Tag Archives: flu

Sentient Spambots vs. Journalism

As a blog owner, I get a lot of spam. Of course my automatic filters weed out the usual ads for anatomical enlargement, financial offers from alleged Nigerian clergy, and suggestions to earn advanced degrees from diploma mills, but in recent years a new category has cropped up, and it’s getting harder and harder to classify it.

Consider the infographic link spammers. These folks use standard online tools to create some marginally interesting illustration, then promote it to any blogger who covers even tangentially related topics. The infographic includes code that helps direct traffic to another site, helping them increase their search engine rankings. I haven’t posted any of these, partly because I’m not into running other people’s ads for free, and partly because the graphics tend to be gimmicky, often misleading representations of questionable data. All the ones I’ve received have included links to “get your degree online” types of sites, which are themselves just extended advertisements for diploma mills. So as an evolutionary byproduct of their efforts to circumvent ever-more-sophisticated filters, the University of Phoenix’s spambots have finally achieved sentience.

Recently, though, I got a note that’s pushed this trend even further, to the point that it’s right next door to legitimate journalism:

Hello,

I help maintain the site [name similar to Diploma-Mills-R-Us.com], and I am writing to let you know about an article we have created that shares essential information on the 2012-2013 Flu Vaccine. You can view part 1 here: [link, to which I’ve added a nofollow tag].

As you may already know, it is flu season and as the seasons change, the weather gets colder and many people start feeling under the weather. The article offers guidance and information on how and why you should get the vaccine and the effects it may have on your health.

We’re trying to spread the word about this article, and hopefully spread awareness on this subject as many people today are still not getting their flu vaccine and having to pay the consequence. So, if you find it to be useful and interesting, and think others would too, I’d be thrilled if you would share it with your readers, or anyone else you think could benefit from it.

The linked post rehashes information that’s easy enough to find elsewhere, but it isn’t a simple copy-paste job. The author actually created original content, summarizing an important issue and promoting public health. My only real objection to it is that the sponsoring site exists solely to sell dubious training programs for healthcare practitioners.

I can’t get on too high a horse about that, though. Most of the publications my colleagues and I write for make a significant amount of their money from advertising, and for many of them (“controlled circulation” trade magazines, virtually all news web sites) it’s the only revenue source. All of my clients are diligent about maintaining a firewall between the advertising and editorial departments, so the former never directly influences the latter. Reduced to its essence, journalism’s business model is to draw readers to original, independent, useful content, and pay for it by showing them some ads at the same time. The main distinction I see is that at “legitimate” news outlets the content is viewed as the primary product, and the ads as a sort of necessary evil. For sites like the one above, the ads are the main point, and the original content is just eyeball bait. It’s largely a question of intent.

In practical terms, the problem with the latter model is that there are certain types of stories that, while highly relevant to the target audience, could never be permitted to appear there. For example, I wouldn’t expect an unbiased investigative report on the business practices of online degree programs from a site whose existence depends on them. Similar conflicts can arise at traditional news publishers of course, but keeping a diverse stable of advertisers mitigates them, and a business philosophy that values content for its own sake tends to discourage serious abuses.

While I don’t expect the spammers to make the final step in this journey and turn themselves into legitimate journalists, I can’t help wondering whether we’re living in a version of this xkcd comic.

Unleashing the Ferrets of Fear

The second of two controversial papers on H5N1 “bird flu” came out yesterday, and if you didn’t hear about it, it wasn’t for lack of publicity. Not only did journalists get the usual embargoed access to the paper at the beginning of the week, we also got a whole package of related commentary and an invitation to a high-powered press conference with the lead researchers, the journal’s editor, and other luminaries. Even before this week, people were leaking information about the new results like Julian Assange on a bender.

I considered working up a whole post on this research and scheduling it to come out when the embargo expired, but besides being snowed under with paying work, I knew that such a post would probably disappear in the noise. Instead, I just waited for my friend and TWiV co-host Vincent Racaniello to put up his summary and analysis, which I expected would be excellent. It is, so go read it now if you haven’t already. I’ll wait.

