8
First U.S. Book Excerpt: Alan Sokal Slams Le Postmodernisme - P. 6 David Zimmerman's newsletter on science, media, policy and health Vol. VI, No. 7 February 1, 1998, New York, NY $5 Controversi AS Ta Advance; New Engnd Joul Fracas Grows Editors Hang Tough Top editors at the New England Journal of Medicine (NEJM) are circling the wag.ans against a rising storm of collegial criticism. The complaints cus on a Sept. 18, anti- research editorial written by Executive Editor Marcia Angell, M.D., a pathologist, and a dense of the Journal's editorial procedures that she and her boss, Editor-in-chief Jerome P Kassirer, M.D., wrote several weeks later (Nov. 13). At a NEJM Editorial Board meeting on Dec. 1, Kassirer gave their critics no quarter. An excerpt from the minutes can be und on page 4. Kassirer, who is an internist, declined PROBE's request for comment on the issues. The fracas was generated by an ethical odd couple: research editor Angell and research basher Sidney Wol, M.D., an internist, of Public Citizen's Health Research Group, a Washington, D.C., activist organization. In September, the NEJM published a Public Citizen's attack on placebo-con- tro\\ed clinical trials in the Third World. Angeli's supportive editorial was published with it. Some HIV-incted pregnant women in these studies are being given low doses of the anti- AIDS drug AZT, in an effort to protect their babies om inc- tion. The other women in the studies get dummy medication (placebos). Wolfe and Angell denounce the trials as unethical throwbacks to the Tuskegee Syphilis Study. They aver that the only ethical approach would be to give all the control women a long and costly course of AZT, a regimen previously shown to be effective in Americans (PROBE, June, July, Oct.). Varmus Protests Research scientists, led by the National Institutes of Health (NIH) director, oncologist Harold Vannus, M.D., were enraged by Angeli's published position. Varmus "lobbied vehemently for the opportunity to publish a ·dense of the government- sponsored studies," Kassirer told his fellow editors at the continued on page 3 Early ata Assessed Hopes for an early scientific answer to whether low doses of AZT will reduce HIV transmission from mothers to their infants have been dashed - r the moment. But the trials, backed by the Department of Health and Human Services (HHS), under Sec. Donna Shalala, are contin- uing, despite harsh criticism by health activists and a top editor of the New England Joual of Medicine (NEJM) (see adjacent story, and sidebars on pp. 3-5). Clinical researchers here and abroad arc pleased that efforts to derail the studies thus far have failed. Infectious disease expert Neal A. Halsey, M.D., of the Johns Hopkins School of Public Health, said late last month by phone that he and his colleagues are "grateful" to the fed for making "the right decision." ''They have stood up to the inappropriate criticism, based on unscientific thinking," he said. Thai Studies Advance The hope r an early resolution focused on a major ongoing study in Thailand, sponsored by the Thai University Hospital and the U.S. Centers for Disease Control (CDC) in Atlanta. Earlier, a small study of 182 women sponsored by the.Thai Red Cross - the very first to be reported - yielded disappointing findings: no difference in infant infectivity between mothers treated with a low-dus, shun regimen (two weeks) of AZT and control mothers given placebos. In both groups, the infection rate was 9%, according to CDC infectious disease specialist Phillip Nieburg, M.D. He said the preliminary findings were reported at an AIDS meeting in the Philippines. For unknown reasons, Nieburg added by phone, the innt infection rates in both arms of the study were much lower than the 25% previously reported for untreated mothers in the U.S. and elsewhere. Thus, he and other experts noted, if the Thai control women had been given the long, costly ($1,000) U.S. standard AZT treatment, so that the was no untreated control continued on page 5 © 1998 The Probe Newslette Inc.

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Page 1: $5 Controversial AIDS Trials Advance; New England Journal

First U.S. Book Excerpt: Alan Sokal Slams Le Postmodernisme - P. 6

David Zimmerman's newsletter on science, media, policy and health

Vol. VI, No. 7 February 1, 1998, New York, NY $5

Controversial AIDS Trials Advance; New England Journal Fracas Grows Editors Hang Tough Top editors at the New England Journal of Medicine (NEJM) are circling the wag.ans against a rising storm of collegial criticism. The complaints focus on a Sept. 18, anti­research editorial written by Executive Editor Marcia Angell, M.D., a pathologist, and a defense of the Journal's editorialprocedures that she and her boss, Editor-in-chief Jerome P.Kassirer, M.D., wrote several weeks later (Nov. 13). At aNEJM Editorial Board meeting on Dec. 1, Kassirer gave theircritics no quarter.

