What to do about science denialists

This week's column from the Kingston Whig-Standard.

One of the privileges that comes with being an academic is that one is comparably mobile, the world really is one’s job oyster.
I chose to work between 2000 and 2005 in a medical school in Johannesburg, South Africa. Sub-saharan Africa at the time was the world’s region worst hit by HIV and AIDS. At a time when HIV infected people in the West got used to the idea of living to old age, people around me literally were dropping like flies. Talk about culture shock! In the condo-complex where I lived, several of our staff members died preventable AIDS-related deaths. One of my staff member’s life-partner died from AIDS, too. He had just matriculated from college.

Many of our students were infected and discussions began in the university whether we had a responsibility to sponsor medical insurance to ensure their survival while they were enrolled with us. To the outsider this might look like an issue best understood as people in the developing world being unable to afford access to life-preserving medication. And, to be fair, the price tags of essential medicines in many developing countries remain unacceptably high. However, this is not what actually caused in excess of 360,000 entirely preventable HIV-related deaths in South Africa.
The country’s president at the time, Thabo Mbeki, and his health minister, Manto Tshabalala-Msimang subscribed to wild conspiracy theories involving Western agencies wanting to crush African people’s aspirations. In their paranoid world AIDS medicines were a means to poison Africans. HIV was not the cause of AIDS, and AIDS didn’t quite exist as a new disease. They duly found a high-profile, ironically white, United States academic and a few of his, ironically white, allies to confirm their worst fears. Being the country’s president, Mbeki quickly set up a presidential expert panel involving mainstream scientists and a bunch of denialists. A funny idea to create a sparring match between discredited academics and mainstream academics and encourage them to entertain your paranoia. Mbeki clearly thought that a scientific consensus is reached not by evidence but by discussion and some kind of compromise (as if HIV could cause AIDS just a little bit, depending on the compromise reached).

Well, Mbeki and his side-kick Tshabalala-Msimang enforced policies aimed at keeping as many impoverished South African AIDS patients away from life-preserving medicines as was possible. HIV infected pregnant women were not given access to medicines proven to drastically reduce the risk for their newborns to be HIV infected. Thousands and thousands of HIV infected newborns came into this world as a result of these crazy policies. A Harvard University study estimated that in excess of 360,000 South Africans died preventable AIDS deaths during Mbeki’s reign. Some of the medical doctors in public sector hospitals who prescribed and provided AIDS drugs to their infected patients were disciplined by hospital managers carrying out the health minister’s orders.
Ask yourself how the world would have responded if such genocidal policies had been implemented by the apartheid regime preceding the ANC government that’s running the country today. No doubt international bodies would have busily prepared genocide charges. No doubt international campaigns would have got off the ground blaming the racist government for the preventable deaths of such a large number of South Africans. A black politician with liberation credentials presiding over what could demonstrably be described as genocide barely led to people batting their eyelids. Human lives clearly remain cheaper even today in that part of the world than elsewhere. Another, even crazier, head of state, Gambia’s president Yahya Jammeh insists that a herbal concoction he invented cures AIDS. Foreign aid workers disbelieving the story end up being kicked out of the country, and any Gambian criticizing his take on this medical problem end up in jail. Meanwhile Jammeh instructed HIV infected people to stop taking AIDS drugs.

What bothers me greatly is that government policies leading demonstrably to large numbers of preventable deaths remain unpunished. It is one thing if Mbeki had said that his government decided not to provide AIDS drugs due to their high cost. If you don’t have the resources to treat everyone it is fair game to allocate resources. But denying access to life-preserving medicine to large numbers of impoverished South African public sector patients because of truly crazy ideas about Western conspiracies is surely something else. Yet Mbeki walked away, enjoying today his generous retirement pay-out. His alcohol guzzling health ministerial side-kick died eventually of liver cirrhosis. Even there she remained true to her unethical form by jumping the queue toward a donor liver.

Well, enough on AIDS. This week United States talk show host Katie Couric used her show on national TV to peddle nonsense about the HPV vaccine. In Mbeki style she juxtaposed scientific mainstream views with anecdotes supplied by vaccine critics. The impression created was that there is a genuine debate, that there are genuinely two sides to this vaccine, when patently there are no two sides. While some of the stories presented were genuine human interest stories, they showed nothing relevant at all with regard to the safety and efficacy of this vaccine. It was clearly irresponsible of Couric to give a high-profile stage to quacks promoting their anti-science agendas. Almost certainly as a result of her action people who would clinically benefit from getting vaccinated won’t get vaccinated. Some of these women will eventually go on to develop cervical cancer. Is it acceptable, for the sake of ratings to promote quacks’ views on national television? I doubt it.

