I was destined by accident of birth to work in a rural hospital. My grandfather was a missionary doctor who founded and built a Church of Scotland mission hospital in Venda. He was quite literally the hero of the family. Having already been awarded a DSc in botany and well on his way to an academic career, he decided to change direction and study medicine after being inspired by the Reverend Donald Fraser.
He obtained his medical degree at Edinburgh University, then stayed on for a couple of years to do research and obtained an MD (the “real” PhD equivalent — not the American MBChB equivalent). My grandmother joined him in Edinburgh and obtained her PhD in botany — one of the first South African women to obtain a doctorate, I imagine. They then spent more than 30 years working in rural Venda, serving and “ministering to” the local people.
I studied medicine partly in order to emulate my heroic grandfather, and, as the first-born grandson, to fulfil the unspoken yet evident expectation of the family to produce another doctor, preferably one to follow in his footsteps. My grandfather died within three months of my starting at university.
My chance to work in a rural hospital, in fact the very hospital he built, came when I was a medical conscript. Armed with minimal experience, I was dispatched by the military’s medical services to the hospital accompanied by my wife and three-week-old son. (I must admit that a high-quality bottle of brandy for the relevant sergeant had facilitated the posting. Typical “good old” South African corruption and bribery.)
Being the grandson of “the doctor” was not without its own pressures — this, apart from the everyday stresses of a hugely overcrowded outpatients department, frequent interruptions for emergency Caesarean sections and, of course, after-hours duties.
Eventually one nightmare weekend I found myself in charge of the hospital — the superintendent had gone on long leave overseas, and the other “army doctor” had gone AWOL to do a locum and earn some extra money.
Late on the Sunday night, I was called to the labour ward to resuscitate a new-born baby, and ended up taking the mother to a theatre to try to stop a massive postpartum haemorrhage. I could not stop the bleeding. The hospital did not have a blood bank. She died on the table. The post-mortem showed that she’d had a ruptured uterus. Much to my chagrin I lost my temper with the staff during the horrifying process.
The next day we were expelled from the homeland and given 24 hours to leave. Years later, when attending a memorial service for my grandmother at the hospital, an official of the Venda government paid tribute to her by concentrating on my grandfather’s legacy. He appealed to the audience that should any medically qualified member of the family of “the doctor” be interested in working at the hospital, that person would be welcomed with open arms, or some such words. There was only one person there that matched that description.
Fuck you, I thought.
But then I am a selfish person.
Not like Dr Colin Pfaff. He is facing disciplinary charges for being a good doctor. He has chosen to work as a rural doctor in KwaZulu-Natal. Rural doctors nowadays, like my grandfather many years ago, work long hours, often live on the premises of hospitals, and are often woken up in the middle of the night to attend to emergencies — Caesarean sections, gun-shot wounds, car-accident victims. They have new problems that my grandfather did not have to deal with: HIV and Aids; MDR-TB and XDR-TB; chloroquine-resistant malaria; methycillin-resistant staph aureus. And stifling bureaucracy.
In my grandfather’s day, the mission hospitals were relatively independent and autonomous until the apartheid government decided to co-opt them into their highly fragmented health delivery system. By that time my grandfather was on the verge of retiring, but with others he opposed the take-over.
Rural doctors struggle daily to ensure that orders for medicines and equipment are filled and delivered regularly so that vital supplies do not run out. They usually have a whole network of clinics to support. They may have to attend to mechanical failures of equipment — setting up temporary and makeshift repairs. They have to badger their local or provincial departments of health for budgets and even salaries to be paid over.
Rural healthcare practitioners often develop their own bizarre sense of humour. Flashback: in a staff meeting during my brief rural experience, the room erupted into gales of laughter as one staff member in an official report indicated that the hospital possessed 11 ambulances, but only three worked.
Most rural doctors with children will need to send their children to boarding school, depending on how far away they are from a town or city. The sacrifice of family life by rural healthcare practitioners is not adequately recognised. It is not a choice undertaken lightly.
Dr Pfaff knew that dual therapy is more effective than monotherapy* in the prevention of mother-to-child transmission of HIV (PMTCT). He was able to obtain the necessary medicines, in an innovative donor process, to implement dual therapy. He showed exactly the kind of initiative and leadership embodied in the KwaZulu-Natal department of health’s own “Batho Pele” principles, not just as listed in torn or curling posters randomly stuck over peeling paint on various hospital or clinic walls.
Unfortunately, non-medical bureaucrats decided that Dr Pfaff had exceeded the limits of what he was allowed to do, and he was charged with misconduct and acting unlawfully. The reaction has been intense. The Rural Doctors’ Association of South Africa and the SA HIV Clinicians’ Society, among others, have issued statements supporting Dr Pfaff.
The KwaZulu-Natal MEC for health, Peggy Nkonyeni, is meanwhile reported to have made the most extraordinary statements on a visit to Manguzi Hospital where Dr Pfaff works. She stated that antiretrovirals (ARVs) are “toxic”, and questioned the motives of rural doctors who provide Aids treatment. She suggested that they are working for pharmaceutical companies and aren’t primarily concerned about their patients.
The echoes ring across the years from nearby Mpumalanga. The then MEC of health, Ms Manana, evicted the rape-crisis NGO providing post-exposure prophylaxis at Rob Ferreira Hospital, and instituted actions against Dr Thys Mollendorf. Petty bureaucracy took precedence over patient welfare; Batho Pele all but forgotten.
The stronger echo perhaps comes from Pretoria, and the national Department of Health’s minister herself with statements such as “antiretrovirals are poison”. In a meeting of all the provincial MECs of health, the minister of health stood by “Manana”, as she referred to the Mpumalanga MEC, and stated that Manana was quite right and had done nothing wrong. A very strong message indeed to the MECs that she would stand by them if they chose an anti-ARV stance. Post-exposure prophylaxis in cases of rape is now standard of care. Ms Nkonyeni was not yet the KwaZulu-Natal MEC of health, but no doubt the minister’s stance has filtered through.
MEC Nkonyeni claims that she is merely informing patients fully. She said in an interview (à la Anthony Brink): “It tells you [it’s toxic] on the label!” It would appear that her definition of “fully informed” only concerns side effects, and nothing about benefits. The “side effects” of possible HIV infection, chronic illnesses, Aids and eventual death in a baby or child are seemingly not being communicated or considered.
The general manager: corporate communication of the KwaZulu-Natal department of health, Leon Mbangwa, released a statement on behalf of the department stating: “[W]e will not allow anyone to pull vulturistic theatrics to mystify this matter for their own political gains. We will continue to put the interest of our people first, unlike these [political] opportunists.”
No doubt “vulturistic theatrics” referred to something the DA stated. However, any mystifying must belong solely to the KwaZulu-Natal department of health. Mr Mbangwa, like Ms Nkonyeni, is not a medical doctor. Their assumption that they are putting “the interest of our people first” by following the letter of the law is both short-sighted and possibly destructive. How many health professionals considering a career (or just a stint) in a rural setting are now having second thoughts? May we all have long memories so that when or if there are any future complaints about “lack of capacity” in rural KwaZulu-Natal, we will remember who is at least partly responsible.
Not only am I selfish, I am also a coward. I would not have had Dr Pfaff’s courage to initiate dual therapy in a rural setting in 2007, were I to work in such a place. However, I will not again work in a rural hospital in my life. I will not again work in a context where bureaucracy, red tape and the Public Service Act can interfere with the management of patients. I will not again work where I am prevented from fulfilling the principles of Batho Pele to the best of my ability.
As an academic, I strive to ensure that my students learn to question things: statements made, reports submitted, applications of science — even authority itself. It defeats the purpose of acquiring critical thinking skills if healthcare professionals are subsequently made to toe the line unquestioningly by unqualified people blindly adhering to, or trying to enforce, out-of-date protocols and guidelines.
* PMTCT monotherapy involves the administration of single-dose nevirapine to the mother when she goes into labour and a single dose to the baby within 72 hours of being born. It is about 50% effective in preventing intrapartum transmission of the HI virus, but is associated with viral resistance. Dual therapy adds a second drug — in this case zidovudine (AZT). The mother starts taking it at about 28 weeks of pregnancy, and the baby receives a week’s treatment after birth. Dual therapy further reduces the transmission rate to about a quarter or less compared with no treatment, and reduces the development of viral resistance.
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85 Responses to “Why I am not a rural doctor”
I submit Roy has a bloated ego- not sure its just him or doctors in SA or doctors in general. There is nothing special about doctors working in a rural setting. Nurses work there teachers agricultural people etc etc.
There is usually protocols to be followed in any hospital some more strictly adhered to than others. If the protocol says its monotherapy then please try to change the protocol not act in a superior holier than though manner to the protocol.Heads have banged together the midnight oil has burnt out with people trying to put that protocol which would bring “the best possible outcomes” to the majority of the people in the safest possible manner. When this friend of yours the doctor decides all by his own self against established protocol then he is putting the hospital the ministry at the risk of litigation(yes this will come too even in South Africa.)
My problem is really not the second drug its a doctor who decides he knows better than all around him and decides without consultation with anyone else to implimemt what he thiunks is right. Would you be ok if teachers did this , engineers, architects etc.This was not an emergency as I understand it. There was ample time to consult change protocol and implement
Roy starts his blogg with a history of his grandparents etc etc- I felt he was priming us for what was to come.Look one does not have to work in the rural areas if one feels he is unhappy.Just because ones grandfather loved working in the rural areas does not mean one must love to work in the rural areas.In fact I might even venture further and say Roy went into medicine for the wrong reason. To satisfy tradition what was expected of him not that blinding calling to medicine.I am not surprised his attempt to continue his grandfathers mission failed.Medicine in the rural areas involves cooperation with all the providers around you including government ministries for effective rural health delivery.This blogg smacks of blackmail- we will not go to the rural areas unless we do as we please.
It is my considered opinion that its better to have fewer but dedicated doctors in the rural areas than have the prima donnas who would rather do as they please and ignore protocols.
Try that approach in australia and they will haul you up for discipline in no time at all.There was a doctor like this in Bundaberg in Queensland and he had to leave the country in a bit of a hurry.
Indeed question authority but dont think you are cleverer than than the people who have put the protocols. You may not be the only point head out there.I really worry about what this gentleman teaches his med students.If they being taught to do as they please because they are doctors then we have a problem.
Gus’s reply sounds just like the Nats of old, do as i say no diversions or innovation, we know best etc etc - so sad and scary, does no one learn from bad history.
It is people’s lifes we are flirting and arguing about not politics and filing things nicely away before running off home at 5 sharp
.
Rural hospitals are so so bad mainly because officialdom far far away in towns couldn’t care a dam - so what has changed from the past - zero?
Gus I am assuming you are not a doctor otherwise you would not make such a ridiculous statement as to compare what Colin Phaff has done with the actions of an incompetent Indian surgeon in Bundaberg who killed people with poor surgical skills and judgment.
Colin on the other hand was dealing with babies dying every day. He had guidelines that was supposed to be implemented months before, Guidelines that had been approved by the WHO years before and that has been implemented in the Western Cape for a considerable time. Instead he had to deal with a MEC who have NO idea what the correct management of these patients should be. He put in the effort and at NO cost to the taxpayer sourced the drugs and started treating according to WHO and national guidelines as he could no longer stand by and watch babies die while bureaucrats procrastinated - he should get a bloody medal IMHO. Instead people like you will defend the actions of incompetent government officials while children die unnecessary EVERY SINGLE DAY!
It is a shame that you have been driven to such a state, but after being expelled from work and a home after unsuccessfully saving a life one can only try and understand. I wonder if any of those officials would have woken-up at odd hours of the morning to try and save a life. Its so hard for me to understand how does a bureaucrat who sits in an office the whole day and sips tea and has never worked in any development or topic related project before assuming their roles think they can make informed decisions for the well-being of the nation.
I have always maintained that political office bearers are more harmful than they are actually worth and should leave expertise-requiring matters to experts and their official office bearers (i.e. if the official bearer was hired on competence).
Your response is mindnumbing.(must be all the spelling mistakes!) Thanks to the Governments screwed up HIV policy, millions of people are dying every year. Now a doctor, whom has the medical knowledge, is being crucified for doing what he was trained to do, SAVE LIVES!
If the people who drew up the so called protocals had the knowledge, maybe the system would have worked better.
I would prefer a doctor who saved my life, over a doctor who stubbornley followed like a sheep, any day of the week and twice on Sundays. How about you?
Roy Jobson takes a snide crack at me and at KZN’s Health MEC in writing, ‘MEC Nkonyeni claims that she is merely informing patients fully. She said in an interview (à la Anthony Brink): “It tells you [it’s toxic] on the label!” It would appear that her definition of “fully informed” only concerns side effects, and nothing about benefits. The “side effects” of possible HIV infection, chronic illnesses, Aids and eventual death in a baby or child are seemingly not being communicated or considered.’
1.The label to which Health MEC Nkonyeni refers is the label on bottles of AZT supplied, not to pharmacies, hospitals and maternity wards for administration to humans (in South Africa mostly impoverished Africans), but to research laboratories for use on experimental animals and in petri dishes. This label, on bottles containing as little as 25 mg of AZT, bears an orange stripe imprinted with a skull and crossbones icon to signify potentially fatal toxic chemical hazard, and the warning: ‘Toxic Giftig Toxique Toxico Tossico Vergiftig … TOXIC Toxic to inhalation, in contact with skin and if swallowed. Target organ(s): Blood Bone marrow. In case of accident or if you feel unwell, seek medical advice immediately (show the label where possible). Wear suitable protective clothing.’
The latest version of the label also carries a cancer warning.
25 mg of AZT is one twentieth to one sixtieth the quantity GlaxoSmithKine recommends in its package insert that people should swallow on purpose every day until they die (500 – 1500 mg).
White doctors like Jobson obviously don’t tell these things to pregnant African women when pressing this stuff on them.
2.The literature on the deadly ‘side effects’ of ARV drugs like AZT is massive.
