Wednesday, April 07, 2010

H1N1: What Have We Learned?

Now that the annual flu season is over, and it was no worse than usual, is it too early to ask: Do you remember the swine flu? I wrote the post below almost a year ago, in the naive belief that the government-induced panic over H1Ni was subsiding, whereas it had barely begun. I think that's the only thing in it that I have to take back now.

In America, schools closed (against the advice of qualified medical personnel) that didn't have a single case of swine flu. People with no symptoms came into emergency rooms demanding to be tested for the disease. The Egyptian government killed all of the 330,000 pigs in Egypt. Egyptian pig farmers (who for obvious reasons are all Christian) rioted. The only pig in Afghanistan (a zoo animal) has been quarantined. Useless travel advisories have damaged the already devastated economy of Mexico.

Is it too early to start speaking rationally about this thing? I sure hope not.

The excellent Dr. Marc Siegel pointed out a couple of years ago that the two previous global health scares to fizzled in recent years - SARS and the bird flu - had something in common: the CDC and the WHO. The swine flu makes three in a row.

This is a beautiful example of of some of the problems with strategies of anticipation, or searching out possible problems and preventing them from happening, as contrasted with those of resilience, or solving problems after they occur. I've commented on both here and here.

The trouble with resilience is that the costs of waiting until a problem show up can be avoided by heading it off -- if you can predict it. The trouble with anticipation is that prediction is often nearly impossible. Anticipatory systems, if over-used, will waste resources on threats more or less imaginary.

Obviously, the CDC/WHO system is doing just that. Some would say, "well that's just the price you pay -- you can't be too careful!" Oh yes you can! It's possible to spend too much on anything. The limits of the value of anything are given by the things one forgoes in order to get it.

In case it seems like security is so important that it is worth every sacrifice, just remember that the things we could have done with the resources we spend on any one safety precaution might well have been spent on other safety precautions. As Prof. Siegel says of the theoretical possibility of a new avian flu pandemic:
The priority being placed on it as a potential threat to humans is obscuring diseases that are already worldwide killers: malaria, which kills more than 1 million people a year; tuberculosis, more than 2 million; and HIV/AIDS, more than 3 million.
Fearful reactions to danger often block rational reactions to it. Siegel points out that Bush slashed AIDS research and vastly increased anthrax research in the wake of the anthrax attacks that killed five people in the wake of 9/11. Some time after Siegel wrote this, we found that the attack was most likely the work of a deranged FBI agent who worked in the biological warfare labs at Fort Detrick. Oh, the symbolism of that!

As Lewis Thomas said, we are ever at the mercy of our Pentagons. Often it is not the disease but your own immune system that kills you. It is the fever your body fires up in order to cook the invader to death, but ends up cooking you instead, or the flood of secretions that is supposed to float it out of your body, but ends up drowning you first.

Our reaction to certain sorts of dangers -- and terrorist bombers and mutating flu viruses both seem to be cases in point -- are always over-reactions. Sometimes we even create institutions, like the CDC/WHO nexus and the Department of Homeland Security, that are hardwired to mimic these deranged reactions.

No comments: