Perhaps people should be demonstrating on the streets about actual evil perpetrated, rather than spurious G20 silliness.
This is a shocking chapter from the new edition of Ben Goldacre’s ‘Bad Science’. It was not originally published in the first edition due to this deeply unpleasant Matthias Rath character attempting – and failing – to sue Dr Goldacre and The Guardian into oblivion.
Read it and pass it on…
—————————–
This is an extract from
BAD SCIENCE by Ben Goldacre
Published by Harper Perennial 2009.
You are free to copy it, paste it, bake it, reprint it, read it aloud,
as long as you don’t change it – including this bit –
so that people know that they can find more ideas for free at www.badscience.net
The Doctor Will Sue You Now
This chapter did not appear in the original edition of this book,
because for fifteen months leading up to September 2008 the
vitamin-pill entrepreneur Matthias Rath was suing me personally,
and the Guardian, for libel. This strategy brought only
mixed success. For all that nutritionists may fantasise in public
that any critic is somehow a pawn of big pharma, in private they
would do well to remember that, like many my age who work in
the public sector, I don’t own a flat. The Guardian generously
paid for the lawyers, and in September 2008 Rath dropped his
case, which had cost in excess of £500,000 to defend. Rath has
paid £220,000 already, and the rest will hopefully follow.
Nobody will ever repay me for the endless meetings, the time
off work, or the days spent poring over tables filled with
endlessly cross-referenced court documents.
On this last point there is, however, one small consolation,
and I will spell it out as a cautionary tale: I now know more
about Matthias Rath than almost any other person alive. My
notes, references and witness statements, boxed up in the room
where I am sitting right now, make a pile as tall as the man
himself, and what I will write here is only a tiny fraction of the
fuller story that is waiting to be told about him. This chapter, I
should also mention, is available free online for anyone who
wishes to see it.
Matthias Rath takes us rudely outside the contained, almost
academic distance of this book. For the most part we’ve been
interested in the intellectual and cultural consequences of bad
science, the made-up facts in national newspapers, dubious
academic practices in universities, some foolish pill-peddling,
and so on. But what happens if we take these sleights of hand,
these pill-marketing techniques, and transplant them out of
our decadent Western context into a situation where things
really matter?
In an ideal world this would be only a thought experiment.
AIDS is the opposite of anecdote. Twenty-five million people
have died from it already, three million in the last year alone,
and 500,000 of those deaths were children. In South Africa it
kills 300,000 people every year: that’s eight hundred people
every day, or one every two minutes. This one country has 6.3
million people who are HIV positive, including 30 per cent of
all pregnant women. There are 1.2 million AIDS orphans under
the age of seventeen. Most chillingly of all, this disaster has
appeared suddenly, and while we were watching: in 1990, just 1
per cent of adults in South Africa were HIV positive. Ten years
later, the figure had risen to 25 per cent.
It’s hard to mount an emotional response to raw numbers,
but on one thing I think we would agree. If you were to walk
into a situation with that much death, misery and disease, you
would be very careful to make sure that you knew what you
were talking about. For the reasons you are about to read, I
suspect that Matthias Rath missed the mark.
This man, we should be clear, is our responsibility. Born and
raised in Germany, Rath was the head of Cardiovascular
Research at the Linus Pauling Institute in Palo Alto in California,
and even then he had a tendency towards grand gestures,
publishing a paper in the Journal of Orthomolecular Medicine
in 1992 titled ‘A Unified Theory of Human Cardiovascular
Disease Leading the Way to the Abolition of this Disease as a
Cause for Human Mortality’. The unified theory was high-dose
vitamins.
He first developed a power base from sales in Europe, selling
his pills with tactics that will be very familiar to you from the
rest of this book, albeit slightly more aggressive. In the UK, his
adverts claimed that ‘90 per cent of patients receiving
chemotherapy for cancer die within months of starting treatment’,
and suggested that three million lives could be saved if
cancer patients stopped being treated by conventional medicine.
The pharmaceutical industry was deliberately letting
people die for financial gain, he explained. Cancer treatments
were ‘poisonous compounds’ with ‘not even one effective treatment’.
The decision to embark on treatment for cancer can be the
most difficult that an individual or a family will ever take, representing
a close balance between well-documented benefits and
equally well-documented side-effects. Adverts like these might
play especially strongly on your conscience if your mother has
just lost all her hair to chemotherapy, for example, in the hope
of staying alive just long enough to see your son speak.
