Chicken Little alert? Hysteria could sap money from worse health threats
By Rebecca Cook Dube
Special to MSNBC.com
Doomsday predictions about bird flu seem to be spreading faster than the virus itself. But a small group of skeptics say the bird flu hype is overblown and ultimately harmful to the public's health.
There's no guarantee bird flu will become a pandemic, and if it does there's no guarantee it will kill millions of people. The real trouble, these skeptics say, is that bird flu hysteria is sapping money and attention away from more important health threats. "I have a bunch of patients coming in here who are more worried about bird flu than they are about heart disease," said Dr. Marc Siegel, an internist and associate professor of medicine at the New York University School of
Medicine. "The fear is out of proportion to the current risk."
Even Dr. Anthony Fauci, the National Institutes of Health's infectious disease chief, recently cautioned against overreacting if the virus surfaces in North American birds, as it is expected to do later this year.
"One migratory bird does not a pandemic make," Fauci told The Associated Press.
Scary scenarios
It's hard to blame people for feeling skittish. The chief avian flu coordinator for the United Nations, Dave Nabarro, said last fall he was "almost certain" a bird flu pandemic would strike soon, and predicted up to 150 million deaths. The U.S. Secretary of Health and Human Services, Mike Leavitt, advised Americans to stockpile cans of tuna fish and powdered milk under their beds in case of an outbreak. Renowned flu expert Robert Webster has said society needs to face the possibility that half of the population could die in a bird flu pandemic.
"Ridiculous," scoffed Wendy Orent, an anthropologist and author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease."
She said public health officials have vastly exaggerated the potential danger of bird flu. Several factors make it unlikely that bird flu will become a dangerous
pandemic, Orent said: the virus, H5N1, is still several mutations away from being able to spread easily between people; and the virus generally attaches to the deepest part of the lungs, making it harder to transmit by coughing or breathing.
"We don't have anything that makes us think this bug will go pandemic," Orent said. "Yes, it's virtually certain in human history there will be another pandemic strain . but there's no reason for it to happen now, or 10 years from now or 20 years from now."
Public health officials counter that it's better to be safe than sorry; better to prepare for a pandemic that never comes than to be caught unprepared. Avian flu has killed 110 people worldwide since 2003, according to the World Health Organization.
"Even if H5N1 does not evolve into a pandemic, the steps we are taking right now will benefit us down the road," said Tom Skinner, a spokesman for the Centers for Disease Control and Prevention in Atlanta. "We simply want people to be informed and educated about bird flu. The best antidote for fear is information."
But public health funding is a zero-sum game, both Orent and Siegel note. Money that's being poured into short-term bird flu preparations isn't available for long-term fixes that would, for example, increase hospitals' ability to handle a surge of patients in a national emergency.
"People have been riding this for all they can get," said Orent. "We don't need to make this into something it's not in order to get what we need, which is a better public health system."
All the eggs in one basket?
And while everyone is nervously watching bird flu progress through Asia and Europe, some experts worry another bug could sneak up and bite us.
"Preparation is fine, but short-term hysteria interferes with long-term planning," Siegel said. He said he'd like to see more efforts at general pandemic preparation - such as developing better methods for making vaccines - rather than a laser-like focus on H5N1. "We're putting all our eggs in one basket."
Flu virologist Adolfo Garcia-Sastre, a microbiology professor at the Mount Sinai School of Medicine in New York, agrees that all the focus on H5N1 may be unhealthy. As part of the team of scientists who recreated the deadly 1918 flu strain, he's glad people are paying more attention to flu but thinks the level of worry is a bit too high. If this avian flu doesn't turn into a pandemic, he wonders, will all these new flu-fighting measures be tossed aside?
"Focusing only on H5N1 ... I think is a little bit shortsighted," Garcia-Sastre said.
Public health officials always have to walk a fine line when sounding the alarm, said risk communications expert Peter Sandman, of Princeton, N.J., a consultant to the World Health Organization and the U.S. Department of Defense. Bird flu is a tough case because it's both scary and unlikely. People see-saw between overreacting because the potential threat is horrific, and under-reacting because the threat is also unlikely.
"When you look at a risk that's horrific but not likely, it's hard to know how to think about it," Sandman said.
Sandman said public health officials need to do a better job of communicating the uncertainty around bird flu - as Fauci seemed to be attempting this week.
"It's unfair and dishonest to make it sound like we're sure H5N1 is coming soon and it's going to kill half the population," Sandman said. "It's equally irresponsible to say, because only a hundred people have died, it's not a biggie. It's potentially very scary, but potentially is only potentially."
Mixed messages
Vocabulary is part of the problem, Sandman said. The term "bird flu" is used for the virus that is now killing birds - and has infected nearly 200 people who came into very close contact with birds. And it's also being used to describe a mutated virus - which hasn't yet emerged - that would spread easily among humans.
Sandman stressed that the current "bird flu" that kills birds is not the same as the potential "bird flu" that could cause a deadly pandemic.
"Chicken isn't a problem," he explained. "The big problem is the risk of mutation, at which point I'm at risk from the subway seat you sat on, or the doorknob you pulled open. After the mutation happens we should both be more afraid of doorknobs than chicken. Before the mutation, we shouldn't be afraid of doorknobs or chickens."
Even if avian flu transforms into a human pandemic, it may be mild. The most recent flu pandemic, in 1968, went unnoticed by everyone except scientists because it wasn't much worse than a normal flu season in terms of illnesses and deaths.
Government officials continue urging people to prepare by stockpiling a few weeks' worth of food, water and medical supplies. But skeptics like Siegel and Orent say you're better off guarding against more realistic dangers - heart attacks, for example, or even gum disease.
"I'd worry more about flossing my teeth than I'd worry about avian flu," Orent said. "I want people to see what the real dangers are."
