Friday, May 23, 2003

SARS update

The WHO has lifted the travel advisories relating to Guangdong and Hong Kong, stating the situation in both places is very much improved.

Sars travel warnings lifted, BBC News, 23 May 2003

What is the precautionary principle?

Rio Declaration (1992):

'In order to protect the environment, the precautionary approach shall be widely applied by States according to their capability. Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation.'

There are two ways you could interpret such a statement. The first is an old medical dictum: 'first, do no harm'. In other words, it is pointless attempting to make something better if your approach will only make things worse. However, the precautionary principle is defined much broadly as 'better safe than sorry'. In other words, assume that any change will be harmful unless you can pretty much prove that it won't be. Such an outlook seems to me to be a significant barrier to progress.

What underpins such an interpretation of the precautionary principle is a fear of change. Change is almost invariably regarded as having a downside. What is generally ignored is that not changing also has a downside. For example, in the discussion of global warming, the environmentalist view is that we should cut back on many of the elements of economic growth because they will surely lead to climate change and disastrous consequences. But it is quite clear that deliberately reining back growth will definitely have negative consequences for everyone, particularly in the developing world, while the benefits of agreements like the Kyoto Protocol are still uncertain.

Such arguments in turn are usually met with disgust at corporate or individual greed, as if wanting economic growth and increased prosperity were selfish actions rather than enlightened ones. In fact, an improving environment is generally the product of economic growth, not an alternative to it.

Another example might be the discussion of SARS, and of the spread of new diseases in general. It is true that the changing structure of society can provide infections with new niches. But improving living standards and medical knowledge have not only wiped out many old diseases but provides us with a much greater capacity to deal with new infections. We have been able to monitor and study SARS in great detail very quickly. In the past, it would have just been lumped in with so many other respiratory diseases.

It is an interesting aspect of societal change that the fact of human progress is constantly called into question. Such an attitude would have been labelled pejoratively as 'conservative' in the past but is a completely mainstream notion today. Curiously, human progress goes on. We even revel in it: we treat disease better than before, we communicate more frequently and more easily, we travel more often, more cheaply and more extensively. All these are life-enhancing. Yet, the connection of these things with the progress of society as a whole is missing.

Lionising Wakefield

The Media section of the Guardian reports that Channel 5 is planning a drama based on the link between autism and the MMR vaccine, starring Juliet Stevenson. Sounds terrible, especially considering that Andrew Wakefield has almost no support among scientists and physicians in the field for his claim of a link. There is something very attractive about the maverick who takes on the establishment these days but the claims of the outsider need to be subject to the same kind of rigorous analysis as those of the official experts. Being anti-establishment for its own sake is pointless and occasionally dangerous. The on-going campaign by Paul Foot in Private Eye in support of Wakefield is a good example.

The effect of this can be seen in a report this week which showed that the public think that medical opinion is split down-the-middle on MMR. It isn't. Very few doctors would support Wakefield, which is why his pronouncements tend to take place in forums where he will not be subject to the scrutiny of his peers.

Five lands Juliet Stevenson, Guardian, 22 May 2003

Parents 'misled' by media over MMR, BBC News, 19 May 2003

Thursday, May 22, 2003

WHO gets it in the neck over SARS

Dr Mark Salter of the WHO has admitted that WHO acted too slowly in response to SARS. According to BBC News, 'Dr Salter admitted the WHO had not always been "as responsive and as quick as some people might like" in the early stages of the disease.'

I would argue the opposite. In order to ensure that they were seen to be doing something, WHO overreacted to SARS. It should not have issued a global alert in March about the disease, nor should it have declared travel advisories. While it was acting in a sensible manner in attempting to coordinate disease control measures on the ground, it's media strategy could have been a lot more low-key. SARS is not a big killer. It is a disease almost entirely restricted to one region of the world, which has killed a relatively small number of people, and which is coming under control in the majority of affected areas. The SARS panic has caused more problems than the disease.

Sars experts: 'We were too slow', BBC News, 21 May 2003

WHO's to blame for the SARS panic?, by Rob Lyons, spiked, 20 May 2003