There's been quite a bit of blogging lately about HIV denialism, so I thought I would take this opportunity to write a little bit about HIV denialism in South Africa--a subject that gets mentioned pretty often is rarely discussed in much detail. I spoke about this topic in my talk on Wednesday, though, because it serves as a nice lesson in the importance of not looking at certain problems too simplistically. The following--an excerpt--is a basic introduction to Thabo Mbeki's HIV denialism based on what I've learned traveling in South Africa and talking to a variety of people who study the topic.
There are certain scientific subjects that, for one reason or another, inspire a disproportionately large degree of quackery. One of these is vaccination, where a now discredited link between autism and certain preservatives used in vaccine preparations has inspired a large and vociferous group of anti-vaccination advocates. Another is AIDS, where there also exists an outspoken outlier community of people who deny that HIV (the human immunodeficiency virus) causes the disease we call AIDS--despite the fact that the link between the two has been demonstrated beyond any reasonable scientific doubt.
South Africa, like many sub-Saharan African nations, suffers from a deadly AIDS epidemic, with about 11% of the nation's entire (adult and child) population estimated to be carrying HIV, and the infection rate among just adults being almost twice that. Thus, warning flags went up throughout the scientific community when in the year 2000, after having only recently assumed the presidency of this fledgling post-apartheid democracy, Thabo Mbeki invited several crackpot scientists who denied the link between HIV and AIDS to join his AIDS advisory panel.
Today, although AIDS cannot be cured, it has become increasingly treatable, through a variety of antiretroviral drugs developed through well-funded HIV research. However, by denying the link between HIV and AIDS, and not taking a proactive stance in distributing these life-saving antiretroviral drugs, Mbeki's HIV denialism was not just misguided. It was deadly.
About three million people die as a result of AIDS each year, and roughly 1/3 of these deaths are in sub-Saharan Africa. Many of these deaths could be prevented with the proper regimen of antiviral drugs. Although the South African Congress has in recent years overridden the President in rolling out its own plan for the distribution of antiretroviral drugs, many problems remain. There are over 500,000 individuals in South Africa currently suffering from AIDS, who are in need of, but are not receiving, antiretroviral treatment. This is just a subset of the estimated 5 million South Africans who currently carry HIV, the majority of whom have not yet developed AIDS, but will one day.
The current Health Minister, Manto Tshabalala-Msimang, continues to hold on to her position, which she assumed in 1999, despite being an HIV denialist herself. In 2006, the government of South Africa suffered an enormous embarrassment at her hands, when her booth at the International AIDS conference in Toronto featured the use of vegetables such as beetroot and garlic as AIDS treatments. After the conference, a group of 65 HIV and AIDS experts signed a statement calling for her dismissal, citing the scientific consensus that HIV causes AIDS. Then, in August of this year, the Deputy Health Minister, Nozizwe Madlala-Routledge--who had been one of the most outspoken advocates for antiretroviral treatment in the Mbeki government--was fired under dubious pretenses. And so, the saga continues.
On the surface the South African AIDS crisis has all of the makings of a problem with bad science--with some infrastructure and drug delivery issues thrown in there for good measure: president Mbeki has fallen victim to pseudoscience, and surely if Mbeki and the South African government were provided with all of the scientifically accurate information on HIV and AIDS, they would recognize the scientific consensus and change their policies accordingly.
That's the view, at least, that it's easy to take as a Westerner--particularly a Western scientist. However, it's not nearly that simple.
The current HIV denialism crisis in South Africa is in fact firmly rooted in the nation's dark apartheid past, and without understanding this past (the struggle for racial equality, the tumultuous transition to black rule, and the distinct sociological conditions that emerged from all of this) we'll never come closer to understanding--and treating--the root causes of this problem and delivering antiretroviral drugs to those who need them.
The 1980s were a time of deep social unrest in South Africa, as civil disobedience became a way of life and the oppressive white apartheid government began to collapse. It wasn't until 1994, though, when Nelson Mandela became the first president of the new free South Africa, that order began to be restored. During that time, though, not only had AIDS first been identified (in 1981), but HIV had been identified as the cause of AIDS (1983), and even the first antiretroviral drugs had been made available (1987).
However, in 1994, the growing magnitude of the AIDS pandemic in South Africa was only just beginning to become apparent. Over the next five years of the Mandela presidency, although AIDS was a concern in South Africa, the nation still had much bigger problems to face, including poverty, malnutrition, and lack of education. And, of course, there was the issue of building a whole new nation and trying to overcome the legacy of apartheid--no easy task, for sure.
By the time Thabo Mbeki became president in 1999, AIDS in South Africa could no longer be ignored. For example, by this point, the HIV prevalence rate among pregnant women was already a shocking 22%. Unfortunately, it was also around this time that Mbeki first started displaying his HIV denialism. Considering that mother to child transmission during birth is highly preventable with antiretroviral drugs, this was a very dangerous position for Mbeki to take.
Mbeki rationalized this by charging that the focus in fighting AIDS should be on eliminating poverty. In his mind, AIDS was a disease of poverty, and no gains would be made in treating AIDS until this root cause was addressed. To an extent, he was correct, in that poverty in South Africa has exacerbated the AIDS epidemic. With that said, though, HIV and AIDS have become increasingly treatable, and denying the link between HIV and AIDS is doing no one a favor.
Mbeki also saw the discussion of HIV and its prevalence in the black community as a fundamental attack on blackness. By this point, the AIDS epidemic in sub-Saharan Africa had become most severe primarily in black populations, so much of the dialogue regarding AIDS focused on black Africans. Based on the nation's history of racism, it's understandable why he would have reacted so negatively to this focus on black Africans.
The important point, though, is that it was this aspect--his reaction to what he saw as racism in the international dialogue on HIV and AIDS--that led to Mbeki's HIV denialism. He wasn't taken in by quack scientists, but instead he sought out scientists who would provide external justification for his own views on the subject--no matter how misguided they were.
