Sunday, May 3, 2009

Pearls Before H1N1

The swine flu is making me sick. I don't have the virus (at least no symptoms), but the whole panic over it annoys me on multiple fronts. Take this recent AP story as an example. 241 cases? Is this really worth worrying about? I find the following quote particularly telling:

Even if the swine virus doesn't prove as potent as authorities first feared, Besser said that doesn't mean the U.S. and World Health Organization overreacted in racing to prevent a pandemic, or worldwide spread, of a virus never before seen.

With a new infectious disease, "you basically get one shot, you get one chance to try to reduce the impact," Besser said. "You take a very aggressive approach and as you learn more information you can tailor your response."

It was just over a week ago that authorities learned the new flu CDC had detected in a few people in California and Texas was causing a large outbreak and deaths in Mexico, triggering global alarm.

"We didn't know what its lethality was going to be. We had to move. Once you get behind flu, you can't catch up," Homeland Security Secretary Janet Napolitano said.

Maybe an informed reader can help me out here. Is there any reason to believe that the "very aggressive approach" makes any difference at all? Do all of these countermeasures have any effect? I get the feeling there's a whole bunch of "virus nerds" at the CDC just waiting for the opportunity to do something, which more than anything is to feed public hysteria and justify their existence. Maybe I'm being overly pessimistic, but the track record of government science types is pretty abysmal. I do think that they think they're being helpful, but I really have a difficult time shaking the feeling that anything public health authorities do to try and stop a virus (which has evolved over billions of years to be very efficient at spreading infection) is roughly equivalent to piling up cheesecloth to protect yourself from a tsunami.

Western culture seems to be developing increasingly extreme paranoia about all things health related. And of course, this is fueled by the media and other groups (like the CDC) who stand to benefit from spreading fear. Too many people spend too much time worrying about "silent killers": cancer, heart disease, viral diseases, you name it. Correspondingly, there exists as MASSIVE "industry" concerned with disseminating information and treatment. Just look at the amount of money spent helping us with that most deadly of conditions, "high cholesterol". Can you watch TV anymore without seeing at least one advertisment for statins (geez, there's one on now - GO TIVO) or a wonder food (like Ch**rios for crying out loud) that is going to save you from the "silent killer". Ch**rios and statins: the delicious and healthy way to start the day.

Fear is a complicated emotion, and that complication no doubt stems from the underlying complicated nature of trying to survive. I believe the major psychological source of fear is uncertainty, i.e. "was that sound Grog relieving himself due to over-consumption of cachonga root, or a bear coming to eat me?". I suspect the physiological source of fear is hormones, namely the stress hormones. Certainly stress brings about an increase in irrational fear (is there such a thing as rational fear?), and certain drugs can activate those same pathways and create tremendous fear. Our society seems now more than ever in the grip of fear inducers. Though science and technology have advanced human knowledge, the fact is that most of that knowledge is held by precious few. "Back in the day", when we all lived in the forest, you needed lots of knowledge to survive. The "unknown" was largely those aspects of Nature humans could not control, like the weather, hungry bears, and infection. Now we trust that to the "experts", tacitly ceding them control over our lives. And other aspects of lifestyle probably contribute to stress. Crappy nutrition certainly increases stress hormones, as does chronic illness. The diabetes "epidemic" is a pretty good sign that a major portion of the population is suffering from chronic illness due to poor nutrition (and a pronounced lack of sunshine).

The combination is a real mess: a sick and fear-filled population driving a culture of experts to save them from their own ignorance. And of course the experts turn out to have little relevant expertise. Their major source of validation comes from the feedback that we give them. How many people do you know whose doctor fills them full of pills to no effect? The patient experiences little actual improvement in health, yet they keep going back for more. What if people started thinking for themselves and kicked their doctor to the curb in favor of self-informed care? I suspect a swift kick in the pocketbook would change MDs' opinion of statins in a big hurry. Similarly, let's have some fun and watch the shakeout if (as I think is highly probable) swine flu turns out to be a dud. Congress and the media will praise the CDC for quick and decisive action, and they'll wind up with a nice budget increase, which is all the validation they need. I suspect we won't see any sort of critical introspection as to whether or not all of this flopping about and general panic has a measurable benefit on public health. Nobody gets budget increases for that.

In a really nice post on critical thinking, Dr. Mike Eades appropriated one of thousands of fabulous lines from George Carlin (who I personally think was probably smarter than everyone at the CDC - combined). I shall re-appropriate it here:

Think of how stupid the average person is, and then realize that half of them are stupider than that.
I spent about 10 years "in" science, 3 to get my M.S. and Ph.D. another 7 as a post-doc and researcher. I had the chance to interact with many scientists, mostly from physics, but also from other fields, and if there's one thing I can tell you with great certainty it is that the distribution of intelligence amongst scientists pretty much mirrors that of the population at large. By "intelligence", I mean the ability to rationally weight complex evidence as it relates to different hypotheses. My point here is not to say that scientists are dumb (though as we learned from Carlin, half of them are dumb, by definition), but that you likely have the same reasoning capability as the average scientist. In fact, you're probably a little better than the average scientist. Scientists favor complex solutions, precisely because they are hard to understand. This validates their own self-perception of being smarter than the average bear. As a scientist I've had more than one scientific discussion end with "That's too simple to be right." Not, mind you, "that idea contradicts this piece of evidence". It's just too simple for their taste. So I dressed up the same simple idea with complex-appearing math and verbiage, leading to acceptance.

The swine flu situation presents us with the opportunity to watch this in action. I was just watching a clip from a news conference, where some "expert" was simultaneously back-pedaling on the severity of the present threat, while drumming up some more fear about the future. The thrust of it was that the Spanish Flu "took a summer break", and then re-awoke to slaughter millions. So keep on wiping down those door handles and pouring in the taxpayer dollars for stockpiling flu vaccines and anti-virals. Yet our expert likely missed on the glaringly obvious simple hypothesis: people almost never get flu in the summer, an effect seen in both hemispheres. That applied also to the highly deadly Spanish Flu, which apparently spent the summer at the beach before coming back to clobber Western civilization. Or maybe something about the summer that made people more immune to a pre-existing infection. Gee, I wonder what that could be?

(For those in the cheap seats, it's Vitamin D3.)

Can I say with certainty that Vitamin D3 is the answer to the swine flu? No. But the CDC nerds also have no reason to say that it isn't, other than it's a) too simple, and b) puts a fair dent in their raison d'etre. Even WebMD, normally a bastion of medical orthodoxy, is at least considering the possibility. I presume flu cases are being tested for H1N1 antibodies. I wonder if anybody is bothering to test for Vitamin D3 while they're at it?

Nah, too simple. Ramp up that expensive anti-viral production. Far more tasteful.

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