The Ethics of Denialism
Various forms of denialism existed throughout the AIDS epidemic. In fact, the high international visibility of the AIDS coupled with the intense media coverage contributed to providing greater visibility to denialists theories than might have occurred for other diseases. Healthy debates are necessary to stimulate sound approaches to scientific discovery, ensure that research is conducted ethically, and that the conclusions reached withstand outside scrutiny. But within the AIDS epidemic denialism took an extreme and even dangerous turn and we all learned how difficult it was to combat ideas that often focused on conspiracy theories and preyed upon the weak.(1)
The first form of AIDS denialism was easy to identify but strangely emanated from a tenured professor at one of the major universities in the US—the University of California at Berkeley. Prof. Peter Duesberg was convinced that HIV was not the cause of AIDS and that the treatment that had been proven to control infection was actually the cause of AIDS as well as cancer. His followers traveled throughout the US to spread his teachings declaring that HIV-infected mothers could breast-feed their infants, patients could stop antiretroviral treatment, parents could refuse to give antiretroviral drugs to their infants and that all of the science proving HIV was the cause of AIDS was simply a means of scientists promoting their own research. Duesberg was not a physician nor had he ever conducted research into HIV care and treatment. Yet it seemed that nothing could stop Duesberg adherents from influencing individual, national and even and international decisions. In an article published by Chigwedere and associates in Lancet they calculate that the denialists theories were responsible for the loss of at least 300,000 lives in South Africa alone.(2) It is more difficult to calculate the loss of lives by the vaccine denialist who refuse to immunize their children and recommend not immunizing other children because of the unsubstantiated risk of autism and neurologic disorders.(3) At the Durban international conference on AIDS, denialism was felt to be so strong that the Durban declaration was drafted declaring HIV the unambiguous cause of AIDS and its complications and signed by over 5,000 physicians, scientists, Nobel Prize winners, and healthcare workers.(4) The media is not exonerated from promoting AIDS denialism. Articles on HIV and vaccine denialism were/are published in mainstream media picking up on the bandwagon of denialism and publishing articles under the guise of freedom of speech while ignoring the ethics of perpetuating falsehoods and facilitating the spread of theories that result in disease and death.
Of course denialism coexists with freedom of speech and the right of individuals to express contrary views but there is a fundamental question of when does denialism get supported directly or indirectly by public funds and academic institutions without asking serious questions about the ethics of using an academic umbrella to perpetuate contrary theories.
The denial that HIV is the cause of AIDS by Duesberg is an extreme example of denialism coexisting within an academic institution and protected by an administration that refused to intervene based on principles of “academic freedom.” More recently denialism has taken a more subtle and less strident path within the walls of the academy where denialism is portrayed as honest scientific inquiry. The result is unnecessary and sometimes dangerous clinical research that is conducted in large populations of vulnerable individuals, especially those residing in resource poor countries, simply by declaring, as did Duesberg, that the results of previous clinical research studies are not valid. The denialism is often accepted without challenge even though it places large numbers of vulnerable individuals at risk for receiving inferior treatment. The impact of this form of denialism is no less devastating resulting in the denial of effective treatment to millions of individuals especially women and children. The clinical research is “allowed” within the academic environment by reinterpreting previously established international ethical guidelines including those of universal standard of care.(5)
1- Chigwedere P, Essex M. AIDS denialism and public health practice. AIDS Behav.
2010 Apr;14(2):237-47. Doi: 10.1007/s10461-009-9654-7.
2- Chigwedere P, Seage GR 3rd, Gruskin S, Lee TH, Essex M. J. Estimating the lost benefits of antiretroviral drug use in South Africa. Acquir Immune Defic Syndr. 2008 Dec 1;49(4):410-5.
3- Kreesten Meldgaard Madsen, M.D., Anders Hviid, M.Sc., Mogens Vestergaard, M.D., Diana Schendel, Ph.D., Jan Wohlfahrt, M.Sc., Poul Thorsen, M.D., Jørn Olsen, M.D., and Mads Melbye, M.D. A Population-Based Study of Measles, Mumps, and Rubella Vaccination and AutismN Engl J Med 2002; 347:1477-1482
4- The Durban Declaration. Nature. 2000 Jul 6;406(6791):15-6.
5- Ammann, A. J. TREAT ALL as the Standard of Care. What Now? September 12, 2012 http://ethicsinhealth.org/?p=395