Only with such a deeper understanding of this problem can we move forward and hopefully address South Africa's AIDS crisis on the medical, political, and sociological fronts. In the meantime, the AIDS crisis in South Africa remains a problem, and it is likely going to take many talented individuals and organizations, exploring the complexities of the issue, to make significant headway and turn this nation's AIDS policy around.
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True, but it also works the other way around: growing out of poverty is going to be very difficult when a large share of the age groups that should be contributing to that growth is being "culled" by AIDS.
Is it possible to get Mbeki and other denialists to see the issue from that angle instead?
This is one of the many reasons why Mbeki needs to go. Things in South Africa will only get better once there is a new president. And with any luck it'll be Tokyo Sexwale, and not Jacob 'I had a shower to make sure I didn't get AIDS' Zuma.
That's how almost all of the deniers come about their views. I'd like to direct your attention to a dialogue between myself and a poor woman who first presented with anti-liberal politics. It seems that a personal tragedy led her to look for the kind of answers she wanted, and she followed that into mistrust of all scientists, and from there into mistrust of everyone who thinks, "It could be better."
So what does one call blindly and unobjectively denying denialism?
In any reasoned and objective article on this subject I'd expect to see....
* Mention of the (very very low) HIV transmission rate between otherwise healthy/ well fed persons.
* Mention how that goes way way up if the people involved are malnutrited, or have other infections (especially STD's) and/or other stresses.
ie. Mbeki is entirely right in the aspect he has most often repeated. AIDS is a disease of poverty. Remove poverty and the epidemic recedes to first world levels.
Western blind and repeated denying/ignoring of the facts of differential HIV transmission rates amounts to unscientific denialism denialism!
Do better.
I suspected that the reason Mbeki surrounded himself with denialists had some rooted reason. But I rather expected a political concern, such as that antiretrovirals are costly, so looking into "alternatives" would free capital elsewhere while being politically expedient.
That it was really racism that was the root cause makes more sense, but I'm also disappointed by the less reasonable choice. [I guess I rather see political and economical crassness than outright stupidity.]
Not that strawman again! IIRC African AIDS transmission is centered around the very very high HIV transmission rate between mother and fetus. (Which btw AFAIK isn't known to be affected by health.) ScienceBlogs Tara Smith has posts on this.
But with that percentage of population infected it really doesn't matter if the transmission rate is low or high. Prevention is paramount, and condoms are cheaper than antiretrovirals.
Sorry, I missed this. An epidemic doesn't revert itself automatically. Especially with HIV, where no treatment means continued transmission until the individuals die. (Which is why I discussed prevention.)
Also, first world levels depend on general prevention, detection + directed prevention, and antiretrovirals (lowers mother-fetus transmission, suppresses symptoms and extends life). All measures of which Mbeki seems to resist.
I lived in the RSA for a year, so your post (actually, Tara's link to it) caught my eye.
You are quite right in suggesting that part of Mbeki's denialism stems from the country's turbulent past. Mbeki is an intelligent man -- he was considered too "bookish" to be an effective president -- but misguided. There is an underlying suspicion in sub-Saharan Africa that AIDS/HIV is a white ploy to decimate the black population. The perception that white-dominated pharmas are "pushing" their drugs as treatments only underscores the suspicion that whites are still trying to control or subjugate blacks. Thus, the emphasis on local, herbal-based remedies.
(There is a parallel anti-pharma belief system in the US: "alternative therapies" and food stuffs targeted to people who believe that green tea and pomegranate juice are broad-spectrum disease preventives.)
Whether Thabo actually believes this drivel is debateable, but it seems he has painted himself into a corner politically. He seems too proud a man to admit that he was wrong, or perhaps unwilling to appear to be too sympathetic to the whites' arguments. That many non-white members of his own government and the RSA Congress reject his denialist stance seems to make no difference to him.
Mbeki may end up being remembered as the African president who allowed a large percentage of his country's population to die, not through state-supported violence but through state inaction. A passive-aggressive Idi Amin, as it were.
I'm not sure what this reference to the south african congress is?? no you mean the African National Congress or do you mean something else?
One other thing- why is it that when some people deny reality they are crucified on here(I'm think mainly of Christians, and people who deny global warming), but when others deny reality they aren't met with the same wrath.
Mbeki is trying to pull the wool over the eyes of the largely uneducated South African population.
He would never had been made president if he's wasn't the son of Govan, and he has propagated this lie because he was an unpopular president trying to hang on to power. I remember when he got elected, many people believed that he wouldn't last 6 months before somebody within the ANC removed him from power (whether violently or otherwise).
sorry if my rant is not totally coherent, but the biggest mistake Madiba ever made was making Mbeki president. The people of South Africa (and indirectly Zimbabwe, but that is another issue) has suffered untold hardship because of his presidency.
Not the ANC. Sorry. I meant the SA parliament.
And I agree with you. Mbeki has set the country on a course of stagnation. I hope his successor does better.
What a perfectly ignorant and Western-centric little post. Maybe look at the history critically rather than rehashing simplistic propaganda. Perhaps you might then find that we in the West share responsibility for triggering the disastrous present situation in South Africa. Think back to 1997, when the South African government acted on behalf of its people, introducing an act of law to allow for the production of affordable anti-retrovirals. Did the West support this move? No. Quite the contrary. Nearly every Western drug-making corporation sued. That's right...sued an impoverished country. Western governments backed the move. Western profits were more important than African lives, apparently. The suit was eventually dropped, but the S.A. government was forced to back away from allowing the manufacturing of affordable drugs.
Know this history, now imagine yourself in the same situation. Western corporations holding your citizens for ransom, using Western science to leverage their monopolies and squeeze every dollar out of your poor, disease-ridden country. Would you maybe, I don't know, want to critically analyze this science yourself in the same situation? Hear all the arguments for and against and make up your mind? This is what Mbeki has tried to do, and every time he so much as listens to an argument against HIV-AIDS or considers alternatives to patented drugs, the Western media jumps all over him with the "denialist" label. Whose interest is this biased and unfair criticism serving? Hmmmm...big pharma??
