Belief and responsibility
Peter Singer points out the consquences of ignoring science.
Throughout his tenure as South Africa’s president, Thabo Mbeki rejected the scientific consensus that Aids is caused by a virus, HIV, and that anti-retroviral drugs can save the lives of people who test positive for it. Instead, he embraced the views of a small group of dissident scientists who suggested other causes for Aids. Mbeki stubbornly continued to embrace this position even as the evidence against it became overwhelming. When anyone – even Nelson Mandela…- publicly questioned Mbeki’s views, Mbeki’s supporters viciously denounced them. While Botswana and Namibia, South Africa’s neighbours, provided anti-retrovirals to the majority of its citizens infected by HIV, South Africa under Mbeki failed to do so. A team of Harvard University researchers has now investigated the consequences of this policy. Using conservative assumptions, it estimates that, had South Africa’s government provided the appropriate drugs, both to Aids patients and to pregnant women who were at risk of infecting their babies, it would have prevented 365,000 premature deaths.
That’s a conservative estimate, notice, and it’s ‘roughly comparable to the loss of life from the genocide in Darfur.’
[T]he Harvard study shows that [Mbeki] is responsible for the deaths of 5,000 times as many black South Africans as the white South African police who fired on the crowd at Sharpeville…
In Mbeki’s defence, it can be said that he did not intend to kill anyone. He appears to have genuinely believed – and perhaps still believes – that anti-retrovirals are toxic.
But – I thought the instant I read those words – he had no right to believe that. Then I remembered The Ethics of Belief. Well this is a classic case. In a life and death situation, one has no right to believe something in the teeth of the evidence. Mbeki was in just the situation of Clifford’s shipowner.
What shall we say of him? Surely this, that he was verily guilty of the death of those men. It is admitted that he did sincerely believe in the soundness of his ship; but the sincerity of his conviction can in no wise help him, because he had no right to believe on such evidence as was before him. He had acquired his belief not by honestly earning it in patient investigation, but by stifling his doubts.
Mbeki had no right to believe on such evidence as was before him. Singer says as much.
[G]ood intentions are not enough, especially when the stakes are so high. Mbeki is culpable, not for having initially entertained a view held by a tiny minority of scientists, but for having clung to this view without allowing it to be tested in fair and open debate among experts. When Prof Malegapuru Makgoba, South Africa’s leading black immunologist, warned that the president’s policies would make South Africa a laughingstock in the world of science, Mbeki’s office accused him of defending racist western ideas…Mbeki must have known that, if his unorthodox views about the cause of Aids and the efficacy of anti-retrovirals were wrong, his policy would lead to a large number of unnecessary deaths. That knowledge put him under the strongest obligation to allow all the evidence to be fairly presented and examined without fear or favour. Because he did not do this, Mbeki cannot escape responsibility for hundreds of thousands of deaths.
Disturbing, isn’t it.
First let me say that Mbeki strikes me as a very ignorant man,that said doesnt he bear responsibility for the shortening of these peoples lives rather than their deaths? Anti retro viral drugs just prolong life they are not a cure.
Richard I believe he has negatively impacted prevention as well as care. But death sooner is still death that wouldn’t occur otherwise.
His position transcends ignorance. It’s not just a lack of knowledge, it’s belief in and support of a bogus position based on expediency and reactionary politics against all the evidence and despite all the consequences.
One of the most curious aspects of this story is the way that Mbeki was taken in by the myth of Western racist science. The solution he opted for was a crank solution, but it was a solution made in Africa.
Certainly, Mbeki had no right to believe that anti-retroviral drugs were toxic, but it is only fair to remind ourselves that his believing this was largely a result of Western ideas about the pharmaceutical-medical industrial complex all dumped into a box labelled ‘Racism and Colonialism’, with a soupçon of alternative medicine nonsense added in for good measure and stirred. In other words, Mbeki had lots of help, not least from the alternative medicine freaks who campaigned against the identification of HIV as the vector of AIDS, as well as against scientific medicine.
Perhaps it is true that Mbeki ‘must have known that…,’ etc., but the alternative medicine lobby has a way of stirring up a lot of dust. It has even managed, let us not forget, to get degrees in homeopathy granted by a university in Britain, and that homeopathic hospitals are funded by the NHS! (Although I like the joke I saw the other day. A homeopath was so upset by the bad press that homeopathy had been getting that he committed suicide by a massive underdose.)
