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Christine Joy Maggiore (born on July 25, 1956 –December 27, 2008) was an HIV-positive activist who promoted the view that HIV was not the cause of AIDS. She was the founder of Alive & Well AIDS Alternatives, an organization which questions the link between HIV and AIDS and supports HIV-positive pregnant women who want to avoid taking anti-HIV medication. Maggiore authored and self-published the book What If Everything You Thought You Knew about AIDS Was Wrong? Maggiore died on December 27, 2008 after suffering from several AIDS-related conditions.
Maggiore's promotion of AIDS denialism had long been controversial, particularly after the death of her 3-year-old daughter, Eliza Jane Scovill, in May 2005. The Los Angeles County coroner concluded that Eliza Jane had died of Pneumocystis jiroveci pneumonia resulting from untreated AIDS. Consistent with her belief that HIV was harmless, Maggiore had not taken medication to reduce the risk of transmission of HIV to her daughter during pregnancy, and she did not have Eliza Jane tested for HIV during her daughter's lifetime. Maggiore hired a veterinary toxicologist (and AIDS denialist) to review the autopsy report; the toxicologist produced a report attributing Eliza Jane's death to an allergic reaction to amoxicillin, rather than AIDS.
Born in Chicago, Illinois, Maggiore grew up in Southern California. After graduating with honors from Reseda High, she worked in advertising and marketing in Los Angeles until 1984. She traveled through Europe and North Africa in 1984 before settling in Florence, Italy, where she lived from 1985 to 1987. In 1986, Maggiore started what became a multimillion dollar import/export clothing company, Alessi International, based in Tuscany. In 1992, as part of a routine medical exam, Maggiore tested positive for HIV. A former boyfriend also tested positive.
 AIDS work
Following her diagnosis, Maggiore became involved in volunteer work for a number of AIDS charities, including AIDS Project Los Angeles, L.A. Shanti and Women at Risk. However, following an interaction with prominent AIDS denialist Peter Duesberg in 1994, she began to question whether HIV causes AIDS. Maggiore came to believe that her positive test may have been due to flu shots, pregnancy, or a common viral infection.
In 1995, Maggiore left the clothing business to work as a freelance consultant for US government export programs. At the same time, she founded Alive & Well AIDS Alternatives, an organization denying the connection between HIV and AIDS and urging pregnant HIV-positive women to avoid HIV medications for themselves and their children. Maggiore herself drew criticism for breast-feeding her children, as breast feeding has been shown to increase the risk of mother-to-child transmission of HIV.
In a 2002 article entitled My Bout of So-Called AIDS, Maggiore wrote that she had an abnormal Pap smear (a "Grade 3 Pap smear with cervical dysplasia"), which she wrote would qualify her for an AIDS diagnosis. Maggiore's doctors recommended further evaluation with colposcopy; Maggiore instead followed a naturopathic program and had additional Pap tests performed under an assumed name by another doctor, ultimately obtaining a normal result.
In a 2005 article in the L.A. Times, Maggiore claimed to be in excellent health without taking anti-retroviral treatment. Maggiore's husband and partner, filmmaker Robin Scovill, has repeatedly tested negative despite what Maggiore describes as "a decade of normal, latex-free relations"; their son Charlie, born in 1997, has also tested negative for HIV.
On December 27, 2008, Maggiore died at the age of 52. She was under a doctor's care and was being treated for what was originally reported as pneumonia. The Los Angeles County coroner's office stated Maggiore had been treated for pneumonia in the six months prior to her death as well. A doctor familiar with the family noted that anti-HIV drugs could have prevented her death, but Maggiore's fellow AIDS denialists argued that her pneumonia was not related to AIDS and suggested instead that she died as a result of a toxic alternative medicine "holistic cleanse", or stress, or the cold and flu. No autopsy or biopsy evidence was recorded.
Maggiore's death certificate states that the cause of death was disseminated herpes virus infection and bilateral pneumonia, with oral candidiasis as a contributing cause; all three are related to HIV infection. The death certificate also states there was no autopsy or biopsy performed.
 Death of Eliza Jane
Christine Maggiore chose not to take antiretroviral drugs or other measures which reduce the risk of mother-to-child transmission of HIV during her pregnancies. Maggiore also breast-fed her children, despite evidence that breast-feeding can also transmit HIV from mother to child. Her youngest daughter, Eliza Jane, was never tested for HIV, nor did she or her older brother Charlie receive any of the recommended childhood vaccines.(Maggiore later reported Charlie to have tested HIV-negative three times.) Maggiore discussed her beliefs as an AIDS dissident on Air America Radio in March 2005, stating that "...our children have excellent records of health. They've never had respiratory problems, flus, intractable colds, ear infections, nothing. So, our choices, however radical they may seem, are extremely well-founded."
