by Alexey Karetnikov, Department of Molecular Genetics, University of Toronto

Published in: Frontiers in Public Health, 7 August 2015 (doi:10.3389/fpubh.2015.00193)

A commentary on
Questioning the HIV-AIDS hypothesis: 30 years of dissent

by Goodson P. Front Public Health (2014) 2:154. doi: 10.3389/fpubh.2014.00154

A recent Opinion article by Dr. Goodson (1) expresses pseudoscientific views typical of HIV/AIDS denialism (2–13) and ignores the overwhelming evidence that HIV is a causative agent of AIDS, the evidence accumulated during more than 30 years of research.

Fulfilling the Koch’s Postulate 1: HIV is Invariably Epidemiologically Associated with AIDS

Dr. Goodson ignores the fact that Koch’s postulates for viruses have been completely fulfilled in the case of HIV (9, 14, 15).

The overwhelming evidence suggests an invariable epidemiological association of HIV with AIDS. AIDS occurs exclusively in HIV-infected people (16). HIV can be detected in all AIDS patients (17). High levels of HIV in the organism predict progression to AIDS (18–23). Many children born to HIV-infected mothers have developed AIDS and died (24). AIDS-related conditions, such as Pneumocystis pneumonia and disseminated Mycobacterium avium complex disease, have become much more common after the start of the HIV epidemic (25). Death rates are much higher in HIV-seropositive treatment-naïve than in seronegative individuals (26–34).

An HIV-triggered decrease in CD4⁺ T-lymphocyte count is a specific feature of HIV infection, and is extraordinarily rare in the absence of HIV (16, 35–37). The HIV-caused CD4⁺ T-lymphocyte depletion occurs through at least two mechanisms. (1) Direct killing of infected CD4⁺ T-lymphocytes. Dr. Goodson seems unfamiliar with the fact that HIV-1, HIV-2, and other representatives of the genus Lentivirus (e.g., Simian immunodeficiency virus), as well as some other retroviruses (e.g., Feline leukemia virus and members of the Avian leukosis virus group), exert a cytopathic effect in infected cells (38). (2) HIV directly kills Th17 CD4⁺ T-lymphocytes in the intestinal submucosa, triggering the damage of the mucosal integrity, translocation of microbial products from the intestine to the blood and chronic immune activation, resulting in further massive loss of CD4⁺ T-lymphocytes (39, 40).

Dr. Goodson claims that recreational drug use, clotting factor VIII, or receptive anal intercourse, but not HIV, are causes of AIDS. However, all of these claims have long ago been rejected by overwhelming scientific evidence (16, 35–37, 41–45).

Fulfilling the Koch’s Postulate 2: HIV has been Isolated from Patients at all Stages of the Infection

Contrary to Dr. Goodson’s claims, HIV has been isolated from patients at all stages of HIV infection, including AIDS, and propagated in cell culture (17, 46–54). Various protocols for HIV-1 isolation (without “contaminants” claimed by Dr. Goodson) have been developed, and each of these protocols can be considered “standard” (55–62). Detailed images of HIV-1 virions, revealing morphology typical of the genus Lentivirus, have been obtained using transmission electron microscopy (46–48, 53, 63) and electron cryotomography (64, 65). A combination of immunofluorescent and electron microscopy has allowed visualization of intracellular trafficking of individual HIV-1 particles toward the nucleus of the infected cell (66). The process of cell-to-cell transfer of HIV-1 between T-lymphocytes has been visualized using high-speed three-dimensional video microscopy (67).

Fulfilling the Koch’s Postulate 3: Accidental HIV Transmission in Humans

Dr. Goodson ignores several tragic cases of accidental HIV transmission to laboratory workers who worked with purified HIV-1, became infected after a needle-stick or mucosal exposure and developed AIDS-like symptoms. HIV has been isolated from their blood, and DNA sequencing confirmed that the HIV variant isolated was identical to the one they were working with (15, 68–70). Other well-documented cases include HIV transmission from a dentist in the USA to several patients (15, 71), and HIV transmission through blood transfusion to 11 children in the USA (72) and 75 children in the former Soviet Union (73).