Unfortunately, the bad reporting on this topic also appeared right on schedule. Here, for example, is The Telegraph’s take on the work:

Headline: Bird flu pandemic just “three mutations” away, scientists show

A bird flu pandemic may be close to being a real threat after scientists discovered the virus is already just “three mutations” away from evolving into a strain which would be able to pass from human to human. Avian H5N1 influenza can currently only be transmitted to humans from birds, meaning it cannot spread quickly through the air between large groups of people. But a recent study at Cambridge University shows that there are strains already existing which are just “three mutations” away from being passable form one human to another.

You know what the problem is here? Rhetorical vomit. There’s a lot of it in the world, from political bumper stickers to fear-mongering headlines. Just like real vomit, it takes only seconds to splatter out into the world, and anyone who sees it can’t help but notice and be affected. It’s also contagious; when we see vomit, we want to. We can’t help it. It grabs us at a visceral level, and leaves our conscious minds struggling to catch up with a more reasoned response. When that finally happens, the cleanup takes far longer than the hurl, and it’s very difficult to erase the original impression.

But there it is, pooling on the floor, sticking to the couch, and stinking up the room. And now that reporters like The Telegraph’s Richard Alleyne and Nick Collins have spoiled lunch with that mess, someone has to get out the mop and clean it up. Fine.

Let’s begin by understanding the requirements for a new flu pandemic, starting from an influenza strain that infects birds. First, the virus needs to adapt to a point where it can transmit efficiently from one human to another. Humans are very different from birds, so that’s going to take some mutating and selecting. Second, it has to retain enough virulence that we actually need to worry about it. A virus can be highly transmissible without being a major concern. Cytomegalovirus infects half of the world’s adults, but odds are you’ll never know you have it. Finally, a pandemic flu virus needs to encounter an immunologically naive human population. That’s a serious hurdle that keeps getting higher. For example, if you had the 2009 H1N1 “swine flu” or got the vaccine against it, there’s a good chance you’re now also immune to the dreaded 1918 flu. If a lot of people are similarly cross-immune to some newly mutated H5N1 strain, the pandemic will fizzle.

In the new studies, researchers found that H5N1 flu has to undergo at least five separate mutations from its ordinary bird form in order to be transmissible through the air from one ferret to another. Ferrets aren’t people, but they’re a bit closer to us evolutionarily than birds are. Looking at isolates of H5N1 that have appeared so far, we see that two of those five mutations have already occurred in nature. The Telegraph’s story appears to be discussing an extension of those findings, in which some of the same scientists used mathematical modeling to gauge the potential for wild H5N1 strains to pick up the remaining three mutations, based on our current understanding of influenza biology. Like all mathematical modeling studies, that work is useful for telling us what our assumptions mean. It does not tell us what will actually happen.

So are we three mutations away from a pandemic? There’s no way to tell. We appear to be three mutations away from obtaining a strain of H5N1 that could be aerosol-transmissible between ferrets, but not lethal to them. We don’t know whether the same mutations would enable the virus to transmit between humans. We don’t know whether it would be virulent. We don’t know how much of the population would be susceptible to it.

We don’t even know how likely it is that the remaining three mutations found in these studies could ever occur in nature. Any of the numerous selective pressures on viruses in the wild could prevent them from making those changes. So far, despite infecting at least several hundred (and probably many more) humans, H5N1 flu hasn’t managed to make the jump. Have we just been extremely lucky, or does this streak of failures point to an underlying biological barrier that keeps bird flu in birds? Nobody knows.

The new H5N1 flu papers do tell us a lot, and they represent vitally important work. We now know some of the types of changes that can make a bird influenza virus aerosol-transmissible in a mammalian host. We also know that H5N1 has the potential to contribute genes to a future pandemic virus, and might even have the ability to spark a pandemic on its own. We should keep an eye on that, try to take reasonable precautions against it, and keep studying H5N1 and other flu viruses to get a better idea of what they’re capable – and not capable – of doing. In the meantime, I encourage my fellow editors and journalists to keep a bucket handy.

