PFI is down

PFI is down, at least for me.

Hopefully, this is a short term problem. I will post more on this blog if I am unable to access PFI forum within the next 12 hours. 


Now up. Hope it stays up.


Hypocrisy Grips the Huffington Post – Anti-Vaccine Site Reviews “Contagion” … and Flublogia

Flublogia receives little attention from the MSM. However, in a recent review of “Contagion” a blogger at the Huffington Post, Peter Christian Hall, discusses Flublogia. Well, part of it anyways.

In “Contagion” an anti-vaccine, magic-bean selling flu blogger is portrayed with calculated nastiness by Jude Law. It is ironic that a blogger at the Huffington Post would review this movie, and discuss its relationship to Flublogia, given that the Huffington Post has been the source of virulent anti-vaccine blogs. Bloggers at the Huffington Post like Jim Carrey, Joseph Mercola and Bill Maher are strongly anti-vaccine, and, frankly, anti-science. At a critical time in the pandemic when vaccine was just becoming available (September 2009) Dr. Frank Lipman wrote the following at the Huffington Post:

Summer is over and the question I am being asked most frequently in my practice is, “what do I do about Swine flu?” My patients are wondering whether or not they should get vaccinated and the simple answer I give most of the time is ..NO!

From what you may have read, you might think that the swine flu vaccine is the answer to swine flu. Unfortunately this is not true and until we know that the vaccine is safe, I cannot in good conscience recommend it to most of my patients.

All of the available evidence suggests that the pH1N1 vaccine given in the US was both safe and effective. However, due to belief in the anti-vaccine message, some parents did not vaccinate their children. Some of these children subsequently died of pH1N1. How many of these deaths is the Huffington Post responsible for? It is impossible to know. No-one collects statistics on death caused by misinformation.

In his article, Mr. Hall lists many members of Flublogia, but leaves out me and one of the most popular flu forums (which I moderate): Pandemic Flu Information (PFI) . Why? Well, one possibility is that I and many members of PFI_Forum were frequent critics of the Huffington Post and its team of anti-vaccine bloggers, any one of which would have been a good model for the anti-vaccine blogger in “Contagion”. We also criticised the CDC, not for promoting vaccine, but for not promoting vaccine effectively enough. We also criticised the CDC for its lousy testing throughput and incompetence in articulating the need for rapid treatment with Tamiflu. Although some would like to lump PFI in with the anti-science magic bean sellers, the fact is that this is the role the Huffington Post played during the pandemic. We were on the other side.

The continued blacklist of PFI bothers me. But not due to personal pique. I write anonymously and have no magic beans to sell. What bothers me is that the Director of the CDC is so insecure that he cannot countenance any criticism, even when its constructive and accurate. Although the CDC risk communicators claim that they want to “engage” the public, this is a lie. They wish to be praised lavishly and will reward only those who do so.

The Huffington Post also appears to be unable to handle the truth. Goju from PFI tried to post some links demonstrating HuffPo’s role as an anti-vaccine propaganda agent during the 2009 pandemic. His comments were censored. So much for the Huffington Post’s committment to free speech.

I don’t expect the people I criticise to like me. I’m OK with being called names or just being ignored. But censoring valid criticisms and only listening to people who tell you what you want to hear will lead to disaster. The many people who died unnecessarily during the 2009 pandemic are proof of that.

Contagion Review

[Warning, this review contains spoilers]

I recently saw the new movie “Contagion”, directed by Steven Soderbergh. Although I’ve enjoyed many of his films for their artistic merit, this review will focus on the movie from the standpoint of the accuracy of its science, as well as how it depicts the CDC, the World Health Organisation (WHO), the Department of Homeland Security and the blogosphere.

Briefly, the movie is about how ordinary people, scientists and public health officials respond to a new virus. It was apparently spread both by respiratory droplets dispersed by coughing and by touch (fomites). In addition to coughing, symptoms included bad headaches and seizures indicating that the virus could spread to the brain. The virus starts out with an R0 of 2 but this increases with time. The case fatality rate (CFR) is 20-25%. It’s not a flu virus, but the exact nature of the virus is not described. It apparently originated in bats, was transferred to pigs via a piece of fruit and then to humans at restaurant. It is said to have been based on Nipah virus.

The movie is relatively believable for this genre, partly because of the quality of the script and the acting. The cast includes Gwyneth Paltrow, Jude Law, Matt Damon, Laurence Fishburne, Kate Winslett and Eliot Gould. These are far superior actors to the B-list hacks found in other pandemic movies from recent years. The only false note was provided by Marion Cotillard as a WHO representative.