For an overview, see ‘Why do President Mbeki and Dr Tshabalala-Msimang warn against the use of ARV drugs like AZT?’ http://www.tig.org.za/pdf-files/azt-mbeki_tshabalala-msimang.pdf
For an introduction to the literature reporting the brain damage and other serious harm AZT does to unborn and newly born babies, see ‘Why do Zackie Achmat, Nathan Geffen and Mark Heywood want pregnant African women and their babies to be given AZT? What AZT does to unborn and newly born children’ http://www.tig.org.za/pdf-files/azt-achmat_geffen_heywood.pdf
3. Whether AZT really does save African babies from being killed by their mother’s germs in their septic vaginas (according to the AIDS experts) is examined in a 130 000-word monograph ‘Mother to Child Transmission of HIV and its Prevention with AZT and Nevirapine’ http://www.tig.org.za/pdf-files/azt_nevirapine_small.pdf.
4. Some tragic historical precedents to giving deadly cell poisons like AZT to pregnant women and their newborn babies are mentioned in my group’s press statement on 31 October 2007: October 1957: Thalidomide and Pregnancy – October 2007: AZT and Pregnancy – Another Tragedy of Countless Children Killed and Maimed Foretold http://www.tig.org.za/pdf-files/TIG_PRESS_STATEMENT_AZT_in_pregnancy.pdf.
The more things change, the more they stay the same.
Anthony Brink
Chairman: Treatment Information Group www.tig.org.za
Roy Jobson takes a snide crack at me and at KZN’s Health MEC in writing, ‘MEC Nkonyeni claims that she is merely informing patients fully. She said in an interview (à la Anthony Brink): “It tells you [it’s toxic] on the label!” It would appear that her definition of “fully informed” only concerns side effects, and nothing about benefits. The “side effects” of possible HIV infection, chronic illnesses, Aids and eventual death in a baby or child are seemingly not being communicated or considered.’
Let’s think about this.
1.The label to which Health MEC Nkonyeni refers is the label on bottles of AZT supplied, not to pharmacies, hospitals and maternity wards for administration to humans (in South Africa mostly impoverished Africans), but to research laboratories for use on experimental animals and in petri dishes. This label, on bottles containing as little as 25 mg of AZT, bears an orange stripe imprinted with a skull and crossbones icon to signify potentially fatal toxic chemical hazard, and the warning: ‘Toxic Giftig Toxique Toxico Tossico Vergiftig … TOXIC Toxic to inhalation, in contact with skin and if swallowed. Target organ(s): Blood Bone marrow. In case of accident or if you feel unwell, seek medical advice immediately (show the label where possible). Wear suitable protective clothing.’ The latest version of the label also carries a cancer warning. 25 mg of AZT is one twentieth to one sixtieth the quantity GlaxoSmithKline recommends in its package insert that people should swallow on purpose every day until they die (500 – 1500 mg).
2. The literature on the deadly ‘side effects’ of ARV drugs like AZT is extensive. For an overview, see ‘Why do President Mbeki and Dr Tshabalala-Msimang warn against the use of ARV drugs like AZT?’ http://www.tig.org.za/pdf-files/azt-mbeki_tshabalala-msimang.pdf
3. For an introduction to the literature reporting the brain damage and other serious harm AZT does to unborn and newly born babies, see Why do Zackie Achmat, Nathan Geffen and Mark Heywood want pregnant African women and their babies to be given AZT? What AZT does to unborn and newly born children http://www.tig.org.za/pdf-files/azt-achmat_geffen_heywood.pdf
5.Whether AZT really does save babies from being killed by their mother’s germs in their septic vaginas, according to the AIDS experts, is examined in a 130 000-word monograph ‘Mother to Child Transmission of HIV and its Prevention with AZT and Nevirapine’ http://www.tig.org.za/pdf-files/azt_nevirapine_small.pdf
7. Some tragic historical precedents for giving cell poisons such as AZT to pregnant women and their newborn babies, with all the best medical intentions, see my group’s press statement on 31 October 2007: October 1957: Thalidomide and Pregnancy – October 2007: AZT and Pregnancy – Another Tragedy of Countless Children Killed and Maimed Foretold http://www.tig.org.za/pdf-files/TIG_PRESS_STATEMENT_AZT_in_pregnancy.pdf
The more things change, the more they stay the same.
Anthony Brink
Chairman: Treatment Information Group www.tig.org.za
It is unfortunate that the right to choice is infringed through the use of propaganda to advance the political agendas. Why do you then expect those rural folks to make informed choice while our political correct ministers are feeding utopia in the public domain. The rights of poor villagers to true and correct information and consequent they could choice make has been political altered our political inclined bureaucrats.
We speak of bureaucrats as the all knowing establishment whilst so far they have demonstrated beyond reasonable their incompetence in the manner they have handled the HIV/AIDS issue.
Your inclination to defend the system leaves a lot to be desired about your intellectual integrity hence I can conclude that you are of the die hard stalwart of these controversial establishments hence you can’t see beyond.
It is in the interest of our country to entrust health matters to independent professional especially at this defining juncture of our country.
Lastly, you have no legitimacy to address somebody of Dr Jobson caliber with level undue arrogance and ignorance seeing that you never worked in rural hospitals. We are both clueless of the nature and levels of difficulty rural doctors are facing and it is only fair to appreciate their commitment and humility in serving under those trying conditions.
erm Gus? I think a QUALIFIED doctor knows something more than a government official who knows nothing about medicine? You simply chose to take this negative and critical stance and have in no way backed up your argument with any sense! Shame and its always the little people who suffer because of such foolishness!
Thanks for your article. I must say the song “I did it my way” kept ringing in my ears.
The response to your article I guess serves to validate your perception and realities.
The tragedy is that in emancipation we deny the logic of those we are emancipated from purely on the basis that we are emancipated and have freedom.
The consequence is that we sacrifice our ability to think because we sacrifice our ability to hear.
Opposing views have merit even those from our percieved enemies.
Eish there’ no hope when logic or common sense fails as a consequence of a blanket rejection of opposing views purely because they emmanate from the offspring of the philosophical architects of our past.
The rabble babble will be the downfall of this nation yet.
If a hospital or state in Australia had a protocol that forbade dual therapy for prevention of mother to child transmission, the doctors would refuse to follow it, the public would protest and the administrator/state minister for health would be sacked.
It’s not a case of ego, Gus, it’s a case of a child who might otherwise live or die. Although a protocol sometimes appears to develop a life of its own, they are sometimes hard to kill. A baby whose mother has AIDS, dies easily and quickly. Change the protocol, you say. Sure - and how long did it take to change the national protocol (policy) to allow ARVs into the public sector?
I, too, am a doctor. I, too, prescribed AZT to supplement Nevirapine to a small shrunken prem baby born to a mother who died shortly after childbirth from AIDS. Being premature, the baby would have stayed in hospital for more than the 28 days she needed the AZT. There was slight stir, I had to field a few phone calls, but no other problems.
I take my hat off to Dr Pfaff. And to Roy Jobson. And I hang my head in despair at the future of the country when there are still people like Gus running around the place.
I now sign off from my cosy place in rural Australia, counting my blessings that I don’t have to deal with bureaucrats like him.
Maybe Gus has a point about litigation. That makes a certain amount of sense, although one would expect an MEC to cover for a doctor rather than dumping him like this.
Actually, rural health-care (at least where I live) has improved enormously in the last decade or so. You can see the clinics mushrooming. But I suppose most people who read this web-log aren’t interested in what’s happening in rural areas; they already know that the government is evil and don’t want to be confused with any details.
Incidentally, if “dual therapy” is so much better than “monotherapy”, why was the medical fraternity so keen on “monotherapy”? I have an uneasy suspicion that this is a cover-up, and that nevirapine is much less effective than claimed (or maybe not effective at all), and that AZT is being brought in as a fig-leaf to conceal a huge bungle by the medical profession.
After all, prevention of mother-child transmission is very hard to assess, because (since the virus remains dormant in the DNA) antibodies may show up many years later, as I’m sure the author knows. This is a bit of a hobby-horse of mine which has nothing to do with whether or not Dr. Pfaff is being victimised.
I find Gus’s comments mystifying and alarming in their ignorance. Having worked recently as a community service doctor in the rural Eastern Cape, I have experienced the extreme challenge of working within these unique, under-resourced environments (with the right attitude, I found it to be a very demanding but immensely rewarding year – and I know of other doctors who share this opinion despite all the negativity that surrounds this issue). I also know of the massive challenges faced by the people who rely solely on these rural hospitals and clinics to receive even a marginally satisfactory level of health care. The difficulties health workers may face in overcoming beaurocracy and attaining a satisfactory level of care are tremendous. Initiatives undertaken and energy expended towards improving health services in South Africa, as with any sector, should only be encouraged and applauded. Obviously this should occur within an appropriate framework with appropriate guidance – in this case and in others it simply does not exist.
The tragedy and disgrace of politics, HIV and Antiretrovirals has been discussed at great length in the media. It is a tragedy that is truly unacceptable. One need only remember Apartheid to know that fighting against the official orders and protocol is sometimes the right thing to do. The plain fact is that people die in our country because of inexcusable political incompetence. Dr Pfaff should be praised for truly fighting for the community he serves.
I always thought that as African, we have to give back to the community.
Maybe, you did not have the experience to live as a refugee.
My father letf Rwanda in the 60 when ethnic cleansing started.
He had to come back to rescue my mother and had his weddind on the East part of DRC.
People who fleed Rwanda where allocated land in Masisi.
I always thought that my village was in Masisi. During Hollydays, I had the choice between Masisi and overseas. Masisi was always the winner.
No electricity, no running water, but I had such fun.
My cousin becamme the first doctor of our family, we went back to the village to cure our people.
I can tell you something different.
If you are given scholarship to study and than refuses to return saying that you earn more where you are.
Who is to blame?
The State for providing you with funds or you who seems to feel ashamed of your origin?
Africa can and will be buid by african, even if you don’t feel like staying for good in your village, go there every two-three months and stay there for a week.
Lol, Gbu
AB :AZT is toxic - of course. So are all the conventional treatments for cancer; chemotherapy and radiation. Would you refuse treatment for cancer? Most people would opt for the poisonous treatment. My husband & I each take potentially lethal medicines every day for chronic conditions (UC and major depression)- if you read the package leaflets you will see that potential side effects include death! Certain death would follow if we did not medicate. Being well informed includes BOTH sides of the argument.
Anthony Brink has said it all. I’d like an educated response to Anthony’s response to Dr Pfaff’s blog. I wasn’t aware, though, that the blog had an “L” restriction….
Those in the medical fraternity like Dr Pfaff should remember that sickening orders, protocol and systems don’t just exist in the socio-political sphere. They also exist in disciplines of training–like medicine, physics, psychology, etc.
Just ask Galileo what it cost him to tell the rest of the then educated world that the earth is spherical, and Galileo is just ONE, solitary case in point out of several hundreds (if not thousands).
Read in a newspaper yesterday that 50% of SA medical professionals polled said that they are seriously thinking of leaving SA in 5 years. 25% said they’d be leaving in two years.
Dawn
You make a good point.
Knowing that AZT is exceptionally toxic (everyone agrees - having been synthesized as a purpose-designed cell poison) it makes sense to determine what its benefits are.
In the case of AZT, for instance: Is it antiretroviral?
Now being a pharmacologist, Roy will answer to your great surprise that it isn’t.
He’ll tell you that AZT is not antiretroviral; its catabolite AZT triphosphate is said to have this activity.
So your next question to Roy would be: What’s the
inhibition concentration (IC50) of AZT-TP in vivo, Roy?
Has it ever been achieved in vivo?
If he start stuttering here, you can draw his attention to a discussion of the problem in a paper he’s never read, ‘A Critical Analysis of the Pharmacology of AZT and its use in AIDS’, published as a special supplement to the leading edge academic medical journal Current Medical Research and Opinion in mid-1999. http://www.tig.org.za/pdf-files/azt_pharmacology.pdf
AB
Three doctors in my family, all trained in this country, all now working overseas. Join them, Roy.
As a health professional I would never EVER work in government health services in this country. Mainly because ‘State Healthcare’ is a euphimism for Zero Services. Doctors and nurses cannot work with out facilites, gasses, drugs, dressings etc. I think state healthcare should be staffed entirely by traditional healers. Would solve a lot of problems. Besides, bones and buchu are cheaper than ketamine and ARVs.
Enjoyed Gus Mkandla’s comment that we only need a few ‘dedicated’ doctors in our rural areas. Dear Gus, I suggest you exchange the word ‘dedicated’ with ‘burnt out, shattered wrecks of humanity’.
MFB: There is no cover-up re nevirapine. Agreed it is not the optimum choice but in terms of access to therapy and cost at that time this was the “best” option in reducing mother to child transmission not only in South Africa and other developing countries. The clinical studies showed then that the optimum is triple therapy but to have mothers and infants have access to some form of therapy was the starting point. Nevirapine reduces transmission rates of 30-50% to 15 % or less. We now have triple therapy available as part of a comprehensive treatment and care programme and so one hopes the standard of care will improve. Dual therapy is one step closer.
Gus is out of touch, like the health minister and the president. That they may be out of touch does not worry me so much as that they have chosen to be out of touch. What i am saying is they are murderers!
Thanks 2 all the responses, it shows that we have people who care for people out there regardless of race. If only we stop bickering for political gains and let professions do what they are trained to do. Let them have an input/informed say on protocals especially that the WHO has a lot of them ontheir guideline protocal which decided the prefered standards.
Anthony Brink
Get a life. I mean why don’t you campaign against cancer chemotherapy. Some of that has some pretty nasty side effects. An allergic reaction to penicillin can kill you. All drugs have side effects. It is how you manage them and control them that is important. You and your ilk have done enough harm. If these patients are not dying of AIDS then pray tell what are they dying of? The AIDS denialists are not the Simmelwies’s of the 21 st century. They have subtly brewed up a conspiarcy theory that fits into the traditinal beliefs of many African people. It cannot be a virus it must be that I am bewitched. So don’t go to the western doctor go to the sangoma. Now even in the days of Grandfather Jobson the Sangoma was responsible for a lot of mayhem. Smearing cow dung on babies umbilical cords giving toxic enemas, flogging epileptics to get the curse lifted and the like. Great stuff. SO when Brink and co come along this fits right in with the Africanist agenda.Out with western science and in with African traditions. The anti-science agenda is pushed by Brink and co and dovetails nicely with the subcoscious bias of the politicans in charge of health. The result is that people are dying by the bucketload. But who is counting I suppose only the scientists.
