The Iceberg Guy

'Oppenheimer' plus 'It's A Sin' = The Iceberg Guy. Chapter 9 - Cooper gets to hold Occam's razor.

Chapter Nine

An hour after the task force meeting ended, Jean-Marie tapped on Jim’s door. Cooper noted he was carrying a large pile of papers.

‘Hi. Sit down.’

‘Thank you. I thought I’d call in and say au revoir.’

‘Seems like just five minutes since you arrived.’

‘I have a lovely woman called Thérèse waiting for me in Paris. She won’t wait forever.’

‘Love is a wonderful thing.’

‘You sound like a Frenchman.’

‘You’ll come back?’

‘Of course! But until I do, I’ll be in touch. Regularly. There is always something happening at L’Académie. Rest assured, if anything comes up connected with this thing in homosexuals, I’ll call you.’

‘That’ll be great. Thank you.’

‘And that thing is partly the reason why I wanted to speak to you before I left.’

‘Go on.’

‘What do you know about Occam’s razor?’

‘Not a lot. Why?’

‘It’s a guiding principle of logic exhorting us to keep things as simple as possible.’

‘And?’

‘I think you should be applying that principle to these new cases, immediately. Doing so will not win you many prizes and plaudits or get you new funding. However, it will save you more embarrassment after swine flu and perhaps save a lot of lives.’

‘This has got nothing to do with Swine Flu.’

‘If you get this wrong it’ll be the end for you and the CDC. You and it cannot afford another scandal.’

‘Tell me what you’re thinking. I’ve only got about thirty minutes before I have to see the Director.’

‘First, let me apologize for the MMWR bulletin.’

‘What for?’

‘My editorial making life difficult for you.’

‘Don’t apologize. I asked you to write it for me. Saved me hours of work. Hours I don’t have.’

‘Thank you. Which I guess is my main point. You don’t need to spend hours which you, or anybody else in the task force doesn’t have, on a wild goose chase.’

‘What?’

‘All the information you need is in the MMWR, and I don’t mean my editorial.’

‘That’s a big call.’

‘Look at the five cases. What did they have in common? PCP, CMV, leukopenia, candidiasis and inhalant drugs. By which they mean ‘poppers’.’

‘Poppers?’

‘Amyl nitrite.’

‘OK.’ 

 ‘The patients did not know each other, had no known common contacts, or knowledge of sexual partners who had had similar illnesses. The five did not have comparable histories of sexually transmitted disease. Only two of the five reported having frequent homosexual contacts with various partners. So, we go back to what they had in common. CMV, PCP, leukopenia and candidiasis.’

‘Where does Occam’s razor fit into this?’

‘You know I went to Brimingham in ’76, during the Legionnaire’s crisis?’

‘Yes.’

‘And you know I fell in love with CMV?’

‘Yes.’

‘AS I said when I first read it, knowing what I know about CMV, nothing in the bulletin is surprising or mystifying. Look at this.’

It was a research paper dated October 1960. Cooper read the headline.

‘‘Cytomegalic inclusion disease and Pneumocystis carinii infection in an adult.’’

‘Look at what it says here.

‘‘The body was severely emaciated. Generalised cytomegalic inclusion disease in the adult has been described in association with toxoplasmosis and with Pneumocystis carinii infection and severe systemic diseases. The association of CMV and PCP is interesting, and perhaps not entirely fortuitous. In due course a closer relationship may be established. It is important to recognise their potential pathogenicity and their ability to produce, either alone or in combination, fatal infections in man. There is some evidence that this danger is increased by prolonged treatment with steroids and antibiotics. Possibly more cases will occur because of the increasing use of these drugs. At present, there is no effective treatment.’’

One thing we know about the sexually active members of the gay community is that they are forever taking antibiotics either pre-emptively, as Joe Summer does, or as a cure.We also know that lots of gay guys work out in the gym. Some of them will be taking steroids to help them there for sure.’  

‘OK. What about the KS that we’re seeing?’

‘Look at what Giraldo wrote in ’78.

‘‘A specific serologic association of cytomegalovirus with American and European KS patients has been detected. All KS sera contained CMV antibodies.’’

Safai in New York confirmed the same in February. Poppers may also play an important role.’

‘How?’

‘Poppers widen the blood vessels. KS is a cancer of blood vessels. An analogy can be drawn between heavy smokers and lung cancer. Not everybody who smokes gets lung cancer but the more you smoke the more likely you are to get lung cancer. The more poppers you inhale, the greater the chance you’ll get KS. Especially if you’ve got CMV as a catalyst.’

‘Right.’

‘It’s the same with CMV. Many people have CMV but not many become seriously ill.’

‘Why don’t they?’

‘It’s all to do with viral load and tipping points.’

‘Explain?’

‘When I got to Birmingham, I was shown brand new data. Many pregnant mothers passed CMV infection onto their unborn babies, but only the babies with the highest CMV viral load developed CMV disease. These babies had one-hundred times more CMV in their urine than the babies who didn’t develop disease.’ 

‘What about the tipping point?’

‘Many gay patients’ immune systems are probably worn down by their sex, drugs and disco dancing lifestyle. They were in ’76 when I wrote a paper on Gay Bowel Syndrome and I don’t think the situation has improved, This increases their susceptibility to CMV infection. Once someone reaches a stage where the viral load is too much for the immune system to cope with, and that stage varies from one individual to another, then the immune system is overwhelmed by the virus. Rather like a dam bursting. To give a different analogy. The immune system basically acts as a brake upon the virus. Once it’s worn down, the brake comes off, CMV runs amok, invades every organ and cell and wreaks havoc.’

‘What about Bartholomew’s insistence that CMV hasn’t killed killing anyone?’