September 2007 Archives

A Legacy of Death

When South Africa's president Thabo Mbeki fired deputy health minister Nozizwe Madlala-Routledge for "unsubordination" in late July, it was a definite step backwards for that country's Sisyphean battle against AIDS.

South Africa has 5.41 million people who have AIDS, more than any other country in the world. Two million people have already died and during this time South Africa dithered about the viral connection between HIV and AIDS, about the use of drugs to treat patients, and even about the very existence of AIDS.

Last year it seemed like this deadly precedent might be reversed when Nozizwe Madlala-Routledge took over for health minister Tshabalala-Msimang who was sidelined with health problems. Deputy health administrator Routledge acknowledged that the African government had "been in denial at the very highest levels" and mobilized a concerted effort to take on the problem. But then this summer Mbeki abruptly ousted Madlala-Routledge, and the reportedly alcoholic Tshabalala-Msimang, who has denied AIDS patients drugs with such fervor that she's been labeled "Dr. Beetroot", lunged back into the picture after being medically revived (at least temporarily) with a transplanted liver.

The news was covered intently in South Africa, as well as in many international papers. News editors expressed well-founded foreboding about the effect the sacking might have on South Africa's AIDS campaign. The New York Times devoted an editorial to the issue, "Firing an AIDS Fighter" (August 18, 2007) and predicted: "Unless [Mbeki] finally starts listening to sensible advice on AIDS, he will leave a tragic legacy of junk science and unnecessary death."

It seemed like a rational sounding warning from the New York Times. However Mbeki has been subjected to "sensible advice" for years, from South African AIDS patients, activists, international news media, very active local media, scientists around the world, government diplomats, former and current U.S. presidents, and NGO's. He has received tons of gold bullion advice on AIDS since he took over the Presidency in 1999. Yet in spite of the abundant counsel, the AIDS crisis in South Africa gathered momentum while Mbeki denied the most basic science such as the link between HIV and AIDS that is documented in hundreds of research papers.

Public health advocates recognize that successful AIDS campaigns happen in states where at the highest levels of government coordination of treatment and prevention strategies is initiated, funded, supported and given significant public relations effort. Mbeki's efforts distracted any concerted strategy that could have stanched the epidemic; at a minimum he exacerbated the crisis.

Mbeki has proven over and over again that he will stubbornly support junk science rather than endorse "foreign" treatments, come up with a viable prevention plan, or lead his dying countrymen out of the catastrophe. The New York Review of Books reported in July, 2000 that Mbeki accused pharmaceutical companies of being "marauders of the military industrial complex who propagate fear to increase their profits". For this reason, he denied newborns and mothers access to nevirapine and AZT?

Mbeki raised hopes when he (perhaps strategically) verbally supported anti-retroviral treatment for citizens in 2003, shortly before his 2004 re-election. But then Health Minister Tshabalala-Msimang became the voice of his unpopular anti-AIDS ideology, and proceeded to warn people off anti-retrovirals. She instead suggested antidotes such garlic, sweet potatoes, and lemon. She has been criticized intensely but public opinion doesn't deter her denialism, and as a long time loyal compatriot of Mbeki's she has somehow won his undying support.

In the meantime, while slandering pharmaceutical companies, Mbeki pursued his own sketchy homegrown solutions to the AIDS crisis. His government is linked to the development of Virodene as an anti-AIDS drug. Virodene is a chemical containing a dry cleaning solvent. South African company founders were accused by Tanzania of running unauthorized clinical trials in a military hospital before the government of Tanzania rounded up the South African founders and forcibly removed them from that country. The company and its dubious claims and secret clinical trials still exist.

In another unorthodox drug development plan, Enerkom, an affiliate of South Africa's state energy company, along with the University of Pretoria, produced a coal derivative called Oxihumate-K at taxpayer expense. This substance was distributed in little black pills that the makers claimed bolstered the immune system. The pills apparently contained dangerous levels of chrome, but were tested just like Virodene in controversial clinical trials in Tanzania at the same hospital. Soon after the trial was halted by Tanzania, South Africa auctioned off the company and its proprietary formulas for a monetary loss that was born by its taxpayers.

What is it South Africa Doesn't Understand About AIDS?

