Why Science Can't Cope With Mbeki
Washington Post-Sunday, June 4, 2000
By Steven Epstein
Political leaders are expected to know a little about a lot of things, and even when they don't, they often tell us what they think
anyway. Yet, for all their lack of shyness about expressing their views, few are the times in which politicians hold forth on
questions of scientific fact. World leaders aren't presumed to have detailed opinions about, say, the quality of the evidence
presented in a pathbreaking article in the latest issue of Nature. When it comes to science, it seems, politicians are in much the
same boat as the rest of us: disqualified from comment by virtue of a lack of relevant expertise.
That accounts for some of the surprise that greeted South African President Thabo Mbeki's unanticipated foray into AIDS
research. But Mbeki's comments, expressed in a recent five-page letter to President Clinton, did more than raise a few
eyebrows. Mbeki wondered whether the knowledge about the AIDS epidemic generated by Western scientists could even be
applied to an African setting. And he seemed to align himself with a group of marginalized scientists he had stumbled upon via
the Internet and then personally contacted--dissenters who maintain that HIV is not the cause of AIDS, and that the drugs
prescribed to treat HIV infection actually cause the symptoms of the disease.
This was not a comment on an obscure technical debate. This was an intervention into a domain of science where truth matters
with a vengeance--where getting it right has consequences that can be measured in billions of dollars and millions of human
lives. And certainly Mbeki's arguments have implications for South Africa, where his government has resisted spending money
on expensive antiviral drugs like AZT that, if the dissenters are right, shouldn't be consumed at all.
When Mbeki visited the United States last month, his support of the HIV dissidents was the dominant media frame. Scientists
and physicians throughout the country bristled with indignation, and some of them called for a boycott of the 13th International
AIDS Conference, scheduled to take place in South Africa next month.
The ferocity of the response reflected scientists' frustration at the apparent resurrection of a debate many thought had long since been put to rest. In the late '80s, AIDS researchers began responding to the arguments of Peter Duesberg, a formerly
well-respected professor of biochemistry and molecular biology at the University of California at Berkeley and a member of the National Academy of Sciences. Duesberg's argument that HIV has not been proven to cause AIDS has since been the subject of hundreds of articles and letters in scientific journals and the media, and he has gathered a small number of scientists (including one Nobel Prize winner) and a few advocacy groups behind his banner.
Support for the dissenters has waxed and waned, sliding into the background whenever the mainstream approach seems to be
showing a payoff. Ever since the new and more effective antiviral drugs first became available in U.S. pharmacies in 1996, the
media and the public have shown a diminished interest in Duesberg's arguments, and medical authorities may reasonably have
concluded that they had finally vanquished their nemesis--or, at least, that no one was paying him much mind. Now comes the
Mbeki affair to resurrect the argument.
Scientists and government officials are right to worry about the potential costs of the South African president's statements. But
what is the best way to respond to Mbeki, or indeed to any non-expert who endorses contrarian scientific positions? The
problem is that to pose the question dismissively--"Why don't those ignorant people simply accept the conventional wisdom
endorsed by the vast majority of experts?"--misses an important point: Throughout the history of the AIDS epidemic
non-experts have challenged expert pronouncements about AIDS--not always for the better.
Patients, sometimes scouring the Internet much like Mbeki, have confronted their own doctors with printouts of cutting-edge
research that the physicians didn't always know about. Activists, with no formal schooling in virology or statistics but with a
hard-won, seat-of-the-pants grasp of scientific principles, have pressed for changes in the design of clinical trials that have led
to the enrolling of more patients. People are becoming less inclined to embrace an unthinking obedience to the authority of
experts; the very boundaries between non-scientists and experts are becoming harder to pin down. At least in areas like
medical research, where scientists pronounce on topics as intimate as our own bodies, we should expect--and, I would argue,
respect--the active participation of the uncredentialed. In this regard, simply to dismiss Mbeki's foray into medical topics is
problematic and unhelpful.
It's risky to generalize too much from the case of Mbeki, who is responding to a very particular set of political and economic
constraints. Among them, of course, are the global inequities that place medical treatments for illnesses such as AIDS--even
after the recent 80 percent reduction in the cost of antivirals--beyond the reach of most of the world's population. Still, because ambivalence about deferring to expert judgment is now so widespread, it is important to consider the obstacles that stand in the way of developing more productive relationships between experts and the rest of us. Here are three of those obstacles:
When scientific controversies become matters of public debate, claims about how such controversies should be resolved often
get mixed up with arguments about free speech and its suppression. Mbeki, for example, compared the HIV dissenters with
victims of the apartheid regime, who were silenced because the established authority believed that their views were dangerous.
Duesberg's supporters in this country have often compared him with Galileo, who was brought before the Inquisition and
silenced in the 17th century for espousing the then-heretical view that the Earth revolved around the sun. But every scientific
controversy has winners and losers, and not all those on the losing end are victims of persecution, nor will they inevitably be
revealed someday as a Galileo. To be sure, sometimes the scientific mainstream does need to be pressured to listen and
respond to an opposing view. (This may have been the case in the late '80s, when Duesberg first began publishing his critiques.) But sometimes, when scientists stop responding to a challenger, it's because there really is nothing more to be said.
Second, the claim that a dissident theory is being ignored by the mainstream is often connected to a presupposition that
scientific controversies ought to be easily resolved. Surely, the argument goes, there must be a test or experiment that can settle
the matter once and for all. But as sociological studies show, sometimes the very design of the definitive experiment is part of
what is up for grabs in a controversy: The two sides cannot agree on what this experiment would look like. Sometimes the
presumably definitive experiment is conducted, but its results are challenged by those who claim it was not properly carried out. As such controversies drag on and become public, the media begin ranking the tokens of credibility of the participants.
Reporters sometimes place an undue emphasis on certain very public markers of scientific status, such as Nobel Prizes, and
provide inadequate clues for readers to assess the legitimate authority of scientists to speak on specific scientific topics. And the journalistic norm of balance may impel reporters to present controversies as having two sides, even in cases when the vast
majority of scientists stand on one of the sides. All these factors prolong a controversy, while giving credence to the view that
the challengers of orthodoxy are not being given their day in court.
Third, the very existence of ongoing scientific controversy on a topic that ordinary people care about often fuels distrust of
science, to the extent that people imagine science to be a producer of certainty. Scientists themselves know better: They
recognize that most new knowledge is provisional--but they often profess absolute confidence in their findings, because they
believe this is what the public expects of them. The problem is that when scientific findings appear to be contradictory--when
this week's study concludes that eggs or wine are bad for you but next week's study suggests the opposite--people throw up
their hands and declare the scientific enterprise to be bankrupt. Or, when someone like Duesberg points out the failure of a
reigning theory to account for every piece of evidence, some people assume that the theory must therefore be tossed out. The
more that scientists persist in over-claiming, and the more that people demand absolute certainty, the more distrust of science is
likely to escalate, and relations between scientists and non-scientists will become ever more fraught.
Scientists and non-scientists alike remain mired in bad habits that make it hard to respond productively to incidents like Mbeki's letter. Addressing those habits will not solve the vast problems caused by the AIDS epidemic, but doing so would make it easier to confront such problems directly and effectively.
Steven Epstein teaches the sociology of medicine and science at the University of California, San Diego. He is the author of
"Impure Science: AIDS, Activism, and the Politics of Knowledge" (University of California Press).
He can be contacted at: firstname.lastname@example.org
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