Dec 22 2009

Dr. Beetroot and AIDS Denialism

Last week the former health minister of South Africa, Manto Tshabalala-Msimang, died of complications of a liver transplant. She had been health minister under Thabo Mbeki from 1999-2008.

As the BBC reports:

Without doubt, Dr Tshabalala-Msimang was a brave liberation fighter, a deeply loyal comrade in the ruling ANC, and a woman with a formidable intellect.

But sadly the world is likely to remember her for her for just one thing – her Aids policy.

It is unfortunately true that we tend to deal with the overwhelming complexity of the world by oversimplifying. We attach labels and archetypes to people, replacing the rich complexity of their lives with their single most dramatic feature or event. I know very little of Eliot Spitzer’s life and career – I can only spare the neurons to remember that he was that New York governor who prosecuted prostitution, and then had to resign in disgrace because of his own use of prostitutes. Time only exacerbates this phenomenon.

And so Dr Tshabalala-Msimang will be remembered, especially outside of South Africa, as Dr. Beetroot – the health minister who denied that HIV causes AIDS and denied her country modern medical treatment for a terrible epidemic.

Thabo Mbeki takes much of the blame for this as well. But Dr Tshabalala-Msimang was his health advisor – her job was not to go along with the political pressures of the day but to represent the findings of science. In that she failed spectacularly.

It was also not just AIDS denialism, but the alternative medicine culture at work. Dr Tshabalala-Msimang earned her nickname for favoring local traditional remedies to modern pharmaceuticals. Forget anti-retroviral drugs made by greedy Western pharmaceutical companies – eat some natural local herbs instead.

As a result, it is estimated that during the last decade 300,000 South Africans died prematurely from AIDS. That is a heavy toll to pay for a bit of ideology trumping science. But those are the stakes when you are the health minister of a nation.

It seems that now South Africa is back on the right track, and trying to make up for lost time. But they are years behind where they should be – which means that more people will die prematurely due to Dr. Beetroot’s ideology.

There is evidence from a recent prospective trial in a South African clinic that starting treatment with HAART (highly active anti-retroviral therapy – the current standard of care for HIV positive patients) even in advanced cases can still lead to good long term outcomes. So some patients can make up for lost time.

Dr Tshabalala-Msimang has made her career a cautionary tale about the dangers of politics and ideology trumping science. That is her legacy. While historians and scholars will rightly revel in the complexities and contradictions of her life and career, to the public she has been tagged with “Dr. Beetroot – South African AIDS denialist.”

In this respect, she is balloon-boy.

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