The quality of the science in the movie was mixed. A highly infectious virus with a CFR of 20-25% is certainly possible, especially if the carriers are asymptomatic but infectious in the early stages of the disease. They appeared to use real equipment in real labs for many of the scenes. One minor flaw was that it was stated that an attenuated virus would be used but one of the scientists was shown injecting herself. Killed viruses are usually injected. Attenuated viruses are usually given orally or nasally. Indeed, some people later in the movie were shown being given nasal sprays similar to Flumist. The most egregious science errors related to the rapidity with which the CDC was depicted sequencing the genome of the virus and characterising the proteins. Last year during the pH1N1 pandemic, it was revealed that the CDC was conducting PCRs one tube at time, by hand, even though they had bought expensive robots which could have greatly increased their throughput. Although the CDC has the budget to perform cutting edge science, they do not have the personnel for even basic tasks like high throughput PCR. De novo assembly of the genome of a novel virus requires a much higher level of expertise currently not available at the CDC. The recent outbreak of the new E coli strain demonstrated this. German and Chinese labs rapidly sequenced the bacteria and made the sequences public. A number of groups then rapidly assembled the genome. The CDC was not among these groups. Further, the depiction of rapid progress in determining the three dimensional structure and function of novel proteins is not realistic. Nucleotide sequencing can go fast, protein work takes much more time.

The depiction of the role of public health officials during this pandemic was mostly laudatory, but not very accurate. A CDC official played by Laurence Fishburne warns his fiancé to leave a city with a high level of infected people but not to tell anyone else of their danger. This is realistic as these sorts of private warnings have occurred before (see Nights of the Weak-Kneed – Past and Future for more). As mentioned above, the CDC scientists are depicted in the movie as performing miracles of discovery while the truth is that they struggle with basic methods. Mr. Soderbergh was likely snookered by convincing PowerPoints and a VIP tour of very elaborate equipment at the CDC. Some epidemic intelligence officers likely are brave and determined as portrayed by Kate Winslett. However, the extensive role of “Risk Communicators”, otherwise known as PR spin “doctors” at the CDC is not given much attention, although it is hinted at in one scene.

The least realistic, and frankly bizzare, subplot of the movie involved the WHO. We don’t see much going on at the WHO itself. Instead, we follow the strangely robotic Marion Cotillard to China to investigate the source of the virus. One of the Chinese scientists suggests that the WHO is in bed with the American drug companies. A strange line given that the WHO is currently run by Margaret Chan, an unqualified incompetent who owes her position to the Chinese Communist Party and billions of dollars in bribes to African countries. In any case, the WHO representative is kidnapped by Chinese scientists and held in a small village in an attempt to acquire vaccine from the WHO. Mr. Soderbergh obviously knows nothing of contemporary China if he thinks this is a serious possibility. Security forces would be blasting away at everyone in that village within hours of such a crazy scheme. The idea that the location of a kidnapped WHO representative could be kept secret from the central government for weeks to months is beyond silly. In any case, if there was such a virus on the loose now, the Chinese governement would get whatever it wanted from Margaret Chan whenever it wanted it. This was demonstrated during the pH1N1 pandemic when China got early access to the virus and was allowed to prepare a vaccine more quickly than other countries.

The depiction of the Department of Homeland Security (DHS) was brief. A DHS representative raises the possibility of a weaponised bird flu virus which was immediately shot down by the CDC official. This is realistic, imo. DHS is far more aware of the negative consequences of a pandemic than the CDC, imo, and much more willing to warn people to prepare. However, the CDC has apparently overruled them on this. In the movie, the DHS representatives are depicted as scary, unappealing guys. A pity, given their message in support of individual preparedness could save a lot of lives. I wish Mr. Soderbergh had taken their concerns more seriously and perhaps assigned one of his A list actors to portray a DHS official.

There was no mention of Flublogia or the preparedness community in general in the movie. Instead, the only blogger mentioned was a quack selling a fake cure to the disease caused by the virus. This character, portrayed by Jude Law, was obviously patterned on Mike Adams of NaturalNews, an anti-vaccine activist who pushes supplements of dubious effectiveness. Although I agree with the charterisation of the blogger in the movie as irresponsible and immoral, I am disappointed that Mr. Soderbergh decided to ignore the rest of the online community which follows and contributes to identifying outbreaks. The SARS cover-up in China was first reported on BOXUN, an anti-Communist ex-patriot website. I am aware of several instances where the online community of flu watchers made positive contributions to science and public health. Too bad that, once again, the mainstream media implies that the online community consists entirely of “those crazy internet people”. Maybe we need to make our own movie.

Commentators at PFI_Forum have characterised the portrayal of everyday events as a mild version of what the real thing would be like. I agree. Although overcrowded ERs, empty grocery shelves, home invasions, and movement restrictions are shown briefly, the full impact of a high CFR pandemic is not depicted. However, for all its faults, this movie might convince some that prepping is not a bad idea. Although I hate to say it, I think the the early scene where Gwyneth Paltrow dies was one that will affect many people the most. If Gwyneth can die from a virus, then surely no-one is safe!

Whatever works.

The Future?

Predicting the future of influenza pandemics is difficult. Many participants in Flublogia, including me, are concerned about the effects of a high case fatality rate pandemic on our globalised, interconnected civilisation.

We’re not the only ones.