An excerpt from the minutes can be found on page 4. Kassirer, who is an internist, declined PROBE's request for

comment on the issues. The fracas was generated by an ethical odd couple: research

editor Angell and research basher Sidney Wolfe, M.D., an internist, of Public Citizen's Health Research Group, a Washington, D.C., activist organization. In September, the NEJM published a Public Citizen's attack on placebo-con­tro\\ed clinical trials in the Third World. Angeli's supportive editorial was published with it. Some HIV-infected pregnant women in these studies are being given low doses of the anti­AIDS drug AZT, in an effort to protect their babies from infec­tion. The other women in the studies get dummy medication (placebos). Wolfe and Angell denounce the trials as unethical throwbacks to the Tuskegee Syphilis Study. They aver that the only ethical approach would be to give all the control women a long and costly course of AZT, a regimen previously shown to be effective in Americans (PROBE, June, July, Oct.).

Varmus Protests

Research scientists, led by the National Institutes of Health (NIH) director, oncologist Harold Vannus, M.D., were enraged by Angeli's published position. Varmus "lobbied vehemently for the opportunity to publish a ·defense of the government­sponsored studies," Kassirer told his fellow editors at the

continued on page 3

Early �ata Assessed Hopes for an early scientific answer to whether low doses of AZT will reduce HIV transmission from mothers to their infants have been dashed - for the moment.

But the trials, backed by the Department of Health and Human Services (HHS), under Sec. Donna Shalala, are contin­uing, despite harsh criticism by health activists and a top editor of the New England Journal of Medicine (NEJM) (see adjacent story, and sidebars on pp. 3-5).

Clinical researchers here and abroad arc pleased that efforts to derail the studies thus far have failed. Infectious disease expert Neal A. Halsey, M.D., of the Johns Hopkins School of Public Health, said late last month by phone that he and his colleagues are "grateful" to the fed for making "the right decision."

''They have stood up to the inappropriate criticism, based on unscientific thinking," he said.

Thai Studies Advance

The hope for an early resolution focused on a major ongoing study in Thailand, sponsored by the Thai University Hospital and the U.S. Centers for Disease Control (CDC) in Atlanta. Earlier, a small study of 182 women sponsored by the.Thai Red Cross - the very first to be reported - yielded disappointing findings: no difference in infant infectivity between mothers treated with a low-dust:, shun regimen (two weeks) of AZT and control mothers given placebos.

In both groups, the infection rate was 9%, according to CDC infectious disease specialist Phillip Nieburg, M.D. He said the preliminary findings were reported at an AIDS meeting in the Philippines.

For unknown reasons, Nieburg added by phone, the infant infection rates in both arms of the study were much lower than the 25% previously reported for untreated mothers in the U.S. and elsewhere. Thus, he and other experts noted, if the Thai control women had been given the long, costly ($1,000) U.S. standard AZT treatment, so that there was no untreated control

continued on page 5

© 1998 The Probe Newsletter, Inc.

Page 2: $5 Controversial AIDS Trials Advance; New England Journal

Follow-up

Contest Hype Endures; Abortion Shifts Seen

The publicity machine for the Westinghouse Science Talent Search (STS) rolls on, even as doubts have been raised about the contest's future (PROBE, Nov., Jan.). The New York

Times says, in a recent story based on a Westinghouse press release, that the annual awards have been "a prestigious ticket to college and even to Nobel Prizes for generations of students . ... " (Jan. 13, B3).

PROBE readers may recall, however, that our November report, based on data from the Washington, D.C. company that runs the contest, found that no first placed winner has ever won a Nobel Prize. Of the five STS finalists who have won Nobel Prizes, the most recent was a finalist in 1955, who won his Nobel Prize in 1981 - some 17 years ago!

In Pittsburgh, meanwhile, the Westinghouse Foundation, which has supported the STS since 1944, is going out of busi­ness. It's pledged to support the contest at the current rate of $650,000 per year (the student prizes are $205,000), through the year 2000, the Pittsburgh Post-Gazette reports (Dec 16). The Westinghouse Corp., which bought, and has now become the CBS Corp., will drop the STS, the P-G said.

A new sponsor is being sought.

# # #

Varmus on Alternative Care. We reported last month that NIH chief Harold Varmus, M.D., who is a very politic offi­cial, has only once commented negatively, on the record, about his agency's Office of Alternative Medicine (OAM) and its adherents. We published that quote - from a commencement speech to medical school graduates - but it ended up strung out to ajump page. It's worth repeating, compactly, here.

Varmus said there are two cultures, and added: "Ours has been the �scientific record of accomplishment. 13ut the

other one is acquiring enormous public support-even getting the credit for many preventive, behavioral, and low-tech methods that mainstream medical science introduced and validated."

# # #

Abortion Advances. The annual January anniversary of the Supreme Court's Roe v. Wade decision is stock-taking time for all sides in the abortion conflict. This year, for the first time in a long while, there were some noteworthy changes.

