Cultures Conflict Over Medicine : Purported Cure for AIDS Stirs Africa Controversy

One day about a year ago, Dr. Zirimwabagabo Lurhuma, one of Zaire’s most respected immunologists, left his one-story medical institute here, went before the national television network’s cameras and announced that he had discovered a cure for AIDS.

African medicine has not been the same since.

What followed has been a year of controversy over whether the vaccine is real or a fraud--or whether Lurhuma is simply guilty of overstating the efficacy of a genuinely promising treatment. There also have been charges that international researchers have questioned his claims more closely out of prejudice against African science.

Meanwhile, the announcement has stirred a political ferment in parts of Africa. One health minister came close to losing his job for branding the vaccine a hoax. And officials of Zaire’s own anti-AIDS program, on whose board Lurhuma sits, have complained that his announcement undermined their own efforts at AIDS education and prevention by encouraging Zairians to believe that the epidemic had been halted.

At the heart of the controversy is a formula that Lurhuma and a partner, a Cairo proctologist named Ahmed Shafik, labeled MM-1. That the letters refer to Mobutu Sese Seko and Hosni Mubarak, the presidents of the two researchers’ countries, is about all that is known for sure about the formula.

“He’s never told us what’s in it,” complained Dr. E.G. Beausoleil, a Ghanaian public health expert who was recalled from retirement two years ago to assist the World Health Organization’s global program on acquired immune deficiency syndrome.

Also, Lurhuma has never published his results in a form that could be properly scrutinized by colleagues. He says he has prepared a technical report on his work for a respected Western medical journal, but he has not identified the journal. No such report has yet appeared, and none is known to be circulating for customary pre-publication peer review, international health officials say.

Lurhuma has also consistently turned away WHO’s inquiries about the methodology with which he established that MM-1 “cured” as many as 80% of the more than 200 African and European patients who underwent his treatment last year.

Another baffling element of the MM-1 affair is Lurhuma’s otherwise considerable stature in his field.

A Belgian-educated immunologist, he is participating in other research with WHO’s blessing and funding. He has co-authored at least one technical report on Zaire-based research into a possible anti-AIDS vaccine developed by Dr. Daniel Zagury, a French scientist who last year announced that he had tested the drug by injecting himself. In Kinshasa, Zagury and Lurhuma are testing 40 French and Zairian volunteers, according to WHO sources.

The MM-1 controversy is only the most striking illustration of how cultural sensitivities have affected AIDS research in Africa.

Gruesome Prospects

Almost from the first recognition in the mid-1980s that Africa faced gruesome prospects as the epidemic progressed--and presented a promising research opportunity as well--Western doctors have been accused of disregarding African research and overlooking African sensibilities in designing epidemiological and prevention programs.

“There were Western researchers involved at the beginning who came into some countries to get information without intending to share it with the governments,” one WHO official said. “Then, they would publicize their findings elsewhere.”

In some cases, the initial reporting was misleading or exaggerated, as was the case with early findings tracing a form of the human immunodeficiency virus, or HIV, to African green monkeys. Many African countries regarded this theory, since discredited, as an attempt to somehow blame Africa for the worldwide AIDS epidemic.

African doctors believe that the Western world in general harbors a disrespect for African traditional medicine such as herbal therapy. WHO has tried to defuse this issue by establishing an office for African traditional medicine at its regional headquarters in Brazzaville, Congo. Some African countries sponsor separate programs; Ghana’s Center for Scientific Research in Plant Medicine claims to have developed herbal treatments for malaria and asthma, among other diseases.

Indeed, many professionals in the developed world are loath to write off traditional medicine in Africa, if only for the reason that as much as a quarter of the West’s drugs are derived from plants. Environmentalists argue that among the costs of the continuing destruction of the African and South American rain forests is the loss of untold species of potentially life-saving flora.

‘African Pharmacopeia’

Accordingly, health professionals walk a tightrope between acknowledging the potential value of the “African pharmacopeia” and insisting that traditional treatments be subjected to Western-style testing.

“Our position is that traditional medicines should be evaluated using the same standards as any other drug,” said Dr. Jose Esparza, head of the biomedical research unit of WHO’s Global Program on AIDS.

AIDS experts working in Africa say reports circulating about herbal cures for the syndrome remain entirely anecdotal. And they fear that news about miracle cures coming from deep in the bush will undermine efforts focused on prevention, such as attempts to cut down on sexual promiscuity and to distribute condoms in urban areas where AIDS is most prevalent and the HIV infection is spreading the fastest.

“We’ve tried to use some herbs in our hospitals,” said Dr. Samuel I. Okware, head of Uganda’s national program against AIDS. When stories spread in Uganda of one herbal cure, Okware subjected it to a “double-blind” test--one in which neither the patients nor the doctors knew who was getting the herb and who was getting a placebo. “After four months, we found the patients had not improved,” he said.

