It's a point I've made often in these letters — South Africa is a small country. Little happens that is not nationally known. Any news is national news. No matter the field, few experts exist and they are incessantly quoted.

An olive branch has been extended by our Health Minister to South African civic organizations hoping to attend the UN General Assembly Special Summit on AIDS (UNGASSA) in New York at the end of May.

The sides in the Great AIDS Debate are lining up quite crisply. Here we have Minister of Health Manto Tshabalala-Msimang, MD, who has exercised her ministerial right and excluded all non-governmental organizations from her delegation to this month's United Nations General Assembly Special Session on AIDS (UNGASSA) in New York.

If you know where to look, the HIV/AIDS edifice is showing some big cracks.

Top of the list is the reinstatement of Jonathan Fishbein, MD, at the U.S. National Institutes of Health (NIH). (1) Fishbein blew the whistle on the problems with the NIH-linked study in Uganda known as HIVNET 012, which Nevirapine manufacturer Boehringer Ingelheim utilized as a basis for applying for a licence in South Africa for the use of the drug in preventing mother-to-child transmission (MTCT) of HIV.

Looking back at 2005 brings home the message of a year without progress on the HIV/AIDS front. Just three subjects dominated the headlines here: two old ones, statistics and antiretrovirals, and one newcomer, nutrition. Like previous years, journalists failed to apply their code of practice — accuracy, balance and fairness.

The biggest story by far, though, was one noticeable by its absence: the lack of any scientific breakthrough.

Such is my status here that the official opposition political party this week named me No. 2 on the HIV/AIDS Dissident Hit List and called for my excommunication.

I am miffed at being pipped to the No. 1 spot by Adv. Anthony Brink, gratified to be in the company of President Thabo Mbeki, who is at No. 3, and contemptuous of No. 4 — our ham-in-the-sandwich Health Minister Manto Tshabalala-Msimang, MD, who bears legal responsibility for implementing a policy based on the internationally accepted assumption that HIV causes AIDS, but hesitates to clarify that it runs counter to the dictates of her conscience.

Proof that the scientific community would like to close the book on health issues which are far from over arrived this week in the form of two news stories.

First, a United Nations (UN) report that the aftereffects of the Chernobyl nuclear accident in 1986 on health and the environment had not proved as dire as scientists predicted. It found fewer than 50 deaths had been “directly attributed to radiation from the disaster,” and roughly 4,000 deaths “probably attributable” — compared with the tens of thousands forecast at the time.

It’s truly astonishing what publicity a letter published in Nature Medicine online can garner. (1) In fact, to be precise, the letter had not yet been posted, when a Google search revealed dozens of media outlets had already given "Top of News" status to a press release pre-empting the online publication.

The letter was from researchers at the University of Texas Medical Branch and claimed to have found a way to detect the misfolded proteins called prions associated with mad cow disease, or Bovine Spongiform Encephalopathy (BSE), in blood. This has not previously been possible; prion detection has been limited to post-mortem retrieval from the brain tissue of animals that have been slaughtered.

I still naively believe that universities are places for open discussion of ideas, even if those discussions might sometimes be heated or impolite. But I am learning that even polite and peaceful discussion of AIDS at my local institution of higher learning, the University of Calgary, are only allowed when pre-approved by the University. Worse yet, on June 5th 2005 a precedent was set. Those, like me, who insist on talking out of turn will be evicted from the campus and threatened with arrest.

NEWS FLASH! June  21, 2005

SOUTH AFRICA: Jacob Zuma, goes from second-most powerful position in government, to being released from political office. The National Prosecuting Authority has announced it would now charge him with two counts of corruption related to associations with armaments people. Zuma has of his own free will stepped down from activities in his political party as deputy president. He will not address or attend its meetings, or comment on behalf of the ANC.

Dear Sir,

Re: Nature Medicine online: 26 May 2005; AIDS denialists back on the upswing Paroma Basu Madison

With reference to the above, I take strong exception, to Nature printing a defamatory statement about 2,192 people listed on the Alberta Reappraising AIDS Society website who question some or all aspects of the scientific consensus on AIDS.

What a momentous week here. Only in Africa can there be so much drama, while the media fails lamentably to record it accurately, with balance and fairness.

From one executive editor I learned why his newspaper was coming up with old rumours long settled. The repetition of old rumours long put to rest is a common ailment in many newspapers. The executive editor told me that in 2002, the paper converted to electronic files and junked all hardcopy files. As a result, time started in 2002 for reporters at the newspaper. Everything written by journalists going back to the founding of the newspaper more than 100 years ago is lost.

