The highlight of this week has been the news that Matthias Rath has folded in his attempt to sue Ben Goldacre and the Guardian. Rath will end up paying about half a million pounds for his attempt to silence and harass his critics. It couldn’t happen to a more deserving man.
Matthias Rath is a modern day Lysenko. Trofim Lysenko was the Russian peasant who worked his way up through the Soviet hierarchy, twisting science to suit the ears of Stalin. He rejected Mendelian genetics and denounced it as a capitalist plot. Any scientist who criticised this nonsense met with severe treatment, imprisonment and death. Soviet science was held back for decades under his influence. Chairman Mao adopted his agricultural theories in the cultural revolution resulting in the starvation of millions.
Today, we have the South African government rejecting science when it comes to the biggest crisis they face. AIDS is causing havoc in Southern Africa – killing hundreds of thousands, and needlessly. We now know how to manage the illness so that is essentially, no longer becomes life-threatening. But it has been a struggle for South Africans to get hold of the drugs they need to survive.
The heroes here are the Treatment Action Campaign, a charity set up by Zachie Achmat to raise awareness of HIV in South Africa and to make treatment available to all. Achmat said he would not take ARV drugs until they were available to all. One of the first acts of TAC was to assist the government in clearing the way for the distribution of generic drugs despite opposition from the pharmaceutical industry. The government quickly turned its back on TAC though and refused to distribute the medication, instead adopting fringe AIDS -denialist theories, and supporting quack ‘cures’ for he disease. In echoes of Stalin’s support for Lysenko, Mbeki, the president, and his government promoted the view that AIDS was a conspiracy of ‘Western’ interests and racism. Throughout Africa, similar themes were adopted where being an AIDS-denialist was part of the package you took for opposing ‘colonialism’ as represented by ‘western science’ and drug companies.
In this climate, in walks Matthias Rath, a German vitamin salesman. Rath proclaimed that,
Never before in the history of mankind was a greater crime committed than the genocide organized by the pharmaceutical drug cartel in the interest of the multibillion-dollar investment business with disease. Hundreds of millions of people have died unnecessarily from AIDS, cancer, heart disease and other preventable diseases and the only reason that these epidemics are still haunting mankind is that they are the multibillion-dollar marketplace for the pharmaceutical drug cartel.
Rath treads a well worn quack path. He plays to the inherent distrust we have of pharmaceutical companies and then makes the leap that their drugs are dangerous and ineffective and that his own ‘cures’ are the answer. He plays to the nationalistic views that there is a colonial conspiracy to kill Africans and then promotes his own vitamin pills as the answer. He ran newspaper adverts in South Africa telling people that ARVs were ‘poison’ and to urge people with HIV to take his ‘natural’ vitamin pills. His venom spewed at the Treatment Action Campaign is appalling.
Rath has been conducting ‘trials’ in South Africa illegally. The government at best, turned a blind eye and at worst encouraged him. The South African Medicines Control Council (MCC) and the Treatment Action Campaign had to take their own government to court to prevent the Rath Foundation from promoting its quackery and to force the government to uphold its own laws. TAC quite rightly call Rath the ‘definitive charlatan’.
Ben Goldacre had been documenting the horrors in South Africa in the Guardian. Rath decided to sue. The result has been that the Guardian has been unable to discuss the calamities in South Africa for about a year now. Rath had managed to effectively silence one of his chief critics. One can speculate that Rath thought that the Guardian would not defend one of their non-staff minor columnists, but to their credit, they did. Rath has failed and he now faces a mammoth legal bill. The Guardian’s bill was £500,000. His own must have been similar.
