Pandemic flu: will there be a second wave?

Dear Fiona Godlee,

Congratulations on your subdued tone on the rhetoric that swine ‘Flu
kills and Oseltomivir saves! (1) Epidemiology is an inexact science and
has never predicted the unpredictable future; neither can it do so in
future. It is some “sciencey” medical journalists who keep on harping on
this topic in the lay press supporting the manufacturers. They also
demonise all other methods of preventing or relieving ‘Flu symptoms. After
all Oseltomivir only shortens the symptoms by a whole long day. Beyond
that its usefulness is in doubt, especially in preventing or curing the
fatal complications.

By now we have enough evidence to show that Oseltomivir might not be
all that good and the dangerous adverse reactions could even be worse than
the disease. Japanese experience published in The Lancet in 2006, and the
present Oxford study published in your BMJ, along with the one in London
Times on line have all come to almost similar conclusions, although the
WHO, the governments, and the manufacturers keep refuting these scientific
claims for reasons best known to them. (2, 3)

Time was when small pox was thought to be due to the wrath of a
Goddess in the East. Time is now in the West to think of a virus as a
cause of all enigmatic problems like AIDS, SMON, ‘Flu of all shades down
the ages, ‘Flu like illnesses, viral fevers of all hues and colours, etc.
Even diseases like Beriberi and Pellagra were treated as infective
disorders for long periods of time. (4) God only knows how many innocent
humans were dispatched to meet their maker by that logic. Both, eastern
and western points of view are rational in that they have a cause and
effect relationship! Passion makes some of the best observations but draws
wretched conclusions many times.

However, human body defies that logic. If one goes deep into all the
deaths in the intensive therapy units due to ‘Flu, one is struck by the
glaring fact that it is the human immune system, for some unexplained
reason, getting overwhelmed in the setting. It is the cytokine aberrant
response that results in the final outcome of pneumonia and ARDS. Why does
the immune system do that is any body’s guess?

We need a holistic approach to the aetio-pathogenesis in that
setting, as in many other instances. Our skewed logic of a cause and
management might have to be recast sooner than later. Mary Tinnetti, of
Yale, in her milestone publication, The end of the disease era, points to
the lacunae and dangers of that approach. (5) She rightly points out that
in the present knowledge base that logic might result in under treatment
at best or over treatment, with more suffering for the patient, at worst.
‘Flu management needs such a holistic approach where the immune system
should get greater attention! Many complementary systems have that exact
approach. Let us explore the science behind those rather than condemning
them wholesale.

An analogy comes to mind. Before the 1980s sudden deaths at the
Moscow City Hospital used to be around thirty per day; all labelled as
myocardial infarctions. The epidemiologic statistic for Coronary disease
shot up until Maurice Lev and Saroja Bharati from California went over
there to perform detailed post mortem studies of those deaths with special
permission from Gorbochev. They revealed the cause, in most cases, as the
newly discovered alcoholic cardiomyopathy! (6) The latter was the main
culprit with an occasional sprinkling of myocardial infarcts. Gorbochev
banned Vodka in all Russian parties and rest is history!

Oseltomivir 75mg/24h PO has been provisionally recommended by NICE
for post- exposure prophylaxis in at-risk patients (i.e. immune-
compromised. Diabetics) avers the Oxford textbook of clinical medicine.
(books.google.co.in/books ISBN=0198570716.) But the media hype is that it
should be given as a prophylactic! The caption of this letter is
attributed to Benjamin Disraeli but was popularized in the USA by Mark
Twain.

The next point that is raised in your editorial is the future
prediction of a winter avalanche of swine ‘flu in the Northern hemisphere.
Much of the ‘Flu scare in the Southern hemisphere today also is based on
media hype, thanks to the electronic media’s power to sell any idea with
its 24/7 visibility! Our estimated guess for the future, like that of an
astrologer’s predictions, will certainly fall short of expectations.
History will record our botched attempt at making a mountain out of a mole
hill of the last Bird ‘Flu scare where scientific scrutiny (changing anti
bird ‘flu antibody titre based diagnosis) did not show any confirmed human
deaths.

Less said about the vaccine, threatening to be let loose on the
gullible public, the better in view of the enormous capacity of the virus
to mutate faster than a chameleon changing its colours. This should not
belittle the dangerous role played by the preservatives in the vaccine.
Modern medicine is not based on hard science. It is only statistical
science of ranodmised studies and short term cross sectional cohort
studies. We need better scientific basis for medicine as shown by David
Eddy (7) and Douglas C Wallace (8) in their epochal studies, not to
mention many other attempts by true scientists to change the face of
modern medicine and make it more scientific in view of the new revelations
in quantum mechanics which has shown the significance of human
consciousness. (9, 10, 11)

Mind rules the body. Fear affects the immune system adversely. Let us
do all we have to do in this time of stress but not let the lay people be
frightened to death due to sheer fear of ‘Flu. Scare mongering is a good
business proposition but bad medical ethics. Let us not make a mockery of
our efforts to be called medical scare system while our aim is to “comfort
mostly and console always”. “Cure” we do rarely! Let us remind ourselves
of what T. S. Eliot wrote: “where is the wisdom we seem to have lost in
knowledge, and where is that knowledge that we have lost in information?”
How true in relation to this ‘Flu outbreak? Medical world is deluded with
information most of it being “noise”. The occasional “signal” in the noise
is lost in the bargain!

Yours ever,
Bmhegde

References:
1) Godlee F. Pandemic ‘Flu: will there be a second wave? BMJ 2009; 339:
b3394.

2) Jefferson T, Demichelli V, Rivetti R et. al. Antivirals for influenza
in healthy adults. Lancet 2006; 367: 303-315.

3) The Times, London July 31, 2009.

4) Duesberg P. Inventing the AIDS virus. 2004. Regnery Publishers, USA.

5) Tinnetti M, Stead T. The end of disease era. Am J Med. 2004; 116: 179-
183.

6) Lev M and Bharati S. Cardiac conduction system in unexplained sudden
death. Ann. Int. Med. 1991; 115: 834.

7) Smith R. Where is the wisdom? BMJ 1991; 303: 798-799.

8) Wallace DC. Mitochondria as Chi. Genetics 2008; 179: 727-785.

9) Hegde BM. Reductionism to holism-the flip-flop science of modern
medicine. JSHO 2008; 1: 05.

10) Smith R. Illness to wellness: Pursuing health and fleeing disease.
JSHO 2009; 1: 07.

11) Chopra D, Weil A, Roy R. Leave the sinking ship. JSHO 2009; 1: 11-12.

Competing interests:
None declared