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Matthias Rath's Bad Science Finally Catches Up With Him

By John Clarke

Bad ScienceYes­ter­day, Ben Gol­dacre of Bad​Science​.net pub­lished the “missing chapter” from his awe-inspir­ing book, Bad Science. This book teaches us to use the most fool­proof bull­shit detector out there (yes, ourselves!) to sift though the moun­tains of pseudos­cientific horse shit in search for the corny nuggets of truth. Ear candles? Homoe­opathy?  Fish oil? Gillian McBitchKeith?  Dangers of the MMR vaccine? All horse shit. Ser­i­ously, this is one of the best books I’ve read in a long time, and if you don’t already own it, you can buy a copy and get it delivered for little over a fiver!

This new chapter takes on Mat­thias Rath, a vitamin pill sales­man, and reveals him to be one of the biggest bas­tards out there. You think Big Pharma is the ulti­mate evil power in the uni­verse? Maybe you should look at the evils of altern­at­ive therapy:

***

The Doctor Will Sue You Now

This chapter did not appear in the ori­ginal edition of this book, because for fifteen months leading up to Septem­ber 2008 the vitamin-pill entre­pren­eur Mat­thias Rath was suing me per­son­ally, and the Guard­ian, for libel. This strategy brought only mixed success. For all that nutri­tion­ists may fan­tas­ise in public that any critic is somehow a pawn of big pharma, in private they would do well to remem­ber that, like many my age who work in the public sector, I don’t own a flat. The Guard­ian gen­er­ously paid for the lawyers, and in Septem­ber 2008 Rath dropped his case, which had cost in excess of £500,000 to defend. Rath has paid £220,000 already, and the rest will hope­fully follow.  Nobody will ever repay me for the endless meet­ings, the time off work, or the days spent poring over tables filled with end­lessly cross-ref­er­enced court doc­u­ments.

On this last point there is, however, one small con­sol­a­tion, and I will spell it out as a cau­tion­ary tale: I now know more about Mat­thias Rath than almost any other person alive. My notes, ref­er­ences and witness state­ments, boxed up in the room where I am sitting right now, make a pile as tall as the man himself, and what I will write here is only a tiny frac­tion of the fuller story that is waiting to be told about him. This chapter, I should also mention, is avail­able free online for anyone who wishes to see it.

Mat­thias Rath takes us rudely outside the con­tained, almost aca­demic dis­tance of this book. For the most part we’ve been inter­ested in the intel­lec­tual and cul­tural con­sequences of bad science, the made-up facts in national news­pa­pers, dubious aca­demic prac­tices in uni­ver­sit­ies, some foolish pill-ped­dling, and so on. But what happens if we take these sleights of hand, these pill-mar­ket­ing tech­niques, and trans­plant them out of our dec­ad­ent Western context into a situ­ation where things really matter?

In an ideal world this would be only a thought exper­i­ment. AIDS is the oppos­ite of anec­dote. Twenty-five million people have died from it already, three million in the last year alone, and 500,000 of those deaths were chil­dren. In South Africa it kills 300,000 people every year: that’s eight hundred 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 under the age of sev­en­teen. Most chillingly of all, this dis­aster has appeared sud­denly, and while we were watch­ing: in 1990, just 1 per cent of adults in South Africa were HIV pos­it­ive. Ten years later, the figure had risen to 25 per cent.

It’s hard to mount an emo­tional response to raw numbers, but on one thing I think we would agree. If you were to walk into a situ­ation with that much death, misery and disease, you would be very careful to make sure that you knew what you were talking about. For the reasons you are about to read, I suspect that Mat­thias Rath missed the mark.

This man, we should be clear, is our respons­ib­il­ity. Born and raised in Germany, Rath was the head of Car­di­ovas­cu­lar Research at the Linus Pauling Insti­tute in Palo Alto in Cali­for­nia, and even then he had a tend­ency towards grand ges­tures, pub­lish­ing a paper in the Journal of Ortho­molecu­lar Medi­cine in 1992 titled “A Unified Theory of Human Car­di­ovas­cu­lar Disease Leading the Way to the Abol­i­tion of this Disease as a Cause for Human Mor­tal­ity”. The unified theory was high-dose vit­am­ins.

He first developed a power base from sales in Europe, selling his pills with tactics that will be very famil­iar to you from the rest of this book, albeit slightly more aggress­ive. In the UK, his adverts claimed that “90 per cent of patients receiv­ing chemo­ther­apy for cancer die within months of start­ing treat­ment”, and sug­ges­ted that three million lives could be saved if cancer patients stopped being treated by con­ven­tional medi­cine.  The phar­ma­ceut­ical industry was delib­er­ately letting people die for fin­an­cial gain, he explained. Cancer treat­ments were “pois­on­ous com­pounds” with “not even one effect­ive treat­ment”.

The decision to embark on treat­ment for cancer can be the most dif­fi­cult that an indi­vidual or a family will ever take, rep­res­ent­ing a close balance between well-doc­u­mented bene­fits and equally well-doc­u­mented side-effects. Adverts like these might play espe­cially strongly on your con­science if your mother has just lost all her hair to chemo­ther­apy, for example, in the hope of staying alive just long enough to see your son speak.

There was some limited reg­u­lat­ory response in Europe, but it was gen­er­ally as weak as that faced by the other char­ac­ters in this book. The Advert­ising Stand­ards Author­ity cri­ti­cised one of his adverts in the UK, but that is essen­tially all they are able to do. Rath was ordered by a Berlin court to stop claim­ing that his vit­am­ins could cure cancer, or face a €250,000 fine.

But sales were strong, and Mat­thias Rath still has many sup­port­ers in Europe, as you will shortly see. He walked into South Africa with all the acclaim, self-con­fid­ence and wealth he had amassed as a suc­cess­ful vitamin-pill entre­pren­eur in Europe and America, and began to take out full-page adverts in news­pa­pers.

“The answer to the AIDS epi­demic is here,” he pro­claimed. Anti-ret­ro­viral drugs were pois­on­ous, and a con­spir­acy to kill patients and make money. “Stop AIDS Gen­o­cide by the Drugs Cartel” said 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. “Mul­tiv­it­amin treat­ment is more effect­ive than any toxic AIDS drug. Mul­tiv­it­am­ins cut the risk of devel­op­ing AIDS in half.”

Rath’s company ran clinics reflect­ing these ideas, and in 2005 he decided to run a trial of his vit­am­ins in a town­ship near Cape Town called Khayel­it­sha, giving his own for­mu­la­tion, Vita­Cell, to people with advanced AIDS. In 2008 this trial was declared illegal by the Cape High Court of South Africa. Although Rath says that none of his par­ti­cipants had been on anti-ret­ro­viral drugs, some rel­at­ives have given state­ments saying that they were, and were act­ively told to stop using them.

Tra­gic­ally, Mat­thias Rath had taken these ideas to exactly the right place. Thabo Mbeki, the Pres­id­ent of South Africa at the time, was well known as an “AIDS dis­sid­ent”, and to inter­na­tional horror, while people died at the rate of one every two minutes in his country, he gave cre­dence and support to the claims of a small band of cam­paign­ers who vari­ously claim that AIDS does not exist, that it is not caused by HIV, that anti-ret­ro­viral med­ic­a­tion does more harm than good, and so on.

At various times during the peak of the AIDS epi­demic in South Africa their gov­ern­ment argued that HIV is not the cause of AIDS, and that anti-ret­ro­viral drugs are not useful for patients. They refused to roll out proper treat­ment pro­grammes, they refused to accept free dona­tions of drugs, and they refused to accept grant money from the Global Fund to buy drugs. One study estim­ates that if the South African national gov­ern­ment had used anti-ret­ro­viral 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 could have been pre­ven­ted between 1999 and 2007. Another study estim­ates that between 2000 and 2005 there were 330,000 unne­ces­sary deaths, 2.2 million person years lost, and 35,000 babies unne­ces­sar­ily born with HIV because of the failure to imple­ment a cheap and simple mother-to-child-trans­mis­sion pre­ven­tion program. Between one and three doses of an ARV drug can reduce trans­mis­sion dra­mat­ic­ally. The cost is neg­li­gible. It was not avail­able.

Inter­est­ingly, 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. 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”. This led to a public exchange with a leading vir­o­lo­gist. Brink con­tac­ted Mbeki, sending him copies of the debate, and was wel­comed as an expert.

This is a chilling test­a­ment to the danger of elev­at­ing cranks by enga­ging with them. In his initial letter of motiv­a­tion for employ­ment to Mat­thias Rath, Brink described himself as “South Africa’s leading AIDS dis­sid­ent, best known for my whistle-blowing exposé of the tox­icity and inef­fic­acy 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?.

In 2000, the now infam­ous Inter­na­tional AIDS Con­fer­ence took place in Durban. Mbeki’s pres­id­en­tial advis­ory panel before­hand 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, and that South Africa should stop screen­ing sup­plies of blood for HIV. “If I had the power to outlaw the HIV anti­body test,” he said, “I would do it across the board.” When African phys­i­cians gave testi­mony about the drastic change AIDS had caused in their clinics and hos­pit­als, Rasnick said he had not seen “any evid­ence” of an AIDS cata­strophe. The media were not allowed in, but one reporter from the Village Voice was present. Peter Dues­berg, he said, “gave a present­a­tion so removed from African medical reality that it left several local doctors shaking their heads”. It wasn’t AIDS that was killing babies and chil­dren, said the dis­sid­ents: it was the anti-ret­ro­viral med­ic­a­tion.

