21 April 2009
Mr Desmond Painter
University of Stellenbosch
And for information,
The Editor, Die Burger, Henry Jeffreys;
The Books Editor, Die Burger, Dr Gerrit Brand;
All academic staff of the Psychology Faculty, University of Stellenbosch;
Other interested parties;
And online at www.tig.org.za
Dear Mr Painter
‘THE TROUBLE WITH NEVIRAPINE’ BOOK REVIEW:
QUESTIONS OF INTELLECTUAL INTEGRITY
Thanks for reviewing my book The trouble with nevirapine in Die Burger on 16 February 2009.
I’d have liked to talk to you about it earlier, but I’ve been very busy with other pressing things, including dealing with some academic fraud on the go at Cardiff University in the UK, ’Martin Weinel, Thabo Mbeki and AZT: Bogus Scholarship in the Age of AIDS: A Case Study’, posted on Politicsweb on 27 March, and an Open Letter to Dr Essop Pahad, concerning some aspects of his new magazine the Thinker (filed under ‘NEW’ at www.tig.org.za).
I’m glad you found The trouble with nevirapine a ‘pleasure’ to read, albeit a reading ‘pleasure’ you felt forbidden to you in view of the intense ‘moralization of AIDS’ in our country – leading you to worry that ‘some might question the “wisdom” of [your] review’, since the ARV drugs puffed by their promoters as ‘life-saving’ have become so sanctified by journalists like yourself that obviously only a depraved maniac would actually question them.
As you rightly stated, for daring to investigate and expose a drug as popular as nevirapine, ‘most readers will probably dismiss Brink as demented, dangerous and even immoral without further ado’, such as actually reading the book.
In the circumstances it really was tremendously brave of you to have reviewed a book by someone like me.
I was very pleased that you found the book so ‘radical’, ‘fascinating’ and ‘challenging’.
And that you liked my ‘biting satire’ and thought I was right ‘on the mark’ with my ‘mockery’ of the ‘often unsophisticated, sentimental, moralistic representations of AIDS in the media’ and of the ‘pharmaceutical industry, politicians and activists’, and the way in which, I ‘rhetorically mowed down [my] opponents’ such as ‘Zackie Achmat … obviously’, but also other ‘almost saintly’ figures such as ‘Desmond Tutu, Edwin Cameron and Albie Sachs … with undisguised contempt’.
Imagine how delighted I was to read your apparent agreement with the writer of the book’s foreword, who thought The trouble with nevirapine ‘a truly radical form of investigative literature – no one else seemed to be within miles of it: the swirling indictment, the cascading shards of evidence, the crescendo of controlled rage, the moral phosphorescence.’ You reckon I might have been a ‘publishing phenomenon’ if only I was ‘directing [my] rhetorical and logical firepower at another subject’ and not the ‘scientific orthodoxy over AIDS’. Thanks a lot.
But that’s not really why I’m writing. I’m writing about other things you said in your review. Very unfortunate things. Rather serious things.
In asking, ‘Is he right that nevirapine is poisonous?’ and stating, ‘He thinks it’s unacceptably toxic’, you represent the simple fact that nevirapine is extraordinarily toxic as mere opinion I hold, and something open to doubt. But you read in the book that:
• the drug’s package insert begins with a deadly ‘Black Box’ warning that it’s so extremely toxic that it can kill you;
• its manufacturer issued a special communiqué to physicians warning them of how dangerously toxic it was turning out to be as the clinical evidence of this mounted after it was released onto the market following ‘fast-track’ provisional approval (without evidence presented of any clinical benefit);
• the US Food and Drug Administration (FDA) also issued a special toxic hazard warning;
• the European Medicines Evaluation Agency (EMEA) issued a similar urgent safety alert too;
• our Medicines Control Council (MCC) found that nevirapine had probably killed and severely injured a number of African clinical trial subjects at Kalafong hospital;
• a suppressed, subsequently disclosed report by paediatric drug safety experts in the Division of AIDS (DAIDS, a branch of the US National Institute of Allergies and Infections Diseases (NIAID)) discussed evidence of widespread poisoning of babies in the Ugandan HIVNET 012 clinical trial given a single dose of nevirapine;
• Westat, the independent professional clinical trial auditors, found that innumerable serious adverse events and infant deaths had gone unreported, numbered in their ‘thousands’ by one of the PIs (principal investigators) running the trial;
• numerous published papers have reported how extremely toxic researchers have found nevirapine to be;
• on the advice of the FDA, the US Centres for Disease Control (CDC) banned nevirapine in early 2001 for even a couple of weeks administration as an anti-HIV prophylactic to doctors and nurses suffering accidental syringe needle pricks;
• nevirapine is not considered safe and effective for administration to newly born children in the US or in any other First World country, and is therefore not licensed for this indication by any drug regulatory authority in these countries;
• the CDC does not recommend nevirapine for American babies accordingly.
