Selling 'pandemic flu' through a language of fear

Americans consider the United States to be a country where debate flourishes. Yet with regard to avian flu, hyped sound bites predominate. When President Bush asked Congress for $7.1 billion toward "pandemic flu preparedness," even his critics replied "not enough." Meanwhile, public health officials seem obsessed with preparing for an impending crisis - even before they have established that doom is truly heading our way.

What is lacking in the overall discussion about pandemic flu is disagreement, criticism, and skepticism - once the bedrock of science - from researchers willing to question and test the data. Further, little has been done to educate the public on what exactly defines a pandemic.

First, some facts: According to the World Health Organization, the first "outbreak" of the H5N1 virus, also known as avian flu, killed six people in 1997 in Hong Kong. Since then, H5N1 has allegedly killed 97 more worldwide, the majority of whom lived in poor, rural areas and had direct contact with dead or sick birds often kept in unsanitary conditions.

These numbers do not suggest the human population faces an insurmountable threat from this virus. Peter Palese, flu scientist at Mount Sinai School of Medicine in New York, told The New York Times in a Nov. 8, 2005, article that H5N1 is a false alarm. The virus has been "around for more than a dozen years, but it hasn't jumped into the human population." The reason? It probably can't. Dr. Palese points to studies of serum collected from rural Chinese populations in 1992. The results indicated that millions of people had natural antibodies to H5N1. This suggests they had been infected and recovered without becoming noticeably or extremely sick - not the outcome one would expect from a virus as feared as this one.

The Centers for Disease Control and Prevention (CDC) estimates that 36,000 deaths in the US occur during an "average" flu season. During the last "flu pandemic" of 1968, however, they state 34,000 Americans died.

In response to an article I recently published in the British Medical Journal, questioning the reliability of US flu death statistics, the CDC countered that "it cannot be assumed a priori that pandemics will cause more mortality than interpandemic seasons." Unfortunately, this information is rarely explained to the general public.

The CDC's statement is echoed by scientists at the National Institutes of Health in Bethesda, Md. "The mild 1968 pandemic was actually exceeded by a few more recent severe A(H3N2) seasons," they say. In other words - technical jargon removed - the annual (nonpandemic) flu season can (and has often been) more deadly than a pandemic. Despite this, the World Health Organization informs readers that among the top 10 things you should know about pandemic flu: "Large numbers of deaths will occur."

If regular flu seasons can be worse than "pandemics," just what does the word mean? Many people seem unsure. The online Merriam-Webster dictionary reports that "pandemic" was the seventh most frequently looked up word in 2005. But what the dictionary doesn't tell its readers is the definition that flu scientists employ.

To influenza researchers, "a pandemic" occurs when the flu virus in wide circulation has changed more dramatically than the normal seasonal variation. While important to flu virologists, it's not clear what relevance this viral caveat holds for the average American. As historian John Barry recently put it, "The last time a new influenza virus reached pandemic levels was in 1968, but the episode was not significantly deadlier than a typical bad flu season. Few people who lived through it even knew it occurred."

Our healthcare system - and Americans' general state of health - is not in such great shape that little is left to do but spend billions of dollars on fighting so-called killers that may never come or may not have a significant impact if they do.

Certainly public health officials are sincerely interested in our well-being. Dr. Julie Gerberding, director of the CDC, stated in a telephone press conference last fall, "We've been putting an awful lot of attention on pandemic influenza, so influenza is on people's minds, and I think the factor of pandemic influenza is very frightening to people." One begins to wonder whether some officials might not cherish their worst case scenario, and even see vindication in it.

There are better ways to promote America's health than selling sickness through the language of fear. Before the government employs "all instruments of national power," including "quarantine authority," as the National Strategy for Pandemic Influenza declares, we need to be told what "pandemic flu" really means. So far, we have not been given the full story in plain language.

• Peter Doshi is a graduate student at Harvard University focusing on issues where medicine, politics, and journalism intersect.