Sadly, chronic pain remains “difficult, if not impossible” to treat, according to MedPage Today. (2)

In an article unfortunately titled “Study: Chronic Pain May Really Be ‘All in Your Head’,” MedPage Today contributing writer John Gever reported new findings that may be a breakthrough in pain research. A large research team based at Boston’s Massachusetts General Hospital (MGH) found that a protein in skull bone marrow may be a previously unacknowledged cause of, or contributor to, chronic pain—especially when it isn’t related to tissue damage (a strained muscle, for example). (2)

This protein, which is found in the bone marrow of skull bones, “18-kDa translocator protein”—we’ll use its abbreviation, TSPO—has recently been found not only to be a contributor to brain inflammation but also to be active in the immune system. (2)

The skull, which many of us (including me) primarily consider a scaffold protecting the brain, is of course made from the same materials as leg or arm bones. An important aspect of our bones, other than being a support system, is the marrow inside. It generates the cells (called myeloid cells) that form the immune system: erythrocytes (red blood cells that transport oxygen), granulocytes (bacteria-fighting white blood cells), monocytes (white cells that mature into the trash collectors of the immune system), and megakaryocytes (which break apart to create platelets, our natural blood clotters). All of them begin as myeloid cells in the bone marrow, including in that inside skull bones. (3)

This pioneering research examined a small group, which is common in proof-of-concept studies—meaning, a first attempt to see if a newly described phenomenon should receive funding for a larger study. A group of 125 individuals included 88 chronic low back pain patients, 37 knee arthritis pain patients, and 22 control subjects. Using PET and MRI scans, the MGH researchers discovered that TSPO protein was elevated in the skull bone marrow of people with these two types of chronic pain but not in the control subjects. (3)

Author’s note: Notice that a protein from the skull’s bone marrow may be involved in causing pain far away from the brain, in the lower back and knees. Is this part of TSPO’s actions in the wider immune system? We don’t yet know.

Previously, in a 2020 study, these researchers found increased levels of TSPO in patients who have migraine with visual aura (a disturbance in vision that precedes and generally predicts a migraine attack). “We suspect that this inflammatory focus results from a signal that migrates from underlying brain and if so, may implicate newly discovered bridging vessels that crosstalk between brain and skull marrow, a finding of potential relevance to migraine and other neuroinflammatory brain disorders,” they suggested. (4)

In other words: increased levels of TSPO, produced in the skull bone marrow, may play an important role in the inflammation, visual aura, and pain in migraine patients. What “other neuroinflammatory brain disorders” may also benefit from this research? These researchers don’t specify but other similar disorders include Alzheimer’s disease, AIDS, encephalopathy, encephalitis, lupus, ME/CFS, multiple sclerosis, Parkinson’s disease, and others.

In the 2026 study of lower back and knee pain patients, these researchers found that increased levels of TSPO were “strongly linked with pain intensity,” Geever reported. And while TSPO is currently used as a marker of brain inflammation, it can also be found in peripheral (blood-borne) immune cells outside the nervous system. (2)

“Because TSPO is highly expressed in myeloid cells, these results link SBM [skull bone marrow] immune dysregulation with chronic pain and its associated psychological and functional impairments,” the MGH researchers pointed out. “These findings provide a strong rationale for investigating this previously overlooked structure, which remains largely underexplored in the context of pain.”

Could it lead to new avenues of pain relief research? Currently, some migraine patients are being treated with drugs that interfere directly with different pain-inducing proteins—not TSPO—that can cause the pain, inflammation, and blood vessel changes that occur during migraines, so this approach certainly seems viable.

It’s past time for new classes of pain relief that lack the addiction and overdose potential of opioids. Because of these risks, opioids are tracked by the FDA down to every single dose prescribed for any patient, limiting their use and leaving many patients without any treatment at all for their pain. New classes of pain killers might actually be prescribed widely enough to treat the chronic pain that currently goes untreated far too often.

BIBLIOGRAPHY
1. Jacqueline W. Lucas, M.P.H., and Inderbir Sohi, M.S.P.H. “Chronic Pain and High-impat Chronic Pain in U.S. Adults, 2023.” Centers for Disease Control and Prevention National Center for Health Statistics, November 2024. https://www.cdc.gov/nchs/products/databriefs/db518.htm
2. John Geever. “Study: Chronic Pain May Really Be ‘All in Your Head’.” September 2, 2026 MEDPAGE TODAY. https://www.medpagetoday.com/neurology/painmanagement/122866
3. Mehrbod Mohammadian, Nikos Efthimio, Katherine Gabriel, Marco L. Loggia et al. “Elevated translocator protein in skull bone marrow is linked to human chronic pain.” Science Translational Medicine, 2 Sep 2026. Vol 18, Issue 86. DOI: 10.1126/scitranslmed.aed872
4. Nouchine Hadjikhani, Daniel S Albrecht, Caterina Mainero, Marco L. Loggia et al. “Extra-Axial Inflammatory Signal in Parameninges in Migraine with Visual Aura.” Ann Neurol. 2020 Jun;87(6):939-949. doi: 10.1002/ana.25731. Epub 2020 Apr 22.

If you aren’t familiar with virologist John Moore, he has been an outspoken detractor of any and all AIDS criticism; he was directly involved in the now-defunct website AIDSTruth. I believe this website lasted until 2015 or so; it was taken down presumably because the powers behind it deemed AIDS criticism to “no longer be a problem.”

However, the truth has a sly way of clawing its way back into the discourse; the Covid pandemic and its mismanagement—including positively nasty suppression of any and all questions—has brought scientific criticism in general, and AIDS criticism in particular, back into the spotlight, hence the recent publication of Kalichman’s Denying AIDS, a “zombie book” (Henry Bauer’s term) that concentrates on criticizing and pathologizing the critics. AIDS critics including myself have been characterized as “not being experts on AIDS” or not being virologists, when in fact Kalichman himself is no AIDS expert; he is a clinical psychologist with what appear to be rather dubious ethics. It is amusing that the first line of Moore’s review is the following:

The author is a professional academic, writing in his area of expertise to produce a scholarly, well-researched and thoroughly referenced book.

Excuse me while I have a chuckle. Note the use of the term “in his area of expertise”—i.e. not AIDS.

The rest of the review says about what you would expect it to say; if you’re interested please follow the link as I am not going to quote from it any further. Also, note that Moore’s review is one of two on Amazon; there are two star rankings as well. Do with that information what you will.

When lawyers began seeking people who may have been injured by Gilead’s TDF-based HIV drugs—including Truvada, Viread, Atripla, Stribild, and Complera—major HIV and LGBTQ advocacy organizations did not merely criticize the ads’ wording. They organized to make the ads disappear.

