House of Numbers

And does Brent Leung know anyone who works at the Chandler Chicco Agency?

Lou, you express surprise at the vehemence of the condemnation of this film from informed cientists, clinicians and public health experts, and you suggest that perhaps they protest too much because they sense they are wrong, and that they would be better served by engaging the “dissidents” in “calm, well reasoned conversation”.

Let me put a hypothetical to you. Suppose the tobacco companies came together and engaged a “public relations” agency to create a piece intended to deny the link between smoking and cancer. Obviously, the scientific evidence is completely against this proposition, so the next best thing would be to make a piece that claims there is a genuine scientific controversy about it. (In fact, this is precisely what the tobacco industry did in the 1960s, as did the asbestos industry in the 1970s.)

They might hire a little known filmmaker to present their viewpoint, framing it as his own “personal journey” in which he is “just asking questions”. He might get some real cancer experts, lie to them about the intentions of the film, and then carefully edit their responses to maximise any minor differences in views or how they are expressed, in order to create a sense of confusion and conflict for his audience. (It’s pretty easy to get scientists to wax lyrical about the arcane details of their field of expertise, oblivious to whether their audience is following them.)

Our filmmaker might then intercut these grabs with brief vox-pops with people who have only a vague understanding of oncology, and with interviews with the very pseudo-experts who conceived the film in the first place, and who deny the smoking cancer link. And – bingo – you have your manufactured controversy. Salt your argument with weaselly statements like “well maybe, just maybe, cancer doesn’t even exist at all”, stick a trailer on youtube and your PR product is complete.

Of course, it would be important to obscure such a film’s funding and origins in the tobacco industry.

What reaction to such a product would you expect from, say, cancer surgeons, or oncology nurses, or cancer researchers, or people who have lost relatives to smoking related diseases? Could you understand their outrage?

In reality, there is no ongoing scientific debate about whether smoking causes cancer. Nor about the basics of HIV/AIDS – that HIV exists, that it causes the disease AIDS, that it’s sexually transmissible, that testing has a high degree of reliability, and that antiretrovirals are an effective if imperfect treatment. These facts haven’t been in informed scientific contention for years if not decades. What there is is a political “debate” kept alive by a tiny group who have abandoned any pretense of scientific engagement, and have adopted the rhetorical techniques of propaganda and PR.

It’s Disinformation 101, Lou, and Leung is not the first to try this. It has nothing to do with “bringing clarity” – its intention is the exact opposite. What surprises me is that someone with an interest in documentary and presumably an understanding of the methods of persuasion could have missed this.

Lou – you are right that the motivations of HIV/AIDS dissidents cannot be simplified down to pure financial interest – they are much more complex and interesting than that. But that wasn’t the point of my comparison between “House of Numbers” and the disinformation campaigns of the tobacco and asbestos industries; rather I was trying to highlight the specific well-worn persuasive techniques used in the film, because that might help explain both your own reaction to it and also what you see as excessively vehement condemnation from the scientific mainstream (including from the eighteen HIV/AIDS scientists who say they were deceived into taking part).

The motivations of the prominent HIV/AIDS denialists are as diverse as their “alternative” theories are mutually contradictory, and include longstanding bitter personal vendettas between themselves and mainstream figures, overvalued pet theories, the promotion of meritless quack therapies, and the journalistic thirst for cracking the Big Conspiracy Story. Only occasionally is there obvious financial self-interest. It’s been going on for decades, and yes you’re right – it’s a fascinating display of politics in the mass media age – particularly as played out over the internet.

What it is not, however, is a dispute about basic facts between equally valid scientific viewpoints.

Virtually none of the denialists have actual relevant experience, qualifications or training in the fields they are pretending to critique. Most of the arguments from the most “scientifically credible” denialist Peter Duesberg, for example, are centred on epidemiology, pharmacology and clinical infectious diseases medicine – areas in which he has no expertise at all. As someone who had attracted some kudos for earlier – largely unrelated – work, he initially tried arguing his case in the scientific literature but was eventually dismissed because his claims lacked cogency and could not be substantiated by evidence. Like other denialists he cherry picks and even blatantly misrepresents the legitimate work of others, and ignores the mass of evidence that contradicts his assertions.

