Bad Science (15 page)

Tshabalala-Msimang disagreed; the researchers should go back to the drawing board, and “investigate properly.” Why? Because HIV positive people who used African potato had shown improvement, and they had said so themselves. If a person says he or she is feeling better, should this be disputed, she demanded to know, merely because it had not been proved scientifically? “When a person says she or he is feeling better, I must say ‘No, I don’t think you are feeling better’? ‘I must rather go and do science on you’?” Asked whether there should be a scientific basis to her views, she replied: “Whose science?”

And there, perhaps, is a clue, if not exoneration. This is a continent that has been brutally exploited by the developed world, first by empire and then by globalized capital. Conspiracy theories about AIDS and Western medicine are not entirely absurd in this context. The pharmaceutical industry has indeed been caught performing drug trials in Africa that would be impossible anywhere in the developed world. Many find it suspicious that black Africans seem to be the biggest victims of AIDS and point to the biological warfare programs set up by the apartheid governments; there have also been suspicions that the scientific discourse of HIV/AIDS might be a device, a Trojan horse for spreading even more exploitative Western political and economic agendas around a problem that is simply one of poverty.

And these are new countries, for which independence and self-rule are recent developments, which are struggling to find their commercial feet and true cultural identity after centuries of colonization. Traditional medicine represents an important link with an autonomous past, besides which, antiretroviral medications have been unnecessarily—offensively, absurdly—expensive, and until moves to challenge this became partially successful, many Africans were effectively denied access to medical treatment as a result.

It’s very easy for us to feel smug and to forget that we all have our own strange cultural idiosyncrasies that prevent us from taking up sensible public health programs. For examples, we don’t even have to look as far as MMR. There is a good evidence base to show that needle exchange programs reduce the spread of HIV, but this strategy has been rejected time and again in favor of “Just say no.” Development charities funded by U.S. Christian groups refuse to engage with birth control, and any suggestion of abortion, even in countries where being in control of your own fertility could mean the difference between success and failure in life, is met with a cold, pious stare. These impractical moral principles are so deeply entrenched that PEPFAR, the U.S. Presidential Emergency Plan for AIDS Relief, has insisted that every recipient of international aid money must sign a declaration expressly promising not to have any involvement with sex workers.

We mustn’t appear insensitive to the Christian value system, but it seems to me that engaging sex workers is almost the cornerstone of any effective AIDS policy. Commercial sex is frequently the “vector of transmission,” and sex workers are a very high-risk population; but there are also more subtle issues at stake. If you secure the legal rights of prostitutes to be free from violence and discrimination, you empower them to demand universal condom use, and that way you can prevent HIV from being spread into the whole community. This is where science meets culture. But perhaps even to your own friends and neighbors, in whatever suburban idyll has become your home, the moral principle of abstinence from sex and drugs is more important than people dying of AIDS, and perhaps, then, they are no less irrational than Thabo Mbeki.

So this was the situation into which the vitamin pill entrepreneur Matthias Rath inserted himself, prominently and expensively, with the wealth he had amassed from Europe and America, exploiting anticolonial anxieties with no sense of irony, although he was a white man offering pills made in a factory abroad. His ads and clinics were a tremendous success. He began to tout individual patients as evidence of the benefits that could come from vitamin pills, although in reality some of his most famous success stories have died of AIDS. When asked about the deaths of Rath’s star patients, Health Minister Tshabalala-Msimang replied: “It doesn’t necessarily mean that if I am taking antibiotics and I die, that I died of antibiotics.”

She was not alone: South Africa’s politicians have consistently refused to step in, Rath claims the support of the government, and its most senior figures have refused to distance themselves from his operations or to criticize his activities. Tshabalala-Msimang went on the record to state that the Rath Foundation “are not undermining the government’s position. If anything, they are supporting it.”

In 2005, exasperated by government inaction, a group of 199 leading medical practitioners in South Africa signed an open letter to the health authorities of the Western Cape, pleading for action on the Rath Foundation. “Our patients are being inundated with propaganda encouraging them to stop life-saving medicine,” it said. “Many of us have had experiences with HIV-infected patients who have had their health compromised by stopping their antiretrovirals due to the activities of this Foundation.”

Rath’s ads continue unabated. He even claimed that his activities were endorsed by huge lists of sponsors and affiliates, including the World Health Organization, UNICEF, and UNAIDS. All have issued statements flatly denouncing his claims and activities. The man certainly has chutzpah.

His ads are also rich with detailed scientific claims. It would be wrong of us to neglect the science in this story, so we should follow some through, specifically those which focused on a Harvard study in Tanzania. He described this research in full-page advertisements, some of which have appeared in
The New York Times
and the
Herald Tribune
. He refers to these paid ads, I should mention, as if he had received flattering news coverage in the same papers. Anyway, this research showed that multivitamin supplements can be beneficial in a developing world population with AIDS. There’s no problem with that result, and there are plenty of reasons to think that vitamins might have some benefit for a sick and frequently malnourished population.

