science
David Le Page
Aids has attacked the intellectual resources of sections of the body politic as successfully as it has assaulted the immune systems of many South Africans.
The heart of the problem appears to be a profound misunderstanding on the part of the president, successive health ministers and their immediate advisers of the nature of science, how it advances and how to make use of its insights.
Several debacles reflect these misunderstandings, the first being the Virodene affair. A Pretoria company invented this so-called treatment based on a dry-cleaning solvent. Exhilarated by a presentation to the Cabinet on the drug’s purported wonders, then deputy president Thabo Mbeki and then health minister Nkosazana Dlamini-Zuma threw their weight behind the researchers.
When the Medicines Control Council (MCC), which regulates trials of new and untested drugs, rejected the proposals for Virodene trials, Mbeki attacked it furiously. He accused the body of denying Aids sufferers “mercy treatment”. The African National Congress accused the MCC of “censoring” research and protecting vested pharmaceutical interests.
The affair culminated in Dlamini-Zuma’s dismissal of two of the MCC’s top officials, both later reinstated by the Commission for Conciliation, Mediation and Arbitration.
Another continuing controversy is the Department of Health’s refusal to fund the anti-retroviral drug AZT for pregnant women in an effort to stem mother-to- child transmission.
As long as the argument against using AZT was couched in terms of how best to make use of existing resources, it left science unscarred. But forced on to the defensive by attacks on the policy, the government has turned to attacking the very science behind AZT. In November, Mbeki declared that AZT is dangerous. His health minister, Manto Tshabalala-Msimang, said that AZT produces congenital defects in babies.
These notions are at odds not just with international knowledge and practice but with local experience.
Researchers at the UNAids programme in Geneva, and at Chris Hani Baragwanath and King Edwards hospitals, to name but a few, have plentiful evidence suggesting that AZT is the state of the art in preventing mother-to-child transmission, with benefits outweighing known risks.
What are the scientific missteps and mistakes demonstrated by these events?
One was the failure of the Virodene researchers to have submitted their research for peer review. Any new scientific discovery must be replicable. Different researchers in different places must achieve through trials or experiments the same results. And however excited individual scientists may be about their results, they know a lengthy intellectual and experimental battle usually precedes the acceptance of those results.
This is why ground-breaking research usually takes decades to attract Nobel prizes.
In the case of AZT, the misstep is the government’s obstinate refusal to credit the scientific consensus as being reasonable.
Now another mistake appears to be unfolding, as the Department of Health announces its intention to form a new committee of “international experts”, reportedly for the purpose of re-evaluating the evidence that HIV causes Aids.
Mbeki is said to be about to lobby everyone from Bill Clinton to Tony Blair for “a new look” at Aids science.
The implied suggestion that scientists are not, as an international community, continually re-examining and assessing Aids treatments, biology and theories, risks making South Africa seem the scientific equivalent of the North Korean polity.
According to David Sapire, a Wits academic who teaches the philosophy of science, “the operation of a committee in science can be either good or bad or indifferent.”
But scientific committees do not establish scientific truth. “Certainly, they couldn’t sit down and take a vote on the issue,” said Sapire.
At the most, they could establish a research group, which could then come up with its own conclusions. Even then, those conclusions would be subject to peer review.
“If the purpose [of the committee] is to reassess the science of Aids, it’s the last thing we need in South Africa at the moment”, says Mark Heywood of the Aids Law Project.
Heywood argues that scientists should rather be enlisted to assist with leveraging existing Aids know-how: “We’re probably acting on 5% of our knowledge of Aids. We don’t need to be creating new academic discourses. Why isn’t anybody objectively sifting the results that we have, in order to formulate a sensible policy?”
“If they appoint the accepted leaders in HIV research, what do they expect them to do? Do their research all over again?” asks Sapire.
The disregard for science and scientists appeared yet again at the end of January, when a national Aids council was appointed – without including any conventional medical experts (though two traditional healers made the grade).
Sapire points out that if the government’s new scientific committee conducted its own research, it “might not get the answer it wants”.
“They’re looking for shortcuts, and therefore willing to rubbish the views of the scientific community. With AZT, they’re once again trying to create a red herring, trying to get away from the costs,” says Heywood.
This is the heart of the problem: the government wants particular answers to the Aids problem. Accustomed to political answers that can be negotiated and economic answers that can be argued till the cows come home, it is affronted when science cannot play ball.