What is it with 'these' people?

I don't get it! There have been reports this week that 'illegal' refugees who tried to cross into Italy from Libya's coast were left to die when their little boat ran out of gas, food and importantly water three days into their journey. Only about 5 out of a total of 80 made it. The others died eventually because they drank sea water, starved etc. The survivors were picked up eventually by the Italian coast guard. They told journalists that several ships passed them by and ignored their pleading. One even dropped a bit of water to them and disappeared thereafter.

How can people call themselves civilized who choose to do nothing at all to prevent almost certain death of other human beings when their direct and immediate action could have prevented such a harm from occurring? Surely the cost of taking the refugees on-board would not have fallen into the category of overwhelming burden or serious risk to one's own life. They could have even radioed the Italian or Libyan coast guard to pick those dying folks off the seas, yet these seafarers chose to do nothing at all.

Boggles the mind!

ps: I'm not even going to comment on the US health care debacle. How daft can people be and still be taken seriously ...

Those HIV serodiscordant couples' studies...

There has been some evidence that if guys are circumcised they're less likely to pick up HIV (and possibly other STIs) from people they happen to have unsafe sex with. Some clever public health folks wanted to know whether that cuts also the other way round, ie whether HIV infected men are less likely to transmit the bug when they're circumcised. What better place to investigate such speculations than Africa.

The medical journal THE LANCET just published a piece testing just this hypothesis. The investigators recruited 922 uncircumcised HIV infected men whose female partners happened to be still HIV negative. They then circumcised half of the guys. The women were informed of the objective of the study, but - as far as I can see - it was left open whether the male partner was HIV infected or not. This was so, because in addition to the infected guys they also had non-infected guys in the study, but obviously they were not 'counted' as there was nothing these guys could have passed on to their partners anyhow. So the women had no certainty to assume that their partner was HIV infected (as opposed to the next woman's partner). Indeed, the study authors concede that 'Inclusion of only couples who agreed before enrolment to couples' counselling and result disclosure [sic!] might have resulted in lower HIV transmission rates in both trial groups.' (p.236)

The investigators jumped otherwise thru the usual ethics loops, there's informed consent, folks were counselled to use condoms and that safe sex is imperative. To give them credit where credit is due: anyone who seroconverted during the study (ie who became infected) will be supplied with life-preserving AIDS medication when that is clinically indicated. So, HIV negative women who seroconverted during the study will be offered chemotherapy.

I've got to be honest: I do not believe such studies ought to take place. For starters, there was truly no good reason to assume that circumcision would have any impact whatsoever on transmission rates - and, surprise, surprise, it had no impact. Still, epidemiologists do what epidemiologists do best, they watch and report. So, in our case we had medical professionals who knew that there were a large number of HIV infected men whose partners did not positively know of their infection - the study authors confirm this for a quarter of each group. They then stood idly by and watched what happened. Turns out that circumcision doesn't reduce HIV transmission rates.

I can't get my head around the idea that the medical researchers should have had no moral obligations to warn the women in this study of the HIV infection of their partner. Now, you'll object that that would defeat the purpose of this study. You are right, but it would reduce the incidence of HIV infection and premature death among the women in question. You'll say that that would also prevent the investigators from undertaking this study. Exactly, that is why I think such research should not take place.

We know already what prevents HIV transmission. Put infected people on AIDS medicines (HAART) and drop all the social science investigative nonsense. You'll say that for us to do that we need more cash and more people tested. You're right on both counts. A good start could have been not to waste money on such research then and use the cash where it demonstrably would do some good.

An AIDS NGO worthy of your support!

Let me tell you something about an AIDS charity worthy probably also of your support. It's a (really - trust me) community based project in Southern Africa. What they do, in a nutshell, is to try to keep AIDS orphans in some kind of family unit (most likely relatives or neighbours). In order to ease the burdens on those usually impoverished families, however, the initiative provides 2 meals per day per child through community based food kitchens. Phedisang's approach to the problem is two-fold: It aims to move as many of the kids it feeds as is feasible on to the state grants that these kids are entitled to (but that they would never receive if it wasn't for the logistical support from Phedisang). So, basically, the first step is to keep kids properly fed, the second step is to move them on to state support in order to free donor money for other children in similar need.