Did the MEC read the warning on the label of Nevirapine? It clearly states “Nevirapine can cause severe, life-threatening liver damage” That is presuming she can read
As an ex Rhodian and practicing pharmacist, it is so rewarding to see that the high ideals of free thought and good intelligent journalism are being upheld at that wonderful institution!
What I wonder would be the response of now retired academics such as Prof Dave Woods ex PRINCIPAL AND VICE-CHANCELLOR OF RHODES UNIVERSITY to the articles submitted by Gus mkandla and Brink.
The garbage submitted by these two amongst others is totally contrary to world opinion and modern experience in the rest of Africa (and the world for that matter!!!!!).
Why is our minister of health considered to be a pariah in scientific and medical circles around the world!
What kind of people are these who can still suggest that the medicines used in the treatment of HIV/Aids are ineffective!!What would their responses be if they were indeed HIV patientsthemselves!! Quite different Im sure!!!!!
Whilst we all debate the virtues of Dr’s, AZT and some of the silly reponses to this well balanced point of view, A FEW THOUSAND PEOPLE HAVE DIED FROM AIDS…AND BY TOMORROW, A FEW THOSAND MORE…
So much for the department of Health!
Classic article & a series of classic replies - the party & its processes matter far, far more than ensuring that people get well. There is no Government run medical system in the world that does NOT put politics before patients - in South Africa, politics means the ANC. The people persecuting the good Doctor Pfaff are politicians first & foremost - that is their career - the welfare of patients comes a very, very poor second to that.
As its not “traditionally correct” to request people to limit their family size, population control is exercised by ensuring high infant mortality. Its time-release abortions: that’s why Gus(set)and Brink(of madness)are mired in “pro-choice” language.
Gus is just another lipflapping racist protecting his kind to the death .He should be promoted to mec of health since event though his remark was uninformed it was better than our present mec , actually no mec is better than our present one.
1. MFB: You say, ‘Nevirapine reduces transmission rates of 30-50% to 15 % or less’. In shilling for Boehringer Ingelheim and its patented drug, may I enquire whether you’ve actually researched it? Or are you just repeating what you saw and heard on TV in your Easy Chair with a beer in your hand?
If it’s not too much trouble, please have a close look at this ‘nevirapine for beginners’ presentation, and tell me once you have whether you still think ‘Nevirapine reduces transmission rates of 30-50% to 15 % or less’, and if after reading it you still do, whether you possibly work for the railways:
A Critical Analysis of the Evidence Considered Proof that Nevirapine Prevents Mother-to-Child Transmission of HIV
You also make the claim that ‘There is no cover-up re nevirapine.’ I don’t know what ‘cover-up’ you’re referring to, or whether you even have any specific ‘cover-up’ in mind, perhaps because the lazy mind likes to cast ARV drug critics as conspiracy nuts, but on the subject of ‘cover-up[s]’, I commend you to the opinion of Dr Jonathan Fishbein on the IOM enquiry in the US on the Ugandan HIV NET 012 study (he’s the highest ranking whistleblower in US history – and, by the way, no AIDS dissident). Again, if it isn’t too much trouble for you, you can find this in Chapter Eight of ‘The trouble with nevirapine’ posted at http://www.tig.org.za/pdf-files/trouble_nevirapine.pdf
2. Afronooit: You say ‘Get a life.’ Could you perhaps help me to understand in what manner I lack a life? Thanks.
You say ‘I mean why don’t you campaign against cancer chemotherapy. Some of that has some pretty nasty side effects.’ Yes, actually all of it does; all of it is designed to poison human cells, and that’s why I wouldn’t take it, ever, any more than I’d undergo bloodletting. I don’t campaign against chemotherapy because there are plenty of others who do; I work in a specific ‘Problemfeld’, as the Germans put it, and if it’s all the same to you, I’ll do what I please. Thanks again.
‘An allergic reaction to penicillin can kill you.’ Indeed it can. I don’t take any antibiotics of any sort ever, but please feel free to buy and swallow whatever makes you happy.
The rest of your post goes to pieces here, and so I’m going to pull back to my point: AZT is deadly poisonous and useless, like arsenic injections in the first half of the 20th C. I posted some primers on this in my earlier post, and readers interested in informing themselves about this can read them. Any readers not interested in informing himself about this shouldn’t feel obliged to do so.
3. Paddy: You say, ‘Please read the war[n]ing labels on just about ANY over the counter or prescription drug - many have just as dire warnings.’
Do they also bear skull-and-crossbones decals on them, orange stripes (industry standard for deadly toxic chemical hazard), and warnings that the drug shouldn’t be inhaled, swallowed or be allowed to come into contact with the skin?
What part of ‘Castro Hlongwane’ were you unable to understand and need my help in explaining to you?
4. John: You say, ‘I don’t know what all the fuss is about AZT.’
Would it be fair to conclude that you don’t know what the fuss about AZT is because you don’t know about the harm it causes unborn and newly born children, in South Africa, mostly African.
And if not, does this answer you question. You don’t know what the fuss is about, because you’re an uninformed person who thinks like cows in a herd.
5. Chris asks, ‘Did the MEC read the warning on the label of Nevirapine? It clearly states “Nevirapine can cause severe, life-threatening liver damage” That is presuming she can read.’
Is Chris aware that nevirapine is so toxic that it was banned for even short term use in the US by medical personnel suffering needle-stick injuries, and it’s not licensed for giving mothers and babies in any first world industrial country. This is all referenced and discussed in ‘The trouble with nevirapine’, linked above. Presuming Chris can read.
We have an epidemic on our hands, and people are worried about policies and procedures. I a baby could choose, it will probably take its chances with “toxic” ARV’s and have a chance, than with garlic and beetroot! Anthony Brink, you are obviously a guru on the subject, its a petty you are not working there where the babies are dying. You remind me a bit of the doctors the cigarette companies would hire to “prove” that smoking does not harm you!
You don’t have to like it, but if the government and institution may have opposing aims. Even the most simple of organisations (business) has alot of tension between worker/management/ownership/skills/competitors etc. Government however has a policy objectives which broadly humanitarian and doctors have specific humanitarian objectives. Yes.. they can cause friction. Hopefully a solution can be dictated.
I always love it when wealthy people can boast of their selfishness while the poor are encouraged to humiliate themselves if they are.
Mr Brink, has it ever occurred to you that the overwhelming majority of scientists might just have got it right on AIDS and thhat you and your loud fringe academics could, just could be wrong?
udo schuklenk, prof on February 21st, 2008 at 10:10 pm
Anthony, old mate, you deserve all the snide cracks you can get.
Why hasn’t anyone taken this prat to court? He’s attitudes and actions can surely be construed to be costing lives.
Despite the articles he loves quoting there is overwhelming evidence that appropriate use of anti-retrovirals, particularly as multi-drug therapy, does improve and extend the lives of HIV sufferers. If anyone was to take him to court the bulk of the scientific evidence would be with them (and Tony might even enjoy it, he does seem to have a flair for the dramatic and a love of the spotlight to rival Manto).
Anthony – Medical labels are aimed at alerting illiterate people to the dangers - hence the toxic labels and pictures – don’t many scheduled medicines have them? http://www.ajhp.org/cgi/content/abstract/63/11/1048
‘Castro Hlongwane’ – Who actually authored it for a start?
What killed Peter Mokaba?
The efficacy of drugs like AZT and NVP in the field of PMTCT have been well researched and published. The protocols of the CDC, WHO and BHIVA are put together by epidemiologists and clinicians who are trained to interpret evidence of the highest level. Usually the evidence comes from studies that have been conducted by reputable academics and published in reputable journals.
Okay AB, before you start throwing me another list of dissident website addresses to prove your point-
I have to tell you that I have been managing a privately funded PMTCT programme for the past 2 yrs in South Africa. Thanks to international funding we have been able to offer not just monotherapy (AZT +NVP), but also tripple therapy specifically for the purpose of PMTCT. If you are so convinced by the evidence you quote on paper, why don’t you see how practice works? Our transmission rate is currently only 2%, comparable to the rate in the first world. Our mothers and infants are well and most of the babies are HIV negative. In countries like the US, peadiatric HIV has virtually been eliminated due to these regimens.
Before you start talking about the long-term side effects, I need to tell you that we also have been following up our mothers and babies since the program started. I have never seen a child with any of the side effects you describe. Before PMTCT, I have seen MANY with PCP pneumonia and end stage AIDS- something that does not have to be.
I also have had only one woman in the history of the programme who developed the bone-marrow supression side-effect you have referred to (See, when dr’s give drugs, we take cognisence of the fact that patients can get side-effects and so we monitor our patients for this). She is doing well on her new regimen. Of course drugs have side-effects. Even garlic and beetroot will have side-effects if you take it in the quantities required to have any effect on HIV.
I do agree that single dose NVP as a regimen is a problem. Together with AZT it does work better. The ideal is tripple therapy like in the first world. If you really want to protest about ART in PMTCT, why don’t you complain about the fact the the new DOH monotherapy policy has not made provision for the AZT+3TC tail that you need after NVP exposure- this is vital to prevent the development of virological resistance. The proof of the literature is in the practice of it.
Just find yourself one mother to tell you the sad story of how her 6 week old baby died of AIDS (there are thousands out there)and then contrast that with the happy, chubby babies and mothers who come to our follow-up programme. I sincerely hope this will convince you.
Dr Erika Drewes
[…] Jobson has referred to this in his blog “Why I am not a rural doctor“. In South Africa, we seem to have the means to solve these problems and the technology to do […]
I am posting this directly received email here. I have no intention of responding to it or to Antony Brink’s comments.
The main point of my blog was not to debate ARVs — but to support Dr Pfaff, and to highlight the daily heroism of hands-on healthcare professionals working in rural areas, in spite of the health systems they often find themselves in.
——————————-
Subject: Email from Thought Leader user
Date: Thu, 21 Feb 2008 10:34:07 +0200
From: Anita
To:
CC: iAfrica
Dear Dr Robson,
I read your “why I am not a rural doctor” post through to the end, and then
re-read it, to make sure I had not missed any information. It is the first
time as far as I remember that I have read anything under your byline. I
found a number of things that puzzle me.
First, among, these is that you appear to have laboured in the footsteps of
your ancestors among Venda people, yet you do not appear to have
internalised any of the traditions of those particular Africans. It is
rooted in healing based on knowledge of “do no harm” and “only by the fruits
of the Earth shalt thou heal them”. From what you have written it is clear
you have decided this approach warrants “Fuck you” status compared to your
own pump pregnant women full of chemotherapy. Such arrogance is
breathtaking, and the epithet I wish for your sake you will live to deeply
regret.
Secondly, you dismissed Adv Anthony Brink, as a link in your “Fuck you”
chain. The implication was that you had read everything on that one page
website - and everything there was not true - ARVS do have benefits. I must
inform you, that I too have painstakingly assembled the facts, especially
the scientific facts of viral theory of disease, and I concur with ADV
Brink’s assessment that ARVS are toxic at any dose, there is no threshold of
safety. In the mouths of two shall the truth be heard, as the good book
says, and the law concurs.
Thirdly, in dismissing ADV Brink’s view of ARVS, you have also dismissed his
view of the science underpinning viral theory in toto. This is the specific
field which I have painstakingly investigated and assembled puzzle pieces. I
say, not only do ARVS hold no benefits against HIV - or AIDS (
Ant If you really care for your people, you should either:
1) Go and study pharmacolgy at a proper university facility (even Roy may take you on as a student - for his sins), where you’ll find that all that web-claptrap pseudo-pharmacology he’s been spewing on us now for years, was just a bad acid trip.
2) Work for a rural NGO HIV clinic as an volunteer assistant for even a month. When you see’s the dead rising like Lazarus; viral counts dropping and the immune marker CD4 counts rising from as low as 40 to well over 800. All due to ARV treatment and the side effects can and are managed You’ll also be relieved to know that Most ARV’s are now generic and few sourced from your demonised big pharma GSK, Boehringer, MSD etc.
You would return to the thoroughly fabulous chap you were when you worked in your area of competency - law. And we could listen to you playing great jazz and talk cr@p till dawn about real issues.
I’ve absolutely no doubt in my mind that HIV/AIDS denialism (Refer: Manto, Mbeki, MEC’s like Mkonyeni and all those petty bungling bureaucrats like Gus), will be judged by history as an act of deliberate dereliction of duty amounting to genocide that killed millions of innocent African people
Please Ant my bru -! I don’t want to be associated with a mass murderer
The TIG share with the support groups for Alien abductees, the Illuminati, and the Knight’s Templar.a common feature. They are all conspiracy nuts. We are all fully aware of the double standards and corruption in the large drug companies. This is what makes conspuracy theories so powerful. Thye take elements of truth and combinbe them with complete fantasy to make a really potent story. Karl Popper believed that a theory could only be scientifc if you could disprove it. He called this falsibility. The problem with Marxism and psychoanalyis was tht it could neverbe disproved. Whenever a something happened whihc wasn’t predicted then you soimply changed the explanation. When Einstein siad that a heavy mass would bend light this was a rsiky statement as it was opne to falsification. When light waves were noted to bend in their journey past the sun, then his theory was confirmed. The TIG theories are not opne to falsification. There will always be a new explantion whatever the facts. The TIG believes that AIDS is a plot by wealthy multinationals to squeeze mony out of the third world. I have no doubt that the drug trade does squeeze money out of the third world, but to deny the existence of AIDS or the role of chemotherpay is highly irresponsible. The TIG have linked their conspiracy theories to an Africanist agenda which seeks to elevate traditional African beliefs to a complete knowledge system just as valid as that taught in any western university. The problem is that the African knowledge based systems are also like Marxism and astrology incapable of being falsified and hence are not science. They are all epistemologically flawed. The TIG is a dangerous organization. I note most of the references are to their own publications and no others. This is self referential in the extreme. So Mr Brink when I say get a life that is what I mean. Stop your senseless crusade as it is hurting people. Why don’t you go and rescues people from aliens. You will be doing much more good then.