Granted, the New York Times' did write an editorial about the dismissal of Nozizwe Madlala-Routledge, "Firing an AIDS Fighter" at a time when many other papers didn't write anything and when public interest in AIDS is flagging. Also, throughout the years, the paper has devoted significant coverage, hundreds of articles, to all aspects of the AIDS crisis. But despite their collective attention and wisdom of the situation, the writer of the August 14th editorial dared only to ask weakly : "What is it about South Africa's devastating AIDS epidemic that President Thabo Mbeki just doesn't want to understand?"

Seven years ago, in 2000, Mbeki's stance on AIDS might have more reasonably been considered mystery. But even then the New York Times reported frequently on the devastating situation. Their take in "Comments on AIDS Weaken Mbeki" (November 1, 2000), sounded not very different than their recent August editorial. Seven years ago, they wrote:

"The real question now may be how seriously he has damaged himself....Mr. Mbeki has often been his own worst enemy, repeatedly disregarding the advice of his government's doctors and seemingly oblivious to the impact his statements were having on efforts to prevent the spread of the virus.

Perhaps those who haven't followed the AIDS crisis in Africa would think it was a perfectly reasonable question-- what he doesn't he understand? But we all know Mbeki's history now, and so its more curious why the U.S. seems so chronically puzzled....and perhaps a little flat-footed.

The Tragedy of the No Offense Doctrine

South Africa, on the other hand, has had no choice but to wake up quickly to Mbeki's politics. On May 16, 2000 when the South African president was planning to visit the U.S. to brief President Clinton on his ideas about AIDS learned from American AIDS denialists, the Washington Post wrote an article titled: "Mbeki vs. AIDS Experts; S. African's Radical Views on Epidemic Baffle Allies". While they described AIDS "experts" as "baffled", here's what the Post wrote about the AIDS situation as it was happening in South Africa:

"We have 600,000 children admissions each year," said Gray [the perinatal unit at Baragwanath Hospital in Soweto's] director. "Forty percent of those children are HIV positive. We're spending a lot of time and resources every day dealing with something that is almost preventable."

She paused. "If they're not going to provide us with AZT," she said, "then the best thing that the government can do is to ask us to strangle them all at birth."

So we're left to wonder, seven years later -- why the understatement in the August NYT editorial? Why the kid glove treatment given the scope of Mbeki's malfeasance? Is it Mbeki's charm, his pivotal position in Africa, our ambivalence, our own acceptance of his solution?

In another article in the New York Times "Mbeki's Visit To U.S. Puts AIDS Activists In a Quandary" (May 21, 2000), the Times wrote that the United States government dictated a diplomatic strategy of muting criticism about AIDS:

"...activists and those who treat AIDS are wondering how to greet Mbeki. Most seem to have decided that the best offense is to give no offense, an approach that they say is being counseled by the Clinton administration."

This "no-offense" diplomatic approach seems like it's a policy that's still embraced by Western news media, almost a decade later. Mbeki once claimed that he knew no one with AIDS. Everyone scoffed. But European, Canadian and North American patients generally have access to life-prolonging AIDS drugs. None of us live with the disease and all it's repercussion. Perhaps we are all rather like Mbeki in a way -- knowing of no such AIDS crisis.

Perhaps that opinion seems unduly cynical. Most people, of course, will recognize that AIDS is a pandemic or pandemics, a global problem. But why then are we writing editorials couched so as to "not offend"? With two million people dead in South Africa, who do we fear we will offend, exactly?

AIDS on a Distant Planet

AIDS often seems like a far away problem, not our problem. Thomas Friedman wrote in his book "The World is Flat", that he actually "knows the world isn't flat". He goes on to describe four groups of people who inhabit the "Unflat World". Those who are "sick", he says, inhabit "...those communities in the grip of HIV/AIDS, malaria, tuberculosis, [who] simply can't plug and play into the flat world."

To be fair, the book is a primer for global business, a compendium of catchy phases for busy people. Nifty labels like the "The Dell Theory", update "The Golden Arches" from his previous ode to business. We acknowledge that it's not book dedicated to an analysis of public health policy. But which is it? If the world is flat, and the "playing field" for business "level", how does this "unflat world" simultaneously exist? And does Friedman suggest that we truly objectify this other world, take a glance at it dispassionately when we walk by the newsstand, as if peering through a telescope at some distant moon on a planet eons away, some faraway place where the vagaries and violence of global warming, dust storms, crime, terrorism and pandemic disasters play out?

