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Mbeki's foot-in-mouth syndrome

The Star

In trying to explain his approach to HIV and Aids during his term, Thabo Mbeki is digging himself an even deeper hole, writes Malegapuru William Makgoba.

Medical doctors and scientists make diagnoses from four interdependent factors: history; examination; investigation and treatment. Heart attacks are often diagnosed from history alone because the description of the symptoms by the patient is often so classical.

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Former president Thabo Mbeki, whose Aids policy is blamed for the early deaths of about 300 000 South Africans, has triggered fresh criticism by defending some old pronouncements about the disease. File picture: Anja Niedringhaus

However, some diseases are often easily diagnosed by taking a history followed by medical examination. The examination reveals what doctors call signs, while the patient provides symptoms in the history.

Read: Mbeki's Aids comments a distraction: Sanac

But many other diseases are better diagnosed through investigations, which take many forms following the taking of history and medical examinations. The investigations often reveal the underlying pathology for the explanation of symptoms and signs of the patient.

Rarely a diagnosis is made by giving specific treatment which leads to specific response and recovery. The anaemias, especially vitamin B12 deficiency, fall into this category. Most often response with recovery to specific treatment confirms the diagnosis.

Understanding these two basic terms of symptoms and signs is the hallmark of medical training and practice and at the heart of former president Thabo Mbeki’s misunderstanding and confusion in his letter. Symptoms are from patients and signs are findings by a trained doctor.

The diagnosis defines a medical condition or a disease and determines treatment, in this case Aids. A correct diagnosis leads to correct treatment just as a wrong diagnosis leads to wrong treatment with at times dire consequences. Such is the importance of diagnosis.

The simple English Oxford Dictionary’s definition of a syndrome is “a group of symptoms and signs which consistently occur together, or a condition characterised by a set of associated symptoms or a disease or disorder that involves a group of signs and symptoms or a group of signs and symptoms that occur together and characterises a particular abnormality or condition, a medical disease or condition”. The emphasis of the definition is on signs and symptoms. So, Aids is a disease or a medical condition that fulfils this uncomplicated definition.

In an article titled “I never said HIV does not cause Aids” Mbeki, if quoted correctly wrote: “What I said is that a virus cannot cause a syndrome’.”

He further wrote: “Aids is an acronym for Acquired Immune Deficiency Syndrome - therefore Aids is a syndrome; ie a collection of well-known diseases, with well known causes. They are not, together caused and cannot be caused by one virus! I said HIV might be a contributory cause of immune deficiency - the ID in Aids’.”

For Mbeki, the definition of syndrome is a “collection of well-known diseases, with well known causes”, and for the trained medical doctor, a syndrome is a collection or group of signs and symptoms that occur together to define a medical condition. From this simple statement, it is obvious but not surprising that Mbeki does not understand the language of medicine or science.

Clearly Mbeki’s definition and understanding of a syndrome is wrong as defined in simple English. In Mbeki’s world a virus (HIV) cannot cause a syndrome (Aids). This is another misunderstanding as medical literature provides many examples of viruses causing syndromes.

Every well trained doctor knows that poor nutrition causes generalised immune deficiency but this is not Aids. Equally many doctors recognise that tuberculosis as a specific disease is not Aids. So a “collection of medical conditions with known causes” is not Aids but these may be Aids-related. Understanding these subtleties in medical sciences are what distinguishes hospital and patient-based trained medical doctors from naive internet-surfing trained medical charlatans.

By twisting the common English definition of syndrome Mbeki creates his own medical encyclopaedia and in effect confirms that “HIV does not cause Aids” because it is a virus and a “virus cannot cause a syndrome”; a statement he denies. Perhaps the most serious lesson and conclusion is this: a president cannot create his own medical and/or scientific definitions and/or assumptions and that one cannot, no matter how powerful, learn to be a good doctor or good scientist by surfing the net.

Here are basic facts: HIV is a retrovirus. It is the cause of Aids. The specific destruction of CD4 cells by HIV leads to Aids. Aids is a specific condition, with a specific cause, a specific pathology and a specific treatment. Luc Montagnier and Francoise Barre-Sinoussi would be first to admit these as they discovered the virus in the lymph nodes of a patient. For this breakthrough discovery, they were awarded the Nobel Prize.

As the cause of Aids, HIV has fulfilled the classic Koch’s postulate, the litmus test for an infectious agent to be accepted as the cause.

A response to specific treatment serves to confirm a specific agent as a cause of disease. ARVs are designed specifically for the treatment of HIV. South Africa has the largest ARV programme in the world. Since the introduction of ARVs to the treatment of HIV/Aids patients, mortality has been drastically reduced, many lives have been saved, many patients are active and live productive lives, the life expectancy has risen and mother-to-child transmission of HIV has plummeted from 25% to less than 1%. How specific can you get in understanding this causal relationship between this virus and this syndrome?

When so many lives and talent were lost and so much untold suffering occurred in our country, that Mbeki seems to show no remorse, unable to simply say “HIV causes Aids” but hellbent on using outdated statistics and wrong medical definitions and assumptions in his long latest letter is not only astounding but also so regrettable. The letter removes any lingering doubt or ambiguity about his true stance: dissident and denialism.

As a country we have moved decisively away from the voodoo, reputationally-damaging and ignorant days of Mbeki’s ill-advised, ill-informed and pernicious policies on HIV/Aids and evidence is everywhere for us to be proud and confident that we are on the correct path and with scientifically proven evidence-based sound health policies.

With an estimated 330 000 deaths during his reign, as a result of “failure to accept the use of available ARVs, perhaps as South Africans we should seriously consider a case of “crimes against humanity” to the International Court of Justice.

Makgoba, an immunologist and physician is vice-chancellor of the University of KwaZulu-Natal

Every well-trained doctor knows that poor nutrition causes a generalised immune deficiency, but this is not Aids.

Clearly the former president's definition and understanding of a syndrome is wrong.

* Makgoba, an immunologist and physician is vice-chancellor of the University of KwaZulu-Natal

** The views expressed here are not necessarily those of Independent Media.

The Star

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