US flu mortality estimates are based on solid science

doi:10.1136/bmj.332.7534.177-a

BMJ 2006;332:177-178 (21 January), doi:10.1136/bmj.332.7534.177-a

Letter

US flu mortality estimates are based on solid science

The first 150 words of the full text of this article appear below.

Editor—Doshi implies that the use of statistical modelsto estimate flu related mortality is inappropriate.¹ Not so.Epidemiologists rely on statistical models because the InternationalClassification of Diseases (ICD) code for influenza (ICD9 487)severely undercounts the true number of flu related deaths.Doshi also implies that the Centers for Disease Control andPrevention (CDC) deliberately exaggerates flu mortality forthe benefit of the pharmaceutical industry, while other scientistsstand by, meek and mute. The BMJ's decision to publish Doshi'scommentary with no counterpoint from an expert in the fieldserved only to sow unnecessary confusion.

We need statistical models partly because flu is rarely confirmedin the laboratory and partly because flu brings about many moredeaths from secondary bacterial pneumonia or exacerbations ofunderlying chronic diseases than from primary flu pneumonia.The classic Serfling modelling approach measures the total seasonalnumber of flu related deaths as the . . . [Full text of this article]

Lone Simonsen, senior epidemiologist

National Institutes of Health, Bethesda, MD 20892, USA LSimonsen@niaid.nih.gov

Robert Taylor, contract analyst, Cecile Viboud, visiting fellow, Jonathan Dushoff, research scientist, Mark Miller, director, Division of Epidemiology and International Population Studies

National Institutes of Health, Bethesda, MD 20892, USA

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