A Chat with Mike Osterholm

I got a call last night from Mike Osterholm, noted epidemiologist and member of the National Science Advisory Board for Biosecurity (NSABB). He wanted to talk about H5N1 flu – if you don’t know why, scroll down to the previous few posts.

First, I want to thank Mike for calling. We had a good conversation in which I think we came to understand each others’ viewpoints a bit better, though we still disagree strongly on some key issues. That means that as I had hoped, the H5N1/censorship debate is finally moving forward. To clarify my own position, and also help those who aren’t in direct touch with NSABB members, here’s a synopsis of what we talked about. Bear in mind that this was not an “on the record” interview, so I won’t be quoting Mike, but I’m pretty sure he won’t mind me discussing our conversation publicly. If I misstate anything, I hope he posts up in the comments to correct it.

We talked briefly about his alleged dis of Peter Palese at the New York Academy of Sciences meeting Thursday night. Mike says he was misquoted, and I believe him. Let’s move on.*

Next, we talked about the controversial case-fatality rates for H5N1 flu. Mike has some valid methodological criticisms of some of the serological surveys, as I expected he would. I disagree with his assessment of the situation, but that’s not really relevant to what I see as the main point here. My real complaint is that the figures being cited for H5N1 fatalities shouldn’t be presented to the public in the first 50 words of an editorial – or anywhere, unless accompanied by a detailed explanation of their limitations. Comparing those rates to the mortality rates for, say, 1918 flu, is particularly misleading; the numbers were calculated by different standards. Indeed, if we apply a sufficiently strict definition of “case,” we can generate eye-popping figures even for the relatively mild 2009 H1N1 swine flu virus. Whether the 59% fatality rate for H5N1 is off by one order of magnitude or twelve isn’t the point. The point is that public statements that cite that figure and use it for apples-to-oranges comparisons are going to get called out by virologists as propaganda.

But all of that is really a sideshow. The main question we need to focus on is whether it’s appropriate to redact key data from a paper that reports unclassified research. Mike was blunt and consistent in stating that the NSABB wants this to be an isolated incident, not a general approach. That’s reassuring. Unfortunately, I’m afraid it’s not up to him. My biggest concern about the NSABB recommendation is that it sets a dangerous and potentially corrosive precedent, a possibility I don’t think the committee gave adequate weight.

I’m not terribly worried about the NSABB, or about what happens with the H5N1 data, so long as they’re eventually published. I’m worried about the much broader picture. We’ve now seen a government advisory board pressure publishers to censor what they publish, based on entirely theoretical “security concerns.” Because said advisory board’s media statements created a public panic over the issue, the publishers really can’t negotiate this censorship from a position of strength. They pretty much have to go along with it. Prior restraint on publication is an extreme, radical intervention, even if it’s applied indirectly, as this was. US courts have consistently (and correctly) ruled that this type of censorship is only barely acceptable if there is an absolutely compelling public interest in suppressing the information. Theoretical threats don’t cut it.

So would it now be okay for the Minerals Management Service, citing undefined “security concerns,” to pressure a publisher over an article on fracking? Can a politically-motivated appointee at HHS threaten to smear researchers who publish data on abortion? Could a rightward-facing President appoint an advisory panel to lean on climate change publications? These are the sorts of scenarios that worry me, and they seem much more likely than the idea of terrorists synthesizing super-flu. There’s a long history of governments – even in democracies – trying to censor information, while the number of deadly non-state bioterror attacks still stands at precisely zero. From where I sit, the potential harms of censorship far outweigh any benefits of trying to conceal the data, especially since that horse is already out of the barn.

To his credit, Mike didn’t push the bioterrorist angle. Instead, he brought up a new argument: that a biohacker hobbyist might try to generate the new H5N1 strains just for bragging rights. While that’s theoretically possible, it’s hardly a compelling reason to cripple an entire field of research. There are already regulations in place requiring people to work with these viruses under stringent containment conditions, and animal experimentation involves more paperwork than a satellite launch. It would be virtually impossible to do such work undetected. So while a few exceptionally motivated (and deep-pocketed) biohackers might try to do this, they’re extremely unlikely to succeed. Even if they did, it’s not at all clear that the resulting virus would be dangerous.

