Joseph Sonnabend
Encyclopedia
Joseph Adolph Sonnabend, M.D. (born 1933 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
.
s at the University of Witwatersrand in Johannesburg
and the Royal College of Physicians
of Edinburgh
. 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.
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
.
. 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).
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
. This suggestion conflicted with the prevailing view that a single agent was responsible.
A key implication of Sonnabend's "multifactorial model" was that frequent unprotected anal sex
increased risk of AIDS. 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 in which the multifactorial theory is described. 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.
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.
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. 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 US. The PWA Health Group went on to become an important source of AIDS treatment education and advocacy; it is now part of DAAIR.
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. In 2006 he expressed his view that high doses of AZT had "killed thousands" during the late 1980s and early 1990s.
Until the late 1990s Sonnabend continued to assert that the issue of AIDS causation "remained open" and that many factors might be involved. This led some researchers and activists to associate him with "AIDS denialists" 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").
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 infected with HIV only develop AIDS if exposed to cofactors such as other virus
es 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
).
:
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
) is a distinguished retired physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
, scientist
Scientist
A scientist in a broad sense is one engaging in a systematic activity to acquire knowledge. In a more restricted sense, a scientist is an individual who uses the scientific method. The person may be an expert in one or more areas of science. This article focuses on the more restricted use of the word...
and AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
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
HIV positive people
HIV-positive people are people who have the human immunodeficiency virus HIV, the agent of the currently incurable disease AIDS.Over the years of coping with the stigma and discrimination that accompany the diagnosis in most societies, a large number of support groups have been formed...
.
Background
Joseph Sonnabend was born in 1933 to a physician mother and a university professor father in South Africa. He trained in infectious diseaseInfectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
s at the University of Witwatersrand in Johannesburg
Johannesburg
Johannesburg also known as Jozi, Jo'burg or Egoli, is the largest city in South Africa, by population. Johannesburg is the provincial capital of Gauteng, the wealthiest province in South Africa, having the largest economy of any metropolitan region in Sub-Saharan Africa...
and the Royal College of Physicians
Royal College of Physicians
The Royal College of Physicians of London was founded in 1518 as the College of Physicians by royal charter of King Henry VIII in 1518 - the first medical institution in England to receive a royal charter...
of Edinburgh
Edinburgh
Edinburgh is the capital city of Scotland, the second largest city in Scotland, and the eighth most populous in the United Kingdom. The City of Edinburgh Council governs one of Scotland's 32 local government council areas. The council area includes urban Edinburgh and a rural area...
. During the 1960s he conducted research at the National Institute for Medical Research
National Institute for Medical Research
The National Institute for Medical Research, commonly abbreviated to NIMR, is a medical research facility situated in Mill Hill, on the outskirts of London, England. It is mainly funded by the Medical Research Council, or MRC, and is its largest establishment and the only one designated as an...
in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
, where he worked under Alick Isaacs
Alick Isaacs
Alick Isaacs was a British virologist. He is best remembered for his work on interferon, having been Head of the Laboratory for Research on Interferon, National Institute for Medical Research, 1964–7....
, a pioneer of interferon
Interferon
Interferons are proteins made and released by host cells in response to the presence of pathogens—such as viruses, bacteria, or parasites—or tumor cells. They allow communication between cells to trigger the protective defenses of the immune system that eradicate pathogens or tumors.IFNs belong to...
research.
In the early 1970s Sonnabend moved to New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
to be an associate professor at the Mount Sinai School of Medicine
Mount Sinai School of Medicine
Mount Sinai School of Medicine is an American medical school in the borough of Manhattan in New York City, currently ranked among the top 20 medical schools in the United States. It was chartered by Mount Sinai Hospital in 1963....
. 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
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
in Greenwich Village
Greenwich Village
Greenwich Village, , , , .in New York often simply called "the Village", is a largely residential neighborhood on the west side of Lower Manhattan in New York City. A large majority of the district is home to upper middle class families...
.
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 AIDSAIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
. 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
AIDS Research and Human Retroviruses
AIDS Research and Human Retroviruses is a peer-review scientific journal focusing on AIDS and HIV search, as well as on human retroviruses and their related diseases. The journal was founded in 1983 as AIDS Research, and acquired its current name in 1987...
in 1986, after Sonnabend's departure).
Multifactorial model of AIDS
Prior to the identification of HIVHIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
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
Epstein-Barr virus
The Epstein–Barr virus , also called human herpesvirus 4 , is a virus of the herpes family and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis...
and repeated exposure to cytomegalovirus
Cytomegalovirus
Cytomegalovirus is a viral genus of the viral group known as Herpesviridae or herpesviruses. It is typically abbreviated as CMV: The species that infects humans is commonly known as human CMV or human herpesvirus-5 , and is the most studied of all cytomegaloviruses...
and semen
Semen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
. This suggestion conflicted with the prevailing view that a single agent was responsible.
A key implication of Sonnabend's "multifactorial model" was that frequent unprotected anal sex
Anal sex
Anal sex is the sex act in which the penis is inserted into the anus of a sexual partner. The term can also include other sexual acts involving the anus, including pegging, anilingus , fingering, and object insertion.Common misconception describes anal sex as practiced almost exclusively by gay men...
increased risk of AIDS. This was the inspiration for the world's first attempt to promote safe sex
Safe sex
Safe sex is sexual activity engaged in by people who have taken precautions to protect themselves against sexually transmitted diseases such as AIDS. It is also referred to as safer sex or protected sex, while unsafe or unprotected sex is sexual activity engaged in without precautions...