Having read all this, why did you pretend that nevirapine’s extraordinarily severe toxicity is my questionable opinion?
Was it because you were afraid that to plainly state this generally unknown, unmentionable fact in your review might make you appear ‘too extreme’, too ‘rigid’, even ‘fanatic’, like me, and that you’d show up on the incorrect side of the propaganda consensus behind nevirapine that the Treatment Action Campaign (TAC) and its fans have generated in the newspapers and on TV?
In light of the facts revealed in my book, do you honestly think a sensible, middle-of-the-road ‘compromise’ with nevirapine can be made, and that it should continue to be administered to African babies?
You concede I ‘build a good case’ by ‘relentlessly stacking up the facts’ against nevirapine with an ‘often skilful assembly of the evidence’. In so saying you accord yourself with two high-ranking mainstream medical experts, who thought my meticulous, exhaustive review and analysis of the research literature on nevirapine, in which I show it to be completely useless as a therapeutic and prophylactic drug, was ‘expertly written’, and ‘an amazing job’ that ‘brilliantly dissects an avoidable tragedy’.
On what basis then do you claim in the next breath that I’m ‘wrong to allege that there are no good reasons to believe the opposite’, viz. that nevirapine is a safe and effective drug and should continue to be given to African babies? What ‘good reasons’ did you have in mind?
Is the truth of it that you didn’t actually have any ‘reasons to believe the opposite’ at all, let alone ‘good’ ones, and you were just inventing your argument from nothing, which is another way of saying you were basically lying?
Why did you misrepresent my case against nevirapine in your review by suggesting that it was all about toxicity, when I scrutinized and blew the drug’s alleged efficacy to pieces as well?
If the whole point of my book was to ventilate the little known facts about a useless, very poisonous pharmaceutical drug, by canvassing them in the context of its political history, why did you propose that I’d ‘win more sympathy if [I’d just] apply myself to … the structure and consequences of AIDS discourse and the political economy of AIDS’ that you reckon I ‘have a feel for’?
Did you think this sounded groovy?
Do you think in spending several hard years writing the book I was looking for ‘sympathy’ or approval?
Even though ‘it’s known that [I] question the link between HIV and AIDS’ and that I’m ‘one of the dissidents who had a decisive (some say fatal) influence on Thabo Mbeki’, you correctly note that I ‘concern [myself] specifically with nevirapine’ in my book and not the AIDS causation controversy. In other words what I think of the HIV theory of AIDS or any number of other current controversies in biology, medicine and politics, is perfectly immaterial to my critical examination of the pharmacology and politics of nevirapine.
In May last year I delivered a scientific paper on the ‘HIV’ isolation problem at an international, multilingual AIDS conference in Ekaterinburg, Russia, with a supporting slide show of electron micrographs. In contradistinction, all that you know of ‘the virological aspects’ of the AIDS controversy is what you’ve read in Rapport, Huisgenoot and maybe a pamphlet you got from Clicks. On your own version you ‘can’t properly judge the matter’. So what scientific considerations informed your opinion that ‘Brink is probably wrong about the virological aspects and realities of AIDS’? Particularly since the ‘virological aspects and realities of AIDS’ were not canvassed in the book beyond an incidental mention? Have you read even a single critical scientific paper about AIDS?
What ‘dissident opinions’ did I ‘go on about too uncritically’? In what respect do you suggest I should have taken after your example and been less gullible and more critical? Between you and me who believes? Who no longer believes anymore? Who’s the gullible, uncritical bozo with ‘opinions’ that he doesn’t even know why he holds?
You say ’One doesn’t have to be a dissident to appreciate that AIDS is … a humanitarian crisis’. Is it really a ‘dissident opinion’ that there’s a new sex-plague rife among Africans since the South African national democratic revolution in 1994 (but not whites, coloureds or Indians according to the Human Sciences Research Council’s December 2005 ‘HIV Prevalence’ report)? Or are you just so excited by your white racist delusion about this that you can’t imagine anyone disagreeing with you, not even a ‘dissident’?