More than 50 HIV/AIDS, LGBTQ, and public-health organizations signed an open letter urging Facebook and Instagram to remove the litigation advertisements. Their argument was that the ads could dissuade people at risk of HIV from using PrEP. Facebook subsequently disabled some ads after an independent fact-checking process found particular advertisements misleading.

That history must be stated plainly: whatever the advocates’ stated intentions, their campaign had the practical effect of restricting one of the principal ways patients might learn that their kidney disease, bone loss, fractures, tooth loss, or other serious health problems could merit medical and legal investigation.

This was outreach—not an abstraction

The lawsuit ads were designed to find people who had used TDF-based drugs and believed they had suffered serious harm. In a mass-tort case, that kind of outreach matters. Potential claimants are scattered across the country; many have no idea that they are not alone; many may never have been told that their injuries could be linked to a medication they took for years.

Yet the advocates’ requested remedy was not merely a correction, disclaimer, or requirement that the advertisements identify disputed claims accurately. They asked the platforms to treat these legal solicitations much like health misinformation and remove them. Their letter urged Facebook and Instagram to take down the ads and to prevent similar advertisements from appearing.

This was an effort to cut off contact between lawyers and possible clients.

The activists may have believed they were preventing HIV infections. The research they pointed to found that the ads reached a wide audience and that some surveyed people said the advertising affected decisions about beginning or continuing Truvada-based PrEP. But that is an argument for accurate risk communication and careful clinical counsel—not for treating people seeking information about alleged injury as a public-health threat.

What patients may have lost

For a person who had developed renal impairment after years on Truvada, an advertisement could be more than a solicitation. It could be the first clue that their experience deserved examination.

For a person coping with osteoporosis, fractures, avascular necrosis, or tooth loss, it could be the first indication that similar stories existed. It could be the first opportunity to obtain records, speak with an independent lawyer, request an expert review, or learn whether litigation might uncover documents that patients and clinicians never saw.

The legal claims concern allegations that Gilead knew of TDF’s renal and bone risks and delayed a newer TAF-based formulation that plaintiffs say was less toxic in these respects. Gilead has disputed wrongdoing, and the existence of a lawsuit does not prove causation in an individual patient’s case. But that is precisely why potential patients need information, independent advice, and access to legal process—not suppression of the channels through which they might discover their rights.

The human evidence

Rebecca Culshaw Smith drew attention to individual plaintiffs whose allegations are rarely visible in the broader press coverage.

• Kenneth Calhoun alleged that after taking Atripla and/or Truvada beginning in 2006, he developed avascular necrosis and tooth loss associated with a bone-density disorder.

• Artis Crandell alleged that years of Truvada use preceded chronic kidney disease and tooth loss associated with bone-density problems.

• Thomas Henderson alleged that after taking Atripla and/or Truvada, he developed chronic kidney disease and fractures associated with bone-density disorder.

• Michael Scarlett alleged that use of Viread and/or Truvada preceded osteoporosis, avascular necrosis, fractures, and tooth loss.

• Tyreese Buchanan, profiled by ABC 10News, described severe hip pain, kidney failure, and tooth loss; he said his pain made walking extremely difficult and that he seldom left home.

These are allegations, not adjudicated findings. But the proper response to allegations of this gravity is not to make it harder for similarly situated people to find counsel.

The press mostly looked away

The press covered the political fight over the advertisements: the danger of fear, the prospect that PrEP uptake might decline, the activism directed at Meta, and Facebook’s decision to remove some ads. It covered the campaign to stop the lawyers’ outreach far more readily than it investigated the lives of the people whom the lawyers were trying to reach.

Rebecca Culshaw Smith did something different. In “Truth cannot be disinformation” and “Another Truvada lawsuit filed,” she centered the injuries alleged by patients, identified plaintiffs by name, and highlighted Buchanan’s account. Her work pressed a question that much mainstream coverage avoided: why should a person seeking to learn whether a drug caused grave harm be portrayed as a problem to be managed rather than a patient to be heard?

One can disagree with Culshaw Smith’s wider conclusions about HIV medicine and still recognize the value of that reporting. She directed attention toward the people whose stories had been submerged beneath a dispute about public messaging.

Activism’s reversed moral compass

The moral irony is difficult to miss. AIDS activism historically insisted that patients had a right to information, access, participation, and protection from pharmaceutical and governmental indifference. It rejected the idea that officials or companies could decide which risks patients were permitted to know about.

But when people with alleged TDF injuries needed to be located, some modern activists helped frame the process of finding them as dangerous “misinformation.” In so doing, they risked substituting confidence-management for patient advocacy.

A movement committed to informed consent should have demanded three things:

• That legal ads describe risks and allegations accurately, without exaggeration.

• That patients be encouraged to consult qualified clinicians about the benefits and risks of PrEP or HIV treatment—not simply stop medication in response to advertising.

• That people who believe they were harmed retain every reasonable avenue to learn about their legal rights and reach independent counsel.

Those goals are compatible. What is incompatible with genuine patient advocacy is demanding that potentially injured patients remain difficult to find.

The public should be able to discuss PrEP’s benefits without denying TDF’s documented safety concerns. It should be able to insist on responsible advertising without helping a powerful drug manufacturer remain insulated from claimants. And it should be able to defend prevention without treating injured people as collateral damage to the prevention narrative.

Lawsuits Over TDF Drug Injuries Dismissed After California Supreme Court Ruling

As a reminder, there are multiple lawsuits that have been filed against Gilead for continuing to promote TDF (“bad Truvada”) while knowing that the drug had severe adverse effects affecting the kidneys and bones, and while also knowing that they had a safer alternative in the pipeline (TAF, or “good Truvada”) that they refused to promote. The California Supreme Court evidently found that Gilead should not be held liable.

In a 6-to-1 opinion (PDF) issued on August 3, the California Supreme Court agreed with Gilead that the cases should be dismissed. The justices defended the company’s freedom to stop investing in a potential drug product, even if it showed the potential to be a better treatment.

Furthermore:

According to the majority opinion, plaintiffs failed to meet essential elements of negligence claims under California law. The court determined a company’s existing duties under law, while encompassing a broad area of reasonable care, do not extend to owing its customers the development of a safer alternative product.

I find the wording interesting here. A company’s “existing duties under law do not extend to owing its customers the development of a safer alternative???” In the case of Truvada, the “safer alternative” (which still had its problems) had already been developed and was being held back. This seems to me to be an important distinction.

This is a deeply disappointing outcome. However, it is not the end of the road. There remain avenues that can be pursued regarding this litigation, such as appealing to the U.S. Supreme Court, reframing claims to other state courts (this ruling applies only to California), or pursuing non-tort avenues.

