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Math Science

The Gap Between Stats and Understanding In Flu Cases 83

Posted by Zonk
from the we-need-more-science dept.
KentuckyFC writes "Bird flu gets all the headlines but ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society. The frightening thing about ordinary flu is how little we understand about how it spreads. According to a report at the physics arXiv blog, researchers trying to model this process say they still don't know some basic probabilities associated with infection (pdf, abstract). For instance, given that the disease has manifested itself clinically in an individual, what are the chances of that person dying? And if a virus can be caught from a number of different host species (as it might eventually be with bird flu) what is the probability of transmission?"
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The Gap Between Stats and Understanding In Flu Cases

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  • by Eukariote (881204) on Saturday November 24, 2007 @05:49AM (#21461377)

    but ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society.

    That is a the popular perception. But it does not reflect reality: death risk from ordinary flu is actually statistically negligible. See for example this page http://thinktwice.com/cdc_2001.pdf [thinktwice.com] taken from the CDC National Vital Statistics Report.

    Yes, those are official statistics. Time to think twice. Yes, part of it is the good money made on all those flu shots. But that is only a small part of it. To learn more about the real reason, watch this talk by radiologist David Ayoub: http://video.google.com/videoplay?docid=6890106663412840646 [google.com]. Hard to believe? Verify the sources, they check out. Welcome to the real world.

    • He is obviously trying to get you to get your "inoculation" so that you will become one of them. Just don't sleep.

    • by timmarhy (659436)
      i'm sure if your not too young, too old, have heart problems or asthma that's very comforting, asshole.
    • even if the sources check out on that google clip it doesnt mean they arent being misrepresented to prove something they don't.

      don't let yourself be trapped inside the "real world" of yet another conspiracy theory. you might want read this and at least be open minded to the possibility that you are being misled by people who mean well, but are totally deluded.

      http://www.theness.com/neurologicablog/default.asp?Display=124 [theness.com]

      also this podcast has a good segment on it http://www.theskepticsguide.org/skeptics [theskepticsguide.org]

    • this is a pretty good link too http://skepticalsurfer.blogspot.com/2007/09/cult-of-autism.html [blogspot.com]
    • Certainly, mortality-wise, it is far more important to ban private cars than it is to cure flu. But will anyone go for that? There's so little connection between reality and public policy (at least that I can see) that I can hardly imagine how this can be discussed rationally.
    • by puck01 (207782) on Saturday November 24, 2007 @09:49AM (#21462079)
      First, the flu shot is not universally recommended for everyone, but is certainly available to anyone in the US. It is recommended universally in young children and very old because of their high risk as well as those with co morbid conditions such as asthma or diabetes. Health care workers should get it to reduce the risk of spreading it to high risk patients.

      Second, the data you referenced only used death as an end point. That is only one of several measures. For every death, the flu causes much more morbidity which is entirely ignored by you. It causes a huge numbers of hospitalizations and ICU stays which are incredibly expensive.

      Third, very little money is made in vaccines. Primary care doctors are lucky if they don't loose money on vaccines. How do I know? I am a primary care doctor and its a wash between the cost of storing and purchasing them vs how much we get paid to give them. Manufactures almost have to be begged to make vaccines because there is little financial incentive to do so. Its not uncommon to have shortages occasionally because of this.

      Forth, your referencing a radiologist to talk about an infectious disease / epidemiology problem. That's usually a red flag right there. For instance I know an orthopedic surgeon that argues quite well to the uneducated how evolution is genetically impossible. He's a doctor so the uneducated take his word and believe him. Problem is, he's a idiot outside orthopedics and anyone with half an education about genetics would butcher him. Another example would be this is like getting a plumbers opinion on what type of roof to put on your house. Would you do that?
    • Any joy on pointing us to those sources? I can't see any details of this guy posting in any medical journals. I can find that I can buy his CD for $9 and that he is still researching to determine if there is a link or not.

      I did find this though.
      http://en.wikipedia.org/wiki/Thiomersal_controversy [wikipedia.org]

      This points to sources of the CDC saying there is no link, as does WHO and the Institute of Medicine. So if you know something those guys though feel free to link it.
    • Give it a rest. Vaccines don't cause autism. Mercury in vaccines especially doesn't cause autism, because there isn't any mercury in most vaccines, and there hasn't been any for years. This was effectively ended by going to single-dose vaccines to prevent the need to stabilize or sterilize the multi-dose vials. It increased cost, but it eliminated a small (but nonzero) dose of a heavy metal. There's still no evidence of significant harm during the mercury era, but that era ended years ago.

