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Journal editor bemoans bird flu scare mongering

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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?"

You can tell it’s TV sweeps-ratings time

As my research has shown, whenever ratings-sweeps periods roll around, television news departments miraculously find time to cure the problem of not having enough time to devote to health news.

In my market, Minneapolis-Saint Paul, the May sweeps period has been filled with tears, joy and new hope surrounding dramatic breakthroughs and promising developments for victims of illness. (There, I just polished off my “seven words you shouldn’t use in medical news? in almost the same time as the normal TV anchor lead-in.)

This week on local TV, I saw:

• The “countdown to separation? for conjoined twins. And I saw it over and over and over on all local stations. All conjoined twins all the time. Like it's never been done before. You'd never know there were 45-million uninsured in this country but you sure know a lot about these two kids.

• A single-source story, “Doctor Has New Method To Break Up Kidney Stones,? with no input from any independent source

• “Minnesota Twins’ wives step up to fight cancer?

• “States prepare for bird flu fears, pandemic? – how health officials from California to New York were taking steps to allay any fears that might arise from the TV movie "Fatal Contact: Bird Flu in America" – a local ABC affiliate story about the ABC network movie that was panned by critics. Nice cross-promotion, huh? Or, the local affiliate could have just refused to air the sappy production.

• Another station posted on its website, “Bird Flu Preps,? asking the tough questions for which we all want answers, such as: “But what happens if there's no one to anchor the news? No one to operate the cameras? And no reporters in the field to tell us what's going on??

To be fair, I saw only a portion of one story that reported: “An organ donation group that gives priority to members over others in need is causing medical ethicists to question its appropriateness.? This is the kind of issue-oriented health news story that is lacking in many TV newscasts. So credit should be given to KSTP-TV for digging beneath the surface of news releases on breakthroughs and cures.

“Hitchcockian? reaction to the bird flu

Dr. Marc Siegel, author of ''False Alarm: The Truth About the Epidemic of Fear," blasts bird flu expert Robert Webster of St. Jude's Children's Research Hospital in an editorial in the Boston Globe.

Siegel wrote that Webster “told ABC News this week that there were ''about even odds at this time for the virus to learn how to transmit human to human,’ and ''society just can't accept the idea that 50 percent of the population could die. . . . I'm sorry if I'm making people a little frightened, but I feel it's my role.’ “

Siegel disagrees with Webster, calling it “the latest Hitchcockian pronouncement? about the bird flu. He writes: “Why provoke the public to see a potential pandemic in end-of-the-world terms? A pandemic simply means people in several areas having a disease at the same time -- but it may be hundreds rather than millions. The last flu pandemic, in 1968, killed 33,800 Americans, which is about the flu's toll in an average year. We don't need to panic in advance for that kind of pandemic.

Cooking poultry kills any flu 100 percent of the time, yet the fear of H5N1 bird flu is already so out of control in Europe that 46 countries have banned French poultry exports after a single turkey was found to be infected. France, fourth in the world in poultry exports, is already hemorrhaging more than $40 million a month.

Imagine what would happen if a bird in the United States gets H5N1 bird flu. At the rate we are going, the fear of birds will be so great that our own poultry industry, number one in the world, is likely to be in shambles. We already have this problem with mad cow disease, where a single sick cow that is not even in the food chain makes people very nervous, despite the fact that it is almost impossible to get mad cow disease from eating beef.

Flu is worthy of our concern. But concern can lead to long term preparation whereas panic can be far more virulent and costly than the bird flu itself.?

Newspapers review Bush pandemic plan

Editorials:

The Charlotte Observer: "[I]t's one thing to have a plan and quite another to have the capacity to carry it out." The plan "depends on citizens seeking and getting medical help when flu symptoms crop up," but "millions of Americans lack health care coverage."

The Greensboro News & Record: "Stockpiling drugs doesn't amount to preparedness."

Opinion Pieces

Daniel Hollander, UCLA professor of medicine, in the Los Angeles Times: "Once again, President Bush is misinforming the public," because there is "no effective vaccine against bird flu, ... no proven therapy" and "no proof that the present bird flu virus can be transmitted from person to person." He concludes, "It is time to stop misinforming the public and time to stop fanning mass hysteria."

Marsha Mercer, in the Richmond Times-Dispatch: "If we can't get shots to Americans for the ordinary flu that comes every fall, what will happen if, and more likely when, the dreaded bird flu arrives?" She continues, "The government's plan relies on several assumptions -- that people will cooperate, that they'll accept rationing of drugs, that they'll stay at home and stay calm. That requires people to trust their government."

Tamiflu hype

There's been too much hype about the antiviral drug Tamiflu as an answer to stopping an avian flu pandemic. U.S. Health & Human Services Secretary Michael Leavitt reminded Congress last week that Tamiflu has not yet been proven as a treatment for avian flu, adding, "Any sense that Tamiflu is synonymous with preparedness is wrong."

Bush pandemic plan puts more pressure on states

The Wall Street Journal reports that state and local officials said they support the national strategy to prepare for an avian flu pandemic and have begun making their own plans, but some expressed concern that the funding earmarked for their efforts in the president's plan is insufficient. States will be responsible for 75% of the cost of buying antiviral drugs. The Journal reports that Rex Archer, president of the National Association of County and City Health Officials, said the cost-sharing plan is a "beautiful strategy to pass the buck." He added, "Plans don't mean much if there aren't the people to do it at the local level." Archer also said the funding for states under the plan contradicts a separate plan by the Bush administration to reduce by $130 million this year federal funding for state and local health department's general preparedness efforts. In the New York Times, Mary Selecky, secretary of health for Washington state, said the Bush administration's funding priorities are "a little out of whack," adding that the plan should do more to improve state health departments and less to purchase drugs to fill national stockpiles. And in the Los Angeles Times, Linda Rosenstock, dean of the University of California-Los Angeles School of Public Health, said the additional costs will burden health systems already strained by existing problems. She said, "We have had evidence for decades of erosion of the public health infrastructure."

Bird flu gets a blog

The Wall Street Journal now offers an Avian flu news tracker.

In it is a story wherein a Roche pharmaceutical exec cautions that governments need to do much more than stock up on the antiviral drug Tamiflu to fight any bird-flu pandemic, and says "mad" consumer purchases of the drug to ward off possible bird flu were making it difficult to supply patients for the normal flu season.

To that I would add some words of caution: there is not overwhelming evidence of how Tamiflu would even work against the Avian flu. And there is already at least one case reported of resistance to the drug.

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