Bird flu, TB, anthrax and some thoughts on New Years Day

The Reveres get a lot of emails from folks who think their issue is worthy of mention on Effect Measure. For the most part, they are right, and the only reason for not mentioning them is the time and attention span of The Reveres. One of the privileges of blogging is the blogger gets to set the agenda. Periodically I get emails from someone who feels very passionately about the harm being done to military personnel by mandatory anthrax vaccination. I've even blogged about it on occasion (on the old site, here, here, here and here), and I think there are some serious public health issues involved. But the emails also have another characteristic I see from strong advocates: the belief only their issue is worthy of attention. Everything else is hysterical media hype.

Here's a case in point. Today I got one from the anti-anthrax advocate that is becoming typical of him. The subject line said: Vietnam bird flu -- media-generated hysteria proves wrong. Again. There followed links to 28 stories online, all of which except the top one reported on the four suspect cases of bird flu in Vietnam. The top one was a story reporting that Vietnamese officials believed the cases were "ordinary pneumonia" and not bird flu after an initial round of testing. (We noted both sides in a post yesterday).

There are two points I'd like to make about this. The first is the obvious one that intellectually dishonest claims about another public health concern don't boost the credibility of your own. There has been no hysteria (that I am aware of) generated by the perfectly appropriate reports of the media that Vietnamese health authorities (a country that has registered the largest number of cases of bird flu than any other in the world) were investigating whether four members of the same family who developed pneumonia after slaughtering sick chickens had contracted bird flu. If the advocate knows who was hysterical and could point to a single report among the 27 he links to that reported anything but the facts and their meaning in the Vietnamese context, he should have done so. It isn't clear what he thought the media should have done. Not reported it? Vietnam hadn't reported a case since a year ago November and they were being held up as an example of a bird flu control program that was working. The reports of poultry outbreaks now occurring there was important public health news and the human cases plausible. Nothing inappropriate or hysterical about any of this.

The other point relates to why we report on so much bird flu and so little on other public health issues of great importance, like polio, malaria and extremely drug resistant TB (XDR TB). I note that given this line-up, mandatory anthrax vaccination would hardly make the cut. But that's not my point, which is directly related to my oft-repeated statement that Effect Measure is not "a bird flu site." It's not just that we deal and have dealt with a wide range of topics "of interest to the editor(s)" as our masthead states, although bird flu has been and remains the topic we discuss most. The question of XDR TB has come up a couple of times and it is something of great interest to me. One of my closest friends is the person who discovered it in South Africa and published the original paper in The Lancet on the topic in November. It is clearly a major public health problem with huge implications. He believes it is of much more importance than bird flu and he is a person whose opinion I respect a great deal. But.

We aren't "a bird flu site" because we make no special attempt to be there first with breaking news or to cover all the significant bird flu news. There are some great sites for that, like Crawford Kilian's H5N1 or Orange's The Coming Influenza Pandemic (apologies to all the other great sites who help people keep abreast). Our interest is two-fold. One is to provide some public health perspective on selected bird flu news. We rarely just report it but almost always offer some observation, explanation, commentary or analysis with it. It's our value-added. The other is the original reason we started writing about bird flu over two years ago (and we were among the first, if not the first, in the blogosphere to do so regularly). For us the bird flu "problem" is also a metaphor for the void in public health leadership and vision we see within our profession, in our state and national leaders and in the international public health community, generally. It is a lens through which to look at what we need to do in public health to meet the challenges of the 21st century, of which the biggest appears to be emerging and re-emerging infectious diseases. We could have picked other lenses, and certainly XDR TB would be a good candidate. We picked bird flu and have stuck with it.

This is not just a blog, it is an explicitly political blog. The Reveres (or Revere, if there is only one of us) are people of the Left. We/I came out of the political upheavals of the sixties and have been continuously active politically ever since. One of our political principles is that we don't mess with the science and make every effort to be intellectually honest when dealing with it. That doesn't mean other scientists wouldn't disagree with us. Disagreements in science are the norm, not the exception, and they mostly do not have political roots.

It does mean, however, that we try to be accurate and honest about our arguments regarding science and other things. Not everyone will agree we are completely successful, I'm sure, and I have do doubt we slip up from time to time. It's one of the things that happens when you write 500 to 1000 words a day, seven days a week and also hold down a demanding day job. That's both our excuse and our apology for any lapses on this first day of 2007.

Consider it confession, repentance and a resolution to do better all rolled into one.

May you have a happy, healthy and prosperous New Year. And may it bring Peace.

The Reveres, New Years Day, 2007.