Pres­id­ent Mbeki sent a letter to world leaders com­par­ing the struggle of the “AIDS dis­sid­ents” to the struggle against apartheid.  The Wash­ing­ton Post described the reac­tion at the White House: “So stunned were some offi­cials by the letter’s tone and timing during final pre­par­a­tions for July’s con­fer­ence in Durban that at least two of them, accord­ing to dip­lo­matic sources, felt obliged to check whether it was genuine.  Hun­dreds of del­eg­ates walked out of Mbeki’s address to the con­fer­ence in disgust, but many more described them­selves as dazed and con­fused. Over 5,000 research­ers and act­iv­ists around the world signed up to the Durban Declar­a­tion, a doc­u­ment that spe­cific­ally addressed and repu­di­ated the claims and con­cerns – at least the more mod­er­ate ones – of the “AIDS dis­sid­ents”. Spe­cific­ally, it addressed the charge that people were simply dying of poverty:

The evid­ence that AIDS is caused by HIV-1 or HIV-2 is clear­cut, exhaust­ive and unam­bigu­ous… As with any other chronic infec­tion, various co-factors play a role in determ­in­ing the risk of disease. Persons who are mal­nour­ished, who already suffer other infec­tions or who are older, tend to be more sus­cept­ible to the rapid devel­op­ment of AIDS fol­low­ing HIV infec­tion.  However, none of these factors weaken the sci­entific evid­ence that HIV is the sole cause of AIDS… Mother-to-child trans­mis­sion can be reduced by half or more by short courses of anti­viral drugs. What works best in one country may not be appro­pri­ate in another. But to tackle the disease, every­one must first under­stand that HIV is the enemy. Research, not myths, will lead to the devel­op­ment of more effect­ive and cheaper treat­ments.

It did them no good. Until 2003 the South African gov­ern­ment refused, as a matter of prin­ciple, to roll out proper anti­ret­ro­viral med­ic­a­tion pro­grammes, and even then the process was half-hearted. This madness was only over­turned after a massive cam­paign by grass­roots organ­isa­tions such as the Treat­ment Action Cam­paign, but even after the ANC cabinet voted to allow med­ic­a­tion to be given, there was still res­ist­ance. In mid-2005, at least 85 per cent of HIV-pos­it­ive people who needed anti-ret­ro­viral drugs were still refused them. That’s around a million people.

This res­ist­ance, of course, 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 cheer­fully go on tele­vi­sion to talk up their dangers, talk down their bene­fits, and became irrit­able and evasive when asked how many patients were receiv­ing effect­ive treat­ment. She declared in 2005 that she would not be “pres­sured” into meeting the target of three million patients on anti-ret­ro­viral med­ic­a­tion, that people had ignored the import­ance of nutri­tion, and that she would con­tinue to warn patients of the sideef­fects of anti-ret­ro­vir­als, saying: “We have been vin­dic­ated in this regard. We are what we eat.”

It’s an eerily famil­iar catch­phrase. Tshabalala-Msimang has also gone on record to praise the work of Mat­thias Rath, and refused to invest­ig­ate his activ­it­ies. Most joy­fully of all, she is a staunch advoc­ate of the kind of weekend glossy-magazine-style nutri­tion­ism that will by now be very famil­iar to you. The rem­ed­ies she advoc­ates for AIDS are beet­root, garlic, lemons and African pota­toes. A fairly typical quote, from the Health Min­is­ter in a country where eight hundred people die every day from AIDS, is this: “Raw garlic and a skin of the lemon – not only do they give you a beau­ti­ful face and skin but they also protect you from disease.”  South Africa’s stand at the 2006 World AIDS Con­fer­ence in Toronto was described by del­eg­ates as the “salad stall”. It con­sisted of some garlic, some beet­root, the African potato, and assor­ted other veget­ables. Some boxes of anti-ret­ro­viral drugs were added later, but they were reportedly bor­rowed at the last minute from other con­fer­ence del­eg­ates.

Altern­at­ive ther­ap­ists like to suggest that their treat­ments and ideas have not been suf­fi­ciently researched. As you now know, this is often untrue, and in the case of the Health Minister’s favoured veget­ables, research had indeed been done, with results that were far from prom­ising. Inter­viewed on SABC about this, Tshabalala-Msimang gave the kind of responses you’d expect to hear at any North London dinner-party dis­cus­sion of altern­at­ive ther­apies.

First she was asked about work from the Uni­ver­sity of Stel­len­bosch which sug­ges­ted that her chosen plant, the African potato, might be act­ively dan­ger­ous for people on AIDS drugs. One study on African potato in HIV had to be ter­min­ated pre­ma­turely, because the patients who received the plant extract developed severe bone-marrow sup­pres­sion and a drop in their CD4 cell count – which is a bad thing – after eight weeks. On top of this, when extract from the same veget­able was given to cats with Feline Immun­ode­fi­ciency Virus, they suc­cumbed to full-blown Feline AIDS faster than their non-treated con­trols. African potato does not look like a good bet.

Tshabalala-Msimang dis­agreed: the research­ers should go back to the drawing board, and “invest­ig­ate prop­erly”. Why?  Because HIV-pos­it­ive people who used African potato had shown improve­ment, and they had said so them­selves. If a person says he or she is feeling better, should this be dis­puted, she deman­ded to know, merely because it had not been proved sci­en­tific­ally? “When a person says she or he is feeling better, I must say ‘No, I don’t think you are feeling better? I must rather go and do science on you’?” Asked whether there should be a sci­entific basis to her views, she replied: “Whose science?”

And there, perhaps, is 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 indeed been caught per­form­ing drug trials in Africa which 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.

