[DEBATE] : journal Nature takes on the denialists -- and Thabo and Manto

[MFleshman at aol.com]

from the indispensable HealthGap e-group. Nature takes on the denialists,  
with Thabo and Manto front and center.

http://www.nature.com/nm/journal/v12/n4/full/nm0406-369.html   
Editorial    


Nature Medicine 12, 369 (2006) 
doi:10.1038/nm0406-369  

Denying science

'There are non-HIV causes for every  AIDS disease; HIV has never been
properly isolated; AIDS can be treated  effectively without anti-HIV
drugs.' Such views, typical of AIDS denialists  and taken from one of
their websites, may have exited the scientific press by  the mid-1990s,
but they persist to the detriment of millions of HIV-infected  people.

These ideas have clearly had a big impact, particularly in South  Africa,
home to the largest number of HIV-positive people in the world.  AIDS
denialists there continue to spread conspiracy theories  and
misinformation to a susceptible public wary of antiretroviral  drugs.
Even more dangerously, government support of such views-tacit and,  in
some cases, open-hinders the task of getting drugs to the people  who
need them.

Activists, voters and politicians must continue to  exert pressure to
counter this onerous trend. Scientists also have a role to  play in
explaining the science behind AIDS and showing that antiretroviral  drugs
can effectively treat the disease. One group of scientists has done  just
that, launching a website  (http://www.aidstruth.org
<http://www.aidstruth.org/> ) in response to  a recent article in
Harper's Magazine that gives credence to denialist  viewpoints.

People with ill-conceived ideas calling themselves mavericks  (or in this
case, 'rethinkers') will always be among us. Still, it's  difficult to
gauge what motivates AIDS denialists to champion their views in  the face
of overwhelming evidence to the contrary. The denialists  almost
universally invoke distrust of what they call "pharma-corporate  vested
interests" and they exploit fears arising from controversies over  drug
pricing or safety. Some even claim that antiretroviral drugs  actually
cause the symptoms of AIDS.

Despite their deep distrust of  science, people who promote these views
seek scientific credibility,  repeating the tired theories of a tiny
minority of scientists who say they  are unconvinced that HIV causes
AIDS. To support their ideas, some AIDS  denialists have also
misappropriated a scientific review in Nature Medicine  which opens with
this reasonable statement, "Despite considerable advances in  HIV science
in the past 20 years, the reason why HIV-1 infection is  pathogenic is
still debated" (Nat. Med.  9, 853-860;  2003
<http://dx.doi.org/10.1038/nm0703-853> ). For the record, we think  that
the scientific evidence that HIV causes AIDS is conclusive and  that
antiretroviral drugs save lives.

Unfortunately that  knowledge-informed by years of research-has failed to
reach many in the  African-American community, a group with
disproportionately high rates of HIV  infection. According to a 2005
survey by the RAND Corporation and Oregon  State University, 53% of
African-Americans say that a cure for AIDS is being  withheld from the
poor, and 44% believe that the people who take HIV drugs  are being used
as government guinea pigs. Men who agree with such myths  report that
they are less likely to use condoms regularly.

In South  Africa, extreme ideas on antiretroviral treatment have made it
to the top.  President Thabo Mbeki is well known for recruiting
'dissident' scientists as  HIV advisors and for his vocal distrust of
antiretroviral therapy. In 1999,  he urged government ministers to
examine whether AZT is toxic and dangerous  to health by "accessing the
huge volume of information on this matter over  the internet."
Fortunately, Mbeki's overt early embrace of AIDS denialism has  been
quelled in public, partly through persuasion by scientists. Six  years
ago, 5,000 scientists signed the 'Durban Declaration,' published  in
Nature, affirming the link between HIV and AIDS.

But the health  minister of South Africa, Manto Tshabalala-Msimang,
carries on. She publicly  praises nostrums such as garlic and beetroot,
while emphasizing the side  effects of HIV drugs. She has failed to
energize the rollout of  antiretroviral drugs and has fostered an
environment where hucksters thrive  (Nat. Med.  11, 581; 2005 and Nat.
Med.  12, 6; 2006).

Chief  among these is the German salesman Matthias Rath. He blankets
communities  heavily affected by AIDS with pamphlets proclaiming that his
vitamin  treatment reverses the course of AIDS and that antiretroviral
drugs  exacerbate the disease. Msimang has not publicly refuted  Rath's
views-instead, Rath's employees were reportedly invited to  address
health officials last September. The famed activist group  Treatment
Action Campaign (TAC) and the South African Medical Association  have
together filed a lawsuit against Rath and the South African  government.
These groups aim to stop Rath from running human trials with his  pills,
which he has detailed on his website. TAC has already won a case  against
Rath, ruling that he cannot defame them as a front for  the
pharmaceutical industry.

Rath's vitamins are just one of many  unproven AIDS treatments gaining
hold in South Africa. The country, one of  the wealthiest in Africa,
could serve as a model for how to combat HIV. But  as of December, only
about 112,000 people were receiving treatment through  state
facilities-far behind the government's own targets. An estimated  500,000
of the 5.3 million HIV-infected people in the country need  treatment.

Efforts by scientists to counteract AIDS misinformation take  time away
from the very real scientific, political and economic challenges of  the
epidemic. But these efforts are necessary.

In South Africa,  overworked doctors and nurses must often coax HIV
patients into taking their  drugs. They gently explain to them that
antiretroviral therapy itself is not  poisonous, that in fact the drugs
will save their lives. For providers and  patients in South Africa and
elsewhere, AIDS denialism is not a product of  academic argument or an
oddity on the internet. For them, it's  reality.


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