The life-saving drug nevirapine has been endorsed for the prevention of mother-to-child transmission of HIV by the World Health Organisation (WHO), and its efficacy is almost universally acknowledged in the medical fraternity. Its relatively low price and simplicity of use makes it particularly suitable for developing countries. The subject of a landmark Constitutional Court judgement ordering the authorities to make it generally available, it is thought to have been administered to more than 50 000 South African women — 47 000 of them in Gauteng alone. Yet in three months, it may be banned for use in mother-to-child transmission cases. How has this absurd situation — the latest in the continuing tragicomedy surrounding Aids treatment — arisen?
Nevirapine is an anti-retroviral whose reputation for success in mother-to-child transmission cases is based on a single set of tests, conducted in Uganda, that were not originally intended to meet the stringent standards of the United States Food and Drug Administration. An application by its manufacturer, Boehringer-Ingelheim, to register it in the US for mother-to-child transmission was, therefore, rejected. Our Medicines Control Council (MCC), which originally registered the drug on the strength of the Ugandan research, has now gone the same route. It has given Boehringer-Ingelheim 90 days to supply additional data proving the drug’s safety and efficacy, failing which it will deregister nevirapine for prescription to pregnant HIV-infected women.
Those active in the Aids treatment field accused the company this week of “opportunism” and “shoddiness” in submitting paperwork that was clearly flawed. But this does not fully excuse the MCC, which has chosen to override the WHO endorsement, as well as considerable independent research confirming that the drug is safe to use and that it works. This includes a recent report by the US-based National Institute of Health, a reputable body that conducted the original Ugandan tests.
It is unlikely that there has been direct official government pressure on the MCC. But there are said to be individuals on the council who have bees in their bonnet about anti-retrovirals in general, and nevirapine in particular. Critics suggest the council has become more “sensitive” to government thinking since the coup three years ago that resulted in the axing of its chairperson, Professor Peter Folb, and its restructuring. It is certainly interesting that all the controversies in which the council has been embroiled in recent years have arisen in the HIV/Aids context, including rows over Virodene and AZT.
Aids dissidents in official circles should be careful about crowing too loudly about the threatened demise of nevirapine. To ensure the government will not be shackled to the drug if better remedies become available, the Constitutional Court ordered the provision of nevirapine or an adequate alternative in mother-to-child cases. The implication is that if nevirapine is deregistered, public health institutions will have to supply something at least as effective to pregnant mothers with HIV. That is likely to be AZT, or a cocktail including AZT, Minister of Health Manto Tshabalala-Msimang’s pet bogey. AZT is more effective than nevirapine in checking the transmission of the virus from mother to baby. But it will be expensive for the government, and more complicated to administer.
Plagiarists must be punished
It was only a few months ago that the world was aghast at the news of the plagiarism and fabrications of New York Times journalist Jayson Blair.
The paper, regarded as one of journalism’s standard-bearers, went to extraordinary lengths to right the wrong and rehabilitate itself. Besides getting rid of Blair and replacing its editor, it published a tome of an apology to its readers for all the occasions it had inadvertently misled them. The world’s media went on a feeding frenzy. Media practitioners the world over vowed to raise their guard, so as not to be duped in the same way.
The same principled ethos does not seem to apply in South Africa.
One of South Africa’s foremost columnists and a published author, Darrel Bristow-Bovey, was recently exposed for having generously borrowed from renowned writers Bill Bryson and PJ O’Rourke and passing off their prose as his own brilliant work. Both Bristow-Bovey and his publisher, Zebra Press, have responded with arrogant indignation — even threatening legal steps against those who accuse this knight of South African journalism of plagiarism.
The newspapers for whom Bristow-Bovey writes continue to publish him regardless of the seriousness — in journalistic terms — of the offence he has committed. What this says to Bristow-Bovey, and all other aspiring plagiarists, is that there is no sanction for what the entire writing fraternity regards as a cardinal sin. This can only mean that South Africans are content with inferior standards. After all, why should the media in a lowly Third World country bother about such things?
Journalists demand certain standards of politicians and other public figures, and frequently call for the heads of those found wanting. The least the reading public could have expected from Bristow-Bovey is a humble mea culpa. And from those who publish him, some form of sanction.