The end of the year is a time for looking back and remembering important and interesting science news of the year. There are often a few lessons one can learn from doing this. The first is always how crappy my memory is. It is amazing how much I forgot about. It’s also interesting to see if there are any trends evident – are we at the beginning of any new breakthroughs in science? In ten years is there anything we will look back on in 2013 and see as the beginning of something big?
For me one big lesson of 2013 was a news item that perhaps did not get as much attention as it deserved. The latest statistics on life expectancy of those with HIV infection jumped significantly over the last 10 years. In fact, for some populations – non-IV drug abusers who started treatment before their CD4 counts dropped below 350 – a 20 year old with HIV can expect to live into their late 70s and beyond.
Essentially, if treatment is started early enough, those living with HIV can have a normal life expectancy. In the last 30 years HIV was reduced from a rapidly fatal disease to a manageable chronic illness.
Although the virus had been simmering for a few decades, it came to recognition in 1980 when San Francisco resident Ken Horne presented with a rare cancer, Kaposi’s sarcoma, and an unusual infection, Cryptococcus. The unusual case was presented to the CDC, and the HIV epidemic began.
In 1983 the virus was isolated. By 1985 we had an antibody screening test for HIV. In 1987 AZT became available as the first anti-retroviral treatment for HIV. In 1992 combination drug therapy became available. Such anti-HIV “cocktails” are now known as HAART – highly active anti-retroviral therapy. Life expectancy for those with HIV skyrockets, peaking this year at essentially normal life expectancy. In 2007 the first case of a possible cure is reported, and this year, in 2013, a toddler is reported “functionally cured” of HIV.
In 33 years we went from having no idea what was going on with a scary new illness, to normal life expectancy. There are still challenges with HIV we have not conquered. Making a vaccine has been challenging, mainly because the virus mutates and hides from vaccine-induced antibodies. We also cannot routinely cure those with HIV of their infection. They need to take lifelong drugs to stave off the effects of the infection.
This news has not received the attention it deserves, I suspect, because we tend to take such progress for granted. This progress should not be taken for granted, however. This success was hard won – due to the diligent work of many scientists. Those scientists were not engaging in magical thinking, practicing “holistically,” falling for the naturalistic fallacy, wasting time with magic potions like homeopathy, or trying to manipulate the energy fields of HIV patients.
They were engaged in good-old-fashioned reductionist science. They searched for and found the materialist cause of the disease, a virus. They explored how the virus works, how it causes disease, and tried to understand its life-cycle. They then developed (or repurposed) drugs to interfere with that life-cycle. They relied upon principles of biology, physiology, immunology, virology, and pharmacology, building on past scientific knowledge.
How much success has the world of so-called “alternative” medicine had against HIV in the last 30 years? Zippo. This is not for lack of trying or even funding. The NCCAM is now funding such research with billions of dollars. The problem with the alternative medicine approach is that it is mostly not based on reality. It is a failed paradigm based on wishful thinking and muddied logic.
Today if you have HIV and you get treated with homeopathy, acupuncture, or anything alternative, that is a death sentence. If you get treated with science-based medicine, you will live a normal life span.
One reason for the failure of such systems is that they are doing it wrong. When they try to study their treatments we tend to see one of two things – a well-designed and executed trial that is negative, or a fatally flawed study that is reported as positive. A 2008 review of Indian and homeopathic treatment for HIV found universally poor quality:
“Common reasons for poor quality included small sample sizes, high drop-out rates, design flaws such as selection of inappropriate or weak outcome measures, flaws in statistical analysis, and reporting flaws such as lack of details on products and their standardization, poor or no description of randomization, and incomplete reporting of study results.”
The utter lack of evidence or rationale for the use of homeopathy in HIV and AIDS has not stopped homeopaths from recommending, and even promoting, homeopathic potions for HIV, especially in Africa.
It is important to frequently remind the public of recent history, otherwise the spin-doctors will have free reign to rewrite that history for their propaganda and marketing purposes. Science is not perfect, and the practice of medicine is horrifically complex and also imperfect, but science-based medicine is the best thing we have. Science, when done properly, is an amazingly powerful tool, and it has proven itself over and over again.
Science works. It has added decades to the life expectancy of HIV patients.
Fantasy, magic, bad science, sloppy thinking, and ancient superstitions do not work, and have not added a nanosecond to the life expectancy of those with HIV, or anyone else.
Steven Novella, M.D. is the JREF's Senior Fellow and Director of the JREF’s Science-Based Medicine project.