In addition, the Koch’s postulates for HIV and another lentivirus, Simian immunodeficiency virus, have been fulfilled in experiments with animal models (15, 74).

HIV Laboratory Testing

Three types of assays are used for HIV detection: (1) ELISA – specificity 98.5–99.9% (75–77), (2) Western blot (77), and (3) PCR – specificity 98.3–100% (78–80). The probability that both ELISA and Western blot would give false-positive results is extremely low (<1/140,000) (77). Thus, contrary to Dr. Goodson’s claims, these tests are highly specific for HIV-1. Since the diagnosis is based on the combination of the three tests (77), HIV testing will produce similar conclusions irrespective of the country.

Dr. Goodson misrepresents the study by Rodriguez et al. (81), which has never stated that PCR “is not sufficiently accurate” (1).

Antiretroviral Therapy

Contrary to Dr. Goodson’s claims, antiretroviral therapy (ART) has profoundly improved the prognosis for HIV-1-infected patients, suppressing their viral load, restoring CD4⁺ T-lymphocyte count, and reducing the risk of developing AIDS or dying (Figure 1A) (82–104). The success of ART has been determined by its high specificity for HIV-1-encoded proteins (105, 106). Along with therapeutic agents for many other diseases, ART does have side effects, but these are far outweighed by its benefits (106). New anti-HIV agents should help to mitigate side effects, overcome drug resistance, and ultimately cure HIV infection, e.g., through excising HIV proviral DNA from the chromosome (107–109).

Dr. Goodson misrepresents the study by the ART Cohort Collaboration, which showed that ART is extremely beneficial for HIV-infected patients, but better clinical outcomes are observed when CD4⁺ T-lymphocyte counts at the start of ART are higher than 200 cells/μl (110). These conclusions have been corroborated by many other studies (111–117) and serve as a background to recommend starting ART early, when the HIV-triggered damage of the immune system is easier to restore (106).

Detrimental Impact of HIV/AIDS Denialism on Public Health

P. Duesberg, D. Rasnick, and some other HIV/AIDS denialists served on a controversial advisory panel of the South African president Thabo Mbeki. The policy of the South African government over HIV/AIDS during the period 2000–2005 is considered by a majority of scientists to have resulted in the death of at least 330,000 HIV-infected people (Figure 1B) (9, 12, 118). The Opinion article by Dr. Goodson (1) [as well as earlier published or publicly expressed opinions of P. Duesberg, K. Mullis, and other denialists, none of whom has ever worked with HIV/AIDS (2–5, 7–12)] is similarly harmful for public health, as it disseminates dangerous misinformation about HIV/AIDS that can affect prevention decisions made by uninfected people and treatment decisions made by HIV-infected people. Therefore, the following recommendations should be given to public health workers: (1) to learn and disseminate up-to-date knowledge on HIV/AIDS based on the most recent scientific literature, and (2) to be aware of HIV/AIDS denialism and be able to effectively counteract its detrimental impact on public health.

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

I would like to thank Dr. Nicoli Nattrass for providing an electronic file for Figure 1B, Raymond W. Wong for providing PDF files, and Andrew Reddin for critical reading of the manuscript.

References

Keywords: HIV, AIDS, antiretroviral therapy, AIDS denialism, pseudoscience, public health

Citation: Karetnikov A (2015) Commentary: Questioning the HIV-AIDS hypothesis: 30 years of dissent. Front. Public Health 3:193. doi: 10.3389/fpubh.2015.00193

Received: 30 April 2015; Accepted: 23 July 2015;
Published: 07 August 2015

 

Copyright: © 2015 Karetnikov. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

AIDSTruth contributor Prof Nicoli Nattrass (director of the AIDS and Society Research Unit at the University of Cape Town) has written a new book The AIDS Conspiracy: Science Fights Back, published by Columbia University Press. In the book, she explores conspiracy theories on the origins of AIDS (such as that it was manufactured by the US government), their surprising longevity, the campaigns by scientists to correct misinformation and the consequences of these myths for behaviour.