To my mind it's a very clever system because it is sustainable in the longterm, because it's small and doesn't rely on massive administrative operations (gobbling up much of the donor money), and reassuringly, there are no overseas consultants on obscene international salaries that need to be 'fed', too. Check it out and consider supporting them!

On pedophilia

The world's media and the world's cops (aka Interpol) are currently hunting a high-profile pedophile suspect. Paul Neil, a 32 year old Canadian English language teacher is currently hiding somewhere in Southeast Asia. Bizarrely local Canadian media outlets published the photo of a house where the suspect's mother and brother are currently renting a flat. So, in case I steal a car tomorrow, they'd probably also publish a photo of my parents' house, just so that you know where they are, so they may be punished for my alleged deed. Beats me ...

Anyway, pedophilia: I am almost certain this is one of those blogs I will regret to have ever written, but then, that hasn't stopped me in the past. So, some disclaimers first: Kids don't do it for me, never have, never will. I think legislation outlawing pedophile sexual activity (ie between adults and prebubescent children) is a desireable thing. It's probably also sensible that modern psychiatry has decided that pedophilia is some kind of mental illness, though, just like with other calls they made in terms of DSM inclusion, their coin flipping activitiy could have ended with a different call just as easily.

Having said all that, it gets more difficult to get one's head around the question of what it is that is bad about pedophilia. Fair enough, most of us, myself included, think it's kinda 'yuck'. Beyond that though, what are the main ethical reason against pedophilia (not in the sense of sexual orientation but in the sense of action)? It seems to me that we should reject pedophilia as a reasonable (as in: acceptable) sexual orientation, because children are unable to give informed, voluntary consent (the famous autonomous choice in other words) to sexual interactions with adults. The meaning they'd give to such acts are different to the meanings we ascribe to them (regardless of whether the actual action includes painful penetrative sex or not), and given the power differential between them and us, they're probably not really in a situation to say 'no'. So, this probably is sufficient to outlaw pedophile sex acts.

Still, I have some nagging doubts ultimately about the intellectual integrity of either of these arguments. If the first part of the argument constituted a correct interpretation of the situation, could that not also be read as a case against putting it on the 'shameful' list? Subject to no bodily harm occurring, I wonder whether the real harm doesn't occur when the kids learn from us how badly they have been abused. There is evidence that (some) kids actually enjoy the sexual activity with adults, and that how badly they have been abused only dawns on them much later in life. Well, this makes me wonder, of course, how this pleasurable activity was turned into a horrific experience of abuse retrospectively many years later. I wonder how much of our cultural bias against such activities is actually contributing to this re-interpretation of the initial pleasant experience. Prior that that some kids didn't even think of their experience in terms of abuse. Would they not be better off then not to find out? I wonder how harm minimisation could be most efficiently executed under the circumstances.

The second half of the argument seems even weaker. It is self-evident that there is a substantial power differential between an adult and a child. This power differential renders probably much of what goes on between the adult and the child involuntary. No doubt, prima facie that makes it a bad thing. The thing is, tough, that that is also true for relationships between adults. Power differentials exist in all relationships. Economic, psychological and other dependencies exist in the real world. They can be strong enough to render consent involuntary. We have no laws to protect weak willed adults, financially impoverished adults and the like from exploitation (sexual or otherwise) by other adults. It seems to me that if the second half of the argument rests on the non-voluntariness, to be consistent, we would have to cast our legislative web wider to include many relationships between adults, too.

I kind of hope that some readers of this blog might rise to the challenge and deliver deadly blows to these two counter arguments.