You claim ‘it’s difficult not to suspect Brink of political naivete, even intellectual dishonesty’. These being grave charges to level, one would understand that you’ve found good evidence to support them. That I’m both simple-minded and dishonest. But the best evidence for your charges is suggested in two unbelievably stupid rhetorical questions:
You ask: ‘How can a person [Brink] separate Mbeki’s actions around AIDS from wider issues such as poor delivery of services and the dilution of democratic processes?’ Did you not consider as a solution to your terribly perplexing riddle the fact that my book is about nevirapine and has nothing to with Mbeki’s role in the AIDS controversy, and even less with service delivery or the state of our democracy, and that’s why I didn’t write on any of this? Again, did you think you were sounding groovy writing this utterly non-sequitous rubbish?
You wonder: ‘How can a person [Brink] see the TAC as nothing more than a lackey of the pharmaceutical industry, and not recognise its role in the rise of democratic social movements?’ Could it be that applying the cui bono test, on any elementary objective analysis, the TAC is precisely a lackey of the pharmaceutical industry: a snow-plough for Western geo-political and commercial interests, funded entirely by foreign governments and corporations accordingly? Comprador NGOs campaigning for ‘human rights’ being the way to go these days in low intensity ideological, political and commercial warfare waged by the North on the South. Could it also be that the TAC is not ‘democratic’ at all, not being a representative organization with a due-paying membership, but a pharmaceutical industry lobby group, pure and simple?
With such a childish lack of analytical judgement on display in your review, would I be right in guessing that you’re the sort of guy who cruises Stellenbosch’s coffee-shops grinning at everyone in a ‘HIV Positive’ tee-shirt and boutique hairdo, thinking you look incredibly cool and radical?
Did reading my book make you feel ‘politically naive’, for having naively, ignorantly, and uncritically allowed yourself to be swept along by the popular moral tide, driven by relentless newspaper propaganda churned out by naive, ignorant, uncritical journalists? Like you.
Did you feel that you were being ‘intellectually dishonest’ in shirking your responsibility in your role as a journalist to respond honestly to the horrors you discovered in my book – with gargantuan ramifications – because you were frightened that ‘some’ might think ill of you for contradicting the monolithic propaganda consensus in favour of the drug?
By falsely smearing me as ‘intellectually dishonest’ and ‘politically naive’ were you trying to dump your own bad feelings about this onto me? (Look up ‘scapegoating’ and ‘projection’ in your psychology textbooks.)
You claim that I ‘portray anyone who subscribes to the orthodoxy as irredeemably stupid, or part of a cover-up’.
To the stupidity first.
Did your claim that I ‘portray anyone who subscribes to the orthodoxy as irredeemably stupid’ possibly spring from the feeling as you read my shocking revelations that you were among those ‘irredeemably stupid’ people you mention, for having unthinkingly supported the TAC’s campaign for nevirapine to be given to African women and their newborn babies, perhaps because it felt like a trendy cause to support and associate yourself with, also completely politically safe and personally risk-free, and therefore very attractive to you as a conformist, risk-averse sort of person, who’s never taken a principled stand on anything in his life; and that (to quote John le Carré after reading my first book Debating AZT) you thought to yourself after reading The trouble with nevirapine, ‘I suppose I look a bit of a fool because I’m one of the numberless well-intentioned people who have been championing cheap antiretrovirals for the Third World’s afflicted’?
Now to the ‘cover-up’.
