Childish jibes are no substitute for serious debate

Whether it is wielded against sensible people who criticise the political exploitation of AIDS or less-than-sensible people who claim that vaccines cause autism, the accusation of ‘denialism’ is shrill, intolerant and censorious.

Dr Michael Fitzpatrick

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The use of the concept of ‘denialism’ as a cudgel with which to beat anybody who questions the Holocaust or global warming has become familiar (1). It is used by people like social psychologist Seth Kalichman, author of Denying AIDS: Conspiracy Theories, Pseudoscience and Human Tragedy, who seem incapable of winning a rational argument.

Kalichman provides a comprehensive illustration of the deployment of the concept in relation to controversies around AIDS. His onslaught is not restricted to those, such as virologist Peter Duesberg, who dispute that HIV causes AIDS, but extends even to leading UK cancer specialist Karol Sikora, who does not ‘deny’ the role of HIV, but merely – in an article in the Daily Mail in 2007 – criticised public health authorities for exaggerating the risks of AIDS and for promoting an ‘overblown panic, based more on politics than science’. Similar criticisms of scaremongering have been made by former AIDS bureaucracy insiders Elizabeth Pisani and James Chin, but Kalichman does not take the insiders on (2).

In his epilogue, Kalichman indicates the widening scope of what he terms ‘medical denialism’ to embrace ‘autism denialism and vaccine hysteria’. He observes that ‘it is fair to say that Andrew Wakefield is to autism as Peter Duesberg is to AIDS’, meaning that to suggest that vaccines cause autism is the moral equivalent of disputing that HIV causes AIDS. Given that I have criticised the AIDS bureaucracy along similar lines to Sikora (though some 20 years earlier) and have in more recent years also been critical of the Wakefield campaign claiming a link between the MMR vaccine and autism, I seem to find myself in agreement with Kalichman about Wakefield (at least to the extent that I think Wakefield’s theories are wrong) but in disagreement with him about the extent to which public authorities exaggerated the risks of AIDS in the West (at least to the extent that I think Sikora, and Pisani and Chin, had a point) (3,4).

It is instructive to examine both the AIDS and the autism controversies, because the similarities and differences between these issues can tell us a great deal. At the outset, however, we should note that the intellectually and morally disreputable concept of ‘denialism’ has no place in this or any other civilised debate.

The AIDS and autism controversies have this in common: both Duesberg and Wakefield were reputable scientists whose persistence with theories they were unable to substantiate took them beyond the limits of serious science into the realms of pseudoscience. Though he has no record of research on HIV/AIDS, Duesberg was a world-renowned authority on the role of retroviruses in cancer when, in the course of the 1980s, he challenged the emerging theory that AIDS was caused by HIV. However, while other scientists successfully demonstrated the role of HIV in AIDS, Duesberg failed either to validate his critique or to substantiate his alternative theories. Wakefield was a more junior researcher in a struggling academic unit when, in 1998, he postulated a link between the MMR vaccine and autism, mediated by inflammatory bowel disease. In the subsequent decade he has not produced convincing evidence for any aspect of his speculative hypothesis. They have this in common, too: though they failed to persuade their scientific peers of the validity of their theories, Duesberg and Wakefield, both capable and charismatic figures, readily attracted supporters from outside the world of science.

There are striking similarities in the campaigns in which Duesberg and Wakefield respectively have become the most prominent personalities (indeed some individuals are active in both). Supporters include disaffected scientists (usually without relevant expertise), credulous journalists (usually lacking scientific training), charlatans and quacks (often peddling herbs and vitamins and other miracle cures), cranks and conspiracy theorists (provided by the internet with a global platform), and opportunist politicians.

