Alberta Reappraising AIDS Society

David R. Crowe, President
Phone: +1-403-289-6609
Fax: +1-403-206-7717
Email: David.Crowe@aras.ab.ca

Roger Swan, Treasurer
Box 61037, Kensington Postal Outlet
Calgary, Alberta T2N 4S6
Canada
Office
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Email: aras@aras.ab.ca
Web: noaids.ca

Syphilis and AIDS

David Crowe
August, 2011

Syphilis and AIDS are identical twins born generations apart. The face of syphilis in our collective memory is so much older that nobody puts the portraits side-by-side to observe the remarkable family resemblance between these blood brothers in the dynasty of sex, doom and death.

What is generally accepted about these diseases is first and most obviously that they are sexually transmitted. They are also almost entirely diagnosed by antibody tests. The pathogen is rarely, if ever, detectable. The symptoms are vague, diverse and not unique. People with black skin are a risk group and opportunity for experimentation. Positive tests occur without symptoms. Symptoms occur without positive tests. The aim of treatment is to change surrogate markers not to improve health. Unethical testing has caused scandals. Early treatments were extraordinarily toxic. The disease progresses glacially with years between initial infection and serious symptoms. The proof that the disease will progress when other factors are considered is missing. It is widely believed that the disease came from nations colonized and driven into poverty and squalor by Europeans, American Indians in the case of syphilis, Africans in the case of AIDS.

Syphilis created a state of emergency that justified extraordinary measures that AIDS paralleled on an even higher plane of fear decades later. The notion that a deadly sexually transmitted disease could exist was embedded into society’s shared consciousness by syphilis and the danger was so palpable that justification for toxic treatments and other drastic actions was easy both then and in the era of AIDS.

Another interesting connection between syphilis and AIDS is that some HIV=AIDS rethinkers, notably John Scythes, Lynn Margulis and Colman Jones, propose that ‘AIDS’ is actually late stage syphilis, so the apparent disappearance of syphilis in the 1970s and 1980s was just an illusion.

A recent book, Examining Tuskegee: The Infamous Syphilis Study and its Legacy, published in 2009 by historian Susan Reverby, made me put my thoughts about these twins on paper for the first time. Before discussing the book it is important to review what people thought about syphilis during its prime.

What They Thought Then

A few years ago a nurse sent me a 1969 Canadian nurse’s manual titled “Venereal Diseases and Their Control” [ODH, 1969] with her annotations indicating that I should look at the parallels between syphilis and HIV/AIDS. The manual said, for example that, "The treponema pallidum [spirochete believed to cause syphilis] arouses but little local reaction in the human tissues. For this reason the changes in the course of the disease, which ultimately have the most disastrous effects, take place slowly, and with few symptoms. The patient may believe himself well through long periods of time during which his infection is undermining his health.”

Syphilis was, despite this, illustrated as a methodical killer, proceeding step by step, from Primary Syphilis to Secondary Syphilis to Latent Syphilis and finally to Late Syphilis which resulted in a miserable death.

The manual continues, “The primary sore [Primary Syphilis] is not painful and will heal with or without treatment…the diagnosis of primary syphilis can only be made after careful consideration of several factors: the history of exposure; the thorough clinical examination; the serologic test reports of blood examinations which are positive, or which change from negative to positive…Where the diagnosis of primary syphilis can be made and the blood is negative, it is termed seronegative primary syphilis…[if] the blood is positive, it is termed seropositive primary syphilis. Seronegative primary syphilis is always darkfield positive [spirochetes are visible] while on the other hand seropositive primary syphilis may be either darkfield negative or darkfield positive.”

Secondary syphilis, the manual admits, “is also essentially a laboratory diagnosis and depends on the physical signs or symptoms being confirmed either by darkfield examination or by repeated positive serologic tests. The history should always include questions respecting exposure and symptoms of secondary syphilis such as headache, sore throat, general malaise, etc. The physician should look for…skin rashes, mucous patches, other skin lesions, enlarged lymph glands, etc…final confirmation should always be made by darkfield examination on the skin or mucous membrane lesion, or S.T.S. [serological, i.e. antibody, test for syphilis]”

Latent Syphilis, “is purely a laboratory diagnosis…the physical examination, by definition, must be completely negative”. Disease without illness should be a contradiction in terms but syphilis (and other diseases like polio) had ingrained in most people, by the early twentieth century, that a disease is still a disease even if the person who has it is not diseased, as long as a doctor says it is a disease.

