...that the possibility of an influenza pandemic is being discussed more widely today than it was a few weeks ago, but I note with frustration that discussion of this topic is also becoming more polarized with time. It's bad enough that political matters in this country are rarely publicly discussed without the obligatory "us vs. them" dichotomy; we certainly don't need that sort of thing muddying and clouding our thinking when it comes to national security, and some public health issues rise to that level. I think this is one of them.
Now, I'm not a doctor or a microbiologist (nor have I recently portrayed one in a motion picture that grossed over, say, $100 million), but I don't think it should be necessary to be one in order to rationally discuss this subject, any more than I should have to be a mathematician in order to wax poetic about limits and derivatives, both fascinating but simple enough to be appreciated by mere "laymen." Besides, we have more than enough doctors and other health professionals out there writing that we're either all going to DIE!! or that we're all merely falling for mindless hysteria.
And that's what this post is about. (Actually we are all going to die, but that's beside the point.) I'm noticing that more and more pandemic-related writing is either employing, or at least strongly implying, a false dichotomy: if we're foresighted enough (and can afford it) to, say, procure enough seltamivir phosphate (Tamiflu) for ourselves or maybe our families to have a prophylactic run (only should this be indicated, lest we increase viral resistance to the drug), or to simply make other preparations so as to be able to temporarily isolate ourselves from the general population should that end up being necessary, we're "succumbing to hysteria and stockpiling" things. If we don't do so, we're "idiots in denial."
Lest I be misunderstood, I'm not arguing against taking firm stands on issues like this, even when derided by others as "extreme." That's what "moderates" do, or anyone else afraid to really believe in anything (like so many politicians). What I'm protesting is the false dichotomy that's appearing—the meme that if we're taking any kind of precautions at all against the possibility of a flu pandemic, then we're being driven by, and adding to, the "hysteria" that often indeed appears in many writings about this and similar subjects.
And that's simply wrong, period.
The latest example I've seen, via Rand Simberg, is this article by Michael Fumento. Disclaimer: while Mr. Fumento is neither a doctor nor any other kind of biological professional, he probably knows a lot more about this than do I. He's certainly written more about it. These facts, of course, hardly make him infallible or immune to logical fallacies. He's writing from an authoritative point of view; he wants you to believe what he does about this because he's right. I do the same thing, of course, and if it should turn out that I'm the one who's off-target here, I hope that I can count on someone to let me know.
In "Fuss and Feathers: Pandemic Panic Over the Avian Flu" (© The Weekly Standard, 21 Nov 2005), he makes several accurate and salient points, starting with this:
"The indication is that we will see a return of the 1918 flu virus that is the most virulent form of flu," warns America's top health official. "In 1918, half a million people died. The projections are that this virus will kill one million Americans . . . "
A quotation ripped from today's papers about an impending "bird flu" pandemic? No, the year was 1976 and the prediction of a deadly "swine flu" overshot the mark by 999,999 deaths (although dozens did die from the vaccine campaign). That's something to remember amid the current alarms. Another is that we've been here before with the identical virus over which the feathers are now flying, avian influenza type H5N1, which first hit poultry flocks in 1997. "Race to Prevent World Epidemic of Lethal 'Bird Flu,'" and "Hong Kong 'Bird Flu' Could be the Next Big Outbreak," blared the headlines then.
The world death toll from that "wave"? Six. And let's not forget the outbreak of SARS (severe acute respiratory syndrome) two years ago, which led to 750 stories in the New York Times and Washington Post – one per death worldwide, as it turned out. The 71 U.S. cases of SARS, which resulted in zero deaths, did not "Overwhelm U.S. Health System," as CNN had predicted.
He's quite right, of course. In fact, his very next sentence is "None of which is to say there won't be another flu pandemic," but he quickly passes over that fact to get back onto his anti-hysteria track.
His primary points seem to be that:
Precious little has been proven when it comes to there being an imminent pandemic of anything, let alone H5N1 "avian" flu (or mutation thereof).
"[T]here is never such a thing as helpful hysteria. And the line between informing the public and starting a panic is being crossed every day now by politicians, public health officials, and journalists." The two images of a running, desperate-looking Chicken Little and a B&W still from Hitchcock's Birds help make his point.
Both of these points are true. The problem I have with this article, and others like it, is the strongly-implied bifurcation of the issue such that a reasonable response does not seem to include making some preparations just in case a particularly lethal flu variant makes its way here. And he crosses a line himself, namely into using the existence of hysteria itself as an argument against the probability of a thing occurring. This is fallacious thinking.
I remember the "swine flu" which he cites, and from which we were all advised to become immunized back in 1976, when Jeni and I were newlyweds. I did so (being violently allergic to eggs, my wife, alas, cannot take any form of flu vaccine). Under the same circumstances I would do the same again. It was a flu shot, people—unless you're one of those who are virulently opposed to vaccinations of any kind (and I'm not bringing that topic up here; go read Orac), that was hardly an response borne of hysteria.
Our ability to accurately predict outbreaks of disease is still hardly a hard science. We make lots of mistakes, and we'll make more before we become really good at it. Good grief, even when it comes to something as relatively deterministic as computer science—remember Y2K?—there are some things we're just not sure about, and prefer to err on the side of doing too much about it rather than too little.
(Actually, I'm not convinced that the very reason nothing much happened on the morning of 01 Jan 2000 was the fact that such massive amounts of time and money were poured into preparations for it. We'll never know what would have happened had we not done so, and therein lies one of the ironies of disaster preparedness: sometimes being successful means looking like a fool, appearing to have "cried wolf" and wasted time and money on a non-problem, which in turn makes persuading others of future potential problems a lot more...problematic.)
