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The “just asking questions” maneuver is familiar to many skeptics. The idea is to feign neutrality, to insulate oneself from accountability or being held to answer for any specific position, but meanwhile to sow doubt about a scientific claim by raising (dubious) questions.

Sometimes the “I’m just asking questions” gambit also tries to disguise itself as sincere journalism. That’s what journalists do, right, ask the tough questions, uncover the uncomfortable truth?

I find this approach particularly deceptive. It tries to hide the fact that the journalist is working off of a particular narrative. Asking questions is, in fact, just another narrative style, one that is meant to lead the reader/viewer to a particular conclusion about the subject. The narrative determines what questions are asked and how they are answered.

A perfect example of this deceptive approach is the HIV denialist movie, House of Numbers . Here is the synopsis from the movie’s website:

What is HIV? What is AIDS? What is being done to cure it? These questions sent Canadian filmmaker Brent Leung on a worldwide journey, from the highest echelons of the medical research establishment to the slums of South Africa, where death and disease are the order of the day. In this up-to-the-minute documentary, he observes that although AIDS has been front-page news for over 29 years, it is barely understood. Despite the great effort, time, and money spent, no cure is in sight.

Hyping ignorance is one denialist strategy. Leung asks questions, pretending to be neutral, but implying that those questions are controversial or unanswered. He characterizes AIDS as “barely understood” and summarizes the current medical situation as “no cure in sight.” The summary continues:

The HIV/AIDS story is being rewritten, and this is the first film to present the uncensored POVs of virtually all the major players — in their own settings, in their own words. It rocks the foundation upon which all conventional wisdom regarding HIV/AIDS is based. If, as South African health advocate Pephsile Maseko remarks, “this is the beginning of a war…a war to reclaim our health,” then House of Numbers could well be the opening salvo in the battle to bring sanity and clarity to an epidemic clearly gone awry.

Clearly, this is a denialist movie. Rocking the foundation of conventional wisdom, bringing clarity, and being uncensored are all standard parts of the denialist rhetoric.

A brief history of HIV

HIV denial was galling in the 1990s, but it is even more so today given the stunning advances in HIV medicine.

On June 5th 1981 the CDC published a report of five cases of a rare pneumonia (PCP pneumonia) in five otherwise-healthy young gay men. In 1982 it was recognized that these and other patients were suffering from an immune deficiency syndrome and opportunistic infections. In 1983 a retrovirus was discovered as the probable cause of this new syndrome (AIDS). The virus was initially called Lymphadenopathy Associated Virus but later renamed Human Immunodeficiency Virus (HIV). In 1985 the first blood test for HIV was approved. In 1987 the FDA approved the first drug for the treatment and prevention of HIV – AZT.

Over the next 20 years scientists developed what is called highly active antiretroviral therapy, or HAART, treatment. This is a cocktail of multiple drugs designed to interfere with HIV at multiple steps in its infection and replication. As these drugs continue to be developed, the life expectancy of those with HIV increases. Just last year, in 2013, data suggests that those with HIV who start HAART treatment early have essentially a normal life expectancy. In 30 years HIV went from a short term death sentence to a chronic illness with an essentially normal life expectancy.

There have been only a few “cures” of HIV, meaning that those with a documented infection are now virus free after treatment. One such cure was effected with a bone marrow transplant, and another with high dose HAART in an infant infected at birth. These approaches will likely not be applicable to most patients with HIV.

Research into an HIV vaccine is ongoing. The best we have done so far is a phase III trial showing 31% efficacy in preventing initial infection. This is a modest result, but shows we are making progress. HIV is particularly challenging for various reasons – it mutates throughout the infection, it evades the immune system, and it can hide in a dormant state.

In short, HIV is one of the stunning success stories of modern medicine. Science rapidly discovered the nature and cause of AIDS, we have had a steady increase in our understanding of this virus, it is now a manageable disease and we continue to make progress toward a vaccine and even possible cure.

HIV denialism

Throughout this 30 year success story, there have been those who have denied that HIV exists and/or is the cause of AIDS. Initially they claimed that the lack of clear benefits from anti-retroviral therapy was evidence that the HIV hypothesis was wrong. If that were true, then the stunning success of HAART should be considered evidence that the HIV hypothesis is correct. In fact, the success of HAART has taken the wind out of the sails of much HIV denialism, and yet it limps on.