Lastly there is the feared “Late Syphilis” (also called Tertiary Syphilis) which is when that darned spirochete is really supposed to ruin your life as your body falls apart. According to this manual, “Any or all organs of the body may be damaged by syphilis”, although the manual focuses mainly on cardiovascular, neurological, musculo-skeletal and gastro-intestinal symptoms. At the other end of the spectrum is “Asymptomatic neurosyphilis (no clinical signs)”. This means that fluid obtained from a (dangerous and painful) spinal tap is positive for syphilis (antibody and other tests that fall short of detection of treponemes) but there are absolutely no symptoms. The other form of neurosphyilis is, obviously, “Symptomatic Neurosphyilis”, where symptoms are necessary, but both spinal fluid and blood tests can be negative. What the manual does not say is that, “It is extremely difficult to detect spirochetes in tertiary syphilis”.

The reliance on antibodies has not changed. The same government (Ontario, Canada) forty years later recommended the use of only four blood tests, all based on antibody detection. It’s not just Canada. WebMD describes similar antibody testing although leaving the door open for darkfield microscopy “mainly to diagnose syphilis in an early stage”, implying that spirochetes are rarely found during other stages.

Gathering the parallels with HIV/AIDS we have, in syphilis, a syndrome that is diagnosed mainly by antibody tests and that, with a positive test, is happily diagnosed without any symptoms. Symptoms are defined broadly and will be called disease if there is (or previously has been) a positive test or even without a positive test if there are vaguely defined lifestyle factors (such as having black skin). The same syptoms in the absence of a positive test or the doctor’s belief that a person is at risk could easily be called something else, such as heart disease or insanity.

What is missing from this manual on syphilis is a discussion of the impact of pre-penicillin therapies. These included the toxic heavy metals mercury (from the 16th century), arsenic (from 1910, in the organic form salvarsan) and bismuth (starting in the 1920s) and could have easily explained symptoms, particularly neurological, that occurred years after a syphilis diagnosis and subsequent treatment. Just as with HIV/AIDS today, people receiving a positive test for syphilis before World War II were put on toxic therapies and their later symptoms blamed on the pathogen they were believed to be harboring. Even penicillin was not considered curative and, while safe in most people, can cause dramatic allergic reactions in a minority.

Syphilis experts even have a special name for a dramatic worsening of illness that can occur after administration of therapy, including in more than half of the cases receiving high-dose penicillin therapy [Idsoe, 1972]. This Jarisch-Herxheimer reaction [Wiki A] is thought to be caused by a “cytokine storm” that occurs when the therapy wipes out too many spirochetes at once. Since this is theorized to be a sign of success some doctors felt that administration of medicine should induce this side effect, increasing the dose to ensure that patient got this ‘benefit’. There are eerie parallels with the syndrome called IRIS (Immune Reconstitution Inflammatory Syndrome) or IRD (Immune Reconstitution Disease), a similarly dramatic worsening of symptoms in an AIDS patient after initiation of AIDS drugs that is blamed not on the drugs, but on the pesky immune system that, reconstituted by the drugs, suddenly starts to cause inflammation.

Tuskegee: Two Wrongs Make an Almost Right?

The Tuskegee study has been infamous since emerging into public view in 1973 as a nazi-like experiment on black Americans. Reverby’s book, Examining Tuskegee contains references to a wide range of important historical documents concerning this experiment, but is strangely void of judgement, at times implying that the importance of Tuskegee and the damage to the participants was over-rated and at times the author just seems shocked like everyone else. Because I was interested in a trial that was declared unethical because highly toxic therapy was withheld, I wanted to see what scientific information on syphilis she would reveal about this experiment, and whether any of the flaws and contradictions in the syphilis-as-major-public-health-problem theory would be noticed by this historian.