The Republican National Committee (RNC), meeting just before the anniversary, voted not to make opposition to "partial birth abortion" - a late second- and third-trimester procedure - a litmus test for Republican congressional candidates whoseek RNC funding. A candidate will be able to get money with­out denouncing the rarely-used abortion procedure. The GOPthus is backing away from the hard line pro-life position.Cooler heads pointed out that adherence to it could destroy theRepublicans' current congressional majorities - and cost them

Page 2

the presidency in 2000.

Old Saw Repeated The New York Times, meanwhile, ran a two-part, Page one

series on the Roe anniversary and a Times Magazine piece, which deplored the mortal hazards that face doctors who per­form abortions; it deplored, too, the lack of training programs and of young ob-gyns willing to do the procedure. The first of the two daily Times pieces (Jan. 16) restated the same old saw about how abortion is America's most divisive issue since the Civil War. But the second article, next day, broke new ground for the Times - and signaled some important changes.

In interviews conducted at urban abortion clinics, reporter Tamar Lewin found that many patients didn't know what Roe v. Wade was! But, these women couldn't conceive of a situation in which abortion services were not readily available. Abortion has become a fact of life in big cities, although it's still unavail­able in rural areas, particularly in the South and the Midwest.

Equally important, the Times discovered, abortion has shifted from a political to a moral issue - of individual choice - in many Americans' minds. Somewhat fewer Americans approve of it now than they did several years ago - although it still has majority support. But it is now seen more and more as a mat­ter of individual moral judgment, not a call to the ramparts.

Ambivalence Acknowledged It is perhaps in this context that the Ttmes allowed its reporter

to report a fact that previously, in the 15 years we've been watch­ing, they've carefully avoided: that many women who get abor­tions consider themselves Pro-Life, and even feel the procedure is murder. This of course has long been the case, as we reported exclusively in the I 980s and early '90s, in a story the Times

declined to publish. Now, however, they're willing to report: Almost every abortion-clinic counselor can tell sto­

ries of patients who say that they have always opposed abortion but that their own situation is different, or men who bring their pregnant wives or teenage daughters to the same clinics that they long have spoken out against.

0.0., a 26-year-old Boston woman, said that she S_QOlE!_,irTl�� h�d to argue_ h�r_p_r_o-choice position with her boyfriend in the past, but that his� view c:hanged when

continued on page 8

PROBE

Circulation: Tom Gilgut

Editor and Publisher David R. Zimmerman

Comptroller Veva H. Zimmerman

PROBE is written and published independently, on a monthly schedule. Subscription: $60 per year. Editorial office: 139 West 13th St., New York City, NY 10011-7856. Phone: 212-647-0200. For subscriptions, Box 1321, Cathedral Station, New York, NY 10025. Opinions expressed are those of the Editor and Publisher, unless otherwise indicated. Contents of this newsletter may not be reproduced without permission. ISSN 1062-4155

Internet address: PROBENEWSLETTER.COM

Probe

-,-------- - --~-----~

Page 3: $5 Controversial AIDS Trials Advance; New England Journal

I Researchers Bristle at Journal's Stance I Infectious disease specialists working on overseas AZT studies to prevent mother-to-infant AIDS transmission were infuriated by the New England

Journal's dismissive attitude. Study coordinator Neal A. Halsey, M.D., of Johns Hopkins, said by phone that a Nov. 13 NEJM editorial by J. Kassirer and M. Angell justifying their right to publish their individual opinions on the AZT tri­als is "an embarrassment to the scientific community."

the NEJM's erratic stance - they have published other, similar, placebo-con­trolled foreign studies that would be unethical in the U.S. - represents "an unbelievable loss of face" for the Joumal. He said he was "amazed" by what the editors are doing, and said he suspects they have withheld publication of letters criticizing their stance because they were "scathing."

lancet (Nov. 22) that criticized Angeli's insistence that in randomized clinical tri­als abroad the control group must be given the best available treatment, rather than a placebo.

"If her arguments are accepted," the 39 signers, most or whom were from the Third World, said, .;then the implications for medical research on the health prob­lems of poor countries are profound. Many cheap interventions that have been shown to reduce mortality and morbidity

A colleague added, off the record, that

Some critical letters have been printed elsewhere. Thirty-nine researchers from around the world signed a letter in The continued on page 5

Fracas. ••

continued from page 1 Dec. I meeting. This request was honored; Varmus's piece appeared in the Oct. 2 NEJM.

The Joumal chiefs' disregard for the crucial AIDS research prompted two NEJM board members to resign: AIDS virolo­gist David Ho, M.D., head of the Aaron Diamond Research Institute in Manhattan, quit at once. Pediatric AIDS specialist Catherine Wilfert, M.D., of Duke University, in Durham, N.C., resigned as of year's end. She waited, so that she could attend the Dec. J Editorial Board meeting to protest the publica­tion's anti-research stance and the chief editors' high-handed practices: Neither she nor Ho had been asked for their views on Angeli's piece, albeit both are internationally known AIDS experts.