We may indeed live this dichotomy. We may believe, as Mbeki once said, that AIDS is just a problem of poverty. He's is right, of course, poor people do die from AIDS. Wealthier ones often don't and this may explain the SA president's laser focus on trade rather than AIDS treatments. But Mbeki's statement could be taken a number of ways, well-meaning and realistic -- or far more sinisterly. Diseases stemming from poverty give we who live in well-off countries a sneaky excuse not to care.

But do not peacefully reassure yourself that this option, ignoring the issues, is a livable solution. Someday your insurance rates will go up after the next Hurricane Katrina, or you'll be forced to flee your home after the next 9-11, or your portfolio will take a dive because of a subprime lending scheme on the next continent. Someday you might receive a call from the airline informing them that the man sitting next to them on the way back from Paris had multiple drug resistant TB. Oh, you only fly charter planes? Then it was the witty fellow who spoke at your conference, or the woman who ate the chicken cacciatore and green beans amandine while sitting across from you at table L24...And when can you come in and get tested?

Aside from flat world ditties and in addition to altruism, we care about issues like pandemics that seem far away because they threaten our personal economics and health. HIV/AIDS is costly to prevent and treat, but more costly to ignore. Prevention and treatment are uphill battles, but the cost of not confronting the problem leaves 20-40 year old populations in many sub-African countries decimated from death and disability. South Africa's wealth demands that it to do better. Working age adults who could be contributing to national economies instead die. Children left parentless may not have food, get an education, or find a job. Not only will they not fulfill their potential, they may not even live to be adults. In a humane global economy this is our loss.

What We Don't Understand About AIDS: It's Our Legacy

AIDS is a complicated set of problems intertwined in confusing ways, never to be resolved perfectly. AIDS is also an "issue" with history, funding, international attention and talking points. It has been isolated from public health for the sake of public awareness and fundraising. So when Mbeki said that deputy health minister Nozizwe Madlala-Routledge was fired, purportedly for attending an international AIDS conference in Spain, the reaction was reflexive. Media condemnation was demanded as is custom with such issues.

News in general is a collective enterprise, and everyone's bit counts. We can't expect to get a full report on a complicated issue if we choose to read a reduced, digestible black and white, soy and pulp editorial, nor can we expect that from a 57 word blog. But even after acknowledging the nuances of news coverage, 'what doesn't Mbeki understand' still doesn't seem like quite the right question under the circumstances.

The South African president earned a Master's of economics and is by all accounts very intelligent. The South African stance is one of a country that understands AIDS fully, but is making economic choices that don't allow an option of 'redistributing wealth' to AIDS patients. Or perhaps Mbeki shunned foreign pharmaceutical companies because of his "African Renaissance" philosophy. Or maybe defiance still seems like the only path. We don't know. But when all of us perennially ask 'what doesn't Mbeki understand', we should acknowledge that it's not a knowledge barrier holding up progress on South Africa's AIDS crisis, but the application of an economics that values life in ways we are not accustomed to nor comfortable confronting.

A valid counter-question might be, what is it that we don't understand about the South Africa's AIDS crisis that compels us to keep asking the same questions? Or, why are we asking softball questions that we know the answers to? Or, how do our habits of asking the same questions about AIDS over and over again as the decades pass us by ease our consciences, fulfill our editorial duties, or harm us?

Mbeki has successfully put-off doing anything about AIDS for years. That may be his legacy. But AIDS is well-established global catastrophe that citizens in wealthy countries often turn our backs on. This is our legacy.

It's a story that few American newspapers have written about. Not the Washington Post, or the New York Times. The Los Angeles Times wrote about it back in 2005. The Milwaukee Journal Sentinel wrote a piece, as did a Pittsburgh paper. But chemical trade journals have been actively worrying the subject of the European Union's REACH (Registration, Evaluation,Authorization and restriction of CHemical substances) chemical legislation for the last few years, publishing hundreds of articles on the subject. Chemical companies have sent lobbyists to speak in the European Union parliament. And the United States ambassador to the European Union has exerted significant resources to fight the legislation.

