BOOK REVIEW (NEW YORK TIMES)

FOR almost a decade, Peter Duesberg has been publicly arguing that AIDS is not caused by H.I.V. infection. Given his prominence as a professor of molecular and cell biology at the University of California, Berkeley, and his membership in the National Academy of Sciences, his arguments commanded attention. Since he first made this claim, in 1987, many major biomedical research journals have arranged for formal, published debates between Mr. Duesberg and other distinguished scientists. They have disagreed almost uniformly with his increasingly strident contentions, but he has remained undaunted, writing voluminously about his belief.

"Inventing the AIDS Virus" is the next assault in Mr. Duesberg's war on what he perceives to be a monolithic scientific establishment. Any reviewer who is also a scientist, as I am, is placed in an awkward position, for his iconoclasm is extreme. One wants to begin with a rebuttal that evokes the overwhelming numbers of biomedical scientists, physicians, public health and health care professionals who have considered the evidence in depth and have arrived at conclusions very different from his. But the book's central theme is that we are all wrong-that the entire scientific army is out of step except for Mr. Duesberg. And he perceives self-interested collusion behind that nearly universal agreement. After eight years of such exchanges, he continues to object vehemently to the nearly unanimous conclusion in the microbiological community that H.I.V. is a newly pandemic virus that over a period of years causes inexorable depletion of immunologically important cells in almost all the people it infects, thus leading to AIDS.

The importance of the argument is clear: if H.I.V. is the cause of AIDS, it follows that prevention of the further spread of H.I.V. is critical to stem the swelling tide of the disease. Scientists at the National Institutes of Health, the World Health Organization and elsewhere who have studied the new phenomenon of lethal immunosuppressive illness are convinced not only that the advent of H.I.V. explains the worldwide spread of AIDS but that it represents a striking premonitory example of an emerging infection and deserves intensive, coordinated reaction around the globe.

They are all wrong, Mr. Duesberg says: myopic or worse. He hints at vested interests and implies that diligent, intelligent scientists at every level have bought into an empty H.I.V. hypothesis for self-aggrandizement or material gain.

At the core of Mr. Duesberg's thesis is his belief that, by definition, there can be no such thing as an illness induced by a virus that has its overt onset years after initial infection. Further, he asserts that no virus can cause more than a single disease, or any disease that appears after a neutralizing immune response develops.

This remarkable belief flies in the face of decades of progress in understanding infectious diseases. Early in this century, when the germ theory of disease was quite new, research focused on examples of acute, clear-cut interactions between parasitic microbes and their infected hosts. But with each passing decade, the potential complexity of so-called host-parasite relationships has become better appreciated. In recent years, many chronic viral infections (such as recurrent herpes simplex or the reactivation of the latent chicken pox virus to cause shingles) have been studied in depth, and investigation of the role played by viruses is considered by most researchers to offer a particularly rich source of insight into the cause of other chronic diseases and even of cancer.

Those of us struggling with the problems presented by AIDS are somewhat inured to the author's acrid complaints and accusations, for he has indeed had his day in court many times over. He has made his views familiar through initial colloquies in the journals Science, Proceedings of the National Academy of Sciences, and Nature, and he has maintained a reiterative public correspondence contending that H.I.V. does not cause AIDS. In itself his dissent is not unreasonable, for in most arenas, but particularly in science, conflicting interpretations should always be attended to carefully.

In this book Mr. Duesberg now goes considerably farther, saying in essence that there is no pandemic at all-that nothing unusual is happening, that there is no such thing as AIDS. He ascribes the loss of life-more than 300,000 deaths in this country alone in the 15 years since the epidemic surfaced- to drugs or to underlying generic ill health or both.

Gay men in whom AIDS was diagnosed in the early years, he asserts, were not being truthful if they denied drug use. More recently, he believes, the decimation of their ranks is exacerbated by treatment with AZT (zidovudine). Mr. Duesberg feels that AZT is so toxic it should be banned by the Food and Drug Administration.

It is generally held that the large number of hemophiliacs now suffering from AIDS were made ill by their use of Factor VIII concentrate (needed to stem their bleeding), which is prepared by pooling plasma from literally thousands of donors. Before the development of heat-treated plasma in 1983, and before blood donor screening became possible in 1985, many hemophiliacs were given clotting factor contaminated with the virus and became infected with H.I.V. But Mr. Duesberg argues that H.I.V. is not the cause of their illness: they were sick anyway, and are simply dying of their underlying disease and, again, of the toxic effects of AZT.

