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HIV/AIDS: The Perils of Pseudoscience
by Dr M W Makgoba, President, Medical Research
Council of South Africa
Dr Makgoba warns of the havoc that pseudoscience can wreak to an African
continent needing to show confidence in its scientists. The HIV/AIDS
debate in 2000 on the use of anti-retroviral drugs is targeted as an example of
the damage pseudoscience can
inflict to a country and to the credibility of scientists in Africa. The South
African Department of Health has now shifted its stance , but Dr
Makgoba's warning is still clear: Beware the Perils of Pseudoscience
Politics has inappropriately taken center stage in the South African
response to the AIDS epidemic with the publication of the open letter
from President Mbeki stating that "whatever lessons we have to and
may draw from the West about the grave issue of HIV/AIDS, a simple
superimposition of Western experience on African reality would be
absurd and illogical." Ironically, those who offer misguided solutions
for this "African reality" are not Africans, but a loosely connected group
of Western scientists often referred to as "dissidents."
This latest instance is merely another entry in a lengthening list of
politically driven decisions regarding the South African AIDS crisis. In
1998, a number of politicians, including President Mbeki, enthusiastically embraced virodene as an inexpensive therapeutic against AIDS without any scientific evidence. The government's refusal to give AZT to pregnant women for the prevention of maternal fetal HIV transmission flies in the face of evidence showing that AZT and nevirapine reduce mother to child HIV transmission. This decision poses serious moral and
ethical dilemmas in a nation where maternal fetal transmission of HIV accounts annually for 10% of the total HIV disease burden. Most recently, the politically motivated suggestion, in the absence of scientific evidence, that malnutrition and poverty cause AIDS in Africa is
not only absurd but may represent a form of national denial. South Africa is rapidly becoming a fertile ground for the types of pseudoscience often embraced by politicians.
During the critical period of 1990 95, when the HIV epidemic could have
been curbed, South Africa had no effective government and no public health policy to deal with the epidemic. The current government was going through a process of massive renewal. New democratic civil
institutions were being created at a phenomenal rate. In the midst of the heroic efforts to build a new, pluralistic South Africa, the HIV epidemic simply became one challenge too many. Now that the euphoria of Uhuru and social transformation in Africa has settled, the government finds itself lurching from one crisis to the next with no coherent short or long term strategy to deal with the explosive HIV/AIDS epidemic. Instead of accepting our mistakes, the government
is retreating behind revisionist theories.
There is little doubt that HIV causes AIDS, as has been demonstrated
by many carefully conducted experiments and clinical case studies. In
contrast, there is no evidence that common African conditions such as
poverty, malnutrition, and many chronic infectious diseases by themselves, singly or in combination, cause the characteristic immunodeficiency typical of AIDS, that is, progressive depletion of CD4+ cells. To conflate causation with cofactors through a mixture of pseudoscientific statements is scientifically and politically dangerous
in societies
where denial, chauvinism, fear and ignorance are rampant. In such
societies, the manipulations and misrepresentation of scientific facts only serve to fuel the epidemic.
The introduction of highly specific and effective antiretrovirals has
transformed the natural history of HIV/AIDS. Today, in the developed
countries, AIDS is seen as a controllable disease. Yet, these drugs are
neither a panacea for the management of HIV/AIDS nor a cure. Furthermore, there are deep moral and ethical dilemmas with regard to
sustainability and affordability of these treatments in developing countries. The South African government must address these problems immediately and unambiguously, at the level of policy and research.
The current political and scientific furor in South Africa, fuelled largely by
the dissidents' theories on HIV/AIDS and the seeming support of Mr.
Mbeki, has much broader implications for South Africa and South
Africans than some are prepared to admit. The current controversy is
undermining the constructive public health messages this government
has put in place. It is sending mixed messages to all those who have
dedicated themselves to the alleviation and eradication of this
epidemic and is having a negative impact on the morale of affected
patients and
families. The undermining of scientists and the scientific method is especially dangerous in a developing country still in the process of establishing a strong scientific research base. Furthermore, it may
erode investor confidence in our country, with dire economic
consequences. We present South Africans cannot afford to make any
more mistakes lest history judges us to have collaborated in one of the
greatest crimes of our time.
As published in SCIENCE . VOLUME 288 . 19 MAY 2000
Note: Dr Makgoba will be a key-note speaker at the Sasol Scifest (28 March-3
April 2001) in Grahamstown, South Africa. His talk the Perils of Pseudoscience
will provide an in-depth insight into this important issue. Do not miss it.
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