Friday, December 29, 2006

Betting On A Pandemic


# 268


Apparently two small paragraphs in a blog I wrote on December 19 has evoked the ire of Mr. Michael Fumento, author of an article purportedly debunking avain flu hysteria in the Weekly Standard. Why my blog, among all of those out there that challenged his assertions should have captured his interest is unknown. Unlike some of my compatriots in the blogosphere, I didn’t call him names or disparage his lineage.


In fact, the sum total of my comments regarding his article are reproduced here:

Opinion pieces ridiculing pandemic concerns, such as the one written by Michael Fumento this past week called The Chicken Littles Were Wrong, certainly don’t help matters. He is, of course, entitled to his opinion. And admittedly, when I want a medical opinion, or an analysis of the veracity of scientific research into virology and emerging infectious diseases, I know I always rely on the advice of a Washington Lawyer.

Sadly, Mr. Fumento’s opinion will likely be taken to heart by many who would rather think of more pleasant things than a pandemic. People, quite naturally, are looking for reasons not to prepare, not to spend scarce resources on a potential crisis, and many will find favor and comfort with his position

The next day, after directing my readers to his response, I posted on the comparisons between pandemic preparedness and hurricane preparedness. In this opinion piece, I stated.

For what it’s worth (and granted, it’s not worth much), my sense is that the odds of us seeing a pandemic event over the next year or so are roughly 50%/50%. I am not in the corner of those who believe it is inevitable. But I recognize we have a contender out there, a virus that shows signs that it could evolve into a pandemic strain, and believe it is prudent to prepare.

Just in case.

WOW! How could I have made such an absolute statement? What could I have been thinking? It might happen. Or, just as likely (in my humble opinion), it might not happen. But either way, it’s wise to prepare.


Horrors! I expressed an opinion. Shame on me.


How does expressing my opinion differ from Mr. Fumento expressing his opinion that a pandemic won't happen?  


Mr. Fumento then posted a long reply to this piece, which admittedly, I only discovered today after seeing his latest blog entry, where he calls me out like a gunslinger in an old western movie.


(Quoting my blog)

The H5N1 bird flu virus shows signs of being a Category 5 pandemic, if it should evolve into a human-to-human (H2H) strain. The early CFR (Case fatality ratio) is over 60%, or 10 times higher than the Spanish Flu."

(End Quote)

Stuff like this shows you're not just lame-brained but an outright liar. You claim to have read my piece. If so, then you read:

"It's true that, of bird flu cases recorded by the World Health Organization, 59 percent have died. But this is a mere artifact with an obvious explanation: Only people with the most severe cases go to the hospital and become part of the dataset.

"Research from Vietnam shows that even with inferior health care, the human death rate from H5N1 is considerably less than 1 percent, not higher than 50 percent.

"As to what the true mortality rate is, over a three-month period in 2004, Swedish and Vietnamese researchers studied 45,478 residents in a rural district in Vietnam that had H5N1 outbreaks to find out how many had contact with sick birds and how many had flu-like illnesses. They published their results in January 2006 in the Archives of Internal Medicine. They found that of 8,149 who had a flu-like illness, 650 to 750 probably caught it from birds. Yet for all of 2004, the World Health Organization data indicated only 29 Vietnamese cases with 20 deaths. Thus what might seem to be a horrific mortality rate of almost two in three, or 69 percent, appears to be actually around one in 140 or 0.71 percent. This, in the rural portion of a Communist country with a state-run medical system. That 0.71 percent is in the same range as seasonal human flu."

So you knew all this, and yet you persist with your "over 60%." The 50-50 chance thing is also a complete fabrication. Name even one ALARMIST (other than you) who is willing to stick his or her neck out this far? Robert Webster? No way! Laurie Garrett? Uh-uh! Just you, the omniscient paramedic. How would you like to put your money where that over-sized ignorant mouth is? 10-1 there will be no pandemic flu in the next 365 days. You choose the amount. I'd go beyond 365 but I've got better things to do than track bets for years on end. 2-1 would be even odds for your prediction; I'm making it 10-1.


Lamebrained?   Outright liar?    Ignorant?


Really Mr. Fumento, name calling rarely advances a debate. I'm certain if you tried, you'd find you are capable of reasonable discourse.  Who knows?  It might even advance your cause.


I note that you conveniently truncated my statement to which you took such exception, by leaving out the sentence that followed it, which completed the paragraph:


If those numbers held (by no means a certainty) during a pandemic, an Avian Flu outbreak would be devastating.


Hmmm.  I refered to the CFR we have today as `early' numbers, and then suggested that in a pandemic, the actually numbers might be lower.  Where, exactly, did I cross the line here?


Now, since I can only count those cases we actually know about, based on the data we have; the current CFR exceeds 60%. Throwing an unknown number of uncounted cases into the mix, simply because it helps to make your case, doesn’t make it a scientifically sound argument.


As far as the Vietnamese study you seem to hang your hopes on, this was done using questionnaires, not Seroprevalence studies (blood workups), and so the assumption that 650 to 750 probably caught it from birds is highly speculative at best.