She reflects on some of the arguments in the book in a piece for The Scientist, which has also published a short extract of the book on its website.

There is a substantial body of evidence showing that HIV causes AIDS—and that antiretroviral treatment (ART) has turned the viral infection from a death sentence into a chronic disease.1 Yet a small group of AIDS denialists keeps alive the conspiratorial argument that ART is harmful and that HIV science has been corrupted by commercial interests. Unfortunately, AIDS denialists have had a disproportionate effect on efforts to stem the AIDS epidemic. In 2000, South African President Thabo Mbeki took these claims seriously, opting to debate the issue, thus delaying the introduction of ART into the South African public health sector. At least 330,000 South Africans died unnecessarily as a result.2,3

The “hero scientist” of AIDS denialism, University of California, Berkeley, virologist Peter Duesberg, argues that HIV is a harmless passenger virus and that ART is toxic, even a cause of AIDS. He has done no clinical research on HIV and ignores the many rebuttals of his claims in the scientific literature.4,5 As I describe in my new book, The AIDS Conspiracy: Science Fights Back, this has prompted further direct action against Duesberg by the pro-science community.

Read the rest of Nicoli Nattrass’s article in The Scientist.

Read an extract of The AIDS Conspiracy: Science Fights Back.

By Nathan Geffen
The obscure Italian Journal of Anatomy and Embryology has published an article by AIDS denialist Peter Duesberg packed with errors. It claims that data from Uganda and South Africa shows that there is no evidence of an HIV epidemic. This journal, whose title indicates no expertise in HIV, has a track record of publishing peer-reviewed AIDS denialist nonsense.

The article will have no influence on medical science. Nor is it likely to influence the South African government; the days of state-supported AIDS denialism are gone. Nevertheless its publication and the subsequent unnecessary publicity it received in the world’s leading science journal, Nature, provide a good opportunity to explain how we do know there is a massive HIV epidemic in South Africa.

The two main arguments Duesberg et al. offer are that (1) the population has increased by 20 million in the past three decades and (2) mortality reports released by Statistics South Africa (Stats SA) show relatively few AIDS deaths.

The first argument, that the population has increased, can be swiftly dealt with.

The annual number of births in South Africa over the last two decades has been between 1 and 1.2 million. By the best estimate the number of deaths rose between 1997 and 2006 from about 400,000 to about 650,000 annually. This rise in deaths, as I explain below is entirely consistent with our large HIV epidemic, but it is still far below the number of births: hence South Africa’s population has risen. Source: ASSA2008 Provincial Outputs

The second argument is one that has been raised repeatedly by denialists, despite the fact that a little bit of analysis shows it is wrong.

Stats SA regularly publishes a mortality report which tabulates death statistics based on death notification forms. Every time someone dies in South Africa, a death certificate is supposed to be filled in and eventually finds its way into national statistics. A doctor is supposed to indicate the underlying cause of death and Stats SA always publishes the top 10 such causes for natural deaths. It is true that HIV as the underlying cause of death features near the bottom of the top 10 and is quite low. For example in 1997 there were just over 6,600 recorded HIV deaths and this rose to just under 18,000 in 2009.

The reason for this massive underestimate of HIV deaths is explained in an article published in 2005 by Medical Research Council researchers:

In a country such as South Africa, where the HIV status of the deceased is often unknown or the medical certifier does not have access to a full medical history, mis-classification to the immediate cause of death rather than the underlying cause often takes place. Furthermore, since 1992 it has been possible for traditional headmen to complete an abbreviated death notification form, often resulting in misclassification of the cause of death to a generalized ill-defined rubric … in some rural areas.

In addition, some doctors are reluctant to write HIV as the underlying cause because, even though the cause of death is noted on a confidential form, they remain worried that insurance companies will access the forms and thereby deny funeral and life-insurance payouts to the families of the dead.

But the evidence for a massive increase in deaths due to AIDS is nevertheless abundant from the death data.

