The Eliza Jane Scovill case on Primetime Live

I was debating whether or not to write about the Eliza Jane (EJ) Scovill case yet again, given that I've already written two different articles about it, the last of which summarized the commentary of myself and two other physicians. I didn't think that I had much more to say, barring new developments. Then, on Thursday night, ABC News broadcast a lengthy report on this case on Primetime Live. Even after watching the show, I wondered whether it would be worth commenting. True, there was indeed new information in the report that I didn't know about, but was it enough to justify another post? Then, on Friday morning, I checked out what ABC News had posted about the story on their Primetime Live. Amazingly, ABC News had posted a link to the actual coroner's report about EJ's death.

Wow. Finally, I could compare what Dr. Al-Bayati said about the coroner's report with what the coroner's report actually said! Also, Trent McBride of Catallarchy, who had already also commented on this case, has made some relevant observations about the Primetime Live story.

Before I get to the coroner's report, I'll briefly discuss the news report itself. First, my impression was that Christine Maggiore alternated between appearing very sympathetic (not surprising, since, whatever her scientifically incorrect and dangerous beliefs about HIV not causing AIDS, she is a grieving mother who did love her daughter and it's hard not to feel sympathy for her on that basis, particularly after hearing her 911 call from the night EJ collapsed) or deluded (prominent showing of old footage from 1998 of her breastfeeding her older son in public, even though it is known that breastfeeding increases the risk of transmission of HIV to the child). Another example of the depth of her belief that HIV does not cause AIDS, as Trent mentioned, when asked what it would take to persuade her that her daughter had died of AIDS, Maggiore said, "He would need to show evidence of fatal pneumonia. If there is such evidence I welcome that being brought forward." Then, the coroner showed her slam-dunk evidence of Pneumocystis carinii pneumonia under the microscope, and she still didn't believe it. In fact, that segment was the most effective part of the report, where the coroner showed Maggiore the actual slides from EJ's lungs and brain. EJ's lungs showed clear evidence of Pneumocystis pneumonia, with organisms and foamy infiltrates, but what surprised me the most was the slides of the brain. The immunohistochemical staining for HIV p24 protein was very intense, even seen on a video of a video monitor. My only complaint is that they didn't show the slides long enough for me to get a better look, but I understand that the vast majority of viewers are not doctors and would probably not appreciate lingering shots of the slides. It would have been nice if they could have posted some of the images on their website.

The next point that soon became apparent is that, contrary to previous descriptions by Maggiore and other HIV "dissidents," this story as presented strongly implied that EJ was sicker right from the very start of her illness than what has been described previously. Maggiore's own description of EJ's rasping cough and rapid, shallow breathing sounded pretty bad, and this was three weeks before her daughter's death. Consider: Maggiore is a woman who clearly has an extreme distrust of "conventional" medicine. She didn't get her children tested for HIV, and she didn't get them vaccinated. She doesn't trust "conventional" doctors. Yet, after EJ became sick, Maggiore became so concerned about her daughter that she actually took her to see three different pediatricians in three weeks and kept her out of school that whole time. Her explanation for her seeking three opinions was:

There was a stirring in my soul. That's about all I can say. It motivated me to seek a third opinion.

Clearly, despite the protestations by her apologists that EJ wasn't very sick, Maggiore was all but admitting that she had become very concerned that her daughter was seriously ill, so much so that she acted on that fear by taking her to three different pediatricians. Unfortunately, at least one of these pediatricians (Dr. Jay Gordon) may not have known about Maggiore's HIV status at the time he examined her daughter and now says that, given EJ's symptoms, he wishes that he had insisted on an HIV test. (The original LA Times story states that Dr. Gordon did know about Maggiore's HIV status, and the Primetime Live report was not clear one way or the other but seemed to imply that he was not aware.) Not surprisingly, Maggiore ultimately blamed mainstream medicine for EJ's death, with the explanation:

I believe the unfortunate irony in this situation is that the one time that we were asked to and that we complied with mainstream medicine, we inadvertently gave our daughter something that took her life.

Later, Maggiore's HIV/AIDS denialism hindered the search for the cause of her daughter's illness and collapse after it happened. For example, Maggiore failed to volunteer information about her HIV status to the treating physicians at the hospital where EJ was taken after her collapse. Her reason? She wasn't asked. Her rationalization for not volunteering the information was that she "wanted an unprejudiced evaluation of her daughter," even though her HIV status would have been very important for the treating physicians to know. Later, she did not let the coroner know about her HIV status. Ultimately, the coroner's office apparently found out about it independently. In the past, Maggiore has expressed anger that the direction of the investigation changed once the coroner became aware of her HIV status, and did so again in the Primetime Live report. (Of course the investigation changed direction. That sort of information makes a huge difference.)

