The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition

Progressive and degenerative journals: on the growth and appraisal of knowledge in scholarly publishing

Despite continued attention, finding adequate criteria for distinguishing "good" from "bad" scholarly journals remains an elusive goal. In this essay, I propose a solution informed by the work of Imre Lakatos and his methodology of scientific research programmes (MSRP). I begin by reviewing several notable attempts at appraising journal quality - focusing primarily on the impact factor and development of journal blacklists and whitelists. In doing so, I note their limitations and link their overarching goals to those found within the philosophy of science. I argue that Lakatos's MSRP and specifically his classifications of "progressive" and "degenerative" research programmes can be analogized and repurposed for the evaluation of scholarly journals. I argue that this alternative framework resolves some of the limitations discussed above and offers a more considered evaluation of journal quality - one that helps account for the historical evolution of journal-level publication practices and attendant contributions to the growth (or stunting) of scholarly knowledge. By doing so, the seeming problem of journal demarcation is diminished. In the process I utilize two novel tools (the mistake index and scite index) to further illustrate and operationalize aspects of the MSRP.

The COVID misinfodemic: not new, never more lethal

'Infodemia' is a portmanteau between 'information' and 'epidemics', referring to wide and rapid accumulation and dissemination of information, misinformation, and disinformation about a given subject, such as a disease. As facts, rumors and fears mix and disperse, the misinfodemic creates loud background noise, preventing the general public from discerning between accurate and false information. We compared and contrasted key elements of the AIDS and COVID-19 misinfodemics, to identify common features, and, based on experience with the AIDS pandemic, recommend actions to control and reverse the SARS-CoV-2 misinfodemic that contributed to erode the trust between the public and scientists and governments and has created barriers to control of COVID-19. As pandemics emerge and evolve, providing robust responses to future misinfodemics must be a priority for society and public health.

Editorial: genetic and genomic research-changing patterns of accountability

Debates about genomic science have raised questions about the implications for ethics and accountability. Accountability has external and internal aspects. Whereas ethical review, including attention to appropriate consent procedures, has been central to 'giving an account' externally, there are also issues internal to the practice of science itself. The pursuit of truth is central to the scientific endeavour, but truths can sometimes be 'inconvenient', leading to complex questions of accountability that go beyond the issues of consent. This is illustrated by the case of the Havasupai.

Defending the boundaries of science: AIDS denialism, peer review and the Medical Hypotheses saga

This paper explores the boundary work undertaken by HIV scientists and activists against the journal Medical Hypotheses over its lack of peer review. Their action was sparked by the publication of an article by Peter Duesberg claiming that HIV does not cause AIDS and that antiretrovirals do more harm than good. Precisely because such 'AIDS denialism' can undermine HIV prevention and treatment interventions, as was demonstrably the case in South Africa under President Mbeki, the episode raised questions about when, in the interests of public health, the boundaries of legitimate scientific debate may be drawn to exclude unreasonable and unscholarly arguments. The paper argues that normative concerns motivated the complaints which resulted in the publisher withdrawing Duesberg's paper and imposing editorial policy changes on Medical Hypotheses. Concerns were raised about the implications for academic freedom of this boundary work in defence of peer review as a core practice in science. The paper concludes, however, that Duesberg's freedom to write what he likes remains intact, but that if he wants his work to carry the imprimatur of science, he now has to subject it to peer review.

AIDS denialism and public health practice

In this paper, we respond to AIDS denialist arguments that HIV does not cause AIDS, that antiretroviral drugs are not useful, and that there is no evidence of large-scale deaths from AIDS, and discuss the key implications of the relationship between AIDS denialism and public health practice. We provide a brief history of how the cause of AIDS was investigated, of how HIV fulfills Koch's postulates and Sir Bradford Hil's criteria for causation, and of the inconsistencies in alternatives offered by denialists. We highlight clinical trials as the standard for assessing efficacy of drugs, rather than anecdotal cases or discussions of mechanism of action, and show the unanimous data demonstrating antiretroviral drug efficacy. We then show how statistics on mortality and indices such as crude death rate, life expectancy, child mortality, and population growth are consistent with the high mortality from AIDS, and expose the weakness of statistics from death notification, quoted by denialists. Last we emphasize that when denialism influences public health practice as in South Africa, the consequences are disastrous. We argue for accountability for the loss of hundreds of thousands of lives, the need to reform public health practice to include standards and accountability, and the particular need for honesty and peer review in situations that impact public health policy.

The first postmodern pandemic: 25 years of HIV/ AIDS

Science responded to the challenge of AIDS by rapidly identifying aetiology, describing pathogenesis and transmission routes, and developing diagnostic tests and treatment. However, this did not prevent the global spread of HIV, with 25 million fatal cases so far, another 33 million infected, and disastrous socioeconomic and demographic consequences. In spite of unprecedented political attention and financial resources, the response is falling further behind the growth of the epidemic. This is partly due to the unique characteristics of the virus, such as persistent infection, vertical transmission and a variability that allows it to escape immunity and antiretroviral drugs, and partly due to human characteristics such as a strong procreative instinct, drug use and ostracism. Denial, myths and complacency are major obstacles to rational measures. With no cure or vaccine in sight, scaling up prevention is of paramount importance. To meet the goal of universal access to prevention, treatment and care by 2010 would require a quadrupling of funding to an estimated US$42 billion by 2010, including adequate overall strengthening of healthcare systems, but in any case, the world will have to learn to live with HIV for the foreseeable future.

Lessons from previous predictions of HIV/AIDS in the United States and Japan: epidemiologic models and policy formulation

This paper critically discusses two previous studies concerned with predictions of HIV/AIDS in the United States and Japan during the early 1990s. Although the study in the US applied a historical theory, assuming normal distribution for the epidemic curve, the underlying infection process was not taken into account. In the Japan case, the true HIV incidence was estimated using the coverage ratio of previously diagnosed/undiagnosed HIV infections among AIDS cases, the assumptions of which were not supported by a firm theoretical understanding. At least partly because of failure to account for underlying mechanisms of the disease and its transmission, both studies failed to yield appropriate predictions of the future AIDS incidence. Further, in the Japan case, the importance of consistent surveillance data was not sufficiently emphasized or openly discussed and, because of this, revision of the AIDS reporting system has made it difficult to determine the total number of AIDS cases and apply a backcalculation method. Other widely accepted approaches can also fail to provide perfect predictions. Nevertheless, wrong policy direction could arise if we ignore important assumptions, methods and input data required to answer specific questions. The present paper highlights the need for appropriate assessment of specific modeling purposes and explicit listing of essential information as well as possible solutions to aid relevant policy formulation.