1. The number of recorded deaths in SA in 1997 was 316,505. This rose to 613,040 in 2006 and has since declined to 572,673 in 2009. Improved registration and population growth only explains this partially. I am not using false accuracy here; these are the actual counts of recorded death certificates. According to Stats SA, about 80% of deaths are recorded. Sources: Stats SA P0309.3 reports 2005 and 2011
2. The number of recorded deaths from opportunistic infections associated with HIV has risen dramatically. For example Tuberculosis deaths rose from 22,071 in 1997 to 77,009 in 2006. This is by far the biggest cause of recorded deaths. Influenza and Pneumonia deaths rose from 11,518 in 1997 to 52,791 in 2006 to become the second-largest cause of death after TB. Deaths due to Intestinal Infectious Diseases was not in the top 10 in 1997. In 1998 it was 9th at 8,808. In 2006 it was 3rd at 39,239. Most of the increases in these causes of death were almost definitely due to HIV.
3. By contrast death from Ischaemic Heart Disease rose marginally from 9,797 in 1997 to 13,025 in 2006.Diabetes deaths rose a bit more significantly, from 10,828 to 19,549 (and South Africa is indeed experiencing a diabetes epidemic). While these causes of death are not commonly associated with HIV, it’s quite conceivable that their relatively small increases are at least in part explained by HIV since we know that HIV also increases the risk of death from non-AIDS causes. For example, the SMART trial found that untreated HIV causes increased risk of dying from heart disease.
4. With the introduction of antiretroviral treatment (ART) in the public sector in 2004, the number of people on treatment has risen to approximately 1.5 million. This correlates with a decline in recorded deaths in recent years, which is what would be predicted by an increase in the number of people taking ART. This decrease in deaths is the one silver lining of the South African epidemic.
5. Andrew Warlick and I prepared the graph below for the Treatment Action Campaign some years ago. It shows the changing age pattern of deaths in South Africa. It is perhaps the most compelling proof of the massive HIV epidemic in SA. It destroys AIDS denialism in one pretty picture. It shows how in 2004 the women who died in South Africa were mainly young adults, not old people. This was in contrast to 1997 as well as the situation in Brazil in 2004, a country with a comparatively tiny HIV epidemic. Only the presence of the large HIV epidemic in South Africa can explain this.

   

   Constructed using mortality data from Statistics South Africa and Instituto Basileiro de Geografia e Estatística

6. In 2002, Stats SA closely analysed a 12% sample of death certificates. The death certificates often contained synonyms for deaths caused by HIV and, in contrast to the standard mortality reports that Stats SA publishes, these were counted as AIDS. It offers clear evidence of the growing epidemic. In 1997 TB and HIV were responsible for 6.5% and 4.6% of underlying causes of death respectively. This steadily rose to 9.7% and 8.7% in 2001. The only larger causes were Unspecified unnatural causes (15.3% and 8.2% in 1997 and 2001 respectively) and ill-defined causes of mortality (8.6% in 1997 and 2001). Influenza and Pneumonia deaths rose dramatically too. But deaths due to diseases not usually related to AIDS didn’t show similar increases. For example, heart disease deaths declined.
7. In 2001, the Medical Research Council published a meticulous study based on the Department of Home Affairs Population Register. The report carefully and convincingly showed rising HIV mortality in adults.
8. The Actuarial Society of South Africa uses multiple sources to calibrate its models in order to come up with the best estimate of the number of annual AIDS deaths in South Africa. Their latest published model,ASSA2008, calculates that between 1997 and 2008, 2.1 million people died of AIDS in South Africa. That’s an average of nearly 500 people per day. It’s difficult to fathom such a catastrophe. By comparison it’s almost the equivalent of the 2004 Tsunami happening in just one country every year, year after year. In 2006, the worst year of the epidemic so far, over 700 people died daily.

