If the number of emails I've gotten about the new "market" in pandemic risk were buy orders, I'd be doing very well. A market in pandemic risk? Of course. Is this a great country, or what?
Is a bird flu pandemic coming? Health experts say there is no way to know, and especially no way to know when.But someone does know, or, rather, the combined experience of a lot of someones -- doctors and nurses treating the odd human patient, microbiologists studying virus samples and virus experts studying disease patterns.
A new "market" launched on Thursday aims to take advantage of this combined knowledge to predict any actual pandemic.
[snip]
WHO and other health agencies are watching closely to see if more people become infected, but reporting and testing can be slow. A lab technician working in an affected country, like Indonesia, might notice something before the global bureaucracy does.
A market attuned to quick trading on information might pick up that little tick more quickly.
In such a prediction market, people make investments in events they think are likely. They are given some seed money to start with and use it to invest in various outcomes.
"We are going to start with 11 questions that all relate to events that, if they occur, raise the likelihood of a pandemic from this strain of virus," [Dr. Phil Polgreen, an assistant professor of medicine at the University of Iowa] said.
"You buy either 'yes or 'no.' If you think it is going to happen, you buy a lot of yeses. So the price of 'yes' will go up and the price for 'no' would go down."
One of the questions: "Will Phase Five of the WHO-defined Pandemic Alert Period be announced before July 1, 2007?" (Maggie Fox, SciAM)
The basic idea of a market as a way to elicit timely opinion isn't new but it depends on some basic assumptions. One is that the participants in the market will shed their prejudices and think much harder about what they think the risks are if they have money at stake. It's hard to tell whether the money here is virtual money or real money and whose it is. If it's virtual money, you'll get virtual opinions. Real money means one important premise of a market mechanism might work, depending on how much is at stake. But many people regularly spend small amounts on lottery tickets without much thought, risk or real hope they will get rich doing it. But they do it, and the lottery is a market of sorts and the bigger the pot, the more people are likely to buy a ticket (and of course the lower their chances). But since no one has knowledge in advance of the winning number (we hope), the size of the pot means nothing.
The other premise of the pandemic risk market is the more important one, the idea that "the combined experience of a lot of someones" is informative about an imminent pandemic and will determine how much they will invest. If it is really true that predicting the timing of a pandemic is beyond our expertise at the moment, they are just buying a lottery ticket. The example of someone in the flu community with what amounts to "insider information" (they see the first cases and run off to buy shares in a pandemic) assumes they will recognize what is happening before the rest of the world does and be able to cash in on the market. There is a saying in the stock market that might be relevant here: Buy on the rumor, sell on the news. The pandemic risk market might be a good indicator of rumor or false alarm, but there is still no indication it will be an accurate barometer of a true signal. Telling the false evidence from the true evidence is the problem the flu community lives with daily. It isn't clear that the pandemic flu market will not be just another way to amplify the noise, a daily occurrence on many internet "flu boards." The internet flu community is a valuable source of information and anyone serious about keeping track of an impending pandemic should monitor it seriously. But would you really want to stake money on it?
Maybe the pandemic risk market is a good idea. But at this point, I'm not buying it.
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Imminence of pandemic is the keystone question which will prompt preps for pandemic. Even you who think pandemic to be an indeterminable event will then meet your maker; you'll either prep or expose yourself with no food, no water, and no medications (excluding Tamiflu and Relenza and a vax, all of which you eschewed years ago due to your ethics.)
No "imminence", no preps. It's simple to understand.
The PH community, the CDC and you, have taken the high road; it's impossible, it requires assumptions, it is fraught with risk, let's stay in the gray area...but every PH institution should prep, of course.
The response to the PH community, guided by seniors such as yourself, shirking of responsibility and failure to pursue what humans want, guidance, albeit for a myriad of good reasons...x y z and z prime, is a turn to ego and greed.
As these are endemic in humans, you get a flood of emails, and your response is to diss your accolytes. Foolish, can't be done, untrustworthy individuals, untrustworthy and indeterminate levels of thought, etc ad nauseum.
Well, this is one time when PH is being swept aside, and I believe there will be hell to pay by PH for its rejection of responsibility. The public will now think that PH is an appendage instead of a central, required system. Who needs epidemiologists when the market can determine truth?
We're about to find out. The market will speak for itself. Reality will influence pricing, and pricing will be the easily readable gauge of current risk.
