David Baronov in his article, “Colonial Rule, AIDS, and Social Control in Puerto Rico” (S&D #34), is right to denounce the effects of US neo-colonial rule in Puerto Rico and the way in which health workers following US Centers for Disease Control (CDC) behaviour modification models contribute to social control. But Baronov’s failure to even mention the possibility that HIV may not be the cause of AIDS weakens his whole approach. Moreover, for democratic socialists the whole HIV/AIDS phenomenon offers valuable lessons which the Left has been reluctant to explore. These include the nature of Science, today a business and career path; the possibility and meaning of democracy within such an institution as Science;1 the role of socialists in a situation where scientific theory having serious social implications is controversial; and, for those regarding themselves as marxist, the meaning and application of dialectics. It is not my purpose to judge the issues I raise, but only to suggest that the phenomenon of HIV/AIDS, an important issue in itself, provides an illuminating context within which to examine these issues.
Like others on the Left,2 Baronov accepts the science of AIDS uncritically and vents his criticisms on the island’s Health System and other aspects of US colonial rule.
Therefore while he gives figures for the number of reported AIDS cases, he does not distinguish between full-blown AIDS and people testing HIV-positive. Nor does he comment on the definition of AIDS being used, which as we shall see is important in view of the way the CDC has constantly enlarged it. His initial description of ‘the AIDS epidemic’ washing over the island ‘with horrific consequences… on the health of Puerto Ricans’ seems to conflict with the more detailed description he gives later, where it seems to be confined to the same groups affected in the USA and Europe: those homosexuals who are highly promiscuous, and intra-venous drug users. Or have there been other sufferers? Has AIDS (not those diagnosed HIV-positive) spread beyond the ‘high levels of prostitution and drug abuse’ which Baronov draws our attention to?
Baronov draws an interesting comparison between Taylorism and HIV/AIDS behavior modification models in Puerto Rico, complaining that ‘the strategic focus of behavior modification is on the acceptance of conditions of colonial rule through individual-level behavior change rather than addressing the broader oppressive social conditions.’ His description of the community-based ‘Fundación SIDA de Puerto Rico [which] emerged in the early 1980s from the organizing efforts of a handful of gay, lesbian and transgender activists on the Island’ is particularly interesting. But while among the transgender sex workers he mentions workshops on safer sex methods and avoiding ‘high-risk sexual practices’ it is clear that overall the emphasis is on preventing transmission of HIV. If the scientists whom I shall be discussing below are right, these approaches will fall short of really empowering these groups in their attempts to stay healthy.
History & Definition of AIDS
What came to be called AIDS was first identified among the homosexual and intravenous drug users in Los Angeles and New York around 1980.3 Healthy young men were becoming ill and dying, with a combination of already-known diseases. In addition to gonorrhoea and other venereal disease, they were suffering from such fungal infections as Candida albicans, commonly called thrush, and a number of amoeboid diseases. Particularly serious and previously uncommon in these younger age groups were skin cancer, Kaposi’s sarcoma, and fungal pneumonia, Pneumocystis carinii (PCP). It became clear that the immune system was affected and the condition was first called Gay Related Immune Deficiency (GRID). This was changed to Acquired Immunodeficiency Syndrome (AIDS) by the CDC,4 a name which assumed a single cause (syndrome).
While at first a variety of explanations for this condition were put forward, in April 1984 Margaret Heckler, Secretary for Health and Human Services, announced that Gallo and his co-workers had discovered the “probable” cause of AIDS and had developed a sensitive blood test to detect the virus in the body.’5 The career of HIV (Human Immunodeficiency Virus) was launched! Almost immediately claims were being made that HIV/AIDS posed a threat worldwide, and subsaharan Africa became a particular focus of attention. In the last few years there have been media reports of widespread infection in China and, in 2004, among the new-poor and drug-using youth of the former USSR.
The road to disbelief in the HIV explanation for AIDS varied. Dr. Peter Duesberg,5 professor of molecular and cell biology at the University of California, Berkeley, honoured for his work on identifying genetic changes related to certain cancers, arrived at it from his specialist knowledge in retroviruses.