As evidence of irrational hysteria—which I hardly deny—he includes this:
Officials at the Centers for Disease Control and Prevention (CDC) have been handling numerous fearful phone calls from the public and the media, fielding questions about the safety of bird feeders and Thanksgiving turkeys. "It's been insane," spokesman Dave Daigle told MSNBC. In a recent Q&A session with Wendy Orent, science writer and author of the book Plague, a Nashville resident asked why "don't we just kill off all the domestic birds and poison the food on the migratory bird routes?"
Headlines like "Flu Pandemic Could Kill 150 Million, U.N. Warns" (Reuters) certainly haven't helped. Never mind that the figure was tossed off by a single official who provided a range of "5 million to 150 million." (Translation: "We haven't the foggiest.") Similarly, the media have generally morphed the federal government's estimate of 200,000 to 1.9 million deaths to simply "1.9 million deaths." Also not helping is the media propensity to seek out the most alarmist "experts."
Sure, it's insane to suggest the mass elimination of billions of birds out of fear that they could bring an as-yet nonexistent threat to our shores. But being in the position of not having "the foggiest" cuts both ways—we can no more say with confidence that this threat will not materialize, or even not turn out worse than the most alarmist propaganda suggests. Not knowing means that you take a risk any way you decide to act; you risk wasting precious resources that will certainly be needed elsewhere if you over-respond, and you risk millions of lives by under-responding.
Don't mistake this reasoning for argumentum ad ignorantiam, or an argument from ignorance. We must base our response on the very best scientific analysis of our situation that we can get, political ramifications be hanged. (Yeah, I know, fat chance that politics won't have quite a bearing on whatever we end up doing.) We know much about the pathways that past flu epidemics have taken, including whether they came by swine or avian variants, and this clues us in that what we see in today's H5N1 "bird flu" is, much like a hurricane looming off the Atlantic coastline, on a path that might cause untold devastation, or...move harmlessly out to sea. So what do we do? In the case of hurricanes, we make our best predictions, act accordingly, then we see what happens. Sometimes that means we order evacuations too late, people die, and we blame our decision-makers for that. Or we order the evacuation of a city that a day later is spared more than a bit of wind and rain, and we blame the same officials for that, too.
Among the "alarmists" out there helping to spread hysteria, Fumento lists several who have been known to commit acts of irresponsible fear-mongering before. He's quite right that these people shouldn't exactly be the ones invited onto ABC Primetime to "discuss" the possibility that disaster may strike. But there will always be people like that—people who will jump onto whatever is the latest available bandwagon-to-hell-in-a-handbasket and scrape out another 15 minutes of infamy. It's the reasonable people who think we should be concerned that we should be listening to, and the fact that there are plenty of unreasonable ones helps us to fall into another logical fallacy: because there are many non-credible sources arguing in favor of a matter, one cannot therefore conclude that all sources arguing in favor of that matter are similarly non-credible. The undeniable fact that there are many non-credible voices arguing that we are doomed is completely and totally irrelevant to the question at hand—what actions, if any, should we take to prepare for a possible flu pandemic—and anyone attempting to write seriously and credibly about it himself shouldn't have fallen into that trap.
Then, after making sure that we know beyond any doubt that there isn't much of anything we know beyond any doubt (about the potential for a flu pandemic), and even several reasonable paragraphs detailing what good antivirals can and can't do, he goes and says this:
Ira Longini, a professor of biostatistics at Emory, has created with his colleagues a model of a 3,500-square-mile-area containing half a million people in rural Thailand where, if there is a pandemic, it's likely to start. He thinks health officials would have two weeks to a month to intervene with antivirals before the disease broke out of the cordon, because people in such areas don't tend to jump on jets to JFK.
Wait a minute. Isn't this the very thing he just took numerous others to task for? He just stated something about a future flu pandemic—in this case, the country where it is likely to start—when we really don't know the answer. What makes him think we can say this with any more certainty? Sure, it's a good possibility, but there are lots of good possibilities, such as that this pandemic might occur at all, that have just been derided as being so uncertain, so unproven, that we shouldn't take them seriously. If not them, why this one? And if this possibility should be taken seriously, why not the others as well?
He does present evidence against a pandemic deveoping at all from H5N1, such as the length of time—since 1959, in Scotland—that it has already existed among European and Asian bird populations without yet mutating into a pandemic strain. Why now? Why is this suddenly being considered an imminent threat?
I'd say it's probably the 122 known human cases since less than two years ago. (The high reported fatality rate, over 50%, might well be too high due to an unknown number of unreported cases.)
I can't say with any certainty that Michael Fumento completely buys into the false dichotomy that I'm protesting here, because all he does is imply it by relative silence. And the only real reason I'm picking on him in particular is that he was convenient and timely—there are lots of other targets I could have chosen. But I believe that it's incumbent on anyone who writes about this, particularly when in a position of authority, to avoid the temptation of trying to balance hysteria with an equally-unbalanced dose of assurance that it's all very unlikely to happen. This approach only increases the polarized nature of discourse until it becomes a debate over whether there's even anything to concern ourselves with, rather than what we should do about it.
Yes, there is something here to concern ourselves with. Ten years from now we all could be chuckling to ourselves how nothing happened in spite of all those silly doomsday scenarios in what passes for "the news" nowadays. But there is at least an even probability, from what we do know, that we'll end up glad for whatever preparations we made.
And either way, as always, we'll be looking for someone to blame. Anyone but ourselves.
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