Gloria Brame, Ph.D.

Did the Army spin the AIDS vaccine story?

Filed By Gloria Brame, Ph.D. | October 07, 2009 11:00 AM | comments

Filed in: Living
Tags: AIDS vaccine, HIV/AIDS, Thai AIDS Study, U.S. Army AIDS study

Big and little media, including this blogger, welcomed recent news from Thailand that trials of an AIDS vaccine were very promising. Today, word in the scientific community is, sadly, that this drug is not nearly as promising as the U.S. Army led the public to believe, and that the US and Thai officials created false expectations at their press conference. Army spokespeople are denying they rushed to announce but scientists are fuming.

When the U.S. Army and its collaborators in Thailand announced at press conferences on 24 September that a large clinical trial of an AIDS vaccine had lowered the rate of new HIV infections by about one-third, researchers were surprised and encouraged. Although it was only a modest reduction, it was the first positive result from any AIDS vaccine trial.

Now some researchers who have seen more of the data in confidential briefings are complaining that a fuller analysis undermines even cautious claims of success, and they are raising questions about the way the results were announced.

"The press conference was not a scholarly, rigorously honest presentation," said one leading HIV/AIDS investigator, who like others asked that his name not be used. "It doesn't meet the standards that have been set for other trials, and it doesn't fully present the borderline results. It's wrong." Two biostatisticians who specialize in HIV prevention trials and have not seen the data, said that the results from all participants are the more important data, but they were puzzled that the press conference did not include the analysis that excluded those who didn't follow the protocols. "I think if people saw [the two analyses] diverging in a vaccine study, they'd have a lot of questions," says David Glidden, a biostatician at the University of California, San Francisco.


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I wouldn't jump to any conclusions that the Army et al did this with deliberately dishonest intent. Sloppy science is insidious, and slips in occasionally even when motivations are pure. That is why peer review is so important --- the greater scientific world can detect falsehoods that smaller groups sometimes cannot, and IMHO that is exactly what has happened here.

I don't believe there was a deliberate effort to manipulate the news. I do believe they rushed to the press with the news instead of following scientific protocols. Sloppiness, however pandemic, is still no excuse for sloppiness. If science isn't rigorous it isn't science.

Robert Ganshorn Robert Ganshorn | October 7, 2009 9:05 PM

Gloria,

Thank you for posting on this topic. When first I heard about this last week I went ballistic. There is no way to educated people about safe sex practices and give them a vaccine and suggest the vaccine is working.

The ethical dimensions of this are frightening. It is as though Thais are being treated like hamsters and they are doing it aided by American tax dollars. Without a certain vaccine risky behaviors can multiply and because of uniformly low educational standards in Thailand they could well believe they are invincible from the disease because of an injection.

Should the vaccine work partially we could be helping create another mutated version. Even urban Thai people still believe in protective "spirits" and I do not mean the 80 proof variety. They are in denial about the degree of the Aids problem here and attribute it to something else.

Robert, you raise a vital point about the ethics of these (and other US funded) HIV/AIDS trials in poor countries. Another program that's of profound concern to me is the push to circumcise African men that the US has pursued. Rather than emphatically supporting the use of condoms (with its proven 98%+ rate of prevention of transmission) and thus endorsing birth control, we are pushing circumcision which -- at best -- may reduce rates of transmission by about 60%. Meanwhile, African men are being circumcised in adulthood, and one cannot help but assume that very few of them understand the potential consequences and after-effects of an adult circumcision.

G.

--Should the vaccine work partially we could be helping create another mutated version.

There is not a cintilla of scientific evidence to support that assertion. You have no understanding of how vaccines work and mutations occur.

--They are in denial about the degree of the Aids problem here and attribute it to something else.

Thailand has been one of the greatest successes in the world on the comprehensiveness of HIV prevention activities, particularly condom use, and a resulting decline in the incidence of new HIV infections.

--African men are being circumcised in adulthood, and one cannot help but assume that very few of them understand the potential consequences and after-effects of an adult circumcision.

Completely untrue. Many southern african tribes have a tradition of male circumcision as a rite of passage to adulthood, so they are very aware of the effects. One of the reasons why the three circumcision trials were able to quickly recruit young men is that they were desirous of the procedure but could not afford to pay the local shaman for it.

Robert Ganshorn Robert Ganshorn | October 8, 2009 9:46 PM

Bob,

I am not an immune diseases specialist, but my memory of the Vietnam era and development of penicillin resistant strains of venereal disease (caused in great measure by prostitutes quaffing penicillin to prevent infection) would lead me to believe that a partially effective vaccine could lead to a stronger Aids virus. We already know we have a virus that actively mutates. Do we wish to risk making it stronger?

But even if I am wrong in this the giving of an experimental vaccine to people who also still worship spirits living in trees does not constitute honest informed consent. Education is very primitive in Thailand and is done by rote repetition in classes where students are not permitted to ask questions if they do not understand. That is the state of Thai education. Repeat, repeat, repeat and the whole class graduates. No one dreams of asking a question of a teacher or a person giving a lecture.

Thai Buddhism also emphasizes the acceptance of fate which is what I meant when I stated that they attribute AIDS transmission to something else. This along with drug use mentioned below.

The Thai minimum wage is about $180.00 monthly. How many condoms do you think they can afford? The manager of my condo building is a college grad and makes three times this amount monthly.

I always take guests to dine at "Cabbages and Condoms" here in Jomtien. It is a resort began by a Thai politician and all profits go to Aids awareness and treatment in this country. I am not suggesting that there are not improvements in HIV transmission levels, but there is a rampant drug problem here and one type of death is often misreported as something else. Also "100% condom use programs" among prostitutes are played as often for story value than actual practice.

Still, six hundred thousand live with HIV and over 31,000 deaths occur annually out of a total population of sixty five million. It is estimated that 80% of AIDS transmission here is heterosexual in 2008. As of 2007 it is 1.4% of the population down from 2% of the population in 1997.

My source is Avert.org for the last paragraph.

Back to the question at hand: Did the U.S. Army spin the vaccine announcement? Based on the track record of past AIDS vaccine announcements, I think Gloria is right -- they did.

The most glaring example is the much-hyped VaxGen vaccine, whose phrase III trial results were announced by the company in 2003. (This trial was also done in Thailand.) The company put a maximum spin on the announcement, only to get egg on their faces shortly afterward when the actual trial results revealed that the vaccine was next to useless.

But major media also participate in these AIDS-vaccine spins. The fact is, a vaccine that works is the holy grail of HIV/AIDS treatment. So typically the pattern of news announcements has been to rush into stating that the grail has been found.

The U.S. Army has been involved in AIDS vaccine research from the very beginning -- in fact, our military are heavily involved in all kinds of biomedical research. To date, billions in taxpayer money have been spent on AIDS vaccine development, both through NIH and DOD spending, and the government has nothing to show for it so far. For several years now, critics are saying, "Enough already" on AIDS vaccine spending.

So my guess is, that the ongoing expenditures have to be justified...with spin, if nothing else.