All of the above is of course ignored by Duesberg et al. But it is well known to experts on the South African epidemic. This raises a perplexing question: who were the peer reviewers of the Duesberg et al. article? It is very unlikely that any genuine expert in AIDS statistics would have given their paper the go-ahead.

by Phillip L. Murphy

This note first appeared on a Facebook page. It is republished here with the author’s permission.

After speaking with Shannon, we decided it would be beneficial to those interested in Kim’s history to hear my own personal story.

I was diagnosed with HIV in the fall of 1984. It was my final year of undergraduate work at KU, and i was deciding whether to attend medical school. after receiving the news in a very seedy sedgwick county health department office, I was terrified, horrified and in shock. I had been in a monogomous relationship with a man for almost a year. He began to hear rumors that a man he had dated previously was “sick”. After his test results came back positive, it was my turn. Neither of us knew what to do or where to turn. In those days there was talk of quaranteening the infected in asylums or deserted islands. We were a pariahs, angels of death. From that moment on we couldn’t plan for our futures or make decisions beyond what was for dinner because we expected to drop dead at any moment. That is what was happening to those in our situation.

Randy became ill quite quickly, and had no choice but to begin the hellish drug treatments that were available at the time. I on the other hand was more fortunate in that my health remained good for more than a decade. During that time I watched as friend after friend fell from opportunistic diseases that a compromised immune system could not fight off. I felt like i had no future and just kinda twittled my life away, waiting for the end. Randy died about 4 years later, and I was alone; I thought for the rest of my short life. I saw an HIV specialist regularly. He gave me the option of going on antivirals, or waiting until i was truly sick to start. On his advice I waited and waited. In 1995 my T-cells began to plummet, and we decided it was time. New, more promising therapies were on the market, and he had every hope we could keep the virus in check. I continued with my regular check-ups and my T-cells and my overall health improved. Soon i almost forgot that i was sick. I began to have hope that maybe i could beat this, maybe I’d be the first.

After about a year of therapy, and a normal T-cell count, we decided to get off the drug therapy. They are harsh, complicated and overwhelmingly expensive. Within 6 months my T-cells were once again at an alarmingly low level and I went onto a new drug regimen that I remain on to this day, and will for the rest of my life. My T-cells remain in the normal range, I have an undetectable <0 number of virus in my blood, and remain healthy, at least physically (LOL).

I WANT EVERYONE TO READ AND UNDERSTAND. THE HIV VIRUS AND THE CONDITION CALLED AIDS IS VERY REAL, AND VERY TREATABLE.

Until i returned to Wichita in 2002 to try and save my baby sister Tricia, and re-met Kim, I had never heard of these lie-mongering denyers. Knowing Kim as a strong-willed, highly intelligent young woman, I thought it odd that Kim was so influenced by them, but I know we each have our own path. The lies they concocted, then spewed to the public is the one and only reason Kim is where she is today. PLEASE, PLEASE don’t let these lies continue to hurt and kill the ones you love and care about. Stomp the lies and the people that perpetuate them into the dirt.

Today I am in a loving and healthy relationship with the love of my life and soul-mate Mando. After nearly 16 years together he is still HIV-negative and that is because of the care of great physicians and incredible advancements in HIV therapies. My life hasn’t turned out exactly how i had planned, but I have played the cards I was dealt as best I could and so far I am winning the hand.

Please feel free to contact me about what I have said. If you have any questions I will be glad to answer, or find the answers for you. And again, if you can find the time to stop and say hi to Kim, you’ll feel better for doing it. She is still a loving, caring, and generous spirit, even if she is trapped inside an unhealthy body.

My best love to all of you.

Phillip

P.S. Forgive the typos, Mrs. Cates really did teach me better than this.

This opinion piece by Kerry Cullinan appeared on the Health-e News Service:

OPINION: Doctors call them Thabo’s children – the thousands of kids infected with HIV by their mothers at birth who still fill hospital paediatric wards, suffering from a range of debilitating infections.

When many of them were born, they did not get antiretroviral medication that could have prevented their mothers from passing HIV on to them. This was because then-president Thabo Mbeki had decided that ARVs were “toxic” and somehow less desirable than a fatal, incurable virus.