The group around Dr. Eleni Papadopulos-Eleopulos,6 professor of medical physics at Royal Perth Hospital, a teaching hospital at the University of Western Australia, appears to have been directly concerned with AIDS from the beginning. Already in 1982 Dr. Papadopulos was proposing an explanation which she repeated in 1988, saying then: ‘There is no compelling reason for preferring the viral hypothesis of AIDS to one based on the activity of oxidising agents. In fact, the latter is to be preferred, since unlike the viral hypothesis it leads to possible methods of prevention and treatment using currently available therapeutic substances.’
Dr. Kary Mullis7 is a Biochemist who got the 1993 Nobel prize for his invention of the Polymerase Chain Reaction, a technique used in AIDS tests. His doubts began in 1988 when working as a consultant to Specialty Labs in Santa Monica, to apply his PCR technique to the detection of retroviruses in blood. In his book, Dancing Naked in the Mind Field, he writes: ‘I asked a virologist at Specialty where I could find the reference for H.I.V. being the cause of AIDS. “You don’t need a reference,” he told me. “Everybody knows it.”’ On insisting, he was referred to the CDC Report. Trying to go further he did computer searches, only to find that neither Montagnier, Gallo, nor anyone else had published papers describing experiments which led to the conclusion that HIV probably caused AIDS.
Dr. Mohammed Al-Bayati,8 perhaps the most recent to reject the HIV explanation, is a toxicologist and pathologist, author of Get All the Facts: HIV Does Not Cause AIDS. As Professor Otto Raabe says in the Foreword to that book: ‘Rather than beginning his analyses with a preconceived hypothesis, Dr. Al-Bayati used the techniques of differential diagnosis to let the biomedical data, epidemiological profiles, and other relevant information implicate the causative factors…. [T]he virus called HIV never surfaces as a necessary or even likely causative agent!’
The Dissidents’ Case
Duesberg, Al-Bayati and other dissidents accept that HIV exists, but assert that it is harmless. Duesberg draws attention to the contradiction of Gallo’s asserting that HTLV-1 ‘caused infected cells to grow into cancers’ and then proposing that it also killed these same cells.9 While Duesberg’s objections derive from his understanding of the nature of retroviruses, Al-Bayati’s derive from the application of a differential diagnosis to the medical evidence in the various risk groups.
In a recently published paper by Duesberg, Koehnlein and Rasnick they give a list of 17 predictions from the HIV/AIDS hypothesis which are not borne out by the facts. They use the version of the hypothesis known as the Durban Declaration, signed ‘by over 5000 people, including Nobel prizewinners’ and published in Nature in 2000.10
One example of such a prediction is: ‘Since HIV is “the sole cause of AIDS,” there is no AIDS in HIV-free people.’ But the facts are: ‘the AIDS literature has described at least 4621 HIV-free cases according to one survey’ and there have been many others.11
The Perth Group has from the start thrown doubt on the existence of HIV and repeatedly asked its believers to produce the evidence on which they base their claim. To date their requests have been ignored. The Group has also made the most detailed criticism of the tests which are used to identify HIV infection.
These tests are said to be of antibodies to the virus, but the Group shows that in fact they are non-specific. The ELISA test takes a mixture of assumed HIV proteins, and if they react to produce a colour change with serum from a patient, it is said to be positive. But this is admitted to produce a high proportion of false-positives, and is now always followed by a Western Blot test. This test separates the “HIV proteins” along a strip so that reactions between these and the patient’s antibodies show up as darkened bands. As the Group shows, since there is no evidence that the virus has been isolated, one cannot be sure that the proteins used in the tests are really those of HIV. On the contrary, there is evidence that they are proteins commonly found in the human body.12
Another cause for concern is the definition of AIDS and the way this has been altered over time. The CDC and supporters of the HIV/AIDS hypothesis claim that this is in response to increasing knowledge of the action of the virus. But it has certainly been convenient for supporters of the HIV/AIDS hypothesis! Al-Bayati draws attention to the adding in 1993 of cervical dysplasia and cervical cancer to the category of AIDS-related diseases, thus augmenting the number of women said to be suffering from AIDS. He comments: ‘this action increased the fear in the community and also it increased funding to the NIH as well as the sale of antiviral drugs’.13 Turner and McIntyre note that ‘although AIDS began to decline in 1987, this trend was countered by the addition of more and more diseases, and, most recently, mere laboratory abnormalities’.14
Al-Bayati shows in a number of places how Fauci et.al., in publications like Harrison’s Principles of Internal Medicine, give considerable evidence which refutes their claims in that same book about HIV and AIDS. They show the effects of illicit drug and alcohol abuse and the effect of extensive use of medications (Al-Bayati notes especially glucocorticoids) to treat the illnesses resulting from the abuse of these drugs. In Africa they are aware of the effects of malnutrition. I shall attempt to show why these authors and many others prefer to hold to the HIV/AIDS hypothesis when the alternatives might have been so much more successful.