According to the minutes, Wilfert came to argue that:

The Editorial Board should play a more active role in determining editorial policy of the NEJM. Specifically, she called for a procedural change which would require editors to consult members of the Editorial Board before publishing controversial editorials.

The editors, she said, are often out of their depth when dealing with fields outside their own expertise, and should call upon the 'collective expertise' of the Editorial Board for their opinions about potentially controversial material before it is published. She noted that the Journal's 'one-sided' view of the government-funded [AIDS] trials could have disastrous consequences for all HIV studies outside the U.S. She also noted that Wolfe and [his co-author, family practitioner Peter] Lurie [M.D.,] had publicized their criticisms of the U.S.-funded studies months before their Journal article appeared - a clear violation, she said, of the lngelfinger Rule.

That rule says the Journal will not publish research reports that have been partly or wholly published elsewhere.

Kassirer rejected Wilfert's criticism and her proposed editorial changes.There is no indication in the minutes that he acknowledges that eit�er substaqtive or procedural errors were made.

A discussion followed. The minutes indicate that Angell remained silent. The minutes say:

February 1998

Members of the Board discussed the issues. Many expressed admiration for Dr. Wilfert for showing up at the meeting to make her stand. Some voiced confusion about why, exactly, she was resigning from the Board. Dr. Steven Schroeder was particularly supportive of Dr. Wilfert's position, suggesting that the editors solicit the Board's 'friendly criticism' before publishing controver­sial editorials. Dr. David Hillis dissented, noting that while he disagreed with Dr. Angeli's opinion, he had no problem with the editorial process.

Dr. Wilfert ended the discussion by reiterating her position. She then left the meeting.

Angell, meanwhile, had already lashed back at her critics in a Wall Street Joumal (WSJ) op-ed piece (Oct. 28), in which she continued to argue that the Third World AIDS studies are comparable to Tuskegee. In it, black American men with syphilis were examined periodically, but were not treated, even when penicillin, which is effective against syphilis, became available.

Angell said that now, as then, the unavailability or a useful treatment, such as penicillin or AZT, in the community al large does not justify withholding it from human subjects who are under researchers' care:

"The misfortunates of the larger population do not justify exposing people in [the researchers'] care to preventable risks."

Angell Not Persuaded Angell acknowledges that Third World women in the studies,

unlike black men at Tuskegee, are getting treatments that "may be of great benefit" - both to them, and to others who follow, provided the low-dose AZT works. But this fails to persuade her the AZT studies are ethical. While she offers no scientific or logical objection in her op-ed piece, she argues from the Tuskegee analogy that the means are not justified by the ends

continued on page 4

PROBE. Has Web Site! You can now find PROBE in hyperspace. Our web

address is:

WWW.PROBENEWSLETTER.COM

Page 3

Page 4: $5 Controversial AIDS Trials Advance; New England Journal

Fracas ... continued from previous page

of improved knowledge.

(Our view, opposed to Angeli's, is this: Take JOO women

walking into a prenatal clinic in a Third World country. If

untreated, 25 might be expected to infect their babies, based on

previous findings. If the low, unproven AZT dose is half as

effective as the proven high dose - which cuts infections to

8% in the U.S. - then the infection rate in the treated mothers

will be I 6%: Eight mothers will bear uninfected babies

who otherwise wouldn't have. That's a prospect for real and

significant benefil for the experimental subjects. Thus, the

means immediately benefits women/children, as do the ends -

validation of an affordable, low-dose regimen.)

Ho Resigns AIDS researchers challenge Angell on both scientific and

ethical grounds. David Ho told Time (Sept. 29) that the

comparison of the AIDS studies to Tuskegee is "inflammatory

and unfair." He added:

"Insisting on the infeasible in the name of ethical purity is

counterproductive in the struggle to stop this deadly virus."

Many researchers have written letters of protest to the

Journal, colleagues say. Despite the matter's urgency, more

than four months after Wolfe's and Angeli's objections were

published on Sept. 18, the Journal has not published any of the

letters. Journal sources have said the usual gap between an•

article and critical letters about it is about eight months. But

the Journal also has well-publicized procedures to publish

urgent material much more rapidly.

Kassirer and Angell seem not to think the research commu­

nity's defense of the ongoing AIDS studies is an urgently

pressing matter. ■

NEJM Editor

Stands Pat The following excerpt is from the minutes of the December

1, 1997 meeting of the New England Journal of Medicine

Editorial Board:

Dr. [Jerome] Kassirer (Editor-in -chief] opened the

meeting shonly before 9 a.m. and . . . remarked on

changes in the Editorial Board. Dr. David Ho resigned

.. . in protest over an editorial by [Executive Editor Dr. Marcia] Angell about the ethics of some federally funded

studies in the Third World, and Catherine Wilfert's resig­

nation over the same issue will become effective at the

end of December ....

