Thursday, November 24, 2005

Dr. Toshiro clarifies (or does he?)

Responding to the report in ProMed that Dr. Masato Tashiro has said a German medical meeting that more than 300 deaths from bird flu have been systematically covered up by Chinese authorities (see post), Dr. Toshiro has issued this statement:
Statement to ProMed by Dr. Masato Toshiro

I am surprised to read the report in ProMED-mail, Avian influenza,human - East Asia (180): China, RFI [part 1] (archive number 20051123.3399).

First of all, it is not correct. Therefore, I would ask you to correct it.

[NB: The first two sentences were inadvertantly left off this post and have been restored.]

In my presentation at the meeting in Marburg, I stated that WHO's official numbers of H5N1 human cases are only based on laboratory confirmed cases. It should be therefore an iceberg phenomenon. Due to poorly organized surveillance and information sharing systems in many affected countries including China, it is reasonable to consider that more cases have occurred actually. We have heard many 'rumors' or unauthorized information which we cannot confirm. In this context, I talked about a few examples of non-authorized information and rumors about Asian countries which I received through private channels. I clarified that I do not know the original sources and I cannot confirm whether they are true, how these numbers were derived and what laboratory tests and epidemiological investigation were done.

Therefore, the article cited in ProMed-mail is incorrect and misleading. I did not receive any interview during my stay in Germany. I did not say anything that I believe the figures of the unauthorized information.

My message at the meeting was that international societies should help China to establish and perform nationwide surveillance and information sharing systems. I do not think that the Chinese Authority will conceal the facts from the world. Since the SARS event, they are collaborative to WHO. But they may have still limited capacity to monitor all human cases particularly in rural areas.
Dr. Tashiro is not issuing a denial, as I read it. It sounds more like he is doing damage control in a delicate diplomatic situation. He is saying he cannot source or verify the information, and that cases beyond the officially reported ones should be expected. He further says he did not give a newspaper interview. But the newspaper article only said he presented this information to "astonished colleagues," not that they were part of an interview. He acknowledges that there are many rumors about additional cases (presumably including the 300 deaths) within China. This is of some interest as the Boxun News source is an expatriate organization. This appears to corroborate the fact they are reporting information from within China, whether correct or not.

We and others have assumed there were many other cases in China besides the officially reported ones. Given the extent of the poultry infection and the degree of population contact, this is to be expected. The Toshiro report was alarming in that it appeared to be reporting a large cluster of deaths which might indicate a new transmission pattern. With Dr. Tashiro's "clarification" we are left wondering again.

Update, 11/25/05: Monotreme (in Comments) points out correctly that the 300 cases are not a cluster but are scattered throughout China. Some may be in clusters in particular localities, but not all in one large cluster. EastWestNorthSouth cast a skeptical eye on the Boxun reports last week. According to their reckoning, we clearly fall in option 3. (Hat tip crofsblog)

Update, 11/25/05, 8:18 pm EST: In an email to ProMed, Dr. Toshiro confirms Chinese statements that he was not in Hunan, as widely reported. He reiterates that he was merely passing on unsourced and unverified information from a private source. Thus we are back to Square One on the Boxun reports, which were given additional credence by being passed through a mainstream media outlet (Frankfurter Allgemeine Zeitung) and New Scientist via Dr. Tashiro. It was these additional reports that overcame our original hesitation about repeating this information. A cautionary tale, once again.