 Illness and death
Several weeks after this interview, in April 2005, Eliza Jane became ill with a runny nose. She was seen by a physician from the family's pediatric practice, who documented a normal physical exam. Several days later, Maggiore took Eliza Jane to see another pediatrician, Jay Gordon, who felt she had a mild ear infection. Reportedly, Gordon was aware of Maggiore's HIV status, but did not have Eliza Jane tested for HIV. According to the hospital report, filed just after Eliza Jane's death and based upon an interview with Maggiore, Eliza Jane "had been diagnosed with pneumonia" in the weeks preceding her death.
When Eliza Jane failed to improve, Maggiore took her to see Philip Incao, a holistic practitioner and board member of Maggiore's AIDS-denialist organization Alive & Well AIDS Alternatives. Incao stated that Eliza Jane appeared "mildly ill... no way I considered her in danger... she did not act as a patient acts if she's severely ill or in danger." On May 14, 2005, Incao prescribed amoxicillin for a presumed ear infection.
The following day, Eliza Jane became lethargic and vomited several times. While Maggiore was on the phone with Incao, Eliza Jane collapsed and stopped breathing. She was rushed by ambulance to Valley Presbyterian Hospital in Van Nuys, California. Physicians attempted to resuscitate Eliza Jane, but were unsuccessful. According to the hospital report, a "chest x-ray revealed pneumonia," and Eliza Jane was pronounced dead at 5:40 AM on May 16, 2005.
 Cause of death
An autopsy was performed. The Los Angeles County coroner found that Eliza Jane was markedly underweight and underheight, consistent with a chronic illness, and that she had pronounced atrophy of her thymus and other lymphatic organs. Examination of her lungs showed infection with Pneumocystis jiroveci, a common opportunistic pathogen in people with AIDS and the leading cause of pediatric AIDS deaths. The post-mortem examination of Eliza Jane's brain showed changes consistent with HIV encephalitis; protein components of HIV itself were identified in Eliza Jane's brain tissue via immunohistochemistry.
Based on the clinical information, the immunohistochemical documentation of HIV in Eliza Jane's brain, the evidence of pronounced immunosuppression, and the isolation of the opportunistic pathogen Pneumocystis jiroveci from Eliza Jane's lungs, the coroner concluded that Eliza Jane had died of Pneumocystis pneumonia in the setting of advanced AIDS. This conclusion was described by the coroner as "unequivocal".
Maggiore rejected the coroner's conclusion, ascribing it to political bias and attacking the personal credibility of the senior coroner, James Ribe. Maggiore retained a board member of Alive & Well AIDS Alternatives, Mohammed Al-Bayati, to review the autopsy report. Al-Bayati holds a Ph.D. in comparative pathology (the pathology of animal diseases). He is not a medical doctor, nor is he board-certified in human pathology. He is the author of a book entitled Get All The Facts: HIV Does Not Cause AIDS.
Al-Bayati released a report concluding that Eliza Jane had not died from AIDS or pneumocystis pneumonia, but from an allergic reaction to amoxicillin. Maggiore embraced Al-Bayati's conclusion that a reaction to amoxicillin was responsible, stating, "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."
Al-Bayati's report has been dismissed as both biased and medically unsound. Both the L.A. Times and ABC PrimeTime Live consulted independent experts in pathology about Eliza Jane's case; these experts agreed unequivocally with the coroner's conclusion that AIDS and resultant Pneumocystis pneumonia were the cause of death, and rejected Al-Bayati's report.
 Criticism and controversy
Following Eliza Jane Scovill's death, Maggiore's beliefs and advocacy became points of controversy. Maggiore had held fast to her belief that HIV does not cause AIDS, and that Eliza Jane died of a reaction to amoxicillin. She submitted a letter to the LA Times alleging factual errors and omissions in their articles on Eliza Jane; the Times did not print the letter, stating that "If facts in an article are wrong, a correction would be published. However, no correction is warranted in this case."
Others point to the evidence which indicates that Eliza Jane acquired AIDS from Maggiore perinatally or via breast feeding, that Eliza's HIV infection might have been prevented had Maggiore taken antiretroviral drugs or avoided breast feeding, that Eliza Jane's death was due to complications of AIDS, and that her death may have been preventable with proper medical care.
