Archive for the ‘science’ Category

Science has lost a friend in Parliament – goodbye to Ian Gibson

August 1, 2009

In which Dr Aust mutters darkly about “real world experience” (are Universities the real world?  I always rather hoped not) and laments the loss of one of the few MPs who actually knew anything about science and Universities. Plus some “University Finance 101″.

Before Conservative Party Leader “Call me Dave” Cameron got into a bit of rather inconsequential bother over his use of a naughty word on the radio this week, he and his chums had presumably spent last weekend celebrating. This was, of course, because on Friday 24th July a 27-year-old Management Consultant and Tory Bright Young Thing named Chloe Smith was elected as the new MP for Norwich North, overturning a decent-sized Labour majority.

There are several ironies about this victory. One that amused me was Ms Smith being quoted as saying that she considers it important for MPs to have “experience of the real world”.

While I wholeheartedly agree with the sentiment as quoted, it is slightly undercut for me by her bio, as printed in various newspapers. Judging from this her short-ish employment history consists of several stints as researcher or assistant to various Tory MPs – and, of course, of being a Management Consultant. She has been working, we were told, for Deloitte, though it emerged during the by-election campaign that she was on secondment to a Tory “Implementation Unit”. This is apparently the set-up which is trying to work out how Call Me Dave and his chaps and chap-ettes will run Britain after the next general election.

The whole idea of which fills me with deep foreboding.

Chloe Smith’s bio reminds me somewhat of that earlier Conservative meteor, former teenage Party Conference speaker and later Tory Leader William Hague. Though William had clearly been training to be a politician since he was barely out of short trousers, he did fit in a few years of management consultancy before he became a youthful MP at the age of 28.

Now, from the tone of the above you may have gathered, if you didn’t already know, that Dr Aust is an ageing leftie. But politics is not really the point of this post. And it is a truism of modern life in the UK that the baffling enthusiasm for Management Consultants transcends political affiliation, at least if one is talking about the major parties. The Consultants are all over the Health Service too, to the profound dislike of pretty much every doctor I know. Even Universities have a worrying tendency to call in the Consultants, though in academia the slight saving grace is that Universities are too hard-up – or at least penny-pinching – to splash out the kind of vast amounts that the NHS burns on the suits from McKinsey, PricewaterhouseCoopers, Deloitte & co.

The brightest and the best – errrm….

Of course, one is frequently told that Management Consultants, a bit like lawyers, are the brightest and the best, ultra-high-flyers and intellectual stars etc. etc. All of which may indeed be true. I actually know several Consultants, but not enough to tempt me to a nice glib generalization.

However, I do struggle to think of several years of political wonk-ery, and a brief-ish stretch serving the Consultancy cult, as being “experience of the real world”.  No matter how bright the person getting the experience is.

“Experience of the real world”, in my Grumpy Old Man’s view, comes of having done a job long enough to have some idea of what it is really like to do it – preferably as both an inexperienced and an experienced person, and at several levels of the hierarchy. In my view, you need to have put in some meaningful time in a business, or sector – earned your experience from the inside – to speak about it with any real authority or knowledge.

Which brings me to the main subject of this post, or at least the first part of it – the now ex-MP for Norwich North, scientist and trade unionist Ian Gibson.

i_gibson

Ian Gibson was that rarity in modern British politics – someone who became an MP comparatively late in life, having actually worked his way through a full career in something first. In Gibson’s case, the career was biological science; he did a B.Sc. and Ph.D. in genetics in Edinburgh, and post-doc work in the US, before going to work at the then new University of East Anglia in 1965. Gibson rose through the ranks at UEA to eventually become Dean of Biological Sciences from 1991 until 1997, when he was elected as an MP at the age of 59.

Gibson stayed a back bencher during his twelve years in parliament, generally characterized as an “Old Labour” type figure, becoming a notable scientific voice in the Commons. He was a member of the Science and Technology Select Committee for many years, and its influential Chairman from 2001 to 2005. The Committee contained most of the (few) MPs who had any first-hand knowledge of science, plus some others who were at least interested. The Committee was abolished in 2005, something which conspiracy theorists – possibly including Gibson himself – have been known to attribute to Government annoyance at the Committee’s tendency, under Gibson’s leadership, to point out when the Government was doing something that the committee did not believe was the best thing for science.