It has been argued that pedophile sex tourists roaming developing countries are particularly despicable characters. The argument goes that in addition to the already mentioned two arguments, they abuse the particular vulnerabilities of impoverished peoples for their own purposes. It has also been reported that dire poverty drives parents in some developing countries to sell their kids off to pedophile networks. - I do think the exploitation argument is sound and there can be little said in defense of such kinds of sex tourism. That's the easy one. It's an argument that has also been deployed in the context of child labour. Except that in the child labour scenario quite a few people (many of whom no doubt well-intentioned) defended child labour by pointing out that, yes, these kids are being exploited (and that's undoubtedly bad!); BUT, they go on to argue, what's the alternative? Surely most parents wouldn't sell their kids as workers to some company if they had a viable alternative. So, here's the conundrum, while the companies exploiting such dire need arguably behave unethical, those trying to make the best of out it (eg the parents) under the circumstances, quite possibly did the ethically right thing.

I still recall as if it happened yesterday, oodles of years ago, when I was a student at Monash I had a shouting match type conversation with a guy who admitted to going to Southeast Asian countries as a sex tourist targetting 'young people' as he called them. I went on and on about how terrible his behaviour is and and that he should not be doing this etc. Then he came with the argument that if he, and many other white males like him, didn't go and didn't buy 'young people' for sex, nobody would be any better off (he implied that they might starve) and arguably some would be worse off. He railed against us do-gooders who didn't understand the dependence of many many people on characters like him. I can't say that I like him much more now, just thinking back about this episode, but it seems to me that those campaigning against sex tourism need to do better than they do currently, in terms of offering viable alternatives to those in dire need. Otherwise there will always be an obliging response to market driven demand, no matter how hard we politically correct folks waive our hands. I know that some NGOs offer such programs, BUT surely if there were sufficient alternative out there, the needs of sex tourists would not be met any longer in developing countries. As we all know, this isn't exactly what's happening in the real world.

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

Helping AIDS orphans to live lives worth living

Let me tell you something about an AIDS charity worthy probably also of your support. It's a (really - trust me) community based project in Southern Africa. What they do, in a nutshell, is to try to keep AIDS orphans in some kind of family unit (most likely relatives or neighbours). In order to ease the burdens on those usually impoverished families, however, the initiative provides 2 meals per day per child through community based food kitchens. Phedisang's approach to the problem is two-fold: It aims to move as many of the kids it feeds as is feasible on to the state grants that these kids are entitled to (but that they would never receive if it wasn't for the logistical support from Phedisang). So, basically, the first step is to keep kids properly fed, the second step is to move them on to state support in order to free donor money for other children in similar need.
To my mind it's a very clever system because it is sustainable in the longterm, because it's small and doesn't rely on massive administrative operations (gobbling up much of the donor money), and reassuringly, there are no overseas consultants on obscene international salaries that need to be 'fed', too. Check it out and consider supporting them!

HIV dissidents - continuing crackpottery causes untold harm in Africa

I have written before about the unprofessional conduct of a small group of scientists insisting that HIV isn't the cause of AIDS, that AIDS isn't an infectious illness and importantly that medication proven to keep people with AIDS alive actually causes AIDS.

Well, these folks pretty much lost their battle for the professional and public opinion in the developed world, so they shifted their lunatic campaign to the developing world. You can find a pretty detailed analysis of their activities in Southern Africa here. South Africa in particular carries one of the highest HIV disease burdens in the world. I don't want to spend too much time dwelling on the reasons for that, except to say that this is caused by a mix of poverty, education and importantly a government propagating these minority views until very recently. The ANC government as a trusted source of information spent years sending out misleading, confusing and outright false information on HIV/AIDS.

A few days ago I received this message from an outfit in Kwazulu Natal:

The subject heading of the email ... 'HIV not a real problem its [sic!] the sugar'

The spam-type email continues:

'Dear friends,

You believe in HIV because you did not know the real facts.

We make a juice (UMLINGO WAMANGCOLOSI) that lets any one start their life again, strong and healthy.