John Moore, a prominent HIV/AIDS researcher speaking at the 16th International AIDS Conference, described Eliza Jane's death as a concrete example of the human harm that can result from pseudoscientific beliefs such as AIDS denialism:
...infants whose HIV infected mothers listen to AIDS denialists never got the chance to make their own decisions. The Maggiore case received wide publicity. Christine Maggiore is a person who’s proselytized against the use of antiretrovirals to prevent HIV/AIDS. She’s a classic AIDS denialist, and she gave birth to a child who died at age three late last year of an AIDS-related infection. The coroner’s report clearly reports that the child died of AIDS. That was another unnecessary death.
Maggiore's influence on Thabo Mbeki's decision to block funding of medical treatment of HIV-positive pregnant woman was criticized following her death, with medical researchers noting a Harvard study which estimated "330,000 lives were lost to new AIDS infections during the time Mbeki blocked government funding of AZT treatment to mothers."
The journalist and AIDS denialist Celia Farber wrote an article in June 2006 in the independent paper Los Angeles CityBeat, arguing Maggiore's case and alleging incompetence, conspiracy, and coverups on the part of the coroner, the mainstream AIDS community, the mainstream media, and the medical community. In particular, Farber's article claimed that the coroner's office had not disclosed the records of Eliza Jane's HIV serology test, and quoted another denialist who claimed Eliza Jane's total lymphocyte count was elevated at the time of her death.
 Legal ramifications
The death of Eliza Jane was investigated by the Los Angeles Police Department and the Los Angeles Department of Child Protective Services as a possible case of medical neglect or child endangerment. On September 15, 2006 the LA County District Attorney's office announced that it would not file charges against Christine Maggiore, noting that Maggiore did take her sick child to several physicians.
In September 2006, the Medical Board of California filed charges of gross negligence against one of these physicians, Paul Fleiss, a convicted felon who was Eliza Jane's pediatrician, alleging a failure to test Eliza Jane for HIV (or to document her parents' refusal of testing), a failure to counsel Maggiore to avoid breast-feeding at any time during the three years Maggiore breast-fed her daughter, given the risk of transmitting HIV, and similar violations of standard medical practice in Fleiss' care of a second HIV-positive child.
In September 2007, the Medical Board of California issued its decision in the Fleiss case, effective October 8, 2007. The Board revoked Fleiss' medical license, but stayed this action in favor of a 35-month probation period during which Fleiss must submit to regular monitoring, pay costs, notify insurance and hospitals of the decision against him, and take continuing medical education (CME) classes and record-keeping courses. He is not permitted to supervise Physician's Assistants and has affirmed the practice of referring HIV-positive patients to a specialist.
In an admonition letter dated September 13, 2007, an Inquiry Panel of the Colorado State Board of Medical Examiners issued its finding that Philip Incao's "care and treatment and lack of timely documentation" in the case of Eliza Jane Scovill "falls below the generally accepted standards of medical practice". The Panel warned Incao that any further instances of such behavior could result in "formal disciplinary proceedings against your license to practice medicine".
Maggiore and her husband, Robin Scovill, sued Los Angeles county in 2007 for allegedly violating their daughter's civil rights and privacy by releasing her autopsy report, which indicated that she was HIV-positive. A settlement was reached in 2009.
 See also
- ^ a b France, David (2000-08-28). "The HIV Disbeliever". Newsweek.
- ^ a b c d e f g h "Did HIV-Positive Mom's Beliefs Put Her Children at Risk?". ABC Primetime Live. 2005-12-08. http://abcnews.go.com/Primetime/print?id=1386737. Retrieved on 2008-12-23.
- ^ a b c Borger, Julian (2005-09-26). "Mother who denied Aids link faces police investigation after death of daughter". The Guardian. http://www.guardian.co.uk/international/story/0,,1578142,00.html. Retrieved on 2007-03-28.
- ^ a b Link to death certificate
- ^ a b c d e f g h i j k l m n Ornstein, Charles; Daniel Costello (2005-09-24). "A Mother's Denial, a Daughter's Death". Los Angeles Times. http://www.latimes.com/news/local/la-me-christine-maggiore24-2005sep24,0,7927684.story. Retrieved on 2008-12-29.
- ^ For examples, see:
- Nduati R, John G, Mbori-Ngacha D, Richardson B, Overbaugh J, Mwatha A, Ndinya-Achola J, Bwayo J, Onyango F, Hughes J, Kreiss J (2000). "Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial". JAMA 283 (9): 1167–74. doi:10.1001/jama.283.9.1167. PMID 10703779.
