Thursday 6 May 2010

The Medical Hypotheses Affair - Times Higher Education

"Without prejudice" - 6 May 2010 - Times Higher Education

Bruce G Charlton

"Bruce Charlton explains why he published a paper by 'perhaps the world's most hated scientist' and the importance of airing radical ideas"


On 11 May, Elsevier, the multinational academic publisher, will sack me from my position as editor of Medical Hypotheses. This affair has attracted international coverage in major journals such as Nature, Science and the British Medical Journal.

How did it come to this? Last year I published two papers on Aids that led to a complaint sent to Elsevier.

This was not unexpected. Medical Hypotheses was established with the express intent of allowing ideas outside the mainstream to be aired so that they could be debated openly. Its policy had not changed since its founding more than three decades ago, and it remained unaltered under my editorship, which began in 2003.

Nevertheless, managers at Elsevier sided with those who made the complaints and against Medical Hypotheses. Glen P. Campbell, a senior vice-president at Elsevier, started a managerial process that immediately withdrew the two papers - without consulting me and without gaining editorial consent. After deliberating in private, the management at Elsevier informed me of plans to make Medical Hypotheses into an orthodox, peer-reviewed and censored journal. When I declined to implement the new policy, Elsevier gave notice to kick me out before my contract expired and without compensation.

One of the papers, by Marco Ruggiero's group at the University of Florence, (doi:10.1016/j.mehy.2009.06.002) teased the Italian health ministry that its policies made it seem as if the department did not believe that HIV was the cause of Aids. The other paper, by Peter Duesberg's group at University of California, Berkeley (doi:10.1016/j.mehy.2009.06.024), argued that HIV was not a sufficient cause of Aids.

The Ruggiero paper seems to have been an innocent bystander that was misunderstood both by those who made a complaint and by Elsevier. The real controversy focused on Duesberg's paper.

Why did I publish a paper by Duesberg - perhaps the world's most hated scientist?

Peter Duesberg is a brilliant and highly knowledgeable scientist with a track record of exceptional achievement that includes election to the US National Academy of Sciences. However, his unyielding opposition to the prevailing theory that HIV is a sufficient cause of Aids has made Duesberg an international hate figure, and his glittering career has been pretty much ruined.

I published Duesberg's paper because to do so was clearly in line with the long-term goals, practice and the explicitly stated scope and aims of Medical Hypotheses. We have published many, many such controversial and dissenting papers over the past 35 years. Duesberg is obviously a competent scientist, he is obviously the victim of an orchestrated campaign of intimidation and exclusion, and I interpret his sacrifice of status to principle as prima facie evidence of his sincerity. If I had rejected this paper for fear of the consequences, I would have been betraying the basic ethos of the journal.

Medical Hypotheses was founded 35 years ago by David Horrobin with the purpose of disseminating ideas, theories and hypotheses relating to biomedicine, and of doing so on the basis of editorial review instead of peer review. Horrobin argued that peer review intrinsically tended to exclude radical and revolutionary ideas, and that alternatives were needed. He chose me as his editorial successor because I shared these views.

Both Horrobin and I agreed that the only correct scientific way to deal with dissent was to publish it so that it could be debated, confirmed or refuted in an open and scientific forum. The alternative - suppressing scientific dissent by preventing publication using behind-the-scenes and anonymous procedures - we would both regard as extremely dangerous because it is wide open to serious abuse and manipulation by powerful interest groups.

Did I know that the Duesberg paper would be controversial?

Yes. I knew that Duesberg was being kept out of the mainstream scientific literature, and that breaching this conspiracy would annoy those who had succeeded in excluding him for so long.

When I published the Duesberg article, I envisaged it meeting one of two possible fates.

In the first scenario, the paper would be shunned or simply ignored - dropped down the memory hole. This is what has usually happened in the past when a famous scientist published ideas that their colleagues regarded as misguided or crazy. Linus Pauling (1901-94) was a Nobel prizewinner and one of the most important chemists in history. Yet his views on the medical benefits of vitamin C were regarded as wrong. He was allowed to publish them, but (rightly or wrongly) they were generally ignored in mainstream science.

In the other scenario, Duesberg's paper would attract robust criticism and (apparent) refutation. This happened with Fred Hoyle (1915-2001), a Fellow of the Royal Society whose work on the "steady state" theory of the Universe made him one of the most important cosmologists of the late 20th century. But his views on the origins of life on Earth and the Archaeopteryx fossil were generally regarded as eccentric. Hoyle's ideas were published, attracted much criticism, and were (probably) refuted.

