Mental Ill Woman (creative commons)
(Photo via The Wellesley News courtesy of Creative Commons)

The New York Times on July 31, 2007 carried an Op-Ed article titled, “Why Africa Fears Western Medicine.” I was curious; my wife and I traveled extensively in Africa, and being physicians our antennae were obviously tuned to anything medical. We never came across the slightest hint of fear of medicine, or western medicine, in particular.

 

What does the article say?

The author, Harriet A. Washington is the author of “Medical Apartheid: The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present.” Indeed, some horrible medical atrocities were perpetrated on black people. The Tuskegee experiment, in which black people were allowed to go without treatment for syphilis they had contracted in order to follow the natural history of the disease, is well known.

The article cites similarly terrible medical “experiments” conducted in Africa by the Apartheid regime. These episodes are purported to be the root cause of widespread fear of white doctors and suspicion of medicine, in general. And from here, it is really a skip and a hop to the conclusion that the awful episode of the Bulgarian nurses in Libya is understandable, if not justified. To quote:

The evidence against the Bulgarian medical team, like HIV-contaminated vials discovered in their apartments, has seemed to Westerners preposterous. But to dismiss the Libyan accusations of medical malfeasance out of hand means losing an opportunity to understand why a dangerous suspicion of medicine is so widespread in Africa.”

First, a slight correction. Those nurses (and a Palestinian doctor, who somehow escapes the author’s attention; is it because he is not “western” enough?) were not tried for malfeasance—they were tried for premeditated murder. Minor difference, I suppose.

Now that the background was explained, and the reasonableness of such an accusation accepted, here is the outrageous sleight-of-hand sophistry:

Several esteemed science journals, including Nature, have suggested that the Libyan children were infected in just this manner, through the re-use of incompletely cleaned medical instruments, long before the Bulgarian nurses arrived in Bulgaria. If this is the case, then the Libyan accusations of iatrogenic, or healer-transmitted, infection are true.”

 

Let’s deconstruct

Ms. Washington is guilty of the “true believer” sin. We are all familiar with the mental gymnastics that religious fanatics and ideologues of all stripes go through to fit life, however messy, into their constricted view of the world. Less familiar is what I call “the Ph.D syndrome”. During my time in academia and in biotech, I’ve had the opportunity of meeting literally hundreds of scientists, many of them working in some obscure corner of biology and medicine. Yet, they are totally convinced that if only the world paid attention to their all-important research, all human misery would come to an end. Of course, I am exaggerating. But if you wonder why so many drugs fail clinical trials, it is partly because people with great power and limited understanding bought the optimistic story of the scientists. But please note, these ideas were tested, and failed. Not so with religious or ideological ideas—they cannot be adequately tested, and they never fail. To wit, talk to any academic Marxist and you’ll hear that the idea did not fail, it was the poor execution that betrayed the great cause. Ms. Washington is gravely mistaken in stating that the Libyan outrage can be explained by Western colonial misdeeds. She has a point of view about the world, and forces everything to fit it.

 

The enigma of delusional societies

If the spread of the AIDS virus was indeed iatrogenic and preceded the arrival of the Bulgarian nurses, why weren’t any of the Moslem nurses and doctors preceding the Bulgarians indicted? Why was the irrefutable evidence that the virus was rampant not only in this hospital but in the community at large ignored by the Libyan courts? And why were the testimonies of the most eminent HIV researchers, demonstrating that the multiple HIV strains in the hospital make a plot to infect the children almost impossible to carry out, dismissed by the judges? I have a much simpler answer: Because the evidence and the testimonies of the scientists were inconvenient—they didn’t fit the Libyan worldview.

Is it a worldview specific to Libya? I would suggest that this affliction plagues other Middle Eastern societies.

An example: The Palestinians are convinced that Israeli doctors and nurses are trying to spread HIV to their children and wouldn’t let them get immunized.

Is this paranoia somehow limited to HIV? Or to Libya, or Palestine? Here is an item from the New York Times, July 31, 2007, same day as the Harriet A. Washington Op-Ed:

“Many residents of the city of Basra in southern Iraq have convinced themselves that the British Army has loosed savage cattle-eating badgers onto its unsuspecting populace as a final gesture of ill intent before it departs this summer.

Throw in, for good measure, the fervent belief that British soldiers have planted snake eggs in waterways and unleashed bomb-sniffing dogs purposely infected with rabies.”

Same day, same newspaper, same region of the world. Is there an explanation?

We, civilized and rational and progressive intellectuals, have ready answers for this phenomenon: It is ignorance; it is poverty; it is colonialism; it is a cynical plot by their own rulers. I say, none of the above.

A few years ago, I had the pleasure of meeting a Palestinian scientist. He received his Ph.D in Genetics from the Hebrew University in Jerusalem. He did genetic research at a university in the West Bank, supported by Israeli academics and financial grants. Later on, he received an appointment at the famed Hadassah Medical Center in Jerusalem. So here is a highly educated Palestinian, with whom I had a wonderful conversation on human genetics. Then the conversation drifted to the Middle East mess. I asked him about those crazy allegations of HIV being spread by his medical colleagues. I was astounded to hear him say that he indeed believes that Israeli doctors and nurses were trying to infect the Palestinian children with HIV. My heart sank; this highly educated scientist, secular, economically successful, working in an Israeli medical center, believes this garbage.

So if it is not all the usual suspects of ignorance and poverty, it must be something else. My feeling is that there must be something wrong with a culture that nourishes such delusional thinking. As Tom Friedman of the New York Times and one of the most astute observers of the Middle East put so aptly: There are many angry Norwegians, but they don’t go around planting bombs. Poor and hungry Africans don’t blow themselves up. None other than the courageous Palestinian scholar and Princeton Professor Fuad Ajami has been pointing out, with great anger and pain, the propensity of his brethren to create an alternative reality and believe in it. Thomas Friedman has argued that unless the Arab world abandons its hallucinatory visions and accepts the real world, its science, its values, and its facts, they will be doomed.

In psychiatry, one of the maxims I learned in my medical training is that you don’t “play along” or validate a schizophrenic’s delusions. What Ms. Washington is doing by trying to “understand” the outrageous Libyan miscarriage of justice, and what social pundits are doing by looking for the “root causes” for the most awful atrocities, is validating the hallucinatory world of this culture.

Dov Michaeli, MD, PhD
Dov Michaeli, MD, PhD loves to write about the brain and human behavior as well as translate complicated basic science concepts into entertainment for the rest of us. He was a professor at the University of California San Francisco before leaving to enter the world of biotech. He served as the Chief Medical Officer of biotech companies, including Aphton Corporation. He also founded and served as the CEO of Madah Medica, an early stage biotech company developing products to improve post-surgical pain control. He is now retired and enjoys working out, following the stock market, travelling the world, and, of course, writing for TDWI.