The longest weekend
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7462.400 (Published 12 August 2004) Cite this as: BMJ 2004;329:400All rapid responses
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It is fascinating to note that Dr. Drury's article seems to be
generating more heat than light in the Rapid Response Column.
My interest in Dr. Drury's remarks stems from the fact that I am a
Behcet's patient, for whom every weekend can be a long weekend: not
because of HIV counseling and testing, but because of the pain and
suffering caused by the disease itself.
As the above respondents quibble about HIV testing, Behcet's patients
are languishing in pain, awaiting a correct diagnosis and an aggressive
plan of treatment. As was the case for Dr. Drury's patient, they also wait
in agony, albeit for different reasons.
As a patient and student of health information management (medical
coding), my sincere hope is that current medical education will alert
students to the clear and present dangers posed by this disease, and that
healthcare providers will take Dr. Drury's account as an alert to the
presence of Behcet's disease in patients under their care.
In my case, it required residence in Israel to obtain a diagnosis for
a disease that has been a lifelong menace. May Behcet's patients in the UK
find knowledgeable, compassionate caregivers in a timely fashion.
Thanks to Joanne Zeis for posting credible journal and internet
citations concerning the nature of Behcet's and those who suffer from it.
Competing interests:
None declared
Competing interests: No competing interests
While the discourse concerning HIV testing has been informative in
follow-up responses to this article, no one has addressed the author's
original intent: showing compassion for a patient (ultimately diagnosed
with Behcet's disease) who anxiously awaited the results of his HIV test
over a long holiday weekend. Waiting for test results is a common
complaint of patients; Behcet's patients carry an inordinate emotional
burden during this wait, as genital lesions often suggest an STD scenario
to attending physicians. How much of this burden might be relieved by
telling patients (in advance of testing) that non-contagious reasons for
genital lesions also exist, and that HIV or herpes are not the only likely
diagnoses? It is possible for emotional stress to cause a new flareup of
symptoms in Behcet's sufferers, or to exacerbate a flare already in
progress; thus a lack of timely and considerate communication between
doctor and patient may set off an unfortunate cascade of additional
symptoms, for no good reason. Many are the BD patients who have (finally)
received negative test results for herpes, for example, only to be told
that "the test results must be wrong," and are then prescribed a useless
course of treatment for their continued BD-related genital lesions --
along with a rejoinder to "look to their marriage/partner" for a
discussion of probable sexual activity outside of their relationship.
Compassionate? Hardly. Anxiety-producing, and possibly symptom-
exacerbating? Most definitely.
Nigel Drury must be commended for recognizing and addressing his
patient's emotional pain (albeit after the fact), and for suggesting that
no physician "assume" that someone else will deliver anxiously-awaited
results. Following the Golden Rule should be standard for healthcare as
for life: "do unto others..." I would only ask readers to place
themselves in their patients' shoes: arriving at an unknown doctor's
office with unusual and painful oral, genital and bodily lesions, being
told that s/he is being tested for HIV, and then forced to wait four days
for test results. Expressions of fear, frustration and anger are all
understatements for the extreme range of emotions caused by this
situation.
Remember -- First, do no harm....
For more information on Behcet's disease/syndrome, please reference
the following sites:
Behcet's disease overview by Kenneth T. Calamia, MD, Mayo Clinic
http://www.arthritis.org/research/Bulletin/Vol53No2/Introduction.asp
Emedicine.com article on Behcet's disease:
http://www.emedicine.com/derm/topic49.htm
Behcet's Syndrome Society (U.K.) http://www.behcets.org.uk
American Behcet's Disease Association http://www.behcets.com
Joanne Zeis (joanne@behcetsdisease.com)
PO Box 255
Uxbridge, MA 01569 USA
author of "Essential Guide to Behcet's Disease" and "You Are Not Alone: 15
People with Behcet's".
Competing interests:
None declared
Competing interests: No competing interests
The Lifestyle/AIDS hypothesis.
John Bolton stated: "Scientific progress is made by proposing a
hypothesis, testing it, and revising it until the subsequent theory best
explains the observed facts. The viral theory of AIDS fits the known
observations best, unless Mr Russell has another theory he has tested? If
so, he might do better to publish his findings in a journal rather than
protest on a website or two".