So I expected that Duesberg's paper either would be ignored or would trigger letters and other papers countering the ideas and evidence presented. Medical Hypotheses would have published these counter-arguments, then provided space for Duesberg to respond to the criticisms and later allowed critics to reply to Duesberg's defence. That is, after all, how real science is supposed to work.

What I did not expect was that editors and scientists would be bypassed altogether, and that the matter would be settled by the senior managers of a multinational publishing corporation in consultation with pressure-group activists. Certainly, that would never have happened 25 years ago, when I began research in science.

The success of Medical Hypotheses

Nor did I not expect that I would be sacked, the journal destroyed and plans made to replace it with an impostor of the same name. I did not expect this because I had been doing a good job and Medical Hypotheses was a successful journal.

Elsevier managers in the UK had frequently commended my work, I got a good salary for my work as editor, and I was twice awarded substantial performance-related pay rises. The journal was expanded in size by 50 per cent under my editorship, and a spin-off journal, Bioscience Hypotheses (edited by William Bains), was launched in 2008 on the same principles of editorial review and a radical agenda.

The success of Medical Hypotheses is evidenced by its impact factor (average citations per paper), which under my editorship rose from about 0.6 to 1.4 - an above-average figure for biomedical journals. Download usage was also exceptionally high with considerably more than 1,000 online readers per day (or about half a million papers downloaded per year). This level of internet usage is equivalent to that of a leading title such as Journal of Theoretical Biology.

But Medical Hypotheses was also famous for publishing some rather "eccentric" papers, which were chosen for their tendency to provoke thought, trigger discussion or amuse in a potentially stimulating way. Papers such as Georg Steinhauser's recent analysis of belly-button fluff have polarised opinion and also helped make Medical Hypotheses a cult favourite among people such as Marc Abrahams, the founder of the IgNobel Prizes. But they have also made it the subject of loathing and ridicule among those who demand that science and the bizarre be kept strictly demarcated (to prevent "misunderstanding").

It is hard to measure exactly the influence of a journal, but some recent papers stand out as having had an impact. A report by Lola Cuddy and Jacalyn Duffin discussed the fascinating implications of an old lady with severe Alzheimer's disease who could still recognise tunes such as Oh, What a Beautiful Mornin'. This paper, which was discussed by Oliver Sacks in his book Musicophilia: Tales of Music and the Brain, seems to have helped spark a renewed interest in music in relation to brain disease.

The paper "A tale of two cannabinoids" by E. Russo and G.W. Guy suggested that a combination of marijuana products tetrahydrocannabinol (THC) and cannabidiol (CBD) would be valuable painkillers. This idea has since been widely discussed in the scientific literature.

And in 2005, Eric Altschuler published in Medical Hypotheses a letter outlining his idea that survivors of the 1918 flu epidemic might even now retain immunity to the old virus. A few 1918 flu survivors were found who still had antibodies, and cells from those people were cloned to create an antiserum that protected experimental mice against the flu virus. The work was eventually published in Nature and received wide coverage in the US media.

What is my own position on the cause of Aids?

As an editor of a radical journal, my position was resolutely agnostic - in other words, I was not pursuing an agenda. I would publish papers presenting both sides of the debate. Most of the papers I published on Aids were orthodox ideas relating to HIV as the main cause. However, as well as Duesberg's article, I published some other papers challenging the HIV causal theory and proposing different mechanisms, such as work by Lawrence Broxmeyer arguing that some Aids patients actually have tuberculosis.

As for my personal opinions on the cause of Aids, these are irrelevant to real science because the subject is too far away from my core expertise and I do not work in that area. It is clear that Duesberg understands far more about HIV than I do, and more than at least 99 per cent of his critics do. Therefore, the opinions of most of Duesberg's critics, no matter how vehement, are just as irrelevant to real science as are mine.

But for me to collude with prohibiting Duesberg from publishing, I would have needed to be 100 per cent sure that Duesberg was 100 per cent wrong. Because even if he is mostly wrong, it is possible that someone of his ability may be seeing some kind of problem with the current consensus about Aids that other people of lesser ability (that is, most of us) are missing.

And if Duesberg may be even partially correct, it is extremely dangerous that the proper scientific process has been so ruthlessly distorted and subverted simply to exclude his ideas from the official scientific literature.

Bruce G. Charlton is professor of theoretical medicine, University of Buckingham.