      Britain did a lo
      • by mvdwege (243851)

        We still don't understand whether (or why) autism is on the rise,

        Hypothesis: because more and more the outliers of human behaviour are being medicalised, turned into a syndrome. Active kids? ADHD, put 'em on Ritalin. Slightly excentric with communications difficulties? Call 'em Aspergers or borderline autistic.

        This is merely a thought fed by media attention on these 'syndromes'. I may be wrong, I haven't done a study, but I think it is worth looking at how our view on what constitutes normal behaviour ca

    • by reboot246 (623534)
      If anyone takes the time to read that report from thinktwice, they'll see that flu is grouped together with pneumonia, and that it's actually pneumonia that is responsible for the thousands of deaths.
    • by iabervon (1971)
      Ordinary flu is an order of magnitude more deadly than bird flu in number of deaths caused. In 2001, ordinary flu killed over a hundred people, and an average year has under 10 deaths from bird flu. Rule of thumb: any dumb thing you can think of that somebody could die from is an order of magnitude more deadly than anything where individual deaths are world news.
    • by zopf (897522)
      Good point. Another important point to recognize is that while ordinary influenza may kill more people in sheer numbers per year, it is likely that avian flu could kill a larger fraction of those who contract it. Thus, while avian flu might only kill 10 people this year, that could be 10 out of 20 cases, whereas ordinary flu might kill 250 out of hundreds of thousands. If avian flu did turn out to have that sort of survival ratio and the ability to spread at a pandemic rate, we could have a real problem
  • Odd (Score:5, Informative)

    by Asmodai (13932) on Saturday November 24, 2007 @05:52AM (#21461381) Homepage
    Given the fact in the Netherlands and Belgium we have http://www.degrotegriepmeting.nl/ [degrotegriepmeting.nl] -- an effort by some medical institutions and related institutions to monitor the migratory patterns of the flu. This is the fourth year they're monitoring. The same kind of project happens in Portugal: http://www.gripenet.pt/ [gripenet.pt] Moreover there's http://www.eiss.org/ [eiss.org] -- the European Influenza Surveillance Scheme. So if you want to talk about current statistical data, it's right there and active.

    Nothing like that even enters into their paper, so pardon me for finding it a bit one-sided approach.
    • Sorry, off topic and of course, I know that "gripe" means flu in Portugese, but a site with the name of "gripenet" just sounds like it should redirect to slashdot :P
  • The problem with the flu is the same as the common cold; the virus mutates too quickly for scientists to create a vaccine. Molecular biologists are making great advancements in understanding the genetics of pathology - advancements are occurring at such a phenomenal rate that even studies from a few years ago are considered out of date.
    The media is unfortunately oblivious to the reality of virology; announcing that the bird flu or SARS or some other pandemic will decimate the population in the near future
    • by SnoopJeDi (859765)
      The editors and assholes that release sensationalist claims have to get their initial lead to follow into stupid bullshit.

      Maybe PR in the field of science needs a little sprucing up.
  • by 2ms (232331) on Saturday November 24, 2007 @06:23AM (#21461447)
    I have an idea. How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve and put all that research time and money toward some of the infinite number of more pressing problems that need to be addressed now? We're the one species that's going to go down as not only having messed up the planet and ecosystems for all the other species, but also the one that actually largely put the most effort they possibly could into actually making themselves maladapted to the very planet they forced the most adaption of species for.
    • Because an individual is conscious while an abstract thing like "the human species/gene pool" is not. Fortunately, many of us value the good of the former more than the good of the latter (trying to value the latter one more tends to lead to less-than-nice results.). This is not a game of Civ.
    • Nature intended nothing. If we survive by foregoing adaption, so be it. The means are judged only according to their ends.
    • Because no one wants another pandemic like the one that killed more people than WWI. No one wants to be responsible for that, so they use the tools they have available--antibiotics. Those tools become less effective every day, but when it's all you have it's all you have.

      As far as being "maladapted," it depends on how you want to look at it. All species will reproduce until they come up against the limits of the resources. Other animals don't reach equilibrium with the earth because they're smarter,

      • by jschottm (317343)
        Because no one wants another pandemic like the one that killed more people than WWI. No one wants to be responsible for that, so they use the tools they have available--antibiotics. Those tools become less effective every day, but when it's all you have it's all you have.

        The WWI era pandemic was an influenza virus pandemic and antibiotics do not affect it. People who think that antibiotics work against the flu are part of why they become less effective every day.
    • by KWTm (808824) on Saturday November 24, 2007 @08:31AM (#21461851) Journal

      I have an idea. How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve?
      You seem to be lumping vaccination in with other anti-infectious measures that protect you from exposure, such as sterilizing potentially infectious objects or wearing disposable gloves, but in this case your concerns are not valid.

