Maggiore Redux

[John Bleau]

Maggiore was called criminally stupid on these boards for "letting her daughter die of AIDS."

From http://www.lacitybeat.com/article.php?i ... sueNum=157

Maniotis said something that I have never heard noted before. “They did a lymphocyte count on Eliza Jane when she was admitted to the hospital. Forget everything else. Her absolute lymphocyte count was 10,800 cells per milliliter. She was not immune suppressed. That’s all you’ve got to know. She could not have died from PCP and had 10,800 lymphocytes in her bloodstream at the time of death. No way. It just doesn’t happen. Nor could she have encephalitis. End of story, it’s that simple. 10,800 lymphocytes is very high, and the World Health Organization has said that it is a legitimate standard way of gauging the immune system, in the absence of testing for CD4/CD8 ratios. An AIDS patient has to have below 1,000 total lymphocyte counts. Normal is about 4,000 to 8,000. EJ’s was 10,800. Even according to the most strident HIV dogmatists, AIDS is still a disease of too few lymphocytes, not too many. All the pathologists I talk to find this logic hard to refute. She could not have had PCP, nor died of it.”

[jbuck919]

I doubt that anybody is going to go to that link, Mr. Bleau. We know you for what you are on this subject, and personally I wonder why you keep posting here on it, except that I really don't, because nutcases (myself being unqualified to make more official psychiatric diagnoses) with very clever covers are fond of utilizing every outlet they can find.

[John Bleau]

Now, if BWV wonders why I'm so condescending, contrast my opening post with its pertinent information, with that of jbuck. Good god, jbuck, how on earth could that girl have been said to have "AIDS-related pneumonia"?

[John Bleau]

jbuck changed his post, but it's still shallow. Do you think "John Bleau" is a cover?

[BWV 1080]

Yes, the LA aternative weekly rag is such a reputable source. Bet this story is wedged right between the ads for psychics and tatoo parlors.


A more in depth analysis is at:


it mentions that the high lymphocyte count was indicitive of a viral infection, by no means inconsistent with the Coroner's findings of AIDS:

In addition there is additional evidence that the hypoplastic bone marrow had nothing to do with the decline in red cell counts. For starters there is the fact that her platelet counts and overall white counts were normal, arguing against chronic bone-marrow suppression
as the cause for the anemia (regardless of the autopsy findings). Al-Bayati makes mention of a relative lack of neutrophils, but there is also a relatively high number of lymphocytes, indicative of an immune response to a viral infection. Such a shift in cell
populations is normal (i.e. in a bacterial infection the shift goes the other way). Most
importantly, in aplastic anemia, which Al-Bayati argues is the cause of the low red cell
count, there is a RAISED mean cell volume (MCV). EJ’s was low at 75.6 (normal range
86-98). And in any case, contrary to Al-Bayati’s report, there is no link between amoxicillin and aplastic anemia (marrow suppression).

http://catallarchy.net/blog/wp-content/ ... a_Ver2.pdf

[BWV 1080]

More here:

http://oracknows.blogspot.com/2005/12/e ... etime.html

The next point that soon became apparent is that, contrary to previous descriptions by Maggiore and other HIV "dissidents," this story as presented strongly implied that EJ was sicker right from the very start of her illness than what has been described previously. Maggiore's own description of EJ's rasping cough and rapid, shallow breathing sounded pretty bad, and this was three weeks before her daughter's death. Consider: Maggiore is a woman who clearly has an extreme distrust of "conventional" medicine. She didn't get her children tested for HIV, and she didn't get them vaccinated. She doesn't trust "conventional" doctors. Yet, after EJ became sick, Maggiore became so concerned about her daughter that she actually took her to see three different pediatricians in three weeks and kept her out of school that whole time. Her explanation for her seeking three opinions was:

There was a stirring in my soul. That's about all I can say. It motivated me to seek a third opinion.
Clearly, despite the protestations by her apologists that EJ wasn't very sick, Maggiore was all but admitting that she had become very concerned that her daughter was seriously ill, so much so that she acted on that fear by taking her to three different pediatricians. Unfortunately, at least one of these pediatricians (Dr. Jay Gordon) may not have known about Maggiore's HIV status at the time he examined her daughter and now says that, given EJ's symptoms, he wishes that he had insisted on an HIV test. (The original LA Times story states that Dr. Gordon did know about Maggiore's HIV status, and the Primetime Live report was not clear one way or the other but seemed to imply that he was not aware.) Not surprisingly, Maggiore ultimately blamed mainstream medicine for EJ's death, with the explanation:

I believe the unfortunate irony in this situation is that the one time that we were asked to and that we complied with mainstream medicine, we inadvertently gave our daughter something that took her life.
Later, Maggiore's HIV/AIDS denialism hindered the search for the cause of her daughter's illness and collapse after it happened. For example, Maggiore failed to volunteer information about her HIV status to the treating physicians at the hospital where EJ was taken after her collapse. Her reason? She wasn't asked. Her rationalization for not volunteering the information was that she "wanted an unprejudiced evaluation of her daughter," even though her HIV status would have been very important for the treating physicians to know. Later, she did not let the coroner know about her HIV status. Ultimately, the coroner's office apparently found out about it independently. In the past, Maggiore has expressed anger that the direction of the investigation changed once the coroner became aware of her HIV status, and did so again in the Primetime Live report. (Of course the investigation changed direction. That sort of information makes a huge difference.)
The one thing that bothered me about the Primetime Live report, however, is how the story dealt with Dr. Al-Bayati's "rebuttal" of the coroner's report. It concentrated too much on Al-Bayati's lack of qualifications (certainly a valid point to bring up, but not as the--seemingly--primary reason that his report is a pile of rubbish) and not enough on the many deficiencies of his "rebuttal," which have been outlined in some detail by Dr. McBride, Dr. Bennett, and me. The treatment of the report left the reporters open to the common charge by HIV/AIDS denialists of ad hominem attack (an attack some of them aren't shy about making themselves despite their complaints when they perceive it being leveled at them). The Primetime Live producers did make up for this lapse somewhat by sending both the coroner's report and the Al-Bayati "rebuttal" to an independent medical examiner, who concluded that the coroner's report was accurate and the Al-Bayati report was not. Unfortunately, there is no link to the independent report on the Primetime Live website. It would have been interesting to be able to read that report in addition to the coroner's report and the Al-Bayati "rebuttal." It would have been even better if the pathologist who prepared the independent report had been interviewed on screen.

Overall, though, the real added information was the link to the coroner's report on the Primetime Live website. The first thing I noticed right away when perusing the coroner's report is that, contrary to what Dr. Al-Bayati said about the report, the neuropathology section of the report states clearly that positive and negative controls were done for the p24 protein found in EJ's brain:

Select immunohistochemical reactions were performed on the blocks 1-3, 2-3, and 3-3. These studies included the HIV core protein, p24 and HSV 1 and 2. Appropriate positive [and] negative controls were used on the paraffin sections. A strongly positive p24 reactivity was detected in all three sections in the previously described zones of subcortical and deep white matter focal demyelination with microglial-giant cell reaction. No signal was recognized for HSV 1 or 2.
Nick Bennett, who wrote perhaps the best rebuttal of the Al-Bayati pointed this out in his updated rebuttal (once again kindly hosted by Trent):

Al-Bayati says that such controls were not performed. It is interesting to note that he quotes VERBATIM from the section which mentions the use of controls but DELETED all reference to the use of controls. In fact Al-Bayati specifically states that no control tissue types were used, but the common interpretation of this in the online discussion groups has been that no controls at all were used. This misconception needs to be corrected.
Nick's right. He's corrected it, and I'm trying to correct it here. If you don't believe me or Nick, though, feel free to compare the coroner's report to Dr. Al-Bayati's report for yourself. While you're at it, you might notice that Dr. Al-Bayati repeats over and over that a "pneumonia" requires consolidation and that there was no evidence of pneumonia in EJ's lungs. Note that the coroner's report plainly states that there was consolidation of the lungs, in addition to congestion, not to mention the findings of foamy alveolar infiltrates consistent with Pneumocystis pneumonia. Note that the coroner's report also mentions on p. 22:

On 05-04-2005, the mother took her [EJ] to Dr. Jay Gordon in Santa Monica for a second opinion. He thought she may have had pneumonia and she was then found to have a "low grade ear infection."
To me this indicates that at least one clinician had entertained the diagnosis of pneumonia before EJ collapsed (although he must have rejected pneumonia as the cause of her illness, since he didn't prescribe any treatment for pneumonia). Given that PCP is an atypical pneumonia that is often hard to diagnose until it is advanced, it is difficult for me to decide in retrospect, not knowing what clinical findings were there when he examined EJ, whether Dr. Gordon should have made the correct diagnosis or not. For one thing, if Dr. Gordon truly didn't know that there was reason to suspect that EJ might be immunosuppressed, then there would have been little, if any, reason for him even to consider the diagnosis of PCP in the differential. On the other hand, if he did know Maggiore's HIV status at the time, then he definitely should have at least considered an HIV-related infection in the differential diagnosis. It was not clear from the broadcast whether he did consider an HIV-associated illness or not.