This ruling effectively ends any litigation at the California level; however, the story is not over just yet as there remain multiple lawsuits active in other states and in Canada. Stay tuned.

In his introduction to the Fauci diaries, Paul notes, “This is his own historical record containing almost-daily entries. ... Many entries in Fauci’s daily historical account completely undermine the official narrative that Fauci and other public health officials espoused.” (1)

One of Fauci’s first entries, on January 10, 2020, reads: “Appeared on Voice of America to discuss the new Wuhan virus documented to be a novel coronavirus. Interesting that over the past several years we have had 3 emerging novel coronaviruses that have caused serious disease in humans: SARS, MERS, and now the Wuhan virus.
“Chinese publish sequence of the virus on public data base” (1) [Emphasis Fauci’s]

Several hundreds of pages later, the penultimate diary entry reads in part:
“Dec 16, 2022: Momentous Day!!! Today we had the ceremony for my “stepping down” at NIH.” (1) [Emphasis Fauci’s]

Throughout, Fauci reproduces and comments on news stories about him. He described some as “flattering”; a diary entry dated March 21, 2020, reads: “Big front page article about me appeared in the Washington Post. Very flattering. The situation with my national and international fame is explosive and really unimaginable. It is not hyoperbole to say that today I am the most famous and talked about person in the country and one of the most recognizable person in the world. Countless profiles on me in multiple media. I cannot even read all the things that are written about me since I am so busy….seriously. POTUS seems to be enamored of me even though I am taking the spotlight away from him. ...” (1)

Following a White House meeting with Trump and others on March 11, 2020, Fauci wrote: “After I went home and watched on TV, the CNN commentators (Chris Cuomo, Anderson Cooper, David Gergon, David Gregory) all discussed me as the adult in the room and the person we should all trust.” (1)

If you don’t feel like—or have the bandwidth to—submerge yourself in hundreds of pages of Fauci’s diary, Amanda Macias on the Fox News website (2) and Joseph Choi at The Hill (3) published more easily digestible overviews.

Stay tuned for Fauci’s turn at testifying in Chairman Rand Paul’s US Senate Committee on Homeland Security and Governmental Affairs on Tuesday, July 28.

BIBLIOGRAPHY

1. Rand Paul. “Tony’s Diaries.” July 26, 2026. https://www.paul.senate.gov/wp-content/uploads/2026/07/2026.07.24_Tonys-Diary-Package.pdf#&_intcmp=fnc_politics_article_main-content_article-body_6_1

2. Amanda Macias. “Inside Fauci’s private diary: What he wrote about Trump, TV personalities and celebrities: Entries document relationships with Mark Meadows, Dana Bash, Julia Roberts, Steph Curry and Hunter Biden.” FoxNews.com, July 26, 2026. https://www.foxnews.com/politics/inside-faucis-private-diary-what-he-wrote-about-trump-tv-personalities-celebrities

3. Joseph Choi. “Fauci diary entries: ‘Press is going wild with me’.” The Hill, July 27, https://thehill.com/homenews/5992015-fauci-diary-entries-released/ 2026.

More to come.

Some people really don’t want you to read “The Real AIDS Epidemic”—March 14, 2023

My book does not deny the AIDS epidemic.—March 20, 2023

How to Kill a Book About AIDS—May 15, 2023

TAG attacks RFK Jr and Skyhorse Publishing—July 11, 2023

It will be interesting to see whom Kalichman attacks in this new edition of his book, originally published in 2009. A glance at its Amazon page hints that RFK Jr will be a target. Next week should be interesting.

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I recently obtained a copy of the book Denying AIDS: Conspiracy Theories, Pseudoscience, and Human Tragedy by Seth Kalichman, a Professor of Social Psychology at the University of Connecticut. He is also the developer of the Sexual Compulsivity Scale, which is evidently used to help “predict a range of health outcomes.”

I had been aware of this book since it was released in 2009 but I never bothered to read it, although I had heard through the grapevine that my name was mentioned (it was; in an appendix listing some well known “denialists”). I was knee deep in early motherhood at that time, but one thing I do recall was that one of my cousins blocked me on social media after reading that book.

I will give Dr. Kalichman credit for having taken a novel approach. Rather than trying to debunk “denialist” arguments (for the most part—more on that momentarily), he instead attempts to use his skill as a psychologist to psychoanalyze the entire “HIV AIDS denialist” movement as though it were a monolith. He must not be aware that “denialism” takes many forms. Some people think HIV does not exist (heck, some people think no viruses exist, but this has less to do with HIV than you’d imagine—topic for a future post), some think it is a harmless passenger virus, some believe it is pathogenic but needs cofactors for progression to AIDS, and even some merely reject the drugs.

Nevertheless, we are apparently paranoid conspiracy theorists with “suspicious minds” and that politically we are almost certainly “socially far right conservatives” or libertarians (these two things are not the same). There is also the suspicion that we might be homophobic, although I wonder how Dr. Kalichman explains the fact that many members of the gay community are themselves “denialists.”

There is an entire chapter on Peter Duesberg, and it says about what you think it would say.

I will mention one last oddity before I close. In the first chapter, Dr. Kalichman attempts a little debunking. Specifically, he reproduces a slightly changed version of an appendix from The Real AIDS Epidemic in which I list the failed predictions of HIV AIDS, and attempts to debunk said debunking (on my part) of said predictions. He lists the prediction as “Historical Prediction,” my analysis “Denialist Myth,” and his “debunking” as “Scientific Fact.” It is fascinating to me because in every case he fails to debunk my argument in one of two ways. He either makes some sort of vague statement like “HIV AIDS is becoming medically manageable with antiretroviral medications, and one day, there may be a cure. However, today there remains no cure for HIV AIDS,” or he subtly changes my statement to something that doesn’t reflect my original intention and then debunks that changed statement. It is very peculiar.

Overall, I will admit that this was an entertainingly written book. Of course, I disagree with its thesis, but as a fierce advocate of freedom of speech, I am grateful to live in a time when Dr. Kalichman’s book and my book can sit together on the same shelf, as it were. Let’s hope that doesn’t change.

In The Real AIDS Epidemic, I present an analysis of data that falsify the HIV/AIDS hypothesis and warn about the toxic drugs being given to people in the name of that falsified HIV/AIDS hypothesis. In the afterword, I offer constructive suggestions for a paradigm shift in AIDS research and treatment that emphasize the recognition of the massive Non-HIV AIDS epidemic in the general population.

To support my work on Substack, please purchase my book for yourself or for a friend, and leave a review on Amazon. You can learn about efforts to ban my book here. You can also preorder my new book Almost Cancelled.