Ultimately, this comes down to the question that always plagues decisions based on the “precautionary principle.” Yes, we should avoid doing something that risks causing harm, but where do we draw the line on risk? Giving every nation equal access to enriched plutonium would probably be a bad idea. But should we shut down the CERN supercollider, lest it destroy the universe? Or mandate that everyone wear hardhats outdoors to guard against falling space debris?

Clearly, many risks don’t justify the interventions that would be required to mitigate them. I think that the risks of publishing the new H5N1 studies fall firmly into that category. Others are certainly free to disagree, but the time to have that discussion is before the work is done. And that was one point on which Mike and I seem to be in violent agreement; it was nice to chat, but neither of us wants to find ourselves having this same conversation again.

* (2012.2.4 18:30) I did not intend to minimize what was apparently an extremely acrimonious exchange, regardless of exactly what words were used (see comments below). My intent here is to move the public discussion forward, though, and dwelling on questions of tone won’t do that. Mike, if you’re reading this, I suggest giving Peter a call to see if you two can bury the hatchet. It wouldn’t hurt to drop Vincent a line, too. Reasonable people can disagree, but pissing people off, as you apparently did, won’t help your case.

Some Unsolicited Debate Coaching for Tonight’s Speakers

The New York Academy of Sciences is hosting a panel discussion tonight about H5N1 influenza, “dual-use” research, and scientific censorship. Of course this stems from the ongoing debate about the alleged development of mammal-adapted H5N1 strains (see my earlier summaries here and here).

So far, I’ve found the public discussions on this issue disappointing, not only as a virologist and journalist, but also as a former debate coach. Both sides are advancing arguments, but there’s been a distinct lack of clash. In order to have a debate, each side has to listen to what the other is saying, and then respond directly, point-by-point, to the claims. Simply restating your own claims doesn’t cut it. If the arguments don’t clash, we can’t find out which ones are sound. Let me give some examples.

Members of the National Science Advisory Board for Biosecurity (NSABB) have made numerous public statements and published several essays about their recommendation to censor the new research. In all of those statements, they repeat the claim that H5N1 flu is a concern because it is highly lethal. In fact, they almost always quote a specific number: 59% of people infected with this virus die.

In blog posts and academic journal articles, virologists have repeatedly pointed out that this statistic is quite likely several orders of magnitude too high. The response of NSABB members has been simply to repeat the erroneous statistic. This is a crucial question that lies at the center of the debate, but there’s no clash.

Meanwhile, several commenters (including Howard Markel in an Op-Ed in today’s New York Times) have pointed out that redacting key data from the new papers, as the NSABB advocates, is a pointless gesture. As Markel explains:

In this case, censorship is too little, too late. The data generated by one of the research teams was already presented at a conference in Malta in September, where copies of the paper were distributed. But even if the data weren’t already available, the key details could likely be inferred from other information that is already available. I recently spoke with several prominent influenza scientists, all of whom agreed that, based on the knowledge that certain mutations can make H5N1 highly transmissible in ferrets, they could consult previously published literature and probably figure out what those mutations are.

In addition, none of this research was conducted in classified facilities. Hundreds of people without security clearances have already seen the data, which have also been emailed across multiple minimally-secured servers in at least four countries. If evil-doers wanted this information, it would be trivial for them to figure out which door to kick down to get it. The only people who actually can’t get access to the data are the scientists who might actually be able to use it beneficially.

The NSABB response to this criticism has been deafening silence. Again, it’s a crucial issue, but there’s no clash.

In the NSABB’s official policy statement explaining the rationale for their recommendations, we are simply told that they found the risks outweigh the potential benefits. For the past month, scientists have pressed the group, collectively and individually, to explain exactly what evidence they considered in reaching that conclusion. The policy statement, though, provides no more detail than their earlier editorials. So even when it comes to the central thesis of the argument, we have no clash.

