Tuesday, August 23, 2016

Zika Virus, Diane Rehm and the CDC

Be afraid, be very, very afraid – terrified even. Stay inside, bathe yourself in DEET, wear long sleeves, embrace GMO mosquitoes, don’t travel to South or Central America, especially not Brazil, or go to certain parts of Miami, or maybe avoid Miami altogether as well as Puerto Rico, and maybe the Caribbean. Don’t get pregnant for a year or maybe two, or have unprotected sex with your spouse for 6 months…….  But the Olympics – oh the Olympics in Rio, Brazil? Yeah! Be sure to go to the Olympics! But before you go, how about an extra $1.9 Billion for the CDC?!

Oh, the Zika virus – where to start? My Inner Angry Wonk has been simmering about this since day one (just ask my poor sister), but over the last couple of weeks I have hit the boiling point. On August 3rd, driving home from taking my youngest to Shakespeare Camp, listening to the Diane Rehm show on our local NPR station I was dismayed to hear them talking, yet again, about the latest CDC horror show known as the Zika virus. Among those on her panel that day were Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, and Dr. Irina Burd, director of the Integrated Research Center for Fetal Medicine at Johns Hopkins University Hospital. In between all the pearl clutching and hand wringing over 15 Zika cases in Florida, they gave call-in advice to panicky mothers of small children living near those cases (listen at 18:55). To protect their very small babies, and infants as young as 2 months old, these doctors were recommending that these mothers keep their babies in long sleeves and long pants at all times and when taking them outside slather their exposed skin – i.e. their hands and faces with both sunscreen and a DEET containing insecticide – where it will undoubtedly wind up in their tiny mouths. Can you hear my Inner Wonk screaming?????

The CDC has been studying autism since the epidemic they refuse to acknowledge began almost 30 years ago - growing in incidence from 1 in 10,000 in the 1980's to the current rates of 1 in 68 over all, 1 in 42 boys and a shocking 1 in 28 in the children of Somalia immigrants living in and around Minneapolis. Yet despite the untold millions they have spent on research, the CDC remains stubbornly clueless about the causes of autism, not even certain if this dramatic increase in numbers represents a real rise or simply better counting and diagnosis (?!?!), and absurdly suggesting their best guess is that there is a strong genetic component in a condition that has increased exponentially in just one generation!?!. Nowhere on the CDC autism pages is it even entertained that maybe, just maybe there could be some sort of environmental factor involved – or maybe even factors…..

However, unlike the impenetrable mystery that is autism, a few short months into the current Zika outbreak and the apparent increase in microcephaly cases in Brazil, the CDC is certain – absolutely, completely, unequivocally certain – that Zika and Zika alone, is the sole cause of a profoundly devastating birth defect. A virus that has been around since at least the 1940’s (If not longer...Western medicine has a maddening tendency to equate their finding and naming something with the definitive starting point of said disease or condition….) that is so mild and harmless that 80% of the people who have had it didn’t actually notice, is suddenly harming fetuses, causing miscarriages and striking others with Guillame-Barre syndrome. However, despite their certainty, their pronouncement was remarkably, frustratingly, data light and only asks one question – could Zika cause birth defects? No other possibility is even entertained. In the paper the CDC itself actually admits there is no “smoking gun” linking the Zika virus to the cases of microcephaly. This lack of data has not, however, stopped the CDC from issuing a long list of unprecedented recommendations and advice – which the news media has gleefully, breathlessly. reported far and wide – impacting untold millions of people, many countries and communities with wide-ranging and significant - some might even say profound -personal and economic consequences. Not to mention that $1.9 Billion funding request and the burgeoning coffers of bug spray, GMO mosquito companies and vaccine developers.

How data light are we talking? Let’s start to break this sketchy story down.

First off, as I said above, there seems to be an apparent increase in microcephaly cases. To document an actual increase, what do you need first? You need a baseline - a “before” number. Well, pretty much every media report or article I cite in this series of posts is missing the before number. Why? Because Brazil apparently did not have a very well-documented “before” number. One of the very few news reports that I could find with a before count was an article in Nature which reports that the number of microcephaly cases recorded in Brazil in 2014 was 147 – a number, the article points out, so low as to be unbelievable given the number of microcephaly cases which occur annually worldwide (for example, approximately 25,000 babies are diagnosed with microcephaly every year in the US). The paper cited in the CDC report, used as the CDC basis for their "before" number, claims the number of microcephaly births in Brazil to average 157.3 cases per year from 2000 – 2014, also unrealistically low. So much for the "before" number.

Even as a skeptic, however, one cannot deny the existence of the heartbreaking pictures of the babies and sad, painful stories of mothers and fathers truly suffering in Brazil. They exist. They are hurting. They need help and services. And they deserve answers – truthful answers. Exactly how many babies and families are we talking about? Good question – that is another disquieting piece of this story. You would think if the CDC is telling every woman of child-bearing age in the Americas to panic, consider terminating pregnancies and demanding Congress come back in the middle of August recess in an election year to approve emergency funding, they would have a pretty good handle on this – but no, again.