Gibson’s downfall was the MPs’ expenses scandal. Rather curiously, however, he is the only MP so far to actually resign over expenses. His misdeed was not all that untypical, but arguably less egregious than some. No moats, tennis courts, mortgage claims for already-sold flats, or claims for 3rd homes in the country. Gibson had claimed on expenses the mortgage costs of a London flat where he admitted he only lived for three days a week, a flat that he later sold to his daughter at well below the market rate.

Gibson was deselected (barred from standing again as an MP) by a national Labour Party “Star Chamber” disciplinary committee. Four other Labour MPs “convicted” by the Star Chamber mechanism had already stated they would not stand again; they thus remain in office until the next General Election. Gibson, in contrast, had stated his intention to stand again, unless the local Labour party in Norwich North did not want him to. However, they did not get a chance to say yea or nay, as the national Labour party barred Gibson from being a candidate.

The decision was, according to most observers, highly unpopular with Gibson’s constituents in Norwich North, where he was well-liked as an “activist” MP. During the by-election campaign the Financial Times quoted some of them, noting:

“All six mothers [who spoke to the FT] said they would have voted for Ian Gibson, the outgoing Labour MP, had he run as an independent – even though the by-election was triggered by Labour disciplining Mr Gibson over his expenses.”

Similarly, the politics.co.uk website, in a story entitled

“Gibson’s ghost haunts Norwich North”

- quoted another of Gibson’s constituents as follows:

“He’s been tremendous in this area for us, for our community, all the way, Everybody’s been doing it [i.e. over-claiming on their expenses]. So why aren’t the guys at the top being hung out the same as Ian Gibson? It’s a tragedy, what’s happened to him.”

Now, the remark about “the guys at the top” is interesting, since it re-iterates an earlier point about Gibson. Despite his scientific background, both as scientist and “science manager”, and a knowledge of both science and higher education probably unsurpassed among Members of the Commons, Gibson never made it to even the lowest rung of Junior Ministerial Office. If you wonder why, Gibson’s own webpage bio offers a clue:

“During my time in Parliament, I have acquired the reputation of a rebel.”

Gibson was not really a part of New Labour, and indeed not really a part of the modern British  “political class”, which seems to be characterized, in the major parties, by people who have been training to be professional politicians since their early teens. Indeed, most political commentators – see e.g. the Guardian’s Polly Toynbee here – interpreted Gibson’s fate as his being thrown to the wolves  largely because he was not part of the clique.

And this returns us to the reason why Gibson was very popular among rank and file scientists, especially in the Universities.

He was one of us.

As in – a bit of a grumpy bugger, but someone who was passionate about his beliefs, whether in science or in politics. A bloke who was prepared to distinguish between what was important, and what the Government of the day was telling various biddable journalists was important. A paid-up member of the awkward squad, not an on-message apparatchik.

Thus, when the Blair or Brown Government could be heard telling you how very much they valued research, or how much new money they had put into the Research Councils, Gibson could generally be relied on to deconvolute the bullshit and give a more realistic verdict.

He was also an old trade unionist at heart, interested in hearing from people who wanted to tell him what was really going on at the grass roots in the science base and the Universities – notably about the ways in which career progression had become problematic for many 20- and 30-somethings stuck in the postdoc ghetto, and (not entirely unrelated) the many ways that the Research Assessment Exercise had distorted the system. I personally know two people who had significant exchanges with Gibson on these kind of topics.

Gibson did not always articulate the views of “the academy”, of course – he was and is his own man, with his own views. Notably, he continued to campaign against students having to pay “top up fees”, something most academics had reluctantly concluded was unavoidable if British Universities were to be put on some kind of sustainable financial footing.

But even when you disagreed with Gibson’s views, at least you knew they stemmed from a belief in, and a lifetime’s experience of, the University system, and science, and the opportunities that both offered people.

But anyway, now Gibson is gone from the House of Commons, and science has lost a real friend and champion in the House. He will be missed. Though I would not be altogether surprised to see him re-emerge as the head of some scientific Think-tank or perhaps even as a  University Vice Chancellor.

Meanwhile, at a University near you… cuts are coming

In an odd coincidence, the Norwich North by-election results appeared the very same day as this story on the BBC Education site:

———————————————————————-

University teaching cut by £65m

Funding for teaching at England’s universities is being cut by 1.36% next year to save £65m.

Every university is affected by the revised grant allocations from the funding council (Hefce).

But the biggest cuts are at those with the most students: £2.5m at the OU (Open University), £1.4m at Manchester, £1.2m at Leeds.

