I am frankly baffled by a news release from Gideon Informatics, a company that describes its mission as developing and marketing "point-of-care medical-decision support applications that help reduce diagnostic errors." It claims to be "managed by an expert executive team and medical advisory board." Apparently they forgot to give this press release to their advisory board before releasing it:
Despite the recent fatal case of avian flu in Beijing, overall avian flu cases in humans worldwide have decreased 55%, from 88 to 40, from 2007 to 2008, according to GIDEON Online (www.gideononline.com), the largest online database of infectious disease information for medical professionals. Human deaths from avian flu worldwide declined from 59 to 30 (49%), from 2007 to 2008.Over the last five years (2003-2008), human avian flu cases increased 900%, from 4 to 40; and deaths increased 650%, from four to 30. A total of 391 cases and 247 deaths from avian flu were reported in humans from Nov. 26, 2003 to December 15, 2008. (Gideon online)
There seems to be only one way to read this: despite the fact that we just had a fatal human case of bird flu in China (and a number more since this press release in China, Vietnam, Indonesia and Egypt), the disease is disappearing, amounting to less than half the cases last year compared to the year before. This statement is followed by noting huge increases in the years just prior to last year. A reasonable person would be led to think the worst was over.
Memo to Gideon Informatics: this is influenza. If you look at estimated excess mortality from seasonal influenza from year to year it bounces up and down, sometimes much more broadly than the avian flu data. We've known this for a very, very long time. I went back to look at a paper by Simonsen et al. in the American Journal of Public Health in 1997 [Am J Public Health. 1997 December; 87(12): 1944-1950] and found (Table 2) a tabulation for excess mortality for mild flu seasons and severe flu seasons (not counting the pandemic years of 1957 or 1968). They exhibit a range of five fold in mortality, not the mere two fold drop Gideon points to.
We've pointed out often here that there is quite a bit of annual variation in seasonal influenza. The dynamics of flu are clearly quite complicated and not fully understood. What we do understand (at least most of us do) is that how much flu you have this year is not a good guide to how much you will have next year or the year after.
The corollary to the fact that we don't understand seasonal flu is that we have no idea what avian flu is or is not going to do. We hope it will stay at the current low level or even disappear as a human threat. Hoping is not the same thing as knowing, being fairly confident or even being cautiously optimistic, none of which I am or have any grounds to be. The only thing I do know is that this virus is still out there in huge amounts, bubbling away in the animal population, and on occasion fatally splattering humans.
I wouldn't care that much about what some PR hacks do to promote a client, but this release got fairly wide notice and it didn't serve public health. If this is an example of the kind of decision support Gideon provides and the kind of oversight by its medical experts, it isn't a very good advertisement.
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I tagged this a couple of days ago Revere. The information didnt square with the facts and it sounds like a WHO press release. The glass is always half full.
If flu of any kind gets into humans, it always spreads and mutates once its there-Webster 2007
55% based upon what? Well if you call it pneumonia and not pneumonic BF then I guess its down about 75%. One day we will just wake up, as its flattening the crap out of a region inside of a country. Then they will acknowledge it and everyone will pony up and say they have it too.
Global statistics for Avian Influenza reported in GIDEON are derived from official numbers published by the World Health Organization. The cyclic nature of influenza in large populations generally reflects the periodic appearance of new viral strains. Avian influenza H5N1 is a single strain which has persisted for over five years, and should not follow such patterns.
GIDEON does not seek to editorialize or explain the fact that lower numbers were reported in a given year, but merely to report the numbers themselves.
Um. H5N1 is a single strain?
Dr. Berger: As phyosleuth observes (comment following yours), H5N1 is not a single strain. It is a subtype that has many strains. The dynamics of flu is very complex and likely not solely related to antigenic variations. Moreover, why would you "just report" data in a press release?
Excerpt from Gideon Informatics by Dr. Stephen Berger, cofounder of GIDEON Online, and Director of Geographic Medicine and Clinical Microbiology at the Tel Aviv Medical Center, "'[Our] easy-to-use Web-based database provides doctors with accurate and current information to better diagnose infectious diseases - and save lives...'â
Dr Berger you write in your EM response that, "GIDEON does not seek to editorialize or explain the fact that lower numbers were reported in a given year, but merely to report the numbers themselves."
There appears to be an obvious "reality disconnect" between the ideals of your database's purpose -- prviding doctors with accurate and current information -- and enacted practice...
Utilizing a very basic media research-analysis of global H5N1 news reports from the last several years clearly raises evidence of governmental/WHO undereporting of actual H5N1 infections/fatalities. This "evidence" could indeed be used in a legal context by individuals seeking to "punish" healthcare providers who have failed in their duty of care:*)
Do you believe Gideon Informatics has a "duty of care" to accurately report ALL the facts of a given infectious disease eg. multi-strain (clade) H5N1 to those individuals who utilize your database for professional medical purposes!?!