Friday, December 4, 2009

Deciding which experts to follow can be a puzzle

HOW should we respond to our own ignorance? If you are ignorant about a technical subject — such as the efficacy of antiretroviral drugs — and experts disagree about the issue, then how should you, as a lay person, decide whose views to follow?

The question is brought into even sharper focus when you imagine being a president at the end of the ’90s — say, for example, one who is short, smokes a pipe, and has a penchant for Shakespeare — who is forced by the nature of your job to decide who among disagreeing experts to follow.

The mainstream AIDS lobby thinks it is obvious for a leader to take a decision on technical issues. Yet, this is not so and it is worth understanding why.

But first one should note that the puzzle of which experts to follow does not arise when the experts are fake. I am therefore not referring to traditional healers on the streets of Cape Town selling nonsense as remedies for HIV, or the likes of Matthias Rath who, despite being a medical doctor, is not a medical expert on HIV/AIDS.

No leader should take seriously someone like Rath, who says vitamin tablets will cure HIV. We can set aside those who promote quack remedies as unethical egomaniacs. One can’t imagine why a government would want to take them seriously. To the extent that our government humoured these folks, it displayed inexcusably poor leadership.

However, among the AIDS dissidents, there are many award-winning international scientists, as much as many of us do not like them. These include Prof Peter Duesberg and Dr David Rasnick. Now, before anyone gets upset after the satisfying display of rationality on President Jacob Zuma ’s part on World AIDS Day, it is worth stating that the point, in the first instance, is not that these dissidents are right in their convictions about the relationship between HIV and AIDS or the efficacy of antiretroviral drugs.

The point is that many of us, myself most definitely included, know very little or nothing about science and so have no honest basis for adjudicating these disputes. I hardly understand more than one or two lines in the articles that flow between orthodox scientists and these dissidents. That is the heart of my own nonexpertise and ignorance. And, truth be told, this extends to the ultimate policy chiefs very often, including the minister of health and the president.

All of this implies that it was acceptable for former president Thabo Mbeki to take seriously the existence of expert dissidents on an issue of such magnitude as an unfolding pandemic. Of course, only Mbeki’s shrink would know whether this kind of leadership angst, based on an appreciation of the existence of expert disagreement , was the actual reason for his denialism.

More than likely — though here I am speculating — the real drivers of Mbeki’s dalliance with denialism had to do with the now well-rehearsed pop theories about his irrational concern that negative stereotypes about African sexuality motivate the case for the virus’s presence.

Still, the general point remains: it is proper for a responsible leader who knows nothing about a technical issue to reflect on how to respond to disagreement among experts. The situation is not unique to AIDS policy. No leader anywhere in the world will be an expert on more than one or two out of a thousand issues on which he or she will have to adopt a view and policy.

A sensible principle to follow in such circumstances is surely the following: adopt the view endorsed by the majority of experts. This principle is obviously somewhat dissatisfying. It suggests that numbers are indicative of academic or intellectual strength. There is no reason in principle that the majority of scientists cannot be wrong on an issue. So the application of the principle can, indeed, lead to the odd disastrous result. This is particularly serious in the context of a pandemic where the wrong intervention can cause society massive harm.

However, the point about one’s own ignorance necessitates this principle. Given that I have no basis for assessing the challenges of Rasnick or Duesberg as an outsider, I cannot but accept that for purposes of decision-making, the best procedure is to trust that there is a higher likelihood (even if no guarantee) that the majority of experts are right. Even if this turns out false, as a leader my decision to follow the majority remains rational, even with hindsight.

So, given this principle, Mbeki ought to have followed orthodox views on HIV/AIDS rather than to give dissidents a platform. After all, such a platform would not have improved Mbeki’s own chances of deciding who to follow. Presidents are not experts on these issues and so they had better get on with trusting the majority of experts.