This is where the "denialist" slander and propaganda is coming from; you'd do dying South Africans a service to do some research and think critically before helping to spread it.
so because I criticize the president that has not delivered on any of his promises and continues to drag our country under, that makes me ignorant and western-centric?
Lincoln,
My comments were directed at Nick's original post. It is commendable to criticize your government when you feel they have gone astray.
I hope I was clear in my comment - who I take issue with are the Western "activists" who jump to place blame on the SA government without first questioning the actions of our own Western institutions.
As it is right for you in South Africa to hold your government accountable for its actions (or inactions) on the HIV epidemic, so too must we in the West critically examine the role our own corporations and governments have played and force them to act responsibly.
In the end, I believe all parties involved (Western governments, scientists, drug makers, and the South African government) truly want to see an end to the South African HIV epidemic - no one is happy to watch people die. Indeed, these parties must in the end co-operate if success is to be achieved. However progress will only be possible when each group involved takes responsibility for its own actions rather than pointing the finger at the others.
Nick, you have done a wonderful job of parrot-ting what you have been told to believe about HIV and AIDS and Mbeki's situation, but have you ever stepped out of your own personal programming on the subject, and stepped out of any bias on the issue that you might have, long enough to actually look at and consider some of the evidence provided by the growing dissident community?
You may think yourself to be an unbiased individual with a healthy sense of scepticism, and perhaps you are in many areas. However, your post betrays the simple evidence that you have not, indeed, looked at any of what had been presented to Mbeki and Manto.
Neither of these individuals are in any way ignorant or unworldly. Both are exceedingly intelligent. Mbeki is an Oxford educated Economist, the same AS YOU, and is surely intelligent enough to understand anything he puts his mind to. He is also the ONLY head of state to have personally investigated both sides of the issue. Manto also is the ONLY state director of health to have unbiasedly researched the issue.
The fact that they both experienced apartheid simply enhances their ability to recognise when pure bias when they see it. These people are nobody's fool, and it is damn pristine elitist white of you to delude yourself into thinking that they are.
When Mbeki had his conference, and invited both sides to the table to present their evidence, he was witness to the one and only forum ever held in this entire world, to have looked in depth at both sides of the HIV causality issue. When the conference had begun, Manto was indeed rabidly sceptical of the dissident camp and was firmly against the dissidents. She was an avowed believer that HIV was absolutely and unquestionably the cause of AIDS and that the only solution was medication. However, both Mbeki and Manto attended all of the meetings and looked at all of the evidence. For two weeks both night and day, Manto studied both sides evidence. Two weeks after the conference began, Manto was dancing the Pata Pata with the dissidents.
Have YOU Nick, bothered to spend even two hours informing yourself? Have you read a single one of the dissident books, in order to inform yourself of what it was that Manto had discovered that had even managed to convince her completely predisposed beliefs?
No Nick, you have not done so. You have not read Dr. Peter Duesbergs reports or 1995 book "Inventing the AIDS Virus", nor Dr. Harvey Bialy's 2004 book "Oncogenes, Aneuploidy, and AIDS", nor Rebecca Culshaws 2006 book "Science Sold Out", nor Henry Bauers very recent 2007 book "The Origin, Persistance, and Failings of HIV/AIDS".
What kind of reporter looks only at one side of an issue before reporting?
Nick, you are studying to become a scientist?
What kind of scientist simply follows consensus when determing what part of the evidence he will look at and how he should interpret it?
Perhaps this would be a good time to consider the meaning of the word "mediocre" and "mediocrity", and recognize just how much the world is drowning in such already.
I think, Nick, that in order to rise above the flood of mediocrity that burdens the worlds of both science and journalism, one would do well to consider deeply what Einstein meant when he said "A problem cannot be solved on the same level of thinking that created it".
Which would you prefer to be, Nick, would you be a brave and wary shepherd or an unthinking sheep blindly following the rest of the flock, and on his own way to being fleeced?
Nick, kindly remember that the world was caught up in an irrational panic and mass hysteria and many remnants of such are still reverberating through the global society. Such panic and hysteria can keep even the brightest individuals from thinking rationally.
By the way, you have several statements in your post that plead for correction. For instance:
You said: During that time, though, not only had AIDS first been identified (in 1981), but HIV had been identified as the cause of AIDS (1983), and even the first antiretroviral drugs had been made available (1987).
Three bads in one brief sentence, Nick:
1) AIDS was called GRID in 1981, after five gay men, who by the way had no sexual partners in common, were found to be ill by a Los Angeles doctor. They did, however, share the commonality of heavy drug abuse and other factors such as run down bodies due to heavy partying, many shots of antibiotics, poor diet, and highly stressed lives.
2)HIV had NOT been identified as the cause of AIDS in 1983, in fact, it had been identified only as the "PROBABLE" cause of AIDS in March of 1984. Gallo had found evidence of RT activity that he assumed was retroviral activity due to HTLV-III in ONLY 36% of 72 sick gay men with what was called AIDS. 36% is NOT enough to call it the definite cause of AIDS.
3) AZT was never designed as an "antiretroviral". It was a failed cancer chemotherapy from the 1960's. The reason it was "failed" was because of excessive deadly toxicity to animals exposed to it.
High dosage AZT monotherapy was the only drug in use from 87 to 95, the years of highest death. It was given to ALL who tested HIV positive. Those taking this drug lived an average of 8 months to 1-1/2 years.
Please remember that it was the "dissident", or as you prefer to call them, the "denialist" community who vocally opposed the use of this drug all the way back in the late 1980's. It took the rest of the world and the rest of science and medicine 7 more years to wake up to the fact that doctors and government and pharma were the leading cause of AIDS death due to the use of this drug.
In 1995, AZT was coupled in a lesser dosage with other drugs such as protease inhibitors. Seems the lesser dosage helped a lot, but these drugs also devastated most who took them, with liver failure and disfigurement from lipodystrophy, and painful neuropathy.