All you have to do is stop the following food, drinks and stress:

1. SUGAR

2. Chemicals

3. FACTORY FARMED MEAT

4. MILK

5. CHEMICAL MEDICATION

6. PROCESSED FOOD

7. ALCOHOL

8. STRESS

Visit us every monday and thursday between 9 and 16.00pm at the KwaNgcolosi Court House and you will be healthy with in weeks.

KwaNgcolosi is under Hillcrest/Waterfall by the Inanda Dam just 40Km from Durban.'

I wonder how many, mostly Black, South Africans will fall for this nonsense and die a preventable death from AIDS due to this quackery!

TB is coming our way again... -

An interesting article was published recently in a free online medical journal. Academics from Southern Africa and Canada discuss the question of whether or not it is necessary to quarantine tuberculosis sufferers in South Africa in order to stop the development and spread of a drug resistant variety of the bug. Part of the man-made problem of XDR-TB is that instead of staying in hospital voluntarily in order to receive proper care patients leave as quickly as they can, because otherwise their welfare benefits would be cut by government. This is a serious problem obviously. While proper care cures about 98% of TB sufferers in developed countries, this figure comes down to 50% in South Africa. One consequence is that ever more dangerous variations of TB develop. The reason is that people out of hospital are less compliant when it comes to taking their medication as they should. A paper worth reading.

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.

... there's something about African Heads of State

... well, some of em anyway. I'm sure you will remember the South African President's ruminations about HIV being not the cause of AIDS, and it all being a nasty conspiracy of white supremacists aimed at denigrating black men. Anyway, Thabo Mbeki has since been engaged in a bitter race towards the ultimate goal, namely the title of 'Nuttiest President on the African Continent'. His most recent efforts in that regard are not focused anylonger on AIDS, he has moved on to suggesting crime isn't that serious a problem in South Africa (population: about 40 million, annual number of murders: 18,000). Another serious contender for the covetted title was for awhile his that-time Deputy President Jacob Zuma. Zuma thought nothing of having unsafe sex with a woman he knew to be HIV infected. Incidentally that woman was not one of his wives (plural, odd, I know) and claimed to have been raped by Zuma. Zuma decided to take serious efforts at post exposure prophylaxis in form of ... guess what ... a shower. Yep, Zuma thought if he washed himself properly his chances of contracting HIV would be reduced. Truly challenging to determine whether Mbeki is ahead or whether Zuma is currently the frontrunner.

My apologies, I have to concede that I kind of digress. I really wanted to tell you about another serious African presidential contender for the title of 'Nuttiest President on the African Continent'. I'm talking about the Gambian President Yahya Jammeh. He claims (yep, proudly on the record) that he is capable of curing AIDS within three days. I understand he was offered a place in various local psychiatric hospitals but he declined, obviously worried that he might have to share a room some time down the road with Thabo Mbeki, or (scary thought) Manto Tshabalala-Msimang, Mbeki's Minister for Health Prevention.

Beware: AIDS microbicide makes you more vulnerable to HIV infection

An HIV prevention trial was halted in various Southern African countries and in India. The BBC reports that the investigators discovered that instead of reducing the risk of HIV infection the microbicide in question actually increased the risk. In other words, more participants (it being a microbicide, all women, of course) became infected in the active agent arm then in the placebo controlled arm of the trial.

There are several interesting questions with regard to this trial, none of which was flagged in the BBC news report:

1. The women who participated in the trial, by definition were HIV negative when they enrolled. They became infected (almost certainly due to unsafe sex) during the trial. The question is whether these infections constitute a trial related injury that ought to be subject to compensation. Many of them might well have had a therapeutic misconception, that is they might have thought that the stuff they got in the clinic gave them some (a lot - complete?) protection against HIV.
   
2. Indeed, one wonders whether these women will be provided with access to HAART when this could be clinically beneficial to them.
3. Sexy as the idea of an HIV microbicide is, none of the trials undertaken so far have led anywhere. As a non-expert I wonder whether this is a dead-end type concept that is never going to work. You might say, reasonably so, that only further research will tell. The trouble is that we will only find out when women become infected during a trial. That's arguably a pretty high price to pay, even if the women were volunteers and even if they gave truly informed first person consent.