“A new kind of institutional vandalism appeared last month in the form of a 412-page Trump administration regulatory proposal and a comment period,” Dr. Finucane began. “If the proposal passes, it will damage one of the most rigorous, productive and valuable scientific enterprises in the world.” (1)

The major problem with this new regulatory proposal, Dr. Finucane continued, is that it would “impose restrictions on the kinds of research that can be funded and give political appointees the final authority to deny federal funding for research deemed inconsistent with presidential priorities.” (1)

This new proposal by the Office of Management and Budget weakens, according to Dr. Finucane, the strong accountability now in place within the peer review process.

“The proposal demotes peer review where expert scientists, working inside and outside the agencies, evaluate research based on the scientific merits and strengths of the underlying evidence. Instead of being ‘routinely deferred to,’ peer review would now be only ‘advisory.’ That upends the longstanding compact between the federal government and the scientific community, where Congress appropriates funds, agencies administer them and scientists (through peer review) determine which proposals represent the best science.” (1)

Hold on: Peer review has had good and bad outcomes.

If you’re a regular reader of this SubStack, you’re aware of the articles my writing partner Dr. Rebecca Culshaw Smith and I have posted here that examine how medical research, funded and published via the peer review system, sometimes goes very much awry.

Rebecca has taken a deep dive into the often-under-disclosed adverse effects of the PrEP drugs given for life to healthy people to (allegedly) keep them from contracting HIV. She is, inexplicably, the only reporter in North America who’s monitoring the potentially billion-dollar lawsuits filed against the maker and aggressive marketer of these drugs, Gilead Sciences. (2) Rebecca has also published several books on the subject of AIDS and its underlying scientific, mathematic, and medical lapses, toxic treatments, and fraudulent science. (3-5)

Over the last 40 years, I’ve written about the outright prejudice against and medical/psychological mistreatment of ME/CFS patients, as I did at The New York Native (1988-1997), and in several books. (6-8)

But back to this week in the New York Times: I agree with Dr. Finucane that no politician of any stripe should decide which scientific research should be funded, conducted or published in any field. But what Dr. Finucane doesn’t acknowledge in her guest essay is that the peer review process is already subject to an only slightly subtler form of political pressure from within the scientific establishment.

Have we already forgotten how Dr. Anthony Fauci ruled the grant-awarding process at the National Institute of Allergy and Infectious Diseases for close to 40 years? (9)

On SubStack, I’ve documented that some of the fraud discovered in the search for Alzheimer’s Disease (AD) treatments has occurred because the discipline’s “thought leaders” are presumed to be more correct than everyone else. Not only have they created the (now questionable) AD paradigm that all other scientists must accept and recreate in their own studies—if they want to be funded and published—but AD thought leaders also receive the lion’s share of research grant monies and are often given author credits for papers into which they had little intellectual input. (10)

I’m not accusing all younger scientists of simply emulating the senior researchers in their fields, but there exists an element of hero worship that can cause not-famous researchers not to question, ever, the work done by their discipline’s leaders.

For example: I worked for a while with a scientist who’d done his postdoc in New York’s Memorial Sloan Kettering Cancer Center lab of Dr. William T. Summerlin, who carried off the pre-AIDS era’s most breathtaking feat of laboratory fraud. Dr. Summerlin was trying to prove that trans-species skin grafts could be performed without using harmful immunosuppressant drugs. In the early 1970s, he claimed to have transplanted black fur onto white lab mice without the help of any immunosuppressant therapy. There was just one problem: No one could replicate his findings.

An article in O&G Magazine described the debacle:

“In 1974, Summerlin was exposed when lab assistants discovered that the patches on the mice could be removed with alcohol. The ‘black patches’ turned out to be the result of a black marker pen. Summerlin later attributed his deceptive behaviour to a combination of mental and physical exhaustion, and pressure to publicise positive results. As a result of the Summerlin incident, the term ‘painting the mice’ became a synonym for research fraud.” (10)

About a decade later, conversation in the lab turned to why all of Summerlin’s postdocs, including my friend, didn’t question why they couldn’t replicate the professor’s finding. He shrugged and said, “We just assumed he was smarter than the rest of us.”

This detour has taken us into one type of bias in science that’s probably existed for centuries: not questioning the famous professor, the institutional leader, or the paradigm creator because they’re thought to be smarter, more adept, downright infallible.

But in 2000, the HIV thought police took bias-by-group think to an even more absurd height: The Durban Declaration. It was named after Durban, South Africa, where the XIII International AIDS Meeting was held in July 2000.

Published in Nature on July 6, 2000, the Durban Declaration stated, in bold type:

“HIV causes AIDS. Curbing the spread of this virus must remain the first step towards eliminating this devastating disease.” (11)

The Nature publication included a couple of introductory paragraphs explaining that the “current controversy” in South Africa over whether HIV causes AIDS had created “massive consternation among all scientists, doctors and many others in the international community who treat AIDS patients or who work on AIDS in other ways. There is widespread anxiety that denying or doubting the cause of AIDS will cost countless lives if blood screening, use of condoms, and methods to prevent mother-to-child transmission of the virus are not implemented or, worse, even abandoned.” (11)

No similarly Stalinist-lite effort to suppress dissent would be complete without lists: Lists of those who could be depended upon to toe the party line (the Declaration’s signers), and of those who couldn’t.

“The declaration has been signed by over 5,000 people, including Nobel prizewinners, directors of leading research institutions, scientific academies and medical societies, notably the US National Academy of Sciences, the US Institute of Medicine, Max Planck institutes, the European Molecular Biology Organization, the Pasteur Institute in Paris, the Royal Society of London, the AIDS Society of India and the National Institute of Virology in South Africa,” Nature asserted.

And how could it not have gathered so many signatories, having an “organizing Committee” comprised of “over 250 members from over 50 countries.” (11)

All of which is to say, science’s past is not pristine; nor will its future be. But, with effort, we can correct the known biases and keep our eyes open for the new ones that cutting-edge technologies and scientific innovation will inevitably create.

And hopefully, well-meaning individuals will some day agree that curtailing originality and restricting certain areas of research—be it the structure of the solar system in the 1630s, the research use of human embryonic stem cells in the 1990s, the implacable insistence that HIV is the sole cause of AIDS in 2000, or the “incentive to prioritize loyalty to a political leader over quality,” as argued by Dr. Finucane in this week’s New York Times—is ultimately destructive to increasing our common reservoir of human knowledge.

