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Case Study: Wishful Thinking Masked as Science
08/08/2002
Jody, blogland's most vocal atheist and an AIDS activist, links to a UCLA press release that carries the bold title "UCLA AIDS Institute Scientists Show Antiretroviral Drugs Can Eradicate AIDS Epidemic." Let's take a look.
The hook: "UCLA AIDS Institute researchers have predicted that widespread use of antiretroviral (ARV) drugs can eventually stop the HIV epidemic in its tracks — even in African nations where a high percentage of people are infected."
"It's sort of like having a vaccine out there," says Sally Blower, UCLA professor of biomathematics. Sounds great! Much better than the gloomy statistics we've been hearing lately about 65 million dead by 2020.
Now look very carefully at the construction of the paragraph that introduces the dark cloud:
Blower's team discovered that the rate of HIV infection was extremely sensitive to changes in risky sexual behavior. They concluded that any behavioral programs addressing HIV prevention and transmission must be tightly coupled with ARV drug therapy.
Changing risky sexual behavior is still the key. Notice how that next sentence shifts the logical order: the study is trying to prove that drug therapy works "like a vaccine," yet it is a currently known solution (behavior modification) that is stated as the add-on — "any behavioral programs," as if they're optional. The conclusion is the premise. Well, maybe I'm just too much of a language guy. Let's read on.
An increase in risky sexual behavior will worsen the epidemic — even if drug-resistant strains of HIV are not very fit.
What does this mean for San Francisco? "Our model suggests that it is possible to eradicate HIV in San Francisco," Blower said. "But given the high volume of unprotected sex and drug-resistant HIV strains, it's the worst of all possible worlds and doesn't look good."
The logic: Drugs will work! If behavior changes, which doesn't look likely. So here's the solution:
1. Treat more HIV-infected people to reduce the epidemic's severity.
2. Develop more effective drugs to reduce viral load. Even a slight drop in viral load would provide great benefit.
3. Prevent drug resistance from developing in order to prevent the transmission of drug-resistant viral strains.
4. Reduce the rate of risky sexual behavior in order to heighten the overall effect of treatment on the HIV epidemic.
Wait a sec! I thought the central problem was sexual behavior... why is that the last thing on the list? If the drugs cannot even prevent the epidemic from getting worse without the behavior change, how can reducing "the rate of risky sexual behavior" be said to only "heighten the overall effect"? This is like claiming that a pogo stick can reach the moon, with a space shuttle "heightening" its lift capacity.
Then Blower just restates the wish. It's shameful that public university academics are apparently in the propaganda business. It's criminal that people will die from heightened (false) expectations.
Posted by Justin Katz @ 09:32 PM EST
9 comments
I await the day Andrew Sullivan declares that he is leading a chaste life and that is the answer to the AIDS mess. Don't laugh,I bet he's had some reflective moments about the criminal homosexual actions of the clergy.
tony
tonymixan @ 08/10/2002 10:23 AM EST
Justin... if you click the "time" line on my page that will give you a direct link to the post. That way I also know what wonderful words of wisdom of yours I'm missing.
Justin, I think it would be nice if you quoted a little more extensively from the article.
Antiretroviral therapy makes an effective prevention tool," Blower said. "It extends the lives of HIV-infected individuals who take it. It also decreases the number of new infections in the community. The eventual outcome is epidemic eradication.""It's sort of like having a vaccine out there," she said. "Although the drugs can't cure people, they do decrease the community level of HIV infection. As less people become infected, the epidemic eventually runs out of steam."
According to Blower, the UCLA study suggests that the treatment and prevention of HIV infection are not two entirely different approaches. "Treatment is prevention," she said.
There is no "propaganda" in the press release. The scientists are very clear. HIV prevention efforts must include both behavior modification and ARV use. You can't think of the two as separate. Their study, which was a "...mathematical model examined multiple scenarios created by manipulating the value of several different variables..." pointed that out. They were stating, very explicitly, that ARV helps to depress the amount of HIV capable of being spread while safer sex depresses the amount of HIV that is spread. You have to go after both aspects in order to "eradicate HIV in San Francisco." Something that, they caution is not currently occurring there:
"But given the high volume of unprotected sex and drug-resistant HIV strains, it's the worst of all possible worlds and doesn't look good."They make no claims that it is a done deal, only that the opportunityis there. It's a model for how to send this damn virus packing once and for all. There is no grand conspiracy there -- just probabilities and potentials.
Jody @ 08/12/2002 02:14 PM EST
[I'm new to blogging. Henceforth, I will utilize entry-specific links where available... I also didn't know that it alerted the linkee, which is a desirable functionality.]
Look, the title of the press release is: "UCLA AIDS Institute Scientists Show Antiretroviral Drugs Can Eradicate AIDS Epidemic." I don't see "behavior changes" anywhere in there.
I never said that the scientists denied the influence of behavioral changes nor that treatment should be abandoned. The problem is that "treatment" is not "prevention." It is part of prevention. I was showing the rhetorical "sleight of brain" that they used to promote one aspect and deemphasize the other.
It's obvious to anybody who pays even slight attention to the use of language that there's quite a bit of spin going on in that article. It should be obvious to those who don't. That's what I was bringing attention to.
Whether the scientists were just trying to avoid responses of "yeah, so?" to their money-costing study, were trying to shift emphasis to drugs as the preeminent solution, or were trying to bolster a failing political argument, I'll let others decide for themselves.