The trial involved black men, and only black men, who were studied for the health impacts of untreated syphilis, 427 of which were classified as “syphilitic” (i.e. with some evidence of syphilis) and 185 as “controls” with another 12 men being moved from the control to the syphilitic side of the trial when they first tested positive. The so-called controls were misnamed because they were not randomized to receive a placebo instead of an intervention. Tuskegee was an observational trial, a style more subject to bias than treatment-vs-placebo trials because it is likely that the two groups being observed will have significant differences in socio-economic status, initial health, age or location. If syphilis symptoms did have an environmental component (such as diet, living conditions or exposure to toxins) dividing the group in this way would automatically add bias from the very beginning, as the ‘syphilitics’ would start off sicker.

The outrage over Tuskegee has always bemused me given the toxicity of the treatments that trial participants were being denied. Even when penicillin became standard treatment, it was not without risk. Another irony is that the experiment was under the auspices of a black institution, even though most of the researchers were white. The trial even received the approval of the “local, virtually all black, medical society in Macon County.” [Reverby, 2009] Nurse Eunice Rivers, who recruited most of the men and kept them in the study through lies, was herself black. Higher status blacks apparently had no problems with unethical experiments on low class blacks, reminiscent of the thin crust of well-connected gay men who helped route toxic AIDS drugs to their supposed comrades while receiving enormous salaries running pharmaceutically-funded organizations.

Before I am accused of racism I should emphasize that the Tuskegee experiments truly were unethical, not because they denied toxic therapy, but because they denied these men informed consent even if the outcome did not actually harm them, and this denial was racist, based on the fact that they were black (and poor), some of the least powerful people in American society at that time.

One aspect of the study that was not just unethical but directly harmful was the spinal taps. Participants were told it was a “special free treatment” (unethical) but [Reverby, 2009] correctly notes that this procedure is also “dangerous and painful”. While she reports at least one death caused by a needle that broke, she does not appear to have thought that if any side effects were caused by this procedure designed to look for (possibly asymptomatic) neurologic syphilis they would be blamed on neurologic syphilis.

The trial was also unethical because it was unscientific. It did not, for example, have a defined protocol but just kept going, gathering data without any other apparent purpose. Moving people from the control group to the syphilis group (but not in the other direction) contaminated the data. And there was syphilis drug treatment of some of its participants both at the beginning by the trial organizers and also later as some of the men discovered they had syphilis and sought treatment elsewhere (there is some suspicion, although perhaps just wishful thinking, that Nurse Rivers dropped some hints to men she felt most needed syphilis therapy [Reverby, 2000]). While researchers have argued that this therapy was insufficient in most cases, the trial researchers claimed in the 1960s that almost every participant had some therapy and about a third had what they considered curative [Rockwell, 1964]. The presence of syphilis therapy in the trial did not make the trial ethical but it further reduced the value of the data it produced. And enrolling people in a trial with scientific flaws is unethical because it means that even willing volunteers are risking their lives for nothing because, without valid data, any clinical trial is worthless.

A table of data at the end of Reverby’s book enumerates the common understanding of the pathogenesis of syphilis. Based on another famous syphilis study, known as the “Oslo Experiment” one-quarter to one-third of people with syphilis (antibody positive probably) were estimated to spontaneously ‘cure’ without treatment, meaning that the antibodies would fade away. A similar quantity would remain latent, meaning that they would still have positive tests but no symptoms. What would remain is no more than half of the cases, the majority of whom would be found to have skin, bone and heart problems which, in the absence of a positive syphilis test, could easily have been given another explanation. Only 1-2% would have neurosyphilis and the author does not indicate how many of these would have asymptomatic neurosyphilis.