To be fair, Couric’s case is different to Mbeki’s actions. Women choosing not to get vaccinated did it on bad information they received through her TV show. Arguably women making such important health care choices would do better than to listen to anecdotes on a talk show when making important health care related choices affecting themselves. Let the buyer beware, as the old Romans said. On the other hand, the impoverished HIV infected South Africans depended on the national health care system to deliver life-preserving medicines. They did not have the luxury of choice to begin with. So, while the blame for bad choices in Couric’s cases arguably should be shared between those who act on anecdotes heard on her talk show and those who produced the show, the blame in South Africa falls squarely on Mr. Mbeki’s shoulders. Remarkably until today he was neither prosecuted nor did he ever utter an apology for the genocidal policies he presided over.

Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.

Farewell to the genocidal duo

Good bye to Thabo Mbeki and his health prevention side-kick Manto Tshabalala-Msimang, formerly health minister of South Africa. Manto, like AIDS denialist Thabo was kicked out of the Presidency, was shafted from the health ministry during the ANCs recall of 'comrade Mbeki'. A lot of South Africans are worried about what might come unter Jacob Zuma, a shady Zulu warrior tainted by a substantial number of scandals including corruption and sexual conduct. But truth be told, what can be much worse than the AIDS policies of the Mbeki government, policies responsible for hundredthousands of preventable AIDS deaths among the impoverished Black majority population in the country. Mbeki also presided over the systematic undermining of state institutions (including the security services, the courts and the national broadcaster) into mouthpieces of his administration. Many South Africans seem to have forgotten already that the president of the South African Medical Association called - justifiably so - these Mbeki/Tshabalala Msimang policies 'genocidal'. It's a shame - as South Africans of all shades are fond of saying - that the country doesn't seem to have more competent politicians prepared to step up to the serious challenges the country faces. That being the case it seems somewhat inevitable that a vindictive paranoid (arguably antidemocratic) character such as Mbeki was replaced by a washed-up populist ala Jacob Zuma. Interesting times ahead for the rainbow nation... - Only the future will tell though whether Zuma really will do much worse than Mbeki.

Bob Madhat and 'God'

Going Canada - (South) Africans on the move

This has been an interesting week for me. You know, I have worked in South Africa for some five years or so. To be honest, in intellectual terms, I had the best time of my career there, as the work I undertook was - on my books anyway - truly meaningful. Made some great friends there, too. Eventually I left, for all sorts of reasons, chief among them the unpleasantly low salary that made me wonder about my pension (or lack thereof), lack of personal security (living in Jozi probably didn't help), the deteriorating administrative infrastructure at my university, continuing electricity failures in my suburb, and most importantly nagging doubts about the country's future (I had seen what happened to Zimbabwe next door).

Anyone who has been following this blog knows that I am continuously railing about the dangers to democracy the ANC poses in the country. Large sections of its senior leadership are convicted fraudsters and thieves who have decided to use the public purse as their private piggy-bank. The organisation has long ago begun to use the public broadcaster as a propaganda instrument. The lack of any serious opposition in effect renders the country a one-party state akin to Mexico during its decades under the PRI. Well, there is one-party states and one-party states. Singapore is also more or less run by one party, but it's well-run, something one cannot reasonably claim for South Africa. Its current President presided over a preventable genocide-equivalent tragedy due to his crazy handling of the AIDS crisis in the country. Nobody has as yet held him accountable for the crimes he and his health minister committed against the South African people (aided and abetted by the ANC). Here is evidence demonstrating that the President was pro-actively involved in protecting corrupt underlings of his, in this case the country's former Police Commissioner. His most significant rival (the party's current President) is a bone head of sorts. Aged 65 he just married his fifth wive, a 33 year old woman. Him becoming the next President of the country would be akin to Homer Simpson becoming President of the USA ... well, come to think of it, someone akin to Homer Simpson is currently President of the USA. In South Africa, the separation of state organs and party organs is weakening.

