Monday, March 20, 2006

Crying wolf about crying wolf

Dr. Jody Lanard, of the formidable Sandman - Lanard team of risk communication gurus, points to an important phenomenon: the out-of-phase levels of concern exhibited by scientists on the one hand and the public and news media on the other:
"There is a kind of seesaw of attention between the public and officials," says Lanard.

"When everyone is ignoring the problem, officials focus on raising the alarm. When people finally pay attention and start worrying, the officials instantly want to calm them down again.

"Everybody in the warning business worries that people will accuse them of crying wolf," she adds. "They forget that in the actual Boy Who Cried Wolf story, the wolf finally showed up." (Helen Branswell, Canadian Press)
It wasn't just the public whose attention it was hard to get. It was also responsible public health officials. At the state and local levels this lack of awareness is forgivable, or at least understandable. With shrinking budgets, disappearing personnel and competing demands they were inundated with urgent needs. Getting their attention for a possible threat in the middle distance, even a catastrophic one, wasn't going to happen unless they got the "signal" from on high that this needed to be done. "On high" in this case is the federal Centers for Disease Control and Prevention (CDC) and CDC never sent the message because the upper levels of the CDC hackarchy were too focussed on staying on the Bush message that bioterrorism was the threat (instead of part of a Rove election ploy). The blame for this rests squarely on the desk of the CDC Director, Dr. Julie Gerberding, who has carried enough water for the Bush Administration to turn sub-Saharan Africa into a Garden of Eden.

Now that bird flu is infecting birds in half the globe, everyone is paying attention and the former Cassandras are getting nervous they will be blamed for raising a false alarm if a pandemic doesn't materialize.
Some express concern that nuances of the actual risk are being lost as the virus continues its flight across Asia, Africa, the Middle East and Europe.

Dick Thompson, the World Health Organization's spokesperson on the issue, worries people have come to - or have been led to - the conclusion that a pandemic arising from this strain of avian influenza is inevitable.

"When we initially started talking about this and to today, we were always saying: We don't know if H5 is going to be the virus, we don't know if it is going to be a bad pandemic, when it will strike, any of that stuff," Thompson says from Geneva.

"All of that seems to me now lost. It seems to me that in everything I'm reading, it's a lock."
This is a misplaced concern and highlights a basic defect in public health policy. This shouldn't have been about whether we are ready for a bird flu pandemic, although now that is the only practical form it can take. The public health challenge in a highly interconnected world will be coping with emerging and re-emerging epidemic infectious disease. This has been clear for almost two decades.

This is a generic problem, not a bird flu problem. As some flu experts have noted, the next flu pandemic could be an H9 or H7 or some other subtype besides H5 or another virus altogether. What is clear is that we have too few weapons at our disposal, both technologically and socially, against any number of diseases that can spread on the complicated social web that characterizes human life on our globe.

Getting our communities ready to withstand the shock of one or more such global disease events should have been the order of the day long ago. Yet we still fail to act. Secretary Leavitt is advising everyone to look after themselves by stashing a tin of tuna under the bed. What his Department and all the other Departments should be doing is urging and assisting local communities to strengthen their social service and public health infrastructures.

We need to stop crying wolf about crying wolf. Dr. Michael Osterholm has it exactly right:
"I worry that too many policy leaders dance around this issue fearful that somehow they will either offend or frighten the public," says Osterholm, the director of the Center for Infectious Disease Policy and Research at the University of Minnesota.

"Our job is not to upset people or to calm people. Our job is to tell the truth."
There is still much too much dancing around and much too little leadership. People turn to newspapers because our nation's public health leaders have been AWOL for so long. The federal government's health establishment is demoralized and a shambles. The honor of being in public service is but a memory, destroyed by right wing ideologues who hate government and ignored by two generations of young people enticed into a me-first mentality. The Democratic party has rolled over in a fruitless and cowardly attempt to court the "center" (which is really the far Right redefined).

Here's my message to public health officials worried about the problem of "crying wolf." That's not your business. Your business is to do what Mike Osterholm said: tell the truth as best you know it and let the chips fall where they may. That does entail assuing a leadership role. Sorry. Anything else and the empty spots you leave will be filled by the tabloids, the local news and the political spinners, who already have their hands too much on the levers of power.

Crying wolf is not the issue. Lack of leadership and failed policies are the issue. It's late to repair the damage. But you do what you can, when you can.

Get some backbone. This hand wringing about "crying wolf" infuriates me.