- Tess B, Rodrigues L, Newell M, Dunn D, Lago T (1998). "Infant feeding and risk of mother-to-child transmission of HIV-1 in São Paulo State, Brazil. São Paulo Collaborative Study for Vertical Transmission of HIV-1". J Acquir Immune Defic Syndr Hum Retrovirol 19 (2): 189–94. PMID 9768630.
- Watts D (2002). "Management of human immunodeficiency virus infection in pregnancy". N Engl J Med 346 (24): 1879–91. doi:10.1056/NEJMra013338. PMID 12063373.
- ^ In fact, although invasive cervical cancer is an AIDS-defining illness, an abnormal Pap smear has never been an AIDS-defining condition
- ^ Maggiore, Christine. "My Bout of So-Called AIDS". From the website of Alive & Well AIDS Alternatives. http://www.aliveandwell.org/html/rethinking/my_bout_of_so.html. Retrieved on 2006-12-06.
- ^ a b "Christine Maggiore, vocal skeptic of AIDS research, dies at 52". Los Angeles Times. 2008-12-30. http://www.latimes.com/news/local/la-me-christine-maggiore30-2008dec30,0,7407966.story. Retrieved on 2008-12-30.
- ^ a b "Death of an AIDS Skeptic; Friends Say Christine Maggiore Endured Media Stress; Doctors Say She Caused Misery". ABCNews. 2009-01-01. http://abcnews.go.com/Health/story?id=6558202&page=1. Retrieved on 2009-01-02.
- ^ Given the known and unknown risks of antiretroviral use in pregnancy, National Institutes of Health guidelines state that the final decision regarding their use "should be made by the woman after discussion with her health care provider about the known and unknown benefits and risks of therapy" in a "noncoercive" environment; see "Recommendations on HIV therapy during pregnancy". National Institutes of Health. http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf. Retrieved on 2006-12-04.
- ^ http://articles.latimes.com/2005/sep/24/local/me-eliza24
- ^ a b c d PDF (2.29 MiB)
- ^  Accessed 20 July 2007.
- ^ Justice For E.J., website maintained by David Crowe of the Alberta Reappraising AIDS Society, accessed 5 September 2006.
- ^ Costello, Daniel; Charles Ornstein (2005-12-09). "HIV Skeptic Takes Her Case to TV Audience". Los Angeles Times. http://www.latimes.com/news/local/la-me-christine-maggiore9-2005dec09,0,6599725.story. Retrieved on 2008-12-29.
- ^ Mohammed Al-Bayati's review of Eliza Jane Scovill's autopsy, accessed 5 September 2006.
- ^ Christine Maggiore: AIDS naysayer, accessed 5 September 2006.
- ^ Rebuttal to Dr. Mohammed Al-Bayati's report, by Nicholas Bennett, accessed 5 September 2006.
- ^ Maggiore's view of the L.A. Times article, accessed 5 September 2006.
- ^ HIV and Responsible Journalism, presented at the 16th annual International AIDS Conference, accessed 5 September 2006.
- ^ Criticism of Maggiore's inclusion in the 13th International AIDS Conference
- ^ Celia Farber, A Daughter's Death, A Mother's Survival, Los Angeles City Beat.
- ^ a b "L.A. County D.A. Won't Act in Girl's AIDS-Related Death", article in the L.A. Times, published 16 September 2006. Accessed 5 October 2006.
- ^ "Fleiss (the father) is placed on probation, article in the L.A. Times, published 9 October 2007. Accessed 10 October 2007.
- ^ Attorney General (2007-09-10). "Decision in the Matter of the Accusation Against: Paul Fleiss, M.D. - MBC Case #17-2005-169843" (in English) (PDF). Medical Board of California. 14. http://www.aidstruth.org/MedBoardResult.pdf. Retrieved on 2007-10-21.
- ^ State of Colorado State Board of Medical Examiners letter to Dr. Philip F. Incao, M.D. Accessed 04 May 2008.
- ^ Hennessy-Fiske, Molly (March 6, 2009). "L.A. County settles suit on autopsy of HIV skeptics' daughter". Los Angeles Times. http://articles.latimes.com/2009/mar/06/local/me-maggiore-lawsuit6. Retrieved on March 16, 2009.
 External links
- A Mother's Denial, A Daughter's Death: from the Los Angeles Times.
- Did HIV-Positive Mom's Beliefs Put Her Children at Risk? An ABC News Primetime special.
- AIDS denial: A lethal delusion Jonny Steinberg, New Scientist, 17 June 2009.