But by 2000, at the height of Mbeki’s AIDS debating society, four independent studies had shown that two ARVs, AZT and nevirapine, could cut HIV transmission from mothers to babies by up to 50%.

Also by 2000, research showed a radical change in the death patterns of South Africans with a peak in young women and men, rather than the elderly, that could only be explained by AIDS.

It is well documented that some 330,000 people died under Mbeki’s watch because his government delayed the introduction of ARVs.

What is less known is that Mbeki’s refusal to accept that AIDS was caused by a viral infection caused his government to under-fund health services at the very time that hospitals were starting to see a surge in AIDS patients. They closed nurses’ training colleges and flat-lined health budgets to save money, hastening the collapse of health services that we see today.

Yet in a series of articles published in Independent newspapers countrywide recently, Mbeki’s loyal director general, Frank Chikane, has tried to portray his former boss as a deep thinker who took a principled stance after thorough research. Chikane’s criticisms of Mbeki are mild – painting his bizarre refusal to accept that HIV causes AIDS as a bit of a public relations blunder requiring some spin-doctoring – rather than a criminally irresponsible academic obsession that caused death, suffering and hardship for hundreds of thousands of South Africa citizens who depended on their president for leadership.

Chikane constructs his defence of Mbeki on three pillars. Firstly, that Mbeki believed that ARVs (especially AZT) were “toxic” and were being foisted on poor countries by evil pharmaceutical companies. Secondly, that he was defending “the historically disadvantaged” from “racism”. Thirdly, he was defending his own right to “think independently” of Europe and the US.

According to Chikane, “there could be no disagreement about AZT’s toxicity”.

However, he fails to spell out that four trials had shown that a four-week course of AZT and a single dose of nevirapine were safe and had been able to cut mother-to-child transmission by up to half – potentially saving 150,000 of the 300,000 babies born HIV positive annually at the time.

The first of these trials was carried out in the US as early as 1994, while two others were in Thailand and the fourth in South Africa in 2000.

In any medical treatment, risk is balanced with the seriousness of the condition. Chemotherapy is not acceptable to treat a cold but it is to treat an almost incurable disease such as cancer. Ditto ARVs: there are side-effects but the side-effect of HIV is death, so the risk is justifiable.

Chikane argues that Mbeki felt South Africa was “being asked to do what no developed countries were no developed country was doing” – namely to use AZT and nevirapine, “as monotherapy rather than as a combination of drugs”.

Chikane adds that Mbeki was disturbed that the World Health Organisation (WHO) approved of the use of single-dose nevirapine to prevent mothers from passing HIV to their babies in developing countries.

He fails to mention that, at a meeting in 1999 between then health minister Nkosazana Dlamini-Zuma and the Treatment Action Campaign (TAC) two months before Mbeki became president, Dr Zuma said that price of AZT was the major barrier to introducing it to prevent mother-to-child HIV transmission.

Chikane also fails to mention that the South African Medicines Control Council (MCC), despite all manner of political contortions to rob the body of its independence from government, found in 2000 that the benefit of using ARVs to prevent mother-to-child transmission outweighed the risks.

Time and again, Chikane raises the bogeyman of big bad Pharma – the all-powerful pharmaceutical companies – as being at the forefront of the “war” against Mbeki in a bid to safeguard their profits.

Yet at a time when Mbeki could have formed a powerful alliance with organizations like the TAC to fight for cheaper ARVs, Mbeki turned on them with viciousness, accusing TAC’s Zackie Achmat of having CIA links and the TAC of being a pawn of the pharmaceutical companies!

In addition, he fails to recall that Boehringer Ingelheim, the manufacturers of nevirapine, offered the drug free to South Africa for five years – an offer spurned by government because its president believed it was poison!

Describing the attacks on Mbeki as “ferocious” and unexpected, Chikane says “we” were forced to ensure that the Cabinet had to make compromises on HIV/AIDS and Mbeki was absolved from taking responsibility. So much for leadership!