This is why his claims are rejected by virtually every scientist and HIV/AIDS clinician in the world, not because of some kind of vast global conspiracy of self interest.

Unfortunately, HIV/AIDS denialists have since turned their attention from scientists with the background and expertise to critically analyse their assertions, and are now pitching direct to the lay public through books, films, and especially via the internet. In particular they target people with HIV/AIDS, in some cases recruiting them as spokespeople for the “cause”.

(This has great propaganda value, because ones personal medical history is only as public as you make it, and it is almost impossible to argue with someone in denial of their own serious disease without it appearing as a personal attack.)

Lou – by all means observe the broader picture of what is going on here (it’s fascinating as well as infuriating), but above all bear in mind your own level of scientific expertise before giving credence to those who present themselves as bona fide critics of genuine scientific experts.

And as a documentary film critic, don’t underestimate your own ability to recognise spin, obfuscation and cant in that medium.

Lou – I wouldn’t say that most HIV/AIDS denialists deny the existence of AIDS, although many of them claim that the immune system disease we know by that name is actually something else.

But the central view of HIV/AIDS denialists is that HIV is not the cause of AIDS. Usually associated with that belief are contentions that HIV is not sexually transmissible, that testing is unreliable, and that treatment is worse than useless. Denialist belief also divides into two mutually incompatible ideas about HIV itself: one side contends that the virus exists, but that it is harmless, while the other says it doesn’t exist at all. In public, denialists try to minimize this obvious contradiction, but they are finding it increasingly hard to do so. In private they are at each other’s throats on the issue. And some denialists go so far as to claim that many, if not most pathogenic viruses are actually non-existent.

When I became interested in HIV/AIDS denialism, the first thing I wondered was is there anything to it. And I can honestly say that after 2 or 3 years of carefully and critically reading denialist claims I have yet to come across a single one of their argumentoids about the basic points above that stands up to even basic informed scrutiny.

This doesn’t stop them repeating the same memes again and again on the net and elsewhere ad nauseam – typically in the form of rhetorical “questions” with a hidden underlying misconception, often a straw man. If you try to answer, your explanation will be ignored, or the goalposts get shifted (a common technique). Later you come across the same person asking the same “question” on another thread, as if nothing has happened. Often the existence of “unanswered questions” is merely asserted: if you read any of the multiple HON threads on the net you’ll note repeated claims that the film raises Unanswered and Unanswerable “Questions” – but precisely what these are is a mystery.

This rhetorical game has been going on for years now (well before I first discovered it), over thousands of blog threads and literally hundreds of thousands of individual postings. Most mainstreamers know there is little point to engaging the denialists, except to correct obvious disinformation for the benefit of lurkers and uncommitted onlookers and the rare individual whose questions are genuine rather than rhetorical. Picking the latter is tricky, because denialists on the net commonly pose as genuinely information-seeking neophytes. The name of the game for them is not necessarily to win the “debate” but simply to create the impression for the benefit of onlookers that a valid informed “debate” exists to be had. And that it is being officially suppressed.

In short:

- Is there anything to what the AIDS denialists are claiming? (no, even though their argumentoids might seem superficially plausible, none of them stand up to even moderately informed scrutiny. It’s empty rhetoric designed to create the illusion of controversy).

- So how do they maintain the traction they do? (repetition and seeking virgin audiences, especially through the copy-paste keys, applying standard rhetorical techniques like cherry picking, moving goalposts, demanding impossible standards of “proof”, posing rhetorical questions with hidden false premises and then claiming they are unanswered, quote mining, basic errors of logic like straw man propositions and unjustified generalizations from often incomplete and unverifiable anecdotal stories, citing fake “experts”, deliberately misinterpreting real ones, and ultimately claiming vast implausible conspiracies to hide the truth.)

As for what motivations drive denialists to promote their beliefs? Tough question.

