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View Diary: Flu Stories: UK Deals With H5N1 Outbreak; US Plans For Graded Response (115 comments)

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  •  But the risk is so low (0+ / 0-)

    We're not very good with assessing risk. Here we have a situation where the mortality rate is high but the risk is so low as to be negligible. Zero Americans have died from bird flu, yet 36,000 Americans die from regular flu. Which should we make sure we vaccinate for? Which should have long posts with 100s of comments?

    But this isn't about DemFromCT. Extreme reactions to tiny risks is what brought us the thinking behind the White House's The One Percent Doctrine.

    It's also what contributed to several thousand more people dying in vehicle accidents when they decided to drive instead of fly after 9/11. If you drive 12 miles to the airport to take a cross-continental flight, the most dangerous part of your journey is already over.

    We have to balance false worry with complacency I guess. The public feel that there is every likelihood of human-to-human transmission of avian flu (a study showed they estimated it at 60%) while experts think it more like 10% (source: the Time article).

    By the way, according to the CDC diagram we're already undergoing a Category One in the US (regular flu, and what is the lower limit here, it just says <90,000?)</p>

    Here are some other ways of dying we could worry about:

    Category One: Suicide (30,000 deaths annually)
    Category Two: Smoking (438,000 deaths annually)
    Category Three: Heart Disease (685,000 deaths annually)

    My issue with public health PSAs is that they can cause unnecessary worry for some and complacency in others. Remember how sickle cell anaemia is a "black" disease? Well it isn't; there's no biologically meaningful category of race, but if you're black you worry about this, while others, who may have sickled cells won't. Same with diabetes.

    Public health that doesn't look across the culture-nature spectrum is going to be incomplete.

    •  actually this is not a cat 1 (2+ / 0-)
      Recommended by:
      splashy, tzt

      cat 1 would be above and beyond the usual 36,000 annual deaths, although your point about how nasty seasonal flu can be is well taken. Some see seasonal->pandemic as a spectrum, hence the graded response.

      But it goes back to hurricane thinking. The flaw in your argument is in looking only at the risk as of this moment (miniscule) instead of understanding that this is a cumulative risk (which, over time, grows larger) and that the plans and concerns are for this year, next year and the next 10 years. Yet, the complexity of planning requires a multi-year milti-agency/stakeholder effort.

      Again, think of hurricanes. You can't say "well, more people die in motor vehicle accidents than cat 4 hurricanes, so why bother planning, especially since we didn't have a hurricane this year?" The result is Katrina-type aftermaths in a non-predictable but inevitable fashion, and that is simply not acceptable. Saving lives requires that we avoid a failure of imagination, as in "no one could have predicted..."

      Been there, done that.

      BTW, the cross-cultural need is well-taken and the point is important. We can't just help the internet-savvy. That's a flaw in pandemicflu.gov, and that's why we need PSAs.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 04, 2007 at 06:43:47 AM PST

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      •  risk is relative... (0+ / 0-)

        Again, think of hurricanes. You can't say "well, more people die in motor vehicle accidents than cat 4 hurricanes, so why bother planning, especially since we didn't have a hurricane this year?" The result is Katrina-type aftermaths in a non-predictable but inevitable fashion, and that is simply not acceptable. Saving lives requires that we avoid a failure of imagination, as in "no one could have predicted..."

        I feel you're lurching between extremes. I did not suggest we "should not bother planning" for things that have a lower risk than others.

        My point was that we aren't very good (as a society) at assessing risk, and that the very mentality of risk is what gives us the one-percent doctrine in response to terrorism (a point you did not address). We often over-play things with minuscule risk (avian flu, homicide) and underplay things with known, high, risks (smoking, driving). I do this too, btw!

        Risk may or may not be cumulative. The risk of dying from last year's strain of flu is lower now than then.

        PS Re: PSAs. I didn't say we don't need them, rather that they can give misleading impressions, because in their attempt to get a clear message out they're not adequately describing a complex situation.