BIBLIOGRAPHY
1. Melissa L. Finucane. “Trump’s Assaults on Scientific Research Just Got Worse.” New York Times, June 9, 2026. https://www.nytimes.com/2026/06/09/opinion/science-federal-government-funding.html?smid=nytcore-ios-share
2. Rebecca Culshaw Smith. “Truvada Side Effects—from Truvada users. A brief examination of the PrEP enthusiasts of Reddit.” April 25, 2024. The Real AIDS Epidemic on SubStack.
3. Rebecca V. Culshaw. The Real AIDS Epidemic: How the Tragic HIV Mistake Threatens Us All. Skyhorse Publishing, 2023.
4. Rebecca Culshaw Smith. The Truvada and PrEP Disaster. July 2024. Available on Amazon.
5. Rebecca V. Culshaw. Almost Canceled: How AIDS Activists Almost Stopped the Publication of The Real AIDS Epidemic. September 2023. Available on Amazon.
6. Neenyah Ostrom. 50 Things You Should Know About the Chronic Fatigue Syndrome. January 1, 1993. St. Martin’s Press, NYC, NY.
7. Neenyah Ostrom. Ampligen: The Battle for a Promising ME/CFS Drug. June 2, 2022. Available on Amazon.
8. Neenyah Ostrom. AMERICA’S BIGGEST COVER-UP: UPDATED 2ND EDITION 50 More Things Everyone Should Know About the Chronic Fatigue Syndrome Epidemic and Its Link to AIDS. March 9, 2022. Available on Amazon.
9. Joseph Choi. “Fauci sits through first 7 hours of questioning with COVID select subcommittee.” The Hill, January 8, 2024. https://thehill.com/homenews/4396265-fauci-sits-through-first-seven-hours-of-questioning-with-covid-select-subcommittee/
10. Neenyah Ostrom. “Fraud in Stroke and Alzheimer’s Disease Drug Trials—Again?Whistleblowers detect data and images in published papers that appear to have been manipulated, according to Science magazine.” November 16, 2023. SubStack. https://immuneillnessreport.substack.com/p/fraud-in-stroke-and-alzheimers-disease
11. Gerald Lawson. “Painting the mice: research fraud.” O&G Magazine, published by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. EVIDENCE, Vol. 14 No 2 | Winter 2012. https://www.ogmagazine.org.au/14/2-14/research-fraud-painting-mice/
12. “The Durban Declaration.” Nature 406, 15–16 (2000). https://doi.org/10.1038/35017662

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No doubt many of you already know Dr. Sam Bailey, who is located in New Zealand and interviews many fascinating guests. She is a medically trained doctor and an author of the recent book Virus Mania. I sat down with her (virtually) last week for a great talk about all things related to HIV AIDS, Covid, and medical tests and drugs of dubious efficacy and even worse safety. I won’t add any commentary; here’s the link. Let me know what you think in the comments!

Fake Epidemics, Tests, and Drugs — Interview with Dr. Sam Bailey

To support my work on Substack, please purchase my book for yourself or for a friend, and leave a review on Amazon. You can learn about efforts to ban my book here. You can also buy my new book Almost Cancelled.

If you’re a new reader and would like some background as to my views on HIV AIDS, including the “existence” question, please refer to this post and the links contained therein.

Emily O’Reilly: My brother’s HIV seemed under control. So why did he die?

Shortly after 8pm on May 29th, 2023, my brother Brian, aged 62, died at London’s Whittington Hospital. He had been admitted by ambulance late the previous night following a collapse at a nursing home.

At 11.40 that morning – observing his frailty – a doctor who did not know him advised against resuscitation should his heart stop.

“We like to have this conversation earlier rather than later,” she wrote in her medical notes, “and given his complex medical history, he is unlikely to benefit from CPR and [it] is more likely to cause more harm than good.”

[…]

Brian’s death certificate recorded the immediate causes of death; a pneumonia caused by food and liquid entering his lungs – and a “pseudo” internal obstruction.

As we know, pneumonia—and specifically, pneumocystis pneumonia (PCP), a fungal lung infection—was among the first five AIDS defining diseases. We will also see that Brian suffered from another AIDS defining illness, which is now acknowledged to be caused by a herpes virus, KSHV/HHV8—Kaposi’s sarcoma.

The underlying causes were: human immunodeficiency virus, the cancer Kaposi’s sarcoma (KS) and severe frailty.

By the time he died, Brian weighed just over eight stone, having lost four stone “unintentionally” in six months.

He had cachexia, wasting syndrome, his clothes loose around his body.

The russet lesions of KS – a cancer consigned in public memory to last-century deaths from Aids yet still recorded by the World Health Organisation as “Aids defining” – were visible on his legs, arms and chest.

Everything about this death – the virus, the cancer, the wasting – felt as though from another time.

I’m waiting until we get to the point that his treatment is described. It might provide some clue as to why he was so sick despite being on medication that allegedly kept his “HIV” at bay.

Brian had died more than 40 years after the western Aids epidemic began, more than 30 since his HIV diagnosis, a quarter of a century since effective HIV treatment had emerged.

It was so effective that he died despite it—or because of it?

Why then, at the end, did he look less like a survivor of the modern HIV era than a casualty of its first?

After his death, my conscious self split in two.

One part was a grieving sister, mourning the loss of a brother, friend, confidant, beloved of my children, his Christening my first conscious memory.

This must be very difficult and enraging for the survivors.

The other part was the curious professional – a former journalist, Ombudsman – wondering at the disconnect between the contemporary framing of HIV and my brother’s final two years and death.

His dying seemed impolite, offending against the narrative: that, with treatment, the crisis had passed, that people would live lives as long as anyone else’s.

But if that were true, how could someone whose HIV was well controlled by antiretroviral therapy die like this – in London – die in 2023?

How was it possible for someone to get KS on the very treatment that is meant to hold it in check?

How, indeed, was it possible? It’s almost as though “HIV” is irrelevant and that these illnesses were caused by something else entirely.

And if that cancer is – still – categorised as “Aids defining” – what did that mean in his singular case?

In a scant two years, Brian’s body had unravelled, developing cardiac, renal and liver failure alongside electrolyte instability that caused blackouts. A sling supported a shoulder fractured and repaired after a fall. Nerve damage to a foot confined him to a wheelchair. Chemotherapy in late 2022 weakened him; his body still dealing with the aftermath of intestinal surgery six years earlier, albeit successful.

I’d like to know if he was on Truvada, given the kidney and bone problems he experienced. I’m also curious about the “chemotherapy” he received. Was this to treat his KS?

Perhaps Brian’s history will help us understand how everything went so wrong.

Brian had emigrated to New York in 1982, aged 21.

[…]

As Brian planned his New York life – arriving at a peak of sexual freedom for gay men – a new threat was quietly announcing itself.

A June 1981 report from the Centres for Disease Control and Prevention described a rare lung infection, pneumocystis carinii pneumonia, in five gay men in Los Angeles. Two had died.

It was the first official report of what later became known as Aids. By 1995, one gay man in nine in the US had been diagnosed with Aids; one in 15 had died.

