The AIDS Pandemic: The collision of epidemiology with political correctness, by James Chin, MD, MPH. Clinical Professor of Epidemiology at the School of Public Health, University of California at Berkeley. Foreword by Jeffrey Koplan. MD, MPH. 2007. Radcliffe Publishing, Oxford and Seattle pp 230 £27,50
ISBN-10 1 84619 1181, IBSN-13 978 84619 118 3.
Gordon Stewart was invited to write this review, and submitted it to the Royal Statistical Society, of which he is a fellow, in June, 2007. The society has so far neither published it, rejected it, nor explained this unusual delay.
Reviewed by Gordon T. Stewart, MD, FFPH, FRSS. Emeritus Professor of Public Health, University of Glasgow, UK, former consultant in epidemiology, UK National Health Service, New York City, WHO, etc.
James Chin is deservedly described in the Foreword of his book as a pillar of the international public health establishment by Jeffrey Koplan (Atlanta, Ga), of whom the same can be said. The book reflects their companionship as well as their expertise. It is replete with experience, data and reasoning, seasoned by enthusiasm which makes it entertaining as well as required reading in what is regarded as the Great Plague of our time, responsible currently for 10 million deaths according to UN AIDS. But it is not easy to review because, although no paragraph can be ignored, there are many repetitions and contradictions which prevent it attaining cumulative authority in resolving some of the basic problems in the arguable compendium of 27 or more diseases registrable cumulatively and irreversiblysince 1985 as HIV/AIDS, with or without the surrogate tests which suffice for official validation.. There are also some surprising omissions, for instance with regard to the specificity of diagnostic tests, the questionable plurality of clinical features and the isolation of HIV itself. These also detract from the book’s authority but unintentionally leave space for informative correction.
Chapter One is an introduction and overview of ten following chapters in which, with summaries and a glossary, Chin links epidemiological analyses of facts to opinion and conclusions in a logical sequence. He begins, in Chapter 2, by describing his happy emergence in 1961 from medical school into a career in public health in California via a series of brief appointments in academic and field training programmes provided by the expanding epidemiological intelligence service of the Centres for Disease Control of the USA. He became quickly mature overseas where he gained practical experience in surveillance and control of leprosy and cholera in Malaysia before returning to California eventually as State Epidemiologist in the 1970s. He was therefore a key witness of the emergence of AIDS there as a devastating new disease of homosexual men in 1980, and was appointed by the WHO as one of the first consultants to the new unit headed in HQ Geneva by Jonathan Mann, who had detected similar cases in Zaire and was the first to recognise the danger of spread in the sub-Sahara. With support from Halfdan Mahler, the DG of WHO, this was start of the global programme on AIDS (GPA) which then had to find a successor to Mann after his sad death in an air crash. Chin was selected to fill the gap.
This leads him logically in the book to discuss the probable – I would say possible – origin of HIV and to its rapid spread to 7000 males (32/million) in similar communities and in needle-sharing drug users (IVDU) in coastal cities in the USA by 1984 (1) when there were only 247 (4.3/million) in UK and 762 (~ 2/million) in all of Europe – a tenfold difference in period prevalence which is persisting in 2007 with over a million registrations in the USA. Chin refutes beliefs that AIDS is mainly an American disease by concentrating instead and at length on evidence of Explosive spread in developing countries, especially in sub-Saharan Africa.
Chin’s experience thereafter relates mainly to field studies of the description, incidence and distribution of AIDS internationally, with emphasis and insider detail of events in countries of high prevalence, mainly in SSA, SE Asia and the Phillipines where his analysis of differences in transmission rates between males and females, including prostitutes, is an important lesson (pp 81-83) in field epidemiology. He is critical of academic, desk-top “Modellers” and activists who use, persuade or coerce health authorities to acknowledge high estimates, because of lack of basic experience, or local insight, or “To facilitate receipts of donor support” for their AIDS programs (p 137). In this respect, Chin was born in China, trained in medical science in USA and has worked in there, in Europe, Africa and SE Asia. His immense personal experience and diligence, extending into retirement, is obvious and should not be ignored by the persons with less or no field experience but more authority, influence and above all FUNDS who are now running the show for better or worse. Until now, Chin has been diplomatic in such situations where political correctness is mandatory but now he writes frankly about the “Myths, misconceptions and credibility “ of official estimates which have led to “Titanic” projections of HIV/AIDS in Asiatic and some other communities where empirical control by ABCD (Abstinence, Be faithful, Condoms and Dignity) has often been equally or more effective. Chin does not recognise this. Despite his criticisms, he accepts the HIV hypothesis of causation of AIDS without reservation, despises all dissidents as flat earthers and dismisses them collectively as disciples of Duesberg. In so doing, he conforms to the politically correct climate of the prevailing consensus that submerges independent evidence and blocks opportunities to resolve differences by convergence of the natural and biomedical approaches which have manifestly controlled HIV/AID in all developed and many developing countries, even in Africa. The book is light in references to alternative viewpoints but full of competitive data for statisticians, anomalies for sceptics and openings for wannabees, so there is something in it for the entire motley in the circus of HIV/AIDS to get on with as a stimulating and perhaps the best practical manual for identifying and filling gaps in the epidemiology, aetiology and management of AIDS along with its profoundly unhealthy accompaniment of related disorders including traditional and new STD’s, tuberculosis, malaria, dysenteries and and enteritis which are equally in need of attention and insight, especially in unaware and deprived locations. Chin’s book will provoke objections but it is sincerely committed to this need. It is remarkable that, to date, none of the major journals which never miss a trick in the minutiae of HIV/AIDS, have accorded it individual attention.
(1) Source: US CDC, Atlanta Ga; International Collaborating Centre, Paris, 1984.