Justin Katz @ 08/12/2002 02:33 PM EST
As a writer, you know as well as I, that a catchy title or first sentence gets people to stop, look and read an article. In advertising and public relations that is doubly so. You are complaining about a press release and not a scientific paper.
The point of their paper -- and it is ties directly to the other point you make in your post -- is that prevention is the same thing as treatment as far as eradication goes. It's very clear, from the quotes and from their bullet points, that they are saying in order to kill off HIV once and for all, both aspects must be approached together, if not equally then with the knowledge that they influence the other.
What bothers me the most? Your implying that the authors of the study were being deceitful or misleading as to the results of their study based on the title of a press release. I expected better.
Jody @ 08/12/2002 03:02 PM EST
C'mon, Jody. Behavior isn't mentioned until about two-thirds of the way through the article.
And what of it being a press release? Do you honestly believe that the researchers expect reporters to call them on the basis of the release and to receive (and print) a more-balanced view of the truth, which is that this study found that behavioral changes are the key to eradicating HIV? (Not exacty a ground-breaking, government-grant-earning conclusion.)
Even look just at the opening line of your handling of the press release, "Even in light of above mentioned anti-condom crowd and all of the previously mentioned no-sex-please we're British-or-we'll never end this blasted AIDS epidemic, a word of hope."
The conclusion of the study, honestly taken, seems clearly to be that there is no hope without addressing other issues first. At this point, you've mitigated the statement made by the press release and attempted to ignore the fact that I addressed the entire body of the article.
As always, readers of our exchange can decide.
I can't find the actual research paper. If it were to turn out that somebody in the UCLA press office manipulated the thrust of the scientists' work, then the shame would be on them.
Justin Katz @ 08/12/2002 03:24 PM EST
Again Justin, you are missing the point of the article. It's that both pieces, both the behavior change and the ARV use, are necessary to stop HIV. One isn't going to work without the other.
As for behavior change, again, what's your point? People -- gay men in particular -- have changed their behavior to use condoms. What is occurring now, something I've also talked about here and railed against is that some gay men are taking the advances in ARV as a reason to no longer protect themselves from HIV. The Andrew Sullivans think that their obligation is over and they can do whatever the frell they want -- which isn't the case at all.
The encouraging thing from the article is that by pointing out through the combination of ARV and continued safer sex practices, HIV can be eliminated. That is big news.
Jody @ 08/12/2002 05:37 PM EST
Jody,
While I agree that "both pieces, both the behavior change and the ARV use, are necessary to stop HIV" is important to note and ought to be the point, this article (and the study, apparently) actually treats the behavioral change aspect as an add-on ("any behavioral programs") when, by the study's own math, it is the core component to which the drugs should be an added bolster.
The truth of the matter is that "gay men are taking the advances in ARV as a reason to no longer protect themselves from HIV" is why it is, at the very least, imprudent for researchers to be saying such things as, "It's sort of like having a vaccine out there."
Unless that statement is taken way out of context by the press release, it is an extremely callous one to make, considering the implications that "vaccine" usually carries (i.e., can't get the disease).
Justin Katz @ 08/12/2002 05:49 PM EST
The paper explicitly states -- from the title of the article on down -- how ARV's can eradicate HIV. It outlines, between ARV and behavior, how such an event can occur.
You seem to be picking nits by focusing on the word "vaccine" and ignoring the sentence modifiers of "sort of like" and the further qualifiers about how the program they outline is not a cure and how behavioral change is still a key element to any of their predictions.
I'm wondering if your complaint with the article is that it doesn't advocate for a behavior change of abstinence and committed heterosexual relationships instead of safer sex and ARV use?
Jody @ 08/12/2002 07:03 PM EST
One of the most satisfying moments I've seen on debate TV was Walter Williams saying to Alan Colmes (of Hannity & Colmes), "I think you must be kidding." I feel similarly here.
First of all, we've been running with the condom & drug plan for decades, and, as recent international studies have shown, it isn't working. Yes, abstinence outside of committed long-term relationships — of any orientation — must be the central message of AIDS education initiatives, with condom use presented, in realistic terms, as a far distant alternative. This message is so important that I don't believe orientation judgments should enter into it at all, and proselytization (outside of what is necessary to convey the idea of changing behavior) should be reserved only for those who seek it.
The fact of the matter is that ARV drug use cannot "eradicate" HIV. It can't kill it in individuals, it can't prevent it from spreading, and it can't reduce the number of infected people unless at-risk groups change their behavior.
The premise that "treatment is prevention," that ARV drugs are "like a vaccine," and that they can "eradicate AIDS" is ludicrous. The big "IF" on which the benefits that are presented depend is deliberately downplayed throughout the article. If you strip out all of the spinning, the actual mathematical findings are that changed behavior is the only solution, although drugs can heighten the effect (beyond helping infected individuals, which is obviously good and right). The statement of the article and, presumably, the study phrases this fact in exactly the opposite terms!
I'm at a loss, Jody, because this is so obvious that your reluctance to admit it leads me to believe that you are so adamantly guarding against arguments that I am not making that you refuse to see that this study — or at least the way in which it is presented — can only lead to more people taking ARV drugs as "a reason to no longer protect themselves from HIV," which you say you've railed against.
Justin Katz @ 08/12/2002 09:54 PM EST