Joseph Sonnabend

Joseph Sonnabend (born 1932 in South Africa) is a distinguished retired physician, scientist and AIDS researcher, notable for pioneering community-based research, the propagation of safe sex to prevent infection, and an early and unconventional multifactorial model of AIDS. During the 1980s and 1990s he treated many hundreds of HIV positive people.

Background

Joseph Sonnabend was born to a physician mother and a university professor father in South Africa. [http://www.virusmyth.net/aids/data/bnclapdoctor.htm The Clap Doctor] ] He trained in infectious diseases at the University of Witwatersrand in Johannesburg and the Royal College of Physicians of Edinburgh. [ [http://www.aegis.org/news/mh/1990/MH900910.html THE QUEEN OF AZT: To Our Only Weapon Against AIDS, Margaret Fischl Owes Everything: Her Fame and Her Infamy] ] During the 1960s he conducted research at the National Institute for Medical Research in London, where he worked under Alick Isaacs, a pioneer of interferon research. [http://www.amfar.org/cgi-bin/iowa/amfar/record.html?record=22 Honoring with Pride 2000 Honoree: Joseph Sonnabend, M.D.] ]

In the early 1970s Sonnabend moved to New York to be an associate professor at the Mount Sinai School of Medicine. After losing his interferon research grant he worked at Kings County Hospital Center and as Director of Continuing Medical Education at the Bureau of VD Control for the New York City Department of Health. In 1978 he started a private clinic for sexually transmitted infections in Greenwich Village. [http://www.personals.poz.com/articles/229_1638.shtml The Good Doctor] ]

Early AIDS work

Dr. Sonnabend was one of the first physicians to notice among his gay male patients the immune deficiency that would later be named AIDS. Independently of government agencies he conducted some of the earliest research on the syndrome, and in 1983 founded one of the first AIDS journals, "AIDS Research" (renamed "AIDS research and human retroviruses" in 1986, after Sonnabend's departure).

Multifactorial model of AIDS

Prior to the identification of HIV as the cause of AIDS in 1984, Sonnabend's investigations led him to propose that AIDS among gay men was caused by multiple factors including Epstein-Barr virus and repeated exposure to cytomegalovirus and semen. [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=6300480 Acquired immunodeficiency syndrome, opportunistic infections, and malignancies in male homosexuals. A hypothesis of etiologic factors in pathogenesis] ] This suggestion conflicted with the prevailing view that a single agent was responsible. [ [http://query.nytimes.com/gst/fullpage.html?sec=health&res=9B0DE3D91339F933A15752C1A965948260 New theory given for cause of AIDS] ]

A key implication of Sonnabend's "multifactorial model" was that frequent unprotected anal sex increased risk of AIDS. [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=6100000 A multifactorial model for the development of AIDS in homosexual men] ] This was the inspiration for the world's first attempt to promote safe sex: a booklet written under his direction by two of Sonnabend's patients, Michael Callen and Richard Berkowitz in 1983. At the time, such attempts to change sexual behavior met with vilification from many gay community leaders; later they would be regarded as fundamental in HIV prevention.

Role in founding AIDS organizations

To help fund his research and that of other scientists, Sonnabend collaborated with his friend Dr. Mathilde Krim and others to set up the AIDS Medical Foundation (AMF) in 1983. This organization would later become amfAR, one of the world's leading nonprofit supporters of HIV/AIDS research, prevention and advocacy. [ [http://www.amfar.org/cgi-bin/iowa/abouthiv/record.html?record=8 Twenty-Five Years of HIV/AIDS: Snapshots of an Epidemic] ]

A pioneer of community-based research, Sonnabend also helped to establish the nonprofit Community Research Initiative (CRI, later renamed CRIA, then ACRIA) in New York in 1987. One of CRI's early achievements was a trial that contributed to the approval of inhaled pentamidine for preventing PCP, a common AIDS-related infection. [ [http://www.aegis.org/pubs/cria/2001/CR100302.html A Long Road Traveled: Conflicts, Community and Clinical Trials] ] Sonnabend served as Medical Director of CRI/CRIA until 1996.

Another of Sonnabend's projects was the PWA Health Group, which he founded in 1987 with Michael Callen and Thomas Hannan. This nonprofit organization aimed to widen access to promising AIDS therapies not approved in the U.S. The PWA Health Group went on to become an important source of AIDS treatment education and advocacy; it is now part of [http://www.im-resource.com/html/sites_clients/daair/index.html DAAIR] . [ [http://www.aidsinfonyc.org/pwahg/welcome.html Welcome to the People with AIDS Health Group] ]

Controversies

As a popular physician, Sonnabend was renowned for protecting and promoting patients' rights. He did not shy away from criticizing the scientific establishment when he felt it was failing to put patients' interests first. He often disagreed with mainstream opinion on AIDS.

Views on AIDS treatment and causation

In the late 1980s, Sonnabend became a prominent critic of the use of AZT monotherapy to treat asymptomatic, HIV-positive people, which he thought was based on insufficient clinical evidence. Nevertheless he did prescribe the drug in short courses for people with indications of elevated interferon, which he believed might play an important role in pathogenesis and could be controlled by AZT. [ [http://www.aegis.org/pubs/gmhc/1993/GM070401.html The Concorde Study] ] In 2006 he expressed his view that high doses of AZT had "killed thousands" during the late 1980s and early 1990s. [http://www.poz.com/articles/451_2788.shtml Dead Certain?] ]

Until the late 1990s Sonnabend continued to assert that the issue of AIDS causation "remained open" and that many factors might be involved. [ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=7880263 "The Duesberg phenomenon": what does it mean?] ] [ [http://www.virusmyth.net/aids/data/jsoforum.htm Fact and speculation about the cause of AIDS] ] This led some researchers and activists to associate him with "AIDS dissidents" who deny that HIV has any role in AIDS — a charge that Sonnabend refuted:

His unconventional views on the causes and treatment of AIDS led to accusations of malpractice; he says he was shunned by mainstream scientists and refused funding.

Sonnabend later became an advocate for combination antiretroviral therapy, which he prescribed to numerous patients. However he strongly disagreed with early U.S. guidelines that recommended treating people during the initial stages of HIV infection (known as "hit early, hit hard"). [http://www.aegis.org/pubs/gmhc/2005/GM190903.html Treating HIV is Rarely an Emergency: An Interview with Joseph Sonnabend] ] [ [http://www.nowtoronto.com/issues/16/18/News/feature.html Has AIDS been beaten?] ]

The effects of modern medication helped to change Sonnabend's views on AIDS causation, leading him to assert that, "the evidence now strongly supports a role for HIV." Nevertheless, he still disagrees with the scientific consensus, and maintains that people infectedwith HIV only develop AIDS if exposed to cofactors such as other viruses and bacteria. He suggests that in many people HIV lies dormant without provoking a sufficient immune response to generate a positive antibody test result (seroconversion).

Other controversial views

In the 1980s, Sonnabend criticized activists who he believed were overplaying the threat of a heterosexual AIDS epidemic in America, causing a rift that led to his resignation from AMF. [ [http://www.virusmyth.net/aids/data/cffatal.htm Fatal Distraction] ]

He has also suggested that much of the funding for fighting AIDS in Africa has been misspent:

Assessments of Sonnabend's career

Despite his unconventional and often controversial opinions, mainstream AIDS researchers have in recent years become less critical of Sonnabend, recognizing his devotion as a physician and patients' champion. According to NIAID Director Anthony Fauci:

Personal life

For most of his life Sonnabend identified as gay, though in his twenties he fathered two sons. He has retired from medical practice and now lives in London.

References