In House of Numbers , Leung (who is just asking questions) asks: Is there really a consensus on HIV? Is the test reliable? Why do doctors ask about risk factors? Why doesn’t everyone who is exposed get the disease? Why is the disease so variable?

And, of course, the Big Pharma gambit – isn’t HIV just an invented fiction so that pharmaceutical companies can make money from selling drugs?

Jeanne Bergman over at AIDSTruth.org does a good job of answering these questions. Yes, there is a robust consensus on HIV, based upon mountains of evidence. Yes, the test is reliable. Asking about risk factors is standard practice. Not everyone exposed to an infectious illness catches the disease. The disease is actually very consistent. The opportunistic infections may vary by region, however.

Regarding the Big Pharma gambit – I suspect that someone living a normal life with a normal life expectancy on HAART medication doesn’t think the pharmaceutical industry is ripping them off. If you search for HIV on Pubmed you get 265,637 results. That is a lot of research. In there are clinical trials and systematic reviews of HAART therapy demonstrating clear efficacy. There is no controversy over the appropriateness and effectiveness of HAART therapy in those with HIV.

The response to Bergman’s deconstruction of House of Numbers by the denialists is predictable. They simply double down on the “we’re just asking questions” gambit. On the HoN Website they include this formal response by the HIV denialist Perth group:

The “legitimate scientist” and Nobel laureate Jacques Monod: “In science, self-satisfaction is death. Personal self-satisfaction is the death of the scientist. Collective self-satisfaction is the death of the research. It is restlessness, anxiety, dissatisfaction, agony of mind that nourish science”. Perter Abelard: The first key to wisdom is assiduous and frequent questioning…For by doubting we come to inquiry, and by inquiry we arrive at truth”.

They further state:

Howard Temin, the father of modern retrovirology: “when an experiment is challenged no matter who it is challenged by, it’s your responsibility to check. That is an ironclad rule of science, that when you publish something you are responsible for it…even the most senior professor, if challenged by the lowliest technician or graduate student, is required to treat them seriously and consider their criticisms. It is one of the most fundamental aspects of science” (emphasis in original). HIV scientists do not respond to challenges. In fact, according to the rules at AIDSTruth, “We will not engage in any public or private debate with AIDS denialists or respond to requests from journalists who overtly support AIDS denialist causes”. Apparently these “legitimate scientists” cannot stick to their own rules.

Here we see the true agenda of “just asking questions” laid bare. Denialists are not asking sincere questions with the goal of further exploration and getting closer to the truth. They have an agenda of casting doubt on established science. They will tirelessly ask questions in order to create the false impression of controversy where none exists, all the while pretending to be skeptics who just value doubt as a scientific tool.

The quote above from Temin does not apply. Even the lowliest technician who is asking questions is assumed by Temin to be sincere in their motives. This does not apply to denialists, who abuse questioning, abuse skepticism, and abuse doubt for an a priori agenda of denial.

“Just asking questions” is a win-win for denialists. If you respond, you validate the notion that there is a controversy, a question that needs answering. If you refuse to engage, then you are hiding something and not being a true scientist.

Conclusion

The medical science behind HIV/AIDS is astoundingly robust. Of course there is much more to be discovered, and we need to further develop HIV treatments. An effective vaccine and/or effective cure are greatly needed, especially if we are ever going to eradicate HIV. Eradication is possible, however, as HIV has no significant non-human reservoir.

Denialists, however, confuse consensus with being closed minded. They confuse refusal to engage with cranks with being evasive. They pretend to be just asking questions when in reality they clearly demonstrate that they are not honest brokers. Rather they are merchants of doubt and confusion with an agenda.

I don’t know if Leung came to this question a denialist, or if he is just a journalist who decided to build his career off a “man bites dog” story. A movie confirming the standard scientific view of HIV would not have been as sensational.

We also have to acknowledge the potential harm of HIV denialism. Trying to convince the public that they are not being told the true story of HIV has the potential to convince some people not to trust the system, and therefore not to get tested or take HAART medication. With serious medical issues, “just asking questions” has a body count attached to it.