MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

doctors

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I have been sent a press release dated 26/5/2022 that might interest some of my readers. As it is in German, I took the liberty of translating it:

The 126th German Medical Congress today in Bremen deleted the additional designation of homeopathy from the further education regulations for doctors (MWBO). The request brought by Bremen delegates was decided by the physician parliament with a large majority.

The Bremen delegates justified their request with the fact that 13 of 17 state medical associations have already deleted the additional designation of homeopathy from their further education regulations. The further education regulation is to create uniform rules for the post-graduate training of doctors. However, there is no longer any question of uniformity if 13 state medical associations do not follow the MWBO.

In the debate, Dr. Johannes Grundmann once again pointed out that it is not a matter of prohibiting people from using homeopathic remedies. “However, it is the task of the medical associations to define and check verifiable learning objectives,” Grundmann said to great applause.

In September 2020, the Bremen Medical Association had become the first such chamber in Germany to remove homeopathy from its education regulations. The complaint of a Bremen physician against it had subsequently been rejected in two instances. Most recently, the Bremen health insurance was the first to terminate three selective contracts for the remuneration of homeopathic services.

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I feel that this is a nice victory of reason over unreason. I might even go as far as assuming that our petition of 2021 might have helped a little to bring it about:

Dear President Dr Reinhardt,

Dear Ms Lundershausen,

Mrs Held,

Dear Ms Johna,

We, the undersigned doctors, would like to draw your attention to the insistence of individual state medical associations on preserving “homeopathy” as a component of continuing medical education. We hope that you, by virtue of your office, will ensure a nationwide regulation so that this form of sham treatment [1], as has already happened in other European countries, can no longer call itself part of medicine.

We justify our request by the following facts:

    1. After the landmark vote in Bremen in September 2019 to remove “homeopathy” from the medical training regulations, 10 other state medical associations have so far followed Bremen’s example. For reasons of credibility and transparency, it would be desirable if the main features of the training content taught were not coordinated locally in the future, but centrally and uniformly across the country so that there is no “training tourism”. Because changes to a state’s own regulations of postgraduate training are only binding for the examination committee of the respective state, this does not affect national regulations but is reduced to only a symbolic character without sufficient effects on the portfolio of medical education nationwide.
    2. Medicine always works through the combination of a specifically effective part and non-specific placebo effects. By insisting on a pseudo-medical methodology – as is “homeopathy” represents in our opinion – patients are deprived of the specific effective part and often unnecessarily deprived of therapy appropriate to the indication. Tragically, it happens again and again that the “therapeutic window of opportunity” for an appropriate therapy is missed, tumors can grow to inoperable size, etc.
    3. Due to the insistence of individual state medical associations on the “homeopathic doctrine of healing” as part of the medical profession, we are increasingly exposed to the blanket accusation that, by tolerating this doctrine, we are supporting and promoting ways of thinking and world views that are detached from science. This is a dangerous situation, which in times of a pandemic manifests itself in misguided aggression reflected not just in vaccination skepticism and vaccination refusal, but also in unacceptable personal attacks and assaults on vaccinating colleagues in private practice.

[1] Homöopathie – die Fakten [unverdünnt] eBook : Ernst, Edzard, Bretthauer, Jutta: Amazon.de: Kindle-Shop

Responsible:

Dr. med. Dent. Hans-Werner Bertelsen

Prof. Dr. med. Edzard Ernst

George A. Rausche

_______________________________________

The first reported reactions from politicians are positive, while those of homeopaths are predictably the opposite:

German Health Minister Karl Lauterbach (SPD) expressly welcomed the delegates’ decision, writing via Twitter. “Good medicine stands on the ground of science. For homeopathy, there is no place there. In such a question, one must show one’s colors.”

Paula Piechotta, a Green Party member of parliament, was equally pleased. “… it is good when in times of Fake Facts and right-wing conspiracy theories clarity is provided where clarity is needed. Thank you Ärztetag,” she tweeted.

Michaela Geiger, chairwoman of the German Central Association of Homeopathic Physicians, noted the decision “with astonishment.” Homeopathy has a high acceptance among the population, she claimed.

