Monday, June 15, 2009

Speaking of Swine Flu

Fear of disease vs. death toll
see more Funny Graphs


  1. Then there's the Andromeda Strain -- you know the government is holding out on us about that.

    Dr. Phil

  2. Eeeehyeah. I'd put AIDs in with the overblown fears.

    But what this graph does not represent is the "airshow over a crowded city" phenomenon - we don't hold airshows over cities despite the fact that most shows would be just fine, because if there is a crash, it would be devastating.

    Similarly, breast cancer isn't an airshow - it's not going to mutate into an even deadlier form and suddenly hop from person to person on a crowded train. Nor is malaria going to suddenly hop to the developed world and spread violently. (And breast cancer is not the killer of young adults via cytokine storm that the flu is).

    But the flu could both hop to new regions and mutate into a deadly strain at any point, and without warning. While the odds are it won't, if it does it could be devastating. This particular strain of H1N1 is worth keeping an eye on, if only for the rapidity of its mutations.

    /Risk Manager

  3. Just to second John, you're comparing apples and oranges.

    Flu is a contagious disease that you can get just by being in public.

    Breast cancer and malaria you aren't going to pick up from door handles.

    Now if you compared swine flu morbidity and mortality with the morbidity and mortality rates for the regular flu and measles and other infectious disease that are making a comeback because parents refuse to vaccinate their kids, then you'd be comparing apples to apples.

    And sorry, but I am concerned with the swine flu, just the same as I'm concerned with the flu strains that go around every winter. I work in a medical facility, so I have constant exposure to cooties. And my 91 1/2 year old grandmother lives with me. Any strain of the flu could easily kill her. But a strain for which we don't currently have a vaccine is a big problem.

    Personally, I expected the next flu pandemic to come from Asia.

  4. My impression of this chart was not about the "how much should I worry about this" question, but rather "is attention being given to this".

    In that respect, the contagion issue is immaterial. Could we save thousands of lives by distributing mosquito nets to countries with high malaria rates? Yes. Do we? No, 'cause it's someone across the globe's problem and doesn't affect us or our loved ones directly. Can we cure breast cancer by running in 5K races? Maybe, maybe not, but it's fun and it makes us feel like we're doing something. You'll have to fill in the blank about what the hysteria about the flu is contributing towards curing/protecting us from it. Seems to me that it's a good opportunity to educate people about protecting themselves from contagion, but that's not necessarily what I'm seeing.

    Interesting how we read the same chart and get different reads on it based on our preconceptions.

  5. Anne, the graph title is "Fear of Disease", not "Resources Devoted to the Disease", which are different phenomena, because one is an issue of almost Homeland Security proportions, and the other two are science policy and foreign policy issues, respectively.

    To some degree, government resources should be distributed to those governed (and taxed) first.

    Not to say we should not do more about malaria. You should not get me started on the developed world's resistance to limited DDT use in Africa because of ecoweenie concerns about raptors here in the Northern Hemisphere.

  6. Oh, and I meant to add that the hysteria about the flu has spurred an accelerated H1N1 vaccine development, which is a positive side effect.

  7. Even so Anne, note that one of the markers is, "We need to take action NOW."

    Yes, we should do things to ameliorate malaria, such as mosquito netting. But the important thing here is that the morbidity and mortality of malaria are unrelated to human to human transmission.

    A public health failure with malaria does not have the same consequences as a public health failure with the flu.

    We fail to contain malaria, the morbidity/mortality will remain about the same. We fail to contain an infectious disease, such as the flu, and you're looking at global consequences, with (as usual) the poorest countries with the worst public health systems getting hit.

    To look at it another way, the average individual can take steps against breast cancer and (if they are in the developed world) malaria.

    There is little you or I can do to ameliorate our chances of getting the flu, other than washing our hands and staying away from sick people--people who are most likely contagious and shedding virus before they actually feel sick.

    In other words, the failure of the public health system regarding a contagious disease has very different results than the failure of the public health system re vector transmitted diseases such as malaria.

    Or, to look at it yet another way, swine flu is wandering over to Asia as we speak. Asia is still dealing with the bird flu, which although not highly contagious via human to human transmission, is extremely deadly, with a low survival rate that is dependent upon prolonged quality hospital care.

    If the swine flu and the bird flu were to interact and mix, what you could end up with is a contagious illness that is extremely deadly.

    Which is essentially how deadly pandemic happen. You get a mixing of two flu strains and the result is something to which most people lack immunity.

    Essentially, the threat of the flu is far higher than the threat of a non-contagious illness, and in public health, you need to focus first on communicable diseases, and then after you've dealt with those, look at non-communicable disease, like breast cancer.

    It's like comparing the homicide rate to the deadly accident rate. They two statistics simply aren't comparable, even though they both involve people dying.

