Cape Town

Hot seat: Mbeki, seen here at a national AIDS broadcast last year, is under pressure to act.

South Africa's Minister of Health, Manto Tshabalala-Msimang, last week defended claims by the country's president, Thabo Mbeki, that the anti-retroviral drug AZT (zidovudine) may be too toxic to give to patients with HIV (see Nature 402, 3; 1999).

Her statement came in spite of an interim report from the country's statutory body for drug control, the Medicines Control Council (MCC), compiled by the council on its own initiative after Mbeki's claims. This concludes that, although AZT has some negative side effects, they are outweighed by its potential advantages.

But there is also evidence that the president may have been influenced by a Pietermaritzburg-based lawyer, Anthony Brink, who appears to hold views similar to those of the US molecular biologist Peter Duesberg — described by Brink as “a paragon of scientific integrity in relation to conventional orthodoxy”.

Tshabalala-Msimang said that the government would not make AZT routinely available at state hospitals until it receives the MCC's full report, due in two months. But she added that the drug would not at this stage be withdrawn, and that those receiving it should continue to be treated, pending the final report.

Peter Moore, research director for sub-Saharan Africa for Glaxo-Wellcome, met with Tshabalala-Msimang last week. He described the meeting as “cordial”, but says the minister was unable to identify any specific safety concerns, or any specific side effects that she was concerned about.

According to Mbeki's spokesman, the president got his information on the drug from the Internet. But Brink, a barrister specializing in medical litigation who has been campaigning against the use of AZT, claims that he was the source, having provided information to Tshabalala-Msimang. He also says that Mbeki's office contacted him for more information after the president's statement.

Brink wrote a review article on the alleged dangers of AZT after a debate earlier this year in The Citizen, a Johannesburg newspaper — for which he had written an article entitled “AZT: a medicine from hell”. A rebuttal was written by Des Martin, president of the Southern African HIV/AIDS Clinicians Society.

Brink's review article lists papers in a number of medical journals that he claims show the dangers associated with the drug. He says that the “scientific accuracy of his article is impeccable“, and has been checked by researchers in Australia and Florida.

Brink denies that Duesberg, an outspoken proponent of the view that AZT is unacceptably dangerous, is the progenitor of his ideas. But he admits that Duesberg has congratulated him on his article, and encouraged him to submit it to a scientific journal. The two share the view that AIDS is not related to any specific virus.

But immunologist Malegapuru Makgoba, president of the Medical Research Council (MRC), describes the grounds of Brink's argument as “nonsensical”. He adds: “I've read nothing in the scientific or medical literature that indicates that AZT should not be provided to people.”

Makgoba stresses the need for government policies to deal with three issues which, he says, have become confused in the minds of the South African public: the AIDS epidemic, the high incidence of rape in the country and the provision of AZT by the state.

Mbeki's statement is widely seen as an attempt to justify his government's failure to develop such policies. Salim Abdool Karim, head of AIDS research at the MRC, has been reported as saying that “if the president doesn't want to provide AZT, he should find an excuse based on fact”.

Meanwhile, the government has laid five charges of misconduct against Costa Gazi, head of public health at Celia Makiwane Hospital in East London, for allegedly contravening the Public Service Act. The charges arise from an article in a local newspaper earlier this year in which Gazi — who is health secretary of the opposition Pan Africanist Congress — was quoted as criticizing the government for not providing AZT to pregnant women with HIV (see Nature 396, 504; 1998).