Laurie Garrett on the lessons of the 1918 flu

I’ve been sucked into a TED vortex. I’ve probably watched five lectures already tonight. I was going to post one of them here about orgasms, but, at the last minute, I decided that, instead, I’d throw out this 2007 presentation by Pulitzer Prize winning science author Laurie Garrett on the lessons of the 1918 flu. I thought that it may be of particular interest to those of you who felt as though our public health officials overreacted when, a month or so ago, they heard that people were dying in Mexico from the swine flu. [And that presentation on orgasm is really entertaining, if you’re looking for something to cheer you up after all the talk of pandemics and bodies being piled in the streets.]

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  1. Ol' E Cross
    Posted May 26, 2009 at 10:09 pm | Permalink

    I’m sorry Mark. It’s not that I don’t think global pandemics aren’t possible or shouldn’t be dealt with with due diligence, but my cynicism makes me distrust both the TV news as well as “fund my research” labs, “order our vaccine” companies, and “buy my books Bill Gates did, ‘…this is the black death,’ ‘…we have been dancing with the devil'” experts.

    Can you help me with a source that doesn’t hold some expectation of profit on our fear?

  2. Posted May 27, 2009 at 5:58 am | Permalink

    You’re asking me if I can provide a credible pandemic expert who wouldn’t be getting on CNN, and thus furthering his or her career, as a pandemic expert?

  3. Andy1313
    Posted May 27, 2009 at 10:44 am | Permalink

    Yeah, I’m surprised you didn’t post the photo of the fetus jerkin’ it.

  4. Mr. Crabtree
    Posted May 27, 2009 at 12:36 pm | Permalink

    I used to play in a band called Orgasm Pandemic.

    We rocked.

  5. Posted May 27, 2009 at 1:26 pm | Permalink

    OEC, I really cannot defend the press because they do their job and do it well, which is to sensationalize issues in order to maintain viewer/readership. You, of all people, must know better than to take them seriously.

    However, you are incorrect in your assessment of public health officials and resarchers as being exclusively self-serving. While I am not going to to dispute that all persons are to an extent self-serving, I really do not believe that the limited amount of funds devoted to research into infectious diseases is misplaced. Hell, drug development for pharmaceuticals such as Viagra and Cialis get more money than all research into diseases that kill millions every single year. No public health worker is getting rich off research into H1N1.

    Do you think that people who research earthquakes and who work in disaster preparedness are self serving? Let’s stop giving them money. Earthquakes don’t happen here in Michigan, why should we even talk about it?

    Here’s an abstract from someone who holds no expectation of profit from fear. I was going to make a statement about how a pandemic would disproportionately affect the poorest members of the globe, but I think even this one paper says it all. Perhaps we here in pretty, safe America have no reason to worry, but sick populations lead to unstable economies and unstable governments, which have ripple effects here at home. Think that it’s an accident that sicest countries are also the poorest and most unstable ?

    Murray CJ, Lopez AD, Chin B, Feehan D, Hill KH.

    Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis.

    Harvard Initiative for Global Health, Harvard University, Cambridge, MA 02138, USA.

    BACKGROUND: The threat of an avian influenza pandemic is causing widespread public concern and health policy response, especially in high-income countries. Our aim was to use high-quality vital registration data gathered during the 1918-20 pandemic to estimate global mortality should such a pandemic occur today. METHODS: We identified all countries with high-quality vital registration data for the 1918-20 pandemic and used these data to calculate excess mortality. We developed ordinary least squares regression models that related excess mortality to per-head income and absolute latitude and used these models to estimate mortality had there been an influenza pandemic in 2004. FINDINGS: Excess mortality data show that, even in 1918-20, population mortality varied over 30-fold across countries. Per-head income explained a large fraction of this variation in mortality. Extrapolation of 1918-20 mortality rates to the worldwide population of 2004 indicates that an estimated 62 million people (10th-90th percentile range 51 million-81 million) would be killed by a similar influenza pandemic; 96% (95% CI 95-98) of these deaths would occur in the developing world. If this mortality were concentrated in a single year, it would increase global mortality by 114%. INTERPRETATION: This analysis of the empirical record of the 1918-20 pandemic provides a plausible upper bound on pandemic mortality. Most deaths will occur in poor countries–ie, in societies whose scarce health resources are already stretched by existing health priorities.

