HIV & Duesberg Phenomenon - Case Notes

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Author - Tom Huber - Summer 1997

Background The intent of this case is to allow students to see how science "works out" disagreement and addresses the concerns of dissenting scientists. It also allows students to evaluate the kinds of arguments and evidence used to support a position in the natural sciences. If the second section is also used, students will compare research papers concerning a topic related to AIDS from the natural, behavioral, and social sciences.

The case does not fit well with any chapters of Ziman, although the second section can be used to illustrate and evaluate Ziman’s last chapter. The case is best conducted near the end of the semester, since it requires considerable work on the students’ part in researching the topics.

Other than the original pair of articles, the most important background sources are those that summarize how HIV defeats the immune system, and how the human immune system works under normal circumstances. This material is conveniently located in the following two articles, included in this package:

As more recent articles are published, these can be updated accordingly. The use of the paper by Deng et al. (Deng, H., R. Liu, W. Ellmeier, S. Choe, D. Unutmaz, M. Burkhart, P. DiMarzio, S. Marmon, R.E. Sutton, C.M. Hill, C.B. Davis, S.C. Peiper, T.J. Schall, D.R. Littman and N.R. Landau. 1996. Identification of a major co-receptor for primary isolates of HIV-1. Nature 381: 661-666) during the second week demonstrates how we constantly have to revise the "narrative" we tell about life. The information presented in this paper, and the paradoxes it resolves, are barely mentioned in the review paper and the book chapter!

Student Materials The case does not use a written scenario. Instead, it involves the use of papers from the literature. A copy of each paper listed in the References section of the Cover Sheet is in the SCI archive together with copies of the seven possible papers for a second week of activities. The archive also includes two overhead transparencies: one with a model of HIV and one that verhead masters summarizes the interactions of the human immune system.

Teaching notes

First day: Students are given the pair of opposing papers (Blattner, W., R.C. Gallo, and H.M. Temin. 1988. HIV causes AIDS. Science 241: 515 and Duesberg, P. 1988. HIV is not the cause of AIDS. Science 241: 514) and responses (Blattner, W., R.C. Gallo, and H.M. Temin. 1988. Blattner and colleagues respond to Duesberg. Science 241: 514 & 517 and Duesberg, P. 1988. Duesberg’s response to Blattner and colleagues. Science 241: 515-516). Working in groups of four, they are asked to read the papers and generate a list of what they know with confidence about HIV and AIDS and what they need to learn more about. The students work in their small groups, attempting to identify issues that are important to the papers, as well as to identify the terms, concepts, and information needed to resolve the problem as they see it. Then, the class is brought back together. During a general discussion, the following questions should be expected and listed on the board:

With coaxing, the questions can be folded into four basic areas for additional library research:

  1. What are viruses (and retroviruses) and how do they replicate and survive? What are the different forms of a virus (free virus, provirus, etc.) and of what importance is this to HIV and AIDS? What other constituent parts of HIV are important to the disease process?
  2. How does the human immune system work? What are the different components of the immune system, how do they interact with each other, and how do they recognize and respond to foreign material?
  3. What is a disease syndrome? What is the clinical definition of AIDS? What is the epidemiology of AIDS? How do you "get" AIDS?
  4. What is the disease course of AIDS? How does an AIDS test work? When are the results reliable? What are Koch’s postulates and how do they relate to a disease?

Students are then asked to find the answers to the questions in these groups using library resources before the next class period. Each student within a team attempts to answer one of the four groups of questions. Suggested resources should include: general biology texts, GALILEO, General Science Index, and introductory immunology texts. The text books should be on closed reserve in the library.

Second day: A general discussion that focuses on the four groups of questions to ascertain what the students have learned about HIV and AIDS. Students present their information and summarize the issues as they see them. A few additional papers can be passed out to be certain that all students will have information at an appropriate level of sophistication. These could include: Duesberg, P. 1991. AIDS epidemiology: Inconsistencies with human immunodeficiency virus and with infectious disease. Proceedings of the National Academy of Science, USA 88: 1575-1579; Moore, J. 1996. A Duesberg adieu! Nature 380: 293-294; Nowak, M.A. and A.J. McMichael. 1995. How HIV defeats the immune system. Scientific American Aug. 1995: 58-65; Richardson, S. 1997. Crushing HIV. Discover 18 (Jan. 1997): 28-29 and Richardson, S. 1997. The Second Key (HIV virus receptors). Discover 18 (Jan. 1997): 29-30. Also, an overhead that summarizes HIV and the working of the immune system could be used (see inclusions). Students are again placed into their groups and asked to identify any new issues, terms, or information that is needed. Additional assignments are made and students use library resources to complete them.

Third day: Students meet in their groups and discuss the latest information they’ve found. A final assignment is given to them. It should be made clear that this assignment must be typed and turned in. As a group, they should evaluate and respond to each of the nine points that Duesberg makes in his original Science article. They should cite supporting evidence and make the strongest argument possible. During class, they should write their initial responses longhand. After class, one member should refine and type up the answers to be turned in the next class day. If continuing with the second week, the paper "Identification of a major co-receptor for primary isolates of HIV-1" by Deng et al. should be passed out, in order to be read before the next meeting.

Fourth day: If desired, a second set of papers can be read during the second week. A single paper will be the focus each day, with papers from the natural sciences, behavioral sciences and social sciences constituting the reading material. The goal this second week is to compare and contrast the nature of the research in the different disciplines. Special attention should be paid to:

  1. The kinds of questions addressed by each discipline;
  2. The specific question(s) addressed in each paper;
  3. The different approaches evident in the research designs;
  4. The use(s) of mathematics in each study;
  5. The style of the research report;
  6. The types of knowledge added by each report;
  7. The reliability of the knowledge added by each report.

Since students now have a somewhat sophisticated understanding of HIV and the course of the infection process, they should be able to grasp the issues in the first paper, "Identification of a major co-receptor for primary isolates of HIV-1" by Deng et al., although some of it will still be beyond their understanding. Working in groups of four, they should prepare responses to the seven issues raised above, assigning a scribe to record and, eventually, report their ideas. After listing answers on the board, a general discussion led by the faculty member should follow. One of the papers listed for fifth day should be passed out as assigned reading before the next class period.

Fifth day: One of these three papers (or another chosen by the instructor) can be discussed:

The same procedure as described for the previous day can be followed. One of the papers listed for sixth day should be passed out as assigned reading before the next class period.

Sixth day: One of these three papers (or another chosen by the instructor) can be discussed:

The same procedure as described for the previous day can be followed. Assign chapter 7 of Ziman for (re)reading before the next class day.

Seventh day: After rereading chapter 7 of Ziman (Social Knowledge) before class, students should discuss the issues raised by Ziman as evidenced in the three previous papers, one from each of the natural, behavioral, and social sciences. Comparisons and contrasts should be made.