Using the law to silence critics is a typical cowardly quacks trick. I have been at the end of legal threats myself when I pointed out that the Society of Homeopaths were failing to uphold their own regulations by not condemning their own members who were peddling AIDS quackery in South Africa. The British Chiropractic Association is currently suing science writer Simon Singh for daring to suggest that their evidence base for their bone crunching is shockingly poor. One can hope that this case will be a warning shot for other quacks who wish to use the law to silence people. I have had my fair share. Fighting in the courts is not easy for all. But there are ways of dealing with it, but it is not pretty. There is one quack who has threatened me who is in for a nasty shock soon. People in glass houses…
South Africa has become the playground of every quack wanting to make their mark. It is causing enormous problems for activists on the ground. There are many dedicated people in South Africa struggling to pump sense into their own government. Our western soft headed approach to alternative medicine is at the root of this insanity. It provides the ‘intellectual’ back drop for nonsense views to take hold. This is not fun and games – people are dying because of it. The University of Cape Town estimates that 340,000 deaths could have been prevented if the government had not been enthralled by quack alternatives. In reporting Jeanette Winterson’s misrepresentation of AIDS activist and South African Supreme Court of Appeal Justice, Edwin Cameron’s views on homeopathy, I quoted Yusef Azad, Director of Policy and Campaigns for the National AIDS Trust. His words are worth repeating.
The tragedy is that there are still far too many governments not funding the treatment properly, and too many people with HIV who have not been informed of its benefits. Quack cures abound of course, all unproven, all cruelly deceiving, all a massive distraction from what we know genuinely works.
Every supporter of alternative medicine in the UK has a little guilty role to play in this tragedy. By using the same arguments as Rath, such as the evils of drugs and the naturalness of vitamins, you are responsible for the deaths of real live people. Alternative medicine is not just the idle plaything of the middle classes from Islington. It matters. And when our Universities teach it as if it was science, and our hospitals offer it as if it was medicine, then charlatans are able to use this as justification for their own self-interest.
Rose Shapiro in her recent book Suckers described how alternative medicine makes fools of us all. It is worse than that, it makes us all genocidal.
Nice one. Right to the point.
Sorry, chaps! You are wrong a bit. Because you don’t know my native country.
This bugg…r has not enough sh..t to become new Lysenko in Russia 😉 It seems does this idiot try to seek a luck in Russia, eh? He has signed his sentence of death, starting his business in Russia. He will come away from there without his money, skin and his addle-head! 😛 🙂
I hope that gaining such victory, Guardian will not longer fear to defend the quackbasters, how it was in Singh’s case and will not fear to publish their articles?
… as if it were science.
And don’t forget, my foreign friends, – Lysenko was Russian quack and, by the way, he harmed Russia most of all and never acted outside USSR. But now the muddy stream comes to Russia from YOUR territory. Mattias Rath is German, which lives in USA and has business on USA’s territory. And he considered Europe, Britain, Africa and Russia as a range for his dirty business.
Rath shamelessly uses political rhetorics in his affairs, in particular, he likes to pose himself as a votary of peace, opposing possible III World war. But it is known that any wolf likes to wear sheep’s clothing.
It is fair to say, Russian doctors know about dishonest tricks of this “businessman” and warn all patients about danger of his methods:
Sorry, these links in Russian only, however, I can translate the final paragraph in the second link:
“It will be observed, that soon after Mattias Rath made a startling statements that he can cure of AIDS with vitamines, WHO’s representative Dianne Kohler Barnard had called Rath a quack.”
To Germany’s credit, Ruth’s native country treats him also enough coldly, determining him in Wikipedia as “…ein umstrittener deutscher Arzt” ( http://de.wikipedia.org/wiki/Matthias_Rath), i.e. “a debatable German doctor”.
I apologize for (probably) considerable heat of my statement, but I’d like to remind that world did change of late years and some people must settle down to new world and look at themselves in mirror though sometimes 😉
And surely – it is great that Guardian and Ben won this battle. Congratulations!
Your article is waaaaay over the top.
Many people, myself included, have suffered and do suffer from the adverse side-effects of prescribed medications.
Excellent article and I completely agree with your sentiments.