It’s not altogether clear what Mbeki must have known. Thinking scientifically is an achievement. It’s not obvious that Mbeki had attained it. Clifford’s shipowner, however, did know, and could not make excuses for his careless assumption that a ship in bad condition, having made the same voyage many times, would probably last another one. Mbeki’s mistake is faith-based – he thought he knew; Clifford’s shipowner was just crossing his fingers. However, Mbeki should have known, and should not have relied on his own judgement in a matter so far outside his own area of expertise, since he had experts to advise him, though doubtless here racism (his) played its part.
I think Mbeki probably did know, on some level, that his beliefs about AIDS were likely to be wrong.
He was probably deluding himself rather than making an honest mistake. That seems to be the case with a lot of alternative medicine types.
If they really believed that they were right, they wouldn’t be so insecure. They wouldn’t refuse to test their hypotheses. They would meet disagreement with arguments and evidence instead of intimidation and obscurantism.
I remember listening to an mp3 file on Bad Science where Ben Goldacre was interviewing a homoeopath, and was trying to get her to explain why the supposed effects homoeopathy can’t be detected by double-blind control trials. It was quite obvious that she knew she was wrong and was desperately trying to deflect his question and hoping he would stop asking them.
Well, yes, Jakob. He had to be deluding himself, because he was so very wrong. He didn’t look at the evidence. As I say, scientific thinking is an acheivement. It doesn’t come naturally.
But there was a huge movement at the time that sought to deny the connexion between HIV and AIDS. In fact, the movement had all the trappings of science, without the controls. It’s a fascinating story, told so well by Richard Wilson in his book Don’t Get Fooled Again. Countless people with AIDS died because they were convinced that HIV-AIDS was a construction of the pharmaceutical-industrial complex (they even used those words I think) in order to sell drugs (that were really toxic). Conspiracy theory on a huge scale, with devastating results.
The Bush Administration has played the same kind of game on a larger scale, with all sorts of faith-based initiatives and the downgrading of science in many fields.
Lest we not forget another Peter: PETER DUESBERG, who thanks to his early scientific accomplisments, but later perverted by his infatuation in his own Gallilei/Semmelweiss role, have contributed to this abmysal situation.
To anyone claiming that AIDS does not follow Koch’s postulate, and is not caused by HIV:
Ask them if they are willing to receive a blood transfusion from an AIDS patient (with the appropriate blood type).
And then to put up or shut up!
Cassanders
In Cod we trust
This is not to defend Mbeki in the least, but I wonder how the ethics of belief relative to medical ideas can be framed so that it does not amount to the maxim, “Laypeople ought always to accept majority medical opinion.” This would be an unsound principle, since there is a distinction between, on the one hand, a consensus of medical opinion because some idea has been well demonstrated, and, on the other hand, a consensus of medical opinion because some undemonstrated hypothesis is simply the fashion of the moment (e.g., the notion that tonsils are useless and should be removed at the first instance of pharyngitis). When I have suggested that one should inquire into what is the basis for a majority medical opinion, I have been met with the rejoinder, “You, being a layman, are not qualified to make such judgements”, the implication being that I should just passively and uncritically (but at my own risk)obey.
Yeh it is a difficult question – as Singer says. But Mbeki didn’t just inquire into what is the basis for a majority medical opinion; he used coercion to block opposition to his opinion. He had no right to be so convinced that he was right and the medical consensus was wrong that it made sense to prevent open discussion.
OB,
I agree, Mbeki was not using his own critical judgement; he was surely operating from some sort of fatuous emotional prejudice. But I really do wonder how the ethics of belief can be stated so as to leave the door open for laypeople to thoughtfully reject fashionable professional opinion, and at the same time to exclude mere subjectivism.
Peter Singer says:
(my italics)
The problem lies in those words, “Mbeki must have known…” Why must he have known? Take the claim that he was “under the strongest obligation to allow all the evidence to be fairly presented and examined without fear or favour.” In some sense, we are all under that obligation, as Clifford points out, but the pope apparently doesn’t think so, nor do the mullahs, nor so many other representatives of religion.
This is a point of some importance. To take it simply as an example, Richard Dawkins published The God Delusion in an effort to convince people that religion is a force of unreason. Is it just his so-called militancy that has prompted the militant response of the religious? Not so, religions have been militantly against the right of people to think for themselves for generations. Alister McGrath’s The Twilight of Atheism was published before Dawkins’ book, and it is viciously anti-freethinking (and duplicitously so, as well).
How many religious people have allowed any of Dawkins’ evidence and argumentation to stand up to examintation without fear or favour? Very few, I’d say. So obviously, in the minds of many, that seems like a perfectly legitimate paradigm (if you like) for how we respond to evidence. Why do people think that, as soon as we talk about medicine, of course everyone is going to come onside, and follow the course of the evidence or the scientific consensus? They won’t, because deeply irrational forms of thinking are so deeply embedded.