Will the PH community learn a lesson? Doubtful. However, the good news is that the public will get the guidance it seeks...good, bad or indifferent, from the ProMed-member-only bookies.
As an aside, at the University of Iowa's website describing this market, it states every participant up to 100 people can participate, each being grubstaked $100, and at the end of the time window, the money they have in their account will be available to them for books and research-related, supplemental expenses.
If someone here is a Pro-Med member, they could sign up.
The FAQ is here: http://fluprediction.uiowa.edu/fluhome/FAQ.html#q5
Gaudia, all you are doing is demonstrating at great length your ignorance of statistics and viral genetics. Go play with the idiots in Iowa. Everybody in the flu community knows that this is a scam.
"University of Iowa School of Medicine = Idiots"
signed, Melanie
Thank you.
thanks revere for posting about it. I hadn't thought that you would do,
as your strategy had been in the past to avoid pandemic prediction.
This market doesn't deal with lots of money, as e.g. compared with
the billion dollar market in mortality bonds, which also more directly
trades the panflu-risk.
But it is transparent, prices can easily be followed and hopefully there will
be some discussion about the prices.
It might bring the issue to the public's attention, most of which considers
the pandemic as extremely unlikely.
It might also bring the issue to the attention of the journalists
and the politicians who have to decide on the amount of funding
for panflu-research and preparation.
You can hardly argue against the market. If you do, you could better
enter it.
This is even more important , as most experts refuse to give estimates
on panflu-probabilities. When we can't get expert estimates, then we must
rely on other sources. Mortality bonds, risk-management companies,
insurances, rating agencies. Just strange, that these don't seem to
seek for advice from medical experts. I feel that they just don't talk with each other,
and I hope this is going to change.
It's easier for the medical experts to attack an existing market prediction
than to come up with an own estimate.
Several years ago, the Pentagon.. or maybe White House people located in that building.. ran one of these auctions. I forget the details. The concept was widely claimed to synthesize, accurately,, sometimes,, informed opinion. Given that we don't really know what people are thinking, if it occasionally drew our attention to troubled hearts and minds, it would be probably worth the minimal cost of a website and the unpaid time of anonymous opinionated volunteers.
There was an outcry, apparently many people feared that an adminstration eager to "project force" would more likely send cruisemissiles than agents to sort out the false warnings. The project was publicly shutdown.
If you know how to work the financial markets (read George Soros for example) then it is pretty easy to manipulate one of these auctions, for fun or profit, to accuse or to shield. Also, every multinat drug cartel with products to sell and governments to influence, and every government with populace to pacify, will have the site hacked, probably today.
Corporations, government bodies, and entertainment organizations, often employ the similar but smaller scale 'focus group' to discover or to create public opinion. The faculty coffee room can often function tha same way.
Reminds me of that CDC bureaucrat in Sweden whom you mentioned. We know the answer, or maybe the question, might be out there. We wish we couold recognize its shining face when it steps out of the bushes. Unfortunately, we can remember the only past not the future.
it worked pretty well with their other flu-contracts
in the past, though.
There is no real interest in manipulation and they
take care of it , they check their traders.
Hm. So far, all the 'no' buys would have been winners.
So, say you buy a 'yes'. If you're right, does that mean you win or lose? Great, you get a few hundred dollars credit toward buying books, because everyone knows if you won buying 'yes', stocking your library will be your first priority. Or that of your heirs. (insert sarcastic emoticon here).
There's no way to 'win' with a 'yes' vote--at least not at the current CFR.
LGP, that's exactly how I've responded to long term care insurance. Given that pandemic will occur, and the insurance companies will bankrupt, and there won't be an HCW in sight or beyond the horizon, I've decided it's a terrible bet to own insurance on which one cannot collect. Hence, no LT care ins.
Your insight is spot on. Always say "no" because if "yes", there's nobody present to issue you a reward.
Does this mean we should buy our own medals and ribbons, so we can drape them around our shoulders as the power holders will be otherwise unavailable?
GuadiaRay, if I understand you correctly, you think that the Reveres, the CDC, et al. have failed the public by not saying a pandemic is imminent, and thereby not promoting personal pandemic preparedness. I find several flaws in that argument.
The first is that the Reveres have, for as long as I've been reading here, declined to make personal preparations for a pandemic their topic. They know that there are other sites dealing with panflu prep; they are affiliated with and contributors to the Flu Wiki, after all. They don't condemn personal preparations, they just want to focus on their own bailiwick, which is public health.