In response to Mr. Bolton I would like to propose the Lifestyle/AIDS
hypothesis bearing in mind the complete failure of the HIV/AIDS
hypothesis. However, journals such as Nature, Science, New Scientist and
The Lancet would dare not publish it as it would threaten the vested
interests of the 'HIV' multinational industries that they propagate. It is
far too late for these journals to admit that they made a mistake in
promoting this flawed and failed hypothesis for so long now.
I now propose the Lifestyle/AIDS hypothesis. There are two distinct
'AIDS' epidemics: in the West 'AIDS' is a product of extreme wealth and in
the Third World 'AIDS' is a product of extreme poverty.
In the West ‘AIDS’ is driven by exotic lifestyles of drug consumption
inducing toxic, chemical, psychic and inmmunoligical stressors. Hence, in
the wealthy capitalist West, 'AIDS' is a condition of conscious consumer
choice 'lifestyle'.
In stark contrast, 'AIDS' in the Third World is a 'deathstyle'
related to poverty and malnutrition and not a condition of ‘consumer
choice’. Put directly: the West 'chooses' to have 'AIDS' whereas the Third
World does not. Roberto Giraldo proposes the Stressor/AIDS hypothesis as a
toxic and nutritional syndrome caused by the alarming worldwide increment
of immunological stressor agents:
"I propose to define AIDS as a toxic and nutritional syndrome, the
most severe and profound of all acquired immunodeficiencies, due to
multiple, repeated, and chronic exposures to immunological stressor
agents. These stressors cause degenerative immunotoxic and immunogenic
effects on immune cells and reactions, with the accumulation of free
radicals, especially oxidizing agents, in all body systems but principally
in the organs and tissues of the immune system. These progressive and
continuous deleterious actions upon the immune system bring the individual
to a collapse of immunological functions, with the subsequent and
simultaneous appearance of infections, neoplasias, and metabolic
conditions. Simultaneous with acting on the immune system, stressor agents
alter the functioning of practically all other systems and organs. The
continuation of this process eventually causes the death of the person.
The diverse clinical manifestations of AIDS are the direct consequence of
the physiologic and molecular pathogenesis of the syndrome. The
distribution of immunological stressors varies within the groups of people
at risk for AIDS. This fact is the primary explanation for the great deal
of variation in the clinical manifestations of AIDS within the groups of
people at risk for it. While altering the immune system, the exposure to
stressor agents also causes damage to practically all systems, organs and
tissues of the body. This is another factor in explaining the great deal
of variety in the clinical manifestations of AIDS within the groups at
risk for it. In AIDS, not only the immune system collapses, but all other
systems as well.
In brief, AIDS is neither an infectious disease nor is sexually
transmitted. It is a toxic and nutritional syndrome caused by the alarming
worldwide increment of immunological stressor agents."
Roberto Giraldo, A Proposal for the Definition of AIDS, June 2000
(posted during the Internet Discussion of the South African Presidential
AIDS Advisory Panel).
So as long the recreational drug epidemic continues to grow in the
West, Eastern Europe, Thailand, and China, ‘AIDS’ will grow; and as long
as poverty, malnutrition, lack of sanitation, and poor medical care
persist in the Third World, ‘AIDS’ will grow. All these
diseases/conditions and toxic/chemical stressors (as the causes of ‘AIDS’)
are completely independent of the putative ‘HIV’.
To conclude: ‘AIDS’ can only be confronted if ‘HIV' is removed from
the equation. So called ‘HIV antibodies’ should bee seen as an
epiphenomenon associated with oxidative stress of cells due to all the
above listed causes. There is no such thing as a 'human immunodeficiency
virus'. Let us now abandon the failed ‘HIV/AIDS’ hypothesis and
investigate the Lifestyle/AIDS hypothesis.
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor,
I fear Mr Russell, the artist/writer/philosopher, mistakes me for an
immunologist or virologist, whereas I am but a lowly urological trainee. I
am not qualified to answer his questions, and neither am I sure why he is
asking them to me, but I will acknowledge his "thrown gauntlet" thus,:
1. I never said HIV was transmitted by Factor VIII, neither can I, as
a urologist, give a credible answer to the question I feel he should be
asking a virologist. However, I understand it is thought to be the case
that individuals have acquired HIV through blood product use. Just because
I can't explain it, doesn't mean it isn't so.