I have already mentioned the alternative first put forward in 1982 by Eleni Papadopulos-Eleopulos. In the cautious words of the Group’s latest examination they say: ‘From the beginning of the AIDS era there has been evidence that individuals belonging to the AIDS risk group … are exposed to oxidising agents’ and that ‘[t]here is evidence that suggests that MCT [the transmission of HIV from mother to child] may be preventable by anti-oxidants.’ They go on to make the following predictions from the theory:
(a) AIDS patients and those at risk will be oxidised;
(b) the mechanisms responsible for AIDS could be prevented and reversed by administration of reducing agents, especially those containing sulphydryl groups;
(c) “HIV” phenomenology may be induced by exposure to oxidising agents and eradicated by treatment with reducing agents.
Unlike the predictions of the HIV theory of AIDS, most if not all predictions of the oxidative theory, including the above, have been proven correct.15
Further on, they note that Montagnier now admits that ‘a large body of data on in vitro human immunodeficiency virus (HIV) infection and biochemical clinical studies suggests that oxidative stress plays a role in AIDS pathogenesis.’ Of special relevance to Africa, the Group notes that oxidation is associated with such diseases as malaria and tuberculosis.16
I hope this will have shown the seriousness of these critics’ case. I will now try to place it in the realities of today’s Science.
Science: Theory & Theorists17
There have been many attempts to define Science. J.D. Bernal, in a classic of the British movement for social responsibility in science, The Social Function of Science (1939), avoided the attempt to define Science on the grounds that, as he explained in his post-World War Two Science in History:
Science is so old, it has undergone so many changes in its history, it is so linked at every point with other social activities, that any attempted definition … can only express more or less inadequately one of the aspects, often a minor one, that it has had at some period
of its growth.18
Others have been more specific, giving lists like the following, by Hilary and Steven Rose, who pose Science
(i) as the pursuit of natural laws;
(ii) as the application of certain rules of procedure and enquiry;
(iii) as the social institutions within which the activity is carried out;
(iv) as including the whole field of research and development, that is, both science and technology;
(v) as excluding the technological development of science, embracing instead only pure science, typically conducted in certain institutional forms, such as the university or basic research institute.19
This does not clarify the difference between science and technology,20 a distinction which is important in the HIV/AIDS situation. Science is the process of explanation, answering the question ‘why’ in its various meanings, while Technology is the process of knowhow, recipes answering the question ‘how’ to make or do something. On this distinction it is clear that medical workers are technologists. It is also important to note that this distinction also makes clearer the often misunderstood role of practice. If it is a question of knowhow, of a recipe, ‘the proof of the pudding is in the eating’. If the recipe is right it works! But with explanations practice does not prove anything. Some explanation may appear to be true because something for which that explanation has been used works, but later study suggests a different explanation. But this does not falsify the recipe. In the case of AIDS the recipes dictated by the HIV hypothesis patently do not work!
So far I have not mentioned the common myth that science is “the disinterested pursuit of truth”. This is fostered by TV programmes with their emphasis on “discovery” of the new and mysterious. A brief look at the reality of scientists and their institutions will correct that myth.
Individual research scientists in the main work in one of three kinds of institutions: research institutes; industrial research and development departments; or the science departments of tertiary schools (universities). All these are funded by either or both government and industry, and in recent years the individual scientists have been under increasing pressure to attract personal research grants.
The major AIDS scientists, like nearly all scientists, have been trained in a university in what is well called a “discipline”. While much lip-service is paid to being critical, in real life one is trained to accept current theory and to see one’s life’s work as adding to it rather than overthrowing what has already been “established”.