Tuskegee found even a weaker effect. Information was recorded on both syphilitics and the controls and both groups were found to have similar rates of illness. 7% of controls had cerebrovascular events compared with 6% of syphilitics. 4% of controls had atherosclerosis versus 5% of syphilitics and 18% had heart disease compared to 20% of syphilitics. Rates of cancer were identical and nephritis (kidney disease) was 5% versus 6%. Given the many scientific flaws in this study the similar rates of disease indicated that syphilis must be a highly over-rated disease if it has any impact. This shows rather conclusively that the Tuskegee experiment did not endanger its participants nearly as much as is generally thought, if it endangered them at all. In fact, given the toxicity of treatments, it may have inadvertently protected them.

The coup de grace is the last survey of the Tuskegee trial participants in 1968-1970 that showed that “the men diagnosed with syphilis (but never told this) were living longer, and with less illness, than the controls.” [Reverby, 2009]

The treatment that the study prevented them from achieving was largely the older mercury, arsenic and bismuth treatments as the vast majority of study participants were recruited by 1934, more than ten years before penicillin became widely available after World War II. The treatments were admittedly toxic and many patients, quite sensibly, resisted. Early in the penicillin era venerologist J.E. Moore wrote that, “The disadvantages of metal chemotherapy lie in the facts that, if treatment is compressed within a brief time period, the mortality rate from treatment per se is excessive, whereas if it is prolonged for the sake of safety, comparatively few patients can be held to the conclusion of treatment.” [Moore, 1948]

Treatment with metals was indeed brutal, with large amounts over a long period. Thomas Parran described treatment for black men in Macon county in the 1930s (obviously not those in the Tuskegee study) as, “A treatment goal of 20 arsphenamines [injections] and 192 mercury rubs…requiring 34 weeks of treatment” [Parran, 1937].

It seemed important for later commentators to both note the toxicity of heavy metal treatments while also contradictorily claiming that they were effective. Tuskegee critic Susan Smith wrote about, “Salvarsan, a toxic arsenic compound that was the first effective treatment for syphilis”. [Smith, 1996] She, like other commentators, does not define what she means by ‘effective’. Allan Brandt, another Tuskegee critic, tied himself in logical knots by first noting correctly that, “medical authorities firmly believed in the efficacy of arsenotherapy for treating syphilis at the time of the experiment’s inception in 1933” and then, ignoring the possibility that beliefs, even if firmly held, could be wrong, continues in the same paragraph to say, “Provision of effective medication would have violated the rationale of the experiment [Tuskegee]…in fact, the USPHS had prevented the men from receiving proper treatment.”. Medicine that is simply believed to be effective (mainly at eliminating antibodies) is not actually effective without proof. Furthermore, given the known toxicity of the heavy metal medicines, the effectiveness has to be significantly greater than the side effects.

The main purpose of treatment was to eliminate infectiousness. Thomas Parran, for example, commented that, “It [amount of treatment] is not good enough, but even so, many infectious cases were eliminated and many person-to-person epidemics stopped.” [Parran, 1937] This was due to the belief that people with syphilis antibodies but no symptoms (latent syphilis) were still infectious and that infectivity declined with treatment. Treatment might have no immediate benefit to the symptomless patient, but was believed to have an immediate benefit to their sexual partners and children (in the case of women) and a theoretically long-term benefit in the reduction of the probability of recurrence of syphilis symptoms or development of Tertiary Syphilis. No comment from Reverby on how unethical it is to treat people (by definition not in the Tuskegee trial) in a way that will probably harm them without at least informing them of the risk of the therapy and without informing them that the major aim of treatment is to protect society from them, not to improve their health.

Treatment was given to people without symptoms, those with “Latent Syphilis”, on the basis of a positive antibody or other type of test, with success only measurable by the loss of antibodies, “Every major textbook at the time of the Tuskegee Study’s inception strongly advocated treating syphilis even in its latent stages, which followed the initial inflammatory reaction…Although the standard therapies of the time, arsenical compounds and bismuth injection, involved certain dangers because of their toxicity, the alternatives were much worse. As the Oslo Study had shown, untreated syphilis could lead to cardiovascular disease, insanity, and premature death.”[Brandt, 1978]