      Vaccination stimulates the human species' [no need for "s" after the apostrophe] immune system by exposing it to a safe version of the pathogen. In this way the immune system continues to "adapt for the flu", exactly as you had hoped, and in no way short-circuits the continued adaptation. As the influenza virus mutates, so does the vaccination, and each year the scientists try to figure out which strain of flu to protect against. (One year they guessed wrong, and the flu vaccine ended up next to useless as it protected against a strain of flu that only appeared in a small minority of people.)

      Even for other vaccinations such as TdaP (tetanus, diphtheria, acellular pertussis) which is given only every ten years, vaccinations don't interfere with adaptation. The special case you may be thinking of is with smallpox, which was completely eradicated to the point that there is no further need for vaccination. That is not interference with adaptation, since:
      • any reintroduction of smallpox is by artificial means, so in any case adaptation has nothing to do with it
      • it's not worthwhile continuing to administer smallpox vaccine to let the immune system "adapt" to a potential smallpox outbreak, since the smallpox vaccine itself has a number of significant side effects. I myself was offered the smallpox vaccine shortly after the Sept11 incidents, and there was a non-negligible chance of serious illness including hospitalization and, by extension, death. (I did accept, but the threat level then decreased and it was no longer considered necessary.)
      • if smallpox were to return due to natural circumstances rather than some human reintroducing the locked-up version, it would evolve from an existing virus in the wild, and vaccinations would play no part in whether the human immune system adapted
      • Letting the human immune system adapt doesn't work all that well. SARS is an example of a virus for which we don't have a vaccine, and it had a mortality rate approaching 10%. That sucks. No antibiotics or other antimicrobial drugs, either, so you can't blame it on that.
      I don't know if you're actually referring to the use of antibiotics, where pathogens do evolve against a fixed, unchanging drug molecule, but there are certainly advantages to having antibiotics, too, just as there are appropriate circumstances for sterilizing medical instruments or wearing disposable gloves. Nowadays we can treat skin cancer by a simple office procedure, for which the risk is negligible. Can you imagine if we didn't use sterile instruments, or if the doctor didn't wear sterile gloves, or we couldn't treat a surgical wound infection with antibiotics?

      Be careful not to confuse excessive anti-exposure measures with vaccination, which takes leverages rather than suppresses the immune system.
      • By my reading of Strunk [bartleby.com], of Strunk and White, the possessive of "species" should be "species's":

        Form the possessive singular of nouns with 's. Follow this rule whatever the final consonant.

        Strunk names a few exceptions to this rule, but none of them apply here.

        I don't mean to be a grammar nazi, but the parent did bring up the subject.
    • by theshowmecanuck (703852) on Saturday November 24, 2007 @09:40AM (#21462031) Journal
      In one sense I totally agree with you. We need to exercise our "natural" immune system in order for it to become stronger. On the other hand, part of human evolutionary adaptation gave us the ability to modify our situation/environment.

      With respect to the bird flu (being mentioned a lot in the replies), one of the best observations I have heard is that the real bird flu threat is the one you contract from KFC and McDonalds Chicken Nuggets, et al. Heart disease and obesity. That probably kills far more than all influenzas and pneumonias in the U.S. and Canada each year. :) A lot of people will need to become immune to all the advertising for that epidemic to die down.
      • by YoungHack (36385)
        "In one sense I totally agree with you. We need to exercise our 'natural' immune system in order for it to become stronger. On the other hand, part of human evolutionary adaptation gave us the ability to modify our situation/environment."

        I've always pondered that getting a flu shot every year is exercising your immune system. Certainly, I don't take it as obvious that if you get the flu shot and are later exposed to the real virus that something magic happened and your immune system didn't get to hammer on
    • by dcollins (135727)
      Look, human physical evolution is simply over, and it has been for some time. As long as we have medical intervention that saves lives prior to childbearing years that will be the case -- are you really recommending a regime where any children who get a disease are allowed to die off, while those 25+ get medical care?

      I wouldn't want to live in a worl like that, neither would most people. That's basic human compassion. Good riddance to evolution -- our future is in our own hands now, and we have to be smart
    • by YoungHack (36385) on Saturday November 24, 2007 @02:37PM (#21464133)
      "How about letting the human species's immune system continue to adapt for the flu rather than short-circuiting continued adaptation the way we are in countless other areas by creating drugs that then eventually become ineffective as the diseases evolve while human immune systems devolve and put all that research time and money toward some of the infinite number of more pressing problems that need to be addressed now?"