History will forgive them if the majority of experts turn out wrong. As it happens, history will not forgive Mbeki for the alternative attitude he settled for.

http://www.businessday.co.za/articles/Content.aspx?id=88803

Tuesday, December 1, 2009

Now is not the time for inaction on AIDS

Democracy is both irritating and rewarding. This is brought into sharp focus when one talks about democracy in the context of a pandemic like HIV/AIDS. On the one hand, the norms of deliberative democracy require that all stakeholders be consulted in the policy formation processes. On the other, such consultation processes, if not managed properly, deliver us democracy at the expense of necessary action.

That, in a nutshell, is the state of the South African National Aids Council (SANAC), the most important body that is meant to help President Zuma in his visible and justified quest to depart from years of Mbeki denialism. But in order to succeed he must think through how to avoid a democratic deficit that will haunt him at the polls (should he not consult widely) while, nonetheless, showcasing decisive leadership by making sure policy decisions get taken and implemented (by learning when to stop consulting).

The problem is this. Many policies get debated at a forum like SANAC. The body, comprising various stakeholders including both government and civil society, is supposed to make recommendations that could eventually become policy. Unfortunately, SANAC's efficacy is increasingly being hampered. The bottleneck is a tough one to complain about - deliberative democracy. Or so it would seem.

First, it is important that all voices be heard in processes that can lead to policy outcomes. Civil society organisations have fought in our courts to reverse policy processes undertaken by government that failed to do so. It would be bizarre to suddenly moan that citizens are getting too much attention from government.

Second, input from various organisations have substantive merit in designing policies. As a citizen of a country you have a legal and political entitlement to influencing policy to reflect your wishes. If that means lobbying government to prevent the legalisation of sex work then so be it.

Furthermore, policy processes are not perfect. It is only through having tough, open debate and disagreement that we can maximise the chances of decisions being taken that are based both in fact and which reflects the ideological convictions of the population. A process that does not have these elements does not have full legitimacy.

These qualifications about the need for deliberation are important to avert any misinterpretation of this article's contention that too much of a good thing can be bad. The fact of the matter is that public deliberation is not an end in itself. It is a means to the various ends outlined. If, for example, deliberation results in policy inertia, then deliberation has become a pointless exercise. So it is important that we gauge deliberation's success relative to practical standards such as whether or not, in the case of an outfit like SANAC, practical goals and legal mandates are achieved. This, unfortunately, does not seem to be the case.

Two examples are illustrative. Male circumcision can reduce a man's chances of contracting HIV by about 60%. It also slightly reduces the chances of infecting another person. These are established medical facts. They are the basis for why other countries in the region such as Botswana, Zimbabwe and Swaziland are promoting circumcision.

In SA, no policy on circumcisions exists. One objection is located within initiatives to fight the pandemic. It is the fear that more irresponsible behaviour, such as abandoning condom use, will follow.

Another objection is delivered through a wider socio-cultural prism: traditional circumcision is important on the cultural landscape of SA and publically promoted medical circumcision will simply subvert rights to cultural practise. If, for example, a Xhosa boy were circumcised when very young, in the name of fighting the AIDS pandemic, that would make it impossible for him to also undergo traditional circumcision later in life.

The objections to publically promoting medical circumcisions are not sound. However, it is less interesting to rehearse the weaknesses of these objections than it is to ask the question at the heart of this analysis. How much deliberation should a leader preside over? The answer, as challenging as it might be for someone who enjoys coming across as ‘giving a hearing' to all who want to listen to him or her, is that in the context of a pandemic, your context practically demands of you to take urgent action - any action.

This means that an organisation like SANAC, and its ultimate political head, president Zuma, must get on with deciding whether or not it will go with a fact-based intervention to help reduce the HIV transmissions rate or whether it will consider the surrounding socio-cultural sensitivities as overriding. Whatever the decision, inaction is symptomatic of crippling leadership.