After prolonged negotiation last December, the European Union approved the legislation aimed at providing information and regulation of chemicals used across the EU to better protect consumers and the environment. REACH is focused on collecting and making available knowledge about chemicals produced or imported in the EU. It will require companies doing business in the EU to register chemicals and their safety profiles. The data will be overseen by the European Chemicals Agency (ECHA) and stored in a searchable central database, partially open to the public.

REACH attempts to make up for lax regulation in the chemical industry that has led to unprecedented levels of toxic chemicals in the environment and exposures in wildlife and humans. Most of us have one to two hundred chemicals in our bodies. Exposure to some of these chemicals leads to genetic mutations, infertility, disease, and cancer. Many of these chemicals that we are exposed to have unknown safety profiles. 100,000 existing substances were in use in the EU before its chemical legislation went into effect in 1981, which are essentially exempt from safety analysis.

REACH will require that chemicals manufactured in quantities of greater than 1 ton to be registered, and that those manufactured in quantities greater than 100 tons be evaluated. Certain substances of "high concern", as the UK regulating "acceptable socio-economic cost", the substitution will be required.

Not all chemicals fall under the purview of REACH, since some chemicals, like pharmaceuticals, are already legislated by other agencies. REACH primarily regulates monomers.

The REACH legislation changes the load of regulatory oversight, putting the impetus on companies to produce evidence of a chemical's safety profile, rather than burdening government regulatory agencies with the ever unwieldy task of monitoring all chemicals and creating safety profiles for them.

The U.S. and chemical companies lobbied aggressively to thwart passage of REACH. Chemical Week reported as much September 17, 2003:

A coalition of 70 environmental and public health groups -- including Physicians for Social Responsibility, the Natural Resources Defense Council, and World Wildlife Fund -- says President Bush is "intervening in the regulatory process of sovereign nations at the behest of industry." Environmental Health Fund says that the U.S. developed a policy to oppose REACH in "closed-door meetings with the industry to the exclusion of citizens, public interest advocates," and others.

To which an American Chemical Council (ACC) president and CEO Greg Lebedev replied: "We would be mad as hell if the Bush administration didn't lobby on behalf of American manufacturing interests."

According to an article in this month's Harper's, (Mark Shapiro, "Toxic Inaction", Oct., 2007), U.S. efforts included sending emissaries to new EU countries such as Hungary Poland, Estonia and the Czech Republic in an attempt to recruit trading partner states against REACH. American businessmen lobbied aggressively at EU parliamentary hearings, a move that Shapiro called an "historic intrusion into European affairs". Bush also deployed C. Boyden Gray, a Republican with a ubiquitous conservative presence, who serves as ambassador to the EU. Gray's expertise as he explained to Shapiro, is "confining and taming the beast" -- "beast" being the U.S. regulatory laws pertaining to clean air, the environment, drugs.

Taming the Beast

Gray contributed to the public relations effort opposing REACH in Europe and in the U.S., representing a lobby reflexively opposed to REACH, who denigrates the regulation as having an exorbitant cost of implementation that will result in national economic meltdown for the US. Gray is a lawyer, former counsel to George HW Bush, and leader of several think tanks dedicated to privatization and limiting regulation, such as Citizens for a Sound Economy and FreedomWorks. He's also rumored heir apparent to R.J. Reynolds company and has endowed a professorship of public health law at Harvard's School of Public Health.

An editorial he wrote in the Wall Street Journal (""Chemical Reaction", September 6, 2006) criticized the legislation and harped on Europe's failure to do "cost-benefit analysis" before deploying REACH. Lobbyists often use cost as a reason not to implement environmental regulations. However the European Commission refutes cost arguments in an FAQ on its website:

"The original proposal estimated registration costs for the chemical industry to be 2.3 billion euros over 11 years (0.05% of the sector's annual sales). Further to the adoption of a weakened REACH, the cost will probably be lower than expected. The REACH legislation is also expected to induce reductions in public health costs and less negative impacts on the environment."

REACH, albeit somewhat diluted from it's original form, went into effect in June, 2007.

Advice in Day-Glo Green

The European Chemicals Agency (ECHA), based in Helsinki, will manage REACH, and given the scope of the project, it will obviously take a certain amount of time before it is fully operative.