2. I refer Mr Russell to my general principle outlined in previous
letters: The inability to visualise an entity does not exclude its
existence. What used to be explained in Elizabethan times as being caused
by "bad air" and "miasma" is now known to be due to airborne infectious
agents. Perhaps, in future, we will be able to extract pure virions from
semen.
3. What happened to 3.?
4. Again, I am not a virologist, but the natural history of many
illnesses is partly dependent upon the environment in which the affected
lives, the co-existence of other pathogens, and the nature (genetic and
otherwise) of the patient. Variation in presenting symptoms and behaviour
of the syndrome is not evidence that the pathogen doesn't exist.
I have "hidden" behind an "excuse" of not being a virologist, but
only because it is true, and I note neither is Mr Russell. It may be
because of this I do not have the answers to Mr Russell's questions. He
*is* raising important questions, and it is only a science that can
withstand (and address) these questions and criticisms that deserves our
credence. I cannot see into the future, though, to know what developments
hold for us. Thus, I cannot say that technology today is enough to know
all there is about AIDS.
Scientific progress is made by proposing a hypothesis, testing it,
and revising it until the subsequent theory best explains the observed
facts. The viral theory of AIDS fits the known obervations best, unless Mr
Russell has another theory he has tested? If so, he might do better to
publish his findings in a journal rather than protest on a website or two.
Lastly, I apologise if Mr Russell felt my remark about his wager was
snide. I feel that anyone who stands to gain, or lose, money as a direct
result of research undeniably has a competing interest, and should thus
declare it.
Competing interests:
None declared
Competing interests: No competing interests
John Bolton wilfully misinterpreted my point when he stated:
"Thus, prior to the work of Charlotte Friend and the Professor, the
viral particles were not visible, but they existed. Or does Mr Russell
contend they came into being at the time of the photograph?"
Charlotte Friend suspected a novel retrovirus in mice, which caused
cancer. To prove that it actually existed and that it was no merely a
supposition or a laboratory artefact, fresh blood samples from several
mice suffering from cancer were pooled and subjected to centrifugation by
Prof. de Harven. The recovered pellet of virus was cut into slices, fixed
and subjected to electronmicroscopy using standard lab procedures: the
resultant micrographs showed densely packed identical viral particles.
Thus de Harven successfully demonstrated conclusively by visual means the
existence of the suspected novel retrovirus, subsequently called the
Friend virus. In twenty years of ‘AIDS’ research this has never been
achieved with the putative ‘HIV’.
That is the reason I offered a substantial reward to anyone who could
find and visualise ‘HIV’ in a fresh blood sample using de Harven’s
methodology. Perhaps John Bolton would care to explain, if ‘HIV’ has never
been found in a fresh blood sample, how was it supposed to have
contaminated Factor VIII? I challenge Mr Bolton to answer the following
questions:
1) How did ‘HIV’ get into the clotting factor, and how could it
survive the cryoprecipitation used in its preparation?
2) ‘HIV’ has never been found in a fresh semen sample. Precisely how
is it sexually transmitted? As opposed to mere supposition, where is the
scientific evidence that HIV is sexually transmitted at all? What studies
have been carried out which prove this?
4) Why is ‘HIV’ alleged to cause symptoms and death rapidly in
Africa, when it is classified as a lentivirus to explain the slow
development of symptoms in the West?
Is it a ‘lentivirus’ when it suits their book in the West but a rapid
-acting ‘virus’ in Third World? Is this yet another magical property of
this all-singing, all-dancing, all-things-to-all-men ‘virus’?
In conclusion I would like to draw your attention to David Rasnick’s
recent Rapid Response ‘Chicken's Come Home to Roost’ regarding the
impossibility of an ‘HIV’ vaccine (Rapid Response 22nd August).
As Peter Duesberg observed in 1987, an anti-‘HIV’ vaccine is
unnecessary: a test revealing so-called ‘HIV antibodies’ supposes that
the body is already vaccinated – naturally. So what use would synthetic
antibodies generated by a vaccine be? Moreover, there are those who
believe that ‘HIV antibodies’ are autoimmune antibodies that are
themselves the cause of ‘AIDS’.