Saying a pandemic is imminent, when it may not be, is also not without risk. If the Reveres (or the CDC) were to say "a pandemic is imminent," and it didn't materialize within a year (at the outside), they would have blown their credibility on something they always knew was a gamble. They don't want to be the scientists that cried pandemic, not only because of their reputations, but because people would ignore future warnings of "imminent" danger.
It's also odd to lump the Reveres in with the CDC. Not only have they often been highly critical of the CDC, they are not and do not represent (here, pseudonymously, anyway) a government health authority. If the CDC recommended x, y, or z, it would get reported on the news. If "the Reveres" did the same, it would... cause ripples in Flublogia.
No offense to the Reveres' work here intended. I believe and hope their writing is influential in public health circles. But it doesn't directly set policy or reach the vast majority of the public.
This being the case, why shouldn't they focus their blog where their interest and expertise lie?
caia: I agree with everything you say. Our influence in policy making is minor if it exists at all. One of the things we try to do here for the public health community is give voice to, and validate, things that many public health workers in the public sector feel but can't say. You are right about our CDC views. We are not beloved in the corridors of power at CDC. We believe that is the reason we are read in the agencies and departments, not as guides for policy.
revere: You write "One of the things we try to do here for the public health community is give voice to, and validate, things that many public health workers in the public sector feel but can't say."
My question is WHY is that? What is it about government employment that seems to shut down full discourse and dialogue among the professionals so that the public interest is served? What is holding these workers back, exactly? What is wrong with the system?
I don't understand why we pay good money for public service and then don't get it.
flutracker: Public health departments have become very political, even in the states. Among the feds, the Bushies have taken it to new heights as well. That's the reality today, I'm afraid. But we don't pay good money for public service. We pay lousy money for it. That's what happens when we cut taxes.
Caia, you do not "understand me correctly". That is not what I stated. Therefore, the entirety of your response logic is to be questioned. What you conclude here is incorrect: >GuadiaRay, if I understand you correctly, you think that the Reveres, the CDC, et al. have failed the public by not saying a pandemic is imminent, and thereby not promoting personal pandemic preparedness. I find several flaws in that argument.<
What I did say is that the Reveres should advocate for an exploration of imminence by competent experts who can apply virological, epidemiological and historical perspectives to develop a range of probabilities and who would state the reasoning so that thinking humans can decide for themselves the level of risk they face, and which in turn would be a clear basis which would motivate people to prepare for pandemic or would support their doing nothing extraordinary.
Caia, as an aside, my nom de plume is GaudiaRay, not GuadiaRay,
GR: I have no idea what would allow any competent expert to use any method to come up with a probability. They'd still have to guess. There is no computation available to do this. What does "an exploration of imminence" mean except for a probability estimate that a pandemic would happen within a specified time period? Do you have a suggestion as to what method you would use to do this? I am mystified as to the meaning here.
GaudiaRay:
My mistake. I said "if I understand you correctly," because I found your comment somewhat inscrutable. Perhaps you will see how warnings of death, followed by "no imminence, no preps," followed by "failure to provide... guidance," stongly implies that such guidance should involve claims of imminence.
Several things in your comment I still do not understand. There's the claim that the Reveres have eschewed a vaccine... they have? I thought they just pointed out the difficulties in getting one produced in time.
I maintain that public health scientists' credibility carries far greater repercussions than those involving their own careers or reputations. But even assuming that "failure to provide... guidance" is indeed "a turn to ego," where does the greed come in? What financial gain do the Reveres stand to make by not calling for the odds-setting you seek?
Scientists including the Reveres have been giving warnings in the strongest terms they feel are scientifically supportable for years now. The Reveres' metaphor of feeling the vibrations of a train coming down the track towards us stands out vividly in my mind. Other experts have repeatedly said that a flu pandemic is inevitable, even "overdue," that right now H5N1 is the most likely candidate, and that it bears uncanny and alarming resemblance, both structurally and symptomatically, to the H1N1 1918 pandemic virus. These warnings may not have made the societal impact you would like, but I'm not sure the flaw is in the warnings themselves; they may fail to move people because they are not repeated prominently enough, or often enough, or by people they've heard of (celebrities, politicians, etc.) rather than by, say, Dr. Leavitt.