If that is the way a large proportion of the people in the world assess evidence, then why is Mbeki being held to a higher standard? Because people’s lives depend on it? Tell that to the Vatican and the Muslim authorities and their refusal to permit the use of condoms. They’ve ganged together several times to condemn UN projects to encourage family planning, etc. How many lives are they responsible for? Why is no one saying this to the pope or the mullahs?
This is why it is so important that scientific modes of reasoning be encouraged everywhere, not only in South Africa. But it’s not as simple as Peter Singer makes it seem. He’s right, of course, but there’s a lot that he hasn’t said. In needs to be included in this story. The story of the ANC and Mbeki and the HIV-AIDS scandal of the Mbeki government is not something that has made in South Africa, nor has it made SA the laughingstock of the world – far from it, it’s much too deadly serious for that. But it is a cautionary tale, and a reminder that reason is not universally accepted as a way of coming to conclusions.
Sorry to be so long-winded.
Well I am saying this to the pope and the mullahs (and so are other people). I’ve said it quite a few times. I think it’s criminal that the Vatican tells people that condoms are ineffective against Aids. Not figuratively criminal, literally criminal.
Yes, I know you do, but there’s something just a bit too limited about Peter Singer’s indictment of Mbeki. He has to add in the pope and others too, otherwise it looks as though he’s just dealing with… well, you know, something out of Africa. And I think it has to be clear that this is not an unusual way to argue. It’s done all the time, practically everywhere. The Western left falls over itself trying to support the horrors of fundamentalist Islam. And the pope sits in his castle and delivers God’s will to the world. There’s a pattern, and I, for one, wish that Peter Singer had pointed that out. It would have had greater force, and it wouldn’t seem to have singled out one of the first black presidents of South Africa. It would have been good to spread the blame around, and the people of South Africa could have seen the point more clearly. Sorry to be so bull-headed about this, but it seems to me important. If we don’t do this, we keep winning the skirmishes but losing the bloody war.
Yes but Mbeki was Singer’s subject in this particular piece. One is allowed to talk about one thing at a time – and it’s often much better to do that. It would just look scattershot if he said ‘and the pope and the mullahs too’ – especially since they’re not relevant to the particular subject of this piece. And I don’t think it’s fair to accuse him of singling out ‘one of the first black presidents of South Africa’ – what’s he supposed to do, turn a blind eye just because Mbeki is one of the first black presidents of South Africa?
Sorry, that sounds grumpy. I’m not grumpy, just not agreeing.
I think there’s a large middle ground between singling someone out and not talking about him at all. Singer could have talked of Mbeki and ALSO talked of the pope, or American Christian fundamentalists. Unfortunately a heavy focus on African unreason makes it just look like “oh, those Africans are being crazy again” which misses the point that unreason is a worldwide problem.
Correct me if I’m wrong, Eric, but I think that’s what you were getting at?
Deaths that should not have happened – its hard to understand culpability at the level of the disaster that is HIV in Africa.
Denial and ‘face’ are more important than the lives of innocents, not because people CHOOSE to let the innocents die but because they CHOOSE to believe self-serving bullshit about life-threatening risks. Not a black thing but a human one – the Old Lefts denialism of Communist massacres, the modern journalists partnership with terrorists to achieve headlines or (after AUDS was discovered) the gay activists standing up for the right to give blood when they were asked not to.
If we hunted these people down as individuals and tried them for their selfish and deliberate ignorance, we would be consumed in a pointless witch-hunt.
Peter Singer: “When Prof Malegapuru Makgoba, South Africa’s leading black immunologist, warned that the president’s policies would make South Africa a laughingstock in the world of science, Mbeki’s office accused him of defending racist western ideas…”
So, sensible black guy vs irrational black guy. Sorry people, but why should Singer have to disavow something he neither said *nor implied*?
Yes, Jenavir, that’s precisely the point I was getting at. A subsidiary point is that popes and other such seem to get a free ride on things like this. But it’s important, I think, to show the connexion between someone like Mbeki and someone like Benedict. They’re both examples of foolish, irresponsible men, mired in unreason. And it’s too easy to think that that kind of unreason is something, as you say, that we can dismiss as ‘those crazy Africans again.’
However, of course I don’t want to deny that Singer can choose whatever topic he likes to talk about. The clout would have been bigger, if he had added in someone like the pope. And it would have brought more attention to his article too. Also, the pope is relevant. The effects of catholic teaching about condoms has had a devastating effect in Africa, yet I have never heard the pope being accused of being responsible for … now, how many deaths was that? – an indeterminate but conceivably large number of deaths in Africa.