Unions reacted angrily but the Department for Business, Innovation and Skills (Bis) said the sector had to tighten its belt like everyone else.

The University and College Union (UCU) said the £65m would equate to the loss of a further 1,500 full time lecturing and support staff, days after it had complained at nearly 6,000 cuts affecting 100,000 students.

‘Disgraceful’

UCU general secretary Sally Hunt said this was just the first wave of likely new cuts.

“What kind of message does this send out to future generations of educators?

“It seems absurd that in a week when the government has done so much soul searching over widening participation that it is putting up new barriers for people wishing to study.”

———————————————————————————————————–

Now, you might thing that the £ 65 M saved is a drop in the bucket compared with the billions and billionsthat have gone into bailing out the banks. Especially given that the banks caused the crisis.

You might think.

Meanwhile, of course, the Government was busy elsewhere congratulating itself for this:

——————————————————————————————————

The government says there will be 10,000 more university places in England this autumn, mainly in maths, science, technology and engineering.

The extra places will be allocated by the higher education funding council in consultation with universities.

They will be part-funded: universities will get students’ tuition fees but not grants for teaching and other support.

Funding is from existing budgets and in part by cutting student loan repayment holidays from five years to two.

————————————————————————————————–

The BBC story, unlikely most of the feeble newspaper stories that covered the extra places when the announcement was made, correctly noted that the Govt was basically inviting Universities to take these students on while receiving only 30-40% of the normal funding level “per student”.

University Finance 101

For those not familiar with the numbers, let me spell it out.

For each UK student my (biological science) faculty taught we received, last year:

£ 3,145 a year from the student (the so-called “top-up fee”).

£ 6,710 a year from the Government (the standard subsidy for lab–based sciences).

Thus a total of nearly £ 10 K per student per year (the Govt figure, often referred to as HEFCE teaching income, is explained clearly here).

If we take on extra students under the Government’s grandiosely titled “10, 000 extra places” scheme, we will be taking those students at an (effective} fee of £ 3,145 each – less than a third of the standard rate.

Given the cuts in teaching funding, I would suggest that Universities will not be taking the extra students unless they are expecting major difficulties  in balancing the budget otherwise.

Now, if you are as cynical as me about politicians, you might think that is just the point. The Government cuts the teaching funding allocation – the cuts were trailed a couple of months ago – and waits for the message to filter through that the Universities are going to be up against it financially.

Then it says “But you CAN take extra students, of course – for a third of the rate you normally get, and at a net saving to us of several thousand pounds a student”.

All Universities are equal – but some are more equal than others

Not all Universities are equal in this, although the % cut in funding for teaching students is the same across the sector.

Although the headline “reductions in teaching funding” are mostly biggest for the research-intensive Universities, which typically also have a lot of students, they are not the institutions likeliest to be facing melt-down. After all, even though they are losing the most income, these are also the institutions with the biggest budgets, the largest reserves, with their choice of students (that is, courses are far more likely to be full than “lower down” the sector), and with the most money from NON-teaching sources.

Meanwhile, it is in the less research intensive and “post-92” Universities that I expect the cut to be felt the hardest. These are often smaller institutions, and ones where teaching accounts for most of income. In addition, filling courses is sometimes problematic.

Of course, the Govt has cynically given them a partial solution to the budget problems produced by the cut; if you are facing a loss of £ 0.6 M from the cut, as many of the post-92 Universities are, you can rebalance your budget by taking 200 extra students with NO Govt funding – because each student will be ponying up three grand plus. Well, you can take these students if you can find them, that is.

Note that you will not be able to hire any extra staff to teach them – not without spending money you haven’t got – but at least the £ 3 K per student will mean you don’t necessarily have to sack anyone. Unless you want to. But all your staff will be working harder, and teaching more students, quite possibly in larger classes. And necessarily having less time to do research and other stuff.

What a tremendous bargain.

It will also not have escaped the notice of most people that a further effect of all these cuts will be to push the post-92 and other less research-intensive Universities a bit further towards being teaching-only institutions for science degree subjects. Which many science academics think is what all UK Govts have wanted, at least since the Thatcher years.

Now, I like to think that, if Ian Gibson were still in the Commons, and sitting on the Innovation, Universities, Science and Skills Committee (as it is now called), he would call all this the hypocritical piece of Realpolitik wrapped in spin that it really is.

I shall be interested to see if any of the current crop have the guts.