There was some limited regulatory response in Europe, but it
was generally as weak as that faced by the other characters in
this book. The Advertising Standards Authority criticised one of
his adverts in the UK, but that is essentially all they are able to
do. Rath was ordered by a Berlin court to stop claiming that his
vitamins could cure cancer, or face a €250,000 fine.
But sales were strong, and Matthias Rath still has many
supporters in Europe, as you will shortly see. He walked into
South Africa with all the acclaim, self-confidence and wealth he
had amassed as a successful vitamin-pill entrepreneur in
Europe and America, and began to take out full-page adverts in
newspapers.
‘The answer to the AIDS epidemic is here,’ he proclaimed.
Anti-retroviral drugs were poisonous, and a conspiracy to kill
patients and make money. ‘Stop AIDS Genocide by the Drugs
Cartel’ said one headline. ‘Why should South Africans continue
to be poisoned with AZT? There is a natural answer to AIDS.’
The answer came in the form of vitamin pills. ‘Multivitamin
treatment is more effective than any toxic AIDS drug.’‘Multivitamins
cut the risk of developing AIDS in half.’
Rath’s company ran clinics reflecting these ideas, and in 2005
he decided to run a trial of his vitamins in a township near Cape
Town called Khayelitsha, giving his own formulation, VitaCell,
to people with advanced AIDS. In 2008 this trial was declared
illegal by the Cape High Court of South Africa. Although Rath
says that none of his participants had been on anti-retroviral
drugs, some relatives have given statements saying that they
were, and were actively told to stop using them.
Tragically,Matthias Rath had taken these ideas to exactly the
right place. Thabo Mbeki, the President of South Africa at the
time, was well known as an ‘AIDS dissident’, and to international
horror, while people died at the rate of one every two minutes
in his country, he gave credence and support to the claims of a
small band of campaigners who variously claim that AIDS does
not exist, that it is not caused by HIV, that anti-retroviral
medication does more harm than good, and so on.
At various times during the peak of the AIDS epidemic in
South Africa their government argued that HIV is not the cause
of AIDS, and that anti-retroviral drugs are not useful for
patients. They refused to roll out proper treatment programmes,
they refused to accept free donations of drugs, and they refused
to accept grant money from the Global Fund to buy drugs.
One study estimates that if the South African national
government had used anti-retroviral drugs for prevention and
treatment at the same rate as the Western Cape province (which
defied national policy on the issue), around 171,000 new HIV
infections and 343,000 deaths could have been prevented
between 1999 and 2007. Another study estimates that between
2000 and 2005 there were 330,000 unnecessary deaths, 2.2
million person years lost, and 35,000 babies unnecessarily born
with HIV because of the failure to implement a cheap and
simple mother-to-child-transmission prevention program.
Between one and three doses of an ARV drug can reduce transmission
dramatically. The cost is negligible. It was not available.
Interestingly, Matthias Rath’s colleague and employee, a
South African barrister named Anthony Brink, takes the credit
for introducing Thabo Mbeki to many of these ideas. Brink
stumbled on the ‘AIDS dissident’ material in the mid-1990s,
and after much surfing and reading, became convinced that it
must be right. In 1999 he wrote an article about AZT in a
Johannesburg newspaper titled ‘a medicine from hell’. This led
to a public exchange with a leading virologist. Brink contacted
Mbeki, sending him copies of the debate, and was welcomed as
an expert. This is a chilling testament to the danger of elevating
cranks by engaging with them.
In his initial letter of motivation for employment to Matthias
Rath, Brink described himself as ‘South Africa’s leading AIDS
dissident, best known for my whistle-blowing exposé of the
toxicity and inefficacy of AIDS drugs, and for my political
activism in this regard, which caused President Mbeki and
Health Minister Dr Tshabalala-Msimang to repudiate the drugs
in 1999’.
