of a bad attitude, not a virus. Others dispute the existence or disease-causing potential of HIV only. For many, HIV/AIDS denialism is just one beast in a weird menagerie of conspiracy theories. Some are bigots or misguided "wrath of god" zealots.
Sadly, there is one more category of denialists: the dead. All too often, HIV-positive denialists have practiced what they preached, and died because they refused treatment.
Does Denialism Still Matter?
The heyday of HIV/AIDS denialism may be past, but lives are still being lost. There was a time when entire countries were threatened. Fifteen years ago, the questionable "scholarship" of University of California, Berkeley, professor Peter Duesberg provided the rationale for the South African government to refuse distribution of desperately needed antiretroviral drugs. Duesberg, who dismissively referred to black Africans as "Schwartzes," said the life-saving anti-HIV drugs were the true cause of AIDS. The resulting tragedy stretched over many years, with hundreds of thousands of needless deaths and new infections.
The political climate has long since changed for the better. However, denialism still matters as long as its adherents remain a threat to themselves or to others who might understandably embrace a soothing message about a harmless virus and forego needed treatment.
Who Is Responsible?
Demonstrably, denialism kills. Duesberg and lesser leaders in the tiny denialist community certainly share some culpability for deaths in South Africa and elsewhere. But are their actions, however reprehensible, surprising? Crackpots will always be with us, and we expect them to behave as crackpots.
Much more disappointing and inexcusable is the behavior of those who know better: those with authority who do nothing. Where would Duesberg's arguments be without the name of his university behind him? Would former South African President Thabo Mbeki have been more influenced by the scribblings of a retired rabble-rouser or a full professor at Berkeley? Sadly, University of California administrators have refused to kick out or even censure their scientifically unproductive, morally loathsome resident HIV/AIDS denier in any way, valuing a twisted notion of "academic freedom" over human life.
Scientific Publishers Have a Tremendous Responsibility … to Discriminate!
Scientific publishing is not and should not be inclusive. In a way, it is the careful application of censorship: burning away mistakes, laxity and invalid postulates. Evidence must be revealed; disproven notions should be rejected and removed.
Biomedical publishers who allow nonsense to appear in their pages because of misguided ideas about freedom of speech compromise the scientific enterprise and public health. Like Duesberg's unprincipled academic protectors, the Frontiers editors failed in their capacity as gatekeepers.
Just as the fraud Andrew Wakefield and the anti-vaccine movement depended on a paper in The Lancet (since retracted), HIV/AIDS denialists draw strength from publication in the scientific literature. When this happens, drastic action is needed, as occurred several years ago in response to a denialist piece in the journal Medical Hypotheses. The publisher retracted the article, removed the editor responsible and instituted new guidelines.
In contrast, Frontiers failed on all fronts after an outcry from scientists led Frontiers to issue a Statement of Concern and begin an investigation.
(Please note that the links below work through an intermediary service and thus will not be credited to the journal for web rankings.)
- The investigation ended with a decision to reaffirm the piece, simply reclassifying it as an opinion article.
- Worse, the editors listed it in PubMed, the repository for biomedical literature. Inexplicably, the initial Statement of Concern was deleted and expunged from the record.
- Frontiers even commissioned a debate-style response by an HIV/AIDS researcher, suggesting that the inaccuracies of HIV/AIDS denial deserve serious consideration.
Given an opportunity to correct its mistake, Frontiers deliberately compounded it instead.
What Must Be Done?
Frontiers must retract this piece. No matter how it is classified, this manuscript is a travesty of a scholarly work and has no place in the literature, not even as an occasion for a "teaching moment."
Second, Frontiers should dismiss or reassign the editors who were involved in the deliberate decision to retain the article. It is particularly astounding that anyone involved in HIV/AIDS research could sanction the promotion of this piece.
Finally, Frontiers must take steps to avoid irregularities like those that allowed the article to be published in the first place. Until these actions are taken, Frontiers cannot be taken seriously as a scientific publisher and should be boycotted.
Reflecting on this episode, I recall my first year as a graduate student, when my classmates were asked to invite a speaker to address the university. Our first choice was a somewhat slimy former scientist who was also an HIV/AIDS denialist. In our immaturity, we were amused by him. Our program director was not, and he wisely vetoed our first choice.
Exercising his role as gatekeeper, the director recognized something that the Frontiers editors would do well to consider: Not all viewpoints have equal value, and some viewpoints have no place in a reputable setting.
Kenneth Witwer, Ph.D., is an assistant professor in the Department of Molecular and Comparative Pathobiology at The Johns Hopkins University School of Medicine. His research program examines the role of the body's innate and intrinsic defenses in protecting against HIV infection and disease. The opinions expressed are his own and not necessarily those of his employer or funding sources.