      That sounds great, but adaptation at the level of a species as we understand it happens through evolution. To clarify, you're basically saying, "Let the weak die (of pneumonia and complications) and the strong survive." If you believe that, perhaps by your logic we really should refrain from vaccinating kids. If they die young before reproducing, then evolution has been served. With luck, in about 20 generations we may see some difference, although we're talking about random processes (i.e. there's no guarantee).

      But the old are past child-bearing age. They've passed on their genes or they haven't. How is the species to be served by their suffering? Personally, comments like the quote sound more like pseudo-science than reasonable argument. It seems like wisdom to say we meddle too much until it is your precious 3-year-old daughter in the intensive care unit.
    • by wikinerd (809585)
      how about fight flu with drugs and train our immune system at the same time?
  • by Anonymous Coward on Saturday November 24, 2007 @09:05AM (#21461931)

    ...ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society.

    Are you scared yet?
    • by Durrok (912509)
      Yes, and for some odd reason I suddenly feel the urge to go out and buy something!
  • by Iwanowitch (993961)
    Sounds like the perfect job for an AI system to figure out. A Bayesian net or a hidden Markov model should be right up to this. Less complaining, more coding!
    • by frisket (149522)
      There are already several perfectly good epidemic models for the spread of disease, including some which handle multiple sources.

      What's needed is more data, not more models.

  • I like how the next article on the blog is about increasing your Google page rank and tips for within-site cross linking. The link from slashdot should help.
  • by khallow (566160) on Saturday November 24, 2007 @10:43AM (#21462327)
    Let's take a look at the last century. As I see it, roughly half of the people who died of flu, did so in the 1918 pandemic. In other words, one single variant of the flu killed as much as a century's worth of regular flu. It makes no sense to ignore a flu variant which to all appearances is more lethal than the 1918 flu (all we know is that more than half of the people who we figure out had it die which is much worse in general than the 1918 flu was), even if it is barely contagious. Obviously, there might be a big drop in lethality, if it adapts to humans. But if there isn't, and as in the 1918 flu epidemic, it infects about 20% of humanity (as I dimly recall), then that means 10% of humanity dies (as opposed to about 2% for the 1918 flu).
    • In 1917-18 human mobility was much less than it is now, and a much lower percentage of humanity lived in large cities. Cheap air, bus and train travel mean that viruses can spread much faster than they could in 1918. Also, the fear of disease is much less and people will less willingly take precautions against exposure. Given the short exposure needed and the rapid incubation of the influenza virus, the spread could be so rapid as to overwhelm government agencies and hospitals. The Black Death reduced the p
  • FTFS:

    For instance, given that the disease has manifested itself clinically in an individual, what are the chances of that person dying?
    I would say that in the long run the probability of that person dying is 1.
  • by Kjella (173770)

    "Bird flu gets all the headlines but ordinary flu kills several orders of magnitude more people each year and represents a significant threat to our society.

    Not really. The regular flu is a fairly known quantity, kills off a few with poor immune system and may be a threat to the individual dying but isn't a threat to society at all. On the other hand, a powerful new pandemic (remember, disease now travels at airplane speed) can kill off a lot of healthy young people, cause general panic and really threaten society. To evaluate the threat to society, you have to be a bit of a cynic and ask "Would society keep going as before?". And yes, it does.

  • OK, so bird flu gets more press than normal human strains.

    I think the question is not is bird flu more dangerous than normal flu, but what will happen if bird flu infects people and then mutates.

    Normal human strains of flu have been around for a long time, sometime mutates into something really bad. We have had a lot of experience of this, and there are a lot of infection models.

    We know nothing of what will happen if bird flu gets into humans and mutates because it hasn't yet happened (although there is con
  • We had a nurse at work give Flu shots but only six of 150 employees got one, the same number as last year. Last year nearly everyone in the entire building, except for those who had the shot, got the Flu.

    When I asked people why, their excuses were: they saw something on the Internet about how vaccines makes you sick, it will give you the Flu, they want their body to fight it naturally, there's mercury in it. I was amazed at the level of paranoia.

    One woman had a valid excuse she lost her hea
  • Bird Flu is not some kind of crazy new flu. It is regular flu. It happens to be a strain that is particularly virulent but not so great at spreading from human to human. It is the same virus that causes regular flu but has a chromosomal arrangement that is just not so great for birds or people. That is what makes influenza so versatile and adaptable. It has a rearrangeable chromosome.

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