However there is a flurry of activity of all sorts to prepare for REACH. China's Chamber of Commerce of Metals, Minerals & Chemicals Importer and Exporters (CCCMC) was the first to open an office in Helsinki, where ECHA is located. Other countries seem less enthusiastic. South Africa "ignores [REACH] at it's peril" says an editorial in Johannesburg's Business Day.

Four chemical companies have sued in UK courts over the interpretation of REACH. And a new consulting specialty has bloomed to advise clients on how to deal with REACH. Chemical Industries Association (CIA) subsidiary called REACHReady apprises clients about REACH on its day-glo green site, a peculiar soylent green background color not uncommon to industrial sites.

Despite the alarmist tones of article after article, in trade journals like the Chemical Week, corporations do have time -- up to eleven years -- to implement the changes. According to Inside Counsel, a magazine for corporate counsel:

"Companies can save themselves some pain by taking advantage of the directive's pre-registration period. Pre-registration lasts for 18 months after REACH's April 2007 adoption and offers participating companies extended deadlines for full compliance of up to 11 years."

REACH is an ambitious effort and ECHA will no doubt take time to ramp up also. The organization's project plan hints at a leisurely implementation: "during the first 12 months the Agency [by] building up its organization and recruiting personnel to be ready to accept registrations from 1 June 2008".ECHA marked its June opening by launching a website, where it explains itself on the home page under the title: "How to discover the ECHA website".

If the EU manages the effort it could not only change chemical regulation, but also further diminish the U.S. role in the environmental health regulation arena. The U.S. has historically had strong regulatory oversight, while U.S. companies shipped banned substances to developing countries. As Shapiro notes, it would be a turn-around for U.S. citizens to be on the receiving end of their own companies' EU banned chemicals. -------------------------------------------------------------------

Acronym Required previously wrote about REACH in 2005: Chemical Regulation in the EU - REACH. Acronym Required has also written several articles about Bisphenol A, plastics, phthalates, and endocrine disruptors.

--------------------------------------------------------------------

Updated Sept. 20th, added links to WSJ and European Commission articles. Updated WSJ article information.

Today, Craig Venter published his genome sequence in the journal PLoS Biology, along with a self-portrait so large, in the journal's 'Synopsis' version, that this startled reader recoiled with fright.

Sheesh. Science should be soothing...first you have your abstract, your introduction, the methods, results, discussion...No unassuming reader seeking to understand science's newest frontiers, for the greater good, should ever be confronted with SO MANY individual facial hairs, in such...lewd...detail. Shotgun sequencing indeed, he's a bit in the reader's face, as they say.

The published sequence is diploid, both his mother's and father's contributions. Much of the sequence may seem familiar, due to the fact that Venter contributed his DNA to the first composite sequencing human genome effort made by Celera (his company, which is also behind the current effort), the results of which were published in 2001. His genetic contribution to that effort was 60%. According to today's Financial Times unique scoop, Venter is predisposed to "novelty-seeking behaviour and a preference for evening rather than morning activity". News you can use.

However both the journal and the author stress that individual human traits are each influenced by many genes. The PLoS paper concludes that human-to-human sequence variation is five- to seven-fold greater than earlier estimates, which Venter says, proves that we are in fact more unique at the individual genetic level than we thought.

Yawn. Good enough. Nevertheless, maybe next time, a composite photo? Perhaps? To display your essential humanity?

Whales

"The safety of the whales must be weighed, and so must the safety of our warriors. And of our country."

So said Judge Andrew Kleinfeld of the U.S. 9th Circuit Court of Appeals, in a 2-1 ruling over the future of the Navy's sonar testing program off Los Angeles waters. Last Friday's stay allows the U.S. Navy to resume training exercises halted August 6th by a Los Angeles judge because the sonar testing endangered 30 species. The Natural Resources Defense Council has more information about the effects of sonar testing here.

The 3 judge panel noted the exceptional situation the U.S. faces today when regarding ecological questions: of being "engaged in war, in two countries." According to the ruling:

"we customarily give considerable deference to the executive branch's judgment regarding foreign policy and national defense."

The Navy's testing is not constrained to these waters, it conducts tests elsewhere. But the judge frames an issue of the local environment in the context of the war on terror. Outrageously, while spewing fallacies, the court also hasn't caught up with the rest of the world's judgment of the executive branch's abilities "regarding foreign policy and national defense". The NRDC will appeal the decision.

