It goes like this. Yesterday I chaired a panel discussion at the Cambridge Film Festival called “Science on Screen: Darwin, Denial and Documentary”. The idea was to gather together science-themed films from the festival in a discussion about how (well) science is depicted in documentary and fiction films. The films under discussion were the Darwin-denial film Expelled: No Intelligence Allowed, an exploration of belief called The Nature of Existence, the Darwin biopic Creation and, most important for this discussion, a film called House of Numbers a documentary about AIDS.
So in preparation I watched all four films last week. On Thursday I was a guest on the Guardian Science Podcast, where I discussed some of the films, as a part of the issue of how we decide who to engage in constructive dialogue, and who are the nutters that are best avoided. You should listen to it so you can follow what comes next. The issue is what I said about House of Numbers - as you will hear I said that it was a film that raised important questions, that I didn't consider it a denial film, and that after watching it I felt I was armed with a greater understanding of issues pertaining to AIDS and HIV and that it had persuaded me to find out more.
Now I have found out more, and the questions that people are asking, and I'm asking myself is: was I conned into taking the film seriously as an insight into a scientific controversy rather than a shoddy, ideologically driven and utterly unscientific piece of AIDs-denial propaganda. I'm asking this both because of what I have found out myself since I did the podcast, and because – I have been lead to understand –there are others out there, including Mr Bad Science himself Ben Goldacre, who not only take the latter position on the film but having heard me on the podcast, think I've let the rationalist side down.
So what have I learned since Thursday?
The first thing that happened when I arrived in Cambridge was that one of the festival organisers told me that he thought the film was a clear example of "AIDs-denial" (we'll get to what that is in a minute), that the festival was going to reject the film but then decided to include it as long as there was discussion about it, that the local hospital had requested that the film not be shown since it misrepresented the science and could, if believed, endanger lives, and that Ben Goldacre himself had similarly argued that the film should not be shown at the festival.
Then I met Brent Leung (that's him in the picture, me in the glasses), the director/presenter of the film, who I was asked to add to the panel. We sat round with the other panellists and discussed some of the issues arising from the film. Then we did the panel discussion, during which time I got a chance to hear Leung defend his film, hear the other panellists (historian Louise Foxcroft and Leonor Sierra from Sense about Science) criticise it in various ways, and members of the audience have their say. I have spent today reading up on the controversy that surrounded the screening of House of Numbers in the US and Googling the experts Leung talked to in the film, in order to try to figure out if the film does indeed count as a credible expose on the heretofore hidden controversy about AIDs numbers, the relationship (if any) between AIDs and HIV and the effectiveness of treatment.
I'm still trying to marshal my thoughts around this issue - some of which are contradictory - so this might not be very coherent but here's the current state of my thinking on the subject, for what it's worth, with a random selection of mitigating factors, new insights, mea culpa(s) and restatements.
First up the podcast. I wish I had been able to raise, alongside what I said, all the reservations I had about the film - in terms of its structure, the sense that it was not reliable or had somehow stacked the decks - as I ended up giving it a kind of endorsement. That was not my intention. Partly this was a consequence of the fact I was comparing it to Expelled, which is such a ludicrous cack-handed piece of propaganda which does not even attempt to discuss actual science. House of Numbers couldn't hep but look better by comparison. But also it is true that the effect of House of Numbers on me was to raise an issue I had not thought much about, in such a way as to provoke a desire to know more.
Its critics argue that the film makes a clear case that HIV doesn't exist, that ART (anti-retroviral treatment) does more harm than good, and that it is poverty that causes AIDS. But I didn't, and don't, think that this is the only conclusion the viewer can reach - perhaps this is because the film is not a particularly effective or well-made piece of propaganda - and I appreciated it for raising these questions (even if they are, as appears the case, not genuine scientific questions or questions which have long-ago been settled in the scientific community). I also liked the way in which the film presented science as a conflicted area, where scientists do not agree with each other, and researchers become wedded to particular perspectives out of a sense of proprietorship, or for reasons of funding or reputation. This is, of course, true (as Dawkins said yesterday) of science as of any other specialist field with money and prestige attached to it. (I am reconsidering this now, see below).
