One Flu Over the Cuckoo’s Nest

Flu fearmongers must be quite depressed these days. Seasonal flu is late. Bird flu – despite all the headlines – hasn’t gained much traction among humans. And we haven’t had pandemic flu in 36 years.

The good news is so good (for the rest of us, that is) that the flu lobby seems to be resorting to manufacturing fantasy flu statistics.

A new study published this week in the medical journal The Lancet (Dec. 23/30) estimates that a global pandemic flu could result in 62 million deaths worldwide, mostly in poor nations. The researchers naturally conclude that “prudence” requires “focusing on practical and affordable strategies for low-income countries where the pandemic will have the biggest effect.”

But the study is yet another example of how out-of-touch with the real world some public health researchers can be.

First, the researchers’ estimate of 62 million deaths has far more shock-value than credibility. It’s guesswork derived from other (cherry-picked) guesswork.

The 62 million-death sound-bite is the product of statistical modeling that uses worst-case death rate estimates from the 1918-1920 pandemic influenza – an epidemic that medical historians believe killed somewhere between 20 million to 100 million people.

In addition to the obvious uncertainty surrounding the actual death toll from the 1918 flu pandemic, the researchers ignored several key (not to mention glaring) differences between 1918 and 2006.

First, while there’s no sure-fire cure or preventative measure for the flu, modern medical care and public health practices have dramatically improved since 1918. So any flu epidemic is likely to be far less severe – a point we’ll come back to in a moment.

Next, a great proportion of the deaths in 1918 was probably due to secondary bacterial infections that followed the initial viral infections. Today, antibiotics would be used to treat bacterial infections.

And let’s not forget that during 1918-1920, much of the world was still recovering from the strains of World War I. Poverty, hunger, unsanitary living conditions and stress likely made much of the global population ripe for a killer flu pandemic.

None of these considerations were factored into the researchers’ estimate of 62 million deaths.

But perhaps the researchers’ choice that most reveals their apparent desire to come up with a scary – rather than a realistic – death toll from pandemic flu is their decision to use the 1918 pandemic flu data in the first place. There were, after all, two other more recent and, in all likelihood, more relevant pandemic flu outbreaks in the 20th century.

There was the 1957-58 Asian flu pandemic that killed somewhere between 1 million to 4 million people. The 1968-1969 Hong Kong flu killed an estimated 750,000 people.

Now if one wanted to estimate a death toll from a hypothetical pandemic flu in today’s world, it seems as though data from the Asian and Hong Kong flu pandemics would be much better starting points than the far more uncertain data from a chaotic period almost 90 years ago. That presumes, of course, that one is interested in more realistic (albeit smaller) estimates that better reflect modern conditions as opposed to overblown numbers aimed at producing scary headlines.

What this sort of study reveals is how public health researchers can put more stock in frightening the public than informing it. It’s as though they assume that we’re too stupid to work with facts and must be terrified into action.

And then, what is the action that the researchers desire? In this case, they want more money allocated to pandemic flu preparedness. While this may sound reasonable at face value, let’s consider several key realities.

First, pandemic flu is quite rare and we ought to be cautious not to over-allocate scarce public resources to events that seldom happen and that seem to be getting less severe when they do occur.

Next, millions of people in the developing world die every year from preventable diseases, such as mosquito-borne malaria and diarrheal diseases caused by unsafe food and water. Why not spend available resources on saving people from those deadly diseases that are taking lives right now rather than on over-preparation for a hypothetical epidemic that is highly uncertain.

Moreover, by tackling these other ongoing diseases, populations will be made less vulnerable to pandemic flu should it occur.

Finally, pandemic flu frenzy is also a problem in the U.S. The federal government has already spent $600 million in local and state government preparedness planning for a pandemic flu that may or may not happen any time soon, according to a report this week in the Chicago Tribune. That “preparedness” includes stockpiling vaccines – a stockpile that could very well prove entirely useless since no one can be certain that the vaccines will be effective against a specific strain of flu virus from which pandemic flu might actually develop.

Useless preparation may be worse than no preparation because it means that precious public health resources, efforts and time have been wasted.

If we can’t expect truthfulness and clear-thinking from public health researchers and officials in a time of relative calm, how much confidence can we have in them should a public health emergency develop?