The researchers enrolled 1,078 HIV positive pregnant women and randomly assigned them to have either a vitamin supplement or a placebo. Notice once again, if you will, that this is another large, well-conducted, publicly funded trial of vitamins, conducted by mainstream scientists, contrary to the claims of nutritionists that such studies do not exist.

The women were followed up for several years, and at the end of the study, 25 percent of those on vitamins were severely ill or dead, compared with 31 percent of those on placebo. There was also a statistically significant benefit in CD4 cell count (a measure of HIV activity) and viral loads. These results were in no sense dramatic—and they cannot be compared with the demonstrable lifesaving benefits of antiretrovirals—but they did show that improved diet or cheap generic vitamin pills could represent a simple and relatively inexpensive way to marginally delay the need to start HIV medication in some patients.

In the hands of Rath, this study became evidence that vitamin pills are superior to medication in the treatment of HIV/AIDS, that antiretroviral therapies “severely damage all cells in the body—including white blood cells,” and worse, that they were “thereby not improving but rather worsening immune deficiencies and expanding the AIDS epidemic.” The researchers from the Harvard School of Public Health were so horrified that they put together a press release setting out their support for medication and stating starkly, with unambiguous clarity, that Matthias Rath had misrepresented their findings. Media regulators failed to act.

To outsiders the story is baffling and terrifying. The United Nations has condemned Rath’s ads as “wrong and misleading.” “This guy is killing people by luring them with unrecognized treatment without any scientific evidence,” said Eric Goemaere, head of Médecins sans Frontières SA, a man who pioneered antiretroviral therapy in South Africa. Rath sued him.

It’s not just MSF that Rath has gone after. He has also brought time-consuming, expensive, stalled, or failed cases against a professor of AIDS research, critics in the media, and others.

His most heinous campaign has been against the Treatment Action Campaign. For many years this has been the key organization campaigning for access to antiretroviral medication in South Africa, and it has been fighting a war on four fronts. First, it campaigns against its own government, trying to compel it to roll out treatment programs for the population. Second, it fights against the pharmaceutical industry, which claims that it needs to charge full price for its products in developing countries in order to pay for research and development of new drugs, although, as we shall see, out of its $550 billion global annual revenue, the pharmaceutical industry spends twice as much on promotion and administration as it does on research and development. Third, it is a grassroots organization, made up largely of black women from townships who do important prevention and treatment literacy work on the ground, ensuring that people know what is available and how to protect themselves. Lastly, it fights against people who promote the type of information peddled by Matthias Rath and his like.

Rath has taken it upon himself to launch a massive campaign against this group. He distributes advertising material against them, saying, “Treatment Action Campaign medicines are killing you” and “Stop AIDS genocide by the drug cartel,” claiming—as you will guess by now—that there is an international conspiracy by pharmaceutical companies intent on prolonging the AIDS crisis in the interests of their own profits by giving medication that makes people worse. TAC must be a part of this, goes the reasoning, because it criticizes Matthias Rath. Just like me writing on Gillian McKeith, TAC is perfectly in favor of good diet and nutrition. But in Rath’s promotional literature it is a front for the pharmaceutical industry, a “Trojan horse” and a “running dog.” TAC has made a full disclosure of its funding and activities, showing no such connection. Rath has presented no evidence to the contrary, and has even lost a court case over the issue, but will not let it lie. In fact, he presents the loss of this court case as if it were a victory.

The founder of TAC is a man called Zackie Achmat, and he is the closest thing I have to a hero. He is South African, and Coloured, by the nomenclature of the apartheid system in which he grew up. At the age of fourteen he tried to burn down his school, and you might have done the same in similar circumstances. He has been arrested and imprisoned under South Africa’s violent, brutal white regime, with all that entailed. He is also gay and HIV positive, and he refused to take antiretroviral medication until it was widely available to all on the public health system, even when he was dying of AIDS, even when he was personally implored to save himself by Nelson Mandela, a public supporter of antiretroviral medication and Achmat’s work.

And now, at last, we come to the lowest point of this whole story, not merely for Matthias Rath’s movement but for the alternative therapy movement around the world as a whole. In 2007, with a huge public flourish, to great media coverage, Rath’s former employee Anthony Brink filed a formal complaint against Zackie Achmat, the head of TAC. Bizarrely, he filed this complaint with the International Criminal Court at The Hague, accusing Achmat of genocide for successfully campaigning to get access to HIV drugs for the people of South Africa.

It’s hard to explain just how influential the AIDS dissidents are in South Africa. Brink is a barrister, a man with important friends, and his accusations were reported in the national news media—and in some corners of the Western gay press—as a serious news story. I do not believe that any one of those journalists who reported on it can possibly have read Brink’s indictment to the end. I have. The first fifty-seven pages present familiar anti-medication and AIDS dissident material. But then, on page fifty-eight, this “indictment” document suddenly deteriorates into something altogether more vicious and unhinged, as Brink sets out what he believes would be an appropriate punishment for Zackie. Because I do not wish to be accused of selective editing, I will now reproduce for you that entire section, unedited, so you can see and feel it for yourself.