Furthermore, Kalichman’s appraisal of the rhetorical style of the pro-Duesberg campaigners could equally apply to the anti-vaccine activists. They are skilled at ‘morphing science into pseudoscience’, using ‘jargon, buzzwords and highly esoteric language to give an impression of plausibility’; they present a ‘façade of science’ which ‘appears credible even if it is utterly unintelligible’. They make bold statements lacking evidence, preferring anecdote and speculation; they ‘cherry-pick’ favourable data and studies while ignoring contradictory evidence. Their style is suspicious, even paranoid, and while they are uncritically loyal to their leaders, they are savagely hostile to their opponents.

One significant difference between the Duesberg and the Wakefield campaigns lies in the extent of their media support. With the important exception of the case of South Africa, where local political factors gave the ‘HIV denial’ cause a particular influence under the premiership of Thabo Mbeki, the Duesberg campaign has remained marginal. It has signally failed to win mainstream influence in the US or Western Europe. By contrast, in its heyday in the early 2000s, the Wakefield campaign in Britain attracted significant media sympathy, including a special edition of Private Eye and a docudrama on Channel 5. It won endorsements from a host of celebrity columnists, including the Daily Mail’s Melanie Phillips. In the US, the wider vaccine-autism cause has more recently enjoyed a major upsurge in publicity, fronted by actress Jenny McCarthy (who has a son with autism) and her filmstar partner Jim Carrey, who have appeared on high-impact TV chat shows hosted by Oprah Winfrey and Larry King. Whereas Duesberg is more likely to be depicted in the media as a sinister figure, Wakefield is presented as the heroic champion of autistic children and as a pioneering researcher victimised by the medical establishment.

Some opponents of Duesberg and Wakefield justify demands for the suppression of their views on the grounds that these are damaging to public health. For Kalichman, ‘AIDS denialism is a genuine menace to global public health’ because it may discourage people from taking ‘safe sex’ precautions and deter some with HIV from taking anti-retroviral medications. This goes way beyond the specific case of South Africa, as is confirmed when Kalichman attacks Sikora. He hints darkly that, though some ‘denialists’ are ‘not evil’, others ‘cross the line between what could arguably be protected free speech’.

In his survey of epidemic scaremongering, Philip Alcabes perceptively notes that the great debate about ‘safe sex’ in the West in the late 1980s and early 1990s was ‘a shell game’, a fraud (5). Despite all the heated controversy about condoms and abstinence, ‘there was no important public health question at stake’. Given the very low prevalence of HIV infection in the US and Western Europe and its slow rate of spread, ‘the exact mode by which prevention of sexual spread was implemented would have made little difference to the overall level of infection in the population’. It seems unlikely that anybody’s sexual behaviour would be influenced by an esoteric scientific controversy and the cost of anti-retrovirals remains a vastly greater obstacle to their consumption than Duesberg’s theories. But to the extent that these theories have public influence, this is an argument for open debate rather than for censorship.

In both Britain and the US, Wakefield has been blamed for recent outbreaks of measles associated with declining levels of uptake of the MMR vaccine. But though the anti-vaccine campaign has damaged public confidence in MMR, uptake was already stagnating before 1998 and recent measles cases have occurred predominantly in communities with historically low uptake of vaccines where the Wakefield campaign has little influence. It is true that the Wakefield campaign has had a baleful impact on families affected by autism, drawing them into futile litigation and encouraging promoters of quack treatments for alleged ‘vaccine damage’. But an open and tolerant dialogue about vaccination and autism is more likely to improve vaccine uptake and protect children with autism than pursuing a witch-hunt against Wakefield.

The main difference between the HIV/AIDS and vaccine/autism controversies lies in the responses of the public health authorities. In the case of HIV/AIDS, the authorities were right to defend the scientific case for HIV causation, but wrong to allow science to be subordinated to moralising and scaremongering propaganda. In the case of autism, the authorities were right to reject unsubstantiated claims for a causative role for MMR, and right again to insist on the benefits of childhood immunisation (and in particular in their refusal to compromise in response to demands to provide separate measles, mumps and rubella vaccinations). The irrationality of the official AIDS policy tended to encourage the sort of irrational responses and conspiracy theories that flourished in the prevailing climate of fear. By contrast, the generally sensible, if sometimes cautious, responses of the child health authorities to the Wakefield campaign helped to contain the damage it caused.

