AIDS and Syphilis: The Hidden Link. 
Harris L. Coulter. 
Berkeley, California: North Atlantic Books. 
Wehawken Book Company, Washington, DC, $8.95. 
Distributed in the UK by Francis Trueherz, 
81 Platine Road, Withington, Manchester M20 9LJ. 
ISBN 1-55643-0231-3. 
Pp. 126. 

The acquired immune deficiency syndrome (AIDS) was first recognized in 1981 in homosexuals in San Francisco. Within two years of the start of research to find the cause of the disease, a virus, later designated the human immunodeficiency virus (HIV), was isolated almost simultaneously in a number of centres throughout the world and was generally recognized to be the cause of AIDS. Intensive research has continued to find methods of treating AIDS and of producing a vaccine against HIV.

A small minority of scientists, however, remain unconvinced that HIV is really the cause of AIDS. Among these is Professor Peter Duesberg, the highly respected Professor of Microbiology at the University of California, Berkeley. With backing like this, the case against HIV certainly cannot be dismissed as medical flat-earthism.

Critics of the HIV hypothesis point to a number of facts which, they claim, are difficult for its supporters to explain. For example, some patients with clinical AIDS lack anti-HIV antibodies; only about 80 per cent are positive. The actual virus can be isolated from only about 50 per cent of these, using highly sophisicated techniques, and in only 10 per cent is it actively replicating.

Furthermore, a number of people who are HIV-antibody-positive have not developed the clinical syndrome of AIDS, at lest up to now. Moreover, HIV is a retrovirus, and there are technical reasons for thinking that this makes it less likely to be capable of causing AIDS.

AIDS is still, in Europe and North America, mainly a disease of homosexuals and intravenous drug users, and these patients also have a high incidence of syphilis. There is, not surprisingly, difficulty in separating the two diseases clinically, and a recent editorial in The New England Journal of Medicine drew attention to the fact that in patients with AIDS and syphilis the usual serological tests for syphilis may give misleading results.

Coulter's book is in part a survey of these facts and theories about AIDS and HIV. In addition, it contains two lengthy interviews with doctors who believe, as does Coulter, that AIDS and syphilis are not merely difficult to separate clinically but are actually causally connected. They believe, in fact, that AIDS is a modified form of syphilis and that HIV is at most a mere 'co-factor' and is possibly an innocuous 'passenger'.

The more interesting of these interviews is with Dr Stephen Caiazza, who if nothing else has the courage of his convictions. Having worked with AIDS patients for some time, he began to feel ill and found that he was HIV-positive. He then inoculated himself with syphilis, and later was able to confirm that, although he had developed clinical syphilis, he remained seronegative for the disease. He later treated himself for both diseases with penicillin, apparently successfully; at any rate, he has recently appeared on television in this country looking quite healthy.

A startling footnote to this story is that, while on a visit to Germany, Caiazza survived two apparent attempts on his life, made, we are given to understand, at the behest of people who stood to make a large profit from the sale of drugs to treat HIV infection.

Logically enough, Caiazza and a few other doctors in America who favour the syphilis theory have tried using long-term high-dose penicillin therapy; so far this has been in progress for only six months but the results are said to be promising.

It would be pleasant to believe that the syphilis theory is true, since it would mean that AIDS was relatively amenable to treatment, but there are difficulties in accepting it. If it is right there must be a large pool of subclinical untreated or inadequately treated syphilis. This may perhaps be true in America, where, we are told, 80 per cent of syphilis is treated by private physicians, who notify only 10-25 percent of cases to the health authorities; but very few cases of syphilis are treated by general practitioners in Britain. However, the theory does at least yield a testable prediction: if Caiazza is right, his patients will recover, and then there is no doubt we shall all hear about it.

Another prediction, made by Coulter, is that the death rate from AIDS among people infected with HIV accidentally (for example, by needle-stick injury) will be much less than many epidemiologists believe, and certainly much less than the 100 per cent estimated by the most pessimistic authorities. Again, time will tell.

For the moment, the question of the role that HIV plays in AIDS-cause, co-factor, or merely harmless commensal-is, I think, still undetermined. Clearly it is a very important issue politically and sociologically as well as scientifically, and there is still sufficient doubt about the orthodox view to give one a sense of disquiet.

Coulter's book provides quite a useful review of the critics' case. Neverthless, I found it difficult to know for whom this book is intended. Coulter is well known as a writer on homoeopathy, but surprisingly there is only one glancing reference to homoeopathy. Readers familiar with the homoeopathic literature will inevitably think of Hahnemann's miasm theory, but this is not mentioned at all. Probably most readers will be non-medical, and it may therefore be reasonable to explain medical and pathological concepts in a popularized form for the general reader; but is it really necessary to pursue the colloquial to the extent of describing AIDS patients' immune systems as being 'in a shambles'? And certainly it is misleading to say that the bone marrow 'produces bits of protein called lymphocytes'.

A more serious problem, for me at any rate, was that I felt I was being bludgeoned into accepting a particular view by Coulter's excessively one-sided approach. The chief villain of the piece is identified uncompromisingly: 'Modern "scientific" medical practice relies very largely on medicines whose ultimate effect is to impair the patient's immune system.' Prominent among the indicted medicines are antibiotics, including penicillin; but of course, as Coulter rather reluctantly acknowledges, there is no alternative to using antibiotics to treat syphilis and-on this theory of its causation-AIDS.

Coulter's hostility to orthodox medicine leads him into some dubious logic.

Having proclaimed the eradication, or at least the taming, of [syphilis], the medical profession may not want to admit that it was wrong. Furthermore, researchers avid for Nobel prizes may be repelled by the prospect of having once again to tackle the intractable problem of syphilis instead of pursuing some glamorous new virus from an exotic Africa country. Research funding may be less easy to obtain once AIDS is found to be essentially the reincarnation of syphilis.

It is far from clear why a convincing scientific demonstration that AIDS is due to modified syphilis would not attract funding or fail to bring renown to the researcher who made the demonstration.

In spite of these reservations, the book raises some interesting and important questions and the ample reference list provides the raw material for helping one to make up one's own mind about the issues. However, an inexplicable omission in a book of this kind is the absence of an index.

ANTHONY CAMPBELL

British Homoeopathic Journal 
Volume 77, Number 4, October 1988