1. Solo: Firstly, supposing an unborn child could think like an adult, it may want to ‘take its chances with “toxic” ARVs and have a chance’ if told by a frowning doctor, probably white, that AZT is good for it and will assure of a long and healthy life, but no baby (able to think) would choose to be exposed to a drug that, consistent with its basic pharmacological action as a cell-poison, has been found in dozens of studies to cause a massively increased incidence of early death, serious disease, immunological disorders, brain damage, blindness, paralysis, spasticity, epilepsy, mental retardation, learning difficulties and other neurological injuries, as compared with unexposed babies born to untreated HIV-positive mothers. The studies are reviewed and discussed in ‘Poisoning our Children: AZT in Pregnancy’ and cited without comment in ‘Why do Zackie Achmat, Nathan Geffen and Mark Heywood want pregnant African women and their babies to be given AZT? What AZT does to unborn and newly born children’. I think it behoves anyone who wishes to debate the merits or demerits of giving AZT to pregnant women and their babies, nearly all African, to at least be familiar with this literature and not just frothily parrot the sales propaganda they read in the newspapers.
Yes indeed I’m a ‘guru’ on the subject; I’ve been studying these drugs very closely for nearly twelve years and have written extensively about them.
But how can my campaigning against useless, toxic drugs like ARVs possibly remind you of doctors who promoted smoking? The fact that many doctors promoted smoking, and that cigarettes were advertised in their medical journals such as Lancet for their alleged health benefits, is a comment on the medical profession, the sort of medical profession, mostly white, that promotes the administration of AZT to pregnant African women and their babies – indifferent to the terrible harm that the drug, a purpose-designed metabolic poison, causes them.
2. Udo: Yes, of course it’s occurred to me that the majority of scientists have got it right on AIDS and that I could be wrong. This is why I decided to investigate the matter for myself. But let’s stick to the point. This discussion is not about whether you can die from lovemaking, as the Americans tell us (thanks to a miniature invisible demon that jumps between our favourite organs); it’s about giving AZT to pregnant mostly poor African women and their newly born babies, who’ll be disappearing into their peri-urban shacks or rural huts, after the doctors are done with them, and wondering why several months later the mitochondrial damage caused to their children manifests in leaning disabilities, epilepsy and all the other clinical manifestations of neurological and other injury mentioned earlier. The majority of scientists blessed the injection of arsenic just a few decades ago, the deadliest, most toxic substance known to man, weighted for risk of exposure, by the US Agency for Toxic Substances and Disease Registry. The Health Organization of the League of Nations (predecessor of the WHO) formally commended arsenic injections for syphilis, yaws, malaria and recurrent fever in 1934. I go with Mark Twain: Whenever you find yourself on the side of the majority, it’s time to pause and reflect. But please feel free to stay with all the neighing sheep, reading nothing, and expressing smug, ignorant opinions.
As a bio-ethics professor do you teach your students to debate serious subjects by slapping the opposition down with pejoratives around such as ‘loud fringe academics’? If I wrote this in one of your exams, would you give me a First?
Readers will be interested to learn that Professor Schuklenk, who’s a very thoughtful person, decided, on the basis of a meticulously careful conspectus and evaluation of the available data, that the American HIV theory of AIDS wasn’t supported to his satisfaction by the scientific evidence. In fact Professor Schuklenk was so dismayed by this discovery that he put his name to a petition, joining hundreds of other eminent scientists, clinicians and other academics, in calling for a reappraisal of this American theory in the form of a brief statement submitted to the editors of a number of top scientific journals in the following terms:
To the editor:
‘It is widely believed by the general public that a retrovirus called HIV causes the group diseases called AIDS. Many biochemical scientists now question this hypothesis. We propose that a thorough reappraisal of the existing evidence for and against this hypothesis be conducted by a suitable independent group. We further propose that critical epidemiological studies be devised and undertaken.’
In fact, the learned professor was way ahead of me in this thing: he was a signatory by March 1993 already; I only wised up in September 1996. He’s the coauthor of an excellent article – really – entitled, ‘DEATHLY DOCTRINE: Christian Churches and AIDS’ (http://www.virusmyth.com/aids/hiv/dmchurch.htm) and he’s thanked for his helpful input in the writing of a seminal scientific critique of the HIV theory of AIDS: ‘A CRITICAL ANALYSIS OF THE HIV-T4-CELL-AIDS HYPOTHESIS’, (Genetica 95: 5-24, 1995) (http://www.virusmyth.com/aids/hiv/ept4cells.htm).
Does this outstanding contribution to the AIDS dissident discourse by Professor Schuklenk qualify him as one of those ‘loud fringe academics’?
‘The results of this collaborative study, which involved … over 20 000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART [Highly Active Antiretroviral Therapy] has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period. [We noted a] discrepancy between the clear improvement we recorded for virological response and the apparently worsening rates of clinical progression’. – The Antiretroviral Therapy (ART) Cohort Collaborative, Lancet 368:451-458 (2006)
‘The major findings are that, despite improved initial HIV virological control … there were no significant improvements in early immunological response as measured by CD4-lymphocyte count, no reduction in all-cause mortality, and a significant increase in combined AIDS/AIDS-related death risk in more recent years.’ – Lancet editorial commenting on ‘these somewhat paradoxical trends’ reported in the above-cited study
4. Paddy: The curious thing about the skull-and-crossbones label on bottles of AZT with the warning that you should cover yourself up with ‘suitable protective clothing’, not even sniff it or let it come into contact with your skin, is that this is for research workers to heed. Pregnant African women aren’t told this when smiling white doctors press them to swallow it, threatening that unless they do their babies will die, because of the germs they harbour in their septic vaginas (according to the white doctors, who are clever because they’re white).
It’s an open secret that President Mbeki is the principal author of ‘Castro Hlongwane’; see Gevisser’s book, ‘Thabo Mbeki: A Dream Deferred’.
The veteran journalist Patrick Laurence confirmed to me that Peter was in perfect health when he interviewed him on the Thursday before the weekend in which he suddenly died. You’ll see photos of him on the day in question in the Helen Suzman Foundation magazine ‘Focus’ looking just fine. On the advice of a doctor, he took a dose of antibiotics prescribed to him for the sniffles that had set in on Friday; he suffered an acute allergic reaction to them, fell very ill, and died as a result on Sunday. But there isn’t a white in South Africa who doesn’t know for a fact that Peter died of ‘AIDS’ (it’s what the blacks get, you know).
5. Erika: Would you be interested in hearing ‘the sad story’ of the prominent African woman in this country who phoned me distraught over how AZT had caused her daughter brain damage, consistent with the published research literature on this score?
You say AZT, nevirapine and a third drug (AZT-similar 3TC?) administration turns out ‘happy chubby babies’. Really?
‘Children born to HIV-positive women who take antiretroviral therapy (ART) during pregnancy are significantly smaller in terms of height, weight and head circumference compared with children born to HIV-positive women not on ART, or who took monotherapy, according to the results of a European study examining the effects of ART on uninfected children’s growth up to the age of 18 months [European Collaborative Study, JAIDS 40(3):364-370 (2005)].’
Edwin Bernard, AIDSmap News, 3 November 2005
‘[In a major review of data collected between 1986 and April 2004, AIDS drugs such as AZT were found to cause a] substantially increased risk of severely curtailed pregnancy [i.e. dangerously critical prematurity] … coupled with a very high neonatal mortality rate.’
Thorne et al. AIDS 18(17):2337-2339 (2004)
‘The study cohort included 92 HIV-1-infected and 439 uninfected children … Antiretroviral therapy (nonprotease inhibitor) was independently associated with FTT [Failure to Thrive] in our cohort … ZDV [AZT], in particular, alters mitochondrial metabolism and may have direct nutritional effects.’
Miller TL et al. Pediatrics 108(6): 1287-96 (2001)
‘In this retrospective study, the risk of RPD [rapid progression of disease] was five to six times higher among infants born to [AZT] treated compared with untreated mothers. … RPD was three times more likely to occur in infants born to [AZT] treated compared with findings in untreated mothers.’
De Souza et al. AIDS 24(2):154-61 (2000)
‘The probability of developing severe disease at 3 years of life was significantly higher in children born to mothers [administered AZT during their pregnancies] than in those born to [untreated] mothers. … The same pattern was observed for severe immune suppression: the probability of developing severe immune suppression was significantly higher in children born to [AZT-treated] mothers … than born to [untreated] mothers. … Finally, survival probability was lower among children [born to AZT-treated mothers] … compared with children born to [untreated] mothers.’
De Martino et al. AIDS 13(8):927-33 (1999)
‘Prenatal and perinatal ZVD [AZT] exposure were associated with 1.8-fold increased risk of progression to AIDS or death after adjusting simultaneously for all variables associated with disease progression … Restricting the analysis to children born after April 1994 (date of public release of the results of ACTG 076), ZDV exposure was associated with 2.5-fold increased risk of progression to AIDS or death after adjusting simultaneously for the same variables. … Steady improvements in prognosis of [HIV] infected children unexposed to ZVD were observed in each successive birth cohort, but infected children exposed to ZVD lagged behind these temporal changes. Our results … are consistent with recent results from the Italian Registry for HIV Infection in Children [reported by de Martino, cited above].’
Kuhn et al. Journal of Infectious Diseases 182(1):104-11 (2000)
Happy, chubby, bouncing babies, eh?
Do you find that exposing unborn and newly born African babies to AZT and similar cell-poisons also makes them more intelligent?
‘Our findings support the hypothesis of a link between mitochondrial dysfunction [in babies and infants] and the perinatal administration of prophylactic nucleoside analogues.’ [Eight children were born with severely impaired energy metabolism and corresponding muscle and other cell damage, manifesting in heart muscle injury and muscle weakness generally. Five children, of whom two died, presented with delayed neurological symptoms – extensive brain damage in the form of massive cortical necrosis, cortical blindness, epilepsy and spastic quadriplegia, and three were described as ‘symptom-free’ but had ‘severe biological or neurological abnormalities’. Four of the children had been exposed in utero and after birth to AZT and 3TC (a similar drug) combined, and four to AZT alone. None were HIV-positive. Please see the annexed APPENDIX for an excerpt from this report detailing these injuries. Following further ‘exhaustive’ investigation by Barret et al., the ‘hypothesis of a link’ between perinatal AZT exposure and grave harm to unborn and newly born babies was ‘confirmed’; see the report cited immediately below.]
Blanche et al. Lancet 354(9184):1084-9 (1999)
‘An exhaustive study in a large prospective cohort [of AZT- and 3TC-exposed children found] unexplained symptoms compatible with mitochondrial dysfunction. A total of 2644 of 4392 children were exposed to antiretrovirals … All the children with “established” or “possible” mitochondriopathy diagnosed in this study had been exposed to antiretroviral drugs … in the pre, per- and post-partum periods. … The finding that the use of antiretroviral nucleoside analogues in the perinatal period is associated with persistent mitochondrial disease is confirmed … a risk about 30 times higher than that in the general population. … Despite active screening, no similar cases were found in the antiretroviral unexposed group. … by age 18 months … a coherent syndrome is appearing with three main features: neurological symptoms (principally developmental retardation, seizures and behavioral disturbances), significant abnormalities on cerebral MRI (principally lesions of the white matter and brainstem) and often hyperlactataemia either persistent or transient outside the treatment period. First described as a myopathy associated with zidovudine [AZT], the issue of mitochondrial toxicity of nucleoside analogues is currently a growing problem. Its clinical expression is highly variable, from peripheral neuropathy to severe lactic acidosis.’
Barret et al. AIDS 17(12):1769-1785 (2003)
‘Mitochondrial dysfunction has been reported in HIV-negative children perinatally exposed to zidovudine [AZT], a drug often used in HIV-seropositive mothers during pregnancy. The purpose of this study was to determine the incidence of cerebral MR imaging findings in HIV-uninfected children exposed to zidovudine who present with unexplained neurologic symptoms. … Images observed in children with antiretroviral-induced mitochondrial dysfunction are similar to those observed in congenital mitochondrial diseases.’
Tardieu et al. American Journal of Neuroradiology 26(4):695-701 (2005)
Erika, you argue:
‘The efficacy of drugs like AZT and NVP in the field of PMTCT have been well researched and published. The protocols of the CDC, WHO and BHIVA are put together by epidemiologists and clinicians who are trained to interpret evidence of the highest level. Usually the evidence comes from studies that have been conducted by reputable academics and published in reputable journals.’
Would I be right in concluding from this sort of appeal to authority that you have never taken the trouble to evaluate for yourself the quality of the studies to which you allude: their design, execution and interpretation? If not, would it be too much to expect that you do so now? Have you read this paper for instance?
Mother to Child Transmission of HIV and its Prevention with AZT and Nevirapine (PDF, 2.03 MB) http://www.tig.org.za/pdf-files/azt_nevirapine_small.pdf
It’s a critical evaluation of the studies claiming to support the administration of those drugs to pregnant women, following which might think of abruptly changing careers, horrified to learn what you’ve been doing - in the belief that you’ve been saving little African babies with the miraculous strong medicine from overseas.
Hey Terry in exciting Pietermaritzburg, you say:
‘Ant If you really care for your people, you should either:
1) Go and study pharmacology at a proper university facility (even Roy may take you on as a student - for his sins), where you’ll find that all that web-claptrap pseudo-pharmacology he’s been spewing on us now for years, was just a bad acid trip.’
Well I’m sure this is very entertaining writing, Terry, the tremendously colourful way you write and everything, but seriously, do you think Roy can really teach me anything I don’t know about AZT and nevirapine? I mean I’ve written whole books about these drugs, having researched them intensively for ore than a decade. Roy, on the other hand, can’t even tell us what the triphosphorylation problem is. Actually, until I mentioned it, he’d never even heard of it before. Which is why he smugly announced on his own blog, that he will not debate with me the issues that he himself raised. Because he can’t. He’s outclassed. He doesn’t know what’s going on.
If you think I don’t know what I’m talking about, as you suggest in your post, maybe because I didn’t take notes in Roy’s class at university and then write in his exams in nice neat easy-to-read handwriting that AZT is ‘life-extending’(in the words of George Bush), what should we make of this statement by the guy who invented AZT in 1961? I’m quoting from Professor Richard Beltz’s email to me on 11 May 2000:
‘… you are justified in sounding a warning against the long-term therapeutic use of AZT, or its use in pregnant women, because of its demonstrated toxicity and side effects. Unfortunately, the devastating effects of AZT emerged only after the final level of experiments were well underway, that is, the experiments which consisted of giving AZT to large numbers of human patients over a long period of time. Your effort is a worthy one … I hope you succeed in convincing your government not to make AZT available.’
