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Taking the panic out of pandemic….

This investigation from The Atlantic, raising many questions about the merits of influenza vaccination and the pandemic response generally, is worth reading for a few reasons.

Firstly, the authors, investigative journalists Shannon Brownlee and Jeanne Lenzer are at the cutting edge of showing there is a place for philanthropic and not-for-profit funding of health journalism. The Huffington Post Investigative Fund has published some of their other pieces, including this investigation raising concerns about the conduct of clinical trials. Brownlee is a senior research fellow at the New America Foundation and the author of Overtreated (2007), and  Lenzer is a frequent contributor to the British medical journal, BMJ.

As you may have seen from recent reports, Croakey is taking a keen personal interest in this funding model just at the moment.  This article, from the Columbia Journalism Review, reviewing the state of the media in the US, gives a number of examples of universities and health organisations getting involved in funding journalism.

The other reason the Atlantic article is worth reading is that you’re unlikely to have heard of many of the issues it raises before, at least if you’ve been relying on Australian media’s coverage of the influenza pandemic. So far as I’m aware, we’ve seen nothing from the local media (for-profit or otherwise) to rival the depth and incisiveness of the Brownlee/Lenzer piece. Much coverage has simply amplified the statements of government spokespeople and public health officials without critically examining the evidence underpinning them.

Meanwhile, here are two reviews of the article by local flu-watchers.

Associate Professor Heath Kelly, University of Melbourne, writes:

“This article provides a succinct account of some of the issues that impinge on our understanding of the control of both seasonal and pandemic influenza. It concentrates on the pharmacological interventions aimed at controlling influenza, the influenza vaccine and ant-viral medications. We learn that the evidence for the use of both interventions is not as good as many in the influenza community would like it to be. The facts are reported faithfully and the insight into responses to reputable researchers who have rattled the cage of public health orthodoxy makes for interesting and recommended reading.

Part of the problem with our imperfect understanding on the effectiveness of the pharmacological interventions arises from our imperfect understanding of the laboratory confirmed burden of influenza. This issue is addressed briefly on a commentary on the pandemic to be published on-line in the Medical Journal of Australia on Monday 16 November.”

***

Professor Peter Collignon, Canberra Clinical School, Australian National University

“Swine flu continues to generate both fear and controversy.  It is very important that the community has adequate information available so that we can know what were the mortalities and complications associated with this virus in various age groups and in certain risk groups (e.g. pregnant women).

We now have data available to answer some of these questions, particularly from data made available by NSW Health. These show that when the H1N1 virus spread thru the NSW population last winter 1,214 people with pandemic H1N1 influenza infection were hospitalised (17.2 per 100,000 population), 225 were admitted to intensive care (3.2 per 100,000), and 48 died (0.7 per 100,000).

Figures for the whole of Australia were similar with an overall death rate of 0.8 per 100,000.  The death rate in those under the age of 40 was 0.4 per 100,000. About three quarters of deaths were in those with associated risk factors. Thus the death rate in those under the age of 40 years and who had no known risk factors was 0.1 per 100,000 (or 1 per one million people).

We need to remember that at the beginning of this epidemic many experts and even Heath Departments were postulating that 20% or more of the population would get infected and there would be an associated case fatality rate of 1% or more. That translates to a population mortality rate of 200 per 100,000 people (or 300 times higher than what occurred).

Thankfully we did not get anywhere near that figure but it shows how we need to reassess many of our assumptions as they have proved to be wrong.

Figure such as these are important as we need these to make sensible decisions re the likely benefits versus risks from vaccines or other interventions. The Atlantic magazine article looks at these issues with regards to the efficacy and safety of influenza vaccines and also the likely benefits and pitfalls of the widespread use of drugs such as Tamiflu. It shows there are still many unanswered but fundamental questions.

We need research studies done with appropriate control arms so that we can move forward after we gain essential information that is currently lacking. The article is essential reading if you want to see the broader picture about swine flu and what actions we can take to ameliorate the problem and the likely success of these actions.”

And a final pointer from Croakey:

• A new journal, World Medical & Health Policy, has just published an article arguing that there are sound reasons for NOT expecting the worst of the 1918 pandemic to recur. It says the debate about the threat posed by pandemic influenza should move beyond “facile analogies and worst-case scenarios”.

It states: “While there has been sustained attention to the myriad trends that increase our risk from emerging infectious diseases such as pandemic influenza, far less attention has been paid to countervailing forces… It is important to take the panic out of pandemic. The response to the pandemic influenza should be guided by sound science, realistic risk assessments, and good public policy.”

DEM – that’s what is left when you take the panic out of pandemic. Any thoughts on what that might stand for?

Post Script with some more links that may be of interest:

• The public health blog The Effect Measure, compares the paediatric toll of pandemic influenza and pneumonia

• The Wall Street Journal health blog analyses the swine flu toll in the US

• A bowel cancer screening program in Northern Ireland is reportedly a casualty of swine flu spending