The alternative-therapy industry is worth billions of pounds and the techniques used to market it are very familiar: buzzwords like “natural” and “holistic”, distortions of trial data, the denigration of mainstream medicine, conspiracy theories involving the pharmaceutical industry, and so on. They are indulged because they seem harmless, and tend to target the “worried well”. But what would happen if we took these sleights of hand and transplanted them out of our Western context, into a situation where medicines can literally mean living or dying?
In an ideal world, this would be only hypothetical. Aids is the opposite of anecdote, and the numbers involved are so huge that it is hard to mount an emotional response to them. Around 25 million people have died from it already, three million in the last year alone, and 500,000 of those who died were children. In South Africa it kills 300,000 every year: that’s 800 people every day, or one every two minutes. This one country has 6.3 million people who are HIV-positive, including 30 per cent of all pregnant women. There are 1.2 million Aids orphans. Most chillingly of all, this disaster has appeared suddenly, and while we were watching: in 1990, just one per cent of adults in South Africa were HIV-positive. If you were walking into this situation with a solution, you’d make very certain that you were on solid footing.
Matthias Rath is one of the world’s leading vitamin-pill salesmen, his fortune made in Europe and America on the back of huge sales in health-food shops and online. He went to South Africa in 2004, and began taking full-page adverts in newspapers.
“The answer to the Aids epidemic is here,” he proclaimed. Antiretroviral (ARV) drugs were poisonous, and a conspiracy to kill patients and make money. “Stop Aids Genocide by the Drugs Cartel,” ran one headline. “Why should South Africans continue to be poisoned with AZT? There is a natural answer to Aids.” The answer came in the form of vitamin pills. “Multi-vitamin treatment is more effective than any toxic Aids drug. Multivitamins cut the risk of developing Aids in half.” Rath’s company ran clinics that gave multivitamins away for free. In 2005, he decided to run a trial of his own formulation, VitaCell, in a township near Cape Town called Khayelitsha, giving it to people with advanced Aids. Tragically, he had taken these ideas to the right place. Thabo Mbeki, South Africa’s president until 2008, is an “Aids denialist” who has compared Aids researchers to Nazis. At various times during the peak of the Aids epidemic in South Africa, his government argued that HIV is not the cause of Aids, and that antiretroviral drugs are not useful. It refused to roll out proper treatment programmes; it refused to accept grant money from the UN’s Global Fund to buy anti-Aids medication; and it refused to accept donations of medication.
The consequences were inevitable. One study estimates that if the South African national government had used antiretroviral drugs for prevention and treatment at the same rate as the Western Cape province, which defied national policy on the issue, around 171,000 new HIV infections and 343,000 deaths might have been prevented between 1999 and 2007. It’s an astonishing death toll for nothing more than a bad idea. Another study estimates that between 2000 and 2005 there were 330,000 unnecessary deaths, 2.2 million person years lost, and 35,000 babies born with HIV unnecessarily because of the failure to implement a cheap and simple mother-to-child transmission- prevention programme. Between one and three doses of an ARV drug can reduce transmission dramatically. The cost is negligible. It was not available. Matthias Rath’s colleague and employee, a South African barrister named Anthony Brink, takes the credit for introducing Thabo Mbeki to many of these ideas. In his letter of introduction to Matthias Rath, Brink described himself as “South Africa’s leading Aids dissident, best known for my whistleblowing exposé of the toxicity and inefficacy [sic] of Aids drugs, and for my political activism in this regard, which caused President Mbeki and health minister Dr Tshabalala-Msimang to repudiate the drugs in 1999”.
This was not an unfair summary of events. Brink stumbled on the “Aids dissident” material in the mid-1990s, and after much surfing and reading, became convinced that it must be right. In 1999 he wrote an article about AZT in a Johannesburg newspaper titled “A Medicine from Hell”, which led to a lengthy and public exchange with a leading professor of virology. Brink contacted Mbeki, sending him copies of the debate, and was welcomed as an expert.
In 2000, Durban hosted an infamous International Aids Conference. Mbeki’s presidential advisory panel was packed with “Aids dissidents”, including Peter Duesberg and David Rasnick. On the first day, Rasnick suggested that all HIV testing should be banned on principle. It wasn’t Aids that was killing babies and children, said the dissidents: it was the antiretroviral medication.
Researchers and activists around the world were horrified. Over 5,000 signed up to the Durban Declaration, reaffirming that Aids is caused by HIV, and that treatment can be effective, but it did no good. Until 2003 the South African government refused to roll out proper antiretroviral medication programmes, and even after the ANC cabinet voted to allow medication to be given, there was resistance. In mid-2005, at least 85 per cent of HIV-positive people who needed antiretroviral drugs were still refused them. That’s about a million people.