Beyond that I liked the film because it was going to provide a very good case study, alongside Expelled, for a debate about the acceptable limits of questioning scientific orthodoxy, whether we should engage 'denialists', outsiders, cranks etc in discussion or ignore them (might one of them be, as they claim, a new Galileo?), and how we decide who is to be listened to and who ostracised (i.e. I 'liked' the film because it was going to be useful to me).
So what did the panel teach me?
First up, Brent. He is young and confident and just like his film he talks the talk about being 'objective' and dedicated to free speech and having merely stumbled upon a controversy, and wanting people to make up their own mind because lives are at stake and we are not being told the truth, while at the same time leading one to think there is probably a bit more to it than that, and you’d certainly like to find out more. In the debate he held his own, but was very punchy (perhaps the legacy of the vociferous debates he has had in America, but also suggesting an awareness he would be strongly criticised) and fairly unsophisticated. He baulked at a very gentle suggestion that perhaps a more thorough grounding in the philosophy and history of medicine might have deepened his understanding of the subject, and hotly argues that he gave equal screen time to both ‘sides’ of the arguments. He said that even if you removed the interviews with the more controversial figures in the film, what the mainstream scientists said would still lead us to think that AIDS drugs might be doing more harm than good, that the link between HIV and AIDS was not clearly established and that healthy people were bring misdiagnosed.
It was during these exchanges that it dawned on me that what I had at first appreciated about the film – that it throws some light on the fact that science is always partial, riven with contradictions, gets things wrong etc – was in fact somewhat bleeding obvious. The great shocking conspiracy Brent thinks he has uncovered and is waking the world up to could look, from another perspective, like a not very original insight, or even a very dangerous one if shackled to an unconvincing argument about the alternatives (what do the denialists propose?).
Originally I was more sanguine about the film than about Expelled, because Ben Stein’s film is a clear piece of propaganda with the clear ideological aim of undermining the audience’s confidence in evolution and making the case for allowing the teaching of ID in classrooms. It is at first blush much harder to find a clear ideological message, or aim, in House of Numbers. During the discussion I asked Brent several times what he was trying to achieve with the film – what his aim was. His platitudes about informed consent and trying to help the search for a system of testing that makes no mistakes at all sounded naive and unconvincing. But (and I still think this for now) whether it is because the film is not actually very well put together, or because it really wasn’t made, at least initially, strictly as propaganda, I still think it poses questions that encourage the audience to think and seek out more information. If they do that, as I have done, they quite quickly find plenty of evidence to contradict the AIDS-denial claims that critics of the film argue it is supporting. Incidentally, although the panellists were critical of the film for several reasons – including its faux naive Candide-esque narration, its wide-eyed incredulity at the fact that science isn’t right all the time, and its lack of historical and social context – neither Louise nor Leonor felt the film should not have been shown, and believe, I think, that the discussion it triggered was a productive one.
However, if you judge films and film-makers by the company they keep then there was clearly something else going on. Scattered amongst the audience were people who were clearly there because they felt that House of Numbers was a profound film, revealing a scandal at the heart of the AIDS industry which Brent has bravely exposed. One of these people held the floor for a few minutes in a rant which suggested that science is completely flawed, peer review is ineffective, and doctors prescribing ART are practising a form of genocide. There are more of those kinds of people here , and I must say when you hear this kind of swivel-eyed irrationalism from the supporters of the film you have wonder what it is really trying to say.
What I did not know until I read about it here, was the existence of a vociferous AIDS-denial faction in the US, who have rallied around House of Numbers (if not actually funded it – Leung is very reticent about the sources of his funding) and have been waging a campaign in the US to discredit the use of ART, cast doubt on the notion that HIV cases AIDS, and argue that they have been censored. Confusingly, AIDS-denialism does not deny the existence of AIDS per se, but denies that it is the HIV virus that causes AIDS (and also therefore that the way to treat Aids is to treat HIV). One such group is Rethinking Aids, who, according to the Bay Window article cited above, have taken to describing House of Numbers as ‘our film’. And this is hardly surprising, since if you peruse their website you can find a list of supporters that features many of the denialist experts featured in House of Numbers. Looked at in the light of this, House of Numbers actually looks a lot more like Expelled than at first sight – an insidious interweaving of interviews with ‘the establishment’ that makes their position look arrogant or incoherent (or is edited so as to make them appear to agree with the film's thesis) and interviews with ‘expert witnesses’ who turn out to all be representatives of one view (if not organisation) and whose expertise is questionable if not non-existent.