  6. Ol' E Cross
    Posted May 27, 2009 at 10:40 pm | Permalink


    I know, I know. And yes, you’re right. But, look at Laurie Garrett’s Web site with a teaspoon of cynicism. Watch her panicked “the boogie man has his fingers on your shoulder” TED presentation and watch how she churns uncertainty ala “will it all be okay? or will everyone DIE? We don’t KNOW?!!”

    Then, consider that she’s a senior fellow at the Council on Foreign Relations, whose corporate sponsors include Halliburton, De Beers, and, um, Pfizer.

    Then watch as she goes after Tamiflu (Roche) and Sanofi Aventis, both Pfizer competitors… and I can’t help but feel the creeping fingers on cynicism leaving nail marks on my shoulder.

    If there’s a pandemic, whoever has the vaccine will make a ton of money. If there’s not one, whoever convinces countries and counties to stockpile vaccines will make a ton of money.

    As I think we’ve agreed on before Dude, there’s real moms pops and children dying in under and over developed nations right now for lack of available vaccine. I’m trying not to get sucked into some hyped hypothetical threat to healthy Americans which seems like the only thing that gets our attention.

    Here’s a dollar. Guaranteed to save an African’s life or buy an American another good night’s sleep.

    Did I mention, that all those surgical masks she says are only made in China, are also made in the U.S. by Kimberly-Clark (Kleenex), another big Corp with ties to the CFR?

    Very cynical, I know. The Garrett stuff just pushes my particular buttons.

    All that aside, I find a presentation from 2007 that hypes a 2007 scare that never materialized rather unpersuasive.

    Dude, how many folks in poor countries have died from lack of simple vaccines in the two years since Garrett gave this frantic “we have airplanes now” speech?

  7. Posted May 28, 2009 at 8:59 am | Permalink

    To be honest, I hadn’t even watched the video. I am rarely in places where sound is acceptable. I have read Garrett’s book and was unimpressed. I am happy that she is out there touting a message that we need to be concerned about these issues, but, as you might agree, I strongly believe that Ms. Garrett only has Ms. Garrett’s welfare in mind.

    That being said, we obviously need to look at corporate interests in pharmaceutical development with at least some skepticism, although it can be argued that a financially robust pharma company has much to offer to persons who most desperately need medications. For example, I am personally familiar with a gentleman who once worked at Gglaxosmithkline and was able to take advantage of their strong financial resources to implement low cost HIV medications for developing countries. While I am often, as you obviously are, extremely cynical when it comes to large corporations, I really don’t see any mom and pop operations coming up with medications and vaccines that improve the lives of millions every single year. For example, every dollar that Viagra makes for Pfizer in part goes to producing HIV medications for the developing world. Pfizer is hardly perfect, in fact, I would say they are fairly evil, but without them, there would be no medications for people who need them. Zero. In short, profits and financial success of companies are the only way that drugs for the developing world and marginalized populations will ever come into existence and use.

    I guess what I’m trying to say is that it’s a difficult issue. Without profit, there is no motivation to develop drugs. With profit, there is motivation to develop drugs that we may not necessarily need. Really, it’s up to the consumer to be aware of the risks and benefits of any medication, including vaccines.

    My guess is that the present strain of H1N1 that’s making the news will be included in the normal round of flu vaccinations that will happen in the fall. As far as masks, Asians live in areas of extremely high density and are prone to wearing masks anyway. Go to China during flu season. There’s a ton of masks. Sure, it means profit, but I’d rather people buy masks than cigarettes.

    And OEC, people are always dying from lack of vaccines. No vaccine is 100% effective. Influenza viruses are so genetically volatile that it’s nearly impossible to predict whether a vaccine will effectively provide protection against illness. Only a few diseases lend themselves to “simple vaccines”. Examples would be tetanus, measles, mumps, rubella, diptheria, smallpox, etc. These are a minority however.