  8. Another lens you could use on this. A guy could die of H1N1. Including a guy in government voting on resources or spreading fear. Though it CAN occur quite nastily in men, breast cancer is a "woman's disease", and like making sure that women are part of big studies on aspirin use to prevent heart attacks, etc., women are not always on the radar of guys-in-government. Finally malaria kills poor people overseas who don't look like guys-in-government, who will say, "Not my problem."

    Now, if you want to talk about resources being spent by corporations, then the BIG medical problems are, in no particular order, ED, Low-T and losing hair. In men. (The big advertising rush on Low-T is really annoying me these days -- I have a blog rant coming. We need to worry about guys getting MORE testosterone?)

    To be fair, some guys are getting it on the breast cancer thing, because baseball players, etc., have mothers, sisters, aunts, grandmothers, girlfriends and wives in varying quantities. Not sure whether politicians have wives or they are merely spawned from the forehead of Satan... (grin)

    Dr. Phil

  9. Whoops, that's supposed to be "not sure if politicians have mothers". Stupid Blogger won't let you post edit.

    Dr. Phil

  10. A sadly accurate yet funny view of how the public views risk.

  11. Actually, Dr. Phil, the big resources are not being spent on those diseases. Do not confuse the visibility of a Direct to Consumer ad with actual research dollars being spent. Or scrips being written. Anti-cholesterol drugs outsell ED and hair loss drugs by over two orders of magnitude.

    The ED and hair loss drugs have not, in fact, made as much money as they were expected to.

    So the groups commercializing those drugs spend money on DTC. Those DTC dollars drive people into the physician's office for a scrip, because sales have leveled out, otherwise. Hence they are the ones you see.

    Advertisements to physicians, which you do not see, do not concentrate on ED or hair loss, they concentrate on the diseases with the highest populations. Heart disease being the biggest.

    The big resources in drug development are being spent in two main areas: diseases with high epidemiology (atherosclerosis, osteoarthritis) or in diseases with small populations where insurers will pay big bucks to avoid death or morbidity (oncology, auto-immune diseases such as MS).

  12. Having worked in medical facilities in the past, our policy was innoculate first, ask questions later, both for staff, support departments and long term residents.

    As a matter of fact, I did tech support there. One year I was crawling under a desk to plug in cables when I heard the voice of our Employee Health nurse saying "oh, good, you're ready for your flu shot!" Yes, she knew who's ass was in the air and had I stayed in that position, I can guarantee you she would have shot me in the ass on the spot! I thought the CEO's secretary was going to hit the floor laughing at how fast I got up!!

    But, on the swine flu issue, I take public transportation daily. And THAT concerns me, most people don't have the wherewithall to take even simple precautions like covering their mouth when they sneeze or cough.


  13. You know what I like about you people? I can put up a simple graph like this, and you completely get the point of it. You all immediately see why it's wrong (apples and oranges) and yet still see why I posted it - and then go on to have an intelligent conversation about the real subjects.

    Speaking of illness, I am deathly ill this morning. Some kind of bronchial infection. They've got me on antibiotics and it seems to be helping. The sore throat is gone, but I still feel like I'm hacking up my lungs when I cough and I gurgle when I breath. Chest hurts, damnit.

    I honestly think I'm improved over yesterday, but between this and the hand injury don't expect much in the way of posting. My brain feels like sludge.

  14. John, there you go talking about reality. I'm talking about perception. Guys don't really give a flying fuck about their cholesterol levels and just wish their doctors and their wives would shut up about it and let them eat steak and potatoes with butter on it. Guys see those Butterton ads and cry. Hell, even Scalzi blogged about thinking about eating a stick of butter.

    But Broke Dick Disease, No Hair Disease and OMG I'm Not Man Enough Disease -- those are the sorts of things that guys worry about. And Jim's original graph was about fear.

    Guys worry about cholesterol in the ER while waiting for the doctor to either grab the paddles or schedule a quadruple bypass... (grin)

    Poor guys.

    We, of course, meaning the Men of the UCF, are much superior than that. Except for those UCF Men currently showing their human frailings. (ducks)

    Dr. Phil

  15. But see, that's the thing, Dr. Phil, you'd think that Viagra et al. would generate big sales because of the interest, but they're more like a nudie bar - people flock to look, but they don't touch.

    Research with partners has shown a lot of women in their 60s are relieved their partners are not so randy any more.

    Add in the contraindications (can't take it with nitrates, and heart disease is a big cause of ED) and the market is a lot smaller than you'd think from the interest.

  16. Wait, you're saying the market is shriveling?

    ::Spock eyebrow::

  17. No, Karl, he said the market was flaccid, they expected it to rise, but it didn't. This has been hard on the marketing department, and it left the research folks hanging. Not to mention that the competition is stiff and growing...

  18. No, the competition is rigid with envy because of Viagra's first mover advantage.

    The girlfriends and wives, however, are left holding the bag.

  19. I dunno, John, sounds like a inflated opinion...

  20. ...or half-cocked - at best, premature...