Could he learn something from Roy’s pharmacology classes too, do you think? Particularly concerning giving AZT to pregant African women and their babies.
You say that fed ARVs in rural clinics, one sees ‘the dead rising like Lazarus’. Do you mean like the touch of Jesus? Fantastic! AZT brings dead people back to life!
Even if you meant that ARVs restore mortally sick people to vibrant good health, but not being a person who thinks clearly you weren’t able to express yourself clearly, your enthusiastic biblical convictions are not supported by any clinical research; and this is why not a single ARV manufacturer makes the claim that its drug makes sick people better. Not one. If there was any scientific basis for your claim in the form of cogent clinical research findings, the drug corporations would be quick to trumpet it, wouldn’t it now?
You say that on ARVs patients’ ‘viral counts drop[…] and the immune marker CD4 counts ris[e] from as low as 40 to well over 800’. It seems you prefer reading Loslyf to your medical journals, because in August 2006 Lancet published the biggest ARV clinical study yet conducted, involving more than 20 000 cases, and it found that the better you got on the drugs according to the laboratory tests, the sicker you got:
‘The results of this collaborative study, which involved … over 20 000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART [Highly Active Antiretroviral Therapy] has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period. [We noted a] discrepancy between the clear improvement we recorded for virological response and the apparently worsening rates of clinical progression’. – The Antiretroviral Therapy (ART) Cohort Collaborative, Lancet 368:451-458
A covering editorial commented: ‘The major findings are that, despite improved initial HIV virological control … there were no significant improvements in early immunological response as measured by CD4-lymphocyte count, no reduction in all-cause mortality, and a significant increase in combined AIDS/AIDS-related death risk in more recent years.’
Now in the light of these findings, especially the bit about how ARVs accelerate the death rate of HIV-positive people given them – which is not so incredibly complicated for non-doctors and non-pharmacy shopkeepers to understand, considering that AZT was specifically designed to kill human cells – why would anyone with any brains want to swallow it, or want anyone else to?
Perhaps because, as the late great philosopher of science Paul Feyerabend put it: ‘It is very difficult, and perhaps entirely impossible, to combat the effects of brainwashing by argument.’
Seems you have high jacked this thread but I can’t resist adding my bit.
I am a colleague of Dr Pfaff and have worked with him for the last six years.
We are in an almost perpetual state of moribund depression watching close friends and colleagues and masses of patients suffer and die. Sure poverty contributes but the relatively wealthy are dying too. Yes, from AIDS.
Of course AZT is toxic, so is panado.
Roy will remember the debates we had in the family medicine department at Wits whether a warning should be put on the bottle of panado about the fatal consequences of an over dose.
On the whole panado is a very useful drug, and yes some people do die from it.
I can’t resist using one of your favoured quotes:” Gentlemen, I beseech you. In the bowels of Christ, think it is possible that you are wrong.”Oliver Cromwell.
You repeatedly mention the skull and crossbones on a bottle of AZT. Remember that was from the sixties and pre clinical trails.
I accept that many people have been killed by the bone marrow suppression due to AZT and thank god (lower case intentional) we have learned how to use the drug better.
Your research is astounding in its depth, but still significantly out of date and frequently out of context. I can’t help wondering if this is all a preamble to a massive tort case.
To go back to Colin Pfaff.
Should he be considered a hero? I know that was never his intention.
The program was very carefully thought out and initiated looking at results from the Western Cape and other places were dual therapy has been successfully used for some time.
If you think we are still doing the wrong thing I invite you to come and spend time in our wards. Not just a fleeting glimpse, but a significant time were you can get to know the mothers of dying children and get immersed in their pain.
I now you too have lost friends to AIDS/AZT, but treatment has improved dramatically since. A single drug (stretching a one month course over two) will certainly not provide any improvement. You also seem to keep omitting why your friend was on the drug in the first place. He was dying wasn’t he?
Please spend time away from your computer and in the wards.
You may find your concerns alter course dramatically.
Mark at Manguzi on February 23rd, 2008 at 10:36 am
AB
Like I said. All drugs have side-effects. Taking a drug is like getting into a car to get from point A to point B. We all know that there is a risk of the car breaking or getting into a car crash, but if the car is the best available means of transport, that is what we will use.
Patients need to be informed of the risks (which is what is called informed consent,) and then choose for themselves.
When faced with a life threatening illness (HIV), most women will choose the risk of “possible” side effects above the risk of certain death.
As long as people are informed, they can make an informed choice.
It can be compared to the Hormone replacement therapy and chemotherapy choices patients often have to make.
Don’t assume that just because I don’t agree with you I don’t read the evidence.
1000 signatures in support of Colin Pfaff is evidence that many agree with this.
Mark, you say:
‘Of course AZT is toxic, so is panado.’
This is like arguing, ‘Of course cancer chemotherapy is toxic, so is cough mixture.’
It’s no argument at all:
‘It is self-evident that ANAs [antiretroviral nucleoside analogues, such as AZT], like all drugs, have side-effects. However, the prevalent and at times serious ANA mitochondrial toxic side-effects are particularly broad ranging with respect to their tissue target and mechanisms of toxicity: Haematological [blood]; Myopathy [muscles]; Cardiotoxicity [heart]; Hepatic toxicity [liver]; Peripheral neuropathy [nerves].’ – Lewis and Dalakas, Nature Medicine 5:417-22 (1995)
You say: ‘I can’t resist using one of your favoured quotes:” Gentlemen, I beseech you. In the bowels of Christ, think it is possible that you are wrong.” Oliver Cromwell.’
Yes Mark, please do. And thanks for at least troubling to read my book Debating AZT. Most people mouthing off on this subject have never read further than the Sunday Times.
You say: ‘You repeatedly mention the skull and crossbones on a bottle of AZT. Remember that was from the sixties and pre clinical trails.’
You are quite wrong about this. Sigma-Aldridge’s label currently appears on bottles of AZT containing as little as 25 mg – one quarter the quantity in a single capsule supplied by GlaxoSmithKline. Strictly speaking, you’re right to imply the label is out of date. It is. The current one carries the additional warning that accidental contact with the drug may cause you to develop cancer.
You say: ‘I accept that many people have been killed by the bone marrow suppression due to AZT and thank god (lower case intentional) we have learned how to use the drug better.’
Mark, how have we learned to use AZT better, this drug that you concede has killed so many people? It sounds to me like a doctor defending bloodletting - still being recommended for the cure of pneumonia in Osler’s standard Principles and Practice of Medicine as recenly as the 1943 edition. Doctors, the clever guys!
You say ‘Your research is astounding in its depth, but still significantly out of date and frequently out of context.’
Thanks for the first compliment. But as for the rider: I’ve been tracking the research literature closely for over a decade, and it just mounts up. Please let me know what research findings that I cite are ‘out of date’, and how they’ve become ‘out of date’. Is talking like this an easy way out of not having to think about it, and not have to change you mind? Take this study for instance:
‘[AZT and other nucleoside analogue drugs] are much more toxic than we considered previously. … The layer of fat-storing cells directly beneath the skin, which wastes away … is loaded with mitochondria … other common side effects of [AZT and similar drugs are] nerve and muscle damage, pancreatitis and decreased production of blood cells … all resemble conditions caused by inherited mitochondrial diseases.’ – Brinkman et al. Lancet 354(9184):1112-5 (1999)
Would you say that’s ’significantly out of date’ now?
Concerning Colin Pfaff, I don’t doubt for a moment that he’s a very nice guy, compassionate and dedicated. Of course I think that he was misguided in giving pregnant African women AZT and exposing their unborn children to this stuff, but I accept completely that he acted with all the best will in the world. Had Colin been practising in the 1940s, with the same best intentions, compassion, professional concern for his patients, and faithful eye on best medical practice according to the unanimous expert medical conventions of the day, he would have been injecting these women with arsenic: Michael Gelfland’s The Sick African, published in Cape Town in 1944 (Stewart Printing Co) put it like this:
‘Syphilis is a subject of paramount importance. The incidence is difficult to gauge, but it seems to be present in 20 per cent. or more of all Natives. Its recognition is important, not because the treatment given to the Native is in any way inadequate, but largely in order to prevent his spreading the infection by contact with the Europeans or his own people. This is accomplished by giving the syphilitic a short course of arsenical injections, to render him non-infectious. … Of course, if … the Native can be persuaded to attend for a longer course, better results will be obtained. … Perhaps the solution to the problem may be found in the administration of arsenic in massive doses by intravenous injection continued over a few days. Reports from the Union of South Africa … appear to be promising. This is certainly a form of therapy that should draw the attention of the public authorities. … I am confident that the solution to syphilis in the Native lies in this form of treatment, but its potential danger must not be overlooked.’
Of course any doctor injecting arsenic into anyone, let alone a pregnant woman, even one, never mind repeatedly in ‘massive doses’, would be arrested by the police for attempted murder today and locked up as criminally insane.
You say ‘I [k]now you too have lost friends to AIDS/AZT, but treatment has improved dramatically since. A single drug (stretching a one month course over two) will certainly not provide any improvement. You also seem to keep omitting why your friend was on the drug in the first place. He was dying wasn’t he?’
The fellow you speak of wasn’t a friend of mine, he was a legal colleague practising in a faraway town. He wasn’t sick, he was run down. No clinical symptoms of any disease of any sort. Just tired, always tired, his wife complained. He went for a battery of tests. He was found to have hypogammaglobulinaemia – a raised level of non-specific antibodies, a textbook cause of false reactivity to HIV antibody tests (so guess what other test he lit up). He was put on AZT and 3TC, took violently ill on them, never recovered and was dead in months, vomiting his life away into a bucket, unable to get up from the floor when he fell, unable to speak, his muscles wasted away – just as the AZT literature, even the package insert, predicts.
You say ‘Please spend time away from your computer and in the wards.’
You may find your concerns alter course dramatically.
If you don’t mind, I’ll continue researching this drug and continue ventilating the research literature on it until someone else takes over, so I can move on. No one else here is.
I trust you regard yourself as a democrat, or believe in the principles of democracy?
In this case, you should understand my insistence upon having free and unfettered access to any medical treatment of MY choosing, which I believe is best for me, as a ‘Human Rights Issue”
You should also be able to understand my resentment when these choices are expressly limited through statutory regulation, enforced by panels of bureaucrats who ‘know what is best for me’ better than I do.
( After all, I’m lay and uninformed, and they’re not….yeah right! )
I cannot afford private treatment, and am dependant upon the public healthcare system, funded in part by a hefty ‘deduction’ from my monthly income.
Imagine the frustration when a healthcare professional informs me that effective treatment cannot be administered because ‘protocols’ put in place by non medical bureaucrats to ‘protect’ me and my rights would be breached, resulting in legal problems.
The 21st centaury field of medicine is fast and dynamic, new treatments emerge in weeks or months, a state regulated treatment regimen simply cannot respond quickly enough to take advantage of these developments, ( read as: the state graciously ‘allow’ us access after their due consideration) and citizens are deprived of both choice and access in their rights to treatment.
Gus, you have ‘democracy’ upside down.
Rights do not flow from the state; the state is our paid servant, not our nanny who protects us from ourselves.
If I want a new cancer treatment which is not yet part of the states’ ‘protocol’, and am prepared, in consultation with a healthcare professional, to bare the risks and cost of its use, then that is not the business of the state and their ‘regulations’
I don’t buy the usual argument that the Constitution ‘provides’(in their interpretation) for the state to impose such regulations because of their ‘mandate’. Choice of medical care lies outside the ambit of the state in any sane democracy, of which there are very few left in this world.
@ Anthony
Go for it, Ant, and to hell with your critics.
There is this constant, veiled implication that your ‘findings’ are not in the public good and should therefore be suppressed.
I wholeheartedly defend your right to campaign publicly and disseminate information you believe will result in citizens arriving at ‘fully informed’ choices concerning their healthcare.
Should you graduate from an information campaign to one of action, by attempting to influence the meddling bureaucrats to further limit my treatment choices through their regulatory legislation, then that is another matter entirely.
It is not for private citizens to lobby in order to foist their personal world view onto everyone else any more than it is the legitimate premise of the incumbents of state to do so.
Perry Curling-Hope on February 23rd, 2008 at 12:51 pm
Anthony Brink wrote: ” If you don’t mind, I’ll continue researching this drug and continue ventilating the research literature on it until someone else takes over, so I can move on. No one else here is”.
You’re on your own Ant - much of the hysterical data and information you spew, is based on outdated and discredited debates that revolved around initial skepticism to a disease that was unknown before 1983 and required totally tests, new drugs and treatment protocols. There were many mistakes made but dedicated people have honed the art of testing for and treating this incurable disease with cocktails of 1st, 2nd and 3rd generations of ARV’s, to the point where victims can lead relatively healthy and productive lives. Its been incontrovertibly shown that PMCTP 2 or 3 ARV drug treatment protocol protects the infant from sero-conversion as Nevirapine alone was insufficient. The NDoH adopted this program over 2 years ago but is still prevaricating over its implementation. Hence the Dr Pfaff and similar debacles by Health workers with a conscience and a strong need to save lives .
All you do is sit at you laptop and spew reams of bilge on two subjects - Aids denialism and AZT toxicity. The train has long since left the station and even your chums Mbeki, Ronnie SR and Christine Qunta have passed their sell by date. Wake up and smell the roses. Lives are being saved by the likes of Dr Pfaff against homicidally obdurate official resistance and bureaucracy - in part encouraged by you Ant.
Recant now Ant, and move on, before its too late - no-one is interested in your job. Get back to your keyboards and chill - Bru!
Let’s round this off by going back to the beginning.
Roy dragged me into this by slagging me off:
‘MEC Nkonyeni claims that she is merely informing patients fully. She said in an interview (à la Anthony Brink): “It tells you [it’s toxic] on the label!” It would appear that her definition of “fully informed” only concerns side effects, and nothing about benefits. The “side effects” of possible HIV infection, chronic illnesses, Aids and eventual death in a baby or child are seemingly not being communicated or considered.’
In order for AZT to have ‘benefits’ such as preventing ‘HIV infection, chronic illnesses, Aids and eventual death in a baby or child’, it must have the pharmacological activity claimed for it, namely that it’s an antiretroviral drug.