Other recently reported research dealt with the number of mutations necessary for H5N1 to achieve efficient human-to-human transmission.
If you require percentage odds, Dr. Bob Gleeson, I believe, both polls others and floats his own numbers of the likelihood in a given time frame, on his blog. It's not dissimilar to this market idea, except for the money part. (What, no cries of greed over that?)
Even if mathematicians and virologists could manage to come up with a model to gauge the imminence of a pandemic, given finite resources and time, I also question whether that would be the best use of that time. They already consider it likely enough, and are working on better understanding the virus, and/or ways to prevent, contain, vaccinate, limit, and treat a pandemic. I wouldn't want them pulled away from those needful tasks to play Vegas style bookies.
And finally, you're assuming that a model would give you the result you want, i.e., one that would make the public prepare. What if it didn't? What if a model said there was a 5% chance a pandemic is imminent? Personally, I'd consider that a large number, but the public, largely ignorant of statistics, wouldn't. They might well ignore a 30% chance of imminence. And then where would you be?
Blabla... :)
My guesstimate is next year. This easy it is if you just say it aloud. Of course I can be wrong, it would be stupid to assume the guesstimate be anything else than an educated guess. But it's still worth saying aloud. I hope you others have courage, too ;)
we should allow the experts to use the word
"guess" or "guesstimate" to describe the process
if they feel better then.
Please answer this:
would you prefer the Websters and Osterholms to form
the traders rather than the promed-members ?
Would you prefer promed members over any
traders who trade on everything ?
Would you think the prices were more qualified, more worth, more predictive then ?
If the answer is yes, then you somehow admit, that the whole system has some merit.
If the answer is no, then consequently the reporters should stop interviewing the Websters and Osterholms, but start interviewing the traders instead.
anon: The core issue here is whether anyone has information that enables their guesses to be any better than anyone elses' in terms of what will happen in 3 months or 6 months or a year. If they don't, the market is no better than a state lottery. If they do, it might be. But we won't know this before something happens and therefore won't know whether to trust the market or not. Note that professional stock traders don't do better than market averages or indices so why expect ProMed traders to be? I am a ProMed registrant but I don't know what's coming and wouldn't bet any of my own mney on it. And if it's not my own money, then who is to say I've risked anything?
The best that can be said about this scheme is that under the right conditions it might be able to elicit opinions in a less biased way, since a person's money is involved. It doesn't =help those opnions be any more accurate and if they aren't accurate to begin with, the crowd has no wisdom to share.
Revere, you are talking about possibility range under one year ("3 months or 6 months or a year"). Do you mean that the guesstimating is impossible because of the short timeline? It's obvious that the pandemic will come in ten years with almost 100% probability, anyone could say that and be right. But when talking about shorter periods the estimating is much more difficult.
I got an impression of your text that you might be betting on under one year, if you would bet?
Thinlinna: No, I wouldn't bet on less than a year because I wouldn't bet. If you told me it was tomorrow for sure I wouldn't be surprised or you told me it was in 12 years I wouldn't be surprised or never (with H5N1) I wouldn't be surprised. Nobody seems to believe me that I don't have a genuine guess other than some arbitrary number. Please stop assuming I do (if that is possible; you all are just like people who think it's impossible to be an atheist) but for sure stop asking me. I'm not going to tell you unless and until I have some basis for doing so. When and if I do, I'll tell you what it is and why.
revere, your answer reminded me of two Samuel Butler's phrases:
- There is no such source of error as the pursuit of truth.
and
- The voice of the Lord is the voice of common sense, which is shared by all that is.
I think it's better for the peoples of the world to give an estimate, even if it turned out to be wrong (like the swine influenza warning a couple of decades ago) than not to say anything and let the people sleep in ignorance.
Everybody needs to settle down and pay a little more attention to the fundamental psychological process at work here: adjustment reactions. In the face of an incalulable risk, people go looking for certainty. There is none on offer. Study Dr. Sandman's essay and figure out what you need to do to move on.
Read again what I wrote... sorry for repeating. You have all rights to not say anything, of course. Wasn't intending to pressure. Sorry.
Melanie, I saw your post only after sending my previous. Very good link!
GaudiaRay: 1-800-call a psychic
Revere, two facts are in evidence.