The Rockefeller Foundation and The Global Business Network have envisaged four future scenarios in a document entitled: Scenarios for the Future of Technology and International Development (published May 25, 2010) [hat-tip, MAinVA at PFI_Forum]. The first scenario describes the response to a severe influenza pandemic:

In 2012, the pandemic that the world had been anticipating for years finally hit. Unlike 2009’s H1N1, this new influenza strain — originating from wild geese — was extremely virulent and deadly. Even the most pandemic-prepared nations were quickly overwhelmed when the virus streaked around the world, infecting nearly 20 percent of the global population and killing 8 million in just seven months, the majority of them healthy young adults. The pandemic also had a deadly effect on economies: international mobility of both people and goods screeched to a halt, debilitating industries like tourism and breaking global supply chains. Even locally, normally bustling shops and office buildings sat empty for months, devoid of both employees and customers.

The pandemic blanketed the planet — though disproportionate numbers died in Africa, Southeast Asia, and Central America, where the virus spread like wildfire in the absence of official containment protocols. But even in developed countries, containment was a challenge. The United States’s initial policy of “strongly discouraging” citizens from flying proved deadly in its leniency, accelerating the spread of the virus not just within the U.S. but across borders. However, a few countries did fare better — China in particular. The Chinese government’s quick imposition and enforcement of mandatory quarantine for all citizens, as well as its instant and near-hermetic sealing off of all borders, saved millions of lives, stopping the spread of the virus far earlier than in other countries and enabling a swifter postpandemic recovery.

Every empirical study of the effect of movement restrictions that I am aware of has demonstrated the effectiveness of movement restrictions in mitigating flu pandemics. Although commonly cited, most “modeling” studies assume just enough movement will continue to occur as to make such efforts fail. This is equivalent to the “lenient” option that the United States is suggested to take in the Rockefeller study.

One of the curious features of the 2009 H1N1 pandemic was the strong recommendation by the Chinese Director-General of the WHO, Margaret Chan, that countries refrain from imposing any movement restrictions whatsoever while China imposed the strongest movement restrictions in the world. Did Director-General Chan criticise the Chinese government for their response? On the contrary. From China Daily, May 29, 2009:

The Chinese government has mounted “a very robust response” to the threat of A(H1N1) influenza and the efforts are paying off, the head of World Health Organization (WHO) said on Thursday.

“The ministry of health under the coordination of government leaders mounted a very robust response so that they are able to track down all the cases,” Dr Margaret Chan said in an interview.

“So far the efforts are paying off,” she added.

The WHO director-general reiterated the unpredicability of the H1N1 virus and stressed the importance of continued surveillance as well as response adjustments.

“And of course my advice to them is that they need to adjust their public health response in line with the changing pattern of this virus,” she said.

“It’s important that they do not let their guard down,” she added.

What’s wrong with this picture?

In another scenario from the Rockefeller Foundation report, the following is suggested:

New threats like weaponized biological pathogens and destructive botnets dominate public attention…

Suppose this scenario was combined with the first one.

Just suppose.

Don’t make friends with the band

What is a blogger? Truthfully, I’m not sure I know. Some blogs are stream-of-conscious rants about deeply personal issues. Others are carefully researched articles that put mainstream journalism to shame.

But one thing I do know about bloggers, they aren’t supposed to party with the people they critique.

There is a speech in a movie called “Almost Famous” that captures this thought. An experienced rock and roll reporter is giving advice to a newcomer:

Lester Bangs: You CANNOT make friends with the rock stars. That’s what’s important. If you’re a rock journalist – first, you will never get paid much. But you will get free records from the record company. And they’ll buy you drinks, you’ll meet girls, they’ll try to fly you places for free, offer you drugs… I know. It sounds great. But they are not your friends. These are people who want you to write sanctimonious stories about the genius of the rock stars, and they will ruin rock and roll and strangle everything we love about it.

Recently, the federal government held a private meeting with selected members of the media and flublogia. The stated purpose was “to prepare for some possible communications challenges” associated with the ongoing pandemic. Here’s the thing: many members of the public who participate in flu forums and read flu blogs are furious that supposedly independent bloggers went to this event and agreed not to talk about it. For many in this community, those bloggers who agreed are “burned”, ie, identified with the government. They have lost credibility and will not get it back. Second, people who were suspicious of the government before are even more suspicious now. It is not enough that the mainstream media kowtow to politicians, they are now reaching into the blogosphere to “turn” the last vestige of free reporting into yet another wing of their PR campaign.

Government attempts to control the media are understandable. From the government’s point of view, journalists just make their job harder. Things are so much easier  if the press get their notes directly from the government. The thing is, a free press is a critical feedback mechanism the prevents wrong policy from being implemented without challenge. Remove this feedback, and there is no limit to the damage that can be done. There are many examples of disasters that occurred in the US when journalists did not do their jobs, some of them quite recent. A pandemic is exactly the wrong time to shut off external critiques, imo.

One good thing has come out of this conference. We have three new flu blogs today (see my blogroll), born out of outrage at government attempts to control the blogosphere. I’m glad to have fellow flu bloggers who have a bit of daylight between themselves and the government PR office.

I have one bit of advice to them:

Don’t make friends with the band.