Journal editor bemoans bird flu scare mongering

| 6 Comments

BMJ deputy editor Tony Delamothe writes in this week's issue:

"Somewhere, I imagine, there's a small group of people proud to be counted among the Friends of Avian Flu, or FAF for short. I suspect they have a catchy mission statement, such as "Keeping the nightmare alive," and lapel badges of vaguely bird-like shape.

Their challenge is to keep bird flu forever in the public eye. This should be getting harder, as influenza H5N1 is proving particularly resistant to undergoing the killer mutation that would allow efficient human to human transmission of the virus. Ten years after the strain first appeared in humans, it has killed just 191 people. This is despite the most propitious of circumstances: millions of people and poultry living in very close proximity in South East Asia. Although these deaths are a tragedy for the victims and their families, it's as well to remember that a similar number of people die on the roads world wide every 84 minutes.

Traditionally, we've blamed the drug companies for talking up the risks of diseases, or even inventing diseases, but this is not the case with bird flu. The track record of oseltamivir (Tamiflu) as a treatment for H5N1 is decidedly mixed, and its use in seasonal flu has been linked to suicides and neuropsychiatric symptoms in Japanese teenagers. FAF has incorporated this pharmaceutical failure into its story for bird flu: The Drugs Don't Work. Be afraid. Be very afraid.

FAF knows that the best way to generate column inches is high profile scientific conferences with well oiled media machines, and in this week's BMJ Richard Smith, our previous editor, reports on a session he chaired at a conference of Health Technology Assessment International. Some of the observations were familiar: the inevitability of the pandemic and the possibility of drug resistance. But others were relatively new: the terminological mutation from "avian flu" to "pandemic flu," in recognition of H5N1's failure to mutate genetically.

H5N1 had been groomed for stardom, but now it can be any influenza strain that becomes pandemic, further details unknown. As influenza pandemics occurred in 1918, 1957, and 1968, another one is likely. But why should we be any more worried in 2007 than in 1997 or 2017? Couldn't those responsible for planning for the next pandemic do their planning less publicly and put the frighteners on the rest of us at the appropriate time?"

6 Comments

Jeez, without this kind of fear-mongering, how would public health officials get on the National Security radar for some of those juicy grant dollars?

Dude,
On your very campus is one of the top influenza readiness guys. And in the words of another flu expert, "Influenza smoulders." Two more amino acid changes and it could be lights out. Do not be in such a rush to dismiss this H5N1 virus. One such mutation, M230I on the hemagglutinin chain, has already been theorized as the gene responsible for increased lethality of the virus. And M230I is showing up in more and more samples taken from both people and birds.

Failure to mutate genetically? H5N1 is a mutating fool. That may be why it has not yet sparked a padndemic. It may be TOO prolific to become pandemic. Or it is so prolific that, somewhere in the world and in the not-too-distant future, the three dominant clades of H5N1 will get together and throw a little aquatic party, share baseball cards and see what comes out.

The reason why vigilance is so important is the inability of experts to accurately predict when or where a pandemic will start. Many feel that, due to more aggressive culling of poultry and wild birds and stepped-up surveillance of such areas as Indonesia and Egypt, we may have averted a lethal pandemic three or four times already.

I can give you two specific examples. The first was in Hong Kong in December 1997, when then-HK health officer Margaret Chan ordered the culling of every bird in the city regions. As you know, she now heads the WHO.

The second time was just last August, when a cluster in Indonesia prompted the immediate air transport of tamiflu and the placing of a "Tamiflu blanket" over some 2,000 villagers for weeks, in an attempt to stamp out what may have been the largest cluster of H5N1 cases ever seen.

Did you see what happened in Wales recently? A mild H7N2 infects 17 humans, and sends several to the hospital's ICU ward. H7 loves people, as the Netherlands outbreak of 2003 has shown. If H7N2 were to reassort with H5N1, I shudder to think of the byproducts.

There are so many problems here that it is difficult to know where to begin.

No one who watches the H5N1 virus wants it to become a pandemic virus. We watch it because of the damage it will do and in the hope we can help people to prepare.

The virus has killed “only 191 people� because it does not yet pass easily from person to person, and we are concerned that will change.

The number of people killed on roadways worldwide is a tragedy but has absolute no relation to H5N1 deaths - just as ovarian cancer deaths are not discounted because there are more breast cancer deaths each year.

The term “pandemic flu� is not new. Its use predates our concern about this virus. A virus in birds is called avian flu. A virus that causes illness in people over wide areas of the globe is called pandemic flu.

A virus other than H5N1 could cause a pandemic. But H5N1 is positioned to do so. It is being passed from person in some cases – it only needs to be able to do so more easily to cause a pandemic.

Currently the fatality rate is over 60% worldwide, and it could keep this high fatality rate if it becomes more easily transmissible from person to person.

Those responsible for planning in New Orleans did their planning in private, didn’t they? And they “put the frighteners� on the public at the time that they thought was appropriate – not when there was still time to prepare. That didn’t work out too well, did it?

Experience tells us that it is not good to rely on government at any level for emergency preparation. People need to understand what is happening with this virus and the appropriate time is now.

Scott,

I hate being called "Dude."

Let's be clear. I didn't write what I posted. I posted what a deputy editor of a major medical journal wrote.

I believe in freedom of expression and the marketplace of ideas.

I know who my faculty colleague experts are.

Mr. Schwitzer, or Gary if you prefer,
Sorry if you don't like being called "Dude." Did not mean to insult you.

You did not write it, but you did post it. There are many factual inaccuracies in the story. I meant to express my opinion and also clarify those inaccuracies.

I, too, believe in that marketplace of ideas. But do not be surprised when others take issue with what is written, no matter how lofty the original source appears to be. Medicine, like academia, is as responsible for stifling new ideas as embracing them. Witness the decades-long struggle by that Australian doctor to get anyone to support his theory that bacteria caused ulcers! After a campaign that makes simple character assassination look tame, the world finally came around and began treating ulcers with antibiotics.

Thanks
Scott

Bird Flu is going to be rampant with global warming. Already the glaciers at Nepal has been melting by 30% and definitely our grandchildren will not be able to see glaciers unless we do something quick.

Birds are migrating with the temperature increase in climate. Good luck to Mother Earth.

About this Entry

This page contains a single entry by Gary Schwitzer published on June 29, 2007 8:36 AM.

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HRT study miscommunicated by NIH? is the next entry in this blog.

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