[Letter to Colleagues from Peter Duesberg]

PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES, U.S.A.
Request for opinion on manuscript by, I I7
r f.Title 'i. d 4 t t% Q
The Proceedings of the National Academy of Sciences, U.S.A., a multidisciplinary journal, publishes brief reports of
original research of exceptional importance and novelty. I am writing to ask your opinion on the following points, together
with any other comments you may offer. Please reply to all questions. The Editorial Board considers the first two the most
important. Please note that the Editorial Policy states that the referees should remain anonymous.
L Is this con 'bution of sufficient general interest to justify 'publication i the Proceedings rather than a specialty journal?
O Yes I 'No O0Don't know
2. Is the overall quality of this paper suitable for this journal? Oes No 0 n't know
3. Does the evidence justify the conclusions drawn? 0 Yes No 0 Don't )ehow
4. Is this paper clearly written for a diverse audience of scientists? 0 Yes No 0 Don't know
5. Are the procedures described sufficiently well that the work can be repeated? 0 Yes 0 No Not relevant
6. Comments (use additional pages if necessary; send original and two copies): If the answers to questions 1 and 2 are Yes, please
describe here the aspects of this paper that are novel and important:
This manuscript does not represent a scientific article, but appears to be
a loose collection of facts marshalled to support a hypothesis that excessive
drug use may be the cause of AIDS. Excessive drug use has been suggested
previously as a cause of AIDS in some populations. Intravenous drug users do not
use amyl nitrite, however, and the use of this drug cannot be included as a cause
of AIDS in IV drug users. Drug use does not explain AIDS occurring in children
or AIDS in health care workers who are stuck with a needle from an HIV-infected
patient. Drug use may deserve further study as a risk factor. But the author
needs to be more specific about which populations he is referring to. Certainly
the toxic effects of AZT which the author rightfully lists deserve further study
for the possible lymphocyte damage which this (nay cause. Unfortunately the
author's arguments offer little new information to*enhance the case that drug use
may cause AIDS.
The manuscript offers a possible argument for the association between IV
drug use and AIDS. None of the links are convincing. Unfortunately the author
does not consider any alternative argument. A scholarly article requires
consideration of alternative explanations and none are provided in this
manuscript. This article could be vastly improved by focusing only on the
possible association between AZT use and lymphoma. A critical review of the data
supporting AZT use as a possible factor in the increase in AIDS-associated
lymphoma and also a comment on the data which does not support an association
might provide a useful contribution to the scientific literature.
Attention to the following specific items would result in an improved
manuscript.
1. pg. 10 - The author states that HIV- patients may get Kaposi's Sarcoma.
He states that 5 of 6 patients were negative for HIV but used nitrites. No other
alternative explanations are offered and this is a significant omission.
2. pg. 11 - The author states that patients with AIDS survive a median of 12
months. This is true for untreated patients. Patients with AIDS who are
receiving AZT at 500 mg/day and PCP prophylaxis, however, are surviving for a
median time of 21 months (Fisch L et al. NEJM 1990, 323: 1009-1014). This
should be referenced in the article.

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