# 308
There is an old adage in medicine that says: If you are in Central park and you hear hoof beats coming up behind you; think horses, not zebras.
This admonition was created to remind young doctors (and later, the equally dangerous paramedic) that while exotic and unusual diseases do present themselves from time to time (that’s why we learn about them), it is generally wiser to consider the most common cause of an illness first.
Most of the time, this principal works pretty well.
When a patient shows up at a doctor’s office with flu-like symptoms, they don’t usually run elaborate tests to determine the root cause. The doctor assumes it’s the flu, and makes the appropriate recommendation. If the patient’s condition deteriorates, perhaps into pneumonia or sepsis, well then, that’s when additional tests are run.
For the one person in 1000 who ends up in intensive care, perhaps this approach didn’t work out very well, but for the other 999 it is both cost efficient and sensible.
So it is not surprising that officials in other countries are looking only at chickens as the primary vector of bird flu, since to date, that appears to have been the case. After all, poultry die of the disease by the thousands, and on rare occasion, people in contact with infected poultry have contracted it.
The causal link here appears pretty strong.
The problem with this logic is, the H5N1 virus is an exotic disease. Our knowledge of it is limited, and what we think we know about it may be, to some extent, faulty.
I’ve no doubt that in most cases; the route of infection so far has been bird to human.
But we keep seeing cases where the link to infected birds is tenuous at best. In some cases, it is strenuously denied by the patients and their families. At the same time, we get reports of other species: notably cats, and dogs, and pigs, harboring the virus and dying from the disease.
Circumstantial evidence of another vector, perhaps an as yet unproven mammalian reservoir, exists. How often this occurs is unknown. Perhaps it is so rare, as not to be a major factor. Or perhaps it is more common than we know.
But we won’t find out until we start looking for it.
The avian flu virus is mutating, and changing the playbook on influenza. Instead of always being one step behind it, we need to start getting ahead of this disease. And to do that, we need to be looking at credible theories, even if they aren’t the simplest solutions.
And that means research in the field.
In some countries, this is obviously happening. South Korea is one of those nations that appear to be devoting a great deal of resources to tracking the H5N1 virus. But in many other countries, little is being done.
There is, of course, resistance to the idea. Research costs money. And there are religious and cultural barriers to overcome. These are sovereign nations with their own laws, policies, and agendas.
In some nations, it is pretty obvious that officials aren’t terribly interested in finding answers, preferring to ignore the problem, rather than address it. In countries where tens of thousands die each year due to poverty, malaria, dengue, AIDS, malnutrition, and natural disasters, it’s hard for locals to get too worked up over a few dozen deaths from bird flu.
And so their policy is reactive instead of proactive. Worries over a possible pandemic `someday’ are overshadowed by the exigent circumstances of today. And while understandable, it is taking a terrible gamble.
The international community has pledged 2 billion dollars to mostly developing countries to aid in their fight against the bird flu. Perhaps it is time to attach some strings to these funds, and demand unfettered access for research teams so that they can begin to answer critical questions about this disease.
A radical idea, I know. A quid pro quo. And one that some countries might not appreciate. Money without strings attached is always preferable. But in this case, with the stakes being what they are, I think a reasonable argument can be made for a little diplomatic arm twisting here.
An illness with an unknown cause is called an idiopathic disease.
Probably because we’d be idiots for at least not trying to figure it out.