The bottom line is that the pathologic evidence from the autopsy clearly shows that EJ died of AIDS, no matter how much Maggiore believes otherwise and no matter how much Dr. Al-Bayati tries to spin and distort the coroner's report to suggest the cause of death was some fantastical anaphylactic reaction to amoxicillin (a reaction that, if you believe Dr. Al-Bayati, supposedly caused a type of liver damage that amoxicillin has never been reported to show in the scientific literature). However, it should not be forgotten that, as tragic as EJ's death is, the real danger of the pseudoscientific belief that HIV does not cause AIDS is to dissuade people from being tested, being treated, or taking prudent measures to halt the spread of the virus, potentially leading to many more tragic and largely preventable deaths like EJ's. An additional tragedy of this case is that Christine Maggiore is still preaching the same pseudoscientific nonsense that HIV does not cause AIDS that she was before EJ died, only now she's claiming the mantle of martyr and blaming "conventional" medicine for the very death that her own beliefs contributed to.

[John Bleau]

The sheer number of words and non-sequiturs does not hide the fact that EJ's high lymphocyte count, even if it did indicate viral infection, categorically means she did not have AIDS. It goes counter to the WHO definition by a long shot and she therefore did not have AIDS. Lymphocytes, being central to an immune system, are in shortage, not abundance, in case of immune deficiency.

From http://sidanet.refer.org/webapps/komple ... l&page=869 :

Les experts OMS ont recommandé l’approximation de la valeur des lymphocytes CD4+ au nombre total de lymphocytes (NTL), la valeur de 1000 lymphocytes/mm3 (actuellement 1200 lymphocytes/mm3) étant considérée la limite supérieure pour la définition, sur la base du marqueur de substitution, de l’immunodéficience sévère.

[The WHO experts have recommended that the CD4+ lymphocytes be approximated by the total number of lymphocytes, with 1000 lymphocytes/mm³ (currently 1200) being the upper limit for the definition, as a surrogate marker for severe immunodeficiency. - JB]

EJ's count was 10,800 lymphocytes per mm³. A high lymphocyte count is diametrically counter to the definition of immunedeficiency.

It is not just a matter of posting other people's thoughts (though I do appreciate your putting up a little more meat than others have here): you must also apply your own critical thought. Reread the articles, look at the value-laden words (dissidents in quotes, "apologists", "pseudoscientific belief", "denialism"), and realize that it's a smear job. Realize also that the writers can convince readers who are unfamiliar with what immune suppression is that the girl had AIDS, but they can't convince someone who knows that a girl with 10,800 lymphocytes per mm³ of blood cannot possibly be suffering from immune deficiency.

There are many inconsistencies in the coroner's report, and it is worth noting that the coroner himself is under criminal investigation for other wrongdoings similar to this one.

[BWV 1080]

the 10800 number is post-mortem paid for by Maggiore, which was done by a Mohammed Ali Al-Bayati who was not even an MD:

From another discussion at
http://oracknows.blogspot.com/2005/11/h ... nesty.html

So who is Mohammed Ali Al-Bayati, PhD, DABT, DABVT? He represents himself as a toxicologist and "pathologist." However, most pathologists who deal with HIV are MD's. So what kind of pathologist is he? "DABVT" stands for Diplomate, American Board of Veterinary Toxicology; so basically he's a veterinary pathologist and toxicologist. Whether that means he's qualified to evaluate postmortem findings in AIDS, I don't know. He has a few papers published in the peer-reviewed medical literature, but none of them concern HIV; so his publication history doesn't help me evaluate him. He does, however, have a very obvious and undeniable bias. Dean will no doubt characterize it as an ad hominem attack to point out Dr. Al-Bayati's bias, but it's not at all inappropriate in this case to mention his prominent listing on the infamous Virus Myth website or his book Get All the Facts: HIV Does Not Cause AIDS. Also, Dr. Al-Bayati runs a company called Toxi-Health International, which, according to its website, provides expert witness services and "can evaluate the health effect resulting from acute and chronic exposure" to various agents," including medication reactions, adverse reactions to vaccines (shades of the Geiers!), pesticides, and a variety of other compounds. No doubt Dean will lambaste me for even mentioning such things. Tough. If Dean considers it not to be an ad hominem attack to blithely accuse the L.A. County Coroner and L.A. Times without evidence of making "a political diagnosis in order to grandstand," I consider it acceptable to point out an obvious bias in the source Dean chooses to use to make the case that the autopsy findings were incorrect.