Does Africa need cloned animals - or am I missing something?

Calestous Juma argues on the BBC website that Africans need cloned animals to generate their meat products. He claims that cloned animals would be more likely to survive in the harsh African climate. Juma is, and here I quote from the BBC's website, 'Calestous Juma is a professor of international development at Harvard University's Kennedy School of Government, and co-chairs a high-level expert panel of the African Union on modern biotechnology'. A lot of heavy-weight competence and business class airfares, that much is certain. Anyway, I shouldn't bitch too much - have been there, done that (well, the junket trips). Juma's argument strikes me as odd. He acknowledges that cloned animals tend to be more likely to suffer serious health problems (read: die faster, die younger), and that they also happen to be much more expensive than the average local cow that came about by her parents doing ... (well, you get the drift). Everyone knows these days that meat production is hugely inefficient in terms of how much energy we have to invest and how much we eventually get out of it. Many more Africans could be fed by means of local produce if no meat production took place on that continent at all.

Juma can think of another good reason why cloning is so important, namely because African nations could utilise such competence to eventually clone animals from species that are on the verge of extinction. No doubt that is just what Africans would do, at least those Africans that desperately need cloned cows so they can feed themselves. However, in all fairness, he's got a point when he stresses that joint research partnerships between developed and developing countries would increase biotech capacity on the African continent. That indeed is a very worthwhile thing, even if it is probably wasted on trying to clone cows for Sudan.

Please do note that I am not at all making a case for or against utilising sentient animals as a food product. The argument against is overwhelmingly strong, but my doubts about cloning for Africa are unrelated to that case.

Unethical HIV research

ACT UP Paris has been critical of currently ongoing clinical HIV trials in Uganda and Zimbabwe. Check out this link for further detailled information. The organisation is concerned about standards of care, informed consent issues and claims that patients in these trials are subjected to unnecessary risks.

madonna's children

So it's 'amtlich', Madonna is trying to adopt a boy in Malawi. Should she be allowed to do so? A whole bunch of professional do-gooders believe she shouldn't. Mostly children's charities operating in Malawi and the perhaps inescapable church groups. They're currently going to court in Malawai to prevent the adoption from going ahead.

This leads to various interesting questions, chief among them whether Madonna's course of action was the best she could have taken under the circumstances. This question is being asked by lots of commentators and the opinion of most is that Madonna is doing something wrong. Their main rationale is that she could help more orphans in Malawai if she sponsored instead schools or sponsored a much larger number of children thru a charity.

The critics clearly have a point here. However, that taking legal action in order to prevent the adoption from going ahead is the right response is doubtful. Imagine if it became a universal rule that unless you undertook a particular course of altruistic action some charity or other would sue you and demand that you do what it believes is the best thing (usually probably sponsor the charity and its staff...). In Madonna's case, it seems somewhat clear that everyone is better off (the child will have a fairly comfortable upbringing together with Madonna's other pampered off-spring; Madonna got the additional child that she wanted, the kid's biological father is supportive because he doesn't have to worry anylonger abbout the child's welfare).

So, while we're probably entitled to snigger at Madonna's action, clearly the actual outcome is desireable. There certainly is no reason to take legal action to prevent the adoption from going ahead.

A second question that puzzles me a bit is this: If the charities are really so concerned about children in need, is it acceptable to put a lot of stress on a little child in order to pursue a legal (and, let's face it, political) case against Madonna. After all, while the kid is getting used to seeing Madonna and her other half as his parents, there are these children's charities trying to bring this process to an end. How would the kid feel if they succeeded? Surely it's not better off returning to an impoverished African orphanage. The point I am trying to make is that the legal case is surely not in the child's best interest, quite to the contrary.

This, again, makes me wonder about the charities' motives.

I can't help thinking that this adoption is also a fairly powerfulstatement against racism...