 

This study used a US nationally representative 11-year sample of office-based visits to physicians from the National Ambulatory Medical Care Survey (NAMCS), to examine a comprehensive list of factors believed to be associated with visits where complementary health approaches were recommended or provided.

NAMCS is a national health care survey designed to collect data on the provision and use of ambulatory medical care services provided by office-based physicians in the United States. Patient medical records were abstracted from a random sample of office-based physician visits. The investigators examined several visit characteristics, including patient demographics, physician specialty, documented health conditions, and reasons for a health visit. They ran chi-square analyses to test bivariate associations between visit factors and whether complementary health approaches were recommended or provided to guide the development of logistic regression models.

Of the 550,114 office visits abstracted, 4.43% contained a report that complementary health approaches were ordered, supplied, administered, or continued. Among complementary health visits, 87% of patient charts mentioned nonvitamin nonmineral dietary supplements. The prevalence of complementary health visits significantly increased from 2% in 2005 to almost 8% in 2015. Returning patient status, survey year, physician specialty and degree, menopause, cardiovascular, and musculoskeletal diagnoses were significantly associated with complementary health visits, as was seeking preventative care or care for a chronic problem.

The authors concluded that these data confirm the growing popularity of complementary health approaches in the United States, provide a baseline for further studies, and inform subsequent investigations of integrative health care.

The authors used the same dataset for a 2nd paper which examined the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Descriptive estimates were employed of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians (N = 5622, weighted response rate = 59.7%). The endpoints were the reasons for the recommendation or lack thereof to patients for:

  • herbs,
  • other non-vitamin supplements,
  • chiropractic/osteopathic manipulation,
  • acupuncture,
  • mind-body therapies (including meditation, guided imagery, and progressive relaxation).

Differences by physician sex and medical specialty were described.

For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]).

For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]).

The authors concluded that there are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians’ decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.

I am not sure what these papers really offer in terms of information that is not obvious or that makes a meaningful contribution to progress. It almost seems that, because the data of such surveys are available, such analyses get done and published. The far better reason for doing research is, of course, the desire to answer a burning and relevant research question.

A problem then arises when researchers, who perceive the use of so-called alternative medicine (SCAM) as a fundamentally good thing, write a paper that smells more of SCAM promotion than meaningful science. Having said that, I find it encouraging to read in the two papers that

  • the prevalence of SCAM remains quite low,
  • more than 60% of all physicians recommended SCAM not because they were convinced of its value but because of patient requests,
  • the lack of perceived benefit was the most frequently reported reason for not recommending it.

During the last two years, I have written more often than I care to remember about the numerous links between so-called alternative medicine (SCAM) and COVID-19 vaccination hesitancy. For instance:

Whenever I publish a post on these subjects, some enthusiasts of SCAM argue that, despite all this evidence, they are not really against COVID vaccinations. But who is correct? What proportions of SCAM practitioners are pro or contra? One way to find out is to check how they themselves behave. Do they get vaccinated or not?

Here are some recent data from Canada that seem to provide an answer.

A breakdown of vaccination rates among Canadian healthcare professions has been released, based on data gathered from 17 of B.C.’s 18 regulated colleges. The findings are most revealing:

  • dieticians, physicians, and surgeons lead the way, with vaccination rates of 98%,
  • occupational therapists were at 97%,
  • Chinese medicine practitioners and acupuncturists were at 79%,
  • chiropractors at 78%
  • naturopaths at 69%.

The provincial health officer Dr. Bonnie Henry said the province is still working with the colleges on how to notify patients about their practitioner’s vaccination status. “We are working with each college on how to build it into professional standards. The overriding principle is patient status,” she told a news conference. “It may be things like when you call to book, you are asked whether you would prefer to see a vaccinated or unvaccinated professional. We are trying to protect privacy and provide agency to make the decision.”

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As far as I am aware, these are unique data. It would be interesting to see additional evidence. If anyone knows about vaccination rates in other countries of acupuncturists, herbalists, homeopaths, osteopaths, Heilpraktiker, etc. I would love to learn more.

Harad Matthes, the boss of the anthroposophical Krankenhaus Havelhoehe and professor for Integrative and Anthroposophical Medicine at the Charite in Berlin, has featured on my blog before (see here and here). Now he is making headlines again.