————————————————————————–

Instant Update:

Since I originally wrote most of the above some time last weekend, we have actually heard which Universities are going to take the extra 10,000 students. Surprise surprise – or rather, “no surprise at all” – Oxford and Cambridge, and most of the Russell Group, said they would not be taking any extra students, thank you.

Various noises were made about “quality of the education experience being sacrosanct”. Which is good to hear, don’t get me wrong.

Though another way to put this is that these Universities simply don’t need the money enough to be prepared to take extra students for 30% of the usual “rate per head”. The list of who is taking the students shows, entirely predictably, a heavy slant towards the post-92 institutions (the full list is linked from this article).

The future is online… but not necessarily open

March 19, 2009

No Bad Science today. Instead Dr Aust is grumbling about non-open access journal archives

Learned journals in the sciences have worked out that the future is online. Well, they have worked out that the present is already pretty much all online, and the future is likely to be more so, possibly exclusively.

And now, even the past is mostly online.

By which I mean that journals are digitizing their back issues and generating online PDF archives of their historic content.

Some journals, laudably, are putting this stuff online for free. The Journal of Physiology is an example. You can read every paper more than a year old ever published in the Journal of Physiology (in the somewhat unlikely event that you should wish to), right back to issue 1 from March 1878.

jp-covers_

Other journals, less laudably, are putting all the back issue content behind paywalls.

I say “journals”, BTW, but I should really say “publishers”. Most scientific societies that own journals feel that published papers should be open access, though many embargo access for the first six months to a year after publication. This is so that their journal can turn a profit for the society via subscription sales to academic libraries. Many of the older academic science journals are owned by learned societies; for instance the Physiological Society owns the Journal of Physiology and Experimental Physiology, the American Physiological Society owns the American Journal of Physiology stable of journals, and the American Society for Biochemistry and Molecular Biology owns the Journal of Biological Chemistry. I mention these journals in particular because they are the ones I have published stuff in the most often.

It should be said that most of the money generated by the journal goes to fund the activity of the learned society.  So the Physiological Society’s journal profits go to subsidise scientific meetings in physiology, to provide travel grants for scientists to visit other labs or attend conferences, to help support Ph.D. students, to provide small prizes for top-ranking undergraduate students doing B.Sc. Physiology degrees, and similar sorts of stuff.

Publishers who own journals behave a little differently. They want your money. And not just for looking at the new research – some want it if you look at the back numbers.

This can lead to some interesting side-effects.

For instance, just yesterday Dr Aust noticed that a review he and one of his students wrote a decade-plus back has now appeared online.

“First published online Feb 5th 2009″, it says.

Now, Dr Aust thought it might be nice to have a PDF copy of this article. It was hardly a ground-breaking review, rather a methodological introduction to something. It has been cited only a less than impressive three (!) times, and one of those times was by me.

But…it tried to be clearly written and instructional. Though it is now obviously rather dated, it would still probably make a useful primer for final year undergraduate project students, and starting Ph.D. students, in the lab, since it takes them through the principles underlying the way we analyse a lot of our experimental data.

Now, another reason for getting the PDF is that Dr Aust, probably like a good few other academics, collects PDF versions of his published papers. Yes, deeply sad, I know, but there you go. And it was the first review article I ever wrote.

Finally, Dr Aust has a soft spot for this article because I wrote most of it at my mate Phil’s house in Sydney, Australia, while on a sort of half-working holiday. I would write for two or three hours in the morning and then catch the train in from the North Shore and mooch off around Sydney harbour with a sandwich and a ginger beer. After a leisurely afternoon’s pottering I would join Dr Phil down at Sydney Uni for a couple of after-work cold ones – or perhaps a trip to the Thai or Chinese supermarket, or the Sydney fishmarket, to gather some choice ingredients (Dr Aust’s mate was a a bit of a gourmet amateur chef in those days).

Anyway, I clicked the link to see the full PDF version of the article.

No joy. Access denied.

Dr Aust’s University, it turns out, does not have a subscription to the journal in question. And without a subscription, the content is paywalled. Even stuff from back in 1997.

I can, apparently, get the article for a mere 30 US Dollars.

The slight paradox of my own words being online, but me not being able to read them, has its ironic aspects. But it does seem a bit of a cheek.

After all, I didn’t get paid by the publisher for the article. Nor did my student sidekick who co-authored it. A government agency (a Research Council) was funding his Ph.D. The lab was funded at the time by the Wellcome Trust. And Dr Aust’s trip to Australia (and to a conference in Japan) was being part-funded by a Royal Society travel grant.