Ironically, perhaps tragically, even if elimination of antibodies was a worthwhile goal, the treatments were not good at it. In one report cited by Reverby eight doses of arsenic-based medicines combined with heavy metals (mercury or bismuth presumably) only 6% became antibody-negative which presumably would have led a lot of doctors to extend the treatment. Better results were apparently obtained with more intensive therapy. Penicillin was, at least at first, worse than the best antibody-elimination results obtained with metals, “the failure rate of treatment with penicillin in patients with early syphilis after 18 to 24 months of observation is, with the treatment systems which we have employed, in the general range of 25% to 35%…These are results which are substantially worse than the best obtainable by metal chemotherapy without penicillin, where the failure rate may be as low as 3-10%, provided the patient completes treatment and is not made seriously ill or killed as a result of it.” [Moore, 1948]

There are indications that the heavy metal therapies were a possible cause of the neurological symptoms that were prominent in tertiary/late stage syphilis. One indication was that these symptoms were rare in blacks who much more frequently experienced cardiovascular disease. Metal treatments were expensive and thus would have been used with more frequency among whites. In particular, “The [untreated] Tuskegee patients did not develop neurosyphilis”. [Roy, 1995] Another indication that heavy metal therapy was the cause is that, “Tertiary and late latent syphilis have been decreasing in incidence since the 1950s…in the Oslo study neurosyphilis eventually developed in 7% of the patients”. [cited in Caplan, 1992] The 1950s were the decade when penicillin supplanted heavy metal treatment and the Oslo study was the other major study of untreated syphilis although, in the decades after isolation, some participants may have obtained heavy metal therapy.

The major harm most people believe came from the Tuskegee experiments was the withholding of treatment. It is therefore interesting that Reverby implicitly criticizes doctors considering this experiment who asked a perfectly legitimate question about whether latent syphilis should be treated or not by quoting Irwin Schatz MD, one of the people who tried to stop Tuskegee, complaining in 1964 that he was, “utterly astounded by the fact that physicians allow patients with potentially fatal disease to remain untreated when effective therapy is available.”[Reverby, 2009]

Reverby’s concern about treatment seems to be that the emphasis on syphilis stymied the development of more wide-ranging and useful public health programs, only briefly and ambiguously mentioning a doctor who believed he had seen two deaths from heavy metal treatments. Her concern is certainly reasonable, similar observations have been made about the emphasis on AIDS in Africa which has sucked what little life there was in providing basic health care in favor of HIV testing, distributing condoms and also the “life-saving” drugs with life-threatening side effects. But, if syphilis is a toothless tiger, it is even more tragic to displace primary health care with treatments for a phantom.

Syphilis was believed to be widespread in blacks because the Wasserman antibody test was positive more often than in whites. [Reverby, 2009] cites a 1930 survey that found a rate of 20% Wasserman (antibody) positive in “apparently healthy” Mississippi blacks. Reverby does not note that that the Wasserman test is now believed to produce far too many false positives due to other diseases and conditions, even when faced by this huge rate of ‘disease’ without illness. She does, however, document the racist beliefs that supported the interpretation of inaccurate antibody tests citing a 1930 report by doctors that, “their [negroes’] prodigality is inordinate and their sex appetite is enormous.” [Brandt, 1978] quotes a doctor writing in 1906 that, “In a practice of sixteen years I have never examined a virgin negro over fourteen years of age.” On the other hand, it was hard, but obviously not impossible, to ignore the high rate of syphilis antibodies in elderly blacks who had not yet experienced the ravages of syphilitic symptoms [Johnson, 1934]. The majority of whites who held racist views in that time would not have been surprised at an extraordinarily high rate of a sexually transmitted disease and would therefore be unlikely to question the accuracy of the test or feel it necessary to look for other causes for illness (in those who actually had symptoms).

One alternative explanation for some of the symptoms called syphilis could be pellagra. This vitamin deficiency, common in poor southern people who relied largely on lime-treated maize for food, is only mentioned by Reverby three times. Not once does Reverby mention that pellagra causes skin disorders, heart disease and neurological illnesses that are part of the wide spectrum of diseases often called syphilis. Not once does she consider that health symptoms in blacks might be preferentially diagnosed as syphilis because doctors would prefer their beliefs about black sexuality to consideration of the economic inequalities that led to bad diets, poor sanitation and bad living conditions.