        This often leads to inappropriate responses by the public (eg., over-estimating the chance of sickle-cell anaemia or diabetes if you're black, even though there is no biological meaning to race). Corporations then profit from this, eg BiDil, the first FDA "race-based medicine". There's a website in Florida that sells race-based vitamins ("if you're Latino, click here"). Coincidence? Maybe, but I think it's because we're presented with race-based information so often.

        Risk assessment is a political act, as surely Katrina showed. Katrina was predictable in the same way that global climate change leads to predictable consequences.

        •  pandemics are in the category (0+ / 0-)

          of global climate change and Katrinas rather than 1% solutions. They are cumulatively higher probability,  although they are low probability, high risk for any given year.

          Sorry if I've misinterpreted what you are saying. I don't think a rational transparent data-driven approach to things like pandemics and hurricanes, with stakeholder input from the public, has much to do with political approaches to terrorism.

          Now, if you are saying you don't trust the government or this administration regardless, that's another issue altogether. I would point out that there's plenty of outside-the-government opinion supporting thhis pandemic approach, some of which I've quoted in the comments.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Feb 04, 2007 at 08:28:15 AM PST

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          •  Guess I wasn't clear... (0+ / 0-)

            Now, if you are saying you don't trust the government or this administration regardless, that's another issue altogether. I would point out that there's plenty of outside-the-government opinion supporting thhis pandemic approach, some of which I've quoted in the comments.

            No, I wasn't saying that. I'm saying let's put it in perspective! Killers such as malaria and AIDS have not disappeared. We've spent billions of dollars on developing millions of doses of anthrax and smallpox vaccines (most of which are thrown away), yet in 2003 Congress approved only half the $100 million requested to develop better flu vaccines.

            I was linking to the Time article about misperceptions of risk, which in turn is based on interesting work of people like Gerd Gigerenzer on "dread risk," and discussions about the whole way the risk-to-fear meme operates (hereand herefor example).

            One might also usefully read this book by an MD on the politics of fear: False Alarm. He usefully differentiates between potential risk and actual risk.

            And as he points out, one does not need to claim that there are no risks to understand that risk is not always correctly perceived by the public and the media, or that public authorities can exacerbate those misperceptions. For example, flu is likely to be more of a worry in developing countries where medical resources are stretched, rather than the USA.

            When parents of newborn babies won't let relatives visit in case of flu transmission, when there is panic about school closings, we might wonder how we got to that point.

            As Dr. Gerberding (Director of the CDC) has said:

            "for almost everyone, flu is not such a serious disease. We don't need to panic or assume that the worst-case scenario is going to happen to everyone. Most of us will get through this fine."

            Thanks for the conversation. I'm off to wash my hands!

            •  thank you! it is an interesting topic! (0+ / 0-)

              I cringe when I see the word 'panic' used in relation to bird flu, because no one is panicking. Everyone who uses the term should be required to give two examples of actual panic over bird flu.

              Instead, the assumption is made (and a faulty one, disputed by research and congressional testimony from communication experts) that "people will panic".That's wrong. The public will not panic. They will adjust. The problem is too little info, not too much. A background awareness needs to become the 'new normal' as risk communication expert peter sandman describes it. And the paternalistic attitude towards information only engenders distrust.

              So, thanks for bringing up the topic. it is really interesting.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Feb 04, 2007 at 06:51:57 PM PST

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    •  PS this kind of thinking (0+ / 0-)

      may well lead to mandatory flu shots for health care workers.

      All health-care workers should be required to get a flu shot every year, unless they formally refuse in writing, the Infectious Diseases Society of America (IDSA) said today.

      The society called on the federal government to plug what it called a "critical weakness" in the nation's influenza preparedness by ensuring health-care workers are protected.

      "It's our professional duty to first do no harm," pronounced Andrew Pavia, M.D., chief of pediatric infectious diseases at the University of Utah and chair of the society's National and Global Public Health Committee.

      "Voluntary systems haven't brought immunization rates up far enough," Dr. Pavia said, calling for a regimen with "more teeth in it."

      It's not just business as usual.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Feb 04, 2007 at 06:47:22 AM PST

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