In 2000, the now infamous International AIDS Conference
took place in Durban. Mbeki’s presidential advisory panel
beforehand was packed with ‘AIDS dissidents’, including Peter
Duesberg and David Rasnick. On the first day, Rasnick
suggested that all HIV testing should be banned on principle,
and that South Africa should stop screening supplies of blood
for HIV. ‘If I had the power to outlaw the HIV antibody test,’ he
said, ‘I would do it across the board.’When African physicians
gave testimony about the drastic change AIDS had caused in
their clinics and hospitals, Rasnick said he had not seen ‘any
evidence’ of an AIDS catastrophe. The media were not allowed
in, but one reporter from the Village Voice was present. Peter
Duesberg, he said, ‘gave a presentation so removed from African
medical reality that it left several local doctors shaking their
heads’. It wasn’t AIDS that was killing babies and children, said
the dissidents: it was the anti-retroviral medication.
President Mbeki sent a letter to world leaders comparing the
struggle of the ‘AIDS dissidents’ to the struggle against apartheid.
The Washington Post described the reaction at the White House:
‘So stunned were some officials by the letter’s tone and timing –
during final preparations for July’s conference in Durban – that
at least two of them, according to diplomatic sources, felt
obliged to check whether it was genuine.’Hundreds of delegates
walked out of Mbeki’s address to the conference in disgust, but
many more described themselves as dazed and confused. Over
5,000 researchers and activists around the world signed up to
the Durban Declaration, a document that specifically addressed
and repudiated the claims and concerns – at least the more
moderate ones – of the ‘AIDS dissidents’. Specifically, it
addressed the charge that people were simply dying of poverty:
The evidence that AIDS is caused by HIV-1 or HIV-2 is clearcut,
exhaustive and unambiguous … As with any other chronic
infection, various co-factors play a role in determining the risk
of disease. Persons who are malnourished, who already suffer
other infections or who are older, tend to be more susceptible to
the rapid development of AIDS following HIV infection.
However, none of these factors weaken the scientific evidence
that HIV is the sole cause of AIDS … Mother-to-child transmission
can be reduced by half or more by short courses of antiviral
drugs … What works best in one country may not be
appropriate in another. But to tackle the disease, everyone must
first understand that HIV is the enemy. Research, not myths,
will lead to the development of more effective and cheaper
treatments.
It did them no good. Until 2003 the South African government
refused, as a matter of principle, to roll out proper antiretroviral
medication programmes, and even then the process
was half-hearted. This madness was only overturned after a
massive campaign by grassroots organisations such as the
Treatment Action Campaign, but even after the ANC cabinet
voted to allow medication to be given, there was still resistance.
In mid-2005, at least 85 per cent of HIV-positive people who
needed anti-retroviral drugs were still refused them. That’s
around a million people.
This resistance, of course, went deeper than just one man;
much of it came from Mbeki’s Health Minister,Manto Tshabalala-
Msimang. An ardent critic of medical drugs for HIV, she
would cheerfully go on television to talk up their dangers, talk
down their benefits, and became irritable and evasive when
asked how many patients were receiving effective treatment.
She declared in 2005 that she would not be ‘pressured’ into
meeting the target of three million patients on anti-retroviral
medication, that people had ignored the importance of nutrition,
and that she would continue to warn patients of the sideeffects
of anti-retrovirals, saying: ‘We have been vindicated in
this regard.We are what we eat.’
It’s an eerily familiar catchphrase. Tshabalala-Msimang has
also gone on record to praise the work of Matthias Rath, and
refused to investigate his activities. Most joyfully of all, she is a
staunch advocate of the kind of weekend glossy-magazine-style
nutritionism that will by now be very familiar to you.
The remedies she advocates for AIDS are beetroot, garlic,
lemons and African potatoes. A fairly typical quote, from the
Health Minister in a country where eight hundred people die
every day from AIDS, is this: ‘Raw garlic and a skin of the
lemon – not only do they give you a beautiful face and skin but
they also protect you from disease.’ South Africa’s stand at the
2006 World AIDS Conference in Toronto was described by
delegates as the ‘salad stall’. It consisted of some garlic, some
beetroot, the African potato, and assorted other vegetables.
Some boxes of anti-retroviral drugs were added later, but they
were reportedly borrowed at the last minute from other
conference delegates.
Alternative therapists like to suggest that their treatments
and ideas have not been sufficiently researched. As you now
know, this is often untrue, and in the case of the Health Minister’s
favoured vegetables, research had indeed been done, with
results that were far from promising. Interviewed on SABC
about this, Tshabalala-Msimang gave the kind of responses
you’d expect to hear at any North London dinner-party discussion
of alternative therapies.
