29 December 2011

Unhealthful News 196 - Reports on censoring bird flu research lack realistic context

A lot has been written already about the recent request(?) by the US government for a couple of journals and researchers to censor the discovery of how the "bird flu" virus (influenza H5N1) can be changed to allow airborne transmission (it is currently believed that the only transmission vector to humans is contact with birds) and related research.  The press has reported this being a case of "biosecurity" (which Phil Alcabes appropriately ridicules) concerns about an incredibly deadly flu, pitted against the problem of censorship and losing the free exchange of valuable scientific information.  The thing is that almost none of these exciting motifs accurately describes the situation.

First is a point I have written about at greater length before, so I will offer just an abbreviated version here:  People who write about infectious diseases, including most of the ostensible experts, never seem to learn that when a novel disease appears, there is a huge bias toward identifying only people who have gotten extremely sick from it.  After all, who shows up in a hospital to get diagnosed, thus leading to the discovery of a brand new or rare disease?  This is even more true in extremely poor populations where medical care is mostly limited to when someone is on the verge of death.  So the observation that half the people who get the disease die from it (a common claim in the hype about H5N1 right now) really means that only half the people die from it among those who are treated after they are on the verge of dying from it, when combined with those diagnosed on autopsy who could not afford any medical care.

How many others got/have the virus, having suffered only an everyday bout of illness, or perhaps nothing at all?  No one knows.  Only the rarest of nasty diseases would not have 100 like that for every one that went to the hospital, and 1000 or 10,000 is quite plausible.  A million is possible.  So is bird flu an utter terror, that is deadlier than contracting Ebola, or is it a fairly typical disease of its kind that kills perhaps as many as one out of every 100,000 that get it?  And for that matter, might it already be airborne in the wild, but just not virulent enough to notice?  We really do not know.

On top of that, there is no evidence that there are any significant and capable international terrorists who are waiting to use information like this.  (Indeed, the place to end the previous sentence might be before the qualifying phrase, "who...".)  There are lots of ways to engage in untargeted random destruction, and no one seems to be employing them.

So, the possibly low risk might argue for protecting the tremendous value of communicating the new discoveries and avoiding the horror of censorship.  Except that avoiding publishing the details represents be almost no loss of useful communication or genuine censorship.  I would guess that there are a couple of hundred people in the world who could make good use of the information that is being kept secret, and I would bet that most of them will still have access to it if they want.  In a matter of years, technology will evolve so that more people could make use of that information somehow, but by then it will inevitably be common knowledge.

As for censorship, this qualifies in only the most technical sense.  Censorship matters when it results in suppression of information, not the mere suppression of someone's words.  Everyone is being told the publicly relevant information, and indeed the dispute has called far more attention to that information than it otherwise would have gotten.  It is government suppression of useful health science when, for example, the CDC quietly hides relevant data it has about the benefits of tobacco harm reduction, as they do, and people are widely misled.  But if they reported the general result or the data and merely refused to tell us some highly technical detail about how they did the research, that would be a welcome relief from the self-censorship.

Or consider an analogy:  It was suppression of the worst kind that the US military prevented any reporting about a gunship crew gleefully killing a group of civilians in Iraq until Bradley Manning (or if not him, whatever hero actually did it) leaked the video.  It would not have been censorship in any important sense of the word if the they had allowed the incident to be reported, but prevented publication of some technical details about the weapons used that could benefit an actual enemy.  All the useful information would be out there, and the withholding would have been explicit and purposeful.

So what we really have is a case of withholding information that probably is no threat, and that will inevitably be public before long anyway, but that is probably actually still available to those who really need it, and is a situation where preventing the technical information from being made public does not constitute the kind of censorship we should fear.  Yawn.  Now I forget why this seemed important to write about.

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