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Court case shines spotlight on South African AIDS policy
World Report
Court case shines spotlight on South African AIDS policy A maverick physician who believes that vitamins can stave off AIDS is being sued in South Africa after accusing an AIDS advocacy group of being a front for drug firms. The case is also being seen as a protest over the health minister’s staunch opposition to antiretrovirals. Clare Kapp reports. In a case which illustrates the contradictions and complexities of South African health policy, authorities are under increasing pressure to clamp down on Matthias Rath, a German doctor who claims that antiretrovirals are toxic and that nutritional supplements heavy in vitamin C can stave off AIDS. WHO, UNAIDS, Harvard University, and Médecins Sans Frontières (MSF) all issued statements within the space of a few days condemning Rath’s claims made in full-page newspaper advertisements—amid deafening silence from the South African health ministry. Meanwhile, South Africa’s Treatment Action Campaign (TAC)— an organisation which lobbies for cheaper generic drugs and greater access to antiretrovirals—filed a temporary interdict with Cape Town’s High Court to stop the Rath Health Foundation from alleging that TAC is in fact a front for pharmaceutical multinationals. The court hearings, held May 13 and 26, were a precursor to a planned fullblown defamation suit by TAC against Rath. TAC leader Zackie Achmat said he was “very confident” about the
AP
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
German physician Matthias Rath accused TAC of acting as a front for drug firms
1916
outcome of the case—judgment is expected in the near future—as Rath hadn’t produced any evidence of drugcompany funding. “The Rath Foundation is preying on vulnerable people with life-threatening illnesses with two aims: to sell their products and to support the HIV denialists who have caused enormous damage to our country”, TAC said in court papers. Although the TAC legal suit was explicitly aimed Rath, it was also designed to send a message to South African Health Minister Manto Tshabalala-Msimang who has repeatedly stressed her mistrust of antiretrovirals and her belief in the efficacy of garlic, olive oil, lemon, and beetroot. “At best she is tolerating [Rath’s] activities”, said Achmat, who himself is on antitretroviral treatment. “At worst she is colluding with him”, he added, leading demonstrators in chanting the by-now familiar refrain: “Manto Must Go”. Outside the courtroom there were scuffles between hundreds of TAC supporters and the Traditional Healers’ Organization, which has 25 000 members in southern Africa and has allied itself to Rath. The noise from horns, whistles, and songs of the rival demonstrators was so loud that court proceedings were briefly adjourned as officials sought to calm the large crowd. AIDS is the leading cause of death in South Africa, accounting for some 30% of all deaths nationally, according to a new report by the Medical Research Council. Although its official publication was delayed, it was widely reported in the press that nearly 42% of deaths in the hardest hit province, KwaZulu-Natal, and 33% in the industrial heartland of Gauteng were due to HIV/AIDS.
The TAC estimates that 500 000 South Africans urgently need antiretrovirals out of the estimated 5·3 million people infected with the HIV virus. Some 42 000 people are now being given antiretrovirals in the public health sector, according to health ministry figures. The increase in people on therapy— it was an estimated 28 000 at the end of last year—was met with evident displeasure by Tshabalala-Msimang at a recent press conference. “When we were being pressurised to use antiretrovirals, we did warn of the side-effects”, she said. “When I get reports of people on antiretrovirals, nobody reports to me how many have fallen off the programme or died of the side-effects. I don’t know what happens to those who started on antiretrovirals.” “All I am bombarded about is antiretrovirals, antiretrovirals”, she said. “There are other things we can be assisted in doing to respond to HIV/AIDS in this country.” At the May 5 press conference, Tshabalala-Msimang was openly scathing of WHO’s ambition to have 3 million people on antiretroviral therapy by the end of this year. WHO has singled out South Africa as one of the countries which could derail the global target. “WHO set that target themselves. They didn’t consult us. I don’t see why South Africa today must be the scapegoat for not reaching the target”, she said, insisting that she would not be pressured by the health body. Given the health minister’s attitude, TAC activists say that it is hardly surprising that the Rath Foundation has found fertile ground in which to operate. Rath himself admits that his views are “complementary to what this www.thelancet.com Vol 365 June 4, 2005
World Report
www.thelancet.com Vol 365 June 4, 2005
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
country has been doing”, describing himself as “the founder of the scientific concept of ‘Cellular Medicine’, the systematic introduction into clinical medicine of the biochemical knowledge of the role of micronutrients as biocatalysts in a multitude of metabolic reactions at the cellular level.” He maintains that chronic deficiencies of micronutrients are the primary cause of health conditions ranging from arteriosclerosis to HIV/AIDS and that such diseases could “essentially be unknown in the future” if his theories were implemented globally. Rath has offices in Germany, the Netherlands, and California. He has fallen foul of advertising-standards authorities in several countries, including South Africa. The TAC has complained to the Medicines Control Council about Rath’s activities in the poor townships around Cape Town where he is campaigning against “toxic” antiretrovirals, and insisting that his multivitamins are a better treatment for HIV/AIDS. TAC also accuses Rath of conducting experiments on people and photographing them in their underwear without proper counselling in breach of the Medicines Act. The Medicines Control Council says it is investigating Rath but so far has taken no action against his foundation. At a press conference during the recess of the May 13 court hearing, Rath was unbowed by all the criticism. Flanked by David Rasnick, a prominent AIDS dissident and member of President Thabo Mbeki’s AIDS advisory panel, Rath presented findings of a study in the impoverished township of Khayelitsha which he said was “so encouraging” it was not sent for peer review. Instead he took out full-page advertisements in the New York Times and International Herald Tribune detailing the experiments under the title “Stop AIDS Genocide by the Drugs Cartel”. “The HIV/AIDS epidemic has become one of the greatest threats to