So ALL these folks would have had a legitimate claim to have supported the writing of the article. as, of course, would the “red brick” University that was paying, and still pays, Dr Aust’s salary.

In contrast, Karger, the publisher, definitely weren’t paying anything for anything. They got the content for the journal for nothing.

And they are the ones now selling the article for 30 bucks a pop.

Now, I suppose this meets some business model, though I reckon the chance of anyone paying 30 dollars for this article is nil. Let’s face it, if I’m not going to, you had better believe no-one else is.

It is also, I think, short-sighted, because it virtually ensures that the journal will get cited less often

Why? Well, consider the following. Suppose a scientist needs to cite a reference for something in a paper s/he is writing (say, a description of a  method of analysis). They will be looking for a reference to cite. This might be the paper where they read about the method, or it might be something else on similar lines that describes the method particularly clearly.

Let’s suppose out hypothetical scientist finds two possible references s/he could cite.

It is fairly obvious to me that if one of these is free to read online, accessible from your desk or home computer – while the other is paywalled and would require a trip to the library stacks or the coughing up of 30 dollars – that you will be far more likely to cite the one you can read.

So somehow, I don’t think that Dr Aust’s little review is going to get cited any more than the three times it has already. A shame, really.

And I still don’t have my PDF.

[BPSDB]

Mothers, HIV tests, consent and choices

December 30, 2008

Dr Aust and the family Aust live in a decent sized city in the North of England. As cities tend to, this one has a good share of urban poverty.

A few years back we were discussing how to incorporate a ”learning outcome” (yuck) into Dr Aust’s bit of the University’s medical degree that would point the med students to think a bit about diseases associated with poverty in the UK. As part of this, Dr Aust asked all his clinician mates what medical conditions they would think of as being most strongly associated with poverty.

The two answers, pretty much universally, were “Anything caused by smoking” and “Anything caused by substance abuse, and particularly by intravenous drug use”.

Mrs Dr Aust at the sharp end

Mrs Dr Aust spent several of her years in general medicine (Internal Medicine to US readers) at our big local University hospital that serves some of the more deprived bits of the city. So she became well-acquainted with the full spectrum of disease associated with intravenous (IV) drug (ab)use.

Over these years, one thing she used to have to do reasonably regularly was to try and persuade pregnant women who had histories of IV drug use to get tested for HIV. This would usually happen when these women had turned up on the medical wards having been admitted to the hospital for some other health problem associated with their drug-taking.

Now, you cannot compel a pregnant woman to have an HIV test1. But you would very much like to know whether the mother-to-be is HIV positive, both so that she can get appropriate antiviral treatment for herself, and also to reduce the risk of her transmitting the virus to her child.

But I repeat – you cannot compel the mother to get tested. Indeed, this is one of those potted scenarios we might use for getting the medical students to explore the ethical issues relating to ”patient autonomy”. It would clearly be in the best interests of the unborn child – or foetus, if you prefer – for the mother’s HIV status to be determined. But it is the mother that is the patient – not the foetus she is carrying. And there may be reasons why someone who is at a high risk of becoming HIV positive does NOT want to know if they actually are. Who wants to be given the news that they have a potentially fatal disease? Not everybody does. Some would rather not know.

Obviously this is a potentially difficult scenario for doctor and patient. The doctor wants the patient to get tested, as medically speaking it would be in the patient’s best interests. The patient refuses. And the decision is potentially damaging, not just to the patient, but also to the foetus the patient is carrying.

However: Mrs Dr Aust says that in several years of dealing with such cases, she never had a case where, once the facts were explained to her, the mother-to-be did not decide to get tested for HIV.

The reason?  The much improved chance that the baby will be born HIV-free if a mother who is HIV positive gets the appropriate medical treatment, notably with anti-retroviral drugs. Whatever the pregnant woman’s feelings about how much she did, or didn’t, want to know her own HIV status, it was the implications for the baby that were the clincher, every time.

So what prompted me to remember this story today?

One reason is that I have been writing recently about HIV, and the disastrous effects in South Africa of the Mbeki government’s AIDS denialism – including with respect to mother-to-child transmission of HIV.