And these are new coun­tries, for which inde­pend­ence and self-rule are recent devel­op­ments, which are strug­gling to find their com­mer­cial feet and true cul­tural iden­tity after cen­tur­ies of col­on­isa­tion. Tra­di­tional medi­cine rep­res­ents an import­ant link with an autonom­ous past; besides which, anti-ret­ro­viral med­ic­a­tions have been unne­ces­sar­ily – offens­ively, absurdly – expens­ive, and until moves to chal­lenge this became par­tially suc­cess­ful, many Afric­ans were effect­ively denied access to medical treat­ment as a result.

It’s very easy for us to feel smug, and to forget that we all have our own strange cul­tural idio­syn­crasies which prevent us from taking up sens­ible public-health pro­grammes. For examples, we don’t even have to look as far as MMR. There is a good evid­ence base, for example, to show that needle-exchange pro­grammes reduce the spread of HIV, but this strategy has been rejec­ted time and again in favour of “Just say no.” Devel­op­ment char­it­ies funded by US Chris­tian groups refuse to engage with birth control, and any sug­ges­tion of abor­tion, even in coun­tries where being in control of your own fer­til­ity could mean the dif­fer­ence between success and failure in life, is met with a cold, pious stare. These imprac­tical moral prin­ciples are so deeply entrenched that Pepfar, the US Pres­id­en­tial Emer­gency Plan for AIDS Relief, has insisted that every recip­i­ent of inter­na­tional aid money must sign a declar­a­tion expressly prom­ising not to have any involve­ment with sex workers.

We mustn’t appear insens­it­ive to the Chris­tian value system, but it seems to me that enga­ging sex workers is almost the corner­stone of any effect­ive AIDS policy: com­mer­cial sex is fre­quently the “vector of trans­mis­sion”, and sex workers a very high-risk pop­u­la­tion; but there are also more subtle issues at stake. If you secure the legal rights of pros­ti­tutes to be free from viol­ence and dis­crim­in­a­tion, you empower them to demand uni­ver­sal condom use, and that way you can prevent HIV from being spread into the whole com­munity. This is where science meets culture. But perhaps even to your own friends and neigh­bours, in whatever sub­urban idyll has become your home, the moral prin­ciple of abstin­ence from sex and drugs is more import­ant than people dying of AIDS; and perhaps, then, they are no less irra­tional than Thabo Mbeki.

So this was the situ­ation into which the vitamin-pill entre­pren­eur Mat­thias Rath inser­ted himself, prom­in­ently and expens­ively, with the wealth he had amassed from Europe and America, exploit­ing anti-colo­nial anxi­et­ies with no sense of irony, although he was a white man offer­ing pills made in a factory abroad. His adverts and clinics were a tre­mend­ous success. He began to tout indi­vidual patients as evid­ence of the bene­fits that could come from vitamin pills – although in reality some of his most famous success stories have died of AIDS. When asked about the deaths of Rath’s star patients, Health Min­is­ter Tshabalala-Msimang replied: “It doesn’t neces­sar­ily mean that if I am taking anti­bi­ot­ics and I die, that 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 or to cri­ti­cise his activ­it­ies. Tshabalala-Msimang has gone on the record to state that the Rath Found­a­tion “are 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,” it said. “Many of us have had exper­i­ences with HIV infec­ted patients who have had their health com­prom­ised by stop­ping their anti-ret­ro­vir­als due to the activ­it­ies of this Found­a­tion.”  Rath’s adverts con­tinue unabated. He even claimed that his activ­it­ies were endorsed by huge lists of spon­sors and affil­i­ates includ­ing the World Health Organ­iz­a­tion, UNICEF and UNAIDS. All have issued state­ments flatly denoun­cing his claims and activ­it­ies. The man cer­tainly has chutzpah.

His adverts are also rich with detailed sci­entific claims. It would be wrong of us to neglect the science in this story, so we should follow some through, spe­cific­ally those which focused on a Harvard study in Tan­zania. He described this research in full-page advert­ise­ments, some of which have appeared in the New York Times and the Herald Tribune. He refers to these paid adverts, I should mention, as if he had received flat­ter­ing news cov­er­age in the same papers. Anyway, this research showed that mul­tiv­it­amin sup­ple­ments can be bene­fi­cial in a devel­op­ing world pop­u­la­tion with AIDS: there’s no problem with that result, and there are plenty of reasons to think that vit­am­ins might have some benefit for a sick and fre­quently mal­nour­ished pop­u­la­tion.

The research­ers enrolled 1,078 HIV-pos­it­ive preg­nant women and ran­domly assigned them to have either a vitamin sup­ple­ment or placebo. Notice once again, if you will, that this is another large, well-con­duc­ted, pub­licly funded trial of vit­am­ins, con­duc­ted by main­stream sci­ent­ists, con­trary to the claims of nutri­tion­ists that such studies do not exist. The women were fol­lowed up for several years, and at the end of the study, 25 per cent of those on vit­am­ins were severely ill or dead, com­pared with 31 per cent of those on placebo. There was also a stat­ist­ic­ally sig­ni­fic­ant benefit in CD4 cell count (a measure of HIV activ­ity) and viral loads. These results were in no sense dra­matic – and they cannot be com­pared to the demon­strable life-saving bene­fits of anti-ret­ro­vir­als – but they did show that improved diet, or cheap generic vitamin pills, could rep­res­ent a simple and rel­at­ively inex­pens­ive way to mar­gin­ally delay the need to start HIV med­ic­a­tion in some patients.