I have no idea what the real lymphocyte count is or its significance. I have no medical background to evaluate this. What I do have is the credibility of the LA coroner over a hired veterinary pathologist, a man unqualified to do a proper postmortem, who happens to share Maggiore's AIDS denialism.

The rebuttal of Al-Bayati's Post-Mortem by Nicholas J Bennett MB/BChir, PhD Clinician and Research Dept of Pediatrics SUNY Upstate Medical University lists the following evidence of PCP:

The primary evidence for pneumocystis pneumonia (PCP) in contributing to EJ’s death is
the detection of pneumocystis carinii (now called Pneumocystis jiroveci) in the lungs of
EJ. PCP is an extraordinarily rare occurrence in the absence of immune compromise
either through concurrent infection with another, immune-supressive organism, or
through iatrogenic immune suppression, or through leukemia/lymphoma.
Al-Bayati disregards the whole concept of EJ having a pneumonia by referring to one
accepted definition, however in the case of PCP the classical findings of a pneumonia are
absent (in fact, in any pneumonia other than a bacterial pneumonia the findings may not
be classical). In particular the chest x-ray findings in non-bacterial pneumonia may be
quite limited compared to the clinical manifestations. There is quite often a far lower
inflammatory exudate for non-bacterial causes. In fact, according to several researchers
working on HIV, “PCP is defined as an acute respiratory syndrome that is confirmed by
positive morphological staining of P. carinii organisms on respiratory samples” in which
case EJ clearly meets criteria for PCP, regardless of how Al-Bayeti wants to redefine
PCP by using a definition of “pneumonia” that suits only his agenda (and that of his
paying clients!) (Journal of Clinical Microbiology, March 2000, p. 1307-1308, Vol. 38,
No. 3). In addition, the clinical signs of PCP are not the same as those of typical bacterial
pneumonias – the fever is lower, there are few crackles or other sounds on auscultation,
and shortness of breath is not usually reported except on exertion. Blue lips and other
signs of cyanosis are late signs, and in a child are indicative of fulminate collapse.
Findings that are consistent with PCP are foamy alveolar casts and the appearance of
fungi under microscopy, or detection of PCP DNA by PCR. Inflammatory cells are
normally seen, but far from always (9/13 times in one small series). Pleural effusions are
also a complication. On X-ray diffuse, patchy infiltrates are seen. EJ demonstrated
alveolar casts (the fluid/inflammatory infiltrate that Al-Bayati says is not present!), PCPlike
fungal organisms under microscopy with specific staining, pleural effusions and the
initial x-ray also showed diffuse infiltrates. All of these, together, are pointing towards
PCP as the likely diagnosis. The later X-ray showed more substantial shadowing, and I
agree with Al-Bayeti that this most likely is due to an acute process of edema
accumulating, most likely as part of acute respiratory distress syndrome (ARDS)
although severe PCP can mimic ARDS.
Al-Bayati’s complaints about the diagnosis of PCP are invalid:
He states that no findings of inflammation or infiltration were found – to the contrary,
foamy alveolar casts (FAC’s) were found that are inflammatory infiltrates that are
practically diagnostic for PCP (highly sensitive and specific). In several series, FAC’s
are the only finding that is found in every case. These casts in EJ in addition contained
the Pneumocystis organisms, implicating them in causation.

Not being qualified to evaluate any of this, I will take the pediatric clinician with a PhD over the veterinary tech.

[John Bleau]

"the 10800 number is post-mortem paid for by Maggiore, which was done by a Mohammed Ali Al-Bayati who was not even an MD" - well, I don't mention Al-Bayati, but if you insist that the 10,800 number comes from him, I'd like proof. The text you cite does not provide it.

It is obviously a very important figure.

[BWV 1080]

The 10,800 number is actually in both Al-Bayati's report and the coroners. There does not appear to be a CD4 count available, which apparantly is the more reliable measure. One commentator did mention that:

the blood counting machine may have counted some nucleated red cells as lymphocytes. These may have been released from the bone marrow during resucitation- cardiac massage.

Like I said before I am not qualified to evalutate any of this. Al-Bayati is not a credible medical expert IMO and I see no reason to doubt the LA Coroner's report which by this time has been reviewed repeatedly by medical professionals.

[John Bleau]

"the blood counting machine may have counted some nucleated red cells as lymphocytes. These may have been released from the bone marrow during resucitation- cardiac massage" - this is clutching at straws.