Science: as Institution
The major scientific institutional actors in the early story of HIV, with the exception of the Pasteur Institute in Paris, have been in the USA. Particularly important has been a government body described very thoroughly by Duesberg in Inventing the AIDS Virus. It goes back a long way, to 1912 when the US government formed the Public Health Service (PHS). A branch of this, the National Institutes of Health (NIH), was responsible for biomedical research. The system got a big boost in World War Two, anticipating a repeat of the malaria of the First World War. Active during the War, in 1946 the NIH hastened to set up the more all-embracing Communicable Disease Center (CDC) in Atlanta, Georgia. This, after several name changes, is now called the Centers for Disease Control and Prevention. At the time of the Korean War (1951), a new Director formed the Epidemic Intelligence Service (EIS). These institutions became major sources for funds and employment.
With lots of money and staff the CDC needed work to justify them, so it set out to find epidemics. A number of false alarms, some dangerously so, followed: the Hantavirus; Asian flu; Swine flu; and Legionnaires’ disease. What they were to call AIDS (July 1982) was an opportunity to recover credibility and, with expanding definitions of AIDS, to spread influence far beyond the shores of the USA. The CDC decided that the various symptoms presented were a single contagious disease, and since viruses were their favourites, settled on them as the cause. Both economic and political weight have been too strong for any alternative explanations to obtain a hearing, and even some wranglings over misconduct and theft have been settled at the highest international political level.
The Pharmaceutical Corporations
A large number of scientists working on AIDS are employed by the transnational pharmaceutical corporations, names like Abbott Laboratories, Glaxo-Wellcome, Merck, Pfizer, and Pharmacia & Upjohn, Inc. Their job is to produce drugs, not to question accepted theories of disease causation. It is probable that the fashion for viruses is widespread among them and among the non-scientists who direct their work. However, the influence on the belief in HIV as the cause of AIDS among the wider community comes not from the scientists working in these firms, but rather from the activities of the organisations they work in.
Bayer is active making propaganda in Belford Roxo near Rio de Janeiro. Every month representatives of the firm visit schools, creches and community centres, putting on music shows and distributing leaflets. The firm’s Web Site22 says: ‘Information does not exclusively focus on AIDS, but AIDS prevention plays an important role in the program.’ The Merck Company Foundation has made a $3 million grant to the Harvard AIDS Institute for ‘HIV care’ in developing countries.23
John S. James, writing in AIDS Treatment News,24 comments: ‘Pharmaceutical companies are marketing organizations, not research organizations. They conduct or fund only a little basic research (much of it for public-relations purposes), and usually farm out clinical research to specialized companies.’ He adds:
[I]ncreasingly pharmaceutical companies are lobbying organizations, with more Federal lobbyists, 623, than members of Congress, 535. These lobbyists include 23 former members of Congress, who have special access to their colleagues. The industry spends over $78 million a year on Federal lobbying — an average of over $145,000 every year to influence each member of Congress, with all this money often targeted to changing just a small number of key votes. Campaign contributions, real and fake “issue” ads, and monies to change public discussion by influencing academics, medical journals, think tanks, physicians, reporters, activists, and other “thought leaders” are not counted in this total.
The industry as a whole contributes generously to both the Republican and Democratic Parties. In 2000 the former received $18,351,034 while the latter received $8,295,897.25 This has no doubt encouraged US governments to grant specially favourable patent regulations and oiled the hinges of the revolving door between government and the industry.
In response to worldwide protests at the cost of drugs to help AIDS victims, a number of companies, including GlaxoSmithKline announced reductions. An article in The Scientist by John K Borchardt (December 8, 2000) cited the Director General of the European Federation of Pharmaceutical Industries and Associations (EFPIA) as saying that patent infringement is a key concern. Corporations see offering cheaper drugs, or at least being seen to do so, as a way of preventing Third World nations from going ahead and overriding patents one way or another.
Censorship & Discrimination
The myth of science is that it is an institution which encourages free discussion and exchange of ideas. In the case of HIV/AIDS, as in other instances in modern capitalism, the reality has been very different. Sadly, those who could have benefited from supporting a more critical approach were among the first to heap abuse on those like Duesberg who questioned the role of HIV. John Lauritsen, a gay activist, was among the exceptions. On the Rethinking AIDS Web Site,26 he complains of slander campaigns against him and Duesberg by the ‘multi-billion dollar AIDS industry’. Journalist Celia Farber was similarly attacked, including in an unpleasant lawsuit against the magazine Spin.