Certainly any drug compared to the deadly AZT high dosage monotherapy that was used from 87 to 95, would look like a wonder drug in comparison. Is this not simply a highly misleading comparison by those controlling health policy, in not wishing to look at, or own up to, the devastation caused by the AZT they had championed for eight years?
The leading cause of death in HIV positives, since 1995, was shown by researcher Amy Justice, who examined 5700 HIV positive American deaths, to be liver failure, directly in correlation to who was taking the newer therapies.
Are the newer therapies really so life extending, or do they simply kill more slowly? Would you be willing to admit to the truth of the matter if you ran the NIH NIAIDS program or ran the FDA? After all, the matter only affects 97% gays or blacks or drug addicts!
Is society yet still irrational with fear and hysteria over AIDS?
I would have to say that yes, society is still quite irrational on the subject.
Are they as yet able to think rationally or own up to earlier mistakes and failures?
I would say, no indeed, society is not yet able to be rational, and most assuredly, those such as now an old man in his 70's, Dr. Robert Gallo, who only ever showed 36% probability of what was believed to be RT due to HIV, and therefore only a 36% probability or less of HIV as being the cause of AIDS, and whose evidence of actual viral isolation of the cause of AIDS is highly contentious for all who have investigated, and who has NEVER presented us with the mechanism of such a virus causing such a health syndrome, surely would not be willing to consider that he may well have been completely wrong. Same as well with Tony Fauci, who is yet director to the NIH NIAIDS program for 30 years now, and who also just yesterday won the prestigious Lasker award for his stewardship of the Good Ship HIV/AIDS, surely is NOT willing to own up to any errors at this point.
After all, Fauci is now 66 years old, and simply wishes to retire as a hero, not as the abject failure that he surely is, if the dissidents points hold any water whatsoever.
They have presented evidence upon evidence of devastation caused by AZT, highly questionable studies thathave yet to properly show causation of AIDS as due to HIV and not due to the other obvious cofactors that are ALWAYS present in those who suffer actual illness in the syndrome of AIDS, the proven toxicity of the newer and still poorly studied yet fast tracked AIDS drugs since 1995, the lack of any vaccination, the unanswered questions of the mechanism by which HIV could possibly cause AIDS, the lack of correlation of CD4 counts and viral load counts to actual AIDS illnesses, the notorious unreliability of HIV tests, zero cured and zero saved, even after more than 100 billion US dollars and 25 years of investigation by hundreds, if not thousands of mediocre, yet taxpayer paid scientists.
But Nick, please do not take my word for any of this. Kindly investigate these issues for own self, that is, if you have a strong enough stomach to properly do so.
wheatdogg said:
> And I agree with you. Mbeki has set the country on a course of stagnation.
> I hope his successor does better.
Stagnation? With real terms economic growth of ~4.5%, and clear evidence of broad based economic development, I wouldn't call the country stagnant. Sure, South Africa has many social problems (HIV being just one), but criticism must be aimed where it is due, perhaps at the slow pace of growth in service delivery to rural communities.
>IIRC African AIDS transmission is centered around the very very high HIV
>transmission rate between mother and fetus. (Which btw AFAIK isn't known
>to be affected by health.) ScienceBlogs Tara Smith has posts on this.
Mother to child transmission is part of the picture, but can't be used to explain the high prevalence of HIV infection in people over the age of 25, can it? Clearly, a more direct transmission mechanism exists, one that can be partially addressed by better education (and, possibly, nutrition) - though that doesn't do those who are already infected much good.
Well, I see that Mr. Anthis is attracting whackjobs like Mr. Michael who usually hang out over at Tara Smiths' blog. Welcome to the AIDS/HIV deniers land of make believe. I suspect that as Mr. Anthis comments on this issue, he will find the threads hijacked by these folks, as similar threads over at Prof. Smiths' blog are hijacked by them.
SLC,
There are "whackjobs" on both sides of the debate. Why not do something constructive and address viewpoints with which you disagree with rational criticism and counter-arguments rather than useless name-calling?
Michael's arguments appear rational and fairly well-argued to me. Actually you're the first one to comment who comes across as an obvious "whackjob". Not doing your point of view very much credit.
Re bayman
"Michael's arguments appear rational and fairly well-argued to me. Actually you're the first one to comment who comes across as an obvious "whackjob". Not doing your point of view very much credit."
Mr. Michael has merely cut and pasted arguments from HIV/AIDS denialist web sites which sound good to the initiated but have no more validity then material from evolution denialist web sites. I have had some experience in discussions with young earth creationists and believe me, they also make arguments that sound rational and well argued but are, of course completely bogus. The tipoff is when the HIV/AIDS denialists start quoting Prof. Peter Deusberg or the evolution denialists start quoting Prof. Michael Behe. Both of these gentleman have been completely discredited in their respective scientific communities, just as Linus Paulings' claims about vitamin C discredited him, William Shockleys' claims assertions about black American inferiority discredited him and Brian Josephsons' claims about cold fusion, ESP, and PK have discredited him. I would point out that the latter 3 gentleman are all Nobel Prize winners, proving that even first rate scientists can go off the deep end.
SLC,
Ok so you think Michael's wrong. Because you think Duesberg's wrong. So let's hear why. Give us the arguments and the evidence. Or do you not know the arguments? Duesberg "has been discredited"? How? How have his arguments been defeated? Or are you just repeating what someone else told you? Someone you think is important said Duesberg is wrong so he just is? If you can't explain why, you're not adding to the discussion, in fact you're making your side of the debate appear weaker than it really is.
And listing a bunch of other scientists who have held non-mainstream or even quirky viewpoints has absolutely no bearing on this issue and certainly doesn't help your case either.
Re bayman
Prof. Duesbergs' claims and assertions have been discredited by the overwhelming majority of the scientific community. If Mr. bayman wants further information, I would refer him to Prof. Tara Smiths' web site or the denialist web site. I see no need to cut and paste arguments from those web site like Mr. michael has cut and pasted arguments from the HIV/AIDS denialist web sites. Quite frankly, I very much doubt that Mr. bayman has any more interest in the facts about HIV/AIDS then the young earth creationist I argued with over at Jason Rosenhouses' web site had in evidence for the age of the earth.