Special to MSNBC.com
Doomsday predictions about bird flu seem to be spreading faster than the virus itself. But a small group of skeptics say the bird flu hype is overblown and ultimately harmful to the public's health.
There's no guarantee bird flu will become a pandemic, and if it does there's no guarantee it will kill millions of people. The real trouble, these skeptics say, is that bird flu hysteria is sapping money and attention away from more important health threats. "I have a bunch of patients coming in here who are more worried about bird flu than they are about heart disease," said Dr. Marc Siegel, an internist and associate professor of medicine at the New York University School of
Medicine. "The fear is out of proportion to the current risk."
Even Dr. Anthony Fauci, the National Institutes of Health's infectious disease chief, recently cautioned against overreacting if the virus surfaces in North American birds, as it is expected to do later this year.
"One migratory bird does not a pandemic make," Fauci told The Associated Press.
Scary scenarios
It's hard to blame people for feeling skittish. The chief avian flu coordinator for the United Nations, Dave Nabarro, said last fall he was "almost certain" a bird flu pandemic would strike soon, and predicted up to 150 million deaths. The U.S. Secretary of Health and Human Services, Mike Leavitt, advised Americans to stockpile cans of tuna fish and powdered milk under their beds in case of an outbreak. Renowned flu expert Robert Webster has said society needs to face the possibility that half of the population could die in a bird flu pandemic.
"Ridiculous," scoffed Wendy Orent, an anthropologist and author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease."
She said public health officials have vastly exaggerated the potential danger of bird flu. Several factors make it unlikely that bird flu will become a dangerous
pandemic, Orent said: the virus, H5N1, is still several mutations away from being able to spread easily between people; and the virus generally attaches to the deepest part of the lungs, making it harder to transmit by coughing or breathing.
"We don't have anything that makes us think this bug will go pandemic," Orent said. "Yes, it's virtually certain in human history there will be another pandemic strain . but there's no reason for it to happen now, or 10 years from now or 20 years from now."
Public health officials counter that it's better to be safe than sorry; better to prepare for a pandemic that never comes than to be caught unprepared. Avian flu has killed 110 people worldwide since 2003, according to the World Health Organization.
"Even if H5N1 does not evolve into a pandemic, the steps we are taking right now will benefit us down the road," said Tom Skinner, a spokesman for the Centers for Disease Control and Prevention in Atlanta. "We simply want people to be informed and educated about bird flu. The best antidote for fear is information."
But public health funding is a zero-sum game, both Orent and Siegel note. Money that's being poured into short-term bird flu preparations isn't available for long-term fixes that would, for example, increase hospitals' ability to handle a surge of patients in a national emergency.
"People have been riding this for all they can get," said Orent. "We don't need to make this into something it's not in order to get what we need, which is a better public health system."
All the eggs in one basket?
And while everyone is nervously watching bird flu progress through Asia and Europe, some experts worry another bug could sneak up and bite us.
"Preparation is fine, but short-term hysteria interferes with long-term planning," Siegel said. He said he'd like to see more efforts at general pandemic preparation - such as developing better methods for making vaccines - rather than a laser-like focus on H5N1. "We're putting all our eggs in one basket."
Flu virologist Adolfo Garcia-Sastre, a microbiology professor at the Mount Sinai School of Medicine in New York, agrees that all the focus on H5N1 may be unhealthy. As part of the team of scientists who recreated the deadly 1918 flu strain, he's glad people are paying more attention to flu but thinks the level of worry is a bit too high. If this avian flu doesn't turn into a pandemic, he wonders, will all these new flu-fighting measures be tossed aside?
"Focusing only on H5N1 ... I think is a little bit shortsighted," Garcia-Sastre said.
Public health officials always have to walk a fine line when sounding the alarm, said risk communications expert Peter Sandman, of Princeton, N.J., a consultant to the World Health Organization and the U.S. Department of Defense. Bird flu is a tough case because it's both scary and unlikely. People see-saw between overreacting because the potential threat is horrific, and under-reacting because the threat is also unlikely.
"When you look at a risk that's horrific but not likely, it's hard to know how to think about it," Sandman said.
Sandman said public health officials need to do a better job of communicating the uncertainty around bird flu - as Fauci seemed to be attempting this week.
"It's unfair and dishonest to make it sound like we're sure H5N1 is coming soon and it's going to kill half the population," Sandman said. "It's equally irresponsible to say, because only a hundred people have died, it's not a biggie. It's potentially very scary, but potentially is only potentially."
Mixed messages
Vocabulary is part of the problem, Sandman said. The term "bird flu" is used for the virus that is now killing birds - and has infected nearly 200 people who came into very close contact with birds. And it's also being used to describe a mutated virus - which hasn't yet emerged - that would spread easily among humans.
Sandman stressed that the current "bird flu" that kills birds is not the same as the potential "bird flu" that could cause a deadly pandemic.
"Chicken isn't a problem," he explained. "The big problem is the risk of mutation, at which point I'm at risk from the subway seat you sat on, or the doorknob you pulled open. After the mutation happens we should both be more afraid of doorknobs than chicken. Before the mutation, we shouldn't be afraid of doorknobs or chickens."
Even if avian flu transforms into a human pandemic, it may be mild. The most recent flu pandemic, in 1968, went unnoticed by everyone except scientists because it wasn't much worse than a normal flu season in terms of illnesses and deaths.
Government officials continue urging people to prepare by stockpiling a few weeks' worth of food, water and medical supplies. But skeptics like Siegel and Orent say you're better off guarding against more realistic dangers - heart attacks, for example, or even gum disease.
"I'd worry more about flossing my teeth than I'd worry about avian flu," Orent said. "I want people to see what the real dangers are."