The second example is that of sex work. The SA law reform commission has long ago made available a very comprehensive report into different possible responses to sex work ranging from retaining the status quo to having controlled areas within which sex work can legally take place.

In terms of the AIDS pandemic, there is unquestionable evidence that the criminalisation of sex work exacerbates the AIDS pandemic. This logically implies that one of the many tools needed to reduce the transmission of HIV is to bring sex workers into the legal fold so that the state can empower them and their industry to be better equipped to practise their work while taking the best possible precautions to minimise the contraction and spreading of the virus.

Obviously it is not politically easy to endorse this policy. If the success criterion is only the reduction of HIV transmission then it would be a no-brainer. Politicians are right, however, to take into account moral and social sensitivities. The debate on sex work is as much about HIV/AIDS as it is about whether or not sex work is morally acceptable and whether or not the SA government should take account of the views of the majority.

Again, however, the critical issue is not what position is ultimately taken on these substantive areas of disagreement. Some of us would lobby for a liberal attitude based in part on medical fact and in part on liberal ideologies. Others are entitled to lobby for more conservative decisions. As with circumcision, however, leadership inertia with respect to taking a position - any position - is unacceptable.

A body such as SANAC needs a political head that can pull together the strands of different viewpoints that have been debated, lay them on the table, and propose a solid policy position that can then be developed. Failure to do will reduce SANAC to a high school debate chamber: fun, but with no impact.

Deliberative processes are crucial for developing our democracy. We should continue to hear all views on major policy issues. But when facing a pandemic, sensible political leadership requires someone - call him Jacob Zuma or Kgalema Mothlanthe? - to demonstrate an understanding of the need to balance deliberation with urgent action. Time is not on our side.

http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page71619?oid=152986&sn=Detail

Sunday, November 29, 2009

Remembering apartheid with fondness

What does it mean for black South Africans to remember life under apartheid with fondness? This is the question Jacob Dlamini explores in his debut book aptly entitled Native Nostalgia. Dlamini is the most lyrical South African writer since Johnny Steinberg drifted off to New York. Like Steinberg, he delivers reflective insights with rhythmic beauty. It is worth reflecting on his main claim - which will surely stimulate debate in the months ahead - that many black South Africans harbour nostalgic memories of life under Verwoerd's government.

His key premise is that life within South African townships during apartheid was rich and complex, contrary to widespread descriptions of them as mere sites of socioeconomic depravity. Life happened in the township both despite apartheid and in complex relation to apartheid. Fond recollections by blacks are not an inadvertent legitimation of an immoral political system. Of course, fear of being seen to retrospectively endorse apartheid explains why a book like Dlamini's might not have been written before - it invites a lazy accusation that the writer wishes apartheid had never ended.

By arguing that not all aspects of life in townships were hell, Native Nostalgia humanises township residents. It recognises that township residents have always exhibited complex agencies with which they built and negotiated daily life during apartheid. These lived realities - lying at the heart of nostalgic recollections by blacks - include music, art, games, partying and other markers of normalcy that showcase the human spirit's defiance of the psychological insult that was apartheid. Dlamini adds to this rich characterisation with a number of thought provoking related claims.

He claims that Afrikaans is the language of nostalgia for many black South Africans. Phrases such as a ‘Waar was jy?' - which also became the title of a hit song for the outfit Skeem - and ‘Toeka!' and many others instantly evoke a litany of fond memories. A jazz track may invite a lover or friend, for example, to implore another to ‘Hoor net daar!' The appearance of Afrikaans across the cultural landscape of township life means that there is an Afrikaans cultural grammar that white Afrikaans speakers might never recognise. This is not to deny the fact that Afrikaans still has an oppressive resonance for many black South Africans. The salient point is that the relationship between black South Africans and the ‘oppressors' language' is more ambiguous than simplistic accounts of that relationship that start and stop with the 1976 Soweto uprisings.