Pharmacologists like Roy know, or should know, that AZT is supplied a pro-drug. In its native form administered to people as a medicine, it is therapeutically inert. It can only exert its claimed pharmacological action as an antiretroviral after being triphosphorylated within the patient’s cells by the sequential action of intracellular enzymes. You can read this on the package insert.
So the question is: is it?
Is it Roy?
You tell us whether AZT is triphosphorylated in vivo - and I mean significantly, and not to one or more orders of magnitude below its inhibition concentration.
No one around here will be dumb enough to intepret your sulking silence as holding some sort of moral high ground in refusing to debate ‘denialists’(ARV drug pushers’ favourite stunt when stuck for an answer to a hard question).
If you can’t answer the question, providing a supporting citation in the form of a research report in which AZT-TP was found at a concentration in vivo equal to or exceeding its inhibition concentration, we’ll all accept there isn’t any such data available.
Actually, it’s a trick question; there’s no such paper.
Which is another way of saying AZT isn’t antiretroviral.
Just as, contrary to popular European belief, garlic isn’t anti-vampires.
So it’s all risk and no benefit.
Terry
Have you possibly been quietly tucking into the anti-depressants that you sell in your chemist shop?
I ask because your writing has this sort of thorazine, slipping-clutch quality.
Just wondering.
Whether a single research report that I cited actually went in.
Cheers
AB
Dear Anthony
I will stand by my plea to get you to spend significant time with the masses that are dying from HIV.
Literature searches may be academically rewarding but will never let you truly understand the dreadful crisis we are in.
Let’s assume all you worries are correct.
Do you not think all your energies could be put to use in finding a better treatment.
Nutrition certainly helps, but a fat Yank will get HIV just the same as a thin African given the same exposure factors. Indecently SA now has a higher proportion of obese people than America.
Money only helps because you can buy food and get medical care. But ultimately the death from HIV is the same.
So those two really are not the answer.
I guess I am a bit of a commie, and believe in the greater good…
Of the interventions which are currently available full HAART is the best an HIV positive mother can take for her child. Get the mothers virus load undetectable and she has little to pass on. Yes, we can even measure the amount of virus now. Not sure of your belief of HIV/AIDS causation but I would find it difficult to believe that anyone is still in doubt.
I am sure we will knock off a child or even a mother once in a while and that is what you will grasp at.
The vast majority will be free of the guilt of passing on a death sentence.
So in that I agree.AZT is not the great panacea, but medicine has moved on.
We should be advocating for triple therapy.
Unless you have a better suggestion.
My concern is your efforts are being used to the detriment of my friends and patients and could be used so much more positively on an updated tack.
It is a pity that Anthony Brink has chosen to hijack this thread with his misguided and WRONG information - people that he quote has been shown to be WRONG in the information that they spread - refer to the very long trial held in 2006 in Australia where there was an in depth look at the issue and where the evidence submitted by Brinks’ friends where thorougly rejected by a supreme court after extensive arguments by experts on both sides (http://www.theaustralian.news.com.au/story/0,20867,21631724-1702,00.html) - unfortunately the full trial information is no longer freely available on the Net but I DID read it when it was originally available and as a doctor and a biochemist I was once again re-affirmed in my beliefs that mainstream HIV theories are CORRECT.
If even ONE person listens to your pseudoscience Mr Brink you will have blood on your hands. To peddle this snake oil BS to sick and scared people is absolutely criminal and you and your ilk have the deaths of many people on your hands.
If I wasn’t living here, I might find some humour in Thabo&Manto’s mad hatters party. Spike Milligan or Monty Python could run an entire season on the odd ball antics of the Dept of Health.
But its not just a clash of paradigms or ideology. Its not just gross incompetence and lack of Batho Pele and ubuntu. Its a deliberate policy of demonising all western medicine in favour of some mumbo jumbo afrikanist hallucination - that bears no resemblance to reality.
We have one of the highest infant mortality rates in the world, our health intervention benchmarks score badly, even compared to blighted Uganda and poor African countries. It’s not just money - we spend somewhere close to 8% GDP on public health.It all boils down to a lack of coherent leadership and a gross dereliction of duty by those in stewardship roles (MoH, MEC’s, DoH etc)
Yes Ant! I do take antidepressants to dull the fact that I live in Mamparaland where we would rather sack national heroes like Dr Pfaff than dismiss the entire top structure of the DoH and put them on trial at the High Court in de Hague - for crimes against humanity. Would you defend them - of course you will! At least you’ll be doing something within your area of competence
Did any one read the tome by Peter Mokaba just befor he died about HIV not causing AIDS.
Fair enough to denigh yourself treatment but anouther to hamper others.
I picture a lot of hand wringing in the future to the mantra;out, out, damned spot.
Mark: Peter Mokaba was not the pricipal author of ‘Castro Hlongwane’, President Mbeki is. Read up in Mark Gevisser’s new biography, ‘Thabo Mbeki: The Dream Deferred.’
I revealed what killed Peter in an earlier post, and it had nothing to do with ‘AIDS’. So wy do you persist in insinuating that he was ‘HIV-positive’, that he died of ‘AIDS’, and that he should have taken ARVs?
Is it because he’s black? And all whites like you know, they just know, that Peter died of AIDS.
I was just wondering whether Roy’s unwillingness to answer my question about whether AZT is triphosphorylated intracellularly, as GlaxoSmithKline and other generic producers claims it is, might have to do with the fact that a direct, honest answer in the negative (meaning it can only poison people, and nothing else) might harm his prospects of scoring a cushy big-ticket job with a pharmaceutical corporation when he pitches up offering his services waving his new ‘PhD in advertising and marketing of medicines’, as his ‘Profile’ puts it.
AB1:
Yurtdisi: What particular language did you have in mind? My leaflets, ‘Why do President Mbeki and Dr Tshabalala-Msimang warn against the use of ARV drugs like AZT?’ and ‘Why do Zackie Achmat, Nathan Geffen and Mark Heywood want pregnant African women and their babies to be given AZT? What AZT does to unborn and newly born children’ are now in Spanish, Russian, German and Italian; and my criminal complaint against the TAC’s Zackie Achmat in the International Criminal Court (a sophisticated parody that some got, some didn’t) is in French and Dutch too. http://www.tig.org.za/pdf-files/azt-mbeki_tshabalala-msimang.pdf http://www.tig.org.za/pdf-files/azt-achmat_geffen_heywood.pdf http://www.tig.org.za/pdf-files/icc_achmatcomplaint.pdf
AB4:
Thinus: The Paranzee case was not lost on a determination of the merits of the Perth Group’s contentions, but for other reasons that would take a while to explain. Be patient: a detailed analysis of the reasons for the failure of the case is in preparation and will be posted online in a few weeks (I’ve read the draft). I’m thoroughly familiar with the case, having been consulted repeatedly by the defence counsel and the expert witnesses.
It doesn’t surprise me to learn that you’re ‘a doctor’. The quality of your reasoning in your post squares with my general experience of the constipated thinking style of you guys. Everything you know, you learned off by heart. No knowledge of history, no cultural studies, no philosophy, no literature; you blokes are complete barbarians, man!
But since you’re also a ‘biochemist’ could you possibly enlighten readers about the AZT triphosphorylation problem? See if you can understand this easy-to-follow explanation: http://www.tig.org.za/pdf-files/openletter_gsk.pdf
Just let me know if there are any big technical words in there that you can’t understand, and I’ll try to explain them for you.
Which of the citations from the peer-reviewed medical literature that I’ve put up in this discussion would you describe as ‘pseudoscience’?
What ‘snake oil BS’ do I ‘peddle’? I’m not peddling anything; I’m critiquing a very bad drug, the contemporary version of arsenic injections between 1910 and the mid-fifties. That’s all.
If you now persist in telling ‘sick and scared people’ that unless they swallow AZT or a similar drug in combination with other similar drugs, or they’ll surely die, now that you know how it will poison them, who’ll have the ‘blood on [his] hands’ and whose conduct will be ‘absolutely criminal’ causing the ‘deaths of many people’?
AB3(a):
Paddy: It appears Parks lit up an HIV antibody test. Anybody can: a prominent white newspaper editor here, faithfully married for many years, once phoned me, freaked out; he’d just had the test for a life policy, and it came back positive. He was suicidal, talking of driving his car at speed into a bridge – until I told him relax, the test is junk, like a Nazi doctor’s nose caliper to measure whether you’re a Jew or not, like the Wassermann test for syphilis that once ruined so many lives, and drove so many people to suicide in terror and despair.
Although these ‘HIV antibody’ tests are designed and licensed for blood screening only – being non-specific for ‘HIV’ – and are not intended as a diagnostic instruments for making life and death diagnoses (yet are used by ignorant doctors for this every day), Parks was told by a doctor that he had the deadly sex-virus in him. But never mind, the doctor said. There’s a nice strong medicine from overseas invented by clever white Americans called AZT that will slay this sex-virus, so you won’t die. But die he sure did. AZT killed him, slaughtering his red, oxygen-carrying blood cells, just as the research literature has predicted from the beginning (it’s common cause that Parks was given AZT and died of massive anaemia). Search on ‘anaemia’ in Debating AZT: http://www.tig.org.za/pdf-files/debating_azt.pdf
AZT kills or maims every cell it reaches. This is what it was designed to do.
AB3(b)
Here’s a recent report (Feiterna-Sperling et. al Journal of Acquired Immune Deficiency Syndromes 45(1):43-51 (1 May 2007)) on how AZT causes anaemia in babies exposed to it in the womb and after birth:
‘[In a] prospective observational study to investigate hematologic alterations during the first 3 months of life in HIV-exposed uninfected infants subjected to antiretroviral medication before and after birth … Two hundred twenty-one consecutive uninfected infants born to HIV-positive mothers on antiretroviral medication during pregnancy were included. Perinatal transmission prophylaxis comprised zidovudine (ZDV) administered intravenously intrapartum and 10 days after birth. … Median hemoglobin was significantly lower in HAART-exposed newborns from birth … until day 28. During follow-up, 119 (53.8%) infants had anemia grade 2 or higher on at least 1 occasion; 16 (7.2%) received red blood cell transfusion at 23 (range: 1-56) days of age. Neutropenia grade 2 or higher occurred in 106 (48.0%) infants at least once; 8 infants had staphylococcal infections, and 2 infections were severe. … Antiretroviral transmission prophylaxis is associated with significant anemia and neutropenia in HIV-uninfected infants during the first 3 months of life. Anemia was more profound in HAART-exposed infants.’
So as I was saying: ARVs combined as ‘HAART’ are worse than AZT alone (see this, Mark?).
And here’s a report before it by the European Collaborative Study in AIDS (18(15):2009-17) on 21 October 2004:
‘Antiretroviral drugs (ARV) as prophylaxis to prevent mother-to-child transmission of HIV results in decreased haematological parameters during and shortly after exposure, with recent data suggesting a more prolonged inhibition of haematopoiesis until at least 18 months [i.e. ARVs given to pregnant women cause persistent, probably permanent, bone marrow suppression, thus reducing blood cell production]. In uninfected children … ARV exposure [before birth was] associated with reduced neutrophil count until at least 8 years of age. … CONCLUSION: A considerably longer effect of exposure to ARV was shown in uninfected children than previously thought.’
Anaemia in babies is deadly; there’s a massive corpus of literature on this. See the detailed discussion in ‘Poisoning our Children: AZT in Pregnancy’ http://www.tig.org.za/pdf-files/poc.pdf
Is this all so very hard to for everyone to understand?
For a general introduction to AZT, quoting scientists, doctors and activists both for and against it, providing a balanced perspective to give both sides, see ‘Introducing AZT: “A world of antiretroviral experience”’: http://www.tig.org.za/pdf-files/introducing_AZT.pdf
The ‘HIV antibody’ test that Parks was given was non-specific, like the once ubiquitous, now abandoned Wassermann test for syphilis (in some American states compulsory before marriage). Spend some time here: http://www.virusmyth.com/aids/perthgroup/
You’ll find everything you need to know about ‘HIV antibody tests’ – summed up in the title to an article I wrote on the subject, ‘Why the “AIDS test” is useless and pathologists agree’. It’s in the appendices of Debating AZT: http://www.tig.org.za/pdf-files/debating_azt.pdf
Apropos of Edwin Cameron, it’s quite a story – written up in my big book in preparation, ‘Just say yes, Mr President’: Mbeki and AIDS, which I hope to have out by the end of the year.
Your question about ‘all the funerals’ is a big one too. Since this discussion is about AZT in pregnancy (Roy began it by mocking the KZN Health MEC and me for pointing out that packaged in the tiniest amounts for research use, AZT comes with deadliest toxic hazard warning possible), let’s stay on point. But if another thread begins on the death stats, let’s go for it.
AB2(a):
Mark: You’ll appreciate that living in a rural village or urban shanty-town or a while, or spending time at the bedsides of people who are ill, will not assist one determine whether a particular medicine being hawked by a multinational pharmaceutical corporation with its multi-billion-dollar PR operation in full spin is good or bad. One needs to study the clinical and molecular pharmacology literature on that drug to decide. And when one discovers that the drug is very toxic and therapeutically useless, and kills people, one might feel moved to do something about it, particularly if no one else is.
By the way, I’m a musician. I’ve spent plenty of time in the townships and ‘locations’. I know the scene. I’ve also traveled to Hlabisa on a special trip to investigate this renowned epicenter of the ‘African AIDS epidemic’, but when I asked the resident MRC researcher’s assistant where I should go to find all the AIDS cases, he told me, ‘No, you have to go to Richards Bay, Durban, Empangeni, and Matubatuba. It’s where the prostitutes are.’ (It’s always over the next hill.)
Believe me: I don’t doubt that severe broken health is widespread among the destitute African poor. I doubt that it’s because they had sex just as other people all over the world do.
If my ‘worries are correct’ how can I possibly abandon my work to ventilate the research literature on AZT and similar drugs? There’re enough people working on ‘finding a better treatment’ than AZT and similar drugs, and they don’t need me.
You say, ‘Nutrition certainly helps, but a fat Yank will get HIV just the same as a thin African given the same exposure factors. Indecently SA now has a higher proportion of obese people than America.’
According to the Centers for Disease Control, of a US population of around 275 million, there have been an estimated one million HIV-positive people in the US from the start of the AIDS era, whether ‘fat’ or ‘thin’ ; it’s never increased (some epidemic!). Whereas according to our Human Sciences Research Council’s AIDS research wing (run by an American, naturally), just about every second young African women in our country has the deadly sex germ teeming invisibly in her filthy, deadly vagina, no matter how lovely and healthy she looks. So there is no comparing ‘HIV prevalence’ and ‘AIDS’ in our countries.
