Charlie Sheen is HIV positive. As was revealed on the Dr. Oz show, when diagnosed his viral load was 4.4 million. After six months of the a standard anti-HIV cocktail his viral loads were undetectable.
This does not mean he is HIV negative or free of this virus. As part of the viral life-cycle it goes into hiding inside of cells. It is undetectable while hiding, and also cannot be eradicated by medications. This is a major challenge to curing HIV, or even pushing the efficacy of our current treatments further. Researchers are looking into ways to force the virus out of hiding so that anti-retroviral medications can go to work.
With current anti-HIV treatment someone who is HIV positive can expect to live an almost normal life expectancy free of any major complications of the disease and will not go on to develop AIDS from the virus. The big challenge now is to get this modern medicine to those who are HIV positive in the third world, or to those who cannot afford it.
Interestingly, Charlie Sheen, who has all of the advantages of wealth in a Western industrialized country, opted for third-world treatment of his HIV. He recently went off of his anti-HIV medications and instead decided to rely on the ministrations of an unknown doctor in Mexico making bold claims.
This prompted an on-air intervention by Dr. Oz and Sheen’s own doctor (which was ethically dubious but good television, I guess), after which Sheen reported he would go back on his medications.
Of course, most HIV patients who are lured to Mexico with the promise of a miracle cure will not benefit from a personal intervention by Dr. Oz. Hopefully they will benefit from watching that episode, but if history is any guide (unfortunately) the exposure is likely to lead more people to the Mexico charlatan than warn them away.
Why People Seek Charlatans
The Sheen episode raises a fascinating and important question – what is the allure of the lone maverick making bold claims? Often the answer provided is desperation, but what makes the Sheen example so interesting is that desperation was not a factor. He was effectively in remission from his HIV with undetectable loads. He still has to take medications for the rest of his life, but that seems a small price to pay for taking a horrible deadly disease and transforming it into a benign chronic condition with a normal life-expectancy and quality of life. The situation did not call for desperation.
Psychologists have found that people fear losing out on a possible benefit more than they fear losing something they already have. This is why people play the lottery, spending real money for an insignificant chance of winning a lot more. They will take risks and spend resources for the possibility of gain. In this case Sheen was willing to risk his health and his life for the possibility of a small benefit – not having to take medications.
[Editor: This is also why otherwise intelligent people, out of emotion, or hope of a gain, will fall prey to quacks, or the latest suggestion of a cure on the internet.]
Successful professional gamblers learn to control this urge. They learn to play the odds, rather than their hopes. They have to suppress their natural instincts and play by the numbers. Medicine is also a game of probability, and that is the role of the doctor, to help patients make optimal decisions based upon the evidence, not make statistically bad decisions based upon their hopes.
There is more to it than just this aspect of human psychology, however. Charlatans are like magicians, over the centuries they have honed their craft through trial and error, emulating those who are successful. They know how to manipulate emotions, how to manipulate those in power, and how to work the system.
This HIV quack (who also claims to have the cure for cancer) knew exactly what he had in Sheen – a celebrity meal ticket. Unfortunately, I do think Oz played into his hands by giving him exposure, even if it was negative.
The Mexican doctor used a few tactics that are very common. First, he covers his treatment in the patina of science. He told Sheen that his treatment was based on patented technology and based on published science. Of course, the only published paper he cited was from 20 years ago, and this line of research was abandoned because it did not work.
Most new ideas in science and medicine do not work out. They do, however, create a huge reservoir of plausible but failed hypotheses, with preliminary encouraging evidence. If you ignore the fact that the hypothesis ultimately failed, or has not yet been fully studied, it makes for a great con. It is a pre-packaged pseudoscientific narrative.
A non-expert has almost no chance of sorting this out on their own. You have to be familiar with the science and the research. You could, of course, just listen to the experts, but con artists divert their marks away from the experts with claims of conspiracy, vested interest, hidden cures, closed-mindedness, and industry influence. Those narratives come pre-packaged also.
Apparently this quack also pulled a dramatic stunt – he reports that he injected Sheen’s blood into himself, to show him how confident he was that Sheen was cured. No reputable doctor would ever do this. This was a clear stunt, and only demonstrates how desperate the con artist was to convince his celebrity mark. He knew what was at stake – and it worked.
In addition he claims lab tests that show Sheen is HIV negative, and claims the first cure of HIV in an adult. Without independent verification, this is worthless, of course. Fake lab tests are all just part of the con.
Another part of the psychology here is that people want to feel that they are one-step ahead of the herd. Getting standard treatment available to everyone just seems so mediocre. If, however, you do “research” and find that there is a reported better option, that you can get a treatment that is safer or more effective than the regular treatment, that has a huge appeal. You can congratulate yourself on your cleverness and ingenuity, your open-mindedness, and your wisdom in seeing how corrupt the system is. You are not only one of the enlightened few, you will use your knowledge to cure yourself.
This view also creates a massive disincentive to ever admit that you were wrong. Admitting error, even when the disease that could have been cured or managed by modern medicine is now ravaging your body and killing you, is just too difficult. You would have to abandon your entire self-image. You would have to admit that you were not being clever, wise, and open – just naive and desperate.
Con-artists know this and count on it.
The Charlie Sheen episode is a teachable moment. I do hope that it helps get the word out that modern anti-HIV treatment is effective, and should not be abandoned for the equivalent of magic beans.
It is also an opportunity to spread awareness of the psychology of con-artists, especially medical con-artists. Sheen is not stupid or crazy, he is just an average person. He was vulnerable to the promises of a quack in the same way that everyone is vulnerable.
Scientific literacy helps, but honestly it takes a pretty high degree of such literacy to counter a sophisticated con. Critical thinking and skeptical knowledge are needed, knowing how con-artists work, how they try to manipulate people.
Perhaps the most useful take-away is not to let the con-artists turn you against the experts, the very people who are in the best position to give you advice, the advice you need to understand that the con-artist is a dangerous quack and not your savior.