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.

And the weekend good news: Manto Tshabalala-Msimang is dead

I like the hypocrisy of people insisting that we must never speak bad of the dead. Why not? If the dead were bad people, what's wrong with wishing them good riddance. A case in point is Manto Tshabalala-Msimang (better known as Dr Beetroot), the former South African health minister. Her policies and that of her boss Thabo ('I don't know anybody who died on AIDS in South Africa.') Mbeki led to about 300,000 preventable deaths among infected people. Beetroot insisted that it ain't clear that HIV causes AIDS, and claimed that anti-retrovirals for Africans were an evil scheme by the CIA and the pharmaceutical industry to poison Africans. Those suffering from, and dying on AIDS she offered, well, you guessed it, beetroot, lemon juice and garlic. Moron that she was she thought nothing of it to jump the waiting list for organ transplantations in order to grab a liver when her old failed as a result of her marriage to alcohol. Excuses were found for why this woman, in her 60s at the time, was deserving of the liver (ie public sector clinicians, working for her, colluded in lies about her legitimate rank on the waiting list). During the time it became public knowledge that as a hospital doctor in Botswana she was convicted of stealing patients' property while they were in surgery. It didn't occur to the ANC and its senior officials to fire Dr Beetroot. Well, I was elated when I found out that the transplant liver crapped up on her, and the system refused to offer her yet another one. Good riddance Dr Beetroot. Thabo, we're waiting for you to join her. After all, you also like your booze and there's some 300,000 people who are dead today because of you. Why don't you also call it a day?

On a slightly more analytical (as opposed to purely angry) level (even though my anger about these two South African politicians' murderous policies knows few boundaries, I have admit): What is of interest is that there's a pattern of colonial mentalities in play in South Africa as well as in Uganda. In South Africa, black nationalist politicians happily ganged up with Western crank scientists against their own people, because they were suspicious of mainstream Western science and knowledge. White Westerners taught them stuff that translated into genocidal policies costing about 300,000 predominantly black people's lives in that country alone. The attempted political emancipation drove these black nationalists straight into the hands of crackpots, that's how substantial their concern was that hooking their people onto life saving medicines was just another ruse by the West to poison and keep Africans down and dependent on the West. Incomprehensible. As good nationalists are wont to do, they insisted on 'local solutions', hence beetroot, garlic and lemon juice. African scientists and medical doctors standing up to them were fired and bullied sufficiently that Stalin could have taken a page from that book (Beetroot managed this without actually killing the scientists, she simple removed them from jobs and funding).

Uganda is another example. It has become clear by now, that draconian anti-gay legislation, threatening gays with the death penalty, was inspired by US evangelicals, white US evangelicals. How ironic that Africans, busily trying to assert themselves against 'evil Western values', are being goaded by other Westerners (crazy ones) to implement seriously civil rights violating policies against their own people ... bizarre stuff. The only good news is that they're being opposed frequently by younger generations of Africans who won't stand for that sort of crap.

Anyhow, Manto is gone, let's go and drink to her demise :).

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