In describing Mbeki’s inner circle’s discomfort at having to confront the then-president about his position on AIDS, Chikane inadvertently reveals Mbeki’s dictatorial manner, his narcissism and his inability to accept criticism.

He tells us few “could risk” raising Mbeki’s HIV stance with the president; that Mbeki felt those who wanted him to back down were “cowards” and that “there was no one bold enough to take on this cause” than himself.

It is hard to have sympathy for such a man, let alone such a president. Nowhere is there mention of the impact of Mbeki’s bizarre views of those living with, or affected by, HIV. Nowhere is there sympathy for the current president and health minister, who are trying valiantly to address the irresponsible legacy of the Mbeki regime. Instead, all Chikane offers is puff, paranoia and conspiracy – vintage Mbeki but wholly out of touch with current reality. – Health-e News Service.

by Nathan Geffen, 28 August 2010

This is a corrected version of a position argued by the author at a debate that took place at the University of Cape Town in August 2010 about traditional and scientific medicine. Geffen is the treasurer of the Treatment Action Campaign, but this paper presents his personal views only. He is also author of the book Debunking Denialism (Jacana 2010)

Scientists can be elitist and patronising. In that way, they are no different to any other people with power, including some traditional healers and including people who defend science, like myself.

There are multiple knowledge systems. Cultural diversity, including African culture, is a valuable treasure. Traditional medicine is used by people across the world. African traditional medicine, in particular, is used by millions of people across Africa. It is therefore important to build relationships with traditional healers to ensure that their patients receive appropriate care. Many organisations, such as the Treatment Action Campaign (TAC), attempt to do this, with varying degrees of success.

However, In critiques of medicine and, on the other hand, efforts to accommodate traditional healing, humanities researchers sometimes stand accused of being relativist, i.e. promoting or implying multiple incompatible positions as being true or valid. They also sometimes stand accused of being less than forthright about the problems with traditional healing. With this in mind, I present seven frank points which I hope will inform this discussion.

1. For the most part what is true is independent of what we believe. Many cultural or traditional beliefs, despite being fiercely held, are false. This applies to all knowledge systems. The scientific method is the best way to ascertain true facts about the universe and correct the often dogmatic beliefs that we acquire via tradition. In contrast to untested traditional and cultural beliefs, scientific knowledge depends on carefully controlled and recorded observations and experiments, done according to continuously refined standards developed across the world by people with diverse races, languages, creeds and cultures. The scientific method sometimes elicits the wrong answers, but it generally corrects mistakes over time. It has greater explanatory power and is right more often than dogma or tradition.

2. Once the placebo effect is exhausted, what heals is independent of what is believed to heal. It is one thing to acknowledge that different people have different knowledge systems, but knowledge systems are often factually wrong about the treatment of human illness. Traditional healing, whether it be Western Judeo-Christian traditional methods, homeopathy, acupuncture, Chinese herbs or African traditional medicine often has a healing effect. But it is very seldom that these effects are found to be more effective than what we call placebo, which is admittedly a complex concept in need of much greater understanding. Traditional healers can also have a profound effect on the psychological health of people. For example in Debunking Delusions, I describe the profoundly beneficial effect of a visit by Busisiwe Maqungo, a woman with HIV who takes antiretrovirals, to her traditional healer.
   But there can be dire consequences of believing that something heals when it actually does not. TAC recently held a press conference in which we criticized ETV for hosting a faith-healing advertisement of a church called Christ Embassy. TAC has subsequently received many angry letters from members of this church since that press conference. We and the letter-writers have different knowledge systems. But consider this:

a. A woman with XDR TB and HIV was doing well on TB and antiretroviral treatment at a health facility in Cape Town. Her TB had smear-converted to negative.

b. But then she attended a Christ Embassy ceremony and was led to believe that she had been faith-healed. She consequently saw no need to continue taking her medicines.

c. Over a period of about a year she became ill and developed XDR TB again. She died.

d. Before she died, she transmitted XDR TB to her family members. They are now fighting for their lives.