In The trouble with nevirapine I recount several ‘cover-ups’, to quote your expression, whose occurrence is a matter of historical record:
• I quote a handwritten annotation made by an official in the Division of AIDS on a copy of Boehringer Ingelheim’s own audit of the Ugandan HIVNET 012 trial, recording the company’s request to ‘destroy’ the minute of the audit (the word used) before the Food and Drug Administration could see it, in view of what a shambles the company’s own inspectors had found the trial to be;
• I describe how the director of DAIDS, Edmund Tramont, corruptly suppressed a damning report written by his own paediatric drug safety experts detailing the clear evidence of nevirapine’s dangerous toxicity for African babies, and how he substituted it with an all-clear one that he whipped up himself and sent over to the FDA in its place;
• I quote Fishbein’s email to me that DAIDS’s ‘Remonitoring Report’ submitted to the South African MCC was specifically drawn to whitewash the trouble with HIVNET 012 in view of the commitment of the US administration to buying the drug for Africans, and political impossibility of an embarrassing about-face for the Bush administration on this;
• I mention Boehringer Ingelheim’s misleading, soothing press release to distract from the core rot in HIVNET 012 after Associated Press published Fishbein’s revelations;
• Likewise I quote from equally misleading, face-saving press releases of NIAID and DAIDS;
• I review how, following Associated Press’s disclosures, the professional and lay press closed ranks around the US AIDS bureaucracy involved with HIVNET 012, and propagated the false narrative that the fundamental problems with the study that had been turned up amounted to no more than mere ‘problems with paperwork’;
• And I report that the verdict on the HIVNET 012 trial returned in a report by the Institute of Medicine – misdirected by the terms of reference and riddled with massive financial conflict of interest (falsely denied to Senator Charles Grassley, but spilled soon after) – namely that it was ‘a very well done trial … an A’, to quote one of its panel members, was in Fishbein’s opinion ‘lies, distortions and a cover-up of the truth’.
Why did you perversely trivialise my disclosures about these many ‘cover-ups’ documented in the book by claiming that I charge anyone who disagrees with me on AIDS of being part of a ‘cover-up’? As if I’m a weak-headed conspiracy nut.
Was it because while writing in such a grossly dishonest manner, you felt you were party to a ‘cover-up’ yourself?
You say, ‘He doesn’t consider that he could be wrong’ about nevirapine, which is to imply that I am.
Since you don’t specify on what score I was ‘wrong’, and you say I ‘relentlessly stack up the facts’ against the drug and make my case amply supported by way of ‘skilful assembly of the evidence’, do you admit that your unfounded insinuation that I was wrong about something in particular, or in general, which is to say my book is basically rubbish, was another of your lies?
When you say, ‘He writes out of intense moral indignation that spills out in an overheated, sometimes histrionic rhetorical style’, what aspect of my account of the poisoning of African babies with nevirapine do you consider to have been exaggerated and overly dramatic?
Or is it cool to poison African babies with nevirapine?
The title of your review, ‘This attack on the pharmaceutical industry rather too harsh’, announced the conclusion you wanted your readers to draw, namely that my book tendentiously attacks the drug industry, and inordinately severely.
In fact my criticism of Boehringer Ingelheim is not the point of the book; it was a relatively minor part of it, and one of many other matters covered. But where I do treat the company’s behaviour, do you honestly consider that its conduct in dumping nevirapine in the Developing World without charge and promoting it for administration to pregnant women and their babies (to build a future market) has been a model of corporate ethical probity, and that my criticism of this was unjustifiably harsh?
Were you perhaps using the expression ‘the pharmaceutical industry’ in a broader sense to include the TAC, journalists, politicians, doctors, judges, priests, academics, drug regulatory agencies – in fact all of Boehringer Ingelheim’s supporters and promoters industriously working hand-in-hand to get nevirapine squirted down African babies’ throats?
If you thought I was ‘on the mark’ the way I ‘rhetorically mowed down [my] opponents’ with ‘biting satire’, ‘mockery’ and ‘undisguised contempt’, namely the ‘pharmaceutical industry, politicians and activists’, journalists with their ‘often unsophisticated, sentimental, moralistic representations of AIDS in the media’ and ‘almost saintly’ nevirapine advocates such as ‘Zackie Achmat … Desmond Tutu, Edwin Cameron and Albie Sachs’, why did you claim that my ‘attack on the pharmaceutical industry [was] rather too harsh’. After reading my book, did you think I should have been kinder to these clowns?
Or again, was your title another lie, a lie you told because you quailed at the possibility that for telling it honestly like it is, ‘some’ might call you a ‘dissident’ for expressing such an ‘unpopular viewpoint’? Since no one wants to be called a ‘dissident’ these days – certainly not in relation to the marketing propaganda of the pharmaceutical industry and all those who’ve bought it. At least no one like you who wants to get ahead in life.
This brings me to ask.
When grading your psychology students’ papers and research assignments, do you mark them down for writing things that you don’t like, because you find them novel and original, knocking against your prejudices, and threatening to unseat your own fixed, preciously-held, white suburban views and convictions?
Would it be prudent for your university to revisit your Masters thesis and audit all your references to check whether the authors you quote actually said what you claimed they said, to find out whether you weren’t possibly telling lies about what they said, just as you told lies about what I said?