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Parturient montes, nascetur ridiculus mus

Blog entry posted by anciendaze, Dec 12, 2011.

When we consider medical triumphs of virology, we have to mention smallpox, rabies, yellow fever and poliomyelitis. Vaccination for smallpox was discovered in the 18th century, and refined and improved throughout the 19th and 20th centuries. In 1979 the World Health Organization declared that a massive global vaccination program had made smallpox extinct in the wild. This still appears to be true.

Pasteur developed a vaccine for rabies at a time when no one knew what a virus might be. The name was simply a Latin term for a poison. His associate, Chamberland, created a filter to remove all bacteria, allowing a distinction between filterable and non-filterable viruses. Most causing human diseases are not filterable, and could only be imaged when electron microscopes became available. (Even research in quantum mechanics has played a role in medicine.)

Yellow fever was another triumph from the prehistory of virology. It was controlled, though not eliminated, by controlling the mosquito vector which spread it, and quarantining those infected behind screens and/or mosquito nets. The medical story behind this merits the adjective "heroic".

Polio is the prime example of the medical and technological triumph in virology which took place in the 1950s. It is possible existing vaccination programs may yet eliminate the disease.

All the above came about before the current generation of virologists took over. Most data concerning viruses has been collected since that time.

When it comes to retroviruses, there is much less success to report. Denmark has eliminated bovine leukemia virus from its herds by testing for this, and ruthlessly culling animals which test positive, an approach less suitable for human beings. Other nations have had little success.

The discovery of HTLV-1 in humans did not stop its spread. The distribution of that virus is now global.

The discovery of HIV-1 remains a controversial issue. Virologists and epidemiologists were not in the forefront. The disease was reported by dermatologists, oncologists and other clinicians long before anyone in research was willing to admit a retrovirus might be causing it. After the fact, enormous resources have been poured into virology to deal with the pandemic. What are the results after 30 years? (Surely, this is not too soon for a preliminary tally.)

Those who test positive for the virus can be maintained on antiretroviral drugs (ARV) indefinitely. This is costly, carries risks, and does not entirely prevent transmission of the infection. By and large these drugs were found by trial and error. Existing pharmaceuticals with unexpected antiretroviral properties are still turning up.

Vaccines have been developed, but only reduce the chance of infection by about 30%. Plug that number into mathematical models of epidemics and you will find it does not justify widespread immunization programs. A false sense of immunity might even jeopardize compliance with other preventive measures.

Prophylactic use of ARVs has had mixed results, with some reporting great reductions in rates of infection, and others finding too little evidence of effectiveness even to justify wider trials. (This is not ancient history. I'm referring to recent news about Tenofovir.)

Prevention primarily depends on use of condoms, which were obvious measures widely available before researchers became deeply involved.

Two patients, out of millions, now appear to have been cured by hemopoietic stem cell transplants, one done because of cancer. The first such successful treatment of leukemia/lymphoma took place in 1968, before any retrovirus had been explicitly identified. The procedure was developed by oncologists and transplant surgeons. It amounts to giving the patient a new immune system from someone else, and could have been suggested as soon as the nature of AIDS became known. Resurrecting this option at the present time is a tacit admission of failure.

Falling mortality rates from AIDS are a welcome sign, though the human cost remains horrific. We are now down 21% from peak global mortality. While many are willing to take credit for this, there is a null hypothesis seldom mentioned: in many places it looks like the epidemic simply burned itself out. Those infected died, which stopped them from transmitting the infection. Even with no effective medical intervention, the Black Death eventually ended this way. There are groups and places in which the mortality rate for AIDS approached historical rates for bubonic plague.

(A rodent-centered approach to that plague would make sense. Do retrovirologists remember this example of a rodent/insect vector contaminating humans?)

Considering the mountains of paper which have resulted from the study of the problem, (fusillades of paper appear to be the primary weapons in this war,} and the money, time and effort which has gone into that research, I would have to describe the research results seen by patients as "a mountain of crumbs" (to borrow a phrase used by Elena Gorokhova in a very different context).

Whatever virologists have been doing for the last 30 years just might not be the best way to improve public health. Expert qualifications need to be judged according to "a fructibus eorum cognoscetis eos". ("By their fruits you shall know them", which is not exactly a radical new idea, hence the Latin. My keyboard won't accept the koine Greek original.)
anciendaze

About the Author

As the name suggests, I am old and dazed. The avatar illustrates my rule of thumb: "Hang on! This ride isn't over."
  1. Enid
    But you know what was wrong surely anciendaze - ME/CFS presents (in the absence of refined testing) fatigue to the observer - open to the non science of psychiatry who could turn their blind eyes to the multi-system symptoms because the general medical profession turned in their ignorance away from sufferers. Real data has been coming in for years now. My own feeling about all this is the mis-education of the ordinary general practioner lead to believe themselves all knowing and therefore beyond question. They don't make good Docs in a time of rapid scientific discoveries in medicine. Think the attitudes (can you believe it) of the Middle Ages. On the way now though.
  2. anciendaze
    The paradox I'm pointing to is that we now have mountains of data and tools of which pioneers could scarcely dream, and we have more people to tell us why nothing can be done without far more money than is presently available.

    What's wrong with this picture?
  3. Enid
    Much done in all areas of medicine but by no means there yet in understanding everything - science they say builds on the shoulders of giants - so many "defining" things in order to move forward in all areas - got the Higgs boson particle now and closer to home viruses, bodily systems and interactions seem well on the way.