: a booklet written under his direction by two of Sonnabend's patients, Michael Callen
Michael Callen
Michael Callen was a singer, songwriter, composer, author, and AIDS activist. He was a significant architect of the response to the AIDS crisis in the United States....
and Richard Berkowitz
Richard Berkowitz
Richard Berkowitz is a gay American author and activist best known as an early advocate of safe sex in response to the AIDS crisis among gay men in the 1980s.-Life and career:...
in 1983 in which the multifactorial theory is described. At the time, such attempts to change sexual behavior met with vilification from many gay community
Gay community
The gay community, or LGBT community, is a loosely defined grouping of LGBT and LGBT-supportive people, organizations and subcultures, united by a common culture and civil rights movements. These communities generally celebrate pride, diversity, individuality, and sexuality...
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 KrimMathilde Krim
Mathilde Krim, Ph.D. is the founding chairman of amfAR, an association for AIDS research.-Biography:Krim received her Ph.D. from the University of Geneva, Switzerland, in 1953...
and others to set up the AIDS Medical Foundation (AMF) in 1983. This organization would later become amfAR
AmfAR
amfAR, The Foundation for AIDS Research, is an international nonprofit organization dedicated to the support of AIDS research, HIV prevention, treatment education, and the advocacy of sound AIDS-related public policy.-History:...
, one of the world's leading nonprofit supporters of HIV/AIDS research, prevention and advocacy.
A pioneer of community-based research, Sonnabend also helped to establish the nonprofit Community Research Initiative (CRI, later renamed CRIA, then ACRIA
ACRIA
The or ACRIA was founded in December 1991 to provide community based clinical drug trials for people living with AIDS. They also run the HIV Health Literacy Program . ACRIA can trace their history back to the founding of the Community Research Initiative by Michael Callen and Joseph Sonnabend....
) in New York in 1987. One of CRI's early achievements was a trial that contributed to the approval of inhaled pentamidine
Pentamidine
Pentamidine is an antimicrobial medication given for prevention and treatment of Pneumocystis pneumonia caused by Pneumocystis jirovecii , a severe interstitial type of pneumonia often seen in patients with HIV infection...
for preventing PCP, a common AIDS-related infection. 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
Michael Callen
Michael Callen was a singer, songwriter, composer, author, and AIDS activist. He was a significant architect of the response to the AIDS crisis in the United States....
and Thomas Hannan. This nonprofit organization aimed to widen access to promising AIDS therapies not approved in the US. The PWA Health Group went on to become an important source of AIDS treatment education and advocacy; it is now part of DAAIR.
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 AZTZidovudine
Zidovudine or azidothymidine is a nucleoside analog reverse-transcriptase inhibitor , a type of antiretroviral drug used for the treatment of HIV/AIDS. It is an analog of thymidine....
monotherapy to treat asymptomatic
Asymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
, 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
Pathogenesis
The pathogenesis of a disease is the mechanism by which the disease is caused. The term can also be used to describe the origin and development of the disease and whether it is acute, chronic or recurrent...
and could be controlled by AZT. In 2006 he expressed his view that high doses of AZT had "killed thousands" during the late 1980s and early 1990s.
Until the late 1990s Sonnabend continued to assert that the issue of AIDS causation "remained open" and that many factors might be involved. This led some researchers and activists to associate him with "AIDS denialists" 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
Medical malpractice
Medical malpractice is professional negligence by act or omission by a health care provider in which the treatment provided falls below the accepted standard of practice in the medical community and causes injury or death to the patient, with most cases involving medical error. Standards and...
; he says he was shunned by mainstream scientists and refused funding.
Sonnabend later became an advocate for combination antiretroviral therapy
Antiretroviral drug
Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...
, 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").
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
Scientific consensus
Scientific consensus is the collective judgment, position, and opinion of the community of scientists in a particular field of study. Consensus implies general agreement, though not necessarily unanimity. Scientific consensus is not by itself a scientific argument, and it is not part of the...
, and maintains that people infected with HIV only develop AIDS if exposed to cofactors such as other virus
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
es and bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
. He suggests that in many people HIV lies dormant without provoking a sufficient immune response
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
to generate a positive antibody test
HIV test
HIV tests are used to detect the presence of the human immunodeficiency virus , the virus that causes acquired immunodeficiency syndrome , in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA.- Terminology :...
result (seroconversion
Seroconversion
Seroconversion is the development of detectable specific antibodies to microorganisms in the blood serum as a result of infection or immunization. Serology is used to determine antibody positivity...
).
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. 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 FauciAnthony Fauci
Anthony S. Fauci is an immunologist who has made substantial contributions to research in the areas of AIDS and other immunodeficiencies, both as a scientist and as the head of the National Institute of Allergy and Infectious Diseases .-Education and career:Anthony Stephen Fauci was born on...
:
Personal life
Sonnabend is known to have fathered two sons in his twenties. He has retired from medical practice and now lives in London. His sister is Yolanda Sonnabend the world-renowned theatre designer.External Links
- Joseph A. Sonnabend papers, 1963-2004. Manuscripts and Archives, New York Public Library.