Saturday August 26th, 2006
What happens if you transplant western ideas like nutritionism, and anti-vaccination panics, into a developing world context? Unfortunately thatâ€™s not a thought experiment. Between 600 and 800 people die every day in South Africa from HIV/AIDS, and their government was roundly criticised at last weeks International AIDS conference in Toronto.
Everyone knows that the South African government is headed by a longstanding denialist of the link between HIV and AIDS, Thabo Mbeki, who held back anti-retroviral treatment for many years; but less well known is the fact that his health minster, Tshabalala-Msimang, is also a staunch advocate for weekend glossy magazine-style nutritionism, an ardent critic of medical drugs, and a close associate of a controversial vitamin salesman.
South Africaâ€™s stand at the conference was described by delegates as the â€œsalad stallâ€, and consisted of some garlic, some beetroot, the African potato, and other vegetable action. Some boxes of anti-retroviral drugs were added, but these were apparently borrowed, from conference delegates.
Interviewed on SABC about this, the health minister came out with exactly the kind of thing youâ€™d expect to hear at any North London dinner party discussion on alternative therapies (only not in the context of one death every 2 minutes). First she was asked about work from the University of Stellenbosch, suggesting that African Potato might be positively dangerous for people on AIDS drugs.
Hereâ€™s some quick background to make the punchline funnier: one study had to be terminated prematurely, because most of the HIV positive patients who received the plant extract showed severe bone marrow suppression and a drop in their CD4 cell count (this is a bad thing) after 8 weeks. When African Potato extract was given to cats with the excellently uncuddly â€œFeline Immunodeficiency Virusâ€, they too succumbed to full blown Feline AIDS, faster than their non-treated controls.
But Tshabalala-Msimang disagreed: the researchers should go back to the drawing board, and investigate properly, she said. HIV positive people who used African potato had shown improvement, and they had said so themselves. Is this line of argument sounding familiar? Why, she demanded, if a person said he or she was feeling better, should this be disputed, merely because it had not been proved scientifically? â€œWhen a person says she or he is feeling better, I must say no, I donâ€™t think you are feeling better? I must rather go and do science on you?â€ Asked whether there should be a scientific basis to her views, she replied: â€œWhose science?â€ Perhaps you have had similar arguments at parties yourself. I have, but I have never had them with a health minister.
Meanwhile polio, which has almost been completely eradicated – throughout the world – thanks to an inspiring vaccination program, is endemic in Nigeria. The reason for this is that in 2003, imams in the North of the country decided that polio vaccine was part of a US plot to spread AIDS and infertility in the Islamic world, and imposed a ban. (These beliefs will seem entirely reasonable to you if you live in North London and have children of the right age for MMR.) In 2005 there were unexpected new outbreaks of polio in Yemen and Indonesia: both were caused by poliovirus strains that originated in Nigeria.
And before you get too smug about being Western, letâ€™s just remember that we all have our own weird cultural idiosyncracies that prevent us taking up sensible public health programs. There is a good evidence base to show that needle exchange programs reduce the spread of HIV, for example: but you try telling that to the Americans, and theyâ€™ll â€œJust Say No!â€ With that cold, pious stare.
You couldnâ€™t express it in less than a lecture series, but thereâ€™s something incredibly interesting and complicated going on here â€“ something to do with religion, reactions against imperialism, cultural relativism, denial, decadence, exploitation, irrationality, and, somewhere, science. But as to what that something is, youâ€™ll have to make your own mind up.