In the hands of Rath, this study became evid­ence that vitamin pills are super­ior to med­ic­a­tion in the treat­ment of HIV/AIDS, that  anti-ret­ro­viral ther­apies “severely damage all cells in the body – includ­ing white blood cells”, and worse, that they were “thereby not improv­ing but rather worsen­ing immune defi­cien­cies and expand­ing the AIDS epi­demic”. The research­ers from the Harvard School of Public Health were so hor­ri­fied that they put together a press release setting out their support for med­ic­a­tion, and stating starkly, with unam­bigu­ous clarity, that Mat­thias Rath had mis­rep­res­en­ted their find­ings.

To out­siders the story is baff­ling and ter­ri­fy­ing. The United Nations has con­demned Rath’s adverts as “wrong and mis­lead­ing”. “This guy is killing people by luring them with unre­cog­nised treat­ment without any sci­entific evid­ence,” said Eric Goemaere, head of Méde­cins sans Frontières SA, a man who pion­eered anti-ret­ro­viral therapy in South Africa. Rath sued him.

It’s not just MSF who Rath has gone after: he has also brought time-con­sum­ing, expens­ive, stalled or failed cases against a pro­fessor of AIDS research, critics in the media and others.

But his most heinous cam­paign has been against the Treat­ment Action Cam­paign. For many years this has been the key organ­isa­tion cam­paign­ing for access to anti-ret­ro­viral med­ic­a­tion in South Africa, and it has been fight­ing a war on four fronts.  Firstly, TAC cam­paigns against its own gov­ern­ment, trying to compel it to roll out treat­ment pro­grammes for the pop­u­la­tion. Secondly, it fights against the phar­ma­ceut­ical industry, which claims that it needs to charge full price for its products in devel­op­ing coun­tries in order to pay for research and devel­op­ment of new drugs – although, as we shall see, out of its $550 billion global annual revenue, the phar­ma­ceut­ical industry spends twice as much on pro­mo­tion and admin as it does on research and devel­op­ment. Thirdly, it is a grass­roots organ­isa­tion, made up largely of black women from town­ships who do import­ant pre­ven­tion and treat­ment-lit­er­acy work on the ground, ensur­ing that people know what is avail­able, and how to protect them­selves. Lastly, it fights against people who promote the type of inform­a­tion peddled by Mat­thias Rath and his ilk.

Rath has taken it upon himself to launch a massive cam­paign against this group. He dis­trib­utes advert­ising mater­ial against them, saying “Treat­ment Action Cam­paign medi­cines are killing you” and “Stop AIDS gen­o­cide by the drug cartel”, claim­ing – as you will guess by now – that there is an inter­na­tional con­spir­acy by phar­ma­ceut­ical com­pan­ies intent on pro­long­ing the AIDS crisis in the interests of their own profits by giving med­ic­a­tion that makes people worse. TAC must be a part of this, goes the reas­on­ing, because it cri­ti­cises Mat­thias Rath. Just like me writing on Patrick Holford or Gillian McKeith, TAC is per­fectly in favour of good diet and nutri­tion. But in Rath’s  pro­mo­tional lit­er­at­ure it is a front for the phar­ma­ceut­ical industry, a “Trojan horse” and a “running dog”. TAC has made a full dis­clos­ure of its funding and activ­it­ies, showing no such con­nec­tion: Rath presen­ted no evid­ence to the con­trary, and has even lost a court case over the issue, but will not let it lie. In fact he presents the loss of this court case as if it was a victory.

The founder of TAC is a man called Zackie Achmat, and he is the closest thing I have to a hero. He is South African, and col­oured, by the nomen­clature of the apartheid system in which he grew up. At the age of four­teen he tried to burn down his school, and you might have done the same in similar cir­cum­stances. He has been arres­ted and imprisoned under South Africa’s violent, brutal white régime, with all that entailed. He is also gay, and HIV-pos­it­ive, and he refused to take anti-ret­ro­viral med­ic­a­tion until it was widely avail­able to all on the public health system, even when he was dying of AIDS, even when he was per­son­ally implored to save himself by Nelson Mandela, a public sup­porter of anti-ret­ro­viral med­ic­a­tion and Achmat’s work.

And now, at last, we come to the lowest point of this whole story, not merely for Mat­thias Rath’s move­ment, but for the altern­at­ive therapy move­ment around the world as a whole. In 2007, with a huge public flour­ish, to great media cov­er­age, Rath’s former employee Anthony Brink filed a formal com­plaint against Zackie Achmat, the head of the TAC. Bizar­rely, he filed this com­plaint with the Inter­na­tional Crim­inal Court at The Hague, accus­ing Achmat of gen­o­cide for suc­cess­fully cam­paign­ing to get access to HIV drugs for the people of South Africa.