First, the CDC in 1957 attempted to determine the probability of pandemic. Smart people were alive and active then. There must be a paper trail of the factors they chose and the weights they assigned to those factors. At CDC Chatter website there is reference to this fact. There is a framework available. It deserves to be aired. I don't work for CDC, but CDC can drag it out, mount it and let those who have an interest have a go at thinking and expanding on that logic.
Second, yearly, virologists gamble on normal human flu probabilities as they make their selections for the annual trivalent. They must have selection criteria. Those too should be made public and used as a filter to measure the advancement of H5N1.
Additionally, we now have easy methodology to produce relevant and complete sequences. NIAID will do it for free.
Looking at the HA, NA and M genes can tell us of our risk.
Without question, this will be the last great pandemic about which humans cannot project and guesstimate.
IMO if we are not projecting our mental power into mental sculptures of what we yet don't know for sure, we are being irresponsible. We have the capacity to dream of cloned animals and then to make it a reality. We are not destined to sit around and group think, "We don't know how. And we can't do it." That was for generations past. We're unfettered, especially if we are agnostic.
I myself think that guessing what polymorphisms will finish the job (as in get to phase 6) is what should be done right now. If Niman could, and he did, state that the MidEast would generate a specific polymorphism, then every scientist should have their minds buried in attempting to prove this one more time, using recombination and or a combination between recombination and reassortment. There's enough data to think if this can be done. If it can be done, then a primitive tool to forecast H5N1 viral evolution will have been developed.
There is no certainty as to imminence for H5N1, but I've spent years in marketing and I know what moves people, and I can say adamantly that the measured approach being taken (as it won't scare and after all it is something) is soporific and beyond incompetent as a selling tool. It was a failure; it is a failure; and it will continue to be a failure.
But because it's not surprising as it's impossible to know, it is a total turn off to the publics at every level, be they lay or governmental.
@ GaudiaRay
Why are you harrassing Revere?
You say you know CDC has a model. Go ask CDC for it. Here, you are the drunk seaching under the light for the keys he lost in the alley.
Just some random thoughts. I really like caia's analysis above 'Saying a pandemic is imminent, when it may not be, is also not without risk. If the Reveres (or the CDC) were to say "a pandemic is imminent," and it didn't materialize within a year (at the outside), they would have blown their credibility on something they always knew was a gamble.'
I also think GaudiaRay's statement 'I've spent years in marketing and I know what moves people, and I can say adamantly that the measured approach being taken (as it won't scare and after all it is something) is soporific and beyond incompetent as a selling tool. It was a failure; it is a failure; and it will continue to be a failure.' is very interesting and has merit.
I also like Sandmans adjustment reaction work but think this process is mainly going on in flublogia without effectively engaging the public. This 'market system' approach already seems to be getting mainstream media attention and may be a way to engage the public in panflu issues.
I had also wanted to mention this book which discusses the thinking at the time of the Swine Flu scare. One of the criticisms was that we may have relied too much on a few key people rather than critically analyzing the situation....
'Thinking in Time, The Uses of History for Decision Makers' by Richard Neustadt and Ernest May 1986. They talk
about the Swine Flu Scare of 1976 and one of the problems seemed to be that hard questions weren't asked and people tended to go down a party line. They pointed out that it's important to assess what we know and don't know and to look critically at each of these points and to reassess as new information is developed.
Gaudia, since you are so much smarter than everybody else, put your own credit card on the line and attend The 4th Annual Bird Flu Summit so you can tell all the experts how wrong they are.
Kent Nickell >... hard questions weren't asked and people tended to go down a party line. They pointed out that it's important to assess what we know and don't know and to look critically at each of these points and to reassess as new information is developed<
Neustadt and May in 1986 said to the PH leaders, the decision makers, here is what you missed, here is what you need to do.
30 years later, and what happens? The PH community forgot the message, ignored their thinking, and attempts to reinvent the wheel without even bothering to look it is own historical data and analysis.
WHO has its staffing issues. But CDC is expected to be the intellectual boots on the ground. Sadly, they're barefoot; and their critics haven't been sure if pandemia's worth the effort when there's TB, AID's, and ingrown toenails all competing for scarce resources.
TY Kent for the posting reference and the community memory to recollect the book and the point:
--they're not asking the hard questions
They are not assessing what we know and don't know.
They are not looking critically at each of these points of ignorance and then boldly reassessing as new information is developed.
And the outcome is obvious. (Too strong? OK, highly probable.)
