Thursday, 30 April 2009

Making a pig's ear over swine flu - the Jenkins/Goldacre debate over media coverage of H1N1

OMG teh Pig Feva iz cumming to get u!!

Or, to put it in rather more prosaic language, the outbreak of porcine influenza virus that has claimed dozens of lives in Mexico is spreading, and with each day comes news of confirmed cases in North America, Europe and Israel. With each day too we see more and more alarming headlines, such as that in the first link above -
The whole of humanity is under threat
- from the esteemed publication The Sun, to choose but one example. How is the public meant to balance these two streams of information? On the one hand we have the World Health Organisation steadily increasing its pandemic alert - currently at phase 5 out of a possible 6 - and on the other we have the likes of the People's Medical Journal (aka the Daily Mail) spouting stories that to many would appear to be parodies. Who to trust - are we doomed, or is the meeja up to its old crying-wolf trick?

This question has occupied, amongst others, Simon Jenkins, who wrote a riotous piece in The Guardian damming the entire episode as hype and scaremongering. In response Dr. Ben Goldacre penned a somewhat more considered article in today's Grauniad, in what he describes rather unfairly on his blog as "possibly the most boring thing I’ve ever written in the Guardian." I respectfully disagree, Ben; boring to some maybe, but it's hugely important to how the country reacts to this latest potential pandemic.

I'll say at this point that Jenkins' frankly absurd suggestion that the World Health Organisation is over-funded has been expertly dealt with by Gimpyblog, and I'll refrain from commenting further on that other than to say that I for one applaud everything in that post that is supportive of scientific research and dissemination thereof.

Jenkins' main contention appears to be that because previous health scares on this scale failed (SARS, Avian flu etc) to materialise into the full-blown 28 Days Later scenario, this current flu outbreak will turn out to be nothing more than
a panic stoked in order to posture and spend.
Jenkins goes on to reveal a really quite blasé attitude to influenza:
Flu makes you feel ill. You should take medicine and rest. You will then get well again, unless you are very unlucky or have some complicating condition.
Yes Simon, but it's this last bit that's crucial isn't it? Although exact numbers are difficult to find, it is estimated that several hundred deaths per annum are caused by influenza-related respiratory illness in the UK (although these figures relate to influenza and pneumonia together, I haven't yet found reliable figures for influenza alone, presumably because of the lack of molecular analysis from patients...). And this is for plain, vanilla Influenza A, before those pesky porkers sent their virus our way.

Yes of course that's but a fraction of the total deaths from all causes (in the USA it's estimated to be associated with around 7% of all deaths in winter months), but a significant fraction nonetheless. So to say that flu makes you feel ill is somewhat missing the point - yes it does, but it can also kill.

So why the supposition that this too shall pass? Is that any more sensible a position to take than the end-of-the-world doomsday outlook? Well, according to Goldacre, and to this blogger for what it's worth, not really. As Ben points out, from the sparse data available thus far it is nigh on impossible to predict how many will get infected, how many of those unfortunates will fall seriously ill, and how many in turn will die. Too many variables will impact on each of those outcomes. What is certain is that it is responsible and appropriate to make such preparations as we can - applying the precautionary principle seems sensible as in the even of a major pandemic, we need to be prepared to matter how many people voice their concern that this is just another media-driven scare.

Which brings us to what I think is Goldacre's central observation. Following health scares that really have been exaggerated by the Fourth Estate (MMR springs to mind...),
not only have the public lost all faith in the media; not only do so many people assume, now, that they are being misled; but more than that, the media themselves have lost all confidence in their own ability to give us the facts.
Quite. Having heard journalists cry wolf for so long without any wolves appearing, the default position of many is now "oh, it's just the press ratcheting up the fear again..." Problem is, istdoes appear as if this time there is a significant risk of pandemic and pandemonium. Which is the point - it's a risk, not a certainty either way, but a risk, and until the public understands the difference and how to deal with it I'm afraid we'll always have the hyperbole and the cynicism, the sandwich-board Armageddon types and the sneering cocksure Jenkins-ites.

Suffice to say that time alone will prove Jenkins right or wrong, as of now I hope it's the former but am more and more concerned that history will prove him to be closer to the latter. Watch this pig-shaped space...


Rick said...

The problem is context. It's all very well to say "Well, 180 million dead IS a possibility" if we don't know how possible that is.

It could be a one in a billion chance that the virus will turn out so devastating, but we'd never know that from the coverage.

Ben's article is fine: yes, they're merely stating risks. Yes, the papers are a vastly devauled currency on these issues. But having said that, it helps no-one simply to state the wild possibilities of the epigdemic without context.

The 'balance' needed in the coverage isn't phoning up Ben to debunk the lot. It's giving us some kind of range of probabilities: while it might well wipe out civilisation as we know it, chances are it'll leave some Mexicans dead and a few thousand other people sniffling.

teekblog said...

@ Rick: thanks for the comment. Fair point about context, only I'd question how anybody is supposed to calculate the odds of the virus killing for example 180 million. I interpreted Ben's article as saying that this is precisely the sort of thing science cannot predict to any degree of accuracy, and that some amount of guesswork is required.

