Saturday, August 7, 2010

Kevin's Review of House of Numbers

After my involvement in a lengthy debate on the House of Numbers (HoN) Facebook page I wanted to watch the film for myself. But I was stuck in an unfortunate catch-22. I wanted to see the film but in no way wanted to contribute to funding of its message. Luckily, some others in the HIV dissident community made it possible for me to watch their copy. I am very thankful.

I have been trying to figure out how to write about the film. I saw it three weeks ago and right now I am wishing I had taken some notes. I think my overall impression of the film may actually be shocking, I did not think it was that bad. In fact I agree with a few points. I was really expecting a parade of pseudoscience, blatant denialism, questionably edited clips, and just plain misinformation. Although, the documentary is defiantly biased, I thought it was going to be A LOT worse. Maybe that’s why I do not think it was that bad. Either way, I am jealous of Brent Leung (pictured left) for talking science with some of the leading names in HIV. I wish I could have had the opportunity to meet with his interviewees. I would have put that time to better use too.

Overall, Mr. Leung puts his own stamp on HIV dinialism. While some argue that thevirus does not exist, the virus does not cause AIDS, or the virus is harmless and the drugs cause AIDS, the main message of HoN is that the testing and diagnoses are inherently unreliable and that poverty is the real issue at hand

I do not disagree with him on the last point. With poverty comes a lack of education, nourishment, medical care ect.. I agree with his point that we simply cannot combat HIV in Africa without addressing the issue of poverty; unfortunately right now both of these are “incurable.” Does more need to be done about poverty? YES! Poverty and infectious disease are inseparable they each contribute to the other. No one can deny that the number of people who are in desperate need dwarfs the number of people living with HIV. If you combine poverty related ailments such as starvation, malnutrition, deaths from preventable/treatable illnesses, water borne illness, and deaths due to lack of sanitation or medical care that number would again dwarf the 30-35 million estimated people living with HIV (UNAIDS 2007). Malaria alone caused 190 - 311 million clinical episodes in 2008 (WHO). In the USA these problems sound foreign but for millions, if not a billion people, they are a daily reality.

To this extent I accept the poverty argument. However, Mr. Leung conveniently ignores poverty’s influence of the very thing he attacks- HIV testing and diagnosis. A significant portion of the film is dedicated to testing/diagnosis and how it is part of some big consperiency. From Leung’s experience at a free HIV testing kiosk in South Africa, to reviewing diagnosis criteria for remote African locations, to interviews with some individuals who may have had a false positive (emphasis on may), Leung tries to imply that the testing/diagnoses are fundamentally flawed and biased by some unknown hand.

The most glaring example of the omission of poverty as a factor for the “correct” HIV/AIDS diagnosis came from the criteria used by remote African doctors. Numerous times throughout the film the stringency of these criteria are compared to those in developed nations, however, WE ARE NOT TALKING ABOUT DEVELOPED NATIONS. When doctors lack basic supplies like gloves, clean instruments, antiseptic, antibiotics and a dying patient comes in, confirming a 100% positive HIV/AIDS diagnosis is not as important as easing the pain or saving/extending the life. I am sure mistakes are made, but what would doctors rather do, spend what little money they have on sophisticated tests to confirm an HIV diagnosis or use their meager funds to buy supplies to save many more lives? Seriously, what good does a highly accurate test do for a person dying of AIDS? Sure, you can accurately tell them exactly what they are dying from, but you can also tell them that they are shit out of luck when it comes to morphine to dull the pain from the many systematic infections ravaging their bodies. POVERTY COMPOUNDS EVERYTHING, IT IS THE THEME OF THE ENTRIE MOVIE! WHY IS THIS CONVENIENTLY LEFT OUT?

Another large segment of the movie was dedicated to Mr. Leung taking an HIV test at a free testing kiosk in South Africa. In 2007, UNAIDS estimated that around 11% of the total population was HIV positive. With an instance of infection that high, getting people to know their status is VERY important. What Leung fails to tell the audience is that there are nearly 50 million people in South Africa. Testing a significant portion of the population (possibly testing people more that once) is a massive undertaking. It would be a massive undertaking in the USA, just look at the great lengths the government had to go through to get people to fill out a 10-question census. Now think about getting people to consent to a blood test that could give you some very bad news. South Africa is not a particularly wealthy nation. They need a very cheap, easy to administer (anyone can be trained to do it), and easy to analyze (no expensive or sensitive reagents or equipment). It is possible that a test that meets these criteria sacrifices some small amount of precision. Leung attacks the fact that they confirm a positive result from a marginally less accurate test with a more accurate (probably more expensive) one. However, isn’t this good medicine? They are making sure they do not accidently give someone the wrong diagnosis. Wouldn’t anyone want to be tested again?

The idea of confirming a life-altering diagnosis with multiple tests is a controversial idea in this film. This is a luxury that people have in highly developed nations. There are many ways to test for HIV, antibody, antigen, viral load, and each has positive and negative qualities. Importantly, each test tests for a different marker; immune response, viral protein, and viral genome respectively. Different tests have different levels of accuracy, which are stated in the testing material. No test would be approved by the FDA unless it was pretty damned accurate. Since a positive test is a HUGE deal, tests manufactures commonly suggest that you take another test to confirm the diagnosis. Isn’t it only natural to ask for a second opinion when confronted with some other life changing diagnosis, why not HIV?

Overall Mr. Leung makes some valid points. If the movie argued that we needed to combat multiple ailments instead of focusing on one virus, I would support it. If the movie talked about trying to combat poverty through education and development programs, I would support it. However, these are not the messages of the film. This documentary is simply another attempt at advancing an HIV denialist agenda. I CANNOT SUPPORT THAT. If they were being open minded why would they intentionally omit so many facts? HIV deniers live in a House of Glass and they should not throw stones.

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