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'

Thank you Paddy Ashdown!

At long last, someone is speaking sense in the 'international community'. While the slaughter in Zimbabwe continues unabated, and the delusional, syphilitic and somewhat deranged dictator running the show there declares that he can only be removed from office by God, Africans are once again paying the price for the useless leaders they elected to high office. The one country that could long have made a difference in Zim, South Africa, has been governed by Zanu-PF's (oops, the ANC's) Thabo Mbeki. Remember: Thabo-the-man hasn't seen anyone yet die on AIDS in the country that he has misgoverned for the last 8-10 years or so, and (while holding hands with Bob Madhat Gabrielle Mugabe) he declared that he doesn't think there's a major problem in Zimbabwe. So, the millions of illegal Zim refugees in South Africa are not really an indication that Bob Madhat Gabrielle Mugabe stuffed it up. Not at all, according to Thabo and his lover Robert Madhat Gabrielle Mugabe. That much is clear. Reassuringly the leadership void that is Thabo Mbeki has been filled by many African leaders who have condemned the rapidly escalating genocide in Zimbabwe.

Comes Paddy Ashdown. He suggests in today's TIMES that may be the time has come for a military intervention in Zimbabwe, to stop the thugs governing the country from destroying what's left of it, and to stop them from killing more brave Zimbabweans. Sadly, however, Zimbabwe has no oil to speak of, hence this almost certainly is not going to happen any time soon. All we've got is black-on-black violence, and as anyone knows, that doesn't really count. If there is no other reason than to preserve their lives, we can almost be certain that no truly international intervention will be forthcoming. To be fair, SADC or the AU could send their own troops, but they're probably equally unwilling to interfere with this Zim home-made problem.

Jackie Selebi - South Africa's Police Commissioner and friend of the local Mafia

Jackie Selebi, until recent South Africa's Police Commissioner and head of Interpol has been suspended from his day job in South Africa and forced to resign as head of Interpol. The reason for all this? Well, Selebi admitted some time ago to be best friends with a local crime boss (drug trafficer Glen Agliotti), but insisted that this didn't affect his work. At long last, and despite interference by the country's President, Mr Mbeki, the National Prosecuting Authority has decided that it will charge Selebi with corruption and defeating the ends of justice. Even Thabo Mbeki, South Africa's outgoing President, couldn't protect Selebi anylonger. Despite some skirmishing from Selebi's underlings (eg his police arrested a senior member of the team investigating Selebi under drummed up charges that were straight thrown out of court), his day in court is looming - at long last.
I got to be honest, I can't stand Mr Selebi, he's a pompous, clearly inept, deeply overweight civilian with a strong preference for colourful uniforms. I recall like it was yesterday when I sat with him on a panel and he and I started a discussion about corruption in South Africa. His main mode of reasoning was to explain it away by saying that it wouldn't happen if there were not rich white Europeans (Selebi is a racist kinda character who fits well into the new South African dispensation) offering money to corrupt South Africans. I could see that there was actually some truth in this, yet it seemed at the same time plain stupid to suggest that the person who takes the money and allows him or herself to be bought is kind of innocent. It's clear to me now that Selebi might well have had himself in mind when he tried to suggest that it is (as always) the whities fault. Not a big surprise then that his mafia friend turns out to be a white bloke. He very much knew what he was talking about, it seems.
What is remarkable is how long it took to remove this shady character. The same applies to someone less shady but equally incompetent, South Africa's Minister for Health Prevention, Manto Tshabalala-Msimang. All of these shenanigans can only be explained by the fact that the country is well and truly a one-party state and anything but a functioning democracy. Nobody really has the power to hold the South African government accountable for its failings, of which widespread corruption is just one.

HIV/AIDS: The ANC facilitated genocide seems to be swinging back into higher gear

Interested observers will know that South Africa is currently run by the ANC's President Thabo Mbeki (who informed interviewers repeatedly that he doesn't know a single person who died on AIDS in his country, and who expressed doubts that HIV is the cause of AIDS).

His Minister for Health Prevention is Manto Tshabalala-Msimang (who offered at one point in her illustrious career beetroot, the African potato and garlic as a means to prevent AIDS). They both continue to conspire against millions of HIV infected South Africans with a wide array of truly idiotic statements and every effort to slow down the roll-out of antiretroviral treatments as good as is feasible (ideally without getting caught).