However, I would like Mr. bayman to explain why Prof Deusberg has refused to take an injection of blood infected with HIV, if he really believed his assertion that HIV is a harmless retrovirus. He once proclaimed that he would do so but since has proffered excuse after excuse to avoid the challenge he himself raised. It would appear the Prof. Deusberg has some chicken feathers where his competitive spirt should be. Or, as the old saw goes, actions speak louder then words.
Re bayman
Just to get Mr. bayman started, here is a link to an article co-authored by Prof. Smith and Prof. Novella in which the subject of HIV/AIDS denialism is discussed. Included are a number of references to articles in peer reviewed journals about the subject.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10…
If you have the menatl fortitude you can wade through this discussion Introduction to HIV and HIV denial
When AIDS/GRID turned up in people with haemophilia, intravenous drug users and heterosexual partners and children of these groups it became overwhelming clear that it was caused by an infectious agent and not some "lifestyle" factor.
Since Gallo published his initial findings other groups have replicated the isolation of HIV from people with AIDS. HIV can be isolated from virtually 100% of people with AIDS. In cohorts of homsexual men and people with haemophilia only those that were infected with HIV progressed to AIDS. The focus on Gallo's papers from 1984 is like the antivaccination nuts obsessing over Louis Pasteur.
Michale is simply regurgitating nonsense he read on a Denialist website. He knows it is not true but keeps on repeating it anyway. AZT failed as a cancer drug because it failed to inhibit the growth of tumour cells. It was the very lack of cytotoxicity that lead to it being shelved. In contrast, it was found to inhibit HIV reverse transcriptase at relatively low doses.
This is simply false on numerous grounds. The highest incidence of HIV infection was in the early 80s. The peak in AIDS incidence in 1993 indicates the variable time from infection with HIV to AIDS. AZT was given preferentially to those with full blown AIDS. The early placebo controlled study of AZT used patients with severe AIDS. 19 died in the placebo group compared with in the AZT group.
The question then arose as to when to start giving patients AZT. The Concorde trial demonstrated that there was no benefit to giving AZT to people with asymptomatic HIV infection. It also completely destroys Michael's unfounded assertion that AZT kills in 8-18 months. Michael has just copied this claim from a Denialist website.
This isn't true. The majority of deaths are AIDS related. Liver damage is becoming a problem partly due to the known toxicities of ARTs but mainly due to coinfection with Hep B and Hep C. Of course, HIV Denialists also deny that Hep B and Hep C cause disease.
The level of debate attained by Michael can be seen in these emails he and Harvey Bialy sent to a HIV researcher.
http://www.aidstruth.org/bialy-quotes.php
SLC,
The Smith and Novella paper, in my opinion, is quite bad. They really just scratches the surface of the HIV-AIDS causality issue without getting into any real science.
Chris Noble's comments do a much better job at this.
Personally, I have no reason to doubt that HIV causes AIDS. However I believe that people have a right to express different viewpoints and question popular beliefs. Indeed this makes science, or any type of discourse, all the more powerful tool in the human quest for truth. A rich scientific community, or any society for that matter, is one within which members freely express and discuss a wide variety of ideas and opinions.
To get back to the original post, and my reason for commenting, it's completely ridiculous for concerned "activists" to blame the expression of dissenting or unpopular scientific ideas for the disastrous political situation being now faced in South Africa. Questioning the truth only leads us to know it better. Suggesting that free expression and open scientific discourse are killing people in South Africa is just ridiculous
It isn't meant to. It is describing the nature of the HIV denial movement. There are numerous other articles describing exactly why the denilaists are wrong.
There is a difference between being skeptical and asking reasonable questions and denialism. Denialists do not change their opinions after their questions have been answered.
The vast majority of those who questioned aspects of the relationship between HIV and AIDS changed their minds as the evidence accumulated and unresolved questions were answered. The dramatic reduction of mortality and morbidity achieved through HAART convinced all but a few hard core denialists that HIV causes AIDS and that antiretrovirals are effective treatments for HIV infection.
More critically the denialists are not just asking questions. They are telling people not to take anti-retrovirals. They are telling HIV+ mothers not to take steps to prevent them infecting their children. They are telling people that HIV does not exist or it is harmless and that they don't have to take steps to prevent infecting others.
Look at the example set by David Rasnick and Matthias Rath in South Africa. They went around telling HIV infected people that antiretrovirals are poison and that they should take Rath's patented multivitamins instead. Trying to paint these people as just asking questions is not accurate.
It should also be pointed out that scientific debate takes place in scientific journals. The denialists have failed in this arena. They have been given opportunity to express these views in numerous journals. Their points have been answered. After failing in the scientific debate they chose to take their ideas directly to a lay-audience.
Read this article by former "dissident" Udo Schuklenk.
Professional Responsibilities of biomedical scientists in public discourse
Re bayman
1. Mr. bayman, as I mentioned, the Smith/Novella article has a number of references to papers in the peer reviewed literature. These should be a starting point for anyone interested in the HIV/AIDS issue. As the authors have explained, they had to cut out a number of paragraphs in the paper to satisfy a length requirement.
2. Mr bayman says that he is convinced that HIV is at least the primary cause of AIDS. Good for him. The problem here appears to be that he is not familiar with the goals and tactics of denialist movements. I would suggest that he go to the denialist web site, which I will link to below, where he will find good discussions of the denialist movements. In particular, he will discover the similarities in tactics between HIV/AIDS denialists, evolution denialists, global climate change denialists, vaccination efficacy denialists etc. Examples of these tactics include quote mining and outright lying. As an illustration, Mr. Noble has kindly provided examples of HIV/AIDS denialists lies.
http://scienceblogs.com/denialism/
There are a few things I'm sure of:
1. This post was not meant to convince those who don't believe in the HIV/AIDS connection in the scientific validity of this argument.
2. Mr. Anthis, having visited South Africa last March and April and having been fortunate enough to speak directly with members of the government (including an HIV positive member of the South African Supreme Court of Appeal), probably did more than 2 hours of research, although it would take about 2 years of solid reading to wade through the arguments on both sides.