In 1990, Brian tested positive for HIV. Briefly returning to Ireland, he moved to London, remaining there with his partner for the rest of his life.

In 1997, the roll out of new antiretroviral drug regimens dramatically increased life expectancy. The terrors passed. He would live, but in a space that demanded vigilance, monitoring, blood checks, medication changes as side effects emerged – high cholesterol, anxiety, potential cardiac and kidney risks – 15 different antiretroviral therapy regimens between 1997 and 2022.

Finally we have the acknowledgment that the treatments themselves can be toxic, requiring constant monitoring and vigilance. It’s also unclear whether the author means that Brian himself received fifteen different treatments.

All of this – to me – was invisible. His chemical sentinels demanded attention, yet remained in the conversational shadows.

By the turn of the century, the HIV/Aids story was shifting. Online Aids memorials were less frequently updated; the remembered dead eternally stuck in the gay style subcultures of the decades they had died in.

HIV was there just as diabetes was or any chronic disease. Fewer people remembered the epidemic, even fewer its iconic disease – KS.

I trace the start of my brother’s decline to Easter 2021.

It came early that year. We met in London in late March. Walking down Euston Road, he was limping, his left foot dragging. En route to Sainsburys one day, he tripped. Passersby plucked him from the hedge he had tumbled into.

By the following summer he required a leg brace, ultimately, a wheelchair. An abnormal heart rhythm emerged in May; an attempted surgical fix failed two months later.

In September, his kidney function deteriorated.

His sodium levels fluctuated. He would faint, have seizures, attend A&E departments for sodium infusions.

This is sounding more and more like the treatment was worse than the disease. Had Brian exhibited any AIDS like illnesses prior to his starting ARVs? Read on.

Brian coped, using a spreadsheet to monitor test results, track appointments, forward emails, corral his siloed consultants.

I hovered as he shared the latest, speculative, diagnoses of his doctors; spinal cancer, breast cancer, motor neuron disease.

In March 2022, an older, more terrifying world returned. Lesions on his knee and ankle had concerned his GP, a biopsy to check for KS was planned. His HIV consultant said KS was “highly unlikely”. The markers of his immune defence were normal, his viral load undetectable.

Days later, a biopsy confirmed the cancer.

Allow me to remind you that KS is a very curious phenomenon that might, ironically, demonstrate that “HIV” is not necessary for AIDS.

He had options. This form of KS might remain on the skin and not spread into organs. He could die with it, and not because of it.

Brian did not want it, period. He craved chemotherapy, terrified of facial lesions. In a hospital day room one morning, he watched as people received intravenous chemotherapy.

I envied them, he said.

My brother was not a child of the 21st century with its optimistic HIV narrative, with Aids at least tamed – not even called Aids any more – but rather “advanced HIV” and everyone expected to live long and healthy lives.

Brian was a child of the 1980s western Aids epidemic, when tens of thousands of gay men died and the lesions of KS did more than signal illness. They marked you.

Four rounds of chemotherapy later, bruised from another fall, his treatment was stopped. Some lesions had faded; fresh ones arose on his legs, arms and chest.

So the chemotherapy was for KS.

The spring of 2023 brought more weight loss, more falls, a medication list so long, that in itself – “polypharmacy” – carried the weight of a separate illness.

A shoulder break required an operation and physiotherapy that he was too weak to endure.

He took vitamins, painkillers. He carried from hospital to home and later to care home a plastic bag filled with liquid food supplements. Medical notes suggested that he swap strawberry flavour for chocolate.

Brian had worked for a global corporation. In 2022, no longer able to do so, he lost his job and his health insurance, moving from private rooms, bespoke menus and – in one hospital – views of the playing fields of Harrow – to the chaos of overcrowded NHS wards and finally to a nursing home from where he was brought, on an early summer’s night, to Whittington Hospital to die.

Eight days after his death, the nursing home, in an email, attached its condolences to an unpaid bill.

Following his funeral in London, my brother, sister and I – a cat’s cradle of hands beneath the casket – placed his ashes in our parents’ grave.

I looked for answers to his death, to those final, brutal, two years, to the inability of myriad specialists to identify a unifying “why” or to keep him alive.

I searched for a missed diagnosis, an overlooked infection, a hidden cancer that might explain the catastrophic failing of his body.

But no explanation was forthcoming.

As administrator of his estate, I had access to his medical records.

Thousands of pages – unredacted – landed in my inbox. Over months, I studied them, rabbit holes of detail charting the minutest of procedures; the raising of a bed rail, the administration of a single tablet, the subdivision of a daily calorie intake.

Occasionally, one could sense someone standing back, observing this cascade of illnesses, marvelling at their profusion, musing about HIV, the possible spread of KS, inter-organ damage, undetected other cancers, one medication interfering with another, the notes littered with upside down question marks, the medical shorthand of perplexity.

His emotional state was noted. “Patient visibly anxious”, “frightened”.

Well, of course he was anxious and frightened. According to the AIDS establishment, he was doing everything right, being compliant to his treatment and attending to the numerous side effects with treatment for them as well. No wonder the poor man was terrified.

Obtaining his HIV clinic notes continued to prove difficult, the illness still carrying layers of privacy and protection and shame.

I met his HIV consultant. He asked if a student could attend as he, the student, “hasn’t done one of these before”.

The student – younger than my son – was already in the room, my dead brother and I now a teaching moment.

A “constellation of medical problems” had led to Brian’s decline and death, the consultant said. His deterioration was very apparent, but it was “hard to label him as terminally unwell”.

The emergence of KS was an “unexpected and very unusual scenario” for someone undetectable with a good CD4 count – a key indicator of immune system health – for so long.

As we know, KS has been observed in “HIV” negative people and now, in a patient with undetectable viral load and a healthy T cell count. Read on, though—we shall see an interesting connection to a phenomenon we have discussed here before, and that is accelerated aging.

Listing Brian’s illnesses, he said none were linked to HIV, concluding that while HIV and KS were “mentioned” on his death certificate, they had not been “major players”.

I understood the clinical distinction; HIV did not directly cause Brian’s cardiac, kidney and other system failures as once it had caused normally quiescent infections to run amok, yet the attempt to detach Brian’s death from the virus he had lived with for 33 years, jarred.

So, somehow “HIV” didn’t manage to cause this man’s total immune collapse, yet he supposedly had “HIV” AND AIDS. These are some mental gymnastics we’re engaging in here.

I turned to medical literature, using search terms that might give coherence to medical incoherence. What emerged was something less tidy, less clear cut, the possibility that there was no single explanation at all.

Paper after paper described “premature frailty”, “multi-system illness”, “wasting”, “polypharmacy”, the earlier onset of diseases associated with ageing despite effective HIV treatment.