Dr. Kassirer teviewed the events leading up to the

resignations . . . . Briefly, the Journal published a group

of articles on Sept. 18 that included a Sounding Board

article by Drs. Sidney Wolfe and Peter Lurie, and an edi­

torial by Dr. Angell, both of which criticized the U.S. gov­

ernment for sponsoring placebo-controlled HIV studies

in the Third World. Later that week, Dr. Wilfert wrote to

Dr. Kassirer, expressing dismay that [they] ... had been

Page 4

Probe's View Our quarrel with Drs. Kassirer and Angell is not with their editorial procedures, which are their business and those of

the Journal's owners, the Massachusetts Medical Society. We

do think they are being disingenuous, naive - or unduly mod­

est - when they insist, as they recently have, that the editori­

als they write and sign express only their own opinions, and noc

the Journal's. Their titles, and hence their published words

carry enormous cachet inside and outside of medicine. They embody the Jouma/'s authority even when they claim to speak

only for themselves.

The far more important issue is Editor-in-chief Kassirer's

failure to grapple with - or, better, disagree with - Angeli's

attack on a vital, urgently needed AIDS research program.

Hundreds of Third World infants contract AIDS Jrom their

mothers each day! Almost all will die. Yet, as indicated by the

NEJM Editorial Board minutes, excerpted below, Kassirei· is

dodging this issue. He shouldn't. Shattuck Street shouldn't be

an ivory tower!

Yet, it's still business as usual there. How else interpret the

Journal's long delay in publishing at least some of the many

angry letters submjtted by researchers, denouncing the Wolfe­

Angell attack on the drug trials. It usually takes six to eight

months for letters to see print in the Journal, and Kassirei·

seems unwilling to push up publication of these communiques.

As for Angell: Her position makes no scientific or ethical

sense to us. Her willingness to censure her colleagues - the

researchers in the labs and clinics, here and abroad - is shock­

ing. It suggests she might be more comfortable hosting a TV

medical talk show than she is serving as Executive Editor of

what long has been the world's best regarded medical research

journal. - D.R.Z.

published with no opposing viewpoint represented, and

without consulting the Editorial Board ....

In the meantime ... a copy of Dr. Angeli's editorial

reached NIH Director Harold Varmus, who lobbied vehe­

mently for the opportunity·to· publfsh a-defense··orthe

government-sponsored studies. The Journal published

[it] ... on October 2 ....

Dr. Kassirer yielded the floor to Dr. Wilfert, who

argued that the Editorial Board should play a more active

role in determining editorial policy of the NEJM.

Specifically, she called for a procedural change which

would require editors to consult members of the

Editorial Board before publishing controversial editori­

als. The editors, she said, are often out of their depth

when dealing with fields outside their own expertise, and

should call upon the 'collective expertise' of the Editorial

Board for their opinions about potentially controversial

material before it is published. She noted that the

Journals one-sided view of the government-funded tri­

als could have disastrous consequences for all HIV stud­

ies outside the U.S. She also noted that Wolfe and Lurie

had publicized their criticisms of the U.S.-funded studies

months before their Journal article appeared - a clear

violation, she said, of the lngelfinger Rule.

Dr. Kassirer distilled from Dr. Wilfert's criticisms

continued on following page

Probe

..

Page 5: $5 Controversial AIDS Trials Advance; New England Journal

Trials ... continued from page 1

group, then the clinical researchers would have concluded -

quite erroneously - that the low-dose regimen works equally

well, and therefore should be accepted as the standard care

throughout the Third World.

Recruitment is Complete One small study, of course, would not be conclusive, which

is why interest focused next on the larger Thai University Hospital study, co-sponsored by CDC, of roughly 200 low-dose AZT mothers and 200 no-dose control mothers. This study has

completed its patient enrollment.

All the babies have been born, Nieburg told PROBE. But

since AIDS can't be reliably diagnosed in infants using stan­dard tests until 6-8 weeks post partum, the data are not com­

plete. The investigators have not broken the code to learn which women got AZT and which didn't.

React ... continued from page 3 could never have been properly evaluated . . . [or] widely accepted."

They cite oral rehydration for diarrhea, vitamin A supple­

mentation for children, and "syndromic treatment" of sexually transmitted diseases.

Another correspondent, in the same lancet issue, claims Protocol 076, the U.S. standard of care advocated by Wolfe and Angell, would be "unfeasible and unethical" in Africa, since it requires bottle-feeding, which is hard to get, and dan­

gerous for babies in places where clean water for formula often

continued from the previous page three questions for discussion: (1) should the editors seek opposing viewpoints and try to present 1balance' In Journal opinion pieces?; (2) should Editorial Board members s1gn off on editorials?; and (3) should the Journal publish viewpoints which have been expressed elsewhere?