Armchair Warriors

So much for the whales, says the judge. But to the subject of the executive branch's "judgment". As the war in Iraq seems to lead policy by the nose in many seemingly unrelated areas, the nature of the executive judgment that guided us to this place never ceases to occupy us and the authors of numerous books, reports, legislative investigations, and judicial rulings. Such mendacity outrages the public, fuels years worth of reality comedy, and causes international consternation.

Now the occupation is taking over Hollywood in a slew of new movies, some of which we at Acronym Required have seen recently. And since man cannot live by science alone, we'll ungracefully segue into reviewing them here.

One arresting documentary is No End In Sight, a movie that chronicles the decisions made by Pentagon and White House during the first few years of the Iraq war, and links those decisions to Iraq's subsequent degradation into violence and chaos. The accounts are relayed by administrators and military who served in Iraq. I hesitated before seeing it, I'd heard it all, I thought. But it was especially captivating to view the build-up, invasion, and occupation of Iraq as contiguous history, rather than as news accounts broken up over time with distracting news about science and movie star jail episodes interrupting the narrative.

There's also War Made Easy, narrated by Sean Penn (on DVD) that deals with public relations efforts in by the executive branch of the U.S. in all wars since WWII. The message is that U.S. citizens are far too trusting of the executive branch. This film too is very good, but is not without it's own slant and advertising. (To begin with, it's not narrated by Sean Penn as much as by Norman Solomon.)

You can warm up for these accounts by reviewing Charlie Rose's interviews with Patrick Tyler and with Amy Goodman, at his table, on March 12, 2003. Seeing this display of unfettered war hoopla before the recent releases provided a sharp reminder of the media deluge we were under before the war, and gives a nice backdrop to the documentaries. The Rose interviews happened in the aftermath of a report on the unforeseen risks of going into Iraq just before the invasion. Patrick Tyler, a former New York Times correspondent, who is considered by certain sources to be a part of the (evil) politically "liberal" cabal of the Times, discussed the war with Rose,agreeing that it was "a giant roll of the dice", with unknown risks but possibly great payoffs.

Tyler's best case scenarios for the Iraq war were fairy tales. In the first week, he predicted, liberation Americans would march in and form "that big ring of steel around Baghdad...using psychological operations to break the will of his commanders...force them to choose between Hussein and American forces...Iraqis will cheer the arrival of Americans....". This strategy, Tyler mused, would serve to improve our foreign relations with Europe, Russia and the entire Middle East, teach North Korea a lesson, and set the stage for peace between Israel and Palestine. Not to mention get Bush re-elected. Needless to say, no one had really looked into the future beyond their fanciful visions of leis joyfully draped over the broad shoulders of U.S. military by the grateful Iraqis.

It's fascinating to see exactly how wrong the pundits were -- even the "liberal" ones -- about the pressure put on media to sell the Iraq war, about the actual vs. perceived threats of the invasion. They were not only dead wrong about Iraq, their visions for how other foreign policy would play out were off too. Tyler noted Putin's great leadership, and his remarkable inroads towards the west and democracy. One of the most dire risks predicted by Tyler was that the U.S. could get stuck in Iraq "3 months from now", and Bush would lose the election. All of this discussed in those somber, serious tones reserved for such especially exciting occasions. It's stunning just how much hindsight of a mere four years provides. Amy Goodman of Democracy Now has an interesting and relevant minor showdown with Charlie Rose in the same episode, about whether or not major TV networks were influencing the reportage of their anchors.

Not to focus exclusively on the U.S. and non-fiction, in fiction movies there is the somewhat related This Is England, which tells a story about England during the 1980's, and argues a view that desperate economic straits of that country under Thatcher led to the decision to go war and eventually, of all things, to the rise of skinheads.

These movies are apparently only the beginning. There are more Iraq themed movies attracting attention at the Venice Film Festival. These days, however, almost any movie, Bourne Ultimatum for instance, can be seen by a jaded audience as containing an underlying message for U.S. foreign policy.

In times like these, the courts and Hollywood argue, the place of the whales fades away along with the mystical escapism of movies like Whale Rider, when warriors coexisted with whales, a product of ancient times -- 2002.