It’s true Si, Singer nowhere implies an ‘out of Africa’ putdown, but the name ‘Malegapuru Makgoba’ is buried under an avalanche of ‘Mebeki’s.
Well Eric if you’ve never heard the pope accused of being responsible for X number of deaths then you simply haven’t been paying attention. There’s no shame in that of course – no one can pay attention to everything – but the ‘I have never heard’ argument used as a reproach is always vulnerable. It simply is a fact that the pope and the Vatican do get a lot of stick for their condom policy – not enough, of course, but still a lot. And anyway what do you mean you’ve never heard the pope being accused when you just admitted yesterday that you know I do just that on a regular basis?
I think this whole line is ridiculous. Singer was writing one brief article about one thing; it would diffuse and weaken his point in this particular piece if he threw in the pope because the pope issue is a different one. And frankly it’s just silly to claim that Singer singles out Africans for disapprobation.
And another thing. “The clout would have been bigger, if he had added in someone like the pope.” No it wouldn’t; it would if anything have been smaller, because it would have been a weaker, junkier piece. Throwing in irrelevant material doesn’t necessarily make an article stronger or cause it to have more clout. Singer’s piece was focused on one thing; it would be much feebler if he had included an extraneous example of something he wasn’t talking about. Including the pope would make sense in a different piece on a different (though related) subject, but it wouldn’t make sense in this one.
Well, OB, I won’t press the point, though I do think that mentioning the pope would have strengthened, not weakened, Singer’s point. But, no, though I have heard people say that the pope is probably responsible for people’s deaths, I’ve never heard of it being quantified. I don’t know how you’d go about doing that, nor do I know how they hit on the 350,000 figure for Mbeki, but I think it would have some punch. I guess I’m particularly cross at the pope just now, and he needs to be the focus of some very very public condemnation. Other than that, I cede the field.
Well I yield to no one in my disapprobation of the pope and the Vatican, Eric – so I know what you mean – but one risks the King Charles’s head effect if one drags him into everything.
I know someone did spell out the numbers, causing (of course) a stink by doing so. Polly Toynbee perhaps? Yes I think it may have been. Maybe I’ll try Googling…
King Charles’ Head effect? Not in your dictionary, never heard of it.
Yeah, Polly Toynbee. She was talking about the previous pope, on the occasion of his funeral – but Ratzinger of course has the same policy (and helped formulate the old one) so the point is the same.
Not in my name, April 8 2005.
“With its ban on condoms the church has caused the death of millions of Catholics and others in areas dominated by Catholic missionaries, in Africa and right across the world. In countries where 50% are infected, millions of very young Aids orphans are today’s immediate victims of the curia. Refusing support to all who offer condoms, spreading the lie that the Aids virus passes easily through microscopic holes in condoms – this irresponsibility is beyond all comprehension.”
Crossed.
It’s from David Copperfield. Aunt Betsy’s friend and lodger Mr Dick is gently mad, and unable to talk on any subject without mentioning King Charles’s head.
Ah, never read David Copperfield, though I have read a number of others. My brother even wrote a dissertation on Little Dorrit.
Polly Toynbee’s article is a real scorcher! Well said. Needs saying again, especially in the shadow of the even more medieval tendencies of John Paul II’s successor.
This stands out for me:
Hasn’t permeated yet, either, as the media circus in the last week has shown. I guess, since the Vatican ‘instruction’ came five days before Singer’s CiF article, I still would have welcomed something about the Vatican, and its even wider responsibility for allowing AIDS to spread in all of Africa, not just in South Africa. The only difference is: the pope’s responsibility is greater, the death count larger.* The same unreasoning inability to acknowledge harm is common to both the Vatican and Mbeki’s government.
And when you consider that Tony Blair has just come out with some idiocy about religious values and globalisation – is this man totally mad? – putting more than just Mbeki on the grill might have helped to make his point.
But I already left the field!
*though I still don’t know the basis of Toynbee’s ‘millions’.
Little Dorritt is a brilliant, brilliant novel. Have you seen the Christine Edzard film? I don’t usually link novels with films based on them, but Edzard’s is an exception.
Don’t miss David Copperfield. Really. It’s patchy, as Dickens always is, but it’s not to be missed.
Just picked up a leaflet at the library today, of The Old Curiosity Shop, by CD. which is on at the Gate Theatre, Dublin.
Would it be worth seeing, I wonder. Over to you at B&W. Sorry to be off topic.