Saturday, April 22, 2006

Flu denier two-fer

A new AP-Ipsos poll says half of Americans aren't too confident that its government can handle the situation if bird flu gets into birds in North America.
In the poll, 52% said they were not confident the government would handle an outbreak properly; 48% were confident. Almost two-thirds expect U.S. birds to become infected.

Fear is likely to spread if the virus is detected in the United States: Half of the people questioned said they thought the bird flu would kill them if they got it.

The survey found strong majorities in favor of these steps to contain any outbreak among humans: quarantining those who have been exposed to the bird flu, closing the borders to visitors from countries that have experienced the flu, closing schools, offering experimental vaccines or drugs, and encouraging people to work from home.

The poll of 1,001 adults was conducted Tuesday to Thursday with a margin of sampling error of plus or minus three percentage points. (USA Today)
The public has no particular reason to believe in the competence of the government, since all it has seen from this Administration is a surfeit of incompetence. I won't bother with the whole list (Katrina, Iraq, etc.) It's too long.

But does it mean the public health system can't handle bird flu? Unfortunately, it probably does. Because one aspect of the incompetence has been to starve public services that would be needed in the event of a pandemic, including health care and public health but also the social services what we would all depend on.

To make matters worse, everyone, ourselves included, are learning on the job about this virus. There are confusing and mixed messages coming from Washington, from academia, from state officials, from the private sector, because we are all more than a little confused by this virus and there are more than the usual mixed opinions. This bug is presenting surprise after surprise. But it is an unusually nasty virus, of a type that periodically sweeps the globe in pandemic form. What most people agree on is there is serious public health potential here and recognizing this and preparing for it quickly would be, to understate the case, prudent.

Most people.

There are still a few contrarians who are making a living (literally) by muddying the waters further. The two most prominent flu deniers are Wendy Orent and Marc Siegel. Despite errors in fact and atrocious judgment they continue to peddle their shoddy wares wherever and whenever they can get a hearing. Since the press loves man-bites-dog stories, they are often successful. Here's a sample:
But a small group of skeptics say the bird flu hype is overblown and ultimately harmful to the public’s health.

There’s no guarantee bird flu will become a pandemic, and if it does there’s no guarantee it will kill millions of people. The real trouble, these skeptics say, is that bird flu hysteria is sapping money and attention away from more important health threats.

“I have a bunch of patients coming in here who are more worried about bird flu than they are about heart disease,” said Dr. Marc Siegel, an internist and associate professor of medicine at the New York University School of Medicine. “The fear is out of proportion to the current risk.”


“Ridiculous,” scoffed Wendy Orent, an anthropologist and author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease." [NB: her own fear-mongering book about the Black Death]

She said public health officials have vastly exaggerated the potential danger of bird flu.

Several factors make it unlikely that bird flu will become a dangerous pandemic, Orent said: the virus, H5N1, is still several mutations away from being able to spread easily between people; and the virus generally attaches to the deepest part of the lungs, making it harder to transmit by coughing or breathing.

“We don’t have anything that makes us think this bug will go pandemic,” Orent said. “Yes, it’s virtually certain in human history there will be another pandemic strain … but there’s no reason for it to happen now, or 10 years from now or 20 years from now.”


But skeptics like Siegel and Orent say you’re better off guarding against more realistic dangers — heart attacks, for example, or even gum disease.

“I’d worry more about flossing my teeth than I’d worry about avian flu,” Orent said. “I want people to see what the real dangers are.” (MSNBC)
Orent is an anthropologist who sets herself up as an expert in epidemic infectious disease and the pandemic potential of a virus neither she nor real virologists understand well enough to be able to say what will happen, although they understand all too well what might happen. Siegel is a primary care doctor who writes books about how other people are scaring us. He is a fear-monger of fear. He is also careless about his science and when it is pointed out to him he doesn't care enough to correct his errors (Example: "This bird flu appears to be better absorbed by the deep pockets of bird lungs, whereas human flu is absorbed by the cells of our upper airways." This is an intestinal disease of birds. The paper he refers to was about human lungs, not bird lungs).

Orent and Siegel know perfectly well that the public health and health care systems aren't up to coping with an epidemic of infectious disease that affects a sizable proportion of the population. It doesn't matter if it's an H5 or H9 influenza subtype or some other virus altogether. Proper preparation for an H5N1 pandemic is an investment for all sorts of other problems, extraordinary and ordinary, against which our long-term disinvestments have rendered us defenseless. The claim that a "laser-like" focus on H5N1 must impede more general preparations is a straw man. Bush has been glad to shovel money to Big Pharma for antivirals, which are mainly aimed at influenza. That's short-sighted, I agree, but I don't hear Orent or Siegel criticizing it. Instead they attack others trying to defend public health. They misleadingly assert the conservative line that public health is a zero sum game. It isn't, at least not in the sense they are implying. When Bush wanted to wage war in Afghanistan and Iraq (to the current tune of $10 billion a month), he just allocated money. He also simultaneously shrunk the size of the pie by cutting taxes.

Those were social decisions "The Decider" made. If we had another Decider we would have other decisions.

Let's hear more about this from Orent and Siegel, not the kind of know-nothing scepticism that does little to advance public understanding and makes the work of those worried about people as much as birds less difficult.