This racist idea, that keeps recurring in Western medicine, that Africans are rife with sexually transmitted disease (it used to be syphilis), is deconstructed in two critiques I wrote of the HSRC’s ‘HIV Prevalence’ study, published in December 2005. But they’re quite rude, and so unsuitable for Christians and children: http://www.tig.org.za/pdf-files/Shisana.pdf http://www.tig.org.za/pdf-files/Shisana2.pdf
AB2(b)
You say: ‘Of the interventions which are currently available full HAART is the best an HIV positive mother can take for her child.’
HAART (Highly Active Antiretroviral Therapy’) is generally AZT or a similar nucleoside analogue drug, combined with another one, such as AZT first cousin 3TC, and another non-nucleoside analogue, such as nevirapine. If you read ‘Poisoning our Children’, cited above, you’ll discover that the poisons mixed are more dangerously toxic in their effects than the poisons alone. So is ‘HAART’ really the ‘best an HIV positive mother can take for her child.’ It’s certainly the best for poisoning African babies, if that’s what you had in mind.
You say, ‘Get the mothers virus load undetectable and she has little to pass on.’
You’ll be surprised to learn that AZT has no significant effect on viral load according to all the studies.
Search on ‘viral load’ in ‘A Critical Analysis of the Pharmacology of AZT and its use in AIDS’: http://www.tig.org.za/pdf-files/azt_pharmacology.pdf
And in HIVNET 012, the study on the basis of which nevirapine is given to babies in the Developing World, not the First, the drug didn’t reduce the mother’s ‘viral load’. Search on ‘viral load’ in ‘The trouble with nevirapine’: http://www.tig.org.za/pdf-files/trouble_nevirapine.pdf
You say, ‘Yes, we can even measure the amount of virus now.’ But not even the manufacturers of these ‘viral load’ tests make this claim. In fact the test is so non-specific, that it’s not permitted even for screening blood, let alone diagnosing or confirming an ‘infection’. It doesn’t measure viruses. It gives you a reading of how many copies of RNA it detected – RNA presumed, but never shown, to be viral. A doctor friend sent her HIV-negative blood in (under a made-up name) and it came back with a sky-high ‘viral load’ count. The test is worthless.
You say, ‘I am sure we will knock off a child or even a mother once in a while and that is what you will grasp at. The vast majority will be free of the guilt of passing on a death sentence.’ Non comprehendo.
You admit, ‘AZT is not the great panacea, but medicine has moved on.
We should be advocating for triple therapy.
Unless you have a better suggestion.’
Triple therapy is generally based on AZT and/or similar drugs. So we haven’t moved on at all. We’re just mixing our poisons now.
Personally I think the sick benefit from intensive nutritional therapy better than the ingestion of patented synthetic metabolic poisons. That’s my ‘better suggestion’.
You worry, ‘My concern is your efforts are being used to the detriment of my friends and patients and could be used so much more positively on an updated tack.’
In what manner is my airing of the research literature on AZT and similar drugs ‘detrimental’?
Should I stop putting this negative information about because it’s upsetting for doctors to think that they’re poisoning people, like they used to do with arsenic?
Would it make you feel better if I told you, congratulations, you’re saving lives?
I started off by planning of flooding you with references in a similar fashion to what you have done - after all I have a degree in Biochemistry and a medical degree so I have a reasonable grasp on the subject matter. I then thought about it and the futulity of posting on the life saving effects of anti-HIV treatment to someone who does not even believe the basic principle of HIV causing AIDS.
I realised I would be wasting my time - I could send you the hundreds of references from Medline, pubmed and Cochrane databases that shows that these toxic (never argued that they were not) drugs saves the lives of hundreds of thousands of babies.
But you don’t believe that HIV exists or causes the disease/syndrome, won’t take antibiotics, etc. and on top of that your replies are becoming increasingly racially abusive and vitriolic.
Trying to convince someone like you is a waste of precious time - time I should be spending on helping people that want to be helped and that has hopefully not lent their ears out to pseudoscientists and their babbling.
Don’t bother sending another ream of replies because I won’t be reading it - I am unsubscribing as I really don’t have time to read your crap and am happy to stick with what much more authoritive medical resources say.
TvR
Guys, it’s all about RISK-BENEFIT ratio. A lot of things we do in clinical medicine are not perfect treatments, far from it: anti-mitotic drugs used in cancer are lethal and have horrific side effects but we still use them because we don’t have better alternatives. These drugs in effect interfer will all normal cell processes and slowly kill patients, it’s just a question of killing the tumour at a lower dose than needed to kill the patient. Pretty horrific and unacceptable if you think about it like that but cancer isn’t such a politicised illness. We could wait for the perfect cure/treatment but we’ve ben waiting several decades and we’re still making slow progress.
ALL drugs, and I mean all drugs are lethal and have bad side effects: Amoxycillin can be lethal to people who have severe allergic reactions to it but it’s prescribed so frequently, for minor things because the risks are low.
Ibuprofen (Nurofen) can cause bone marrow suppression as well as renal failure and you don’t even need a prescription for it. Chlorpromazine (used for Schizophrenia)also causes bone marrow suppression.
Every time a medicine is prescribed, you have to ask yourself as a prescribing doctor and informed patient: ‘Will I be better off without this, would I rather take my chances with the disease?’
Surgery could be considered torture or greveous bodily harm or assalt if done without concent or if not necessary. But I’m sure many people who’ve had an infected appendix will tell you, it was a better option than letting the disease run it’s course.
ARV’s are toxic drugs, they’re not great and they have higher side effect profiles than would be permitted for other classes of drugs or drugs for minor illnesses but HIV is also a nasty, lethal disease that has horrible side effects.
We could say that these drugs are too toxic and let’s wait for better options but there really aren’t any at the moment and won’t be a low toxicity treatment for decades. We are in an epidemic and have to do what we can to help people through it with what we have.
I’m a doctor and have prescribed them. I’d be very concerrned about taking them myself if I had to but I’d still do it.
ARV’s aren’t justified if you have HIV and no symptoms of AIDS becasue they’re so toxic. But once you have AIDS, the risk of dying from the virus and consequent immune suppression are higher than dying from the treatment.
Informed consent and whether we are adequately informing patients is an other issue in a poorly resourced health care system is a separate issue. But many patients do refuse the tretment and that’s their right which we have to respect.
These drugs are used all over the world so it’s not a case of providing risky care in the third world, on the other hand; giving mixed messages to the public and denying we have a problem is very third world. We now have the highest infection rate in the world. Not something to be proud of in light of the years of questioning international committeess’ consensus on the disease and treatment.
ARV’s aren’t perfect and they are dangerous but worth the risk in fighting a lethal disease for which there aren’t better alternatives for a while to come.
Its sad when a brilliant mind wraps itself around a singular obsessive crusade - especially when he’s criminally wrong!
I could prescribe an extra strength elephant mood stabilizer, preferably shot from a dart gun, from a helicopter This may ease the ranting, foaming at the mouth and gnashing of teeth, but regrettably, blog bog dysentery is as incurable as HIV/AIDS
Thinus: You say, ‘I have a degree in Biochemistry and a medical degree so I have a reasonable grasp on the subject matter.’
If it’s true that you have a ‘reasonable grasp of the subject matter’, kindly state for readers of this discussion (a) what the IC50 of AZT-TP is in vivo; and (b) the range of concentrations of AZT-TP in vivo that have been reported in the scientific literature.
I asked you to elucidate the triphosphorylation problem in my last post. Instead of doing so, you come back huffing and puffing about how clever you are because of your academic wallpaper.
Would it be right to conclude from this that in truth you don’t have ‘a reasonable grasp on the subject matter’; that, to put a point on it, you lied about this; and that you’re a actually conman, the sort of ignoramus who says, Trust me, I’m a doctor.
You say you ‘could send … hundreds of references from Medline, pubmed and Cochrane databases that shows that these toxic (never argued that they were not) drugs saves the lives of hundreds of thousands of babies.’ I’ll be satisfied with just one single paper from any of these databases showing that these ‘drugs saves the lives of hundreds of thousands of babies’. You may have some difficulty here, because I know the literature well, and no such study exists. On the contrary, the research literature consistently shows that children exposed to these drugs in utero and after birth have a much higher rate of serious disease and death than untreated children. For instance:
‘Children born to HIV-positive women who take antiretroviral therapy (ART) during pregnancy are significantly smaller in terms of height, weight and head circumference compared with children born to HIV-positive women not on ART, or who took monotherapy, according to the results of a European study examining the effects of ART on uninfected children’s growth up to the age of 18 months [European Collaborative Study, JAIDS 40(3):364-370 (2005)].’
Edwin Bernard, AIDSmap News, 3 November 2005
‘[In a major review of data collected between 1986 and April 2004, AIDS drugs such as AZT were found to cause a] substantially increased risk of severely curtailed pregnancy [i.e. dangerously critical prematurity] … coupled with a very high neonatal mortality rate.’
Thorne et al. AIDS 18(17):2337-2339 (2004)
‘The study cohort included 92 HIV-1-infected and 439 uninfected children … Antiretroviral therapy (nonprotease inhibitor) was independently associated with FTT [Failure to Thrive] in our cohort … ZDV [AZT], in particular, alters mitochondrial metabolism and may have direct nutritional effects.’
Miller TL et al. Pediatrics 108(6): 1287-96 (2001)
‘In this retrospective study, the risk of RPD [rapid progression of disease] was five to six times higher among infants born to [AZT] treated compared with untreated mothers. … RPD was three times more likely to occur in infants born to [AZT] treated compared with findings in untreated mothers.’
De Souza et al. AIDS 24(2):154-61 (2000)
‘The probability of developing severe disease at 3 years of life was significantly higher in children born to mothers [administered AZT during their pregnancies] than in those born to [untreated] mothers. … The same pattern was observed for severe immune suppression: the probability of developing severe immune suppression was significantly higher in children born to [AZT-treated] mothers … than born to [untreated] mothers. … Finally, survival probability was lower among children [born to AZT-treated mothers] … compared with children born to [untreated] mothers.’
De Martino et al. AIDS 13(8):927-33 (1999)
‘Prenatal and perinatal ZVD [AZT] exposure were associated with 1.8-fold increased risk of progression to AIDS or death after adjusting simultaneously for all variables associated with disease progression … Restricting the analysis to children born after April 1994 (date of public release of the results of ACTG 076), ZDV exposure was associated with 2.5-fold increased risk of progression to AIDS or death after adjusting simultaneously for the same variables. … Steady improvements in prognosis of [HIV] infected children unexposed to ZVD were observed in each successive birth cohort, but infected children exposed to ZVD lagged behind these temporal changes. Our results … are consistent with recent results from the Italian Registry for HIV Infection in Children [reported by de Martino, cited above].’
Kuhn et al. Journal of Infectious Diseases 182(1):104-11 (2000)
If, as you say, you’re ‘happy to stick with what much more authoritive medical resources say’, what ‘more authoritative medical resources’ than Pediatrics, AIDS and the Journal of Infectious Diseases did you have in mind?
Zoe: You make a sound point that all synthetic chemicals administered by Western doctors as medical drugs are toxic to some degree (because they’re alien and inimical to healthy human metabolism). But we’ve been through this sort of argument before. Search in this blog for ‘Lewis’. And read the distinction he and Dalakis drew between AZT and similar ARVs and other drugs – on account of how exceptionally dangerously toxic they are.
You make a long argument well summed up in your last line: ‘ARV’s aren’t perfect and they are dangerous but worth the risk in fighting a lethal disease for which there aren’t better alternatives for a while to come.’
For AZT to be ‘worth the risk’ of being severely harmed or killed by it – having been designed as a cell poison, which is to say to poison our cells – it’s necessary to show that it has the pharmacological activity claimed for it, namely that it’s triphosphorylated within our cells into its active form as an antiretroviral drug: AZT-TP. But it isn’t. This risk-benefit ratio is therefore infinite.
Anyone who wants to contradict this conclusion, should start by referring me to any reported finding that AZT works in the body as alleged. And after that, we can look at the clinical studies, perhaps starting with the biggest ARV study yet done, which found that ARV treatment doesn’t save lives and conversely actually accelerates the death rate of HIV-positive people:
‘The results of this collaborative study, which involved … over 20 000 patients with HIV-1 from Europe and North America, show that the virological response after starting HAART [Highly Active Antiretroviral Therapy] has improved steadily since 1996. However, there was no corresponding decrease in the rates of AIDS, or death, up to 1 year of follow-up. Conversely, there was some evidence for an increase in the rate of AIDS in the most recent period. [We noted a] discrepancy between the clear improvement we recorded for virological response and the apparently worsening rates of clinical progression’. – The Antiretroviral Therapy (ART) Cohort Collaborative, Lancet 368:451-458 (2006)
‘The major findings are that, despite improved initial HIV virological control … there were no significant improvements in early immunological response as measured by CD4-lymphocyte count, no reduction in all-cause mortality, and a significant increase in combined AIDS/AIDS-related death risk in more recent years.’ – Lancet editorial commenting on ‘these somewhat paradoxical trends’ reported in the above-cited study
I choose not to respond to Advocate Brink. I am well aware of how any response made tends to evoke an avalanche of counter-responses from him (11 yesterday). My choice is also partly through my own previous experience of his voluminous correspondence (via an institution), and my observations from the Thought Leader website (see the thread around http://www.thoughtleader.co.za/ronaldsureshroberts/2007/11/28/aids-denialist-brinks-loony-letter-to-mbeki/) for one. [I am not at all implying anything about the validity or otherwise of Ronald Suresh Roberts’ contributions or those of Anthony Brink in this different context.]
I’m actually more concerned about whether or not “community service doctors” and other health professionals are today “abandoned” as I was some 25 years ago. (I sincerely hope not.)
I’m more concerned about whether or not a woman can still die of a ruptured uterus in a South African hospital because of no blood bank among other things.
I’m more concerned about whether or not nursing staff would still call a doctor to resuscitate a newborn baby while failing to recognise that the mother is dying of a postpartum haemorrhage. (She did not even have a drip!)