Die Zeit‘ reported that Matthes went on German TV to claim that the rate of severe adverse effects of COVID-19 vaccinations is about 40 times higher than the official figures indicate. In the MDR broadcast ‘Umschau’ Matthes said that his unpublished data show a rate of 0,8% of severe adverse effects. In an interview, he later confirmed this notion. Yet, the official figures in Germany indicate that the rate is 0,02%.

How can this be?

Die ZEIT ONLINE did some research and found that Matthes’ data are based on extremely shoddy science and mistakes. The Carite also distanced themselves from Matthes’ evaluation: “The investigation is an open survey and not really a scientific study. The data are not suitable for drawing definitive conclusions regarding incidence figures in the population that can be generalized” The problems with Matthes’ ‘study’ seem to be sevenfold:

  1. The data are not published and can thus not be scrutinized.
  2. Matthes’ definition of a severe adverse effect is not in keeping with the generally accepted definition.
  3. Matthes did not verify the adverse effects but relied on the information volunteered by people over the Internet.
  4. Matthes’ survey is based on an online questionnaire accessible to anyone. Thus it is wide open to selection bias.
  5. The sample size of the survey is around 10 000 which is far too small for generalizable conclusions.
  6. There is no control group which makes it impossible to differentiate a meaningful signal from mere background noise.
  7. The data contradict those from numerous other studies that were considerably more rigorous.

Despite these obvious flaws Matthes insisted in a conversation with ZEIT ONLINE that the German official incidence figures are incorrect. As Germany already has its fair share of anti-vaxxers, Matthes’ unfounded and irresponsible claims contribute significantly to the public sentiments against COVID vaccinations. They thus endangering public health.

In my view, such behavior amounts to serious professional misconduct. I, therefore, feel that his professional body, the Aerztekammer, should look into it and prevent further harm.

WARNING: SATIRE

This is going to be a very short post. Yet, I am sure you agree that my ‘golden rules’ encapsulate the collective wisdom of so-called alternative medicine (SCAM):

  1. Conventional treatments are dangerous
  2. Conventional doctors are ignorant
  3. Natural remedies are by definition good
  4. Ancient wisdom knows best
  5. SCAM tackles the roots of all health problems
  6. Experience trumps evidence
  7. People vote with their feet (SCAM’s popularity and patients’ satisfaction prove SCAM’s effectiveness)
  8. Science is barking up the wrong tree (what we need is a paradigm shift)
  9. Even Nobel laureates and other VIPs support SCAM
  10. Only SCAM practitioners care about the whole individual (mind, body, and soul)
  11. Science is not yet sufficiently advanced to understand how SCAM works (the mode of action has not been discovered)
  12. SCAM even works for animals (and thus cannot be a placebo)
  13. There is reliable evidence to support SCAM
  14. If a study of SCAM happens to yield a negative result, it is false-negative (e.g. because SCAM was not correctly applied)
  15. SCAM is patient-centered
  16. Conventional medicine is money-orientated
  17. The establishment is forced to suppress SCAM because otherwise, they would go out of business
  18. SCAM is reliable, constant, and unwavering (whereas conventional medicine changes its views all the time)
  19. SCAM does not need a monitoring system for adverse effects because it is inherently safe
  20. SCAM treatments are individualized (they treat the patient and not just a diagnostic label like conventional medicine)
  21. SCAM could save us all a lot of money
  22. There is no health problem that SCAM cannot cure
  23. Practitioners of conventional medicine have misunderstood the deeper reasons why people fall ill and should learn from SCAM

QED

I am sure that I have forgotten several important rules. If you can think of any, please post them in the comments section.

This paper is an evaluation of the relationship between chiropractic spinal manipulation and medical malpractice. The legal database VerdictSearch was queried using the terms “chiropractor” OR “spinal manipulation” under the classification of “Medical Malpractice” between 1988 and 2018. Cases with chiropractors as defendants were identified. Relevant medicolegal characteristics were obtained, including legal outcome (plaintiff/defense verdict, settlement), payment amount, nature of plaintiff claim, and type and location of the alleged injury.

