Christine Maggiore has died at the age of 52, from pneumonia. Why is this significant? Because, following her diagnosis as HIV positive in 1992, she had become an outspoken critic of the scientific consensus that infection with HIV causes AIDS.
She was a highly controversial figure, mainly because she had taken the decisions not to take antiretroviral drugs during her pregnancies, not to give birth by caesarean section, and had breastfeed her two children, even though evidence suggests that all of these actions can increase the risk of transmitting HIV to the child. Things reached a head in 2005, when Maggiore’s three year old daughter, Eliza Jane, died. The autopsy report prepared for the coroner found that:
- Eliza May’s lungs were infected with pneumocystis jiroveci, which causes PCP, a form of pneumonia most commonly found in people with AIDS
- her brain showed changes that were consistent with HIV encephalitis
- components of the HIV virus were found within her brain tissue
- she was underweight and under height for her age (something that is consistent with a chronic illness like PCP, but not with the short-term ear infection Maggiore believed her daughter to have).
As a result of this autopsy report, the coroner concluded that Eliza Jane had died of pneumonia brought on by AIDS. This seemingly irrefutable conclusion was vigorously challenged by Maggiore, and she commissioned an alternative report which concluded that Eliza Jane had died as a result of an allergic reaction to an antibiotic. This report was provided by Mohammed al-Bayati, who specialises in the pathology of animal diseases, but who lacks any medical qualifications (he holds a PhD, not a medical degree). al-Bayati was also a close associate of Maggiore, and a member of the board of her organisation, Alive & Well: AIDS Alternatives. At the time of her death, Maggiore was in the process of suing LA County on the grounds that their autopsy report had shown a lack of proper medical and scientific evidence.
It doesn’t seem that Maggiore was an uncaring (or even entirely irresponsible) parent – Eliza May was taken to see several doctors before her death, not all of whom were HIV sceptics, and Maggiore seems to have followed the advice she received for the treatment of her daughter’s illness. Despite this, it still seems very likely to me that Maggiore bears partial responsibility for the death of her own daughter. With the death of Maggiore herself, this means that her scepticism has now directly contributed to two deaths that were both very likely to have been avoidable.
I do have some sympathy for Maggiore’s position. Back when she was first diagnosed, the only treatments available for HIV were drugs which had significant side-effects, and initially seemed to provide only limited benefits. The decision not to take antiretrovirals during pregnancy is also one I can understand, to some extent. There is as yet no evidence to show if there are long-term risks to the health of the child, although it has to be said that most HIV positive women conclude that the definite risk of HIV transmission is more significant than the potential risks of unknown drug-related complications. What is unquestionably a tragedy, though, is that Maggiore did not update her thinking in the light of the new treatments and ever-increasing evidence that have been consistently emerging. It’s more of a tragedy that, even after the death of a friend they believed would not die, Maggiore’s associates have vowed to continue her misguided fight.
It seems to me that there are a number of questions that HIV sceptics have to answer before they can expect to be taken seriously. The first and most obvious of these is why Christine Maggiore died in the way she did. Affluent, healthy women in their early 50s don’t usually die of pneumonia. The explanations put forward by her associates – that she was made ill by an alternative ‘cleansing’ treatment, or that she had flu, or that she was affected by the cold weather – are, on their own, inadequate. It’s very likely that a ‘cleansing’ treatment, especially if it involved fasting or purging, will have left her physically weakened. It’s also very possible that a respiratory virus like flu was the immediate cause of her pneumonia, and cold weather may well have exacerbated her symptoms. But there is still no getting away from the fact that a normal, healthy woman of Maggiore’s age would be expected to recover from pneumonia, and would certainly be expected to recover from flu. One very plausible explanation for why she did not is that the functioning of her immune system was compromised, in exactly the way that would be expected in someone suffering from AIDS. Since Maggiore’s associates have dismissed this explanation, it’s up to them to supply an adequate alternative one.
Another question that the sceptics need to answer is why, in the absence of effective treatment, those who are diagnosed with HIV will go on to develop AIDS, but those who test HIV negative will not. A number of alternative causes for AIDS have been put forward over the years, but no-one has yet been able to adequately explain why these alternative causes affect only those who are HIV positive, and not those who are HIV negative. This is, as it happens, another area where it would seem that the sceptics have not kept pace with medical developments.
Early tests for HIV were unreliable, and ‘false positives’ and ‘false negatives’ were both very common. This meant that, initially, there was some genuine confusion as to whether or not all those dying of AIDS really did have HIV, and so it was perfectly reasonable to search for potential alternative causes of AIDS. However, with the development of newer and more reliable (though still not infallible) tests, and especially with the practice of ‘longitudinal testing’, in which people are repeatedly tested for the presence of HIV antibodies in their blood, it’s now possible to say with almost complete certainty that everyone exhibiting symptoms of AIDS will also show evidence of HIV infection, and that all cases of untreated HIV infection will, after a variable period of time, lead to the development of AIDS. Those who reject the idea that HIV causes AIDS need to supply an alternative explanation that adequately accounts for this remarkable correlation.
The sceptics also need to explain why, if HIV does not cause AIDS, antiretroviral treatments aimed at inhibiting HIV have led to such a dramatic fall in the numbers of people dying of AIDS. If the ‘real’ causes of AIDS were being ignored by the medical establishment, as the sceptics allege, one would expect to see the number of deaths from AIDS to be unaffected by efforts to treat HIV. Of course, one possibility is that antiretrovirals have some other, unrelated, benefit which has not been investigated by medical researchers. If this is the case, it is unclear why Maggiore refused to take antiretrovirals herself, and campaigned against their use. Alternatively, if HIV sceptics believe that the substantial reduction in deaths is utterly unrelated to the availability of antiretrovirals, then they need to provide a plausible alternative reason for the reduction, and also explain why the reduction suddenly kicked-in at exactly the same time as antiretrovirals were made available.
There are lots of other questions that could be asked of the sceptics – for example, why, if an infectious agent like HIV is not responsible for AIDS, did AIDS begin in discrete groups of people, then gradually diffuse into the wider population? – but those will do to be going on with, I think.
I would normally get angry at obvious denialism like Maggiore’s, but I find that very hard to do in this case. Maggiore was clearly absolutely sincere in her beliefs – she was prepared to die rather than take the drugs that would have, most likely, saved her life – and she has paid the highest possible price for staying true to them. This is a state of affairs that makes me sad rather than angry (although my sympathy for Maggiore stops well short of condoning her irresponsible behaviour towards her children).
There is at least something approaching a happy ending to this story. It’s been reported that Maggiore’s husband (with whom she apparently had regular unprotected sex) and her surviving child are, thankfully, both HIV negative. If this is true, then I’m prepared to make a prediction that, unlike their wife/mother and daughter/sister, they will not go on to die decades before they should of diseases that frequently kill AIDS patients. I can only hope that Maggiore’s associates will eventually come to recognise this as very personal evidence for the obvious link between HIV and AIDS.