A second reason is that back in July Mrs Dr Aust and I became the parents of Baby Aust, our second child. Mrs Dr Aust opted for the routine HIV test (again). Baby Aust did not, as it happens, have the easiest time in the womb. All turned out well in the end, but suffice to say it was not the most stress-free pregnancy one could imagine. So our feeling on being presented with a healthy baby boy was one of overwhelming relief, as well as happiness.

But the third reason for writing this, and the decisive one, is that just today the news has hit the networks and the Blogosphere that prominent HIV positive mother and “Rethinking AIDS” activist Christine Maggiore has died of pneumonia, aged 52, in Los Angeles.

Read Maggiore’s story, and see what you think.

(Orac also has a post here)

[BPSDB]

  1. For those interested in current UK health policy on HIV testing in ante-natal clinics there is a leaflet (PDF), now fairly old, here. Many antenatal clinics (and certainly our local ones) offer pregnant women HIV testing as a routine prenatal screening test (i.e. offered to everyone as a matter of course), along with Hepatitis B and C and syphilis. Women can still refuse the HIV test, but the hope is that relatively few do. This kind of approach was designed specifically to reduce the numbers of pregnant women with HIV whose HIV status is not known before delivery.

The Tragic Human Cost of Political Idiocy and AIDS Pseudoscience

December 13, 2008

In which Dr Aust ruminates somewhat unoriginally on the desperate consequences of delusional thinking about medicine… when the deluded are the people running the country.

Somewhat submerged under the media storm over the Bombay terrorist attacks, last month saw the publication of a sobering estimate of the true human cost of the Mbeki government’s decade of incomprehensible HIV denialism in South Africa. The Guardian covered the story here.

The basic history is no doubt well known to most readers in the Badscience blogosphere; as the millenium dawned, South Africa faced an unprecendented AIDS crisis, with 10% of the population infected with HIV. However, seemingly enchanted by the claims of maverick scientists like Peter Duesberg, President Thabo Mbeki and his government decided to pursue a policy based on the view that HIV was not the cause of AIDS. They therefore failed to implement programmes of treatment with antiretroviral drugs – the drugs that had transformed the prognosis of HIV-positive patients in other parts of the world in the late 90s.

They continued with this policy as yet more scientific evidence accumulated that HIV was the cause of AIDS.

They continued as HIV-positive people in many other countries had their death sentences stayed by antiretroviral therapy.

They continued even when the cost of the antiretroviral drugs tumbled, and when global schemes were set up to fund the treatment programmes.

They continued even though studies showed antiretroviral treatment was cost effective in South Africa.

And they continued even when South Africa’s poorer regional neighbours, like Botswana and Namibia, managed to implement treatment programmes.

The authors of the recent estimate summarise some of the timeline in a handy diagram:

hiv-timeline

To see the original,  go to the paper, click the “Full text” link, then “Fig. 1″, and finally click the figure itself to get an enlarged version – or, when you reach the full version of the paper, click “View full-size inline images”.

Among the things the Mbeki government failed to do was implement programmes to treat HIV-positive pregnant women. An untreated HIV-positive woman has around a 25% chance of passing HIV on to her child during childbirth. With antiretroviral therapy, that transmission risk can be reduced to around 10% in developing world settings with vaginal delivery, or even to only a few per cent in some recent studies (for a medical review of some recent trials see here, or the Cochrane summary here). This is not enough on its own, sadly, as breast feeding can also pass on the virus – but it is a start. Around half to two-thirds of children who acquire HIV from their mothers in the developing world do so during delivery.


Estimating the true cost in lives

The stories that appeared last month centred round a new analysis, by a group of workers from the Harvard School of Public Health, that estimated how many lives the Mbeki regime’s failure had cost. They did this by assuming that South Africa could have achieved something approaching the kind of treatment coverage and results that proved possible in neighbouring Botswana and Namibia, countries with similar social and infrastructure “contexts”.

The authors estimate – and they make clear that their estimates are “conservative”, so likely to be on the low side – that each year from 2000 to 2005, about 7000 HIV-positive babies were born in South Africa who could have been born virus-free had their mothers been treated.

They also estimate that around a third of a million people in all died unnecessarily over these five years. People who might have lived had they got timely treatment with antiretroviral medication.

The terrible effects of this death toll, of course, go beyond the lives of those lost. In the Introduction of their paper, the authors note that:

Approximately 1.2 million children [in South Africa] younger than 17 years have lost one or both parents due to the [HIV/AIDS] epidemic”.