Melanie, it's painful to me to read your suggestion. If you've taken the time to look at their flyer invite, which I circular filed last week (as I'm on the invite list), you'd know it's for the generally curious and it's introductory at best. None of the repeating posters need attend that "conference" unless they're selling something. I'm selling nothing. I'm buying "peace of mind". But you'd rather diss me than stand up for what Kent Nickell just said.
Revere, would you address the message of Neustadt and May as paraphrased by Nickell?
GR and Kent: I read Neustadt's account of Swine Flu he did in 1976 and his account at that time showed how difficult the decision was. IMO the right decision was made then, and hindsight only quetions it, but we will all interpret it differently. I have also read Goldberg's book on the subject and I don't see how anything during that episode suggests we should pull the trigger on whether a pandemic is imminent, which is exactly what the Swine Flu decision was based on, then. As I say, I think they had good reasons at that time for worrying about it and they did what was reasonable at the time. I don't think they would do it again, now, given how much more we know that we don't know about flu. So GR, I think I'd actually read it if I were you, rather than depend on Kent's summary of it (which is't inaccurate but which in context would argue strongly against your position).
I am not defending the public health establishment in the US, which I believe I have been extremely consistent in condemning for being missing in action as far as leadership is concerned. I believe they should have been fighting hard for more support for public health infrastructure, something strongly resisted by small and large business like yours, GR, who just wanted tax cuts (and still want them; I don't know what your personal position is on this, but your similarly situated colleagues are among the chief problems and the public health community has been cowardly in calling them on it).
If you think you know how to predict the imminence of a pandemic, please tell the rest of us how to do it. Spell it out, please. I am willing to listen to evidence that shows me how to calculate the probability, even with, say 10% margin of error for a particular time period. Don't just give me your guess, since your guess is worth nothing to me unless you tell me why you think so. I'd be delighted to give you my own guess, if I could do the same. I can't. If you think you know someone else who can do so, tell me who it is and point me to where they have spelled it out.
I'm not trying to set the standard impossibly high. I just want you to tell me how I am supposed to make my guess or how you make yours. What is yours, by the way? What is your guess we will have a pandemic in the next two months? If you don't know, tell me who does know. Then tell me what we should do about it. Then tell me what would be the consequence if it didn't happen.
Revere, as to Neustadt's book, just bought 2 new copies at Amazon, $9 each. There are more if others want them.
My thinking on this topic: I don't think we can "push" the decision of imminence. What I do think is that we can all agree on what is phase 6, and then look at what facts indicate nearness to it. We're looking for a match or a close match. On the virological level, we should also agree based on 1918-Taubenberger work and what we know now on the list of highest probability polymorphisms that affect mammalian transmissibility that we should be watching for them. And we should be watching virulence changes in reality and at the polymorphic level.
Those are some of the key factors I think can be used as imminence determinant filters.
I'm a layperson here, but I'm not a mushroom. Its the responsibility of PH to determine the filters, argue inclusion and prioritization right now, and set that up. And, as in any good dialectic, there should be devil's advocates whose job it is to attack the credibility academically, so the tough questions get asked repeatedly. A vigorous dialogue within academia, and itself open to public scrutiny, will be a great plus. (I know, academia, while vicious, doesn't show that face to outsiders; everything's ever so polite and respectful...that should not be allowed to kill this golden goose...a continually reviewed strategy of understanding.)
With a prioritization and filtration system, imminence can be more than a vague concept. There would be a hunt for the factors believed to be decisional.
The public loves a mystery. Get the public involved. Look at the Bernard Matthews affair. The press bathed in the most outlandish of headlines; the populace was entralled. Of course, the Brits dropped the ball in terms of educating the public, but their new massive computing data gathering system appears to have been given a good push onto the stage due to this little dust up. This is where you need the sales people who I know you consider as the ilk. They can do the job, like maggots in a wound; they like it and it works.
Along the way, I strongly suggest probability odds, expressed in percentages, because the public is incapable of considering a multiplicity of factors. In sales, there's a baserock logic that must be followed without variation, "One" sells. "Two" confuses. There must be one number, one concept, one idea. More than one causes the human mind to cross its eyes and become befuddled (which is why the WHO can get away with saying repeatedly, "We're confused" because the public understands the feeling of confusion.
I've bought into Osterholm's definition of the first proof of Phase 6, "sustained 3rd Generation transmission" H2H2H. If we see it, that's one of the starting points of phase 6.