Willow, I’m sure no-one is suggesting that prescribed drugs can have powerful side-effects; HIV drugs in particular can be very nasty. But they also have main effects – that is, they work. If you have HIV, then antiretrovirals will extend your life. Vitamins won’t. Telling people – people who are sick with side-effects and desperate for a full cure – to stop taking the antiretrovirals, and sell them vitamins instead, is a very twisted form of murder.
Ditto to anandamide. Side effects are almost inevitable due to the fact that drug target molecules are very often present in many tissues and situations in the body. Radio and chemo therapies for cancer for eg work by killing rapidly dividing cells, ie cancers almost by definition. But they also hit those cells in us that are also rapidly dividing, the gut lining and hair follicles. So you get hair loss and nausea and gut upsets. But what are those compared to cancer?
The side effect free drug does not exist. Not to mention that people blame any malady, perceived and real, while on medication on that medication. Which is why even placebos have side effects. Many side effects disappear when the patient does not know they are taking anything.
So you have to ask yourself if you want to use treatments with clinical trials evidence of efficacy or those that contain no active or proven benefits?
Drugs don’t always ‘work’. And very often the side-effects are far worse than any improvement. – You may like to read about my own experience here http://www.wildeaboutsteroids.co.uk/obesity_and_the_salt_connection.html
Also a fellow I have been in touch with for many years has been HIV+ since the early 80’s and he has steadfastly resisted all the persuasions doctors have made to try to get him to take antiretrovirals, relying instead on optimised nutrition – and he is still working…(o: (though he now works at home and only about 16 hours a week). He is sure that his anti-drugs stance is the reason he is still alive. – His friends who were infected roughly the same time as he was took the antiretrovirals and all of them died years ago.
Willow – I’m very glad your friend is coping so well, and unfortunately you are right – often drugs can seem like they are worse than the illness they are an attempt to treat. I recall reading an paper which discovered that doctors often don’t appreciate the severity of those side effects on an individual’s life – in this instance it was a paper regarding anti-depressants, but I can easily imagine the same holds for many other forms of powerful treatment.
However, I can’t accept your friend as proof that nutrition works to effectively treat HIV; my granddad, having smoked since he was a young teenager, died at the age of 93 – with not a trace of heart disease or lung cancer. This doesn’t alter the fact that smoking can cause lung cancer and heart disease – I think that his case proves that individual humans are individual, and it’s difficult to make predictions regarding individuals. This is why medicine works with probabilities and populations. It sounds heartless, but ultimately it allows medicine to progress beyond the level of ‘it worked for me’. Examination of the figues shows that smoking causes lung cancer – even if not everybody gets lung cancer. And figures also show that people diagnosed HIV+ now will live much longer if they take antiretrovirals than if they don’t. If the reverse were true then the results would be obvious at a ‘grass roots’ level – within the particular communities affected by the virus.
ARVs are certainly not pleasant drugs – I know a number of people who have either taken short courses of them or who are on them ‘for good’. I’m not averse to the idea that individuals might exist who can ‘live with’ HIV without being treated, and even that treatment could do some harm for that very specific set of people, for reasons we currently don’t know – I think that’s a credible assumption to make, given how wrong we can often be with something as complicated as human biology and virology. But if we don’t have a method of screening those individuals, then it comes down to possible harm v certain harm: That is, we know (from detailed studies carried out not just by ‘Big Pharma’ but also by hundereds of scientists and statisticians who care deeply and humanly about the impact of their work) that ARVs reduce the death rate among people with HIV; this is not a matter of belief, it is a matter of knowledge. Even if it is granted that there is a chance that a small number of people might be able to survive appreciably without the drugs, until we have a way of knowing who those people are (and, more excitingly, why they can survive), it makes sense to treat everyone with ARVs – and continue to look for better ways of treating HIV.
Sorry for the long reply; all too often on the net it’s easy for differences of opinion to turn into offence and vilification, and as you were good enough to reply to me with courtesy I thought I should return the favour.