So what caused the Mbeki Government’s disastrousfailure? The authors of the study discuss one salient issue, that of the cost of the antiretroviral drugs, and conclude that this cannot account for the South African government’s actions. They could have afforded the programme, as their poorer neighbours ultimately did. The cost of the drugs has dropped dramatically over the last decade, largely due to pressure on the pharmaceutical companies from activists and campaigners – the real heroes of the hour – as well as from governments, NGOs and charities. So cost alone was unlikely to have been the decisive issue.

The South African government also chose to convince itself that the scientific consensus that HIV caused AIDS was uncertain.

One vehicle for this was Mbeki’s notorious Presidential Advisory Panel on AIDS in 2000. The Panel included Peter Duesberg and a bunch of other “HIV sceptics”, like Harvey Bialy and David Rasnick (the latter now seems to have fetched up working for the Dr Rath Health Foundation in South Africa).

As the British Medical Journal noted at the time:

“At least half of the Presidential Advisory Panel on AIDS, as the group is now known, are scientists and doctors who have disputed the orthodox views on AIDS. Many of these do not believe HIV causes AIDS.”

Unsurprisingly, the Panel rapidly split into two distinct groups; those who believed HIV was the cause of AIDS, and recommended rapid institution of retroviral treatment programmes along with public health measures; and those, like Duesberg, who denounced the HIV hypothesis and recommended (largely) public health measures alone. The Panel’s report, which can still be found online in full here (warning! – 1 MB PDF), makes bizarre reading; it is really two reports in one.

What appears nowhere in the report is any hint that the HIV sceptics, who were well represented and even in a majority on the Panel, were representative of a tiny – if vocal – minority of the scientists and doctors studying AIDS worldwide.

In a recent editorial, entitled “The Cost of Silence?” Nature suggests that the mainstream scientists and doctors might have done better to have refused to serve on the Mbeki Advisory Panel at all. Their participation, Nature says, led to the appearance in the Panel’s deliberations that there was a real scientific issue to be argued. The Panel’s report, in turn, presented this “dichotomy of views” – when really there was a massive preponderance of evidence, and expert views, on one side, and a lot of evidence-free fringe theorizing on the other. This appearance of an undecided issue gave the Mbeki government the fig-leaf it needed to state that the issue was still contested, and to stall on antiretroviral therapy programmes. While Nature does not state outright that it thinks the South African government had already made up its mind when it set up the Panel, the implication is clear.

Reading the Advisory Panel report, one can perhaps catch glimpses of why the “HIV is not the cause” case might chime with the thinking of some populist politicians. Since they had decided HIV was not the agent causing the AIDS epidemic, the “HIV sceptics” could instead call for progress on a long list of the kinds of things dear to politicians’ hearts:

———————————————————————————————–

The recommendations listed below were proposed as necessary and sufficient to combat all the risk factors that are the real cause of AIDS:

1. Improving sanitation and public health measures to decrease water-borne diseases.

2. Strengthening health infrastructure.

3. Reduction of poverty and improving general nutrition and implementing nutritional education and supplements for the general population.

4. Improving screening for and treatment of sexually transmitted diseases.

5. Promoting sex education based on the premise that many sexually transmitted diseases and pregnancies could be avoided.

6. Implementing public education campaigns to destigmatise AIDS and reduce public hysteria surrounding the disease.

9. Treating infections vigorously and timeously (sic – possibly meaning “in a timely fashion”).

10. Increased support for and promotion of research into the development of drugs against AIDS, its cofactors and risk factors.

12. Implementing aggressive programmes to empower women and change the power relations between men and women.

13. Reducing the vulnerability of communities by improving access to health care.

14. Improving literacy.

[Presidential AIDS Advisory Panel Report: March 2001: pp 86-87].

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Now, none of these is a bad thing – far from it. Who could argue with any of it? All good stuff, and the “HIV causes AIDS” group on the panel said many of the same things in their recommendations.

But – and it is a very, VERY big “But”- these laudable measure were, sadly, just not what was needed as a first priority in the face of an unprecedented epidemic of a deadly but slow-acting viral disease. Or, at least, they were not enough, and never would be. They would do some good – but not nearly as much good as if they had been combined with an immediate and vigorous campaign of treatment with antiretroviral drugs.