The one thing that bothered me about the Primetime Live report, however, is how the story dealt with Dr. Al-Bayati's "rebuttal" of the coroner's report. It concentrated too much on Al-Bayati's lack of qualifications (certainly a valid point to bring up, but not as the--seemingly--primary reason that his report is a pile of rubbish) and not enough on the many deficiencies of his "rebuttal," which have been outlined in some detail by Dr. McBride, Dr. Bennett, and me. The treatment of the report left the reporters open to the common charge by HIV/AIDS denialists of ad hominem attack (an attack some of them aren't shy about making themselves despite their complaints when they perceive it being leveled at them). The Primetime Live producers did make up for this lapse somewhat by sending both the coroner's report and the Al-Bayati "rebuttal" to an independent medical examiner, who concluded that the coroner's report was accurate and the Al-Bayati report was not. Unfortunately, there is no link to the independent report on the Primetime Live website. It would have been interesting to be able to read that report in addition to the coroner's report and the Al-Bayati "rebuttal." It would have been even better if the pathologist who prepared the independent report had been interviewed on screen.

Overall, though, the real added information was the link to the coroner's report on the Primetime Live website. The first thing I noticed right away when perusing the coroner's report is that, contrary to what Dr. Al-Bayati said about the report, the neuropathology section of the report states clearly that positive and negative controls were done for the p24 protein found in EJ's brain:

Select immunohistochemical reactions were performed on the blocks 1-3, 2-3, and 3-3. These studies included the HIV core protein, p24 and HSV 1 and 2. Appropriate positive [and] negative controls were used on the paraffin sections. A strongly positive p24 reactivity was detected in all three sections in the previously described zones of subcortical and deep white matter focal demyelination with microglial-giant cell reaction. No signal was recognized for HSV 1 or 2.

Nick Bennett, who wrote perhaps the best rebuttal of the Al-Bayati pointed this out in his updated rebuttal (once again kindly hosted by Trent):

Al-Bayati says that such controls were not performed. It is interesting to note that he quotes VERBATIM from the section which mentions the use of controls but DELETED all reference to the use of controls. In fact Al-Bayati specifically states that no control tissue types were used, but the common interpretation of this in the online discussion groups has been that no controls at all were used. This misconception needs to be corrected.

Nick's right. He's corrected it, and I'm trying to correct it here. If you don't believe me or Nick, though, feel free to compare the coroner's report to Dr. Al-Bayati's report for yourself. While you're at it, you might notice that Dr. Al-Bayati repeats over and over that a "pneumonia" requires consolidation and that there was no evidence of pneumonia in EJ's lungs. Note that the coroner's report plainly states that there was consolidation of the lungs, in addition to congestion, not to mention the findings of foamy alveolar infiltrates consistent with Pneumocystis pneumonia. Note that the coroner's report also mentions on p. 22:

On 05-04-2005, the mother took her [EJ] to Dr. Jay Gordon in Santa Monica for a second opinion. He thought she may have had pneumonia and she was then found to have a "low grade ear infection."

To me this indicates that at least one clinician had entertained the diagnosis of pneumonia before EJ collapsed (although he must have rejected pneumonia as the cause of her illness, since he didn't prescribe any treatment for pneumonia). Given that PCP is an atypical pneumonia that is often hard to diagnose until it is advanced, it is difficult for me to decide in retrospect, not knowing what clinical findings were there when he examined EJ, whether Dr. Gordon should have made the correct diagnosis or not. For one thing, if Dr. Gordon truly didn't know that there was reason to suspect that EJ might be immunosuppressed, then there would have been little, if any, reason for him even to consider the diagnosis of PCP in the differential. On the other hand, if he did know Maggiore's HIV status at the time, then he definitely should have at least considered an HIV-related infection in the differential diagnosis. It was not clear from the broadcast whether he did consider an HIV-associated illness or not.

The bottom line is that the pathologic evidence from the autopsy clearly shows that EJ died of AIDS, no matter how much Maggiore believes otherwise and no matter how much Dr. Al-Bayati tries to spin and distort the coroner's report to suggest the cause of death was some fantastical anaphylactic reaction to amoxicillin (a reaction that, if you believe Dr. Al-Bayati, supposedly caused a type of liver damage that amoxicillin has never been reported to show in the scientific literature). However, it should not be forgotten that, as tragic as EJ's death is, the real danger of the pseudoscientific belief that HIV does not cause AIDS is to dissuade people from being tested, being treated, or taking prudent measures to halt the spread of the virus, potentially leading to many more tragic and largely preventable deaths like EJ's. An additional tragedy of this case is that Christine Maggiore is still preaching the same pseudoscientific nonsense that HIV does not cause AIDS that she was before EJ died, only now she's claiming the mantle of martyr and blaming "conventional" medicine for the very death that her own beliefs contributed to.

(Note: If you wish to be reminded yet again of the rest of the distortions, half-truths, and selective quoting in the Al-Bayati hatchet job, check out Trent's, Nick's, and my rebuttals again. Pay special attention to Nick's updated rebuttal--also linked to here--as it's the most comprehensive. To go over that material in detail again here would be needlessly repetitive.)

ADDENDUM: Apparently ABC News has removed the link to the L.A. County coroner's report. Perhaps the bandwith was too great. (It was a PDF containing a scan of the file and weighed in at 2.3 MB.) However, in the comments of a previous post, a reader has pointed out another link where the coroner's report can be found.)