The court case against Rath brought demonstrations of support from traditional healers
mankind ever”, he wrote in the advert. “This human tragedy has become a multi-billion dollar market for the pharmaceutical investment business— the drug cartel—in which the return on investment is based on the continuation of the AIDS epidemic”, the advertisement claimed. UN agencies called the advertisements “wrong and misleading”, and said Rath’s pretence that the UN agencies supported his nutritional approach were “dangerous and unhelpful”. “Vitamins and nutritional supplements alone can not take the place of comprehensive treatment and care for people living with HIV/AIDS”, the agencies said in a joint statement, adding that antiretroviral therapy “has turned AIDS from a death sentence into a chronic but manageable disease.” Wafaie Fawzi, associate professor in the departments of nutrition and epidemiology and David J Hunter, professor in the same departments at Harvard University, MA, USA, accused Rath of deliberately misinterpreting findings from their research studies in Tanzania to promote his viewpoint that vitamins are superior to antiretrovirals. In a statement they said that their work showed that multivitamin sup-
plementation slowed the rate of HIV disease progression and other HIVrelated outcomes. For adults at earlier stages of the disease, a daily multivitamin supplement could slow progression and lengthen the time before initiation of antiretrovirals, thus achieving treatment cost savings and improving the quality of life. However, Fawzi and Hunter emphasised that the multivitamin supplements should be considered as complementary to antiretroviral therapy as part of a treatment package, and not an alternative to conventional medicine. MSF, whose pioneering work in Khayelitsha helped prove the feasibility of antiretrovrials for people in resource-poor settings, said it was appalled by Rath’s “disinformation campaign”, about the dangers of antiretrovirals, especially in the latter stages of pregnancy. A statement from the charity said: “MSF calls on the Ministry of Health to recognize the plight of people in advance stage of HIV infection by unequivocally stating that nutrition alone will not save them from death. For them [antiretroviral] therapy remains the only hope for survival.”
Clare Kapp 1917
Court case shines spotlight on South African AIDS policy A maverick physician who believes that vitamins can stave off AIDS is being sued in South Africa after accusing an AIDS advocacy group of being a front for drug firms. The case is also being seen as a protest over the health minister’s staunch opposition to antiretrovirals. Clare Kapp reports. In a case which illustrates the contradictions and complexities of South African health policy, authorities are under increasing pressure to clamp down on Matthias Rath, a German doctor who claims that antiretrovirals are toxic and that nutritional supplements heavy in vitamin C can stave off AIDS. WHO, UNAIDS, Harvard University, and Médecins Sans Frontières (MSF) all issued statements within the space of a few days condemning Rath’s claims made in full-page newspaper advertisements—amid deafening silence from the South African health ministry. Meanwhile, South Africa’s Treatment Action Campaign (TAC)— an organisation which lobbies for cheaper generic drugs and greater access to antiretrovirals—filed a temporary interdict with Cape Town’s High Court to stop the Rath Health Foundation from alleging that TAC is in fact a front for pharmaceutical multinationals. The court hearings, held May 13 and 26, were a precursor to a planned fullblown defamation suit by TAC against Rath. TAC leader Zackie Achmat said he was “very confident” about the
AP
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
German physician Matthias Rath accused TAC of acting as a front for drug firms
1916
outcome of the case—judgment is expected in the near future—as Rath hadn’t produced any evidence of drugcompany funding. “The Rath Foundation is preying on vulnerable people with life-threatening illnesses with two aims: to sell their products and to support the HIV denialists who have caused enormous damage to our country”, TAC said in court papers. Although the TAC legal suit was explicitly aimed Rath, it was also designed to send a message to South African Health Minister Manto Tshabalala-Msimang who has repeatedly stressed her mistrust of antiretrovirals and her belief in the efficacy of garlic, olive oil, lemon, and beetroot. “At best she is tolerating [Rath’s] activities”, said Achmat, who himself is on antitretroviral treatment. “At worst she is colluding with him”, he added, leading demonstrators in chanting the by-now familiar refrain: “Manto Must Go”. Outside the courtroom there were scuffles between hundreds of TAC supporters and the Traditional Healers’ Organization, which has 25 000 members in southern Africa and has allied itself to Rath. The noise from horns, whistles, and songs of the rival demonstrators was so loud that court proceedings were briefly adjourned as officials sought to calm the large crowd. AIDS is the leading cause of death in South Africa, accounting for some 30% of all deaths nationally, according to a new report by the Medical Research Council. Although its official publication was delayed, it was widely reported in the press that nearly 42% of deaths in the hardest hit province, KwaZulu-Natal, and 33% in the industrial heartland of Gauteng were due to HIV/AIDS.
