good news

It looks like Roche is going to license other drug companies to produce Tamiflu.

Sounds like a smart move. If demand keeps going up, they will make a lot of money from the licensing fees. And, should the worst-case scenario occur, they won't spend the next 50 years being known as the company whose selfishness killed millions of people...

(Thanks to PowerLineNews)

Catchphrase du Jour...

I sure get bored with the way journalists have to reduce every "type" of story to a formula.

At the moment I'm peeved at the many Avian Flu stories that use the "is it time to panic?" phrase. Like this one: As the deadly bird flu makes its appearance in Europe, should we stay calm or start panicking?

I suppose they are just being cute, but obviously panicking is stupid, whatever the danger...

Fear can be useful...

A doctor argues in the LAT that getting people frightened over the threat of Avian Flu is a bad idea. [Thanks to Betsy Newmark] I think he doesn't have a grasp of how to match danger against probability...and of course that's always a tricky problem, because there are many low-probability high-danger scenarios in life, most of which will not happen. Dr Siegal writes:

...Fear is a warning system intended to alert us to impending danger. The bird flu, though a potential large-scale danger, is not impending.

This is very misleading. It's like taking the high likelihood that a big quake will hit San Francisco in the next 50 years and saying: "an earthquake is not impending." It's not something we can say is or is not "impending" (at our present state of knowledge)--it could happen tomorrow or not at all

The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected.

The actual mutation feared is something that could take less than a minute. There isn't any such thing as "being on the road to mutation." This is similar to the mistake of flipping a coin and getting "heads" ten times in a row, and then thinking your next flip just has to be "tails." Each flip of the coin has the same probability, no matter what happened in the past.

Most human influenzas begin as bird flus, but many bird flus never change to a form that can harm us. Though flu pandemics occur on the average of three times per century, and we are clearly overdue (the last was in 1968), there is absolutely no indication that the transformation to mass human killer is about to happen. The threat is theoretical. Unfortunately, the attention it has received makes it feel like something terrible is inevitable.

EVERY threat that hasn't yet happened is "theoretical." It's silly to imply that this makes the threat less. And again, the mutation isn't something that "gives an indication that it is about to happen."

Why the overreaction? For one thing, direct comparisons to the Spanish flu of 1918, a scourge that killed more than 50 million people worldwide, has alarmed the public unnecessarily. In fact, there are many scenarios in which the current bird flu won't mutate into a form as deadly as the 1918 virus.

Of course there are. But the number of scenarios doesn't change or help us gauge the probability of any one scenario.

And even if we accept the Spanish flu scenario, health conditions in 1918 were far worse in most of the world than they are now. Many people lived in squalor; 17 million influenza deaths occurred in India, versus about half a million deaths in the U.S. There were no flu vaccinations, no antiviral drugs, and containment by isolating infected individuals wasn't effective, largely because of poor information and poor compliance.

Many people still live in squalor, and population density is now much greater. Flu vaccine won't be available for at least 6 months after the new virus appears, and there are questions about the efficacy of anti-viral drugs. Containment is unlikely to work, because Flu is more infectious than almost any disease.

Today's media reach could be a useful tool to aid compliance. Of course, the concern that air travel can spread viral infections faster may be valid, but infected migratory birds were sufficient in 1918.

Siegal has an anti-fear ax to grind, (he's pushing his book on the subject) and here he's talking nonsense. There is NO QUESTION that air travel can spread flu faster, and the 1918 flu was a Human Flu (of Avian origin) and spread from human to human.

Unfortunately, public health alarms are sounded too often and too soon. SARS was broadcast as a new global killer to which we had zero immunity, and yet it petered out long before it killed a single person in the United States.

That SARS petered out has no relevance to the POTENTIAL danger it posed. A Flu might fizzle out, or mutate into a less dangerous form. Or might not. That doesn't change its POTENTIAL danger, which is what we need to deal with. Siegal is basicaly saying that, because we didn't have an earthquake this year, the likelihood of an earthquake has decreased. That's idiocy. And the fear of SARS galvanized the efforts to contain it, and possible saved us from disaster.