It’s hard to explain just how influ­en­tial the “AIDS dis­sid­ents” are in South Africa. Brink is a bar­ris­ter, a man with import­ant friends, and his accus­a­tions were repor­ted in the national news media –and in some corners of the Western gay press – as a serious news story. I do not believe that any one of those journ­al­ists who repor­ted on it can pos­sibly have read Brink’s indict­ment to the end.

I have.

The first fifty-seven pages present famil­iar anti-med­ic­a­tion and “AIDS-dis­sid­ent” mater­ial. But then, on page fifty-eight, this “indict­ment” doc­u­ment sud­denly deteri­or­ates into some­thing alto­gether more vicious and unhinged, as Brink sets out what he believes would be an appro­pri­ate pun­ish­ment for Zackie. Because I do not wish to be accused of select­ive editing, I will now repro­duce for you that entire section, uned­ited, so you can see and feel it for your­self.



The doc­u­ment was described by the Rath Found­a­tion as “entirely valid and long overdue”.

This story isn’t about Mat­thias Rath, or Anthony Brink, or Zackie Achmat, or even South Africa. It is about the culture of how ideas work, and how that can break down. Doctors cri­ti­cise other doctors, aca­dem­ics cri­ti­cise aca­dem­ics, politi­cians cri­ti­cise politi­cians: that’s normal and healthy, it’s how ideas improve. Mat­thias Rath is an altern­at­ive ther­ap­ist, made in Europe. He is every bit the same as the British oper­at­ors that we have seen in this book. He is from their world.

Despite the extremes of this case, not one single altern­at­ive ther­ap­ist or nutri­tion­ist, any­where in the world, has stood up to cri­ti­cise any single aspect of the activ­it­ies of Mat­thias Rath and his col­leagues. In fact, far from it: he con­tin­ues to be fêted to this day. I have sat in true aston­ish­ment and watched leading figures of the UK’s altern­at­ive therapy move­ment applaud  Mat­thias Rath at a public lecture (I have it on video, just in case there’s any doubt). Natural health organ­isa­tions con­tinue to defend Rath. Homeo­paths’ mail­outs con­tinue to promote his work. The British Asso­ci­ation of Nutri­tional Ther­ap­ists has been invited to comment by blog­gers, but declined. Most, when chal­lenged, will dissemble.”Oh,” they say, “I don’t really know much about it.”  Not one person will step forward and dissent.

The altern­at­ive therapy move­ment as a whole has demon­strated itself to be so dan­ger­ously, sys­tem­ic­ally incap­able of crit­ical self-appraisal that it cannot step up even in a case like that of Rath: in that count I include tens of thou­sands of prac­ti­tion­ers, writers, admin­is­trat­ors and more. This is how ideas go badly wrong. In the con­clu­sion to this book, written before I was able to include this chapter, I will argue that the biggest dangers posed by the mater­ial we have covered are cul­tural and intel­lec­tual.

I may be mis­taken.

***

If you liked that, buy the book! I swear you won’t be able to put it down. You can find more for free at Bad​Science​.net, includ­ing Ben’s column in The Guard­ian of the same name..

3 Responses to Matthias Rath's Bad Science Finally Catches Up With Him

  1. PoisonedV says:

    Is the book avail­able any­where in the US?

  2. Synchronium says:

    Hmm, doesn’t look like it’s out yet. You can get an impor­ted copy though.

  3. Damon Freeman says:

    This article of Gol­dacre is really a very good example of “bad science” includ­ing ques­tion­able premises, ‘cherry picking’ and a host of others. If ever I had to choose a piece to exem­plify the HIV = AIDS bias by people who are either unaware of or ignore the many con­trary studies by prom­in­ent sci­ent­ists in the field, then this is it. This article is really just a hatchet job and, if you read it through care­fully, the tone of the lan­guage used already shows its bias.
    Take the fol­low­ing para­graph that he provides as ‘the oppos­ite of anec­dote’, that is, as fact as a typical ‘bad science’ example:
    “..In South Africa it kills 300,000 people every year: that’s eight hundred 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 under the age of sev­en­teen. Most chillingly of all, this dis­aster has appeared sud­denly, and while we were watch­ing: in 1990, just 1 per cent of adults in South Africa were HIV pos­it­ive. Ten years later, the figure had risen to 25 per cent.”
    Gol­dacre does not mention that peoplewere dying in their thou­sands long before the advent of AIDS from identical dis­eases that have now been redefined as AIDS-related. His figure of 6.3 million people was arrived at not by using the Elisa or Western Blot test on those indi­vidu­als but by stat­ist­ical manip­u­la­tion of tests done on a frac­tion of this number at various clinics. In fact, many of these “tests” were simply clin­ical obser­va­tions that were then inter­preted as “HIV-pos­it­ive”. The change from 1% in 1990 to 25% now is sim­il­arly based on a redefin­i­tion of HIV/AIDS defin­ing ill­nesses during the period and NOT because more people were sud­denly testing HIV-pos­it­ive — bad science at its best. Brink and Rath have cri­ti­cized these methods on numer­ous occa­sions.
    Gol­dacre is very crit­ical of Adv. Brink. However, Richard Beltz, the person who inven­ted one of the main anti­ret­ro­vir­als (AZT)wrote the fol­low­ing to him in May 2000: “..you are jus­ti­fied in sound­ing a warning against the long-term thera­peutic us of AZT, or its use on preg­nant women, because of its demon­strated tox­icity and side effects. Unfor­tu­nately, the dev­ast­at­ing effects of AZT emerged only after the final level of exper­i­ments was well under­way. ..your effort is a worthy one.. I hope you succeed in con­vin­cing your gov­ern­ment not to make AZT avail­able.”
    Gol­dacre writes: “The founder of TAC is a man called Zackie Achmat, and he is the closest thing I have to a hero.” Achmat, who even­tu­ally con­ceded to start using anti­ret­ro­vir­als, had a heart attack within a few months after start­ing on Nevirapine. This is a well-known side effect of Nevirapine although the HIV = AIDS lobby have been denying that, in this case, it had any­thing to do with it.