Gordon Stewart M.D., emeritus professor of public health at the University of Glasgow, a consultant in epidemiology and preventive medicine, was acting as a consultant to the World Health Organization (WHO) on social and behavioral aspects of communicable diseases when AIDS broke out in the USA. In an article with the subtitle ‘HIV-AIDS model owes popularity to wide-spread censorship’ in the UK journal, Index on Censorship (1999), he describes his long battle to be heard. He comments: ‘colleagues and I attempting to publish have met an unholy alliance intent on rejecting any papers that offer serious criticisms of the orthodoxy. There are, naturally, vested interests involved; many bodies and individuals receive high rewards for their work within orthodox AIDS science. Underlying much of this, the pharmaceutical companies have their own obvious agenda.’ He also makes the point I am trying to emphasize: ‘in the world of medical science, as in all other science, difference of opinion is the sine qua non of all advance.’
Scientists who have tried to publish in the main scientific journals have encountered considerable difficulty, only occasionally breaking through the censorship. Eleni Papadopulos-Eleopulos’s important early article setting out her alternative oxidation hypothesis was published by Medical Hypotheses, a journal which specialises in publishing articles with the minimum of editorial interference. Its Web Site states: ‘Medical Hypotheses takes a deliberately different approach to peer review. Most contemporary practice tends to discriminate against radical ideas that conflict with current theory and practice. Medical Hypotheses will publish radical ideas, so long as they are coherent and clearly expressed’. A problem with such publication is that scientists normally consult a small range of publications and therefore never see non-Establishment views.
The Perth Group’s Web Site includes both published and unpublished articles and letters. Readers can judge for themselves the policy of censorship adopted by the journals Nature, Science and The Lancet. We are fortunate that the current operation of capitalism provides the Internet for those of us who are determined to gain access to information.
Finally on censorship, Nature27 published a full page attacking the British Medical Journal for allowing AIDS dissidents to contribute freely to their Internet feature, Rapid Responses. Typical was the attack by Brian Foley, an AIDS researcher at the Los Alamos National Laboratory in New Mexico, who ‘criticizes the BMJ for allowing what he describes as the misuse of a respectable scientific journal to contribute to the dissemination of disinformation. “I do not think responding to BMJ posts is a worthwhile use of my time,”he says.’
A Question of Levels?
As I mentioned earlier, those on the Left have accepted the Establishment science and even joined in the abuse of those scientists who have criticized it. Could this, in the case of marxists, be because of their long-standing avoidance of serious attention to the philosophy of dialectics, and particularly the concept of levels of integration? Joseph Needham, in his Science and Civilization,28 speaking of ‘the point of view of the scientist’, describes levels of organisation, or integrative levels, as ‘a temporal succession of spatial envelopes’ and goes on to say that there were certainly atoms before there were any living cells, and living cells themselves contain and are built up of atoms.’ Richard Levins and Richard Lewontin, in The Dialectical Biologist,29 speak of ‘all objects [being] internally heterogeneous’ and of ‘the legitimacy of investigating each level of organization without having to search for fundamental units’. They see ‘the various levels of organization as partly autonomous and reciprocally interacting’. Taking account of integrative levels in the case of HIV/AIDS would require an examination of the science and medicine as well as the social questions of community organisation and empowerment, and strains on the health service. To neglect the scientific-medical levels, as the Left has done, is to disempower the social.
Baronov is right to denounce the effects of US neo-colonial rule in Puerto Rico and the way in which the behavior modification models used by those following CDC inspiration contribute to social control. But his failure to even mention the possibility that the cause of AIDS may not be HIV emasculates his case again US imperialism. Socialists need to study the whole history, in all its aspects, of the HIV/AIDS phenomenon, if we are to learn the lessons it can teach us, both for people’s health, and for overcoming capitalism itself.
1. I use a capital when referring to Science as an institution.
2. Charles W. Hunt, writing on several occasions in Monthly Review (vol.39, nos. 8 & 9 & vol.40. no. 11); and Chris Talbot on World Socialist Website,
3. Graphic accounts are given by Jad Adams, AIDS: the HIV Myth (London, MacMillan, 1989) and Neville Hodgkinson. The Failure of Contemporary Science (London, Fourth Estate, 1996); Eleni Papadopulos-Eleopulos, “Reappraisal of AIDS – Is the Oxidation Induced by the Risk Factors the Primary Cause?”
(http://www.virusmyth.net/aids/data/epmedhypo.htm) gives a detailed clinical picture.