There are interesting academic insights too that flow from this analysis. There is often a temptation in the social sciences to trot out an overarching narrative that can explain human behaviour particularly at a group level. This is why many liberal researchers mistakenly think they are doing township inhabitants a favour by viewing the township as an object of pity. It is, as Dlamini points out, telling that townships are often referred to as ‘sites' to be examined rather than as ‘places' to be experienced. Sites can be placed under an outsider's microscope for a couple of weeks and then written about as a social science thesis project.

Places, on the other hand, are a challenge to be avoided. They imply the existence of irreducible complexities in the details of a community's life and the lives of its individual members. Few theses and books engage South African townships as places of ordinariness. Even contemporary black writers like Eric Miyeni unreflectively assume that the ultimate marker of upward mobility is whether one can run from a Johannesburg township to Melville or Sandton more quickly than one's township friends can kill one of those township rats that look like a cat.
A moment of critical reflection should reveal an implicit assumption that township life is one dimensional. As Dlamini puts it, many wrongly assume that township life is poor just because many of those who live in the township are poor. He urges researchers to put the senses at the heart of their research methodology. In order to understand the inner lives of communities, it is important to live with them- through the senses.

One cannot help but feel, smell, listen, touch and see with Dlamini as he locates us successfully within his world. It reminded me of Fhazel Johennesse's poem Living in a flat in Eldorado Park which also succeeds in using mere words on a page to evoke in the reader the full range of experiences that constitute the messy, busy life in the block of flats in Eldorado Park that the poem focuses on.

Dlamini recounts his stories with the same kind of linguistic magic. He also describes it with honesty reminiscent of Dambudzo Marechera's account of Zimbabwean township life in the classic novella House of Hunger. Unlike Marachera, we are painted a picture of South African township life in nonviolent language that helps to keep an ignorant reader's prejudices at bay. Academics chipping away in the social sciences would do well to take Dlamini's methodological challenge seriously.

The overall analysis suffers two shortcomings. First, Dlamini promised too much. The book initially gives the impression that hard answers will be provided to the question of why many black South Africans remember life under apartheid with fondness. We never quite arrive at an actual answer. The book is better described as a bouquet of insightful anecdotes that render township lives more complex and more human than countless outsiders assume.

Of course, it was always going to be difficult to step back from such an account of township life and ask, "Have I succeeded in accounting for native nostalgia or did I create something else?" The answer is, "Something else of equal value." That "something else" just is a rich narration of life in the township. But that is very different from delving into philosophical and psychological territory about memory which a more genuine account of nostalgia anywhere would have to provide.

This connects with the second weakness. Dlamini does not explore the real possibility that there is ultimately nothing special or puzzling about black South Africans remembering the past with fondness. It may simply be a universal human tendency. The English saying "the summers were hotter when we were kids!" captures that universal tendency to think nostalgically about the past. Of course, in the context of life under an oppressive regime, this tendency seems somewhat bizarre. But ultimately it might still say more about the general psychology of remembering than about anything peculiar about black South Africans.

No doubt many Germans have fond memories of life before the fall of the Berlin wall. And it would not take long to elicit some charming stories from Ugandans about elements of normal life during Idi Amin's reign. The thrust of Dlamini's book provide material for ‘remembering' to be explored. But the full exploration of the act of remembering, with all its conceptual, psychological and philosophical complexity, awaits another day.

These weaknesses are not jarring. It is a magnificent achievement to detail the tapestry of township life so completely. Dlamini forces us to ponder uncomfortable truths. In the end many of these truths do not (as some readers will wrongly claim) invite us to review our moral assessment of apartheid.

Instead, these uncomfortable truths disturb the racist spirit of Verwoerd by adding to his defeat with memories that scream, "Despite your violent apartheid evil, we've got news for you! Our humanity and agencies were never entirely within your racist control!" We have no reason to fear native nostalgia.

http://www.politicsweb.co.za/politicsweb/view/politicsweb/en/page71619?oid=152786&sn=Detail