At this point, I strongly suspect that the scientific backlash against the censorship recommendation took the NSABB by surprise. The group appears to have been looking for a test case on which to launch a discussion, and when the new H5N1 work came up they decided this would be it. Board members talked amongst themselves, made their recommendation on (probably inadequate) evidence, and expected the scientific community to go along peacefully. The scientists had other ideas. Having drawn a line in the sand, though, the NSABB now finds itself unable to retreat from it without looking foolish.

So here’s what both sides of the debate need to accomplish tonight. The virologists need to state their counter-arguments once more, but in the process they need to insist on direct responses from the NSABB. Don’t let them simply restate incorrect figures for the fatality rate, or just stipulate that redacting the data will prevent a terrible harm. Be nice, but press firmly. Don’t take “because we said so” for an answer. However, be sure you listen to the responses – it’s likely that NSABB members have some criticisms of the data you’re citing, and you’ll need to answer those as directly as you expect them to answer you.

The NSABB should begin by explaining their decision process, transparently and plainly, and acknowledging that it may have been flawed. Hey, we’re all people, and we all make mistakes sometimes. Next, address each and every one of the virologists’ counter-arguments directly. No dodging or pretending not to hear. Be prepared to concede any arguments for which you don’t have solid, evidence-backed answers. That will actually boost your credibility. Being wrong isn’t a character flaw. Being wrong while insisting you’re right is. On issues where you do have evidence, though, go ahead and press on. You had reasons for making the recommendation you made. Explain them. Finally, back off the fear button. Telling scientists that they have to agree with you or Congress will implement “Draconian restrictions on research,” or asserting (without solid evidence) that terrorists are on the verge of developing high-yield bioweapons, is fear-mongering. Stop it.

The Day the Science Died

This afternoon, a coalition of influenza virologists released a statement saying that they are voluntarily suspending research on H5N1 “bird flu” for 60 days. This was in response to the Category 5 hype storm that has accompanied the publication of two papers about this virus. My previous post on this topic (and links therein) provides a quick review for those who haven’t been following this story.

I’m of two minds about the new moratorium. As a scientist, I think it’s moronic. H5N1 flu is biologically interesting, and could become a major public health concern if it ever manages to sustain human-to-human transmission. Though its lethality has probably been vastly overstated, there’s no doubt that it is capable of killing at least some people, under some circumstances. The demonstration that it’s possible for H5N1 to adapt to a mammalian host, even one that diverged from the primate lineage many millions of years ago, shows that we need to step up H5N1 research, not halt it.

However, the biodefense industry’s recent push to whip up fear has completely distorted the public’s perception of this issue. Millions of nonscientists are now convinced that the recent virus transmission work was dangerous, perhaps even foolhardy, and that terrorist groups could easily take advantage of the new findings to kill millions. None of that is even remotely true. Unfortunately, people who are in a panic aren’t capable of rationally evaluating the nuances, so the scientists who’ve been trying to defend ongoing H5N1 work are at a disadvantage. Saying they’ll suspend that work is the only reasonable public relations strategy at this point.

Around the same time the moratorium was announced, a partially overlapping group of virologists sent an open letter to the National Science Advisory Board for Biosecurity (NSABB), giving that board a thump on the head. It was the NSABB that started this whole circus, by calling for the new H5N1 publications to be partially censored. In the open letter, the virologists argue that this censorship is unjustifiably hindering scientific progress. They were apparently too polite to say that deliberately omitting data from a publication in response to a nebulous, entirely theoretical “security risk” is antithetical to the whole scientific enterprise, so I’ll do it for them.

The moratorium should help bolster public confidence in the scientists’ ability to address this issue themselves, while the letter to the NSABB lays the groundwork for a productive debate based on reason rather than fear. Hopefully, in a couple of months everyone will be able to calm down and get back to work.

The Biodefense-Industrial Complex vs. Science

I was revving up to post a long rant about the censorship of a new paper on H5N1 influenza, but my friend and TWiV co-host Vincent Racaniello beat me to it. I do, however, have a couple of things to add.