    The use of both AZT and Nevirapine is based on ques­tion­able “Studies” done in Africa and this was one of the reason Thabo Mbeki was reluct­ant to intro­duce them here. The fol­low­ing is from my PhD thesis:
    AZT, a failed cancer drug was approved in 1987 as the first anti­ret­ro­viral treat­ment for AIDS. The approval for AIDS treat­ment was based on a single highly flawed study. Both the FDA and Bur­roughs Wellcome, the phar­ma­ceut­ical owner of the drug, admit­ted weak­nesses in the study. Patients admit­ted that they knew whether they were getting the placebo or the real drug and that they then obtained the drug on the under­ground market. The study was thus not double-blinded. It was also not com­pleted. Sev­en­teen weeks into the study, all the patients were put on AZT. Ellen Cooper, a dir­ector of the FDA who was aware of the prob­lems in the study, remarked that approval would be a “sig­ni­fic­ant and poten­tially dan­ger­ous depar­ture from our normal tox­ic­o­logy require­ments” (as cited in Farber, 2006, p. 116). In spite of the reser­va­tion of many people, polit­ical pres­sure pre­vailed and the head of the FDA’s Center for Drugs and Bio­lo­gics inter­vened per­son­ally to have the drug approved, faster than any drug in the organization’s history. All the patients who had taken part in the 1986 AZT study had died by 1989. Farber reports that several follow-up studies on the clin­ical effects of AZT found that although AZT was effect­ive for a few months, its effects drop dra­mat­ic­ally there­after. A study con­duc­ted at the Claude Bernard Hos­pital in France by Dournon et al. showed that AZT had no lasting effect on HIV levels, that it left people with fewer CD4 cells than when they started the study and that it was too toxic for most people to tol­er­ate (Dournon et al., 1988). This was con­firmed by the 3-year Anglo-French “Con­corde” study. The results of a study by Dr. Jens Lun­d­gren and his co-workers sug­ges­ted that the use of AZT shortens the lives of AIDS patients. The study involved 4,484 patients over a 5-year period. Their study indic­ated that the death rate [of those who took AZT] in the third and fourth years was higher than for those who never took the drug (Lun­d­gren et al., 1994). In spite of its inef­fect­ive­ness in the long-term sur­vival of AIDS patients, AZT is nowadays used extens­ively to prevent mother to child trans­mis­sion of HIV through some unknown mech­an­ism. Farber con­demns this usage on the basis of the many false pos­it­ives that HIV tests produce in the case of preg­nancy as well as the pos­sible long-term adverse effects of an extremely toxic drug like AZT. AZT used to be clas­si­fied as a muta­genic agent, similar to thalidom­ide, and is there­fore not a sub­stance that one wants a fetus to consume. The study on which the FDA’s AZT approval for preg­nant women was based, showed that HIV trans­mis­sion during birth was reduced from 25.5% for the placebo group to 8.3% for the mothers who received AZT through­out their second and third tri­mesters. However, the authors of the study admit­ted that due to the small number of infec­ted babies involved, the effic­acy could not be quan­ti­fied with a reas­on­able measure of accur­acy (Vadrevu et al., 2002). At the same time, a Malawian study showed HIV trans­mis­sion to be closely related to Vitamin A levels of the mother. In that study, mothers with the lowest Vitamin A levels had a trans­mis­sion rate of 32.4% while those with the highest Vitamin A levels had a trans­mis­sion rate of only 7.3% which is LOWER than that of the mothers receiv­ing AZT (Semba et al., 1994). Pre­lim­in­ary results from a Thai­l­and study showed no dif­fer­ence between trans­mis­sion rates of AZT treated mothers and a placebo group ( cited in Farber, 2006). The more dis­turb­ing fact is that the use of AZT on animals show anemia, bone marrow deple­tion, leuk­emia, T-cell deple­tion, atrophy of the thal­amus gland, lymph­o­tox­icity, neph­ro­tox­icity, cell death, lung, liver and vaginal cancer, retarded devel­op­ment, and fetal death (Farber, 2006). Farber also men­tions the inter­est­ing fact that it takes from 6 to 18 months for babies born to HIV-pos­it­ive mothers but who are NOT infec­ted with the HIV virus them­selves, to revert to a neg­at­ive status. HIV tests on babies during this period can thus often return false pos­it­ives – an aspect that is not taken into account when con­duct­ing studies on mother to child trans­mis­sion.

