RIP Medical Hypotheses

Medical Hypotheses was established with the express intent of allowing ideas outside the mainstream to be aired so that they could be debated openly.

My article on medicine as a way to show we care was published in this (not especially prestigious) academic journal. Alas its editor Bruce Charlton has been sacked, its editorial policy ended, and two papers withdrawn, because it published a paper by UC Berkeley’s Peter Duesberg’s saying official South African mortality statistics seem at odds with a particular previous study’s estimates of the harm of their not using anti-HIV drugs. (The author of that previous study responded, suggesting official statistics are unreliable, and citing other sources that agreed with him.)  Duesberg’s inexcusible crime was suggesting at the end of his article that available data might be better explained if HIV is not the main cause of AIDS:

“Is academic freedom such a precious concept that scientists can hide behind it while betraying the public so blatantly?” asked John Moore, an Aids scientist at Cornell University, on a South African health news website last year. Moore suggested that universities could put in place a “post-tenure review” system to ensure that their researchers act within accepted bounds of scientific practice. “When the facts are so solidly against views that kill people, there must be a price to pay,” he added.

So how sure would we have to be of an academic claim for it to be reasonable to ban any academic publications offering evidence questioning that claim?  And how sure would be have to be before we could reasonably revoke the tenure of any academic who attempted such a publication?  I doubt we are that confident in the HIV-AIDS connection, and would love to see prediction market odds here.  Are there any offers to bet on record here?

HT Arnold.

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  • Peter Twieg

    I wonder what these people would think if economists started making dicta about “policy views that kill people” and how those who express aforementioned views should be subject to “post-tenure review.”

    • Jayson Virissimo

      Arguably, the economic policy of farm collectivization has killed millions of people all around the world. What should we think about the people who advocate such economic policies?

  • Vladimir M.

    My impression is that what we’re seeing here is a smart crackpot attacking the establishment of a field with lots of naked emperors, which is bound to provoke a nasty backlash.

    Duesberg’s hypothesis was interesting 20 years ago, but it’s been refuted quite decisively since then, and I think we can safely conclude that he’s become a crackpot. On the other hand, however, the AIDS establishment — by which I mean the whole vast network of academics, activists, national and transnational bureaucrats, NGOs, medical professionals and industries, etc. involved in AIDS-related work — has grown immensely and commands ever larger budgets, influence, and public prominence, while at the same time, the disease has become a politicized and ideologically hot issue. Under these circumstances, humans being what they are, it’s inevitable that the establishment will have lots of dirty open secrets, and its officially correct positions will be at least somewhat detached from reality.

    In such a situation, a smart crackpot dissenter like Duesberg, even if his basic idea is nutty, can be damaging to powerful interests if he’s given a prominent public platform to ask unpleasant questions. Thus, I’m not at all surprised that willingness to provide him with a platform will provoke extreme hostility from the establishment. This always happens whenever someone questions official positions that serve as basis for vast schemes of money and patronage, let alone when the issue also touches on identity politics.

  • Yes, we *really are* that confident in the HIV-AIDS connection.

    And Duesberg is not just “suggesting at the end of his article” that HIV does not cause AIDS – that suggestion is the entire point of the article and, indeed, most of Duesberg’s publications since about 1990.

    Most interestingly, Duesberg was himself a major contributor in convincing the South African government to not use anti-HIV drugs.

    • Roko

      > Yes, we *really are* that confident in the HIV-AIDS connection.

      Will you make a million to one bet that HIV is the only cause of AIDS?

      • No, because setting up that bet would incur transaction costs way beyond my potential winnings.

        Besides, it’s *not* about HIV being the only cause of AIDS overall (hard to claim that, since it basically amounts to a host of opportunistic infections due to a weakened immune system, and we know there are other things that weaken the immune system) – Duesberg is claiming that HIV is not causing AIDS, period.

  • Robert Koslover

    1. I wouldn’t “ban” the publications. On the other hand, there might be an effective ban in place if most/all of a person’s publications couldn’t seem to pass peer review. And frankly, I wouldn’t object to that situation at all if the reviewers honestly believed that they were being fair. But if the editors and reviewers of any particular journal want to publish a paper, no matter how silly it is, then I don’t think outsiders should be legally able to stop them. Likewise, outsiders should have no obligation to fund such journals. In other words, I support the free market (i.e., just my usual “axiomatic libertarianism”).