Forty-eight cases involving chiropractic management in the US were reported. Of these, 93.8% (n = 45) featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% (n = 34) of cases, with a plaintiff (patient) victory in 20.8% (n = 10) (mean payment $658,487 ± $697,045) and settlement in 8.3% (n = 4) (mean payment $596,667 ± $402,534).

Over-aggressive manipulation was the most frequent allegation (33.3%; 16 cases). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%, 32 cases) with 87.5% (28/32) requiring surgery. C5-C6 disc herniation was the most frequently alleged injury (32.4%, 11/34, 83.3% requiring surgery) followed by C6-C7 herniation (26.5%, 9/34, 88.9% requiring surgery). Claims also alleged 7 cases of stroke (14.6%) and 2 rib fractures (4.2%) from manipulation therapy.

The authors concluded that litigation claims following chiropractic care predominately alleged neurological injury with consequent surgical management. Plaintiffs primarily alleged overaggressive treatment, though a majority of trials ended in defensive verdicts. Ongoing analysis of malpractice provides a unique lens through which to view this complicated topic.

The fact that the majority of trials ended in defensive verdicts does not surprise me. I once served as an expert witness in a trial against a UK chiropractor. Therefore, I know how difficult it is to demonstrate that the chiropractic intervention – and not anything else – caused the problem. Even cases that seem medically clear-cut, often allow reasonable doubt vis a vis the law.

Apologists will be quick and keen to point out that, in the US, there are many more successful cases brought against real doctors (healthcare professionals who have studied medicine). They are, of course, correct. But, at the same time, they miss the point. Real doctors treat real diseases where the outcomes are sadly often not as hoped. Litigation is then common, particularly in a litigious society like the US. Chiropractors predominantly treat symptoms like back troubles that are essentially benign. To create a fair comparison of litigations against doctors and chiros, one would therefore need to account for the type and severity of the conditions. Such a comparison has – to the best of my knowledge – not been done.

What has been done, however – and I did previously report about it – are comparisons between chiros, osteos, and physios (which seems to be a more level playing field). They show that complaints against chiros top the bill.

The pandemic has shown how difficult it can be to pass laws stopping healthcare professionals from giving unsound medical advice has proved challenging. The right to freedom of speech regularly conflicts with the duty to protect the public. How can a government best sail between Scylla and Charybdis? JAMA has just published an interesting paper addressing these issues. Here is an excerpt from the article that might stimulate some discussion:

The government can take several actions, including:

  • Imposing sanctions on COVID-19–related practices by licensed professionals that flout substantive laws in connection with providing medical services, even if those medical services include speech. This includes physicians failing to comply with COVID-19–related public health laws applicable to medical offices and health facilities, such as mask wearing, social distancing, and restrictions on elective procedures.
  • Sanctioning recommendations by professionals that patients take illegal medications or controlled substances without following legally required procedures. The government can also sanction the marketing by others of prescription medications for unapproved indications. However, “off-label” prescribing by physicians (eg, for hydroxychloroquine or ivermectin) remains lawful as long as a medication is approved by the US Food and Drug Administration for any indication and no specific legal conditions on use are in effect.
  • Enforcing tort law actions (eg, malpractice, lack of informed consent) in cases of alleged patient injury that result from recommending a potentially dangerous treatment or failing to recommend a necessary treatment.
  • Imposing sanctions on individualized medical advice by unlicensed individuals or organizations if giving that advice constitutes the unlawful practice of medicine.

In addition, the government probably can:

  • Impose sanctions for false or misleading information offered to obtain a financial or personal benefit, particularly if giving the information constitutes fraud under applicable law. This would encompass physicians who knowingly spread false information to create celebrity or attract patients.
  • Threaten disciplinary action by licensing boards against health professionals whose speech to patients conveys incorrect science or substandard medicine.
  • Specify the information that may and may not be imparted by private organizations and professionals as part of specific clinical services paid for by government, such as special programs for COVID-19 testing or treatment.
  • Reject legal challenges to, and enforce through generally applicable contract or employment laws, any restrictions private health care organizations place on speech by affiliated health professionals, particularly in the absence of special laws conferring “conscience” protections. This would include medical staff membership and privileges, hospital or other employment agreements, and insurance network participation.
  • Enforce restrictions on speech adopted by private professional or self-regulatory organizations if the consequences for violations are limited to revoking organizational membership or accreditation.

