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.

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