SARS was something to be taken seriously, but the real lessons of SARS, smallpox, West Nile virus, anthrax and mad cow disease weren't learned by our leaders — that potential health threats are more effectively examined in the laboratory than at a news conference.

Bullshit. The political impetus that puts money in the laboratory stems from the scary news conference. And in many flu scenarios the laboratory work is irrelevant, and the preparations that ordinary people should make are vital. And will be stimulated by fear.

With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further.

Again, a mutation could change things instantly.

It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer.

And they may not. But government has been very slow to prepare, and now that fear is growing, it is starting to move. Fear is USEFUL. It would be better if we all acted like wise philosophers, but we don't. And anyway, here we have a supposedly wise professor, who seems to know nothing of the rules of probability.

But, right now, there is no value in scaring the public with Hitchcockian bird flu scenarios. The public must be kept in the loop, but potential threats should be put into context. The worst case is not the only case.

What "context?" We don't really know. There are many many scenarios where I play golf in the rain, and have a good time. And one scenario where I get struck by lightning. So, not to worry, right? The worst case is not the only case, right?

Time to start paying more attention...

Here are a few Avian Flu blogs
H5N1
Avian Flu - What we need to know
birdfluwatch.co.uk

Influenza Pandemic has interesting historical charts of epidemics and pandemics.

Also, I've added Avian Flu to my list of categories. You can click to see other posts...

Avian Flu: "This is a right now issue..."

Hugh Hewitt:

...Even as work accelerates along the Gulf, the dangers from terrorism remain, and a new threat continues to approach: avian bird flu. Given that everyone who follows the subject sees the threat of an epidemic as a real possibility, the Adminsitration simply has to have a plan and it has to work. Today's Wall Street Journal's report on vaccine production is thus not comforting. (Subscription required.) Key infromation: The Department of Homeland Security gave Sanofi-Aventis Group a $100 million contract to produce a supply of the vaccine to thwart the killer flu. Other, smaller contracts have been let as well, but the gap between promised supply and obvious need is huge:....

.....Look. This is a right now issue, with Indonesia reporting its fifth case just hours ago. The UN's chief health official is ramping up his warnings, and although the president emphasized the threat at his UN speech, the American public is not aware of the magnitude of the threat, and a plan to produce vaccine for 20 million people in a nation of 300 million when the disease may have as much as a 50% kill rate just isn't "preparedness."

A whole lot of money is about to gush out of the Congress, and while the recovery effort on the Gulf deserves its priority status, the Congress should appropriate whatever it needs to in order to get the supplies of the necessary drugs up and running. A couple of well-publicized hearings on this matter would also be useful.

The buck will again stop on the president's desk, though, and he knows it. I hope he has communicated to all involved that he wants a plan on his desk on the hour by hour response once ABF reaches the US.

Skeptical? Read this. There are plenty of threats in the world (including this terrorist plot that almost got started in Los Angeles, and very few of them can be thwarted just by spending more money. ABF is, however, one of those threats which can be boxed in with planning and budget as it is a question of having and distributing the vaccines and treatments that work...

My understanding is that, no matter what we do, there will not be vaccines to combat the first wave of the pandemic. The flu that hits will be different from what's seen now; Flu mutates easily, which is why it is so hard to fight. and vaccine production takes time. (And the mutations could make the flu less deadly. So this could all fizzle-out, but that doesn't mean the threat wasn't real!)

More on possible Flu Pandemic...

When I was writing about a possible flu pandemic recently my good wife reminded me to check with my sister Jan. Well, duh. <smack forehead> She's an epidemiologist! (Janet McClure, nurse and epidemiologist BSN, MPH). I still think of her as a nurse, but she's in a doctoral program in epidemiology, and will soon be "my sister the doctor." </smack forehead>

She did not find my alarm in the least bit excessive. Quite the contrary...

...The reason this strain of flu is so worrisome is that it attacks the lung's microscopic air sacs and prevents exchange of oxygen and CO2. Modern medicine cannot solve this problem because ventilators can push air into the lungs but cannot  make oxygen go through lung membranes that are not functioning.

 If you read the letter at the end of the link you provided, you will read a description how rapidly healthly men became ill and died of what is called "air hunger".