Dr. Thomas Parran, director of the Public Health Service’s Division of Veneral Disease when Tuskegee began and soon after US Surgeon General, wrote about conditions here, “At the other extreme was Macon County, Alabama, where in spite of the wholesome influence of Tuskegee Institute, very primitive conditions exist…The houses were tumble-down shacks, many without floors, with no furniture, and only a few rags for bedding; there were no screens, a privy only when underbrush was not conveniently close…They ate a pellagrous diet–salt pork, hominy grits [maize with most nutrients bleached out], and molasses. They had no green vegetables, no fruit, no milk, no red meat”[Parran, 1937]. He also noted a low rate of syphilis in plantations that had some concern for their workers or perhaps simply realized that “sickly niggers” did not work as hard. The Delta & Pine Land Company, for example built sanitary outhouses, insisted that all workers maintain a garden and provided canned salmon in their store to encourage a better diet. But this example was quoted in [Parran, 1937] as an example of the benefits of heavy metal therapy (supplied by this plantation) that even increased the number of babies born and cured rheumatism in one old man more than for the sanitary and dietary improvements.

Given the bad press that Tuskegee received it is noteworthy that untreated “syphilitics” did not have significantly more actual illness than controls. Doctors facing this problem invented interesting excuses. Untreated syphilitics, they opined, must be divided into those that die quickly and those that cure themselves. Any clinical trial would obviously only be able to enroll the living, who would then have no higher burden of disease than the uninfected. It seems like an early version of the argument that increasing rates of cancer and liver patients in people taking AIDS drugs are due to the drugs keeping then alive long after their best-before date.

Another theory, advanced by Fred Gray [Reverby, 2000], the lawyer who brought the class action against the US government, was that the syphilitics were healthier than the controls because by 1933 (one year after the start of the trial) the researchers were forced to recruit their men in workplaces to avoid being beseiged by black women who wanted whatever their husbands were getting. This theory fails scrutiny, however, because the change to recruiting in workplaces occurred before the enrollment of controls, so all controls would have been recruited from workplaces.

Other experiments did actually expose people to syphilis which just illustrated how uninfectious it was. Reverby cites an experiment at Sing Sing prison in the 1950s that injected ground up testicles of infected rabbits into men. The researchers had to use 2,000 times the normal infectious dose in order to produce an ulcerating nodule at the injection point. No mention of the effects of injecting macerated testicles from uninfected rabbits. In 2010 Reverby also brought to light similar US-funded experiments in Guatemala in the 1950s, reminiscent of the corrupt US-funded Nevirapine experiments in Uganda. In Guatemala they first tried bringing in syphilitic prostitutes to have sex with prisoners but, when that failed to produce antibodies in many men, they started injecting bacteria (almost certainly not in a pure state) into the prisoners, even into their spinal cords although Reverby has implied that even this was not very successful.[Reverby, 2010] The idea, in Guatemala, was to first produce syphilis, and then try to cure it with penicillin.

It is perhaps unfair to criticize Reverby, who does not claim to be a scientist, for missing so many obvious conundrums with the syphilis theory. She talks about intense dosing with heavy metals without once mentioning that this could cause neurological problems that inevitably would be diagnosed as neurosyphilis. She documents that the aim of treatment was to eliminate antibodies, not illness (particularly when used in cases of latent syphilis). She mentions pellagra in passing, but not the similarity of symptoms with syphilis. This is probably due to the compartmentalization of academics, considering themselves experts in one area, and incompetents in all others. Yet it is obvious to a critical mind that the syphilis dogma has major flaws and no examination of clinical trials, ethical or unethical, can afford to ignore them.

