American Journal of Epidemiology Vol. 154, No. 5 : 484-485
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health
BOOK REVIEWS |
The River: A Journey to the Source of HIV and AIDS
1 Department of Epidemiology School of Public Health University of Michigan Ann Arbor, MI 48109-2029
The River: A Journey to the Source of HIV and AIDS (1
) is very different from books typically reviewed in the American Journal of Epidemiology. Most have a strong epidemiologic focus and are not designed to promote a particular point of view. The sole agenda of this book is convincing the reader that human immunodeficiency virus type 1 (HIV-1) infection in humans originated inadvertently from the large-scale evaluation of a live attenuated poliovirus vaccine in Africa. In so doing, it has sparked legal action, laboratory investigations, newspaper articles, and a spate of meetings, one held at the Royal Society in London. More recent reports covering these allegations have laid them to rest for most people, but probably not for all.
Given the amount of controversy stirred by The River, I expected that the book would be a carefully constructed, well-edited presentation of the author's views, with the evidence for and against his hypothesis presented along with data to support his claim. Instead, the book is incredibly diffuse and confusing. In part, this may reflect the author's background as a journalist. The style is an informal one that reports his personal investigations into events surrounding the testing of oral polio vaccines near the Congo River prior to licensure. At that time, the late 1950s, there were several competing candidate vaccines, with accompanying corporate and personal rivalries (2–4). The personalities of the main players and those of their successors become a major topic for discussion in the book. There are presentations of data recovered or not recovered from records unearthed at various sites (the reader is quickly reminded of the difference in the rigor of laboratory record-keeping between the present and the past). However, there are many more interviews, plus anecdotes of events surrounding the activities of the key individuals involved. The anecdotes often become the focus of inquiry, rather than the material that should be a prime concern. We hear more about how the author was received when he arrived for a particular interview and the appearance and mental state of the person being interviewed than the content of the interview itself. In addition, there are frequent digressions about the physical rigors of the author's journey to a specific site. Other diversions include descriptions of the work of John Snow and Louis Pasteur—hardly relevant, even as background information. As a result, the reader's attention is diverted from the main thrust of the book.
The volume itself is 877 pages in length, including a postscript dated October 2000. There are also appendices and extensive footnotes, so the book's total length is 1,118 pages. Consequently, the reader frequently gets lost in unedited verbiage. This may be why an appendix providing evidence for and against the author's position was added to the current edition. Not surprisingly, the list of evidence favoring his hypothesis is much longer than the list of evidence opposing it.
The basic thesis is clear: Clinical trials of the CHAT live polio vaccine carried out in the Congo in 1957–1959 initiated the epidemic of HIV-1 infection and acquired immuno-deficiency syndrome (AIDS). This is the region that is also considered the epicenter of the HIV-1 outbreak—the place where the virus first caused significant numbers of human infections. Once observing this association, the next step for the author is to look for evidence to support it. However, to do so, he is forced to pile speculation on speculation. Since chimpanzees are the probable animal source of HIV-1, the basic supposition is that lots of the vaccines made in the Congo's Lindi Research Camp or elsewhere used chimpanzee kidney cultures rather than rhesus monkey kidney cells for production. Indeed, chimpanzees were held in the camp, but no real evidence is ever presented that they were used for anything but safety testing. Chimpanzee kidneys were also shipped to the laboratory at the University of Pennsylvania for use in attempts to isolate a hepatitis virus. The author speculates that perhaps these kidneys were shared with workers at the nearby Wistar Institute to adapt poliovirus, but again no evidence of any sort in support of this speculation is presented. This is just one example of the method used to promote the author's theory. The author insinuates that the name given to the vaccine, CHAT, represents a code for its chimpanzee origin. Only at the end of the book does the reader discover that it was derived from the name of the child from whom the poliovirus was isolated.
Another repetitive speculation involves the "Manchester sailor," a British man found to have died of an AIDS-like illness in 1959 (5). The reader is led down several dead ends. The first speculation is that the sailor might have acquired the infection in Africa. When no evidence of his ever having been in Africa is uncovered, it is then hypothesized that he might have been infected secondarily when the CHAT vaccine was tested in children in Northern Ireland, even though there is no known evidence of HIV-1 infection among children given the vaccine. Finally, we are told to forget about the whole episode, because the case was not truly a case of HIV-1 infection but rather a result of contamination in polymerase chain reaction testing.
This book is mainly recommended only for people with plenty of free time who would like to see how nonscientific reasoning can capture so much attention. It is fortunate that recent laboratory tests of appropriate lots of the CHAT vaccine have confirmed that it contains neither HIV-1 nor chimpanzee DNA (6, 7). Otherwise, it would be impossible to bring the matter to closure.
NOTES
ISBN 0-316-37137-8, Back Bay Books, Little, Brown and Company, New York, New York (Telephone: 212-522-8074, Fax: 212-467-4348), 2000, 1118 pp., $24.95
REFERENCES
- Hooper E. The river: a journey to the source of HIV and AIDS. New York, NY: Back Bay Books, 2000.
- Koprowski H. Live poliomyelitis vaccines. JAMA 1961;178:1151–5.
- Sabin AB. Present position of immunization against poliomyelitis with live virus vaccines. Br Med J 1959;1:663–80.
- Cox HR, Cabasso VJ, Markham FS, et al. Immunological response to trivalent oral poliomyelitis vaccine. Br Med J 1959;2:591–7.[Medline]
- Williams G, Stretton TB, Leonard JC. Cytomegalic inclusion disease and Pneumocystis carinii infection in an adult. Lancet 1960;2:951–5.[ISI][Medline]
- Plotkin SA, Koprowski H. No evidence to link polio vaccine with HIV... (Letter). Nature 2000;407:941.
- Blancou P, Vartanian JP, Christopherson C, et al. Polio vaccine samples not linked to AIDS. Nature 2001;410:1045–6.[Medline]
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  W. Winkelstein Jr. From the Editor Am. J. Epidemiol., September 1, 2001; 154(5): 484 - 484. [Full Text] [PDF]
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