3. No one is able to explain in the mere 1300 words used in this post all of the complexities of the issue, but I think if you bothered to read past word 400, you might just notice that there's more to this post than the typical science rhetoric or the typical stupid stupid South-Africa why can't they notice that their population is dying arguments of the truly "Western-centric."
4. It's commendable that President Mbeki is an Oxford-educated economist; he certainly isn't an Oxford-educated scientist. Mr. Anthis is.
Re Mr. SLC and Chris.
Your points are valid and I certainly agree that many "denialist" words and actions appear to me, as well as you, irrational and irresponsible. However name-calling and ridicule helps no one. All you can do is try to explain the science to people with the faith they will eventually see reason if you communicate effectively. One cannot, however control which opinion and actions people take in the end. This is just democracy and freedom of expression.
(ie "Denialists do not change their opinions after their questions have been answered.")
I empathize with your frustrations, but this does not justify trying to force your viewpoints upon people, no matter how rational you believe them to be.
Re Meredith.
"4. It's commendable that President Mbeki is an Oxford-educated economist; he certainly isn't an Oxford-educated scientist. Mr. Anthis is."
No, Mr. Anthis is not. Mr. Anthis is a graduate student who spends his time in an Oxford lab learning about protein structure. By night, he surfs the web and rehashes what he reads in the online Western media on his blog.
I am also a graduate student who studies biology in a laboratory, so I know a thing or two about what special insight this type of background might provide into a complex geopolitical issue - zero. Although I in fact study virology, a topic with arguably slightly more relevance to the HIV in SA debate, I still would never be so pretentious as to pass judgment on a developing nation's government from my privileged and isolated Western vantage point. Especially when Western science and corporations are largely to blame for the current crisis in SA in the first place.
Keep in mind that you are not reading this blog because Nick Anthis has demonstrated any particular expertise or made any valuable contribution in any field related to HIV, medicine or geopolitics. Rather, Nick Anthis' blog gained notoriety when he demonstrated an ability to use Google to verify the credentials of a sketchy NASA scientist, post the results on his blog and gain the attention of mainstream media. Likewise, his form of "activism" demonstrates his proficiency in performing Google searches and recycling sensational Western media perspective on issues, nothing more.
Bayman,
I keep a pretty loose commenting policy here, only filtering out comments that I judge as spam, comments that are derogatory or hateful to others without constructively contributing to the discussion, or comments that are clearly false. If this means that I have to read (a lot of) things I don't like, so be it. It's worth it, in the name of promoting the free exchange of ideas.
However, I give more weight to comments that are not anonymous, because these comments lead to a more honest discussion. I do not blog under a pseudonym. And, although I don't hold commenters to the same standard, I am not impressed by those (such as you) who attack others from behind the shield of anonymity.
If you wish to engage in a productive discussion (whether arguing for or against the points of view that I express), you need to shape up. Do not expect me to engage in a discussion with anyone who shows so little regard for the others involved and does not appear to be familiar with the contents of the post. Also, don't assume that such libelous comments will be accepted.
Let me now address three points from your last comment.
Point #1: I am, in fact, a scientist. I am on track to have my PhD in a little over a year, and I have published in the peer-reviewed scientific literature, and I have presented at several conferences. With that aside, I am someone who engages in the scientific process for over sixty hours a week, every week, and it is the perspective and understanding that comes from that that leads me to call myself a scientist and comment on current events from the perspective of a scientist. On the other hand, I have no idea whether you are a "real" scientist, since you give us no verifiable credentials to go on.
Point #2: I have no idea where you get this idea that I'm "rehashing" Western ideas. In fact, you'll find that the views I express are not particularly prevalent in the Western media. I would find it pretty difficult to parrot something I'm not even sure exists. I formulated these ideas from conversations that I had with people of all walks of life when I was actually in South Africa, which is more than I can say for the vast majority of Westerners who comment on HIV/AIDS in South Africa.
Point #3: Google had nothing to do with the George Deutsch revelation--something that came from careful research through a variety of sources (i.e. real people). I'm not sure how exactly Google would have helped when nobody else had reported these findings that immediately led to his resignation and the removal of a major obstacle to scientific progress at NASA. In fact, every single media organization mentioning Deutsch's credentials said that he was a graduate of Texas A&M University. While it was somewhat shocking to discover how little original research was required to unearth the truth in this case, at the end of the day, that's what it took.
Re bayman
1. Its Dr. SLC.
2. This blog is Mr. Anthis'. He is under no obligation to put up with personal abuse directed at him by Mr. bayman or anybody else.
Hi Nick,
Thanks for taking the time to respond. I'm glad you agree with me that blogs are beautiful forums for democratic free exchange of ideas. This is in fact why I personally believe that it is irrelevant whether my comments to your post are anonymous or not. I would like to think that anyone who reads what I have to say will examine my ideas on the merits of the arguments and evidence I provide rather than who I am or what credentials I possess. As an anonymous commenter I made no claim to expertise on the topic and therefore have none to defend, on the other hand, Meredith Clancy, in her comment, did so on your behalf. In the same sentence, she managed to simultaneously belittle President Mbeki's educational background and insinuate that your opinion on the subject is somehow more important than his.
In retrospect, I realize that you are not responsible for Meredith's comments regarding yourself, and so calling your background into question was perhaps unjustified. I also made several incorrect statements as I speculated as to how you might have struck upon the George Deutsch revelation, an incident that I clearly know less about than yourself. I'm glad you corrected me. I apologize if you found my comments unjustified, libelous or offensive. My intent was simply to point out to Meredith that just because one has studied and perhaps even excelled in a particular field of science does not make one an expert above all others on all topics. Of course, this does not in the least undermine your accomplishments in exposing Deutsch's fraud, or the great work you are doing in writing on activist issues from the viewpoint of a scientist-in-training.