But you're right about balance not coming from having naysayers damming the entire thing, it's to put the threat into perspective - the point I was making was that Jenkins, in trying to calm the hysteria, misses the point of why the media is reporting swine flu as a potential pandemic in the first place: because it's exactly that, a potential pandemic, which has some chance of becoming a major global crisis. There, I used the word crisis - maybe according to Jenkins I'm now stoking the hype...?!

NM said...

I, for one, think the sandwich-board Armageddon types are on to something :)

Warhelmet said...

da aporkalypse pwn u. It killz yr d00ds in yr base.

Political interference in public health policy has also eroded public confidence in public health communications. Edwina Curry, anyone? Of course, the media descended on Curry like a flock of vultures, or perhaps a pack of hyenas. And some elements of the media will knee-jerk against any public health message because they are incapable of seeing public health as anything other than a political issue. Sorry, I don't subscribe to the "everything is political" meme.

pj said...

I'd be prapred to put money on Jenkins being near the front of the queue to condemn the WHO and medical profession for complacency if it did turn into a global pandemic.

yesalem said...

It was called "the Great White Plague." It is hard to imagine the devastation caused by the Flu Epidemic of 1918-19. People who lived through it reported that some one who was up and well in the morning could be dead by evening.

Dr. H. A. Roberts was a physician on a troop ship at the time. Another boat pulled alongside to get any spare coffins- it's mortality rate was so high. On his return to port, the commander said to Roberts, "used all your coffins?" To which Roberts, who had been treating his ship with homeopathy, replied, "Yes, and lost not one man!"

The following is an extract from an article entitled "Homeopathy In Influenza- A Chorus Of Fifty In Harmony" by W. A. Dewey, MD that appeared in the Journal of the American Institute of Homeopathy in 1920.

Dean W. A. Pearson of Philadelphia collected 26,795 cases of influenza treated by homeopathic physicians with a mortality of 1.05%, while the average old school mortality is 30%.

Thirty physicians in Connecticut responded to my request for data. They reported 6,602 cases with 55 deaths, which is less than 1%. In the transport service I had 81 cases on the way over. All recovered and were landed. Every man received homeopathic treatment. One ship lost 31 on the way. H. A. Roberts, MD, Derby, Connecticut.

In a plant of 8,000 workers we had only one death. The patients were not drugged to death. Gelsemium was practically the only remedy used. We used no aspirin and no vaccines. -Frank Wieland, MD, Chicago.

I did not lose a single case of influenza; my death rate in the pneumonias was 2.1%. The salycilates, including aspirin and quinine, were almost the sole standbys of the old school and it was a common thing to hear them speaking of losing 60% of their pneumonias.-Dudley A. Williams, MD, Providence, Rhode Island.

Fifteen hundred cases were reported at the Homeopathic Medical Society of the District of Columbia with but fifteen deaths. Recoveries in the National Homeopathic Hospital were 100%.-E. F. Sappington, M. D., Philadelphia.

I have treated 1,000 cases of influenza. I have the records to show my work. I have no losses. Please give all credit to homeopathy and none to the Scotch-Irish-American! -T. A. McCann, MD, Dayton, Ohio.

Warhelmet said...

@Yesalem - I pwn ur base. All ur d00ds iz dead.

yesalem said...

yr hell mate will protect u like a vaccine does-:) Bah

Warhelmet said...

Ooh. Elektro-magnetical wave forse front. Meh hat = tin foil.

CGR said...

@yesalem - love the gallows humour spoof.

Spent the last two weeks in France and UK and on both radio and TV in both countries I have only heard cautious, sober, realistic warnings from the scientists/medics when they were presented to speak for themselves. And that even allows for media types to do their selective editing. As has been widely observed, it is the media themselves that are creating the hype that they go on to condemn. Funny old world.

Trouble is, the media do have a real role to play. There is a powerful need right now to tell the public that there is a real risk of shit happening, and there are some fairly simple things - like more hand-washing - that can be done to reduce the risk. It is a subtle message: of raising anxiety enough to induce a change in behaviour but not enough to cause panic (or in our cynical times, disbelief in any message whatsoever). Sadly the media, especially the large-circulation papers, do not appear to be up to it. They have disappeared into their own post-modern maelstrom of fact-free hysteria.

PS. It's a delight to hear the French radio presenters rolling their tongues around "La grippe porcine". It has to be said with full rolling of every guttural r, explosive p sounds and formidable emphasis on the final "-ine". And - at least a few days ago - the smugness as it was announced that no cases had occurred in France was almost tangible. I do love that country.

bengoldacre said...

ace. just wanted to say, time will not prove jenkins right or wrong.

if the current risk of a pandemic does not manifest into a pandemic, that will not change the fact that there is currently a risk of a pandemic.

similarly we have not had a SARS outbreak, or bird flu (yet), but that does not mean they were not risks previously.


teekblog said...

@ bengoldacre: yep, good point - risk is independent of whether it manifests, if that point is lost on me then Jenkins has somewhat less chance of getting it...!