Thank you for your reply. I’m happy for us to agree to disagree…(o:
Dear Feathered Friend,
Your report on the Rath case is very timely. The law, being an ass and a clumsy one at that, is seldom an appropriate tool to use to try to settle scientific issues, and should never be used to suppress debate or dissent. (That’s my Western, middle-class colours nailed to the mast). We should all be grateful that The Grauniad won, as a loss could have set a very dangerous precedent. On this occasion, however, you have over-simplified the case; Anandamide’s contribution is more subtle, more measured, and more open-ended, although he/she may well not agree with my belief that there is some substance in Rath’s argument.
Strip out Rath’s demagoguery, and the argument that the pharmaceutical industry / complex / mindset (whichever) has considerably contributed to illness and death has considerable merit. My own research with the historian Dr Judith Rowbotham into health issues in Britain in the period 1850 – 1885 has shown, rather counter-intuitively, that at that time people lived longer and healthier lives than we do today; largely due to high levels of calorific throughput and a vastly superior diet. Despite living as long or longer than we do (depending on which socio-economic class you analyse), their incidence of degenerative disease was far lower than ours, running at about 10% of 1997 levels. There are a number of contributory factors, including the relative absence of tobacco and spirits, but it is overwhelmingly clear that the nutrient density of the mid-Victorian diet conferred near immunity to heart disease and cancer, the two most important causes of death today.
Political and economic forces combined to end this short period of great good health, and by an unfortunate coincidence, the first great victories for pharmaceutical medicine – the antibiotics – arrived on the scene at more or less the same time. This laid the foundations for the currently hegemonic xenomolecular model of health care; one that is pretty good at managing the symptoms of degenerative diseases but not good at all at curing them. The corollary is that we have been left with a rump of nutritional studies that are predominantly epidemiological, and a relatively small number of intervention studies which mostly use inappropriate, pharmaceutical methodology. (I’m not agin the RCT, it’s the best tool we have, but we have consistently used the wrong independent variables).
Notwithstanding, there is now a considerable body of evidence that when it comes to most illness, it’s your lifestyle stupid. Nutrition, of course, being a considerable element in the lifestyle package. So Rath is half right. Unfortunately he is also half-wrong – which in this context means all wrong – in that his ideas about what constitutes appropriate nutritional intervention are half-baked. The supplements business is unique in that most manufacturers plainly do not understand what they are selling, and it is self-evident that most purchasers do not understand what they are buying. I cannot think of any other business that operates on such a profound basis of ignorance!
If anyone is interested in deconstructing this thesis, you can find it in the June, July and September issues of the Journal of the Royal Medical Society.
Excellent article and how thrilling to know that the quacks don’t always get their own way!
Willow, there’s a good reason that science doesn’t rely on anecdotes for its data – one anecdote can easily be easily be balanced by another, opposing, anecdote and we can find it out to work out ‘the truth’ that way. For example, I had three friends who were proud to proclaim that they were not taking anti-retrovirals (ARVs) two of them are now dead from AIDS-related diease, and the third admitted that actually, he had been taking ARVs for several years, but asked me to please not tell any of his other friends in the ‘alternative’ world, as he would lose their ‘respect’. I asked him what kind of friends they were…
In any illness, there will be always be some who are immune, or able to bear the symptons better or longer. In HIV, these people are known as ‘non-progessors’ and they are a source of much interest for scientists trying to work out why. However, buying vitamin supplements from a quack has nothing to do it. I work one day a week at an HIV charity, and I know several ‘non-progessors’. At least two of them have pretty dreadful diets and one of them is a heavy smoker!
Anyway, THAT’S why we can’t rely on anecdotes!
Quite frankly, and with all due respect, you’re “let’s agree to disagree”, is just a cop out.
You are wrong.
And others have done you the favour of explaining clearly why you are wrong.
Please do not “agree to disagree” when the facts of the matter tell you clearly what is correct and what is incorrect.
I was just about to say to Willow…
You are wrong. Others have explained why you are wrong: your agreeing to disagree is a complete cop-out.
Then I discovered Anonymous had already said this, so I won’t bother saying it again.
