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The Blog
By Robert B. Teague, MD



October 17, 2005
Halloween. The First Part.

Freddie’s back on Elm Street and trying his best the scare the hell out of everybody. If it’s not mad cows, it’s West Nile. If not that, then Avian flu. Or how about reflux treatment or is it lack of treatment and esophageal cancer. Let’s see, do I zig or do I zag? Or both at once? Or just lay down and die now and get it over with?

How do humans figure personal risk? Assessing information good to know vs. imminent danger? The answer is very poorly. It seems to be a hole in our software operating system. And it is compounded by another human trait stated thusly:

The greatest strength of human cognition is the ability to ask “why?” The greatest weakness is the need to.

It is the weakness part of this equation that causes a problem. It forces us to assign “causation” to events and facts that may not be related. It goes with our need to reduce uncertainty and create certitude in our personal space for survival purposes. The fact is we have trouble dealing with the probabilistic universe in which we exist.

Humans have created a number of mechanisms to assign causation and create certitude whether it is knowable or unknowable. Among these are religion and science.

A third human creation--politics--leverages our human traits of poor personal risk assessment plus the need to assign causation (or blame) plus our need to reduce uncertainty to access resources for both common good and not. Creating beliefs to drive actions generally derive from the control emotions of fear, anger, and guilt.

So back to Halloween. The first mask I see at the party is Avian flu. I wonder who it is? OK, some chickens get the flu and die. OK, a lot of chickens. Mostly in Asia. Sixty or so people get the avian flu from chickens. Some scientist guys recreate the flu virus from 1918 and say, “Yep, it is an avian flu virus.” And viola!! The world ends as we know it from a pandemic of avian flu.

It reminds me of the dialogue from Ghostbusters (1984):
Dr. Peter Venkman: This city is headed for a disaster of biblical proportions.
Mayor: What do you mean, "biblical?"
Dr Ray Stantz: What he means is Old Testament, Mr. Mayor, real wrath-of-God type stuff.
Dr. Peter Venkman: Exactly.
Dr Ray Stantz: Fire and brimstone coming down from the skies. Rivers and seas boiling.
Dr. Egon Spengler: Forty years of darkness. Earthquakes, volcanoes...
Winston Zeddemore: The dead rising from the grave.
Dr. Peter Venkman: Human sacrifice, dogs and cats living together--mass hysteria

What better Administration than the current one to deal with Old Testament retribution?

Humans being human, we assign the greatest importance to things that occurred most recently, were of great impact, or caused great emotion. Could it be Katrina under that mask?

Writing in the October 12 Wall Street Journal Holman Jenkins, Jr. notes: “How a catastrophe with low probability of occurring became a focus of Washington's attention can be explained in one word: Katrina. Unlike the universe, politicians operate on psychological principles. George Bush gave the press conference last week he wished he'd given in the year past about the danger of New Orleans being submerged in a hurricane. He even cited John Barry's book about the 1918 Spanish flu pandemic -- the same Mr. Barry whose earlier book on the 1927 Mississippi flood was widely cited in the aftermath of the New Orleans debacle.”

He goes on to review the probabilities: “The virus would have to mutate in its animal host to develop the possibility of casual human-to-human transmission. It would have to survive and reproduce until it reached a human host. It would also have to retain the virulence of bird flu in the few humans that catch it today, yet somehow not snuff out its own spread by killing its carriers.”

“This does indeed amount to a giant long shot. Jeffrey Taubenberger, a civilian Army pathologist who recreated in a lab the 1918 Spanish flu, says today's bird flu would have to accumulate specific mutations on each of its eight RNA segments. Presumably a powerful selective pressure would be required to drive the virus down this path. If so, it's hard to imagine the virus not also discovering the adaptive benefit of less human lethality, which would aid its spread.”

So what has Washington’s response been so far? The Bureaucrats weighed in: “HHS Secretary Mike Leavitt has stated, quite accurately, that the U.S. is unprepared for a worst-case pandemic. But when pressed on the odds, he said, "From all I hear from scientists and physicians it is relatively low, but it is not zero." Declared Julie Gerberding, head of the Centers for Disease Control, in more interviews than you can count last week: a global pandemic is "not a matter of 'if' but 'when.'" But note that she was speaking of any flu pandemic, not the mega-killer of recent Washington scenarios.”

“Panic is certainly not a sustainable response. Mr. Bush didn't tell families to stock up on Dinty Moore and Parmalat, enough to hunker down for an eight-week flu siege. After the duct tape and plastic sheeting nuttiness in the wake of the al Qaeda attacks, this suggests he's learned a lesson about using signals to help Americans put given risks in a realistic perspective. Instead, stuck for something to do, Washington is turning bird flu into an opportunity for overdue progress on the vaccine industry's lawsuit problem. And China is being pressured to cooperate on disease control. Its agricultural sector, wedged weirdly between peasant husbandry and agribusiness, has become a hothouse for virus mutation. Progress here really might someday stop a global plague.”

So here we are on Halloween eve. The goblins are out. Trying to scare everybody and leveraging some of our greatest weaknesses. To what purpose? Stay tuned for Part 2.


Robert B. Teague is a pulmonologist and business consultant who is based in Houston, Texas. E-mail him.

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