First she was asked about work from the University of Stellenbosch
which suggested that her chosen plant, the African
potato, might be actively dangerous for people on AIDS drugs.
One study on African potato in HIV had to be terminated
prematurely, because the patients who received the plant extract
developed severe bone-marrow suppression and a drop in their
CD4 cell count – which is a bad thing – after eight weeks. On
top of this, when extract from the same vegetable was given to
cats with Feline Immunodeficiency Virus, they succumbed to
full-blown Feline AIDS faster than their non-treated controls.
African potato does not look like a good bet.
Tshabalala-Msimang disagreed: the researchers should go
back to the drawing board, and ‘investigate properly’. Why?
Because HIV-positive people who used African potato had
shown improvement, and they had said so themselves. If a
person says he or she is feeling better, should this be disputed,
she demanded to know, merely because it had not been proved
scientifically? ‘When a person says she or he is feeling better, I
must say “No, I don’t think you are feeling better”? “I must
rather go and do science on you”?’ Asked whether there should
be a scientific basis to her views, she replied: ‘Whose science?’
And there, perhaps, is a clue, if not exoneration. This is a continent
that has been brutally exploited by the developed world, first
by empire, and then by globalised capital. Conspiracy theories
about AIDS and Western medicine are not entirely absurd in this
context. The pharmaceutical industry has indeed been caught
performing drug trials in Africa which would be impossible
anywhere in the developed world. Many find it suspicious that
black Africans seem to be the biggest victims of AIDS, and point
to the biological warfare programmes set up by the apartheid
governments; there have also been suspicions that the scientific
discourse of HIV/AIDS might be a device, a Trojan horse for
spreading even more exploitative Western political and economic
agendas around a problem that is simply one of poverty.
And these are new countries, for which independence and
self-rule are recent developments, which are struggling to find
their commercial feet and true cultural identity after centuries
of colonisation. Traditional medicine represents an important
link with an autonomous past; besides which, anti-retroviral
medications have been unnecessarily – offensively, absurdly –
expensive, and until moves to challenge this became partially
successful, many Africans were effectively denied access to
medical treatment as a result.
It’s very easy for us to feel smug, and to forget that we all have
our own strange cultural idiosyncrasies which prevent us from
taking up sensible public-health programmes. For examples,we
don’t even have to look as far as MMR. There is a good evidence
base, for example, to show that needle-exchange programmes
reduce the spread of HIV, but this strategy has been rejected
time and again in favour of ‘Just say no.’ Development charities
funded by US Christian groups refuse to engage with birth
control, and any suggestion of abortion, even in countries
where being in control of your own fertility could mean the
difference between success and failure in life, is met with a cold,
pious stare. These impractical moral principles are so deeply
entrenched that Pepfar, the US Presidential Emergency Plan for
AIDS Relief, has insisted that every recipient of international
aid money must sign a declaration expressly promising not to
have any involvement with sex workers.
We mustn’t appear insensitive to the Christian value system,
but it seems to me that engaging sex workers is almost the
cornerstone of any effective AIDS policy: commercial sex is
frequently the ‘vector of transmission’, and sex workers a very
high-risk population; but there are also more subtle issues at
stake. If you secure the legal rights of prostitutes to be free from
violence and discrimination, you empower them to demand
universal condom use, and that way you can prevent HIV from
being spread into the whole community. This is where science
meets culture. But perhaps even to your own friends and neighbours,
in whatever suburban idyll has become your home, the
moral principle of abstinence from sex and drugs is more
important than people dying of AIDS; and perhaps, then, they
are no less irrational than Thabo Mbeki.
So this was the situation into which the vitamin-pill entrepreneur
Matthias Rath inserted himself, prominently and expensively,
with the wealth he had amassed from Europe and America,
exploiting anti-colonial anxieties with no sense of irony,
although he was a white man offering pills made in a factory
abroad. His adverts and clinics were a tremendous success. He
began to tout individual patients as evidence of the benefits that
could come from vitamin pills – although in reality some of his
most famous success stories have died of AIDS. When
asked about the deaths of Rath’s star patients, Health Minister
Tshabalala-Msimang replied: ‘It doesn’t necessarily mean that if I
am taking antibiotics and I die, that I died of antibiotics.’