The number of cases reported have varied wildly since the CDC and the press began hyping this story. In February 2016 the NY Times reported the numbers were upwards of 4,783. The Nature article from March 21st cites 6,398. The next day, in the Washington Post the number dipped much lower, maybe only 2,500. Then there was talk of how to “define” microcephaly.  Wait, what? There wasn't even an agreed upon definition of microcephaly to begin with? No, apparently not. In the beginning, Brazilian health authorities asked doctors to report a case of microcephaly when a newborn baby’s head measured 33 centimeters (cm) or smaller. Then it was decided that measurement was too inclusive and the number changed to 32 cm. Eventually Brazilian Health authorities adopted the World Health Organization’s (WHO) definition of microcephaly, with head measurements of 31.9 cm for newborn boys and 31.5 cm for girls.

Wait. What’s that you ask – we’re defining this devastating neurological deficient SOLELY on the measurement of a baby’s head circumference? No other physical characteristics? The muscle constrictions? Brain calcification? Eye disorders? An MRI or CT scan? No. It appears that, especially in the beginning, microcephaly cases in Brazil were being counted by head circumference alone. Here, National Geographic tries to make sense of the numbers in March - they are reporting 641 cases of “confirmed” microcephaly in Brazil. According to the article another 4,222 are being “investigated” and 1,046 cases have been “rejected” for not meeting the “criteria” although what that criteria consists of is not shared with us. I could not find a description of that criteria anywhere. Hmmm…..

All the news stories aimed at scaring the dollars – oops, I mean crap – out of us acknowledge that this Zika outbreak has been working its way around various parts of the world starting sometime in 2014, hitting the Pacific Islands near Guam and the Marshall Islands, Haiti and most of the Caribbean and pretty much all of the countries in Central and South America. If, indeed, Zika causes microcephaly, and various other disastrous outcomes, the virus should have left a trail of miscarriages, paralysis, death and profound disability across all these countries, right? Well, in a nutshell, not so much.

Try as they might, the CDC, the Washington Post and the NY Times have not been able to produce any real evidence of increased cases of any of these ills in any other country besides Brazil (begging the question, once again, what the heck has happened to investigative journalism???). 

Missing the numbers to convince you to be terrified, they’ve done their best to explain away the lack of data with a variety of excuses – most of them ridiculous and highly offensive to the population of the countries involved. Haiti? TheWashington Post says the residents there don’t go see doctors often enough for either fevers or childbirth and therefore Haitian mothers missed the fact that their babies were born horribly malformed and disabled. To the extent that they did notice? The physicians in Haiti and the wise reporters of the Washington Post speculate that their superstitious mothers interpreted their births as the work of “evil spirits” and left them somewhere to die. The doctors of French Polynesia and Yap? They just forgot to document women were giving birth to babies with tiny, unnatural looking heads – if you go back looking for them you can find a few – maybe an increase from 2 cases a year to 8 – and again, no other cause for such an increase has been explored (some of the sentences written in these articles have actually caused ME harm – smacking my forehead with my keyboard – how did someone write these things and how in the world did they think we would believe it????). And as Columbia announces Zika is on the way out, and we’ve hardly heard a peep about microcephaly cases there, the NY Times assures us that there are still six reasons we should still believe that Zika causes microcephaly.

So hey, better go ahead and slather that baby – and any pregnant woman you see – with both sunscreen and DEET, just in case (I can pretty much guarantee you that that safety study has not been done). But while driving and listening to the radio that day, My Inner Angry Wonk was at least relieved to hear Diane Rehm’s response to the DEET recommendation – she was horrified – she refuses to use DEET on herself she said – why in the world would she use it on a baby?? Both Dr. Fauci and Dr. Burd chastised her and insisted that it was safe to use, citing EPA “pesticide registration” as proof of safety. Hey, I worked for EPA, and I believe that a lot of good things get done there. But I would NEVER and I mean NEVER tell someone to forgo their own research, their own instincts, their own skepticism simply because the EPA said so. Decisions in big bureaucracies get made for many reasons, under various circumstances and you better believe that I’ve seen bad decisions made under both "big P" and "little p" political pressures and for other dubious reasons. Yay Diane!

But this disease is worth a lot of money for a lot of people. Maintaining the public's level of fear is important to the CDC. Imagine my disappointment, but not my surprise, when 2 days later, on her Friday News Round-up show, Diane Rehm revisited the issue (at 34:32). After talking with a caller from Miami about a different topic, Rehm used the caller’s location as a reason to launch another discussion of the Zika virus. She reminded people that she is going to Florida later this month. That two days before she had declared her worries about the safety of using DEET-containing insecticides and her life-long refusal to use it. Well, never mind, she said, Dr. Fauci had had another conversation with her and changed her mind. Zika is just too dangerous and the CDC just too important to ignore. She would, in fact be using DEET insecticides on her very person on her trip to Florida she declared. One of her panelist, Ruth Marcus, a columnist at the Washington Post, doubled down on this message. “This is very scary. Listening to Tony Fauci is one of my rules in life. Everyone should listen. Everyone should listen to the CDC.” Rehm chimed in – “Absolutely!”

That noise – that noise you hear along with the screaming – I need to go ice my forehead……

Next time…. But of course that test they are using is really accurate – right? (Until then, enjoy this video - Zika 101)

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