It is worth stressing that when every prediction based on an
hypothesis fails, as has been the case with the ‘HIV’ causation of ‘AIDS’,
then that hypothesis is wrong. Not one prediction based on the ‘HIV’
hypothesis has ever been fulfilled in 20 years. ‘AIDS’ is in the same
category as beri beri, pellagra and SMON – all diseases originally wrongly
believed to be caused by an infectious agent, and subsequently shown to be
due to non-infectious causes.
John Bolton stated: “I would also humbly suggest that if the reports
of a £10,000 reward being offered by Mr Russell are true, this might be a
"competing interest" for the purposes of correspondence on this issue.”
Regarding Mr. Bolton’s snide remark about my offer of a reward
showing a "competing interest" – if I stood to gain £10,000, I would tend
to agree with him, but I am offering to give that amount to anyone able to
produce a micrograph of densely packed 'HIV' particles directly recovered
from a fresh blood sample.
BMJ readers may ponder why, in 20 years of obscenely over-funded
‘HIV’ research, no one has shown ocular proof of ‘HIV’ particles in a
fresh sample of any body fluid. I think the ‘HIV’ gravy train is
beginning to run out of steam. Why can't we see 'HIV'?
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor,
It is perhaps most difficult to demonstrate something to the man who
would not see, but the fallacy of Mr Russell's argument is in his own
words.
My point was that the current inability to isolate and photograph
viral particles to the satisfaction of a man who has bet some serious
money that it can't be done does not prove the particle does not exist.
Mr Russell himself points this out: "When Charlotte Friend isolated
the murine retrovirus that now bears her name, her colleague Professor
Etienne de Harven was able to recover and pellet down sufficient viral
particles to photograph them..." Thus, prior to the work of Charlotte
Friend and the Professor, the viral particles were not visible, but they
existed. Or does Mr Russell contend they came into being at the time of
the photograph?
I would also humbly suggest that if the reports of a £10,000 reward
being offered by Mr Russell are true, this might be a "competing interest"
for the purposes of correspondence on this issue.
John Bolton
Competing interests:
None declared
Competing interests: No competing interests
Dr. Noble stated: "For a start, there are many published electron
micrographs of HIV. Alex Russell chooses to deny their existence."
I have never denied the existence of micrographs purporting to show
putative ‘HIV’ particles but we still do not know if they really are ‘HIV’
or even viral particles at all. There are no published electron
micrographs of tightly packed ‘HIV’ viral particles.
Dr. Noble always ignores my main point: the published images are
invariably of particles produced in extreme laboratory conditions,
invariably the result of co-culturing with cancerous cell lines, and in
the complete absence of an immune system response. To this extent these
questionable particles are merely cultural artefacts. No particles have
ever been recovered directly from any bodily fluid taken from an assumed
‘HIV positive’ person.
However, there also exit micrographs of morphologically identical
particles commonly found in placental tissues, as well as lymph node
tissues of individuals suffering from lymphadenopathy but who show no
evidence of the hypothetical ‘HIV infection’.
What does Dr. Noble consider those particles to be?
Dr. Noble’s dogged belief in the existence of ‘HIV’ is theological rather
than scientific. Religious fanaticism is no substitute for scientific
rigour.
Competing interests:
None declared
Competing interests: No competing interests
John Bolton asks: While we may not yet be able to "see"
a free viral particle, what we have is an abundance of
albeit indirect evidence that there is a virally
transmitted immunodeficiency syndrome. If not, what is Mr
Russell's explanation to the relatives and friends of
those who have died of AIDS?
For a start, there are many published electron micrographs
of HIV. Alex Russell choses to deny their existence.
In addition, Alex Russell is all too aware of the tragic
effects of HIV infection. He had a number of friends that
also denied the existence of HIV. Unfortunately, these
friends, unlike Alex, were infected with HIV and died from
AIDS.
In a bizarre display of cognitive dissonance Alex Russell
uses these people to deny that HIV exists.
The Huw Christie Memorial Prize
The same "prize" - two corpses.