    2. And hey, speaking of the free market, why are academics entitled to, or need, tenure anyway? I’ve worked in my present (non-academic) job for nearly 11 years and I don’t have any tenure whatsoever, nor do I have any particular fear of being fired. I like my job and my employer likes me. It’s a mutually-beneficial relationship, after all. I don’t need tenure. So why do academics need tenure? Is it to protect them from employers who don’t like them? Why should an employer be forced to continue to employ a worker that he/she doesn’t like? Also, if I am doing a good job and my employer decides to terminate me anyway, then another company will probably be happy to hire me and then my employer will suffer because he foolishly threw away a valuable employee. Likewise, if an academic is doing a good job for his/her university, but the university decides to lay him/her off, then surely he/she could find a job elsewhere too, where he/she would be better appreciated and his/her former employer (who was foolish to terminate him/her!) would lose status. It’s called the free market! Hmmm… is that why at least some academics want tenure? I.e., they have no confidence that they can compete in the free market? Ok, I can appreciate that, but don’t forget there already exist very many (and constantly growing in number) government jobs with virtually guaranteed job security too. So there really is no shortage of very, very secure jobs for people who don’t have the stomach (and really, I do sympathize with that!) for competing in the often- stressful free market. But it sure seems that adherence to free market principles in academia would solve a boatload lot of problems stemming from the inability to fire academics who don’t do a good job. Right?

  • david

    No, Duesberg’s inexcusable crime was to hijack a journal dedicated toward non-well-known alternative ideas to push his already-well-known HIV denialism.

    Duesberg didn’t need to get his ideas out, everyone already knows too damn well what they are. He just needed the ability to be claim to have published, preferably to people who don’t know what Medical Hypotheses is about.

    And Charlton’s mistake was to fail to recognize that there is a difference between some unknown researcher pushing an uncommon idea to the profession and Duesberg pulling this crap again. A way of breaking orthodoxy became a tool for a crank to push well-debunked crackpottery; that is what got the journal shut down.

    • david

      * whoops, the editor asked to resign, not the journal shut down.

  • I’d gladly bet that HIV will ever be found to not cause AIDS on 20:1 odds, and that’s really the threshold where I think it’s worth my while bothering to place a bet.

  • brazzy, how confident is “that” confident?

    Chris, should hypotheses with <4% chance not have publications about them?

    david, but what about publications offering new evidence on an old already-known hypothesis?

    • michael vassar

      That would imply that any hypothesis that was rightly discussed in a publication and which subsequently validated by a second study at p<.05 could be said to be more likely than not (given many assumptions).

    • Notice the qualifier “worth my while bothering to place a bet.” If decision markets were widely used and I were a habitual player of decision markets and it wasn’t much trouble to place bets on all kinds of different outcomes to spread around my risk, I’d consider taking far worse odds. How much I’m not sure, really small probabilities are hard to think about. But basically, I think the chance of the consensus on HIV being overturned is negligible.

      Also, what Aaron says below. Most scientists who’ve looked at his work think Duesberg is guilty of cherry-picking data. The real issue is the quality of a given piece of research, not the probability of the hypothesis it supports being accepted in the long run.

  • This is not the first time that something like this has happened. Occurrences like this seem to happen more frequently due to a breakdown of the peer review system than anything resembling a conscious thought of the form “This is controversial and likely to be false but needs more attention.” For one extensively discussed example where the real problem was an outright unscrupulous editor see the Sternberg peer review controversy. Similarly, consider the Sokal incident or the Bogdanov affair. Whether or not the introduction of an unlikely or pathological hypothesis is deliberate, it can demonstrate serious holes in the peer review at a journal.

    • Aaron

      Medical Hypothesis doesn’t use peer review, the editor decides which papers get published by themselves.

      I think the issue is simpler than Robin makes it out to be. The issue isn’t just the AIDS denialism (which is responsible for a lot of deaths), but deliberately publishing bad research. It’s possible to do proper research that tries to throw doubt on the hypothesis that HIV causes AIDS. But when you start writing papers that take information out of context and misrepresent facts you’re going to be in trouble whether you’re with the majority or are out in the woods.

      The standard is higher for the researchers out in the woods (as it should be, extraordinary claims require extraordinary evidence). But if a mainstream researcher started trying to publish papers with false information and undisclosed conflicts of interest they’d eventually get in trouble too.

    • Aaron, are you saying this particular paper, about South African death stats, has such sloppy analysis that the paper should be retracted and the journal editor sacked no matter what hypothesis that paper had been said to support? Do you really think that would have happened for most other hypotheses it might have been said to support?