The expectation by public health experts is that due to lack of preparation and the nature the most worrisome flu strains, there will be a collapse of the US commercial and healthcare infrastructure as there was in 1918. Many deaths will occur not from the flu but from lack of food, fuel, etc as there will not be sufficient people who are able, willing, and available to provide services such as banking, transportation and sale of  food, gasoline, medication and basic healthcare even for serious existing conditions such as asthma, diabetes, heart disease etc. This is described in academic terms in the attached article p.590-1  " Social disruption, interruption of commerce, school closings, and public unrest are likely when many people are ill at the same time."...[link]

It's time to wake up and get ready! Make preparations. Be wise.

(Oh and by the way, I discovered she is ALSO a Vitamin C enthusiast)

"Hoping to dodge a bullet" is not a plan...

...as we have seen recently. And there is a possible disaster on the horizon that could dwarf Katrina.

Our friend Dave recently passed us some links on the subject of Avian Flu. (Read THIS, and this) The possibility of a Flu pandemic really looks like a threat that should be taken seriously. NOTE: You will, when you read up on this subject, find frequent references to the 1918 Pandemic killing 20 million people. That figure is long out of date; historians now have estimates ranging from 60 to 100 million deaths worldwide. The equivalent for today's much larger population might be half-a-billion!

I have one bit of advice to add to what's easily available on the Web. There is, in the world of medicine and health, a large blind spot on the subject of Vitamin C. (I bet some of you are recoiling at this moment, and thinking, "Oh no, another food-faddist." But if you read Random Jottings you probably know that I'm pretty down-to-earth, and don't recommend any Appalachian folk remedies).

Anyway, I've been following the subject for about 30 years now, and I've seen that blind spot often. As one web site put it:

...Many studies have shown that Vitamin C is quite effective in treating and preventing colds. The medical profession is not very interested. The popular media always seem to take the same position. It goes something like this:

• A study shows positive results
• The results are discussed
• The story ends with the warning of taking too much C and that we are all probably better off just eating a proper diet.

It is all such a shame

I think scientists and doctors shy away from the subject because it seems flaky and "amateur." And probably the herbal remedy types find Vitamin C too clinical and chemical (unless in the form of Rose Hips). But in fact, the scientific evidence in favor of routinely taking doses of Vitamin C much larger that the RDA is compelling. I'll just give you one example: Almost all animals synthesize their own Vitamin C. And they ALL do so in amounts much higher than the RDA, some as much as 10,000 mg (10 grams) per day per 70 kg of body weight. Compare that with the US RDA of 60mg! (Those RDA's, by the way, never had much science in them. They are regarded with awe, because they are from the GOVERNMENT, but in fact they were mostly guesswork.)

So, Vitamin C and the flu.

And what does your body do with this stuff? A lot--Vitamin C is a co-enzyme in hundreds of enzymatic reactions. Most importantly, it is used by your Immune System, and if you are sick your body wants plenty of it.

This is a complicated subject; you might want to read Vitamin C, the Common Cold and the Flu, by Linus Pauling. I won't tell you what to do, but I personally consider 2-4 grams per day a minimum, and if I or my family has Flu, we are going to be taking at least a gram or two an hour. I feel confident it will make a big difference, but even a small difference could be crucial, because a killer flu will leave a lot of people hovering right at the edge of death, or too weakened to nurse others. (And hospital beds will not be available!)

And you are probably asking, does John Weidner get colds and flus? Well, the answer is, no, sort of. What usually happens is that, when all about me are taking to their beds with boxes of Kleenix, I just feel run-down and blah. But not so much so that I can't work. (Hmm. That may be a disadvantage.) I'm rarely sick in bed with a cold, certainly less than once a year. And those times seem to be connected with neglecting to keep my C level extra high when I'm not feeling my best. (And yes, I am perfectly aware that this is anecdotal evidence, and doesn't carry a lot of scientific weight. Make of it what you will.) And I would normally never blog about personal health matters, but the thought of a killer epidemic kinda concentrates the mind. Makes me remember reading The Stand.

[Bronson is a good source for C. Add baking soda to powdered C to make it less acidic (ratio 1-3). And Costco has good 1000mg tablets.]