Nor is transfusion with H.I.V.-infected blood a cause of AIDS, Mr. Duesberg says: studies show surgery patients die with equal frequency within the first year after surgery whether they have been infected with H.I.V. or not. This is correct but irrelevant: what he is failing to note is that there is an interval of no less than two years between initial H.I.V. infection and overt AIDS. According to Mr. Duesberg's fundamental assumption, such a long interval between infection and disease is impossible.

What about infants born to H.I.V.infected mothers? The mothers, according to Mr. Duesberg's reasoning, must have been drug users (it's the only possible explanation of their infection, according to Mr. Duesberg's theories), and all of the infants would have been damaged anyway, he asserts, since they spent nine months in the wombs of drug users. That circular argument is downright dizzying-especially since it is based on flawed premises at every turn, not the least of which is the assumption that children born to drug-using mothers are always born damaged.

As for H.I.V. and AIDS in other countries, Mr. Duesberg dismisses the issue: existing indigenous diseases explain everything. According to the Global AIDS Policy Coalition's most recent estimate, there have been 7,600,000 AIDS deaths in sub-Saharan Africa, with 1,300,000 in 1995 alone.

Mr. Duesberg seems oblivious of the fact that immune suppression caused by H.I.V. takes a distinctive form. Nor does he acknowledge the existence of enormous bodies of evidence based on epidemiologic or clinical science that firmly implicate H.I.V. in AIDS. On occasion, when he feels the need to deal with the reality of large numbers of people dying with profound immune suppression, he invokes a diffuse (and unproved) immune incompetence that he ascribes to drug use, life in underdeveloped countries or underlying illness. Taken together, those dismissive statements almost seem to suggest an assumption of "poor protoplasm."

At every turn Mr. Duesberg faults both modern microbiological science and the way its insights have been translated into feasible public health programs. His position is not simply that of a benign naysayer: much of what he advocates would have truly malign effects on the health of the public.

Mr. Duesberg blithely disregards the mountains of data contributing to the present understanding of microbial pathogenesis in general. He is at least consistent in his iconoclasm, for he disbelieves many things. He insists, for instance, that the late-stage neurologic disease that threatens syphilis patients has nothing to do with the syphilis bacterium: it occurs years later and thus must reflect instead the results of toxic treatments. But syphilis patients don't get neurologic disease unless the syphilis has gone untreated. In any case, the treatment for syphilis is penicillin, which is not toxic.

He dismisses hepatitis C as a pathogen or even as a virus because it cannot as yet be grown in cell culture (a technical problem that has been true of virtually all viruses early in their recognition). But he goes much farther, criticizing the F.D.A. for approving the screening of donated blood for hepatitis C. Most analysts believe that policy has resulted in dramatic reduction of the occurrence of post-transfusion hepatitis since it was instituted in the early 1990's. Mr. Duesberg views it as collusion between government and industry to dupe the public.

He scathingly rejects studies of so-called "slow viruses" like those implicated in some cases of Creutzfeldt-Jakob disease. As for any role for viruses in causing cancer in humans, he rejects the mounting evidence as spurious.

Mr. Duesberg makes virtually no effort to substantiate his most contrarian assertions, many of which are contradicted by reams of published data, while he berates his adversaries for failure to identify the "one paper that proves" that H.I.V. causes AIDS. A disproportionate number of footnotes refer to Mr. Duesberg's own work.

For the thousands who are suffering from AIDS or trying to cope with the escalating demands of treating this deadly illness, Mr. Duesberg's suggestion that nothing new is happening is as outrageous as it is insulting. Mr. Duesberg's last chapter sets forward what he thinks should be done in its full simplicity: don't do drugs and don't have hemophilia or other diseases.

Mr. Duesberg's credentials make his assertions both distracting and disabling of preventive response. Denial has always been the most devastating social and political dynamic of the AIDS epidemic-and his book feeds it abundantly. In sum, this book is destructive of personal morale, prevention efforts and public understanding both of H.I.V./AIDS and of biomedical science in general. It has the potential to wreak serious harm at a crucial point in the AIDS epidemic, which has been judged by many to be one of the greatest public health challenges of our time.

Here you find Duesberg's reply.