CDC vs PCAST, Politicians vs Scientists

The President’s Council of Advisors on Science and Technology (PCAST) recently released a report suggesting that up to 90,000 Americans might die in the pandemic. I think this is a grossly optimistic prediction, but Dr. Thomas Frieden, Director of the CDC, did not.

From the New York Daily News, August 27, 2009:

Nearly 90,000 deaths from swine flu this fall? Not quite, the chief of the Centers for Disease Control and Prevention says.

“Everything we’ve seen in the U.S. and everything we’ve seen around the world suggests we won’t see that kind of number if the virus doesn’t change,” Dr. Thomas Frieden said in a C-SPAN interview taped Wednesday.

Frieden’s downgrading of the swine flu threat marks yet another volley in what appears to be a growing battle between the CDC and the White House’s top medical advisors over the dangers of the next wave of the H1N1 virus.

On Monday, the White House unveiled a grim report estimating the swine flu will wipe out up to 90,000 Americans in the coming months. The deadly virus will also infect half of the population and force some 1.8 million people into hospital intensive care units, the President’s Council of Advisers on Science and Technology predicted.

Dr. Harold Varmus, the New York doctor who spearheaded the report, told the Daily News Tuesday the “flu could be extremely dangerous” and “needs to be taken seriously.”

But a day earlier, after Varmus’ estimates were released, Frieden and White House health czar Kathleen Sebelius virtually ignored them.

Sebelius merely acknowledged that swine flu “will cause a more serious threat this fall.”

Bolstering the notion that even the White House was at odds with Varmus’ report, its release came with little fanfare and no official news conference.

What’s more, the panel’s dire report appears to have been released two weeks late. It was dated Aug. 7.

So, whom should we believe?

Harold Varmus is referred to as a “New York doctor” in the Daily News article quoted above. Other media stories also refer to him as “a doctor”. Technically, that is correct. However, one might think it is worth mentioning that he won the Nobel Prize for his discovery of oncogenes and the role of retroviruses in cancer, one of the most important discoveries in the history of cancer research. He was also the Director of the National Institutes of Health, easily the most prestigious job in biomedical research. The other members of the PCAST include another Nobel Laureate, several MacArthur (“Genius”) award winners and other top scientists and engineers.

The CDC, on the other hand, consists primarily of career bureaucrats, risk communicators and a few decent scientists. I would not include Dr. Frieden among the latter. Although he has published a lot of papers, the vast majority of them are routine “counting” studies of how many people have this disease or that disease. Like many in public health, he had privileged access to the primary data due to his managerial position. His contribution to science has been minor.

It should be obvious who is more credible, the CDC or PCAST. Hint, it is not the CDC.

The fact that a career politician, Secretary Sebelius, also does not appear to want acknowledge the work of PCAST is not surprising. After all, she has been minimising the danger of the new H1N1 virus for months. Can you guess again who I think is more credible, politicians or the members of PCAST?

Some have criticised PCAST for not going further in their predictions of likely death toll. I certainly agree that the worst case scenario is much worse than they predict. However, I can cite the CDC’s leaked Director’s reports. They can’t publicly acknowledge that they’ve seen them. They also must base their recommendations on the data the CDC gives them. They likely feel they have gone as far as they can without pointing out the extreme incompetence of the CDC in responding to this pandemic.

I hope that they will reconsider this choice.

Someone needs to say it.

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