- Personal vendettas and personal loyalties, particularly surrounding Peter Duesberg, whose personal animus toward a number of prominent AIDS scientists, particularly Gallo and Fauci verges on the sociopathic. At the same time he can be quite charming and charismatic, and inspires quite intense loyalty from his personal friends.

- The Dunning Kruger effect – a cognitive distortion in which lack of competence in a subject robs an individual of the metacognitive ability to recognize this very lack. You see this a lot on the net: the more ignorant the claim the more confidently it is asserted and the more impervious it is to reason. You also see this with scientists whose expertise in one field, seems to render them insightless about their incompetence in another. Bauer, Duesberg, the Perthians and others are classic examples.

- The high stakes of the issue makes it difficult to back down. If, for example, you have invested time and effort into trying to convince an HIV positive woman to ignore competent medical advice proven to prevent mother to baby transmission, and her child then dies of AIDS at age 3 it’s pretty hard to then say, “Oops, sorry, I was wrong. My bad?” Ain’t gonna happen. This is particularly important at this late stage, because there is solid evidence about the catastrophic impact of denialism, particularly in South Africa, where it resulted in a public health policy paralysis that cost literally hundreds of thousands of lives. The denialists responsible are in damage control.

- Overvalued and frankly cranky beliefs about human health: the single cause of all chronic diseases is variously: lack of stomach acid, cortisol, psychological stress, cellular redox states, anal sex, prescribed medications (especially antibiotics), recreational substance use, not enough enemas, too many enemas, voodoo curses, dental amalgam, latex, cleaning products, pesticides, the gay lifestyle, racism, vitamin deficiency. Among Africans it’s always poverty and dirty water. Oh, and AZT if none of the above apply.

-Denialism also feeds into basic memes of distrust of authority and social institutions, particularly governments and the scientific community.

There’s more to it than this, of course, including some very real issues around how people diagnosed with a frightening and stigmatizing diseases engage with a monolithic medical and scientific culture whose arcane ways of processing information can seem frankly alienating to someone for whom this is foreign to their ways of thinking and sense of self, but is forced by circumstance to depend on it. It’s primarily this point of engagement which denialists target with their disinformation….

…I can talk about that more, if you like – I think it’s central to understanding how denialism works, but I’m worried I’m boring you. Let me know if you want me to continue. I can also link you to some excellent websites on the topic that discuss the phenomenon better than I can.

But the nub of it is: don’t mistake ideological rhetoric for scientific debate and don’t mistake carefully crafted propaganda for information

Lou, I think you need to be very careful about the anecdotal health claims of individuals, particularly when they are used to support controversial claims.

The fact is, a person’s complete medical record is not a public document, and inevitably you get tempted to speculate to fill in the gaps in the story.

Magic Johnson says that he has been on HAART since the mid 1990s, and he attributes his continuing good health to this. I don’t have any reason to doubt this claim, which is entirely unsurprising.

Karri also tells us she took HAART for 11 years, and stopped two years ago after coming across the dissident viewpoints on the internet. She says she currently feels well, although the last time she checked her CD4 count it was quite low. I don’t have any reason to doubt her, but I’m not sure what this is supposed to demonstrate about HIV and AIDS. I suppose what concerns me is whether having been thrust into the limelight she will have difficulty changing her mind again if the need arises.

I’m not quite sure what to make of the Lindsey Nagel story. No one has ever made clear whether she ever had a confirmed diagnosis of HIV infection (this is not always straightforward in infants who carry maternal antibodies for some months or even a year or two after birth), and I think the expression “symptoms commonly associated with AIDS” is pretty vague. It’s possible she and her family have a case for claiming misdiagnosis or mistreatment, but the court case dramatically announced by Celia Farber (a journalist closely associated with promoting Duesberg’s cause) in 1995 never saw the light of day, for reasons that have never been disclosed.

I’m also uncomfortable about an 18 year old girl being made a poster child for agendas that are not all that clear. There are a lot of “unanswered questions” here, and personally I think it’s entirely appropriate they remain that way.