To the first question, Dr. Kasslrer replied that some­times, over time, the Journal does achieve 1balance' on controversial Issues, and sometimes it does not. It is not, he noted, something to which the Journal aspires.

On the second question, Dr. Kassirer vigorously dis­agreed with Dr. Wilfert. Many of the editorials and Sounding Board articles published in the ./ournal are controversial, he noted, and to ask Editorial Board mem­bers to approve each one would be impractical, given the Journars tight production schedule. Further, he argued that such involvement by the Editorial Board would Infringe on the editors' independence. He noted that edi­tors frequently consult individual board members for advice, but he strenuously opposed institutionalizing this practice.

To the third question, Dr. Kassirer explained that whlle the Journal does, indeed, have a strict prior publi­cation policy, editors have the discretion to publish dif­ferent versions of important points of view that have been expressed elsewhere. ■

February 1998

However, this double-blind control trial, like others, has a

safety feature: an independent Data Safety and Monitoring

Board (DSMB). This one met late in January, at the National

Institutes of Health (NIH). The board has the coded data and

the codes. So it is prepared to stop the trial early if the prelim­

inary data show that the intervention is unequivocally success­

ful, or alternatively, if unanticipated harm is found.

The earlier U.S. trial, Protocol 076, which proved the effica­

cy of high-dose AZT, was stopped in just this way: The moni­

tors decided that the early results proved AZT's efficacy - so

that it then would no longer be ethical to deny it to the control women, or for that matter anyone else who could afford the

$1,000 cost. The present DSMB decided that the Thai University study

has not yet shown that low-dose AZT is beneficial enough or dangerous enough to stop it now, a CDC spokeswoman told PROBE. So it, like a dozen other studies in Third World nations around the world, will continue until the DSMB, which meets again in the spring, stops it. Or, it will continue until all the data are collected and analyzed for scientific presentation.■

can't be found. Halsey and three Johns Hopkins colleagues published a

rebuttal in the British Medical Journal (Oct. 18) saying

Angell's "medical and ethical imperialism" would "prevent developed countries from collaborating with developing countries to identify practical and affordable health interven­tions."

One U.S. scientist claimed to be worried that Angell is cherry-picking the letters of protest reaching the NEJM, in an effort to publish some that support her views. In response, PROBE has learned, some researchers are considering an effort to collect and publish critical missives that the NEJM doesn't run. ■

Andrew Weil Is Called A 'Snake Oil' Salesman The last time we spoke to former New England Journal editor Arthur Reiman, M.D., a lawsuit filed against him by an alterna­tive care provider had just been quashed. Reiman was ·relieved.

We asked him then if he would speak out again against health fraud and quacks. He said he might be more cautious in the future, but, if need be, he still would speak his mind. For this reason, we're pleased to note that when the writer of a New York Times Magazine cover article on alternative health guru Andrew Weil, M.D. - who apparently has no recognized med­ical specialty - called internist Relman to ask about Weil, the ex-editor replied:

"Throughout history people have wanted to believe that there are easy, natural ways to defeat disease, and there have always been people like Andrew Weil who peddle a variety of snake oil .... "

The Weil piece by Times Mag first-timer Larissa MacFarquhar was refreshingly skeptical for a newspaper that is becoming more and more attentive to alternativists. ■

Page5

Page 6: $5 Controversial AIDS Trials Advance; New England Journal

I Scientists' Book Deconstructs By Alan Sokal and Jean Bricmont We have been surprised and distressed by the intellectual trends in certain precincts of American academia. Vast sectors of the humanities and the social sciences seem to have adopt­

natural sciences. The quoted passages are absurd or meaning­less, but they are nonetheless authentic. In fact, Sakai's only contribution was to provide a "glue" (whose "logic" is admit­tedly whimsical) relating these quotations to each other. And

ed a philosophy that we will call, for lack of a better term, "postmodernism": an intellectual current characterized by the more-or-less explicit rejection of the rationalist tradition of the Enlightenment; by theoretical discourses disconnected from any empirical test; and by a cogni­tive and cultural relativism that treats sci­ence as nothing more than a "narration," or "myth," or a social construction among many others.

To react to this phenomenon, one of us (Sokal) decided to try an unorthodox (and admittedly uncontrolled) experi­ment: Submit to a fashionable American cultural-studies journal, Social Text, a parody of the type of work that we've seen proliferate, and see whether they would publish it. ...

Article Was Published The article was accepted and published

- and in a special issue of that journaldevoted to refuting scientists' criticismsof postmodernism! For the editors ofSocial Text, it was hard to imagine amore radical way of shooting themselvesin the foot.

The hoax was immediately revealed by Sokal himself, provoking a firestorm of reaction in both popular and academic publications. Many young (and not-so­young) researchers in the humanities and social sciences wrote, sometimes very movingly, to thank him and to express their rejection of the postmodernist and relativist tendencies dominating large parts of their disciplines.

