South Africa’s Health Minister, Manto Tshabalala-Msimang, is fighting to protect the traditional healers of her country from having their methods tested scientifically. She warns that, “We cannot use Western models of protocols for research and development,” and that she does not want the incorporation of traditional healing to get “bogged down in clinical trials.” Her arguments are anti-scientific and represent a health tragedy for South Africa. However, such attitudes are not uncommon within the community of sectarian medicine and represent some of the common rhetoric used to disguise anti-scientific positions.
This is also not the first controversial statement made by South Africa’s health minister. In 2006 she advocated using garlic and beetroot to treat HIV infection, prompting outrage from South Africa’s academic community. In response to criticism about delays and funding cuts in providing anti-retroviral drugs to HIV sufferers in South Africa, the Health Minister said, “Garlic is absolutely critical, we need to do research on it. We cannot just ridicule it.” South Africa’s president, Thabo Mbeki, resisted calls for Ms. Tshabalala-Msimang’s resignation.
President Mbeki has a spotty history on this front as well, gaining international infamy when in 2000 he declared that he was unconvinced as to the cause of AIDS and convened a panel to discuss its true causes. Just last year Mbeki came under further criticism when he fired the deputy health minister, Nozizwe Madlala-Routledge, who was an outspoken critic of Mbeki and Tshabalala-Msimang and is credited with reversing many of South Africa’s disastrous HIV and health policies.
This fight over the role of science in public health would likely have escaped world attention were HIV/AIDS not at the center of the controversy in a country that is itself at the epicenter of the African AIDS epidemic. (It is estimated that about 10% of the population may be infected with HIV.) But let us take a look at Tshabalala-Msimang’s statements in the broader context of science-based medicine.
“We cannot use Western models of protocols for research and development.”
The implication behind this statement is that science is somehow a “Western” cultural endeavor, or that there is “Western science” vs “Eastern science” or perhaps in this case “African science.” Such attitudes are simply a way to take a position that is anti-science while providing rhetorical cover.
There is no such thing as “Western science” or any other qualified science. Science is a set of methods for systematically and carefully gathering reliable evidence, for testing ideas by seeing if their predictions can be verified, using valid logic to draw conclusions, and fairly considering all available evidence. What, exactly, about “Western” protocols does Tshabalala-Msimang find objectionable or incompatible with the public health goals of her country? Does she object to using valid logic or to considering all available evidence? Perhaps she objects to the transparency of “Western” research.
“bogged down in clinical trials.”
Her other statement does clarify what she does not like about “Western” protocols – its reliance upon clinical trials. So perhaps she prefers anecdotes to placebo-controlled trials (in other words preferring inferior forms of evidence whose conclusions one likes to superior forms of evidence whose conclusions one does not like). Apparently she feels that taking the time to see if a treatment is safe and effective is a waste of time and only slows the widespread incorporation of the treatment.
We hear this type of thing from promoters of dubious and sectarian methods frequently – they are too busy healing people to take the time to do the research. Of course this is based upon the assumption that their methods work. History has clearly shown that such assumptions are not warranted. The research is necessary to determine if they are helping people and not hurting them.
Medicines used for thousands of years
Tshabalala-Msimang believes that because traditional healing methods have been used for thousands of years they do not need to be subjected to proper scientific study. I call this the argument from antiquity, which is a special case of the argument from authority. It falsely assumes that a treatment modality that has stood the test of time must be safe and effective. History shows this is not always the case. For example, blood letting based upon the humoral philosophy of illness survived for a couple thousand years in Europe and was only abandoned when it was replaced by scientific medicine. Also, the argument from antiquity is just another way of appealing to anecdotal evidence. Large amounts of anecdotal evidence, even spread out over many centuries, is still anecdotal and therefore subject to all the uncertainty and limitations that implies.
This is not to say that collective experience with a treatment is of no value. Uncontrolled observation is capable of detecting very obvious and immediate effects. But it is not reliable enough to detect long term risk or toxicity from treatment, nor to judge if it truly changes the course of an illness.
I will further note that Tshabalala-Msimang is relying upon traditional healing practices to claim that garlic and beetroot are effective in treating HIV/AIDS. It is, of course, not possible that there is thousands of years of experience with such a treatment, since HIV has been recognized for only two and a half decades. She therefore must be extrapolating from more non-specific claims made for these treatments. There simply is no evidence for the efficacy of nutrition in general or garlic and beetroot in particular as first-line therapy for HIV. The Academy of Science of South Africa, after studying the role of nutrition in HIV and TB, made the following statement:
The Study Panel is frankly appalled by the dearth of reliable and truly informative studies of the nutritional influences/interventions on the course and outcomes of the pandemic chronic diseases addressed in this report.
The argument from antiquity, when stripped down, is just another way to argue that poor quality evidence should replace or even trump high quality scientific evidence, or for putting health claims and practice ahead of proper evidence.
Unfortunately it seems that by firing the deputy health minister, while keeping Tshabalala-Msimang on as health minister despite widespread calls for her resignation, President Mbeki is making his intentions clear. Science-based medicine is being denigrated in South Africa as “Western,” tedious, and unnecessary, while implausible health methods are being offered without evidence or adequate justification. This does not bode well for South Africa’s health crisis.
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