However, the government probably cannot:

  • Compel or limit health professional speech not made in connection with patient care, even if the speech is false or misleading, regardless of its alleged effect on public trust in health professions.
  • Sanction speech to the general public rather than to patients, whether or not by health professionals, especially if conveyed with a disclaimer that the speech is “not intended as medical advice.”
  • Sanction speech by health professionals to patients conveying political views or skepticism of government policy.
  • Enforce restrictions involving information by public universities and public hospitals that legislatures, regulatory agencies, and professional licensing boards would not be constitutionally permitted to impose directly.
  • Adopt restrictions on information related to overall clinical services funded by large government health programs, such as Medicare and Medicaid.

_____________________________

The article was obviously written with MDs in mind and applies only to US law. As we have seen in previous posts and comments, the debate is, however, wider. We should, I think, also have it in relation to practitioners of so-called alternative medicine (SCAM) and medical ethics. Moreover, it should go beyond advice about COVID and be extended to any medical advice given by any type of healthcare practitioner.

The German Heilpraktiker has been the subject of several of my posts. Some claim that it is an example of a well-established and well-regulated profession. Others insist that it is a menace endangering public health in Germany.

Who is right?

One answer might be found by looking at the training the German Heilpraktiker receives.

In Germany, non-medical practitioners (NMPs; or ‘Heilpraktiker’) offer a broad range of so-called alternative medicine (SCAM) methods. The aim of this investigation was to characterize schools for NMPs in Germany in terms of basic (medical) training and advanced education.

The researchers found 165 schools for NMPs in a systematic web-based search. As the medical board examination NMPs must take before building a practice exclusively tests their knowledge in conventional medicine, schools hardly include training in SCAM methods. Only a few schools offered education in SCAM methods in their NMP training. Although NMP associations framed requirements for NMP education, 83.0% (137/165) of schools did not meet these requirements.

The authors concluded that patients and physicians should be aware of the lack of training and consequent risks, such as harm to the body, delay of necessary treatment, and interaction with conventional drugs. Disestablishing the profession of NMPs might be a reasonable step.

Other interesting facts disclosed by this investigation include the following:

  • There is no mandatory training for NMPs. Some attend schools but many do not and prefer to learn exclusively from books.
  • The training programs of the NMP schools comprise an average of 7.4 hours per week of classroom teaching for an average of 27.1 months.
  • Course participants thus complete an average of ~600 hours of training. (A degree in medicine takes an average of 12.9 semesters. With a weekly working time of 38.9 hours, this amounts to ~15,000 hours of training excluding internships etc.)
  • Three-quarters of all NMP schools do not offer any practical teaching units.
  • If training programs do contain practical instruction, it is usually limited to individual weekend workshops in which the measurement of vital data, physical examinations, and injections and infusions are practiced.
  • The exam that NMPs have to pass consists of a written test with sixty multiple-choice questions and a 30 to 60-minute interview on case studies.
  • The examination covers professional and legal anatomical and physiological basics, methods of anamnesis and diagnosis, the significance of basic laboratory values as well as practice hygiene and disinfection.
  • Not included are competence in pharmacology, pathophysiology, biochemistry, microbiology, human genetics and immunology.
  • The average 600 hours of training of an NMP is thus ~5% of that of a medical student.
  • If an NMP fails the exam, she can repeat it as often as she needs to pass.
  • The day after the exam, an NMP can open her own practice and is allowed (with only very few exceptions) to do most of what proper doctors do.

So are NMPs a danger to public health in Germany?

I let you answer this question yourself.

 

Homeopathy was born in Germany about 200 years ago. Now we are witnessing its slow demise due to a lack of convincing evidence.

It is only a small announcement by, but it sends out a big signal: Bremen’s doctors’ parliament has decided to cancel all homeopathy contracts.

Opponents and supporters of homeopathy agree on one thing: the latest decision of the Association of Statutory Health Insurance (KV) Bremen is an important nail in the coffin for alternative medicine. The KV representative assembly has just decided to terminate all selective contracts concerning the reimbursement of homeopathic services.