The TAC estimates that 500 000 South Africans urgently need antiretrovirals out of the estimated 5·3 million people infected with the HIV virus. Some 42 000 people are now being given antiretrovirals in the public health sector, according to health ministry figures. The increase in people on therapy— it was an estimated 28 000 at the end of last year—was met with evident displeasure by Tshabalala-Msimang at a recent press conference. “When we were being pressurised to use antiretrovirals, we did warn of the side-effects”, she said. “When I get reports of people on antiretrovirals, nobody reports to me how many have fallen off the programme or died of the side-effects. I don’t know what happens to those who started on antiretrovirals.” “All I am bombarded about is antiretrovirals, antiretrovirals”, she said. “There are other things we can be assisted in doing to respond to HIV/AIDS in this country.” At the May 5 press conference, Tshabalala-Msimang was openly scathing of WHO’s ambition to have 3 million people on antiretroviral therapy by the end of this year. WHO has singled out South Africa as one of the countries which could derail the global target. “WHO set that target themselves. They didn’t consult us. I don’t see why South Africa today must be the scapegoat for not reaching the target”, she said, insisting that she would not be pressured by the health body. Given the health minister’s attitude, TAC activists say that it is hardly surprising that the Rath Foundation has found fertile ground in which to operate. Rath himself admits that his views are “complementary to what this www.thelancet.com Vol 365 June 4, 2005
World Report
www.thelancet.com Vol 365 June 4, 2005
Rights were not granted to include this image in electronic media. Please refer to the printed journal.
AP
country has been doing”, describing himself as “the founder of the scientific concept of ‘Cellular Medicine’, the systematic introduction into clinical medicine of the biochemical knowledge of the role of micronutrients as biocatalysts in a multitude of metabolic reactions at the cellular level.” He maintains that chronic deficiencies of micronutrients are the primary cause of health conditions ranging from arteriosclerosis to HIV/AIDS and that such diseases could “essentially be unknown in the future” if his theories were implemented globally. Rath has offices in Germany, the Netherlands, and California. He has fallen foul of advertising-standards authorities in several countries, including South Africa. The TAC has complained to the Medicines Control Council about Rath’s activities in the poor townships around Cape Town where he is campaigning against “toxic” antiretrovirals, and insisting that his multivitamins are a better treatment for HIV/AIDS. TAC also accuses Rath of conducting experiments on people and photographing them in their underwear without proper counselling in breach of the Medicines Act. The Medicines Control Council says it is investigating Rath but so far has taken no action against his foundation. At a press conference during the recess of the May 13 court hearing, Rath was unbowed by all the criticism. Flanked by David Rasnick, a prominent AIDS dissident and member of President Thabo Mbeki’s AIDS advisory panel, Rath presented findings of a study in the impoverished township of Khayelitsha which he said was “so encouraging” it was not sent for peer review. Instead he took out full-page advertisements in the New York Times and International Herald Tribune detailing the experiments under the title “Stop AIDS Genocide by the Drugs Cartel”. “The HIV/AIDS epidemic has become one of the greatest threats to
The court case against Rath brought demonstrations of support from traditional healers
mankind ever”, he wrote in the advert. “This human tragedy has become a multi-billion dollar market for the pharmaceutical investment business— the drug cartel—in which the return on investment is based on the continuation of the AIDS epidemic”, the advertisement claimed. UN agencies called the advertisements “wrong and misleading”, and said Rath’s pretence that the UN agencies supported his nutritional approach were “dangerous and unhelpful”. “Vitamins and nutritional supplements alone can not take the place of comprehensive treatment and care for people living with HIV/AIDS”, the agencies said in a joint statement, adding that antiretroviral therapy “has turned AIDS from a death sentence into a chronic but manageable disease.” Wafaie Fawzi, associate professor in the departments of nutrition and epidemiology and David J Hunter, professor in the same departments at Harvard University, MA, USA, accused Rath of deliberately misinterpreting findings from their research studies in Tanzania to promote his viewpoint that vitamins are superior to antiretrovirals. In a statement they said that their work showed that multivitamin sup-
plementation slowed the rate of HIV disease progression and other HIVrelated outcomes. For adults at earlier stages of the disease, a daily multivitamin supplement could slow progression and lengthen the time before initiation of antiretrovirals, thus achieving treatment cost savings and improving the quality of life. However, Fawzi and Hunter emphasised that the multivitamin supplements should be considered as complementary to antiretroviral therapy as part of a treatment package, and not an alternative to conventional medicine. MSF, whose pioneering work in Khayelitsha helped prove the feasibility of antiretrovrials for people in resource-poor settings, said it was appalled by Rath’s “disinformation campaign”, about the dangers of antiretrovirals, especially in the latter stages of pregnancy. A statement from the charity said: “MSF calls on the Ministry of Health to recognize the plight of people in advance stage of HIV infection by unequivocally stating that nutrition alone will not save them from death. For them [antiretroviral] therapy remains the only hope for survival.”
Clare Kapp 1917