4. For a thought-provoking account of this organization see Duesberg, Inventing the AIDS Virus (Washington, D.C.: Regnery, 1996), pp.134-168.
5. Turner & McIntyre, “A Great Future Behind it: the Yin and Yang of HIV,” http://www.virusmyth.net/aids/data/vtyinyang.htm
6. Web page at http://www.duesberg.com/index.html
7. Web page at: http://www.virusmyth.net/aids/perthgroup/index.html
8. See under “Controversy” on the Rethinking AIDS Website of the The International Forum for Accessible Science at http://www.virusmyth.net/aids/news/ifaspr2.htm
9. Web page at: http://www.virusmyth.net/aids/index/abayati.htm
10. 1996, p.156.
11. A list of dissidents, signatories to a statement by the The Group for the Scientific Reappraisal of the HIV-AIDS Hypothesis, can be found at
12. E.g. Al-Bayati, Get all the Facts: HIV Does Not Cause AIDS (Dixon, CA, Toxi-Health International, 1999), p.155.
13. The best account of these tests is to be found in Part 1 of the recent book by the Group: Mother to Child Transmission of HIV, 2001. Some information on their use is to be found in Duesberg, 1995.
14. Al-Bayati. p.164.
15. “The Yin and Yang of HIV”
16. Mother to Child Transmission, p.104. They give references to work by others to support their theory.
17. Ibid. p. 108. Here again the Group inserts a warning against rushing to conclusions without further work!
18. This section draws heavily on the book I wrote with Roger Cross, Teaching Science for Social Responsibility (Sydney: St. Louis Press, 1992).
19. Bernal, Science in History (London: Watts & Co.,1954), p. 5; Harmondsworth, Penguin, 1969 ed. vol. 1, p.30.
20. 1969, p. 2.
21. Roger Cross and I, writing in 1992, when it was fashionable to introduce technology into science teaching in secondary schools, made the given distinction.
23. www.merck.com/about/cr/policies_performance/social/enhancing_care.html (March 2004).
24. http://www.aids.org/atn/a-397-02.html (March 2004).
25. http://www.opensecrets.org/industries/indus.asp?Ind=H04 (March 2004).
27. vol. 426, 20 November 2003, p. 215, www.nature.com/nature
28. Needham, Science & Civilisation in China (Cambridge University Press, 1956), Vol.2., esp. pp. 474 & 498.
29. Levins & Lewontin, The Dialectical Biologist (Cambridge, Mass.: Harvard University Press), their Conclusion: “Dialectics,” pp. 278 and 288.
R.F. Price makes several salient points concerning the scientific claims surrounding HIV and AIDS. In this regard, I am pleased that my essay could serve as his starting-off point, so to speak. Price is certainly correct in criticizing me for unqualifiedly adopting the much-disputed clinical definition of AIDS as well as for disregarding the active debate around the link between HIV and AIDS. Indeed, while I do not consider myself qualified to comment on the underlying medical science, I consider the work of Duesberg, Papadopulos-Eleopulos and others whom Price discusses to be contributions to a debate that cannot be ignored.
I therefore find Price’s criticisms to be generally relevant and constructive. At the same time, without wishing to be defensive, I would suggest that my core argument largely stands, notwithstanding the resolution of the important issues raised by Price. In fact, to a large extent it seems to me that Price’s central claim—the politicization of Science and of medical knowledge—can be seen as an underlying theme of my essay.
It is precisely the social position of public health officials, within the production and distribution of medical science, that allows them to shape medical knowledge (such as defining AIDS or linking HIV to AIDS). While the inherently oppressive nature of this situation holds¾as Price suggests¾for any capitalist society, the consequences can be particularly grave for colonial societies, as I try to argue. In fact, to invoke the dialectic, this is precisely the social contradiction that yields the potential for organizing collective action.
Consider the example of transgender sex workers in San Juan that I discussed. On the one hand, the medical community has artificially grafted a horrible malady on these sex workers and has thus enhanced social control over them. On the other hand, this collective punishment has arguably sown the seeds for transgender sex workers to take the resources ostensibly intended to “stop HIV,” and use them to engage in community-building. Ultimately, it is no easier to control the social forces that result from the manipulation of medical knowledge in Puerto Rico than it is to control the social forces unleashed by the “liberation” of Iraq.