School of Health Sciences, Hunter College, City University of New York, New York, NY 10010
I remained as unconvinced of Hooper's theory of the origin of the human immunodeficiency viruses (HIV) after reading The River (1) as I had been before, but Dr. Monto dismisses the work too lightly (2
). Monto's review offers only five disdainful paragraphs, dispatching the book with a coup de grace in the sixth: He recommends it "... only for people with plenty of free time who would like to see how nonscientific reasoning can capture so much attention" (2, p. 485). Unfortunately, this breezy review exemplifies a closed-mindedness in the health sciences profession, evidence of exactly what Hooper alleges: We circle the wagons around the ideas and people we prefer and exclude the ones we do not.
Monto is right that The River is overlong and repetitive, but he is wrong to ignore its subplots. The book is indeed primarily a search for confirmation of Hooper's own hypothesis about the origin of HIV, that is, that the virus originated in oral polio vaccine lots contaminated with tissue from chimpanzees. Hooper's authorial legerdemain in the service of promoting his hypothesis is exasperating, and his unwillingness to understand when the evidence is going against him is frustrating, as Monto points out. Still, Hooper's quest to convince readers of the validity of his hypothesis is hardly the book's "sole agenda" (2, p. 484).
One subplot is a time travelogue of research in Africa in the 1950s. If new viruses arise not only through natural accidents but also by inadvertent human manipulation, the HIVs (and possibly other pathogens) might well have emerged through and because of European and American scientific neglect in 1950s Africa. Amid a chaos of unregulated laboratories, clinics, and animal colonies, it is impossible to be sure that no interspecies transfer of viral genetic material ever occurred. Monto responds not at all to the revelations of The River about the sloppiness of researchers, the consequent potential for biologic disaster it produced, or the ethical insouciance involved. Nor does he value Hooper's reports on the concomitant inattention to salient events in the emergence of acquired immunodeficiency syndrome. He notices only the accounts of poor record keeping; he neglects the deeper background about scientists' own misadventures. Hooper's oral polio vaccine hypothesis aside, the larger theory of viral emergence as an unintended consequence of technical innovations in the name of public health (3) is advanced by The River and merits attention.
Monto misses the third thread entirely: a story of self-protection by the science industry at the cost of good science. This is a pertinent issue for epidemiologists of all sorts, not acquired immunodeficiency syndrome researchers alone. Hooper was probably a pest about pursuing his failed hypothesis, but he shared with many scientists a concern about the crucial events of the emergence of HIV. He critiqued existing ideas and gathered quantities of evidence about complex matters pertinent to the origin of HIV. We claim to credit the pursuit of evidence, testing of theories, and critiquing of existing theories. However, we often fail to honor them when they are carried out by outsiders (and we can be downright disparaging if those outsiders also insult our icons, as Hooper did to Hilary Koprowski). Nonmembers of the scientific establishment are not always wrong. A single example suffices: It took a journalist, Jean Heller, to blow the whistle on the US Public Health Service's infamous disgrace, the Tuskegee Syphilis Study (4).
To ignore Hooper's allegations about his own reception at our hands strengthens them. If we demean the attempts of educated laypersons to enlighten us about the possible shortcomings of our standards of evidence and rules of inference, then science deserves the reputation for superciliousness and collusion that it holds in some quarters.
Hooper merits a closer reading than Monto has given him. The River reveals much about what Africa was like around the time that HIV probably arose, and the book could shed light on the role of human hands in the emergence of viruses as well as the events by which a virus went from being an endemic simian infection to an epidemic human pathogen. It reveals even more about how science operates in the name of public health; that should alert us to the slipperiness of ethics in health research and the need for consideration and oversight in what we do.
REFERENCES
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 481092029
One may ask what the function of a book review should be. In my view, it should primarily examine the book itself and how well it communicates its message. The main theory of The River (1) is that the clinical trial of oral polio vaccine is the origin of human immunodeficiency virus in Africa. In this regard, Dr. Alcabes (2
) agrees with me (3
) that the theory is not proven. He also agrees that the book is overlong and difficult to follow. Our basic difference concerns the obligation of the reader. Is it reasonable that various subtexts scattered through the volume will be picked up? Further, when it becomes clear that the author is not an independent investigator, but rather someone who is out to prove a point, how much credibility do these points have? Personally, I think not much, but since Dr. Alcabes has brought up a number of points, I will give my views on some of his comments. First, I do not believe that the scientific community should be immune from scrutiny by the press. However, I feel that we do not have to applaud the kind of personality dissection that goes on in this book, especially when people carrying it out are pursuing their own agendas, which happen to be wrong. In addition, I think it is incorrect to apply the standards of the 21st century to work done in the middle of the 20th. This does not mean that what was done in Africa during that period was right. Neither was research done in vulnerable populations in the developed world. However, this was not the main topic of the book. Such value judgments are unrelated to my conclusion that it might not be worth the time of busy readers to work their way through this diffuse text.
REFERENCES