And getting back to the original reason for writing the blog, I am more concerned about the role of unqualified bureaucrats interfering in patient care, and the irrational “targeting” of a person who is implementing a nationally and internationally accepted programme. The underlying motivation for charging Dr Pfaff remains a mystery.
The ‘voluminous correspondence’ to which Roy refers is several letters to the Medicines Control Council on the foetal toxicity of AZT, collated under the title Posioning our Children: AZT in Pregnancy - in regard to which one of the MCC’s members remarked on their ‘impressive detail’, and said that the MCC had been ‘unaware’ of the studies I’d reviewed. I imagine this includes Roy.
Roberts’s letter is discussed at page 414-5 of ‘Lying and Thieving: The fraudulent scholarship of Ronald Suresh Roberts in “Fit to Govern: The native Intelligence of Thabo Mbeki”‘ www.lyingandthieving.com (free download).
In ‘choosing not to respond to Adv Brink’, is the real problem, Roy, not that you’re stumped for answers to my questions?
I am a retired accountant and social researcher with an interest and involvement in our country’s social statistics going back to 1959 when I began working with my late mother, a courageous Black Sash activist, in trying to communicate the fact that 50% of children in rural areas were dying before the age of 5 from malnutrition diseases like kwashiorkor. During the seventies I worked on poverty related studies in the rural areas of KZN.
For the past 7 years I have had the privilege of knowing and assisting Anthony Brink as secretary of the Treatment Information Group. A standard response of those who are seduced by the HIV/Aids hypothesis is to assert that ‘ people are dying’ with the implication that they care more deeply about their fellow humanity and consequently cannot stoop to engage with opposing arguments. Assumptions of moral superiority have no place in scientific and academic scholarship. We are concerned with the facts as was Anthony Brink’s father, Robin, while serving as Evidence Leader for the TRC.
Having collected several files of the statistical pronouncements of ‘Aids experts’ over the past few years, I present a small sample of the many contradictions and false predictions that have fuelled the ‘opium of our age’.
1)In 2002 it was widely reported in our media( Mercury 24 Jan 02) that, according to insurance experts, the death rate in South Africa would peak at 16,000 per day in 2006, or nearly 6 million per year.
2)In 2002 UNAIDS estimated worldwide HIV cases at 42 million with a prediction of 60 million by 2010( Mercury 2 Oct 02).Their most recent estimate has been revised downwards to 33 million.Their estimate of 3 million deaths for 2000 is the same as the most recent year.
3)The National Intelligence Council of the USA predicted in 2002 that there would be 50 to 75 million cases in India,China,Ethiopia,Nigeria and Russia by 2010(Mercury 2 Oct 02)
4)As highlighted by Rian Malan the predictions of the Actuarial Society of South Africa have been continuously revised downwards. ASSA 2000 model predicted 7 million cases by 2004 under a change of behaviour model, with AIDS deaths of 408,000.
5)At an MRC Aids forum in 2003 Professor Alan Whiteside predicted 8 million cases by 2007.
6)Barnett and Whiteside (Aids in the 21st century ) twice quote the prediction by the US Bureau of Census of a negative growth rate in SA by 2003. Our population is growing at a steady rate of between 0.5 to 1.0%.
7)Despite very high HIV rates reported in Botswana and Uganda in the early 90’s their populations have continued to grow.
In the business world persons making such wildly inaccurate predictions would lose their jobs. The standard response of the HIV believers is what does it matter whether it is 4 or 6 million, but it is critically important because the HIV/Aids hypothesis is founded upon these statistics. Science has traditionally progressed by discarding hypotheses where predicted outcomes are not confirmed by later evidence.
The deceptive allure of the hypothesis is partly based on the delay period between so-called infection and death, currently an estimated average from 8 to 10 years. A progressively rising graph of HIV is followed by the rising graph of deaths. In 2001 the MRC published a study arguing that the rapid increase in adult deaths was caused by HIV, which indicated that many had died before 10 years, as HIV rates at ante-natal clinics had only been recorded at 4.3% by 1993 and the increase in adult deaths becomes evident by 1998. The fatal flaw in the hypothesis is revealed by a detailed analysis of the relationship between HIV rates and deaths among children aged five to fourteen years.
In March 2003 the MRC (mrc.ac.za)published a detailed analysis of child mortality for the year 2000, finding in the age group 0 to 4, 42,000 of a total of 106,000 deaths were caused by HIV/AIDS, in 5 to 9,1,000 of a total of 3,900 and 10 to 14 none of 3,800.
StatsSA(statssa.gov.za)report death totals for 2000 of 39,192 for 0-4, 3,610 for 5-9 and 3,059 for 10-14, indicating a registration completeness of 37%, 92% and 80% respectively. It reports 0-4 increasing to 61,461, 5-9 to 6098 and 10-14 to 3,968 by the year 2005. From the annual totals, even disregarding the population growth, any improvement in registration and other causes of death, the maximum possible total of HIV deaths in the 5 years to 2005 is 8,000 for 5-9 and effectively zero for 10-14.In addition 15 to 19 increases by only 1,400 over the 5 year period.
In their HIV study published Nov 2002 the HSRC(hsrc.ac.za)reported 5.4% from 2-18 broken down to 6.2% from 2-9, 4.7% from 10-14 and 5.0% from 15-18.Applying these percentages to the published 5 year census totals we can estimate 5-9 at 300,000 and 10-14 at 200,000. In their later study of Nov 2005 they revised these totals down to 214,000(4.5%)for 5-9 and 80,000(1.7%) for 10-14. Arithmetically(80+8) the prevalence could not have exceeded 88,000 in 5-9 in year 2001 which raises some awkward questions. Why had the MSRC, with its considerable expertise in scientific sampling, significantly over-estimated 5-9 in its 2002 study ? If 5-9 was only 88,000 in 2001 why was there no new incidence in that group as it moved through to 10-14 despite the MSRC finding 200,000 in 10-14 in 02 ?
The fatal question for the hypothesis, however, is why there is no evidence from statsSa of any correlation between HIV and later death among children 5-14.The significant increase in female deaths aged 25-29 is,according to the hypothesis, a result of infections while 15-19 and for males aged 30-34 from infections while 20-24.The HSRC study of 02 gives 6% for 15-19 or approximately 250,000 yet the same % for 5-9 is not correlated with any significant increase in deaths from 10-14 or 15-19.In fact the increase in deaths for these groups from 04 to 05 is effectively zero, as is the increase for 20-24 despite the HSRC reporting 200,000 for 10-14 in 02.
According to the experts the great majority of those infected by MTCT or breastfeeding die before the age of 5 which is confirmed by the MRC study of the year 2000. The experts assert that the incidence in 5-9 and 10-14 is a result of sexual abuse and hospital acquired infections which raises yet further awkward questions about experience in other countries,patterns of sexual abuse and conditions in hospitals. If the 5-14 prevalence found by the HSRC in 02 had arisen in a single dramatic jump in year 2000 why did this happen and why did the totals then decrease. Most importantly why do infants die before the age of 5,adults within 10 years, yet 5-14 survive indefinitely. The 06 death statistics are due soon but there is no evidence from our schools and colleges of any significant increase in deaths from 10-19. A significant proportion of these deaths are from non-natural causes.
Dr Rodney Richards,an American scientist who spent ten years designing advanced HIV diagnostics for Abbott Labs, presented a 22 page statistical analysis in 2004 to the MRC, challenging the conclusion of Bradshaw et al of a real increase in adult deaths resulting from HIV/AIDS. There was no response and the SAJS would not publish it.I have had several letters in our national press directly challenging the statistics of bodies like the MRC, HSRC and ASSA but have never had any response. I remain confident that there are researchers of courage and integrity within our scientific community.
Had I wanted the correspondence addressed to you in the public domain I would have done that in the first place. You really should consider going
back to your origins in the Misty Isles, because Africa is not for sissies.
Yours faithfully,
Anita Allen
MA HDipEd BA
—–Original Message—–
From: Roy Jobson [mailto:R.Jobson@ru.ac.za]
Sent: 25 February 2008 10:25
To: Anita
Subject: Re: FW: Email from Thought Leader user
Dear Ms Allen,
I tried repeatedly to re-post your entire email without success. I also contacted the moderators to see if they could “fix” whatever problem it
was, but no luck. It always cut off at the same point. Perhaps you would have more luck if you tried posting it?
Regards,
Roy Jobson
Anita wrote:
since you have put this correspondence in the public domain, please be so kind as to post the entire email, except my contact details, as pasted below.
—–Original Message—–
From: Anita [mailto:anita@theallens.co.za]
Sent: 21 February 2008 10:34
To: R.Jobson@ru.ac.za
Cc: iAfrica
Subject: Email from Thought Leader user
Dear Dr Robson,
I read your “why I am not a rural doctor” post through to the end, and then re-read it, to make sure I had not missed any information. It is the first time as far as I remember that I have read anything under your byline. I found a number of things that puzzle me.
First, among, these is that you appear to have laboured in the footsteps of your ancestors among Venda people, yet you do not appear to have internalised any of the traditions of those articular Africans. It is rooted in healing based on knowledge of “do no harm” and “only by the fruits of the Earth shalt thou heal them”. From what you have written it is clear you have decided this approach warrants “Fuck you” status compared to your own pump pregnant women full of chemotherapy. Such arrogance is breathtaking, and the epithet I wish for your sake you will live to deeply regret.
Secondly, you dismissed Adv Anthony Brink, as a link in your “Fuck you” chain. The implication was that you had read everything on that one page
website - and everything there was not true - ARVS do have benefits. I must inform you, that I too have painstakingly assembled the facts, especially the scientific facts of viral theory of disease, and I concur with ADV Brink’s assessment that ARVS are toxic at any dose, there is no threshold of safety. In the mouths of two shall the truth be heard, as the good book says, and the law concurs.
Thirdly, in dismissing ADV Brink’s view of ARVS, you have also dismissed his view of the science underpinning viral theory in toto. This is the specific field which I have painstakingly investigated and assembled puzzle pieces. I say, not only do ARVS hold no benefits against HIV - or AIDS (less than 200CD4) but the entire scientific base has been upended by a new paradigm. Yes, it is taking time for everyone to recognise the changes, not least because self-styled thought leaders merely throw in a link to a website - without actually reading it.
I don’t think you quite appreciate the implications of dismissing the two of us - that is the particular person Adv Anthony Brink and all he stands for, together with me, President Mbeki, Manto Tshabalala-Msimang, and our friends, colleagues, associates and the rest in the world who do not hold to your particular world view. I email you today in the hope that I can persuade you to give your best “thought leader” response to Adv Anthony Brink’s post - in public on the blog.
Who knows along the way maybe he can convince you that there’s more to pharmacology than a trademark name in a MERCK manual. Or just be a coward and ignore him, then he and I can add you to our list of those who never will be missed.
Remarkable how HIV dissidents like to dwell on the past. I did sign the petition for a scientific re-appraisal for thre HIV/AIDS hypothesis oodles of years ago. A lot has changed since then (little do Mr Brink and Ms Allen know, it seems). Anyway, that’s neither here nor there obviously. If it makes you feel good, much like Don Quichote, or those folks in Galaxy Quest, ‘never give up, never surrender’.
I think that Roy’s refusal to engage with mr Brink is important. It has been noted with regard to the debate surrounding the introduction of ‘creation science’ in the US that to engage in debate with the purveyors of idiocy grants legitimacy to their cause. Kudos.
All the arguments in the world will not convince Mr Brink and the other dissidents that they are incorrect. Their obstinacy would be amusing if it wasn’t for the consequences on human life and sufferring.
So instead of aruing and affording these people the ‘right to free speech’ and consequently, in this csae, the right to cause widespread harm to millions of peoplpe under the guise of inttelligent argument. I say string em up, burn them, lock them up, muzzle them..or better yet..give em HIV and lets see how they respond.
They Bastards with a capital B. There is no reasoning with them. All of you that respond are wwasting your times..you surely know that right? These people must be stopped..for the good of all of us.
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Roy Jobson is a medical doctor and 'educator of adults' who teaches pharmacology to pharmacy students at Rhodes University. He is a vicarious observer of South African society through his association with the Khulumani Support Group -- his wife is the director. Until recently, he participated in medicines regulation as a member of the MCC, particularly in the area of pharmacovigilance. He is at present registered for a PhD in the advertising and marketing of medicines in South Africa.
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I submit Roy has a bloated ego- not sure its just him or doctors in SA or doctors in general. There is nothing special about doctors working in a rural setting. Nurses work there teachers agricultural people etc etc.
There is usually protocols to be followed in any hospital some more strictly adhered to than others. If the protocol says its monotherapy then please try to change the protocol not act in a superior holier than though manner to the protocol.Heads have banged together the midnight oil has burnt out with people trying to put that protocol which would bring “the best possible outcomes” to the majority of the people in the safest possible manner. When this friend of yours the doctor decides all by his own self against established protocol then he is putting the hospital the ministry at the risk of litigation(yes this will come too even in South Africa.)
My problem is really not the second drug its a doctor who decides he knows better than all around him and decides without consultation with anyone else to implimemt what he thiunks is right. Would you be ok if teachers did this , engineers, architects etc.This was not an emergency as I understand it. There was ample time to consult change protocol and implement
Roy starts his blogg with a history of his grandparents etc etc- I felt he was priming us for what was to come.Look one does not have to work in the rural areas if one feels he is unhappy.Just because ones grandfather loved working in the rural areas does not mean one must love to work in the rural areas.In fact I might even venture further and say Roy went into medicine for the wrong reason. To satisfy tradition what was expected of him not that blinding calling to medicine.I am not surprised his attempt to continue his grandfathers mission failed.Medicine in the rural areas involves cooperation with all the providers around you including government ministries for effective rural health delivery.This blogg smacks of blackmail- we will not go to the rural areas unless we do as we please.
It is my considered opinion that its better to have fewer but dedicated doctors in the rural areas than have the prima donnas who would rather do as they please and ignore protocols.
Try that approach in australia and they will haul you up for discipline in no time at all.There was a doctor like this in Bundaberg in Queensland and he had to leave the country in a bit of a hurry.
Indeed question authority but dont think you are cleverer than than the people who have put the protocols. You may not be the only point head out there.I really worry about what this gentleman teaches his med students.If they being taught to do as they please because they are doctors then we have a problem.
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