Some are rejoicing: “In Bremen it’s over” tweeted Dr. Hans-Werner Bertelsen, for example. The “sugar-sugar affine clientele” will have a harder time in the future, he stated. And: “The financing of woo must be stopped politically.”

Oliver Borrmann, a general practitioner and homeopath from Bremen, on the other hand, is outraged. He speaks of discrimination, of a conflagration, and of being the “whipping boy for everything”. “They are watching alternative medicine die right now,” he professes. It is considered chic to rise above homeopathy, he claims, and anyone who defends it is put down.

In Bremen, three contracts existed with several companies and health insurance funds which extended the range of paid services to include homeopathy for their patients. Both the KV Bremen and the homeopath Borrmann speak of a group of insured persons that is not particularly large – in Borrmann’s practice there are about 30 patients – but of a political signal that emanates from the decision.

It is the reason for the termination that makes him concerned and take notice, says Borrmann. It states: “As long as not all treatments whose benefits have already been scientifically proven can be fully financed in the statutory health insurance system, there will be no funds left for procedures for whose concrete benefits there is no evidence.”

This phraseology which quotes the KV board members Bernhard Rochell and Peter Kurt Josenhans sounds unwieldy – but it contains a clear message: homeopathy is considered useless by the KV.

——————————————-

One does not need to be a clairvoyant to predict that other parts of Germany will follow Bremen’s example. Effective lobbying and financial interests have protected German homeopathy for decades, but the eventual victory of reason, science, and evidence was inevitable.

The new German secretary of health, Prof Lauterbach, tweeted in connection with the news from Bremen:

“Mit der Wissenschaft werden Pandemien bekämpft und Krankheiten geheilt. Wir brauchen mehr Wissenschaft in der Behandlung, nicht weniger. Die Homöopathie hat keinen Platz in der modernen Medizin.”

(Science is used to fight pandemics and cure diseases. We need more science in treatment, not less. Homeopathy has no place in modern medicine.)

 

The Nobel Prize laureate Luc Montagnier has died at the age of 89.

Montagnier became the hero of the realm of homeopathy when he published findings suggesting that ultra-molecular dilutions are not just pure water but might have some activity. In this context, he has been mentioned repeatedly on this blog. During the years that followed his support for homeopathy, things got from bad to worse, and Montagnier managed to alienate most of the scientific community.

Amongst other things, he became a champion of the anti-vax movement, supported the view that vaccination causes autism, and argued that viral infections including HIV could be cured by diet. During the pandemic, he then claimed that Sars-CoV-2 had originated from a laboratory experiment attempting to combine coronavirus and HIV. On French television, he claimed that vaccination was an “enormous mistake” that would only promote the spread of new variants.

Before Montagnier became a victim of ‘Nobelitis‘, he had a brilliant career as a virologist in his world-famous Paris lab. A co-worker of Montagnier, Barré-Sinoussi, managed to isolate a retrovirus from an AIDS patient in 1983. They called it ‘lymphadenopathy-associated virus’, and concluded that it may be involved in several pathological syndromes, including AIDS.

Meanwhile, in the US, Gallo had identified a family of immunodeficiency retroviruses that he called human T-lymphotropic virus (HTLV). In 1984, Gallo announced that one of these viruses was the cause of AIDS. The US government swiftly patented a blood test for detecting antibodies to it. Thus it became possible to screen for the virus in the blood.

When it became clear that material used in Gallo’s studies included samples that Montagnier had supplied in 1983, one of the fiercest rows in the history of science ensued. Eventually, negotiations between the two governments settled it by resolving that the two scientists should be equally credited. In 2002, Gallo and Montagnier published a joint paper acknowledging each other’s role: Montagnier’s team discovered HIV, and Gallo’s proved it caused AIDS. When Gallo was excluded from the Nobel prize given in 2008 to Montagnier and Barré-Sinoussi, the world of science was stunned. The spectacular dispute between Galo and Montagnier became the subject of a movie and several books.

Montagnier died on 8/2/2022 leaving behind his wife Dorothea and their three children, Anne-Marie, Francine, and Jean-Luc.

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