These sad facts are true independently of how much respect we afford the knowledge system of the adherents of Christ Embassy.
In Debunking Delusions, Andile Madondile describes his visits to traditional healers which delayed him going onto antiretroviral treatment and consequently almost led to his death. As with Christ Embassy, no matter how much respect we afford the knowledge system of traditional medicine, it should be acknowledged that Andile’s story is a familiar one played out frequently in South Africa often with deadly consequences.

1. There is very little traditional medicine that works out the box (beyond placebo). Millions of dollars are spent testing traditional and herbal medicines (read Eduard Ernst and Simon Singh’s book Trick or Treatment to see how many studies have been done on acupuncture for example). In South Africa, there are researchers testing traditional medicine at the University of the Western Cape, University of Cape Town, University of Kwazulu-Natal and the Medical Research Council. Yet I know of only one traditional medicine that has been found to be effective at treating an HIV-related opportunistic infection, herpes, and even that study, published in an obscure journal, has not to my knowledge been repeated. Some traditional medicines show promise, but there have been many failures, for example African potato in people with HIV, Hoodia to control appetite, as well as mixed results with garlic.

Nevertheless many proven medicines have their roots in what we would consider natural items: Paclitaxel, an anti-cancer drug, is derived from the Pacific Yew tree. Zidovudine, the first antiretroviral, was first made using an extract from herring sperm. There are many more. But getting an effective medicine is not as simple as scraping off the bark of a yew tree or extracting sperm from a herring. A complex technological process has to be carried out to get the final beneficial medicine.

1. It is right that patients may choose, but it is not right that healers may offer whatever they choose. Choice is often poorly understood in this debate and it is used as a mantra to justify unethical behavior. Patients should have choice. Patients can choose the healing method they wish. But healers should not have unlimited choice. In fact they do not have unlimited choice in South African law or in any reasonable ethics system. We do not accept it when we are sold a dud DVD player or a car, or when we receive unsound financial advice or even when our General Practitioner fails to treat us properly. Likewise traditional healers cannot be said to have a choice in what they offer their clients. They are obligated not to do anything to their patients that will endanger their lives.

2. The economic incentives involved in traditional medicine are immense. In this debate, the economic interests of doctors and members of the pharmaceutical industry are frequently pointed out. But if you read Andile Madondile’s story in Debunking Delusions or walk around the alternative health shops in the Waterfront Craft Market or you watch who is selling traditional medicines at the Site B train station in Khayelitsha, it is clear that there’s serious money in traditional medicine as well as alternative medicine. And yet it remains largely unregulated despite the false and dangerous claims that many of these healers make and the delays in seeking appropriate treatment that they often cause.

3. There are racial misnomers in this debate. There are many high-quality African scientists working on AIDS: Peter Mugyeni, James Hakim and Paula Munderi to name a few. Yet the worst quacks I have dealt with over the last few years, who have hidden behind the paradigm of traditional medicine, have been mostly white. All cultures have traditional medicine. My culture too has its traditional medicines. Homeopathy is decidedly European in origin and complete quackery. In fact it is the romanticisation of African traditional medicine, while other forms of traditional medicine are not so much romanticized anymore at least not by academia, that suggests a racial undercurrent.

At its worst, the romanticisation of traditional medicine has been accompanied by a dangerous distorted form of African nationalism, exemplified by Thabo Mbeki, but in more recent times by Sowetan columnist Andile Mngxitama.
Natural science is empowering and socially uplifting when correctly utilised. Science is universal and to portray it as ‘western’ and not suited to some parts of Africa is like saying African children should not be taught mathematics at school. Presenting science as un-African, even if this presentation is implicit, is in fact racist.

1. Humanities courses need to teach science better. The quality of debate about medicine in the humanities indicates that graduates are not being equipped with the skills to differentiate between good science, bad science and outright nonsense. Are humanities courses teaching students basic statistics, how to read medical abstracts and articles, how medical research is carried out and how to search pubmed? It is this frequently encountered apparent lack of knowledge that undermines respect for what emanates from the humanities.

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