Back to Oslo

The Oslo experiment of 1890-1910, from which Reverby, and just about everyone else, got their data on the long-term effects of syphilis, was the only other major study that deliberately withheld treatment from people diagnosed with syphilis. Reverby concludes that since this trial had already shown what the impact of syphilis was it rendered Tuskegee unnecessary, ignoring the lack of a control arm. Oslo is still important today simply because it is thought to be important and also because there were two serious attempts at followup of the participants decades after the trial concluded first in the 1920s and then again in the 1950s so the quantity and quality of the data from the study is surprisingly good.

The trial was initiated because Dr. Caesar Boeck “Practically forbade the use of mercury [the main treatment at the time] in the treatment of the syphilitic cases in his wards, believing that mercury generally interfered with the patient’s own defence” [Harrison, 1956]. The trial was terminated in 1910 after the first medical magic bullet became available, Paul Ehrlich’s organic arsenic drug known as Arsphenamine, Salvarsan or 606.[Wiki B]

Boeck, believing that syphilis was infectious, isolated his patients for an average of almost 3 months (men) and 4 months (women). Isolation continued until the clinical signs of primary or secondary syphilis (or both) disappeared, which they always did (without any treatment). Nobody was admitted on the basis of darkfield microscopy or antibody tests because those were not available. Researchers who reviewed the detailed records kept by Boeck agreed that, even without lab tests, the diagnosis was right in most cases. Yet nobody knows whether even a single person had spirochetes in their body at the time of their entrance into the study, let alone whether the spirochetes were causing their symptoms.

The Oslo study is used to justify the conclusion that only 40% of people with untreated syphilis would experience any significant later illness, and only about one-third of those who did would have "benign late stage syphilis", mostly skin disorders, similar to primary and secondary syphilis. The 1949-1951 restudy examined a large number of death records and concluded that only 28% of the participants had any signs of syphilis at the time of death.

But there was no control group which means that 40% with illness or 28% dying with syphilis signs present is an upper limit on the fraction of people without ill effects. A control group is necessary to show that a similar group who did not have syphilis symptoms at the starting point would, in fact, experience less illness later and would live longer. Without a control the lower limit in both cases would be 0%. There were, after all, other factors. All that can be said is that 0-40% of people diagnosed clinically with syphilis would have recurrences of a similar disease and that 0-28% would die of it. The Oslo experiment is perfectly compatible with the spirochete blamed on syphilis having no effect on health whatsoever.

The main confounding factor in this experiment, just as with Tuskegee, was socio-economic. 62% of the patients were referred to Boeck by the Bureau of Indigents and almost all of them came from East Oslo which, at the time, was the poorest part of the city. [Clark, 1955] These people, the poorest of the poor, probably survived with inadequate food, contaminated food and water, higher levels of air pollution and generally poor living conditions.

Doctors in the 1950s did not see any of this. American doctors bemoaned “the fact that more than one-half of the persons (in the United States in the past decade) who acquire syphilis do not reach medical attention until after the early lesions have disappeared, some many years afterward, others not at all. American literature contains many statements lamenting this fact and point out that the golden opportunity for therapy in these patients has been lost”[Clark, 1955]. Lack of symptoms was certainly no excuse for not treating people, “Every year more persons are diagnosed as having early latent syphilis, and each year this ratio is increasing, meaning that relatively more each year remain untreated for primary and secondary syphilis. In 1954 the ratio of early latent to primary and secondary was approximately 3.5 to 1”[Clark, 1955].

Another puzzle that was glossed over was that people diagnosed with syphilis appeared to have a significantly elevated rate of illness and death that was not symptomatic of syphilis: “among a 100% syphilitic population 84.9% of males and 91.7% of females died of other [non-syphilis] causes.”[Clark, 1955] It is surprising that they did not reach for the solution used in the AIDS era – add these symptoms to the definition – they just listed this as a mystery. But this excess mortality is more compatible with socio-economic problems causing skin problems, malaise, headaches and other supposed manifestations of primary or secondary syphilis than it is with an infectious cause which should cause only the symptoms of the pathogen.

Although treatment was usually referred to with adjectives such as “effective” syphilis appeared to come and go unrelated to treatment. [Clark, 1955] quotes researchers from the 1920s emphasizing that “the rhythmic course of syphilis [is] unrelated to treatment” This appears to indicate that treatment now might eliminate antibodies but it would not stop recurrences of the antibodies later, even though it was claimed to do so.