She is not alone: South Africa’s politicians have consistently
refused to step in, Rath claims the support of the government,
and its most senior figures have refused to distance themselves
from his operations or to criticise his activities. Tshabalala-
Msimang has gone on the record to state that the Rath Foundation
‘are not undermining the government’s position. If
anything, they are supporting it.’
In 2005, exasperated by government inaction, a group of 199
leading medical practitioners in South Africa signed an open
letter to the health authorities of the Western Cape, pleading for
action on the Rath Foundation. ‘Our patients are being inundated
with propaganda encouraging them to stop life-saving
medicine,’ it said. ‘Many of us have had experiences with HIVinfected
patients who have had their health compromised by
stopping their anti-retrovirals due to the activities of this Foundation.’
Rath’s adverts continue unabated. He even claimed that his
activities were endorsed by huge lists of sponsors and affiliates
including the World Health Organization, UNICEF and
UNAIDS. All have issued statements flatly denouncing his
claims and activities. The man certainly has chutzpah.
His adverts are also rich with detailed scientific claims. It
would be wrong of us to neglect the science in this story, so we
should follow some through, specifically those which focused
on a Harvard study in Tanzania. He described this research in
full-page advertisements, some of which have appeared in the
New York Times and the Herald Tribune. He refers to these paid
adverts, I should mention, as if he had received flattering news
coverage in the same papers. Anyway, this research showed that
multivitamin supplements can be beneficial in a developing
world population with AIDS: there’s no problem with that
result, and there are plenty of reasons to think that vitamins
might have some benefit for a sick and frequently malnourished
population.
The researchers enrolled 1,078 HIV-positive pregnant
women and randomly assigned them to have either a vitamin
supplement or placebo. Notice once again, if you will, that this
is another large, well-conducted, publicly funded trial of vitamins,
conducted by mainstream scientists, contrary to the
claims of nutritionists that such studies do not exist.
The women were followed up for several years, and at the end
of the study, 25 per cent of those on vitamins were severely ill or
dead, compared with 31 per cent of those on placebo. There was
also a statistically significant benefit in CD4 cell count (a measure
of HIV activity) and viral loads. These results were in no sense
dramatic – and they cannot be compared to the demonstrable
life-saving benefits of anti-retrovirals – but they did show that
improved diet, or cheap generic vitamin pills, could represent a
simple and relatively inexpensive way to marginally delay the
need to start HIV medication in some patients.
In the hands of Rath, this study became evidence that
vitamin pills are superior to medication in the treatment of
HIV/AIDS, that anti-retroviral therapies ‘severely damage all
cells in the body – including white blood cells’, and worse, that
they were ‘thereby not improving but rather worsening
immune deficiencies and expanding the AIDS epidemic’. The
researchers from the Harvard School of Public Health were so
horrified that they put together a press release setting out their
support for medication, and stating starkly, with unambiguous
clarity, that Matthias Rath had misrepresented their findings.
Media regulators failed to act.
To outsiders the story is baffling and terrifying. The United
Nations has condemned Rath’s adverts as ‘wrong and misleading’.
‘This guy is killing people by luring them with unrecognised
treatment without any scientific evidence,’ said Eric
Goemaere, head of Médecins sans Frontières SA, a man who
pioneered anti-retroviral therapy in South Africa. Rath sued
him.
It’s not just MSF who Rath has gone after. He has also
brought time-consuming, expensive, stalled or failed cases
against a professor of AIDS research, critics in the media and
others.
His most heinous campaign has been against the Treatment
Action Campaign. For many years this has been the key organisation
campaigning for access to anti-retroviral medication in
South Africa, and it has been fighting a war on four fronts.
Firstly, it campaigns against its own government, trying to
compel it to roll out treatment programmes for the population.
Secondly, it fights against the pharmaceutical industry, which
claims that it needs to charge full price for its products in developing
countries in order to pay for research and development of
new drugs – although, as we shall see, out of its $550 billion
global annual revenue, the pharmaceutical industry spends
twice as much on promotion and admin as it does on research
and development. Thirdly, it is a grassroots organisation, made
up largely of black women from townships who do important
prevention and treatment-literacy work on the ground, ensuring
that people know what is available, and how to protect
themselves. Lastly, it fights against people who promote the
type of information peddled by Matthias Rath and his like.