  8. Haunted Chicken Coop
    Posted May 28, 2009 at 7:57 pm | Permalink

    I actually like Garrett and am a fan of her writing, particularly “Betrayal of Trust.” Yeah, yeah, yeah…she has her ties to pharma, but – though she generally focuses on the roles&responsibilities of governments – she’s also stuck out and struck down on pharma & managed care.

    Bottom line – we are grossly under-prepared to handle a flu of this proportion.

  9. Ol' E Cross
    Posted May 28, 2009 at 10:25 pm | Permalink

    Haunted Chick/Dude,

    That’s good. I’m guessing Garrett is a much better read than her Web designers convey.

    I can only suggest we’re also grossly under-prepared to handle an alien invasion, earthquakes, hurricanes, teen pregnancy, and a shortage of adhesives.

    Seriously, I’m not trying to undermine the importance and benefit of science, the pharm industry, and trying to be prepared.

    But, fear sells shit. Again and again and again.

    I’m not saying Garrett’s not right. But we should take a pause before panic.

    The thing that generally bites our species in the ass is the thing we’ve not even imagined.

    We will never be prepared for everything. That’s life. That’s death.

    In the meantime, my petering attempt is to live and deal with relative certainties. For the price of a cup of coffee, THIS child won’t die today vs. For the price of a cup of coffee, we will stockpile antidotes for a disease we know very little about.

    No, it shouldn’t be either/or. But Jesus, how many Y2Ks with people buying and burying water and beans in their backyard do we have to live through before we realize all the end-of-the-world paranoia is distracting us from just living in and dealing with the real world?

    If you haven’t gathered, this has personal applications for me. Please discount the above as me thinking through stuff.

    Really, the whole pandemic thing is way outside my area of expertise.

  10. Posted May 29, 2009 at 8:54 am | Permalink

    We’re as prepared as we could possibly be for a pandemic. Maybe we could do better, but there’s no guarantees since pathogens usually don’t send us a memo when they are ready to kill large numbers of us.

    I, too, tire of doomsday scenarios especially when I hear them coming from the left. In the end, humanity is tough as nails. This country is tough as nails. Sure, shit might hit the fan, but in the end we adjust and move on.

    That’s not to say I don’t take health events seriously, but the goal is to minimize the possible negative effects of grave events like a serious flu pandemic, not to make them zero.

    The Catch 22 is that if health workers do their job and manage to stave off a pandemic, they catch hell and are accused of fear mongering and making much ado about something that was never a threat. If a pandemic kills millions, then health workers are accused of not doing their jobs and are vilified in the press. Personally, while cynics like you and BA are prone to accuse workers and publicists of fear mongering and creating panics, I am reassured that this made the news at all. At least now, regular people have some idea that there are people out there who work in this field and are actively monitoring for potential threats.

    Sure, the press is bullshit. No argument there. Sure, there’s profit to be made. But don’t you think that Smith and Wesson is at least somewhat behind all the fear mongering about black people with guns invading innocent white people’s homes and raping their daughters? Please. “Save us, NRA, you’re our only hope!” I remember the local gun store posting a sign outside stating to buy your guns now, since Obama will take them away the day he’s inaugurated. Truth is, it appears that gun freaks are so stupid that they believed it and said gun shop owner walks away with a big, fat paycheck, wrought entirely from fear-mongering.

    H1N1 never scared me. It causes me concern, but I know better. The best defense against a pandemic is awareness. Unfortunately, many folks don’t see it that way or don’t want to take the time to become aware. It’s nearly impossible to explain everything that’s going on in a one line headline, which is all people want to read.

    Also, Garrett is a writer trying to sell books and communicate science topics to the common world. There’s a necessity for people like her, but she still needs to be viewed with some level of skepticism.

One Trackback

  1. By Happy Birthday to Myrna Loy on August 2, 2012 at 9:34 pm

    […] pretty fascinating stuff… I’d never know, for instance, that her father had died in Spanish flu epidemic of 1918.And, before anyone mentions it, yes, I know that she started her career in yellowface, portraying […]

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