This resistance went deeper than just one man. Much of it came from Mbeki’s health minister, Manto Tshabalala- Msimang: an ardent critic of medical drugs for HIV, she would appear on television to talk up their dangers. She declared in 2005 that she would not be “pressured” into meeting the target of three million patients on antiretroviral medication, that people had ignored the importance of nutrition, and that she would continue to warn patients of the side-effects of antiretrovirals. She also went on record to praise the work of Matthias Rath, refusing to investigate his activities, and advocating the kind of glossy-magazine nutrition advice that is very familiar from Western media. The remedies she advocated for Aids were beetroot, garlic, lemons and African potatoes. South Africa’s stand at the 2006 World Aids Conference in Toronto was described by delegates as the “salad stall”, as it featured these and assorted other vegetables on prominent display.
Interviewed on television about this, Tshabalala-Msimang insisted that HIV positive people who ate African potatoes had shown improvement, and they had said so themselves. Asked whether there should be a scientific basis to her views, she replied: “Whose science?”
And here, perhaps, was a clue, if not exoneration. This is a continent that has been brutally exploited by the developed world, first by empire, and then by globalised capital. Conspiracy theories about Aids and Western medicine are not entirely absurd in this context. The pharmaceutical industry has been caught performing drug trials in Africa that would be impossible anywhere in the developed world. Many find it suspicious that black Africans seem to be the biggest victims of Aids, and point to the biological-warfare programmes set up by the apartheid governments. There have also been suspicions that the scientific discourse of HIV/Aids might be a device, a Trojan horse, for spreading even more exploitative Western political and economic agendas around a problem that is simply one of poverty.
These are also new countries, struggling to find their commercial feet and cultural identity after centuries of repressive colonisation. Traditional medicine represents an important link with an autonomous past, and antiretroviral medications have been kept inaccessibly expensive by the pharmaceutical industry. This was the situation into which vitamin-pill entrepreneur Matthias Rath inserted himself, exploiting anti-colonial anxieties – despite being a German-born white man offering pills made in a factory abroad.
His adverts were a tremendous success. He began to tout individual patients as evidence of the benefits of vitamin pills – though some of his most famous success stories died of Aids. When asked about the deaths, Tshabalala-Msimang replied: “It doesn’t necessarily mean that if I am taking antibiotics and I die, I died of antibiotics.” She is not alone: South Africa’s politicians have consistently refused to step in. Rath claims the support of the government, and its most senior figures have refused to distance themselves from his operations. Tshabalala-Msimang has gone on the record to state that the Rath Foundation is “not undermining the government’s position. If anything, they are supporting it.”
In 2005, exasperated by government inaction, a group of 199 leading medical practitioners in South Africa signed an open letter to the health authorities of the Western Cape, pleading for action on the Rath Foundation: “Our patients are being inundated with propaganda encouraging them to stop life-saving medicine... [They] have had their health compromised by stopping their antiretrovirals due to the activities of this foundation.” Rath’s advertising continue unabated.
He claimed that his activities were endorsed by huge lists of sponsors and affiliates including the World Health Organisation, Unicef and UNAIDS. All have issued statements flatly denouncing his claims and activities. He claimed that Harvard School of Public Health had produced evidence showing vitamin pills to be better than antiretroviral medication. The researchers were so horrified that they put together a press release setting out their support for ARV and stating starkly, with unambiguous clarity, that Rath had misrepresented their findings. He ignored them.
The UN condemned Rath’s adverts as “wrong and misleading”. Eric Goemaere, head of Médecins sans Frontières SA, says of Rath: “This guy is killing people by luring them with unrecognised treatment without any scientific evidence.” Goemaere pioneered antiretroviral therapy in South Africa. Rath sued him for defamation, but had to drop the case.
It’s not just MSF that Rath has gone after: he has also brought time consuming, expensive, stalled or failed cases against a professor of Aids research and critics in the media. In 2007, he brought an unsuccessful legal action for libel against me personally and the Guardian newspaper. In the interests of fairness and transparency, Wired gave Rath the opportunity to respond to the criticisms laid out in this piece. In a letter issued via his lawyers, Rath denied claiming that vitamins are more effective in the treatment of HIV/Aids, though also states: “There are no placebo controlled, long-term studies showing that ARVs are life-saving or life-prolonging.” He added: “The value of vitamins in stimulating production of immune cells and improving immune function has been recognised by no less than nine Nobel Prizes.” Rath’s conclusion is uncompromising: that “the promotion of micronutrients is the only responsible strategy” to the Aids crisis. He also challenged the suggestion that his ideas had influenced the attitudes of South Africa’s president, as his foundation began its “educational and charitable work” in the country in 2004, five years after Mbeki denounced ARVs.
