The source of lay belief in the causes of diseases and their treatments is the medical literature that abounds with fraudulent studies designed to affirm the safety and efficiency of drugs and surgical interventions. Medical history is punctuated with disasters resulting from drug tests and interventions of unproven safety, and with Procrustean interpretations of trials.
Statistics can provide opportunities ”to suggest different conclusions from the same basic data” according to R Lewontin and R Levin, who calculated United States population densities by two different methods. They showed by the one that average density was 59,94 persons a square mile and by the other about 3 000. They also said that in both contrast and correlational analysis ”all the real work is done by the a priori decision imported in the analysis”. An example of the misinterpretation of data was the conclusion that black South Africans have genetic susceptibility to tuberculosis, because researchers last century ignored their greater exposure to environmental risk factors like poverty, homelessness, stress and malnutrition.
The divergent epidemiologies of Aids-defining diseases in different countries and risk groups dictate the need for a departure from American and European research and treatment methods. While Kaposi’s sarcoma and other cancers have been termed Aids-defining on those continents, Kaposi’s has recently been found not to be a consequence of the HIV infection in South Africa. Here it has always been endemic but under-reported owing to once scarce health services for black South Africans. A national cancer registry became operational in 1986, four years after the advent of the Aids epidemic and eight years before earnest surveillance of the HIV epidemic began in 1994. It is limited to histologically verified cancers in South Africa, thereby previously excluding cases from apartheid’s bantustans and from the large proportion of undiagnosed and histologically unverified cases of those with little access to health facilities. Despite the inclusion of previously excluded groups, the registry’s documented incidences of many cancers declined between 1990 and 1995. Thus local associations between ”Aids-defining” cancers and Aids have been obfuscated.
Sponsorship of many medical schools and research programmes by drug companies ensures few embarrassing exposes are published and unwelcome research remains unfunded. Thus much evidence refuting studies is embargoed, and the public is persuaded to support unscientific orthodoxies propagated by the pharmaceutical industry.
While the operations of the medico-industrial complex cannot be divorced from political agendas, neither can the philosophy of science. Karl Popper, an old-fashioned rationalist widely read by non-philosophers, was a liberal philosopher of science who sought to do away with the constraints of institutions like the state. To use an incomplete argument of Popper’s (as Louis Liebenberg did in the Mail & Guardian in May this year) to castigate President Thabo Mbeki for ”wasting time on futile academic debates and get on with doing his job” (presumably making nevirapine freely available in public hospitals) is dishonest. Apart from his belief that a scientific theory could not be confirmed with any positive degree of probability, Popper also distinguished science from pseudo-science, a pursuit in which those holding to an empirical theory refuse to be deflected by observational disproof. Imre Lakatos, disagreeing with Popper’s falsification theory, substituted negotiated ”scientific success” and the notion of progress for truth. Liebenberg also suggested Mbeki read Lakatos for his enlightenment.
Another philosopher of science, Thomas Kuhn, argued: ”No part of the aim of normal science is to call forth new sorts of phenomena; indeed those that will not fit the box are often not seen at all. Nor do scientists normally aim to invent new theories and they are often intolerant of those invented by others. Instead, normal scientific research is directed to the articulation of those phenomena and theories that the paradigm already supplies.” In his Structure of Scientific Revolutions Kuhn also wrote: ”Given a paradigm, interpretation of data is central to the enterprise that explores it. But that interpretive enterprise … can only articulate a paradigm, not correct it.” Having established the paradigm through repeated circular referencing to its articulators and through suppression of opposition, the ”enterprise” can provide lucrative avenues for industry.
It is ironic that none other than Dr Robert Gallo, who co-authored the HIV causes Aids theory with Dr Luc Montagnier, and made more than a few bucks on the patented HIV test before the theory had been scientifically proven, declared at the 2002 Barcelona HIV/Aids conference that protease inhibitors (nevirapine is one) are harmful (an observation shared by Mbeki, who is called a madman for his views). Gallo added that they were likely to be switched out of drug cocktails within a few years and replaced with entry inhibitors. This could explain the urgency with which AZT and nevirapine producers dump their drugs on unwary countries whose people are mobilised by drug company representatives to demand them.
We face the danger of diverting all our resources to anti-retroviral treatment of HIV at the cost of interventions in and preventative measures for all other diseases including opportunistic infections, endemic diseases and complications that may arise in the first place from anti-retroviral therapies.
The time has come for uncensored access to unexpurgated research texts, raw data and contextualised theories and philosophies if we lay people are not to be missed by self-seeking medico-industrialists, scientists and philosophers.
Cara Jeppe is a research assistant in the department of surgery at Chris Hani Baragwanath hospital