Emperor Is Naked

Introduction: The cleverest riposte

against academic anti-science intellec­

tuals - or postmodernists, or relativists,

as they sometimes are called - was the

hoax perpetrated two years ago by

physicist Alan Sokal, Ph.D., of New

York University on the editors of the

cultural studies journal Social Text.

Sokal submitted, and Social Text unwit­tingly published, an article chock full of

postmodernist jargon, absurdities, and

non-sequiturs. Sokal's hoax was inel­

uctable nonsense from start to finish.

But the duped Social Text editors failed

to catch on - and published the essay

as serious criticism of science. Sokal's hoax was a howl in academic

magazines and in the general press for

months.

Now, he and a Belgian colleague,

Jean Bricmont, D.S., a mathematic�

physicist at the University of Louvain,

have taken a major new step in decon­

structing the deconstructionists and

other postmodernists, whose leading

thinkers have been French intellectu­

als, including Jacques Derrida, Jacques

Lacan, and Bruno Latour. The Sokal­

Bricmont book, Impostures Intellec­

tuelles (lntellectuaJ Impostures) was

published in French in Paris last year by Editions Odile Jacob. An English edition is planned.

PROBE is pleased to present here an

excerpt, abridged from the forthcom­

ing English edition. It is the first piece

of Intellectual Imposters to be published

in the U.S.

among the cited authors one finds a ver­itable pantheon of contemporary "French Theory": Gilles Deleuze, Jacques Derrida, Felix Guattari, Luce Irigaray, Jacques Lacan, Bruno Latour, Jean-Fran�ois Lyotard, Michel Serres, and Paul Virilio.

Since the quotations in the parody were rather brief, Sokal subsequently assembled a series qf lQ_nger te_xts t9 ___ _ illustrate these authors' handling of the natural sciences, and he circulated these texts among his colleagues. Their reac-tion was a mixture of hilarity and disbe-lief: They could hardly conceive that anyone could write the nonsense on the page in front of them. At the same time, several non-scientist readers suggested that one should explain, in lay terms, exactly why the cited passages are absurd.

Dishonesty Seen The goal of this [book] is to make a

limited but, we hope. original contribu­tion toward the critique of the admitted­ly vague Zeitgeist that we have called "postmodernism." We make no claim to analyze postmodernist thought in gener­al; our aim is rather to call attention to a relatively little-known aspect, which nevertheless reaches the \eve\_of inte\­lectual dishonesty, namely the repeated abuse of concepts and terminology com­ing from mathematics and physics.

More generally, we shall analyze cer­tain confusions of thought that are fre­quent in postmodernist writings and which bear on either the content or the philosophy of the natural sciences.

One student, who had financed his own studies, felt that he had spent his money to acquire the clothes of an emperor who, as in the fable, is naked. Another student wrote that he and his colleagues were thrilled, but asked that his sentiments be held in confidence because he wanted to help change his discipline - which he could do only after obtaining a perma­nent job.

'Abuse' Defined

The parody was constructed around quotations from emi­nent French and American inteliectuals concerning the alieged philosophical and social implications of mathematics and the

Page6

To be precise, the word "abuse" here denotes one or more of the following characteristics:

1) Holding forth at length on scientific theories about whichone has, at best, an exceedingly hazy idea. The most common tactic is to use scientific (or pseudoscientific) terminology without bothering much about what the words actually mean.

2) Importing concepts from the natural sciences into thecontinued on following page

Probe

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Anti-Science Postmodernism humanities or social sciences without giving the slightest con­ceptual or empirical justification. A biologist who wanted to apply, in his or her research, elementary notions of topology, set theory, or differential geometry would be asked to give some explanation. A vague analogy would not be taken very serious­ly by his or her colleagues. Here, by contrast, one learns from Lacan that the structure of the neurotic subject is exactly the torus (it is reality itself!); from Julia Kristeva one learns that poetic language can be theorized in terms of the cardinality of the continuum; and from Jean Baudrillard one discovers that modern war takes place in a non-Euclidean space.

3) Showing off a superficial erudition by shamelesslythrowing around technical terms in a context where they are comp\ete\y irre\evant. The goa\ is, no doubt, to impress and especially to intimidate the non-scientist reader.

4) Manipulating phrases and sentences that are, in fact,devoid of meaning. Some of these authors are truly intoxicat­ed by words, and utterly indifferent to their meaning.

These authors speak with a self-assurance that far outstrips their competence. They imagine, perhaps, that they can exploit the prestige of the natural sciences to give their own discourse a veneer of rigor. Moreover, they seem assured that no one will notice their abuse of scientific concepts. No one

Wildlife Refuge Plans For the Korean DMZ Inch Slowly Forward

New needs and new movers are advancing plans for a wildlife refuge in the Korean Demilitarized Zone (DMZ).