Brian ticked every box.

His consultant had told me, “… ageing in people who have had HIV for a long time is an emerging topic that we are still learning about”.

I encourage you to read my post on “HIV” positivity and accelerated aging. Is it caused by the drug regime? One wonders.

A lot of people, it appeared, were doing so. In 2021, as Brian’s illnesses began to gather, The Lancet medical journal – in the first of a series of papers on ageing with HIV – had noted that prolonged survival with HIV translates – even on antiretroviral therapy – into an “increase of non-Aids-defining illnesses associated with age”.

But Brian’s illnesses—pneumonia and KS—ARE AIDS defining illnesses. This is really quite incredible an attempt to claim this man did not suffer from massive immune collapse—after all, he was medicated and presumably undetectable—his having AIDS surely is an inconvenient truth.

The terms “accelerated ageing” and “accentuated ageing” recurred across the literature, with calls for the greater integration of the science of biological ageing with HIV care.

We have discussed accelerated aging before.

What had happened to Brian was hiding in plain sight; his biological clock appeared to have detached from his chronological age.

The old epidemic had changed tempo but Brian’s generation of people with HIV had had to age before science could see that, to see clinically what ageing with HIV looked like.

But if his virus was suppressed and he had a healthy level of T cells, what was causing the accelerated aging, since “HIV” cannot be the culprit if it’s suppressed, per the mainstream. It’s not just me saying this.

It was one thing to examine cells under a microscope, another to see a hypothesis played out in a human being many years later.

Brian’s generation had lived through the uncontrolled first encounter with the virus, through successive generations of treatment, surviving into middle age many years after the epidemic’s peak.

The treatments extended life dramatically, but many early regimens carried toxicities that became fully visible only over time.

Finally we have the truth bomb—these medications are not as simple and happy as we are led to believe. For every patient who claims that their diagnosis is “nothing” when treated with ARVs, we have several whose bodies have been decimated by the drugs. Recall the 26,000 Truvada plaintiffs, whose kidney function and bone density have been compromised, sometimes permanently.

HIV had not produced the catastrophic immune collapse associated with the epidemic years, but decades of immune activation, illness and treatment perhaps exacted a slower, cumulative, price.

The role of KS in Brian’s death remains unresolved. It did not appear to be the aggressive KS of the epidemic years but nor did it appear to be the slower moving “classic” KS.

Perhaps we haven’t solved KS, and therefore AIDS, because we are barking up the wrong tree with “HIV?” Could the activation of KSHV hold some clues?

Nothing else had been found to explain the wasting that had consumed him.

No one said, “this is what he needs to get better”.

Interventions were reactive, fragmented: sodium levels corrected, falls treated, scans ordered. Each intervention made individual sense, collectively they mirrored the dissonance of his decline.

My brother has now been dead for three years. I have found no simple answer to the question I had asked then: how do you die like that when the dominant post-crisis consensus suggests that people on effective HIV treatment are no longer expected to die this way?

What I found instead is that ageing with long-term HIV can look like this for some of the first western epidemic generation: not one catastrophic opportunistic infection, not the old Aids deaths of the 1980s and 1990s, but rather an accumulation of frailty, inflammation, malignancy, organ damage, medication, fear and exhaustion.

My brother’s story had not been drawn from an older playbook. It was not out of date, not an outlier, not drawn from an obsolete HIV past.

It was, rather, recognisably contemporary.

I am really sorry that this man was so failed by the medical system, and I am sorry for what his surviving family members are going through. They must be internally screaming with frustration.

I do wish more information had been given as to what medications he was on and his surrogate markers of T cells and viral load; the context of the article certainly indicates that his markers were normal.

However, this case study ought to serve as a cautionary tale. An “HIV” diagnosis is dangerous not because it might lead to AIDS, but because it retains people in care using treatments that cause not only kidney failure, bone density loss, liver damage (in the early days of the protease inhibitors), metabolic issues such as lipodystrophy and elevated cholesterol, but also massively accelerated aging, despite the total suppression of “HIV.” An urgent reckoning is far overdue on the true causation of AIDS, and if this does not happen sooner than later, we will see many more Brians moving forward. Never again.

All of that was true before AI swept into, it seems, every industry on the planet. Are preapprovals—for medications, outpatient procedures, inpatient surgery, in-home healthcare and a multitude more—about to exit the realm of human decision making because it’s faster and less expensive to design an AI program to do it?

That’s the question recently explored by MedPage Today’s N. Adam Brown.

“The U.S. healthcare system has officially entered the era of artificial intelligence (AI). Organizations, practitioners, and patients are no longer merely trying on a new fad, they are operationalizing the tool,” Brown reported. “...In doctor’s offices and hospitals, AI is used to write notes, triage messages, predict readmissions, summarize charts, suggest differential diagnoses, and even to make prescription decisions that, previously, a physician would have made.” (1)

Now, whether you love your doctor or barely tolerate him/her, a physician can take human situations under consideration when making treatment decisions.

And if you have a difficult-to-diagnose or treat illness like ME/CFS—or if you’ve been diagnosed as HIV-positive but aren’t down with taking the toxic cocktail du jour—you might be lucky enough to have a doctor who understands.

Does Dr. AI possess the same sensibilities?

While AI in the doctor’s office is helping reduce paperwork overload, allowing more patients to be seen while reducing “clinician burnout,” doctors are beginning to worry that decisions by insurers—particularly prior approval decisions—are already being made by machines without any human input.

“They are right to worry,” according to Brown. “In some reported cases, denial decisions were processed at a speed that makes meaningful physician review unlikely.” (1)

Is AI an important and helpful tool in doctors’ offices? The answer is often yes.

“The core issue is not that AI is being deployed in healthcare settings,” Brown pointed out. “It is how it is being used. There is a fundamental difference between viewing AI as a tool to enhance human skill and knowledge and using AI as a gatekeeper for care.

“A tool supports human judgment. A gatekeeper replaces it.” (1)

Fortunately, doctors’ associations like the AMA, governmental agencies like the Centers for Medicaid and Medicare (part of HHS), are demanding “greater oversight of insurer AI use, emphasizing transparency, bias mitigation, and the need for human review in decisions that affect patient care.” (1)

And what can patients do if they feel the wrong decision has been made by the insurer, possibly by an AI algorithm instead of a physician?

Enter the lawyers.

Unfortunately, the law around AI’s technological advances is still somewhat murky.

As David S. Greenberg wrote on ASFlaw.com, “The question is whether health insurers are using their AI predictive tools properly, in accordance with state and federal law, or whether they are being deployed solely as cost-saving measures to improperly deny patients and health care providers coverage and payment for medically necessary services.” (2)

Both Cigna and United Healthcare (UHC) have been sued by families or groups of patients who suspect that a machine made crucial healthcare decisions that resulted in death or disability, overriding the patients’ physicians.