The only hope I have for the country rests with its young people. Many of them don't have the near-pathological hang-up's about race/ethnicity/skin-color that frequently prevent the current ruling class from instituting prudent policies. Thinking back of many of my students, and reading what's currently going on in the country, you'd think they were already a different kind of person. They seem to have been spared the crippling effects of apartheid South Africa on their personalities, very much unlike many members of the current ruling class who have undoubtedly sustained very serious psychological damage. Given a decent education (I won't even go into years of failing education policies that the ANC can also take credit for), they are the last best hope for the country. Thing is, they got to get rid of the current ruling elites altogether, as well as their hand-groomed 'youth' successors in the ANCYL (the party's youth league). Oh well, there's wishful thinking.

So, bad news all around. Let me get to what triggered this commentary: I got three different email messages independently of each other from South African friends/former colleagues during the last week. One from an Afrikaner who has decided to leave the country for good. One from an Indian student of mine who has just graduated as a medical doctor, and will move to Canada. One from a Nigerian medical professional who is in the middle of sorting out his immigration documents so that he can also move to Canada. He told me that he holds little hope for the future of the country and that he's getting out. This, while completely anecdotal, is quite significant. All three of them are very highly trained - and badly needed - professionals, yet they all have decided to get on with life, having lived in Africa for many years. Just today the Mail and Guardian reports that Gauteng's (the country's - and continent's - industrial and commercial powerhouse) pathology services are 'bleeding pathologists dry', meaning that they're in danger of collapsing due to too many of these specialists leaving the country. A brand new survey in Human Resources for Health reports that about 1 out of every five Africa born doctors now works in a developed country.

I have had the 'brain drain' discussion the other night with a Jamaican acquaintance of mine who pointed out that at the end of the day, people only have one shot at life, so one cannot really blame people for moving to countries that are reasonably stable and guarantee a better life for these professionals and their families. He is right, of course. It is all the more important then that developing countries leaders think more carefully about how to make life and work for such professionals better than it is right now, or else risk losing them to countries like Canada, Australia and the UK.

For some African countries the failure to have done so translates into a loss of 70% of its locally trained medical professionals. The signs are probably on the wall for the powers that are in South Africa, get your acts together or join the rest of the African basket cases. It's your call.

ANC working tirelessly to render South Africa a true banana republic

Quite remarkable, South Africa's elite crime fighting unit, THE SCORPIONS, is going to be disbanded. The reasons are fairly simple, the crime fighters found too may senior ANC politicians with their hands in the till, showed them to be thieves, corrupt or worse. Among those investigate and prosecuted were Jackie Selebie (once the country's ANC appointed police commissioner), Jacob Zuma (currently the ANCs president) and many others.

The people of South Africa might want to read up on the history of Mexico's PRI to see what is going to happen to their society if they permit the ANC to continue down the path it so clearly has chosen.

So far for the 'new South Africa'. A less than convincing move from historically white-corruption to 'new South Africa' black-corruption. The masses remain as poor as they always were, service delivery is collapsing across the place (even the country's electricity supply is unreliable these days). Just think about it, the ANC cadres were given the amazing choice to stick to President Mbeki (a leader whose warped AIDS policies have cost hundreds of thousands of HIV infected South Africans their very lives!), or Jacob Zuma (a politician current prosecuted for corruption, and a guy who has a habit of sleeping around with plenty of women without using condoms, and who tends to have a shower as a means of post-exposure prophylaxis!). - How sad can it get? It surely looks like a second democratic revolution is called for.

The trouble for South Africans, of course, is that the country has no credible opposition party and, for that reason alone, the ANC is free to do pretty much anything it wishes. And so it does! Sad developments indeed.

Medical professionalism African style - more on Manto Tshabalala-Msimang

Hey, what a tendentious headline this is... I don't mean to write about medical professionalism African style, but about the disgraceful conduct of the (current, and would you believe it, still in office) South African Minister for Health Prevention, Dr Manto Tshabalala-Msimang. Manto has succeeded for several years to aid and abet the line of her boss, Thabo Mbeki, on HIV/AIDS. Hundreds of thousands of South African people with HIV/AIDS died preventable deaths because those two shady characters colluded in slowing down the roll-out of effective life-preserving AIDS treatments for as long as was/is feasible. She instead continued to promote various vegetables as a serious alternative to proper AIDS treatments.