      • Aaron

        My comment wasn’t particularly well written but in my final paragraph I note that the fact this paper took a non-standard position meant that it was judged more harshly, a double standard that I believe is justified.

        For instance if you only wanted to publish papers with a minimum value, p, of being correct. A mainstream paper is to an extent backed up by the conclusions of the rest of the field, thus giving it a p advantage to start with. If you are coming to a different conclusion than everyone else than you need a much higher quality paper to achieve the same p value.

        On top of that consider the secondary consequences of the publication. In this case the hypothesis, widely thought to be wrong, could (and probably did) lead to a large number of deaths. When the consequences of publication are that severe I believe a higher p-value is justified.

  • Mass_Driver

    I’d place a bet for $10 against $10,000 in nominal 2010 USD that HIV will continue to be confirmed as the leading cause of AIDS. Other variables may influence the development of AIDS, but I will bet that in any year you care to name — 2020, 2025, 2030, etc — that any leading journal you care to name — Science, Nature, PubMed’s greatest hits, etc. — will still think that HIV explains 51% or more of the variability in AIDS vs. not-AIDS.

    If anyone actually wants to take that bet, private message me on Less Wrong and I’ll draft a contract for us.

    Dr. Hanson, I do think that if a journal is publishing studies that conflict with previous results that had p < .001 without critiquing the methods used in those previous studies, it should probably be shut down. Obviously not by the government or anything like that, but if academics shut it down in that situation, they made the right decision.

    • If there are many previous studies it will be infeasible for any one ordinary new paper to critique all their methods, just in order to present one new piece of evidence. Are you saying that no new evidence should be presented on the subject in any paper that does not fully review all previous evidence in enough detail to critique their methods?

  • Presumably the resulting controversy will ensure Duesberg’s paper gets the maximum possible circulation.

  • Abelard Lindsey

    The success of the anti-retrovirals makes clear that HIV does cause AIDS. However, the fact that many people are HIV-positive, but do not come down with AIDS, suggests that HIV infection ALONE is not sufficient to cause AIDS in many cases. That there must be a factor IN ADDITION to HIV infection that causes one to come down with AIDS. This is Duesberg’s argument and one I think is credible.

    I think HIV is a lot like Chicken pox or Herpes. If you get it and you have a robust immune system, your immune system keeps it bottled up in the spinal column and you never get sick. However, if something affects your immune system such as traumatic injury, aging, or even a party life style where you do not take proper care of yourself, then the virus gets out and you get sick and die.

    Such a two-step mechanism strikes me as being a very plausible explanation of AIDS and one that fits with what I have seen over the past 30 years. I fail to see why it should be so controversial.

    • anon

      Your hypothesis still posits that HIV is the main cause of AIDS. As far as I can tell, Duesberg does not claim this: he argues that HIV itself is mostly or entirely harmless.

  • albatross

    Above, aaron talked about the secondary consequences of some claims about reality. This is a common issue people raise in controversial scientific questions: calling AGW into question makes it less likely we’ll do anything about it in time (assuming the basic idea of AGW is correct), discussing racial differences in IQ can be used to justify discrimination or worse political/social nastiness, pointing out data showing that seasonal flu vaccine may make you more susceptible to swine flu may convince people to skip their seasonal flu shots and maybe get sick as a result, etc.

    The problem is, these consequences can tell us something about the best policies to pursue in the gambling sense (if AGW costs much less to head off than to adapt to, it’s probably worth heading off even if you’re not too certain it’s real), it can’t tell us *anything* about the truth of the underlying factual question. And this kind of consequences/implications are like a kind of poison for our minds, making it harder to think clearly about the factual question because we so dislike the consequences.

  • ggh

    Duesberg “cherry-picks” his evidence, not likely. His hypothesis is so obviously correct that the evidence may have to be condensed but not cherry-picked. It appears to me that his opponents may be cherry-picking to keep a $billion hoax afloat – but boys the ship is sinking ( convert you stocks in this one to something else – global warming is the current fad/can’t think of a current biology-type fad -cancer is a good one usually).
    I love the repeated ascertion that Duesberg has been “scientifically” proven wrong – wow but I never see a citation ( just forgot them all i guess, maybe you can remember 1 someday).

  • thomas

    Where was Duesberg disproven?
    And in which sense are ARV successful? Because they kill more slowly than the higher dosage AZT?

    Just name any sources for both, please. No empty “he was proven wrong” when you cannot name any sources.