If you’re just tuning in, the short version goes like this: some researchers claim to have isolated a novel strain of H5N1 “bird flu” that is highly transmissible in ferrets, the standard animal model for human flu infection. This triggered a huge round of hand-wringing by various quasi-official groups, claiming that this information could allow some imaginary “bioterrorist” to create The Plague of The Apocalypse. Or words to that effect. Today, the authors of the study announced that they would redact some of the data from the paper to prevent that from happening.

But as Vincent explains in his post:

The article hints that details of the experiments may be made available to influenza virologists ‘with a legitimate interest in knowing them’. Who will decide what constitutes a legitimate interest? And what if a virologist, or another scientist who does not work on influenza virus, has an idea for an experiment and would like the details? Will they be denied because they are not card-carrying influenza virologists? Science often works in unusual ways, and one of them is that difficult problems are often solved by individuals from different areas of research.

In addition, the data have already passed through dozens, perhaps hundreds of hands. There are the folks in the lab who did the work, any collaborators they worked with, the peer reviewers for the papers, anyone at Science and Nature who handled the manuscripts, and of course the sysadmins for every email server connecting all of those geographically distant points. Most scientists don’t have the first clue about information security, so any terrorist who actually wanted these experimental details could probably get them. The only people who won’t have easy access to the data are precisely the folks we want working on this problem.

But why would the terrorists even bother? What the paper shows (allegedly – it still hasn’t been published) is that H5N1 can become contagious in ferrets while retaining its virulence. That certainly could be bad news for weasels who spend a lot of time around poultry farms, but it’s not at all clear what it means for the rest of us. While ferrets are probably the best animal model we have for studying influenza infection, that’s not saying much. Their track record on predicting virulence is particularly spotty; H1N1 “swine flu” is terribly deadly to ferrets, but actually less lethal in humans than most regular seasonal flu strains. There have been quite a few human cases of H5N1 already, so whatever adapting the virus can do in us, it’s already had lots of chances. We’re not dead yet.

If I were a terrorist, I certainly wouldn’t waste my time following up such a weak lead, particularly since there are so many easier, cheaper, more reliable ways to cause terror. How about 1918 flu? It’s unquestionably deadly to humans, and the full sequence – unredacted – came out in 2005. Or anthrax? Or SARS? Nature abounds with nasty microbes.

But why bother with these fickle biological agents at all? Explosives aren’t nearly as hard to work with, and from the headlines it looks as if they continue to serve terrorists’ needs quite well. Finally, let’s remember that most of the official paranoia of the past decade was brought to us by a small group of guys armed with nothing but box cutters, basic flight training, and hatred. How are we going to redact that?

So Does The Flu Vaccine Work Or Not?

A paper that came out Wednesday on influenza vaccine efficacy has generated a new round of speculation about what is probably the hardest sell in the vaccine business. There’s a lot to complain about with our current flu vaccines: everyone needs a new shot every year, vaccine makers don’t always guess right about which strains of flu will be circulating that season, and plenty of people can tell stories about how they got the shot and still got sick.

Now, in the middle of flu vaccine season, we get a new peer-reviewed report – and of course an accompanying press release – that seems to bring more bad news:

“Evidence for consistent high-level protection is elusive for the present generation of vaccines, especially in individuals at risk of medical complications or those aged 65 years or older. The ongoing health burden caused by seasonal influenza and the potential global effect of a severe pandemic suggests an urgent need for a new generation of more highly effective and cross-protective vaccines that can be manufactured rapidly”, explains Michael Osterholm from the University of Minnesota, USA, lead author of the study.

The news coverage was a mixed bag, ranging from predictable rantings from the antivaccination nuts (no links – you can find them yourself) to balanced, nuanced explanations such as this. Most of it was somewhere in between, no doubt confusing plenty of regular folks.

While Mark Crislip provided a typically excellent and thorough overview of flu vaccine efficacy back in ’09, I’m just going to highlight a few important features of the new paper from Osterholm’s group.