Of course, as is usually the case when it comes to such people, there's one rule for the people and another for the rulers. All the politically correct rhetoric of the ANC is not going to change that. It has since transpired that Manto,a card carrying member of the League of Continuing Alcoholics (LCA), jumped the queue in order to access a fresh liver. It would have been very difficult for her to continue drinking otherwise. Other people of her age who happen to continue to enjoy large quantities of alcohol (as she does) tend not to get access to life-preserving new organs. These scarce resources are usually preserved for people younger than Manto, and people who, unlike Manto, stopped drinking. Well, despite much by way of denials (attending doctors were seemingly pressured into claiming that her alcohol induced liver disease wasn't alcohol induced...), it's clear now that the country's health prevention minister is not only incompetent but also otherwise unfit to run the Department of Health. She doesn't seem to mind bending the rules that have been put in place to allocate scarce transplant organs justly in the country.

Since these facts came to light it was also discovered by an investigation published last weekend by the country's SUNDAY TIMES that Manto was fired a couple of years ago from her day job as a superintendent at a hospital in Botswana because she stole plenty of hospital property and even a watch from a patient who was undergoing surgery under full anaesthesia.

Here's a revealing excerpt from yesterday's SUNDAY TIMES:

This week some of the key witnesses who testified during her trial and who had worked with Tshabalala-Msimang at the time, told the Sunday Times that jewellery, hats, handbags and even shoes had disappeared from the hospital over several months.

They had not suspected Tshabalala-Msimang and had were shocked when she was arrested for the thefts.

“It was unbelievable that a superintendent of the hospital would do something like that,” said a retired nurse who worked at the hospital at the time. Tshabalala-Msimang was arrested after an oval-shaped watch belonging to a female patient disappeared while she was under anaesthetic. The theft was reported to the police. Tshabalala-Msimang was arrested when she arrived at work three weeks later, wearing the watch. Staff contacted the investigating officer and Tshabalala-Msimang was arrested in front of her employees. A warrant was obtained to search Tshabalala-Msimang’s home and police found, among other things, linen, blankets and heaters that belonged to the hospital.'

So, an incompetent, drinking crook that is how one could best describe South Africa's Minister for Health Prevention, Dr Manto Tshabalala-Msimang. No wonder the ANC leadership has promoted her straight into the health department. There are only few senior people in the ANC that haven't managed to get their hands in one till or another, so Manto probably had the perfect character profile for the job.

Mind you, there's still people left in South African medical schools seriously trying to teach ethics.

... to be continued

Irresponsible governments - accountability for acts and omissions

The South African Health Minister Manto Tshabalala - Msimang and Treatment Action Campaign's Zackie Achmat have frequently crossed swords in the past. He was asked by a local paper whether he could ever be friends with her. Achmat replied "no", and explained: "Almost a million people have died and for that I don't think that I could ever establish a friendship with her."

Forget the question of whether or not anyone would want to be friends with such an egotistical, petty character as the South African Minister for Health Prevention and the country's similarly deluded President. There's a more interesting issue, and that issue is this. Consequentialist ethicists (among others) have made much of rejecting the acts and omissions doctrine. They claim, essentially, that all other things being equal, you are as responsible for the consequences of your actions as you are for the consequences of your omissions to act when you could have acted. I think that this makes perfectly sense.

Here then is an interesting challenge: Remember a mass murderer like Slobodan Milosevich, the Christian slaughterer or anything not Christian/Serbian during the civil wars in former Yugoslawia? Many people died as a direct consequences of his actions (read: policies). Well, if we really believe that the acts and omissions doctrine doesn't make much sense, we surely need some international court of justice that holds governments responsible for policies that omit to act when they could have acted to prevent significant harm to their citizens. Thabo Mbeki, Manto Tshabalala-Msimang and the ANC government are responsible for up to 1 million of preventable deaths in Southern Africa due to their refusal to provide medication to these people when they could have.

I am still flabbergasted that nobody in South Africa seems keen on holding these liberation politics apparatchicks responsible for the preventable deaths of more than a million poor Black South Africans. Just imagine such genocidal policies had been enacted by a white government. The world would have been up in arms, and quite rightly so. Surely, holding a Black run government to lower standards of performance, competence etc is in itself racist, isn't it?

... or am I missing something?

Torture and political assassination in Zimbabwe - the ANC is silent...

Morgan Tsvangirai, the leader of the Zimbabwean movement for democratic change, has reportedly been nearly beaten to death by Zim security forces during recent demonstrations his organisation staged against the kleptocratic rule of one Bob Mugabe. There is nothing really newsworthy with regard to that collapsing country and its corrupt ruling class. What remains very worrisome is that there isn't a word of criticism from neighbouring South Africa's ANC. The organisation's tacit approval of what is happening in Zim makes one wonder what the future might hold for democracy in South Africa itself.