"Although some policy-makers have focused on antiretroviral provision as the duty of rich countries and pharmaceutical companies (see, for example, Sachs [2000, 2004]), the results here indicate that this type of treatment should not be the first line of defense."

-- Emily Oster

Upstart Economist causes a commotion on the HIV/AIDS scene
NotAIDS Editorial

Emily Oster has caused a stir. Esquire Magazine called her a "brilliant young economist" who is taking the spotlight away from those who have been monopolizing the AIDS stage for the past 25 years: doctors, AIDS researchers, social scientists, and policy wonks. Her work on the AIDS 'epidemic' in Africa has proven "controversial" and "uncomfortable" for those entrenched in the field. (Esquire, December 2006)

She drew brisk reaction from The New York Times , (Leonhardt, 10 Jan 2007) which, taking a different view, said she and other economists were "acting a lot like intellectual imperialists" because they apply economic formulas and data models to analyze social problems. Obviously, nobody on staff at the Times took intermediate macro economics, or studied financial markets and public policy.

Maybe those people at the New York Times, ardent and vocal supporters of UNAIDS, are terrified of an honest evaluation of the numbers. Emily Oster says her research indicates UNAIDS' estimates are about three times too high.

As a postdoctoral Becker Fellow for the Initiative on Price Theory at the University of Chicago Graduate School of Business, Ms Oster's areas of interest include HIV/AIDS in Africa, and female infanticide in Asia.

She has been on the lecture circuit lately, speaking in front of a presidential commission on AIDS, and sharing the results of her research with other groups. Her paper, "SEXUALLY TRANSMITTED INFECTIONS, SEXUAL BEHAVIOR, AND THE HIV/AIDS EPIDEMIC" has made a splash both on and off the AIDS scene.

One of Emily Oster's most contentious conclusions has been that although African nations have a much higher prevalence of HIV and AIDS than the United States, they do not exhibit such differences in 'high-risk' sexual behaviors like 'unprotected' or 'bareback' sex.

In other words, a population in the United States with the 'highest risk' sexual behavior has a much lower rate of AIDS than a similar population in Africa.

Ms Oster finds that an African 'at risk' is 5 or 6 times more at risk than his or her American counterpart of developing AIDS symptoms, and she argues that it is because of untreated bacterial STDs, and unacceptable poverty.

She says that on the average, a 'high-risk' African "could not expect to reach old age, whether or not they contracted HIV."

Ms Oster boldly draws the obvious conclusion that in order to reduce the numbers of AIDS cases, poverty must be alleviated, and bacterial STDs should be treated with proven, less harmful, and more cost effective medicines before feeding everyone dangerous and expensive designer antiretrovirals.

In her paper, Emily Oster writes, "The results indicate that treating untreated bacterial STIs could prevent as many as 24 percent of new infections over the next decade, at a cost of less than $80 per infection, or around $3.67 per life year."

She asserts that even while more effective at reducing the transmission rates of HIV, treating bacterial STDs (STIs)is "more cost-effective than antiretroviral therapy, for which (generic) drug costs alone are $1 per day, or $365 per year, substantially higher than the estimated yearly cost of bacterial STI treatment."

Ms Oster makes some serious mistakes in her paper, however, that cannot be overlooked. She accepts as fact that HIV causes AIDS, and in doing so uses dangerous assumptions in sculpting her position.

In a footnote she explains how her data model "does not address mother-to-child transmission; although this is an important part of the epidemic, individuals infected at birth will not live to sexual maturity, so there will not be interaction between the share of a cohort infected at birth and adult HIV rate."

Quite the opposite is true: many infants' seropositive status converts to negative after several weeks of life, with or without damaging 'treatments' like Nevirapine or AZT.

Should Ms Oster wish to pursue further research in the AIDS field, it would be wise to dig deeper than she already has, and compare general populations to so-called 'high risk' groups. Not only will such a study reveal the true rate of HIV positive serostatus, but it will also prove wrong the lingering fallacy that HIV causes AIDS. New discoveries about RNA's myriad functions, and its other forms - RNAi and MRNA - reveal how common and indeed, how vital reverse transcriptase is.

The unfounded notion that HIV causes AIDS is reinforced by flawed studies that do not include control groups from the general population. There is only marginal usefulness in comparing one 'high risk' group to another - these groups are from whom the genetic protein markers were handpicked to create the concept of 'HIV' - which is akin to doing a drug study with the objective of proving its effectiveness, but only choosing indicators that support that objective.

Clinical trials for HIV/AIDS drugs have made standard practice of skewed drug studies that compare illness rates of one high-risk group to another, not bothering to consider occurence rates of the same illnesses in the general population.

Looking for an agent that can cause a syndrome of t-cell death and rapid decline of health was an exciting goal for Robert Gallo twenty-something years ago. It was so exciting that he ignored two-thirds of the AIDS patients' blood samples which did not contain the mix of proteins and genes that he decided would be his AIDS virus.

Photo of Emily Oster courtesy of "Capital Ideas, Selected Papers on Price Theory," Chicago Graduate School of Business, April 2006.

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