Hopefully I have clarified my position somewhat. Back to your original post, to which I did intend, in my first comment, to raise genuine questions. I hope you now might finally respond to them. Again, I realize I may not have been clear here. My tone was intended to be provocative and challenging however I realize now it was probably mistaken for the insulting and ignorant type of comments that seem to have been made in the past by some visitors to your blog.
So please let me rephrase, and perhaps you might respond:
First off, I agree with nearly all the statements you make in the post, and I think you are on the right track in trying to understand the HIV/AIDS issue from the South African point of view. My question is why then, following this line of thinking, and trying to understand the South African viewpoint, when you summarize the history of the issue do you highlight the emergence of AIDS, the discovery of HIV, the development of anti-retrovirals, the evolution of the HIV pandemic in South Africa and then suddenly jump to Mbeki's "denial" of HIV-AIDS, as if he suddenly took leave of reality when the pandemic hit? Why did you leave out a massively significant chain of events that occurred in the intervening time, one that to this day seems vital to consider if we are to have any hope of understanding how events have shaped the viewpoints of Mbeki and others in the South African government? Why no mention of a)the attempt, in 1997, by the South African government to pass a law supporting the development of affordable generic HIV drugs by and for South African citizens or b)the filing of a lawsuit by 39 big pharma corporations against the South Africans for filing this act. That lawsuit was eventually dropped but succeeded in derailing, to some extent, South Africa's efforts to make affordable HIV drugs for its own people. I'm no expert on the history of these events, I just read about it in the newspaper. For example:
1) A 1998 NYT piece on the issue of the South African position on the act versus the reaction by American governments and big pharma to it: http://query.nytimes.com/gst/fullpage.html?res=9E04EED9143BF93AA15750C0…
2) The 180 degree reversal of big pharma's position and dropping of the lawsuit:
http://query.nytimes.com/gst/fullpage.html?res=9F00E6DE1330F933A15757C0…
Now, I can�t read Mbeki�s mind and I'm sure he's not a perfect leader. Perhaps he's even at fault for not bringing cheap HIV drugs to South Africans fast enough � I�m not in a position to be a good judge of this either. However, in light of the recent history described in the articles above, is he not justified in critically examining the efficacy of any HIV drug and it potential relevance to the South African pandemic? Is he not also justified in exploring alternative therapies and public health measures that might also be of benefit to his people? Does this suddenly make him an HIV-AIDS �denialist�?
This brings me to the second question I had for you. Why, after rightly identifying the need to understand the complexity of the South African perspective on HIV, do you then in your post go on to paint Mbeki with the label of the irrational �denialist� without providing any rationale whatsoever? What is your reason for believing this? What is the evidence that Mbeki does not believe that HIV causes AIDS? Has he ever said such a thing? Since you provided no rationale for calling Mbeki a denialist, I could only speculate that you adopted this view based on the reasoning that has been bouncing around the media and blogosphere as of late. From what I have read, this often-stated viewpoint usually seems to be based on the faulty logic that because Mbeki questions aspects of AIDS science, listens to a wide variety of viewpoints or suggests that non-pharmacological strategies might also be useful in combating AIDS, he is therefore an HIV-AIDS �denialist�. An assertion with harmful implications as it allows him to then be lumped into the same category with the clearly delusional and dangerous denialists such as the Perth group and Christine Maggiore. It also paves the way for the suggestion that the expression of non-mainstream ideas by scientists such as Peter Duesberg is to blame for Mbeki�s so-called �denialism�, and is therefore directly causing unnecessary HIV deaths in South Africa. This erroneous oversimplification blinds people to the complex reality of the situation, which as you rightly point out needs to be understood if we in the West wish to learn how we can help.
As an example of the faulty rationale that, as far as I can see, has led some to label Mbeki as a HIV-AIDS �denialist�, Nicoli Nattrass� article in the September/October 2007 Skeptical Inquirer (AIDS: Denialism vs. Science) is fairly representative. She first talks about the denialism of the Perth group and Duesberg, and then moves on to imply that Mbeki has been won over to their camp:
�AIDS denialists are eccentric but not irrelevant, because they campaign actively against the use of ARVs and promote the dangerous view that HIV is harmless (and some say not even sexually transmitted). South African president Thabo Mbeki took the AIDS denialists so seriously that he delayed the introduction of ARVs to prevent mother-to-child-transmission of HIV and invited the leading AIDS denialists to serve on his �Presidential AIDS Advisory Panel�. They recommended that ARVs be avoided and that all forms of immune deficiency be treated with vitamins and �alternative� and �complementary� therapies including �massage therapy, music therapy, yoga, spiritual care, homeopathy, Indian ayurvedic medicine, light therapy and many other methods�.
This blatantly one-sided misrepresentation of reality has been echoed by others in the Western media, and so far as I can tell, has provided the rationale for labeling Mbeki as a �denialist�: the basic idea is that he got together with a bunch of denialists, adopted their views, decided ARVs were evil, and decided that the answer to AIDS was quack therapy.
In fact, Mbeki�s panel consisted of many diverse viewpoints, not only those of a few denialists such as Duesberg, but many who share more mainstream views, including Luc Montagnier of the Institut Pasteur, co-discoverer of HIV as the AIDS virus along with American Robert Gallo. Gallo was also invited to the panel, but for whatever reason, he declined. When you read the advisory panel report:
http://www.info.gov.za/otherdocs/2001/aidspanelpdf.pdf
it is clear that its purpose was not to determine the cause of AIDS, but simply to hear recommendations and potential solutions from the widest possible variety of scientific viewpoints. Directly quoting from the panel�s report:
�This diversity of expertise and experience also included diametrically contrasting views on several key questions pertaining to AIDS. The assumption, therefore, was that members of the panel would unpack the merits and de-merits of particular scientific, public policy and health policy viewpoints in a dispassionate manner and generate the best possible collective advice to the South African government.�
and,
�The nature and format of the deliberations of the panel could not allow the in-depth scientific argumentation that is necessary to resolve many of the differences over scientific issues of a fundamental nature. An inevitable consequence of this reality was different sets of recommendations made from the varying perspectives of what is perceived to be the 'real' cause of AIDS.�
The report goes on to list the many solutions that were suggested by the various camps, including pretty much everything you could imagine � some sketchy alternative therapies, yes, but also valid public health measures, socioeconomic policy measures, educational measure, and anti-retroviral drugs. The panel�s conclusions are in no way biased against ART, in fact their efficacy is acknowledged and much of the discussion focuses on this.