I don’t have a subscription to JRSM so can’t access the articles. I’m not medically or scientifically trained, but I’m guessing that physcial activity levels, esp among the working classes in 1850-80s, must have been vastly greater than is typical today – lots of hard, manual work, no motorised personal tranport, no labour-saving household machinery, central heating etc etc. No wonder they needed the high calorific throughput! But seriously, do you analyse the contribution of levels of activity to health in the articles?
Not allowed to disagree? – Didn’t know this was a totalitarian thread…(o:
But I DO disagree.
And I disagree with control freaks trying to bully posters whose views do not accord with their own.
Personally, I’m in favour of free speech…(o: – So I’ll not be visiting this thread again and the control freaks/bullies will be able to patronise and insult me with impunity…(o:
I did not say you are not allowed to disagree. I said you are wrong. And you misread my tone, which was meant to be helpful, not bullying.
The point is that when someone goes to all the trouble of giving a long explanation of why you are wrong, it is not appropriate to come back with “I’m happy for us to agree to disagree”.
It shows you are not open to explore the issue, that you do not have valid reasons for your belief, and that you are not happy to consider alternative views.
Anyway you have gone, which is, with all due respect, the ultimate cop out.
Clare – your point about the Victorian’s levels of physical activity is quite correct, and we did try to deal with this in our articles. If you’re interested, I can send you the articles, if there an address I can use. Alternatively, the book (inevitably) is due out from the RSM Press in January ’09.
Thanks PaulC – I’ll wait for the book, due to current snowed-underedness re reading material! Kind of OT but talking to my sister recently(lives in Tanzania), I was reminded of this report of a Swedish study into low rates of cardiovascular disease in Maasai people (following traditional diet and lifestyle) despite high consumption of animal fats. According to these researchers, energy expenditure is the key.
Clare, thanks for the link. I have a longstanding interest in the Massai, from a nutritional perspective and also personally – my father lived with them. High levels of physical activity contribute to their cardio-protection, but the major factor is their low sodium intake. In Finland, a national sodium reduction program has cut both heart attack and stroke by 80% in the last 25 years. The key insigator is Heikki Karpannen, a wonderful man and a great scientist who initiated the most important dietary intervention programme ever; the Karelia Project, which demonstrates inter alia the greater efficacy and far greater safety of achieving better health through dietary change, than can be achieved by drugs. Our abysmal public health figures show the malignant influence of a major multinational company which sells an extraordinarily toxic combination of salty snack foods and sugar-sweetened beverages. High sodium intake is inextricably linked to hypertension, which is exaccerbated by overweight. PaulC
Re Finland, Ben Goldacre refers somewhere in his book to the ‘public health gang’ there and their success in improving things like CV mortality rates. (Useful things, indexes…!). The interventions appear to have consisted of more than just salt reduction (important though that is). The official Finnish nutrition surveillance site ,(KTL) calls the reduction in saturated fat intake the most significant change:
“The most significant change in the Finnish diet over the past few decades has been the reduced intake of saturated fats. In the early 1970’s saturated fats [main sources reportedly milk and butter – see 2006 pdf below] accounted for 21% of total energy intake; by 1982 the figure had dropped to 19% and by 1997 to 14%. At the same time the proportion of energy derived from total fat has declined from 38% to 33% . Although there is still some way to go to reach the recommended levels (saturated fats and total fat should account for 10% and 30%, respectively), the intake of saturated fats is no longer at an exceptionally high level compared to other countries in Europe. The share of trans fatty acids from energy was only 0.9% in men and 0.8% in women in 1997. “
The situation regarding excessive salt consumption, it says, is “slowly improving” – though a 2006 report available from the same site as a pdf, “Nutrition in Finland”, gives the 2002 consumption averages as 9.5g in men and 7g in women, “remarkably” down from 1979 figures (13.5 and 10g respectively). This 2006 report also notes that the favourable downward trend in saturated fats consumption is showing signs of levelling off.