    Another example of a flawed study is the HIVNET 012 Nevirapine trial sponsored by the National Insti­tute of Health (NIH) and con­duc­ted in Uganda. Nevirapine had been rejec­ted twice by Canada in 1996 and 1998 after it had shown no effect on CD4 count and viral load and because of its high tox­icity. The FDA, however, gave it con­di­tional approval in 1996 for use in com­bin­a­tion with other drugs and accord­ing to the initial pro­tocol, a ran­dom­ized, placebo con­trolled trial to study the safety and effic­acy of the drug on preg­nant women was started in Kampala, Uganda in 1997. The Phase I trial on 21 preg­nant women that pre­ceded it was not very prom­ising. Four of the 22 babies that were born died. There were 12 serious adverse events and no lower­ing in the viral load of the mothers. The sub­sequent Uganda trial was to be con­duc­ted on 1500 HIV-pos­it­ive preg­nant women with 500 receiv­ing AZT, a further 500 receiv­ing Nevirapine and two placebo groups of 250 each. The safety of and tol­er­ance to the two drugs would be tested and the HIV mother to child trans­mis­sion would be meas­ured by check­ing the number of babies alive and HIV free 18 months after birth. The trial ended up being no placebo, no double-blind or even single-blind with only 626 mother/​infant pairs. Even­tu­ally the study simply com­pared AZT with Nevirapine. The pub­lished pre­lim­in­ary results of the trial clearly show how flawed results can be mas­saged to present a rosy picture. Nevirapine was shown to be much more effect­ive than AZT and the per­cent­age of infec­ted infants was reduced from 25% to 13%. On the basis of the pub­lished pre­lim­in­ary results, the owner of the drug, Boehringer, applied for licens­ing of the drug for preg­nant mothers. The FDA, to its credit, decided to do an on-site inspec­tion to confirm the pub­lished data. Boehringer did its own inspec­tion first and dis­covered that the trial was in total chaos in respect of both man­age­ment and report­ing of serious adverse events. A private company, Westat, was hired by the FDA to also do an inspec­tion and their find­ings con­firmed the prob­lems of lost data, mixing up of records, drugs given to wrong babies, altered doc­u­ments, a down-grading of serious events and deaths or still-births repor­ted as serious adverse events. Addi­tion­ally, they found that half of the HIV-pos­it­ive babies were also on a Vitamin A trial which made their drug-data totally invalid. However, dir­ector Tramont of DAIDS (the AIDS divi­sion of the NIH) brought out a report that ignored all the safety and incor­rect data prob­lems and as Farber remarks “thus saving HIVNET 012 from the scrapheap of failed sci­entific studies” (Farber, 2006, p. 302). During this period of con­niv­ance, a medical officer of the NIH, Betsy Smith, noticed a prob­lem­atic increase in liver enzymes with the babies who had received AZT. She for­war­ded her safety report to her super­ior, Mary Anne Luzar, who sent the report to the FDA. Dir­ector Tramont rewrote the safety report and ordered Jonathan Fish­bein, a recently appoin­ted staff member at the NIH with duties to oversee staff and clin­ical trials, to chas­tise Luzar for insub­or­din­a­tion. Fish­bein checked the records himself and decided that she was quite correct in doing what she had done. The result of this was that Fish­bein himself was side­lined and he even­tu­ally had to seek whistle-blower pro­tec­tion against intim­id­a­tion from his super­i­ors. In the end, in spite of the two reports on the faulty nevirapine/​AZT study and the dis­cov­ery of the later liver tox­icity symp­toms in the infants, Nevirapine was approved as an effect­ive drug to prevent mother to child trans­mis­sion of HIV (Farber, 2006).

    Now, nowhere in his article does Gol­dacre mention the above back­ground as influ­en­cing Thabo or Manto’s decisions. Instead, he tries to portray them as buf­foons who uncrit­ic­ally sup­ports Rath. He then tries to show that Rath’s cri­ti­cism of chemo­ther­apy is an example of his total irra­tion­al­ity. However, he does not mention the fact that a recent mega-study by 3 Aus­tralian Onco­lo­gists had con­firmed Rath’s con­ten­tion that chemo­ther­apy is inef­fect­ive (http://​www​.ncbi​.nlm​.nih​.gov/​p​u​b​m​e​d​/​1​5​6​3​0​849).

    The real cherry on the top is the fol­low­ing state­ment of Gol­dacre: “The evid­ence that AIDS is caused by HIV-1 or HIV-2 is clear­cut, exhaust­ive and unam­bigu­ous.” This is simply non­sense and indic­ates to me that he has not read any of the recent find­ings by prom­in­ent sci­ent­ists nor the reasoned cri­ti­cism of some “deni­al­ists’, many of whom are well-respec­ted figures in the sci­entific com­munity, often with Nobel Prize cre­den­tials.

    Gol­dacre has really not done himself a favour by writing this article. Anyone with a reas­on­able back­ground on the issues will take him to task for includ­ing this in a book on “bad science”.

    Sent by Damon Freeman with per­mis­sion from the author, Marc Swanepoel, PhD

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