In the Cigna case, “The plaintiffs accused Cigna of relying on the AI algorithm [named “PXDX”] to enable its own doctors to automatically deny thousands of claims at a time for treatments that did not match certain preset criteria without actual physician review of the medical records.” (2)

The UHC lawsuit involved two deceased patients.

“The plaintiffs allege that UHC improperly used the nH Predict AI Model to deny extended care claims for elderly patients based on erroneous health care determinations generated by the algorithm. The plaintiffs also accused UHC of using the AI tool to override the determinations of medical professionals, including ones employed by the insurer.” (2)

But will increasing numbers of such lawsuits be successful?

In MedPage Today, Brown wrote, “Accounting for these realities is one reason the legal framework for AI has not caught up to the technology. As discussed in recent academic work, including analysis from Harvard’s Petrie-Flom Center, liability in the age of AI is deeply uncertain because traditional models of malpractice assume a human decision-maker. AI eliminates that feature.” (1)

And with human decision-making eliminated, Brown asks, who is accountable when things go wrong?

BIBLIOGRAPHY
1. N. Adam Brown “Is AI Healthcare’s Newest Bureaucrat?” MedPage Today, 5/12/26. https://www.medpagetoday.com/opinion/prescriptionsforabrokensystem/121230
2. David S. Greenberg. “Intelligence to Decline Medical Claims.” December 22, 2023. AFSlaw.com. https://www.afslaw.com/perspectives/health-care-counsel-blog/health-insurers-sued-over-use-artificial-intelligence-deny

Queer men's obsession with 'PrEP belly' indicates that our priorities might be a little skewed

If you’re chronically online, you’ve probably heard the term “PrEP belly” emerge from the image-obsessed corners of the gay wide web.

For the uninitiated, PrEP (pre-exposure prophylaxis) is a highly effective medication that helps prevent HIV infection in at-risk populations. One of the most important public health tools in modern history, PrEP dramatically reduces transmission rates of a virus that devastated generations of LGBTQ+ people. I take it every day.

We have the mandatory ode to PrEP. “I take it every day.” This entire piece takes way too long to tell us that AIDS was bad & the only way to stop it is to take PrEP. Why, again, are people clamoring for the government to pay for drug to treat a disease they don’t even have?

Also, this wording is very odd. Why do they say that PrEP helps in “at risk populations?” Does it not help in non risk groups, as it should if it is truly effective? I mean this question sincerely; it’s a very weird statement when you think about it.

At the height of the AIDS crisis — which wasn’t that long ago, by the way —hundreds of thousands of people in the U.S. alone died from HIV-related illnesses. But now, just a few decades later, a new (albeit far less nefarious) panic has emerged: the belief that taking PrEP could give you a potbelly.

The rumor seems to have gained traction after a social media comment claimed that celebrity DJ John Summit had “PrEP belly,” according to Them. From there, the problematic discourse swelled and mutated. Gay men across TikTok and X were scrutinizing their stomachs, wondering whether the medication protecting them from HIV was also making them unsexy.

Medical professionals have overwhelmingly agreed that excessive midsection fat is not a common side effect. Some people may experience temporary bloating or digestive discomfort when they first start taking the medication, but these symptoms are generally mild and last only a few days to a few weeks.

“One area of ongoing discussion is weight gain, and abdominal weight gain in particular, associated with PrEP,” says Dr. Isaac Dapkins, internal medicine HIV specialist and chief medical officer for the Family Health Centers at NYU Langone. “Earlier studies of TDF/FTC [the earlier version of PrEP, known best as its brand name Truvada], including the iPrEx metabolic substudy, suggested that this form of PrEP may have a modest weight-suppressive effect.”

So they’re deliberately obfuscating here. They refer to Truvada, or TDF, as being this drug that can help you lose weight—but that is not the drug under consideration here; the drug that allegedly causes “PrEP belly” is a different medication. Why mention the other drug at all? It’s irrelevant.

I wonder if more people would be rushing to take it if they knew about that potential side effect.

Dapkins, however, says that this potential weight loss is largely viewed negatively because it may have resulted from mitochondrial dysfunction. Mitochondria, you might remember from junior high chemistry, are part of our cells that produce energy. We don’t want that depleted.

More recent studies that tested newer PrEP agents did so in comparison to TDF/FTC, he says, and did find the potential for minor weight gain as a side effect — but some of this difference may reflect the absence of the previous version of the drug’s weight-suppressive effect.

“In addition, observed weight gain with newer agents may be similar to weight trends seen in comparable populations not receiving PrEP, although some groups, including women and non-white patients, may experience greater changes,” adds Dapkins.

Overall, it appears that “PrEP belly” panic might be an overreaction. Still, the panic itself says something darker about where we are culturally as gay men. Gay culture has always revolved, in part, around visibility and ***, but somewhere along the way, it feels like health (and being nice to each other) started becoming secondary to aesthetics. We’re beginning to lose the plot, and as silly as “PrEP belly” is, it does point to a murky issue in our community.

What on earth are those *** intended to mean?

What makes the “PrEP belly” discourse feel especially bleak is the historical amnesia underneath it. Now that we have the tiniest amount of distance from the HIV epidemic, we’re treating HIV prevention as casual lifestyle branding rather than the extraordinary medical breakthrough it actually is.

And yet the fear of maybe gaining a little stomach fat was enough to send parts of the internet into a panic. And trust me, I understand the impulse and I’m not immune to it, either. Gay men are constantly told, both implicitly and explicitly, that our value is tied to how successful, desirable and optimized our bodies appear. But misinformation around PrEP has real consequences and even joking rhetoric can discourage people from taking medication that could quite literally save their lives.

Women, as well as gay men, are told that our value is tied to our bodies, as well. It is a really hard thing to navigate.

“For many patients, the substantial reduction in HIV transmission risk will outweigh the potential concern about weight gain,” says Dapkins, adding a disclaimer of nonjudgment, “but this should be reviewed thoughtfully between the patient and clinician.

More than anything, the “PrEP belly” conversation reveals how distorted some of our priorities have become. A generation ago, queer people would have done almost anything for access to medication this effective, and many risked their lives protesting a government that cared little that gay people were dying in droves. Today, some people are afraid to take it because they think it might blur their abs. I think as a community, we can and should do better.

I don’t know what to say about this. Maybe it’s correct to infer that an adverse effect like weight gain might indicate a deeper medical problem, and that these people are correct to be concerned. Regardless, I wonder how long it will be until there are lawsuits on “good Truvada,” as well.