First, there’s not really any news here. Yes, Osterholm and his colleagues did yeoman’s work mining the literature and compiling their data, but they could not escape the fundamental limitations of all meta-analyses. In a meta-analysis, researchers look at existing publications, pick the ones that meet a particular (and in this case extremely strict) set of criteria, and compile the results into a new paper. There’s no new experimentation involved.

Furthermore, the conclusion of this particular meta-analysis should surprise exactly nobody. We’ve known for a long time that flu vaccines are imperfect, and while Osterholm has now put specific numbers on that imperfection for particular age groups, those numbers are neither definitive nor shocking.

Osterholm’s latest results weren’t exactly secret, either. He presented them at the National Influenza Vaccine Summit in May, and the conference report I wrote for them went on the NIVS web site this summer. It may not be in the top of everyone’s news feed, but anyone who’s really tracked this issue closely already knew these results were coming.

These findings don’t alter the main conclusion of decades of public health advice, either. Flu vaccines aren’t 100% effective, but given their outstanding safety record, and the very real risks involved in catching the flu, they’re a whole lot better than nothing.

Finally, while the study’s headline conclusion was that vaccine efficacy averages only around 59% in healthy adults, the team also found that the H1N1 pandemic flu vaccine was a bit above average (69% effective), and discovered even better results for the live attenuated flu vaccine (LAIV, also known as FluMist) in one of the groups at highest risk of severe flu infection:

By contrast, LAIV showed significant protection against infection in young children, preventing influenza in 83% of children aged 7 years or younger. However, the Advisory Committee on Immunization Practices (ACIP) does not currently recommend LAIV over TIV in these children.

Besides its apparently higher efficacy, FluMist has another huge advantage: it’s inhaled rather than injected. My daughter used to scream her head off each Fall before, during, and after her flu shot. Now she can barely stop giggling through the procedure. With the new meta-analysis showing that this snorted vaccine is probably more effective for her than the shot, I can feel good about it as both a virologist and a father.

Another Great Reason to Get a Flu Shot

Getting an annual flu shot seriously reduces your risk of getting the flu, but now it turns out that it could also help prevent a heart attack:

We included 78,706 patients, of whom 16,012 were cases and 62,694 were matched controls. Influenza vaccination had been received in the previous year by 8,472 cases (52.9%) and 32,081 controls (51.2%) and was associated with a 19% reduction in the rate of acute myocardial infarction.

A little jab'll do ya. Image courtesy US Army Corps of Engineers.

A little jab'll do ya. Image courtesy US Army Corps of Engineers.

The researchers also found that getting the vaccine earlier in the season correlates with a lower rate of heart attacks than getting the vaccine after Thanksgiving. What are you waiting for?

Stick to The Data, Dammit!

The media coverage of H1N1 flu, and many physicians’ approach to the outbreak, are really starting to annoy me. A story in today’s Boston Globe typifies the problem:

Emergency doctors at Children’s Hospital Boston began seeing an increase in what they think are swine flu cases over last weekend, Dr. Anne Stack, clinical chief of emergency medicine, said yesterday.

What they think are swine flu cases. In other words, ER docs are applying the Wagner* technique to diagnose a pandemic. Here’s the money quote:

“Normally this time in October we see 170 kids a day, but on Monday, we saw 240,’’ Stack said. “We are assuming everything that looks like flu is probably H1N1.’’

Brilliant work, Dr. Stack, just brilliant. You didn’t order any tests, didn’t bother to consider any other possible explanations for the increase in your ER census, but nonetheless found the time to blab to a reporter about your “findings.” Here’s a thought: maybe more people with flu-like symptoms are coming into your hospital because of widespread panic. In previous years, they wouldn’t have bothered to go to the ER, but this year they did, precisely because of the kind of mindless hype you’re now perpetuating. If you don’t know what you’re talking about, please keep your damn mouth shut.

There’s a real outbreak going on here, with a real virus causing real deaths. Tracking and containing it will require real data.

* Wagner = Wild Ass Guess, Not Easily Refuted.