In both cases, however, scientists (within and beyond public health authorities) were dilatory in responding to the challenges posed by Duesberg and Wakefield, often appearing to hope that if they were ignored they would quietly disappear. Though Kalichman insists that ‘denialism is defeated when credible science is effectively communicated to a trusting and critical minded public’, he is oblivious to the fact that it took some five years before mainstream AIDS scientists produced a comprehensive rebuttal of Duesberg. He continues to justify their evasion of debate on the feeble grounds that this would only legitimise the ‘deniers’ and that scientists’ time would be better spent on research. Though child health authorities were alert to the threat of the anti-MMR campaign, experts in virology and gastroenterology and autism were slow to respond to the Wakefield challenge, allowing it to gather momentum. Scientists also underestimated the importance of challenging junk science in the public realm as well as in exclusive scientific circles.

This is the key point. We always need more debate not less. The suppression of free speech is not only not the answer, it is the problem. Kalichman’s concept of ‘denialism’ as ‘essentially a psychological and social problem’ is not just pseudo-scientific name-calling. It also reflects the inclination of some public health authorities to evade scientific debate by clamping down on their critics. Supporters of both Duesberg and Wakefield claim that they have been unfairly deprived of research grants, denied academic appointments and generally persecuted by the scientific establishment. No doubt they have been harshly treated, and there is an element of vindictiveness in the way in which Wakefield and his former colleagues have been treated in the current General Medical Council inquiry (6).

A key feature of the vulgar polemic deployed by both sides in the AIDS controversies is the exchange of allegations of fascism and genocide. Kalichman may not be able to spell ad hominem (see his preface, p.xv), but he certainly indulges in shameful personal invective against Duesberg. To clinch his case against the ‘denialists’, Kalichman notes that Duesberg is of German origin, and indeed that ‘his father served in the German army during World War Two’ (like every other German citizen eligible for conscription). Furthermore he discloses that Duesberg ‘spends his summers in Germany’ and that some of his campaign supporters are also German. Kalichman warns that Duesberg ‘may evoke a sort of nationalist sentimental loyalty among some fellow countrymen’. There have been some ill-tempered exchanges between opponents and supporters of Dr Wakefield, but they have so far stopped short of this sort of contemptible abuse.

‘It is all about trust’, observes Kalichman in his concluding chapter. Who could ever trust Kalichman when he argues like this? The cause of public confidence in science is ill served by the dogmatic and intolerant banner of ‘denialism’. Surely we are capable of defeating people like Duesberg and Wakefield in proper argument without descending into the gutter. The pity is that we have been seeing this deplorable trend not only over AIDS and autism, but also in relation to other controversies such as those concerning theories of evolution and passive smoking. Enough is enough.

Dr Michael Fitzpatrick is the author of Defeating Autism: A Damaging Delusion, published by Routledge (buy this book from Amazon(UK) and The Tyranny of Health: Doctors and the Regulation of Lifestyle (buy this book from Amazon(UK)).

Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy, by Seth Kalichman, is published by Springer. (Buy this book from Amazon(UK).)

(1) Denial: a secular inquisition that discourages free thinking, by Frank Furedi, 31 January 2007

(2) AIDS epidemic? It was a ‘glorious myth’, by Michael Fitzpatrick, spiked review of books, August 2008

(3) The Truth About The AIDS Panic, by Michael Fitzpatrick and Don Milligan, Junius, 1987

(4) MMR and Autism: What Parents Need To Know, by Michael Fitzpatrick, Routledge, 2004

(5) Dread: how fear and fantasy have fuelled epidemics from the Black Death to avian flu, by Philip Alcabes, Public Affairs, 2009

(6) Stop witch-hunting Wakefield, by Michael Fitzpatrick

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