trueskeptic
From the little I’ve read about SMON, it was is nothing as huge as you make it seem. It was first noted in the 1950s in Japan in a few cases. It was named in 1964, and by 1970, pathogenesis by clinoquinol toxicity was well nailed down. Before then, a few scientists proposed a viral nature, but it was strictly a guess. It was not the huge wrong commited by the entire medical community that you make it out to be. It was a tiny outbreak in a small community without access to current technology and diagnostic techniques. This kind of reads like the creationists’ cries about Piltdown Man. They claim it was a huge fraud which the evolutionists bought en masse, and was decades before it was disproven. In fact, it was only bought by a few people, it was never subjected to rigorous testing and the best techniques available, it was not repeated, and was quickly discredited.
We are not talking about a presumptive hypothesis floated as the cause of a small outbreak in a small medical community. We are talking about a worldwide conspiracy to suppress evidence in a global pandemic that has so far killed millions. Slightly different, I hope you will agree.
Next, gastric ulcers. If you are asking for an answer for when the exact paradigm shift happened in the Marshall case, I think that question is unanswerable. Scientists and doctors are just people – some will keep disproven beliefs long after good science shows them wrong. Not everybody reads the literature in great detail and modifies their medical and scientific practice immediately. There is no organized opinion-making body in science that tells everybody what to believe.
But, I’ll hazard that few people found much reason to “ridicule” Marshall (and I still haven’t seen a cite of this ridicule – one guy calling the theory preposterous doesn’t really count, especially since that guy quickly was convinced of H. pylori) after the Lancet article. Or after that one was confirmed.
Now, to primary data that would uphold your hypothesis. This is a good line of conversation. I will define AIDS as an acquired CD4+ T-lymphocytopenia that leads to opportunistic infections (OIs). The exact nature of the OIs are determined by a whole host of factors.
What we are concerned about is not the OIs, which have variable clinical presentation. We are concerned about AIDS. My side argues that the cause of AIDS is HIV; yours argues that it is sexual promiscuity, drug use, and antiretrovirals.
So, your side needs to explain some things:
- How do sexual promiscuity, drug use, and antiretrovirals cause a specific decline in CD4+ T-cells? Are there molecular mechanisms?
- Can you make a dose/response correlation between CD4+ T-lymphocytopenias and exposure to sexual promiscuity, drug use, and antiretrovirals?
- Are there cases of acquired CD4+ T-lymphocytopenias that occur in HIV- individuals? Are these explained by sexual promiscuity, drug use, and anti-retrovirals?
- How do you explain AIDS cases in patients with no documented exposure to any of your risk factors, namely health care workers and transfusion recipients who have contracted AIDS?
- How does HAART, or highly-active anti-retroviral therapy, a treatment specifically targeted against enzymes only found in HIV reverse a CD4+ T-lymphocytopenia caused by sexual promiscuity, drug use, or anti-retrovirals?
- Do your risk factors explain the clinical course of AIDS better than the HIV theories?
- Do your risk factors explain the laboratory findings of AIDS better than the HIV theories?
- Does abatement of your risk factors lessen or reverse the disease? What is the molecular mechanism of “lifetime accumulation” of these toxins and other baddies? Are there clinical measures available for assaying “lifetime accumulation?”
This is just a small list. The biggest hole I can see in the argument is with #3 and idiopathic CD4+ T-lymphocytopenia (ICTL), which is an incredibly small sliver of people with a markedly different presentation than AIDS. But drug use, promiscuity, and antiretrovirals doesn’t explain ICTL any better than HIV. It is a zebra, and an exception, which is totally not unusual in medicine.
Look at it simply, with relation to gastric ulcers and Marshall. Q1: What was the old theory? A: gastric ulcers are caused by stress, NSAIDs, or unexplained factors leading to too much acid or mucosal erosion). Q2: Does the theory do a good job at explaining ulcers? A: Not really because while we can treat the acid, we don’t know what the root cause of the acid is. Q3: Is there a new hypothesis? A: Marshall proposed H. pylori. Q4: Does it explain it better than the old theory? A: Absolutely – introduction of the bacteria leads to disease, treating the bacteria treats the disease. It explains most cases of ulcers and gives us mechanisms of this unknown mucosal erosion.
So, we know the old theory. We know the new hypothesis. Does your stuff explain stuff better than the old stuff? Does it give us better understanding of the disease? Does it give us new insights into treating the disease? The answer seems to be no on all counts. Unless you can show me literature which suggests differently, I will be steadfastly unconvinved, as would any scientist.