Competing interests:
None declared
Competing interests: No competing interests
Astonishingly John Bolton contends we don't have to 'see' the virtual
‘HIV’ to know that 'it' is there:
“Not being able to see something does prove it doesn't exist.”
This is the same argument for the belief in the Holy Ghost. Belief is
not proof. Belief is not science. John Bolton seems to believe in the
existence of ‘HIV’ as an article of faith. Theology is not science.
Belief is not sufficient: science is about cold hard factual proof
and ‘indirect evidence’ will not suffice. When Charlotte Friend isolated
the murine retrovirus that now bears her name, her colleague Professor
Etienne de Harven was able to recover and pellet down sufficient viral
particles to photograph them using an electronmicroscope from fresh murine
blood samples: this has never been achieved with 'HIV'.
Typically when viruses cause a disease they are present in blood at
high titre and therefore recoverable: this has never been the case with
the hypothetical ‘HIV’ – the virtual ‘HIV’ has never been directly
isolated from any bodily fluid in pure culture. Why not?
Mr. Bolton further states: “While we may not yet be able to ‘see’ a
free viral particle, what we have is an abundance of albeit indirect
evidence that there is a virally transmitted immunodeficiency syndrome.”
I repeat: ‘HIV’ has never been recovered or visualised in any bodily
fluid taken from an assumed ‘HIV positive’ individual. Thus there is no
evidence that the putative ‘HIV’ is transmitted in semen and blood or
could have ever been present in Factor VIII. However: the world still
believes that haemophiliacs were infected with ‘HIV’ via their clotting
factor, despite the fact that the CDC in the USA has admitted the
hypothetical ‘HIV’ could not have survived the preparation procedures.
If one cannot see ‘HIV’ how can one identify this non-isolated
material as ‘HIV’? All we have been shown are Disneyesque artist’s
impressions of ‘HIV’. Dumbed-down 'HIV' pseudo science is virtual virology
and virtual viruses do not cause disease only fantasies.
Bolton concludes: “…what is Mr Russell's explanation to the relatives
and friends of those who have died of AIDS? Or, as I, and perhaps he, has
not *actually* seen corpse of someone dead of this disease, does he
suggest that AIDS doesn't exist as well?”
I never said ‘AIDS’ doesn’t exist at all: I said that ‘HIV’ does not
exist. My ‘explanation’ – or rather question - ‘to the relatives and
friends of those who have died of AIDS’ is: what exactly did they really
die of? Which one of the 29 diseases/conditions that form the syndrome?
Mr. Bolton wrongly states that ‘AIDS’ is a ‘disease’ when it is in
fact a collection of diseases. No one dies of ‘AIDS’ per se but with a
final presenting disease and some of which are not even connected to or
dependent on immuosuppression – dementia, diarrhoea, lymphoma, KS.
Competing interests:
None declared
Competing interests: No competing interests
Re: Behcet's - Underdiagnosed in the U.S.
I too am a victim of the disease known as Behcets. But before
diagnosis, I was tested for HIV on thirteen separate occassions when
presenting with facial apthous ulcers. I was also tested for other
sexually transmitted diseases due to oral and vaginal lesions. Every
single time was frightening and humiliating, and every single time I was
forced to wait days, sometimes as long as a week for test results that
thankfully always came back negative. But the fear I experienced changed
me. Every time I was told that it was due to stress or it was all in my
head changed me. Behcets Disease is a rare orphan disease and although
there are tremendous amounts of information and correct diagnosis in other
countries. In the U.S. it is misunderstood and underdiagnosed. This is due
in part to funding, but also because there is a real misunderstanding of
the diagnostic criteria that should be used by all U.S. physicians. There
are so many other orphan diseases that already have criteria and
diagnostic information made available to physicians, so why does the same
not hold true for Behcets' patients? Currently only 25,000 people are
thought to have this disease in the U.S., but if every person diagnosed
with Behcets went through the same terrible process of misdiagnosis and
lack of understanding, then how many thousands of people are still not
being correctly diagnosed? The very nature of the disease is already
cruel to the patient, physicians should not add cruelty to cruelty. They
should instead be educated, informed and able to identify this disease. If
you look at the causes of morbidity from Behcets, is it surprising that
suicide is one of those risks?
Competing interests:
None declared
Competing interests: No competing interests