I assume you're revising yourself, because you clearly said that the 10800 number is post-mortem paid for by Maggiore. It is not, as you now recognize: it's on page 1 of the coroner's report. I could not find a CD4 count either, and it is more reliable (as per the orthodoxy), but the discussion is where the cutoff point should be within a range of 1000 to 1500. It's clear that at 10800 lymphocytes per mm³, we're well over any debatable cutoff point. Even allowing for "some nucleated red cells" that "may" have been counted, we can be confident that the child did not have AIDS. If that's too big a step, you will have to admit (to yourself, at least) that you can't be confident that she did die of AIDS.

Without being sarcastic, it's clear that you did some research on this.

[Teresa B]

This whole thing is pointless, but here are some reasons the lymphocyte value may or may not be a valuable piece of info:

Lab errors occur fairly frequently. There has been CDC report of 5 different labs in which one lab showed lymphocytes count off by a power of 10 from other labs.

The presence of great numbers of nucleated red cells could affect the counts significantly, as they are generally automated and the machine can pick up single round nuclei and interpret them as lymphoctes.

We don't know for sure whether the count was done pre-or post-mortem. Post-mortem could have been less reliable.

Dehydration or leakage of a great deal of fluid from the patient's blood into the tissues may produce falsely elevated blood counts.

Steroid or other drug treatment may affect blood counts.

Total lymphocyte counts are arrived at by multiplying % lymphocytes x total white blood cell count. The total count is only valid in terms of the total WBC count. It could reflect high lymphocytes or very low granulocytes.

AND...most important--Even if this child did not have AIDS, it would be one case of an incorrect diagnosis, not proof that HIV does not cause AIDS.

Teresa

[John Bleau]

Teresa, your post is a useful one, but no, the whole thing is far from pointless. There are probably more long term non-progressors than there are patients taking anti-retrovirals, but Christine Maggiore Scovill is such a high-profile one that a sloppy diagnosis¹ is being used to discredit her. So it's not just a matter of does HIV cause AIDS, but also a matter of justice to the Scovill family.

Until the high lymphocyte value is shown to be due to the reasons you hypothesize, the conclusion that EJ died of AIDS is not warranted.

"Even if this child did not have AIDS, it would be one case of an incorrect diagnosis, not proof that HIV does not cause AIDS." - correct.
_____________________

¹By a coroner who is being investigated for misconduct in other cases. I Googled for and found substantiation of this.

[BWV 1080]

Through Orac at Respectful Insolence (http://scienceblogs.com/insolence/) I got an answer directly from Nicholas J Bennett MB/BChir, PhD Clinician and Research Dept of Pediatrics SUNY Upstate Medical University, the author of the Al-Bayati rebuttal above:

The white count EJ had on admission to the ER was
within the normal range. However, that's not all that
helpful.

Lymphocytes (which are themselves composed of B cells,
CD4 T cells and CD8 T cells) typically make up between
a 5th and half of the count, depending on normal
variation. A relatively high lymphocyte count is
suggestive (but not diagnostic) of a viral illness.
However, to properly judge things you would need a
lymphocyte subset study performed to check the CD4
versus CD8 count, which is a very specialist study and
certainly NOT one performed in the ER.

The argument goes however that if the CD4 counts are
dropping, shouldn't the overall lymphocyte count drop.
The answer is no in most cases. CD4 T cells make up
maybe 10% of lymphocytes in healthy people, which make
up at most 50% of the white count. So even if you
wiped out all the CD4 T cells you would affect at most
5% of the total count (this is supported by one study
that showed that for every 1000 cells in the total
count the CD4 count went up by 16). In several
longitidinal studies of people studied for years
before and after HIV infection the total white count
remained mostly the same with a characteristic decline
in CD4 counts and an increase in CD8 counts. Now,
some decline was noted in most lymphocyte lines in the
2 years prior to death in many people (indicating
progression to AIDS from the asymptomatic period), but
we don't know what made up those lymphocytes in EJ's
case.

We're kind of stuck - a normal lymphocyte cell count
(or even raised a bit as in this case) might be
expected in many cases. A lower count might however
to expected in end-stage AIDS (and most people would
agree that PCP counts and an end-stage infection!).
But without the CD4 subsets no side can comment much.

[John Bleau]

BWV, I appreciate your effort here. The French-language link I provided does claim that an absolute lymphocyte count reflects on CD4 counts and is a valid surrogate marker (once removed, if I may say). However, I agree with Bennett that no side can comment much - much less categorically assert that the child died of AIDS. An autopsy concluding AIDS needed more than that.