I was recently asked if I had any documents talking about ‘Medical Fascism’. While I know what my correspondent was driving at, I replied that I wasn’t too sure what the defining features of Fascism were, nor how they applied to medicine, nor if it was even good to try.

Clearly, sometimes medicine is dogmatic, brutal, and sometimes sends people to prison or to their deaths. But, is it Fascism?

If there is anyone who can make sense of The New York Times (TNYT) reports on a "rare and aggressive HIV" found in a New York man, (1, 2, 3) I would like to hear from them

HIV is classified as a "slow virus", hence the taxonomic nomenclature lentivirus. No shoe horning (a term coined by Stephen J Gould) will make this new variant fit the lentivirus bill. If as TNYT reported it leads "to the rapid onset of AIDS…in a month or two", it is really quite simple - it can’t be HIV.

"Entrapment is this society's / sole activity"
  -Edward Dom, Gunslinger

This pure invention of how HIV should behave if it were causing AIDS has, like other things untrue, found its way into text books and is the basis of official U.S. government explanations of AIDS pathogenesis. Nonetheless, among most researchers the problem of massive cell killing by miniscule amounts of virus (David Ho's "new view" and the popular press notwithstanding) remains the central unanswered question about the HIV=AIDS equation, as a Pub. Med. search of the scientific literature using "HIV and," pathogenesis, indirect cell killing, mechanisms of cell killing, cytocidal effects, or similar terms will quickly verify.

In the fall of 1994, when all his grants had become unworthy of funding, students were warned not to seek Peter Duesberg’s mentorship, he was no longer considered qualified to offer graduate-level classes, and he had gone from chairman of the seminar committee to organizer of the yearly departmental picnic. I received a telephone call from Peter I have always remembered as "A Night at the Opera," even though its humor was as far from the Marx Brothers as imaginable.

The Central Villain Is Not A Virus. It Is Poverty. And The Critical Cure Is Not Medicine. It is Justice.

No health issue has so galvanized the world and public attention as has the acquired immune deficiency syndrome (AIDS). The acquired immune deficiency syndrome is a condition in which a person's immune system is severely compromised and left vulnerable to a broad range of infections and diseases that debilitate and can lead to death. It is a medical construct that captures many disease phenomena in one basket for purposes of investigation, diagnosis and treatment. Within this complex syndrome there are many factors. It is my view that no one factor - including the various viruses associated with immunodeficiency - is alone sufficient to bring on the onset of chronic acute immune deficiency. The most determinant predictors of immune suppression and associated disease, in the north and the south, are factors directly related to social and economic status or to medical treatment itself. And increasingly, front line workers in the "fight" against acute immune deficiency are asking that resources be prioritized in the area of basic health promotion.

I almost got arrested for the first time in my life a few nights ago. My crime? Asking questions and pointing out speakers’ errors at a panel discussion organized by the University of Calgary Global AIDS Action Group (GAAG).

It certainly isn’t very Canadian to be so forward. I should have waited until question time, and then asked one question, maybe two, but only after complimenting the speakers for their erudition. But, I did not come to the panel discussion to be a polite Canadian. I suspected that the panelists would all fall over themselves agreeing with each other, and all would repeat dogmatic assertions about HIV and AIDS without contradiction from within or outside of the panel. The student moderators would be unfailingly polite and respectful, and everyone would go away believing that they could play a small part in mitigating an enormous medical tragedy. Well, I was right, except that possibly some members of the audience did actually leave with some nagging questions about HIV/AIDS.

LETTER FROM SOUTH AFRICA

At the start of his Budget Vote in parliament last week, South African President Thabo Mbeki quipped that he had asked for it to be gazetted that life begins at 60. It was his sixtieth birthday, but considering what he had already packed into those years and coupled with his urbane delivery, it was a sparkling moment of pure theatre.

As the riff of a mid-year report back to taxpayers justifying funds to his office, it was fighting talk (1).

The justifiable grim preoccupation of the caring public concerning the threat of global plagues needs to be moderated and re-oriented towards a critical reappraisal of the link between poverty and disease, and a re-emphasis on addressing the social roots of disease.

(Originally published in A & U Magazine, February 2002)

Remember when rednecks dragged black men out of Southern jails and hanged them without a trial? Usually with a mob cheering them on? For a long time, much of our country was ruled by this brand of justice. The lynch-mob mentality goes deep in the American psyche -- it doesn’t always result in actual corpses hanging from trees, but the accused gets hugely punished. And a message is sent, to make sure the public is intimidated.