So, we monitor honestly and proactively for 3rd Generation. We saw it in Karo and we may have seen it in Turkey (but the sequences are still suppressed by Weybridge-WHO and the Turkish gov't). We must ask the tough question. Is this it? Can this be it? Does it look like it's it? Is it an unusual occurrence? Every regionally close and extended familial outbreak should have applied to it a set of criteria that you as epidemiologist can write up in moments.
(We know that they can be released in a heartbeat if there were political motive; but asleep at the wheel has been shown to be the norm at WHO, and an abundance of caution due to responsibility without authority is the norm at the governmental level)
We have the macaques and cats and maybe research with dogs and rats and pigs from which to draw on to identify the polymorphisms. We know about E627K and S310N. There's no "list" yet; it's missing; and I believe it can be produced with relative ease now, including empty-hole space holders for those which may be yet unidentified but will appear. We see what Niman says. I think one of the key bases of his business model is that the list can be generated and influenza in a wide range of mammals can be monitored and blasted to determine the probability of recombination resulting in one of those identified transmissibility polymorphisms.
This is not the time to remain undecided for lack of having encountered appropriate filters. You are charged with building them. Standing on the shoreline and disinterestedly observing is not an option, imo.
I'm the layperson trying to cover my derrier and that of my vendors and customers. I need a hand here and it's your job as PH expert to identify the news and get it out. Sandman will help. I'll even help if you want a crusty salesman to pull a laboring oar.
I predict it will come sooner than the unprepped communities will be ready for, and will last longer than the unprepped communities can bear. Why not start preparing?
Dec 2005, Dr.Nabarro: http://www.gartner.com/research/fellows/fellow_interview_nabarro.jsp
..."Start by looking at the frailty of your business and consider where you might be in big trouble if you had to lose an arm of your supply or distribution chain.
I think that business continuity is pretty important - that's their business, not mine - so companies surely ought to do that.
The second thing I would say to companies is that we have a huge amount to do to bring health services, vet services and our relief services in many countries up to the kind of standards that they're expected to display in the 21st century.
We who work in government or the public sector can't do this on our own.
We can do this only if we work with others who have the expertise. You in the private sector have not only expertise in terms of strategizing and programming at your high levels, but also
huge workforces of motivated people who can themselves become advocates and activists in the influenza arena."...
..."The longer it's there, the longer we have a virus close to humans that is capable of mutating and causing a pandemic. And the situation is very, very serious indeed.
Number two, we've got to be ready to contain the pandemic when it starts. And that's done through rehearsals and other drills, clear command and control.
It requires a level of planning and preparation that's much, much greater than the majority of countries are showing so far.
Number three, the pandemic will kill when it comes.
But more seriously perhaps, it will do massive economic and social damage, because our systems of trade, finance and governance are interconnected and will not survive the impact of a pandemic on workforces.
We need to be able to deal with both the human consequences and the economic, social and governance consequences if we're going to survive it.
And believe me, the pandemic could start tomorrow.
By the time the pandemic starts, preparation will be too late.
So, you should be doing this now, and that's my message."
(Thank you, Dr Nabarro, wherever you are...)
GaudiaRay, your salesmanship has been poorly exhibited here. Doubtless we are not your usual prospects.
At best you have repeatedly accused Revere of not doing what cannot be done. As he and most knowledgeable others explain.. and those who have merely paid attention here understand.
Perhaps a more fitting application of your skills would be in Washington drumming up some of that "political motive" which is so obviously lacking.
Did you know that the seasonal flu vaccine developed in 2005 missed the strain which eventually visited us? Did you know that the 2006 vaccine arrived late due to a production problem? The models aren't good enough yet. The production facilities are inadequate. Especially if we intend to keep our promise to share with the third world.
Money, great gobs of money are need. We can wait a little longer than a heartbeat. We need somebody to go sell the motive, now!
Greg, stop a moment. Think of content, not context. There's nobody to defend here. We're talking content. Would it be wrong to ask you to add your thoughts, focused on the topic, imminence of pandemic flu?
My comments may be overly simplistic; however I'm going to venture into the fray because I'm reading this discussion through the "lens" of having worked in both the stock market area [pre-law school] and the commodity futures market [post-law degree]. Hence, I want to address a very basic issue -- the all-important information upon which trading decisions are made in both stocks or futures. I believe this will be relevant in understanding if an "open market" to determine the imminence of panflu is possible much less "predictive."
