Map of life expectancy at birth from Global Education Project.

Tuesday, January 19, 2010

Wolf! Wolf!

The European medical community was always a bit less amped up about the H1N1 "pandemic" than their counterparts here, and they have been much more reflective about the mass hysteria now that it has passed. There are three items in today's BMJ that, unfortunately, are hidden behind the subscription wall. I will summarize.

First, Deputy Editor Tony Delamothe, in the regular Editor's Choice column, writes:

If influenza was a rock band how would it rate its latest release, H1N1? Not too well, I suspect, despite the greatest prepublicity since—well, its previous release. And it all started so promisingly, in Mexico, whose population had been decimated by the very first outbreak of Spanish flu (and smallpox and measles), courtesy of Cortés and his conquistadores.

. . . Once the international tour began, all eyes were on the southern hemisphere for pointers as to how things might play out in the northern hemisphere winter. So what happened next?

For England, many more misses than hits. Since last August, the consultation rates for flu-like illness have hardly budged above the baseline threshold. They’re now less than half that rate and falling. Even the most generous assessment couldn’t attribute this happy state of affairs to either the use of oseltamivir (Tamiflu) or vaccination against swine flu. Both interventions are now uncomfortably under the spotlight.

Very uncomfortably, as it turns out. As has barely been reported in the U.S., Wolfgang Wodard, the Chair of the health sub-committee of the parliamentary assembly of the Council of Europe has called for an investigation into whether drug companies unduly influenced the WHO and generally ginned up the hype. According to his resolution:

To promote their patented drugs and vaccines against flu, pharmaceutical companies have influenced scientists and official agencies, responsible for public health standards, to alarm governments. . . . They have made them squander tight healthcare resources for inefficient vaccine strategies and needlessly exposed millions of people to the risk of unknown side effects of insufficiently tested vaccines.

And indeed, the conspiracy theory gets a boost because it turns out that Juhani Eskola, a vaccines advisor on the WHO board has recently received $9 million for his research center from GlaxoSmithKline, manufacturer of the H1N1 vaccine Pandemrix, which European governments paid millions to stockpile and are now trying to somehow get rid of.

Meanwhile Catherine F Houlihan and colleagues write:

Over six weeks (1 July 2009 to 15 August 2009) we reviewed cases of potentially life threatening conditions admitted to the Newcastle infection services in which diagnosis and management were delayed because of an initial, incorrect diagnosis of swine flu. . . .

A label of swine flu resulted in an average diagnostic delay of three days in six adults and two children who were admitted with potentially life threatening infection requiring timely antimicrobials. They had instead meningococcal meningitis; severe (11% parasitaemia) and mild (0.2%) Plasmodium falciparum malaria complicated by renal failure; acute myeloblastic leukaemia presenting with febrile pancytopenia; Campylobacter gastroenteritis with renal failure; Haemophilus influenzae respiratory tract infection (bone marrow transplant recipient); complicated soft tissue infection; and a fatal Staphylococcus aureus bacteraemia with multiorgan failure.

Now, personally, I don't necessarily think that Mr. Wodarg is right to be concerned about the safety of the H1N1 vaccine, nor was it necessarily wrong for governments to stockpile as much vaccine as they did. Ending up with too much is better than finding yourself with too little.

The point that sticks with me is the cost of over-hyping and over-obsessing about this matter. It was never certain or even likely that it was going to develop into a major public health emergency, or have catastrophic consequences, but the authorities, internationally and in the U.S.; the news media; and even, unfortunately, some prominent voices among progressives who should have known better, screamed about it for months on end as if the end of civilization were at hand. Furthermore, even the worst case scenario was not sufficient to justify the relentless, exclusive focus on flu and systematically ignore the many very real and much more serious public health crises that already plague humanity and do so continually. A flu pandemic is over with in a year or so; the ongoing scourges of humanity, from HIV to malaria to contaminated water to malnutrition to poverty to child abuse to drug addiction, and on and on and on, keep on happening.

They deserve far more attention, and they got none because of this misguided hysteria.

Now that the manufactured crisis has passed over and we are left with a tragedy for a few hundred families and what has otherwise been a milder than normal flu season, the price we pay for this is, of course, the Chicken Little phenomenon. However sincere the alarmists may have been, whether their motives were pure or not, they are perceived as at best overinvolved in their own areas of self-interest and at worst corrupt. And the next time they try to sound an alarm, even if there is more basis for it, they will not be believed.

That is what I have been predicting all along. Just sayin'.