Rath has taken it upon himself to launch a massive
campaign against this group. He distributes advertising material
against them, saying ‘Treatment Action Campaign medicines
are killing you’ and ‘Stop AIDS genocide by the drug
cartel’, claiming – as you will guess by now – that there is an
international conspiracy by pharmaceutical companies intent
on prolonging the AIDS crisis in the interests of their own
profits by giving medication that makes people worse. TAC
must be a part of this, goes the reasoning, because it criticises
Matthias Rath. Just like me writing on Patrick Holford or
Gillian McKeith, TAC is perfectly in favour of good diet and
nutrition. But in Rath’s promotional literature it is a front for
the pharmaceutical industry, a ‘Trojan horse’ and a ‘running
dog’. TAC has made a full disclosure of its funding and activities,
showing no such connection: Rath presented no evidence
to the contrary, and has even lost a court case over the issue,
but will not let it lie. In fact he presents the loss of this court
case as if it was a victory.
The founder of TAC is a man called Zackie Achmat, and he
is the closest thing I have to a hero. He is South African, and
coloured, by the nomenclature of the apartheid system in
which he grew up.At the age of fourteen he tried to burn down
his school, and you might have done the same in similar
circumstances. He has been arrested and imprisoned under
South Africa’s violent, brutal white regime, with all that
entailed. He is also gay, and HIV-positive, and he refused to
take anti-retroviral medication until it was widely available to
all on the public health system, even when he was dying of
AIDS, even when he was personally implored to save himself
by Nelson Mandela, a public supporter of anti-retroviral
medication and Achmat’s work.
And now, at last, we come to the lowest point of this whole
story, not merely for Matthias Rath’s movement, but for the
alternative therapy movement around the world as a whole. In
2007, with a huge public flourish, to great media coverage,
Rath’s former employee Anthony Brink filed a formal
complaint against Zackie Achmat, the head of the TAC.
Bizarrely, he filed this complaint with the International Criminal
Court at The Hague, accusing Achmat of genocide for
successfully campaigning to get access to HIV drugs for the
people of South Africa.
It’s hard to explain just how influential the ‘AIDS dissidents’
are in South Africa. Brink is a barrister, a man with important
friends, and his accusations were reported in the national news
media – and in some corners of the Western gay press – as a
serious news story. I do not believe that any one of those jour-
nalists who reported on it can possibly have read Brink’s indictment
to the end.
I have.
The first fifty-seven pages present familiar anti-medication
and ‘AIDS-dissident’ material. But then, on page fifty-eight, this
‘indictment’ document suddenly deteriorates into something
altogether more vicious and unhinged, as Brink sets out what
he believes would be an appropriate punishment for Zackie.
Because I do not wish to be accused of selective editing, I will
now reproduce for you that entire section, unedited, so you can
see and feel it for yourself.
The document was described by the Rath Foundation as
‘entirely valid and long overdue’.
This story isn’t about Matthias Rath, or Anthony Brink, or
Zackie Achmat, or even South Africa. It is about the culture of
how ideas work, and how that can break down.Doctors criticise
other doctors, academics criticise academics, politicians criticise
politicians: that’s normal and healthy, it’s how ideas
improve. Matthias Rath is an alternative therapist, made in
Europe.He is every bit the same as the British operators that we
have seen in this book. He is from their world.
Despite the extremes of this case, not one single alternative
therapist or nutritionist, anywhere in the world, has stood up
to criticise any single aspect of the activities of Matthias Rath
and his colleagues. In fact, far from it: he continues to be fêted
to this day. I have sat in true astonishment and watched leading
figures of the UK’s alternative therapy movement applaud
Matthias Rath at a public lecture (I have it on video, just in case
there’s any doubt). Natural health organisations continue to
defend Rath. Homeopaths’ mailouts continue to promote his
work. The British Association of Nutritional Therapists has
been invited to comment by bloggers, but declined. Most,
when challenged, will dissemble. ‘Oh,’ they say, ‘I don’t really
know much about it.’ Not one person will step forward and
dissent.
The alternative therapy movement as a whole has demonstrated
itself to be so dangerously, systemically incapable of critical
self-appraisal that it cannot step up even in a case like that
of Rath: in that count I include tens of thousands of practitioners,
writers, administrators and more. This is how ideas go
badly wrong. In the conclusion to this book, written before I
was able to include this chapter, I will argue that the biggest
dangers posed by the material we have covered are cultural and
intellectual.
I may be mistaken.
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