There are few places more cognitively dangerous to a rational mind than the intersection of political ideology and pseudoscience. Libertarians are increasingly being associated with various anti-scientific beliefs, such as vaccine rejectionism and climate change denialism. This is harmful to traditional libertarian causes, such as curbing excessive bureaucracy and government intrusion into civil liberties because it allows critics to dismiss libertarians as denialist cranks without a second thought.
It is therefore disturbing that the libertarian website LewRockwell.com recently published a screed promoting HIV/AIDS denialism written by medical doctor Donald W. Miller Jr. Despite being an actual medical doctor, he repeats many of the same fallacies that HIV/AIDS denialists commonly deploy. In reality, antiretrovirals decrease progression to AIDS and death rates, HIV can be transmitted sexually and HIV testing is highly accurate.
The specter of “the government”
A common approach used by anti-science libertarians is to portray the mainstream scientific and medical consensus as “the government” or “the official story”. This is a common technique to marginalize their opponents by associating them with something they intensely dislike. However, mainstream scientific communities are not slaves to the government or to politicians. They can design and carry out scientific research and interpret their results on their own.
Initiating antiretroviral therapy regardless of CD4 count
Miller makes a big deal out of the fact that the newest guidelines for treatment of individuals with HIV/AIDS recommend that antiretroviral therapy is given to individuals who are HIV+ regardless of CD4+ count. Had he read the report he is referencing in detail, he would have understood that there is a clear medical reason for why this is done (HHS Panel on Antiretroviral Guidelines for Adults and Adolescents, 2014):
The recommendation to initiate ART in individuals with high CD4 cell counts—whose short-term risk for death and development of AIDS-defining illness is low is based on growing evidence that untreated HIV infection or uncontrolled viremia is associated with development of non-AIDS-defining diseases, including cardiovascular disease (CVD), kidney disease, liver disease, neurologic complications, and malignancies. Furthermore, newer ART regimens are more effective, more convenient, and better tolerated than regimens used in the past.
In other words, untreated HIV infection (even with a high CD4+ count) increases the risk for a number of diseases. To disable the emotional threat of “forced government medicine” or similar, it can be noted that the guidelines specifically states that the wishes of the individual should be taken into consideration, together with a large number of other factors:
Regardless of CD4 count, the decision to initiate ART should always include consideration of a patient’s comorbid conditions, his or her willingness and readiness to initiate therapy, and available resources.
It is both sad and entertaining to see that denialists rarely read the papers and reports that they themselves reference.
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