All Security Laws governing stock transactions emphasize the critical importance of having correct information, presented at the right time and in the right manner [as versus insider trading violations, for example.] The source of that information is generally the traded corporations themselves, although government announcements also play an important role. Thus, the trading public, both institutional and private, must shift through volumes of information from these two major sources in order to make informed trades.
In the commodity futures industry the principle source of information is the US government, although public news events such as weather reports also go into the decision-making mix, hence the commodity laws focus less on how and where information upon which buy/sells are made is presented to the trading public. Still, in both the case of stock trading or commodity futures trading, information is key. One can never have enough of it! And trading without it is tanamount to mere gambling.
Now, as I understand it, there is a proposition to open a "trading market" focused on predicting the imminence of panflu. Those proposing this appear to me to be saying that by having trades executed by participants, the market itself will be generating the information that tells us when the pandemic is likely to occur. As I read what Revere and other virologists and epidemiologists seem to be saying, the reason they believe they cannot predict the timing of a pandemic is that they do not have enough information available to make such a prediction. This is because the very nature [and number] of pandemics in general and H5N1 in particular, which is still a work in progress.
As I see it, the "market" being proposed can best be compared to betting in Las Vegas on when the first snow will fall in Florida, or who will win American Idol. Such bets are often published in the news for their novelty value. They are hardly based on, or contribute to knowledge regarding the subject of the bet. They indicate guesses or personal preferences of the betters. The "panflu market," IMO lacks legitimacy at any level because of a basic lack of sufficient and scientific information. Even if one were to establish "markers," standards or specifications that must be met to make valid predictions, there is no guarantee that WHO, CDC or governments will supply the data needed to plug into them. That doesn't even touch the fact that H5N1 itself doesn't "follow the rules" and is, therefore, unpredictable. In all likelihood we will know what we know about this virus in hindsight. Or, we can place a "bet" and hope that we're right ... or wrong.
MAinVA: I quite agree with you. As far as I can tell, this scheme is being touted as a way to facilitate the expression of latent information amongst experts. If that information doesn't exist or is based on faulty reasoning, it doesn't work. Moreover, because there is no control on the nature or quality of the information being used, as you point out, it is both subject to manipulation and/or only a noise amplifier.
kent nickell: "'Thinking in Time, The Uses of History for Decision Makers' by Richard Neustadt and Ernest May 1986. They talk
about the Swine Flu Scare of 1976 and one of the problems seemed to be that hard questions weren't asked and people tended to go down a party line. They pointed out that it's important to assess what we know and don't know and to look critically at each of these points and to reassess as new information is developed."
Just random associations, but maybe in that time people couldn't ask freely hard questions: wasn't it the time when everybody had to scare not to be stigmatized as a communist? Wasn't it the time when Cuba declared independence?
Maybe we have a litlle bit same kind of a problem nowadays: it isn't nice to speak publicly about things that require mutual governement tax money to be addressed properly. It's a global market and the tax money should be profitable in a quarter of a year...
thinlinna: No, none of the above. It was just post-Watergate and people were speaking up all over the place. But there was a presidential election on and Ford made a courageous decision to go ahead with the Swine Flu despite the criticism he would almost certainly take. He lost the election to Carter. The Cuban revolution was in 1959 and the Red Scare was not a big factor and was irrelevant to Swine Flu.
revvere: Sorry, I meant the 1976 constitution of Cuba. No edit function here...
But thanks for the additional information.
So, all the media was filled up with speculation of post-Watergate elections and no-one had really time or interest to discuss the swine flu?
thin: On the contrary, it was big news and the President (Ford) himself went on national TV to make the announcement they were going to try to vaccinate the entire country. But there was no hesitancy to speak up because of anti-communism and Swine Flu.
GaudiaRay, it would not be wrong. It would be pretty damn silly.
I might remind you once again that the person whom you claim to be the expert says it is unpredictable.
I might remind you that the word "random", as in "random mutation", means "unpredictable".
Or I might ask you to find a good dictionary and look up the words "content" and "context" because you have repeatedly brushed aside content and insisted we move to the context of a sales campaign where the product and its nature, indeed its mere existance, are irrelevant so long as it has or can be give a name which lends itself to snappy slogans.
Most of the people here are scientists. The rest of us play one on tv. If you want a prediction, you need to ask a priest or a salesman.