Book Review

Rethinking AIDS: The Tragic Cost of Premature Consensus

N Engl J Med 1994; 330:71January 6, 1994

Article

Rethinking AIDS: The Tragic Cost of Premature Consensus
By Robert Root-Bernstein. 512 pp. New York, Free Press, 1993. $27.95. ISBN: 0-02-926905-9

Although the vast majority of scientists believe that the human immunodeficiency virus (HIV) is the cause of AIDS, a minority believe, equally strongly, that the cause of AIDS is more complex and as yet only partially understood. Thus far, this disagreement has been played out largely in a public and rancorous debate. Dr. Root-Bernstein has attempted in this book to present in objective detail his argument that HIV is neither necessary nor sufficient to cause AIDS. Instead, he argues that a whole host of factors including age, malnutrition, receipt of blood, rectal exposure to semen, and prolonged or repeated use of antibiotics, acting either as cofactors with HIV or in its absence, can induce an autoimmune state that leads to the syndrome we call AIDS.

As a scholarly work, I found this book lacking in several important respects. This is a largely theoretical work. The author takes more than 500 pages to develop his argument, and much of it is repetitive. Despite the book's length and abundant references to the literature, a mere 2 tables and 18 figures are included. Several of these are, by the author's own admission, composite figures based on pooling of “representative” data. Much of Dr. Root-Bernstein's argument seems to rest on his own work, which he describes only in a very general way. References to it consist of repetitive citations of a few key papers and several others that have been submitted for publication but not yet peer-reviewed.

Thus, I was left with the sense that I had invested a good deal of time and effort in reading about a theory that, although interesting, appears to be at a very rudimentary stage. A much shorter, tighter work should have been possible without sacrificing the author's main arguments, and such a book would have been much more attractive to busy readers.

Despite its drawbacks, those who are involved in AIDS research, especially those likely to be asked to comment on the controversy about the cause of AIDS, may find this book useful. Dr. Root-Bernstein provides enough of a substantiated conceptual framework to permit readers to understand the several different schools of thought among “HIV skeptics” and to form a basis for further discussion. However, the overall lack of scientific rigor in this work and its unconventional format as a book rather than a series of peer-reviewed papers or a monograph are unlikely to make it convincing to many in the scientific community.

Deborah J. Cotton, M.D., M.P.H.
Harvard School of Public Health, Boston, MA 02115