The one Seroprevalence study we do have was done in Cambodia, in a village where a 28-year-old man died of the H5N1 virus after a poultry die off. Villagers living within 1 km were questioned, and blood was drawn. Of more than 350 people who presumably were similarly exposed, none showed antibody titers indicating infection.


While it is possible that one or both of these studies was flawed, the one with data that doesn’t rely on statistical analysis of questionnaires, and instead relied on scientific tests, would seem to refute the Vietnamese conclusion. 


At the risk of stepping into a field in which I am obviously less qualified than you, sir, it would appear you are basing your case on facts not yet in evidence.


Today Mr. Fumento publicly called me out on his blog site.  He didn’t quote me exactly, and  claimed I declared him a `fool'  when I used no such verbiage (in fact, I said he was entitled to his opinion); but this is the blogosphere, and that sort of thing is to be expected.


I’m sure my site hits will go up as a result, and so I thank him for the free publicity.


As far as the bet goes. Thanks, but no thanks.


Possible Interstate gambling law violations aside, this is far too serious a subject to debase by making side bets on whether millions of people will die.  Sorry, but I'm funny that way.  Probably comes from years of dealing with actual life and death situations.


However, if no Pandemic occurs in the next 18 months (I said a `year or so’), I’ll gladly donate $100 to (his choice) either the American Red Cross or the Salvation Army in his name. I will certainly be in a celebratory mood.


In which case, everybody wins.


SophiaZoe said...

Sorry Mr. Fumento,

While virologists are having to re-write the rules in some form or fashion nearly every week because of H5N1's unprecedented (as far as is known) behavior, what is understood clearly supports Fla_Medic's reasoning that it is prudent to prepare for the possibility of a severe, or Cat5 pandemic influenza.

"Should the virus improve its transmissibility by acquiring, through a reassortment event, internal human genes, then the lethality of the virus would most likely be reduced. However, should the virus improve its transmissibility through adaptation as a wholly avian virus, then the present high lethality could be maintained during pandemic."

Sept2006 WHO Report (snip)

While moral indignation and temper tantrums are of some entertainment it's generally a good idea to have something legitimate to be morally outraged over, but I will grant that temper tantrums can be engaged in for no reason whatever.

Are you red in the face yet Mr. Fumento? Might I suggest you take a few deep breaths.

Blitzen said...

Mr. Fumento's offer to bet demonstrates why lawyers are generally held in such low esteem in this country. In the Marine Corps, where men are truely put in harms way, bets of this kind are called Fools Bets. The reason for that is as follows. If Fumento is correct and there is no Pan Flu in the next year he wins the bet. If, on the other hand, Pan Flu comes and is as horrific in its effects as many fear, then the odds of him having to actually pay off are insignificant. First, he may be dead. Second, You may be dead. Third, our societie's financial network may be in to poor a shape to permit the paying of such a debt at long distance, and lastly, People of conscience who survive will have more important things to occupy their time then trying to collect on a debt from yet another pretzel brained, big mouthed, washington con artist.
My compliments to you for your good work and clarity of thought, particulary in seeing through this "lawyers" attempt to get at your wallet, something they are notoriously skilled at. In your future dealings with "lawyers" I suggest the first question you should ask yourself is "What caliber should I use?"

The-Best-Bird-Flu-Blogs-Team. said...

Yes but what is with the "leftist" bit?

What has the political position of a person got to do with his or her opinion regarding the bird flu virus?

Does that imply that only the people with left leaning views, believe that a flu pandemic may appear in the near future?

I do not get that.

JM Tom

FLA_MEDIC said...

JM Tom

Well, that one mystifies me, too.

Not that it matters of course, but I'm hardly what one would call a `leftist'. And my reading of the situation is that those who are concerned over the Avian Flu threat hail from all corners of the political spectrum.

fumento said...

It is duly noted and will be publicized that Mr. Avian Flu Diary has chickened out. He ducked. He doesn't have the courage of convictions because he has no convictions. He doesn't believe what he writes, as well he should not.

Even the 20th century's greatest alarmist, Paul Ehrlich, took Julian Simon up on his bet about the alleged increasing scarcity of resources. Naturally Ehrlich lost but at least he accepted the challenge and paid up when he lost. He didn't go squawking and chirping about violating the law!

SophiaZoe said...

Mr Fumento said...
"He doesn't have the courage of convictions because he has no convictions. He doesn't believe what he writes, as well he should not."

Mr. Fumento,

Knowing Fla_Medic personally I know him to be a man of DEEP conviction. A man that not only gives freely of his time and knowledge to all those who wish to partake of it, he has actually put his money where his convictions lay, where it will help the most should a moderate to severe pandemic come to pass in our near term future. Doing his "bit" to alleviate what suffering he may, where he may, while he may.

You, Mr Fumento, are truly acting like a spoiled child.

Why is anyone, and specifically Fla_Medic, obligated to accept a monetary wager from you? Personally, I find the concept abhorrent...but that's just me...maybe my convictions get in the way of my understanding.

FLA_MEDIC said...

SZ, thanks for having my back.

Mr. Fumento. I'll let the visitors to my blog site, who have demonstrated the ability to read for comprehension and think critically, decide for themselves if I've erred grieviously by declining your `offer'.