The DMZ is the 4-kilometer wide, 250-kilometer long no­man's land that divides North and South Korea where the guns of war fell silent more than forty years ago.

No peace treaty has· as yet been signed; the two sides con­tinue to confront each other warily, and militarily, across the line. But without farming and other civilian development, the DMZ has become, de facto, a major wildlife refuge, the only wintering place for the rare red-crowned crane (Grus japonen­

sis) and the white-naped crane (G. vipio), as well as a refuge for a host of other endemic animals and plants.

Peace Risks Seen

Prospects of a peace treaty between North and South Korea, and the latter's U.S. and U.N. allies, have raised new fears that without the facing armies and the tens of thousands of land mines they have seeded in the soil, farmers and other develop­ers will return and plow up the DMZ. Efforts to forestall this development, and preserve it for wildlife and as a monument to the war dead, began in the I 960s. They have advanced slowly since then. U.S. and international conservationists, working

February 1998

is going to cry out that the king is naked.

Aim Is Described

Our goal is precisely to say that the king is naked (and the queen too). We have no wish to attack philosophy, the humanities or the social sciences in general; on the contrary, we feel that these fields are of the utmost importance, and we want to warn those who work in them (especially students) against some veritable charlatans. In particular, we want to "deconstruct" certain texts' reputation of being difficult because they are so profound. In many cases we can demon­strate that if they seem incomprehensible, it is for the excel­lent reason that they mean precisely nothing.

Let us stress that there are many different degrees of abuse. At one end, one finds ex�lations of scientific concepts beyond their domain of validity that are erroneous but for subtle reasons. At the other end, one finds numerous texts that are full of scientific words but entirely devoid of mean­ing. Our goal is to stimulate a critical attitude, not merely towards certain individuals, but towards a part of the intelli­gentsia - both in the U.S. and in Europe - that has tolerat­ed and even encouraged this type of discourse.• ©1997, by Jean Bricmont and Alan Sokal. All rights reserved.

with colleagues in South Korea, have found it difficult to con­verse or reach agreements with officials from the North.

New interlocutors, however, may facilitate this dialogue: Plans for the DMZ's preservation are now in the hands of Korean­American scientists, particularly entomologist Ke Chung Kim, Ph.D., of Penn State's Center for BioDiversity Research, in University Park, Pa. He reported recently in Science (Oct. 10) that the DMZ preserve now is more needed than ever, because of the loss of much of South Korea's wildlife outside the Zone. A recent survey of South Korea, which he designed, found that development has eliminated or endangered 14% of the bird species, 29% of the mammals, 48% of the reptiles.

New Uses Foreseen

Now, Kim said in a phone interview, the only source of bio­logical stock to repopulate South Korea, and equally if not more-severely depopulated areas in the North, is the DMZ. It is not just a conservation gem, worth saving in its own right, but a unique resource for the rest of the peninsula.

Kim has assumed a leadership role in creating a Korean Peace Bioservices Sy stem, and has been in touch with profes­sional colleagues in both the North and South. He hopes to bring them together at a conference in the U.S. later this year.

# # #

We've visited the DMZ with crane conservationist George Archibald, Ph.D., of Baraboo, Wisc. It's a place of awesome beauty between opposing cannons, and we're hopeful that it, like other battlefields that have long been off limits to civil­ians, can be set aside for wildlife, future generations. -D.R.Z.

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Follow-up ... continued from page 2

she got pregnant. 'He was anti-abortion until it happened to him,' she

said, adding that he ... had brought her to the clinic.

This is precisely what we discovered more than a decade ago,

and published in our pilot issue in June, 1989.

If other newspapers and 1V were to follow the Times' lead, and

report this story in their catchment areas, it would further

de-politicize the abortion debate. This could save the lives of some

abortion providers, who now feel hunted by Pro-Life crazies, like

last month's Birmingham, Ala. clinic bombers. (Striving, as always, for "balance," on Jan. 21, the Times

front-paged a propagandistic story about "Rock for Life," a band

that raises money for Pro Life with rock and roll concerts.)

###

-

Diagnoses Compared PROBE's pre-arrest literary diagnosis of the Unabomber,

based on his "manifesto": paranoid with idee fixe; very

obsessed, very dangerous (Feb. '96).

Forensic psychiatrist Sally C. Johnson, M.D.'s clinical

diagnosis, last month, based on a week's interviews with

Theodore Kaczynski: paranoid schizophrenia.

The abiding fact in the Unabomber case is that the FBI

long ago had more than enough clues to identify and arrest

him, without need for his family to have turned him in.

Now that it is squarely on the record that both sides -

Pro Choice and Pro Life - get abortions, how many more

years will it take for a Times editorialist to ask the obvious

question: "So what's the big deal!" •

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