There is also another side to the catastrophe, as noted by many commentators, including Bad Science’s own Ben Goldacre, and also the Harvard authors:

The South African government, through the Health Minister Manto Tshabalala-Msimang, …continued… to divert attention from ARV drugs to non-tested alternative remedies, such as lemon juice, beetroot, and garlic, sometimes even promoted as better alternatives and not supplements for AIDS treatment

Tshabalala-Msimang scores high on the infamy scales for me because she is, almost unbelievably, a medical doctor who trained in obstetrics and gynecology and later in public health. I am truly dumbstruck that a person with her professional background could have participated in such an orgy of delusion. Though if some of the stuff that newspapers in South Africa have printed about her is true (see e.g. here and here) it is pretty scary that she was a Minister in the first place.

Anyway, the quackery was doubtless not just Tshablala-Msimang’s idea; the promotion of alternative therapies was prominent in the recommendations of the HIV denier half of the Advisory Panel. The keen-eyed reader will have noted the omission of several numbered points from the list above. The missing ones are as follows:

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7. Investigating the use of immune-boosting medications, such as interferons, growth factors, B-complex vitamins and herbs (such as ginseng, Chinese cucumber, curcumin, aloe vera, garlic and echinacea).

8. Encouraging the detoxification of the body through several inexpensive interventions, such as massage therapy, music therapy, yoga, spiritual care, homeopathy, Indian ayurvedic medicine, light therapy and many other methods.

11. Encouraging the involvement of complementary medical and health practitioners, including indigenous healers, in research and clinical fields.

(Italics mine)

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Following the embracing of this menu of delusion by the Mbeki government, Tshablala-Msmang enthusiastically promoted it – no doubt applauded by plausible nitwits, sorry, “Nutritionists”,  like Patrick Holford, and by the “Pope of Vitamins”, Dr med Matthias Rath. Both Holford and Rath have spent a lot of time in, and promotional effort on, South Africa these last eight years or so.

It does not take a genius to surmise that they would have seen a large market, full of often poorly-educated people, where their seductive nutritional remedies (“no nasty toxic drug side effects!”) would appear almost officially sanctioned.

Admittedly, the role of AIDS deniers, of alternative medicine idiots, and of vitamin pushers like Rath and Holford, are minor compared to the overwhelming responsibility of Mbeki, his Health Minister, and the rest of the President’s deluded inner cabal. But there is an obvious element of “toxic enabling” at work.Which suggests:

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A BadScience Formula:

Self-deluding scientifically illiterate politicians

+ vocal “skeptics of the scientific orthodoxy”

+ “traditional healing practices” enthusiasts

+ vitamin salesmen and Nutritionistas

+ endless ill-informed media reportage, especially of the previous three groups

= possibly catastrophic consequences

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Anyway, I would like to think that the next time dear old Patrick Holford says something mind-bogglingly dim like:

“[The retroviral drug] AZT is… proving less effective than vitamin C” [ in treating HIV]

- or the next time that Matthias Rath claims that modern medicine is a Pharma conspiracy to keep people sick – that someone will be there to remind them of just where their preferred nostrums and delusions can lead.

You might, for instance, like to ask Patrick:

“So can Vitamin C prevent mother-to-child transmission of HIV, the way that anti-retrovirals do?”

I would love to know what his answer would be.

Getting back to the paper, the authors’ conclusion is chilling:

“Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available [antiretrovirals] to prevent and treat HIV/Aids in a timely manner.”

One can only hope that political leaders elsewhere have proper scientific and medical advisers. And that they can keep their minds free of the soothing claptrap peddled by the fans of Alternative Reality.

Although looking at the way that politicians in the UK these days persist in regarding CAM as purely an issue of consumer choice, with no health implications… sometimes I am not so confident

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Notes:

This post is not very original, and obviously owes a lot to Ben Goldacre’s coverage of the issue. Talking of which, word in the bookosphere has it that the revised edition of Ben’s Bad Science book, due out next Spring, will have an extra chapter devoted to Herr Dr Med Matthias Rath, in which the learned Herr Doktor’s South African activities can presumably be expected to feature prominently.

Another good guide to the history of the South African HIV denialism catastrophe is the Skeptical Inquirer article by South African economics Professor Nicoli Natrass.

Finally, a longer and more scholarly article written earlier this year by Prof Nattrass for the journal African Affairs, can be found here. It includes an earlier estimate of the human cost of Mbeki’s policies, broadly similar to the Harvard study’s conclusions. This article also has a section (pp 169-171) dealing with Rath and other peddlers of “nutritional solutions”, and their relationships with Tshabalala-Msimang.

[BPSDB]



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