When I read the panel�s report, it strikes me that Mbeki is simply looking for a variety of options as to how his government can best fight the AIDS pandemic in his country � including, but not limited to, expensive ART drugs. The best way to get a diversity of possible solutions, naturally, is to hear from as many different voices as possible. This does not make him a �denialist� per se. I think it is commendable that he is not willing to simply accept the Western solution (ART drugs), as the only solution. It is also commendable that he is actively exploring other solutions instead of just watching people in his country die because they cannot afford brand-name, on-patent drugs and/or because the South African ART industry has been understandably slow to develop.
In the 90s, the Western industry, governments and the scientific establishment had a clear opportunity to help South Africa produce its own affordable AIDS drugs. Instead of lending a hand to help in a humanitarian disaster, the response was to sue over lost patent monopoly profits and paralyze a developing nation�s efforts to find its way out of a devastating pandemic. Now, 10 years later, is it the best we can we can do to ridicule South Africa�s leaders and label them as irrational �denialists� when they look for all possible measures to save their dying citizens?
I haven�t been able to find any evidence indicating that Mbeki himself shares the beliefs of the irrational denialist�s that HIV does not causes AIDS. I have seen so far, in my limited examination, only a leader of a developing nation desperately taking every possible action to save his people from a deadly pandemic after being abandoned by the West. Abandoned because we have a cure and chose to use it to hold a country for ransom, rather than to help.
Because you referred to Mbeki as a �denialist� in your post, I was hoping that you might be able to offer some evidence that I have missed, to help me understand where this viewpoint is coming from.
This is an important humanitarian issue and I applaud you for your efforts to inject a scientific approach into the debate, and to understand Mbeki and the South African point of view. I hope you can help me to understand:
1) What evidence has let you to the conclusion that Mbeki is, in your words, �denying the link between HIV and AIDS�,
and
2) Why you do not feel that the history of efforts made by many in the West to exploit the South African HIV epidemic for profits might an important factor that has led Mbeki to approach some aspects of Western science with skepticism, and to examine all possible approaches in looking for solutions to the unique circumstances of the HIV problem in his country.
I look forward to your response and will continue to read your blog with interest. Keep up the good work.
Regards,
Bayman
Thanks for your comment, Bayman,
This post, of course, was not meant to be a comprehensive summary on HIV denialism in South Africa. It was taken from a part of a talk that I gave at Texas A&M, and I added a bit of context so it could stand on its own. Regardless, this is an incredibly rich topic, one that whole books can (and have been) written about.
The role of Western drug companies have played in this controversy is a topic that I have wanted to write about, but have not yet on this blog. Their culpability is undeniable, but this is certainly not a one-dimensional topic, and I don't see any harm in discussing these other dimensions.
What Mbeki personally believes about HIV/AIDS is known only to him, I suppose. He certainly has not acted as someone who believes that AIDS is treatable by antiretrovirals. The crisis proportions of HIV/AIDS in South Africa demands a highly proactive stance on this issue, and he has not delivered. I base what I wrote in my post on presentations by and conversations with a variety of South Africans, from civilians to high-level government officials--none of whom I have reason to believe would offer false information.
The purpose of this post was to give an example of a case where one-dimensional thinking was not sufficient to address a problem. In this case, the one-dimensional thinking that I so often heard was that Mbeki believed the pseudoscience behind HIV denialism, so he did not take a proactive stance in addressing this crisis. In the post, however, I explain that this issue is much more complex and that the current situation is South Africa is not just a result of bad science. I think we can all agree on that point.
Mbeki has been fairly cryptic about what he believes.
In parlament he said A virus cannot cause a syndrome. A virus can cause a disease, and AIDS is not a disease, it is a syndrome.
He also claimed that he didn't know anybody that has died from AIDS. Several South African ministers have had family members die from AIDS.
Peter Mokaba was closely associated with Mbeki and was the author of a Denialist document titled CASTRO HLONGWANE, CARAVANS, CATS, GEESE, FOOT & MOUTH AND STATISTICS. This paper was cirulated amongst the ANC. It is alleged that Mbeki had a role in this.
The presidential spokesperson, Parks Mankahlana, was an outspoken Denialist. He died after a long illness which officially has nothing to do with HIV.
The document "Castro Hlongwane" claims that Parks Mankahlana had died "vanquished by the anti-retroviral drugs he was wrongly persuaded to consume".
There is also the government's association with the virodene scandal and the support for "traditional" treatments such as Ubhejane and Freddie Isaac's concoction.
The whole issue seems to be polarised into a false dichotomy between Western science and African culture.
Mbeki isn't just rejecting Western drug companies. He rejects Western science.
Since this thread is still active, I am going to repost the link to a thread on Tara Smiths' blog which is now up to 216 comments. I would strongly suggest that Mr. bayman open this link and observe the types of comments posted there to really get a flavor of how the HIV/AIDS denialists operate. I would also like to bestow an attaboy on Mr. Chris Noble and his fellow defenders of good science on this blog and on Prof. Smiths' blog for refuting the denialists' lies, distortions, and quote mining. Its a dirty job but somebody has to do it.
http://scienceblogs.com/aetiology/2007/09/loneliness_causes_aids_claims…
If Bayman is still reading there is an article describing MBeki's Denialism here
There is also a series of articles describing MBeki's involvement in the Virodene scandal here
It is interesting to see the evolution of MBeki's thinking about AIDS and HIV.
Initially he was taking the mainstream view that HIV causes AIDS. His objection to antiretrovirals was not that they didn't work but that they were too expensive. He was attracted to virodene because it was a) an African solution and b) it could be made cheaply.
Great blog !