Treatment, in fact, seemed rather unsuccessful. Those monitoring British soldiers before WWI found a relapse rate of 84% after treatment with mercury and Salvarsan (arsenic) [Harrison, 1956]. Worse yet, there was an epidemic of facial paralysis caused by the use of high-dose salvarsan in the early twentieth century which apparently was resolved, strange as it might seen, by including mercury in combination with salvarsan [Harrison, 1956]. Just as with AIDS so-called improvements of therapy might just represent the replacement of one compound by another that is less toxic – injected arsenic to mercury rubs or AZT to protease inhibitors.

While Tuskegee had its problems, it at least had a control group, which seems to show that the health impacts of late stage syphilis are closer to zero than to 40%. It is fairly clear, however, that a profession that is distinguished from others by their ability to prescribe, will rarely conclude that not-prescribing something is a good idea. It is fine to prescribe penicillin instead of heavy metals for healthy people on the basis of a blood test without symptoms but it is not fine to let nature take its benign course or, even better, look at the root causes of the diseases, such as squalor associated with malnutrition and greater exposure to toxic chemicals. It is fine to claim that penicillin is a miracle, but not fine to say that it is merely less toxic than mercury, arsenic and bismuth.

Conclusions

Susan Reverby has accumulated a mountain of data on Tuskegee and syphilis and must be thanked for that. Yet, despite the many contradictions she documents, she clearly could not question the underlying spirochete=disease model. She shares this blind spot with most social scientists as well as most MDs and scientific researchers. So, she should not be singled out for this failing, it is a characteristic shared with the bulk of the entire academic infrastructure propping up the shack of allopathic medicine.

My beliefs about syphilis have been shattered through a relatively short tour through the research of a historian and some academic papers from the 1930s through the 1950s. The last remaining bastion of the infectious theory of syphilis for me is the presence of spirochetes in early stage syphilis lesions. We cannot says that all lesions have the spirochetes because generally only antibody tests are used. But even if it was true that would not prove causation. Weeping sores are likely to be colonized by bacteria that are somewhat resistant to the immune system and could easily be a cause of the sores rather than the other way round. Furthermore, penicillin might well clear up these sores without proving causation.

Syphilis is important to AIDS rethinkers for several reasons. Firstly, it was a dry run for AIDS, also believed to be a sexual disease predominant in blacks diagnosed with antibody tests, monitored by surrogate markers not health and treated with highly toxic compounds that were not claimed to be cures even in perfectly healthy people. Secondly, it was widely advertised as one of the top, perhaps the top, public health menace despite evidence to the contrary. Thirdly, ethical arguments were invoked to make treatment ethical and non-treatment unethical, ignoring evidence regarding the toxicity of treatment and weak pathogenicity.

In addition, a minority of HIV rethinkers believe that late-stage syphilis, despite the syphilis dogma’s problems (particularly the lack of the pathogen when it really counts), is the cause of AIDS, substituting one flawed disease model for another.

One big difference from the syphilis era is that there does not appear to have been much resistance to the disease model. Educated blacks appeared to support the attack on the disease just as educated blacks enthusiastically support HIV testing and AIDS treatment programs today. Although there were a few critics of the disease model nothing like the HIV/AIDS rethinking movement appears to have existed that to supply comprehensive critiques of the existence of the pathogen, its transmissibility, its causative associated with disease, and the toxicity of drugs. Some things have improved.

On the other hand Tuskegee has been used to promote treatment for AIDS among blacks on the basis that Tuskegee was a racially fuelled tragedy of non-treatment. Tuskegee was a white experiment on blacks with some black establishment support to deny toxic treatments while ignoring underlying environmental causes of illness. By comparison, AIDS is a white experiment on blacks with overwhelming black establishment support to promote toxic treatments while ignoring underlying environmental causes of illness (such as IV drug abuse among urban blacks and malnutrition among African blacks). In both cases diagnosis and treatment are driven more by laboratory results than by the actual health of the patient.

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