Medicine is a science. Alternative “medicine” is an ideology that is unmoored from science. It usually involves an element of defiance and a belief in conspiracy theories. Proponents of alternative medicine fancy themselves as bravely challenging the unreasoning orthodoxy of medicine. Instead, they have merely allowed their ideology to blind them to the real causes of illness.
When alternative medicine is adopted by a political leader, and the ideology is writ large, thousands of people can die of what amounts to medical neglect. It has already happened. The leader was Thabo Mbeki, the country was South Africa and the ideology was AIDS denialism.
A paper in today’s issue of the Journal of AIDS, Estimating the Lost Benefits of Antiretroviral Use in South Africa, by Chigwedere and colleagues, details the carnage:
South Africa is one of the countries most severely affected by HIV/AIDS. At the peak of the epidemic, the government, going against consensus scientific opinion, argued that HIV was not the cause of AIDS and that antiretroviral (ARV) drugs were not useful for patients and declined to accept freely donated nevirapine and grants from the Global Fund… More than 330,000 lives … were lost because a feasible and timely ARV treatment program was not implemented in South Africa. Thirty-five thousand babies were born with HIV… by not implementing a mother-to-child transmission prophylaxis program using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000-2005.
Mbeki, the South African president, followed the classic alternative medicine playbook for challenging medicine. According to Paul Wolpe, in The Holistic Heresy: Strategies of Ideological Challenge in the Medical Profession, an attack on an established discipline in medicine includes four specific elements. The critic:
must portray the discourse as in crisis, must provide an alternative ideology to rescue the discourse, must legitimize their ideology through appeal to a reframed historical myth, and must portray the orthodoxy as a betrayer of the discourse.
Mbeki had no trouble representing the AIDS epidemic as a crisis of historic proportions. Anyone could daily witness the horrible toll in illness and lives lost. As Wolpe points out, the critic “rarely paints its opponent in terms of benign neglect”, but, rather, claims that it is evil. Therefore, Mbeki refuse to acknowledge that the AIDS epidemic is a plague like other historical plagues. Instead, he insisted, according to the New York Times that:
powerful vested interests — drug companies, governments, scientists — pushed the consensus view of AIDS in a quest for money and power, while peddling centuries-old white racist beliefs that depicted Africans as sexually rapacious.
Such claims represent the reframed historical myth to which Wolpe referred. Building on the deep seated and justified suspicion of colonialism, Mbeki portrayed AIDS, not as an infectious disease, but as an opportunity for drug companies run by white men to force toxic drugs on black people.
According to Chigwedere and colleagues, over 300,000 people died because Mbeki rejected the medical explanation for the origin and treatment of AIDS. It is important to understand that Mbeki did not simply deny the medical explanation; he crafted an ideological attack that was meant to replace the medical explanation. According to Mbeke, there was no need for his country to accept and distribute donated antiretroviral medications. Indeed, he believed that his people should fear the medication as nothing more than an attempt of drug companies to push toxic and unneeded treatments in an effort to make money.
Although Mbeki’s AIDS denialism was played out on a far larger scale, and hurt many more people, it has much in common with other popular claims of alternative medicine such as vaccine rejectionism, supplements as treatment or prevention for disease, and homebirth advocacy. All are political ideologies unmoored from the science of medicine. All are efforts to reframe what believers consider to be historical myths, and all characterize medical orthodoxy as a thinly disguised effort of companies or organizations to profit by pushing treatments that are both ineffective and harmful.
Ultimately, alternative medicine is about the flattering portrait proponents wish to draw of themselves. According to Wolpe, whether it is AIDS denialism or vaccine rejectionsism, it is always characterized as:
… the inevitable (or desirable) next step in the history of medicine, and like other heroes of medical history who were initially rejected by the orthodoxy of the day (Pasteur, Semmelweis, Sister Kenny) the [proponent] is simply ahead of his time. Innovation is always initially resisted, they argue, and since their practice causes no harm and brings greater patient satisfaction, it is also true to the ethic of safe practice. Holistic heretics portray themselves as mavericks, leaders, with every expectation that soon all of medicine will, by necessity, follow in their footsteps.
There is no doubt that Mbeki was sincere in his beliefs, and hundreds of thousands of people died as a result. Proponents of alternative medicine are almost always sincere in their beliefs, but alternative medicine is not science, it is ideology. Its false characterization of illness and treatment inevitably hurts people, at a minimum by depriving them of effective care. Mbeki and the results of his policy of AIDS denialism should serve as a cautionary tale for anyone who advocates replacing science with alternative medicine.