Few African research efforts have highlighted this conflict as well as the MM-1 program.

WHO officials and other Westerners have treaded exceedingly lightly in discussing Lurhuma’s claims. Instead of challenging his results directly, they have questioned them obliquely, mindful that when Lurhuma’s initial announcement was greeted skeptically, “the Zairians were not entirely wrong in saying there was kind of a cynical attitude toward a developing country’s efforts,” said Dr. Daniel Tarantola, a top WHO official.

Condition for Further Tests

Through the government of Zaire, WHO has offered Lurhuma money to conduct further tests of the MM-1 treatments--on condition that they conform to accepted scientific standards.

For all of that, Lurhuma’s claims have left international AIDS professionals in a state of consternation, not least because he has consistently refused to disclose his testing methodology or describe his patients.

These details are particularly important in AIDS research, WHO researcher Esparza says, because the most important lesson that researchers have learned from their lengthy tests of the anti-AIDS drug azidothymidine, or AZT, is that tests of anti-viral compounds are subject to wildly misleading results.

Accurate findings depend on subject and control groups having virtually identical cross-sections by sex, age and medical condition, lest some unaccountable factor skew the results.

In an interview with The Times, Lurhuma deflected questions about his work with the remark, “The formula has already been thoroughly discussed in the press, and there is nothing more to add.” He would say only that MM-1 is derived from “plant and animal extracts.”

Complaints of Payments

WHO officials also complain about reports that Lurhuma has been charging patients for MM-1 treatments, which they consider unethical. For his part, Lurhuma says he asked patients only to make voluntary contributions to his Kinshasa research institute.

The MM-1 trials have created an excited stir in several African countries, most notably Tanzania. There, the Lurhuma research rose to the level of a parliamentary issue when Health Minister Aaron Chiduo dismissed the work as a hoax and refused to spend official funds to study the program or send Tanzanian patients to Zaire.

Politicians representing western districts of the country, where AIDS is particularly widespread, charged that Chiduo would have been more amenable to tests if MM-1 had been a European product.

In the end, the minister relented under the threat of dismissal after a member of Parliament from a district particularly hard hit by AIDS went to Kinshasa himself to meet Lurhuma. Tanzanian President Ali Hassan Mwinyi categorized the issue as one of regional pride in May in announcing that “Tanzania will be the first country to test the drug--whether it is approved or not by the World Health Organization.”

The Tanzanian set-to highlighted another WHO concern: Expenditures on mysterious treatments such as MM-1 could divert funds from more important projects and from elementary health care, already starved for money in Africa.

The cost to Tanzania of sending each patient to Kinshasa for a 40-day MM-1 treatment would be about $3,000. That is a high cost indeed for a country so short of foreign exchange that it has trouble keeping its own public dispensaries stocked with medicine.

Lurhuma himself has added to the confusion by at first backtracking from his initial claims, then turning vague on exactly what his treatments did accomplish.

“We believe we have something that extends life,” he told The Times.

Claims Multiplied

In the first months after Lurhuma’s initial announcement, claims for his treatment multiplied like the HIV infection itself, as associates giving impromptu press conferences and meeting with health ministers spread differing versions of the clinical trials around Africa. The core claim was that patients treated with MM-1 survived longer than a control group without the treatment. But some associates went so far as to suggest that MM-1 rebuilt the shattered immune systems of AIDS patients.

Eventually, Lurhuma scaled back the claims, notably at WHO’s Third International Conference on AIDS and Associated Cancers in Africa at Arusha, Tanzania. But even that appearance raised more doubts than it settled. Lurhuma arrived late on the last day of the conference, after many professionals had already departed. He appeared at what many in attendance said was an obviously orchestrated “press conference,” answered only a handful of questions and left as abruptly as he came.

But he did concede that he could show only that MM-1 recipients appeared to be living longer than the control patients and that MM-1 appeared to lack the dangerous side effects of AZT, which so far is the developed world’s most promising anti-viral agent.

Yet in October, Lurhuma and Shafik, in announcing a new formulation of their treatment to be called MM-2, acknowledged that MM-1 did cause such side effects as pain and fever.

Lurhuma also returned to Zaire and expressed caution about his work to the media after anti-AIDS officials there complained that he was giving his compatriots false hope.

“The average man would see this person he knows as a famous doctor saying he had cured AIDS, and the reaction was ‘Thank you very much,’ ” said Dr. Bosenge N’galy, head of the Zaire program.

Asked if Lurhuma’s position as a board member of Zaire’s National Committee for the Fight Against AIDS lent his research a stature it might not otherwise deserve, N’galy paused and remarked:

“Well, after all, that board is a political entity, not a scientific one.”