But Rath’s most extraordinary suit has been against the Treatment Action Campaign (TAC). For many years this has been the key organisation campaigning for access to antiretroviral medication in South Africa, fighting a war on four fronts. First, TAC campaigns against the government, demanding that it roll out treatment programmes. Secondly, it fights the pharmaceutical industry, which insists on charging full price for its products in developing countries, claiming the money is needed for research and development of new drugs (although of its $550 billion global annual revenue, the pharma industry spends twice as much on promotion and administration as it does on R&D). TAC has taken direct action, smuggling off-copyright, generic versions of inaccessibly expensive medications into South Africa. Thirdly, it is a grassroots organisation, made up largely of black women from townships who do vital prevention and treatment-literacy work. Lastly, it fights people who distribute misinformation on HIV, such as Rath.
Rath has launched a massive campaign against this group. He distributes advertising material against them, saying “Treatment Action Campaign medicines are killing you”. This is a front for the pharmaceutical industry, he says. TAC has made full disclosure of its funding, showing no such connection. Moreover, TAC is an ardent critic of the pharma industry. Rath offered no evidence to the contrary, and even lost a court case over the issue, but now presents the loss as if it were a victory. The founder of TAC is a South African called Zackie Achmat. He was an anti-apartheid activist and imprisoned during that regime. He is also HIV-positive, but refused to take antiretroviral medication until it was available to all on the public-health system, even when he was dying, and even when he was implored to do so by Nelson Mandela, a supporter of antiretroviral medication and Achmat’s work. After a litany of horrors, we come to the most challenging point of the story. In 2007, to great media coverage, Rath’s former employee Anthony Brink filed a formal complaint against Zackie Achmat at the International Criminal Court in the Hague, accusing him of genocide for successfully campaigning to gain access to HIV drugs for all South Africans.
Anthony Brink is a barrister, a man with important friends, and his accusations were reported by the national media as a serious news story. The first 57 pages of his claims present familiar anti-medication and “Aids-dissident” material. But then, on page 58, this “indictment” turns into something much more vicious, as Brink sets out what he believes would be an appropriate punishment for Zackie. It’s worth reading unedited: “APPROPRIATE CRIMINAL SANCTION In view of the scale and gravity of Achmat’s crime and his direct personal criminal culpability for ‘the deaths of thousands of people’, to quote his own words, it is respectfully submitted that the International Criminal Court ought to impose on him the highest sentence provided by Article 77.1 (b) of the Rome Statute, namely to permanent confinement in a small white steel and concrete cage, bright fluorescent light on all the time to keep an eye on him, his warders putting him out only to work every day in the prison garden to cultivate nutrient rich vegetables, including when it’s raining. In order for him to repay his debt to society, with the ARVs he claims to take administered daily under close medical watch at the full prescribed dose, morning noon and night, without interruption, to prevent him faking that he’s being treatment compliant, pushed if necessary down his forced-open gullet with a finger, or, if he bites, kicks and screams too much, dripped into his arm after he’s been restrained on a gurney with cable ties around his ankles, wrists and neck, until he gives up the ghost on them, so as to eradicate this foulest, most loathsome, unscrupulous and malevolent blight on the human race, who has plagued and poisoned the people of South Africa, mostly black, mostly poor, for nearly a decade now, since the day he and his TAC first hit the scene.” Cape Town, January 1, 2007, Anthony Brink
The Rath Foundation described this document as “entirely valid”. And the foundation’s missive to Wired regarding this article is eyebrow-raising too, indicating that it is actively pursuing class-action litigation “against companies, media and other ARV-promoting entities” and insisting on a “need to continue the public-health information campaign of our foundation in relation to the dangers of ARVs”.
“This letter serves as our formal notification to you and your journal about the existence of these scientific facts. Should you ignore them and should civil or criminal proceedings subsequently be brought against [Wired] by readers, patients or institutions who are harmed by the provision of misleading information by yourself and/or your publication, we will provide this document as evidence that you acted knowingly and deliberately to deceive your readers.” No prominent figure from the vitamin pill, alternative-therapist or nutritionist community has publicly criticised these activities. Meanwhile, the Pope says condoms don’t work, needle-exchange programmes that reduce the spread of HIV are rejected in favour of “Just say no”, and charities refuse to touch anything involving birth control, abortion or sex workers, for fear of offending their Christian donors. Aids is one of the biggest killers in the world. There is something about this virus that seems to trigger a kind of madness.
You'll soon be able to read the full correspondence between Matthias Rath, Anthony Brink and Wired.
Ben Goldacre is a medical doctor, Guardian columnist and author of Bad Science (HarperPerennial); badscience.net
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This article was originally published by WIRED UK