So, where does this leave us, I mean me?
Well, as I said, I regret sounding so upbeat about House of Numbers on the Guardian podcast, and in particular saying it wasn’t a denial film. On the other hand, I stick to what I said about the way in which it opened up a whole lot of interesting questions. It did. Even if the questions it posed about AIDS and HIV, funding, testing etc… are in fact pseudo-questions, in the sense that there is actually no real scientific credibility to them, they were new to me and having seen the film and done the research I know more about this issue than I did before, and I also now know about AIDS-denial. Beyond that the film does an even better job, not consciously and not in what happens on the screen but in relation to itself as a media object, of bringing to the surface a whole set of issues about free speech – how we legitimate challenges to scientific orthodoxy, who gets a place at the debating table – that are of absolute centrality to what we do. I can’t say, therefore, that I’d prefer it didn’t exist, or should be suppressed.
Another series of questions has been kicked up around the phenomena of AIDS-denialism itself. What is it? What are their aims? Who funds it? At the moment I feel a bit like I did when I first came across Adnan Oktar (so we went and found out LINK). I want to know more about Brent Leung, more about the people who support him, more about the logic of AIDS-denial. Is it fuelled by religious fervour (it is as hysterical as the pro-lifers?), by homophobia, by those who have been diagnosed with HIV who ardently wish to believe they are not going to die? (As suggested by this brilliant quote: “What mattered to me as person living with HIV was to be told that HIV did not cause AIDS. That was nice. Of course, it was like printing money when the economy is not doing well. Or pissing in your pants when the weather is too cold. Comforting for a while but disastrous in the long run.” Winstone Zulu, Zambian AIDS Activist and former denialist. From here)
The best thing I’ve come across so far is this excellent New Scientist piece by Jonny Steinberg (see our review of his book about Aids) which not only summarises the deluded AIDS-denial case but outs several of Brent Lueng’s informants: Christine Maggiore, whose AIDS denial Steinberg argues contributed to the death of her daughter, and her own death in December 2008 (something that is not mentioned in the film), and Eleni Papadopulos-Eleopulos from the ‘Perth Institute’, who feels able to appear in court and claim that HIV doesn’t exist on the basis of her scientific qualifications that amount to an undergraduate degree in nuclear physics.
One of the big problems about debates around AIDS is that, as Louise Foxcroft noted to me, there is a tendency to answer arguments you don’t agree by ‘lobbing dead babies’. Both sides claim to be saving lives with what they are saying, and imply the opposing view are wasting them. That said I must say that I feel chastened by the statistic provided by Steinberg that Thabo Mbeki's adoption of the denialist argument and consequent antipathy to allowing ART in South Africa has reliably been estimated to have resulted in 365,000 premature deaths in that country. Though the arguments about scientific orthodoxy and the limits of free speech are interesting and valid, those issues do somewhat pale in comparison with such a number.
So, for the record, I now think that House of Numbers is a poor piece of work. As science it is hopeless, and hopelessly compromised by its (mis)use of ‘experts’ and misrepresentations of the debate (fourteen of the scientifically credible interviewees have signed a letter claiming that they were mislead or misrepresented by the film) as well as more generally by its lack of depth, context and style. It is an AIDS-denial film, in that it is entirely congruent with, and draws on the argument and resources of, the AIDS-denial movement (however much the film's director and producer dispute this). This does not mean that everything it says is wrong, or that AIDS treatment is perfect or could not be improved. I’m still glad I saw it and would defend the right of everyone else too, but I think it deserves and should be met by a vigorous response from those who know the area well.
So there’s the story. Please do post a comment if you feel moved to. .