Sunday, March 1, 2009

Robert Hood and the AIDS Crisis on a Popperian Methodology

The late twentieth century was the focal point of a renewed interest in scientific method. The logical positivism of the earlier part of the previous hundred years had been largely undermined and almost universally rejected by contemporary philosophers of natural science. However, when one theory is laid to rest, often a whole host of new problems is brought to surface. In the advent of the HIV/AIDS crisis, a number of approaches have gained the medical community’s attention. While past attempts to settle the issue have for the most part fell short, there is an underlying assumption in the process of coming up with a solution. This assumption, specifically, is that old theories ought to be replaced by new ones that have broader scope and bring more immediate results that will continue having a prolonged effect. Robert Hood’s "AIDS, Crisis, and Activist Science," is an appeal to the conscience of scientists who wish to provide the best possible treatments for HIV/AIDS victims. This appeal can be understood and further explicated in epistemological terms, especially through the use of Karl Popper’s theory of knowledge. The theoretical knowledge that Popper’s method intends to bring about is then translated into practical knowledge that may serve to prevent and treat the AIDS epidemic.

Before detailing Hoods treatment of the AIDS crisis and how it relates to the epistemological concerns at hand, it may be helpful to first understand how Popper’s views can be considered. How does a Popperian methodology approach the issues of science, and consequently the ethics of science? In short, Popper proceeds to analyze past scientific theories in light of new ones. Take Newtonian physics, for example, and call it T-1. T-1 can be contrasted with T-2, Einsteinian physics. For Popper, in order for T-1 to be a successful scientific theory, it must be able to account for all of the problems it sets out to resolve, and it must have broad scope. Once a new problem enters in that the axioms of T-1 are unable to account for, then a revolution of sorts takes place and T-1 will eventually be replaced by T-2. T-2, in turn, must be able to both account for all that T-1 was able to, as well as the new problem(s). In the world of physics, Einstein’s General Theory of Relativity has been able to account for much more of the theoretical content than traditional Newtonian physics. Once T-2 faces a problem that it cannot account for, T-3 is anticipated. How, then, does this relate to the AIDS crisis?

Robert Hood’s concern with the AIDS epidemic is that too many people are not receiving adequate treatment for their condition. Some of the failed, or less useful treatments are still being used by the medical community for those suffering with the virus. In 1994, the most effective treatment for the prevention of AIDS transmission from mothers to infants was known as the ACGT 076 protocol, which was used predominantly in industrialized countries. A shorter trial was developed, and came to be known as AZT. It was the AZT that was used comparatively with a placebo trial in a control group. To state this explicitly, those in the placebo group were not receiving any treatment for the transmission of AIDS. [1] This process can be related to Popperian methodology if we call the ACTG 076 protocol, T-1. This became the standard treatment of AIDS prevention in industrialized nations and it was capable of solving a number of health-related (and therefore, scientifically-related) problems. However, a new problem arose, which was the needed expedience for treatment of the AIDS crisis in Africa. Something had to be done quickly. As a result, the original ACTG 076 protocol, which was a long-term treatment, was seen as insufficient for the current emergency. It was discovered that AZT could provide similar results in lesser time, so this became T-2, which was able to resolve the problem of how to quickly and safely treat those who were victims of AIDS. With respect to the new problem, then, T-2 is a better theory to be put into practice, so long as it is safe and effective. Hood argues that T-2b, the placebo trial, is unethical because it had already been widely known that the AZT treatment would be the best route to go. Scientists, therefore, he reasons, have an ethical obligation to provide developing countries with AZT. Hood points out that critics’ apparent criticism of those scientists who were conducting the placebo research is that the research itself was seemingly superfluous. If they already knew it would not do anything to prevent the transmission of AIDS, then why not simply go with the AZT?

Unfortunately, as Hood illustrates, it is not that simple. For one thing, he says that much of the population in developing countries would not have access to the AZT anyway, since there was such a limited supply. Further, because they had not been wronged, there was no breach in their rights to health care. He also points out that defenders of the placebo trial have indicated a number of other important factors that may have an impact on the results of AZT, such as the diversity in the virus itself in Africa as opposed to Europe and North America, as well as cases of anemia in the victims. [2] With all of these complications, it is no easy matter to determine the best course of action for those inflicted and need treatment. On the one hand, advocates of the placebo study argue that the trial will provide the clearest results; whereas those opposed to the placebo trial believe that research subjects ought to be provided with at least some minimum standard of medical care.

In any case, Popper’s approach is best understood as reflecting much time and patience. Just as it took centuries to go from Newtonian to Einsteinian physics, it may take quite awhile to develop a clear understanding of how theoretical knowledge of HIV/AIDS treatment can be translated into practice. Popper points out that, “a scientific revolution, however radical, cannot really break with tradition, since it must preserve the success of its predecessors.” [3] One might ask, then, which of the two options are more faithful to this line of reasoning? Although there is a state of crisis and dire need in Africa because of AIDS, should researchers compromise their use of steady and deliberate procedures in order to provide a controversial, yet potentially beneficial treatment? At this point one might be tempted to say that the subjects have nothing to lose. Why not just try it? Even though this seems like a reasonable conclusion on the surface, it may be the case that placebo studies are necessary for the long run. On the other hand, Hood points out that a Thai study demonstrated the effectiveness of AZT without using a comparative placebo group, on the basis that it would be unethical. [4]

With that said, it becomes unclear as to whether an unambiguous T-2 theory can be an improvement. It seems that no matter what the decision researchers make, any benefits that result will undeniably come about at some kind of cost. Reason would suggest that researchers ought to minimize the cost in order to fully expand the benefits. Although this is economic language, it can certainly apply to issues of socio-economics, and also to the science that deals with problems related to socio-economics. People are certainly not capita, but there are only so many ways to express this.

However one looks at the issue of AIDS and AIDS treatment, one’s certainty of knowledge will always be susceptible to error and to improvement. This is perhaps the greatest strength of Popper’s epistemology. While new problems are brought to surface in the course of solving original problems, theories are constantly being revised, updated, and sometimes done away with completely in order to accommodate the new knowledge that becomes available. Although this view can be contrasted with Kuhn’s notion of a scientific revolution, ultimately theoretical knowledge must be put to use in practice, and there would be little disagreement between them that the best theory ought to be practiced. In this case, it is highly speculative to venture on what the best possible treatment of AIDS is. The only course one can take at the moment is what is feasible, rather than what is possible. Hindsight may tell scientists sometime down the road whether the placebo trials were necessary or not, but for now, it is extremely difficult to say with any precision what the best course of action would be. It may be best to put aside notions of ethical fault, since both sides agree that the most effective treatments ought to be used. What they disagree on is the way in which this treatment can be discovered.

In short, Karl Popper’s theory of knowledge has its proponents and opponents. Likewise, Robert Hood spells out nicely what some of the relevant issues are concerning AIDS treatment and how there are proponents of one view, and proponents of another competitive position. The axiom that old theories should be replaced by broader theories is fundamental to the question of research of any type. When it comes to health care and medical treatment, the question remains the same. How should scientists go about discovering the best theories and putting them into good use?

Works Cited

[1] Robert Hood, “AIDS, Crisis, and Activist Science," in Science and Other Cultures, Edited by Robert Figueroa and Sandra Harding, Taylor & Francis Books, Inc., 2003, p. 17.

[2] Ibid., p. 20.

[3] Karl Popper, “The Rationality of Scientific Revolutions,” in Scientific Revolutions, Edited by Ian Hacking, Oxford University Press, 1981, p. 106.

[4] Hood, p. 19.

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