Eventually they were forced by mostly court decisions to stop the HIV related genocide that they were quietly organising and presiding over. Still, things happen even to truly nasty people like the Pres and his sidekick Manto. Manto, who would fit nicely into Scotland, given her interest in booze, had to be taken out of action to get a new liver (as her old liver truly couldn't handle the amount of alcohol she's guzzling). While she quickly jumped the queue to get a new liver (makes sense, who else would assist so kindly in executing Thabo Mbeki's genocidal activities), her Deputy Minister Nozizwe Madlala-Routledge took over. She is an old hack of the South African communist party and so a member of a party belonging to the triparty alliance making up the government of the country. Being not an ANC cadre she didn't have to insists that the earth is flat, pigs can fly and AIDS is a conspiracy against Black people organised by the CIA and the international pharmaceutical industry bent on selling poisonous AIDS drugs to South African Blacks. There was no need for her to peddle 'African solutions' such as beetroot, African potatos etc etc (as Manto suggested in between a couple of drinks during one of her conference appearances).

Well, Madlala-Routledge worked tirelessly toward getting AIDS ttreatment programs off the ground while Tshabalala-Msimang jumped the liver transplantation queue. It was only a matter of time until she would be cancelled by Thabo and his sidekick, and today she was. The pretext was that she went to (would you believe) an AIDS conference in Spain even though Thabo the Pres explicitly refused her travel. Stupidly Madlala-Routledge seems to have dragged her son and various hangers-on along so this had all the make-up of a junket trip. A good pretext to fire her. Here's a statement on her dismissal from the South African HIV/AIDS Clinicians' Society that I received a few minutes ago. I would normally encourage you to write to the SA High Commission or Embassy in your country and ask that you criticise her dismissal, but what's the point, thhe High Commissioners and ambassadors would report back to Thabo the Pres who is the bloke who fired her in the first place... welcome to the ANC owned rainbow nation in action.

'Statement by the Southern African HIV Clinicians Society (9th August 2007)

We are an organisation of over 12 000 health professionals working in HIV care in the Southern Africa region. http://www.sahivsoc.org/ We support the Rural Doctors Association of Southern Africa (RuDaSA) statement issued on 9th August 2007, National Women’s Day. We believe that Deputy Minister Nozizwe Madlala-Routledge has played a fundamental role in bringing civil society and professionals together to support the government’s National Strategic Plan (NSP) for HIV/AIDS, on an unprecedented level. She demonstrated compassion and commitment to South Africa’s population, with a respect for science and public health that made us realise what we should demand from all public servants. The manner of her dismissal (on Women’s Day), when so much positive work has been done in the area of HIV, to provide political and public leadership for the first time, is deeply distressing. Furthermore, it comes when we are seeing alarming signs of a return to the rhetoric and confrontation of the past over HIV. The Society has asked for urgent clarification, as have others, as to why the mother-to-child HIV prevention programme (PMTCT) has not been expanded beyond 30% coverage after 5 years, and why more effective regimens have not been implemented. Yet again, court action is being threatened as the last resort to force action on this issue. Fewer than 20% of adults requiring antiretrovirals are receiving them, after more than 3 years of publicly available ART. Minister Manto Tshabalala-Msimang, since her return from sick leave, has not addressed these worrying problems. Instead she has focused on the (unsubstantiated) high price of future antiretrovirals, claims of good geographical ‘coverage’ for PMTCT and ART access, and continued references to South Africa having the ‘largest and most comprehensive response’, without critical appraisal of those who do not access HIV care. For HIV infected people, their families, and their caregivers, this looks like more of the same – the Minister demonstrating antagonism to the one thing that can save their lives – antiretroviral therapy. It is deeply ironic that price is cited by the Minister as an issue in access to antiretrovirals, when it has taken the bravery of activist groups and professionals, rather than her own department, to fight for current affordable HIV care. Finally, we remain deeply concerned that the targets set for the NSP for 2007 look increasingly unrealisable. Since their publication, no plan has been forthcoming on how to attain the ambitious targets set in the Plan. Our country desperately needs trusted and brave leadership in the area of HIV. The deputy minister gave us hope that this was possible. We wish her well, and thank her for giving us hope and leadership. We recommit ourselves to ensuring that government, the elected steward of our health system, is held accountable for decisions regarding health care for HIV-infected people. On behalf of the Executive, SAHCS.'

Thabo Mbeki - South Africa's flat-earther in chief on HIV and AIDS

Here's a link to a most interesting on-line article on the history of the current South African President, Thabo Mbeki's denial that HIV causes AIDS. Really worth the read! There's also some reasonably entertaining bickering about his autobiographer Ronald Suresh Roberts, a sycophant if there ever was one.