I think all the above is my loser-length way of suggesting that it’s the whole diet/lifestyle picture that’s important rather than focussing on one element e.g. salt. And what appears to work well in a specific context, such as high animal fat consumption in the Maasai not causing excess CV illness, is not transplantable to other contexts. Or, to quote Ben Goldacre: “it’s a bit more complicated than that”.
I’ve located the “Bad Science” reference to the North Karelia Project – pp.131 (last para.)-132. The preceding paragraph concludes with the point that, as well as diet, social and environmental factors are important in health.
“…Reasonable benefits have been shown in intervention studies – like the North Karelia Project in Finland – where the public health gang have moved themselves in lock, stock and barrel to set about changing everything about an entire community’s behaviour, liaising with businesses to change the food in shops, modifying whole lifestyles, employing community educators and advocates, improving healthcare provision and more, producing some benefits, if you accept that the methodology used justifies a causal inference. …”
(We are then advised to read the study online but there isn’t a specific link in the notes.)But it looks like a major, multi-faceted intervention.
Clare, The Finnish Nutrition Surveillance site is somewhat out of step with the scientists who actually did the work; it was a multi-faceted intervention, but the concensus is that it was the sodium reduction, together with the increased intakes of potassium and magnesium, that is directly responsible for the fall in Finnish blood pressure. A reduction in sat fats would not have had this effect. And for Ben G to dismiss the project by blurring pharmaconutition with social enginering is either disingenuous or dishonest. It is as simple as that. paulC
You’ll notice I haven’t left Ben much wriggle room – he’s either damned or he’s damned. The problem is that he’s too smart to have misunderstood the Karelia project so profoundly, and so I have to assume that he has a specific agenda for wanting to misinterpret it in the way he does. At a certain point, and as the multiple strands of evidence mount and merge, his reluctance to accept a very well-documented argument that he might not like ‘on the grounds that there are still so many unquantifiable variables’, becomes dishonest / disingeuous. paulC
PaulC, I’m not disputing the link between salt intake and high blood pressure, just observing that reports I’ve seen of the NK intervention, including articles by Dr Pekka Puska identify other factors – serum cholesterol reduction (high levels of dairy fat consumed pre intervention), reduction in smoking, increase in fresh vegetable and fruit consumption and dietary fibre, and increasing levels of physical activity – as at least as important in reducing CV and cancer illness and death.Again, the whole package vs. individual interventions argument.
The article I’ve linked to also refers, briefly, to other postulated causes of heart disease, including stress and social injustice/inequality, raising the question (for me) whether high levels of social cohesion aided the success of the Finnish project. The interesting question of the translatability of the Karelia experience into different social contexts is discussed here .
While I agree with your sentiments on AIDS and Cancer treatment with vitamins, one issue that has gone largely unaddressed in your post is that of cardiovascular disease.
It is unfortunate that Rath's extreme endeavors take away from the one area that may hold some truth. The fact is indisputable that Vitamin C is necessary for collagen production in the human body (among other things such as neurotransmitters, some hormones to name a few). Our blood vessels are made up of collagen.
There are many studies independent of Rath that show positive cardiovascular benefits of higher than USRDA levels of Vitamin C supplementation in areas of blood pressure, diabetes, atherosclerotic heart disease, stroke and more. The USRDA for Vitamin C is set at a level to prevent scurvy in the general population and does not take into account the other functions that Vitamin C performs in the human body and the fact that the human body, when under stress, has been shown to make use of more Vitamin C.
While it is important to point out quackery where it exists (like Rath's AIDS/Africa debacle), sites like yours can sometimes go to the other extreme, confusing the average layman. This can be dangerous– steering people completely away from vitamins.
A best path would be for people to make sure that they do have proper nutrition, and supplementing certain vitamins and minerals as needed to attain this, in addition to accepting traditional medical treatments when necessary.
I read somewhere:
< I'm happy for us to agree to disagree.. >
That is the classical expression from persons who feel they are wrong, towards some extent, but won't admit it and flee in words…