"They have already come for the Libyan medics"

"First they came for the Socialists, and I didn't speak up, because I wasn't a Socialist... Then they came for the Jews, and I didn't speak up, because I wasn't a Jew. Then they came for me, and there was no one left to speak up for me." (Martin Niemoller)

The trial of the Tripoli Six is set to conclude on Tuesday, October 31, but already extraordinary events are taking place in the world of high status science.

Yesterday we posted on the letter of protest published in Science from 45 top scientists. The journals Science and Nature are arguably the two most prestigious scientific publications in the world, but it is Nature that has been pushing the envelope in the case of five Bulgarian nurses and one Palestinian doctor on trial for their lives in a Libyan court. Today they published a lead news story about the key scientific evidence in the prosecution's case against the health workers, accused of deliberately infecting Libyan children with HIV. A Nature senior correspondent, Declan Butler, obtained an English translation of the report and sent it to some of the world's top HIV/AIDS and health scientists.

The response was scathing:

"I don't see any evidence in it," says Janine Jagger, an epidemiologist and MacArthur fellow who heads the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. "It wouldn't meet the lowest standards of epidemiological evidence for establishing any causal relationship."

In 2003, the court also ordered a report from Luc Montagnier, who discovered the AIDS virus and is president of the World Foundation for AIDS Research and Prevention, and Vittorio Colizzi, an AIDS researcher at Rome's Tor Vergata University. They concluded that the infections were caused by poor hospital hygiene, and started before the medics arrived in Libya (see "Montagnier and Colizzi's conclusions"). But the court threw out this report, on the grounds that the Libyan panel had reached the opposite conclusion. The panel had dismissed the external report as "hypothetical" and "lacking precision".

[snip]

The Libyan report also suggests that because the genetic sequence of the Benghazi HIV strain is different from any lodged in public databases, there are grounds for suspecting foul play. "That's tosh," says Weiss. Montagnier agrees, pointing out that the virus was a new natural recombinant of a highly infectious strain common in Central and West Africa, which has replaced most other strains in the region over the past few years.

In contrast, Weiss describes Montagnier andColizzi's report as excellent. "Colizzi has done a really superb job in difficult circumstances," he says. After studying both reports, Weiss concludes: "There are no grounds for suspicion of deliberate infection by any staff, and strong evidence of hospital-acquired infection before the arrival, and after the departure, of the Palestinian physician and the Bulgarian nurses."

Jagger, an expert in occupational exposures to blood-borne pathogens, says she is astonished that the medics were even arrested, given the flimsiness of the prosecution's scientific evidence. In this sort of case, she says the minimum standard should be a thorough field study that tracks all medical procedures carried out during the outbreak, and calculates attack rates, epidemic curves and other standard epidemiology measures for inferring cause. She describes the Libyan data as "completely inadequate".

[snip]

Luc Perrin, a clinical virologist at Geneva University Hospital in Switzerland, who has treated many of the infected children, describes the Libyan report as "a lot of generalities that are not always correct". The report also fails to provide any evidence for its assertion that HIV infection has not been seen in children at other Libyan hospitals, he says.

Perrin is an expert on primary HIV infection. He has analysed samples from 148 of the infected children, collected in September 1998, and has obtained further data on 37 of them and 46 of their parents, when they were treated in Switzerland. Perrin says his genetic data support Colizzi's analysis, and that many of the 1998 samples have protein profiles corresponding to infections well over a year old: "I can tell for sure that the HIV infection cases occurred before September 1997 and the first cases most likely before 1996." The accused medics first arrived in Libya in March 1998.(A shocking lack of evidence, Nature)

I have also seen the report and can verify it is not the kind of evidence that would pass peer review even in a low tier scientific journal, much less one that could meet the high standard of being the basis for six death sentences.

This long running case is not the only human rights abuse in the world but it has also become a symbol for the struggle for freeing science from the yoke of politicians and despots. Nature said it best in their strongly worded Editorial earlier this month:

"First they came for the Socialists, and I didn't speak up, because I wasn't a Socialist... Then they came for the Jews, and I didn't speak up, because I wasn't a Jew. Then they came for me, and there was no one left to speak up for me." Martin Niemöller's poem, criticizing the inaction of German intellectuals in the face of the rise of the Nazis, serves as a powerful analogy for why scientists should be concerned by abuses of academic freedom, wherever they occur.
Most readers of Nature take it for granted that they can travel to work each day, free to enquire, express opinions and criticize government policy, without fear of intimidation or reprisals -- let alone imprisonment or torture. Sadly, these freedoms can only be dreamt of in many countries of the world, where academics must live with, and often suffer directly, human-rights abuses. Their plight is our business.

But beyond humanitarian grounds, in this interconnected world we are engaged in a battle of ideas, and the failure to defend any abuse of academic freedom undermines the very principles that guarantee the rights we currently enjoy. Oppressive regimes typically stifle enquiry, as critical minds will inevitably also scrutinize their leaders. Enquiry is further undermined in such environments by the award of senior academic posts to the politically loyal rather than the competent, and the selection of policies or actions that suit governments' agendas, regardless of the scientific evidence.

[snip]

Tripoli may seem far away, but knowledge and academic freedom are central planks in many other struggles across the world for more open, democratic societies. Academics and universities are often hotbeds of such reform movements, and every year hundreds of academics worldwide consequently face threats, or worse. It is important that we do not forget them.

They have already come for the Libyan medics; it is time to "Speak up" . . . (Nature)

We are seeing here the expression of a social conscience coupled with an institutional commitment at the highest levels of the international scientific community. This isn't just about this tragic case.

It is bigger than that. Much bigger.